Parent Perceptions of Caregiver-Mediated Telemedicine Tools for Assessing Autism Risk in Toddlers

Abstract

Telemedicine tools have potential for increasing access to diagnostic services for children with autism spectrum disorder (ASD). Past work has utilized tele-assessment procedures in which remote psychologists observe administration of interactive screening instruments by trained, on-site providers. Although promising, this approach relies on two clinicians, limiting its efficiency and scalability. The present study examined the use, acceptability, and parents' perceptions of two caregivermediated tools for assessing ASD risk in toddlers, in which remote clinicians guided parents to complete interactive screening activities with their children. Most parents found tele-assessment to be comfortable, and many reported liking the parent-led nature of these tools. Parents also offered constructive feedback, which was used to modify the tele-assessment process for future study. Keywords Autism spectrum disorder • Diagnosis • Telemedicine • Young childrenAs the prevalence of autism spectrum disorder (ASD) has increased, so too have needs for screening, diagnosis, and intervention access for young children. Current prevalence estimates indicate that one in 54 children has ASD (Maenner 2020). To maximize early identification and intervention, American Academy of Pediatrics guidelines recommend combining routine developmental surveillance at all pediatric visits with standardized autism-specific screening for all children at 18 and 24 months of age, as well as at any point that caregivers report concerns (Hyman et al. 2020).

Use of the TELE-ASD-PEDS for Autism Evaluations in Response to COVID-19: Preliminary Outcomes and Clinician Acceptability

“…Providers also reported that it was beneficial to observe children and families in their home environments, interacting with familiar people and materials. Past research conducted in a laboratory setting has suggested that caregivers report tele-assessment to be comfortable and convenient, and that caregivers enjoy taking a more active role in the evaluation process (Corona et al 2020b ). Though caregiver feedback was not available for all families represented in the present study, evaluation of family satisfaction with clinical tele-assessment is ongoing and will be an essential question for future research.…”

“…Prior work has demonstrated that many young children with ASD can be accurately identified using clinic-based tele-assessment procedures (Juárez et al 2018 ), but it is unclear how diagnostic accuracy varies within direct-to-home care. With regards to the TELE-ASD-PEDS, there is currently a large study underway examining the psychometric properties of the tool relative to traditional, gold-standard evaluations (1R21MH118539-01), and initial data support the diagnostic accuracy of the TELE-ASD-PEDS when implemented in a laboratory setting (Corona et al 2020b ). However, we have not yet validated the TELE-ASD-PEDS when administered in home settings, introducing the risk that we are missing children who should have received a diagnosis, or providing an inaccurate diagnosis.…”

“…One promising avenue for increasing access to early ASD assessment is telemedicine-based evaluation (Corona et al 2020b ; Juárez et al 2018 ). Most existing work regarding tele-assessment of ASD relies upon having a trained provider present with the family in one location, while a remote psychologist converses with the family and observes the child’s behavior (Juárez et al 2018 ; Stainbrook et al 2019 ).…”

“…Most existing work regarding tele-assessment of ASD relies upon having a trained provider present with the family in one location, while a remote psychologist converses with the family and observes the child’s behavior (Juárez et al 2018 ; Stainbrook et al 2019 ). Additional preliminary work has explored tools for caregiver-mediated tele-assessment, in which caregivers complete assessment activities with their child, while being coached by a remote provider (Corona et al 2020b ). The COVID-19 pandemic has accelerated interest in tele-assessment, particularly methods that allow providers to complete remote assessments with families in their home settings (Narzisi 2020 ; Wright et al 2020 ).…”

Diagnostic Evaluations of Autism Spectrum Disorder during the COVID-19 Pandemic

“…However, in-person assessments have remained drastically reduced and changed as providers work to conduct assessments in as safe and socially-distanced manner as possible. Although there is some literature showing promising results on telehealth assessments in ASD (e.g., Corona Hine et al, 2020;Smith et al, 2017), telehealth assessments need to be further examined to determine how they compare to traditional in-person assessments. It is reasonable to assume that psychometric properties such as sensitivity, specificity, and the validity of scores of diagnostic measures may change considerably in the context of telehealth.…”