Email: info@appliedba.com
Phone: 770-462-8550
Findings from a survey conducted by the Center Medicare & Medicaid Services found that almost two-thirds (61%) of autism centers had waitlists of more than 4 months, and 15% had wait times in excess of 1 year, or were so impacted that they were no longer accepting referrals. In part because of this, even though autism can be reliably diagnosed at 18 months, the average age of diagnosis in the United States is above 4 years. These delays in evaluation and diagnosis means that many children miss the critical early neurodevelopmental window where early intervention therapies have the greatest impact [3].
Specialists identified several barriers to timely evaluation. The most reported reason (69%) was a shortage of qualified professionals to conduct assessments. The sheer number of referrals came in second (61%). The documentation burden, with no centers reporting to able to complete an individual assessment in under 1 hour (54%) and the length of the assessment process (37%) came in third and fourth. In a quarter of cases each evaluation was reported to take more than 8 hours. Other barriers included burdensome reimbursement processes or inadequate reimbursement to incentivize service provision (30%). Access disparities and lack of reimbursement often hit underserved communities such as Medicaid families the hardest, with nearly half (44%) of the centers reporting that they did not accept Medicaid clients [3]. To combat the waitlist crisis some specialists have continued and even increased the amount of virtual ASD evaluations they conduct.
A virtual autism assessment uses digital/telehealth platforms and tools to remotely assess and diagnose ASD. It also involves the use of questionnaire-based assessments and video-based assessments including caregivers recording videos of their child's behaviors and interactions during prescribed activities in different settings. The videos are then shared with autism specialists who analyze the videos to assess the child's social communication skills, behavior patterns, and other diagnostic criteria. In addition, the telehealth assessment involves real-time video interviews conducted with caregivers by specialists [1].
Both utilize questionnaire-based assessments, but what often differs is the use of video – either live or recorded. Some of the tools used in virtual assessments also differ (e.g., BOSA & TAP). However, telehealth methods to diagnose ASD have been found to be between 80% to 91% accurate when compared with traditional in-person diagnosis [5].
In many cases the same tools that are used during an in-person evaluation (e.g., questionnaires) are also used during a virtual assessment. The gold standard assessment models include a caregiver interview that gathers historical information about the child including their early development, symptoms related to autism, general socio-emotional functioning, and adaptive functioning, as well as observations of the child’s social communication skills and behavior, assessments of their cognitive, academic, and language functioning; and teacher questionnaires when application [4]. Specific diagnostic tools may differ due to the need to modify them for the telehealth environment.
Diagnostic | Questionnaire |
---|---|
Autism Observation Scale for Infants (AOSI)
|
Autism Diagnostic Interview-Revised (ADI-R)
|
Brief Observation of Symptoms of Autism (BOSA)
|
Autism Spectrum Rating Scales (ASRS)
|
Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS-2)
|
Autism Symptom Dimensions Questionnaire (ASDQ)
|
Childhood Autism Rating Scale, Second edition (CARS-2)
|
Social Responsiveness Scale, Second edition (SRS-2)
|
Gilliam Autism Rating Scale, Third edition (GARS- 3)
|
|
Telemedicine-based ASD Evaluation Tool for Toddlers and Young Children (TELE-ASD-PEDS, or TAP)
|
Pros | Cons |
---|---|
|
|
|
|
|
|
|
|
|
|
In a study conducted during the Covid-19 pandemic, most clinicians who were interviewed agreed that telehealth worked well enough or was even preferred for clinical interviews and feedback. However, there were mixed responses related to their confidence in using virtual means to conduct behavior observations needed to make a final diagnosis. They cited that obtaining standardized direct observation and assessment of skills could be more challenging because of a lack of control over the family’s home environment, the need to rely on family members to help administer assessments and manage behavior, children with high activity levels where it was difficult to keep them in camera view, children who refused to interact over video, parent/child interaction difficulties that affected the child’s cooperation, and highly anxious children who were inhibited by being on camera. A few clinicians also reported that establishing rapport virtually was more challenging [4].
On the flipside, the primary identified strength of completing an observation virtually was the opportunity to see children and families in their home environment. This allowed for a more natural observation. One clinician stated, “I actually think, with some of the little kids, we’re getting a better picture than we would have gotten when they come into clinic.” This was particularly true for children who were anxious or whose behavior was inhibited in a clinic setting [4].
In clear-cut cases of autism high levels of agreement between diagnosis with telehealth and in-clinic evaluation, as well as high levels of satisfaction amongst families and clinicians. However, virtual evaluations were found to be less effective for more complex presentations. These include those with older children with more subtle impairment and with variable social skills where telehealth made it difficult to notice more nuanced deficits. Clinicians also indicated that these clients continued to be difficult to diagnose even during in-clinic appointments. Virtual assessments conducted with younger children and children who were more developmentally impaired were found to be easier to diagnose in either setting. Multiple clinicians estimated that between 80% to 95% of children were able to be diagnosed by virtual assessment [4].
References:
1. Corona, L., Hine, J., Nicholson, A., Stone, C., Swanson, A., Wade, J., Wagner, L., Weitlauf, A., & Warren, Z. (2020). TELE-ASD-PEDS: A Telemedicine-based ASD Evaluation Tool for Toddlers and Young Children. Vanderbilt University Medical Center. https://vkc.vumc.org/vkc/triad/tele-asd-peds
2. Dow, D., Holbrook, A., Toolan, C., McDonald, N., Sterrett, K., Rosen, N. Hyun Kim S., & Lord, C. (2021).The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration Through COVID-19 and Beyond. Journal of Autism and Developmental Disorder, 16;52(12):5383–5394. doi: 10.1007/s10803-021-05395-w
3. Krafta, C., Badeschc, S., Shannona, J., Salomona, C., Seala, M., Chettiatha, T., & Taraman. S. Wait Times and Processes for Autism Diagnostic Evaluations: A First Report Survey of Autism Centers in the U.S. Retrieved from https://www.cms.gov/files/document/wait-times-and-processes-autism-diagnostic-evaluations-first-report-survey-autism-centers-us.pdf
4. Kryszak, E. M., Albrigh, C. M., Fell, L. A., Butter, E. M., & Kuhlthau, K. A. (2022). Clinician Perspectives on Telehealth Assessment of Autism Spectrum Disorder During the COVID-19 Pandemic. Journal of Autism and Developmental Disorders, 1;52(12):5083–5098. doi: 10.1007/s10803-022-05435-z
5. Kuhl-Meltzoff Stavropoulos, K., Bolourian, Y., & Blacher, J. (2022). A scoping review of telehealth diagnosis of autism spectrum disorder. PLoS One, 10;17(2):e0263062. doi: 10.1371/journal.pone.0263062
Where children with autism, are children first.
770-462-8550
info@appliedba.com
2930 Horizon Park Drive, Suite D, Suwanee, GA 30024
Where children with autism, are children first.
2930 Horizon Park Drive, Suite D, Suwanee, GA 30024
All Rights Reserved | Applied Behavioral Approaches | Website Design by True Digital Marketing