Increasing access to diagnostic services is crucial for identifying ASD in young children. We therefore evaluated a telemedicine assessment procedure. First, we compared telediagnostic accuracy to blinded gold-standard evaluations (n = 20). ASD cases identified via telemedicine were confirmed by in-person evaluation. However, 20% of children diagnosed with ASD in-person were not diagnosed via telemedicine. Second, we evaluated telediagnostic feasibility and acceptability in a rural catchment. Children (n = 45) and caregivers completed the telemedicine procedure and provided feedback. Families indicated high levels of satisfaction. Remote diagnostic clinicians diagnosed 62% of children with ASD, but did not feel capable of ruling-in or out ASD in 13% of cases. Findings support preliminary feasibility, accuracy, and clinical utility of telemedicine-based assessment of ASD for young children.
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Chawarska, K., Shic, F., Macari, S., Campbell, D. J., Brian, J., Landa, R., & Young, G. S. (2014). 18-month predictors of later outcomes in younger siblings of children with autism spectrum disorder: A baby siblings research consortium study. Journal of the American Academy of Child & Adolescent Psychiatry, 53(12), 1317–1327.
Chlebowski, C., Robins, D. L., Barton, M. L., & Fein, D. (2013). Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics, 131(4), e1121-e1127.
Chomienne, M. H., Grenier, J., Gaboury, I., Hogg, W., Ritchie, P., & Farmanova-Haynes, E. (2011). Family doctors and psychologists working together: Doctors’ and patients’ perspectives. Journal of Evaluation in Clinical Practice, 17(2), 282–287.
Christensen, D. L., Baio, J., Braun, K. V., Bilder, D., Charles, J., Constantino, J. N., & Yeargin-Allsopp, M. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States. Morbidity and Mortality Weekly Report: Surveillance Summaries, 65(3), 1–23.
Cisco Systems. (2015). Cisco Jabber (Version 4.8) [Telecommunications platform]. San Jose, CA: Cisco Systems.
Clatney, L., MacDonald, H., & Shah, S. M. (2008). Mental health care in the primary care setting. Canadian Family Physician, 54(6), 884–889.
Corsello, C. M., Akshoomoff, N., & Stahmer, A. C. (2013). Diagnosis of autism spectrum disorders in 2-year-olds: a study of community practice. Journal of Child Psychology and Psychiatry, 54(2), 178–185.
Dawson, G., Jones, E. J., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M. (2012). Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 51(11), 1150–1159.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.
Durkin, M. S., Maenner, M. J., Meaney, F. J., Levy, S. E., DiGuiseppi, C., Nicholas, J. S., Kirby, R.S., Pinto-Martin, J.A., Schieve, L. A. (2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: Evidence from a US cross-sectional study. PLoS One, 5(7), e11551.
Fountain, C., King, M. D., & Bearman, P. S. (2011). Age of diagnosis for autism: Individual and community factors across 10 birth cohorts. Journal of Epidemiology & Community Health, 65(6), 503–510.
Guthrie, W., Swineford, L. B., Nottke, C., & Wetherby, A. M. (2013). Early diagnosis of autism spectrum disorder: stability and change in clinical diagnosis and symptom presentation. Journal of Child Psychology and Psychiatry, 54(5), 582–590.
Hyman, S. L., & Johnson, J. K. (2012). Autism and pediatric practice: Toward a medical home. Journal of Autism and Developmental Disorders, 42(6), 1156–1164.
Interagency Autism Coordinating Committee. (2013). IACC strategic plan for autism spectrum disorder research: 2013 update. US Department of Health and Human Services Interagency Autism Coordinating Committee.
Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.
Lindgren, S., Wacker, D., Suess, A., Schieltz, K., Pelzel, K., Kopelman, T., Lee, J., Romani, P., Waldron, D. (2016). Telehealth and autism: Treating challenging behavior at lower cost. Pediatrics, 137(Supplement 2), S167–S175.
Liptak, G. S., Benzoni, L. B., Mruzek, D. W., Nolan, K. W., Thingvoll, M. A., Wade, C. M., & Fryer, G. E. (2008). Disparities in diagnosis and access to health services for children with autism: Data from the National Survey of Children’s Health. Journal of Developmental & Behavioral Pediatrics, 29(3), 152–160.
Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition (ADOS-2). Torrance, CA: Western Psychological Services.
McPheeters, M. L., Weitlauf, A., Vehorn, A., Taylor, C., Sathe, N. A., Krishnaswami, S., Fonnesbeck, C., Warren, Z. E. (2016). Screening for autism spectrum disorders in young children: A systematic evidence review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Reseach and Quality (US).
Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service.
Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., & Gallagher, N. (2011). Detecting, studying, and treating autism early: The one-year well-baby check-up approach. The Journal of Pediatrics, 159(3), 458–465.
Robins, D. L., Casagrande, K., Barton, M., Chen, C. M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45.
Rotholz, D. A., Kinsman, A. M., Lacy, K. K., & Charles, J. (2017). Improving early identification and intervention for children at risk for autism spectrum disorder. Pediatrics, 139(2), e20161061.
Simacek, J., Dimian, A. F., & McComas, J. J. (2017). Communication intervention for young children with severe neurodevelopmental disabilities via telehealth. Journal of Autism and Developmental Disorders, 47(3), 744–767.
Sparrow, S. D., Cicchetti, D. V., & Balla, D. A. (2005). Vineland-II adaptive behavior scales: Survey forms manual. Circle Pines, MN: American Guidance Service.
Stahmer, A. C., & Mandell, D. S. (2007). State infant/toddler program policies for eligibility and services provision for young children with autism. Administration and Policy in Mental Health and Mental Health Services Research, 34(1), 29–37.
Stenberg, N., Bresnahan, M., Gunnes, N., Hirtz, D., Hornig, M., Lie, K. K., Lipkin, W. I., Lord, C., Magnus, P., Reichborn-Kjennerud, T., Schjølberg, S. (2014). Identifying children with autism spectrum disorder at 18 months in a general population sample. Paediatric and Perinatal Epidemiology, 28(3), 255–262.
Stone, W. L., Coonrod, E. E., & Ousley, O. Y. (2000). Brief report: Screening tool for autism in two-year-olds (STAT): Development and preliminary data. Journal of Autism and Developmental Disorders, 30(6), 607–612.
Stone, W. L., Coonrod, E. E., Turner, L. M., & Pozdol, S. L. (2004). Psychometric properties of the STAT for early autism screening. Journal of Autism and Developmental Disorders, 34(6), 691–701.
Stone, W. L., McMahon, C. R., & Henderson, L. M. (2008). Use of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months: An exploratory study. Autism, 12(5), 557–573.
Suess, A. N., Romani, P. W., Wacker, D. P., Dyson, S. M., Kuhle, J. L., Lee, J. F.,… Waldron, D. B. (2014). Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via telehealth. Journal of Behavioral Education, 23(1), 34–59.
Suess, A. N., Wacker, D. P., Schwartz, J. E., Lustig, N., & Detrick, J. (2016). Preliminary evidence on the use of telehealth in an outpatient behavior clinic. Journal of Applied Behavior Analysis, 49(3), 686–692.
Swanson, A. R., Warren, Z. E., Stone, W. L., Vehorn, A. C., Dohrmann, E., & Humberd, Q. (2014). The diagnosis of autism in community pediatric settings: Does advanced training facilitate practice change? Autism, 18(5), 555–561.
Vismara, L. A., Young, G. S., Stahmer, A. C., Griffith, E. M., & Rogers, S. J. (2009). Dissemination of evidence-based practice: Can we train therapists from a distance? Journal of Autism and Developmental Disorders, 39(12), 1636.
Wacker, D. P., Lee, J. F., Dalmau, Y. C. P., Kopelman, T. G., Lindgren, S. D., Kuhle, J., Pelzel, K.E., Waldron, D. B. (2013). Conducting functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46(1), 31–46.
Wainer, A. L., & Ingersoll, B. R. (2015). Increasing access to an ASD imitation intervention via a telehealth parent training program. Journal of Autism and Developmental Disorders, 45(12), 3877–3890.
Warren, Z., McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra-VanderWeele, J. (2011). A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics, 127(5), e1303–e1311.
Warren, Z., Stone, W., & Humberd, Q. (2009). A training model for the diagnosis of autism in community pediatric practice. Journal of Developmental & Behavioral Pediatrics, 30(5), 442–446.
Warren, Z. E., & Stone, W. L. (2011). Clinical best practices: Diagnosis and assessment of young children. In D. Amaral, G. Dawson & D. Geschwind (Eds.), Autism spectrum disorders (pp. 1269–1280). New York: Oxford University Press.
Wiggins, L. D., Baio, J., & Rice, C. (2006). Examination of the time between first evaluation and first autism spectrum diagnosis in a population-based sample. Journal of Developmental & Behavioral Pediatrics, 27(2), S79–S87.
Zuckerman, K. E., Mattox, K., Donelan, K., Batbayar, O., Baghaee, A., & Bethell, C. (2013). Pediatrician identification of Latino children at risk for autism spectrum disorder. Pediatrics, 132(3), 445–453.
Zwaigenbaum, L., Bauman, M. L., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., McPartland, J.C., Natowicz, M.R., Choueiri, R., Fein, D., Kasari, C. (2015). Early identification of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136(Supplement 1), S10–S40.
This project was completed with Hobbs Foundation funding through the [funding source redacted for blinded review], support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development U54 HD08321, support from the [funding source redacted for blinded review] CTSA award No. UL1TR000445 from the National Center for Advancing Translational Sciences, and support from the [funding source redacted for blinded review] Department of Education/[funding source redacted for blinded review] Early Intervention System. Its contents are solely the responsibility of the authors and do not necessarily represent official views of any funding agency. All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent/assent was obtained from all individual participants included in the study. Conflict of interest: the authors declare that they have no conflict of interest.
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Juárez, A.P., Weitlauf, A.S., Nicholson, A. et al. Early Identification of ASD Through Telemedicine: Potential Value for Underserved Populations. J Autism Dev Disord 48, 2601–2610 (2018). https://doi.org/10.1007/s10803-018-3524-y
- Autism spectrum disorder
- Young children