Vanderbilt Kennedy Center TRIAD researchers at Vanderbilt University Medical Center (VUMC) have found that autism spectrum disorder (ASD) can be accurately diagnosed in young children via remote, telemedicine assessments, a method that could significantly increase access and reduce wait times for autism services.
In a first-of-its-kind study, the researchers compared the accuracy of rapid telemedicine evaluations to in-person evaluations for ASD and found that, in most cases, remote evaluators could accurately identify children with ASD with high levels of confidence.
These findings were released March 10 in the Journal of Autism and Developmental Disorders.
“This study proves remote diagnosis of autism is not only feasible, but under specified circumstances can be highly accurate,” said senior author Zachary Warren, Ph.D., associate professor of Pediatrics, Psychiatry & Behavioral Sciences, and Special Education, and executive director of the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders (TRIAD).
“Appropriate use of telemedicine consultation could radically increase our capacity for reaching young children who are referred for an autism evaluation in a timely manner. We know early intervention with autism is key. When families have questions about autism, they deserve answers that are both timely and accurate.”
ASD is a neurodevelopmental disorder which, according to the U.S. Centers for Disease Control and Prevention (CDC), is identified in one in 68 children, with updated numbers to be released by the CDC this year.
Many studies have reinforced that early diagnosis of autism is critical. The American Academy of Pediatrics recommends screening for ASD starting at 18 months of age. However, in many parts of the country, the demand for services is so great that the wait for an autism evaluation in a specialty clinic may exceed 6 to 12 months or more. This is especially true in rural and impoverished communities, where autism is often not diagnosed until after age 4.
To address this need in Tennessee, TRIAD has built their capacity to evaluate children for autism by expanding its telehealth initiatives, which use telecommunications technologies to support long-distance clinical healthcare.
To test the effectiveness of these telemedicine evaluations, children were evaluated using both in-person and remote diagnostic tools. The assessors, all licensed psychologists with specific expertise in ASD in young children, used audiovisual equipment that allowed them to observe and communicate with the child.
The remote clinicians accurately identified 78.9 percent of all children who ultimately received ASD diagnoses based on a blinded comprehensive assessment with gold-standard identification tools. No children were inaccurately classified as having ASD based on the telemedicine consultation.
“These findings validate our ability to provide more accessible evaluation services in rural and low-resource communities,” said TRIAD Director Pablo Juárez, M.Ed., behavior analyst in Pediatrics and Psychiatry & Behavioral Sciences. “In fact, through initial trials with our partners at the Tennessee Early Intervention System, we have already conducted significantly more autism evaluations than previous years across West Tennessee, an area of the state with very limited access to these types of services. The reality is that many families in service-limited communities do not have the resources or ability to make long trips to diagnostic centers for hours-long evaluations. Our alternative is to go into those communities, provide rapid telemedicine evaluations, and get these families access to services much more quickly.”
As part of this study, the researchers found that over 95 percent of families chose to first participate in a telemedicine assessment when offered instead of an initial referral to the closest university-based diagnostic center, which was on average 144 miles from participating patients.
“Not only did we want to ensure this procedure was accurate, but we also wanted to see if it was practical and aligned with family priorities,” said Amy Weitlauf, Ph.D., study co-author and assistant professor of Pediatrics. “Telediagnosistic assessment could help us provide answers to families who otherwise may be left on their own to grapple with challenging questions for long periods of time.”
This study was completed with Vanderbilt Kennedy Center Hobbs Discovery Grant funding, support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54 HD08321), and support from the Department of Education Tennessee Early Intervention System.
Additional co-authors from Vanderbilt included Amy Nicholson, M.A.; Anna Pasternak, B.A.Sc., Neill Broderick, Ph.D.; Jeffrey Hine, Ph.D., BCBA-D; and J. Alacia Stainbrook, Ph.D., BCBA-D.
Jennifer Wetzel is senior information officer, VUMC News & Communications. This article appeared in VUMC Reporter, March 12, 2018.
Pictured top of page: From his desk at Vanderbilt, Jeffrey Hine, Ph.D., BCBA-D, assistant professor of Pediatrics in the Division of Developmental Medicine, is able to perform an evaluation for autism through videoconference with a patient in another city. Photo by John Russell/Vanderbilt.