Advertisement

Journal of Autism and Developmental Disorders

, Volume 48, Issue 8, pp 2601–2610 | Cite as

Early Identification of ASD Through Telemedicine: Potential Value for Underserved Populations

  • A. Pablo Juárez
  • Amy S. Weitlauf
  • Amy Nicholson
  • Anna Pasternak
  • Neill Broderick
  • Jeffrey Hine
  • J. Alacia Stainbrook
  • Zachary Warren
Original Paper

Abstract

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.

Keywords

Autism spectrum disorder Diagnosis Telemedicine Young children 

Notes

Author Contributions

APJ, AS, AW, and ZW conceived of the study and crafted the experimental design. APJ and AS provided oversight of study implementation across Vanderbilt sites. AW, NB, AN, JH, and AS helped design and implement the rapid diagnostic procedure and methods for capturing diagnostic agreement. AP and AS assisted with data collection and analysis for manuscript preparation. APJ, AW, and ZW significantly participated in drafting the article, revising it critically, and providing final approval of the manuscript. All authors are in agreement with accountability for all aspects of the work.

Funding

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.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefPubMedCentralGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.Google Scholar
  5. Cisco Systems. (2015). Cisco Jabber (Version 4.8) [Telecommunications platform]. San Jose, CA: Cisco Systems.Google Scholar
  6. Clatney, L., MacDonald, H., & Shah, S. M. (2008). Mental health care in the primary care setting. Canadian Family Physician, 54(6), 884–889.PubMedPubMedCentralGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.Google Scholar
  15. Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.CrossRefPubMedGoogle Scholar
  16. 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.Google Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.Google Scholar
  19. 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).Google Scholar
  20. Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service.Google Scholar
  21. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. Sparrow, S. D., Cicchetti, D. V., & Balla, D. A. (2005). Vineland-II adaptive behavior scales: Survey forms manual. Circle Pines, MN: American Guidance Service.Google Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 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.CrossRefPubMedGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 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.CrossRefGoogle Scholar
  39. 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.Google Scholar
  40. 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.Google Scholar
  41. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • A. Pablo Juárez
    • 1
    • 2
    • 3
  • Amy S. Weitlauf
    • 1
    • 2
  • Amy Nicholson
    • 1
    • 2
  • Anna Pasternak
    • 1
    • 2
  • Neill Broderick
    • 1
    • 2
  • Jeffrey Hine
    • 1
    • 2
  • J. Alacia Stainbrook
    • 1
    • 2
  • Zachary Warren
    • 1
    • 2
    • 3
    • 4
  1. 1.Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum DisordersVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of PediatricsVanderbilt University Medical CenterNashvilleUSA
  3. 3.Department of Psychiatry & Behavioral SciencesVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of Special EducationVanderbilt UniversityNashvilleUSA

Personalised recommendations