Early Identification of ASD Through Telemedicine: Potential Value for Underserved Populations.
A Pablo Juárez, Amy S Weitlauf, Amy Nicholson and 5 others
PMID 29527626WHAT IT FOUND
Remote psychologists classified 15 children as having ASD, and all 15 were confirmed in person, but 4 children later diagnosed were missed.
Rural families were highly satisfied. This is not a replacement for full evaluation.
Key findings
01Remote psychologists classified 15 children as having ASD, and all 15 were also diagnosed with ASD by the blinded in-person psychologist.
02Four children who received an ASD diagnosis after the in-person comprehensive evaluation were not classified as having ASD by the remote procedure.
03In the rural study, 91% of families returned the satisfaction survey, and the telemedicine visit saved an average of 3.92 hours of estimated travel time.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The samples were small: 20 children in Study 1 and 45 children in Study 2, and they were over-represented for ASD and impairment. Study 1 had no non-ASD control group, so specificity and predictive values could not be tested. Families and clinicians were not randomly assigned to service modes, so bias is possible. Remote psychologists were licensed clinical psychologists with specific ASD expertise, and STAT administrators were trained, so results may not apply to less experienced providers or settings without support staff. Children with milder symptoms or complex profiles may be missed or need in-person evaluation. Study 1 families had immediate access to a blinded in-person comprehensive assessment, and Study 2 families were connected to early intervention support, which may have affected comfort and acceptance.
The easy way to misread this
Do not conclude that telemedicine can replace in-person diagnosis for all toddlers. It missed 4 children who were diagnosed with ASD after comprehensive evaluation, and specificity was not tested because there was no non-ASD control group.