Utility of Diagnostic Classification for Children 0-5 to Assess Features of Autism: Comparing In-person and COVID-19 Telehealth Evaluations.
Sara Julsrud Holtman, Katherine Skillestad Winans, John D Hoch
PMID 35708824WHAT IT FOUND
Telehealth evaluations during the pandemic saw a drop in full-criteria autism diagnoses and a rise in subthreshold diagnoses like early atypical autism.
Higher scores on the CBCL Autism subscale predicted full diagnoses, while higher total CBCL scores predicted subthreshold ones.
Key findings
01Pre-COVID-19 in-person evaluations were more likely to result in full criteria diagnoses than COVID-19 telehealth evaluations.
02Higher scores on the CBCL Autism Spectrum Disorder DSM-5 subscale were associated with an increased likelihood of receiving a full criteria ASD diagnosis.
03Higher total scores on the CBCL were associated with an increased likelihood of receiving a partial criteria diagnosis (EA-ASD or OND).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study relied on existing clinical data, so it is unknown whether clinicians actually saw the rating scale scores before making their diagnoses. The shift from in-person to telehealth involved multiple changes, not just the medium. In-person evaluations were team-based and included direct observation in a clinic, while telehealth evaluations were individual and conducted in the home. The telehealth group was much smaller (109 participants) than the in-person group (551 participants). Diagnostic certainty was measured indirectly by the choice of diagnostic category, which is a blunt tool for assessing a clinician's internal confidence. The finding regarding Native American/Alaska Native clients was based on a very small sample size (n=11) and requires further investigation.
The easy way to misread this
Do not assume that a subthreshold diagnosis like Early Atypical Autism indicates the child has fewer autism symptoms. The study suggests this diagnosis may reflect the clinician's reduced confidence due to the limitations of telehealth or the presence of co-occurring behavioral issues, rather than a difference in the child's presentation.