ABSTRACT
Development of standardized diagnostic instruments has facilitated the systematic characterization of individuals with autism spectrum disorders (ASD) in clinical and research settings. However, overemphasis on scores from specific instruments has significantly detracted from the original purpose of these tools. Rather than provide a definitive "answer," or even a confirmation of diagnosis, standardized diagnostic instruments were designed to aid clinicians in the process of gathering information about social communication, play, and repetitive and sensory behaviors relevant to diagnosis and treatment planning. Importantly, many autism diagnostic instruments are not validated for certain patient populations, including those with severe vision, hearing, motor, and/or cognitive impairments, and they cannot be administered via a translator. In addition, certain circumstances, such as the need to wear personal protective equipment (PPE), or behavioral factors (e.g., selective mutism) may interfere with standardized administration or scoring procedures, rendering scores invalid. Thus, understanding the uses and limitations of specific tools within specific clinical or research populations, as well as similarities or differences between these populations and the instrument validation samples, is paramount. Accordingly, payers and other systems must not mandate the use of specific tools in cases when their use would be inappropriate. To ensure equitable access to appropriate assessment and treatment services, it is imperative that diagnosticians be trained in best practice methods for the assessment of autism, including if, how, and when to appropriately employ standardized diagnostic instruments.
Subject(s)
Autism Spectrum Disorder , Autistic Disorder , Child Behavior Disorders , Child , Humans , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/psychology , Autistic Disorder/diagnosis , Communication , Psychiatric Status Rating ScalesABSTRACT
Objective To evaluate the feasibility of remotely providing a diagnosis of autism during the Coronavirus Disease pandemic of 2019. Methods A child psychiatrist guided the parents' Autism Diagnostic Observation Schedule (ADOS-2) administration to assess their child's developmental delay through a video conference. Trained clinicians (n = 10) rated the recorded procedure. Interrater reliability for each item was evaluated using the kappa statistic and percent agreement. Results The mean percent agreement across all items was 96%, range = 85.96-100%, and mean weighted kappa = .81, range = .44-1. Conclusions This study highlights the feasibility of providing early identification and continuous psychiatric care during a pandemic lockdown.