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3.
PLoS One ; 17(2): e0263062, 2022.
Article in English | MEDLINE | ID: covidwho-1690733

ABSTRACT

BACKGROUND: Considering the COVID-19 pandemic, understanding the reliability, validity, social validity, and feasibility of using telehealth to diagnose ASD is a critical public health issue. This paper examines evidence supporting the use of telehealth methods to diagnose ASD and outlines the necessary modifications and adaptations to support telehealth diagnosis. METHODS AND PROCEDURES: Studies were identified by searching PubMed and PsychInfo electronic databases and references lists of relevant articles. Only peer reviewed articles published in English with a focus on using telehealth for the purposes of diagnosing ASD were included. Searches were conducted through June 3rd, 2021. OUTCOMES AND RESULTS: A total of 10 studies were identified as meeting inclusion criteria. Of the eight papers that reported on reliability (e.g., accuracy), telehealth methods to diagnose ASD were between 80-91% accurate when compared with traditional in-person diagnosis. Six studies reported on validity (i.e., sensitivity and/or specificity). All six studies calculated sensitivity, with values ranging from 75% and 100%. Five of the six studies calculated specificity, with values ranging from 68.75% and 100%. The seven papers that reported social validity indicated that caregivers, as well as adult participants and clinicians, were mostly satisfied with telehealth. Feasibility was reported by seven studies and suggests that telehealth methods appear largely viable, though some challenges were reported. CONCLUSIONS AND IMPLICATIONS: Although findings reviewed here are promising, more research is needed to verify the accuracy, validity, and feasibility of utilizing telehealth to diagnose ASD. Studies with larger sample sizes and samples across sites will be critical, as these will allow clinicians to identify subjects most likely to benefit from telehealth as well as those more likely to require an in-person assessment. This research is important not only due to the current pandemic, but also due to increased prevalence rates of ASD and an insufficient number of diagnostic providers-particularly in rural and/or otherwise under-served communities.


Subject(s)
Autism Spectrum Disorder/diagnosis , Telemedicine , Feasibility Studies , Humans , Outcome Assessment, Health Care , Reproducibility of Results
4.
Am J Speech Lang Pathol ; 31(2): 982-990, 2022 03 10.
Article in English | MEDLINE | ID: covidwho-1671668

ABSTRACT

PURPOSE: In light of the COVID-19 pandemic, it is critical to understand the feasibility and acceptability of the use of telediagnostic assessments in clinical settings. This study aimed to characterize caregiver satisfaction with a telediagnostic assessment of autism spectrum disorder (ASD). METHOD: Twelve families completed a telediagnostic assessment of ASD through Illinois' Early Intervention program including a caregiver interview, administration of the TELE-ASD-PEDS, and a feedback visit. Following the evaluation, caregivers rated their satisfaction with the telediagnostic assessment. RESULTS: Caregivers reported that the evaluation met their expectations, and they were satisfied with the assessment and feedback visit. However, caregiver satisfaction with the telehealth platform varied, and the majority of caregivers reported a preference for in-person visits. Qualitative analysis of caregiver responses noted the benefits and areas of improvement of telediagnostic assessment. Thematic analysis revealed the strengths of the telediagnostic assessment, including the logistical convenience of the teleassessment, ease of administration, rapport with and expertise of the clinicians, and qualification for intervention services. Although caregivers' perspectives varied, diagnostic accuracy and the amount of information provided about the diagnosis were reported areas of improvement. CONCLUSIONS: Overall, telediagnostic assessments were well received by families. Caregivers' preference for in-person visits highlights the need to incorporate caregiver-reported areas of improvement in the development and administration of telediagnostic assessments.


Subject(s)
Autism Spectrum Disorder , COVID-19 , Autism Spectrum Disorder/diagnosis , COVID-19/diagnosis , Caregivers , Humans , Pandemics , Personal Satisfaction , SARS-CoV-2
5.
Sch Psychol ; 36(5): 377-387, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1442722

ABSTRACT

School psychologists play a critical role in school-based Autism (AU) evaluations. Evidence-based AU evaluations should be multimodal, include multiple informants, and assess functioning across several domains. In the current era of COVID-19, school-based AU evaluations have become increasingly complex with school psychologists having to significantly adapt face-to-face evaluation procedures and/or conduct evaluations via teleassessment approaches. This poses profound challenges for some families, many of whom are from vulnerable groups. In the current article, we outline school psychologists' traditional role in school-based AU evaluations and review best practice guidelines. We then discuss the impact of COVID-19 on these processes and provide a framework for school psychologists to use when conducting school-based AU evaluations during this unprecedented time. We also provide resources school psychologists may find useful as they conduct school-based AU evaluations during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Autism Spectrum Disorder/diagnosis , COVID-19 , Psychology , School Mental Health Services , Schools , Telemedicine , Behavior Rating Scale , Child , Education, Special , Humans , Psychiatric Status Rating Scales , Psychology/instrumentation , Psychology/methods , Psychology/standards , School Mental Health Services/standards , Telemedicine/methods , Telemedicine/standards
6.
Autism Res ; 14(11): 2251-2259, 2021 11.
Article in English | MEDLINE | ID: covidwho-1432360

ABSTRACT

The COVID-19 pandemic has posed unique challenges for families and caregivers, as well as for autism-focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of in-person assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family-centered system of care. LAY SUMMARY: Physical distancing and the abrupt end to in-person services for many children on the autism spectrum has forced clinicians to examine the existing challenges with autism spectrum disorder (ASD) diagnostic assessment and consider things they want to keep and things that should be changed in the years ahead. New approaches such as telehealth both alleviated and exacerbated existing disparities, and brought into stark focus the importance of equitable and timely access to family-centered care. This commentary suggests ways of improving clinical practices related to ASD assessment to continue along this path.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Child , Humans , Pandemics , SARS-CoV-2
7.
Autism Res ; 14(12): 2564-2579, 2021 12.
Article in English | MEDLINE | ID: covidwho-1351195

ABSTRACT

This study examined the feasibility and acceptability of a telehealth diagnostic model deployed at an autism center in the southwestern United States to safely provide autism spectrum disorder (ASD) diagnostic evaluations to children, adolescents, and adults during the COVID-19 pandemic. Participants included all clients for whom a telehealth diagnostic evaluation was scheduled at the diagnostic clinic (n = 121) over a 6-month period. Of 121 scheduled clients, 102 (84%) completed the telehealth evaluation. A diagnostic determination was made for 91% of clients (93 out of 102) using only telehealth procedures. Nine participants (two females; ages 3 to 11 years) required an in-person evaluation. Responses from psychologist and parent acceptability surveys indicated the model was acceptable for most clients. Psychologist ratings suggested that telehealth modalities used in the current study may be less acceptable for evaluating school-aged children with subtle presentations compared to children in the early developmental period, adolescents, and adults. Parents of females reported higher acceptability than parents of males. Findings contribute to the small but growing literature on feasibility and acceptability of telehealth evaluations for ASD and have implications for improving access to care during and after the COVID-19 pandemic. LAY SUMMARY: This study described telehealth methods for evaluating children, adolescents, and adults for autism spectrum disorder. Telehealth methods were generally acceptable to psychologists conducting the evaluations and parents of diagnostic clients. Psychologists reported the methods to be less acceptable for school-aged children and parents of males found the methods less acceptable than parents of females. The telehealth methods described may help to increase access to diagnostic professionals and reduce wait times for evaluations during and after the COVID-19 pandemic.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Telemedicine , Adolescent , Adult , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Child , Child, Preschool , Feasibility Studies , Female , Humans , Male , Pandemics , Parents , SARS-CoV-2
9.
Clin Child Fam Psychol Rev ; 24(3): 599-630, 2021 09.
Article in English | MEDLINE | ID: covidwho-1265524

ABSTRACT

There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.


Subject(s)
Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/therapy , COVID-19/prevention & control , Telemedicine/methods , Telemedicine/trends , Adolescent , Child , Humans , Treatment Outcome
10.
J Autism Dev Disord ; 52(5): 2247-2257, 2022 May.
Article in English | MEDLINE | ID: covidwho-1258230

ABSTRACT

The COVID-19 pandemic has increased the use of telemedicine as an avenue to address the need for diagnostic clarification in young children at risk for autism spectrum disorder (ASD). Although preliminary research has supported the use of telemedicine for identifying ASD in toddlers, little is known about the experiences of practitioners attempting direct-to-home tele-assessment. We surveyed diagnostic providers regarding changes in practice behavior in the initial months of the COVID-19 pandemic and their perceptions of ASD tele-assessment. We also examined the use of the TELE-ASD-PEDS, a novel tool for ASD tele-assessment, in response to COVID-19 at seven sites across the country. Results support the clinical acceptability and diagnostic utility of ASD tele-assessment while also highlighting critical avenues of future investigation.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Telemedicine , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Child, Preschool , Humans , Pandemics , Telemedicine/methods
11.
J Autism Dev Disord ; 52(2): 962-973, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1137153

ABSTRACT

A global pandemic has significantly impacted the ability to conduct diagnostic evaluations for autism spectrum disorder (ASD). In the wake of the coronavirus, autism centers and providers quickly needed to implement innovative diagnostic processes to adapt in order to continue serve patient needs while minimizing the spread of the virus. The International Collaborative for Diagnostic Evaluation of Autism (IDEA) is a grassroots organization that came together to discuss standards of care during the pandemic and to provide a forum wherein providers communicated decisions. This white paper is intended to provide examples of how different centers adjusted their standard approaches to conduct diagnostic evaluations for ASD during the pandemic and to provide insight to other centers as they go through similar challenges.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Humans , Pandemics , SARS-CoV-2
12.
J Autism Dev Disord ; 52(1): 423-434, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1092044

ABSTRACT

The COVID-19 pandemic, and associated social distancing mandates, has placed significant limitations on in-person health services, requiring creative solutions for supporting clinicians engaged in the diagnosis of autism spectrum disorder (ASD). This report describes the five virtual instruments available at the time of manuscript development for use by experienced clinicians making diagnostic determinations of ASD for toddlers across the 12- to 36-months age range. We focus on synchronous virtual assessments in which clinicians guide the child's caregiver through a range of assessment activities and observe spontaneous and elicited behaviors. Assessments are compared on dimensions of targeted behavioral domains, specific activities and presses employed, scoring approaches, and other key logistical considerations to guide instrument selection for use in varied clinical and research contexts.


Subject(s)
Autism Spectrum Disorder , COVID-19 , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Caregivers , Child, Preschool , Humans , Pandemics , SARS-CoV-2
13.
J Child Psychol Psychiatry ; 62(2): 146-148, 2021 02.
Article in English | MEDLINE | ID: covidwho-1082708

ABSTRACT

Kanne and Bishop's (2020) Editorial Perspective 'The Autism waitlist crisis and remembering what families need' offers a strong argument to provide greater access to high-quality assessments for Autism Spectrum Disorder (ASD). They note, correctly, that due to increasing numbers of referrals practitioners are under increasing pressure to provide quicker or abbreviated evaluations, that some cases are extremely complex and require considerable expertise to assess, and that a good assessment is a good investment in effective intervention. I agree with these points but also want to highlight some difficulties and dilemmas associated with the assessment of ASD; and to argue that improving access to assessments and interventions through the use of nonspecialists and new technologies may be a promising direction.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , Autism Spectrum Disorder/diagnosis , Humans
14.
Res Dev Disabil ; 109: 103852, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1065563

ABSTRACT

BACKGROUND: Screening and diagnostic assessments tools for autism spectrum disorder (ASD) are important to administer during childhood to facilitate timely entry into intervention services that can promote developmental outcomes across the lifespan. However, assessment services are not always readily available to families, as they require significant time and resources. Currently, in-person screening and diagnostic assessments for ASD are limited due to the COVID-19 pandemic and will continue to be a concern for situations that limit in-person contact. Thus, it is important to expand the modalities in which child assessments are provided, including the use of technology. AIMS: This systematic review aims to identify technologies that screen or assess for ASD in 0-12 year-old children, summarizing the current state of the field and suggesting future directions. METHODS: An electronic database search was conducted to gather relevant articles to synthesize for this review. OUTCOMES AND RESULTS: 16 studies reported use of novel technology to assess children suspected of ASD. CONCLUSIONS AND IMPLICATIONS: Results strongly supported live-video evaluations, video observations, and online or phone methods, but there is a need for research targeting the feasibility of these methods as it applies to the stay-at-home orders required by the pandemic, and other situations that limit clients from seeing providers in-person.


Subject(s)
Autism Spectrum Disorder/diagnosis , COVID-19 , Communicable Disease Control/methods , Mass Screening , Telemedicine/methods , COVID-19/epidemiology , COVID-19/prevention & control , Child , Humans , Inventions , Mass Screening/methods , Mass Screening/trends
15.
BMJ Open ; 10(11): e037335, 2020 11 03.
Article in English | MEDLINE | ID: covidwho-991817

ABSTRACT

INTRODUCTION: Around 9% of India's children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures. METHODS: This 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants' GMs twice, that is, within 2 months after birth and at 3-5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12-24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12-24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA. ETHICS AND DISSEMINATION: G.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.


Subject(s)
Autism Spectrum Disorder , Cerebral Palsy , Austria , Autism Spectrum Disorder/diagnosis , Cohort Studies , Female , Humans , India , Infant , Infant, Newborn , Pregnancy
16.
J Autism Dev Disord ; 51(9): 3063-3072, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-893306

ABSTRACT

The COVID-19 pandemic has caused unprecedented disruptions to healthcare, including direct impacts on service delivery related to autism spectrum disorder (ASD). Caregiver-mediated tele-assessment offers an opportunity to continue services while adhering to social distancing guidelines. The present study describes a model of tele-assessment for ASD in young children, implemented in direct response to disruptions in care caused by the COVID-19 pandemic. We present preliminary data on the outcomes and provider perceptions of tele-assessments, together with several lessons learned during the period of initial implementation.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Child , Child, Preschool , Humans , Pandemics , SARS-CoV-2
18.
Encephale ; 47(2): 151-156, 2021 Apr.
Article in French | MEDLINE | ID: covidwho-764582

ABSTRACT

OBJECTIVE: The SARS-CoV-2 (or COVID-19) pandemic has been propagating since December 2019, inducing a drastic increase in the prevalence of anxious and depressive disorders in the general population. Psychological trauma can partly explain these disorders. However, since psychiatric disorders also have an immuno-inflammatory component, the direct effects of the virus on the host's immune system, with a marked inflammatory response, but also the secondary inflammation to these psychosocial stressors, may cause the apparition or the worsening of psychiatric disorders. We describe here the probable immunopsychiatric consequences of the SARS-CoV-2 pandemic, to delineate possible screening actions and care that could be planned. METHOD: Data from previous pandemics, and existing data on the psychopathological consequences of the SARS-CoV-2 pandemic, allowed us to review the possible immunopsychiatric consequences of the SARS-CoV-2 pandemic, on the gestational environment, with the risk of consecutive neurodevelopmental disorders for the fetus on one hand, on the children and adults directly infected being at increased risks of psychiatric disorders on the other hand. RESULTS: As in previous pandemics, the activation of the immune system due to psychological stress and/or to infection during pregnancy, might lead to an increased risk of neurodevelopmental disorders for the fetus (schizophrenia and autism spectrum disorders). Furthermore, in individuals exposed to psychological trauma and/or infected by the virus, the risk of psychiatric disorders, especially mood disorders, is probably increased. CONCLUSION: In this context, preventive measures and specialized care are necessary. Thus, it is important to propose a close follow-up to the individuals who have been infected by the virus, in order to set up the earliest care possible. Likewise, in pregnant women, screening of mood disorders during the pregnancy or the postpartum period must be facilitated. The follow-up of the babies born during the pandemic must be strengthened to screen and care for possible neurodevelopmental disorders.


Subject(s)
COVID-19/immunology , Neurodevelopmental Disorders/immunology , Prenatal Exposure Delayed Effects , Anxiety Disorders/diagnosis , Anxiety Disorders/immunology , Anxiety Disorders/prevention & control , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/immunology , Autism Spectrum Disorder/prevention & control , COVID-19/complications , COVID-19/diagnosis , Depressive Disorder/diagnosis , Depressive Disorder/immunology , Depressive Disorder/prevention & control , Female , Humans , Infant, Newborn , Mass Screening , Mood Disorders/immunology , Mood Disorders/prevention & control , Mood Disorders/psychology , Neurodevelopmental Disorders/diagnosis , Neurodevelopmental Disorders/prevention & control , Pregnancy , Prenatal Care , Risk Factors , Schizophrenia/diagnosis , Schizophrenia/immunology , Schizophrenia/prevention & control , Stress, Psychological/complications
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