Summative content analysis of the recommendations from Project ECHO Ontario Autism.

Background: Practitioners report a lack of knowledge and confidence in treating autistic children, resulting in unmet healthcare needs. The Extension of Community Healthcare Outcomes (ECHO) Autism model addresses this through discussion of participant-generated cases, helping physicians provide best-practice care through co-created recommendations. Recommendations stemming from ECHO cases have yet to be characterized and may help guide the future care of autistic children. Our objective was to characterize and categorize case discussion recommendations from Project ECHO Ontario Autism to better identify gaps in clinician knowledge. Methods: We conducted a summative content analysis of all ECHO Ontario Autism case recommendations to identify categories of recommendations and their frequencies. Two researchers independently coded recommendations from five ECHO cases to develop the coding guide. They then each independently coded all remaining cases and recommendations from three cycles of ECHO held between October 2018 to July 2021, meeting regularly with the ECHO lead to consolidate the codes. A recommendation could be identified with more than one code if it pertained to multiple aspects of autism care. Categories from the various codes were identified and the frequency of each code was calculated. Results: Of the 422 recommendations stemming from 62 cases, we identified 55 codes across ten broad categories. Categories included accessing community resources (n = 224), referrals to allied health and other providers (n = 202), ongoing autism care (n = 169), co-occurring mental and physical health conditions (n = 168), resources and tools for further learning (n = 153), physician to provide education and coaching to families (n = 150), promoting parent and family wellness (n = 104), supporting community autism diagnosis (n = 97), promoting patient empowerment and autonomy (n = 87), and COVID-19 (n = 26). Conclusion: This is the first time that recommendations from ECHO Autism have been characterized and grouped into categories. Our results show that advice for autism identification and management spans many different facets of community-based care. Specific attention should be paid to providing continued access to education about autism, streamlining referrals to allied health providers, and a greater focus on patient- and family-centered care. Physicians should have continued access to autism education to help fill knowledge gaps and to facilitate families' service navigation.

Data-Driven Discovery of Predictors of Virtual Reality Safety and Sense of Presence for Children With Autism Spectrum Disorder: A Pilot Study.

Virtual reality (VR) offers children with autism spectrum disorder (ASD) an inexpensive and motivating medium to learn and practice skills in a personalized, controlled, and safe setting; however, outcomes of VR interventions can vary widely. In particular, there is a need to understand the predictors of VR experience in children with ASD to inform the design of these interventions. To address this gap, a sample of children with ASD (n=35, mean age: 13.0 ± 2.6 years; 10 female) participated in a pilot study involving an immersive VR experience delivered through a head-mounted display. A data-driven approach was used to discover predictors of VR safety and sense of presence among a range of demographic and phenotypic user characteristics. Our results suggest that IQ may be a key predictor of VR sense of presence and that anxiety may modify the association between IQ and sense of presence. In particular, in low-anxiety participants, IQ was linearly related to experienced spatial presence and engagement, whereas, in high-anxiety participants, this association followed a quadratic form. The results of this pilot study, when replicated in larger samples, will inform the design of future studies on VR interventions for children with ASD.

Short report: Evaluating the safety and usability of head-mounted virtual reality compared to monitor-displayed video for children with autism spectrum disorder.

LAY ABSTRACT: This study investigated the safety and usability of a virtual reality experience for children with autism spectrum disorder in a laboratory setting. In our study, the negative effects of head-mounted display-virtual reality were similar to monitor-displayed video watching. At the same time, the participants indicated that the head-mounted display-virtual reality experience provided improved realism and sense of presence. This study is a first step in understanding the impact of head-mounted display on children with autism spectrum disorder.