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Validity of Telemedicine for Diagnosing Autism Spectrum Disorder: Protocol-Guided Video Recording Evaluation
Jennie D Sutantio1, Hardiono D Pusponegoro2, Rini Sekartini3
1Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Insights
Telemedicine using video recordings shows significant validity for diagnosing autism spectrum disorder (ASD) in toddlers, offering a solution for early identification when direct assessment is limited.
Area of Science:
- Pediatric Health
- Telemedicine
- Developmental Pediatrics
Background:
- Delayed diagnosis of autism spectrum disorder (ASD) is a significant challenge in pediatrics.
- Limited access to specialists and healthcare facilities exacerbates diagnostic delays.
- Telemedicine offers a potential solution for early ASD identification and intervention referral.
Purpose of the Study:
- To evaluate the diagnostic validity of a telemedicine approach using protocol-guided video recordings.
- To compare the accuracy of video assessments with direct assessments (DA) for ASD diagnosis in toddlers.
- To determine the reliability of video-based ASD screening in a pediatric population.
Main Methods:
- Inclusion of children aged 18-30 months with concerns for ASD and elevated M-CHAT-R scores.
- Parents recorded specific developmental scenarios as instructed.
- Video recordings were assessed by experienced professionals using DSM-5 criteria for ASD diagnosis.
- Direct assessments (DA) served as the gold standard for comparison.
Main Results:
- The diagnostic agreement between video recording and DA was 82.5%.
- Sensitivity for video diagnosis was 91.3%, with a specificity of 70.6%.
- Positive and negative predictive values were 80.7% and 85.7%, respectively.
Conclusions:
- Protocol-guided video recording via telemedicine demonstrates substantial validity for ASD diagnosis.
- This telemedicine method can effectively aid in the early identification and referral of toddlers with ASD.
- The findings support the use of telemedicine as a viable tool to overcome barriers in pediatric ASD diagnosis.
Abstract:
Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric health problem, due to limited access to competent diagnosticians and tertiary health care. A telemedicine method using a store-and-forward approach presents an opportunity to facilitate early identification and referral for intervention. This study aimed to evaluate the validity of protocol-guided video recording compared with direct assessment (DA) for diagnosing ASD. Children aged 18-30 months with chief complaints of delayed speech or social indifference, and Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) score of more than two were included. Parents were instructed to video record certain scenarios, which were assessed by an experienced professional based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) checklist for ASD. DAs using DSM-5 criteria were considered to be the gold standard of diagnosis. Diagnostic agreement, sensitivity, specificity, predictive values, and likelihood ratios were calculated to measure diagnostic validity. The diagnostic agreement between the two methods was 82.5%. The sensitivity of video recording for diagnosing ASD was 91.3% (95% confidence interval [CI] [79.7%-100%]), while the specificity was 70.6% (95% CI [48.9%-92.2%]). The positive predictive value was 80.7% (95% CI [65.6%-95.9%]), while the negative predictive value was 85.7% (95% CI [67.4%-100%]). The positive likelihood ratio was 3.1 (95% CI [1.47-6.5]), while the negative likelihood ratio was 0.16 (95% CI [0.03-0.47]). A telemedicine approach using protocol-guided video recording evaluation has substantial validity compared with DA for diagnosing ASD.
