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Updated: Jul 9, 2025
Eye Tracking Young Children with Autism
Published on: March 27, 2012
Development of a Novel Telemedicine Tool to Reduce Disparities Related to the Identification of Preschool Children
Liliana Wagner1,2, Alison Vehorn3,4, Amy S Weitlauf3,4
1Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA. Liliana.Wagner@vumc.org.
Insights
A new telemedicine tool, TELE-ASD-PEDS-Preschool (TAP-Preschool), aids in diagnosing autism spectrum disorder (ASD) in young children. This approach aims to improve access to care for underserved populations facing long evaluation waits.
Area of Science:
- Pediatric developmental disorders
- Telemedicine and digital health
- Health equity and access to care
Background:
- Long wait times for autism spectrum disorder (ASD) evaluations disproportionately affect preschool-aged children.
- Families from underserved communities face significant barriers in accessing timely ASD diagnostic services.
- Developing equitable identification tools is crucial to address disparities in ASD care.
Purpose of the Study:
- To develop and pilot a novel telemedicine-based assessment tool, the TELE-ASD-PEDS-Preschool (TAP-Preschool), for identifying ASD in preschoolers.
- To incorporate machine learning and community feedback to create an equitable and effective diagnostic instrument.
- To evaluate the diagnostic accuracy and utility of the TAP-Preschool tool.
Main Methods:
- Applied machine learning to a clinical dataset (n=914) of preschoolers to identify key behavioral targets distinguishing ASD.
- Conducted focus groups with diverse clinicians, early interventionists, and parents of children with ASD to inform instrument design.
- Developed a play-based instrument (TAP-Preschool) with language-specific assessment tasks and piloted it with 30 families.
Main Results:
- The TAP-Preschool tool, used in isolation, achieved 63% accurate diagnostic classification for ASD.
- Children with existing ASD diagnoses scored higher on TAP-Preschool compared to those with other developmental concerns.
- Clinician diagnostic accuracy was higher for confirming existing ASD diagnoses (80% agreement) than for ruling out ASD (30% agreement).
Conclusions:
- The telemedicine-based TAP-Preschool tool shows potential for improving ASD evaluation efficiency and accessibility.
- An equity-focused approach in developing tele-assessment tools can help mitigate disparities in ASD care.
- Further research and implementation of TAP-Preschool could transform the ASD evaluation process for young children.
Abstract:
The wait for ASD evaluation dramatically increases with age, with wait times of a year or more common as children reach preschool. Even when appointments become available, families from traditionally underserved groups struggle to access care. Addressing care disparities requires designing identification tools and processes specifically for and with individuals most at-risk for health inequities. This work describes the development of a novel telemedicine-based ASD assessment tool, the TELE-ASD-PEDS-Preschool (TAP-Preschool). We applied machine learning models to a clinical data set of preschoolers with ASD and other developmental concerns (n = 914) to generate behavioral targets that best distinguish ASD and non-ASD features. We conducted focus groups with clinicians, early interventionists, and parents of children with ASD from traditionally underrepresented racial/ethnic and linguistic groups. Focus group themes and machine learning analyses were used to generate a play-based instrument with assessment tasks and scoring procedures based on the child's language (i.e., TAP-P Verbal, TAP-P Non-verbal). TAP-P procedures were piloted with 30 families. Use of the instrument in isolation (i.e., without history or collateral information) yielded accurate diagnostic classification in 63% of cases. Children with existing ASD diagnoses received higher TAP-P scores, relative to children with other developmental concerns. Clinician diagnostic accuracy and certainty were higher when confirming existing ASD diagnoses (80% agreement) than when ruling out ASD in children with other developmental concerns (30% agreement). Utilizing an equity approach to understand the functionality and impact of tele-assessment for preschool children has potential to transform the ASD evaluation process and improve care access.
