Autism Assessment From Home: Piloting a Brief, Remote Autism Observation for Children

Since COVID-19, tele-based methods of autism assessment have been relied upon to a previously unparalleled degree; however, the need for such advancements is not new. Observation-based measures are a crucial component of face-to-face autism diagnostic evaluations, but few validated observation tools exist for remotely assessing autism across childhood, offering minimal guidance for older children and adolescents. Sanchez and Constantino previously validated a brief, face-to-face, clinician-facilitated observation coded according to the Childhood Autism Rating Scale, Second Edition (CARS-2). During the pandemic, this measure was adapted as a remote observation, but has yet to be validated in this format.

The current study validated this remote observation against the in-person Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), in a sample of 30 children ages 1-16 years (M = 7.25, SD = 4.05).

The remote observation was highly correlated with the ADOS-2 (r = .75, p < .001) and Social Responsiveness Scale, Second Edition (r = .74, p < .001), and demonstrated acceptable sensitivity (88.9%) and specificity (80%) in predicting research diagnostic classification. The remote observation correctly predicted whether a child met criteria for a research diagnosis of autism in 82.8% of cases, and the same classification as the ADOS-2 in 72.4% of cases.

This pilot study offers preliminary support for the validity of this brief, accessible, remote autism observation. This is a crucial step in ensuring uniform training and clinical procedures for tele-assessment of autism, to help mitigate long-standing barriers to service access (e.g., geography, cost, availability).