A Telehealth Diagnostic Tool for Autistic Children With Phrased and Fluent Speech: Comparison to In-person Diagnosis

Given the existing barriers to timely ASD diagnosis and the potential of telehealth to mitigate these barriers, it is critical to create and validate telehealth autism diagnostic instruments. Existing instruments largely focus on children under 3 and/or those with minimal verbal speech. We created and investigated the accuracy and validity for two novel instruments: Tele-ASD-KIDS, phrased speech (TAK-PS), and Tele-ASD-KIDS, fluent speech (TAK-FS) alongside an existing measure for minimally verbal children -the Tele-ASD-PEDS (TAP).

We assessed 39 children for autism in a university-based free clinic, both in-person and using telehealth, with blinded assessment teams- TAP (n = 10; M = 47.5 months), TAK-PS (n = 7, M = 74 months), TAK-FS (n = 22, M = 102.77 months). Data were analyzed for diagnostic accuracy and social validity for each telehealth instrument separately.

Our findings suggest that the TAK-PS is highly accurate, whereas the TAK-FS is accurate for some children but not others. Older children, those with behaviors unrelated to ASD that may affect social-communication abilities, and those with ADHD appear least likely to benefit from telehealth diagnostic assessments. For social validity, caregivers were largely satisfied with both TAK versions.

The TAK-PS and TAK-FS are, to our knowledge, the first telehealth diagnostic measures for ASD in children with phrased or fluent speech that have been systematically compared to in-person assessments using blinded clinical teams and randomized assessment order. Although the initial accuracy and validity of these measures are promising, more research on these measures is needed.