Implementation and Assessment of a Tiered Autism Assessment Model

We evaluated a tiered autism assessment model (TAAM) designed to integrate caregiver and provider confidence ratings with an FDA-cleared eye-tracking-based diagnostic device for toddlers (16-30 months) within a specialty autism diagnostic clinic. Despite the availability and purported efficacy of the device, no published research to date has examined its integration into clinical practice.

We used a type I hybrid effectiveness-implementation design and the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to pilot TAAM. TAAM used caregiver and provider confidence ratings on ASD symptoms alongside device eligibility to triage patients to a shortened appointment (75 minutes or 2 hours) or a standard 4-hour appointment. Low caregiver- and/or provider-rated ASD confidence resulted in a 4-hour appointment. Patients with non-ASD device results received further testing. Caregivers and providers completed acceptability surveys. We describe key phases, including identifying barriers, preparing resources, and implementation.

Data from the first 7 months of TAAM indicate that most toddlers were device-eligible (87.80%). Notably, 77.78% of device-eligible toddlers met confidence rating criteria to qualify for a shortened appointment, supporting clinic efficiency. Caregiver and provider acceptability ratings of aspects of TAAM, and of the device specifically, were high.

Preliminary findings suggest that TAAM and the device were acceptable to caregivers and providers. By optimizing triage decisions through ASD confidence ratings, this approach holds potential to improve clinical efficiency.