An Accurate Alternative Method for Diagnoses of Autism Spectrum Disorder Using Video Telehealth Parent Led Play in the Military Medical System

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social interaction and communication, repetitive behaviors and restricted interests. Symptomology and impairments of ASD continue throughout the child’s lifespan, but may decrease in severity with early interventions. Early recognition and identification is encouraged by health care professionals but there remains a significant time difference between initial parental concern and the diagnosis of ASD. Currently the average age for diagnosis of ASD in the United States is above 4 years old. Video telehealth (VTH) models have been found to be successful across a variety of medical and psychiatric conditions; demonstrating positive clinical impact, improved service and interventional delivery. Within the Department of Defense, families may be located in areas that lack the capability to timely diagnose an ASD, requiring them to either wait or travel for an evaluation and delaying receipt of interventional therapy. We hypothesize that children aged 21 to 48months can be reliability evaluated for ASD utilizing a directed selected parent led play observation via VTH without asking the parents to relocate or travel a distance further than their closest army community hospital. Methods: Children receiving care at Bassett Army Community Hospital received comprehensive VTH evaluations by two Developmental Pediatricians (DBPED) located at Madigan Army Medical Center. Following parent interview, two physicians independently observed the child while directing the parent to engage their child in the directed selective play, a semi structured observational opportunity via VTH. The DBPED providers then independently rendered a determination of the presence or absence of autism using a Diagnostic and Statistical Manual of Mental Disorders (DSM -5) structured framework, completed a confidence regarding their diagnosis, and discussed their determination with the family. Parents completed satisfaction surveys and scheduled a confirmatory in-person evaluation with an independent DBPED. Results of the VTH and confirmation evaluation were then compared to generate an agreeability statistic. Results: Of the 25 children enrolled 12 received an ASD diagnosis after the VTH evaluation, 11 were confirmed in-person to have met the DSM 5 criteria for ASD, demonstrating a kappa coefficient for interrater reliability of 0.84 (92% agreement) and a confirmatory evaluation kappa coefficient of 0.92 (96% agreement). DBPEDs were only 10% uncertain utilizing VTH to evaluate the diagnosis of ASD and only 8% uncertain rendering an actual diagnosis of ASD. 96% of parents endorsed a positive experience with the ASD VTH evaluation. Conclusions: This is the first study to report utilizing VTH to diagnose ASD using directed parent led play observations. Some young children can feasibly be diagnosed with ASD utilizing directed parent led play observations via VTH without relying on military families to relocate for an evaluation.