- Reliability and Validity of Autism Assessments and Diagnosis Using Telemedicine
- Autism and Associated Neuro-Behavioral Functioning Among Patients in a Psychiatric Hospital
Autism is a complex developmental disorder that affects approximately 1 in 150 children. In order to initiate treatment as early as possible, it is extremely important to have the most accurate and appropriate diagnostic assessment tools available to qualified professionals. Evaluations for autism spectrum disorders (ASD) are particularly needed in rural communities as these areas have fewer qualified specialists. Dr. Matthew Reese, from the University of Kansas Medical Center Research Institute, received a fiscal year 2007 Autism Research Program Concept Award through the Department of Defense to explore the innovative use of telemedicine (interactive TV) to diagnose ASD in children. Dr. Reese will study the reliability and validity of autism assessments and diagnosis using telemedicine. This project highlights the need to empirically evaluate use of telemedicine for delivery of services to children with autism living in underserved areas. Telemedicine overcomes several barriers, including traveling for appointments, missing work, and accessing services from qualified specialists.
The proposed project will determine whether young children can receive an appropriate diagnosis through telemedicine. The American Academy of Neurology practice parameters for diagnosing autism indicate that adequate diagnosis includes a parent interview, such as the Autism Diagnostic Interview (ADI), and a structured observation of the child using a validated instrument such as the Autism Diagnostic Observation Schedule (ADOS; Filipek et al. 2000). The ADI and ADOS are considered gold standards instruments for use in diagnosing autism. These measures, along with a medical history and review of record, are used to determine whether the child meets the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for autism.
In this study, two clinicians will evaluate the children and participate in the parent interview through telemedicine, and two clinicians will conduct observations in the same room as the parents and child. For half of the families, the assessment will be directed by the two clinicians in the room. The other half of the assessments will be directed by the two clinicians via telemedicine. The reliability of autism measures (ADOS and ADI) will then be compared for those scored live versus those scored by telemedicine. Accuracy of diagnosis as well as patient satisfaction will also be evaluated. Dr. Reese hypothesizes that the reliability of measures, diagnostic accuracy, and patient satisfaction will not be significantly different when comparing telemedicine and live assessments, thus making telemedicine a viable option for assessing autism.
Nesbitt TS, Rogers SJ, Rich BA, et al. 2006. Enhancing Mental Health Services to Children with Autism in Rural Communities. VC Davis Center for Health and Technology, Sacramento, California.
Marcin JP, Ellis J, Mawis R, et al. 2004. Using Telemedicine to Provide Pediatric Subspecialty Care to Children with Special Health Care Needs in an Underserved Rural Community. Pediatrics 113:1-6.
Filipek PA, Accardo PJ, Ashwal S, et al. 2000. Practice Parameter: Screening and Diagnosis of Autism: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology 55:468-479.
Published studies have estimated the prevalence of autism in adult psychiatric patients to be between 0.6% and 5.3%, with an even higher prevalence in those more severely affected. In psychiatric patients, fewer than 10% of cases were diagnosed with autism; most cases were commonly diagnosed with schizophrenia instead. Researchers speculate that autism is overrepresented and underdiagnosed because many hospitalized individuals received their diagnosis before advanced or updated criteria were in place. Current psychiatric patients are more clinically complex with fewer community alternatives to evaluation and treatment. In previous work, Dr. Mandell and colleagues have evaluated 350 state hospital patients for autism, using the Social Responsiveness Scale (SRS). Twenty-one percent (21%) received a score highly specific for autism spectrum disorder. While these findings are highly thought-provoking, more information is needed to determine whether these individuals truly meet criteria for autism or are experiencing the social and communication deficits sometimes associated with other psychiatric and developmental disorders. To this end, Dr. Mandell received a fiscal year 2007 Concept Award through the U.S. Department of Defense Autism Research Program to study autism and associated neuro-behavioral functioning among patients in a psychiatric hospital. Dr. Mandell will determine the prevalence of autism among psychiatric inpatients; validate a screening instrument for autism in an adult, psychiatrically impaired sample; and identify clinical and neurobehavioral characteristics that discriminate between adults with autism and other psychiatric disorders.
Chang H, Juang Y, Wang W, Huang C, Chen C, Hwang Y. 2003. Screening for autism spectrum disorder in adult psychiatric outpatients in a clinic in Taiwan. General Hospital Psychiatry 25:284-288.
Nylander L and Gillberg C. 2001. Screening for autism spectrum disorders in adult psychiatric outpatients: A preliminary report. Acta Psychiatria Scandinavia 103:428-434.