Early detection and early intervention significantly improves developmental outcomes for children with autism, however, availability and access to trained professionals who provide diagnostic and clinical services for children with ASD are limited (Newschaffer, Falb, &Gurney, 2005), particularly in rural areas (Carbone, et al., 2010). The long-term research goal is to identify empirically validated practices for early detection of ASD in rural communities and the objective of this study is to identify reliable and valid evaluation procedures for diagnosing children with ASD in rural communities. The main hypothesis is that clinicians are able to accurately diagnosis ASD in young children through evaluation procedures via interactive television (ITV). Telemedicine, a form of interactive television that uses real-time video conferencing for clinical purposes, is increasingly being utilized as a means to provide health care to underserved areas, including rural and urban areas without providers. Participants will include 46 children ages 2-5 that are suspected of having an autism spectrum disorder. Participants will be randomly assigned to interact with a lead psychologist via ITV or in person. One pair of clinicians will observe in the room with families (Live) while one pair of clinicians will simultaneously observe via ITV. Each pair of clinicians wil provide item scores on the ADOS and ADI, DSM IV criteria for ASD the child meets and overall diagnosis. For each Condition (Live vs ITV) inter-rater agreement will be computed for each pair of clinicians (item by item) and then compared to the inter-rater agreement (item by item) of the other pair of clinicians. Item by item agreement will also be made across conditions. DSM IV, TR autism criteria will be compared across conditions (Live vs ITV) and compared to an interdisciplinary evaluation conducted by a team who is bind to the experimental data. Family satisfaction will also be evaluated between conditions. Primary hypotheses are that clinicians are able to accurately evaluate children for ASD via ITV as evidenced by high inter-rater agreement between evaluation settings (ITV vs Live, ITV vs confirmatory interdisciplinary evaluation, Live-interdisciplinary confirmatory team) for diagnosis, DSM IV criteria for ASD, and on ASD measures. It is also expected that families will be satisfied with the evaluation process regardless of evaluation condition. Identification of a reliable and valid protocol for ASD diagnosis via ITV would allow greater access to quality health care for individuals in rural and underserved areas, with greater access to early intervention and improved developmental outcomes.

Public Health Relevance

Individuals in rural and underserved areas have limited access to professionals with expertise in autism. This project will evaluate the use of interactive television (ITV) in evaluation procedures for children suspected of having autism to ensure greater access to these professionals. Early detection of ASD is associated with increased access to intervention and improved developmental outcomes.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Child Psychopathology and Developmental Disabilities Study Section (CPDD)
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Gilotty, Lisa
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University of Kansas
Schools of Medicine
Kansas City
United States
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