Using teletherapy to assess and/or diagnose autism is becoming increasingly common. In recent years, due to the COVID-19 pandemic, we have adjusted our way of life to what we now refer to as the “new normal.” Many events, routines, structures, and normal daily activities have transformed into a contactless and virtual version of what they once were. Some of these changes were created to make life easier while others were created out of necessity. One necessary change was the creation and advancement of telehealth, also referred to as teletherapy, for behavioral health concerns including the diagnosis and treatment of autism.
A typical diagnostic process for behavioral health requires observation. During the pandemic, in-person observations were nearly impossible to complete due to COVID-19 mitigation measures. This placed a large concern on the accuracy of the screenings and assessments of behavioral health needs. One area in particular that was significantly affected was the assessment of autism spectrum disorder (ASD).
ASD is not diagnosed through lab-related medical tests but rather through observations and interviews that can be completed by medical professionals with assistance from parents and teachers. The observations and interviews provide insight into an individual's social awareness, language development, and repetitive behaviors to name a few. With social distancing, personal protective equipment, and faces covered with masks – some of the most highly respected autism diagnostic tools (such as the ADOS) could not be accurately conducted.
The challenges placed on in-person observations resulted in delayed diagnoses for autistic children, which then created a very serious public health crisis. As a result, it became necessary for behavioral health evaluations to adapt to their version of a “new normal” through remote diagnostic screening. Clinicians and researchers quickly came together to look for alternative ways to properly assess ASD. They formed the International Collaborative for Diagnostic Evaluation of Autism (IDEA) and they determined that virtual assessments are likely here to stay.
The use of live video evaluations in place of in-person evaluations for ASD has grown throughout the pandemic and beyond with data that is continuing to be collected and reviewed. The live video evaluations are helpful for individuals or families that cannot physically attend a medical office due to health concerns or current distance to the nearest clinician. Typical evaluations take place across multiple visits where different portions of the evaluation are completed. With these at-home evaluations, medical experts are finding that they can complete the necessary assessments across fewer sessions (sometimes in just one). 
Measures of development or cognitive abilities, adaptive behavior, and other specific diagnostic measures are attempted during the virtual evaluation. Virtual observations allow professionals to get a glimpse into an individual's daily life in a setting where they are most comfortable. Structured observations of parents interacting with their children or older children and adults interacting with the psychologist proved to be effective through this model. They even found a way to provide a variety of structured and unstructured activities in the areas of independence, play, daily routine, and language.
Providing instructions to parents before the evaluation that included a list of items that can be found around the house to be used during activities proved to be a positive addition. Psychologists even found that they were able to provide coaching to parents, in real-time, as well as prompts for when to change tasks. Following the assessments, medical experts continued to support families after a diagnosis by providing them with materials to get started with finding services and how to share the new diagnosis with various individuals in their lives. They wrote detailed reports, being sure to note the use of telehealth methods, just like they would have if the assessments were traditionally completed in person. Members of IDEA continued to meet and discuss the data collected towards virtual assessments and the possibility of it becoming part of the “new normal.”
With all the changes our lives have undergone during the pandemic, we have learned to adapt quickly and accept a variety of life changes. However, each of these changes has its pros and cons in our daily lives, including their effectiveness, and accuracy.
Below is a list of the pros and cons of virtual autism assessments.
Pros
- Virtual assessments increase access to families and reach more people geographically
- Experts in this field found that they were still able to use rating scales similar to traditional autism assessments
- Insurance companies covered telehealth visits as an emergency measure during the pandemic
- Virtual assessments reduced the amount of paperwork for families
- Virtual observations provided experts with a rare and true view of a child’s daily life that was not always apparent in an unfamiliar medical environment
- Assessments and checklists were chosen to mirror in-person evaluations as much as possible
- Virtual assessments led to the exploration of hybrid assessment options that may be a better option for more complex cases
- Preliminary data taken from parent surveys showed overall family satisfaction in the virtual assessment process
Cons
- Assessments completed within the home come with many distractions
- Data is still being collected on the effectiveness of the virtual assessments
- Even though some clinicians were able to provide tool kits for families to use during the assessments, many families do not have the items needed to complete various in-home assessments.
- Interactions on screen can be challenging for the individuals being assessed
- Telehealth visits were covered by insurance as an emergency measure but it is unknown if this will continue
- Cognitive testing for children under the age of 6 or those with significant developmental delays was unsuccessful and at times not possible to complete virtually
- The world is still working towards understanding the impact that the pandemic has had on the developmental growth of children. This needs to be taken into consideration when completing assessments
Data collection and further development of the accuracy and effectiveness of virtual assessments for ASD is ongoing. Even though virtual assessments may be here to stay based on the virtual diagnostic work from IDEA, there is no official virtual test that has been approved and used as a standard assessment for autism diagnoses. As things continue to evolve, you can learn about the traditional aspects of the diagnostic evaluation for ASD and the implications of the COVID-19 pandemic on the assessments.
We hope you enjoyed the information in this article. STAGES® Learning also offers free downloadable resources to support teaching and learning with individuals with autism. Start with our free Picture Noun Cards and see our collection of other downloadable resources here!
