During the TELE-ASD-PEDS-Preschool, or TAP-P, a clinician coaches the parent and child through a set of play and social activities that allow the clinician to observe the child’s social interactions, communication and play. (photo courtesy of Vanderbilt Kennedy Center)
TRIAD, the autism institute at the Vanderbilt Kennedy Center (VKC), pioneered using telehealth to assess for autism in young children nearly a decade ago. Now the team has received a grant from the National Institute of Mental Health (NIMH) to evaluate a similar telehealth assessment tool for children ages 3 to 6.
“This project is truly a team effort,” said Laura Corona, PhD, Assistant Professor of Pediatrics at Vanderbilt Health, Director of TRIAD Psychology Postdoctoral Training, and principal investigator for the grant. “It builds on more than a decade of work by the VKC TRIAD team to develop tools for assessing autism in young children via telehealth and to study how those tools can be used accurately, in ways that are meaningful to families.”
TRIAD’s early tele-assessment work focused on toddlers and received NIMH funding as well as support from the Tennessee Early Intervention System. In 2018, the TRIAD team developed and began to evaluate a tool called the TELE-ASD-PEDS (TAP), which was designed to assess autism-related behaviors in toddlers. That research has shown that tele-assessment is an accurate way to identify autism in young children. TAP is now used regularly for tele-assessments in Tennessee and beyond.
The current project, titled “Rigorous Evaluation of the TAP-Preschool: Toward Effective, Efficient Models of Autism Tele-Assessment,” will evaluate the use of the TELE-ASD-PEDS-Preschool, or TAP-P. The TAP-P is a tele-assessment tool designed to evaluate children ages 3 to 6 years for autism.
During the TAP-P, a clinician interacts with a child and a parent or caregiver via telehealth. The clinician coaches the parent and child through a set of play and social activities that allow the clinician to observe the child’s social interactions, communication and play.
There are two versions of the TAP-P: one with activities for children who are speaking in sentences to communicate, and another with activities for children who do not use words to communicate or use only single words or short phrases.
After observing the activities, the clinician provides ratings for several different child behaviors that can be related to autism. The clinician uses those ratings, together with other information from the parent and child, to determine whether an autism diagnosis is appropriate for that child.
This study has two main purposes:
- To test the use of the TAP-P in a large sample of children to determine the accuracy of the TAP-P in comparison to an in-person autism evaluation and the psychometric properties of the TAP-P, or how different scores on the TAP-P are related to the likelihood that autism is an accurate diagnosis for a child.
- To develop a tool that can help clinicians predict which children and families will benefit more from tele-assessment — meaning those children most likely to receive an accurate, confident diagnostic decision via tele-assessment.
“We know from our past research that clinicians can accurately and confidently make a decision about autism via tele-assessment for children who are using less verbal language — those who do not use spoken words to communicate or those who are using only one or two words at a time,” Corona said. “Our past research has also told us that tele-assessment is more complicated for preschool-age children who are speaking in longer phrases or sentences.
“For some of these children, clinicians are less confident about making a diagnostic decision over tele-assessment and often recommend in-person evaluation. This research will try to develop a way to know, in advance, which of these more verbal children will be appropriate for tele-assessment and which may be best served with an in-person evaluation.”
This study intends to recruit 350 children ages 36 months to 72 months over the five-year study period. All children will first complete a tele-assessment using the TAP-P with one of the TRIAD study clinicians. All children will then complete an in-person evaluation at Vanderbilt Health with a different clinician.
TRIAD’s tele-assessment efforts were started by Zachary Warren, PhD, Executive Director of TRIAD, Director of the Division of Developmental Medicine and holder of the Donna and Jeffrey Eskind Family Chair in Autism Spectrum Disorder, and Amy Weitlauf, PhD, Associate Professor of Pediatrics and TRIAD Associate Director of Research, together with TRIAD’s co-directors Alacia Stainbrook, PhD, BCBA-D, and Pablo Juárez, MEd, BCBA, LBA.
“The research leading up to this point would not have been possible without our amazing research staff, led by Amy Swanson, MA, CCRP, nor without the participation of many wonderful children and their families,” Corona said.
This research team will include Corona, Warren and Weitlauf, as well as Alexa Dixon, PhD, Assistant Professor of Pediatrics and TRIAD Associate Director of Early Intervention Outcomes, and Chris Slaughter, DrPh, Associate Professor of Biostatistics.
“We know that families often experience significant barriers when they try to access autism evaluations for their children,” Corona said. “There are often long waitlists for autism evaluation for the preschool-age group, meaning that families are waiting and worrying about their child’s development, sometimes for years. Even when an appointment is available, families often have to travel long distances to unfamiliar places. We have seen that tele-assessment can reduce these barriers for families of toddlers.
“My hope is that this research with the TAP-P can extend these successes to preschool-age children and their families, in our state and beyond,” she added.
