Vanderbilt University Medical Center
Use of tele-assessment for evaluation and diagnosis of autism in toddlers has demonstrated success in increasing service access and reducing clinical wait times, with high levels of diagnostic accuracy, clinician confidence, and family satisfaction; however, these models have not yet been rigorously evaluated within the preschool age range. The TAP-Preschool (TAP-P) was developed by the investigative team for tele-assessment of autism in preschool-aged children, with preliminary studies demonstrating utility with many children with limited verbal language and some children with more flexible verbal language. The proposed study will recruit a larger sample of children with varied language and phenotypic profiles to (1) thoroughly evaluate the psychometric properties of the TAP-P and (2) investigate child and family factors associated with diagnostic ascertainment and family satisfaction with tele-assessment to inform the creation of a decision support tool intended to recommend families for either tele- or in-person assessment, with the ultimate goal of optimizing clinical care models to serve patients in efficient ways while routing families to diagnostic care pathways that best fit their needs.
Inclusion Criteria: * Children 36-72 months of age; * Participation of a primary caregiver who can speak and understand English sufficiently to complete questionnaires and interviews; * Primary caregiver access to the technology required for tele assessment (e.g., smartphone, tablet, or computer with internet connection and audio/video capabilities); * Ability to travel to VUMC for the in-person diagnostic assessment; * Referral for questions related to autism, developmental delay, or developmental concerns, or have no identified concerns (to ensure phenotypic variability). Exclusion Criteri…
The TAP-P was developed specifically for telemedicine-based autism assessment of preschool-aged children. It has distinct administration and scoring procedures for children with less verbal language (TAP-P Form 1) and those with more verbal language (TAP-P Form 2). All children first complete an initial set of clinician-guided, caregiver-mediated activities, including independent play, interactive play with caregiver, turn-taking, and bids for social responding. TAP-P Form 1 procedures include activities that elicit a child's social play, requesting strategies, and response to caregiver interference in play. TAP-P Form 2 procedures include additional caregiver-mediated activities (i.e., caregiver-led play) and clinician-mediated activities (i.e., drawing and show-and-tell activities; prompts for conversation). Following TAP-P administration, clinicians score observed child behaviors associated with possible autism.