New Evidence-Based Approach to Autism Telehealth Treatment

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HERE IS HOW

Almost one out of 54 children in the United States lives with autism spectrum disorder (ASD). Early diagnosis and treatment can dramatically help children and their families. Unfortunately, with the overburdened US behavioral health system combined with the lack of qualified professionals, many families must wait up to 12 months for an initial diagnostic interview. The lack of needed assistance for these children and their families is especially severe in low-income and rural areas. Removing the need for in-person meetings by offering autism telehealth assessment and treatment can help many families.

Telehealth Autism Assessment

Assessment professionals and educators face several challenges with autistic individuals, with severe language barriers impeding the use of psychometrically sound outcome measures. While treatment strategies have been introduced to overcome these challenges, better assessments are needed to improve both the processes and efficacy of telehealth autism assessment. These assessment measures are also needed for non-English-speaking individuals.

Expressive Language Sampling (ELS) is currently being evaluated to assess language in treatment studies. ELS offers an appealing alternative to standardized language tests. It provides an immediate snapshot of utterance length, complexity, phonemic repertoire, and articulation errors and abilities in highly structured yet naturalistic interactions with a clinician to compare them with peers from the child’s speech community. The professional collecting the sample write down verbatim what the student says at various times during the day to determine present speech abilities, update progress, and set goals. In the past, the utility and validity of ELS  as outcome measures have been administered by trained professionals in clinical settings for assessing English-speaking clients and patients.

Telehealth and Autism Study

A recently published feasibility study examined the efficacy of teaching native English-speaking parents (NESP) and native Spanish-speaking parents (NSSP) to administer the ELS narrative task (ELS-N) to their children with ASD (between ages 6 and 21) at home through telehealth-delivered procedures. The project taught Spanish and English-speaking parents to administer ELS narrative tasks to their autistic children at home through specialized procedures designed for a telehealth autism assessment. The summary below outlines the autism telehealth study results and how effective ELS may be based on the results.

The 4-week pilot study was conducted by the UC Davis MIND Institute and published in Frontiers in Rehabilitation Sciences by researchers del Hoyo Soriano, and colleagues are titled Using Telehealth-Delivered Procedures to Collect a Parent-Implemented Expressive Language Sampling Narrative Task in Monolingual and Bilingual Families With Autism Spectrum Disorder: A Pilot Study.1 Nineteen families were involved, including parents and children aged 6 to 21. They chose between using their technology or being provided with the technology needed for participation. The participants were asked to use a picture book as a prompt for storytelling, known as narrative ELS-N. It is typically administered by a professional in a clinical setting, but it was administered at home in the study, integrating an autism telehealth approach. Taken from the publication, this is a description of the process of

The following materials were provided to the participating parents to support their learning of the procedures A technology setup guide, a parent-friendly version of the original ELS-N administration manual developed by Abbeduto et al. (26), a PowerPoint presentation regarding the ELS-N principles, video examples of in-clinic ELS-N administrations by clinicians and researchers, and parent-friendly versions of the ELS-N scripts to be used during the administration of the task. The technology materials needed for participation were a laptop computer (e.g., MacBook Air) equipped with a web camera, an earpiece device, and an iPad containing the complete set of wordless picture books to be used during the ELS-N administrations. Parents were offered a choice between using their technology or being sent all or part of the technological materials needed. 

Sixteen of the 19 parents learned to administer the ELS autism telehealth procedures. This study serves as an example of how telehealth-savvy clinicians can adapt in-person techniques to home-based protocols. Although this feasibility study points to further research to validate this model, it suggests that home-based parent-implemented ELS procedures can be successfully learned and administered by parents. In addition to introducing more efficient models for educating and determining efficiency, the ELS methods also reduce inequities in that they are available for Spanish and English-speaking families.

Benefits of Telehealth for Autism

The study’s promising results set a bright future for telehealth and autism, yielding the following benefits:

• More Relaxed Environment: Autistic individuals may feel less stressed learning from a parent than professionals. Tele-ELS promotes a relaxed environment that’s more conducive to learning.
• More Inclusive: Spanish-speaking people make up a large portion of communities. The new ELS methods allow large groups of people to get the educational tools they need to learn. They allow parents to communicate in the language spoken at home to provide a comfortable atmosphere for the child.
• Accessible: Previously, parents would have to travel to get their children the required ELS services. Such travel is often difficult for both parents and children and requires that a child be medicated to travel long distances. The process of medicating a child and introducing them to hotels and a professional’s office environment is fraught with yet more challenges that can cloud assessment with artifacts caused by challenges in the process. When parents get the tools they need to teach at home, they don’t have to commute; they don’t have to complicate the child’s behavioral response with medications that can dull their abilities to interact with the testing materials. They also don’t have to deal with new stimuli, which can be agitating. By offering telehealth for autism assessment then holds much-needed promise for making accurate testing available to this population of families.  

The Future of Autism Telehealth

Results of the most recent study are a promising sign that autism telehealth methods should continue to be adopted in the educational process. They have shown to be valuable in reducing inequities, boosting accessibility, and providing a comfortable learning environment for the families involved. UC Davis MIND Institute researchers del Hoyo Soriano and colleagues plan to conduct larger-scale studies of ELS-N parent-led testing.

Despite the advancements made in telehealth over the past few years, especially since the beginning of COVID, several more barriers remain before telehealth can reach its full potential. Reimbursement rates are not equal everywhere for in-person services versus remote services, which affects the cost of telehealth and can present a financial burden for families. Also, some states do not allow private payer coverage and vary from state to state. Another significant barrier to properly utilizing telehealth services is a lack of access to quality broadband internet.

Need for Telehealth Advocacy

Supportive readers are encouraged to advocate for telehealth by contacting their elected officials to support more than 1,000 telehealth bills currently being decided at state and federal levels in the United States.

Reference

1. del Hoyo Soriano, L., Bullard, L., Hoyos Alvarez, C., Thurman, A. J., & Abbeduto, L. (2021). Using telehealth-delivered procedures to collect a parent-implemented expressive language sampling narrative task in monolingual and bilingual families with Autism Spectrum Disorder: A pilot study. Frontiers in Rehabilitation Sciences, 77.

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