Autism Assessment From Home: Piloting a Brief, Remote Autism Observation for Children

Purpose: Since COVID-19, tele-based methods of autism assessment have been relied upon to a previously unparalleled degree; however, the need for such advancements is not new. Observation-based measures are a crucial component of face-to-face autism diagnostic evaluations, but few validated observation tools exist for remotely assessing autism across childhood, offering minimal guidance for older children and adolescents. Sanchez and Constantino (Develop Med Child Neurol, 62(7): 806–812, 2020) previously validated a brief, face-to-face, clinician-facilitated observation coded according to the Childhood Autism Rating Scale, Second Edition (CARS-2). During the pandemic, this measure was adapted as a remote observation, but has yet to be validated in this format. Methods: The current study validated this remote observation against the in-person Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), in a sample of 30 children ages 1-16 years (M = 7.25, SD = 4.05). Results: The remote observation was highly correlated with the ADOS-2 (r =.75, p <.001) and Social Responsiveness Scale, Second Edition (r =.74, p <.001), and demonstrated acceptable sensitivity (88.9%) and specificity (80%) in predicting research diagnostic classification. The remote observation correctly predicted whether a child met criteria for a research diagnosis of autism in 82.8% of cases, and the same classification as the ADOS-2 in 72.4% of cases. Conclusions: This pilot study offers preliminary support for the validity of this brief, accessible, remote autism observation. This is a crucial step in ensuring uniform training and clinical procedures for tele-assessment of autism, to help mitigate long-standing barriers to service access (e.g., geography, cost, availability).