Meeting the Needs of Families During the Pandemic

An autism diagnosis relies heavily on an assessment of social and communication skills. Until 2020, a confident autism diagnosis could be made only in-person, using a play-based assessment tool that measures social communication and the other key indicators of autism, including restricted/limited interests and repetitive behaviors. Not surprisingly, face coverings which mask facial expressions muddle the effectiveness of this approach as a reliable diagnostic tool.
When the COVID pandemic shut down many in-person visits, autism clinicians worldwide considered new options and found solutions for observing young children’s behavior via telehealth. These new methods use standardized activities that are observed and assessed by a trained autism clinician, can be used in a virtual environment and have been shown to reliably diagnose autism in children.

“Right away, we were worried about what the mandatory shutdown of in-person visits would mean for the families who need us and how we were going to make sure our wait list didn’t grow,” said Saritha Vermeer, PhD, a child psychologist with the Duke Autism Clinic. “The switch to telehealth may have been easier for some of our medical colleagues. Meanwhile, we relied on the methods that involved direct interaction with a child or adult — which is an excellent social communication barometer.”

“COVID disrupted this approach, which relied on in-person interactions, so we set aside our traditional thinking and got innovative,” said Tyler Higgs, PhD, also a psychologist at the Duke Autism Clinic.

Using telehealth, Vermeer and Higgs, along with fellow clinic psychologists Jill Howard, PhD,and Rachel Aiello, PhD, adjusted the clinic’s typical two-day, in-person autism assessment for younger children to a one-day, telehealth-based assessment and feedback session, saving time and travel for families, and helping to address the months-long waitlist created by the pandemic shutdown. By fall 2021, Duke Autism Clinic diagnosticians were up and running at pre-pandemic levels, assessing toddlers and school-aged children and meeting families to provide feedback on autism diagnoses. The temporary adjustment to offering one-day telehealth assessments and feedback sessions worked well for younger children in other ways, too.

“We were able to get an ‘up-close and personal view’ of the child in their own home or familiar setting, where they tend to be much more relaxed. Some families were spared the stress and costs of travel and overnight stays. It seemed even easier for caregivers, other family members, and interpreters to participate, if that is what the family requested,” said Vermeer.

“As it turns out, a reliable autism diagnosis can be done extremely effectively and in a way that opens the door to more families that need us,” said Higgs.