Rigorous evaluation of the TAP-Preschool: Toward effective, efficient models of autism tele-assessment

About This Grant

PROJECT SUMMARY Early identification of autism and access to diagnostic evaluation services are critical priorities within pediatric communities. Efforts to enhance early identification have yielded several successful screening and diagnostic models for toddlers, but less work has focused on the preschool age range. In past work, our team developed the TAP for tele-assessment of toddlers. Research on the TAP has demonstrated high levels of diagnostic accuracy, clinician confidence, and family satisfaction. However, the TAP was not designed for the preschool age group. Many children with autism are not identified until four years of age or later, resulting in a significant need for tools that can meet the needs of a broader age range. Given this need, our team developed the TAP- Preschool (TAP-P) specifically for children from three to six years of age.15 Our preliminary work (R21MH128790- 01) indicated that (1) many children with autism and limited verbal language can be accurately identified using the TAP-P and (2) the TAP-P can support tele-diagnosis of some children with more verbal language. However, this study was limited by a smaller sample size and limited phenotypic variability that precluded detailed psychometric evaluation. Further, differences in tele-assessment diagnostic ascertainment as a function of child expressive language level indicates a need for further investigation into patient and family characteristics that influence for whom the TAP-P is most effective. Specifically, deploying tele-assessment models with preschool- aged children requires understanding who is most likely to benefit from tele-assessment. Without this, large- scale deployment of tele-assessment for this age range risks exacerbating wait times, if a substantial number of children require further in-person evaluation. In the current work, we will recruit a sample of 250 children with varied language and phenotypic profiles to thoroughly evaluate the psychometric properties of the TAP-P. We will additionally 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 to receive either tele- or in-person assessment. We will test the decision support tool with a novel sample of 100 children with flexible use of verbal language to determine whether there are differences in diagnostic ascertainment, clinician certainty, and family satisfaction for children recommended for tele-assessment and those recommended to receive in-person assessment. If successful, this work will provide crucial information about tele-assessment of autism in preschoolers that could increase access to streamlined diagnostic care for the children and families most likely to benefit from tele-assessment, ultimately serving more children and families in efficient, meaningful ways.