Dr. Jennifer Gerdts is an attending psychologist at Seattle Children’s Autism Center and principal investigator at the Center for Child Health, Behavior, and Development at Seattle Children’s Research Institute.

Why is Seattle Children’s offering autism spectrum disorder evaluations by telehealth?

Dr. Gerdts: The move to telehealth was spurred by the new restrictions on in-person visits due to COVID-19. Families already were facing an extensive waitlist for an autism diagnostic evaluation, so honestly, it crushed our soul to think about having to wait for in-person services to resume. We decided to get creative and looked around to see what evidence-based practices were out there for telehealth autism diagnostic evaluations. We really liked Vanderbilt University Medical Center’s method (TeleASDPeds instrument), which has shown to be effective in assessing younger children. We chose their method and have been very happy with it.

Is a telehealth visit available to all families wanting an autism evaluation?

Dr. Gerdts: No. Telehealth visits are being offered only for children who meet the following criteria:

  • Two or 3 years old. Research shows the TeleASDPeds is effective in identifying autism symptoms in this age group. We don’t have evidence-based tools or instruments for other ages that we are fully confident in yet for telehealth.
  • Not speaking in full sentences, i.e. very limited language or less than phrase speech.
  • Family has access to reliable cell phone service or home Internet so that our provider can use video technology to observe the child’s behavior at home.

In-person autism evaluations for older children will begin slowly this summer.

Why is it important for families to get a diagnosis?

Dr. Gerdts: A diagnosis for autism opens the door to many services, particularly if the child is very young. It gives families a direction in terms of accessing needed supports and resources. Importantly, a diagnosis helps families to better understand their child and connects them to a community of other parents for support.

How does a telehealth diagnosis differ from the in-person process? 

Dr. Gerdts: We follow the same general model that we use for in-person visits. During the initial telehealth intake process, our provider spends time talking to the family to gather a good medical, social and developmental history and gathers detailed information about autism-related symptoms. Based on that information, we decide whether to continue with a telehealth evaluation or wait for an in-person visit.

If telehealth evaluation is appropriate, our providers observe the child participating in play-based activities with their parent or caregiver at home by video, gathering diagnostic information and observing their behaviors. Instead of interacting with the child directly, we coach the parent to do some of the tasks we would normally do in-clinic, while we observe them. We ask parents to place toys in certain places so we can observe their child playing and ask parents to start a play routine then pause to see how the child makes requests. We also might coach parents if we can’t clearly see the behavior we are looking for by saying things like “can you try that again?” or “can you move the video to another angle?” or “call his name this time from a different part of the room.” We learn the same information but gather it in a different way.

Is it as good as an in-person visit?

Dr. Gerdts: We think so. While we and most other autism diagnostic providers in the United States weren’t used to evaluating patients entirely on a virtual platform, fortunately some people had begun researching this work — mostly with younger children — so we have been fortunate to learn from them. It can be challenging to read social skills through video, but this method seems to work well for many children in this age group.

Are there any benefits of doing a telehealth diagnosis?

Dr. Gerdts: Yes. It is helpful to see children in their home environment where they are more at ease and comfortable. We don’t get that with an in-person visit. In a clinic, the child can be stressed or feel out of place because they are in a new place that feels like a doctor’s office; families often tell us their child acts differently at home. Now, this doesn’t usually prevent us from adequately evaluating for autism — but yes, it has been nice to see children in their home environment and observe the parent/child interaction in a way we can’t in the clinic.

Of course, a big benefit for the family is that it’s nice to skip what might be a long drive to see us. Many live far away.

Does telehealth work for all families with 2- and 3-year-olds?

Dr. Gerdts: No. For most children in this age group, telehealth proves to be an excellent method, and we can complete the diagnosis from start to finish. But for 5% to 10% of patients, we do need to see them in person as a follow-up to complete the diagnostic evaluation.

Will you continue to do telehealth diagnoses for autism?

Dr. Gerdts: Yes, we have come to embrace this model and plan to keep diagnosing some young children via telehealth even after the COVID-19 pandemic ends. This certainly wasn’t planned, but a silver lining is that we found a method that works quite well for many young children and saves travel time for families.

Are wait times shorter for telehealth appointments?

Dr. Gerdts: Wait times have not gone down, unfortunately. Wait times for our 2- and 3-year-olds are slightly shorter than for other ages right now (at least 18 months for kids 4 years and older) because we are limited in the types of patients we can see in-clinic, but it is not really a timesaver for us to do the visit by telehealth, even if it’s a timesaver for the family.

Will wait times go down any time soon?

Dr. Gerdts: We continue to work on this. We are well aware of what a challenge it is to get an autism diagnosis in a timely manner and what a barrier the wait is to accessing services. We have improved our own processes, embracing an interdisciplinary team model that serves families more efficiently and still provides a valid and reliable diagnosis, but the number of kids in our state needing evaluations continues to rise. We say we’re becoming faster and more efficient swimmers, but the current and waves crashing against us are only becoming stronger and stronger.

What can primary care providers (PCPs) do to make an autism diagnosis available to families more quickly?

Dr. Gerdts: Consider becoming a Center of Excellence (COE) in Autism and join our ECHO Autism Washington telementoring program! The Health Care Authority of Washington has partnered with experts at the Seattle Children’s Autism Center to offer a 1.5-day training in autism in order to become a COE. Our next online COE trainings will be Friday, July 31 and Friday, Sept. 18.  Our COE flyer has more details and a link to registration.

COE providers are eligible to participate in our ECHO Autism Washington program at the University of Washington for PCPs and other providers. The ECHO program increases providers’ skills in the diagnosis and management of autism using case-based learning, didactics and expert consultation so that they can care for autistic patients in their home practices. This twice-monthly telementoring program has an annual cohort of 25 PCPs in Washington state. Participants must first complete the COE training to be offered a spot. We are enrolling a new ECHO cohort later this year.

To learn more about COE training or ECHO Autism Washington, please contact Kate Orville at orville@uw.edu or send an inquiry to echoautismwa@uw.edu.