Multimillion-dollar grant will power a statewide rollout to test its practical utility.

The U.S. Department of Defense is calling on researchers at the Vanderbilt Kennedy Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt to devise a remote assessment and screening program for autism spectrum disorder (ASD).

The DOD awarded the team a $3.1 million grant to evaluate tele-assessment in rural areas of Tennessee.

The project will build on previous findings by the group that helped validate a novel tele-assessment tool for evaluating young children for ASD. In that study, the tool demonstrated 92 percent diagnostic agreement with traditional in-person assessments.

Now, the team will assess tele-assessment’s practical implications and real-world utility.

“This work represents the first rigorous evaluation of the clinical, familial and service system value of a tele-assessment approach for early ASD action in a rural community setting with relevance across the nation,” said Liliana Wagner, Ph.D., co-investigator and an assistant professor of pediatrics at Vanderbilt.

How It’s Being Used

The tool, which the team is calling the TELE-ASD-PEDS, or TAP, offers a standardized set of evaluation activities and a rating form, which can aid providers in making core behavioral observations virtually. Providers use the TAP to guide caregivers through several basic tasks with their child. They then watch for ASD symptoms and can use the TAP score in conjunction with clinical judgement to form a diagnostic impression.

Vanderbilt researchers used extensive predictive modeling to develop TAP. The resultant tool incorporates both machine learning and clinical data from comprehensive ASD evaluations. It is designed for use by providers with expertise in recognizing and diagnosing ASD in children under 3 years of age.

While TAP was partly borne out of necessity during the COVID-19 pandemic, Wagner says its utility extends to those lacking proximity to the specialty care needed for an ASD evaluation, such as rural or military families.

Rollout in Tennessee

The new funding provides an opportunity to deploy ASD tele-assessment on a large scale, across a variety of care systems, Wagner said.

“In the current study, we will partner our state Part C early intervention system to deploy a tele-assessment program, inclusive of the TAP, across four of the most rural and medically underserved regions of Tennessee.”

Each of the four regions will be randomly assigned to incorporate tele-assessment into their existing service systems in six-month intervals. After the test period, Vanderbilt researchers will work with providers and families to evaluate the performance – and cost – of tele-assessment for ASD in comparison to traditional systems of care.

“This project will allow us to identify the specific factors potentially influencing tele-assessment implementation and success with rural communities by talking directly with community members,” Wagner said.

“We can then adapt certain modifiable aspects of our tele-assessment approach to be more responsive to the needs and limitations of these rural families and service providers and generate individualized implementation plans for specific service districts.”

A Growing Toolkit

Wagner is part of a larger team, led by Zachary Warren, Ph.D., executive director of the Treatment and Research Institute for Autism Spectrum Disorders at Vanderbilt, that has been working to expand the reach of early identification tools and processes.

“Understanding the facilitators and barriers to widespread deployment and uptake has potential to transform the ASD evaluation process.”

The team previously created a mobile app to support earlier ASD screening. Renowned nationally, Warren and colleagues have also defined appropriate intervention styles and helped raise awareness of the rise in ASD among American children. The group has also made free training modules available to providers, teachers and parents via their online learning portal.

Now, they have their sights set on supporting autism identification through tele-assessment.

“If successful, results could help address critical existing barriers to accessing autism diagnostic evaluations,” Wagner said. “Understanding the facilitators and barriers to widespread deployment and uptake has potential to transform the ASD evaluation process and improve access for traditionally underserved regions and populations.”

In a separate award from the DOD, the Vanderbilt team is also working to produce a telemedicine tool for assessment of ASD in adults.

About the Expert

Liliana Wagner, Ph.D.

Liliana Wagner, Ph.D., is an assistant professor of pediatrics and developmental medicine at Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt. She is also a clinical psychologist at the Treatment and Research Institute for Autism Spectrum Disorders within the Vanderbilt Kennedy Center.