The use of interactive television in identifying autism in young children

描述(申请人提供)：早期发现和早期干预显著改善了自闭症儿童的发育结果，然而，可获得和获得为自闭症儿童提供诊断和临床服务的训练有素的专业人员的机会有限(Newschaffer，Falb&Gurney，2005年)，特别是在农村地区(Carbone，等人，2010年)。长期的研究目标是确定在农村社区早期发现ASD的经验性验证的做法，本研究的目的是确定可靠和有效的评估程序，用于诊断农村社区的ASD儿童。主要的假设是，临床医生能够通过互动电视(ITV)的评估程序准确地诊断出幼儿的ASD。远程医疗是一种互动电视形式，它将实时视频会议用于临床目的，越来越多地被用作向服务不足的地区提供医疗保健的手段，包括没有提供者的农村和城市地区。参与者将包括46名2-5岁的疑似患有自闭症谱系障碍的儿童。参与者将被随机分配到通过独立电视台或亲自与首席心理学家互动。一对临床医生将与家人一起在房间内观察(现场)，而一对临床医生将通过ITV同时观察。每对临床医生将提供ADOS和ADI的项目评分，儿童符合ASD的DSM IV标准和总体诊断。对于每种情况(直播VS ITV)，将计算每对临床医生的评分员间协议(逐项)，然后与另一对临床医生的评分员间协议(逐项)进行比较。还将在不同条件下达成逐项协议。DSM IV自闭症标准将跨条件(Live和ITV)进行比较，并与与实验数据绑定的团队进行的跨学科评估进行比较。家庭满意度也将在不同条件下进行评估。基本假设是，临床医生能够通过ITV对ASD儿童进行准确的评估，这一点从评估设置(ITV与Live、ITV与验证性跨学科评估、Live-跨学科验证性团队)、ASD的DSM IV标准和ASD措施之间的高度评分一致性来证明。还预计，无论评估条件如何，家庭都会对评估过程感到满意。通过互联网电视确定可靠和有效的自闭症诊断方案，将使农村和服务不足地区的个人更有机会获得高质量的医疗保健，更多地获得早期干预和改善发展成果。 公共卫生相关性：农村和服务不足地区的个人获得自闭症专业知识的机会有限。该项目将评估互动的使用 在对疑似患有自闭症的儿童的评估程序中加入独立电视台，以确保更多地接触到这些专业人员。ASD的早期发现与更多的干预措施和改善的发育结果有关。

DESCRIPTION (provided by applicant): Early detection and early intervention significantly improves developmental outcomes for children with autism, however, availability and access to trained professionals who provide diagnostic and clinical services for children with ASD are limited (Newschaffer, Falb, & Gurney, 2005), particularly in rural areas (Carbone, et al., 2010). The long-term research goal is to identify empirically validated practices for early detection of ASD in rural communities and the objective of this study is to identify reliable and valid evaluation procedures for diagnosing children with ASD in rural communities. The main hypothesis is that clinicians are able to accurately diagnosis ASD in young children through evaluation procedures via interactive television (ITV). Telemedicine, a form of interactive television that uses real-time video conferencing for clinical purposes, is increasingly being utilized as a means to provide health care to underserved areas, including rural and urban areas without providers. Participants will include 46 children ages 2-5 that are suspected of having an autism spectrum disorder. Participants will be randomly assigned to interact with a lead psychologist via ITV or in person. One pair of clinicians will observe in the room with families (Live) while one pair of clinicians will simultaneously observe via ITV. Each pair of clinicians wil provide item scores on the ADOS and ADI, DSM IV criteria for ASD the child meets and overall diagnosis. For each Condition (Live vs ITV) inter-rater agreement will be computed for each pair of clinicians (item by item) and then compared to the inter-rater agreement (item by item) of the other pair of clinicians. Item by item agreement will also be made across conditions. DSM IV, TR autism criteria will be compared across conditions (Live vs ITV) and compared to an interdisciplinary evaluation conducted by a team who is bind to the experimental data. Family satisfaction will also be evaluated between conditions. Primary hypotheses are that clinicians are able to accurately evaluate children for ASD via ITV as evidenced by high inter-rater agreement between evaluation settings (ITV vs Live, ITV vs confirmatory interdisciplinary evaluation, Live-interdisciplinary confirmatory team) for diagnosis, DSM IV criteria for ASD, and on ASD measures. It is also expected that families will be satisfied with the evaluation process regardless of evaluation condition. Identification of a reliable and valid protocol for ASD diagnosis via ITV would allow greater access to quality health care for individuals in rural and underserved areas, with greater access to early intervention and improved developmental outcomes. PUBLIC HEALTH RELEVANCE: Individuals in rural and underserved areas have limited access to professionals with expertise in autism. This project will evaluate the use of interactive television (ITV) in evaluation procedures for children suspected of having autism to ensure greater access to these professionals. Early detection of ASD is associated with increased access to intervention and improved developmental outcomes.