The use of interactive television in identifying autism in young children

描述（由申请人提供）：早期发现和早期干预可以显著改善自闭症儿童的发育结果，然而，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可用性和机会有限（Newschaffer, Falb, & Gurney, 2005），特别是在农村地区（Carbone, et al., 2010）。长期研究目标是确定农村社区ASD早期检测的经验验证实践，本研究的目的是确定诊断农村社区ASD儿童的可靠和有效的评估程序。主要假设是临床医生能够通过交互式电视（ITV）的评估程序准确诊断幼儿ASD。远程医疗是一种利用实时视频会议实现临床目的的互动电视形式，越来越多地被用作向服务不足地区，包括没有提供者的农村和城市地区提供保健的一种手段。参与者将包括46名2-5岁的儿童，他们被怀疑患有自闭症谱系障碍。参与者将被随机分配通过ITV或亲自与首席心理学家进行互动。一对临床医生将与家属一起在房间观察（现场），另一对临床医生将同时通过ITV进行观察。每一对临床医生将提供ADOS和ADI的项目分数，儿童符合的ASD的DSM IV标准和总体诊断。对于每个条件（直播vs独立直播），将计算每对临床医生的评分间协议（逐项），然后与另一对临床医生的评分间协议（逐项）进行比较。逐项协议也将跨条件达成。DSM IV， TR自闭症标准将在不同条件下进行比较（现场与独立），并与与实验数据绑定的团队进行的跨学科评估进行比较。家庭满意度也将在条件之间进行评估。主要的假设是，临床医生能够通过ITV准确地评估儿童的ASD，这可以从评估设置（ITV vs Live， ITV vs验证性跨学科评估，Live-跨学科验证性团队）的诊断、DSM IV ASD标准和ASD措施之间的高度一致性得到证明。同时，无论评价条件如何，都希望家属对评价过程感到满意。通过独立诊断确定一个可靠和有效的ASD诊断方案，将使农村和服务不足地区的个人能够更多地获得高质量的医疗保健，更多地获得早期干预，并改善发展结果。

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.