Autism diagnoses for many children have been canceled as the COVID-19 pandemic has closed clinics and forced face-to-face interactions through masks.
For Katherine Meltzoff, an education professor at the University of California, Riverside, the disruption has exposed significant gaps and opportunities.
“We were looking for a way to make autism diagnosis virtually possible,” Meltzoff said.
The result was the suite of telemedicine tools described in the paper. Journal of Autism and Developmental Disabilities It is designed to help clinicians remotely diagnose autism, especially in older children and those with developing verbal communication skills.
Meltzoff explained that while there are already a number of validated virtual autism assessment tools for children under 3 and those with minimal speech, there are none for older, more verbal children.
“Telemedicine seems to work very well for younger children with more obvious symptoms,” said lead author Merzu.
Meltzoff’s research tested whether these virtual assessments matched the accuracy of traditional in-person assessments, offering a potential solution to a long-standing barrier in autism diagnosis.
Autism spectrum disorder is not diagnosed by a single medical test. Clinicians also consider the child’s developmental history, observing how the child communicates, interacts socially, and responds to the world.
We diagnose behaviorally, so we look at the behaviors the child exhibits. ”
Katherine Meltzoff, University of California, Riverside
Autism evaluations were halted during the first months of the COVID-19 pandemic as “shelter-in-place” guidelines became widespread.
While restrictions began to ease, assessments remained difficult because face masks worn by clinicians and family members obscured facial expressions that accounted for much of the social communication and behavior being assessed.
In traditional clinical settings, these observations occur during carefully structured face-to-face sessions. Meltzoff recreated those interactions online for research purposes. Clinicians used videoconferencing tools to monitor the child’s reactions while guiding parents through activities such as calling their child’s name and participating in play. For older children, clinicians interacted directly with children through conversations and structured tasks.
To test accuracy, Meltzoff and her team recruited 39 children seeking autism evaluation through a university-based clinic. Each child underwent two separate assessments, one in-person and one via telemedicine, by different clinical teams who were blind to each other’s conclusions.
The results were promising. One tool developed for children whose conversations were limited to short phrases showed particularly high accuracy, while another designed for children who spoke more fluently was effective most of the time, but less consistently.
This study also found that parents were generally satisfied with telehealth assessments, suggesting that this approach is feasible and acceptable to families.
Meltsoff said there is a great need for alternatives to in-person diagnosis.
“Many people live two hours away from an autism clinic,” she says. “It’s simply not possible to drive your child two hours to the clinic, then make an appointment and then drive two hours home.”
This approach is especially important for rural families and families with limited economic resources. For some, it is difficult to visit in person due to travel costs or lack of reliable transportation.
Additionally, access to critical services often requires a formal autism diagnosis. Schools can provide some support without a clinical diagnosis, but insurance coverage for treatment usually depends on the diagnosis. These services include speech therapy, occupational therapy, and one-on-one behavioral intervention. These are all important in helping children develop communication and life skills.
Still, Meltzoff cautions that telemedicine is not a one-size-fits-all solution. Even children with more subtle symptoms or co-occurring conditions such as attention-deficit/hyperactivity disorder (ADHD) may require an in-person evaluation for an accurate diagnosis.
The title of the paper is “A telemedicine diagnostic tool for children with autism with phrases and fluent speech: A comparison with in-person diagnosis.” In addition to Metsoff, co-authors include Cameron Alexander, Amy Hoffman, and Jan Bratcher, all of whom are in the UCR School of Education.
“I don’t want to oversell it,” Meltzoff said. “While it worked well for most children, more complex cases, cases that are already difficult even when done in-person, can be difficult to assess remotely.”
Despite these limitations, this study validates a new tool for children with a broader range of communication skills.
“How accurate is telemedicine?” Meltzoff asked rhetorically. “It turned out to be pretty good.”
sauce:
University of California, Riverside
Reference magazines:
Meltzoff, KK, others. (2026). Phrasal and fluent speech telemedicine diagnostic tools for children with autism: A comparison with face-to-face diagnosis. Journal of Autism and Developmental Disabilities. DOI: 10.1007/s10803-026-07325-0. https://link.springer.com/article/10.1007/s10803-026-07325-0.
