Innovating Early Autism Diagnosis: A Telemedicine Model in Primary Care for Children Under 3 Years

OBJECTIVE: Children with suspected autism spectrum disorder (ASD) currently experience significant delays before receiving a developmental evaluation, which in turn delays initiation of services. We aimed to implement and evaluate a novel telemedicine model for diagnosing ASD in children under 3 years at 2 primary care sites. METHODS: Children under 3 years with a concern for ASD were referred to the program by their primary care providers. Families completed an adaptive behavior scale and a structured telemedicine observation administered by a trained program coordinator. A psychologist reviewed all materials and made a diagnosis of ASD if appropriate. Indeterminate cases were scheduled for in-person assessment. Results were sent to primary care providers, who gave feedback to families. Families were asked to complete a survey after evaluation. RESULTS: Between October 2022 and March 2024, 189 patients were evaluated and 146 diagnosed with ASD by telemedicine, whereas 38 required in-person assessment. The median time to evaluation was 32 days, and there was 99% diagnostic concordance among patients seen by a specialist. There were no disparities in time to evaluation by language, race, ethnicity, or insurance type. Overall, parents and providers gave positive feedback about the model, although almost two-thirds of parents expressed a preference for in-person assessment. CONCLUSION: In this primary care-based telemedicine autism diagnosis program patients under age 3 years were diagnosed quickly and accurately with ASD. However, families still expressed a preference for in-person evaluation. Future work should focus on how to improve acceptability while maintaining efficiency, and the impact of the program on the timing of service connectivity.