Research 

Traditionally psychologists have worked with patients face to face in a clinic. For English-speaking expats living abroad the options are often limited as rarely are there sufficiently trained or experienced clinical psychologists locally. Online options therefore are sometimes the only way a patient will receive the help they need. However, it is important that the assessment, diagnosis and treatment process are not compromised by veering away from the evidence base. Currently most evidence we have to demonstrate the reliability and validity of our ASD, Tourette’s, ADHD and cognitive assessment and diagnostic tools is based on in-person settings. There is an emerging evidence base however for remote administration. We detail below some of the protocols and the research supporting them.

Brief Observation Schedule of Autism - BOSA 

This is an adaptation of the ADOS (Autism Diagnostic Observation Schedule) which uses a standardised task and a second person (parents, friend etc) who is with the patient on screen. The psychologist who is located remotely observes how the patient interacts with the second person and uses a standardised rating scale to evaluate certain behaviours known to be associated with autism. 

 

NODA 

The NODA is a form of ‘store and forward’ assessment and is designed to be done with children. In other words, it is not conducted live, but rather parents of the child concerned make a video at home following specific guidelines and the recording is forwarded to the psychologist to rate. NODA provide a secure platform for the video to be uploaded and shared with the psychologist. 

  • Smith CJ, Rozga A, Matthews N, Oberleitner R, Nazneen N, Abowd G. Investigating the accuracy of a novel telehealth diagnostic approach for autism spectrum disorder. Psychol Assess. 2017;29(3):245-252. doi:10.1037/pas0000317

 

ADI-R and ADOS-2 

The Autism Diagnostic Interview- Revised (ADI-R) is a commonly used structured interview with a parents or carer of a person with suspected autism. As such, it is easily translated to telephone or video call administration. In the study below it was compared to remote administration of an adapted play-based activity taken from the ADOS. Parents were coached to engage in a play-based activity with their child while the psychologist observed live remotely.  

  • Reese, R. M., Jamison, R., Wendland, M., Fleming, K., Braun, M. J., Schuttler, J. O., & Turek, J. (2013). Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine journal and e-health : the official journal of the American Telemedicine Association19(9), 671–677. https://doi.org/10.1089/tmj.2012.0312
  • Reese, R. M., Jamison, T. R., Braun, M., Wendland, M., Black, W., Hadorn, M., . . . Prather, C. (2015). Brief report: Use of interactive television in identifying autism in young children: Methodology and preliminary data. Journal of Autism and Developmental Disorders, 45(5), 1474–1482. doi:10.1007/s10803-014-2269-5

 

Tele-neuropsychology 

There are increasing efforts to adapt performance-based neuropsychological tests to remote administration.  

  • BPS Division of Neuropsychology 'tele-neuropsychology' guidelines : bps.org.uk/member-microsites/division-neuropsychology/news 
  • Brearly, T. W., Shura, R. D., Martindale, S. L., Lazowski, R. A., Luxton, D. D., Shenal, B. V., & Rowland, J. A. (2017). Neuropsychological Test Administration by Videoconference: A Systematic Review and Meta-Analysis. Neuropsychology review, 27(2), 174-186. doi:10.1007/s11065-017-9349-1
  • INS Webinar: https://www.the-ins.org/webinars/ 
  • Munro Cullum, C., Hynan, L. et al (2014). Teleneuropsychology: Evidence for video teleconference-based neuropsychological assessment. J Int Neuropsychol Soc, 20(10), 1028-1033. doi: 1017/S135561771400

 

Useful resources for clinicians 

  • UCLA Centre for Autism Research and Treatment: Hour long training on assessing autism remotely. https://www.youtube.com/watch?v=sOGv8vbJeeo&t=4s
  • Alfuraydan, M., Croxall, J., Hurt, L., Kerr, M., & Brophy, S. (2020). Use of telehealth for facilitating the diagnostic assessment of Autism Spectrum Disorder (ASD): A scoping review. PLoS One, 15(7), e0236415.
  • Dr Alesia Moulton-Perkins interviews Dr Clara O'Brien and Dr Tina Cohen (clinical neuropsychologists) about 'The challenges and possibilities of neuropsychology by video call'. Part 1 video. Part 2 video
  • Dr Alesia Moulton-Perkins interviews Sarah Sharp, CBiT Therapist, Dr Seonaid Anderson, Research Psychologist & Jolande van Griendt, Health Psychologist & CBT Therapist about 'Working with people with Tourette's and Tic Disorder by video call. Part 1 video Part 2 video

 

E-Learning 'Developing competencies for digital clinical practice'

Commissioned by the British Psychological Society

Together with colleagues from the Digital Healthcare Committee Dr Alesia Moulton-Perkins co-authored some e-learning on digital mental health. In Module 2 online autism assessments are discussed in an interview with Dr Jessie Gough. Module 2 also features an interview with Dr Nicholas Priestly, clinical neuropsychologist and expert witness

https://www.digitalhealthskills.com/elearning