Telemedicine and autism: researchers and clinicians are just starting to consider telemedicine applications for the diagnosis and treatment of autism.

Autism and the Autistic Spectrum Autism spectrum disorders (ASDs) are developmental disorders, of which autism is the most common. ASDs include Asperger syndrome, Rett syndrome, pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder. Typical symptoms are impaired social interaction; difficulties with verbal and nonverbal communication; and unusual, repetitive, or limited activities and interests. The National Institute of Neurological Disorders and Stroke (NINDS) indicates that 3 to 6 children of every 1,000 will have autism, and males are four times more likely to have autism than females. The Centers for Disease Control and Prevention (CDC) cites 1 of every 166 children has an autism spectrum disorder. According to NINDS, diagnosis is focused on identification of seven core behaviors: • Difficulty making friends with peers. • Impaired ability to initiate or sustain a conversation with others. • Difficulty or absence of imaginative and social play. • Stereotyped, repetitive, or unusual use of language. • Restricted patterns of interest that are abnormal in intensity or focus. • Preoccupation with specific objects or subjects. • Inflexible attention to specific routines or rituals. Peter Yellowlees, M.D., Professor-in-Residence at the University of California–Davis Department of Psychiatry and Behavioral Sciences (Sacramento, CA), says, “I think autism is a good illness in some respects to use telemedicine for. The kids actually interact well with technology and more naturally than they do if you’re in the room. They’re not good with social relationships and they may find it easier to find someone talking to them from a television than they do faceto-face, which might make them more anxious.” Yellowlees notes that the gold standard for an autism diagnosis utilizes the Diagnostic and Statistical Manual of Mental Disorders (DSMIV), “using the diagnostic criteria and also a very long structured work-up using ADOS. But people have to be trained for it—usually child psychiatrists and social workers—and it takes a couple of hours to give.” ADOS is the Autism Diagnostic Observation Schedule. Treatment for autistic patients is typically behavioral treatment. This involves working on social skills, preferably beginning at an early age by trained people, and is best taught face-to-face. Yellowlees says, “What we could do is use telemedicine to train parents to help with that treatment, and instead of having aides come in, have them supervised by more expert therapists from afar. And obviously we can see telemedicine diagnosis for medication treatment.” Yellowlees notes that about 50% of children with autism end up on some sort of psychiatric medication.