How Do I Know if Virtual Testing is Right for My Family?

When I was completing my predoctoral training in Birmingham, Alabama, I took such pride in being able to provide high-quality psychological testing services to children; however, I quickly realized that the waitlists for evaluations were incredibly lengthy. For example, a recent report found that 61.26% of specialty centers that conduct autism evaluations had wait lists longer than four months and 13% had wait lists longer than one year. Another poll at the Society for Developmental and Behavioral Pediatrics annual meeting (see here) found that more than half of providers had wait lists longer than nine months. Although autism can be diagnosed as early as 18 months of age, children are not diagnosed until 4 years of age or older on average. Extended wait lists also negatively impact children and adolescents with ADHD. Overall, waitlists delay to supports and services, which can result in great difficulties at home, school, and other contexts. 

Even once a family has gotten off the waitlist, attending in-person testing can be especially burdensome for families who do not have access to providers nearby. Based on CDC data depicting the number of providers per 10,000 children, several counties in Alabama are underserved. For instance, although counseling services are available, there are no child psychologists located in Prattville, Goodwater, Monroeville, Oxford, Scottsboro, or Marion. In contrast, citizens of Birmingham, Tuscaloosa, Montgomery, and Auburn, can more easily access psychological testing services. For those who do not live in or near a larger city, it can be incredibly difficult to take off work and remove a child from school for the entire day (especially if they are already struggling academically) to attend an in-person evaluation. This can be even more challenging for families who experience transportation barriers.

Fortunately, telehealth methods for evaluating children for neurodevelopmental conditions (e.g., Autism, ADHD) can help increase access to diagnostic professionals and reduce wait times for evaluations, especially for those in rural or underserved communities. Current research suggests that, when the appropriate assessment tools are selected, telehealth assessment procedures are considered acceptable and valid. At Upward Behavioral Health, we are proud to offer virtual neurodiversity-affirming autism and ADHD evaluations for children. But how does a virtual evaluation even work? Our child psychological evaluations generally involve three steps:

1. Intake: This involves interviewing to learn more about your child, including their early developmental, medical, educational, and social history in addition to their areas of strength and difficulty. We will also be sure to review any forms you completed and records (e.g., IEP/504 Plan, Early Intervention evaluations) you submitted to us.

2. Testing: Depending on what diagnostic question you have and the age of your child, this may involve you, your child, and/or their teacher completing questionnaires to give us a better idea of their traits, behaviors, and skills. We may also do direct testing to get an estimate of your child’s intellectual functioning or to observe how they interact socially with you.

3. Feedback: We will take some time to review the results of the evaluation, answer any questions you may have, and provide recommendations to best support your family.

You may be wondering – How do I know if virtual testing is right for my family? While virtual evaluations promote accessibility for many families, they are not always a good fit. These are some examples of situations in which virtual testing may not be appropriate and an in-person evaluation may be warranted:

· Concerns regarding overall problem-solving skills that may require a more comprehensive evaluation of intellectual functioning

· Significant history of trauma or abuse

· Medical complexities that would complicate diagnosis (e.g., visual or hearing impairment)

· Inability to complete testing in a private, secure environment with minimal distractions (e.g., alone in a room with a closed door)

· Unreliable or lack of access to necessary technology (e.g., internet; computer, tablet, or smart phone)

Overall, when telehealth evaluations are a good fit for a family, they can provide valuable diagnostic information about your child and potentially open the doors to supports and services. We are thrilled to be able to offer this service to Alabamians and reduce barriers to accessing diagnostic evaluations!

Sources:

Matthews, N. L., Skepnek, E., Mammen, M. A., James, J. S., Malligo, A., Lyon, A., ... & Smith, C. J. (2021). Feasibility and acceptability of a telehealth model for autism diagnostic evaluations in children, adolescents, and adults. Autism Research, 14(12), 2564-2579.

McDermott, S. M., Sweeney, K., Jacobson, L. A., Lieb, R. W., Wexler, D., & Pritchard, A. E. (2023). Does assessment format matter? A comparison of in-person versus teletesting scores for youth with ADHD. Journal of Attention Disorders, 27(2), 152-158.

Mckenna, K., Wanni Arachchige Dona, S., Gold, L., Dew, A., & Le, H. N. (2024). Barriers and Enablers of Service Access and Utilization for Children and Adolescents With Attention Deficit Hyperactivity Disorder: A Systematic Review. Journal of attention disorders, 28(3), 259-278.

Shannon, J., Salomon, M., Kraft, C., Chettiath, T., Taraman, S., & Badesch, S. (2024, January). Wait Times and Processes for Autism Diagnostic Evaluations: A First Report Survey of Autism Centers in the US. Journal of Developmental and Behavioral Pediatrics (Vol. 45, No. 1, pp. E107-E107).