Reliability of Childhood Autism Rating Scale, Second Edition, Assessments Using Telepsychiatry for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study.

چکیده اصلی

BACKGROUND: The COVID-19 pandemic has increased the demand for telepsychiatry in neurodevelopmental assessment; however, few studies have examined the interrater reliability of clinician-rated autism scales, such as the Childhood Autism Rating Scale, Second Edition (CARS2), when used remotely. Although the feasibility and validity of telehealth assessments have been explored previously, the consistency between remote and in person CARS2 ratings by different clinicians remains underinvestigated. OBJECTIVE: The objective of this study was to evaluate agreement between CARS2 total scores obtained by different evaluators using telepsychiatry and face-to-face assessments in children with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD). METHODS: In this randomized feasibility study, 75 children aged 6 to 17 years with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) diagnoses of ASD, ADHD, or both were enrolled at 5 medical institutions in Japan; 73 of 75 were included in the final analysis. Each participant underwent 2 independent CARS2 evaluations, one face-to-face and the other via telepsychiatry, conducted by different evaluators who were blinded to each other's ratings. Remote assessments were conducted using a secure video platform with caregiver facilitation. Agreement was assessed using intraclass correlation coefficients (ICCs) for the overall sample and subgroups defined by primary diagnosis, sex, and age. RESULTS: The overall ICC for CARS2 total scores between face-to-face and telepsychiatry assessments was 0.582 (95% CI 0.407-0.717), indicating moderate agreement. The ICC was 0.546 among participants with ASD as the primary diagnosis and 0.495 among those with ADHD as the primary diagnosis. Point estimates were higher among girls than boys (0.666 vs 0.495) and among children aged 11 years or older than among those aged 10 years or younger (0.676 vs 0.419). In a sensitivity analysis including all participants with an ASD diagnosis, the ICC was 0.580. CONCLUSIONS: CARS2 total scores obtained through telepsychiatry showed moderate agreement with scores obtained through face-to-face assessment when the assessments were conducted by different evaluators in different settings. Higher point estimates were observed among older children and girls, although these subgroup findings should be interpreted cautiously. Telepsychiatry-based CARS2 assessment may be considered a complementary approach rather than a replacement for comprehensive face-to-face evaluation. Larger studies using more standardized assessment protocols are needed.

ترجمه فارسی چکیده

پاندمی کووید-19 تقاضا برای تله‌پسیکیتری در ارزیابی اختلالات رشد عصبی را افزایش داده است، اما تعداد کمی از مطالعات بررسی اعتبار بین‌ارزیابی مقیاس‌های رتبه‌بندی خودمانی توسط پزشکان مانند CARS2 هنگام استفاده از راه دور را بررسی کرده‌اند. هدف این مطالعه ارزیابی توافق بین امتیازات کل CARS2 حاصل از ارزیابان مختلف با استفاده از تله‌پسیکیتری و ارزیابی حضوری در کودکان دارای اختلال طیف خودمانی (ASD) و/یا اختلال کم‌توجهی-بیش‌فعالی (ADHD) بود. در این مطالعه تجویزی پذیرش‌پذیری، ۷۵ کودک ۶ تا ۱۷ ساله با تشخیص‌های DSM-5 (ASD، ADHD یا هر دو) در ۵ موسسه پزشکی ژاپن enrolled شدند و ۷۳ مورد در تحلیل نهایی شامل شدند. هر شرکت‌کننده دو ارزیابی مستقل CARS2 دریافت کرد، یکی حضوری و دیگری از طریق تله‌پسیکیتری، توسط ارزیابان مختلفی که به امتیازات یکدیگر blind بودند. نتایج نشان داد که ضریب همبستگی درون‌کلاسی (ICC) کل برای امتیازات کل CARS2 بین ارزیابی‌های حضوری و تله‌پسیکیتری ۰٫۵۸۲ (۹۵٪ CI ۰٫۴۰۷-۰٫۷۱۷) بود که نشان‌دهنده توافق متوسط است. ICC در شرکت‌کنندگان با تشخیص اولیه ASD ۰٫۵۴۶ و در شرکت‌کنندگان با تشخیص اولیه ADHD ۰٫۴۹۵ بود. برآوردها در دختران نسبت به پسران (۰٫۶۶۶ در مقابل ۰٫۴۹۵) و در کودکان ۱۱ ساله و بالاتر نسبت به کودکان ۱۰ ساله و پایین‌تر (۰٫۶۷۶ در مقابل ۰٫۴۱۹) بالاتر بود. در تحلیل حساسیت شامل تمام شرکت‌کنندگان دارای تشخیص ASD، ICC ۰٫۵۸۰ بود.

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