1. Telemedicine In Schools For
Children With Developmental
Disabilities
Felissa P. Goldstein, M.D.
Board Certified Adult, Child and Adolescent Psychiatrist
Georgia Partnership for Telehealth Annual Conference

2. Objectives
 Describe telemedicine for children with
developmental disorders
 Discuss how telemedicine may be used for children
with developmental disabilities in the school setting.
 Highlight the benefits and challenges of using
telepsychiatry in school based clinics.
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3. Why Design a Telemedicine Program for
Children on the Autism Spectrum?
“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 face-to-face, which might make them more
anxious.”
Peter Yellowlees at UC Davis, in Terry 2009
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4. Marcus Autism Center
 Not-for-Profit
 NIH Autism Center of Excellence
 Dedicated to diagnosis and treatment of autism and
related disorders
 Serves approximately 5,000 children a year
 Multispecialty center for children and their families
across Georgia and the southeast
 Part of Children’s Healthcare of Atlanta
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5. Why Design a Telemedicine Program for
Children on the Autism Spectrum?
 Improved patient outcomes
• Decreased time to first appointment
• Earlier identification and treatment of autism
spectrum disorders
• Increased access to specialized programs for
children with developmental disabilities
 Education and Support
• Community doctors
• Schools and families throughout the state
 Note: These benefits are critical for children with
autism spectrum disorders. Telemedicine provides
many other benefits.
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6. How is Telemedicine Currently Used ?
A. Videoconferencing
 Patients receive psychotherapy and
pharmacotherapy via telemedicine
 Native American children with Autism Spectrum
disorders living in rural areas received psychiatric
and psychological assessments by telemedicine
(Savin, 2005)
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7. How is Telemedicine Currently Used ?
B. Data Collection
 Behavioral Imaging software allows the parents to
press a button and record the child’s behaviors. Dr.
Christopher Smith (2012) had families capture video
during family mealtime, playtime, and problem
times. Video was sent to an expert for review and
comparison to DSM criteria to make diagnoses.
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8. How is Telemedicine Currently Used ?
C. Behavioral Therapy
 Numerous studies report the effectiveness of
behavioral analysts guiding teachers in conducting
functional behavioral and preference assessments,
implementing treatment protocols and collecting
data (Barretto, 2006; Machalicek, 2009 and in
press)
 University behavioral consultants trained teachers
to implement functional communication training
(Gibson, 2010)
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9. How is Telemedicine Currently Used ?
D. Education
 Educational consultants and university researchers
used teleconferencing equipment to collaborate
with teachers to develop and implement an IEP
(Rule, 2006)
 Using in person instruction and telemedicine,
university researchers taught parents and early
intervention specialists how to use the Early Start
Denver Model to treat children with developmental
disabilities. The differing instruction methods were
equally effective (Vismara, 2009)
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10. How is Telemedicine Currently Used?
E. Autism Spectrum Disorders Diagnosis
 Dr Matthew Reese and his group at the University
of Kansas (2012) used a modified and
nonstandardized Autism Diagnostic Observation
Schedule via telemedicine and compared its
effectiveness with in person administration. It was
equally effective except for pointing.
 A comparison of in person vs. telemedicine usage
of the Autism Diagnostic Interview showed equal
reliability except for sensory (Reese, 2012).
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11. How is Telemedicine Currently Used?
F. Diagnostic Limitations
 Pub med searches using the
search terms: autism,
autism spectrum disorders,
telemedicine, telehealth,
and telepractice showed no
literature on comprehensive
telemedicine evaluations to
diagnose autism
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12. How is Telemedicine Currently Used?
F. Diagnostic Limitations
 After Marcus Autism Center convened a meeting of
autism and telemedicine experts it was determined
that telemedicine be used for screening and triage
purposes and not for diagnoses at this time.
Differing opinions on autism evaluation
requirements, difficulty conducting some tests by
telemedicine, and the absence of a telemedicine
evaluation comparable to the “gold standard” in
person assessment led to this determination.
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13. How is Telemedicine Provided for
Children on the Autism Spectrum?
The need is there
How do we provide it?
Here is one example –
Collaboration between
Children’s Healthcare of Atlanta
Georgia Partnership for Telehealth
Marcus Autism Center
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14. Diagnoses Commonly Treated via
Telemedicine at Marcus Autism Center
 Autism spectrum disorders
 Developmental disorders
 Down syndrome, Fragile X and other genetic
disorders
 Fetal alcohol syndrome
 Psychiatric disorders
 Self injurious behaviors
 Sleep disorders
(nonrespiratory)
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15. Benefits
 Children are already at school
 School provides feedback on student
performance
 Collaborative treatment model
 Less travel
 Less expense
 Access to specialist
 Less missed work and school hours
 Easier for certain patients to engage
 Video and audio technology rapidly
improving
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 Provide patient care across state

16. Drawbacks
 Parents do not always show
 Appointments based on school operating hours
 Stimulant prescriptions must be mailed and take
longer for patients to receive
 Equipment and scheduling problems
 Reimbursement varies
 Increased paperwork
 Sharing bad news is hard
 More difficult to establish rapport
 Hard to schedule emergency appointments
 Lack of providers causes delay to first appointment
16  Lack of other specialists

17. How is the Marcus Clinic Doing?
Year Number of
Appointments
2009 76
2010 348
2011
511
2012 524
Total 1459
(at approx.
34 sites)
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18. Summary
 Pediatric telemedicine may be used for
psychotherapy, pharmacotherapy, data collection,
IEP development, and screening for autism
spectrum disorder diagnosis.
 Telemedicine provides training, education and
support for families, schools and physicians.
 Telemedicine improves patients’ access to specialty
care.
 The Marcus Autism Center collaborates with
several agencies to provide patient care through
rural Georgia.
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19. Questions???
Felissa Goldstein, M.D.
The Marcus Autism Center
1920 Briarcliff Road
Atlanta, GA 30329
(404) 785-9405
Felissa.Goldstein@choa.org
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20. References
Autism Spectrum Disorders. National Institute of Mental Health., 41 pages with
Jan. 2007 Addendum.
http://www.nimh.nih.gov/health/publications/autism/complete-
publication.shtml.
Boisvert, Mary., Lang, Robert, Andrianopoulos, Mary -& Boscardin, Mary Lynn.
Telepractice in the assessment and treatment of individuals with autism
spectrum disorders: A systematic review. Developmental
Neurorehabilitation, December 2010; 13(6): 423–432.
Barretto, A, Wacker, DP, Harding, J., Lee, J., Berg, W. Using telemedicine to
conduct behavioral assessments. Journal of Applied Behavioral Analysis,
39:333-340, 2006.
Cheng, Keith and Myers, Kathleen. Child and Adolescent Psychiatry The
Essentials. Lippincott, Williams and Wilkins, 2005.
Facts for Families –American Academy of Child and Adolescent Psychiatry
Filipek, Pauline, Steinberg-Epstein, Robin, and Book, Teri. Interventions for
Autistic Spectrum Disorders. NeuroRX, 3:207-216, 2006.
Hollander, Eric and Evdokia Anagnostou. Clinical Manual for the Treatment of
Autism. American Psychiatric Publishing Inc., 2007.
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21. References
http://www.cdc.gov/ncbddd/autism/data.html
http://www.dana-farber.org/can/dictionary
http://www.dsmivtr.org/index.cfm
http://www.hrsa.gov/ruralhealth/about/telehealth/glossary.html
http://www.merck.com/mmhe/sec23/ch285/ch285a.html
King, Bryan and Bostic, Jeff. An Update on Pharmacologic Treatments for
Autistic Spectrum Disorders. Child and Adolescent Psychiatric Clinics of
North America. 15(1) 161-175, 2006.
Johnson, Chris Plauche and Scott M. Myers. The Identification and Evaluation
of Children with Autism Spectrum Disorders. Pediatrics. 120 (5) .1183-1215,
2007
Machalicek, W, O’Reilly, M, Chan, J., Lang R, Rispoli, M, Davis, T, Shogren, K,
Sigafoos, J, Lancioni, G. Antonucci, M, Langthrne, P, Andrews, A, Dkidden,
R. Using videoconferencing to conduct functional analysis of challenging
behavior and develop classroom behavioral support plans for students with
autism. Education and Training in Developmental Disabilities, 44 207-217,
2009
Machalicek, W, O’Reilly, M, Chan, J, Rispoli, M, Lang R Davis, T, Shogren, K,
Sorrells, A, Lancioni, G, Sigafoos, J, Green, V, Langthrne, P, Using
videoconferencing to support teachers to conduct performance
assessments with students with autism and developmental disabilities.
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Research in Autism Spectrum Disorders 3:32-41, 2009.

22. References
Machalicek, W, O’ Reilly MF, Rispoli M, Davis, T, Lang, R, Hetlinger-Franco J, Chan, J.
Training teachers to assess the challenging behaviors of students with autism
using video tele-conferencing. Education and Training in Developmental
Disabilities, in press.
Myers, Scott, and Johnson, Chris Plauche. The Management of Children with Autism
Spectrum Disorders. Pediatrics, 120 (5)1162-1182, 2007.
Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities
Monitoring Network, United States, 2006, MMWR, 12/18/2009, 58(SS10);1-20.
Reese, Matthew University of Kansas Autism Telemedicine Project, Thoughtleader
Summit, 2012.
Rule, S, Salzberg, C, Higher, T, Menlove, R, Smith, J. Technology-mediated
consultation to assist rural students : a case study. Rural Special Education
Quarterly, 25: 3-7, 2006.
Savin, D, Garry, MT, Zuccaro, P, and Novins D. Telepsychiatry for treating rural
American Indian youth. Journal of the American Academy of Child and Adolescent
Psychiatry, 45:484-488, 2005.
Smith, Christopher Naturalistic Observation Diagnostic Assessment. Thoughtleader
Summit, 2012
Terry, Mark, Telemedicine and Autism: Researchers and clinicians are just starting to
consider Telemedicine Applications for the Diagnosis and Treatment of Autism,
Telemedicine and e-Health, 416-419, 2009.
Vismara, LA, Young, GS, Stahmer, AC, Griffith, EM, Rogers, SJ, Dissemination of
22 evidence-based practice: Can we train therapists from a distance? Journal of
Autism and Developmental Disorders, 39: 1636-1651, 2009.