Deployment of a Multimedia Screening Tool for ASD in a Diverse Community Setting: Feasibility and Usability

Background: With an increase in autism prevalence (Christensen et al., 2012), there is an urgent need to identify children at risk for developing ASD. The American Academy of Pediatrics suggests developmental screening at 9-, 18-, and 30-month well-child visits (Council on Children with Disabilities, 2006). Screening leads to an earlier ASD diagnosis (Miller et al., 2011), yet children are not screened equally across racial groups, with African-American and Latino children being screened later than Caucasians (Herlihy et al., 2011). Thus, it is essential to create screening tools to help identify those at risk, especially among diverse populations. To fill this need, we have created a tablet-based multimedia screener system, the Yale Adaptive Multimedia Screener (YAMS). The application allows for time-efficient screening through an easy-to-understand platform that automates scoring of risk.

Objectives: To examine the feasibility, acceptability, and usability of a tablet-based multimedia screener in a diverse population of children ages 10-33 months in primary pediatric care centers serving under-resourced populations.

Methods: Feasibility of YAMS use at multiple community pediatrics sites was indexed by our success rate in ability to identify and approach the families of infants and toddlers (10-33 months old) attending their routine well-child visits at three community pediatric locations. Acceptability of the screener was evaluated by recruitment rate. Usability was determined using five questions based on the After-Scenario Questionnaire (Lewis, 1991).

Results: 409 infants and toddlers were identified as potential participants based on their age. 132 (32.3%) families missed their well-child appointment. Of the 277 patients who attended their scheduled appointment, 56 (20.2%) were not approached to participate because of schedule conflicts or lack of sufficient English skills. Of the 221 families invited to participate, 187 enrolled in the study (84.6%). 78 (41.7%) children were African-American, 45 (24.1%) were mixed race, 23 (12.3%) were Caucasian, and 6 (3.2%) were Asian. 82 (43.9%) children were Hispanic/Latino. The average parent/guardian age was 30.42, ranging from 17.2 to 67.7 years. 51 (27.3%) were single parents. Education level for 113 (50.8%) parents was a high school degree or less. Five usability questions related to helpfulness of videos, satisfaction with the amount of time it took to complete, and ability to understand questions, rated on a Likert scale of 1-7, resulted in average parent feedback of 6.52, suggesting YAMS is a highly usable application.

Conclusions: This feasibility study suggests challenges and successes in the ability to reach a diverse inner-city population using an electronic multimedia screening tool. Through initial stages of deployment, results suggest some difficulty reaching participants based on their appointments, but among participants there was a high level of satisfaction in terms of the overall usability, the time it took to complete the application, as well as the helpfulness of the videos as a platform for illustrating screening questions. In addition to high levels of satisfaction with the app, our high participation rate will allow continuation of the development process by expanding the testing of YAMS in additional community settings as well as utilizing front-desk staff to more efficiently recruit participants.