Ask someone who has a child diagnosed with autism about wait times for lining up services, and they measure in months. The backup is only expected to build as the number of children on the autism spectrum balloons. Vanderbilt is now trying out a stopgap to squeeze in more kids — telemedicine.
Modern technology makes treatment via video conferencing relatively simple to set up. Vanderbilt's Treatment and Research Institute for Autism Spectrum Disorders just ships families an iPad on a special tripod controlled from afar.
"No sir, no sir. That's not an iPad for playing with," Stacey Copeland of Knoxville tells her 2-year-old, River.
The mother and son are camped out on the floor of their playroom for an hour-long behavioral therapy session. Copeland tries to get River to play with a ball before moving on to toys he enjoys more.
"I am waiting," she says. "First ball, then puzzle."
"Stacey," interjects Alacia Stainbrook from Nashville, "I might give the direction one more time and then go ahead and prompt a follow through."
Stainbrook directs this program at Vanderbilt's autism center in Nashville. She has a $3.25 million grant from the state's Department of Education to use telemedicine for both autism diagnosis and therapy. Around the country, therapists have been experimenting with video sessions over the last couple of years, primarily to reach families in rural areas as well as in cities that lack specialized autism services.
"Let's try sticking with the clapping for a couple of rounds and see if that repetition helps a little bit," Stainbrook tells Copeland.
Without ever meeting in person, Copeland has worked solely through the weekly video sessions with Stainbrook and behavioral analyst Will Martin to develop new strategies. She now pauses just before doing something River wants and prompts him to do something he doesn't — whether that's saying a word or making eye contact. Sometimes Copeland has him dig toys out of a bowl of beads to manage the sensory overload.
"Anybody can get in the floor and play with their kid," she says in an interview. "But you want play that's effective in helping modify behavior."
Even as a registered nurse who has done plenty of autism homework on her own, Copeland says she needs an expert feeding ideas in the moment.
The big question is whether that can be done well from an iPad.
"I think the biggest difference and challenge we have to overcome is that we're not able to say, 'let me try that with River.’ We have to communicate that verbally," Stainbrook says, adding that it can be done with some extra thought.
Researchers in Iowa found that this kind of teletherapy was still effective. And it was done at less than half the cost, mostly by cutting travel expenses. Therapists spend lots of time on the road since sessions are ideally conducted in the homes of children, where their young patients feel most comfortable.
It can be a sensitive encounter, especially at the diagnosis stage.
"That's the point that you may be finding out, 'this is autism,' or 'this isn't autism, and I don't fully understand what it is yet.' That can be almost as challenging," Stainbrook says.
It's a moment when even the expert would like to offer a hug. But Stainbrook says she's found ways to be comforting virtually, which is why she's hopeful that telemedicine could help autism specialists like her meet the growing need around the country. A new count is expected in the coming weeks, but the latest figures from the Centers for Disease Control find one in 68 school-age children is diagnosed with autism.