The ongoing COVID-19 Pandemic has led to changes in the way non-emergency healthcare is being delivered. Developmental Paediatricians have mostly carried out face to face assessments when assessing children with neurodevelopmental disorders. The opportunity to see the child, observe their interactions with familiar and unfamiliar people were some of the reasons for having a face to face assessment. Most neurodevelopmental disorders require assessments by more than one professional. Children being assessed for these disorders sometimes have to see several professionals before a diagnosis is reached. The challenges of carrying out diagnostic assessments for children with neurodevelopmental disorders during the Pandemic have resulted in clinicians carrying out more remote (video/telephone) consultations.
Video consultations offer the best way of carrying out remote assessments in children with neurodevelopmental disorders when face to face assessments cannot be carried out. They allow the clinician to observe the child in their natural setting.
It may not be suitable for every child hence to be assessed via video consultation and therefore the clinician will need to determine if appropriate or whether they should wait for face to face consultations to resume.
My Experience So Far: I previously struggled with the concept of assessing children through video consultations however my recent experience of conducting remote consultations during the COVID crisis has been very positive.
I have carried out telephone and video consultations for new patients referred for assessment of neurodevelopmental disorders such as ADHD, Autism Spectrum Disorders and Tic Disorder. I have also carried out telephone consultations to review patients with these disorders, including medication management in children with ADHD. The following activities have taken place during the consultations.
1. Obtaining detailed developmental histories is a key part of the assessment. This can be adequately done through remote assessments. Information obtained from the history helps the clinician request for relevant information from parents and school to support the assessment. 2. Observation of children’s behaviour and interaction with peers and other adults is a vital part of the assessment of children with neurodevelopmental disorders. Video consultations of children in their home setting is usually absent in most face to face assessments conducted in hospitals/clinics. Children seen for face to face assessments can appear well behaved in unfamiliar settings and in some cases, lead to diagnostic dilemma for assessors. Video consultations allows the clinician to view the child in their home setting. I have been able to observe several behaviours on video that has helped with my diagnostic assessment. These behaviours are sometimes not observed in face to face clinics which is understandable as this setting is unfamiliar to the child. I have found the children more compliant and relaxed in their home setting. Children have felt more confident to talk about their experiences.
ADHD- I have found Video consultations very useful in assessing children with suspected ADHD. I have been able to observe the child’s ability to focus on activities and tasks whilst the consultation is going on with parents. I am also able to observe the child’s level of activity in the home setting as well as interaction with family members.
ASD- Video consultations can be used for ASD assessment. I have been able to observe children’s communication styles, fixations on some activities and patterns of behaviour. Children with ASD usually struggle with change or visiting new environments. Having the consultation remotely can be beneficial in these situations.
Tic Disorders- I have successfully made a diagnosis of Tourette syndrome through remote consultation. I was able to observe the child’s tics throughout the consultation.
Other Benefits: Families anywhere can access care; families in other localities, counties and countries can access the right level of care for their child without leaving their home. Remote consultations offer flexibility for clinicians and families to schedule consultations outside rigid clinic times.
As we move towards a changing world following the COVID-19 Pandemic, we do envisage we will be carrying out more remote consultations for children with neurodevelopmental disorders. We believe incorporating remote consultation as part of the assessment process for some children will provide useful information for the diagnostic process.
Multidisciplinary assessments can also be carried out remotely hence reducing the need for multiple visits to professionals and shortening the diagnostic pathway.