Assessment Instruments

Due to the clinical context in which this data was collected, the use of instruments varied across in-person as well as telehealth evaluation contexts. The measures used with high enough frequency across COVID-19 and pre-COVID-19 evaluations are described further below.

The CBCL for ages 1.5–5 years is a 99-item caregiver report questionnaire that measures a broad range of behavioral and emotional concerns. Items are rated on a Likert scale (0 = Not true, 1 = Somewhat or Sometimes True, 2 = Very True or Often True; Achenbach & Rescorla, 2000). The measure yields three broad domain scores, seven syndrome scales, and five DSM-5 oriented scales. Notably, there is a DSM-5 scale measuring symptoms of ASD. Use of the CBCL in all mental health evaluations for children under the age of 5 years is mandated by state regulations in Minnesota.

The ASRS is a caregiver questionnaire that measures behaviors commonly associated with ASD (Goldstein & Naglieri, 2009). The form for children ages two to five years consists of 70 questions rated on a 5-point Likert scale (0 = Never, 4 = Very Frequently) and yield a Total Score, ASRS Scores for Social Communication and Unusual Behaviors, as well as a DSM-5 score. The ASRS DSM-5 score was created to align with symptoms in the DSM-5 manual ASD criteria.

Other assessment instruments used by clinicians, but not analyzed here due to insufficient use include the TAP, VABS-3, DP-4, SRS-2, and the CARS-2. Data for these instruments are summarized in Supplemental Materials Table S1 to provide more description of the study participants.