Telehealth autism evaluation under suboptimal network conditions: Technical parameters and clinical implications
- 1Department of Pediatric Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
- 2Department of Telecommunications, Brno University of Technology, Brno, Czech Republic
- 3Faculty of Medicine, Masaryk University, Brno, Czech Republic
Abstract
Telehealth expands access to autism diagnostics, but scoring reliability depends on connection stability. Using an optical-fiber testbed, we imposed controlled packet loss and Wi-Fi attenuation to derive four freeze patterns (1-second freezes every 16.7, 11.1, 8.3, or 5.0 seconds), then applied these to 10 children’s BOSA videos (40 clips) scored by four blinded psychologists. Analyses included Fisher’s exact tests with Benjamini–Hochberg correction, Spearman correlation, and per-item logistic regression with Bonferroni correction. Performance degraded in a dose-dependent manner rather than collapsing: below a Received Signal Strength Indicator (RSSI) of −70 dBm or above ~0.04% packet loss, freeze frequency increased from ~1/16.7 s to ~1/5.0 s. Time-sensitive items–Spontaneous Joint Attention (B10), Integration of Gaze and Behavior (B4), Immediate Echolalia (A4), and Stereotyped/Idiosyncratic Language (A5)–were 4–9 × more likely to be coded unscorable, and poorer stream quality correlated with more unscored items (ρ ≈ −0.58). Importantly, overall BOSA scoring remained stable, with no individual item reaching significance after correction and substantial inter-rater consistency under mild degradation (ICC = 0.93, Cohen’s κ = 0.76), indicating robustness to moderate degradation. In this pilot study, these results support BOSA as a first-line option when packet loss remains below ~0.04% and RSSI stays above −70 dBm, pending validation in larger, more diverse cohorts. Where possible, using wired connections and awareness of item-level sensitivities can further preserve diagnostic confidence.
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BibTeX
@article{kolar2026telehealth,
title = {{Telehealth autism evaluation under suboptimal network conditions: Technical parameters and clinical implications}},
author = {Senad Kolar and Tomas Horvath and Lucie Stroupkova and Martina Vyhnalova and Anna Marie Bittnerova and Nela Novakova and Ivona Packanova and Lenka Knedlikova and Rastislav Repko and Petr Munster and Pavlina Danhofer},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357146},
url = {https://doi.org/10.1371/journal.pone.0357146},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Telehealth autism evaluation under suboptimal network conditions: Technical parameters and clinical implications
AU - Senad Kolar
AU - Tomas Horvath
AU - Lucie Stroupkova
AU - Martina Vyhnalova
AU - Anna Marie Bittnerova
AU - Nela Novakova
AU - Ivona Packanova
AU - Lenka Knedlikova
AU - Rastislav Repko
AU - Petr Munster
AU - Pavlina Danhofer
PY - 2026
DA - 2026/09/09
JO - PLOS One
DO - 10.1371/journal.pone.0357146
UR - https://doi.org/10.1371/journal.pone.0357146
AB - Telehealth expands access to autism diagnostics, but scoring reliability depends on connection stability. Using an optical-fiber testbed, we imposed controlled packet loss and Wi-Fi attenuation to derive four freeze patterns (1-second freezes every 16.7, 11.1, 8.3, or 5.0 seconds), then applied these to 10 children’s BOSA videos (40 clips) scored by four blinded psychologists. Analyses included Fisher’s exact tests with Benjamini–Hochberg correction, Spearman correlation, and per-item logistic regression with Bonferroni correction. Performance degraded in a dose-dependent manner rather than collapsing: below a Received Signal Strength Indicator (RSSI) of −70 dBm or above ~0.04% packet loss, freeze frequency increased from ~1/16.7 s to ~1/5.0 s. Time-sensitive items–Spontaneous Joint Attention (B10), Integration of Gaze and Behavior (B4), Immediate Echolalia (A4), and Stereotyped/Idiosyncratic Language (A5)–were 4–9 × more likely to be coded unscorable, and poorer stream quality correlated with more unscored items (ρ ≈ −0.58). Importantly, overall BOSA scoring remained stable, with no individual item reaching significance after correction and substantial inter-rater consistency under mild degradation (ICC = 0.93, Cohen’s κ = 0.76), indicating robustness to moderate degradation. In this pilot study, these results support BOSA as a first-line option when packet loss remains below ~0.04% and RSSI stays above −70 dBm, pending validation in larger, more diverse cohorts. Where possible, using wired connections and awareness of item-level sensitivities can further preserve diagnostic confidence.
SN - 1932-6203
ER -