Beyond the Screen: Interview with Kristen Math on the Art of Telehealth Autism and ADHD Evaluations for Children
By Rachel L., Contributing Writer
As telehealth has become a staple in mental health and diagnostic services, evaluating children for autism and ADHD over video calls presents unique challenges and surprising opportunities. We sat down with Kristen Math, MS, MA, LPCC-S, a seasoned therapist, neurodevelopmental evaluator, and mother of five whose warm, compassionate approach is making a difference for families navigating the diagnostic journey remotely.
Q: Kristen, thanks for speaking with us. What are some of the biggest challenges you face when evaluating children for autism or ADHD through telehealth?
Kristen Math: Thank you for having me! One of the biggest challenges is not being in the same physical space with the child. In-person evaluations allow you to observe body language, motor movements, and social interaction more naturally. Over telehealth, the context is different—kids might be more distracted at home, or alternatively, more comfortable than they would be in a clinical setting. Either way, it changes the dynamic, and I have to adjust how I gather data.
Another challenge is technical/glitchy audio or video, poor internet connections, or even the child being unsure how to use the computer can all interfere with the flow of the session.
Q: How do you work around those issues and still ensure the evaluation is valid and supportive?
Kristen: Flexibility is key. I plan ahead with parents or guardians to prepare the environment as much as possible—making sure the space is quiet, limiting distractions, and ensuring that a supportive adult is nearby during the assessment.
I also explain to parents that their role is crucial. They aren’t just observers, they’re participants. I often ask them to help manage transitions, prompt their child if needed, and provide insight into behaviors they notice off-screen. I also include structured interviews and standardized parent-report tools that give me a fuller picture.
When tech issues come up, I give us grace. If something doesn’t work one way, I adapt—whether that’s switching to a different task, doing more narrative observation, or following up in a second session. The goal is always to see the child as clearly as possible within the realities of the setting.
Q: What does parent or guardian participation typically look like during a telehealth evaluation?
Kristen: Parents are incredibly important. They know their child best. I’ll often involve them in parts of the session especially when we’re doing structured observation tasks. For instance, I may guide the parent through an activity to complete with their child so I can watch how the child responds socially, emotionally, and behaviorally.
I also use parent interviews to understand developmental history, current challenges, strengths, and any sensory, emotional, or behavioral patterns. Their observations often confirm what I see or fill in the gaps for what I can’t capture on screen.
Q: How do you build rapport with kids through a screen? That seems like a tough ask!
Kristen: It absolutely can be, especially for kids who are shy or hesitant. But I start by being authentic. Kids are great at picking up on sincerity. I speak directly to them, use humor, and follow their lead if they’re interested in something, I find a way to weave that into our interaction.
I might start the session by asking them to show me a favorite toy or pet, or tell me about their favorite video game. Those small windows into their world create connection. I use playful language, visual aids, and engaging tasks to keep them involved. Even little things like letting them help me “choose” the next activity or take a silly break can help build trust.
Q: What techniques do you use to keep children engaged in computer-based tasks during the evaluation?
Kristen: I use a lot of interactive, screen-shared activities and assessment tools designed for telehealth. I narrate what we’re doing, encourage them, and pace the session based on their energy and attention.
If a child is fidgety or restless, I incorporate movement breaks or let them stand up while we work. I keep transitions clear and predictable and always give them a sense of what’s coming next. Engagement isn’t just about the task, it’s about the relationship and how safe they feel doing something that’s cognitively or emotionally challenging.
Q: Are there behaviors you’re watching for during the evaluation, even as you’re engaging them in tasks?
Kristen: Definitely. I’m observing how they respond to change, how they manage frustration, their social reciprocity, how they express emotion, and their communication style. I also note sensory sensitivities, attention patterns, and motor behaviors even through a camera, many of these behaviors are observable if you’re attuned.
Part of my job is creating opportunities for those behaviors to emerge naturally. That’s why rapport is so essential—kids need to feel safe enough to be themselves. That’s when you get the clearest picture.
Q: What would you say to parents who are hesitant about telehealth evaluations?
Kristen: I understand their hesitation. But I want them to know that a well-conducted telehealth evaluation can be just as valid and helpful as in-person, especially when the evaluator is experienced in remote work.
Telehealth can also be more comfortable for some kids; being at home can reduce anxiety and lead to more authentic behavior. The key is thoughtful planning, strong collaboration with caregivers, and a commitment to understanding each child as a whole person—not just a checklist of symptoms.
Kristen Math, MS, MA, LPCC-S, is an autistic therapist and neurodevelopmental specialist with a passion for helping children, teens, and adults understand their unique brains. Through a compassionate, strengths-based approach, Kristen supports families across the diagnostic journey—whether in person or across the screen.