{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:09:06Z","timestamp":1788977346920,"version":"build-2803163510"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003243","name":"Ministerstvo Zdravotnictv\u00ed Cesk\u00e9 Republiky","doi-asserted-by":"publisher","award":["AZV NU22-D-130"],"award-info":[{"award-number":["AZV NU22-D-130"]}],"id":[{"id":"10.13039\/501100003243","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009532","name":"Ministry of the Interior of the Czech Republic","doi-asserted-by":"crossref","award":["VK02030188"],"award-info":[{"award-number":["VK02030188"]}],"id":[{"id":"10.13039\/100009532","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u2019s BOSA videos (40 clips) scored by four blinded psychologists. Analyses included Fisher\u2019s exact tests with Benjamini\u2013Hochberg 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 \u221270 dBm or above ~0.04% packet loss, freeze frequency increased from ~1\/16.7 s to ~1\/5.0 s. Time-sensitive items\u2013Spontaneous Joint Attention (B10), Integration of Gaze and Behavior (B4), Immediate Echolalia (A4), and Stereotyped\/Idiosyncratic Language (A5)\u2013were 4\u20139\u2009\u00d7\u2009more likely to be coded unscorable, and poorer stream quality correlated with more unscored items (\u03c1\u2009\u2248 \u22120.58). Importantly, overall BOSA scoring remained stable, with no individual item reaching significance after correction and substantial inter-rater consistency under mild degradation (ICC\u2009=\u20090.93, Cohen\u2019s \u03ba\u2009=\u20090.76), 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 \u221270 dBm, pending validation in larger, more diverse cohorts. Where possible, using wired connections and awareness of item-level sensitivities can further preserve diagnostic confidence.<\/jats:p>","DOI":"10.1371\/journal.pone.0357146","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:35:55Z","timestamp":1788975355000},"page":"e0357146","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Telehealth autism evaluation under suboptimal network conditions: Technical parameters and clinical implications"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1647-1603","authenticated-orcid":true,"given":"Senad","family":"Kolar","sequence":"first","affiliation":[{"name":"Masaryk University and University Hospital Brno","place":["Brno, Czech Republic"],"department":["Department of Pediatric Neurology, Faculty of 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Marie","family":"Bittnerova","sequence":"additional","affiliation":[{"name":"Masaryk University and University Hospital Brno","place":["Brno, Czech Republic"],"department":["Department of Pediatric Neurology, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nela","family":"Novakova","sequence":"additional","affiliation":[{"name":"Masaryk University and University Hospital Brno","place":["Brno, Czech Republic"],"department":["Department of Pediatric Neurology, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivona","family":"Packanova","sequence":"additional","affiliation":[{"name":"Masaryk University and University Hospital Brno","place":["Brno, Czech Republic"],"department":["Department of Pediatric Neurology, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Knedlikova","sequence":"additional","affiliation":[{"name":"Masaryk University and University Hospital 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