Purpose <p>This work evaluates use of the TELE-ASD-PEDS-Preschool (TAP-P), a telemedicine-based autism assessment tool for the preschool age range. The TAP-P is a play-based instrument with varied administration and scoring procedures based on a child’s language level. This study compared tele-assessment using the TAP-P to in-person autism assessment.</p> Methods <p>Participants were 116 children (aged 36–71&#xa0;months) referred for autism evaluation. Participants first completed in-home tele-assessment (administration of the TAP-P, clinical interview, and Developmental Profile 4). All participants then completed in-person assessment with a different psychological provider, including cognitive or developmental assessment, adaptive behavior assessment, and autism-focused assessment (ADOS-2). Caregivers completed questionnaires after each appointment assessing their perceptions.</p> Results <p>When asked to make a binary decision about presence or absence of autism, tele-assessment and in-person clinicians agreed for 82% of participants (n = 95). In most instances of diagnostic disagreement (n = 17), tele-assessment clinicians indicated the absence of autism and in-person clinicians indicated the presence of autism. When given the option to select “unsure,” tele-assessment clinicians reported uncertainty for 28% of participants assessed using Form 1 of the TAP-P (designed for children with less verbal language, defined as two-word phrases or less) and 52% of children assessed using Form 2 (for children with more verbal language). Families reported broad satisfaction with tele-assessment procedures.</p> Conclusion <p>This work highlights potential utility of tele-assessment for identification of autism in preschool-aged children with less verbal language, while emphasizing the critical need for additional research related to use of tele-assessment for children using more complex and flexible verbal language.</p>