Feasibility and acceptability of a telehealth model for autism diagnostic evaluations in children, adolescents, and adults

Abstract

This study examined the feasibility and acceptability of a telehealth diagnostic model deployed at an autism center in the southwestern United States to safely provide autism spectrum disorder (ASD) diagnostic evaluations to children, adolescents, and adults during the COVID-19 pandemic. Participants included all clients for whom a telehealth diagnostic evaluation was scheduled at the diagnostic clinic (n = 121) over a 6-month period. Of 121 scheduled clients, 102 (84%) completed the telehealth evaluation. A diagnostic determination was made for 91% of clients (93 out of 102) using only telehealth procedures. Nine participants (two females; ages 3 to 11 years) required an in-person evaluation. Responses from psychologist and parent acceptability surveys indicated the model was acceptable for most clients. Psychologist ratings suggested that telehealth modalities used in the current study may be less acceptable for evaluating school-aged children with subtle presentations compared to children in the early developmental period, adolescents, and adults. Parents of females reported higher acceptability than parents of males. Findings contribute to the small but growing literature on feasibility and acceptability of telehealth evaluations for ASD and have implications for improving access to care during and after the COVID-19 pandemic. Lay SummaryThis study described telehealth methods for evaluating children, adolescents, and adults for autism spectrum disorder. Telehealth methods were generally acceptable to psychologists conducting the evaluations and parents of diagnostic clients. Psychologists reported the methods to be less acceptable for school-aged children and parents of males found the methods less acceptable than parents of females. The telehealth methods described may help to increase access to diagnostic professionals and reduce wait times for evaluations during and after the COVID-19 pandemic.

Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals

“…The findings reported here are broadly consistent with those outlined in a handful of recent studies examining professionals’ experiences of providing telehealth autism diagnostic assessments in the United States and Australia [ 13 , 16 , 19 ]. Studies have reported that professionals appreciated the convenience, flexibility, efficiency, and cost and space savings of telehealth.…”

“…Since the start of the COVID-19 pandemic, a handful of studies, primarily conducted in the United States and Canada, have examined the feasibility and acceptability of telehealth autism diagnostic assessments or the perspectives of patients or health professionals [ 14 - 16 , 19 - 21 ]. Preliminary findings indicate that some professionals and services can find telehealth to be convenient, flexible, and satisfactory when working with individuals across the life span.…”

Autism Diagnostic Assessments With Children, Adolescents, and Adults Prior to and During the COVID-19 Pandemic: A Cross-Sectional Survey of Professionals

“…As telehealth is preferred by some patients, a logical step may be for autism diagnostic services to offer choice about whether an assessment will be conducted via telehealth, in person or with a hybrid approach. That said, there are clearly issues with parity of service provision; for example, findings reported here and elsewhere [e.g., ( 18 , 22 , 23 )] indicate telehealth may not be offered to all (e.g., due to clinical presentation or risk), or cannot be offered to all (e.g., due to a lack of internet access). Further evaluation is therefore needed, such as with quality improvement projects, qualitative interviews or focus groups, to establish how to enhance accessibility.…”

“…Overall, ~60% of participants reported feeling confident to assess and diagnose autism remotely. However, as in the study by Gibbs et al ( 23 ), and Matthews et al ( 22 ), there were some consistent problems identified that could impact on the diagnostic process, including technological challenges, poor internet access, environmental challenges (e.g., that the home environment did not seem a suitable place to assess patients) and difficulties with engaging families/carers and/or patients.…”

“…A very limited number of studies have investigated telehealth autism assessments conducted during the pandemic. One study by Matthews et al ( 22 ) examined the feasibility and acceptability of telehealth autism assessments in 102 people aged between 1.25 and 38 years old seen during Spring and Summer 2020 in the US. The assessment was conducted fully online, and comprised obtaining a developmental history, conducting a behavioral observation assessment, assessing adaptive functioning and intellectual ability, and viewing home videos.…”