Rethinking autism spectrum disorder assessment for children during COVID‐19 and beyond

Abstract

The COVID-19 pandemic has posed unique challenges for families and caregivers, as well as for autism-focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of inperson assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family-centered system of care.

Expectations and Concerns about the Use of Telemedicine for Autism Spectrum Disorder: A Cross-Sectional Survey of Parents and Healthcare Professionals

“…In addition, they also need to to prepare and send instructions and educational materials to parents prior to the virtual appointment. Parents, through parent training programs delivered by telematics systems, mediate intervention on their children [ 20 , 73 , 74 , 75 , 78 , 79 , 80 ], thus ensuring a more family-centred approach to care [ 81 , 82 ]. In contrast, few studies focus on distance interventions that directly target children and adolescents with ASD.…”

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

“…There may also be factors related to the pandemic context that have exacerbated waiting times; for example, arising due to stay-at-home mandates, social distancing guidelines, staff redeployment and sickness, widespread disruptions to care pathways and difficulties experienced by people and their families with accessing telehealth ( 18 , 23 , 25 ). Nonetheless, only 58% of services in our study reported longer waiting times for assessment.…”

“…Since the time our study was conducted, a limited number of studies [e.g., ( 21 – 24 )], and commentaries ( 19 , 25 ), have been published, focusing on autism assessment during the pandemic and outlining examples of adaptations to standard practice along with considerations for professionals. Yet overall, there is still much we do not know about how professionals are conducting autism assessments, which adaptations are more or less common (and considered more or less critical for reaching a diagnostic conclusion via telehealth), and whether this impacts on factors such as conversion rates and patient, family/carer and professional acceptability and satisfaction with service provision.…”

“…The need for updated clinical guidelines outlining good practice in conducting autism assessments via telehealth or hybrid approaches was deemed important. There are several commentaries highlighting suggestions and considerations [see ( 19 , 25 )], but more empirical research is likely needed to inform development of these. Interestingly, prior research suggests that professionals may not always follow clinical guidelines for autism assessments [e.g., ( 7 , 9 , 10 , 38 )]; potentially because of a combination of service-related, professional-related and patient-related factors.…”

“…The suddenness of the pandemic means autism diagnostic services have been forced to rapidly change traditional ways of working ( 19 , 25 ). To keep services going, professionals have had to do what seemed best or pragmatic in the circumstances ( 26 ).…”