Autism assessment via telehealth during the Covid 19 pandemic: Experiences and perspectives of autistic adults, parents/carers and clinicians

Abstract

Background The COVID-19 pandemic has seen a rapid increase in the use of telehealth to deliver services to autistic individuals and their families. Research into the provision of autism assessments via telehealth is limited and few studies have explored clinician perspectives of conducting diagnostic assessments for autism in this way. The objective of this study was to examine the acceptability of a new telehealth model from the perspective of key stakeholder groups in an Australian community-based sample i.e. clients undergoing assessment, parent/carers and expert clinicians. Methods Sixteen adult clients ( M age = 39.00, SD age = 14.39) and fifty-six parent/carers of children and adults ( M age = 44.09, SD age = 9.87) undergoing autism assessments completed an online survey about their experiences of assessments via telehealth. Of these, six clients and twelve parent/carers agreed to participate in follow up interviews. Seven clinicians were also interviewed. Results In this study, the majority of adults and parent/carers reported that they, or the person they cared for, felt comfortable interacting with the clinician, would be willing to undergo future assessments via telehealth and were not concerned that important information had been missed during the assessment. Although the clinicians were slightly less satisfied with tele-assessment process compared to face-to-face and relied on external sources of information more than they would during a face-to-face assessment, their overall confidence in their diagnostic decision making remained high. Conclusion Autism assessment via telehealth may be an acceptable alternative in some circumstances. However, a telehealth service should consider screening clients for suitability and adequately preparing clients for tele-assessments.

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.…”

“…Crucially, the onset of the pandemic appears to have exacerbated assessment waiting times. This is clinically concerning, as delays in diagnostic assessment mean that people, and potentially also their families/carers, may not be able to access appropriate needs-led interventions, irrespective of whether they have autism, an alternate condition or both ( 23 , 31 , 32 ).…”

“…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.…”

“…Findings indicated that patients, families, and health professionals endorsed high levels of satisfaction and acceptability. A second study conducted in Australia ( 23 ) used mixed-methods (an online survey with 72 participants and follow up interviews with 25 participants) to investigate autistic adults' (aged 21–76 years old), parents'/carers' and health professionals' perspectives about telehealth assessments conducted between March and September 2020. Overall, findings suggested that telehealth can be convenient, straightforward and satisfactory for some.…”