Evaluating Telehealth Assessment Satisfaction in Children and Adolescents with ASD and ADHD and their Caregivers: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Children and adolescents with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often face structural and psychological barriers in accessing medical care, including economic costs, long wait times, and stress of attending new medical environments. The coronavirus (COVID-19) pandemic accelerated the adoption of telehealth services to overcome these challenges. However, few studies have assessed the satisfaction levels of children and adolescents diagnosed with neurodevelopmental disorders and their caregivers when they use telehealth, particularly in Japan. This study aimed to evaluate satisfaction by conducting telehealth assessments in children and adolescents diagnosed with ADHD or ASD and their caregivers and identify factors associated with higher satisfaction levels. OBJECTIVE This study aimed to evaluate satisfaction by conducting telehealth assessments in children and adolescents diagnosed with ADHD or ASD and their caregivers and identify factors associated with higher satisfaction levels. METHODS A total of 68 patients aged 6–17 years with a confirmed diagnosis of ADHD or ASD and their caregivers participated in this study. The participants were recruited from Keio University Hospital and four collaborating institutions in Japan. Each patient and their caregiver underwent two assessment sessions, one face-to-face and the other via telehealth (a remote video tool), in a randomized order. Upon completing both assessments, the participants completed a satisfaction questionnaire using a five-point Likert scale that covered aspects such as audio and video quality, seamless communication, perceived warmth, reduced burden, and the ability to behave naturally. Spearman's rank correlation coefficients and multiple regression analyses were performed to identify factors associated with overall satisfaction. RESULTS Among the patients, 70.2 % reported being "satisfied" or "very satisfied" with the telehealth assessment, and 88.3 % of caregivers reported similar satisfaction levels. Multiple regression analysis showed that in patients, high satisfaction was associated with seamless viewing of the screen, reduced burden of hospital visits, and ability to speak naturally during the assessment. For caregivers, visual clarity and the child's natural behavior were crucial factors. CONCLUSIONS Telehealth assessments are an effective and practical option to provide care for children and adolescents diagnosed with ADHD or ASD and their caregivers, offering high levels of satisfaction. Technical reliability and reduced travel burden significantly contributed to positive experiences. However, ensuring that children and adolescents behave naturally and feel a sense of warmth during remote consultations is crucial to maximize their satisfaction. Telehealth services can enhance the quality of health care, making them valuable supplementary tools for clinical practice. CLINICALTRIAL The study protocol was registered with the UMIN Clinical Trials Registry (UMIN000039860).