Use of telehealth for facilitating the diagnostic assessment of Autism Spectrum Disorder (ASD): A scoping review

Abstract

There is a significant delay between seeking help and a confirmed diagnosis of Autism Spectrum Disorder (ASD). This delay can lead to poor outcomes for both the families and individuals. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. We conducted a scoping review examining which telehealth approaches are used in the diagnosis and assessment of ASD in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A search for all peer-reviewed articles, combining the terms of autism and telehealth was conducted from 2000 to 2019. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) Real-Time method e.g. video conferencing that enables teams in different areas to consult with the families and to assess the child/adult in real time and (b) A Store-and-Forward method as Naturalistic Observation Diagnostic Assessment (NODA) system to upload videos of child's behaviors to a webportal that enables the clinicians to make an assessment remotely. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages and so only studies with small sample size using surveys and interviews were identified but the findings suggest that there is potential for telehealth methods to improve access to assessment and diagnosis of ASD used in conjunction with existing methods, especially for those with clear autism traits and adults with ASD. Larger randomised controlled trials of this technology are warranted.

Racial, Ethnic, and Sociodemographic Disparities in Diagnosis of Children with Autism Spectrum Disorder

“…There have been increased interest and a growing literature on the feasibility of using either Real-Time or Store-and-Forward telemedicine for ASD diagnostic assessments and interventions. 44 For example, Smith et al 54 compared the use of Naturalistic Observation Diagnostic Assessment with the in-person evaluation and found high rates of both diagnostic sensitivity and specificity (84.5% and 94.4%, respectively). Using a real-time method, Reese et al 55 found improved access to diagnostic services and high agreement between face-to-face and videoconferencing for the diagnostic assessment of children with suspected ASD.…”

“…Using a real-time method, Reese et al 55 found improved access to diagnostic services and high agreement between face-to-face and videoconferencing for the diagnostic assessment of children with suspected ASD. Overall, the use of telehealth in the field of ASD has been shown to be an effective, acceptable, and usable modality for both clinical evaluation and behavioral intervention 44 and represents a scalable alternative to traditional methods. Telehealth offers advantages for increasing access to diagnosis and care, expediting the diagnostic process and receipt of early intervention services, decreasing provider and patient costs, and increasing provider coverage area.…”

“…Telehealth offers advantages for increasing access to diagnosis and care, expediting the diagnostic process and receipt of early intervention services, decreasing provider and patient costs, and increasing provider coverage area. 44 It is important to note, however, that educational, socioeconomic, language, and literacy factors may minimize the impact of telehealth services for populations of color, who are more likely to suffer from the digital divide. Although not a panacea for health disparities, telemedicine can be a viable option for families in remote and underserved areas, which allows for extended and expanded access to quality services, including for children of color.…”

Transitioning to Telemedicine During COVID-19: Impact on Perceptions and Use of Telemedicine Procedures for the Diagnosis of Autism in Toddlers

“…The onset of the COVID-19 pandemic, including suspension of in-person appointments and ongoing social distancing requirements in clinic settings, hastened tele-assessment uptake (Berger et al, 2021;Jang et al, 2021;Wagner et al, 2020). Alfuraydan (2020) reviewed 10 studies investigating ASD tele-assessment from 2000 to 2019. Findings suggest that there is potential for telehealth models to improve access to assessment and diagnosis of ASD, especially in those individuals with clear symptoms.…”

Remote assessment in adults with Autism or ADHD: A service user satisfaction survey

“…Although that study was not powered to show discriminative ability between the face to face and the remote version of Module 4 of the ADOS the study adopted, the authors claimed that “an autism assessment can be administered remotely with high levels of reliability using ADOS-2” [ 17 ]. A different scoping review in the use of telehealth for facilitating the diagnostic assessment of Autism identified 10 studies [ 18 ] and suggested that for certain presentations, remote assessment methods might be as reliable as face to face consultations when making a diagnosis [ 18 ]. This claim however cannot be extended at least to adults, since the only adult study the authors included was the Schutte et al [ 19 ] study.…”