JMIR Publications

ABSTRACT

Background:

Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe, and fluctuate depending on context. Individuals can present for a diagnostic assessment in childhood or adulthood. However, waiting times for assessment are typically lengthy; many individuals wait months, or even years to be seen. Traditionally, there has been a lack of standardisation between services, in terms of how many and which multidisciplinary health professionals are involved in the assessment and what methods (diagnostic tools) they use. The COVID-19 pandemic impacted routine service provision due to stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person, to doing these fully via telehealth (defined as use of remote technologies for provision of health care), or using blended in person/telehealth methods.

Objective:

This study explored health professionals' experiences and perspectives concerning: (1) conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic, (2) potential telehealth training and supervision needs of health professionals, (3) how the quality and effectiveness of telehealth autism diagnostic services can be enhanced, and (4) experiences of delivering post-diagnostic support remotely.

Methods:

Forty-five health professionals, based across England and working in varied settings, participated in one off in-depth semi-structured qualitative interviews. These were conducted via videoconferencing or telephone (mean interview duration 46 minutes). Together, participants represented seven professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, social work). Data were analysed thematically.

Results:

Thematic analysis indicated there were seven themes: (1) practicalities of telehealth, (2) telehealth autism diagnostic assessments, (3) diagnostic conclusions, (4) clinical considerations, (5) post-diagnostic support, (6) future ways of working and (7) health professionals’ experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible and efficient for some patients, families and health professionals. However, not all patients could be assessed this way; for example, due to digital poverty, complex clinical presentation or concerns about risk and safeguarding. Working remotely had encouraged innovation, including development of novel assessment measures. Yet, some participants expressed significant concerns about the validity and reliability of assessing a social communication condition remotely.

Conclusions:

A shift to telehealth meant that autism diagnostic services could remain operational during the COVID-19 pandemic. However, this way of working has potentially impacted parity of service, with people presenting with clinical complexity potentially waiting longer to be seen or given a diagnostic opinion. There is also a lack of standardisation in provision, between services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.