Children and young adults with autism spectrum disorders (ASD) often find it challenging to visit the doctor’s office due to a variety of sensory, social, and communication barriers. The sights, sounds, smells, and textures commonly found in a doctor’s office can be overwhelming and can trigger anxiety. Many people with autism have difficulties with communication, making it hard for them to express their needs, and they may also struggle to understand instructions from the medical staff. All these different factors, in combination with challenging social interactions, create obstacles that an individual with ASD may find complex to navigate.
Telehealth has played an increasingly important role in improving healthcare delivery, making it more accessible and efficient since the COVID-19 pandemic (American Psychiatric Association, 2020). The APA conducted a survey of its members to understand how psychiatrists’ use of telehealth in practice has changed over the course of the pandemic. Prior to the pandemic, 64% of providers said they did not use telehealth to treat patients. In January of 2022, “81% of respondents said that they see 75-100% of their patients virtually” (APA, 2020). Currently, telehealth is a highly regarded tool that allows clinicians to observe patients in a more natural, relaxed setting and offers convenience for families (Ramirez-Moya, 2022).
Telehealth has also played a significant role in the diagnosis, treatment, and management of ASD. Research indicates that telehealth has significantly benefited individuals with ASD and can provide effective and reliable assessments and interventions with accuracy comparable to in-person evaluations. Parents and clinicians report high satisfaction with telehealth, appreciating the flexibility, cost savings, and the ability to observe children in their natural environments. Additionally, telehealth enables regular, consistent therapy and reduces the stress associated with traveling to appointments. These advantages contribute to improved overall care and quality of life for individuals with ASD (Kuhl-Meltzoff Stavropoulos, Bolourian & Blacher, 2022).
Applied behavior analysis (ABA) is a widely studied and utilized treatment intervention for individuals with ASD that has been shown to be effective (Smith & Iadarola, 2015). Using telehealth, therapists can deliver ABA instruction to children and their families via video conferencing to demonstrate techniques and monitor progress. This is particularly beneficial for families in remote or underserved communities where access to specialized care is limited (Nohelty, Bradford, Hirschfeld, Miyake & Novack, 2022). Overall, telehealth has transformed ABA services by making them more accessible, flexible, and efficient, ultimately leading to better outcomes for individuals with ASD and their families.
Telehealth allows individuals with ASD to receive care from a variety of multidisciplinary team members. Speech and occupational therapists, developmental pediatricians, and mental health professionals can be provided remotely, ensuring that children continue to receive consistent intervention despite the physical need for travel (California Telehealth Resource Center [CTRC], n.d.). Virtual meetings can be easily scheduled and conducted, allowing for more frequent and efficient team discussions and case reviews. Telehealth can provide individuals with ASD and their families with comprehensive and holistic care by multidisciplinary teams collaborating to adjust treatment plans in real-time while ensuring that interventions are well coordinated and holistic (CTRC, n.d.).
Telehealth platforms allow for greater involvement of parents and caregivers in the therapeutic process, which can lead to significant improvements in the child’s behavior and social skills. Parental training via telehealth has also been shown to help manage disruptive behaviors and support the child’s development more effectively (Hopson, 2020). One reason for telehealth’s increasing popularity is due to its ability to give an individual more control of their environment. In this way, people with ASD can avoid being subjected to overstimulating medical environments and, instead, can remain at home with more tolerable surroundings. Many parents also appreciate having the freedom to turn off the video camera in the event of a behavioral issue. Providing these options can go a long way in establishing trust between individuals with ASD and clinicians (Ramirez-Moya, 2022). Receiving care in their familiar and comfortable home environment can reduce the sensory overload and anxiety often experienced during in-person visits. This more relaxed setting can lead to better engagement and more accurate assessments.
While telehealth offers many benefits for individuals with ASD, it also presents challenges that can affect the quality of care and the effectiveness of telehealth interventions. Using telehealth to complete a diagnostic assessment may not work for every individual due to differences in symptom severity, age, and developmental impairment. All these factors will affect how a person with ASD responds to the online platform. One of the biggest concerns is that relying on telehealth to treat ASD will cause clinicians to overlook important subtleties that can be more easily observed in person. It can also be difficult to notice suicidal ideation, other co-morbidities associated with ASD, significant aggression, and signs of abuse (Ramirez-Moya, 2022). In situations like this, a hybrid method ensures a more holistic approach to treatment. Additionally, not all families have access to reliable internet or the necessary devices to participate in telehealth sessions. This digital divide can limit the availability of telehealth services for some populations. Connectivity issues, poor audio or video quality, and other technical problems can disrupt sessions, making it difficult to maintain effective communication and engagement. Ensuring privacy and confidentiality during telehealth sessions can be challenging, especially in busy households. Sensitive discussions or assessments may be overheard or interrupted. On the provider’s end, protecting personal health information during telehealth sessions is a priority. It requires secure platforms and compliance with privacy regulations. Healthcare providers and therapists may need additional training to effectively deliver telehealth services and use the technology efficiently. Lastly, for many families experiencing financial hardships, access to the hardware and software needed to participate in telehealth is still a challenge (Ramirez-Moya, 2022).
Telehealth has become increasingly popular for individuals with ASD and their families due to its ability to enhance accessibility, flexibility, and coordination of care. It has improved parental involvement in sessions, reduces stress and anxiety preparing for doctor’s appointments, and offers greater access to a multidisciplinary team. While telehealth can present some challenges, like technical issues and ensuring privacy, it can also help to overcome geographical barriers, offer flexible scheduling, and facilitate real-time support in natural environments. As a result, telehealth continues to be a valuable and widely adopted approach, meeting the diverse needs of the ASD community. The future of telehealth appears to be promising and holds great potential for improving access to care, personalizing treatment, and enhancing the quality of life for individuals on the spectrum and their families.
Jill Krata, PhD, CLC, is the Owner of Evolve Autism and Family Coaching. For more information, please email DrJill@evolveautismandfamilycoaching.com.
References
American Psychiatric Association (2021, July). Psychiatrists use of telepsychiatry during COVID-19 public health emergency: Survey Results. psychiatry.org/File%20Library/Psychiatrists/Practice/Telepsychiatry/APA-Telehealth-Survey-2020.pdf
California Telehealth Resource Center (n.d.). 10 Benefits of Telehealth for Autism Diagnosis and Treatment. caltrc.org/featured/10-benefits-of-telehealth-for-autism-diagnosis-and-treatment/
Hopson, C. (2020, June 23). Telehealth services for children with autism. UF Center for Autism and Neurodevelopment, department of psychiatry in the college of medicine. autism.psychiatry.ufl.edu/2020/06/23/telehealth-services-for-children-with-autism/
Kuhl-Meltzoff Stavropoulos, K., Bolourian, Y., & Blacher. J. (2022). A scoping review of telehealth diagnosis of autism spectrum disorder. PLoS ONE, 17(2): e0263062. journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0263062
Nohelty, K., Bradford, C.B., Hirschfeld, L., Miyake, C.J., & Novack, M.N.(2022). Effectiveness of telehealth direct therapy for individuals with autism spectrum disorder. Behavior Analysis in Practice 15, 643–658. doi.org/10.1007/s40617-021-00603-6
Ramirez-Moya, L. (2022, July 7). Telehealth’s calming effect on autism. Psychiatric times. psychiatrictimes.com/view/telehealths-calming-effect-on-autism
Smith, T., & Iadarola, S. (2015). Evidence base update for autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 44(6), 897–92. doi.org/10.1080/15374416. 2015.1077448.
