# Families’ and clinicians’ experiences with telehealth assessments for autism: A mixed-methods systematic review

## TL;DR

This review explores how families and clinicians feel about using telehealth for autism assessments in children, highlighting both benefits and challenges.

## Contribution

The study provides a systematic synthesis of families’ and clinicians’ experiences with telehealth for autism evaluations, which has not been previously examined.

## Key findings

- Participants reported high satisfaction with telehealth due to increased convenience, flexibility, and efficiency.
- Technical difficulties and challenges in observing behaviors were noted as key disadvantages of telehealth assessments.
- Telehealth may improve access for remote families but could disadvantage socioeconomically disadvantaged or non-English proficient families.

## Abstract

Recently, the utilization of telehealth for the evaluation of autism spectrum disorder (ASD) in children has increased considerably. Although past studies have explored the feasibility and validity of telehealth assessment procedures for ASD, the acceptability and perspectives of families and clinicians regarding telehealth for autism evaluations have not yet been systematically examined. This mixed-methods systematic review aimed to synthesize the available evidence to understand the experiences of families and clinicians with telehealth. We followed the Joanna Briggs Institute methodology guidelines for conducting mixed-method systematic reviews using the convergent integrated approach. We searched relevant databases (EMBASE, MEDLINE, PsycINFO, CINAHL, ASSIA) and other sources (e.g., grey literature) to identify eligible articles (PROSPERO: CRD42022332500). Data from eligible studies were pooled and subjected to thematic synthesis. In total, 27 studies were included in this review, involving 1013 caregivers and 521 clinicians who shared their perceptions and experiences with telehealth. Overall, participants were highly satisfied with telehealth procedures and noted several advantages, including increased convenience, flexibility, and efficiency (e.g., reduced costs and travel time), improved service provision and access to timely care, and enhanced clinical effectiveness. However, certain disadvantages, such as technical difficulties, difficulties observing certain behaviors, perceived lack of accuracy, concerns about the family’s role and safeguarding issues, among others, were also reported. Telehealth was believed to improve equity for some families (i.e., geographically remote families) while potentially disadvantaging others (i.e., socioeconomically disadvantaged families and those with limited English proficiency). Children who were older, less active, less medically and psychosocially complex and those with a clearer presentation of ASD were considered more suitable for a telehealth evaluation for ASD. In conclusion, this review provides new insights into the experiences of families and clinicians with telehealth, highlighting its potential uses for ASD evaluations and identifying areas for improvement and future research.

Although assessments for autism traditionally occur in person in clinical settings, in the last few years, many services have explored ways to conduct these evaluations remotely using telehealth. In this review, we searched scientific sources extensively for articles exploring clinicians’ and families’ experiences with telehealth assessments for autism in children. Both groups described several advantages associated with telehealth, including increased flexibility, convenience, efficiency, service improvement, and timely access for families. However, some disadvantages were also reported, such as difficulties with technology, a perceived lack of accuracy, and challenges navigating complex cases virtually. Participants also believed that, although telehealth can help services reach families residing in remote areas, this approach may disadvantage less affluent families and those less proficient in English. Older children, those presenting with more pronounced autistic traits, and children without additional medical or psychosocial difficulties and needs were considered more suitable for a telehealth evaluation. While telehealth has the potential to significantly improve services and access for autistic children and their families, further research is needed to optimize virtual diagnostic procedures and to broaden accessibility so that a wider range of the population may benefit from these advancements.