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

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.