Evaluating the Efficiency and Equity of Autism Diagnoses via Telehealth During COVID-19.
Megan Micheletti, Briana H Brukilacchio, Haley Hooper-Boyle and 4 others
PMID 37074489WHAT IT FOUND
Time to autism diagnosis did not significantly differ between telehealth and in-person evaluations.
Overall demographics and diagnosis rates were similar, though longer distance and private insurance were associated with longer telehealth diagnosis times.
Key findings
01Time to ASD diagnosis did not significantly differ between in-person (M = 5.3, SD = 2.7 months) and telehealth (M = 5.7, SD = 3.9 months) appointments, t(114) = -0.65, p = 0.517.
02Demographics of children diagnosed with autism did not differ across visit types, and the distribution of ASD, no ASD, and deferred diagnoses did not differ (p = 0.855).
03Private insurance and greater distance to the clinic significantly moderated the relationship between visit type and time to diagnosis, with longer telehealth diagnosis times for those groups.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The data came from one clinic and an 11-month period at the start of the pandemic, so the results may not apply to other settings or later telehealth practice. The time-to-diagnosis analysis included only children who received an autism diagnosis at the first appointment, not children who were deferred or not diagnosed. The sample was young, under 4 years, and diagnosis rates may be linked to that age range. Telehealth visits lacked standardized, documented evaluation procedures and relied more on caregiver report to show the child's behavior. The authors note the visits did not include gold-standard tools such as ADOS-2 or ADI-R. The study did not collect caregiver feedback about their experience of telehealth or what support they wanted. Some parents may have delayed accepting appointments because of pandemic concerns, and that delay was included in time to diagnosis.
The easy way to misread this
Do not conclude telehealth caused longer diagnosis times for privately insured or farther families. The study is a retrospective chart review from one clinic during early pandemic, and these factors only moderated an association, with unmeasured barriers possible.