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 diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of 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 the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals’ experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and 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 in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of 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.

中文翻译：

---

儿童、年轻人和成人的远程医疗自闭症诊断评估：与英格兰范围内的多学科卫生专业人员的定性访谈研究

背景：自闭症谱系障碍（以下简称自闭症）是一种常见的神经发育疾病。核心特征的范围可以从细微到严重，并且会根据上下文而波动。个人可以在儿童期或成年期进行诊断评估。然而，评估的等待时间通常很长，许多人等待数月甚至数年才能看到。传统上，关于有多少和哪些多学科卫生专业人员参与评估以及使用的方法（诊断工具），服务之间缺乏标准化。由于居家令和社交距离准则，COVID-19 大流行影响了日常服务的提供。自闭症诊断服务必须适应，目的：本研究探讨了卫生专业人员在 COVID-19 大流行期间进行远程医疗自闭症诊断评估的经验和观点，包括对此的障碍和促进因素；卫生专业人员的潜在远程医疗培训和监督需求；如何提高远程自闭症诊断服务的质量和有效性；以及远程提供诊断后支持的经验。方法：共有 45 名卫生专业人员，在英格兰不同的环境中工作，参加了一次性的、深入的半结构化定性访谈。这些是通过视频会议或电话进行的。参与者总共代表 7 个专业学科（精神病学、医学、心理学、言语和语言治疗、职业治疗、护理和社会工作）。然后对数据进行主题分析。结果：专题分析指出以下 7 个主题：远程医疗的实用性、远程医疗自闭症诊断评估、诊断结论、临床考虑、诊断后支持、未来工作方式以及卫生专业人员的经验和需求。总体而言，许多参与者认为远程医疗自闭症诊断评估对一些患者、家庭和卫生专业人员来说是方便、灵活和高效的。然而，并非所有患者都可以通过这种方式进行评估，例如，由于数字贫困、复杂的临床表现或对风险和保障的担忧。远程工作鼓励创新，包括开发新的评估措施。然而，结论：向远程医疗的转变意味着自闭症诊断服务在 COVID-19 大流行期间仍然有效。然而，这种工作方法可能会影响服务的均等性，出现临床复杂性的人可能不得不等待更长的时间才能看到或给出诊断意见。在提供服务方面也缺乏标准化。进一步的研究应确定以证据为基础的方法，以提高自闭症诊断途径的及时性、可及性和稳健性，以及远程医疗方法的有效性和可靠性。