Exploring the Potential Use of Telehealth Technology to Improve the Diagnostic Process of Autism Spectrum Disorder (ASD) in Wales, United Kingdom

There is a significant delay between parents initially seeking help and receiving a diagnosis of Autism Spectrum Disorder (ASD). Telehealth has the potential to accelerate the ASD diagnostic pathway. However, user acceptance is essential for the successful implementation of telehealth technology. This thesis therefore aims to examine whether telehealth can be used to increase access to ASD diagnostic services in Wales and reduce the time taken to receive a diagnosis. To achieve this, a multimethod approach was adopted, comprising of three studies. Initially, a scoping review (Study1) was conducted examining the use of telehealth in ASD diagnostic assessment. This identified two methods: (a) Real-Time (b) Store-and-Forward, particularly the Naturalistic Observation Diagnostic Assessment (NODA) system. Results also suggest that telehealth is feasible and acceptable to the families. However, findings indicate that no study had thus far examined the factors of telehealth acceptance, based on theoretical foundation. Therefore, Studies two and three were conducted, to explore the parental experience of the diagnostic process, and investigate the predictors of their acceptance to use NODA for ASD diagnostic assessment, using the Unified Theory of Acceptance and Use of Technology model. Data for both studies was collected via an online questionnaire, targeting parents of children with ASD in Wales. Descriptive and inferential statistics were applied to the closed-ended questions, and thematic analysis was used for open-ended questions. Study 2 findings revealed that the majority of parents were dissatisfied with the diagnostic process, with the time taken to obtain a diagnosis being a predictor of their satisfaction. Study 3 found that the majority of parents felt positively towards the NODA, with their willingness to use the system being predicted by their age, performance expectancy, social influence and comfort with using laptop and smartphone devices. Implications and recommendations are further discussed at the end of the thesis

Use of telehealth for facilitating the diagnostic assessment of Autism Spectrum Disorder (ASD): A scoping review

There is a significant delay between seeking help and a confirmed diagnosis of Autism Spectrum Disorder (ASD). This delay can lead to poor outcomes for both the families and individuals. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. We conducted a scoping review examining which telehealth approaches are used in the diagnosis and assessment of ASD in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A search for all peer-reviewed articles, combining the terms of autism and telehealth was conducted from 2000 to 2019. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) Real-Time method e.g. video conferencing that enables teams in different areas to consult with the families and to assess the child/adult in real time and (b) A Store-and-Forward method as Naturalistic Observation Diagnostic Assessment (NODA) system to upload videos of child’s behaviors to a webportal that enables the clinicians to make an assessment remotely. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages and so only studies with small sample size using surveys and interviews were identified but the findings suggest that there is potential for telehealth methods to improve access to assessment and diagnosis of ASD used in conjunction with existing methods, especially for those with clear autism traits and adults with ASD. Larger randomised controlled trials of this technology are warranted