Examining clinicians' concerns delivering telemental health interventions directly to autistic individuals during COVID-19

Lucy Adams; Nicoletta Adamo; Matthew J Hollocks; Lucia Valmaggia; Aylana Brewster; Jennifer Watson; Maisie Krisson; Emily Simonoff

doi:10.1016/j.rasd.2022.101956

Examining clinicians' concerns delivering telemental health interventions directly to autistic individuals during COVID-19

Res Autism Spectr Disord. 2022 Jun:94:101956. doi: 10.1016/j.rasd.2022.101956. Epub 2022 Mar 29.

Authors

Lucy Adams^{1

2}, Nicoletta Adamo^{2

3}, Matthew J Hollocks^{2

3}, Lucia Valmaggia¹, Aylana Brewster², Jennifer Watson¹, Maisie Krisson², Emily Simonoff^{2

3}

Affiliations

¹ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.
² Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK.
³ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.

Abstract

Background: The COVID-19 pandemic necessitated the adoption of telemental health (TMH). Pre-pandemic, clinicians had voiced many TMH concerns, but these had not been investigated with respect to autism spectrum disorder (ASD) even with it being known that there are distinct ASD-associated challenges for in-person mental health interventions.

Method: A convenience sample of (n = 55) clinicians completed an online survey regarding their perspectives of adopting TMH interventions in ASD, with closed- and open-answered questions. Quantitative and qualitative data were analysed descriptively/inferentially and via Content Analysis, respectively.

Results: Multiple clinicians endorsed each TMH challenges/barrier previously identified as concerns in the non-ASD literature. However, overall levels of concern over challenges/barriers were low, and challenges were more likely to be predicted than experienced and considered to be case/presentation specific. Challenges that were considered ASD-specific included the exacerbation of those associated with in-person delivery in ASD, alongside difficulties with trust and appropriate remote social behaviour. On average, clinicians indicated a preference for 50% TMH interventions post-pandemic. Clinicians' perceived technological competence and extent of professional experience with ASD were not significantly associated with levels of concern, nor number of experienced challenges, with TMH interventions in ASD.

Conclusion: In support of the existing TMH literature, challenges/barriers were more likely to be predicted than experienced and were considered to be case/presentation-specific, though this may be more variable in ASD owing to the well-established marked heterogeneity in this population. Remote provision of interventions exacerbated in-person ASD-associated challenges, as predicted, but clinician-level factors appeared not to impact TMH perceptions.

Keywords: ASD; Mental health interventions; Telehealth; Telepsychiatry.