The soothing effect of telemedicine on autism

Going to the doctor's office can be a sensory obstacle course for people with autism spectrum disorder (ASD). Bright lights, loud noises and confusion along the way can drive patients and their caregivers to the brink of exhaustion. By the time patients meet with their physician, they are often very anxious and agitated.

Assessing and treating patients with ASD presents many challenges for patients, parents, caregivers and psychotherapists. Appointment logistics aside, the biggest hurdle is getting access to treatment. But since the COVID-19 pandemic, telemedicine has been used as a successful way to meet patients and treat them where they are.

Before the pandemic, 64% of physicians surveyed by the American Psychiatric Association said they did not use telemedicine to treat patients. In January 2021, 81% of respondents said they use telemedicine to care for 75% to 100% of their patients. Today, it is a highly valued tool that allows physicians to see patients in a more relaxed environment, provides convenience to families, and ultimately provides better care for patients.

Obstacles in the treatment of autism

ASD is a lifelong neurodevelopmental disorder that is diagnosed in about 1 in 44 children. It is characterized by varying degrees of impairment in social and language skills, limited interests, and repetitive behaviors. Autism can be diagnosed as early as age 2, but the average age of diagnosis is 4 years old. Diagnosis of autism usually includes interviews with parents and caregivers, direct observation of the patient, and opinions from other doctors, teachers, and caregivers. A thorough and early diagnosis can lead to valuable interventions to improve the patient's functioning. However, access to physicians, treatment, and services is not uniform across the country. Economic problems, geographic remoteness, lack of specialized clinics, and lack of cultural understanding are just some of the obstacles.

Children living in rural or remote areas are more likely to be diagnosed with autism six months later than children living in urban areas. Children living at or below the poverty line are diagnosed a full year later than children from wealthier families.

The growing popularity of telemedicine is helping to overcome these barriers and reach more patients. It also provides access to highly specialized doctors with different levels of training. Today, 38% of Americans use telemedicine to meet with doctors or psychiatrists, a figure that will rise to 31% in 2020.

Benefits for patients and families

It takes careful planning to make a medical visit go smoothly, and it is not uncommon for appointments to have to be rescheduled at the last minute. Being in a new or uncomfortable environment can increase any patient's anxiety level. Lively waiting rooms or memories of previous appointments can overexcite sensitive patients. Parents and caregivers quickly learn to ask for morning appointments and communicate their needs clearly. They come with a bag full of snacks and entertainment. They may even arrange a few practice visits to give patients time to get used to the environment.

One of the biggest benefits of telemedicine is its ability to give patients more control over their treatment environment. Patients can avoid abrupt transitions to medical facilities and stay in more natural settings, such as their homes. Many also appreciate the ability to turn off video if face-to-face communication becomes too stressful. Providing such options can go a long way toward building trust and connection between patients and physicians.

Telemedicine is also beginning to replace behavioral analysis therapy home sessions. Conducted up to 5 times a week, these sessions bring clinicians into the patient's home and can be invasive and disruptive in their own way. Telemedicine can be a subtle way for clinicians to observe patients in a relaxed setting. This, in turn, encourages patients to schedule more therapy sessions, leading to better monitoring of treatment and, in theory, better outcomes.

Telemedicine also benefits parents and caregivers by reducing stressful travel to medical appointments and actively engaging them in therapy sessions. This can give them the confidence to learn and apply valuable therapies. Clinicians can also provide more training for parents to review and reinforce strategies.

Benefits for clinicians

A 2013 study noted that there was no significant difference in the use of telemedicine as a reliable diagnostic tool. Parents also reported satisfaction with their experience using the platform. Telemedicine is a boon for clinicians because it facilitates the collection of consistent and naturalistic patient observations. This is supported by a previous study showing that clinicians who watched home videos of infants and toddlers were more successful in analyzing ASD symptoms. Clinicians also note the value of parental participation in telemedicine assessments because it gives them the opportunity to view their child's behavior from a different perspective.

Telemedicine can go even further, allowing physicians to contribute, share information and collaborate through online platforms. Advances in webcams allow physicians to remotely observe and measure patient behavior and even notice subtleties. But while telemedicine has great potential in treating autism, it is not a perfect tool.

Disadvantages

Using telemedicine for diagnostic evaluation may not be appropriate for every patient. Much depends on the severity of symptoms, age, and developmental disabilities. One of the biggest concerns is that by relying on telemedicine for autism treatment, clinicians may overlook important subtleties that are easier to see in person. It can also make it difficult to detect suicidal thoughts and behaviors, significant aggression and signs of abuse.

Telemedicine can also cause patients to behave differently. They may flatly refuse to communicate via video link or simply hang off-screen. Parent-child interactions may cause additional distractions. In such situations, face-to-face therapy appointments may be necessary.

Technological side effects, such as poor lighting and poor Internet connections, can also hinder the development of telemedicine. For families experiencing economic hardship, access to the hardware and software necessary to participate in telemedicine is still an issue.

Clinicians have little control over the patient's home environment, which can affect the success of telemedicine. Ultimately, the success of telemedicine depends on the clinician's confidence in using this tool as well as the willingness of patients and their families to participate. In some cases, nothing can replace the benefits of face-to-face appointments.

Final Reflections

Telemedicine is showing tremendous potential in bridging gaps in access to care. More and more clinicians are gaining confidence by using it to evaluate and diagnose patients with ASD. Of course, there will be situations where telemedicine cannot capture the full picture of a patient's needs. In such situations, clinicians can be more successful by combining in-person and online appointments.

The greatest advantage of telemedicine is its ability to treat patients with ASD in a comfortable and convenient setting. By reducing the stress associated with these visits, telemedicine proves to be a powerful tool to lead patients to well-being.

Dr. Ramirez-Moya is a child and adolescent psychiatrist at Mindpath Health.

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