Assistant Medical Director As You Are Tampa, Florida, United States
Background: Early diagnosis of Autism Spectrum Disorder (ASD) enables timely access to services that support child development. However, due to a shortage of developmental specialists and geographic inequities, wait times for autism evaluations are long. Regional pilot studies have shown that general pediatricians may accurately diagnose autism, and telehealth models validated during the COVID pandemic may help address geographic barriers. Objective: The objective of this study was to significantly reduce wait times for autism assessment across the United States, by employing a novel model that utilized general pediatricians and telehealth evaluations. Design/Methods: This prospective cohort study involved 5602 children, ages 16 months through 10 years, evaluated for ASD between 1/31/23 and 10/20/23. Evaluations were performed by 24 general pediatricians who underwent ≥3 weeks of autism-specific training and received clinical supervision from a child psychologist and a developmental pediatrician. During the intake process, caregivers reported if their child was currently on a waitlist for an in-person autism assessment, and the duration of that wait period. Time from referral to first appointment and referral to diagnosis were tracked on the telehealth platform. For the 1200 children on an in-person waitlist, wait time for in-person and telehealth evaluation was compared with a paired Wilcoxon test. Reductions in wait were compared across state, sex, race, and ethnicity with a one-way analysis of variance. Results: Participating children had a median age of 4.0 (IQR: 3) years, were 69% male (833/1198), 19% Hispanic (229/1200), and 60% White (726/1200). There was an average wait time of 344 days (IQR: 194) for an in-person evaluation. Initial telehealth appointments were completed within 17 days (IQR: 13), and a diagnosis was made within 48 days (IQR: 27) - a significant reduction in wait (Mean diff = 292 ± 7 days, p < 0.001, Figure 1). Telehealth visits were completed across 41 states. Among states with at least 20 appointments, the largest reduction in wait times were observed in Missouri (median 451 days), Washington (409 days), and Maryland (343 days). Reductions in wait times were similar regardless of sex (F = 0.29, p = 0.58), race (F = 0.43, p = 0.81), or ethnicity (F = 0.93, p = 0.39).
Conclusion(s): Telehealth evaluations performed by general pediatricians with autism-specific training significantly reduced time to autism evaluation for children across 41 states. Further studies should investigate the ability of this approach to expedite time-to-intervention for children with autism.
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