Children with autism spectrum disorder (ASD) can benefit significantly from access to a range of services to support well-being (e.g., behavioral support, developmental therapies), especially when started at a young age.1 Services vary with each child, and can be delivered by a diverse array of clinicians and educators.2 Main goals include improving social communication, minimizing meltdowns, facilitating child development, and promoting adaptive skills with the goal of maximizing functional independence.2 Children with ASD frequently also require individualized medical and/or behavioral therapy for co-occurring conditions (e.g., seizures, ADHD).

Many children and families experience barriers in accessing services.3 Children with ASD are at risk for, and experience significantly higher levels of unmet needs than typically developing children4 and children with other special needs.5 Many factors contribute to this disparity, such as insurance challenges, high healthcare costs, and a lack of specialized providers treating common co-occurring conditions and mental health challenges.5 Furthermore many families experience particular challenges in accessing services. A recent systematic review of access and use of allied health services (e.g., occupational therapy, applied behavioral analysis (ABA)), found that the children with ASD who were least likely to receive services were older, had less severe challenges, and were from minority groups and certain geographic regions.6 These results mirror findings of previous studies indicating disparities in service use for children and families with limited English proficiency,7 low-income and racial and ethnic minority children, 8, 9, 10 children with co-occurring psychiatric conditions,11 and children in rural areas.12

Telehealth provides a potential mitigation strategy for many barriers families face in receiving services, such as transportation, child care, and taking time off of work for appointments.10 The COVID-19 (coronavirus disease 2019) pandemic induced an unprecedented shift from in-person care to telehealth, a practice which was not standard in ASD services previously. A growing body of research exists on telehealth in this population, the vast majority of which includes only implementer-mediated interventions, in which specialists (e.g., psychologists) train others (e.g., parents) in the implementation of interventions. Despite encouraging evidence of acceptability and efficacy of virtual-delivery in these studies,13, 14, 15, 16, 17 there are significant gaps in the literature. First, there have been few studies identified that examine telehealth in which the direct recipient of care is the child with ASD.18 In a review of pre-COVID studies,16 only four examples were identified,19, 20, 21, 22 of which only one focused on providing direct care to children with ASD and a co-occurring condition.21 Though the few direct-care studies reported encouraging findings (including satisfaction with the telehealth model), more research is needed that includes larger sample sizes, more types of services, and greater attention paid to the factors that may contribute to success with this model, such as age, ASD symptom severity, and co-occurring conditions,16 information that could assist pediatricians and specialists alike in delivering care via telehealth.

During the onset of the COVID-19 pandemic, providers were forced to change their service delivery model virtually overnight. Due to restrictions related to in-person contact, institutions were confronted with having to prioritize which patients should be seen in person,18 and there was much national variation in the degree of shutdown of in-person services.23 Clinicians with varying levels of experience with telehealth were challenged to successfully administer ASD services by video. As a result, many services for children of all ages were conducted via telehealth for the first time, the experience of which remains largely undocumented.

In order to identify the strengths and challenges of telehealth for children with ASD during this unique time, we conducted qualitative interviews with clinicians providing virtual services during COVID-19 shutdowns. The purpose of this study was to explore provider perspectives on these strengths and challenges. Themes and potential implications for future use of telehealth in ASD services are discussed.