Evaluating Telepsychiatric Assessment Satisfaction in Children and Adolescents With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder and Their Caregivers: Randomized Controlled Trial

Abstract

Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often face structural and psychological barriers in accessing medical care, including economic costs, long wait times, and stress of attending new medical environments. The COVID-19 pandemic accelerated the adoption of telehealth services to overcome these challenges. However, few studies have assessed the satisfaction levels of children and adolescents diagnosed with neurodevelopmental disorders and their caregivers when they use telepsychiatry, particularly in Japan.

Objective: This study aimed to evaluate satisfaction by conducting telepsychiatric assessments in children and adolescents diagnosed with ADHD or ASD and their caregivers and to identify factors associated with higher satisfaction levels.

Methods: A total of 68 patients aged 6-17 years with a confirmed diagnosis of ADHD or ASD and their caregivers participated in this study. The participants were recruited from Keio University Hospital and four collaborating institutions in Japan. Each patient and their caregiver underwent two assessment sessions, one face-to-face and the other via telepsychiatric assessment (a remote video tool), in a randomized order. Upon completing both assessments, the participants completed a satisfaction questionnaire using a 5-point Likert scale that covered aspects such as audio and video quality, seamless communication, perceived warmth, reduced burden, and the ability to behave naturally. Spearman rank correlation coefficients and multiple regression analyses were performed to identify factors associated with overall satisfaction.

Results: Among the patients, 70% (47/67) reported being "satisfied" or "very satisfied" with the telepsychiatric assessment, and 88% (60/68) of caregivers reported similar satisfaction levels. Multiple regression analysis showed that in children, high satisfaction was associated with seamless viewing of the screen, reduced burden of hospital visits, and the ability to speak naturally during the assessment. For caregivers, visual clarity and the child's natural behavior were crucial factors.

Conclusions: Telepsychiatric assessments are an effective and practical option to provide care for children and adolescents diagnosed with ADHD or ASD and their caregivers, offering high levels of satisfaction. Technical reliability and reduced travel burden significantly contributed to positive experiences. However, ensuring that children and adolescents behave naturally and feel a sense of warmth during remote assessment is crucial to maximizing their satisfaction. Telepsychiatric services can enhance the quality of health care, making them valuable supplementary tools for clinical practice.

Keywords: ADHD; ASD; attention-deficit/hyperactivity disorder; autism spectrum disorder; caregivers; mobile phone; telehealth; telepsychiatry.

Figure 1.. CONSORT diagram of participant flow through the study. ADHD: attention-deficit/hyperactivity disorder; ASD: autism spectrum disorder; CONSORT: Consolidated Standards of Reporting Trials.

Figure 2.. Responses of patients and their caregivers to each question. (A) Overall satisfaction, (B) seamless hearing (voice), (C) seamless seeing (video), (D) comparison of face-to-face consultation with seamless expression of message, (E) comparison of face-to-face consultation with warmth or physical touch, (F) comparison of face-to-face consultation with reduced time travel, and (G) comparison of face-to-face consultation with children’s ability to walk and behave naturally.