The implementation of telehealth to assess, monitor and treat neurodevelopmental disorders: a systematic review

Background: In response to COVID-19 there is increasing momentum behind the development and delivery of telehealth. To assess the anticipated exponential growth in telehealth it is important we accurately capture how telehealth was used in specific fields of mental health prior to COVID-19. Objective: The aim of this review was to highlight how telehealth had been used with clinical samples in the neurodevelopmental (NDD) field, including for patients with NDD, their families, and healthcare professionals. To identify which technologies show greatest potential for implementation into health services the review evaluates the technologies for effectiveness, economic impact, and readiness for clinical adoption. Methods: A systematic search of the literature was undertaken (April 2018 - updated until December 2019) using: Medline, Web of Science, Scopus, CINAHL Plus, Embase, and PsycInfo. Data extracted included the type of technology, how the technology was used (assessment, treatment, monitoring), participant characteristics, reported outcomes and the authors’ views on clinical effectiveness, user impact (including feasibility and acceptability), economic impact, and readiness for clinic adoption. A quality review of the research is reported using the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Results: A total of 42 studies met the inclusion criteria. These included participants and/or their families with autism spectrum disorders (ASD; n=21), attention deficit hyperactivity disorders (ADHD; n=8), ADHD and/or ASD (n=3), communication - disorders (n=7), and tic disorders (n=2). The majority of studies were with children/young people and/or their caregivers. The focus of most studies was treatment (n=33), rather than assessment (n=4) or monitoring (n=5). Telehealth services demonstrated promise for being clinically effective, predominantly in relation to diagnosing and monitoring NDDs. In the treatment of NDD, telehealth services were usually equivalent to control groups. There was some evidence for positive user and economic impact, including service delivery efficiencies, such as increasing treatment availability and decreasing waiting times. However, these factors were not widely recorded across all the studies. Telehealth was demonstrated to be cost-effective in the few studies that considered this. The quality of the studies varied, with many having small sample sizes and inadequate control groups. Only 11/42 were randomized controlled trials, the main other methodologies included case studies or case series (n=12), qualitative studies (n=6), and non-comparative trials (n=5). Conclusions: The use of telehealth has the potential to increase the availability of treatment, decrease waiting times for diagnosis, and aid in the monitoring of NDD. Further research, with more robust and adequately powered study designs as well as consideration of cost-effectiveness and efficiency savings, is needed. The review highlights the extent of the use of telehealth technologies prior to COVID-19 and the movement to invest in remote access to treatments