Autistic young people's experiences of remote psychological interventions during COVID-19

Telepsychiatry has been rapidly adopted to help control the spread of coronavirus. Clinicians have raised concerns over this for individuals diagnosed with autism spectrum disorder. The remote delivery of psychological interventions in particular requires further attention as their in-person delivery has autism spectrum disorder-associated challenges which overlap with the challenges of telepsychiatry broadly (i.e. beyond autism spectrum disorder). Autistic service-users (aged 15-18 years, n = 6) and clinicians working with this client group (n = 8) were therefore interviewed about their experience of remote psychological interventions during the pandemic. The sample size was determined using preregistered thematic saturation calculations. Thematic analysis of responses identified challenges/barriers, benefits, facilitators, and factors perceived to cause variability in experiences of remote delivery. These broadly echoed those identified in existing literature, but their underlying reasons had not been explored before and some were novel. Novel findings mostly surrounded difficulties navigating a new social system online, and the intensity of the social interaction feeling reduced remotely. Themes were broadly the same between young people and clinicians, aside from subtle differences. For example, young people provided distinct reasons for some of the perceived benefits. Most participants advocated for the provision of hybrid delivery post-pandemic. Implications of findings are discussed. Lay abstract Recently, therapy has been delivered at a distance (i.e. remotely) to help control the spread of coronavirus. Clinicians have voiced concerns that remote delivery is unsuitable for certain individuals, including those who are autistic, but they have also highlighted potential benefits for autistic individuals. Benefits include some individuals feeling more comfortable receiving therapy at home. This is the first study to interview autistic individuals about their experience of remote therapy. Participants were six young people aged 15-18 years and eight clinicians. Participants described their experience of remote delivery, including challenges, benefits, and suggestions. Most of these supported previous research findings, but some were new or provided further insight into those already identified. A newly identified challenge was knowing online social etiquette. All participants found aspects of the experience challenging, but all identified benefits and most voiced that remote sessions should be offered to young people. Participants further identified individual characteristics that may make someone less suited to remote delivery (e.g. shyness). They also identified ways of making the experience of remote delivery easier (e.g. sitting with a pet). Young people's and clinicians' views were similar overall, with only subtle differences. For example, young people uniquely voiced that remote delivery was similar to in-person, that benefits were hard to identify, and provided distinct reasons for the social interaction feeling less intense remotely. Findings may be used to improve remote delivery, for guiding future research, and as a case for continuing to offer it to those who may most benefit.