Associations of Telehealth Use With Health Outcomes Among Young People With Autism Spectrum Disorder.

Objective

This study aimed to compare clinical outcomes among children and adolescents with autism spectrum disorder (ASD) who did or did not have documented telehealth (TH) utilization.

Methods

Data were aggregated from electronic health records of 112 health care organizations (queried in March 2026). Patients ages 5-18 years who had received a diagnosis of autistic disorder (ICD-10-CM code F84.0) were assigned to a TH or non-TH cohort. After 1:1 propensity score matching (PSM) across 14 comorbid condition categories, the analysis included 12,380 patients per cohort at 6 months and 15,689 patients per cohort at 12 months. Eight outcomes were assessed: medical noncompliance, antipsychotic initiation, emergency department (ED) visit, inpatient hospitalization, antidepressant initiation, attention-deficit hyperactivity disorder (ADHD) medication initiation, irritability-related encounters, and adaptive behavior treatment. Risk ratios (RRs), hazard ratios, and encounter frequencies were derived.

Results

PSM cohorts were well balanced. In the 6-month analysis, TH use was associated with lower antipsychotic initiation (RR=0.81) and hospitalization (RR=0.69) but more ED visits (RR=1.39), irritability-related encounters (RR=2.49), and adaptive behavior treatment (RR=5.17). In the 12-month analysis, higher irritability (RR=2.29) and adaptive behavior treatment (RR=3.40) persisted in the TH cohort, which also had increased antidepressant (RR=1.17) and ADHD medication initiation (RR=1.12) and greater medical noncompliance (RR=1.84).

Conclusions

TH use by young people with ASD was associated with lower rates of hospitalization and antipsychotic initiation at 6 months, although not at 12 months. TH use was also associated with increased irritability-related encounters and adaptive behavior treatment. These findings highlight the need for tailored hybrid care strategies.