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.