Objectives: To examine diagnostic patterns and educational settings for children with ASD living in US states that vary by percentage of rural population.
Methods: Web-based, parent-reported data were analyzed for 40 states with at least 25 IAN participants. Selected variables were correlated with percentage of state rural population (based on Census Bureau 2000 data). States also were assigned to three groups based on percent rural population. The “rural” group was ³30% rural (n=14 states, max = 59.8% rural); the “mixed” group was >16% and <30% rural (n=13); and the “urban” group was ≤16% rural (n=13). ANOVA was performed to determine group differences on IAN indicators.
Results: State rural percentage was strongly correlated with mean age at first diagnosis, r(38)=.51, p<.001. The three state groupings also differed significantly, F (2, 37)= 5.31, p<.01: the mean age of first diagnosis for children in the rural states (M=4.15, SD=.396) was higher than that of the mixed group (M=3.97, SD=.248) and the urban group (M=3.70, SD=.414). However, there was no correlation or significant difference between the groups for age at parent’s first concern. The three groups differed significantly on percent enrolled in public schools, F (2, 37)= 3.70, p<.05: more children in the rural group were enrolled in public schools (M=63.1%, SD=12.6%) than in the mixed group (M=55.1%, SD=8.7%) or the urban group (M=52.8%, SD=8.7%). Children in public schools were more likely to have opportunities for inclusion with typically developing peers, r(38)=.64, p<.0001.
Conclusions: Living in a more rural state may delay ASD diagnosis and limit access to private schools, but encourage community inclusion. Further examination of such state and regional differences may improve service delivery and enhance child outcomes.