Early Intervention for Children with Autism: Which Factors Impact Service Approval?

Background: Autism affects children of all ethnicities, races and socio-economic levels.  Treatment with a program of early and intensive behavioral intervention has been associated with best outcomes for children with autism. Early Intervention(EI) is a federally mandated entitlement program for children birth to 3 years that provides free therapeutic services to eligible children and their families.  The services a child is approved for through the EI program are documented in the Individualized Family Service Plan(IFSP).  Previous analyses have shown that certain groups of children are at risk for delays in initiation of therapeutic services. 

Objectives: To determine clinical and demographic factors impacting on services approved at IFSP for children with autism from a diverse inner-city population.

Methods: Retrospective chart review of all children diagnosed with Autism Spectrum Disorder by a multidisciplinary evaluation at a University Affiliated EI program and whose families participated in an IFSP at the center from 2007 to 2009.  Data included: age, gender, ethnicity, dominant home language, maternal country of origin, level of maternal education, medical insurance coverage, child’s cognitive standard score(SS) and Childhood Autism Rating Scale(CARS) score. The types and intensity of intervention approved for each child at IFSP were also collected including: hours per week of applied behavioral analysis(ABA), speech therapy, occupational therapy, physical therapy, family training, and school program.  Statistical analysis included Chi-Square, independent T-test, and correlation. 

Results: Seventy children meeting inclusion criteria were identified. Demographics: mean age at IFSP:  25.4±5 months(mo)(12-36mo); gender:  75% boys; ethnicity: 10% white, 45.7% hispanic, 28.6% black, 15.7% other; dominant home language:  58% monolingual English, 25% bilingual Spanish/English, 9% monolingual Spanish, 9% other; maternal country of origin:  64% of mothers were born in the United States; maternal level of education: 30% of mothers were college graduates; medical insurance:  49% had Medicaid and 51% private insurance.  Clinical data: 53% had a cognitive SS ≥70.  Mean CARS score was 34±4 (range of 26-48). 

Children older than 24mo at IFSP were approved for more hours of ABA per week (11.97±6.3 vs. 8.48±6.7, p=0.03). Children with higher CARS scores were approved for more hours of ABA per week (r=0.248, p=0.04) and those with CARS scores above 40 were more likely to be approved for >10 hours of ABA than those with CARS scores <40 (67% vs. 29%, p=0.05).  There was also a trend for children with cognitive SS<70 to be approved for more hours of ABA per week (12.1±6.4 vs. 9.3±6.5 hours, p=0.08). There was no significant difference in the amount of ABA approved in terms of maternal country of origin, maternal education, medical insurance coverage, ethnicity, or dominant home language.  There were no differences in the intensity of other services by demographic characteristics.  

Conclusions: In this sample, greater intensity of behavioral intervention was approved for children with increased severity of autistic symptomatology and age greater than 24mo at IFSP. There was a trend towards increased behavioral intervention for children with ASD with lower cognition (SS<70). Other demographic factors (including Spanish home dominant language and ethnicity) did not affect intensity of services approved.