Frequency of Interventions to Children with ASD in the Pre-School Period: Findings From the New Jersey Autism Study

Background: A growing body of evidence supports the early identification of Autism Spectrum Disorders (ASD) and the provision of timely interventions to children with ASD.  While early interventions hold promise for language, cognitive and social improvement, there is scant data describing the frequency with which Early Intervention Program (EIP) and pre-school services for disabled students (PSD) are provided to ASD children.   Analysis of the extent to which these core early intervention services are provided is necessary to determine if these services are being employed to their full potential and to better understand their role in assisting children with ASD.

Objectives: This study investigated the number, proportion and demographic distribution of children with ASD receiving services prior to kindergarten through EIP and/or as a result of PSD classification, in a large metropolitan, population-based sample and analyzed demographic differences among children receiving such services. 

Methods: Data were collected as part of the New Jersey Autism Study (NJAS), an ASD surveillance investigation carried out in Essex, Union, Hudson and Ocean Counties.  Using an active case-finding method established by the Centers for Disease Control and Prevention (CDC), ASD surveillance data were developed for children who were born in 1998 and resided in the surveillance region in 2006.  NJAS data were based on review, analysis and independent ASD case-determination derived from information contained in health and education records.  Demographic information and case-specific data, including the use of early intervention services and the classification of children for PSD services were analyzed. The socioeconomic status (SES) of children with ASD was represented by the District Factor Group (DFG) ranking, a community-level index.  Statistical analysis was performed using Chi-square tests. 

Results: In a population of over 30,000 8-year old children, 528 children were identified as having ASD.  206 of these children (39.3%) received EIP services and 374 of the ASD children (70.8%) were served under a PSD classification. Overall, the receipt of EIP services and PSD classification did not vary significantly by gender.  While PSD classification did not vary by race, White children with ASD received EIP services more frequently than non-White children (p<.003).  Additionally, the frequency of children with ASD from high-SES communities receiving EIP services (p<.01) and classified as needing PSD services was significantly higher than those from children residing in mid or low-SES communities (p<.02).

Conclusions: Despite a growing awareness of ASD in the context of a well-developed pediatric health system, a significant majority of children with ASD residing in our surveillance region did not receive EIP services before the age of 3.  Non-White children were less likely to receive EIP services than White children.  While nearly three-quarters of all ASD children were identified for PSD services, participation in EIP and PSD programs was strongly associated with SES. The relatively low participation of ASD children in EIP and observed disparities in EIP and PSD program participation call for the broad implementation of innovative identification programs for children under age 3 and redoubled efforts to identify and intervene with socially-disadvantaged children at risk for ASD.