International Meeting for Autism Research: The US Recession and Changes in the Use of ASD Assessment Services

The US Recession and Changes in the Use of ASD Assessment Services

Saturday, May 22, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
10:00 AM
C. Klaiman , Mental Health, Children's Health Council, Palo Alto, CA
J. Slay , Children's Health Council, Palo Alto, CA
L. Huffman , Children's Health Council, Palo Alto, CA
Background: In September 2008, the US economy drastically changed. Almost overnight, families were feeling the impact of the economic crisis. The Children’s Health Council (CHC) is a non-profit organization in the San Francisco Bay Area of California. It specializes in comprehensive multidisciplinary assessments of academic, behavioral and developmental problems and sees hundreds of child clients each year, with a large proportion of services related to family concerns about autism. 
Objectives: This CHC study assessed trends in assessment service use by parents of children with a suspected autistic spectrum disorder (ASD). We hypothesized that, due to financial concerns, parents sought and received more streamlined assessments during the year after September 2008 compared to the previous year.
Methods: Secondary data analysis of an extensive CHC clinical dataset was conducted. Current services data were collected 10/1/08 through 9/30/09 (after the estimated start of the economic crisis). Past services data were collected 10/1/07 through 9/30/08 (before the crisis). Analyses addressed demographic, services, and insurance data from all children who, following a diagnostic assessment, were diagnosed with an ASD (i.e., Autistic Disorder, Asperger Syndrome, Pervasive Developmental Disorder NOS).
Results: Across the selected 2 years, 420 children had an assessment resulting in an ASD diagnosis. 229 children started assessments in the ‘past’ year and 191 children started in the ‘current’ year. Preliminary analyses showed that, as in the past year, the current year clients were 86% male with 19% receiving public insurance. Across years, the majority of diagnostic assessments were conducted by a single-discipline (~56 %). However, there were significant year-based differences with regard to client age and number of assessment service hours utilized. In the current year, compared to past year, children were significantly younger at the time of assessment (8.4 yrs vs. 7.4 yrs, p=.00). In addition, there were fewer assessment service hours utilized (timeframe, the average length of diagnostic evaluation was 19.2 hrs vs. 12.5 hrs, p=.00).
 Past (10/1/07 - 9/30/08)
Current (10/1/08 - 9/30/09)
Child demographics
Age (M, SD)
8.4 (4.9)
7.2 (4.3)
Gender (% male)
196 (86%)
165 (86%)
Family financial status
Health Insurance (% public)
46 (20%)
34 (18%)
Assessment services
Service type (% single-discipline)
135 (59%)
99 (52%)
# disciplines included (M, SD)
1.7 (1.0)
1.8 (0.9)
# service hours (M, SD)
19.2 (22.3)
12.5 (13.9)

Conclusions: It appears that, since the downturn in the economy, there are fewer assessment service hours spent evaluating children with possible ASD diagnoses. This shift is true for both publicly and privately insured families.  It may be that while parents are seeking assessment services that cost less, diagnostic clinicians are also offering shorter, more focused assessments to retain clientele. The current economic climate should thus encourage clinicians to revisit assessment protocols and identify tools that provide the most information with less cost.

See more of: Services
See more of: Clinical & Genetic Studies