State Differences and Comprehensive Treatment Model Characteristics Affecting the Receipt of Educational and Therapeutic Services for School-Aged Children with Autism Spectrum Disorder

Background: Extant research suggests state of residence and comprehensive treatment model (CTM) characteristics affect access to and receipt of school-based services for children with autism spectrum disorder (ASD) (Thomas et al., 2007; Stahmer & Mandell, 2007). Speech language therapy (SLT), occupational therapy (OT) and applied behavior analysis (ABA) are types of services families of children with ASD often utilize. The purpose of this study was to examine factors affecting the receipt of both in-school and out-of-school services for school-aged children with ASD. 

Objectives: To examine how the types and dosage of services children receive in private and school settings relate to (1) state of residence (i.e., North Carolina, Florida, Minnesota or Colorado); and (2) participation in a CTM (LEAP or TEACCH) or a “business-as-usual” (BAU) treatment approach.

Methods: Families of children with ASD (n=117), ages 3 to 5, enrolled in self-contained or integrated classrooms participated in the study. For state-to-state comparisons, the ADOS, Mullen Scales of Early Learning (MSEL) and an SES composite variable were included as covariates. Information on the type and dosage of service (i.e., # of minutes per session and # of hours per month) was gathered. Zero inflated negative binomial or poisson regression models were used, where appropriate, to examine the relationship between services used, state of residence, and CTM characteristics. These analyses are appropriate for count data that are overdispersed and/or contain an excess of zeros.

Results: In terms of state differences, families in Minnesota received a larger dose of in-school SLT than those who lived in North Carolina (p= .025) and Florida (p= .025). Colorado families received a larger dose of in-school OT than those in Florida (p= .000) and Minnesota (p= .000). Children with ASD received a smaller dose of private OT in Colorado (p= .010) than those in Florida. With regards to participation in a CTM, children in LEAP received a larger dose of in-school SLT than those in TEACCH (p= .003) and BAU (p= .048) classrooms. Children in BAU received a smaller dose of private SLT than children enrolled in LEAP (p= .050) and TEACCH (p= .038). LEAP children were less likely to receive private OT than those in BAU (p= .004) and TEACCH (p= .010), but when they did receive private OT, it was a larger dose than BAU children (p= .019). Finally, TEACCH children received a smaller dose of in-school OT than children in LEAP (p= .029) classrooms. 

Conclusions: Factors outside of child or family characteristics can affect receipt of services for school-aged children with ASD. Based on this study, state of residence can affect the dosage of OT and SLT services used. Participation in a CTM or BAU also affected the dosage of in and out-of-school OT and SLT as well as the likelihood of using private OT services. Our findings appear to have implications for state-wide policy and practice.