Age-Related Differences In Treatment Utilization for Children with Autism Spectrum Disorders

Background: The phenotypic presentation and needs of children with autism spectrum disorders (ASDs) are complex and diverse, contributing to the lack of a single course of treatment for ASD.  Numerous treatment options have been proposed to address the needs of persons with ASD, and though multiple professionals may be involved, parents typically drive treatment, from choosing treatments to implementation.  Parents choose particular treatments  depending, in part, on their children’s ASD symptomology (Goin-Kochel, Myers, & Mackintosh, 2007), sometimes pursuing treatments before formal diagnosis (Levy & Hyman, 2005). Yet parents often change the treatments they pursue as their children age.  For example, parents of young children often use more simultaneous treatments than those with older children (Green et al., 2006).  Special diets (e.g., gluten-free and/or casein-free) and behavioral/ educational treatments are more often pursued for younger age groups (Goin-Kochel et al., 2007).  Psychopharmacological treatments are more common among older children (Aman, Lam, & Collier-Crespin, 2003; Goin-Kochel et al., 2007), although drug treatments are increasingly offered to younger and younger children (Olfson, Crystal, Huang, & Gerhard, 2010). Collectively, these results have focused on the treatments that different children are using at different ages, but little is known about the patterns of treatment use among the same children at different ages.

 

Objectives: To investigate age-related trends in types of treatments pursued by parents of children with ASD.

 

Methods:  Participants will include children with ASD between the ages of 4 and 18 who are participating in the Simons Simplex Collection (SSC; https://sfari.org/simons-simplex-collection). Currently, 1,887 children have received ASD diagnoses via research-reliable administrations of the ADI-R and ADOS within the SSC.  Data regarding types of treatment pursued by each family were collected through an extensive Treatment History Form, dating back to age 2 years, as well as a Medical History Interview.  Categories of treatments include: speech therapy, occupational therapy, psychotropic medications (e.g., antipsychotics, ADD/ADHD medications), intensive behavioral therapies (e.g., ABA), biomedical treatments (e.g., chelation, special diets), and other treatments (e.g., social-skills training, picture exchange system). Descriptive data will be presented in multiple graphs to enable visual comparison of proportions of children receiving different treatment types at various ages (range = 2—18 years).  Chi-square analyses will be conducted to investigate whether the difference in proportions of children receiving various treatments is statistically significant. 

 

Results: We expect that differences in treatment-type utilization will emerge, both within treatment type and across age groups. For example, it is expected that speech-language services will be used by larger proportions of children at younger ages, while psychotropic medication will be used by larger proportions of children at older ages. Trends will be examined according to the ages at which parents stop using select treatment types and start using others.

 

Conclusions: Results of this study will facilitate understanding of when and how long parents implement different types of ASD treatments.  In addition to potentially enhancing treatment planning, results of this study will also provide the foundation for future studies, such as investigating the influence of early treatment utilization on long-term phenotypic presentation.