Private and School-Based Therapies: Characteristics of Children Receiving Services Across Settings

Background:  Children with autism spectrum disorders (ASD) receive speech (ST) and occupational therapies (OT) in private settings and/or through public school districts.  For many reasons, parents often rely on schools to provide these related services (Thomas et al., 2007).  However, not all students with ASD are eligible for school-based services; clinical diagnosis is not sufficient for eligibility under the Individuals with Disabilities Educational Improvement Act of 2004 (IDEIA, 2004), which also requires “educational need”.  Various factors may contribute to determination of “educational need” and resulting IDEIA (2004) eligibility, including cognitive and communication deficits rather than social impairments, which are central to ASD diagnoses (Eaves & Ho, 1997; White et al., 2007). Understanding characteristics of children with ASD receiving therapies in different settings (e.g., private and/or school-based) may inform gaps in service delivery across settings that may better address the diverse needs of students in this population.

Objectives:  To (a) provide descriptive information about lifetime utilization of private and school-based therapies for students with ASD in a large, well-characterized sample; (b) determine whether specific child and/or family characteristics influence the likelihood of their receiving therapies in private versus school-based settings.   

Methods:  Data were analyzed for students with ASD (N = 2,115; M age = 8.5 years, SD = 3.5 years, range = 4—17.11 years) who participated in the Simons Simplex Collection (SSC). Parents provided detailed history of ever using private and school-based therapies. Verbal cognitive scores were derived from norm-referenced, standardized instruments, and severity of ASD symptomatology was measured using the Autism Diagnostic Observation Schedule (ADOS; Lord et al., 2001). Frequencies of use for private and school-based ST and OT were calculated. Logistic regressions allowed examination of factors predicting use of therapies in different settings. Forthcoming analyses include chi-square tests of homogeneity to investigate potential differences (e.g., cognitive functioning, ASD symptoms, SES) among students who received therapies in different settings. 

Results:  Most participants had received school-based ST (80.4%) and OT (66.4%) at some time. Fewer students had ever received the same services privately (ST: 52.6%; OT: 41.4%).  Logistic regressions indicated factors contributing to students’ lifetime use of private ST were parent education, family income, ASD severity, child age, age of problem onset, and verbal cognitive score. Predictors for lifetime use of school-based ST included race/ethnicity, family income, age of problem onset, and verbal cognitive score. Use of private OT was predicted by parent education, family income, ASD severity, age of problem onset, and verbal cognitive score; factors predicting school-based OT were race/ethnicity, family income, ASD severity, age of problem onset, and verbal cognitive score. Chi-square results are forthcoming.   

Conclusions:  More students received ST and OT services in the school setting compared to private settings, consistent with Thomas et al.’s (2007) suggestion that parents rely heavily on schools to treat their children with ASD. However, logistic regression results suggested lower cognitive functioning predicts receiving all services, not just school-based. Age further influenced services, with younger students being more likely to receive them.  Additional findings and further discussion will be provided.