Predictors of Early Intervention Service Utilization Among Children with Autism

Background:  The National Research Council recommends that children with Autism Spectrum Disorders (ASD) should receive a minimum of 25 weekly hours of intervention, although it is estimated that fewer than 1 in 10 children with ASD receive appropriate services (NRC, 2001). Data from a national survey of Early Intervention Coordinators suggest that in almost half of the reporting states (44%), children with ASD typically receive five or fewer weekly service hours (Wise et al., 2010). Additionally, descriptive research reveals large individual variation in families’ utilization of community services. Only a few published cross-sectional studies have investigated whether this variation in service-utilization can be attributed to family demographics (Irvin et al., 2012; Thomas et al., 2007). 

Objectives:   The current study aimed to evaluate family demographic factors (i.e., household income, ethnic/racial background and parental education) associated with the intensity (hours/week) of children’s early intervention services during the first three years of life for children with ASD.

Methods: This research involved 70 largely nonverbal children with ASD (chronological age: M=58.3 months; SD=12.7). The researchers confirmed children’s ASD diagnoses with the Autism Diagnostic Observation Schedule-Generic (ADOS-G; Lord et al., 2000) and the Mullen Scales of Early Learning (MSEL, Mullen, 1995). Children’s early intervention service utilization was evaluated using a retrospective structured parent interview (Bono, Daley, & Sigman, 2004) that asked parents about services children received during their first three years of life. Parents were also asked to complete a demographic questionnaire that included questions about the child’s ethnicity/race and various indicators of the families’ socioeconomic status (i.e. annual household income, parents’ educational attainment). Change in service utilization was analyzed through mixed models analysis for longitudinal data (SAS Proc Mixed).  

Results:  The percentage of children who received less than 1 weekly hour of individual services was 100%, 90%, and 57% during children’s first, second, and third year of life. While no children received more than 5 weekly hours of services during children’s first 2 years of life, 13% of children received between 5 and 20 weekly hours of services during children’s third year of life. Results from mixed model analyses revealed that the rate of change in children’s weekly hours of individual services (log-transformed) were predicted by several indicators of socioeconomic status, including annual household income, F(1,132) = 6.95; p < .01 and ethnic/racial background, F(1,134) = 6.43; p < .05. Interestingly, children’s service programs during the first three years were not predicted by the parents’ educational attainment (n.s.).

Conclusions:  African American and Hispanic families as well as families with lower annual household incomes had lower utilization of individual early intervention services. Future research would benefit significantly from adding observational measures that also evaluate qualitative differences between children’s early intervention programs.