Prevalence of Multi-Sector Treatment for Young Children with Autism Spectrum Disorder
The period of early childhood (ages 3-5 years) often marks the shift from a focus on early intervention and diagnosis of autism spectrum disorder (ASD) to a focus on treatment. Preschool aged children with ASD and their families often experience changes in treatment that mark the transition from early intervention to preschool special education services. In addition, families may be establishing treatment plans that include school-based and clinic-based services. Despite the significance of this period for the treatment of ASD, little is known about the prevalence of treatment overall or within specific sectors.
Objectives: To estimate the prevalence of treatment for ASD among a nationally representative sample of preschool aged children with autism enrolled in preschool special education services. Rates of treatments both inside and outside of school are estimated and correlates of treatment are identified.
Data from the Pre-Elementary Education Longitudinal Study (PEELS) are used to identify the study population of children with parent or teacher identified autism. The PEELS is a nationally representative sample of 3,104 children ages 3-5 receiving special education services during the 2003-04 school year. A subsample of 246 children with ASD is used in the analysis. Bivariate and multivariate methods are used to analyze the complex survey data. Generalized estimating equations are used to estimate the population average effect of child, family, and school district characteristics on the likelihood of receiving treatment including speech, occupational, or physical therapy, behavior therapy (including applied behavior analysis), and mental health services.
14.3% of children with ASD received one of five treatment services both at school and outside of school at wave 1. The percent decreased to 11.5% three years later. Speech and occupational therapy were the two most common treatments across time with 90.5% and 65.4% of children receiving these services respectively at wave 1. Speech therapy was the service most often received both inside and outside school (12.4% wave1, 10.4%, wave 2, and 13.9% wave 3). Behavior therapies were received by 4.7% of children in wave 1 and 6.9% in wave 3. Significant decreases in the percent of children receiving speech therapy over time were detected even after controlling for severity of disability (p<.0.05). Beyond severity of disability, we could not detected significant correlates of receiving services overall in multivariate analyses; however, the adjusted odds ratio (OR) of receiving occupational therapy both inside and outside school was greater for children with higher family incomes (OR 3.16, 95% CI: 1.37-7.29) while children whose mother’s had a high school diploma or less had lower odds of receiving speech therapy in both settings (OR: 0.28, 95% CI: 0.11-0.70)
The results reveal that a small percent of children with ASD receive treatment services in multiple settings. Overall rates of treatment decline during the preschool and early elementary school years. Socioeconomic disparities in treatment are evident in multi-sector use of speech and occupational therapies. The low rates of some treatment services and particularly multi-sector treatment raise questions about access to treatment and treatment planning.