Utilization of Various Treatment Types for Children and Adolescents with Autism Spectrum Disorder within the Simons Simplex Collection: Do Regional Differences Play a Role?

Background:  Children and adolescents with autism spectrum disorder (ASD) receive a variety of treatments. Yet treatments vary in empirical support (evidence-based versus negligible support), delivery setting (school-based versus private), and target (biochemical processes versus behavior and learning).  Many factors, including family (e.g., parent educational attainment, family income) and child-specific (e.g., age, ASD severity, IQ) characteristics may associate with treatments pursued by families.  Further, cultural norms within various geographic locales may influence treatment selection.    

Objectives:  The aim of the current study was to investigate factors (including geographic location) predicting use of treatment types. 

Methods:  Data were analyzed from children (N=2115, 86.3% male, M age=8.49 years) in the Simons Simplex Collection (SSC).  Potential predictors of treatment use examined included parent education, family SES, child age, child IQ, and ASD symptom severity as indicated by the ADOS calibrated severity score (CSS).  Treatment-history data were collected per parent report (recorded as either “current” or “ever” used) for each age, beginning at age 2. Nine treatment types were investigated: school-based speech therapy, school-based occupational therapy, private speech therapy, private occupational therapy, intensive behavioral, other intensive, biomedical, psychotropic medication, any other treatment, and no treatment. Logistic regression analyses predicted use/non-use of various treatment types.  Regional differences were examined by comparing use of various treatment types in a local sub-sample (Baylor College of Medicine [BCM]; N=199) to the larger North American sample (N=2115) using chi-square analyses.

Results:  Almost all families endorsed using some type of treatment (SSC: 95.6%, BCM: 93.1%; M=4 types).  In both groups, school-based speech therapy was most often used (SSC: 80.4%, BCM: 73.0%).  Separate tests of the full models (logistic regression) could reliably predict (p<.001) use or non-use of most treatment types.  Older age, later ASD onset, and higher verbal-cognitive scores consistently were associated with lower likelihood of ever using various treatment types; higher parent-education and higher income were associated with greater likelihood of using various treatment types.  The SSC and BCM samples differed only on ethnicity, with a higher percentage of Hispanic/Latino participants in the BCM sample (26.1%) versus the SSC sample (10.9%).  Chi-square analyses examining these two groups’ ever having used various treatment types revealed significant differences for use of school-based OT (c²(2, 2372)=59.28, p<.001), any other treatments (e.g., social skills) (c²(2, 2382)=50.52, p<.001), and no treatment (c²=1514.59, p<.001).

Conclusions:  Overall, predictors of using various treatment types were similar between SSC and BCM participants but differed according to the type of treatment.  Exceptions, however, included that BCM participants were significantly less likely to have school-based OT and “any other treatments” and significantly more likely to have no treatment.  Investigating ways in which treatment use differs across the 12 North American-based SSC sites may assist professionals in identifying regions where certain treatment types are more/less widely adopted and exploring why such patterns occur.  It is possible that differing demographic characteristics, such as higher representation of persons from Hispanic/Latino backgrounds, may contribute to differing patterns of treatment use in various regions and that these demographic factors are linked with cultural influences within their communities.