Trajectories of School-Based Services for Youth with ASD

Background: For children with autism spectrum disorder (ASD), educational systems are a central treatment source (Mandell et al., 2005), providing the most accessible route to services (White et al., 2007). Though individuals with ASD often utilize numerous treatments simultaneously, some have been identified as uniquely applicable to ASD (speech, occupational therapy (OT) and physical therapy (PT); Goin-Kochel et al., 2007), while others target more general academic and mental health needs (e.g., resource room and mental health counseling;  Wei et al., 2014; Hammill & Wiederholt, 1972; Griswold et al., 2002). Interestingly, cross-sectional studies suggest that younger children with ASD are more likely to be enrolled in ASD-specific services than older children (Goin-Kochel et al., 2007). It has also been noted that families and teachers of children with ASD seem initially more concerned with addressing core social deficits in the early years of a child’s education before placing an emphasis on academics in later years (Pollard, 1998). As the relative need for services addressing core ASD deficits tends to remain stable or increase across development (Picci & Scherf, 2014), further understanding is needed regarding trajectories of ASD-specific and nonspecific services for students with ASD (Thomas et al., 2007).   

Objectives: To explore the trajectory of school-based services for youth with ASD over time. We hypothesize that the amount of ASD-specific school-based services would decrease over time, while nonspecific services would increase. 

Methods: Caregivers of seventy-one youth with DSM-IV-TR-confirmed pervasive developmental disorder (PDD) diagnoses (N=71; 59 male; M_age=10.17, SD=3.15, range=6-17) completed educational histories from Kindergarten to the child’s current grade, including school-based services received in each grade. Presence as well as intensity (minutes/week) of ASD-specific and nonspecific services was examined. Hierarchical linear growth modeling was used to assess trends within educational service history and between participants over time. 

Results: 92.4% of students received ASD-specific services and 65% received nonspecific services at some time during their academic career. Binomial hierarchical modeling of presence of services indicated that as youths progressed through school they were less likely to receive ASD-specific services (speech therapy: OR = .60, p<.001; PT: OR=.65, p<.01; OT: OR=.76, p=.05), and more likely to receive nonspecific services (counseling: OR=1.71, p<.001; resource room:  OR=1.37, p=.04). In terms of intensity, total minutes per week of occupational therapy services diminished as youths continued through school (B = -5.06, p <.001). No other trends in service categories over time were observed.

Conclusions: Results of this study suggest a decrease in ASD-specific services, and increase in nonspecific services as youth progress through school. The results support the view that as children progress through the educational system, goals may shift from intervening for social and communication problems to increasing academic success. As school-based services are essential to treatment of students with ASD, and their need for such services usually does not decrease over time, these findings show an increasing gap between needed and delivered service categories across school. Further investigation into the cause of differential service trajectories is crucial to ensuring effective treatment access.