The Impact of Demographics on Service Utilization Among Youth with Autism Spectrum Disorder
Background: Early intervention improves the behavior and the developmental outcomes of individuals with autism spectrum disorder (ASD) but there is currently no standard for the type, amount and duration of treatment. Previous research has documented disparities in access to care for youth with ASD, but it is unclear how service utilization may vary by race/ethnicity, parental income and education.
Objectives: To identify how disparities in race/ethnicity, parent socioeconomic status and insurance type affect medical and therapy services for individuals with ASD.
Methods: Between 2008-20015 the Autism Treatment Network (ATN) collected data on almost 7000 youth with ASD, ages 2-17 from United States and Canada. Using data collected through the ATN Registry, we described the sample and performed bivariate analysis to determine relationships between race, ethnicity, SES variables and use of medication, as well as complementary or alternative therapies, behavioral, speech/language, occupational, and physical therapy services.
Results: Race and ethnicity were significantly associated with receipt of speech/language services (ST), occupational therapy (OT) and physical therapy (PT) at baseline (p<0.05). Hispanics were less likely to use all services (53.1% vs. 60.4% ST, 40.3% vs. 47.1% OT, 11.6% vs. 15.6% PT). Service utilization also was associated with insurance type. For all categories, those with no insurance were less likely to use services (34.2% vs. 61.3% ST, 28.1% vs. 48.3% OT, 10.0% vs. 15.9% PT). Household income was significantly associated with all service categories (p<0.05), with behavioral, speech/language and occupational services increasing as income increased. Race and ethnicity, household income, caregiver education, any private insurance status and household income were also associated with using complementary/alternative medications (p<0.05).
Conclusions: Patterns of service utilization vary with race/ethnicity and socioeconomic status. In many instances Caucasians, those with a higher income, and those with any type of insurance were more likely to receive services. The same trend exists for complementary/alternative medication usage. This suggests that youth with ASD from low-income households are at a greater disadvantage. Future research studies should explore how disparities in service utilization affect outcomes of individuals with ASD.