Characteristics of Patients with Autism Spectrum Disorders Who Successfully Initiate Behavioral Intervention Services

Background: Evidence-based treatments rooted in Applied Behavior Analysis (ABA) have been shown to lead to favorable outcomes in children with autism spectrum disorders (ASD). Research evaluating the effectiveness of behavioral treatments is vast but very little is known about which individuals benefit the most from these treatments. As the prevalence of ASD continues to increase and with most states expanding insurance mandates to provide evidence based behavioral treatments, it would be advantageous to characterize the barriers and facilitators to treatment in order to better serve this population.

Objectives: To describe the patient characteristics associated with initiating behavioral treatments among a large and diverse insured ASD population referred for behavioral intervention services.

Methods: The study population is comprised of 380 Kaiser Permanente (KP) members from northern California with ASD aged 2-22 years who were referred for ABA treatment services to Easter Seals Bay Area (ESBA) between February-May 2014. ESBA is the largest vendor providing ABA treatment services for KP northern California members. Patients were grouped based on whether they ever initiated or never initiated treatment within 12 months of the date of referral to treatment. We compared the ever versus never initiated treatment groups with respect to sex, race/ethnicity, age at referral to treatment, and ASD status of siblings using chi-squared tests. Mean age at referral to treatment was compared between the two groups.

Results: The majority of patients referred for ABA were between the ages of 5-11 years of age (32% 2-4, 48% 5-11, 14% 12-15, 6% 16-22), male (82%), white (37%), and the only child in the family with an ASD diagnosis (88%). Overall, 12% of patients referred for ABA never initiated treatment. Among those, 56% never completed the first step, which is an in-person assessment by the vendor; the remaining 44% completed the assessment and were recommended a treatment plan but failed to initiate treatment. Among the 88% of referred patients who started treatment, 25% subsequently discontinued treatment within 12 months of the referral. Patients who initiated treatment were similar to patients who did not initiate treatment with respect to sex (male: 81% vs 82%) and race/ethnicity (White: 37% vs 38%; Asian: 29% vs 27%; Hispanic: 17% vs 22%; Black: 6% vs 7%; Other: 10% vs 7%), and having a sibling with ASD (12% vs 9%).  However, patients who initiated treatment were more likely than patients who did not initiate treatment to be <5 years of age at referral (34% vs 20%). The mean age at treatment referral (7 years vs 9 years) was lower among individuals who initiated treatment compared to those who didn’t.

Conclusions: Demographic characteristics did not distinguish between the ever versus never initiated treatment groups. Other factors that may contribute to treatment initiation and engagement, including referral sources, parental characteristics, and timing of services will be presented.