Racial Disparity in Mental Healthcare Services Access and Utilization Among Children with ASD in the US

Background: Researchers indicate that mental healthcare disparities are apparent among minority children with Autism Spectrum Disorder (ASD) (Mandell, et al., 2009). Disparities in the access and use of health and mental health care services are particularly alarming in the context of children and adolescents with ASD. Poor access to and underuse of health and mental healthcare services, especially among youth, can result in an exacerbation of the current condition as well as the onset of additional and related conditions, which end up being more costly and harmful from a public health standpoint (Parish et al., 2011). Minority children with ASD are at particularly high risk of not receiving adequate and appropriate mental healthcare services. However, this issue has received scant attention as evidenced by the very limited number of research studies about it.

Objectives:

The purpose of this study is to examine the mental healthcare disparities in terms of racial and/or ethnic differences between minority children with ASD and White children with ASD. Specifically, we aim to investigate the types and levels of services minorities children with ASD are using and examine the risk and protective factors that exist for children with ASD from ethnic and racial minority families, which affect accessing and utilizing health care and education services.

Methods:

Using data from the 2011 Survey of Pathway to Diagnosis and Services (“Path Way”) (N=1725; White= 1368, Minority=347), we conducted bivariate and multivariate logistic regression to examine the differences between minority and White children with ASD in accessing and utilizing mental healthcare services. “Pathway” is a nationally representative survey about children, 6-17 years, who were identified by the 2009/10 National Survey of Children with Special Health Care Needs (NS-CSHCN). The data set takes a close look at the current and past use of clinical treatments, interventions, and healthcare services.

Results:

We found minority children with ASD received less behavioral intervention or modification services and less cognitive–based therapy compared to their White counterparts. However, differences related to specific services such as sensory-integration therapy, occupational therapy, physical therapy, social skills training, other social skills training, and speech and language therapy in school and other settings were found to be insignificant. Additionally, the data analysis yielded some significant differences between White and minority children with ASD in regard to working with healthcare providers. Minority families tended to work with audiologists and developmental pediatricians more often than Whites and minorities tended to work with neurologists and psychiatrists less frequently compared to their White counter parts.

Conclusions:

The results of this study indicate that the type and quality services that children with ASD from minority populations receive need improvement. In addition to the need for assertive policy to support the availability of behavioral and cognitive-based therapy, future research needs to explore effective disparity-reduction strategies that promote both the amount and quality of services children with ASD from minority households receive.