Autism Spectrum Disorder and Early Intervention Services in New Jersey from 2006-2012

Background:

Over the past decade Autism Spectrum Disorder (ASD) has increased significantly. One general consensus among all stakeholders is that ASD should be identified early which can allow for benefits of early intervention. Through early intervention, children make gains in cognitive ability, social functioning and even changes in core symptom severity.

Objectives:

The purpose of this study was to describe EI utilization by ASD children in NJ over time and to identify sex, race, ethnicity and SES-based disparities in EI utilization.

Methods:

Data were collected as part of the New Jersey Autism Study (NJAS), an ASD surveillance investigation carried out in Essex, Union, Hudson and Ocean counties. Using an active case-finding method established by the Centers for Disease Control and Prevention (CDC), case-specific data were developed for children who were born in 1998, 2002, and 2004 and resided in the surveillance region during Study Years (SY) 2006, 2010, and 2012 respectively. NJAS data were based on review, analysis and independent ASD case- determination derived from information contained in health and education records. Demographic and case-specific information reflecting and case-specific interventions, including receipt of EI Services, were analyzed. The socioeconomic status (SES) of children with ASD was represented by the District Factor Group (DFG) ranking, a community-level index. Statistical analysis was performed using chi-square tests.

Results:

Information from 2,029 8-year-old ASD-confirmed children identified from three cycles of ASD surveillance in New Jersey between 2006-2012 (SY2006: 533; SY2010: 696; SY2012: 800) was analyzed to determine differences by group, over time. Increasing proportions of ASD children received EI services during the period (EIP – SY2006: 39%; SY2010: 43%; SY2012: 50%) (p<.001). Boys and girls with ASD were equally likely to receive EI services and both males and females enjoyed increased levels of EI participation in the period (Girls - SY2006: 36% and SY2012: 52% (p<.01); Boys – SY2006: 40% and SY2012: 50% (p<.01)). We observed declining race and ethnicity-based disparities, most notably among Hispanic children, 17% increase from 2006 to 2012, from 28% in 2006 to 45% in 2012 (p<.05). SES was associated with greater EI participation in each cycle and increased significantly, across all levels. However, In 2006, 34% of children with ASD from Low SES areas and 36% of children from Mid SES areas were receiving EI services compared to 49% from High SES areas (p<.01). By 2012, there was still a SES disparity where 44% of Low SES children were receiving EI services compared to 50% of children from Mid SES, and 63% of children from High SES areas (p<.001).

Conclusions:

As of 2012, the most recently-completed cycle of ASD monitoring in NJ, half of ASD children received EI services. EI participation increased significantly (11%) between 2006 and 2012. Some disparities may be declining, while SES-based differences are prominent. Improved strategies are necessary to decrease disparities in receipt of Early Intervention services.