Date Presented 4/17/2015
Children with autism spectrum disorder (ASD) are significantly more likely to have an unmet need for therapy than children with attention-deficit/hyperactivity disorder (ADHD), but they are similar in unmet needs compared with children with cerebral palsy (CP). We identify barriers to appropriate care in children with special health care needs and areas for future inquiry.
SIGNIFICANCE: Improving early access to effective care for children with autism spectrum disorder (ASD) is an important health policy objective. Occupational, physical, and speech-language therapies are frequently used services for children with ASD, and children with ASD use these services significantly more than children with other special health care needs.
INNOVATION: Five studies have examined equitable therapy service access and factors contributing to access among children with ASD. Existing research on therapy access used data prior to 2006 before major policy and economic changes, and four of the five studies used convenience samples. The current research is the first known study to examine population-based trends in access to therapy services for children with ASD across two recent national survey time points in comparison to children with other physical (e.g., cerebral palsy [CP]) or mental health (e.g., attention-deficit/hyperactivity disorder [ADHD]) conditions.
APPROACH: Research questions included the following: What is rate of children with ASD who demonstrate reduced access to services compared with children with CP and ADHD at both survey time points of the 2005–2006 and 2009–2010 National Survey for Children with Special Health Care Needs (NS–CSHCN)? To what extent are predisposing, enabling, and need characteristics associated with realized access problems in children with ASD as compared with those with CP and ADHD at both time points?
On the basis of existing literature, questions exist regarding whether factors such as race, urbanicity, and family income are related to decreased access to therapy services. Dissimilarities in samples and comparison groups within existing literature likely contributed to discrepancies. In this study, we utilize newly published data collected across the United States to examine access in children with ASD.
METHOD: We conducted a retrospective, cross-sectional analysis using the 2005–2006 and 2009–2010 NS–CSHCN data using weighted logistic regression models (LRMs) to examine access to therapy at two time points by three diagnostic (dx) groups of children (ASD, CP, ADHD) aged 0 to 18 yr (alpha set to p < .01). These surveys, managed by the Centers for Disease Control and Prevention (CDC), are publically available and have well-established methods for sampling. Missingness was controlled for by use of imputed data. Data were cleaned and concatenated to ensure appropriate merging of similar variables across years. The outcome variable was unmet need for therapy, defined as children who did not receive all needed therapy services in the past year. Predictor variables included dx, survey year, and a dx by year interaction term as well as models that included theoretically identified factors that may be associated with unmet need for services such as age, family poverty level, and child functional ability.
RESULTS AND CONCLUSIONS: Children with ASD are significantly more likely to have an unmet need for therapy than children with ADHD, but they are similar in unmet needs compared with children with CP. Significant predictors of an unmet need for therapy were dx, age, uninsured status, and greater functional limitation. Parent-reported “difficulty finding a provider accepting insurance” differentiated children with ASD from ADHD and CP. Limitations and implications are discussed within the context of policy and practice, and recommendations for future research are presented.
