Prevalence and Correlates of Educational Intervention Utilization Among Children with Autism Spectrum Disorder

Autism Spectrum Disorder at Home and in School

The diagnosis of autism spectrum disorder (ASD) brings a lifetime of considerations for individuals and their families. The core symptoms of ASD vary in severity and influence behavior and function across all environments. Co-occurring medical, mental health, cognitive, language, learning, and behavioral differences add challenges to those associated with core symptoms. Navigating the preschool, school, and transition ages in the educational setting requires continual reassessment of the strengths, weaknesses, and needs of the student to provide appropriate placement and services.

Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services

The primary purpose of this position statement is to define the role of occupational therapy and the scope of occupational therapy services available for persons on the autism spectrum to audiences external to the occupational therapy profession. In addition, this document is intended to articulate for occupational therapy practitioners the role and support of the practice of occupational therapy for this population.1.

Competencies and preferences of online psycho-education for caregivers of transition-aged autistic youth

Purpose

The need for more accessible services is apparent and has become more urgent due to the pandemic, COVID-19. While online psycho-education exists, its feasibility is rarely tested. This study explored the online learning experiences and technology competencies of caregivers of transition-aged autistic youth. Their preferred online transition-related training topics were also explored.

Design/methodology/approach

A quantitative survey was developed based on the review of related literature. The survey was distributed to caregivers of autistic children in the USA.

Findings

Results showed that these caregivers are open to online learning (84%) while preferring asynchronous (74.6%) over synchronous mode (12%). The highest-rated topics include life/independent living skills, employment and social and community involvement.

Originality/value

This paper presented valuable information for researchers and educators who are interested in developing online learning programs for the caregivers of autistic children.

Systematic Review of Disparities and Differences in the Access and Use of Allied Health Services Amongst Children with Autism Spectrum Disorders

Individuals with autism spectrum disorder (ASD) often benefit from allied health services such as occupational therapy, speech and language pathology, and applied behavioral analysis. While there is consistent evidence of disparities in access and use of medical services (e.g. dentistry), no such systematic review has examined disparities and differences in allied health use amongst children with ASD. In this systematic review, we examine disparities and differences in service access and use for children with ASD. Our findings suggest that children who are older, have less severe ASD symptoms, are from minority groups, and those from particular geographic regions are less likely to receive allied health services. Limitations and future directions are discussed.

Development of Neural Structure and Function in Autism Spectrum Disorder: Potential Implications for Learning Language

Purpose Neurodevelopmental processes that begin during gestation and continue throughout childhood typically support language development. Understanding these processes can help us to understand the disruptions to language that occur in neurodevelopmental conditions, such as autism spectrum disorder (ASD). Method For this tutorial, we conducted a focused literature review on typical postnatal brain development and structural and functional magnetic resonance imaging, diffusion tensor imaging, magnetoencephalography, and electroencephalography studies of the neurodevelopmental differences that occur in ASD. We then integrated this knowledge with the literature on evidence-based speech-language intervention practices for autistic children. Results In ASD, structural differences include altered patterns of cortical growth and myelination. Functional differences occur at all brain levels, from lateralization of cortical functions to the rhythmic activations of single neurons. Neuronal oscillations, in particular, could help explain disrupted language development by elucidating the timing differences that contribute to altered functional connectivity, complex information processing, and speech parsing. Findings related to implicit statistical learning, explicit task learning, multisensory integration, and reinforcement in ASD are also discussed. Conclusions Consideration of the neural differences in autistic children provides additional scientific support for current recommended language intervention practices. Recommendations consistent with these neurological findings include the use of short, simple utterances; repetition of syntactic structures using varied vocabulary; pause time; visual supports; and individualized sensory modifications.

Utilization of speech-language, occupational and physical therapy by diagnosis of autism spectrum disorder

BACKGROUND

Although Medicaid coverage of treatment for children with autism spectrum disorder (ASD) is expanding, we know little about when children receive speech-language, occupational and/or physical therapy. The objective of this study was to examine the relationships between predisposing, enabling and need characteristics and utilization of speech-language, occupational and physical therapy by diagnosis of ASD.

METHODS

We integrated administrative, Medicaid and Census data using a large sample of children with ASD who enrolled in a 1915(c) Home and Community Based Medicaid waiver in a south-eastern state (N = 1,968) to explore (1) the percent of treatment utilization by ASD diagnosis, (2) the type of therapy utilized and (3) the predisposing, enabling and need characteristics associated with utilization.

RESULTS

The percent of utilization was 71%; 65.8% utilized SLT, 33.4% utilized OT and 18.4% utilized PT. Enabling (i.e., urbanicity, age of diagnosis and early intervention programme enrolment) and need (i.e., intellectual disability) characteristics were associated with utilization whereas predisposing social characteristics (i.e., sex and child race-ethnicity and neighbourhood racial composition, poverty and affluence) were not associated with utilization.

CONCLUSIONS

Findings highlight the value in monitoring when children begin treatment. As governments in the United States and globally work to maximize children's potential, additional research that can inform efforts to facilitate earlier utilization will be key to promoting optimal outcomes.

Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions.  This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.

Underutilization of Early Intensive Behavioral Intervention Among 3-Year-Old Children with Autism Spectrum Disorder

Funding for early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is rapidly expanding. Yet we know little about children's utilization, and research on inequities in utilization is lacking. We examined the relationship between utilization during the first year of EIBI and (a) child race-ethnicity and (b) neighborhood characteristics. Using a sample of children eligible for a Medicaid waiver through a novel policy of presumptive eligibility (N = 108), we estimated a series of two-level growth curve models. Children's average utilization ranged between 24 and 48% of weekly hours, and utilization did not differ by race-ethnicity or neighborhood during the first year. Findings underscore the need to monitor utilization of EIBI and warrant research on the feasibility of EIBI provision in the general population.

Treatment Utilization Trajectories among Children with Autism Spectrum Disorder: Differences by Race-Ethnicity and Neighborhood

Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is expanding. Yet there is no longitudinal research on patterns of or inequities in utilization of EIBI. We integrated state administrative records with Medicaid and Census data for children enrolled in an EIBI Medicaid waiver (N = 730) to identify and describe the type and prevalence of treatment utilization trajectories, and to examine the association between trajectory types and (a) child race-ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We identified four utilization trajectories (Low, Low-Moderate, Moderate, and High users). Race-ethnicity and neighborhood affluence were associated with trajectory membership. As coverage expands, policy makers should consider strategies to improve overall treatment utilization and enhance equity.

'If I was a different ethnicity, would she treat me the same?': Latino parents' experiences obtaining autism services

This article reports on an ethnographic study with 12 Latino families of children on the autism spectrum related to obtaining autism services in Los Angeles County. Using critical discourse analysis of interviews, observations, and records, we consider the experiences of the Latino families in relation to: 1) A discursively constructed 'autism parent' subject position that mandates 'fighting' service systems to 'win' autism services for children, originating from White middle-class parents' socio-economic resources and social capital; 2) A neoliberal social services climate that assumes scarcity of available resources and prioritizes austerity in their authorization; and 3) A media and institutional 'cultural deficit' discourse that attributes disparities in autism services for Latino children to their parents' presumed culturally-based 'passivity.' We argue that parental discourse about fighting, or not fighting, for autism services is engendered by a tension between a parental logic of care, and the logic of competition of the economic market.

Parent-Reported Severity and Health/Educational Services Use Among US Children with Autism: Results from a National Survey

OBJECTIVE

Little national data exist regarding service use patterns for children with autism spectrum disorder (ASD) of varying severity. This study aimed to assess the relationship between parent-reported severity and use of educational and health care services.

METHODS

Data from the 2011 Survey of Pathways to Diagnosis and Services were used to examine a nationally representative sample of 1420 US children aged 6 to 17 years with ASD, with or without developmental delay and intellectual disability. Weighted multivariable logistic regression assessed associations of parent-reported ASD severity and child sociodemographic characteristics with school-based therapy, non-school-based therapy, behavioral interventions, and specialty provider visits.

RESULTS

Higher parent-reported ASD severity was associated with increased likelihood of current use of school-based therapy (adjusted odds ratio [AOR] = 4.08, 95% confidence interval =1.85-8.98), non-school-based therapy (AOR = 3.60 [1.95-6.66]), and behavioral interventions (AOR = 2.30 [1.22-4.34]), as well as regular specialty provider visits (AOR = 2.99 [1.38-6.46]). Although rates of service use were generally highest among children with severe ASD, non-school-based therapy and behavioral interventions were only used by about half of children with severe ASD, and about 1 in 4 children with mild ASD were using none of the therapies asked about.

CONCLUSION

Parent-reported severity is associated with increased therapy and specialty provider service use among children with ASD. However, substantial variability exists in service use across levels of severity.