Autism and families' financial burden: the association with health insurance coverage

Dysregulated metabolic pathways associated with air pollution exposure and the risk of autism: Evidence from epidemiological studies

Autism spectrum disorder (ASD) is a developmental disorder with symptoms that range from social and communication impairments to restricted interests and repetitive behavior and is the 4th most disabling condition for children aged 5-14. Risk factors of ASD are not fully understood. Environmental risk factors are believed to play a significant role in the ASD epidemic. Research focusing on air pollution exposure as an early-life risk factor of autism is growing, with numerous studies finding associations of traffic and industrial emissions with an increased risk of ASD. One of the possible mechanisms linking autism and air pollution exposure is metabolic dysfunction. However, there were no consensus about the key metabolic pathways and corresponding metabolite signatures in mothers and children that are altered by air pollution exposure and cause the ASD. Therefore, we performed a review of published papers examining the metabolomic signatures and metabolic pathways that are associated with either air pollution exposure or ASD risk in human studies. In conclusion, we found that dysregulated lipid, fatty acid, amino acid, neurotransmitter, and microbiome metabolisms are associated with both short-term and long-term air pollution exposure and the risk of ASD. These dysregulated metabolisms may provide insights into ASD etiology related to air pollution exposure, particularly during the perinatal period in which neurodevelopment is highly susceptible to damage from oxidative stress and inflammation.

Using GPS and Self-Report Data to Examine the Relationship Between Community Mobility and Community Participation Among Autistic Young Adults

IMPORTANCE

Community participation of autistic adults is important for health and well-being. Many clinical efforts and interventions aim to enhance community participation in this population.

OBJECTIVE

To empirically examine the relationship between community participation and community mobility.

DESIGN

A randomized controlled trial using data from baseline and 4- to 6-wk follow-up.

SETTING

Community organizations serving autistic adults in Philadelphia.

PARTICIPANTS

Sixty-three autistic young adults with data on community mobility and participation from a prior study on public transportation use.

OUTCOMES AND MEASURES

Participants were tracked with GPS-enabled cell phones over a 2-wk period. A spatiotemporal data mining algorithm was used to compute the total number of destinations, nonhome destinations, unique destinations, percentage of time spent outside the home, and median daily activity space area from the GPS data. The Temple University Community Participation measure was used to collect self-report data in 21 different areas, and total amount, breadth, and sufficiency of participation were calculated.

RESULTS

Moderate and statistically significant associations were found between community mobility and participation variables at baseline and follow-up. However, changes in community mobility were not related to changes in community participation.

CONCLUSION

Health policymakers and providers should consider community mobility as a factor that can affect community participation in autistic individuals. Plain-Language Summary: Lower levels of community participation among autistic young adults affect health outcomes and overall quality of life. Community mobility is often a barrier to community participation. An understanding of the relationship between community mobility and community participation can lead to occupational therapists tailoring specific interventions and policies that support autistic young adults to engage in important life activities within the community.

Associations Among Autism Symptom Domains and Facets of Caregiver Strain

Parents of children with autism spectrum disorder (ASD) often experience elevated levels of caregiver strain (CGS). Few studies have examined the relationship between core ASD symptoms and each facet of CGS: objective, subjective internalized, and subjective externalized strain. The predictive effect of core and associated features of ASD on CGS facets were investigated, while also exploring the moderating effect of age. Atypical behaviors and behavior problems were the strongest predictors of all types of caregiver strain. For younger children, more repetitive behaviors predicted higher externalized strain, yet the opposite was true for parents of adolescents. Given that caregiver strain impacts parents' service utilization patterns, future research should focus on strategies to support parents in reducing caregiver strain.

The Validity and Reliability of the Turkish Version of the Autism Family Experience Questionnaire (AFEQ)

The aim of this study was to examine the reliability and validity of the Turkish version of the AFEQ for Turkish parents of children with ASD. The Turkish-translated version of the AFEQ was administered to 241 parents of children aged 2-12 years with ASD to examine the construct validity and internal consistencies. Parents completed the Autism Behavior Checklist (ABC), and Quality of Life in Autism Questionnaire Parent version, along with the AFEQ. The mean age of the children of 241 individuals in the study group was 7.63 ± 3.02 and 88.4% (n = 213) were male. Cronbach's alpha coefficient was 0.921 of the total variance. Cronbach alpha coefficients are 0.813 for the "Experience of being a parent" subscale, 0.768 for the "Family Life" subscale, 0.810 for the "Child Development, Understanding and Social Relationships" subscale, and 0.804 for the "Child Symptoms (Feelings and Behaviour)" subscale. In conclusion, the translated and culturally adapted AFEQ shows good reliability and validity to measure the priorities of autistic children and their families in Turkey. It can also be useful in monitoring the effectiveness of intervention programs and changes in the child.

Low-Income Households of Children With Autism and the Economic Safety Net

OBJECTIVE

This paper examines the distribution, parameters, and determinants of safety net program use among a nationally representative sample of low-income children with autism spectrum disorder (ASD).

METHODS

We used data from the 2021 National Survey of Children's Health to produce population estimates of material hardship and safety net program use among 554 low-income households of children with ASD, ages 3 to 17 years, relative to 2831 children with other special health care needs (SHCN) and 8758 children with no SHCN of the same age. Design-adjusted multivariate logistic regression models identified predictors of cash assistance, Supplemental Nutrition Assistance Program, and disconnection from both.

RESULTS

There were few significant differences in material hardship between children with ASD and those with other SHCN, although children with ASD experienced significantly higher levels of hardships compared to children with no SHCN. Having a child with ASD did not significantly increase the odds of safety net use. Health insurance and household income were stronger predictors of use than disability. Nine percent of disconnected children lived in households under 100% federal poverty level and experienced some type of material hardship.

CONCLUSIONS

Future research about the economic security of children with ASD and their families could focus on the following 3 areas of inquiry: assess how race, ethnicity, or socioeconomic position interact with disability to influence safety net program use; examine the intersection between Medicaid and safety net programs at the state and national levels; and identify specific subgroups of children at risk for disconnection and understand why they are not accessing benefits.

The Economic Impacts of COVID-19 on Autistic Children and Their Families

PURPOSE

We used data from the National Survey of Children's Health to (1) examine differences in economic hardship and safety net program use after the implementation of federal relief efforts, and (2) assess whether the COVID-19 pandemic exacerbated autism-based disparities in hardship and program use.

METHODS

We examined five dimensions of economic hardship (poverty, food insecurity, medical hardship, medical costs, and foregone work) and four safety net programs (cash assistance, Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and free or reduced-cost meals). First, we calculated adjusted prevalence and odds ratios to compare pre-COVID (2018-2019) and during COVID (2021) outcomes by autism status. Next, we calculated the adjusted odds of each outcome among autistic children compared to those of children with and without other special healthcare needs at both time points.

RESULTS

COVID-19 exacerbated autism-based disparities in food insecurity, SNAP, and public health insurance, but alleviated inequities in medical hardship, foregone work, and cash assistance. Autistic children did not experience declines in food insecurity or increases in SNAP like other children; medical hardship and foregone work decreased more for autistic children; and the magnitude of autism-based differences in public coverage significantly increased during the pandemic.

CONCLUSION

Federal relief efforts likely improved economic outcomes of children; however, these effects varied according to type of hardship and by disability group. Efforts to promote economic well-being among autistic populations should be tailored to the financial challenges most salient to low-income autistic children, like food insecurity.

Food Insecurity and Health Outcomes of Children With Intellectual and Developmental Disabilities in the United States

We aimed to (a) provide nationally representative estimates of food insecurity (FI) among children with intellectual and developmental disabilities (IDD), and (b) determine the association between FI and four health outcomes (overall health, problem behavior, activities of daily living, functional limitations) in 5,657 children with IDD compared to 1:1 propensity score matched children without IDD. Mixed-effects ordered logistic regression models were used. Children with IDD were more likely to experience FI than children without IDD (43.3% vs. 30.0%, p < 0.001). FI and IDD were independently associated with worse scores on all four health outcomes. Having both FI and IDD further exacerbated the adverse impacts on these health outcomes. The association was stronger among children with moderate-to-severe FI than those with mild FI.

Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress

Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.

Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review

BACKGROUND

Individuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD.

METHODS

In this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.).

RESULTS

Our searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD.

CONCLUSIONS

This systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.

Key stakeholder perspectives on obstacles to an autism-specific Medicaid waiver service delivery model

BACKGROUND

Children and youth with autism spectrum disorder have significant, multi-system needs that require supports, such as the autism waiver (AW) service delivery model. This study aimed to identify and describe characteristics of the AW, define obstacles and strengths in the provision of adequate services and provide recommendations for improving overall effectiveness.

METHODS

This mixed-methods exploratory study used an electronic survey to gain information and perceptions of AW provider agency directors (n = 27) and service coordinators (n = 30).

RESULTS

The key barriers reported were the shortage of qualified staff, inadequate staff training, complexity of cases or symptom severity of clients and lack of communication at multiple levels throughout the agency as well as with parents.

CONCLUSIONS

Recommendations include reinforcing the workforce through higher salaries, greater training and communication interventions. These strategies may reduce staff turnover and shortage, lighten the caseload, reduce the waitlist period and improve the effectiveness and responsiveness of AW services.

Brief Report: Health Expenditures for Children with Autism and Family Financial Well-Being in China

Little is known on the financial well-being of families raising children with autism spectrum disorders (ASD). Family financial well-being has important impacts on the development of children with ASD. The study uses a 2019 survey collected from Chinese families raising a child with ASD (N = 3064) to examine their financial well-being and its association with health expenditures for children. Extensive control variables (i.e., demographic and socioeconomic characteristics of children, respondents, and their families) are adjusted in analyses. Findings suggest that the amount of health expenditures is negatively associated with respondents' perception of their financial status. The significance of health expenditures disappears after household material hardship is adjusted. Health expenditures affect financial well-being mainly through resource competitions against family needs.

Generosity of state insurance mandates and growth in the workforce for autism spectrum disorder

LAY ABSTRACT

To improve access to health services for children with autism spectrum disorder, US states have passed laws requiring health insurers to cover autism-related care, commonly known as state insurance mandates. However, the features of mandates differ across states, with some state laws containing very generous provisions and others containing very restrictive provisions such as whether the mandates include children aged above 12 years, whether there is a limit on spending, and whether there are restrictions on the types of services covered. This study examined the relationship between generosity of mandates and growth in the health workforce between 2003 and 2017, a period during which 44 states passed mandates. We found that states that enacted more generous mandates experienced significantly more growth in board-certified behavioral analysts who provide behavioral therapy as well as more growth in child psychiatrists. We did not find differences in the growth of pediatricians, which is a less specialized segment of the workforce. Our findings were consistent across eight different mandate features and suggest that the content of legislation may be as important as whether or not legislation has been passed in terms of encouraging growth in the supply of services for children with autism spectrum disorder.

Autism Spectrum Disorder and Genetic Testing: Parents' Attitudes-Data from Turkish Sample

We aimed to examine the opinions of parents' having a child with ASD, on genetic testing, in a Turkish sample. 951 parents' attitudes towards genetic testing were included. 89.1% of the parents did not take a genetic test during pregnancy. 87.6% of the parents agreed to take a genetic test if it could explain the cause of ASDs. 93% agreed to take a genetic test, if it would help to have a better treatment in the future. 63.8% of the participants would approve the storage of their DNA samples for the future studies. 94.8% considered being informed about the purpose of taking DNA material for the early diagnosis and 84.2% considered being suggested genetic tests for early diagnosis as important.

Predicting the Outcomes of Parents of Transition-Age Youth or Young Adults with ASD

The transition outcomes for individuals with autism spectrum disorder (ASD) and their families are less than desirable. A survey of parent stressors, resources, coping/appraisals, and adaptation to transition was completed by 226 parents. The mediating mechanisms between stressors and parent outcomes were identified. At the indicator level, three stressors (i.e., autism severity, mental health crisis/challenging behaviors, and filial obligation), four resources (i.e., general social support, transition planning quality, parent-teacher alliance, and parenting efficacy), and three coping styles (i.e., problem-focused coping, avoidance-focused coping, and optimism) predicted parents' outcomes (i.e., burden, transition experience, subjective health, and quality of life). At the structural level, optimism, emotion-coping strategies, and resources mediated the relationships between stressors and parental outcomes. Research and practical applications are discussed.

Economic burdens on parents of children with autism: a literature review

This review aims to summarize evidence from published articles regarding the economic burdens on parents of children diagnosed with autism to elaborate on current research status, discern key findings and provide suggestions for future studies. A total of 1024 records were identified through our systematic literature research, and 33 studies were included in the review. The 33 included studies reported findings from 10 different countries around the world. These articles (published from 2003 to 2017) used a variety of research methods, including quantitative (n = 26), qualitative (n = 4), and mixed (n = 3) study designs. In summary, parents of autistic children were susceptible to adverse employment impacts and increased financial burdens, especially mothers. More attention should be given to the development of appropriate medical resource allocation and the alleviation of economic burdens on parents of children with autism.

State Approaches to Funding Home and Community-Based Mental Health Care for Non-Medicaid Youth: Alternatives to Medicaid Waivers

Home and Community-Based Services (HCBS) Medicaid waivers for children increase the availability of public funding for HCBS by waiving or expanding the means tests for parents' income, basing child eligibility for Medicaid coverage primarily on clinical need. But many states provide mechanisms apart from HCBS waivers to increase coverage for youth with significant mental health needs. Through interviews with public mental health officials from 37 states, this study identifies and explains non-waiver funding strategies for HCBS services for otherwise ineligible youth. Results demonstrate that states expand Medicaid-eligibility through CHIP or use state general revenue funds to pay for medically necessary HCBS for non-Medicaid youth.

Caregiving of offspring with intellectual developmental disabilities in Israeli Jewish and Arab households: Financial and psychosocial differences

BACKGROUND

This research responds to the lack of evidence-based knowledge regarding the psychosocial and financial gaps among caregivers of children with intellectual disabilities living in Jewish and Arab households. It examines the financial gaps and explores whether caregivers' social economic status and households' affiliation (Jewish vs. Arab) can explain the psychosocial variables such as levels of stress, social participation types and rates, and use of public services.

METHOD

One hundred and twenty-five Jewish and Arab caregivers completed an income and expenditure survey, including out-of-pocket expenditures, a services use survey, a questionnaire regarding resources and stress levels, and a social participation scale.

RESULTS

Arab households are more likely to have a low socioeconomic status (SES) than Jewish ones, characterized by lower per capita income, less spending, fewer out-of-pocket expenditures, and less ability to deal with an unexpected expense. In respect to psychosocial measures, Arab caregivers report lower use of public services than Jewish caregivers and lean more toward contact with relatives and religious participation than do Jewish caregivers. Caregivers' social economic status and households' affiliation do not have any interaction effect on psychosocial variables.

CONCLUSIONS

Findings are discussed regarding research and practice.

The Economic Costs of Autism Spectrum Disorder: A Literature Review

Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD.

The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

OBJECTIVE

To examine the effects of Medicaid Home and Community-based Services (HCBS) waivers on reducing racial/ethnic disparities in unmet need for services among families of children with autism spectrum disorder (ASD).

DATA SOURCES

Data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health and the 2005 and 2010 waves of the National Survey of Children with Special Health Care Needs were used. Data on waiver characteristics were collected from source materials that were submitted in support of each state's waiver application. Waiver characteristics were combined to create a single waiver generosity variable.

STUDY DESIGN

Quasi-difference-in-difference-in-difference models were used to determine the effect of waiver generosity on racial/ethnic disparities in unmet need among children with ASD.

PRINCIPAL FINDINGS

Increased waiver generosity was associated with significantly reduced odds of having unmet need for black children with ASD compared with white children with ASD. Unmet needs among black children with ASD were roughly cut in half, a 13 percentage point decrease, with the implementation of an average generosity waiver. No significant differences were seen for Hispanic ethnicity.

CONCLUSION

These findings suggest that Medicaid HCBS waivers have the potential to ameliorate disparities in unmet need among children with ASD. Future policy development should focus on replicating the most effective characteristics of these waivers.

Utilization and medical costs of outpatient rehabilitation among children with autism spectrum conditions in Taiwan

Background

We examined the utilization of rehabilitation resources among children with autism spectrum condition (ASC), a neurodevelopmental condition, in Taiwan.

Methods

We derived from the National Health Insurance Research Database of Taiwan data pertaining to 3- to 12-year-old children for the period 2008–2010. Based on diagnoses executed in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification, we classified these data into the ASC and non-ASC groups and analyzed them through multiple linear regression model, negative binomial model, independent sample t testing, and χ² testing.

Results

Compared with the non-ASC group, the ASC group exhibited higher utilization of rehabilitation resources. Because hospitals are constrained by overall expenditure limits, expenditure on rehabilitation resources has plateaued, preventing any increase in the utilization of rehabilitation resources. In our ASC group, preschool-aged children significantly outnumbered (p < 0.001) school-aged children. When stratified by the hospital level, district hospitals reported the highest utilization (p < 0.001). When stratified by region, the highest utilization was in Taipei, whereas the lowest was in the East region (p < 0.001). The total annual cost, average frequency of visits, utilization of rehabilitation resources, and average cost were all affected by such elements as patient demographics, hospital type and location (p < 0.001).

Conclusions

For improving treatment outcomes among children with ASC and decreasing treatment expenditure, policies that promote the timely ASC detection and treatment should be implemented.

Reliability and validity of the translated Chinese version of Autism Spectrum Rating Scale (2-5 years)

BACKGROUND

Early autism screening is of great value, but there is lack of a screening tool of early age (2-5 years) in China. The Autism Spectrum Rating Scale (ASRS, 2-5 years) is a newly developed autism screening tool in the USA. This study aimed to evaluate the reliability and validity of the translated Chinese version of ASRS (C_ASRS) in Chinese children population before its application in China for early autism screening.

METHODS

Caregivers of general children aged 2-5 years from 17 kindergartens and autism spectrum disorder (ASD) cases from five special education schools in five cities were recruited to complete the C_ASRS. 1910 valid questionnaires from kindergarteners and 192 from ASD cases were included for analyses.

RESULTS

The item reliability (Cronbach's alpha) was more than 0.80 in the screening scale and DSM-5 scale, and 0.51-0.81 in the treatment scale. ASD cases scored higher on total score and most subscales compared to the kindergarteners (Cohen's d ranging from 1.34 to 3.37). C_ASRS showed good discriminatory validity with an area under the receiver operating characteristic curve of 0.850 (95% confidence interval: 0.819-0.881). The cutoff ≥ 60 achieved sensitivity of 65.63% and specificity of 85.63% in discriminating autism children from the general population.

CONCLUSION

The results indicate that C_ASRS (2-5 years) could be used as an early level-2 screening tool for autism screening in China and should be further revised for level-1 screening.

Family perceptions of the impacts of a home and community based services autism waiver: Making family life possible

BACKGROUND

An important mechanism that provides support and services for families with a child/youth with autism spectrum disorder is the home- and community-based services (HCBS) Waiver authorized by Section 1915(c) of the Social Security Act or Medicaid.

METHODS

This study used qualitative research methods to explore parent perspectives about the impact of HCBS Waiver services on the child/youth with autism and their family. In-depth interviews focused on aspects of the programme they valued, identification of barriers and general issues they experienced.

RESULTS

Results of the qualitative study indicated that improved outcomes could be explained by providers of services who were well-trained, flexible and allowed parents' opportunities for choice regarding provision of services to meet child/youth and family needs.

CONCLUSION

The findings of this study provide guideposts for further research about factors that contribute to satisfaction of families receiving waiver services for quality of life and child progress.

Healthcare experiences of young adults with autism spectrum disorder

Purpose

Characteristic challenges that define autism spectrum disorder (ASD), coupled with comorbid conditions and poor communication with providers, can lead to inadequate healthcare. The majority of previous work has focused on children. The purpose of this paper is to examine the healthcare experiences of young adults with ASD within the US healthcare system.

Design/methodology/approach

An online questionnaire was utilized to examine: the accessibility of healthcare for those with ASD: do they make their own appointments, fill out paperwork independently, go in the examination room on their own; the quality of care they receive: what are their medical needs, how effectively can they communicate their needs, do providers understand their disability; and the outcomes of care: do they understand their recommended care, can they follow healthcare instructions accurately, are they satisfied with the care received. The authors compared responses of those with ASD (n=16) with those of parents of adults with ASD (n=50), as well as a matched comparison group of young adults without ASD (n=42) for statistical differences using the Fisher Exact test. The authors also asked parents about their time costs of assisting their adult children through the healthcare process.

Findings

The results suggest that those with ASD overestimated their ability to manage their healthcare needs, felt more positively about the healthcare they received than was warranted, and were significantly less independent in managing their healthcare than their peers. Parents experienced losses and costs in terms of lost productivity, household work, and personal time.

Originality/value

This study furthers the understanding of the healthcare experiences of young adults with ASD which is crucial to dissecting problems which hamper access to quality care.

The availability of services for children with autism spectrum disorder in a Saudi population

Objective:

To assess the perceived availability of various services provided by Autism centers in our region.

Methods:

A cross sectional study was conducted from March to May 2015 involving health care workers at various governmental and private autism centers in Jeddah, Kingdom of Saudi Arabia. A structured 30-item questionnaire was designed to assess their demographics, training, experience, and the availability of various services at their centers.

Results:

Twelve autism centers were included and 136 employees participated in the study. Seventy-eight (57%) participants indicated that their center lacked important and essential services. These included programs for home care and outreach (59%), family recognition incentives and rewards (51%), integrative educational programs (39%), and occupational therapy (16%). Access for outside referral for these services was available in only 24% of cases. They cited several major obstacles in providing adequate service including; family involvement (24%), child’s behavioral problems (13%), increased number of students (9%), and work environment and space (5%).

Conclusion:

Significant deficiencies exist in the availability of autism services in our region. Access for referrals for important services is also limited. We identified several areas that can be targeted to help develop, promote, and improve the provided services for children with autism spectrum disorder.

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

This study examined the prevalence and correlates of educational intervention utilization among U.S. preschool aged children with autism spectrum disorder (ASD) prior to recent policy changes. The analysis was based on a nationally representative longitudinal survey of children receiving special education services during the 2003-2004 school year. All children with parent or teacher identified ASD over a 3-year study period were analyzed. Outcomes included utilization of speech therapy, occupational therapy, behavior therapy, and mental health services by service sector. The analysis revealed low rates of behavioral therapy and mental health services. Parents reported that the overwhelming majority of services were received inside school only. This study identified gaps in the provision of services for young children with ASD.

Examination of Parent Insurance Ratings, Child Expenditures, and Financial Burden Among Children With Autism: A Mismatch Suggests New Hypotheses to Test

OBJECTIVE

Families raising children with autism contribute significant amounts to the cost of care. In this era of health care reform, families have more insurance choices, but people are unfamiliar with health insurance terms. This study uses 2 national data sets to examine health insurance ratings from parents raising children with autism and child expenditures to explore how these measures align.

METHODS

Children with autism who met criteria for special health care needs and were continuously insured were examined. Data from the National Survey of Children With Special Health Care Needs 2009-2010 were used to examine parent report of adequate insurance (n = 3702). Pooled data from the Medical Expenditure Panel Survey 2002-2011 were used to examine expenditures (n = 346). Types of health insurance included private alone, Medicaid alone, and combined private and wrap-around Medicaid.

RESULTS

Having Medicaid doubled the odds of reporting adequate insurance compared with private insurance alone (P < .0001), and children on Medicaid had the lowest out-of-pocket costs ($150, P < .0001). Children covered by combined private and wrap-around Medicaid had the highest total expenditures ($11 596, P < .05) and the highest expenditures paid by their insurance ($10 638, P < .05).

CONCLUSIONS

These findings highlight a mismatch between parent ratings of insurance adequacy, child expenditures, and relative financial burden. Findings generate a number of questions to address within single sources of data. By elaborating the frameworks families use to judge the adequacy of their insurance, future research can develop policy strategies to improve both their satisfaction with their insurance coverage and the service use of children with autism.