Katharine E Zuckerman1, Nora D B Friedman, Alison E Chavez, Amy M Shui, Karen A Kuhlthau. 1. *Division of General Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR; †Portland State University School of Public Health, Portland, Oregon; ‡Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA; §Biostatistics Center, Massachusetts General Hospital, Boston, MA; ‖Division of General Pediatrics, Massachusetts General Hospital for Children, Boston, MA; ¶Department of Pediatrics, Harvard Medical School, Boston, MA.
Abstract
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.
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.
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