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Research indicates that youth with autism spectrum disorder often experience unmet health care needs and receive poorer quality of care. Intellectual disability commonly co-occurs with autism spectrum disorder; however, the nature of unmet health care needs and health care quality in youth with autism spectrum disorder and intellectual disability have not been investigated. As such, this study sought to examine associations among co-occurring intellectual disability, unmet physical and mental health care needs, and health care quality in youth with autism spectrum disorder. Data from this study were acquired from the 2016–2018 National Survey of Children’s Health, a nationally distributed caregiver-report questionnaire. Results found that the frequency of unmet mental health care need was significantly higher among children with autism spectrum disorder with co-occurring intellectual disability than those without intellectual disability. Using a structural equation modeling approach, it was found that the total effect of co-occurring intellectual disability on composite health care quality was significant. Investigation of indirect effects indicated that unmet mental health care need mediated the relationship between co-occurring intellectual disability and health care quality. These findings suggest that youth with autism spectrum disorder and co-occurring intellectual disability may be more likely to experience unmet mental health care needs, and that their unmet mental health care needs may negatively impact their health care quality. Lay abstract The increase in the prevalence of autism spectrum disorder has placed greater demands on the health care system. Children and adolescents with autism spectrum disorder often experience challenges accessing high-quality physical and mental health care due to characteristic social-communication deficits and behavioral difficulties, as well as high rates of complex medical and psychiatric comorbidities. Intellectual disability commonly co-occurs with autism spectrum disorder and individuals affected by this co-occurrence may have additional impairments that compound challenges accessing health care. This study investigated the relations among co-occurring intellectual disability, unmet physical and mental health care needs, and health care quality in a large, nationally distributed sample of youth with autism spectrum disorder using structural equation modeling techniques. Co-occurring intellectual disability was significantly associated with unmet mental health care needs in children with autism. In addition, unmet mental health care needs mediated the relationship between co-occurring intellectual disability and health care quality; youth with autism spectrum disorder and co-occurring intellectual disability who had a past-year unmet mental health need had significantly poorer caregiver-reported health care quality. These findings suggest that youth with autism spectrum disorder and co-occurring intellectual disability may be more likely to experience unmet mental health care needs and receive poorer quality of care than the broader autism spectrum disorder population.

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The ability to discover a regularity among an ordered set of units, termed patterning, is a crucial cognitive ability that precedes pre-algebraic mathematics skills and possibly reading. However, there is limited research on the cognitive underpinnings of patterning. There is some suggestion that there is a relation between cognitive flexibility, which is the ability to switch attention between two aspects of a stimulus, and patterning. However, no research has focused on this relation in children during early school years, which is when these skills are developing. The current study examined the relation between patterning, cognitive flexibility, and reading in first-grade children in the expectation that they would be related. Performance on the patterning and the card sorting cognitive flexibility measures were significantly related. However, reading and cognitive flexibility were not significantly related. This study is one of the first to show that cognitive flexibility may be an important underlying component of patterning ability.

This study examined the effects of reading modality (oral vs. silent) on comprehension in elementary school students with a specific learning disability in reading ( N = 77). A 2 (development-level) × 2 (reading modality) × 2 (time) mixed factorial analysis of variance (ANOVA) was conducted to determine the influence of these variables on comprehension. Significant main effects were found for reading modality and time on comprehension, but the main effect for developmental level was not significant. Students understood more of what was read orally than silently and showed improved comprehension across the year. The development-level by modality interaction was significant. Early elementary students benefited from oral reading in terms of comprehension, whereas equivalent comprehension was observed for late elementary students across modalities. No other two- or three-way interactions were significant. Results from this study suggest that reading modality is an important variable to consider for researchers and educators who are interested in the construct of reading comprehension.