Delayed Diagnosis and Treatment Among Children with Autism Who Experience Adversity

Abstract

The effects of family adverse childhood experiences (ACEs) on timing of ASD diagnoses and receipt of therapies were measured using data from the 2011-2012 National Survey of Children's Health. Parametric accelerated failure time models estimated the relationship between family ACEs and both timing of ASD diagnosis and receipt of therapies among US children (age 2-17 years; N = 1624). Compared to children without family ACEs, the adjusted effects of 1-2 and ≥ 3 ACEs resulted in prolonged time of diagnoses with time ratios of 1.17 and 1.23. Report of 1-2 and ≥ 3 ACEs were associated with a 22 and 27% increase in the median age of entry into services. ACEs may pose significant barriers to diagnoses and treatment of children with ASD.

Adverse Childhood Experiences Are Associated with Unmet Healthcare Needs among Children with Autism Spectrum Disorder

“…This study used data from the 2011-2012 National Survey of Children's Health (NSCH), sponsored by the US Maternal and Child Health Bureau of the Health Resources and Services Administration, similar to the methods described in another publication by the authors. 17,27,28 The NSCH uses a complex survey design stratified by state and sample type (landline and cell phone samples) to collect data on a broad range of variables related to the health and wellbeing of US children aged 0-17 years. 27,28 Parent report data were collected on a total of 95 677 children; survey completion rates were 41.2% and 54.1% for the cell phone and landline samples, respectively.…”

“…We limited our sample to caregivers of children aged 2-17 years because ASD is not typically diagnosed in children younger than age 2 years. 17,29 Children were included in our study if the caregiver endorsed both of the following: (1) was ever informed by a doctor or other healthcare professional that their child had ASD and (2) the child currently had ASD. 17 Based on these criteria, 1624 children with ASD (reweighting procedures indicated estimated population = 1 174 871 US children with ASD) were selected for analysis.…”

“…17,29 Children were included in our study if the caregiver endorsed both of the following: (1) was ever informed by a doctor or other healthcare professional that their child had ASD and (2) the child currently had ASD. 17 Based on these criteria, 1624 children with ASD (reweighting procedures indicated estimated population = 1 174 871 US children with ASD) were selected for analysis. 17 Severity of child ASD was based on caregiver appraisal of children's symptoms as either severe, moderate, or mild.…”

“…17 Based on these criteria, 1624 children with ASD (reweighting procedures indicated estimated population = 1 174 871 US children with ASD) were selected for analysis. 17 Severity of child ASD was based on caregiver appraisal of children's symptoms as either severe, moderate, or mild. 17 Based on the distribution of responses, children with ASD were categorized into 2 groups: mild (N = 844) or moderate/severe ASD (N = 780).…”

“…delay in timing of diagnosis and a 27% increase in median age of service entry among children with ASD who experienced 3+ ACEs. 17 This study, however, was limited to timing of diagnosis and therapy services and did not examine other indicators of unmet healthcare needs among children with ASD, including dental, vision, and mental healthcare. 26 More information is needed to examine whether and to what extent exposure to ACEs contributes to extant disparities in healthcare access/use impacting US children with ASD.…”