Service Use in Preschool Children with Autism Spectrum Disorder and Associations with Insurance Status

Poster Presentation
Friday, May 3, 2019: 11:30 AM-1:30 PM
Room: 710 (Palais des congres de Montreal)
E. Rubenstein1, L. A. Croen2, L. C. Lee3, E. Moody4, L. Schieve5, G. N. Soke5, K. Thomas6, L. Wiggins5 and J. Daniels7, (1)Waisman Center at UW Madison, Madison, WI, (2)Division of Research, Kaiser Permanente, Oakland, CA, (3)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (4)University of Colorado, Denver, Aurora, CO, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)University of North Carolina Chapel Hill, Asheville, NC, (7)University of North Carolina at Chapel Hill, Chapel Hill, NC

ASD-related services can improve outcomes for young children with ASD but little is known about patterns of service receipt in young children. Further, insurance type may effect which services are received outside of school settings. Children may be on federally funded insurance programs (‘public’), employer or personally paid for insurance (‘private’) or through specific service waiver be enrolled in both programs (‘both’). Insurance may cover speech therapy, occupational therapy, behavior therapy, medication, social skills training, respite care, physical therapy, and some complementary and alternative medicines and treatments.

Objectives: To describe amount and type of services used among children age 3-5 years with autism spectrum disorder (ASD) and examine differences across health insurance status (public, private or both).

Methods: We used data on children with past ASD diagnosis in the Study to Explore Early Development, a US community-based study of neurodevelopment conducted between 2012-2016. Mothers reported child insurance status and service use at study entry. We estimated prevalence ratios for cumulative service use and odds ratios for each service type overall and by insurance status for out-of-school and both in- and out-of-school services combined using log-Poisson regression. In adjusted analyses we included maternal education, family income, number of children in the household, and child year of birth to control for confounding.

Results: Of 803 children with past diagnosis of ASD, nearly 40% of children were not receiving out-of-school services at time of study entry. The most common out-of-school services were speech therapy and occupational therapy. In the sample, 34.7% were on public insurance, 50.6% were on private insurance, and 13.3% had both insurances. Children with public insurance had less total services than children with private or both insurances; however, after adjustment for socioeconomic and demographic confounders, children with private insurance alone received fewer out-of-school services than children with public insurance alone (prevalence ratio: 0.83, 95% confidence interval: 0.71, 0.97). Children with public insurance alone were least likely to receive out-of-school behavioral therapy and most likely to receive psychotropic medication compared to other insurance status. Total number and type of service use was similar between insurance statuses for combined in- and out-of-school services.

Conclusions: We found that while most preschool age children received at least one ASD-related service, many did not receive out-of-school services, especially behavioral therapy. Children on public insurance only were more likely to receive medication and less likely to receive behavioral therapy compared to children with any private insurance. Because receiving adequate service is important for young children with ASD to receive optimal outcomes, targeting policy and practice to improve the availability of evidence-based services to children in all types of insurance programs may improve service use and lead to improved outcomes.