Disparities in the Amount of Early Intervention Services Received By Toddlers with ASD: The Role of Demographic Factors

Background: Early access to a diagnosis of ASD can lead to earlier, more intensive intervention, which has been shown to result in optimal developmental outcomes (Peters-Scheffer et al., 2012; Warren & Stone, 2011). However, disparities in the age of diagnosis have been documented, with children of racial/ethnic minority backgrounds being identified much later than White children (Mandell et al., 2009). Less research has extended this work to consider whether such disparities persist, beyond the age of initial diagnosis, to the intensity and amount of early intervention (EI) received.

Objectives: To examine whether demographic factors (parental education, poverty, English proficiency, race/ethnicity, US-born status) predict the amount of early intervention services received by children with ASD. We consider these predictors in the context of a screening and evaluation program that is designed to minimize health disparities in the initial age of diagnosis; as such, our study enables us to consider whether, even in the context of relative equity in the age of ASD diagnosis, health disparities persist in the intensity of EI services received by young children with ASD.

Methods: 381 children (ages 14-36 months) were diagnosed as part of an EI-based, multi-stage screening and university-based diagnostic assessment protocol designed to reduce health disparities. 51% of this sample were of families living below the poverty line, 34% English learners, 50% immigrants, 45% White, 46% Hispanic, 26% Black, and 6% Asian. Follow up interviews were then conducted with 130 of the families of children to ascertain the amount of EI services received post-diagnosis. Next, using a latent class analysis (LCA), we identified six demographic clusters of families to predict ASD service receipt.

Results: First, the six demographic clusters of families revealed that these families were primarily distinguished by their race and US-born status. Additionally a one-way between subjects ANOVA indicated that across all six classes, on average, families from classes holding multiple marginalized identities were receiving significantly fewer hours of weekly services than families with more privileged identities [F(5, 124) = 4.36, p = 0.001]. However, the two classes that were distinguished as being White, differed in immigration status yet still had the same mean hours of weekly intervention services (White immigrants = 13.7 hrs; U.S. born non-Hispanic White = 13.7 hrs). Across other classes, U.S. born Black parents reported receiving significantly fewer hours (m = 6.3) than White immigrants and U.S. born non-Hispanic Whites. Latinx immigrants reported receiving fewer hours (m = 7.2) than White immigrants and U.S. born non-Hispanic Whites.

Conclusions: Despite having a timely access to an ASD diagnosis, disparities continued to persist in subsequent receipt of post-diagnosis intervention services. Our class solutions suggest that these demographics play a significant role in service attainment. Findings may help properly address and identify groups in need of additional support when it comes to service attainment and suggests that there may be systemic barriers at play.