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(SDAS) Access to Therapy for Children with Autism: A Population-Based Analysis


  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)


Improving early access to effective care for children with autism spectrum disorder (ASD), while minimizing costs, are important health policy objectives identified by the Maternal and Child Health Bureau (MCHB). Therapies such as occupational, physical, and speech-language therapy are frequently utilized non-behavioral services for children with an autism spectrum disorder (ASD; Thomas, Ellis, McLaurin & Morissey, 2007), and these therapies are utilized significantly more than in children with other special health care needs (Chiri & Warfield, 2012). Researchers have found that disparities exist in therapy service access for children with ASD, and that these disparities appear to affect underserved populations such as those who are low income or of minority race. Existing research on therapy access is dated, however, and was examined prior to major policy changes such as the Combating Autism Act of 2006 that sought to improve access and reduce disparities. The purpose of this project is to examine population-based trends in access to therapy services for children with ASD under the age of 18 years in the 2005-06 and 2009-10 National Survey for Children with Special Health Care Needs (NS-CSHCN) and to compare differences in access to therapy services to other children with special health care needs. The findings from this study will be used to develop recommendations to reduce inequitable access to therapy services in children with ASD. This project is the first to utilize two recent, existing population-based databases to compare access and utilization of therapy services at two different points in time, and data will serve to establish the direction for future individual, provider, or system (organizational) interventions to promote improved access to therapy services for children with ASD. The specific aims are to 1) Compare rates of access to therapy service in children with ASD at two survey time points (2005-06 and 2009-10) and between other CSHCN at these two survey years; 2) Examine the relationship of individual characteristics to access to therapy services and identify differences in the frequency of parent-reported contextual characteristics that limit therapy access in both groups across the two survey time points; and 3) Develop recommendations to inform policy, service delivery, and training for therapy service providers based on findings from Aims 1 and 2. The use of a recognized theoretical model, Andersen's Behavioral Model (Andersen, 1995), and existing early literature on therapy access will guide the derivation of hypotheses and predicted relationships of variables. This retrospective, cross-sectional study of existing secondary data will use weighted logistic regression models to examine primary hypotheses for Aims 1 and 2. Odds of specific characteristics that contribute to decreased access will be described for both groups. Chi-square statistics will be used to examine frequency of parent-reported access problems across time points and between children with ASD and other CSHCN. Data from this project will address HRSA's MCHB research priority of identifying factors that promote or impede access to needed services, and monitoring the impact of policy designed to improve access.


Listed is descending order by year published.

Benevides TW, Carretta HJ, Ivey CK, Lane SJ. Therapy access among children with autism spectrum disorder, cerebral palsy, and attention-deficit-hyperactivity disorder: a population-based study. Dev Med Child Neurol. 2017 Dec;59(12):1291-1298.

Benevides TW, Carretta HJ, Mandell DS. Differences in perceived need for medical, therapeutic, and family support services among children with ASD. Pediatrics. Feb 2016, 137 (Supplement 2) S176-185.

Benevides TW, Carretta HJ, Lane, SJ. Unmet need for therapy among children with Autism Spectrum Disorder: Results from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs. Matern Child Health J. 2015 Dec 10. [Epub ahead of print]

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