Patterns of Speech-Language, Occupational, Physical, and Behavioral Therapy Utilization Among Children with Autism Spectrum Disorder

Background and Purpose: Public funding of treatment for the 1 in 68 children who meet criteria for autism spectrum disorder (ASD) is increasing, and parents report using multiple treatment modalities at one time. In our prior research, we identified four classes of early intensive behavioral intervention (EIBI) utilization. Yet we know little about utilization of speech-language (SLT), occupational (OT), and physical (PT) therapies. The purpose of this study is three-fold. First, to describe children’s utilization of SLT, OT, and PT during the first year of EIBI. Second, to identify and describe the type and prevalence of utilization patterns of SLT, OT, PT, and EIBI during the first year of EIBI. Third, to determine what child, family, and neighborhood characteristics are associated with utilization patterns.

Methods: We integrated data from state agency paper case files, spreadsheets, and electronic records as well as state Medicaid and Census data. The dataset includes children who enrolled in a Medicaid waiver for children with ASD between its inception (February 2007) and March 31, 2015 (N=2,338). We included children who enrolled in EIBI at least one year prior to the conclusion of data collection (N=1467). For the first aim, we calculated univariate statistics using SAS v9.4. For the second and third aims, we will use Latent GOLD® 5.1. to conduct a latent class growth analysis. Child variables will include sex, age of diagnosis, year of diagnosis, Intellectual Disability, Aspergers Syndrome, and child race (white, black, Hispanic, other non-Hispanic, and unknown). We will include family income (Supplemental Security Income eligible, TEFRA eligible) and we used the residential census tract IDs to determine neighborhood racial composition (percent of white residents), poverty (composite), affluence (composite), and urbanicity (urban, suburban). We measure utilization in hours used per week.

Results: During the first month of EIBI, 74.7% of children used 1 hour or more of SLT, 60% of children used 1 hour or more of OT, and 14% of children used 1 hour or more of PT. Children’s utilization steadily declined during the first year of EIBI utilization. Treatment utilization patterns will be presented.

Conclusions and Implications: Findings provide insight into treatment utilization among children with ASD. This examination has significant implications for policy makers and future research, as it provides a detailed account of the simultaneous use of multiple treatments. Furthermore, it offers insight into the relationship between utilization patterns and child, family, and neighborhood characteristics among a large sample of children with ASD.