Impact of Part C Early Intervention and Health Care Provider on Age of Specialized Treatment Receipt: A Study of a National Sample of Children with Autism Spectrum Disorder

Background and Purpose: Services for the 1 in 68 children who meet criteria for autism spectrum disorder (ASD) are increasing. Research suggests that early treatment is critical for optimal outcomes. To date, however, there is surprisingly little research on service-level factors and age of treatment receipt. In one recent study, most children participated in early treatment prior to evaluation at one regional diagnostic clinic in the United States. Yet average age at the time of the study was nearly four years, and researchers did not record age of treatment receipt. To address this gap, the purpose of this study is two-fold. First, to examine the impact of Part C Early Intervention (EI) participation on the age of specialized treatment receipt among children with ASD. Second, to determine if the relationship between EI participation and age of specialized treatment receipt varies by the type of health care provider who first told parents their children had ASD.

Method: We used data from the nationally representative 2016 National Survey of Children’s Health (NSCH) and included children 3-17 years old diagnosed with ASD at the time of the interview (N = 825). We used PROC SURVEYLOGISTIC in SAS v9.4 to estimate weighted multinomial regression models with age of treatment as the dependent variable, measured as <2, between 2 and 3 years of age, between 3 and 4 years of age, and 4 and older. Less than 2 was our reference group.  Provider type was coded based on respondent identification of who gave the first ASD diagnosis: a primary care provider (PCP), a specialist, a mental health provider, or other providers (as defined in the NSCH data). In our models we controlled for child race, gender, autism severity, primary language spoken at home, parent education, and age at time of interview.

Results: The relationship between EI participation and age of specialized treatment receipt varies by the type of health care provider who first told parents their children had ASD. For example, compared to children who received treatment at <2 years of age and who did not participate in EI, those whose parents were first told that their child had ASD by a specialist or “other” provider were more likely to start treatment before age 4 than those who were first told by a PCP.  Conversely, those that were first told by a mental health provider (vs. PCP) had lower probabilities of starting treatment before age 4.

Conclusions and Implications: Findings suggest that among children who did not participate in EI, parents who are told their children have ASD by a specialist or “other” provider receive specialized treatment earlier than parents told by a PCP. While primary care providers play a critical role in a child’s health care, they may not refer into specialized treatment for ASD as frequently as other more specialized providers. These findings suggest that education and resources could improve PCP referrals for these services. Future research is necessary to explore how EI participation and provider type influence early treatment receipt.