The Role of Adverse Childhood Experiences (ACES) on Health Care Access and Use Among Hispanic Children with Neurodevelopmental Disorders

Background and Purpose: Children with autism spectrum disorders (ASD) and Down syndrome (DS) have an increased need for specialized health care services, including behavioral therapy (Berg et al., 2018). Adverse childhood experiences (ACEs) are serious events related to trauma, maltreatment, and familial stressors that occur in a child’s life and possibly cause long-lasting consequences on a child’s health and well-being (Berg et al., 2016). Few studies have examined ACEs in children with ASD (Berg et al., 2016, 2018); however, less is known about children with DS. This study examined the role of ACEs on health care access and use among Hispanic and non-Hispanic White children with ASD or DS. These findings can inform clinical and policy recommendations for social workers to reduce health care disparities among underserved communities.

Methods: To assess ACEs and health care access and use of children with neurodevelopmental disorders, we used the 2017-2018 dataset from the National Survey of Children’s Health (NSCH; CAHMI, 2019). Households are randomly recruited, with only one child per household participating in the survey. The 2017-2018 NSCH dataset included 52,129 surveys of children between 0 and 17 years of age residing in the U.S. We focused this study on children with an ASD or DS diagnosis based on parent-report. To examine disparities, we focused on children who were identified as Hispanic or non-Hispanic White. For health care access and use, we evaluated the presence of a medical home, adequate insurance coverage, financial burden of health care, and unmet health care needs. Relevant demographic factors were also included in the analyses (i.e., race/ethnicity, parent nativity, parent education, household income, and household language).

Results: We conducted logistic regression analyses to identify factors (ACES, demographic) that corresponded with health care access and use. We currently present findings for access to a medical home. Analyses showed that the number of ACEs (p = .001) and parent nativity (p = .019) were significant factors in having a medical home for children with ASD. For children with DS, only the number of ACEs (p = .004) emerged as a significant factor in accounting for having a medical home. A greater number of ACEs was associated with a lower likelihood of having a medical home for children with ASD and DS. Additional analyses will examine the role of ACEs and demographic factors on additional measures of health care access and use among children with ASD and DS.

Conclusions and Implications: The preliminary results indicate that ACEs may impact the amount and quality of health care that children with neurodevelopmental disorders receive. Although ethnicity did not emerge as a significant factor in having a medical home, ACES (ASD, DS) and parent nativity (ASD) may influence children’s access to “accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective care” (CAHMI, 2019). These findings highlight the importance and need of social workers to address the impact of ACEs on children with ASD and DS. Social workers can significantly assist children with ASD and DS affected by ACEs by increasing awareness and advocacy.