Service Utilization Disparities Among Immigrant Families Raising Children with Autism Spectrum Disorder (ASD)

Background/Purpose: Children with autism from immigrant families in the United States face persistent disparities in accessing specialized services for developmental needs. Despite the benefits of early intervention, barriers such as costs, healthcare access, cultural and linguistic factors, and immigration-related stressors lead to service gaps. Guided by Andersen’s Behavioral Model of Health Services Use, this study examines how predisposing, enabling, and need factors influence service utilization disparities among immigrant and non-immigrant families raising children with autism.

Methods: Data and Sample. We used data from the 2022 National Survey of Children’s Health, focusing on a subsample of 1,788 children with autism (including previous DSM-IV-TR diagnoses of Asperger’s disorder and pervasive developmental disorder). Immigrant families included first- and second-generation households with foreign-born children and parents, US-born children with at least one foreign-born parent, or foreign-born children with parents of mixed nativity. Non-immigrant households had only US-born children and parents.

Measures. We assessed service utilization disparities using two dependent variables: 1) receipt of special services for developmental needs (yes/no) and 2) age of service initiation. Predisposing factors included household immigration status, race/ethnicity, and sociodemographic covariates (e.g., child age, caregiver education, family structure). Enabling factors included household income, health insurance type, and insurance coverage adequacy and continuity. The need-based factor was autism severity.

Analyses. We used chi-square and t-tests to examine demographic differences by immigration status. Multivariable logistic regression investigated the effects of immigration status on service utilization, adjusting for covariates. A two-way ANCOVA examined interactions between immigration status, race/ethnicity, and autism severity on service initiation age when accounting for covariates.

Results: After adjusting for sociodemographic covariates, enabling, and need factors, immigration status did not significantly predict the likelihood of service utilization. However, race/ethnicity, gender, autism severity, and caregiver education were significant predictors. Compared to non-Hispanic White children, Hispanic and non-Hispanic Black children had 49% and 73% higher odds of receiving services. Children with moderate and severe autism were 114% and 296% more likely, respectively, to receive services than those with mild conditions. Girls had 37% lower odds of service use than boys. A one-year increase in child age was associated with a 10% decrease in service utilization likelihood. Children whose caregivers hold a college degree or higher had 128% higher odds of using services. A substantial interaction between immigration status and autism severity (F(2, 1371) = 4.03, p = .018) was found to affect the timing of service initiation. Among non-immigrant children, those with severe autism started services 1.54 years earlier than those with mild symptoms and 1.08 years earlier than those with moderate symptoms. Children from immigrant households with mild symptoms used services 0.95 years later than non-immigrant children with severe symptoms.

Conclusions and Implications: Findings highlight disparities in service by race/ethnicity, gender, autism severity, and caregiver education, with children from immigrant households experiencing greater delays in service initiation compared to non-immigrant children. These disparities call for the need for targeted policies and culturally responsive interventions to address systemic barriers, ensuring timely and accessible services for children with autism across diverse populations.