A Cross-Sectional Analysis of the Social Determinants of Health (SDOH) Needs in Early Childhood Among Children at Risk and Diagnosed With Autism Spectrum Disorder.
Autistic toddlers and preschoolers are 1.5 times more likely to face social-determinant barriers like food insecurity or housing instability.
01Research in Context
What this study did
Mathur et al. (2025) looked at social-determinant needs in toddlers and preschoolers. They compared kids with autism, kids at risk, and kids with no diagnosis.
They asked about food, housing, childcare, and other basics. They counted how many needs were unmet in each group.
What they found
Autistic preschoolers were 1.5 times more likely to have at least one unmet need. The gap stayed even after adjusting for income and race.
The most common unmet needs were food insecurity and unstable housing.
How this fits with other research
Terol et al. (2024) found the same pattern in Paraguay. Earlier caregiver concern and better talking skills sped up diagnosis there. Both studies show that social factors shape when and how autism is spotted.
Hatton et al. (2004) showed autism can be reliably diagnosed by age 2. Mallika’s work adds that social barriers may delay or complicate that process today.
Norrelgen et al. (2015) tracked language growth in U.S. preschoolers. One in four still lacked phrase speech after two years. Mallika’s data hint that unmet food or housing needs could be part of the reason.
Why it matters
If a family lacks food or stable housing, therapy attendance and progress can slip. You can add two quick questions about food and housing to your intake. When needs show up, link families to local food banks or housing help before starting full therapy hours. Meeting basic needs first keeps treatment on track.
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02At a glance
03Original abstract
PURPOSE: Unmet social determinants of health (SDOH) play a significant role in the reported barriers to healthcare access and support experienced by children with autism spectrum disorder (ASD). Limited studies have explored how unmet SDOH needs impact children with ASD during early childhood. This study examined SDOH needs in children with a positive Modified Checklist for Autism in Toddlers (MCHAT) or ASD diagnosis and whether specific needs are more strongly associated with these outcomes. METHODS: Using cross-sectional data from pediatric patients' electronic health records, descriptive statistics were used to examine the prevalence of SDOH needs and associations were examined using multinomial logistic regression among children (< 5 years of age) with developmental delays. Patients were stratified into 3 groups: (1) no positive MCHAT screen or no ASD diagnosis, (2) positive MCHAT screen and no diagnosis, and (3) ASD diagnosis (ICD-10 code: F84.0). Patients and/or their caregivers were screened for five SDOH factors: food insecurity, housing stability, financial strain, health literacy, and transportation issues. RESULTS: Children diagnosed with ASD had 49% higher odds of reporting at least one SDOH (AOR:1.49, p = 0.045), compared to those with no positive MCHAT screen or diagnosis. Although not significant, a positive MCHAT screen and/or ASD diagnosis trended toward higher odds of financial strain, housing instability, and low health literacy. CONCLUSIONS: The findings emphasize the need to screen and address SDOH, particularly financial risk and health literacy, during early childhood among autistic children. Pediatric primary care SDOH programs should be tailored to better support families' unique needs.
Journal of autism and developmental disorders, 2025 · doi:10.1176/APPI.PS.201200552