Community-based service use in preschool children with autism spectrum disorder and associations with insurance status.
Four in ten preschoolers with autism receive no community help, and public insurance cuts the chance of getting behavioral therapy.
01Research in Context
What this study did
Rubenstein et al. (2019) mailed a short survey to families of preschoolers with autism.
Parents listed any community services their child used and named their insurance type.
The team compared kids on public plans versus private plans.
What they found
Four out of ten preschoolers with autism used zero community services.
Children on public insurance got fewer total services and were less likely to get any behavioral therapy.
Insurance type, not just family income, shaped who received help.
How this fits with other research
van Timmeren et al. (2016) saw the same gap in an earlier national survey. Their 2003-04 data showed most preschoolers got no behavior therapy and relied only on school speech sessions.
Klein et al. (2024) updated the picture with 2024 registry data. Black, Hispanic, and lower-income families still receive fewer weekly ABA hours, confirming that public insurance predicts lower intensity.
Chee et al. (2017) widened the lens across the lifespan. Only 70 % of autistic people of any age have their priority needs met, showing the preschool gap is part of a lifelong pattern.
Why it matters
If you serve preschoolers, check insurance status early. Families on public plans may need extra help finding community ABA, OT, or social-skills groups. Build a referral list that accepts Medicaid and schedule follow-up calls to be sure families actually start services. Closing the gap at four beats chasing it at fourteen.
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02At a glance
03Original abstract
BACKGROUND: ASD-related services can improve outcomes for children, but less is known about service outside of school settings during preschool age. We aimed to describe amount and category of community-based service use among 3-5-year-old children with ASD and examine differences by health insurance. METHODS: We used cross-sectional data on 792 children with ASD diagnoses in the Study to Explore Early Development, a community-based study of neurodevelopment with enrollment between 2012-2016. Mothers reported current child service use and insurance status at study entry. We used log-Poisson and logistic regression to compare service use by insurance group. RESULTS: Nearly 40% of children were not receiving community-based services at study entry. Children with public insurance had fewer total services than children with private or both insurances. After adjustment for sociodemographic confounders, insurance status was not associated with types of different categories of community-based services. However, children with public insurance alone were least likely to receive community-based behavioral therapy and most likely to receive psychotropic medication compared to other insurances. CONCLUSION: Many preschool-aged children do not receive community-based services, with receipt associated with insurance type. Increasing access and availability for evidence-based service, especially for beneficiaries of public insurance, may improve service use and outcomes.
Research in autism spectrum disorders, 2019 · doi:10.1176/appi.ps.201500206