Search This Blog

Wednesday, September 23, 2015

Services for Preschoolers

In The Politics of Autism I discuss early childhood education.

At The Journal of Autism and Developmental Disorders, Lucy A. Bilaver, Lisa S. Cushing, and Ann T. Cutler have an article titled "Prevalence and Correlates of Educational Intervention Utilization Among Children with Autism Spectrum Disorder."  The abstract:
This study examined the prevalence and correlates of educational intervention utilization among U.S. preschool aged children with autism spectrum disorder (ASD) prior to recent policy changes. The analysis was based on a nationally representative longitudinal survey of children receiving special education services during the 2003–2004 school year. All children with parent or teacher identified ASD over a 3-year study period were analyzed. Outcomes included utilization of speech therapy, occupational therapy, behavior therapy, and mental health services by service sector. The analysis revealed low rates of behavioral therapy and mental health services. Parents reported that the overwhelming majority of services were received inside school only. This study identified gaps in the provision of services for young children with ASD.
From the study:
Prior to policy designed to increase access to ASD services, the vast majority of children with ASD receiving preschool special education services did not receive behavioral therapies or mental health services either inside or outside of school. We find that only 5.6 % of 3-5 year olds with ASD received behavior therapy and 11.3 % received some mental health or social work service during the 2003–2004 school year. In contrast, we find that large proportions received speech and occupational therapy and did so predominately at school. The low rates of behavioral therapy are particularly troubling given that these services, particular early intensive behavioral interventions (EIBI), are the most widely recommended evidence-based treatment for ASD (Lovaas 1987; McEachin et al. 1993; Rogers 1998; Smith et al. 1997; Vismara and Rogers 2010).
Receiving service outside of school was relatively rare prior to state insurance mandates. The highest percent of children receiving service both inside and outside of school was just 13 % (speech therapy at wave 3). At the time of data collection for the PEELS, only one state had an autism insurance mandate in effect. Given the very low rates of service use outside of school, how much would mandates need to increase access to reduce unmet need for services? Research on the causal effect of autism insurance mandates
is in its’ infancy. To our knowledge, a recent analysis by Chatterji et al. (2015) is the first to use national data to address this question. Using multiple years of data from the National Survey of Children with Special Health Care Needs, the authors find no statistically significant relationship between state ASD mandates and financial burden,access to care, and unmet need for services. Because the survey captures nformation about unmet need for children with all types of special health care needs, questions onservices do not specify ABA or other behavioral therapies. Instead, the authors examined whether state ASD mandates were associated with unmet need for speech, occupational,or physical therapy or unmet need for mental health care or counseling due to costs or insurance issues. They find no effect.
  • Chatterji, P., Decker, S. L., & Markowitz, S. (2015). The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment. Journal of Policy Analysis and Management: [the Journal of the Association for Public Policy Analysis and Management], 34(2), 328–353.
  • Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.
  • McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation: AJMR, 97(4), 359–372. (discussion 373–391. Accessed 24 February 2011).
  • Rogers, S. J. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27(2), 168. doi:10.1207/s15374424jccp2702_4.
  • Smith, T., Eikeseth, S., Klevstrand, M., & Lovaas, O. I. (1997). Intensive behavioral treatment for preschoolers with severe mental retardation and pervasive developmental disorder. American Journal of Mental Retardation: AJMR, 102(3), 238–249. doi:10.1352/0895-8017(1997)102\0238:IBTFPW[2.0.CO;2
  • Vismara, L. A., & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder: What do we know? Annual Review of Clinical Psychology, 6, 447–468. doi:10.1146/annurev.clinpsy. 121208.131151.