Demographic and Clinical Characteristics Associated with Engagement in Behavioral Health Treatment Among Children with Autism Spectrum Disorders

Lisa A Croen,Maria L Massolo,Meghan Davignon,Naomi Shankute,Cathleen Yoshida

doi:10.1007/s10803-017-3247-5

Abstract

This study investigates demographic and clinical factors associated with initiation, continuation, and adherence to behavioral health treatment (BHT) among children with autism spectrum disorder. Among 293 insured children referred for applied behavior analysis (ABA) based BHT, 23% never initiated treatment. Among those initiating treatment, 31% discontinued treatment within 1 year of treatment initiation, and only 15% received 80% or more of recommended treatment hours. Younger age at referral to treatment, private health insurance, and receiving more than 10 h/week of BHT were associated with treatment engagement. Co-occurring psychiatric and medical conditions were related to treatment discontinuation among children 5 years or older. These findings suggest specific subgroups that may benefit from additional support with engaging in recommended behavioral health treatment.

Highlights

Autism spectrum disorders (ASD) are complex neurodevelopmental disorders marked by restricted communication, difficulties with social interactions and repetitive behaviors (American Psychiatric Association 2013)
behavioral health treatment (BHT)—intervention using evidence based principles such as those used in applied behavior analysis (ABA)—has been shown to ameliorate some of the symptoms associated with ASD (Jensen and Sinclair 2002; Granpeesheh et al 2009; Reichow et al 2012)
The majority of patients referred for treatment were male, born in Kaiser Permanente in Northern California (KPNC), had employer or self-funded insurance, had copay amounts of 20 dollars or less, were the only child in the household with an ASD diagnosis, and had parents older than 30 years of age with more than a high school education

Summary

Introduction

Autism spectrum disorders (ASD) are complex neurodevelopmental disorders marked by restricted communication, difficulties with social interactions and repetitive behaviors (American Psychiatric Association 2013). BHT rooted in ABA has a large evidence base and is effective in improving a wide range of outcomes including full-scale IQ (intelligence quotient), receptive and expressive language, and social, daily living, adaptive, and communication skills (Howard et al 2005; Eldevik et al 2009; Virues-Ortega 2010; Reichow et al 2012; MacDonald et al 2014). Behavioral intervention can ameliorate some common co-occurring conditions in children with ASD, including sleep and feeding disorders as well as pica (a disorder marked by ingesting inedible substances) (Kodak and Piazza 2008)

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