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Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. e1149-e1158 (doi:10.1542/peds.2008-1057)
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ARTICLE

A National Profile of the Health Care Experiences and Family Impact of Autism Spectrum Disorder Among Children in the United States, 2005–2006

Michael D. Kogan, PhDa, Bonnie B. Strickland, PhDa, Stephen J. Blumberg, PhDb, Gopal K. Singh, PhDa, James M. Perrin, MDc, Peter C. van Dyck, MD, MPHa

a Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
b National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
c Harvard Medical School, Cambridge, Massachusetts

OBJECTIVES. We sought to examine the health care experiences of children with autism spectrum disorder and the impact of autism spectrum disorder on the family and to assess whether having a medical home is associated with less family impact.

METHODS. We used the 2005–2006 National Survey of Children With Special Health Care Needs to compare 2088 children with special health care needs, aged 3 to 17 years, reported by their parents to have autism spectrum disorder, with children with special health care needs with "other emotional, developmental, or behavioral problems" (excluding autism spectrum disorder; n = 9534) and 26751 other children with special health care needs. We used weighted logistic regression to examine unmet needs for specific health care and support services, delayed care, no usual care source or personal physician, difficulty receiving referrals, and financial, employment, or time problems because of child's care.

RESULTS. Nationally, an estimated 535000 children have special health care needs and autism spectrum disorder, a prevalence of 86 per 10000 children aged 3 to 17 years. Among children with special health care needs, 5.6% have autism spectrum disorder. Compared with other children with special health care needs without emotional, developmental, or behavioral problems, children with special health care needs with autism spectrum disorder were more likely to have unmet needs for specific health care services, family support services, delayed or foregone care, difficulty receiving referrals, and care that is not family centered. Children with special health care needs with autism spectrum disorder were more likely to live in families that report financial problems, need additional income for the child's medical care, reduce or stop work because of the child's condition, spend ≥10 hours per week providing or coordinating care, and paid more than $1000 in the previous year for the child's care. The financial impacts of autism spectrum disorder were significantly more burdensome when children with special health care needs did not have a medical home.

CONCLUSIONS. Children with special health care needs with autism spectrum disorder are significantly more likely to have problems regarding access to care and unmet needs, and their families have greater financial, employment, and time burdens compared with other children with special health care needs. Receipt of primary care in a medical home may reduce these burdens.

Key Words: autism spectrum disorder • children with special health care needs • disability • national estimates • access to health care

Abbreviations: ASD—autism spectrum disorder • CSHCN—children with special health care needs • NS-CSHCN—2005–2006 National Survey of Children With Special Health Care Needs • NCHS—National Center for Health Statistics • EDB—emotional, developmental, or behavioral • OCSHCN—other children with special health care needs • OR—odds ratio • CI—95% confidence interval

Accepted Aug 19, 2008.


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