The Impacts of the COVID-19 Pandemic on Therapy Utilization Among Racially/Ethnically and Socio-Economically Diverse Autistic Children

• Published in: Journal of autism and developmental disorders Vol. 53; no. 3; pp. 918 - 933
• Main Authors: Gonzales, Cassin W., Simonell, Jennifer R., Lai, Mark H.C., Lopez, Steven R., Tarbox, Jonathan
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2023; Springer; Springer Nature B.V
• Subjects: Applied Behavior Analysis; Autism; Autism Spectrum Disorder - epidemiology; Autism Spectrum Disorders; Autistic children; Autistic Disorder; Behavior modification; Behavior Patterns; Behavioral Science and Psychology; Child; Child and School Psychology; Children; Coronaviruses; COVID-19; Demographic aspects; Disruption; Economic aspects; Ethnicity; Humans; Insurance; Medical care; Minority & ethnic groups; Mitigation; Neurosciences; Original Paper; Pandemics; Pediatrics; Psychology; Public Health; Race; Racial Differences; Retrospective Studies; Social aspects; Social Differences; Social services delivery; Socioeconomic Status; Therapy; Use Studies; Utilization; California; United States; COVID-19; Multilevel modeling; Treatment access; Racial disparities; Autism spectrum disorder; Socio-economic disparities
• ISSN: 0162-3257; 1573-3432
• DOI: 10.1007/s10803-023-05905-y

Purpose:
The purpose of current study was to evaluate change in hours of Applied Behavior Analysis (ABA) therapy utilization for autistic children during the year prior to the COVID-19 pandemic, the first three months of the pandemic (crisis phase), and the following 9 months of the pandemic (mitigation phase). Additionally, this study aimed to evaluate if change in therapy utilization differed based on child race, ethnicity, and primary payer of services. Finally, we aimed to identify potential mechanisms of ABA therapy disruption by interpreting findings using an extended version of Donabedian’s structure-process-outcome model.
Methods:
Retrospective clinical data on client demographics and therapy utilization (n = 283) were collected from ABA clinics in California and analyzed with four piecewise growth multi-level models.
Results:
We found that therapy utilization dropped during the first three months of the pandemic (-10.65 h/month; p < .001) and increased during the following 9 months (2.39 h/month; p < .001). Moderator analyses revelated that Asian, Non-Latinx and school-district funded children had significantly different trajectories of change in therapy utilization compared to white, non-Latinx participants and private insurance funded participants, respectively.
Conclusion:
Findings suggest that utilization of ABA therapy was disrupted for a full year following the onset of the COVID-19 pandemic and that child race/ethnicity and primary payer influenced the degree to which autistic children were impacted by service disruption. These findings have implications for autistic children who lost therapy access during key developmental periods and for the ABA care delivery system.