Disparities in the Use of Autism Support Services and Adverse Child Experiences: A State-Level Purview of the National Survey of Children's Health.

Purpose: Adverse childhood experiences (ACEs) may be more prevalent among certain sociodemographic factors and location within the United States. Considering state-level variability in healthcare access and potential sociodemographic disparities, our primary objectives were: (1) to assess potential differences in rates of service utilization and cumulative ACEs scores among children with autism spectrum disorder (children with autism)) and (2) explore geographic locations where these factors may intersect. Methods: The National Survey of Children’s Health (NSCH), a publicly available dataset, was used to explore our objectives. Sociodemographic groupings and ACEs categories were tested using design-based chi-squared tests (χ2). Binary and logistic regression models examined the likelihood a child with ACEs would be receiving support services. We also created an autism support and stability index demonstrating which states provided the most overall support for children with autism. Results: Results demonstrated disparities in rates of ACEs among children with autism regarding urbanicity and region, and by the severity of autism symptoms, age of diagnosis, and whether the child was prescribed medication. Prior research indicates states with lower economic indicators have limited program availability and funding to support services for children with autism. States with the lowest rankings in our study were more likely to be designated Health Professional Shortage Areas for mental health professionals, as well as family physicians. Conclusion: Recommendations for regional differences in access to care and support services for children with autism include increased funding for early intervention programs and improved use of telehealth programs for families living in rural areas.