A Cross-Sectional Analysis of the Social Determinants of Health (SDOH) Needs in Early Childhood Among Children at Risk and Diagnosed With Autism Spectrum Disorder.

purposeUnmet social determinants of health (SDOH) play a significant role in the reported barriers to healthcare access and support experienced by children with autism spectrum disorder (ASD). Limited studies have explored how unmet SDOH needs impact children with ASD during early childhood. This study examined SDOH needs in children with a positive Modified Checklist for Autism in Toddlers (MCHAT) or ASD diagnosis and whether specific needs are more strongly associated with these outcomes.

methodsUsing cross-sectional data from pediatric patients' electronic health records, descriptive statistics were used to examine the prevalence of SDOH needs and associations were examined using multinomial logistic regression among children (< 5 years of age) with developmental delays. Patients were stratified into 3 groups: (1) no positive MCHAT screen or no ASD diagnosis, (2) positive MCHAT screen and no diagnosis, and (3) ASD diagnosis (ICD-10 code: F84.0). Patients and/or their caregivers were screened for five SDOH factors: food insecurity, housing stability, financial strain, health literacy, and transportation issues.

resultsChildren diagnosed with ASD had 49% higher odds of reporting at least one SDOH (AOR:1.49, p = 0.045), compared to those with no positive MCHAT screen or diagnosis. Although not significant, a positive MCHAT screen and/or ASD diagnosis trended toward higher odds of financial strain, housing instability, and low health literacy.

conclusionsThe findings emphasize the need to screen and address SDOH, particularly financial risk and health literacy, during early childhood among autistic children. Pediatric primary care SDOH programs should be tailored to better support families' unique needs.