Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, Piscataway, New Jersey.
Department of Pediatrics, Rutgers New Jersey Medical School, Newark.
JAMA Pediatr. 2022 Sep 1;176(9):906-914. doi: 10.1001/jamapediatrics.2022.2366.
Multiple studies have shown the value of early interventions for autism spectrum disorder (ASD). In the US, the Early Intervention Program (EIP) is mandated by law (Part C of the Individuals With Disabilities Education Act [IDEA]) to provide services to all young children with delays or disabilities. However, the extent to which children with ASD participate in this key service system is unknown.
To evaluate EIP use by children with ASD from 2006 to 2016 and to describe the factors associated with EIP participation.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used repeated data collected from 2006 to 2016 by active ASD surveillance of the New York-New Jersey metropolitan area as reported in the New Jersey Autism Study. The New Jersey Autism Study identified 4050 children aged 8 years with ASD from 2006 to 2016. Demographic and clinical data were collected and participation in an EIP was assessed through active surveillance. Data were analyzed from June to December 2021.
Sociodemographic factors associated with the outcome of EIP participation.
Participation in an EIP assessed at age 8 years. Demographic, ecological, and clinical factors, as well as temporal patterns, were examined by using standard and multilevel logistic regression models.
Among 4050 children aged 8 years with ASD by active surveillance, 1887 (46.6%) received EIP services. Of these children, 3303 (81.6%) were boys; 1105 (27.3%) were Hispanic, 801 (19.8%) were non-Hispanic Black, 1816 (44.8%) were non-Hispanic White, and 328 (8.1%) were non-Hispanic other (included Alaska Native or American Indian and Asian or Pacific Islander). In adjusted regression models, non-Hispanic Black children with ASD had lower odds of EIP participation (adjusted odds ratio [AOR], 0.67; 95% CI, 0.54-0.84) compared with their non-Hispanic White peers, and children residing in affluent areas had higher odds of receiving EIP services (AOR, 1.71; 95% CI, 1.36-2.15) compared with children residing in underserved areas. Children with ASD born in 2008 had higher odds of EIP participation than children born in 1998 (AOR, 2.64; 95% CI, 2.07-3.36).
Early identification of ASD is an important public health priority and receipt of EIP services may improve ASD outcomes. Approximately half of the population of children aged 8 years with ASD received EIP services between 2006 and 2016, and EIP participation by children with ASD increased during the 10-year period. However, receipt of EIP services was marked by strong socioeconomic status- and race and ethnicity-based disparities. Universal ASD screening and additional strategies are needed to address disparities and to increase access to EIP services.
多项研究表明自闭症谱系障碍（ASD）早期干预的价值。在美国，《残疾人教育法》（IDEA）第 C 部分规定了早期干预计划（EIP）有义务为所有有发育迟缓或残疾的幼儿提供服务。然而，患有 ASD 的儿童参与这一关键服务系统的程度尚不清楚。
评估 2006 年至 2016 年间 ASD 儿童使用 EIP 的情况，并描述与 EIP 参与相关的因素。
设计、地点和参与者：本横断面研究使用了 2006 年至 2016 年期间通过新泽西州自闭症研究对纽约-新泽西大都市区进行的 ASD 主动监测收集的重复数据。新泽西州自闭症研究从 2006 年至 2016 年期间确定了 4050 名 8 岁患有 ASD 的儿童。收集了人口统计学和临床数据，并通过主动监测评估了 EIP 的参与情况。数据分析于 2021 年 6 月至 12 月进行。
与 EIP 参与结果相关的社会人口学因素。
8 岁时 EIP 的参与情况。使用标准和多层次逻辑回归模型检查了人口统计学、生态和临床因素以及时间模式。
在通过主动监测的 4050 名 8 岁 ASD 儿童中，有 1887 名（46.6%）接受了 EIP 服务。这些儿童中，3303 名（81.6%）为男孩；1105 名（27.3%）为西班牙裔，801 名（19.8%）为非西班牙裔黑人，1816 名（44.8%）为非西班牙裔白人，328 名（8.1%）为非西班牙裔其他（包括阿拉斯加原住民或美洲印第安人和亚洲或太平洋岛民）。在调整后的回归模型中，与非西班牙裔白人相比，非西班牙裔黑人 ASD 儿童接受 EIP 服务的可能性较低（调整后的优势比[OR]，0.67；95%置信区间，0.54-0.84），而居住在富裕地区的儿童接受 EIP 服务的可能性较高（调整后的 OR，1.71；95%置信区间，1.36-2.15）与居住在服务不足地区的儿童相比。与 1998 年出生的儿童相比，2008 年出生的 ASD 儿童接受 EIP 的可能性更高（调整后的 OR，2.64；95%置信区间，2.07-3.36）。
早期识别 ASD 是一项重要的公共卫生优先事项，接受 EIP 服务可能会改善 ASD 预后。2006 年至 2016 年间，大约一半的 8 岁 ASD 儿童接受了 EIP 服务，在此期间，接受 EIP 服务的 ASD 儿童比例有所增加。然而，EIP 服务的获得存在明显的社会经济地位以及种族和族裔差异。需要普及 ASD 筛查和其他策略，以解决这些差异，并增加对 EIP 服务的获取。
