Department of Psychology, University of Southern California, Los Angeles, United States.
J Autism Dev Disord. 2023 Mar;53(3):918-933. doi: 10.1007/s10803-023-05905-y. Epub 2023 Feb 9.
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.
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.
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.
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.
本研究旨在评估 COVID-19 大流行前一年、大流行的头三个月（危机阶段）和大流行后的 9 个月（缓解阶段）期间接受自闭症儿童应用行为分析（ABA）治疗的时间变化。此外，本研究还旨在评估治疗利用的变化是否因儿童种族、民族和服务的主要支付者而异。最后，我们旨在通过使用 Donabedian 的结构-过程-结果模型的扩展版本来解释研究结果，从而确定 ABA 治疗中断的潜在机制。
从加利福尼亚的 ABA 诊所收集了有关客户人口统计学和治疗利用的回顾性临床数据（n=283），并使用四个分段增长多层次模型进行了分析。
我们发现，治疗利用率在大流行的头三个月期间下降（每月减少 10.65 小时；p<.001），随后的 9 个月期间增加（每月增加 2.39 小时；p<.001）。调节分析表明，与白人、非拉丁裔参与者和私人保险参与者相比，亚洲、非拉丁裔和学区资助的儿童的治疗利用率变化轨迹明显不同。
研究结果表明，自 COVID-19 大流行开始以来，ABA 治疗的利用率中断了整整一年，儿童的种族/民族和主要支付者影响了自闭症儿童受到服务中断影响的程度。这些发现对在关键发育时期失去治疗机会的自闭症儿童以及 ABA 护理提供系统具有重要意义。
