Service disengagement rates are high in youths with autism spectrum disorder after high school

Use of medical, mental health and case management services for young adults with an autism spectrum disorder appears to decline after high school, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"The number of young adults in the United States diagnosed as having an autism spectrum disorder is increasing rapidly as ever-larger cohorts of children identified as having an autism spectrum disorder age through adolescence," according to background information in the article. "Regardless of the root cause, the facts remain that treated prevalence is increasing and that the implications of this trend for service systems are poorly understood."

Paul T. Shattuck, Ph.D., of Washington University, St. Louis, and colleagues analyzed data from a nationally representative telephone questionnaire surveying parents and guardians of young adults between the ages of 19 and 23 years with an autism spectrum disorder. Surveys were conducted from April 2007 to February 2008.

Overall rates of service use ranged from 9.1 percent for speech therapy to 41.9 percent for case management. Other services utilized included medical services (23.5 percent) and mental health services (35 percent). About two-fifths of youths (39.1 percent) had not received any of these services. These rates are lower than estimates gathered six years earlier when all patients were still in high school. During that time, 46.2 percent received mental health services, 46.9 percent received medical services, 74.6 percent were getting speech therapy and 63.6 percent had a case manager.

The adjusted odds of not receiving any of the services was 3.31 times higher for African American youths compared to white youths, and was 5.96 times higher for those with incomes of $25,000 or less compared with those making $75,000 or more. Additionally, the adjusted odds of not using case management services were 5.88 times higher among those making $25,000 or less compared with those with incomes of $75,000 or greater.

"Rates of service disengagement are high after exiting high school. Disparities by race and socioeconomic status indicate a need for targeted outreach and services," the authors conclude. "This study represents an important step in the process of building a foundation of evidence that can help improve services and foster independence and health among youths with autism spectrum disorders."