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Can State Early Intervention Programs Meet the Increased Demand of Children Suspected of Having Autism Spectrum Disorders?

Wise, Marissa D. BA*†; Little, Alison A. MPH*; Holliman, Jaime Bruce MA*‡; Wise, Paul H. MD, MPH§; Wang, C. Jason MD, PhD*‡∥

Journal of Developmental & Behavioral Pediatrics: July-August 2010 - Volume 31 - Issue 6 - p 469-476
doi: 10.1097/DBP.0b013e3181e56db2
Original Article

Objective: To determine whether Early Intervention programs have the capacity to accommodate the expected increase in referrals following the American Academy of Pediatrics' 2007 recommendation for universal screening of 18- and 24-month-old children for Autism Spectrum Disorders (ASD).

Method: We conducted a telephone survey of all state and territory early. Intervention coordinators about the demand for ASD evaluations, services, and program capacity. We used multivariate models to examine state-level factors associated with the capacity to serve children with ASD.

Results: Fifty-two of the 57 coordinators (91%) responded to the survey. Most states reported an increase in demand for ASD-related evaluations (65%) and services (58%) since 2007. In addition, 46% reported that their current capacity poses a challenge to meeting the 45-day time limit for creating the Individualized Family Service Plan. Many states reported that they have shortages of ASD-related personnel, including behavioral therapists (89%), speech-language pathologists (82%), and occupational therapists (79%). Among states that reported the number of service hours (n = 34) 44% indicated that children with ASD receive 5 or fewer weekly service hours. Multivariate models showed that states with a higher percentage of African-American and Latino children were more likely to have provider shortages whereas states with higher population densities were more likely to offer a greater number of service hours.

Conclusion: Many Early Intervention programs may not have the capability to address the expected increase in demand for ASD services. Early Intervention programs will likely need enhanced resources to provide all children with suspected ASD with appropriate evaluations and services.

From the *Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA; †Weill Cornell Medical College, New York, NY; ‡Department of Community Health Sciences, Boston University School of Public Health, Boston, MA; §Center for Policy, Outcomes and Prevention, Department of Pediatrics, Lucile Packard Children's Hospital and Stanford University School of Medicine, Stanford, CA; ∥Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA.

Received September 2009; accepted April 2010.

Supported by the Robert Wood Johnson Physician Faculty Scholars Program (to C.J.W.).

We report no financial or commercial conflicts of interest between our funding sources and any authors or contributors of this study.

Address for reprints: C. Jason Wang, MD, PhD, Department of Pediatrics and Public Health, Boston University and Boston Medical Center, 88 East Newton St, Vose 3, Boston, MA 02118; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.