EBD Blog

Guillermo Montes and Jill S. Halterman examined the relationships among multiple measures of family financial health and having a child with Autism. Based on earlier documentation that childhood autism is correlated with increases in expenses and decreases in income, they found that “Childhood autism is associated with increased enrollment into school-based settings for preschool-aged children. Parents are 7 times more likely to report that child care problems substantially affected employment decisions if they have a child with ASD.”

BACKGROUND. The impact of childhood autism on parental employment is largely unknown.

OBJECTIVE. The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems.

METHODS. Parents of 16 282 preschool-aged children were surveyed by the National Survey of Children’s Health. An autism spectrum disorder was defined as an affirmative response to the question, “Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?” There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent’s Evaluation of Developmental Status. We used 2 and multivariate logistic regression analyses.

RESULTS. Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty.

CONCLUSIONS. Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.

There is a very another very interesting feature of this study. Based on the difference between predicted and observed rates of identification of children with Autism, the authors estimate that “Approximately one third of preschool-aged (3 to 5 years) children with ASD are undiagnosed.” Although one should read the full report to understand this finding (see, in particular, page 205), it is one that merits close examination. It’s hard to be sure exactly why the found fewer preschoolers with Autism than the rate they use for prevalence (60 in 10,000 or 1in 167); perhaps the finding is a consequence of the authors’ sampling strategy, perhaps there is flaw in the identification procedures, perhaps….

Please note that one should not infer causality from this study. It’s correlational. I doubt reasonable people will argue that low family financial wealth causes Autism, that it works the other way around (consistent with increased costs); however, this is not an experiment in which families with known levels of financial wealth are randomly assigned to have or not have a child with Autism.

Montes, G., & Halterman, J. S. (2008). Child care problems and employment among families with preschool-aged children with autism in the United States. Pediatrics, 122, 202-208.

Link to the Pediatrics page for the paper (access may be limited). Flash of the electrons to Paul Nyhan of the Seattle (WA, US) Post Intelligencer for pointing to the article.