Therapy access among children with autism spectrum disorder, cerebral palsy, and attention‐deficit–hyperactivity disorder: a population‐based study

Abstract

This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit–hyperactivity disorder (ADHD) and cerebral palsy (CP). The 2005–2006 and 2009–2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services. After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36–2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97–1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties. Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP. Estudiar la prevalencia de anomalías congénitas en niños con parálisis cerebral (PC) nacidos a término o tardíos y diferencias en las manifestaciones clínicas entre los ninos que no presentan estas anomalías. Se trata de un estudio transversal utilizando datos del Registro de Parálisis Cerebral de Noruega y del Registro Médico de Nacimientos de Noruega. Se incluyeron todos los niños con PC congénita y después de 34 semanas de gestación entre 1999 y 2009. Las anomalías se clasificaron según las guías de clasificación de la European Registration of Congenital Anomalies (EUROCAT). Los grupos se compararon mediante la prueba exacta de Fisher, la prueba de Kruskal-Wallis y la prueba U de Mann-Whitney. Entre 685 niños con PC, 169 (25%) tuvieron una anomalía congénita; 125 en el sistema nervioso central. La PC espástica bilateral fue más prevalente en niños con anomalías (42%) que en niños sin anomalias (34%; p=0.011). Los niños con anomalías con menor frecuencia tenían baja puntuaciones de Apgar (ppp = 0.011). Crianças sem anomalias menos frequentemente tiveram baixos escores de Apgar (pp<0.03). Embora crianças com PC e anomalias tenham baixos escores de Apgar menos frequentemente, elas apresentam limitações mais severas na função motora e mais problemas associados do que crianças com PC sem anomalias.