Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Shelly J. Lane


Children with autism spectrum disorder (ASD) represent a growing category of children who have special health care needs. Recent Centers for Disease Control and Prevention (CDC) estimates suggest that 1 in 88 children in the United States have an ASD (CDC, 2012). Due to difficulty with communication, social skills, and restricted and/or repetitive behaviors that comprise current diagnostic criteria (APA, 2013), children with ASD require significant medical, mental health, and therapeutic supports that contribute to greater heath care utilization costs than persons without ASD (e.g., Shimabukuro, Grosse, & Rice, 2008). Therapies such as occupational, physical, and speech therapy are among recommended services provided to remediate functional or behavioral needs (Johnson & Myer, 2007). Studies investigating access to healthcare services such as diagnostic and genetic screening or primary care are frequently published in the literature; however, few studies examine access to needed therapy services. The purpose of this study was to examine population-based trends in therapy service access in children with ASD compared to children with attention deficit hyperactivity disorder (ADHD) and cerebral palsy (CP) using two waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN). Additionally, this study aimed to identify predisposing, enabling, and need characteristics that predicted lack of access to therapy across the two cross-sectional points in time. Parent-reported contextual characteristics that potentially limited access to needed therapy services were compared between survey time periods (2005-06 and 2009-10). Results of this study suggest that children with ASD are significantly more likely to not receive needed therapy services than children with attention-deficit hyperactivity disorder (ADHD), but are similar in their unmet need for therapy compared to children with cerebral palsy (CP). Significant predictors of an unmet need for therapy were having a current ASD diagnosis, age, uninsured status, greater functional limitation, and having a reported behavior problem. The only access problem that differentiated children from ASD from ADHD and CP was “difficulty finding a provider accepting insurance”. Implications of these results are discussed in the context of Andersen’s Behavioral Model of Health Service Use and recommendations for future research are presented.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2014