Treatment Utilization Trajectories among Children with Autism Spectrum Disorder: Differences by Race-Ethnicity and Neighborhood

  • Marissa E. YinglingEmail author
  • Bethany A. Bell
  • Robert M. Hock


Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is expanding. Yet there is no longitudinal research on patterns of or inequities in utilization of EIBI. We integrated state administrative records with Medicaid and Census data for children enrolled in an EIBI Medicaid waiver (N = 730) to identify and describe the type and prevalence of treatment utilization trajectories, and to examine the association between trajectory types and (a) child race-ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We identified four utilization trajectories (Low, Low-Moderate, Moderate, and High users). Race-ethnicity and neighborhood affluence were associated with trajectory membership. As coverage expands, policy makers should consider strategies to improve overall treatment utilization and enhance equity.


Autism spectrum disorder Early intensive behavioral intervention Medicaid Treatment utilization Inequities 



We acknowledge the South Carolina Department of Disabilities and Special Needs and the University of South Carolina’s Institute for African American Research for their support of this work. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the South Carolina Department of Disabilities and Special Needs.

Author Contributions

The first author conducted the majority of this study while at the University of South Carolina and completed the study at the University of Louisville. MY conceived of the study, led its design and coordination, and drafted the manuscript; BB advised MY on conceptualization, statistical analyses and interpretation, and provided feedback on manuscript drafts, RH advised MY on conceptualization and data collection and provided feedback on subsequent manuscript drafts. All authors read and approved the final manuscript.


This study was funded in part by the Institute for African American Research at the University of South Carolina.

Compliance with Ethical Standards

Conflict of interest

Dr. Marissa E. Yingling declares that she has no conflict of interest. Dr. Bethany A. Bell declares that she has no conflict of interest. Dr. Robert M. Hock declares that he has no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Kent School of Social WorkUniversity of LouisvilleLouisvilleUSA
  2. 2.Hamilton College, College of Social WorkUniversity of South CarolinaColumbiaUSA

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