The effects of family adverse childhood experiences (ACEs) on timing of ASD diagnoses and receipt of therapies were measured using data from the 2011–2012 National Survey of Children’s Health. Parametric accelerated failure time models estimated the relationship between family ACEs and both timing of ASD diagnosis and receipt of therapies among US children (age 2–17 years; N = 1624). Compared to children without family ACEs, the adjusted effects of 1–2 and ≥ 3 ACEs resulted in prolonged time of diagnoses with time ratios of 1.17 and 1.23. Report of 1–2 and ≥ 3 ACEs were associated with a 22 and 27% increase in the median age of entry into services. ACEs may pose significant barriers to diagnoses and treatment of children with ASD.
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National Survey of Children’s Health
Autism spectrum disorder
Adverse childhood experiences
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This study was supported by Grant R40MC Autism Intervention Research Program, from the Maternal and Child Health Bureau Health Resources and Services Administration, Department of Health and Human Services. Dr. Msall and Dr. Acharya’s efforts were also supported in part by T73 MC11047 HRSA.
The authors have no financial relationships relevant to this article to disclose.
Conflict of interest
The authors have no conflict of interest relevant to this article to disclose.
Ethical Approval and Informed Consent
This manuscript is based upon publically available, secondary data from the Data Resource Center for Child and Adolescent Health. The authors requested the dataset and codebook and signed a user agreement form, in accordance with procedures. This study was exempt from human subjects review by the Temple University Institutional Review Board.
Adverse Childhood Experiences Scale
2011–2012 National Survey of Children’s Healtha
Economic hardship (living in a household that often had difficulty affording basic necessities such as housing or food)
Living with a parent who was divorced or separated since the child’s birth
Living with a parent who died
Living with a parent who served time in jail after the child was born
Witnessing intimate partner violence
Witnessing or was the victim of violence in their neighborhood
Living with someone who was mentally ill, suicidal, or severely depressed for more than a couple of weeks
Living with someone who had a problem with alcohol or drugs
Having been discriminated against because of race/ethnicity
Neighborhood amenities/detracting elements
Amenities: counts how many of four amenities are present in the children’s neighborhoods
Detractors: counts how many of three detracting elements are present in children’s neighborhoods
If the following places and things are available to children in your neighborhood, even if [CHILD’S NAME] does not actually use them
1. Sidewalks or walking paths?
2. A park or playground area?
3. A recreation center, community center, or boys’ or girls’ club?
4. A library or bookmobile?
5. Is there litter or garbage on the street or sidewalk?
6. How about poorly kept or dilapidated housing?
7. How about vandalism such as broken windows or graffiti?
Neighborhood social support
The threshold for living in a supportive neighborhood is a mean score of 2.25 or higher, indicating that no more than one item responses was one of the “disagree” options
Respondents were asked whether they strongly agree, somewhat agree, somewhat disagree, or strongly disagree with each statement. Only children with valid responses on at least three items are included in the denominator
To score this indicator, item responses are assigned values (1–4) and an average is calculated for eligible cases
1. “People in my neighborhood help each other out.”
2. “We watch out for each other’s children in this neighborhood.”
3. “There are people I can count on in this neighborhood.”
4. “If my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child.”?
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Berg, K.L., Acharya, K., Shiu, CS. et al. Delayed Diagnosis and Treatment Among Children with Autism Who Experience Adversity. J Autism Dev Disord 48, 45–54 (2018). https://doi.org/10.1007/s10803-017-3294-y