569745 research-article2015
AUT0010.1177/1362361315569745AutismPickard and Ingersoll
Original Article
Quality versus quantity: The role of socioeconomic status on parent-reported service knowledge, service use, unmet service needs, and barriers to service use
Autism 1–10 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361315569745 aut.sagepub.com
Katherine E Pickard and Brooke R Ingersoll
Abstract Research within the autism spectrum disorder field has emphasized the role of socioeconomic status in shaping parents’ ability to access services for their child with autism spectrum disorder. However, research has yet to explore the possible mechanisms underlying this relationship. This study sought to address this research gap by examining the following questions: (1) Does parents’ service knowledge mediate the relationship between parent socioeconomic status and parents’ autism spectrum disorder service use? (2) What are parents’ reported service needs and service barriers, and do these needs vary across higher and lower socioeconomic status groups? Quantitative results from 244 parents of a child with autism spectrum disorder indicate that parents’ autism spectrum disorder service knowledge partially mediates the relationship between parent socioeconomic status and parents’ autism spectrum disorder service use. Qualitative findings helped to clarify this relationship by suggesting that both high and low socioeconomic status parents are aware of their child’s basic autism spectrum disorder needs. However, low socioeconomic status parents more often report needing more information about services and more in-home services and emphasize that a number of structural barriers impede their ability to meet their child’s autism spectrum disorder needs. On the other hand, high socioeconomic status parents more often report a need for “higher quality services,” possibly reflecting their better recognition of best practice guidelines. These results highlight the need for a multi-pronged approach to tackling unmet service needs within the autism spectrum disorder field. Keywords autism spectrum disorder, barriers, disparities, service access, unmet needs
Introduction Intervention research over the past couple of decades has prompted advances in both the quality and the quantity of interventions that are available for children with autism spectrum disorder (ASD; Dawson, 2008; National Autism Center, 2009). This research has emphasized intervention as a means for children with ASD to see significant improvements in IQ, language, social skills, and educational placement (Dawson, 2008; Reichow and Volkmar, 2010; Rogers and Vismara, 2008). Despite these advances, studies examining service use have emphasized that many parents are dissatisfied or only somewhat satisfied with the services that they access for their child with ASD (Spann et al., 2003; Thomas et al., 2007b). When asked about
areas in which ASD service use could be improved, parents generally report the need to improve the quality, quantity, and accessibility of services. For example, parents emphasize being dissatisfied with the information available about services, the insurance funding for service coverage, the lack of collaboration between parents and professionals, and the lack of professionals with Michigan State University, USA Corresponding author: Katherine E Pickard, Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI 48824, USA. Email: [email protected]
Downloaded from aut.sagepub.com at NANYANG TECH UNIV LIBRARY on November 14, 2015
2
Autism
specialized ASD training (Brookman-Frazee et al., 2012; Dymond et al., 2007). Although similar concerns are often reported by parents of children with other special health care needs (CSHCN; Chiri and Warfield, 2012; Kogan et al., 2008; Krauss et al., 2003), overall dissatisfaction with services is higher for parents of children with ASD (Bitterman et al., 2008; Montes et al., 2009) and likely reflects the substantial difficulty that parents of children with ASD experience when trying to access appropriate health and education services for their child. Studies noting challenges in ASD service access have also noted that these challenges are not experienced to the same magnitude by all parents of a child with ASD. Rather, receiving an ASD diagnosis and accessing ASD services can be influenced by a number of factors, including a family’s socioeconomic status (SES; Durkin et al., 2010; Liptak et al., 2008; Patten et al., 2012). Specifically, low SES has been associated with a later age of ASD diagnosis (Durkin et al., 2010; Thomas et al., 2011) and decreased ASD service use (Liptak et al., 2008; Patten et al., 2012). Given the relationship between SES and service use, it is not surprising that lower SES families of CSHCN including ASD report a higher number of unmet service needs (Farmer et al., 2004; Larson and Halfon, 2010; Porterfield and McBride, 2007), greater difficulty accessing care, and a lower level of satisfaction with the services they are using than higher SES families (Farmer et al., 2004; Hare et al., 2004). Although a number of studies have documented SESbased disparities in ASD service use, satisfaction, and unmet service needs (Farmer et al., 2004; Patten et al., 2012; Thomas et al., 2011), only a few studies have speculated about the potential mechanisms underlying this relationship, and existing evidence for these mechanisms has been indirect at best. For example, some researchers have suggested that lower SES families may experience a greater number of structural barriers that impede their service access (e.g. King and Bearman, 2011). In support of this hypothesis, research has found that lower SES parents are more likely to indicate that high service cost and transportation difficulties are barriers to service access (Patten et al., 2012; Porterfield and McBride, 2007; Thomas et al., 2011). This research is particularly important given the evidence that parents’ perceived barriers can impact their uptake and adherence of child mental health services more broadly (Kazdin et al., 1997). If lower SES families do experience a wider variety of barriers, as some research has hypothesized, it may be these differentially experienced barriers that play a role in their decreased service use. However, research has yet to examine which specific structural barriers differ across SES groups, and how these differences may explain the health gradients observed in ASD service use. Alternatively, it has been proposed that lower SES families access fewer services because they are less aware of their child’s needs for specialty services or are less aware
of available service options for their child (Porterfield and McBride, 2007). In support of this hypothesis, Porterfield and McBride (2007) showed that parents from lower SES backgrounds were less likely to indicate that their child needed specialty services than parents of higher SES backgrounds, despite the fact that they reported that their child experienced more severe health pathology. A related possibility is that higher SES parents may be more effective advocates for their child and may be better able to seek out and advocate for needed services when faced with barriers (King and Bearman, 2011). To better understand the potential mechanisms underlying service access disparities in families of children with ASD, we conducted a mixed method study. In the first phase of the study, we used a quantitative approach to determine what services parents were currently accessing for their child with ASD. Consistent with previous health disparities research, we expected to find that higher SES parents would report accessing a greater number of services for their child with ASD. We also asked parents to indicate all of the services that they had heard of as treatment options for ASD. We hypothesized that if differences in parent knowledge about service availability played a role in health disparities (Porterfield and McBride, 2007), then parents from higher SES backgrounds would also report greater awareness of service options for ASD, and that this knowledge might mediate the relationship between parent SES and parent service use. In the second phase of the study, we used a qualitative approach to examine parents’ perceived service needs and barriers to service use. We hypothesized that many themes regarding perceived service needs and barriers to service access would be similar across SES levels. However, we also hypothesized that some unique themes would emerge based on parent SES, and that these differences might help explain the mechanisms underlying the relationship between SES and ASD service use.
Method Participants In total, 244 parents of a child with an ASD diagnosis (i.e. autistic disorder, Asperger’s syndrome, pervasive developmental disorder–not otherwise specified (PDD-NOS)) between the ages of 2 and 17 years (M = 6.41 years, SD = 2.57 years) participated in this Institutional Review Board–approved study. Recruitment for this study occurred in two ways. Of the sample, 73% (N = 177) was recruited through the Interactive Autism Network (IAN) Research Database. To increase the representativeness of the study sample, 27% (N = 65) of participants were non-IAN families who were recruited through ASD resource centers and ASD clinical centers across the United States. Informed consent was provided to all participants. Preliminary analyses indicated the two recruitment samples did not significantly differ
Downloaded from aut.sagepub.com at NANYANG TECH UNIV LIBRARY on November 14, 2015
3
Pickard and Ingersoll on any collected demographic measures. As a result, the two samples were combined in all analyses. Parents came from 35 different US states, were 95% female, and were 38.10 years of age on average (Range: 23–64 years, SD: 6.68 years). Of the parents, 7% had a high school education or less, 33% had completed specialized training, and 60% had a 4-year college education or greater. Parents indicated that 66.5% of their children had an autism diagnosis, 11% had an Asperger’s syndrome diagnosis, and 21% had a PDD-NOS diagnosis. Of the children, 80% were male, and the average age of ASD diagnosis was 3.19 years (Range: 1–14 years; SD: 1.79 years). All participant characteristics are presented in Table 1.
Measures This study was administered over the Internet using Qualtrics software. Socio-demographic information. Parents provided basic demographic information about themselves and their child. This included primary caregiver age, gender, education level, marital status, zip code (county of residence), as well as the age, gender, diagnosis, and age of diagnosis for their child with ASD. Parent SES. For this study, parent education level was used as a proxy for SES. Parents reported their highest educational degree on a 5-point Likert-type scale with a 1 indicating the parent had not obtained a high school degree, a 2 indicating they had a high school degree, a 3 indicating they had a specialized training degree, a 4 indicating they had a 4-year college degree, and a 5 indicating that they had a graduate degree. Education level on this scale was used as the measure of Parent SES in the quantitative data analysis. For the qualitative analyses, parents with less than a 4-year college education were considered lower SES (N = 98, 40.30%), and those with a 4-year college education and higher were considered higher SES (N = 146, 59.70%). Prior to choosing our proxy for SES, we completed a review of how SES has typically been measured in other health disparities research. From this review, it appeared that there were many strategies to approximate SES, all with their unique set of advantages and disadvantages (Shavers, 2007). Although using maternal education as a proxy for SES is also associated with disadvantages, our review of prior research suggested that education is more stable than family income, less affected by parental age, and a better approximation of SES when it is measured as education credentials rather than years of education (Krieger et al., 1997; Shavers, 2007), which was how this variable was measured in this study. ASD symptom severity. Parents completed the Autism Behavior Checklist (ABC) (Krug et al., 1980) as a measure of their child’s ASD symptom severity. The ABC consists
of 57 questions that ask about behaviors that are specific to ASD, as well as other general behavior problems. Parents marked “yes” or “no” to indicate whether the particular behavior applied to their child. Items on the ABC are weighted so that a “yes” to a less severe behavior is scored as a 1, and a “yes” to a more severe behavior is scored as 4. Total scores were summed with higher total scores indicating more severe ASD symptoms. Cronbach’s alphas from this study indicated good inter-item correlations (r = 0.22) and good internal consistency (α = 0.94). Autism services. Parents were provided with a list of 52 services that have been identified as common services used by parents of a child with ASD (Hyman and Levy, 2010; Odom et al., 2010; Thomas et al., 2007b). From this list, parents selected (1) all of the services that they had used for their child over the past 6 months (Service Use) and (2) all the services that they had heard of as intervention options for ASD (Service Knowledge). Parents were also provided with blanks to indicate any services that they used that was not a part of the provided list. Service needs and barriers to service use. Parents were asked to respond to two open-ended questions: (1) What services do you think your child could use that he/she currently does not have? and (2) What are some of the barriers that you have experienced in accessing services to meet your child’s needs?
Data analysis Quantitative data. Initial bivariate correlations between the socio-demographic variables and service variables were examined. Parent SES and child symptom severity were both significantly associated with parent service knowledge and parent service use and thus were included in the path analysis. No other associations between demographic variables and autism service variables were significant. SPSS AMOS software was used to run a path analysis as a means to analyze the quantitative data and to determine whether parent knowledge mediated the relationship between parent SES and parent service use. The path analysis included parent SES and child symptom severity as predictor variables, parent service knowledge as a mediator variable, and parent service use as the outcome variable. In this analysis, mediation would be indicated by statistically significant effects of the predictor variables on the mediator variable and of the mediator variable on the outcome variable (i.e. indirect effects), along with nonsignificant effects of the predictor variables on the outcome variables (i.e. direct effects); partial mediation would be indicated by indirect effects, but still significant direct effects. Qualitative data. Given the open-ended nature of the qualitative questions, not all participating parents chose to
Downloaded from aut.sagepub.com at NANYANG TECH UNIV LIBRARY on November 14, 2015
4
Autism
Table 1. Sample characteristics. Characteristic
Low SES (N = 97) Mean (SD)
Primary caregiver Age Gender (% female) Marital status Married/living with partner Single, widowed, divorced Ethnicity White/Caucasian Black/African American Hispanic Asian/Pacific Islander Biracial/other Household income US$100,000 Other children at home ABC total Child Age Diagnosis Asperger’s syndrome Autism PDD-NOS Other ASD Age in years at diagnosis
High SES (N = 147) Percent
Mean (SD)
Percent
38.69(6.68) 96.80%
96.60%
75.80% 24.20%
89.10% 10.90%
87.50% 5.20% 5.20% 1.00% 1.00%
91.70% 2.80% 3.40% 0.00% 0.70%
27.40% 29.50% 18.50% 12.60% 11.60%
4.20% 11.10% 19.40% 21.50% 43.80%
36.82 (7.26)
1.36 (1.39) 31.42 (10.76)
1.07 (0.87) 26.64 (10.43)
6.08 (2.55)
6.63 (2.57) 9.40% 69.80% 19.80% 1.00%
3.18 (1.77)
3.19 (1.82)
11.60% 65.80% 21.20% 1.40%
SES: socioeconomic status; ASD: autism spectrum disorder; SD: standard deviation; ABC: Autism Behavior Checklist; PDD-NOS: pervasive developmental disorder–not otherwise specified.
respond to these questions. In total, 214 of the 244 participants responded to these questions. Those parents who did respond to the questions did not differ demographically from those that did (all d’s
AUT0010.1177/1362361315569745AutismPickard and Ingersoll
Original Article
Quality versus quantity: The role of socioeconomic status on parent-reported service knowledge, service use, unmet service needs, and barriers to service use
Autism 1–10 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361315569745 aut.sagepub.com
Katherine E Pickard and Brooke R Ingersoll
Abstract Research within the autism spectrum disorder field has emphasized the role of socioeconomic status in shaping parents’ ability to access services for their child with autism spectrum disorder. However, research has yet to explore the possible mechanisms underlying this relationship. This study sought to address this research gap by examining the following questions: (1) Does parents’ service knowledge mediate the relationship between parent socioeconomic status and parents’ autism spectrum disorder service use? (2) What are parents’ reported service needs and service barriers, and do these needs vary across higher and lower socioeconomic status groups? Quantitative results from 244 parents of a child with autism spectrum disorder indicate that parents’ autism spectrum disorder service knowledge partially mediates the relationship between parent socioeconomic status and parents’ autism spectrum disorder service use. Qualitative findings helped to clarify this relationship by suggesting that both high and low socioeconomic status parents are aware of their child’s basic autism spectrum disorder needs. However, low socioeconomic status parents more often report needing more information about services and more in-home services and emphasize that a number of structural barriers impede their ability to meet their child’s autism spectrum disorder needs. On the other hand, high socioeconomic status parents more often report a need for “higher quality services,” possibly reflecting their better recognition of best practice guidelines. These results highlight the need for a multi-pronged approach to tackling unmet service needs within the autism spectrum disorder field. Keywords autism spectrum disorder, barriers, disparities, service access, unmet needs
Introduction Intervention research over the past couple of decades has prompted advances in both the quality and the quantity of interventions that are available for children with autism spectrum disorder (ASD; Dawson, 2008; National Autism Center, 2009). This research has emphasized intervention as a means for children with ASD to see significant improvements in IQ, language, social skills, and educational placement (Dawson, 2008; Reichow and Volkmar, 2010; Rogers and Vismara, 2008). Despite these advances, studies examining service use have emphasized that many parents are dissatisfied or only somewhat satisfied with the services that they access for their child with ASD (Spann et al., 2003; Thomas et al., 2007b). When asked about
areas in which ASD service use could be improved, parents generally report the need to improve the quality, quantity, and accessibility of services. For example, parents emphasize being dissatisfied with the information available about services, the insurance funding for service coverage, the lack of collaboration between parents and professionals, and the lack of professionals with Michigan State University, USA Corresponding author: Katherine E Pickard, Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI 48824, USA. Email: [email protected]
Downloaded from aut.sagepub.com at NANYANG TECH UNIV LIBRARY on November 14, 2015
2
Autism
specialized ASD training (Brookman-Frazee et al., 2012; Dymond et al., 2007). Although similar concerns are often reported by parents of children with other special health care needs (CSHCN; Chiri and Warfield, 2012; Kogan et al., 2008; Krauss et al., 2003), overall dissatisfaction with services is higher for parents of children with ASD (Bitterman et al., 2008; Montes et al., 2009) and likely reflects the substantial difficulty that parents of children with ASD experience when trying to access appropriate health and education services for their child. Studies noting challenges in ASD service access have also noted that these challenges are not experienced to the same magnitude by all parents of a child with ASD. Rather, receiving an ASD diagnosis and accessing ASD services can be influenced by a number of factors, including a family’s socioeconomic status (SES; Durkin et al., 2010; Liptak et al., 2008; Patten et al., 2012). Specifically, low SES has been associated with a later age of ASD diagnosis (Durkin et al., 2010; Thomas et al., 2011) and decreased ASD service use (Liptak et al., 2008; Patten et al., 2012). Given the relationship between SES and service use, it is not surprising that lower SES families of CSHCN including ASD report a higher number of unmet service needs (Farmer et al., 2004; Larson and Halfon, 2010; Porterfield and McBride, 2007), greater difficulty accessing care, and a lower level of satisfaction with the services they are using than higher SES families (Farmer et al., 2004; Hare et al., 2004). Although a number of studies have documented SESbased disparities in ASD service use, satisfaction, and unmet service needs (Farmer et al., 2004; Patten et al., 2012; Thomas et al., 2011), only a few studies have speculated about the potential mechanisms underlying this relationship, and existing evidence for these mechanisms has been indirect at best. For example, some researchers have suggested that lower SES families may experience a greater number of structural barriers that impede their service access (e.g. King and Bearman, 2011). In support of this hypothesis, research has found that lower SES parents are more likely to indicate that high service cost and transportation difficulties are barriers to service access (Patten et al., 2012; Porterfield and McBride, 2007; Thomas et al., 2011). This research is particularly important given the evidence that parents’ perceived barriers can impact their uptake and adherence of child mental health services more broadly (Kazdin et al., 1997). If lower SES families do experience a wider variety of barriers, as some research has hypothesized, it may be these differentially experienced barriers that play a role in their decreased service use. However, research has yet to examine which specific structural barriers differ across SES groups, and how these differences may explain the health gradients observed in ASD service use. Alternatively, it has been proposed that lower SES families access fewer services because they are less aware of their child’s needs for specialty services or are less aware
of available service options for their child (Porterfield and McBride, 2007). In support of this hypothesis, Porterfield and McBride (2007) showed that parents from lower SES backgrounds were less likely to indicate that their child needed specialty services than parents of higher SES backgrounds, despite the fact that they reported that their child experienced more severe health pathology. A related possibility is that higher SES parents may be more effective advocates for their child and may be better able to seek out and advocate for needed services when faced with barriers (King and Bearman, 2011). To better understand the potential mechanisms underlying service access disparities in families of children with ASD, we conducted a mixed method study. In the first phase of the study, we used a quantitative approach to determine what services parents were currently accessing for their child with ASD. Consistent with previous health disparities research, we expected to find that higher SES parents would report accessing a greater number of services for their child with ASD. We also asked parents to indicate all of the services that they had heard of as treatment options for ASD. We hypothesized that if differences in parent knowledge about service availability played a role in health disparities (Porterfield and McBride, 2007), then parents from higher SES backgrounds would also report greater awareness of service options for ASD, and that this knowledge might mediate the relationship between parent SES and parent service use. In the second phase of the study, we used a qualitative approach to examine parents’ perceived service needs and barriers to service use. We hypothesized that many themes regarding perceived service needs and barriers to service access would be similar across SES levels. However, we also hypothesized that some unique themes would emerge based on parent SES, and that these differences might help explain the mechanisms underlying the relationship between SES and ASD service use.
Method Participants In total, 244 parents of a child with an ASD diagnosis (i.e. autistic disorder, Asperger’s syndrome, pervasive developmental disorder–not otherwise specified (PDD-NOS)) between the ages of 2 and 17 years (M = 6.41 years, SD = 2.57 years) participated in this Institutional Review Board–approved study. Recruitment for this study occurred in two ways. Of the sample, 73% (N = 177) was recruited through the Interactive Autism Network (IAN) Research Database. To increase the representativeness of the study sample, 27% (N = 65) of participants were non-IAN families who were recruited through ASD resource centers and ASD clinical centers across the United States. Informed consent was provided to all participants. Preliminary analyses indicated the two recruitment samples did not significantly differ
Downloaded from aut.sagepub.com at NANYANG TECH UNIV LIBRARY on November 14, 2015
3
Pickard and Ingersoll on any collected demographic measures. As a result, the two samples were combined in all analyses. Parents came from 35 different US states, were 95% female, and were 38.10 years of age on average (Range: 23–64 years, SD: 6.68 years). Of the parents, 7% had a high school education or less, 33% had completed specialized training, and 60% had a 4-year college education or greater. Parents indicated that 66.5% of their children had an autism diagnosis, 11% had an Asperger’s syndrome diagnosis, and 21% had a PDD-NOS diagnosis. Of the children, 80% were male, and the average age of ASD diagnosis was 3.19 years (Range: 1–14 years; SD: 1.79 years). All participant characteristics are presented in Table 1.
Measures This study was administered over the Internet using Qualtrics software. Socio-demographic information. Parents provided basic demographic information about themselves and their child. This included primary caregiver age, gender, education level, marital status, zip code (county of residence), as well as the age, gender, diagnosis, and age of diagnosis for their child with ASD. Parent SES. For this study, parent education level was used as a proxy for SES. Parents reported their highest educational degree on a 5-point Likert-type scale with a 1 indicating the parent had not obtained a high school degree, a 2 indicating they had a high school degree, a 3 indicating they had a specialized training degree, a 4 indicating they had a 4-year college degree, and a 5 indicating that they had a graduate degree. Education level on this scale was used as the measure of Parent SES in the quantitative data analysis. For the qualitative analyses, parents with less than a 4-year college education were considered lower SES (N = 98, 40.30%), and those with a 4-year college education and higher were considered higher SES (N = 146, 59.70%). Prior to choosing our proxy for SES, we completed a review of how SES has typically been measured in other health disparities research. From this review, it appeared that there were many strategies to approximate SES, all with their unique set of advantages and disadvantages (Shavers, 2007). Although using maternal education as a proxy for SES is also associated with disadvantages, our review of prior research suggested that education is more stable than family income, less affected by parental age, and a better approximation of SES when it is measured as education credentials rather than years of education (Krieger et al., 1997; Shavers, 2007), which was how this variable was measured in this study. ASD symptom severity. Parents completed the Autism Behavior Checklist (ABC) (Krug et al., 1980) as a measure of their child’s ASD symptom severity. The ABC consists
of 57 questions that ask about behaviors that are specific to ASD, as well as other general behavior problems. Parents marked “yes” or “no” to indicate whether the particular behavior applied to their child. Items on the ABC are weighted so that a “yes” to a less severe behavior is scored as a 1, and a “yes” to a more severe behavior is scored as 4. Total scores were summed with higher total scores indicating more severe ASD symptoms. Cronbach’s alphas from this study indicated good inter-item correlations (r = 0.22) and good internal consistency (α = 0.94). Autism services. Parents were provided with a list of 52 services that have been identified as common services used by parents of a child with ASD (Hyman and Levy, 2010; Odom et al., 2010; Thomas et al., 2007b). From this list, parents selected (1) all of the services that they had used for their child over the past 6 months (Service Use) and (2) all the services that they had heard of as intervention options for ASD (Service Knowledge). Parents were also provided with blanks to indicate any services that they used that was not a part of the provided list. Service needs and barriers to service use. Parents were asked to respond to two open-ended questions: (1) What services do you think your child could use that he/she currently does not have? and (2) What are some of the barriers that you have experienced in accessing services to meet your child’s needs?
Data analysis Quantitative data. Initial bivariate correlations between the socio-demographic variables and service variables were examined. Parent SES and child symptom severity were both significantly associated with parent service knowledge and parent service use and thus were included in the path analysis. No other associations between demographic variables and autism service variables were significant. SPSS AMOS software was used to run a path analysis as a means to analyze the quantitative data and to determine whether parent knowledge mediated the relationship between parent SES and parent service use. The path analysis included parent SES and child symptom severity as predictor variables, parent service knowledge as a mediator variable, and parent service use as the outcome variable. In this analysis, mediation would be indicated by statistically significant effects of the predictor variables on the mediator variable and of the mediator variable on the outcome variable (i.e. indirect effects), along with nonsignificant effects of the predictor variables on the outcome variables (i.e. direct effects); partial mediation would be indicated by indirect effects, but still significant direct effects. Qualitative data. Given the open-ended nature of the qualitative questions, not all participating parents chose to
Downloaded from aut.sagepub.com at NANYANG TECH UNIV LIBRARY on November 14, 2015
4
Autism
Table 1. Sample characteristics. Characteristic
Low SES (N = 97) Mean (SD)
Primary caregiver Age Gender (% female) Marital status Married/living with partner Single, widowed, divorced Ethnicity White/Caucasian Black/African American Hispanic Asian/Pacific Islander Biracial/other Household income US$100,000 Other children at home ABC total Child Age Diagnosis Asperger’s syndrome Autism PDD-NOS Other ASD Age in years at diagnosis
High SES (N = 147) Percent
Mean (SD)
Percent
38.69(6.68) 96.80%
96.60%
75.80% 24.20%
89.10% 10.90%
87.50% 5.20% 5.20% 1.00% 1.00%
91.70% 2.80% 3.40% 0.00% 0.70%
27.40% 29.50% 18.50% 12.60% 11.60%
4.20% 11.10% 19.40% 21.50% 43.80%
36.82 (7.26)
1.36 (1.39) 31.42 (10.76)
1.07 (0.87) 26.64 (10.43)
6.08 (2.55)
6.63 (2.57) 9.40% 69.80% 19.80% 1.00%
3.18 (1.77)
3.19 (1.82)
11.60% 65.80% 21.20% 1.40%
SES: socioeconomic status; ASD: autism spectrum disorder; SD: standard deviation; ABC: Autism Behavior Checklist; PDD-NOS: pervasive developmental disorder–not otherwise specified.
respond to these questions. In total, 214 of the 244 participants responded to these questions. Those parents who did respond to the questions did not differ demographically from those that did (all d’s
