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MPaul Dissertation Final 18Apr17.pdf (1.3 MB)

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Rural-Urban Disparities in the Diagnosis and Treatment of Children with Autism Spectrum Disorders (ASD)

Paul, Marika Haritos
http://rave.ohiolink.edu/etdc/view?acc_num=osu149250986729511

Abstract Details

2017, Doctor of Philosophy, Ohio State University, Public Health.
Little is known about the health care utilization of children with autism spectrum disorders (ASD) in rural areas. Individuals in rural areas experience difficulties accessing health services and consistently show poorer health outcomes, greater chronic disease prevalence, and shorter life spans than individuals in suburban and urban areas. Autism presents a unique lens to examine potential rural-urban disparities. Because autism is idiopathic, disparities cannot be addressed through public health interventions targeted at health behaviors. Treatment is elective and non-curative, which means families may choose what level and intensity of services their children receive. This research project examined potential rural-urban health care disparities of children with ASD in three capacities. The first study used medical claims data from the Partners for Kids (PFK) accountable care organization (ACO). Results showed that children in rural areas are no less likely to initiate physical, occupational, or speech therapy than children in urban areas. However, of those who do, children in rural areas utilize roughly a third as many visits. Children in rural areas also used slightly more primary care services than children in urban areas. These differences were not explained by the presence of ADHD, a common comorbidity in the ASD population. The second study utilized the Pathways to Services and Diagnosis, a national survey of parents of children with ASD and/or intellectual disability, to examine the roles of disability presentation, parental concerns, and reactions of health care providers in accounting for rural-urban variability associated with the age at which children are diagnosed with ASD. Children living in the most rural counties were diagnosed, on average, 18 months later than children living in large metropolitan areas, after adjusting for demographics, parental concerns, and health care provider reactions to parental concerns. The third study also utilized data from the Partners for Kids Accountable Care Organization and showed that, among children with ASDs and co-morbid ADHD, those living in rural areas are 75% more likely to have at least one injury-related Emergency Department visit. The results of this research demonstrate significant rural-urban disparities in the diagnosis and health services utilization of children with autism spectrum disorders. Early and intensive intervention is the best approach in treating symptoms of autism; delayed diagnosis and intervention may result in less than optimal functioning and future dependence on health care and social services. This dependence is compounded by the lack of access to services characteristic of many rural areas.
Thomas Wickizer, PhD (Advisor)
131 p.
Health Care Management; Public Health
autism, disparities, urbanicity, rurality

Recommended Citations

Citations

  • Paul, M. H. (2017). Rural-Urban Disparities in the Diagnosis and Treatment of Children with Autism Spectrum Disorders (ASD) [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu149250986729511

    APA Style (7th edition)

  • Paul, Marika. Rural-Urban Disparities in the Diagnosis and Treatment of Children with Autism Spectrum Disorders (ASD) . 2017. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu149250986729511.

    MLA Style (8th edition)

  • Paul, Marika. "Rural-Urban Disparities in the Diagnosis and Treatment of Children with Autism Spectrum Disorders (ASD) ." Doctoral dissertation, Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu149250986729511

    Chicago Manual of Style (17th edition)

osu149250986729511
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