Autism Spectrum Disorder Study on Early Diagnosis, Treatment and Provider Accessibility in the United States

Dr. Yingling is dedicated to conducting research that can improve access to services for children with autism spectrum disorder (ASD) and their families. Her recent work focuses on early diagnosis and treatment as well as provider accessibility.

For 85% of children with ASD, developmental concerns are documented by 36 months of age. However, only 42% receive a comprehensive evaluation by this time. Given evidence that earlier intervention results in better outcomes, earlier diagnosis is critical. Recently, Dr. Yingling published a study in The Journal of Pediatrics which documented that participation in state early intervention programs (like Kentucky’s First Steps) may be instrumental in earlier ASD diagnosis. Specifically, results indicated that children may receive a diagnosis two years earlier if they participate in these programs. This research underscores the importance of identifying children who qualify for early intervention programs, the value of encouraging childhood professionals (e.g., early care providers and educators) to refer given documented barriers to pediatrician referral, and the need for research that identifies the mechanisms by which programs may promote earlier diagnosis (e.g., service coordination, parent support). The results of this study were featured in a positive editorial that highlighted its importance for pediatric screening and referral of children suspected of ASD.

To assess progress of the Healthy People 2020 objective to increase the proportion of children with ASD who receive treatment by 48 months old, Dr. Yingling and her UofL and University of South Carolina colleagues used two years of data from the National Survey of Children’s Health. Their findings, published in the Journal of Developmental and Behavioral Pediatrics, indicate that the HP2020 objective to enroll 57.6% of 8-year-old children with ASD in treatment by 48 months old was not met (40.9%). However, among 3 to 5-year-old children with ASD, the proportion who received treatment by 48 months old was more than double that of 8-year-old children (88.3%). These findings suggest that the HP2020 target may have been meaningful, motivating efforts that have resulted in earlier treatment receipt among younger cohorts. The expansion of initiatives such as Learn the Signs. Act Early. and Help Me Grow, as well as the strengthening of infrastructure and policies that support more comprehensive systems of care for children with ASD, may be responsible. In addition, the study documented social inequities in the age at which children received services, which reiterate the potential need for targeting outreach efforts to children and families that belong to groups known to be at risk for delayed treatment: families in which English is a second language, with lower educational attainment in the household and in which children are at risk for or have adverse childhood experiences.

Dr. Yingling’s latest work centers on geographic access to providers for children with ASD across the U.S. This spring, she is presenting preliminary results of a study conducted with UofL and University of Pennsylvania colleagues which demonstrate very uneven county-level BCBA distribution. The study demonstrates that approximately half of all counties have no BCBA, and nearly three-quarters of all counties have either no BCBA or one BCBA for every 20 or more children with ASD, which suggests that there is low geographic access for children in most U.S. counties (map below.)

BCBA Presence map