Pathways to Excellent Health Status in Autism: A Secondary Analysis of the 2022 National Survey of Children's Health.

BACKGROUND

Health disparities in autistic people are well-documented. Less is known, however, about how health determinants intersect, including what factors make a difference, for whom, and under what conditions. Coincidence analysis (CNA) is a cross-case, mathematical approach that pinpoints minimally sufficient and necessary conditions for an outcome to appear, making it particularly well-suited to identify intersecting determinants and multiple paths to the same outcome.

OBJECTIVES

Guided by the National Institute on Minority Health and Health Disparities Research Framework, the study aimed to identify difference-makers for "excellent/very good" overall health among autistic children.

METHODS

The 2022 National Survey of Children's Health contains parent-reported data about 1231 autistic children with "excellent/very good" overall health. A literature review informed the selection of 62 potentially relevant factors for analysis. CNA was applied to develop a model for explaining parents' reporting "excellent/very good" health for their autistic children.

RESULTS

Initial exploratory analyses identified 7 strongly related factors. The final model revealed a 2-pathway solution that accounted for 82% of the respondents with 80% consistency: (1) a combination of no intellectual disability, no difficulty with chronic pain, and high family resilience; or (2) a combination of no intellectual disability, no difficulty with chronic pain, and no history of being overweight.

CONCLUSIONS

Combinations of health determinants accounted for differences in the reported overall health of autistic children. This nuanced explanation for "excellent/very good" health among autistic children can guide future interventions and practices aimed at modifiable determinants of health.