Racial and Ethnic Disparities in Receipt of Behavioral Treatment Among Children With Autism Spectrum Disorder in the United States.

Background and objective Minority children have delayed diagnosis of autism spectrum disorder (ASD). However, it is unclear whether racial disparities exist in minority children receiving treatment even after a diagnosis, which may further negatively affect their cognitive, social, and behavioral development. We examined caregiver-reported receipt of behavioral treatment across racial and ethnic groups to determine whether minority children younger than five years with ASD were less likely to receive treatment than White children in the United States. Methods From the 2021-2022 National Survey of Children's Health, we included children with a diagnosis of ASD who were younger than five years of age. We used self-reported responses from parents or caregivers on whether their children had received behavioral treatment for ASD during the previous 12 months. We compared behavioral treatment for ASD by racial and ethnic groups by conducting chi-square tests. We performed multivariable logistic regression models to determine the association between racial and ethnic groups and behavioral treatment after adjustment for age, sex, severity of ASD, parent education, and Medicaid status. Results Among 790 children aged ≤5 years (51 (6.5%) Asian, 143 (18.1%) Hispanic, 78 (9.9%) non-Hispanic (NH) Black, 434 (54.9%) NH White, 84 (10.6%) multi-race; 615 (77.9%) male), 564 (71.4%) received behavioral treatment. Multi-race children had the highest percentage of behavioral treatment (n = 65, 77.4%), followed by Hispanic (n = 106, 74.1%), NH White (n = 314, 72.4%), NH Asian (n = 35, 68.6%), and NH Black (n = 44, 56.4%) children (p = 0.027). Compared to NH White children, NH Black children were less likely to be treated (adjusted OR (95% CI) = 0.47 (0.28, 0.79)). The odds of treatment for Asian, Hispanic, and multiracial children compared to NH White children were not statistically significant. Conclusions NH Black children with ASD were significantly less likely than NH White children to have caregiver-reported receipt of behavioral treatment. These findings underscore the importance of continued efforts to promote equitable receipt of behavioral treatment among children with ASD, particularly for NH Black children.