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Sociodemographic Factors Associated with Autistic Youth's Psychotherapy Service Use
Jessica V Smith1, Rose Nevill2, Pamela B DeGuzman3
1Department of Human Services School of Education and Human Development, University of Virginia, VA, USA. hty7ds@virginia.edu.
Administration and Policy in Mental Health
|June 3, 2025
Summary
Social determinants of health did not influence psychotherapy use in autistic youth. Most autistic youth with mental health needs did not access services, indicating significant access barriers.
Area of Science:
- Child and Adolescent Psychiatry
- Health Services Research
- Autism Spectrum Disorder
Background:
- Autistic youth exhibit high rates of co-occurring mental health conditions, necessitating substantial treatment.
- Significant disparities exist in mental health service access for autistic youth compared to their non-autistic peers.
- Social determinants of health (SDH) are potential contributors to these disparities, but their role remains under-examined.
Purpose of the Study:
- To investigate the association between social determinants of health (SDH) and psychotherapy service utilization among autistic youth.
- To determine if autistic youth with better SDH are more likely to access psychotherapy compared to those with poorer SDH.
Main Methods:
- Utilized state-level insurance billing claims data (2019 All-Payer Claims Database) for 700 autistic youth with co-occurring mental health conditions.
- Assessed SDH using the validated Childhood Opportunity Index, a composite measure of neighborhood-level factors.
- Defined psychotherapy service use by the presence of one or more psychotherapy CPT code claims, analyzing covariates of insurance type and age.
Main Results:
- Approximately 70% of the autistic youth sample did not utilize any psychotherapy services.
- Contrary to expectations, SDH did not predict psychotherapy utilization; both low and high opportunity groups showed similar low access rates.
- Older age was associated with increased psychotherapy use, while Medicaid insurance was associated with decreased use.
Conclusions:
- Findings suggest that SDH do not predict psychotherapy access for autistic youth, highlighting systemic barriers beyond neighborhood opportunity.
- The low overall utilization rate points to compounded challenges, potentially including a shortage of providers accepting Medicaid and autistic youth.
- Further research and policy interventions are needed to address these critical mental health service gaps for autistic individuals.
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