Mental health treatment access among U.S. children according to ASD and ADHD diagnostic status
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Sedra T Alabed1, Mabad Shacker1, Diana B Riestra2
1Department of Psychiatry Rutgers New Jersey Medical School Newark New Jersey USA.
Aim:
To compare mental health treatment receipt and difficulty obtaining treatment among U.S. children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) diagnostic status.
Methods:
We pooled 2023-2024 National Survey of Children's Health data for children aged 3-17 years who received or needed mental health treatment (N = 15,952). Children were classified as neither ASD nor ADHD, ADHD only, ASD only, or ASD + ADHD. The reference group included children without diagnosed ASD/ADHD who nevertheless received or needed treatment. The primary outcome was substantial difficulty obtaining treatment. Survey-weighted models adjusted for sociodemographic factors; same-sample sensitivity analyses additionally adjusted for individual clinical conditions and chronic functional limitation.
Results:
Substantial difficulty was reported for 22.2%, 23.2%, 28.3%, and 28.2% of the neither, ADHD-only, ASD-only, and ASD + ADHD groups, respectively. ASD + ADHD was associated with higher adjusted odds of difficulty than neither condition (aOR 1.38, 95% CI 1.07-1.78; Bonferroni-adjusted P = 0.04) but not ASD only (aOR 1.10, 95% CI 0.75-1.59). In the same complete-case sample (n = 15,037), the ASD + ADHD estimate was 1.37 (95% CI 1.06-1.78) with sociodemographic adjustment and 0.79 (95% CI 0.59-1.05) after additional adjustment for the individual clinical conditions and chronic functional limitation. Chronic functional limitation was associated with difficulty (aOR 1.89, 95% CI 1.54-2.31).
Conclusion:
Differences in difficulty obtaining mental health treatment by ASD/ADHD diagnostic status were attenuated after accounting for measured clinical characteristics and chronic functional limitation. This underscores the importance of considering functional and psychiatric complexity when interpreting access differences across diagnostic groups. Evaluating access should include both treatment receipt and caregiver-reported difficulty obtaining treatment.
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