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Systematic Review of Disparities and Differences in the Access and Use of Allied Health Services Amongst Children with Autism Spectrum Disorders

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Abstract

Individuals with autism spectrum disorder (ASD) often benefit from allied health services such as occupational therapy, speech and language pathology, and applied behavioral analysis. While there is consistent evidence of disparities in access and use of medical services (e.g. dentistry), no such systematic review has examined disparities and differences in allied health use amongst children with ASD. In this systematic review, we examine disparities and differences in service access and use for children with ASD. Our findings suggest that children who are older, have less severe ASD symptoms, are from minority groups, and those from particular geographic regions are less likely to receive allied health services. Limitations and future directions are discussed.

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Authors and Affiliations

  1. Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 200 N. Greensboro St., D-12, Carrboro, NC, 27510, USA

    Aaron R. Dallman & Jonet Artis

  2. Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Linda Watson

  3. Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sarah Wright

Authors
  1. Aaron R. Dallman
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  2. Jonet Artis
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  3. Linda Watson
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  4. Sarah Wright
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Contributions

All authors contributed to the study conception and design. Material preparation and conducting the literature search was performed by SW. Data collection and analysis were performed by AD, JA, and LW. The first draft of the manuscript was written by AD and JA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Aaron R. Dallman.

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Appendix: Search Strategy

Appendix: Search Strategy

Pubmed Database

Searched May 4, 2018

1735 results

Pubmed Search Strategy

(autism AND disparit*) OR (((autism spectrum disorder[mesh] OR autism[tiab] OR autistic[tiab] OR asd[tiab] OR Asperger*[tiab]) AND (rehabilitation[mesh] OR occupational therapy[mesh] OR Rehabilitation of Speech and Language Disorders[mesh] OR Physical Therapy Modalities[mesh] OR "Rehabilitation"[Mesh] OR service*[tiab] OR "occupational therapy" OR "occupational therapies" OR "speech therapy" OR "speech therapies" OR "physical therapy" OR "physical therapies" OR physiotherap*[tiab] OR neurophysiotherap*[tiab] OR therapy[tiab] OR therapies[tiab] OR interven*[tiab] OR occupational[tiab] OR rehab[tiab] OR rehabilitat*[tiab])) OR (autism spectrum disorder/therapy[mesh] OR autism spectrum disorder/rehabilitation[mesh]) AND (ethnic groups[mesh] OR health status disparities[mesh] OR healthcare disparities[mesh] OR socioeconomic factors[mesh] OR medically underserved areas[mesh] OR population characteristics[mesh] OR poverty[mesh] OR disparity[tiab] OR disparities[tiab] OR socioeconomic[tiab] OR sociodemographic*[tiab] OR race*[tiab] OR racial[tiab] OR ethnic*[tiab] OR gender[tiab] OR geograph*[tiab] OR income[tiab] OR poverty[tiab] OR ses[tiab] OR inequalities[tiab] OR inequality[tiab] OR african[tiab] OR hispanic*[tiab] OR latino*[tiab] OR vulnerabl*[tiab] OR multicultural))

Cochrane Database of Systematic Reviews

Searched May 4, 2018

35 results

Cochrane Search Strategy

(autism AND disparit*) OR ((([mh "autism spectrum disorder"] OR autism:ti,ab OR autistic:ti,ab OR asd:ti,ab OR Asperger*:ti,ab) AND ([mh rehabilitation] OR [mh "occupational therapy"] OR "Rehabilitation of Speech" AND [mh "Language Disorders"] OR [mh "Physical Therapy Modalities"] OR [mh Rehabilitation] OR service*:ti,ab OR "occupational therapy" OR "occupational therapies" OR "speech therapy" OR "speech therapies" OR "physical therapy" OR "physical therapies" OR physiotherap*:ti,ab OR neurophysiotherap*:ti,ab OR therapy:ti,ab OR therapies:ti,ab OR interven*:ti,ab OR occupational:ti,ab OR rehab:ti,ab OR rehabilitat*:ti,ab)) OR ([mh "autism spectrum disorder"] OR [mh "autism spectrum disorder"]) AND ([mh "ethnic groups"] OR [mh "health status disparities"] OR [mh "healthcare disparities"] OR [mh "socioeconomic factors"] OR [mh "medically underserved areas"] OR [mh "population characteristics"] OR [mh poverty] OR disparity:ti,ab OR disparities:ti,ab OR socioeconomic:ti,ab OR sociodemographic*:ti,ab OR race*:ti,ab OR racial:ti,ab OR ethnic*:ti,ab OR gender:ti,ab OR geograph*:ti,ab OR income:ti,ab OR poverty:ti,ab OR ses:ti,ab OR inequalities:ti,ab OR inequality:ti,ab OR african:ti,ab OR hispanic*:ti,ab OR latino*:ti,ab OR vulnerabl*:ti,ab))

EMBASE.com Database

Searched May 4, 2018

2923 results

EMBASE Search Strategy

('autism spectrum disorder'/exp OR autism:ti,ab OR autistic:ti,ab OR asd:ti,ab OR asperger*:ti,ab) AND ('occupational therapy'/exp OR 'rehabilitation of speech' OR 'language disorders'/exp OR 'physical therapy modalities'/exp OR 'rehabilitation'/exp OR service*:ti,ab OR 'occupational therapy' OR 'occupational therapies' OR 'speech therapy' OR 'speech therapies' OR 'physical therapy' OR 'physical therapies' OR physiotherap*:ti,ab OR neurophysiotherap*:ti,ab OR therapy:ti,ab OR therapies:ti,ab OR interven*:ti,ab OR occupational:ti,ab OR rehab:ti,ab OR rehabilitat*:ti,ab) AND ('ethnic groups'/exp OR 'health status disparities'/exp OR 'healthcare disparities'/exp OR 'socioeconomic factors'/exp OR 'medically underserved areas' OR 'population characteristics'/exp OR 'poverty'/exp OR disparity:ti,ab OR disparities:ti,ab OR socioeconomic:ti,ab OR sociodemographic*:ti,ab OR race*:ti,ab OR racial:ti,ab OR ethnic*:ti,ab OR gender:ti,ab OR geograph*:ti,ab OR income:ti,ab OR poverty:ti,ab OR ses:ti,ab OR inequalities:ti,ab OR inequality:ti,ab OR african:ti,ab OR hispanic*:ti,ab OR latino*:ti,ab OR vulnerabl*:ti,ab OR multicultural:ti,ab) OR (autis* AND dispar*)

CINAHL (EBSCO) Database

Searched May 4, 2018

1241 results

CINAHL Search Strategy

(autism AND disparit*) OR ((((MH "autism spectrum disorder+") OR TI autism OR AB autism OR TI autistic OR AB autistic OR TI asd OR AB asd OR TI Asperger* OR AB Asperger*) AND ((MH "rehabilitation+") OR (MH "occupational therapy+") OR "Rehabilitation of Speech" AND (MH "Language Disorders+") OR (MH "Physical Therapy Modalities+") OR (MH "Rehabilitation+") OR TI service* OR AB service* OR "occupational therapy" OR "occupational therapies" OR "speech therapy" OR "speech therapies" OR "physical therapy" OR "physical therapies" OR TI physiotherap* OR AB physiotherap* OR TI neurophysiotherap* OR AB neurophysiotherap* OR TI therapy OR AB therapy OR TI therapies OR AB therapies OR TI interven* OR AB interven* OR TI occupational OR AB occupational OR TI rehab OR AB rehab OR TI rehabilitat* OR AB rehabilitat*)) AND ((MH "ethnic groups+") OR (MH "health status disparities+") OR (MH "healthcare disparities+") OR (MH "socioeconomic factors+") OR (MH "medically underserved areas+") OR (MH "population characteristics+") OR (MH "poverty+") OR TI disparity OR AB disparity OR TI disparities OR AB disparities OR TI socioeconomic OR AB socioeconomic OR TI sociodemographic* OR AB sociodemographic* OR TI race* OR AB race* OR TI racial OR AB racial OR TI ethnic* OR AB ethnic* OR TI gender OR AB gender OR TI geograph* OR AB geograph* OR TI income OR AB income OR TI poverty OR AB poverty OR TI ses OR AB ses OR TI inequalities OR AB inequalities OR TI inequality OR AB inequality OR TI african OR AB african OR TI hispanic* OR AB hispanic* OR TI latino* OR AB latino* OR TI vulnerabl* OR AB vulnerabl* OR multicultural))

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Dallman, A.R., Artis, J., Watson, L. et al. Systematic Review of Disparities and Differences in the Access and Use of Allied Health Services Amongst Children with Autism Spectrum Disorders. J Autism Dev Disord 51, 1316–1330 (2021). https://doi.org/10.1007/s10803-020-04608-y

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