Social Inequities in Healthcare Access Among U.S. Children With ADHD, Autism, and Co-occurring ADHD-Autism: Evidence From the 2023 to 2024 National Survey of Children’s Health
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Objective
To compare healthcare access among U.S. children with attention-deficit/hyperactivity disorder (ADHD) only, autism only, and co-occurring ADHD–autism, and to identify social inequities associated with unmet care using recent nationally representative data.
Methods
We analyzed combined 2023 to 2024 National Survey of Children’s Health data for 13,576 children aged 3 to 17 years with current ADHD and/or autism. We examined six healthcare-access outcomes: forgone healthcare, unmet mental health care, no medical home, coverage gap/inadequate insurance, unmet specialist care, and unmet care coordination. Survey-weighted modified Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). We combined six multiply imputed poverty measures using Rubin’s rules. Sensitivity models additionally adjusted for functional difficulty.
Results
Compared with ADHD only, co-occurring ADHD–autism was associated with higher prevalence of forgone healthcare (aPR, 1.73; 95% CI, 1.38–2.16), no medical home (1.11; 1.02– 1.20), inadequate or discontinuous insurance (1.14; 1.03–1.28), unmet specialist care (1.49; 1.14–1.94), and unmet care coordination (1.15; 1.04–1.28). Autism only was associated with unmet mental health care (1.49; 1.13–1.97) and care coordination (1.13; 1.02–1.25). Food insufficiency, housing instability, and non-supportive neighborhood conditions were consistently associated with poorer access. After functional difficulty adjustment, associations remained for co-occurring ADHD–autism with forgone and specialist care and for autism only with unmet mental health care.
Conclusions
Healthcare access inequities differed by neurodevelopmental diagnostic group and social context. Pediatric systems should strengthen care coordination, specialty and mental health access, insurance continuity, family navigation, and responses to food and housing hardship.
