Volume 17, Issue 4 pp. 739-746
RESEARCH ARTICLE

The impact of adverse childhood events on service support and educational outcomes of children who are autistic: A theory-guided analysis using structural equation modeling

Micah Hartwell

Micah Hartwell

Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, Oklahoma, USA

Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA

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Kelsi Batioja

Kelsi Batioja

Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, Oklahoma, USA

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Covenant Elenwo

Covenant Elenwo

Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, Oklahoma, USA

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Ashley Keener

Corresponding Author

Ashley Keener

School of Health Care Administration, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA

Correspondence

Ashley Keener, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107, USA.

Email: [email protected]

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Anya Mazur

Anya Mazur

Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA

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Tessa Chesher

Tessa Chesher

Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA

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First published: 21 March 2024

Abstract

Autistic children who have experienced adverse childhood experiences (ACEs) may have barriers to receiving special education or other developmental services—thus, impacting educational outcomes. Our objective was to model such a pathway using the 2016–2021 National Survey of Children's Health datasets. We extracted data for school outcomes, use of special education and autism-related specialty services and sociodemographic characteristics among autistic children within the data. Associations between sociodemographics and ACEs (categorized as 0, 1–3, and 4+) were tested using design-based X2 tests. We then used structural equation modeling to map the quasi-causal pathways. The sample for our analysis included 4717 autistic children—38.94% were aged 6–10 years, 35.73% of children aged 11–14 years, and 25.32% were between 15 and 17 years—with 88.70% living in metropolitan areas. The X2 showed significant relationships between ACEs and age, ethnoracial groups, and urbanicity among others. The SEM showed ACEs were directly associated with poorer school outcomes (β = −0.14 (0.04), p = 0.002) and through their inverse relationship with support services (β = −0.08 (0.04), p = 0.023)— when support services were increased, school outcomes improved (β = 0.62, p < 0.001). Findings suggested ACEs have a significant direct and indirect impact on school outcomes of autistic children, and 10.76% of children who are autistic have experienced four or more ACEs—which were more likely to occur with severe autism symptomatology and in rural areas. Results highlight the need for communities to recognize the potential long-term impact of ACEs on the academic outcomes of autistic children.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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