Relationship Between Parent-reported Autism Spectrum Disorder Severity and Unmet Healthcare Needs among U.S. Children and Adolescents Aged 3–17 Years: A Cross-sectional Analysis of the 2023 National Survey of Children’s Health

Abstract

Background: Children with autism spectrum disorder may experience difficulty obtaining needed healthcare, particularly when their support needs are greater. National evidence examining unmet care across parent-reported severity levels remains limited. Objective: To examine the association between parent-reported autism spectrum disorder severity and unmet healthcare needs among U.S. children and adolescents. Methods: This cross-sectional study used the revised 2023 National Survey of Children’s Health. The analysis included children aged 3 to 17 years with current autism and complete study data. Survey weights, strata, and household clustering were incorporated. Survey-weighted logistic regression was adjusted for demographic, household, and insurance characteristics. Results: The analysis included 1,869 children, representing 2,440,488 U.S. children. Unmet healthcare needs were reported for 116,472 (10.9%) with mild autism, 149,595 (14.2%) with moderate autism, and 85,043 (26.8%) with severe autism, p = 0.019. Severe autism was associated with higher odds of unmet need compared with mild autism, adjusted odds ratio 3.62, 95% confidence interval 1.75 to 7.48. Moderate autism was not significantly associated with unmet need. Insurance coverage gaps were also associated with higher odds, adjusted odds ratio 10.32, 95% confidence interval 2.79 to 38.15. Conclusion: Severe parent-reported autism and gaps in insurance coverage were associated with greater odds of unmet healthcare needs. Healthcare teams should ask families about unmet care and insurance interruptions and help them connect with needed services. Longitudinal research should identify which services are most often missed and the barriers families face.