Child care problems and employment among families with preschool-aged children with autism in the United States

BACKGROUND. The impact of childhood autism on parental employment is largely unknown. OBJECTIVE. The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems. METHODS. Parents of 16 282 preschool-aged children were surveyed by the National Survey of Children's Health. An autism spectrum disorder was defined as an affirmative response to the question, Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism? There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent's Evaluation of Developmental Status. We used chi(2) and multivariate logistic regression analyses. RESULTS. Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty. CONCLUSIONS. Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.