Socio-Economic Status Significantly Associates With Symptoms of Autism Spectrum Disorder Among Children Receiving Early Therapeutic Intervention

This study looked to identify modifiable early intervention factors that are associated with better outcomes and possible high-risk groups of children with ASD who are at risk of poorer outcomes.

Children with autism spectrum disorder (ASD) who were from lower socio-economic status families were at increased risk for poor functional skills. These findings, from a cross-sectional study, were published in Autism.

Children (N=193) aged 5-12 years were recruited from the National University Hospital in Singapore. The children were assessed for early intervention (wait time and intensity of therapy) and socio-economic status. These characteristics were associated with Vineland Adaptive Behaviour Scales-Second Edition (VABS) Adaptive Behaviour Composite (ABC) score, Wechsler Intelligence Scales for Children (WISC), and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI).

The children were 84% boys aged mean 6 years and 7 months (standard deviation [SD], 6.2 months), 49.7% of mothers and 43.0% of fathers attended university, and 76.7% received financial subsidies for their child’s therapy.

The VABS composite score was mean 76.5 (SD, 15.1), communication subscale was 77.9 (SD, 21.6), socialization subscale was 73.9 (SD, 15.1), and daily living subscale was 79.4 (SD, 15.8) points. The children had an average full-scale intelligence quotient of 88.0 (SD, 19.4).

The children entered the intervention program at the average age of 42.0 (SD, 10.0) months after an average wait time of 6.2 (SD, 3.0) months. The intervention comprised a mean of 8.0 (SD, 3.0) hours per week.

Significant negative correlations were observed between VABS ABC score with autism severity (r, -0.49; P £.01), financial difficulties (r, -0.24; P £.01), and wait time (r, -0.18; P <.05), between wait time and intervention intensity (r, -0.23; P £.01), and financial difficulties and maternal education (r, -0.18; P <.05). Positive correlations were observed between VABS ABS score and paternal (r, 0.28; P £.01) and maternal (r, 0.24; P £.01) education and between maternal and paternal education (r, 0.59; P £.01).

VABS ABC scores were associated with autism severity (b, -0.49; P <.001), wait time (b, -0.15; P =.04), financial difficulties (b, -0.15; P =.04), and paternal education (b, 0.18; P =.03).

This study was limited by its cross-sectional design. However, the authors are planning on conducting a longitudinal follow-up, at which time they will be able to test for causal relationships.

These data indicated that family socio-economic status, parental education, and time on a waiting list were more strongly associated with symptoms of ASD among children than intensity of early therapeutic intervention.


Aishworiya R, Goh TJ, Sung M, Tay SKH. Correlates of adaptive skills in children with autism spectrum disorder. Autism. 2021;1362361321997287. doi:10.1177/1362361321997287.