(PS4-32) Correlates of Family Stress, Quality of Care and Unmet Needs in Underrepresented Ethnoracial Groups with Autistic Children: An Exploration via Path Analysis

Caregivers of autistic children report difficulty finding appropriate services and experience greater financial burden than caregivers of non-autistic children (Smith et al., 2020; Stahmer et al., 2019). Further, family stress (FS) due to adverse social conditions may impact the quality of care received and exacerbate the unmet needs of the family (Iadarola et al., 2019; Hsiao, 2016). Notably, barriers to timely diagnosis and service use are compounded by autism stigma and lack of autism knowledge (Dababnah 2017; 2018). While research suggests that prevalence rates for autism are similar across ethnoracial groups (Maenner et al., 2023), service-use disparities are well-documented among racial/ethnic minorities (Angell et al., 2018). Therefore, it is essential to examine factors that impact service quality and the presence of unmet needs in groups historically underrepresented in research. This study aims to examine the role of autism stigma and autism knowledge in elucidating the association between quality of care (QoC), FS, and the unmet needs of families from underrepresented ethnoracial groups, providing insight into potential targets for increasing community engagement.     

This study recruited parents (Mage = 41.3, SD =5.9, 90% mothers, South Asian: n = 40, MENA: n = 8, East African: n = 4) of autistic individuals (Mage = 11, SD = 8.9, 79 % male) residing in US to complete an online survey to assess autism stigma and knowledge (ASK-Q; Harrison et al., 2017), family stress (Social Determinants of Health; Gottleib et al., 2014), family needs (FNS-R; Bailey & Simeonsson, 1990), and QoC (QS-AS; Jafarabadi et al., 2021). 

Higher FS related to lower autism knowledge (r = -.39, p =.004), higher autism stigma (r = 0.41, p < 0.01), and greater unmet needs (r =.366, p = .01), but not with QoC. Path analysis revealed that the relationship between FS and unmet needs were fully mediated by autism stigma and knowledge, with FS having a significant direct effect on autism knowledge (ß = - .392, p = .009) and autism stigma (ß = .409, p = .006). Moreover, 22% of the variance in unmet needs was collectively explained by FS, autism stigma and knowledge. 

 Critically, these findings show that it is imperative to address family stress around social determinants of health (e.g., affordable healthcare), which relates to unmet needs in ethnoracial minority families affected by autism. Further, it is crucial to decrease autism stigma, and increase autism knowledge to reduce the impact of family stress on unmet needs of minoritized families. These results highlight the importance of increasing awareness of available financial resources (e.g., medical assistance) via multilingual advertising to caregivers from underrepresented groups. Moreover, healthcare providers can connect families to existing minority-led caregiver support groups to increase awareness about available supports. Future research could examine the impact of parental education, addressing social factors that can impact family stress, to better meet the needs of these families.