Social Inequities in Healthcare Access Among U.S. Children With ADHD, Autism, and Co-occurring ADHD and Autism: Evidence From the 2023 to 2024 National Survey of Children's Health
- 1Grambling State University
Abstract
ObjectiveTo compare healthcare access among U.S. children with attention-deficit/hyperactivity disorder (ADHD) only, autism only, and co-occurring ADHD-autism, and to identify social inequities associated with unmet care using recent nationally representative data.
MethodsWe analyzed combined 2023 to 2024 National Survey of Childrens Health data for 13,576 children aged 3 to 17 years with current ADHD and/or autism. We examined six healthcare-access outcomes: forgone healthcare, unmet mental health care, no medical home, coverage gap/inadequate insurance, unmet specialist care, and unmet care coordination. Survey-weighted modified Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). We combined six multiply imputed poverty measures using Rubins rules. Sensitivity models additionally adjusted for functional difficulty.
ResultsCompared with ADHD only, co-occurring ADHD-autism was associated with higher prevalence of forgone healthcare (aPR, 1.73; 95% CI, 1.38-2.16), no medical home (1.11; 1.02- 1.20), inadequate or discontinuous insurance (1.14; 1.03-1.28), unmet specialist care (1.49; 1.14-1.94), and unmet care coordination (1.15; 1.04-1.28). Autism only was associated with unmet mental health care (1.49; 1.13-1.97) and care coordination (1.13; 1.02-1.25). Food insufficiency, housing instability, and non-supportive neighborhood conditions were consistently associated with poorer access. After functional difficulty adjustment, associations remained for co-occurring ADHD-autism with forgone and specialist care and for autism only with unmet mental health care.
ConclusionsHealthcare access inequities differed by neurodevelopmental diagnostic group and social context. Pediatric systems should strengthen care coordination, specialty and mental health access, insurance continuity, family navigation, and responses to food and housing hardship.
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BibTeX
@misc{onwuameze2026social,
title = {{Social Inequities in Healthcare Access Among U.S. Children With ADHD, Autism, and Co-occurring ADHD and Autism: Evidence From the 2023 to 2024 National Survey of Children's Health}},
author = {C. N. Onwuameze and G. Orji and M. A. Bate and V. O. Madu and P. B. KAYA and J. E. INALEGWU},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.02.26364593},
url = {https://www.medrxiv.org/content/10.64898/2026.10.02.26364593v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Social Inequities in Healthcare Access Among U.S. Children With ADHD, Autism, and Co-occurring ADHD and Autism: Evidence From the 2023 to 2024 National Survey of Children's Health
AU - C. N. Onwuameze
AU - G. Orji
AU - M. A. Bate
AU - V. O. Madu
AU - P. B. KAYA
AU - J. E. INALEGWU
PY - 2026
DA - 2026/10/02
PB - medRxiv
DO - 10.64898/2026.10.02.26364593
UR - https://www.medrxiv.org/content/10.64898/2026.10.02.26364593v1
AB - ObjectiveTo compare healthcare access among U.S. children with attention-deficit/hyperactivity disorder (ADHD) only, autism only, and co-occurring ADHD-autism, and to identify social inequities associated with unmet care using recent nationally representative data. MethodsWe analyzed combined 2023 to 2024 National Survey of Childrens Health data for 13,576 children aged 3 to 17 years with current ADHD and/or autism. We examined six healthcare-access outcomes: forgone healthcare, unmet mental health care, no medical home, coverage gap/inadequate insurance, unmet specialist care, and unmet care coordination. Survey-weighted modified Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). We combined six multiply imputed poverty measures using Rubins rules. Sensitivity models additionally adjusted for functional difficulty. ResultsCompared with ADHD only, co-occurring ADHD-autism was associated with higher prevalence of forgone healthcare (aPR, 1.73; 95% CI, 1.38-2.16), no medical home (1.11; 1.02- 1.20), inadequate or discontinuous insurance (1.14; 1.03-1.28), unmet specialist care (1.49; 1.14-1.94), and unmet care coordination (1.15; 1.04-1.28). Autism only was associated with unmet mental health care (1.49; 1.13-1.97) and care coordination (1.13; 1.02-1.25). Food insufficiency, housing instability, and non-supportive neighborhood conditions were consistently associated with poorer access. After functional difficulty adjustment, associations remained for co-occurring ADHD-autism with forgone and specialist care and for autism only with unmet mental health care. ConclusionsHealthcare access inequities differed by neurodevelopmental diagnostic group and social context. Pediatric systems should strengthen care coordination, specialty and mental health access, insurance continuity, family navigation, and responses to food and housing hardship.
ER -