Thursday, May 29, 2008

Autism Spells Loss of Family Income?

No surprise autism imposes a heavy burden on families. But would you believe having an autistic child actually lowers your income?

That's what researchers from The Children's Institute and University of Rochester conclude in their recent study in the journal Pediatrics. A "substantial loss of household income".

Researchers Montes and Halterman pulled data from 11,684 children in kindergarten through eighth grade who participated in the National Household Education Survey. They compared the household incomes of kids with autism to those without autism (and also to other disabilities). Kids were categorized as autistic if the parent reported a health official had ever said their child had autism or pervasive developmental disorder. There were only 131 autistic kids in the sample, another 2,775 with other disabilities.

So even after controlling for a variety of factors that could affect household income - parental ages, parental education, ethnicity, type of family (single vs. two-parent), and region (urban vs. rural) - households with an autistic child reported significantly lower incomes.

How much lower? 6,206.70 dollars to be precise.

Median income for families without autistic kids (or other disabled kids): $51,693.25
Median income for families with autistic kids (or other disabled kids): $45,486.55

BTW, incomes were equivalent for families with autistic children and families with other disabled children.

Then there's this oddity in the data: 1.12% of the children or 1 in 89 were reported to be autistic - much higher than current US estimates of 1 in 150. But we only have parental reports to go on here not official diagnoses. Sounds like parents might be overestimating here. Yet, I'd be more concerned about the results if the opposite had happened (under-reported rates of autism) because then the difference in income between families with and without autistic kids might be less than the stated $6,000 plus dollars. But if parents truly did overestimate (because an overly eager pediatrician or school psychologist said their kid might be autistic when they really weren't) - then the income gap might be even larger in reality.

Raising children with disabilities, autistic or otherwise, poses many burdens, financial, emotional, social, physical, logistical, etc. The researchers mention these. Sure, no one would doubt that.

But it's a leap to state, as the researchers do, rather emphatically, that having an autistic child results in income loss - this without a shred of proof suggesting a causal relationship. Sure, the autism diagnosis, or rather, reference or mention of it by a doctor or school psychologist or whoever, probably occurred early on in their children's lives (but we don't know this for a fact here) - and the reports of family income probably came afterwards - but we don't have a baseline measure of income before the kids were born or diagnosed. That would have been nice to know.

What we have here is an interesting examination of data drawn from another research project - fair enough - in which the researchers stretch their conclusions - not so good. Surprising that reviewers and editors at Pediatrics, a gold-star journal, let the authors keep the word "loss" in the title, not to mention the hypothesis, the discussion and the conclusion. There's no evidence of a loss going on here, a difference, yes, but no suggestion raising autistic children is to blame.

And what about other explanations for the income disparity? What about families with the autism phenotype? Maybe there's something about mom or dad that draws or repells or rejects them from certain jobs or careers? The authors just outright dismiss this possibility. To their credit, they suggest a less rosy explanation but dismiss that too - that some parents might reject higher income in order to secure more government-funded services for their kids.

Do autistic kid spells income loss? Maybe. Maybe not. This study can't tell us.

Montes, G., Halterman, J.S. (2008). Association of Childhood Autism Spectrum Disorders and Loss of Family Income. PEDIATRICS, 121(4), e821-e826. DOI: 10.1542/peds.2007-1594


rmhj said...

Seems like lots of follow up would be nice. And it's hard to tell what was controlled for w/o a detailed look at their data.

Divorce? Parents of autistic kids are (at least anecdotally) more likely to divorce than other parents.

Sleep deprivation? Many autistic kids sleep very little, which may have adverse consequences on parental ability to compete in workplace environments, and/or may make them less likely or able to switch jobs.

Health insurance? This may also make parents less likely to switch jobs (pre-existing conditions &c).

There are so many possibilities...

Dr. Polly said...

Yes, there are a variety of other factors that could explain it! This is what happens when we pull data from surveys looking at other issues. And no, the researchers only controlled for the 5 or so factors I named (parental age, 1 or 2-parent household, parental education level, urban v. rural) - they probably didn't have any other appropriate data. I'm seeing a large model including all the various pathways you've suggested...thanks for your comments.