Economic Burden of Childhood Autism Spectrum Disorders

Published in: Pediatrics, v. 133, no. 3, Mar./Apr. 2014, p. e520-e529

by Tara Lavelle, Milton C. Weinstein, Joseph P. Newhouse, Kerim Munir, Karen A. Kuhlthau, Lisa A. Prosser

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Question

  1. What is the economic burden of childhood autism spectrum disorder (ASD)?

OBJECTIVE: To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes. METHODS: We used national data from the Medical Expenditure Panel Survey linked to the National Health Interview Survey and a study-specific survey to estimate the annual utilization and costs for health care, school, ASD-related therapy, family-coordinated services, as well as caregiver time in children aged 3 to 17 years, with and without parent-reported ASD. Regression analyses estimated the association between ASD diagnosis and cost, controlling for child gender, age, race/ethnicity, insurance status, household income, country region and urban/rural classification, and non–ASD-related illnesses. RESULTS: Children with parent-reported ASD had higher levels of health care office visits and prescription drug use compared with children without ASD (P < .05). A greater proportion of children in the ASD group used special educational services (76% vs 7% in the control group, P < .05). After adjusting for child demographic characteristics and non–ASD-associated illnesses, ASD was associated with $3020 (95% confidence interval [CI]: $1017–$4259) higher health care costs and $14 061 (95% CI: $4390–$24 302) higher aggregate non–health care costs, including $8610 (95% CI: $6595–$10 421) higher school costs. In adjusted analyses, parents who reported that their child had ASD did not have significantly higher out-of-pocket costs or spend more time on caregiving activities compared with control parents. CONCLUSIONS: The economic burden associated with ASD is substantial and can be measured across multiple sectors of our society. Previous analyses that focused on health care underestimated this economic burden, particularly for school systems.

Key Findings

  • Children with ASD had higher levels of health care office visits and prescription drug use, and a great proportion of them used special educational services.
  • ASD was associated with more than $3,000 higher health care costs, and more than $14,000 higher non-health care costs, including more than $8,600 higher school costs.
  • On average, parents of children with ASD did not spend more time on caregiving activities than other parents but parents of children with the most severe form of ASD did have $21,000 higher caregiving time costs compared to parents of children without ASD.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.