All ETDs from UAB

Advisory Committee Chair

Sarah O'Kelley

Advisory Committee Members

Anne Brisendine

Olivio Clay

Document Type


Date of Award


Degree Name by School

Master of Arts (MA) College of Arts and Sciences


Disparities in healthcare are widespread in rural communities, and families with a preschooler with suspected autism spectrum disorder (ASD) might be especially impacted by a dearth of services. By exploring the information gathered from ASD diagnostic visits, the goal of the current study was to inform future research that aims to address access to quality care in the communities that need assistance the most. It was hypothesized that increasing rurality would worsen the following metrics: barriers to care (e.g., social disadvantage & pediatrician availability), clinical evaluation outcomes (e.g., age of diagnosis, language functioning, adaptive functioning, ASD severity), and access to services. To categorize rural healthcare disparities, census tracts were defined by Rural-Urban Commuting Areas (RUCAs) to explore how increasing rurality impacts children prior to an ASD evaluation. When compared to urban communities, rural communities were more socially disadvantaged and had fewer pediatricians, but there were no significant findings across clinical evaluation outcomes or access to services. Due to small sample sizes across groups, results regarding clinical evaluation outcomes and access to services differences based on residence could not be explored fully with the current data set. Given previous literature that demonstrated ASD screeners are less reliable with rural caregivers with a lower socioeconomic status, rural families from these socially disadvantaged areas with few pediatricians are less likely to receive a referral for an ASD evaluation. Innovative models (e.g., Extension for Community Healthcare Outcomes-Autism [ECHO-Autism] or Screening Tool for Autism in Toddlers & Young Children-Behavioral Health Consultant Model [STAT-BHC]) that help improve provider knowledge and reduce diagnostic waitlists should continue to impact reduction of these disadvantages in rural communities.

Available for download on Friday, May 09, 2025