Intellectual and developmental disabilities are pervasive, life-long conditions. Within this diagnostic group, persons with intellectual disability (ID) have impairments in intellectual and adaptive functioning (American Psychiatric Association, 2013), while those with developmental disabilities can have difficulties in one or more global domains, such as learning, physical abilities, language, and behavior (Zablotsky et al., 2019). Among IDDs, autism spectrum disorder (ASD) is frequently diagnosed, with 1 in 44 children identified by age 8 (Maenner et al., 2021). Individuals with ASD experience challenges with social communication and restricted and repetitive behaviors (American Psychiatric Association, 2013).

As part of the law in the United States, caregivers of children with IDDs are granted access to free educational and related services until age 21/22 (Individuals With Disabilities Education Improvement Act, 2004). Services such as applied behavior analysis, speech therapy, and respite care are one of the many services that could be provided to families. Such services have been shown to be beneficial for children with IDD and reduce caregiver stress (Harper et al., 2013; Grenier-Martin et al., 2022). Although these services are mandated by law to be provided to families that qualify for them, families of children with IDD have historically experienced challenges in accessing appropriate services and support to address their children’s social, behavioral, and developmental needs (Vohra et al., 2014), including long waitlists and limited access to specialists (Mayer, 2006; Pletcher et al., 2010; Chiri and Warfield, 2012; Vohra et al., 2014).

Furthermore, youth with ASD experience significantly more challenges receiving quality care and services than those with other IDDs (Magaña et al., 2012). In a study of the National Survey of Children with Special Health Care Needs, caregivers of children with ASD were more likely to report poor outcomes on health care quality measures relative to the overall sample of children with other IDDs (Magaña et al., 2012). For example, these caregivers reported that healthcare providers did not provide enough information or spend enough time with their children and were not sensitive to the family’s values and customs. The study also found a significant effect for race/ethnicity across all quality-of-care outcomes, suggesting that negative outcomes were exacerbated for persons of color (POC), particularly Latine and Black families of children with ASD (Magaña et al., 2012).

Additionally, prior work has identified mental health concerns among caregivers of children with IDD who are responsible for childcare duties (Singer, 2006; Hayes and Watson, 2013); thus respite care has been employed to relieve caregivers of caretaking duties and stress (Harper et al., 2013; Dyches et al., 2016). Respite care can be provided through a professional that comes into the home temporarily, or caregivers can request that another family member provide the respite care within the home. In California, regional center clients can request respite care through their caseworker (Services for the Developmentally Disabled, Welfare and Institutions, 1977). These temporary short breaks have been found to reduce stress for caregivers of children with disabilities (Robertson et al., 2011) and to improve psychological adjustment and lessen fatigue (Remedios et al., 2015). During the pandemic, respite care may have been particularly important for these families.

At the height of the pandemic, many young children were unable to receive early intervention services because of limited support staff and safety concerns during the early stages of the pandemic, and these children may have missed out on weeks of intervention during critical periods (Guralnick, 2011; Zwaigenbaum et al., 2015). Moreover, during lockdowns and social distancing, service providers switched to online administration (e.g., telehealth), forcing caregivers to acclimate to new methods. Some families may not have had the necessary resources (e.g., access to technology) to engage feasibly, reliably, and comfortably in online services (Stavropoulos et al., 2022).

Furthermore, caregivers of children with IDD may face even more mental health concerns than caregivers of children with other disabilities (Singer, 2006; Hayes and Watson, 2013) and those without disabilities (Scherer et al., 2019). In the context of the pandemic, studies found that caregivers of children with IDD experienced mental health issues, such as higher amounts of anxiety (Friesen et al., 2021), strain on caregiver well-being (Ersoy et al., 2020; Lee et al., 2021), elevated levels of stress and depression (Linehan et al., 2022). Some explanations for the rise in mental health issues during the pandemic pertain to financial hardships and loss of services (Friesen et al., 2021), as well as to disruptions in routines (Ameis et al., 2020). Caregivers may have been particularly burdened as they, primarily mothers, had to balance working from home while facilitating their children’s learning at home (Parenteau et al., 2020). Not only were caregivers impacted by the pandemic but so were their children by these rapid changes due to the pandemic. For example, many children with ASD insist on sameness in their routines, but the shifting to online schooling created some distress for children who were not used to these new changes (Ameis et al., 2020). These added stressors have also been found to impact other behaviors associated with ASD, such as an increase in behavioral meltdowns, sensory issues, and self-stimming behaviors (Genova et al., 2021). Given these challenges faced by both caregivers and children with ASD, it is important to examine ASD and other IDD groups separately, and in comparison to each other.

Other explanations for the increase in mental health issues pertain to behavioral challenges of children with IDD. Young et al. (2021) published a case study report recognizing that caregivers of youth with IDD faced caregiver burnout before the pandemic. The report found that stay-at-home orders exacerbated caregiver burnout among children with significant behavioral challenges. Similarly, in a study of Italian caregivers (n = 527) of children with ASD, children who presented with behavioral problems before the pandemic had a statistically significant higher risk for more frequent and intense behavioral problems during the pandemic (Colizzi et al., 2020). Qualitative interviews with 15 caregivers of children with ASD in the United States also support findings of increased child behavior problems since COVID-19 (Parenteau et al., 2020). Two months after the COVID-19 lockdown in the United States (May–June-2020), children with ASD experienced more psychiatric problems (Vasa et al., 2021), including ADHD-related symptoms and disruptive behavior. This increase was correlated with children’s understanding of COVID-19, whether someone in the household had been diagnosed with COVID-19, higher caregiver-reported psychopathology symptoms, and lower income. Pre-pandemic literature has consistently demonstrated that children’s behavioral problems can negatively impact family daily routines (Rodriguez et al., 2019). These findings are alarming, given that children with IDD likely experienced changes in support services during the pandemic, a time when these services may have been needed most.

Studies found that service disruptions resulting from the pandemic, such as medical and educational service changes, have been a cause of strain on individuals with IDD and their caregivers. In a large survey of 6,000 caregivers and caregivers of children with ASD in the United States, over 70% of respondents reported disruptions to school services (Bhat, 2021). School closures also widened inequities for children with disabilities and those within underserved communities (Armitage and Nellums, 2020; Termine et al., 2021). Neece et al. (2020) interviewed 77 Latine caregivers of children with ASD or other developmental disabilities from March to May 2020. They found that about 78% of caregivers reported decreased services for their children. These findings are consistent with other survey data that investigated the healthcare and educational services of individuals with neurodevelopmental and genetic disorders during the early stay-at-home orders. They found that over 70% of the survey respondents who resided in the United States had lost at least one therapy or educational service (Jeste et al., 2020).

Similarly, a global survey disseminated in August–September of 2020 found that 34.6% of caregivers reported receiving a new or alternative service to replace canceled or reduced services caused by the pandemic (Linehan et al., 2022). The disruption of services affected children as well as adults with IDD. Rosencrans et al. (2021) surveyed adults in July 2020 who were over the age of 18 with IDD (N = 404) about their access to state-operated services (e.g., mental health, developmental services). The study found that 81% of adults with IDD reported having state-operated services before COVID-19. Among this subgroup, 71% reported still receiving services, while 19% reported not receiving services at the time of the survey. Over a quarter of respondents (31%) reported having difficulties accessing services, and 44% reported changes in their services. Adults with IDD who no longer received state-operated services were more likely to report mental health symptoms than those who continued receiving services. This demonstrates that COVID-19 had an immediate impact on the IDD community. The current study examines the impact of the pandemic on access and receipt of medical, therapeutic, and respite service care for families of youth with ASD and IDD, paying particular attention to sociodemographic factors (e.g., race/ethnicity, age) that may influence service disruption (i.e., respite and other medical therapeutic services).

The current study is a secondary data analysis of service access and use among families of youth with IDD in California during May 2020. During this time, California had been in lockdown for approximately 3 months, and the United States had surpassed 100,000 COVID-19 deaths (Centers for Disease Control and Prevention, 2021). The purpose of the study was to examine the extent to which COVID-19 disrupted services for the IDD community in California, a state that comprises roughly 12% of the United States population (United States Census Bureau, 2022) and accounts for 15% of the country’s total GDP (Buchholz, 2022). We compared data from respondents with a primary diagnosis of ASD to those with other IDDs (referred to as the IDD group). The reason for doing this was three-fold: First, previous research has shown that families of children with ASD experience significantly more difficulties in accessing services and quality care compared to families of children with IDD (Magaña et al., 2012). Second, children with ASD are reported to have significantly more persistent and pervasive behavior problems than same-age children with IDD (e.g., Mayes et al., 2012). As a result of high levels of behavior problems, families of children with ASD are often more negatively impacted than those of children with other IDDs (Rodriguez et al., 2019). Third, from preliminary studies of COVID-19, the ASD population continues to show poorer outcomes compared to other disability groups and the general population (Ersoy et al., 2020; Lee et al., 2021).

Two primary research questions were addressed in the context of these data collected during the pandemic: (1) How did COVID-19 disrupt medical or therapy services for the ASD and IDD community in California? (2) What were predictors of service access, receipt, and perceived support for ASD and IDD regional center clients? We addressed these questions by utilizing survey data from persons with IDD and their family members in California. For each question, we examined sociodemographic correlates of stakeholder needs, experiences, and concerns. We hypothesized that there would be differences in key outcomes by disability group.

The survey was distributed electronically through Survey Monkey. Nine ASC chapters and community partners such as regional centers, Easter Seals, and the Arc of California, United Cerebral Palsy, and smaller community-based organizations were asked to distribute electronic surveys (email) to families within their network. Multiple reminders were sent to families to respond to the survey. We do not know the exact number of times each community-based organization sent out reminders, nor the exact number sent out. The invitation to participate included a description of the survey, study aims, and procedures. Completion of the survey was regarded as informed consent. Upon completing the survey, respondents were given the option to enter their names into a drawing for a $150 gift card. The survey was open for 2 weeks.

In total, 1,111 individuals (persons with IDD [ASD, ID, and other developmental disabilities] and their family members) responded to the survey. Survey data (n = 29) were omitted if respondents: (a) identified as a person with a disability and a family member of a person with a disability due to concerns about the accuracy of respondents’ answers (n = 11); (b) reported being under 18 years of age (n = 11); and (c) identified as being a service provider (n = 1). Open-ended responses were systematically searched to eliminate responses that: (d) provided identical answers on any of the items due to concerns that the same person completed the survey more than once (n = 5); and (e) indicated that the respondent did not live in California (n = 1). The final sample consisted of 1,082 participants.

The survey was designed by the ASC to assess the service needs and concerns of the IDD population in California during COVID-19. The survey consisted of three general sections: demographic information, services (i.e., regional center, school, employment, day services), and family life. The current study focuses on items related to regional center services. It should be noted that not all respondents (n = 174) were regional center clients but were receiving similar services and were thus eligible for this study.

There were 39 questions in the original survey, but our secondary analysis included those pertaining to regional centers and medical and therapeutic services (i.e., 17 of the 39 questions). Out of the 17 questions used, 15 were categorical (five included an “other please specify)” option where respondents could provide further information. There were two open-ended questions which asked respondents what regional center they were associated with and what county they lived in. There were no questions with continuous variables. The original survey can be made available upon request.

Demographic information was collected through multiple-choice questions for respondent type, primary diagnosis of the person with a disability, primary language spoken at home, age of the person with a disability, and race/ethnicity of the person with a disability. For analysis, respondents who identified as a family member, guardian, or spouse of a person with a disability were grouped as “family member.” A minority of respondents reported being a person with a disability (3.7%). Primary diagnosis was coded as a dichotomous variable: autism spectrum disorder (‘ASD’ as 1) versus all other diagnoses (‘Other IDD’ as 0). Other diagnoses included individuals with cerebral palsy, developmental delay, epilepsy, or intellectual disability, all of whom had cognitive needs commensurate with intellectual disability but no ASD.

Primary language, age, and race/ethnicity were used as predictor variables. Survey response options on these variables are shown in Table 1. Primary language was coded as English (1) and all else (0). Age was dichotomized as 0–5 years (i.e., pre-school age [1]) and 6 years or older (i.e., school-age and above [0]). Race/Ethnicity was coded as a dichotomous variable (White [1] vs. persons of color (POC) [0]) for analyses. Responses were coded as ‘White’ if respondents reported being White/Caucasian only or in addition to any other race.

Respondents were asked about their regional center status, including questions pertaining to: whether they were registered with a regional center (i.e., “As of today, is the person with a disability a regional center client?”), which regional center they were affiliated with (if any); whether they had contact with their regional center caseworker since the start of stay-at-home orders during the early pandemic period; level of satisfaction with caseworker (i.e., “Do you feel you received adequate support from your caseworker since COVID-19?”); and whether they accessed respite services provided through a regional center.

Respondents were asked whether specific services were received in the 3 months before COVID-19 and during the early pandemic period. The five medical services/therapies that were asked about were applied behavior analysis (ABA), occupational therapy (OT), communication therapy (e.g., speech, language, augmentative and alternative communication), social skills groups, and physical therapy (PT). Respondents were able to select more than one medical service/therapy.

All analyses were conducted using SPSS software (Version 26.0; IBM Corp, Armonk, NY, United States). Multi-category demographic variables were collapsed to create binary measures, and descriptive statistics were calculated, including percentages and means. Potential correlates (i.e., primary language, age, and race/ethnicity) of service needs and receipt were explored using chi-square tests by disability group. Post-hoc analysis involved pairwise comparisons with a Bonferroni correction. Significant findings (p < 0.05) at the bivariate level were deemed robust with an effect size ≥0.1 (i.e., Cramer’s V ≥ 0.1; Cohen, 1992).

Binary logistic regression models were conducted to examine whether sociodemographic variables (i.e., diagnosis, age, language, race) significantly influenced (1) whether individuals with IDD were regional center clients, (2) whether they received respite care prior to COVID-19, (3) whether they had contact with their regional center caseworker in the early pandemic period, and (4) whether they felt supported by their caseworker. In addition, receipt of respite services before the pandemic was examined as a predictor of contact by the caseworker and experienced support from a caseworker during the early pandemic period; contact by the caseworker was also examined as a predictor of experienced support from a caseworker.

All outcome variables were utilized as categorical (“Yes” [1] or “No” [0]) variables. The sociodemographic predictor variables were diagnosis (ASD [1] vs. Other IDD [0]), race (White [1] vs. POC [0]), age (under 5 years [1] vs. 6 years and older [0]), and language spoken at home (English [1] vs. non-English [0]). Predictors that did not contribute at the p < 0.10 level were removed to avoid overfitting the model. Hosmer-Lemeshow Test was used as a measure of goodness of fit based on the Chi-square test. We present the odds ratios (ORs) estimating the relationship between sociodemographic correlates and service access, receipt, and perceived support for ASD and IDD regional center clients; their 95% confidence intervals (CIs) can be found in Table 4.

Among demographic items, only data on language were missing, and for only 0.6% of the 1,082 respondents. There were small numbers of missing data on the following items: “Have you had any contact with your regional center caseworker?” (4.8%); “Which regional center are you affiliated with?” (9.0%); “Did you feel you have received adequate support from your caseworker since COVID-19?” (6.4%); “Did you receive respite services before COVID-19?” (4.4%). Of the 635 respondents who indicated receiving respite services, less than 1% had missing data on only two items: “Since COVID-19, has your respite service: increased, remained the same, decreased, stopped for a while, stopped completely” (0.5%); and “Are you aware that you can also refer family members or friends to be respite staff?” (0.8%). Listwise deletion was used in all analyses to enhance transparency.

This section covers service disruption to all respondents that participated in the survey, including regional center clients. The next section will cover predictors of service access.

Findings from this study reveal evident racial disparities in the receipt of developmental disabilities services between White and POC within California. This disparity should be recognized and further investigated since the IDD community continues to be impacted by the pandemic. Indeed, COVID-19 has continued to show surges since the early pandemic period and has forced new restrictions during these surges within the state of California (Ibarra, 2022). For example, in California, the state had to reinforce mask mandates and limits in household gatherings. During these phases of the pandemic, caseworkers and service providers should provide all families the option of virtual visits if families did not feel comfortable with others in the home, rather than canceling visits or sessions completely. These virtual visits can allow caregivers to disclose how they are dealing with the pandemic and what they might need during this time. Caseworkers can provide caregivers with options of virtual support groups, local organizations that meet in outdoor spaces or training for themselves to help their youth or child. It is also important to know how caregivers managed the disruptions to support services and navigated the transition to remote service delivery, especially for those who were regional center clients. Regional centers should ensure that the pandemic does not continue to widen these gaps among racial and ethnic groups (Harrington and Kang, 2016).

There are also silver linings that point to best practices for the future. For instance, telehealth services (e.g., online evaluations) can become a viable option for families who cannot drive to nearby facilities or risk exposure to COVID-19 by attending in-person appointments (Ameis et al., 2020). Moreover, students with high-functioning ASD reported feeling “liberated” from the social and academic demands in school (Reicher, 2020). Caregivers identified the benefit of having more time to spend with family when having to be at home with their children (Neece et al., 2020). Thus, the multi-faceted impact of COVID-19 on families and youth with IDD requires service providers to support families during the continued crisis and beyond. Although the COVID-19 pandemic is coming to an end, there will likely be lasting effects for decades to come, and much can be learned from investigations like this as we move forward.

As in all studies, there are some limitations here. First, we recognize that this study includes only California respondents. There were likely different approaches to the pandemic around stay-at-home orders and developmental disability services in other parts of the country in the early stages of the pandemic. Second, since this was an online survey, there is a concern for self-selection bias. Those who volunteered to be part of the survey could have been respondents who had either been very affected by the pandemic or had experienced little to no impact. Third, the survey did not collect response rates, so it is unclear how many individuals had originally viewed the survey. Lastly, as in most surveys, respondents self-reported their diagnosis or their child’s diagnosis, which could not be confirmed with an independent evaluation or standardized measures.

The present study suggests differences in service use for diagnostic groups, taking into account some sociodemographic factors. The ASD group reported receiving fewer services than the IDD group after stay-at-home orders were in place. In addition, POC reported fewer services being delivered than their White counterparts. It is critical to continue to investigate factors related to the inequity in services being delivered across disability and racial groups.