Beliefs about causes of autism and vaccine hesitancy among parents of children with autism spectrum disorder
Introduction
Although some data indicate that children diagnosed with autism spectrum disorder (ASD) are well-vaccinated until 2 years of age, new evidence suggests that their vaccine receipt may decline later in childhood [28]. Moreover, younger siblings of children with ASD often have lower rates of vaccine receipt compared with both (a) their older siblings and (b) the younger siblings of children without ASD [1], [2], [11], [23], [28]. This suggests that parents of children with ASD may be at risk for becoming vaccine hesitant (i.e., have concerns about vaccines), which ultimately may lead to vaccine delay and/or refusal.
Vaccine hesitant parents (VHPs) have concerns about vaccines but are typically more receptive to vaccination compared to parents who decline all vaccines [13], [22]. Prevalence of VHPs varies geographically, but estimates in the general population range from 9% to 15% [13], [22], [15]. In a local sample, we recently observed that 28% of parents of children with ASD were vaccine hesitant. The odds of being vaccine hesitant were nearly four times greater in this group compared to parents of children with non-ASD developmental delays [16]. Moreover, vaccine hesitancy was significantly associated with the belief that vaccines were a cause for their child’s ASD.
Given the public health importance of widespread vaccination, it is crucial to determine whether this locally observed higher prevalence of VHPs is consistent across the ASD community, as well as to identify other factors associated with vaccine hesitancy in this population that could inform the design of targeted, preemptive vaccine interventions. With this in mind, our objectives were to estimate the prevalence of VHPs within a nationally representative sample of parents of children with ASD, describe beliefs about causes for ASD and parents’ representations of ASD in this sample, examine the association between vaccine hesitancy and parents’ beliefs about causes of ASD, and identify factors associated with ASD-related vaccine hesitancy.
Section snippets
Methods
We surveyed parents of children with ASD who were participating in the national SPARK study (Simons Foundation Powering Autism Research for Knowledge; [25]). Briefly, SPARK enrolls individuals with ASD and their biological parents into an online repository of clinical and genetic data, with the ultimate goal of identifying new genetic causes for ASD and galvanizing the pace of autism research. Individuals of any age who have an ASD diagnosis (including an educational classification of ASD),
Results
Among the 1000 parents initially invited, 291 indicated interest in participating, 240 provided consent, 225 parents completed the PACV, and 217 completed the IPQ-R-ASD (response rate of ~22.0%). Most participants were mothers (92.0%) who self-reported as white (78.7%) and non-Hispanic (89.8%) and who were reporting on a first-born child (53.5%). Among children on whom parents reported, 79.6% were male with an average current age of 7.7 years (SD = 4.0) and an average age at ASD diagnosis of
Discussion
The prevalence of VHPs in this sample was 29%, which is higher than previously reported estimates of 9% to 15% in the general population [22], [15], [5] but similar to the rate of 28% observed among a local sample of parents of children with ASD [16]. Agreement with particular causes of ASD differed significantly between vaccine-hesitant and non-hesitant groups for several causes, with VHPs endorsing a greater number of causes for ASD and more often agreeing that external factors (
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
The authors express their thanks to the SPARK team at the Simons Foundation and the SPARK cohort participants. We appreciate obtaining access to phenotypic data on SFARI Base. Approved researchers can obtain the SPARK dataset described in this study by applying at https://base.sfari.org. The SPARK cohort is funded by the Simons Foundation. This project was initiated by the authors without specific or supplemental funding. The sponsor played no role in designing, executing or writing up the
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