Gender impacts of the new Ontario Autism Program

Quite a few of the points I’ve made on this blog have been picked up by opposition parties and the media. I was a little surprised that none of the points I’ve made on gender impact have resonated, but later I realized the problem likely was that I’ve been explaining them poorly. So here’s a second crack at it.

The short version is this: The income clawbacks keep women out of the workforce, there’s huge financial penalties if single moms get re-married, and girls gets less money than boys do, because they’re diagnosed later (even when controlling for other factors like severity) and the funding is based on age at diagnosis.

We need to consider the impacts that this has on female parents of kids on the spectrum, as well as on female kids on the spectrum. Let’s take these one at a time:

Gender-based impacts on parents

The new OAP adversely affects women in two ways:

1. The way the Childhood Budgets and income clawbacks are designed they act as a tax, creating a disincentive (a.k.a. make it prohibitively expensive) for “secondary earners” to stay in the labour force, because their salary will get eaten up by the income-test clawbacks. You would be hard-pressed to design a better system to keep women from re-entering the workforce after having kids. I talk about the issue in more detail in Childhood Budgets and the Returning to Work Tax.
2. The yearly income re-assessment for the Childhood Budget makes it incredibly expensive for single-parents with kids on the spectrum to get re-married. I talk about it in more detail in Marriage penalties and the Childhood Budget.

These issues affect Dads as well as Moms. The gender impacts are due to the fact that women are more likely to leave the labour force after the birth of a child, more likely to be a secondary earner, and more likely to be a single-parent with sole custody of a child.

Those are the gender impacts on parents stemming from the design of this particular policy. There’s also the general gender impacts of having poor therapy for kids on the spectrum (the burden of caring for kids falls disproportionately on women, particularly if those children continue to require care into adulthood).

Gender-based impacts on kids

A few summary points on how the new OAP works:

• Kids are assigned a Childhood Budget upon entering the OAP. That Childhood Budget covers the child until adulthood.
• The size of their Childhood Budget is determined by two variables: The child’s age when entering the program, and the family’s yearly income.
• Prior to the application of the income test, the Childhood Budget is equal to $5,000 for every year the child is in the program between the ages of 6–17, and $20,000 for every year between ages 2–5. (In other words, the earlier the child enters the program, the higher their Childhood Budget.)
• Those yearly figures do not necessarily represent the amount families can actually spend a year. The amount families can actually spend is governed by a set of rules which haven’t been fully released yet, because we’re not allowed to have nice things.

The obvious question to ask here is “why is the Childhood Budget a function of age at all? And why do more dollars get added for early years rather than later ones?”

The most generous interpretation I can give to the government is that they’re using age as a proxy variable for “severity levels”, based on the DSM-5 criteria. There’s two difficulties with this approach:

1. While there is likely a relationship between age at diagnosis and severity, it is a far from perfect one.
2. “Age of diagnosis” is correlated with many other variables, including gender of the child.

For example, a Pennsylvania study examining age-at-diagnosis found the following relationships:

• Rural children received a diagnosis 0.4 years later than urban children.
• Near-poor children received a diagnosis 0.9 years later than those with incomes >100% above the poverty level.
• Children with severe language deficits received a diagnosis an average of 1.2 years earlier than other children.
• Hand flapping, toe walking, and sustained odd play were associated with a decrease in the age of diagnosis, whereas oversensitivity to pain and hearing impairment were associated with an increase.
• Children who had 4 or more primary care physicians before diagnosis received a diagnosis 0.5 years later than other children, whereas those whose pediatricians referred them to a specialist received a diagnosis 0.3 years sooner.

As a useful literature-review presentation from the Riley Child Development Center puts it “ Gender differences in the ASD phenotype remain poorly understood… research findings are often small and inconsistent.” It does appear that “higher functioning” girls get diagnosed significantly later than their male counterparts, one Dutch study puts the gap at over one year.

In other words, some kids are advantaged by a system that bases funding at time-of-diagnosis (urban, higher income, male) and some kids are disadvantaged (rural, lower income, female).

It doesn’t take much of a diagnosis gap to lead to large funding differences between girls and boys: 3 months for kids under 6, or a year for kids 6 and up leads to a $5,000 difference in the size of a Childhood Budget (prior to the application of the income test). That’s pretty significant.