In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. In many states -- particularly those with large rural populations -- one problem is a shortage of behavior therapists.
The supply of certified applied behavior analysis (ABA) providers is insufficient to meet the needs of children with autism spectrum disorder (ASD) in nearly every state, according to a study published online today in Psychiatric Services. The new study found there is substantial variation across states and regions—for instance, the per capita supply of certified ABA providers is substantially higher in the Northeast than in any other region.
The rising prevalence of ASD underscores the importance of access to evidence-based interventions such as ABA. An estimated one in 59 children had ASD in 2014, up from one in 125 a decade earlier, according to the Centers for Disease Control and Prevention.
ABA uses behavioral learning principles to help children with ASD increase positive behaviors and social interactions and decrease problematic behaviors. It is the recommended treatment for children with autism and is supported by more than 30 years of research. ABA is most effective when it is started in early childhood and the therapy is provided between 20 and 40 hours per week.
Study authors Yidan Xue Zhang, M.C., and Janet R. Cummings, Ph.D., with the Rollins School of Public Health, Emory University, Atlanta, used 2018 data from the Behavior Analyst Certification Board. They compared the per capita supply of certified ABA providers in each state with a benchmark established using the board's guidelines. They found that the per capita supply of certified ABA providers fell below the benchmark in 49 states. The supply was highest in the Northeast, which included the top seven states in the U.S. based on per capita ABA providers. In the Midwest, however, no state had more than one-third of the minimum number of ABA providers needed for number of children with autism.
In addition, the study found that states with higher public education spending had significantly more certified ABA providers per capita than states with lower spending. Similarly, states with higher median household income had more certified ABA providers per capita.
This study provides the first known examination of the supply and geographic variation in certified ABA providers. The authors conclude that new workforce policies are needed to increase the supply of certified ABA providers to ensure that youth with ASD have access to evidence-based interventions.