In The Politics of Autism, I write:
Once parents get past all the red tape, they often find that providers are scarce. Rural states may be especially short on behavior analysts, who tend to prefer to work in large metropolitan areas that have greater educational and technological resources. If psychiatric help is necessary, it may be hard to get. There is a shortage of child psychiatrists, and insurers are of little help in finding them.
Benjamin Zablotsky, Ph.D., and Lindsey I. Black have an article at National Health Statistics Reports titled "Prevalence of Children Aged 3–17 Years WithDevelopmental Disabilities, by Urbanicity:United States, 2015–2018." The abstract:
Objective—This report examines the prevalence of developmental disabilities among children in both rural and urban areas as well as service utilization among children with developmental issues in both areas.
Methods—Data from the 2015–2018 National Health Interview Survey (NHIS) were used to examine the prevalence of 10 parent- or guardian-reported developmental disability diagnoses (attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder, blindness, cerebral palsy, moderate to profound hearing loss, learning disability, intellectual disability, seizures, stuttering or stammering, and other developmental delays) and service utilization for their child. Prevalence estimates are presented by urbanicity of residence (urban or rural). Bivariate logistic regressions were used to test for differences by urbanicity.
Results—Children living in rural areas were more likely to be diagnosed with a developmental disability than children living in urban areas (19.8% compared with 17.4%). Specifically, children living in rural areas were more likely than those in urban areas to be diagnosed with ADHD (11.4% compared with 9.2%) and cerebral palsy (0.5% compared with 0.2%). However, among children with a developmental
disability, children living in rural areas were significantly less likely to have seen a
mental health professional, therapist, or had a well-child checkup visit in the past year,
compared with children living in urban areas. Children with a developmental disability
living in rural areas were also significantly less likely to receive Special Educational
or Early Intervention Services compared with those living in urban areas
Conclusion—Findings from this study highlight differences in the prevalence of developmental disabilities and use of services related to developmental disabilities by rural and urban residence