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Only one US state has ‘enough’ therapists to treat children with autism

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Massachusetts is the only state in the US with enough therapists to treat the growing number of children with autism as rates have doubled in 10 years

  • Between 2004 and 2014 the rate of autism among US children more than doubled from one in 125 to one in 59 
  • Applied behavioral analysis has been used for 30 years to help socialize kids on the spectrum and aid them in cutting out repetitive or destructive behaviors
  • Only one state in the US – Massachusetts – has enough therapists to treat the growing population of children with autism, Emory University researchers found

Every US state but one is vastly unprepared to handle the ongoing surge in children with autism, a new study reveals. 

The number of children estimated to be on the autism spectrum more than doubled over the decade between 2004 and 2014.   

About one in every 59 children in the US is now thought to be autistic. 

Experts disagree about how and if these children should be ‘treated,’ but applied behavioral analysis (ABA) is among the most widely accepted approaches to helping children on the spectrum learn to social skills. 

Yet even as the number of children with autism continues to rise, researchers from Emory University found that only one state in the entire nation had enough therapists certified in ABA to work with growing number of kids in need. 

For 30 years, adaptive behavioral analysis has been used to help children with autism learn social skills and get repetitive behaviors under control – but only one state has enough professionals to help the growing number of kids who might benefit from therapy (file) 

Autism is diagnosed on a spectrum because it encompasses such a wide range of behaviors and levels of functionality. 

Children with autism may take longer to start talking, and once they do they may not communicate the way other people do, sometimes speaking in flat tones and struggling to pick up on social cues many of us take for granted. 

Some also seem to get rutted in repetitive patterns of behavior, not dissimilar from tics. 

These looped behaviors are sometimes self-destructive, and children with autism may be disruptive and prone to frustration or tantrums. 

Others will hardly seem different from average children. 

The main goal in therapy for children with autism – as well as adults, when appropriate – is to help them adapt sufficiently to become independent. 

But these therapies are a delicate and closely monitored affair. 

One of the most well established and studied therapies is ABA. 

It’s been used for decades and has been the subject of at least 20 reviews that deem it helpful to most – though not all – children with autism. 

Typically doctors recommend children go to between 20 and 40 hours a week for between one and three years while kids are young and malleable, ideally. 

That’s rather intensive, considering that the average American adult works about 44 hours a week. 

The Analyst certification Board recommends that each therapist have a maximum caseload of 15 children or 24 if they have an assistant for those who are addressing specific issue – like self-injury or tics – with their young clients. 

For more broad-spectrum therapy, the Board suggests a caseload of just 12 students per analyst, or 16 with an assistant.   

Of all 50 states, only Massachusetts (far left) met the Board's standard. States in the South and Midwest had the most dramatic shortages of therapists to help autistic children (lighter grays)

Of all 50 states, only Massachusetts (far left) met the Board’s standard. States in the South and Midwest had the most dramatic shortages of therapists to help autistic children (lighter grays)

That would mean that there should be between 6.4 and 8.1 behavioral analysts per 100 children estimated to have autism in each state. At the very least, the Board set a bench mark even lower: 3.2 to 41 analysts per 100 autistic kids. 

Only one state – Massachusetts – even met that eased expectation. 

For the most part, states that spent the least on education tended to have fewer therapists (with the exceptions of Florida and Colorado). 

States including Oklahoma, Indiana, Mississippi, Arkansas and Wyoming, had less than one qualified therapist per 100 children with autism. 

East Coast states tended to have more therapists. Vermont came just shy of meting the low end of the Board’s standard, while Massachusetts surpassed the high end of the range with nearly nine therapists per 100 children. 

‘The rising prevalence [of autism] calls for new developments in health service delivery to ensure that affected youths receive timely access to evidence-based interventions such as applied behavior analysis,’ wrote the study authors. 

Their findings also mirror previous research that’s documented the shortage of health care providers in the most general sense and mental health care providers specifically that disproportionately affects poorer and more rural Americans.  


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