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Prevalence of Children with Autism Spectrum Disorder per BCBA by U.S. County Natural breaks categorization of children with ASD per 1000 children enrolled

Prevalence of Children with Autism Spectrum Disorder per BCBA by U.S. County Natural breaks categorization of children with ASD per 1000 children enrolled

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Article
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Research has documented inequities in geographic access to Board Certified Behavior Analysts (BCBAs) among children with autism spectrum disorder (ASD). However, research on their accessibility is outdated. Between July 1, 2018 and July 1, 2021 the number of BCBAs in the U.S. increased by 65%, from 27,320 to 45,103. In this study we examined trends...

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... On the basis of our personal experience and knowledge of faculty and trainees past and present in other LEND programs, behavior analysis as a field has been represented in LEND programs, though often under another discipline such as psychology, special education, speech and language pathology, or occupational therapy. Following changes in insurance coverage of ABA services, state licensure/certification of behavior analysts, and increase higher education degree programs specifically in ABA, there have been a significant increase in jobs for behavior analysts (BACB, 2024;Yingling et al., 2022). Although behavior analysts may participate in many LEND programs, not having a specific discipline designation may limit the participation of behavior analysts who do not have training in an additional discipline or in the number of trainees from behavior analysis who can participate as trainees. ...
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Supporting people with neurodevelopmental disabilities often requires interdisciplinary collaboration and effective partnerships with clients and their families. Behavior analysts receive intensive training and supervision in a variety of domains; however, expanding interdisciplinary training for behavior analysts is needed. Interdisciplinary training programs, such as the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs, offer trainees the opportunity to hone their skills as advocates for people with neurodevelopmental disabilities and collaborators as part of an interdisciplinary team. Historically, many LEND programs have not offered training positions specifically to behavior analysis students or professionals, although some behavior analysts have participated as trainees in other disciplines such as psychology or special education. The benefits, barriers, and possible future directions of interdisciplinary training for behavior analysts within a LEND program are discussed through the experience of the University of Cincinnati LEND Program which added an Applied Behavior Analysis (ABA) training track in 2020.
... Mello et al. (2016) compared the accessibility of services for children with ASD living in rural and nonrural counties and found there was a smaller percentage of behavior specialists present in these communities. In an evaluation of geographic access to behavior services, Yingling, Ruther, and Dubuque (2022) found that between 2018 and 2021 approximately 29,297 children diagnosed with ASD lived in a county with no trained providers. Overall, families living in rural areas must travel longer distances to receive behavioral treatment for their children and face additional barriers such as low reliance on healthcare professionals, low socioeconomic status, and minoritized cultural characteristics (Antezana et al. 2017;Sapiets, Totsika, and Hastings 2021). ...
... Despite the children not demonstrating acquisition of the target skills, the finding that participants improved their implementation of behavioral interventions across a total of six programs is noteworthy. Given the dearth of behavior specialists in many parts of the country (Yingling, Ruther, and Dubuque 2022) and the time and resource intensive process of providing in vivo coaching for behavior technicians, the effective support offered by GAINS evidenced in the present study provides an opportunity for expanding behavioral services. It is possible that technological tools such as GAINS can be used in conjunction with in vivo support to provide behavior analytic services to more individuals, particularly those in remote and underserved communities. ...
... Currently, there are few options available that help to mitigate the barriers that limit access to ABA services for children with autism. The barriers such as the disparity among the number of service providers available (Yingling, Ruther, and Dubuque 2022), the rising number of individuals diagnosed with autism (Centers for Disease Control and Prevention, n.d.; Dudley et al. 2019), and the high cost of ABA therapy for families and the government (Chasson, Harris, and Neely 2007;Buescher et al. 2014) can be mitigated by harnessing the existing resources of the behavior change agents already available in a child's environment to implement the behavior intervention (Sallows and Graupner 2005;Walker et al. 2021). Supporting behavior change agents in the natural environment is possible with the use of technology that provides training to caregivers and implementers via various asynchronous teaching methods (Gerencser et al. 2020). ...
Article
Access to behavior analytic services is limited and often unavailable for many in areas with a dearth of qualified providers. Tools to support behavior‐change agents located in the natural environment of consumers may be a way to provide behavioral interventions. An artificial intelligence (AI) platform that guides the implementation of behavioral interventions may be useful for supporting procedural fidelity. The current studies evaluated whether an AI platform was effective at increasing and maintaining high levels of procedural fidelity in individuals with little to no prior training. Participants were two behavior technicians in training (Exp. 1) and three caregivers (Exp. 2). Introducing guidance provided by the AI platform GAINS improved the procedural fidelity with which behavior technicians and caregivers implemented behavioral interventions with children with autism, except for one caregiver. These results suggest AI platforms may be useful tools for supporting high levels of procedural fidelity by novice users.
... Within the GoM, a substantial discrepancy in nutrient availability creates surface eutrophic and oligotrophic zones (Yingling et al., 2022). The nutrient availability and primary production zones are related to various factors: the LC intensity, the eddies that detach from the LC, the alluvial discharge, and the topography of the seafloor (Martínez-López & Zavala-Hidalgo, 2009). ...
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Collected from the southwestern Gulf of Mexico (GoM), the marine piston Core RC10‐265 was used to reconstruct surface water masses, circulation and paleotemperature shifts at orbital scales over the last ∼180 ka. The chronology was constructed based on radiocarbon ages, planktonic foraminifera biostratigraphy and stable oxygen isotopes (δ¹⁸O). The ocean surface conditions were reconstructed based on planktonic foraminifera assemblages. Applying a Q‐mode Factor Analysis, two scenarios were characterized through seven species. (a) The subtropical assemblage (Globigerinoides ruber—Globoconella inflata (positive scores) and the Globorotalia menardii group—Pulleniatina obliquiloculata (negative scores)) suggest that during the end of MIS‐6, and MIS‐4 to MIS‐2, the surface waters were colder (∼22–25°C), with less oligotrophic and a more profound mixed layer depth (MLD) relative to interglacials. (b) The tropical assemblage (Globigerinoides ruber—Neogloboquadrina dutertrei—Globorotalia truncatulinoides (positive scores) and Globoconella inflata—Globigerina falconensis (negative scores)) suggest that during the early MIS‐6, MIS‐5e to 5b and MIS‐1, the surface waters were warm (∼28–32°C), oligotrophic, with a shallow MLD like average modern conditions. High Fe/Ca and Mn/Ca values could result from early diagenesis or their incorporation in the primary calcite due to high Fe inputs to the GoM. Despite the former, Mg/Ca paleotemperatures are consistent with Caribbean and N Gulf reconstructions. This study confirms the relevance of the Loop Current (extended vs. contracted mode) and the associated variability in mesoscale eddies as a control of the paleoecology and paleotemperatures at orbital scales.
... According to the Behavior Analyst Certification Board (BACB), the number of active registered behavior technicians (RBTs) has increased significantly in recent years, with over 168,000 RBTs worldwide as of January 2024 (BACB, 2024a). However, this increase has not been enough to meet the growing demand for applied behavior analysis (ABA) therapy services (Yingling et al., 2022). The BACB has projected that the demand for behavior analysts will continue to outpace the supply, leading to a persistent shortage of qualified professionals (BACB, 2024b). ...
... While Florida boasts the highest number of RBTs in any state by far (BACB, 2024c), the numbers may be inflated owing to examination and billing fraud (ACHA, 2018;BACB, 2022). A county-by-county assessment of Florida revealed that some counties have no Board Certified Behavior Analysts (BCBAs; Yingling et al., 2022) or RBTs (Gravina et al., 2023), and some have less than 1 BCBA per 100,000 people (Deochand et al., 2024), indicative of service deserts in several Florida counties. The Agency for Persons with Disabilities in Florida website reports that more than 23,000 people are waiting for Waiver services (APD, n.d.). ...
Article
Despite the increasing number of registered behavior technicians (RBTs) certified yearly, applied behavior-analytic organizations report difficulties in hiring and retaining RBTs in Florida. The current study evaluated RBTs’ work experiences related to the shortage of RBTs in Florida, particularly work concerns that lead to burnout and turnover. Eleven RBTs were interviewed regarding their working conditions and perspectives on the RBT working conditions. A thematic analysis yielded four main themes: (1) challenges establishing and maintaining competency; (2) difficult working conditions; (3) a transient or unheard-of career; and (4) dissatisfaction with pay and benefits. Results suggested that RBTs’ experiences vastly differed across organizations and that a combination of variables impact RBT burnout and turnover, which may contribute to burnout and turnover among RBTs in Florida. Implications for future research on RBT burnout and turnover and recommendations for organizations are discussed.
... It remains to be seen whether intervention would proceed as quickly under this latter arrangement. However, teaching caregivers to practice RTN with their children without having to wait on a clinician could be valuable because there are substantial gaps in access to early intervention services, especially for minority and rural populations (Yingling et al., 2018(Yingling et al., , 2022. More research in this area is needed to identify optimal approaches. ...
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Among the developmental milestones related to language and communication in early childhood, one that has been the subject of considerable research is response to name (RTN). Delayed or absent RTN in early childhood is a diagnostic marker for autism spectrum disorder and a target behavior in many early intervention curricula. This article describes two related studies. Study 1 evaluated the efficacy and efficiency of a behavioral screening‐to‐intervention model for RTN proposed by recent research. Overall, trials to mastery were reduced relative to previous research. Study 2 evaluated the efficacy of using behavioral skills training to teach caregivers to implement a RTN intervention with their child after that intervention was successful in a clinical setting. Generalized improvements in RTN with caregivers sometimes occurred but did not maintain without programmed reinforcement. Subsequent behavioral skills training was associated with increases in both child RTN and caregiver intervention fidelity.
... Given the volume of certificants the BACB is reporting now, there appears to be a general lack of access to doctorallevel behavior analysts for early career analysts (Deochand & Fuqua, 2016;Yingling et al., 2022). Many doctoral-level behavior analysts may find themselves working in academia, resulting in fewer available for consultation in applied settings. ...
Article
In their seminal work published in 1988, Van Houten and colleagues established foundational principles for the rights to effective behavior intervention, ensuring ethical and effective treatment for individuals with behavioral challenges. This revisitation of their pioneering article investigates the enduring relevance of these rights in contemporary practice and the evolving context shaping our considerations. Re-examining these principles reveals their continued pertinence and essential role in safeguarding the welfare of clients and their caregivers. In light of evolving therapeutic approaches and societal changes, it is crucial for behavior analysts to reaffirm their commitment to upholding these rights. By highlighting the challenges and barriers persisting in current practice, this paper aims to ignite a vital conversation within the field, fostering collaboration and innovation to identify solutions that protect the well-being and dignity of the individuals we serve. This re-evaluation underscores the ongoing importance of these rights and encourages practitioners to critically assess how they are applied today. By acknowledging the obstacles and dilemmas that clients, caregivers, and professionals encounter in contemporary practice, we can collectively work toward solutions that ensure the ethical and effective treatment of individuals with behavioral challenges. This paper is a call to action, emphasizing the need for a renewed commitment to these rights and inviting dialogue to drive progress in the field of behavior analysis.
... Because of the significant time commitment required from qualified professionals (i.e., BCBAs and BTs) to implement ABA treatment and growing ASD prevalence, there is an overwhelming demand for ABA services, which has resulted in families in need of ABA services struggling to find providers and/or facing long delays on treatment waitlists [24][25][26][27]. Additional factors also impact families' ability to seek care, including cost, geographic limitations, and scheduling constraints [28][29][30]. ...
Article
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Background/objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication difficulties and restricted repetitive behaviors or interests. Applied behavior analysis (ABA) has been shown to significantly improve outcomes for individuals on the autism spectrum. However, challenges regarding access, cost, and provider shortages remain obstacles to treatment delivery. To this end, parents were trained as parent behavior technicians (pBTs), improving access to ABA, and empowering parents to provide ABA treatment in their own homes. We hypothesized that patients diagnosed with severe ASD would achieve the largest gains in overall success rates toward skill acquisition in comparison to patients diagnosed with mild or moderate ASD. Our secondary hypothesis was that patients with comprehensive treatment plans (>25-40 hours/week) would show greater gains in skill acquisition than those with focused treatment plans (less than or equal to 25 hours/week). Methods: This longitudinal, retrospective chart review evaluated data from 243 patients aged two to 18 years who received at least three months of ABA within our pBT treatment delivery model. Patients were stratified by utilization of prescribed ABA treatment, age, ASD severity (per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and treatment plan type (comprehensive vs. focused). Patient outcomes were assessed by examining success rates in acquiring skills, both overall and in specific focus areas (communication, emotional regulation, executive functioning, and social skills). Results: Patients receiving treatment within the pBT model demonstrated significant progress in skill acquisition both overall and within specific focus areas, regardless of cohort stratification. Patients with severe ASD showed greater overall skill acquisition gains than those with mild or moderate ASD. In addition, patients with comprehensive treatment plans showed significantly greater gains than those with focused treatment plans. Conclusion: The pBT model achieved both sustained levels of high treatment utilization and progress toward patient goals. Patients showed significant gains in success rates of skill acquisition both overall and in specific focus areas, regardless of their level of treatment utilization. This study reveals that our pBT model of ABA treatment delivery leads to consistent improvements in communication, emotional regulation, executive functioning, and social skills across patients on the autism spectrum, particularly for those with more severe symptoms and those following comprehensive treatment plans.
... Few ideas on how to achieve a reduction in psychotropic use and polypharmacy for youth with challenging behaviors have been proffered, but increased access to evidence-based behavioral therapies has been proposed as a possible solution. 38 Over the years of this study, both national data 14,59 and state-level data for Iowa 60 have shown a steady increase in the number of behavioral service providers, but no indirect effects on the trends in psychotropic medication use were observed in this sample. Surprisingly, this study also found that children receiving more behavioral services were more likely to be taking psychotropic medication. ...
... In underserved populations, early diagnosis and treatment are negatively affected by complex racial-ethnic and socio-demographic, including immigrant, factors (i.e. (Durkin et al., 2010;Kelly et al., 2019;Khanlou et al., 2017;Yingling et al., 2022)). There are racial-ethnic and neighborhood inequities in the age of treatment receipt . ...
... There are racial-ethnic and neighborhood inequities in the age of treatment receipt . Relatedly, there is both unequal access to services and therapists (Yingling et al., 2022) and inequitable utilization of services, with a smaller proportion of Black and Latino as well as low socioeconomic status children receiving services . In particular, among children with IQ < 70 and ASD diagnosis, there is a 6month lag in the age at first autism diagnosis for African American/ Black infants reported in . ...
Article
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This perspective considers complexities in the relationship between impaired cognitive abilities and autism from a maturational, developmental perspective, and aims to serve as a helpful guide for the complex and growing investigation of cognitive abilities and Autism Spectrum Disorder (ASD). Low Intelligence Quotient (IQ) and ASD are frequently co‐occurring. About 37% of 8‐year old children and 48% of 4‐year old children diagnosed with ASD also have Intellectual Disability, with IQ below 70. And, low IQ in early infancy, including below 1 year of age, carries a 40% greater chance of receiving ASD diagnosis in early childhood. We consider the evidence that may explain this co‐occurrence, including the possibility that high IQ may “rescue” the social communication issues, as well as the possible role of critical periods during growth and development. We consider how early low IQ may subsume a part of a subgroup of individuals with ASD, in particular, those diagnosed with autism in very early childhood, and we provide neurobiological evidence in support of this subtype. Moreover, we distinguish the concept of early low IQ from the delay in speech onset in preschool and school‐aged children, based on (i) age and (ii) impairments in both verbal and non‐verbal domains. The etiology of these early‐diagnosed, early low IQ ASD cases is different from later‐diagnosed, average or higher‐IQ cases, and from children with speech delay onset. Given recent interest in formulating new subtypes of autism, rather than continuing to conceive of ASD as a spectrum, as well as new subtypes that vary in the degree of severity along the spectrum, we identify gaps in knowledge and directions for future work in this complex and growing area.
... Children diagnosed with autism spectrum disorder (ASD) are eligible to receive behavioral health services in Michigan, including those based on the principles of applied behavior analysis (ABA). Demand for these specific services far outpaces the number of qualified professionals in the state (Yingling et al., 2022), thus resulting in delayed access to a much-needed service. The purpose of our survey was twofold. ...
... Although the field of ABA has gained an average of ~6,000 new BCBAs and ~17,000 RBTs per year in the last 5 years (2016)(2017)(2018)(2019)(2020)(2021), the BACB recently reported that the demand for BCBAs has more than doubled in recent years (BACB, 2022). For instance, Yingling et al. (2022) found that whereas the number of BCBAs increased nationwide by more than 21% per year, the number of autistic children also continued to increase by 7% yearly. Although this disproportionate gain is encouraging, Yingling et al.'s results suggested that even after significant growth in certified practitioners between July 1, 2018 (27,320) and July 1, 2021 (45,103), county-level distribution of BCBAs as a function of the number of autistic children remained uneven and demand for ABA services continues to outpace these professionals' current availability (BACB, 2022). ...
... com as of July 2022; World Population Review, 2022a, b). This estimated 24.7:1 "autistic children-to-BCBA" ratio in Michigan is nearly identical to the country-wide average reported by Yingling et al. (2022) and suggests that access to BCBAs in Michigan does not reflect best-practice recommendations for caseload management and significant delays to ABA services for autistic children likely exist. In addition, Drahota et al. (2020) found evidence to suggest that access to available providers in Michigan was significantly influenced by population distribution, socioeconomic status, urbanicity, and immobility resulting in uneven spatial distribution of service providers throughout the state, creating "service deserts" in disadvantaged areas, and contributing further to service delays. ...
Article
Children diagnosed with autism spectrum disorder (ASD) are eligible to receive behavioral health services in Michigan, including those based on the principles of applied behavior analysis (ABA). Demand for these specific services far outpaces the number of qualified professionals in the state (Yingling et al., 2022), thus resulting in delayed access to a much-needed service. The purpose of our survey was twofold. First, we surveyed families throughout Michigan (N = 78) to identify the types of barriers encountered and the extent to which families of autistic individuals experience them when pursuing ABA services. Second, our survey assessed the needs of these families during service delays in an attempt to understand how to best support them during this time. Results indicated that 73% of children spent time on a waitlist, varying in duration from 1 month to over 1 year. Further, most caregivers indicated they were concerned about their children’s behavior while awaiting services and would have been interested in training to help them manage behavioral concerns and teach new skills to their children. We conclude by reviewing recommendations for addressing child and caregiver needs during this time and discussing implications for public policy advocacy initiatives.