Most states don’t have nearly enough therapists trained to meet the needs of young people with autism, according to a first-ever review of the availability of applied behavior analysis, or ABA, providers.

The number of ABA professionals varies across the country, but is inadequate in almost every state, the study published this week in the journal Psychiatric Services found. ABA is the most common form of evidenced-based autism therapy.

Researchers analyzed 2018 data from the Behavior Analyst Certification Board, which certifies ABA providers, to determine the per capita supply of therapists in each state.

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Findings from the study indicate that only one state — Massachusetts — exceeded the certification board’s benchmark for the number of providers needed to appropriately serve the population of children with autism.

Even when the researchers factored for each therapist taking on double the recommended caseload, they found that the supply of ABA professionals was still below the benchmark in 42 states and Washington, D.C.

The availability of ABA therapists was greatest in the Northeast, the study found. By contrast, no Midwestern state had over a third of the minimum number of recommended providers.

ABA professionals were most prevalent in states that spent more on public education and in places with higher median household income, according to the analysis.

“Given the increasing prevalence of ASD among youths, new workforce policies may be needed to improve the supply of ABA providers in the United States to meet the needs of this population,” wrote study authors Yidan Xue Zhang and Janet R. Cummings of Emory University in their findings.