County-level variation in geographic access to Board Certified Behavior Analysts among children with Autism Spectrum Disorder in the United States.

Adams et al. (2021) counted how many BCBAs live in every US county. They looked at kids with autism and asked: can a family drive to a BCBA without leaving the county?

The team used national license data and Census maps. They did not test an intervention. They simply drew a map of where BCBAs are and are not.

More than half of US counties have zero BCBAs. Empty counties stretch across rural plains, mountains, and parts of the South.

If you live in one of these counties, the nearest BCBA may be hours away. The study shows a clear line: no BCBA, no easy ABA.

Yingling et al. (2022) is the direct sequel. It used the same map one year later and found 266 counties had finally gained at least one BCBA. The tiny gain shows the shortage is stuck, not solved.

Garikipati et al. (2024) offers one workaround. They trained parents to run ABA themselves. Kids still learned new skills even when no BCBA lived nearby. The papers sit side-by-side: one shows the desert, the other shows a canteen.

Frazier et al. (2023) adds a warning. When COVID-19 hit, kids in BCBA-rich areas lost 11 hours of ABA per month. If existing supply is that fragile, counties with zero BCBAs have no cushion at all.

You may write perfect treatment plans, but if the family lives in a zero-BCBA county the plan stays on the shelf. Use the map to check your client's county before you promise weekly in-home sessions. If the drive is too far, pivot: telehealth, parent training, or school consults. Push payers to fund these options the same as face-to-face ABA. The desert is real; our job is to build roads across it.