The Impacts of the COVID-19 Pandemic on Therapy Utilization Among Racially/Ethnically and Socio-Economically Diverse Autistic Children.
COVID-19 cut ABA by 11 hours a month, with Asian and school-funded kids recovering slowest.
01Research in Context
What this study did
Frazier et al. (2023) tracked ABA hours for autistic children before and after COVID-19 hit. They looked at kids from many races and income levels. The team compared how fast hours bounced back for each group.
What they found
ABA time fell by about 11 hours per month in the first pandemic quarter. Most families regained hours, but Asian children and kids funded by school districts recovered more slowly. The gap shows COVID-19 did not hit all families equally.
How this fits with other research
Jung-He et al. (2025) extend this picture: families who kept any ABA during lockdown saw small gains in social and communication skills. The two studies pair like puzzle pieces—W shows who lost hours, Jung-Mei shows why keeping them mattered.
Sergi et al. (2021) offer a bright spot. Italian toddlers kept learning through parent coaching when clinics closed. Their skills stayed flat instead of falling, proving lost clinic hours do not have to mean lost progress.
Shawler et al. (2021) echo the equity theme. Low-income and food-insecure families saw three to four times more behavior problems during lockdown. Together the papers trace a clear line: less access, more struggle.
Why it matters
You now have data showing which families are at risk when crises strike. Flag Asian and school-funded cases in your caseload. Build back-up plans like telehealth or parent training before the next disruption. Even short, coach-led sessions can protect skills while full hours return.
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02At a glance
03Original abstract
PURPOSE: The purpose of current study was to evaluate change in hours of Applied Behavior Analysis (ABA) therapy utilization for autistic children during the year prior to the COVID-19 pandemic, the first three months of the pandemic (crisis phase), and the following 9 months of the pandemic (mitigation phase). Additionally, this study aimed to evaluate if change in therapy utilization differed based on child race, ethnicity, and primary payer of services. Finally, we aimed to identify potential mechanisms of ABA therapy disruption by interpreting findings using an extended version of Donabedian's structure-process-outcome model. METHODS: Retrospective clinical data on client demographics and therapy utilization (n = 283) were collected from ABA clinics in California and analyzed with four piecewise growth multi-level models. RESULTS: We found that therapy utilization dropped during the first three months of the pandemic (-10.65 h/month; p < .001) and increased during the following 9 months (2.39 h/month; p < .001). Moderator analyses revelated that Asian, Non-Latinx and school-district funded children had significantly different trajectories of change in therapy utilization compared to white, non-Latinx participants and private insurance funded participants, respectively. CONCLUSION: Findings suggest that utilization of ABA therapy was disrupted for a full year following the onset of the COVID-19 pandemic and that child race/ethnicity and primary payer influenced the degree to which autistic children were impacted by service disruption. These findings have implications for autistic children who lost therapy access during key developmental periods and for the ABA care delivery system.
Journal of autism and developmental disorders, 2023 · doi:10.1371/journal.pone.0248925