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Using this article: Littman, E. R., Gavin, L., Broda, A., Hodges, A. C., & Spector, L. (2023). Barriers to Receiving Applied Behavior Analysis Services in Children With Autism Spectrum Disorder. Cureus, 15(11), e48585. https://doi.org/10.7759/cureus.48585. Provide a general description of the study.Who were the participants, describe the intervention, results, and general findings and implications in paragraph form. Emphasis access to diagnosis and treatment and Financial barriers Methods- A voluntary 51-question survey, including demographics, socioeconomic status, parental assertiveness/self-advocacy, and parent perceptions, was provided to caregivers of children aged one to eight years old diagnosed with ASD. The survey consisted of a series of yes/no, five-point Likert scale, multiple-choice, and text field questions. Results- A total of 540 surveys were completed. The median time since ASD diagnosis was three to five years ago. Respondents were identified as receiving ABA (r-ABA) vs. not receiving ABA (n-ABA). Respondents were from Florida (60%; r-ABA = 61.7%; n-ABA = 57.0%), Pennsylvania (18%; r-ABA = 21.3%; n-ABA = 12.8%), Delaware (17%; r-ABA = 11.7%; n-ABA = 26.8%), and New Jersey (5%; r-ABA = 5.3%; n-ABA = 3.4%) (p < 0.001). Caregiver belief in ABA treatment, empowerment, and comfort level were greater for r-ABA (4.20 ± 0.72; 3.19 ± 0.93; 4.35 ± 0.72) compared to n-ABA (4.06 ± 0.83; 2.90 ± 1.00; 4.03 ± 0.91), respectively (mean ± SD). Conclusion- A total of 540 caregivers of patients with ASD completed a 51-question survey to identify the barriers to children with ASD receiving ABA. Caregivers from Delaware noted a significant disparity in ABA accessibility. Caregivers who were more assertive had a positive outlook on treatment, and caregivers who had more knowledge about ABA were more likely to obtain it for their children. ABA accessibility is a multifactorial issue. Location, income, education of the caregiver, time since ASD diagnosis for the child, as well as caregiver empowerment, belief in treatment, and level of comfort in accessing services most likely contribute to children with ASD not receiving ABA. This emphasizes the need for providers to educate caregivers on the significant impact that these behavioral therapies, such as ABA, can have on their child's behavior, development, and overall long-term outcomes. Caregiver income, education, and work activity- Cost is a barrier to receiving ABA [17]. Horlin et al. found that the median annual cost of having a child with ASD was $34,900, with nearly 90% of that cost due to loss of wages [17]. Our study showed that those with higher household incomes and higher educations were more likely to receive ABA for their child. This may be due to having better access to resources to facilitate treatment, such as time, transportation, or additional help outside the family. We found that of those who worked full-time, part-time, were homemakers, or were unemployed, a greater percentage of their children with ASD have received ABA. Those who were disabled were less likely to receive ABA. This may be due to the high cost of having a child with ASD even before paying for ABA; requiring that caregivers take on more hours to provide financially. Caregivers who work less or are unable to work may not be able to shoulder ABA costs. This may be due to lower income due to fewer hours or an inability to qualify for insurance benefits to allay treatment expenses. Lack of time may be another ABA barrier and suggests that those with more free time are better equipped to engage in intensive therapies for up to seven days a week. Insurance- Over the past few decades, there has been an increase in both Medicaid and private insurance plans covering ABA. However, it is generally believed that caregivers with Medicaid or other government-sponsored plans have a longer wait time to access ABA. There are also differences in reimbursement rates that vary widely across plans [29]. Low reimbursement could deter qualified providers from contracting with particular insurance and, thus, limit available resources for families. Our study found that insurance status was not significant in caregivers securing ABA for their child. Additionally, our data suggest that insurance coverage, or lack thereof, seems to influence family perceptions regarding treatment benefits. Caregivers who did not agree that proper treatment would improve the behavior of children with ASD were more likely to state they were not currently getting ABA and were more likely to state they had to stop getting ABA because their insurance did not cover the therapy.

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