Summary: CDC data shows autism identification varies widely by community and more kids are being evaluated earlier. That can increase demand for ABA, especially for early-childhood services. But demand doesn’t always turn into delivered care because staffing, scheduling, and documentation can limit access. Over the next decade, clinics with strong systems and hands-on leadership will be best positioned to serve families consistently and ethically.
Autism prevalence is rising in the data. Families feel it first as longer wait times and more competition for appointments. Providers feel it as staffing strain, heavier documentation, and tighter scheduling.
But one thing matters most if you want to understand ABA service demand in the next 10 years. It is not just the headline prevalence. It is whether communities can identify children early, and whether clinics can consistently deliver care once families enter the system.
Autism prevalence is a snapshot of how many children are identified with autism in a defined population during a defined time period. It does not mean every child will enter ABA. It does not mean every child will receive the full plan of care. It also does not mean every community has the same access to evaluation and services.
That is why the CDC’s ADDM Network is helpful. It does not just publish one number. It shows how widely identification varies by community.
In the CDC’s latest surveillance, autism prevalence among 8-year-olds was 32.2 per 1,000 children, but the range across ADDM sites ran from 9.7 to 53.1 per 1,000. That spread is the real signal.
It suggests the “autism market” is not one national story. It is many local stories shaped by diagnosis access, school and medical record systems, and referral pathways.
If one community identifies 9.7 per 1,000 and another identifies 53.1 per 1,000, the gap does not automatically mean autism is “more common” in one place. It often reflects differences in identification and access. The CDC makes this point directly by reporting wide site variation and describing the underlying surveillance approach.
For ABA demand forecasting, that means this:
Demand is not only driven by prevalence. Demand is also driven by access.
When a community improves screening and evaluation access, more children get diagnosed, and more families enter the service system. That can increase intake volume, create faster-growing waitlists, and raise the need for clinic capacity, even if the underlying rate in the population did not “change” in a simple way.
A major demand driver for the next decade is not just “how many children.” It is “how early.” In the same CDC 2022 surveillance, among children aged 8 with autism who had available evaluations, 50.3% were diagnosed by age 36 months.
This is a big operational signal.
Earlier diagnosis can shift treatment demand into earlier childhood. It also can extend the service planning window. Families often need more guidance early, not less. They need help navigating benefits, next steps, school supports, and care coordination.
So the next 10 years may bring more pressure on:
You can think of future demand as a simple equation:
More identification plus earlier evaluation plus uneven access equals higher pressure on delivery systems. Here are the demand forces most likely to shape 2026–2036.
If half of identified children are evaluated by age 3, more families are entering the system earlier.
That changes how clinics plan staffing and scheduling. It also changes what families expect. Families want clarity early. They want predictable communication. They want a plan they can understand.
Clinics that build strong intake and onboarding systems will have an advantage. Clinics that treat intake like a loose handoff will see higher drop-off.
The CDC’s range across sites is a clue that access is uneven.
Some markets will have higher evaluation volume and higher demand because identification systems are stronger. Other markets may have “hidden demand” that surfaces later, once evaluation access improves.
For providers, this is why market planning is not just population math. It is also:
As services scale, payers and stakeholders tend to ask harder questions. They want progress tied to a plan. They want clear reporting. They want medical necessity supported by documentation. You do not need to predict the exact policy. You just need to notice the direction: when spending rises, scrutiny rises.
That brings us to the most overlooked part of ABA demand.
Many people talk about demand as if it equals “how many children need services.” In reality, demand also depends on whether the system can deliver what is authorized and recommended.
A large real-world study of ABA service receipt (in an integrated healthcare system) showed how hard consistent delivery can be over time.
By 24 months, only 46% of the sample remained in ABA services. And among the children who did receive ABA for 24 months, only 28% received a “full dose,” defined as at least 80% of prescribed hours.
That is the delivery gap.
Even with referrals and coverage structures in place, families may not receive the intended plan consistently.
This gap usually comes from boring operational problems, not clinical philosophy.
This matters for demand forecasting because the next decade will not only increase “need.” It will increase pressure to deliver consistently.
Clinics that reduce the delivery gap will be the ones that grow responsibly.
When the cost curve rises, payers react. They tighten controls. They demand better documentation. They reduce waste.
Nebraska is a clear example of how quickly ABA-related spending can increase and trigger reviews. In a public statement about the state auditor’s audit, Nebraska DHHS noted Medicaid paid $4.6 million for ABA services in 2020 and $85+ million by 2024.
The state auditor’s materials also describe Medicaid service costs increasing from $4.6 million to $82.8 million over five years and the number of companies working with DHHS rising from 10 to 38 in that period.
You do not need to operate in Nebraska for this to matter. The pattern is familiar in healthcare. Fast growth leads to more oversight. Over the next decade, many providers will likely face more pressure to show:
That does not mean care becomes “less humane.” It means clinics must operate with stronger systems.
You can have more autism identification and more ABA demand, but capacity still depends on people. The Behavior Analyst Certification Board (BACB) reported 74,125 BCBAs at the end of 2024. The same BACB report listed 196,579 RBTs at the end of 2024. Those numbers show scale. They also hint at a reality every operator knows: staffing is the bottleneck.
Workforce capacity affects:
So demand planning for 2036 is not only about how many children are identified. It is also about how well organizations recruit, train, and retain the teams required to deliver care.
The next decade will reward operators who treat operations as part of ethical care. Here are the systems that matter most, because they directly reduce the delivery gap described in research.
Families often exit early because the process feels confusing or slow. High-readiness clinics create a clear path:
This supports retention and improves the chance that authorized care gets delivered.
If you want to deliver more hours, you need stable teams. That means:
Workforce stability is not a “nice-to-have.” It protects access.
Scheduling is where demand turns into delivered care. High-readiness clinics track:
If you do not track delivered hours, you will not see the delivery gap until families complain or outcomes stall.
Payer scrutiny increases when spending increases. Clinics that document clearly will handle scrutiny better. The goal is not “more paperwork.” The goal is consistent, defensible documentation that supports medical necessity and progress.
Outcomes should be understandable to clinicians and families. They should answer simple questions:
This is also what payers increasingly want, especially when costs rise.
If you are thinking about expanding ABA access, the data points to a clear truth. There is real demand pressure. But the winners will not be the loudest marketers. They will be the operators who can deliver care consistently and ethically in a higher-scrutiny environment.
That requires hands-on leadership, not passive ownership. It also requires systems that help you run a healthcare operation with discipline.
Success On The Spectrum (SOS) is a mission-driven ABA franchise system structured for hands-on owner-operators. SOS is designed to support entrepreneurs in opening and operating high-quality autism therapy centers through structured systems, training, and ongoing guidance.
SOS focuses on ethical, compliant expansion of services. It emphasizes transparency, quality standards, and engaged ownership.
Important clarity that matches healthcare professionalism:
Autism prevalence data shows ongoing pressure on the service system, with wide variation by community and improving early evaluation signals.
But the next decade will not reward hype. It will reward clinics that close the delivery gap and deliver care consistently over time. Research shows that continuity and “full dose” delivery can be hard to achieve in real-world conditions, which makes strong operations even more important.
If you are exploring a mission-driven, hands-on path to expanding ethical ABA access, visit SOS Franchising to learn what responsible ownership looks like and how the system is structured to support owner-operators.
It means the CDC’s ADDM Network estimated that 32.2 out of every 1,000 8-year-old children were identified with autism in the monitored communities for 2022, with wide variation across sites.
The CDC’s surveillance shows large differences across sites, which can reflect differences in evaluation access, identification practices, and record systems.
In CDC’s 2022 surveillance, 50.3% of 8-year-olds with autism who had available evaluations were evaluated by age 36 months. Earlier evaluation can shift demand to earlier childhood and increase pressure on intake capacity and staffing.
Because authorization does not always translate into delivered care. A real-world study found only 46% remained in services at 24 months, and only 28% of those receiving ABA for 24 months received at least 80% of prescribed hours. Staffing and scheduling constraints often drive this gap.
More scrutiny. When Medicaid spending on ABA rises quickly, audits and policy reviews follow. Nebraska publicly reported growth from $4.6M in 2020 to $85M+ by 2024, which shows how cost growth can trigger oversight.
Nichole Daher is an American entrepreneur, book author, autism advocate, and founder of Success On The Spectrum (SOS)-the first autism treatment franchise in the United States-known for its parent viewing rooms and quality-driven ABA services. She currently serves as CEO of SOS Franchising, where she provides support, resources, and opportunities for entrepreneurs to open their own Success On The Spectrum autism centers.
