Health Conditions
As Private Equity Cashes in on Autism Epidemic, Kids End Up ‘Big Losers,’ Experts Say
Private equity firms acquired more than 500 autism therapy centers in the last decade, according to a peer-reviewed study published in JAMA Pediatrics. Critics said the trend will generate profits for financiers, but will likely diminish the quality of care for children with autism.
Private equity firms acquired more than 500 U.S. autism therapy centers in the last decade, according to a peer-reviewed study published last week in JAMA Pediatrics.
The study is one of the first national assessments of private equity’s growing role in autism therapies and services, according to a press release.
The authors determined that, as of 2024, private equity firms owned 574 autism therapy centers across 42 states.
Nearly 80% of therapy center acquisitions by private equity firms happened between 2018 and 2022, coinciding with the large increase in U.S. childhood autism spectrum disorder diagnoses.
The prevalence of autism in U.S. children in 2022 was 1 in 31 kids, a roughly 17% increase from 2020, according to the Centers for Disease Control and Prevention’s latest report.
The trend worries Daniel Arnold, Ph.D., a senior research scientist at Brown University’s Center for Advancing Health Policy through Research and the study’s lead author.
“I want the public — and particularly families with autistic children — to realize that optimal care quality in this setting is likely not aligned with companies’ financial interests,” Arnold told The Defender.
Private equity has a bad track record in other areas of healthcare, Arnold said. “Their acquisitions have generally been associated with price increases, and staff and quality decreases.”
After private equity took ownership, the quality of care diminished in nursing homes, psychiatric facilities, dental offices, hospitals and prisons, research shows.
Yet private equity continues to make acquisitions in the healthcare sector. In 2025, global private equity investments in healthcare soared to a record-breaking $191 billion, according to a new report by Bain & Co.
‘Children will end up being the big losers’
Private equity investors are likely to view people with autism as an “untapped market” rather than as “individuals needing excellent services,” said Dr. Elizabeth Mumper, a pediatrician.
Brian Hooker, Ph.D., Children’s Health Defense (CHD) chief scientific officer, agreed. “The corporatization of autism treatment will put profits before children, and the children will end up being the big losers in this whole ‘game.’”
Private equity is “an industry notorious for its secrecy,” according to Laura K. Olson, Ph.D., a distinguished professor at Lehigh University in Pennsylvania who studies private equity acquisitions in healthcare.
Private equity firms aren’t required to report their financial activities to the U.S. Securities and Exchange Commission — “or anywhere else,” Olson wrote in her research statement.
Arnold said, “Given we’re dealing with a vulnerable pediatric population here, I think private equity’s history of prioritizing the financial side of things is particularly concerning.”
Arnold and his colleagues are seeking federal funding to look at how private equity ownership is affecting kids who receive autism therapy.
That’s important, said Karl Jablonowski, Ph.D., CHD senior research scientist, because “autism therapeutic services will, unfortunately, not run out of a customer base anytime soon.”
Scammers, not private equity, are likely responsible for Minnesota’s fraudulent autism therapy scandal that’s received a great deal of mainstream news attention, said CHD General Counsel Kim Mack Rosenberg and Jennifer Larson, founder and CEO of the Holland Center, which provides autism therapy services in Minnesota.
However, private equity’s acquisition of autism centers will likely lead to more fraud, given their lack of oversight, said Kim Rossi, executive director of the Age of Autism and mother of three adult daughters with autism. “Worse still, by profiting off autism, there will be even less incentive to find a way to stem the epidemic.”
Private equity-owned centers push kids into 40 hours of lucrative service a week
The authors of the JAMA Pediatrics study tracked ownership changes for U.S. autism therapy centers by analyzing proprietary databases and reviewing press releases and archived websites.
They found private equity investment was most concentrated in states with higher rates of autism diagnoses among children and states with fewer limits on insurance coverage.
California had the highest number of private equity-owned clinics (97), followed by Texas (81), Colorado (38), Illinois (36) and Florida (36). By the end of 2024, only 16 states had one or no private equity-owned clinics.
As childhood autism rates have increased, more state insurance programs now cover autism therapy services, particularly a one-on-one service called applied behavior analysis (ABA). ABA seeks to increase positive behaviors and decrease negative behaviors through reinforcement, according to the Cleveland Clinic.
There have been stories of kids being pushed to do 40 hours a week of ABA at private equity-owned centers. This is “financially in the best interest of providers,” Arnold said. He hopes his team can shed light on this and other consequences of private equity ownership of autism centers in their next project.
‘There is no one standard, cookie-cutter type of autism treatment’
While many consider ABA to be the “gold standard” in autism therapy, that doesn’t mean kids with autism should necessarily do it 40 hours a week or in place of other therapies, Mack Rosenberg said.
Mack Rosenberg has worked in the autism therapy space for over a decade and has a child with autism. “It’s easy to track a child’s progress over time with ABA, so there’s been a lot of research published on it,” she said. “But other therapies shouldn’t be overlooked.”
Hooker, whose son has autism, agreed. “There is no one standard type of autism and there is no one standard, cookie-cutter type of autism treatment.” He cited other successful approaches, including Biomedical, Floortime, Do Autism Differently (formerly known as the Son-Rise Program) and Spellers.
Corey Cohrs, CEO of Radical Minds, an autism therapy that provides ABA in Omaha, Nebraska, likened blanket prescribing 40 hours a week of ABA for every child to prescribing chemotherapy to every cancer patient just because it’s the most expensive, KFF Health News reported.
And just like any other therapy, ABA can be done well or poorly, said Larson.
Some kids who received ABA and later learned to spell — meaning they learned to express themselves using a keyboard or letterboard — have come out saying their ABA experiences were negative, that they were treated disrespectfully or presumed intellectually incompetent, Larson said.
But that’s not true for all kids who received ABA. Larson’s son, Cade, who has autism and learned to spell after receiving years of ABA, told her, “Mom, I knew everybody loved me and cared about me, but they didn’t know I was in there and understanding everything.”
Cade recently spoke on a panel of Spellers at CHD’s conference in Austin, Texas.
Centers offering ABA should provide adequate support for the behavior technicians working with children, Mack Rosenberg said. While attending an autism therapy conference, she heard a private equity-owned center employee say they were overseeing around 100 behavior technicians — “that’s far more than what’s recommended.”
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Private equity-owned centers lure workers with trip to Mexico
With private equity ownership, “you get a bunch of people who are focused on the money and not the kids,” Larson said. “It’s not like a mom running it like me.”
She said her center is now having to compete with the slew of private equity-owned centers in Minnesota — a state with a high prevalence of autism and good insurance coverage for autism therapies.
Some private equity-owned centers in Minnesota attract new staff by offering them a free trip to Mexico, she said.
Maintaining a good workforce is a challenge for any autism therapy center “because it’s a tough job if you’re doing it right,” Larson said.
Private equity firms are taking talent and committed people away from the “actual legitimate longstanding organizations that provide really great care,” she said. “But then they don’t have the infrastructure of the behavioral analysts and all the things you need to actually run these centers appropriately — because they’re about the money, not about the efficacy.”
Larson said she’s lost staff to private equity-owned centers. Some of those people later returned, telling Larson, “Oh my gosh, the therapy’s so bad. I can’t take it anymore. I feel like it’s a disservice to the children and the families, and they don’t know it.”
Related articles in The Defender- Eyeing Big Profits, a Private Equity Firm Bought a Leading Autism Services Provider — Then COVID Hit
- Patients Face Greater Risks at Hospitals Acquired by Private Equity Firms, Study Reveals
- ‘The Kids Are Not All Right’: Private Equity Psychiatric Facilities Prioritize Profits Over Patient Care
- ‘Parasitic’ Private Equity Consumes U.S. Healthcare System
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