Parents dealing with autism diagnoses encounter daunting choices regarding where their children will dedicate numerous hours weekly to learn communication, emotional regulation, and skills for independence. Most believe they are selecting from local therapy providers. They seldom recognize that they are choosing a portfolio company.
Since 2014, private equity firms have discreetly acquired over 500 autism therapy centers across 42 states, with nearly 80 percent of these transactions happening in a rapid four-year period from 2018 to 2022. This consolidation, highlighted in a study released on January 5 in JAMA Pediatrics, marks one of the first efforts to illustrate how financial investors have transformed a segment of healthcare that caters to some of the nation’s most vulnerable children.
Yashaswini Singh, a health economist at Brown’s School of Public Health and the study’s lead researcher, noted that these acquisitions occurred largely unnoticed by families and regulators. Clinics owned by private equity do not have to disclose changes in ownership, compelling her team to reconstruct the situation through proprietary databases, press announcements, and archived websites. They pinpointed 574 centers across 142 distinct deals, with California having 97, Texas 81, and Colorado 38.
Why Investors Are Drawn to Autism Therapy
Between 2011 and 2022, autism diagnoses among U.S. children nearly tripled, creating a rising demand for Applied Behavior Analysis and similar interventions. For investors, this equated to reliable insurance payments—steady revenue streams that make clinics attractive acquisitions. The study revealed that states with the highest childhood autism prevalence were 24 percent more likely to feature private equity-owned centers. Investments also clustered in states with less restrictive insurance coverage for autism services.
The majority of children receiving these therapies are covered by Medicaid, adding a layer of complexity. If investors encourage clinics toward more intensive schedules for increased billing, state budgets bear those costs. This financial strain could influence who gets care, the amount of care provided, and whether treatment choices focus on clinical needs or reimbursement rates.
“The primary takeaway is that there is another segment of healthcare that has emerged as potentially lucrative for private equity investors, distinct from traditional investment areas, meaning the potential for negative impacts could be much more serious,” Singh articulates.
Daniel Arnold, a senior research scientist at Brown and co-author of the study, mentioned that his concerns reflect patterns witnessed when private equity entered nursing home sectors, emergency departments, and dialysis centers. Those fields experienced cost-cutting methods that occasionally compromised patient outcomes. Whether autism care will follow a similar path remains uncertain.
What Lies Ahead Is Uncertain
The researchers intentionally refrained from making quality assessments. They are still unsure if private equity ownership enhances access through expanded clinic networks or degrades care by emphasizing profit margins. Singh highlighted that modest returns coupled with genuine service expansion wouldn’t necessarily detriment families. The issue lies in the data deficiency.
Her team is pursuing federal funding to investigate whether changes in ownership relate to longer treatment lengths, modified medication patterns, earlier or later diagnoses, or variations in therapy intensity. For the moment, the study establishes a baseline, documenting how swiftly financial firms have integrated into a system designed for children who frequently struggle to voice their own needs.
Families still enter clinics with the same therapists and recognizable waiting areas. However, the financial framework beneath has been restructured by firms more familiar with boardrooms than behavior strategies. Whether this transformation ultimately benefits or harms remains an unresolved question with potentially significant repercussions for millions of children.
JAMA Pediatrics: 10.1001/jamapediatrics.2025.5443
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