Private equity firms acquired 574 autism service delivery sites across 42 states between 2015 and 2024, according to new research published in JAMA Pediatrics. The study offers the first systematic look at PE’s expansion into applied behavior analysis therapy—and raises questions about what that expansion means for children with autism.
Researchers from Brown University, RAND, and Harvard identified 147 PE acquisitions over the decade, with activity peaking between 2018 and 2022, when nearly 80 percent of all deals occurred. The buying spree coincided with a period of rapid growth in autism diagnoses and expanding insurance coverage for ABA services.
“The rapid increase in PE investments in the ASD therapy market coincided with the large increase in childhood ASD diagnoses,” the authors wrote. “PE entry was associated with ASD prevalence, but it is unclear whether entry led to increased availability of and accessibility to ABA services.”
Following the Money
The geographic distribution of PE-acquired sites was uneven. California led with 97 locations, followed by Texas (81), Colorado (38), Illinois (36), and Florida (36). Sixteen states had one or zero PE-owned autism service sites.
The researchers found that PE firms appeared to favor states with higher autism prevalence and more generous insurance mandates. Statistical analysis showed that states in the top third of autism prevalence had a 24 percent higher likelihood of PE entry compared to other states.
To measure insurance generosity, the researchers used a scoring system that rated states from 0 to 8 based on factors like age limits and spending caps on autism benefits. States with scores above 4—indicating fewer restrictions on coverage—also appeared more attractive to PE investors.
The Investment Thesis
The surge in PE interest in autism services tracks with broader trends in the ABA market. Autism prevalence in the U.S. increased from 2.3 per 1,000 children in 2011 to 6.3 per 1,000 in 2022, according to the study. All 50 states now have insurance mandates requiring commercial plans to cover autism treatment, creating a more predictable revenue stream for providers.
PE firms have been drawn to healthcare sectors with similar characteristics: fragmented markets with many small providers, recurring revenue from ongoing treatment relationships, and reimbursement backed by insurance or government programs. Dental practices, dermatology clinics, and veterinary hospitals have all seen comparable consolidation waves.
The ABA industry’s structure made it particularly attractive. Most providers historically operated single locations or small regional networks. PE-backed platforms could acquire these practices, centralize back-office operations, and pursue growth through additional acquisitions—a strategy known as “roll-up” investing.
Open Questions
The researchers noted that their study does not answer whether PE ownership has helped or harmed access to autism services. The data show where PE invested, but not how those investments affected availability, quality, or cost of care.
“Given concerns about PE involvement in ASD services and other health care sectors, further study is needed to determine potential implications for children with ASD,” the authors wrote.
Those concerns have been mounting. A 2023 report from the Center for Economic and Policy Research argued that PE ownership in autism services prioritized investor returns over patient care, citing high staff turnover and pressure to maximize billable hours. A separate systematic review in the BMJ examined PE’s effects across healthcare sectors and found mixed evidence on quality and costs.
Industry representatives have countered that PE investment has expanded access to ABA services, particularly in underserved areas, by providing capital for new clinic openings and technology investments that smaller operators couldn’t afford.
What the Study Doesn’t Show
The researchers acknowledged several limitations. They could not determine what percentage of all ABA providers are now PE-owned, only how many sites PE firms acquired. Some acquisitions may have been missed, particularly smaller deals that weren’t publicly announced or recorded in the PitchBook database they used as their primary source.
The statistical analysis covered 2015 to 2022 because that was the period for which autism prevalence and insurance generosity data were available. The researchers noted that limited state-year observations and potential undercounting of acquisitions could affect the precision of their estimates.
The study also did not examine outcomes—whether children receiving services at PE-owned facilities had different experiences than those at independently owned practices. That question, the authors suggested, warrants future research.
What Comes Next?
The JAMA Pediatrics study arrives as the ABA industry faces growing scrutiny from multiple directions. State Medicaid programs are cutting reimbursement rates in response to surging costs. Federal audits have flagged improper billing practices at some providers. And debates continue about how many hours of therapy children actually need.
PE ownership adds another variable to an already complex equation. Whether consolidation ultimately helps or hinders families seeking autism services may depend on factors the current research can’t yet measure: clinical quality, staff retention, geographic access, and whether the capital PE brings translates into better care or simply better returns.
The research letter, “Private Equity in Autism Services,” was published online January 5, 2026, in JAMA Pediatrics. The study was led by Daniel R. Arnold, PhD, of Brown University’s School of Public Health, with co-authors from RAND and Harvard Pilgrim Health Care Institute. Funding came from Arnold Ventures, The Commonwealth Fund, the National Institute on Aging, and the National Institute of Mental Health. The researchers used PitchBook data to identify acquisitions and the CDC’s Special Education Child Count dataset for autism prevalence.
