By: Dr. Panicha McGuire, LMFT, RPT™
Estimated reading time: 18 minutes
This piece began as an article I submitted to Psychology Today. Unsurprisingly, it was not approved. When you question the economic machinery behind the autism “treatment” industry or point out how autistic people’s lives become commodities in a multibillion-dollar marketplace…gatekeepers tend to get uncomfortable. Consider this the version they wouldn’t publish.
Autism in the Context of Capitalism
Disability as Economic Infrastructure
A foundational body of disability scholarship has documented the ways disability is produced, managed, and commodified under capitalism. This isn’t necessarily new. Gary Albrecht’s The Disability Business traced how rehabilitation industries normalized the medicalization of disabled people while generating massive revenue streams (1992). Capitalism requires a “reserve army” of disabled people who can be alternately marginalized or economically exploited as needed (Russell, 2019).
Under neoliberalism, disability becomes a strategic site of intervention: disabled people are cast simultaneously as economic burdens and as opportunities for profit through service industries, charities, research, and rehabilitation markets (Mitchell & Snyder, 2015). They term this process ablenationalism, wherein disabled people are positioned as national responsibilities whose management justifies public and private investment.
Autism sits squarely within this political-economic landscape. Autism became a profitable arena precisely as neoliberal capitalism expanded market solutions into health, education, and social services (Broderick & Roscigno, 2021).
Autism as Commodity
Autism began to be treated as a consumable identity and marketable condition during the late 20th and early 21st centuries. This is described as the commodification of autism (Runswick-Cole et al., 2016). A process involving: the creation of autism-related markets (e.g., therapy, equipment, curricula, diagnostics), the circulation of autism narratives across media, and the transformation of autism into an object that can be bought, sold, and branded.
Critical scholars emphasize that autism is not merely an abstract concept. It is materialized through autistic bodies (McGuire, 2016). The Autism Industrial Complex (AIC) extracts value from those bodies in the form of billable hours, research subjects, data points, and behavioral outcomes.
Manufacturing “Autism as Crisis”
Metaphors That Create Markets
For decades, autism has been framed through metaphors of threat: an epidemic, tragedy, or crisis. Framing autism this way heightens fear, justifies interventionism, and produces parents as ideal consumers of therapies (Broderick & Roscigno, 2021). These metaphors serve two economic purposes:
- they create urgency (“act now before it’s too late”), and
- they produce consent to intensive and often coercive intervention practices.
These narratives are essential to creating the consumer demand on which the Autism Industrial Complex depends. And in my clinical experience, you can see this machinery at work the moment a family receives a diagnosis. Just ask any parent or caregiver about the avalanche of therapy brochures, pamphlets, flyers, and referral sheets they’re handed before they even have time to process what autism means for their child.
The Role of Global Nonprofits and Media
Organizations such as Autism Speaks have played a profound role in exporting U.S. interventionist narratives worldwide. Large-scale “awareness” campaigns (often couched in philanthropic language) reinforce autism as crisis and disability as cost, fueling global demand for behavioral interventions (Nadesan , 2013). Media industries further reinforce the logic that autistic children require professional correction, creating a cultural loop of fear, intervention, and consumption (Murray, 2012).
Applied Behavior Analysis (ABA) and the Intervention Monopoly
ABA’s Rise as a Market-Secured Standard
Applied Behavior Analysis (ABA) did not become the dominant “gold standard” autism intervention simply because the science was stronger or more compelling than other approaches. Its rise is better understood as the outcome of a coordinated economic, political, and institutional process that gradually positioned ABA as the only legitimate form of “autism treatment” in the eyes of insurers, policymakers, and the general public.
ABA’s ascent began in the late 20th century, when behaviorism aligned with growing neoliberal logics in education and health care. The method appealed to policymakers not primarily because it was humane or developmentally attuned, but because it promised something quantifiable: data, compliance, standardization, and the illusion of control over human behavior. At the same time, alternative approaches rooted in child development, relational work, or sensory integration struggled to compete, not because of inferior outcomes but because they lacked ABA’s institutional backing and built-in economic engine.
A major turning point came with the creation of the Behavior Analyst Certification Board (BACB) in 1999. While often framed as a professional regulator, the BACB quickly became a powerful economic force. Its certification exams, continuing-education requirements, and credentialing pathways generated a reliable revenue stream while establishing a pipeline of behavior technicians and analysts who were trained within a closed, self-referential system. Universities began developing BCBA programs with many of them marketed as one-year or two-year certificate programs because they were cost-efficient to run and extremely profitable. The growth of these programs helped saturate the field with behaviorists, reinforcing the perception that ABA was the standard by sheer numerical presence.
The next phase solidified ABA’s monopoly through legislative action. Beginning around 2007 and accelerating between 2010 and 2019, state after state passed insurance mandates requiring coverage of ABA as the primary or exclusive intervention for autism. Autism Speaks and regional behavior analysis associations were central drivers of these bills. Their lobbying efforts successfully positioned ABA as the “only evidence-based treatment” for autism, language that appears scientific but rests on circular logic. Because the ABA industry dominated its own research base, and because many studies were produced by individuals with financial conflicts of interest, the field could point to a body of literature largely authored by behavior analysts themselves as proof of its scientific legitimacy. Peer-reviewed critiques later documented the methodological weaknesses and pervasive conflicts of interest in this research (Bottema-Beutel et al., 2020), but by then, ABA had already secured its policy foothold.
Insurance mandates locked the model in place. Once states required coverage of ABA, insurers had little incentive to authorize alternative therapies, especially those without an established billing structure. ABA’s architecture (coded sessions, measurable behaviors, discrete trial protocols) fit neatly into medical billing frameworks. Relationship-based developmental therapies, sensory-based approaches, and neurodiversity-affirming supports did not. As a result, the landscape became economically rigged: ABA was the easiest, most reimbursable, and often the only option families could access without paying out of pocket.
This created a self-reinforcing loop. Because insurance would cover ABA, more clinics opened. Because more clinics opened, more behavior technicians were trained. Because more technicians were trained, more universities expanded BCBA programs. Because these programs grew, the profession gained further cultural legitimacy. Parents who are often overwhelmed, frightened, and newly navigating systems encountered ABA not as a choice but as the default, often presented as the responsible or necessary thing to do. Many reported being handed stacks of referrals for ABA providers within minutes of receiving a diagnosis, long before they had time to understand autism itself or consider alternative frameworks.
The rise of private equity in the 2010s accelerated this consolidation. Investors quickly recognized that ABA represented a stable, state-mandated revenue stream with predictable billing volume. Large ABA chains began acquiring smaller clinics, and efficiency pressures intensified. The economic logic was straightforward: maximize billable hours, minimize costs, and expand as rapidly as possible. Autistic children became the mechanism through which revenue targets were met, and ABA’s market dominance hardened even further.
Despite increasing testimony from autistic adults about the long-term harms of ABA including trauma, masking, identity confusion, and PTSD-like symptoms (Kupferstein, 2018), the economic and regulatory machinery supporting ABA has remained remarkably resistant to challenge. Insurance companies continue to treat ABA as the gold standard, not because its outcomes are unequivocally superior, but because the market infrastructure surrounding ABA was deliberately designed to make it the simplest and most profitable option to administer.
Thus, ABA’s position at the center of autism intervention is not the outcome of neutral science. It is the product of decades of coordinated economic strategy, certification pathways, policy lobbying, and industrial growth. ABA became the standard not because it was the best we could offer autistic people, but because it was the best positioned to succeed under capitalism.
Private Equity and the Boom of Autism Services
The rapid expansion of autism services in the United States cannot be understood without examining the accelerating role of private equity. Over the past decade, ABA clinics and autism service providers have become highly attractive investment targets, not because of breakthroughs in autism support or improvements in outcomes, but because the policy landscape has rendered autism treatment a stable, predictable, and extremely lucrative revenue stream. With all 50 states mandating insurance coverage for ABA, the autism services market now guarantees reimbursable hours, high demand, and minimal regulatory oversight (conditions that are ideal for private investors seeking reliable returns).
Investigative journalists have documented how private equity firms began acquiring ABA companies at a remarkable pace in the mid-2010s, treating clinics less as therapeutic environments and more as scalable business units. Blackstone, Rothschild, and a range of mid-tier private equity entities have purchased major autism treatment chains, consolidating the field into an increasingly corporate structure (Fry, 2022; Summers, 2021). Small, community-based agencies that once operated as independent providers are often bought out, absorbed, or pushed to compete with larger, investor-backed chains that have far greater marketing budgets, administrative support, and capacity for rapid expansion.
The economic logic behind these acquisitions is straightforward. Autism diagnoses are rising, insurance mandates guarantee payment, and ABA lends itself easily to scaling. Private equity firms anticipate significant returns by increasing efficiency, reducing costs, and maximizing billable clinical hours. In practice, this often translates into high-pressure environments where productivity targets overshadow clinical ethics, and where the primary imperative is not the development or well-being of autistic clients but the maintenance of profit margins.
The effects of private equity ownership ripple quickly through service delivery. Clinics may reduce labor costs by relying heavily on entry-level, minimally trained technicians rather than highly qualified clinicians. Staff turnover increases as workloads intensify and compensation fails to keep pace with corporate expectations. Treatment plans may expand in volume not because a child’s needs require more hours, but because more hours generate more revenue. Families frequently report feeling pressured to accept intensive programs without being given meaningful alternatives or the opportunity to consider less invasive, relationship-centered support. The structure of ABA with its discrete units of billable behavior interventions makes it particularly vulnerable to this kind of revenue-driven inflation.
These concerns echo findings from research on private equity in other sectors of human services, such as nursing homes, where investor ownership has been associated with declines in care quality, understaffing, and even increased mortality (Braun et al., 2021). Autism services, however, present an even more fragile infrastructure for oversight. Unlike hospitals or long-term care facilities, ABA clinics often operate in private homes, isolated settings, or behind clinic doors with limited external regulation. The combination of high vulnerability (young children, non-speaking clients, sensory distress) and low supervision creates conditions in which exploitation can flourish long before it is detected.
Despite the magnitude of this shift, academic research on private equity in autism services remains sparse. The speed of consolidation has outpaced the slow mechanisms of academic study, peer review, and regulatory reform. From the standpoint of the AIC, private equity represents an intensification, not an anomaly. The political economy of autism had already been oriented toward profitability through insurance mandates, certification pipelines, and interventionist cultural narratives. Private equity simply identifies the financial potential embedded within that landscape and amplifies it. The result is a market that treats autistic children as predictable revenue sources, where growth depends not on innovation or improved outcomes but on expanding caseloads and securing more billable hours.
The moral question is unavoidable: what happens when autism services are governed by investment logic rather than therapeutic responsibility? And who is accountable when the drive for profit eclipses the commitment to care?
In the current system, the answer is often no one.
This is the reality families and clinicians are navigating. Private equity did not create the Autism Industrial Complex, but its presence reveals the full extent of how deeply autism has been absorbed into the machinery of contemporary capitalism. It is where even the most vulnerable populations become sites of extraction, and where the language of therapy becomes indistinguishable from the language of finance.
The Harm: Autistic People as Raw Material
One of the deepest harms produced by the Autism Industrial Complex is the way it positions autistic people as the raw material through which entire industries are built. Broderick and Roscigno (2021) argue that autistic people become the substrate on which economic and ideological systems operate. Their bodies, behaviors, and identities are treated as resources to be shaped, corrected, and monetized. Autism becomes something to intervene on, and autistic people become the objects through which profit and professional authority circulate. In this framing, autism is not simply a diagnostic label. It is a market category, a justification for an expansive and profitable intervention economy.
This dynamic is not unique to the United States. Global research shows that autism itself is not a fixed category. Instead, it is shaped by cultural expectations, community beliefs, and broader social structures. De Leeuw, Happé, and Hoekstra (2020) argue that autism is profoundly contextual and that diagnostic practices largely reflect Western values about communication, independence, and social behavior. This means that the same behaviors that are pathologized in Western clinical settings may be interpreted differently elsewhere. For example, Setswana parents describe autism through cultural and spiritual frameworks, often interpreting their children’s behaviors through concepts of ancestral influence, community roles, or traditional beliefs, which profoundly shape how they seek support and understand their child’s needs (Melamu et al., 2024). These interpretations do not negate autism. They demonstrate that autism is never neutral. It is always filtered through cultural meaning.
Indigenous frameworks further illustrate the limitations of a single globalized model of autism. In Aotearoa New Zealand, Māori communities increasingly use the term takiwātanga to describe autistic experience. Takiwātanga is often translated as “in their own time and space,” a phrase that centers relational context rather than deficit (Tupou et al., 2023). Unlike Western clinical language, takiwātanga reflects a worldview that honors variation, communal responsibility, and the pace of the individual child. This conceptualization stands in direct contrast to intervention models that frame autistic traits as disruptions requiring immediate correction. These cultural perspectives show that autism is not universally defined, yet the Autism Industrial Complex promotes a single, standardized, intervention focused interpretation across diverse communities.
Although cultural understandings differ, the harms of normalization based intervention appear globally consistent. Research across multiple countries shows that autistic children quickly learn that their natural behaviors are framed as problematic or unacceptable. Hull et al. (2019) (i.e., the developers of the CAT-Q) found that autistic adults commonly describe beginning to mask or camouflage as early as childhood. They learned that stimming, avoiding eye contact, or seeking sensory regulation were treated as errors to fix. Over time, these children internalize the idea that their authentic ways of being are wrong. Masking may create short term social acceptance, but it is associated with burnout, anxiety, depression, and suicidality in adolescence and adulthood (Raymaker et al., 2020). Oshima et al. (2024) demonstrated this pattern in both Japan and the United Kingdom, showing that masking is not a Western phenomenon. It is a predictable response to environments that prioritize neurotypical norms and penalize visible autistic traits.
The harm is not only psychological. It is structural. The AIC constructs a particular kind of autistic person: one who is trained to comply, adapt, and accommodate others, regardless of personal cost. Broderick and Roscigno (2021) argue that intervention systems do not simply respond to autistic bodies. They shape them. They produce the very forms of autistic identity that they claim to serve. Diagnostic practices, early intervention protocols, and school based behavior programs all contribute to a narrow ideal of what an acceptable autistic person should look like. This ideal is aligned with market demands for measurable change, insurer preferences for standardized treatments, and educational systems that reward conformity.
As autism markets globalize, these norms are exported into cultural contexts where they do not fit. Western based intervention models increasingly influence policy in countries where local understandings of developmental difference are relational, spiritual, or community centered. Global autism research remains dominated by Western perspectives, and many regions lack culturally grounded tools and frameworks. As a result, autistic children throughout the world are enrolled in systems that train them to suppress behaviors that may be meaningful within their own cultural settings.
To treat autistic people as raw material is to deny their autonomy, their cultural roots, and their right to define themselves. The AIC harms autistic people not only through overt practices of behavioral control, but through its insistence that autistic ways of being must be reshaped in accordance with market driven standards. The harm is cumulative, global, and deeply tied to the political and economic interests that structure how autism is understood.
Is Resistance Possible? Living Within and Against the Autism Industrial Complex
Resistance is possible, though not in the form of a single solution or a wholesale escape from the system. It emerges in everyday acts of refusal, in autistic people reclaiming their narratives, and in communities centering relational, culturally grounded understandings of neurodivergence. It shows up when families question the urgency narratives that have been sold to them, when autistic adults speak openly about masking and burnout, and when practitioners choose approaches that honor autonomy rather than compliance. These forms of resistance do not dismantle the Autism Industrial Complex, but they interrupt it. They make space for autistic people to exist on their own terms, and they expose the limits of an intervention economy that depends on fear, scarcity, and normalization. The path forward is not about abandoning systems entirely, but about reshaping them so that autistic lives are not raw material for profit, but valued experiences deserving of dignity, agency, and cultural respect.
Autistic-Led Movements
One of the most significant sources of resistance to the Autism Industrial Complex has come from autistic-led organizations. Groups such as the Autistic Self Advocacy Network (ASAN) and the Autistic Women and Nonbinary Network (AWN) have fundamentally shifted the landscape by asserting that autistic people must lead conversations about autism policy, research, and services. These organizations challenge the deficit narratives that fuel the intervention economy and instead promote frameworks grounded in autonomy, self-determination, and disability justice. ASAN’s motto, “Nothing About Us Without Us,” exemplifies a broader movement that rejects paternalistic models of care and insists on the legitimacy of autistic expertise. AWN has expanded this work by centering the experiences of women, nonbinary people, and autistic individuals who have been historically overlooked or misrepresented in clinical and public discourse. These organizations illustrate what it means to resist not only harmful practices, but the underlying logics that allow autistic people to be treated as objects of intervention rather than agents of their own lives.
References
Albrecht, G. L. (1992). The Disability Business. SAGE Publications.
Bottema-Beutel, K., Crowley, S., Sandbank, M., & Woynaroski, T. G. (2020). Research Review: Conflicts of Interest (COIs) in autism early intervention research – a meta-analysis of COI influences on intervention effects. Journal of Child Psychology and Psychiatry, 62(1). https://doi.org/10.1111/jcpp.13249
Braun, R. T., Jung, H.-Y., Casalino, L. P., Myslinski, Z., & Unruh, M. A. (2021). Association of Private Equity Investment in US Nursing Homes With the Quality and Cost of Care for Long-Stay Residents. JAMA Health Forum, 2(11), e213817. https://doi.org/10.1001/jamahealthforum.2021.3817
Broderick, A. A., & Roscigno, R. (2021). Autism, Inc.: The Autism Industrial Complex. Journal of Disability Studies in Education, 2(1), 1–25. https://doi.org/10.1163/25888803-bja10008
de Leeuw, A., Happé, F., & Hoekstra, R. A. (2020). A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe. Autism Research, 13(7). https://doi.org/10.1002/aur.2276
Fry, E. (2022). Private equity is the biggest player in a booming autism-therapy industry. Some therapists say the “money grab” is hurting the quality of care. Fortune.
Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6
Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism, 4(1), 19–29. https://doi.org/10.1108/aia-08-2017-0016
McGuire, A. (2016). War on Autism. University of Michigan Press.
Mitchell, D. T., & Snyder, S. L. (2015). The Biopolitics of Disability: Neoliberalism, Ablenationalism, and Peripheral Embodiment. University of Michigan Press.
Murray, S. (2012). Autism. Routledge.
Nadesan , M. H. (2013). Autism and Genetics: Profit, Risk, and Bare Life. In J. Davidson & M. Orsini (Eds.), Worlds of Autism: Across the Spectrum of Neurological Difference (pp. 117–142). University of Minnesota Press. https://doi.org/10.5749/minnesota/9780816688883.003.0006
Neo Jeanett Melamu, Wandile Fundo Tsabedze, Erasmus, P., & Liezl Schlebusch. (2024). “We call it Bokoa jwa tlhaloganyo”: Setswana parents’ perspective on autism spectrum disorder. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1381160
Oshima, F., Takahashi, T., Tamura, M., Guan, S., Seto, M., Hull, L., Mandy, W., Tsuchiya, K. J., & Shimizu, E. (2024). The association between social camouflage and mental health among autistic people in Japan and the UK: a cross-cultural study. Molecular Autism, 15(1). https://doi.org/10.1186/s13229-023-00579-w
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”: Defining Autistic Burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079
Runswick-Cole, K., Mallett, R., & Sami Timimi. (2016). Re-thinking autism: Diagnosis, identity and equality. Jessica Kingsley Publishers.
Russell, M. (2019). Capitalism & disability (K. Rosenthal, Ed.). Haymarket Books.
Summers, J. (2021). As Private Equity Comes to Dominate Autism Services…. The Nation.
Tupou, J., Chevelle Ataera, Wallace-Watkin, C., & Waddington, H. (2023). Supporting tamariki takiwātanga Māori (autistic Māori children): Exploring the experience of early childhood educators. Autism, 28(3). https://doi.org/10.1177/13623613231181622