The Literature on Autism and Employment

In The Politics of Autism, I discuss the employment of people on the autism spectrum.

 Binsfeld, C.R., Grubba, L.S., Schmidt, C. et al. Employment of Adults With Autism Spectrum Disorder: An Integrative Review of Barriers and Facilitators. J Autism Dev Disord (2026). https://doi.org/10.1007/s10803-026-07467-1

Abstract

Purpose

This study aimed to synthesize the international literature on the employment of adults with autism spectrum disorder (ASD), identifying the main barriers and facilitators influencing access, inclusion, and retention in the labor market.

Methods

An integrative review was conducted following established integrative review guidelines, with a systematic search across seven national and international databases. Empirical studies published between 2013 and 2026 were included. Two independent reviewers performed study selection and data extraction. A qualitative thematic analysis was applied to synthesize the findings.

Results

Twenty-two empirical studies met the inclusion criteria. The thematic synthesis identified key barriers, including limited autism awareness within organizations, communication challenges, stigma, inflexible workplace practices, and inadequate managerial support. Key facilitators included supportive leadership, reasonable accommodations, structured communication, organizational flexibility, and recognition of autistic strengths. Overall, the findings highlight the central role of organizational, interpersonal, and contextual factors in shaping employment outcomes for autistic adults.

Conclusions

Employment outcomes for adults with ASD are strongly influenced by workplace structures, managerial practices, and organizational culture rather than individual characteristics alone. The findings underscore the need for evidence-based organizational strategies and public policies aimed at fostering inclusive and sustainable employment. Future research should prioritize intervention studies and longitudinal designs examining how organizational practices and leadership shape long-term employment retention.

From the article:

Diagnostic disclosure emerged as a particularly complex issue. While diagnosis may facilitate access to legal protections, accommodations, and organizational support, it may also expose individuals to stigma and discrimination (Romualdez et al. 2021a, b). Recent studies reinforce this ambivalence by demonstrating that disclosure outcomes depend largely on organizational climate, managerial attitudes, and the availability of concrete supports rather than on diagnosis itself (Chen & Yakubova, 2025). This finding reinforces the importance of understanding disclosure not as an isolated decision, but as a context-dependent process shaped by workplace conditions.

..

Beyond recruitment, leadership emerged as a central determinant of inclusive organizational culture. Leaders are responsible for disseminating accurate autism-related information, fostering respect for neurodiversity, assigning tasks aligned with employees’ strengths, and ensuring that accommodations are implemented effectively (Leopoldino, 2015). Recent evidence highlights that leadership effectiveness lies in everyday practices—such as openness to dialogue, responsiveness to individual needs, and facilitation of psychologically safe environments—rather than solely in formal authority (Chen & Yakubova, 2025; Bualar et al., 2026). Such practices reduce the likelihood that responsibility for adaptation is placed disproportionately on autistic employees. This reinforces the role of leadership as a mediating mechanism between organizational policies and lived workplace experiences.

 

State Policies on Private Equity and Autism Treatment

 The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   Insurance mandates and Medicaid spending have contributed to the growth trend.

Ryan Leitner at the Private Equity Stakeholder Project:

States may want to consider policies that help address some of the specific concerns surrounding private equity ownership of ABA providers. A May 2026 article in Health Affairs both describes those specific issues and proposes regulations that could help improve oversight of ABA services and private equity’s role.

Yashaswini Singh, Corrie Mook, Jared Perkins, Nathan Hostert, and Daniel R. Arnold, the authors of the Health Affairs article,noted that, in general, private equity investment “alters workforce composition and clinician turnover,” and that the rapid growth of private equity-owned ABA services can lead to higher costs and limit access to care. The authors found that in Colorado, “PE-backed centers accounted for half of the increase in billable hours in 2024, prompting concerns over unnecessarily intense treatments that lack clinical benefit.”

To allow for greater oversight of private equity-backed ABA providers, the authors recommend:

• Generating higher quality Medicaid data with more details, including state identifiers;
• Requiring ownership transparency for provider organizations; and
• Enforcing existing anti-kickback statutes, including to investor-backed management companies.

The authors also suggest that policymakers engage with patient advocacy groups and community organizations to provide insight into how to refine reforms more quickly to avoid unintended consequences.

Predatory Providers

 The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   Insurance mandates and Medicaid spending have contributed to the growth trend.

Christopher Weaver and Anna Wilde Mathews at WSJ:

The autism-therapy industry, once a tiny corner of pediatric care, has exploded into a multibillion-dollar business, fueled by rising diagnoses, new providers entering the market and laws requiring insurers to cover more services. It has also attracted predatory providers who bill for phantom services, pad hours and charge steep fees for care delivered by low-wage workers with minimal training.

The billing abuses run wide. Aetna said the number of investigations that found likely fraud or abusive billing by autism-therapy providers in its private-plan business shot up by 300% between 2024 and 2025—and is on track to rise by another 50% this year.

...

Autism-therapy spending has become one of the fastest-growing healthcare expenses for many private insurance plans, insurers, employers and auditors say. The boom has also made the therapy one of Medicaid’s fastest growing segments, according to a Journal investigation published in March. Medicaid claims data showed providers billed as much as $340,000 per patient a year, the Journal reported.

In the private insurance sector, annual spending on hands-on autism therapy for about 40 large employers covering 3.5 million people doubled to $108 million from 2021 to 2025, according to claims data analyzed by the Health Transformation Alliance. The coalition, which helps companies including Walgreens and American Express track and manage medical spending, said that reflects more patients, more hours of service and higher prices.

...

Most of the therapy is delivered by behavior technicians, who in many states need little more than a high-school degree and often earn as little as $20 an hour. By the end of 2025, about 535,000 people were registered as behavior technicians in a federal database of healthcare providers, an increase of 457% from 2019, an analysis by the Journal found.

The front-line workers are overseen by behavior analysts, more highly trained professionals who often have master’s degrees and licenses and can supervise multiple technicians.

 

"The Science Is Beautiful but the Industry Is Very Ugly"

The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   Insurance mandates and Medicaid spending have contributed to the growth trend.

 Sarah Kliff and Margot Sanger-Katz at NYT:

A New York Times investigation has found that this rapid expansion has played out with little regulatory oversight and brought allegations of children being harmed by profit-motivated practices. In interviews, dozens of current and former clinic workers described how clinics frequently overprescribe hours — even recommending that some families remove children from school so they can receive more therapy.

Marquisha Richards worked at two private-equity-backed chains in Texas. She said she became disillusioned about how financial considerations repeatedly drove care decisions. “The science is beautiful, but the industry is very ugly,” she said.

Nationwide, Medicaid spending on autism therapy nearly tripled between 2020 and 2024. In some states it grew much faster: Colorado Medicaid now spends more on autism therapy than on all emergency department visits. North Carolina, which spent $121 million in 2022, projects it will spend over $1 billion next year.

...

Autism treatment did not become big business until the mid-2010s, after state laws began requiring insurers to cover it. Medicaid soon followed, and the industry boomed.

In North Carolina, the number of clinics owned by autism therapy providers grew from 61 in 2019 to 409 in 2026, according to data compiled by Daniel Arnold, a health economist at Brown University.

...

The clinics are enticing to health care investors: Demand is high and payment rates far exceed labor costs.

Medicaid often pays about $70 per hour ($83 in North Carolina) for therapy largely provided by workers with high school diplomas who earn around $20.

Private equity firms have acquired at least 500 clinics over the past decade. “There’s just huge opportunities to grow these businesses and help increase access to care,” said Jon Krieger, a managing partner at Calex, a financial firm that assists with autism clinic mergers and acquisitions. He estimates the market could grow to $90 billion.

...

Nationally, clinic visits have grown longer since private equity entered the business, from a median of four hours in 2019 to 5.5 hours in 2024, according to an analysis of 34 million Medicaid claims by the health data firm Trilliant.

Autism Business

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.   Scams plague the world of autism. Some involve shady or abusive providers.

Christopher Weaver, Tom McGinty, and Anna Wilde Mathews at The Wall Street Journal:

The business of providing therapy to children with autism has surged in recent years across the U.S., fueled by taxpayer-funded Medicaid payments. Some companies have found lucrative opportunities to capitalize on the growing need for such care, sometimes outpacing regulators’ oversight, the Journal’s analysis found.

The number of companies offering such therapy—individualized treatments meant to help patients manage behavior and develop daily living and social skills—almost doubled between 2019 and 2023. Direct payments from state Medicaid programs to autism therapy providers grew to $2.2 billion in 2023, from $660 million just four years earlier, according to the data. Private insurers administering Medicaid benefits paid hundreds of millions more.

That made applied behavior analysis, or ABA, as the therapy is called, the fastest-growing service in Medicaid, the state-run program for low-income and disabled people. Federal taxpayers financed about 70% of Medicaid spending during that period. Entrepreneurs and investors, including some private-equity firms, have piled into the business.

 ...

Indiana became the nation’s hotbed of the booming autism therapy industry, home to nine of the top 10 providers by per-patient spending in 2023. A big part of that was because the state started reimbursing providers 40% of whatever they billed. Unlike the fixed prices that most states use to cap costs, Indiana’s approach became a kind of blank check and therapy providers flooded in to take advantage of the generous reimbursements.

Medicaid spending on autism surged—from $21 million in 2017 to $611 million in 2023, according to a state report.

“Over time you saw an explosion of the children who were diagnosed and in billing practices that in my opinion were the epitome of abuse,” said Mitch Roob, the current secretary of the state’s Family and Social Services Administration and interim Medicaid director.

No one monitored providers’ billing practices during those years, said Roob, who was appointed last year. “If you’re a kid and no one was looking at the cookie jar and the lid was off, would you take another one?”

...

The state scrapped the old billing system in 2024, replacing it with a flat rate of $68 an hour for services paid for by the state. Officials are planning an additional 6% cut this year and also plan to cap lifetime hours of service at 4,000 per child.

Private Equity

The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   After its purchase by Blackstone, the Center for Autism and Related Disorders went bankrupt.

A release from Brown University:

Private equity firms have acquired more than 500 autism therapy centers across the U.S. over the past decade, with nearly 80% of those acquisitions occurring over a four-year span, according to a new study from researchers at the Brown University Center for Advancing Health Policy through Research.

Study author Yashaswini Singh, a health economist at Brown's School of Public Health, said the work highlights how financial firms are rapidly moving into a sensitive area of health care without much public scrutiny or data on where this is happening or why.

"The big takeaway is that there is yet another segment of health care that has emerged as potentially profitable to private equity investors and it is very distinct from where we have traditionally known investors to go, so the potential for harm can be a lot more serious," Singh said. "We're also dealing with children who are largely insured by Medicaid programs, so if private equity increases the intensity of care, what we're really looking at are impacts to state Medicaid budgets down the road."
Study findings and national context

The findings of the analysis were published in JAMA Pediatrics and offer one of the first national assessments of private equity's growing role in autism therapies and services. Autism diagnoses among U.S. children have risen sharply in recent years, nearly tripling between 2011 and 2022, and the condition has been in the national spotlight amid political debate falsely linking autism to childhood vaccines.

The researchers, Singh said, did not evaluate the impacts of private equity ownership on access to treatment, quality of care or the experience of families seeking services. The findings do suggest that investment has been concentrated in states with higher rates of autism diagnoses among children and states that have fewer limits on insurance coverage.

The researchers identified a total of 574 autism therapy centers owned by private equity firms as of 2024, spanning 42 states. Most of those centers were acquired between 2018 and 2022, the result of 142 separate deals. The largest concentrations of centers were in California (97), Texas (81), Colorado (38), Illinois (36) and Florida (36). Sixteen states had one or no private equity-owned clinics at the end of 2024.

States in the top third for childhood autism prevalence were 24% more likely to have private equity–owned clinics than others, according to the study.

The scale and speed of acquisitions underscore the growing trend of private equity's entry into the market. According to Singh, researchers were prompted to investigate after hearing anecdotal reports from families and health providers about changes following private equity takeovers.

The primary concern is private equity firms putting money over families, said Daniel Arnold, a senior research scientist at the School of Public Health.

"It's all about the financial incentives," Arnold said. "I worry about the same types of revenue generating strategies seen in other private equity-backed settings. I worry about children receiving more than the clinically appropriate amount of services and worsening disparities in terms of which children have access to services."

To establish a baseline of where private equity firms are investing and why, the team used a mix of proprietary databases, public press releases and manual verification of archived websites to track changes in ownership. Unlike public companies, private equity firms and private practices are not required to disclose acquisitions, making data collection challenging and labor-intensive.

The team now hopes to examine how private equity ownership affects outcomes, including changes in therapy intensity, medication use, diagnosis age or how long children stay in treatment. They will determine whether these investments are helping meet real needs or are primarily a way to make money.

"Private investors making a little bit of money while expanding access is not a bad thing, per se," Singh said. "But we need to understand how much of a bad thing this is and how much of a good thing this is. This is a first step in that direction."

Antivaxxers Making Money

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

Antivaxxers have found lots of ways to make money from their movement.

Michelle R. Smith and Laura Ungar at AP:

Many of the people involved in groups pushing anti-science bills have built lucrative careers on their stance and benefited from the millions of dollars that flow through the movement.

One of Bigtree’s companies was paid $350,000 working on Kennedy’s presidential campaign in 2023 and 2024. A second was paid $184,000 from another Kennedy-affiliated group, the MAHA Alliance, from October to December of last year. In 2023, another anti-vaccine group he leads, the Informed Consent Action Network, or ICAN, paid him $234,000.

After Kennedy was picked as health secretary, Kennedy gave the MAHA trademark to a company managed by Bigtree. Kennedy’s ethics disclosure said he transferred ownership for “no compensation” after making $100,000 in licensing fees from it in the few months he had the trademark.

In an ICAN video on Facebook in August, Bigtree celebrated the group’s successful lawsuit to compel Mississippi to allow religious exemptions from vaccines. Then he said they would “double down” on efforts to change the law in other states where religious exemptions aren’t allowed. Bigtree asked supporters to help by buying a brick for as much as $300 to pave a terrace at ICAN’s offices, where he works.

At The Times, Megan Agnew reports on Andrew Wakefield, whose fraudulent article started it all.  After losing his British medical license, he moved to Texas and made a bundle of money.   

Wakefield thrived in America, speaking at conferences and heralded as a martyr by mothers of autistic children who believed the disorder was caused by a vaccination. He was the father of the modern conspiracy theory. Crowds cheered, fans sobbed, people called him their “Jesus Christ”. It is from these Texan-born groups that Robert F Kennedy Jr, President Trump’s health secretary, was introduced to the same doctrine. Kennedy said in 2019 that Wakefield was “among the most unjustly vilified figures of modern history”.

Today, Wakefield is back on the conference circuit, speaking at events in the UK this month and Austin in November for which he is titled “Dr Andy Wakefield”, despite the fact he is barred from practising.

... 

He has restyled himself as a filmmaker, releasing anti-vaccine propaganda movies, has a multi-million dollar home and a polished reputation. This is the reinvention of Britain’s most infamous fraudulent doctor.

On Saturday night, Wakefield hailed “a revolution in America” over vaccine policy while making a rare public appearance in the UK. He was speaking at an all-day conference at a hotel in York, and told the audience — who had paid up to £150 to see him — of his excitement over Kennedy’s appointment as US health secretary.

Peter Hotez, a researcher of infectious diseases at Baylor College of Medicine in Houston, said: “Wakefield’s paper was version 1.0 of the antivax movement; before him there wasn’t a link between autism and vaccines. Texas has since become an epicentre of this political movement.”

Lit Review: No Good Evidence That Alternative Medicine Works on Autism Symptoms

In The Politics of Autism, I write:

The conventional wisdom is that any kind of treatment is likely to be less effective as the child gets older, so parents of autistic children usually believe that they are working against the clock. They will not be satisfied with the ambiguities surrounding ABA, nor will they want to wait for some future research finding that might slightly increase its effectiveness. They want results now. Because there are no scientifically-validated drugs for the core symptoms of autism, they look outside the boundaries of mainstream medicine and FDA approval. Studies have found that anywhere from 28 to 54 percent of autistic children receive “complementary and alternative medicine” (CAM), and these numbers probably understate CAM usage.

A lot of people in RFK Jr's MAHA orbit are making a lot of money from supplements. 

Michelle R. Smith and Laura Ungar at AP:

A core criticism Kennedy and his allies repeat about big pharmaceutical companies and the medical establishment is that they are motivated by profits. But the $1.5 trillion global wellness market is big business, too, and it’s benefiting them. Surgeon general nominee Casey Means has made money promoting dozens of health and wellness products, including a blood testing service, and she cofounded a nutrition, sleep and exercise-tracking app. Her brother, Calley Means, a close Kennedy aide, continues his involvement in TrueMed, a company that promotes wellness alternatives.

 There is no good evidence that they help autistic people.

Gosling, C.J., Boisseleau, L., Solmi, M. et al. Complementary, alternative and integrative medicine for autism: an umbrella review and online platform. Nat Hum Behav (2025). https://doi.org/10.1038/s41562-025-02256-9  Abstract:

The use of complementary, alternative and integrative medicine (CAIM) is highly prevalent among autistic individuals, with up to 90% reporting having used CAIM at least once in their lifetime. However, the evidence base for the effects of CAIM for autism remains uncertain. Here, to fill this gap, we conducted an umbrella review of meta-analyses exploring the effects of CAIM in autism across the lifespan and developed a web platform to disseminate the generated results. Five databases were searched (up to 31 December 2023) for systematic reviews with meta-analyses exploring the effects of CAIM in autism. Independent pairs of investigators identified eligible papers and extracted relevant data. Included meta-analyses were reestimated using a consistent statistical approach, and their methodological quality was assessed with AMSTAR-2. The certainty of evidence generated by each meta-analysis was appraised using an algorithmic version of the GRADE framework. This process led to the identification of 53 meta-analytic reports, enabling us to conduct 248 meta-analyses exploring the effects of 19 CAIMs in autism. We found no high-quality evidence to support the efficacy of any CAIM for core or associated symptoms of autism. Although several CAIMs showed promising results, they were supported by very low-quality evidence. The safety of CAIMs has rarely been evaluated, making it a crucial area for future research. To support evidence-based consideration of CAIM interventions for autism, we developed an interactive platform that facilitates access to and interpretation of the present results (https://ebiact-database.com).

RFK's False Promise

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

 At NBC, Brandy Zadrozny reports on the Autism Health Summit:

The conference room at the Town and Country hotel was already abuzz with Kennedy’s latest bombshell. While rattling off his department’s early endeavors at a televised Cabinet meeting last week — they included getting “bad chemicals” out of food and “good food” into school lunches — he stated plainly that he would, in five months, discover the cause of autism. “By September,” he had said to the president, “we will know what has caused the autism epidemic. And we’ll be able to eliminate those exposures.”

“That would be so big,” Trump replied.

And it would — if it weren’t so unlikely. Kennedy later told Fox News that National Institutes of Health Director Jay Bhattacharya had only just begun soliciting proposals from scientists around the world, and HHS hasn’t said more about the timeline. Even if they handed out grants immediately, it would give them barely more than a season to solve a puzzle that has preoccupied researchers for over 80 years.

...

Outside the ballroom were the vendors, about 50 tables packed together, all offering the same message: healing was possible — for a price.

Each table pushed a product or service promising some pathway to wellness. There were water filters — one to detoxify, another to “alkalize”— and a nearly $6,000 electromagnetic gadget that claimed to improve circulation.

Contraptions emitted infrared light or pulsed electromagnetic fields. Supplement kits promised to flush out mold, heavy metals and microplastics. Vibrating plates were pitched as neurological reset tools. And there were countless devices — necklaces, patches, laptop shields, pet collars and full-body blankets — meant to block 5G, electromagnetic fields and radiation, including the Wi-Fi all around us.

Report on Private Equity

The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   After its purchase by Blackstone, the Center for Autism and Related Disorders went bankrupt.

Private Equity Stakeholder Project, "Private Equity in Intellectual and Developmental Disability Services."  Executive Summary:

Private equity firms have been acquiring companies providing services for people with intellectual or development disabilities (IDD). This includes residential facilities, home health and personal care, supported and independent living services, and others. These services were historically provided primarily by non-profits and religious organizations. Through recent buyouts and consolidation, several large private equity owned companies have emerged with tens of thousands of employees at numerous locations across the United States. In some cases, these companies have achieved regional market concentration obscured by complex ownership structures and disparate branding. Case studies in this report illustrate the risks that the private equity business model poses to IDD providers and the people they serve, including:

• Sevita (Centerbridge Partners, Vistria Group)
• Help at Home (Centerbridge Partners, Vistria Group) \
• Broadstep Behavioral Health (Bain Capital)
• Texas Medicaid HCBS provider landscape 
• Advoserv/Bellwether Behavioral Health (GI Partners, Wellspring Capital)

...

 PE Cost-Cutting Tactics & Impacts 

• Reducing staffing 
• Failing to provide adequate training 
• Underpaying employees, resulting in high-turnover and understaffing 
• Failing to hire employees with adequate licensing (which can be more costly) 
• Cutting services (e.g., therapy or educational services) 
• Failing to maintain facilities, leading to unsafe or unsanitary living conditions

RFK Jr. Bucks

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

He is now Trump's nominee to head HHS.

Mary Ann Akers at The Daily Beast:

Robert F. Kennedy Jr. failed to disclose hundreds of thousands of dollars he made from his anti-vax crusade, Donald Trump’s transition team has admitted to the Daily Beast.

Trump’s pick for health secretary previously said his career as the founder, chairman, and general counsel of the nonprofit Children’s Health Defense was “unpaid” and “the opposite of a profit motive.”

In personal financial disclosure forms required for all presidential candidates, Kennedy initially reported that he had earned $731,470.53 in 2022 and 2023. (In the summer of 2023, he reported making $515,960 the previous year from CHD; in the summer of 2024, he reported making $215,510.53.)

But documents obtained by the Daily Beast show that Kennedy—after being nominated by Trump for his Cabinet—then quietly amended those forms to disclose that he had actually earned far more from his anti-vaccine nonprofit: a total of $1.2 million.

“Bobby’s [personal financial disclosure] amounts were reported incorrectly,” a Trump transition team official told the Daily Beast in response to questions about the new documents.

 

Antivaxxers Making Money

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen."

He is now Trump's nominee to head HHS.  He and his pals have made a lot of money from this stuff.

Brandy Zadrozny:

Del Bigtree, a leading voice in the anti-vaccine movement, brought in a record windfall last year for the nonprofit group he founded, according to the latest tax filings.

The Informed Consent Action Network, known as ICAN, reported $23 million in revenue for 2023, a 74% increase from the previous year. The group spent nearly $17 million on efforts including legal battles and anti-vaccine advocacy, an increase of about 25% from the year before.

The tax documents, obtained by NBC News from ICAN, show the increasing prominence and profitability of the anti-vaccine movement in the ongoing fight over vaccine policies and public health. The pandemic supercharged groups like ICAN, which reported about $3.5 million in revenue in 2019, expanding the audience interested in anti-vaccine content and growing the coffers of those who produce it. Numerous studies have found that vaccines are safe and save lives, and are not linked to autism, but that hasn’t stopped misinformation from spreading.

Revenue for Children’s Health Defense, the anti-vaccine organization founded by Robert F. Kennedy Jr., had been on the rise as well until last year, when it dropped more than 30%, to $16 million. This loss coincided with Kennedy taking a leave from his positions as chairman and chief litigation counsel to launch an unsuccessful presidential bid.

But ICAN’s revenue continued to grow, and Bigtree’s profile has risen. The former television producer and anti-vaccine filmmaker, whose organization was known for attention-grabbing stunts and filing freedom of information requests, became communications director for Kennedy’s third-party presidential campaign and advised Kennedy as he prepared for his potential role as secretary of Health and Human Services.

Bigtree and ICAN did not respond to requests for comment.

FBI Searches Minnesota Providers

 In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.   Scams plague the world of autism. Some involve shady or abusive providers.

J. Patrick Coolican at The Minnesota Reformer:

The FBI served search warrants Thursday at two autism treatment providers, as part of a wide-ranging Medicaid fraud investigation first reported by the Reformer in June.

The search warrants were served at Smart Therapy Center in Minneapolis and Star Autism in St. Cloud.

FBI Special Agent Kurt Beulke wrote in an unsealed warrant application that the state autism program has exploded in both the number of providers and cost in recent years: “The investigation has found substantial evidence that many of these companies have been submitting fraudulent claims for (autism) services that were not actually provided or that were not covered.”

According to the warrant application, employees of Smart Therapy were “18 or 19-year old relatives of the owners who had no formal education beyond high school and no training or certification related to the treatment of autism.” Many of the children did not appear to be autistic, according to a witness. The same witness said they believed parents were being paid to bring their children as part of the scheme.

Both Smart Therapy and Star Autism billed the state even when the provider — who was ostensibly giving treatment to a child on the autism spectrum — was out of the country, according to the warrant.

Medicaid Reimbursement Rates

The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities.

Morgan Gonzales at Behavioral Health Business:

Medicaid reimbursement rates are largely trending upward for autism therapy providers, but burdensome regulations still pose significant hurdles to growth.

To overcome these challenges and improve rates, all players in the autism therapy industry, including private equity firms, must become involved in advocacy work, industry insiders said at the Behavioral Health Business Autism & Addiction Treatment Forum.

“No margin, no mission,” Darren Patz, partner of government affairs and public policy at international law firm DLA Piper, said at the event. “You get the rates, and everything can flow from that.”


Medicaid reimbursement for services performed by registered behavior technicians (RBTs) and board-certified behavior analysts (BCBAs) is relatively new, according to Patz, so states are still in the process of determining rates.
...

Private equity-backed ABA providers must also join advocacy efforts, Patz said. Group advocacy work also provides a platform for providers to share best practices, he added.

Private equity has played an increasingly prominent role in autism therapy dealmaking. Private equity firms completed 85% of all M&A between 2017 and 2022, according to research. The federal government has also increasingly scrutinized private equity activity in behavioral health, launching a probe into private equity’s role in health care in March.

Autism and Tech Startups: The Rest of the Story

In The Politics of Autism, I discuss the employment of adults with autism and other disabilities. Many posts have discussed programs to provide them with training and experience.

Michael Bernick at Forbes:

In the early 2010s, a wave of tech start-ups arose with the goal of employing adults with autism, building on the claimed skills of these adults in software testing and quality control. Most of these tech start-ups failed to survive: casualties of the offshoring and competitive price pressures of the software testing and quality control jobs they focused on, as well as an overhyping of the tech skills of most adults with autism. But a few of these start-ups have survived and even grown, and they point to possibilities in this niche market of employment going forward.

The wave of autism-focused tech start-ups was generated in good part by a glowing New York Times article in June 2011 on the Danish tech firm, Specialisterne. The article uncritically accepted Specialisterne’s story, neglecting to note a key element in Specialisterne’s growth: the large subsidies that the company received from the Danish government for its mission. The American start-ups soon ran into the market realities of competing without large government subsidies, and in an environment of greater global competition.

Three start-ups from that period were able to navigate this competition, and continue to do so: AutonomyWorks, Ultranauts, and VenturesATL. Their success is due to the unusual skills and missions of the individual entrepreneurs who founded and continue to lead them, the teams they have built, and their ability to pivot and adapt to changing markets. Though the business lines of these companies differ, a common pivot has been to higher-level data and AI-related services.

Disability Inclusion

 In The Politics of Autism, I discuss the employment of adults with autism and other developmental disabilities. Many posts have discussed programs to provide them with training and experience.

A release from Accenture:

Companies that lead in disability inclusion drive more revenue, net income and profit, according to a new research report from Accenture (NYSE: ACN) in partnership with Disability:IN and the American Association of People with Disabilities (AAPD).


Building on the 2018 landmark report on disability inclusion at work in the United States, the follow-up research, titled “The Disability Inclusion Imperative,” explores disability inclusion amid major technological advances, changes in geopolitical dynamics and the effects of a global pandemic across 346 companies in the US. These companies participated in the Disability Equality Index (DEI), a leading global benchmarking tool that scores businesses on their disability inclusion policies and practices.

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The report identifies that, over the last five years, the business case for hiring persons with disabilities has become even stronger. Specifically, companies that have led on key disability inclusion criteria over that time saw 1.6 times more revenue, 2.6 times more net income and 2 times more economic profit than other companies in the DEI. Further, leaders are more likely to outperform industry peers in productivity by 25 percent.

Since 2018, the number of people with disabilities in the workforce has swelled from 29 percent to 37 percent with most progress occurring since February 2020 at the beginning of the pandemic. This increase can be attributed to increased work opportunities at home—making it easier for people with disabilities to participate in the workforce and an increased awareness and understanding of digital accessibility and inclusion in the hiring process. Additionally, newer and emerging technologies are excellent sources to advance disability inclusion, including AI-powered platforms.

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Additional Accenture research has showed that 76 percent of employees with disabilities do not fully disclose their disabilities at work. Further, the 2023 DEI report found that only 4.6 percent of employees self-identify their disability status with employers. When the US Securities and Exchange Commission (SEC) began requiring companies to provide a human capital overview in their filings, voluntary mentions of disability inclusion at work are notable. Organizations can ensure that disability inclusion remains a fundamental aspect of their overall sustainability and responsible business practices by incorporating ESG principles into their accountability frameworks and publicly sharing outcomes.

Wait Times for Diagnosis

In The Politics of Autism, I discuss evaluation, diagnosis, and waitlists

 A release from Cognoa:

Cognoa, a leading child development and behavioral health company, today published a new report, The State of Pediatric Autism Diagnosis in the U.S.: Gridlocks, Inequities and Missed Opportunities Persist, that underscores the longstanding waitlist crisis for children and their families seeking a diagnosis of developmental delays and autism evaluation. The report assesses results from 111 specialty centers across the U.S.

On average, children and their families are forced to wait three years from the time of first concern of developmental delay to an autism assessment. Delays in diagnosis mean that children are missing the opportunity for early intervention during the critical early neurodevelopmental period when interventions have the greatest life changing impact.

Excessively long waitlists to see the small number of available specialists and the absence of a "standard of care" are major causes for concern throughout the healthcare community. The study, which was conducted by Scott Badesch, Former President of the Autism Society of America, and sponsored by Cognoa, uncovers widespread reimbursement issues that prevent families, especially the already disadvantaged, from receiving an evaluation and subsequent early interventions altogether.

Key findings reveal the inequities and inefficiencies in status quo processes that are leaving most children and families behind:

Unacceptably Long Wait Times for Evaluation

• Nearly two thirds of specialty care centers surveyed report wait times of over 4 months between an initial request for an autism evaluation to the time a diagnostic evaluation is conducted.
• Of that group, 21% report waitlists of more than a year or that are so impacted that they are no longer accepting new referrals.

Reimbursement Barriers Reinforce Healthcare Inequality

• 44% of centers surveyed do not accept Medicaid, pointing to access disparities which affect already underserved communities most.
• Only 65% of practices accept commercial insurance, forcing those who cannot pay initial costs up front to forego care.
• 77% of clinics identified the extreme length of assessment processes and heavy documentation burdens among the top barriers to timely evaluation.
• 69% of clinics identified staffing issues, including clinician and administrator shortages.
• 43% cited burdensome reimbursement processes and inadequate or lack of reimbursement as barriers to timely care.

No Standard of Care

• The data shows high variability in the assessment tools used in today's diagnostic processes, of which there are over 30 listed.
• There are vast state-to-state and healthcare payer-to-payer differences in requirements of both assessment and provider type for an autism diagnosis to be recognized for reimbursement.
• 83% of centers report that autism evaluations take over 3 hours. Of these, 25% report evaluation completion times of over 8 hours. Research shows that these lengthy assessments are not necessary for most children.

The full report can be found here.