In February, on orders from the U.S. Department of Government Efficiency, Medicaid officials created a first-of-its-kind online portal containing hundreds of millions of billing records that supposedly would allow everyday people to crowdsource investigations into healthcare fraud.

“DOGE is not a department,鈥� Elon Musk . 鈥淚t’s a state of mind.”

At the time, thousands of heavily armed federal agents were smashing into cars and battering their way into homes throughout Minnesota鈥檚 Twin Cities, under the guise of investigating what the Trump administration insisted was unchecked fraud in autism therapy committed by Somali immigrants.

There was a grain of truth: Fraud is indeed widespread in autism therapy, something a series of federal audits begun during the Biden administration found in red states and blue. In the wake of the audits鈥� release, the Trump administration raided autism centers, blaming lawless immigrants, welfare cheats and 鈥渨oke ideology鈥� for the scandals unfolding nationwide. 

But a 74 investigation found another problem entirely: a massive influx of private equity players capitalizing on the autism therapy industry to the tune of $7 billion in taxpayer-funded Medicaid payments over the course of six years. And much of this explosive growth has come at the expense of children.

The explosive growth of applied behavior analysis

社区黑料 downloaded the 275 million-record DOGE dataset and analyzed Medicaid claims for autism therapy from 2019 to 2024. Our analysis reveals how an unproven, even harmful, behavior modification system called applied behavior analysis, or ABA, is crowding out more effective 鈥� and humane 鈥� treatments for children with autism.

And it shows how a well-intentioned campaign by parents desperate to find a “cure” for their autistic kids has mushroomed into a poorly implemented but extremely lucrative mechanism for providing ABA 鈥� a system of rewards and punishments designed to eliminate certain behaviors 鈥� to as many autistic children as possible, regardless of their age or actual needs. 

Pediatricians, psychologists and other professionals who diagnose autism reflexively prescribe ABA to parents, typically unaware that there is mounting disagreement about the therapy鈥檚 effectiveness and the associated trauma that can follow an autistic individual into adulthood. Told this is the child鈥檚 best chance at a decent life, few caregivers question the guidance until harmful effects start to show.

Experts consulted by 社区黑料 weren鈥檛 surprised by our findings. Health officials turned on the fiscal taps before instituting meaningful legal oversight 鈥� creating the exact kind of loosely regulated environment that draws the opaque investment strategy employed by private equity. 

A secretive corner of the financial sector not held to the same standards as exchange-traded stocks, bank loans and other publicly monitored investments, private equity has acquired businesses in numerous industries over the last decade, hoovering up billions of dollars. 

Private equity typically acquires privately held companies that have access to steady streams of revenue, extracting as much cash as possible in the short term and leaving debt when investors move on. To maximize profits, they often deliver the easiest, most lucrative services, rather than the personalized treatments Medicaid and other public funds were supposed to pay for.

From 2019 to 2024, 社区黑料 found, Medicaid claims for the six most common autism therapy billing codes shot up some 381%, from $400 million a year to nearly $2 billion 鈥� with private equity-backed providers leading the billing pack.

Indeed, federal begun in 2022 鈥� two of them in blue states and two in red 鈥� reveal a very purple problem. They detail how bad actors in the for-profit business sector, whether greedy or merely inept, push autistic children toward ABA therapy at the expense of other, more effective supports at school that students with disabilities are guaranteed by law. 

Families whose children are referred to ABA by pediatricians and other providers are typically urged by private therapy centers to sign them up for as many hours as possible 鈥� up to 40 hours a week 鈥� and to keep them there for years. That is a prescription ripe for exploitation, says Ari Ne鈥橢man, an assistant professor of health policy and management at Harvard’s T.H. Chan School of Public Health and former director of the Autistic Self-Advocacy Network.  

鈥淧rivate equity was attracted to ABA because the industry as a whole had set up a very tidy financial arrangement for itself,鈥� says Ne鈥橢man. 鈥淚t鈥檚 not that private equity is corrupting a previously fine field. Private equity entered the field because of the flaws that were already there.鈥� 

For fiscal year 2026, federal spending on special education . If the $2 billion now being spent every year on ABA for children with publicly subsidized health insurance were added to schools鈥� annual budgets, every district in the country could add one full-time and one half-time occupational therapist 鈥� specialists in desperate short supply who have proven success in addressing many issues facing autistic children.

DOGE鈥檚 intentions notwithstanding, many in the autism community have hoped the crisis posed by runaway Medicaid spending might present an opportunity to take a hard look at how ABA has grown into an industry with the fiscal might to stave off even basic state and federal oversight. And how it is crowding out more effective, humane alternatives, and even preventing children from going to school.

Instead, now they fear that politics will further overshadow needed autism therapy reforms. The second Trump administration has withheld some $3 billion in Medicaid funding from California and Minnesota, insisting that their governors 鈥� whom the president views as foes 鈥� are not attending to fraud. As a consequence, people with disabilities have already lost services. 

As the Medicaid cuts in Trump鈥檚 One Big Beautiful Bill go into effect, and as he and Health and Human Services Secretary Robert F. Kennedy Jr. continue to promote disproven and dangerous 鈥�cures鈥� for autism 鈥� at the cost of research into better treatments 鈥� disability advocates fear the future will look a lot like a dark past.   

ABA claims vastly outpace spending on autistic people鈥檚 quality of life

In addition to the financial boondoggles, there鈥檚 a human cost. 

During the six years of records we analyzed, Medicaid billing for ABA therapy totaled nearly $7 billion. That鈥檚 $1 billion more than the United States has spent in 20 years on research and programs under the Autism CARES Act, which pays for services to better autistic people鈥檚 lives.   

As disproportionately small as the CARES Act funding is, even after two decades of lobbying by autists and advocates, very little of it is spent on . Of the $2 billion appropriated last year, to be spent over five years, $30 million will go to creating support for caregivers, $13 million to job training and $19 million to safety and well-being.    

Now, even that modest pot of funding is imperiled, as Kennedy is redirecting federal resources toward new research on vaccines and other long-discredited 鈥渃auses鈥� of autism and dangerous, ineffective treatment strategies. 

Meanwhile, is that the most widely used therapy, ABA, is frequently ineffective and . The therapy was pioneered in the 1960s by Norwegian-born UCLA researcher Ole Ivar Lovaas, who used the same regime of rewards and punishments to develop LGBTQ conversion therapy 鈥� now widely acknowledged as abusive.

Independent researchers and autistic adults who went through ABA say its focus on 鈥渆xtinguishing鈥� natural and frequently beneficial autistic traits and in their place demanding compliance with 鈥渘ormal鈥� behaviors is traumatizing. Much as conversion therapy can鈥檛 change a person鈥檚 identity but can instead instill shame, behavior conditioning will not make autists nondisabled and sends the message their strengths are unimportant.

Lovaas is one of two early autism researchers whose histories are now known to include ties to Nazi Germany. In interviews, Lovaas said that during the five-year German occupation of Norway, he and his family were forced to labor on farms. But a 2025 report in the journal History of the Human Sciences documents his role as a local of Norway鈥檚 Nazi youth movement. The Third Reich sought to 鈥�euthanize鈥� autistic people, who were seen as a financial and genetic burden to society.  

The other autism researcher who played a role in the Nazis’ eugenics campaigns was Dr. Hans Asperger, who reported of 鈥渕alformed children鈥� to be targeted for sterilization or death. 

Proponents are quick to assert that today鈥檚 ABA is a far cry from the slaps and electric shocks of what was known as the Lovaas Method early on. Yet the goal 鈥� to 鈥渆xtinguish鈥� autistic traits in children鈥� typically remains. Kids as young as 2 are routinely subjected to as many as 40 hours a week of repetitive behavior modification drills.   

A past 74 investigation found that for years, the evidence used to legitimize ABA was produced by the industry itself, was rife with undisclosed conflicts of interest and neglected basic guardrails such as documentation of harmful 鈥渁dverse events.鈥� By contrast, independent research into ABA by the and academic scholars found little to no evidence of effectiveness.

A of 460 autistic adults and caregivers of autistic children found that nearly half of those who went through ABA showed symptoms of post-traumatic stress, while 72% of those who did not participate in the therapy were asymptomatic.   

, researchers at the University of Wisconsin-Madison, Ohio State University and the University of Texas at Austin found that people who had participated in ABA before age 18 were 30% more likely to experience a mental health hospitalization than autistic people who had not. Autistic people who had been treated with ABA and hospitalized were also admitted with 32% greater frequency than those who had not.   

Again, says Ne鈥橢man, the industry is predicated on a flawed, but very profitable, model. ABA industry recommendations call for every child, regardless of how young they are or what their needs are, to receive the same intensity of treatment.     

鈥淚 would argue that ABA is potentially harmful in any situation because we haven鈥檛 really addressed the ethical concerns of the potential mental health consequences,鈥� says Ne鈥橢man. 鈥淏ut even if we were to set that aside, the idea that there is an evidence base for applying ABA in all instances without regard to any consideration for age or the types of challenges that someone has, it鈥檚 just ludicrous.鈥�

鈥淔orty hours a week of therapy is a full-time job for a 3-year-old,鈥� says Ne鈥橢man. 鈥淚t鈥檚 harmful for kids and families first and foremost, but I also think it鈥檚 a poor use of public funds.鈥� 

When therapy supplants school

The four federal audits of state Medicaid spending show what advocates have long decried: ABA service providers are allowed to keep children in lucrative standalone treatment centers where they are barred by Medicaid law from receiving academic instruction 鈥� often for years after they should begin attending school.

Auditors raised similar concerns in Indiana, flagging the case of a child who was referred to ABA in January 2014 at the age of 2 and was still receiving more than seven hours of therapy a day, five days a week, at age 8 鈥� years after they should have been in school. Medicaid payments for this child increased from $52,000 a year in 2017 to more than $185,000 in 2022, when the child was 11, for a total of $677,448. 

(For perspective, state spending on school-based special education services varies wildly and is poorly reported. One often-used estimate is that an average of $26,000 is spent annually on each student with a disability, versus $9,000 per non-disabled pupil.)     

Special education teachers say that when these students show up in a classroom, it鈥檚 after years of lost academic instruction. In practice, often this means they will be denied the chance to learn alongside their typically developing peers 鈥� a right enshrined in federal law. 

Advocates say the exact number of children in this position is probably unknowable. As a youngster approaches kindergarten age, families are often warned by their ABA provider that taking their child out of private therapy and enrolling them in school will cause regression. Much as homeschoolers often do, these families can sign official documents saying they are taking responsibility for their child鈥檚 education.    

In the case of the Indiana youngster, now 11, auditors noted that the treatment plan did not say whether the child attended school, 鈥渂ut had a standardized statement: 鈥楾he patient鈥檚 family [has] taken on responsibility for meeting the educational needs of this patient.鈥� 鈥� 

After the audit, Indiana lawmakers on how much therapy centers could bill per child, and for how much time. Many children have reached or are near reaching the cap.  

A state task force appointed to address issues likely to follow the changes repeatedly heard from parents and advocates concerned about older children who, no longer eligible for Medicaid-funded ABA, would attend school for the first time. As a result, a new law allows private ABA therapists to accompany children to class for a transition period. 

How did the ABA industry get so big?

For the first 20 years after Lovaas announced he had 鈥渞ecovered鈥� 鈥� his term for cured 鈥� nine of 19 autistic children on whom he had developed ABA, the supposed miracle cure was inaccessible to almost all families. Insurers were not required to cover the diagnosis or treatment of autism.

Then, in 2005, the mother of a 4-year-old autistic boy sat down at her kitchen table and drafted a bill to require health insurers in South Carolina to cover the 鈥済old standard鈥� therapy being touted as a child鈥檚 best shot at a 鈥渘ormal鈥� life. Then she enlisted hundreds of parents of autistic children to lobby state lawmakers to pass it. 

was compelling. To afford ABA, then costing $70,000 a year, she and her husband had downsized their house and spent their home equity 鈥� plus her entire salary as a law professor 鈥� on therapy for their son, Ryan. 

The grassroots push paid off. In 2007, despite ferocious insurance industry opposition, the South Carolina legislature approved the bill 鈥� only to have the governor veto it, with just one day left in the session. 

Unumb put out another call. Accompanied by a CNN camera crew, an army of parents flooded the statehouse, demanding a veto override. 

When the vote was cast, Unumb , the lawmakers on the floor turned toward the families in the gallery and gave them a standing ovation.    

Weeks later, Unumb held a summit to teach other parents, who flew in from around the country, how she had succeeded in getting what鈥檚 known as Ryan鈥檚 Law passed. She spent the next decade working with Autism Speaks, helping to organize families in other states.

The parents had potent lobbying partners. To convince insurers that ABA was not experimental, a growing community of practitioners created an organization, the Behavior Analyst Certification Board, that set standards, bestowed credentials and promoted research. 

The board did not respond to a request for comment.  

Few questioned whether there was an inherent conflict of interest in an industry creating its own proof points. Most people were more focused on the plight of families 鈥� and the promise heralded by a miraculous, if frightfully expensive, cure. By 2019, every state required most private insurers to pay for autism services, though with wildly differing benefit levels. 

The bigger turning point occurred in 2014, when the Obama administration clarified that the Affordable Care Act required publicly subsidized care plans, including Medicaid, to pay for autism treatment. 

At the same time, the rate at which children were identified as autistic began rising dramatically. The ACA for the first time required insurers to pay for autism assessments, and improvements to diagnostic criteria helped to identify autistic children whose traits were previously missed. 

An analysis of special education Child Count data shows that between 2011 and 2022, autism鈥檚 prevalence rose from 2.3 to 6.3 per 1,000 children, with the greatest increases among those aged 5 to 8 years.

Today, Unumb is the CEO of the Council of Autism Service Providers. The organization, she wrote in an email to 社区黑料, 鈥渂elieves ABA providers must continuously earn the public鈥檚 trust in caring for children with autism. Genuine fraud, waste and abuse must be called out and punished to uphold accountability and patient safety.鈥�

鈥淏ad actors exist in every healthcare profession, including ABA, but that doesn鈥檛 mean they are prevalent,鈥� she added. 鈥淭housands of qualified, ethical ABA providers are at work every day, doing the right thing and making a difference in children鈥檚 lives.鈥�

Private equity enters the picture 

Private equity funds are groups of investors who pool their money to buy ownership stakes in privately held companies or real estate. These firms and their deals are subject to far less government oversight than public companies that trade on the stock market. They rarely disclose information about their activity. 

They typically have managers, who make decisions about the businesses they acquire but don鈥檛 put much of their own money into the investments. Frequently, the goal is to simultaneously cut costs and increase revenue to create a cash flow for the investors. The businesses are usually resold within three to five years. 

Over the last two decades, private equity has become increasingly common in healthcare, even though the acquisition of doctor鈥檚 practices, hospitals, medical equipment manufacturers and nursing homes can . In terms of public oversight, though, all those industries are tightly regulated compared to ABA. 

The mandates for insurance coverage of autism were instituted with very little initial oversight of the quality of services being provided. States that did require providers to be licensed often simply decided to recognize the ABA industry鈥檚 internal credentials.

While these standards are often stricter than a provider鈥檚 hiring requirements, the practice of adopting industry credentials leaves behavior analysts in charge of overseeing their own members. When, in the wake of a scathing federal audit of its Medicaid billing practices, Colorado recently moved to license therapists, it rejected a suggestion that a newly created oversight board contain outside professionals such as psychologists. Instead, the board will be composed of four therapists and one public member, who can also have industry ties. 

The combination of lax standards and ready cash proved irresistible to private equity firms, which began buying ABA practices and consolidating them into large, multi-state chains. From 2015 to 2024, private equity firms acquired 574 sites run by 147 providers, according to researchers from the Brown University School of Public Health.

Of the 50 largest providers by Medicaid billing in 社区黑料鈥檚 dataset, 23 are (or, in two cases, were) owned by private equity. From 2019 to 2024, their claims totaled $2 billion. 

Private equity firms own 11 of the top 15, with claims totaling more than $1.5 billion between 2019 and 2024. 

The process has dramatically reshaped an industry already in need of reform 鈥� in the wrong direction. 

鈥淭hey have created massive national chains with the primary purpose of extracting high returns in a short period of time,鈥� write the authors of 鈥�,鈥� a report from the Center for Economic and Policy Research. 鈥淐onsolidation gives private equity-owned provider organizations a large competitive advantage over other for-profit and nonprofit providers, as well those offering other approaches to [autism] services.鈥�

鈥淚t also gives them more bargaining power to negotiate higher rates for themselves vis-脿-vis state agencies, regulators and insurance payers. Some PE firms have used this leverage to extract higher reimbursements under threat of closing down sites in states in which they do not get the rates they prefer.鈥�

Many of the large networks also advertise immediate openings for autism assessments, which they tout as a quick path to enrolling in therapy. Otherwise, according to the National Institutes for Health, the median time a family spends on a wait list for an independent evaluation is a year and a half. 

How private equity works

Some private equity funds take a partial ownership stake in a business that needs cash to expand or improve. But most of those investing in autism therapy are typically buyout funds, which acquire and consolidate existing businesses.

These funds’ managers invest very little of their own money, maybe 1% or 2% of the total. Investors, which often include pension funds and other institutions, put in another 30% to 50%. The rest of the cost of the acquisition is borrowed 鈥� what鈥檚 referred to as a leveraged buyout.

To make these transactions, a fund sets up a series of companies. Responsibility for the debt is transferred to the company being acquired. 

As the purchased company struggles to make the loan payments, a share of the cash coming in is returned to the investors. Sometimes, the fund managers take out loans on the already indebted business and give the cash to their investors as a dividend.   

Meanwhile, the leaders of the investment fund 鈥� whose expertise is typically in maximizing profits 鈥� are allowed to make decisions about staffing, levels of patient care, who they will serve and where. 

ABA is supposed to be highly individualized, with therapists continually collecting data on children鈥檚 responses to repeated efforts to get them to stop behaviors deemed undesirable, such as hand-flapping or rocking, or to perform actions the therapist wants, like making eye contact. 

This information, gathered by the lowest-rung member of the ABA team, a behavior technician, is supposed to be reviewed by a credentialed provider known as a board-certified behavior analyst, who uses it to modify the child鈥檚 treatment plan on a regular basis.       

But in state audits, federal investigators found repeated instances where the therapists鈥� notes submitted as claims documentation had been copied and pasted, often day after day, bearing the names of numerous different children working with different therapists.

Notes were often signed off by therapists before they had finished the session in question, and Medicaid was frequently billed for unallowable activities, such as naps and lunch.   

For their 2023 report on private equity鈥檚 influence on ABA, investigators at the Center for Economic and Policy Research interviewed former employees of one of the oldest therapy center networks, the Centers for Autism and Related Disorders, or CARD. Founded by one of Lovaas鈥� graduate students, the chain was sold to the private equity group Blackstone in 2018 for a reported $700 million.  

The former employees said that under Blackstone鈥檚 management, they were told to prioritize younger children. Not only can smaller kids remain enrolled for several years before reaching school age, they are most likely to be referred for additional hours of therapy per week under the guise of early intervention. 

鈥淭hey would literally terminate patients in our programs who required lower hours and replace them with those requiring at least 30 to 40,鈥� the researchers quoted one former employee as saying.

CARD did not respond to requests for comment. In a statement to 社区黑料, Blackstone said the network of centers was hit by a 鈥減erfect storm鈥� of COVID-19-era lockdowns, labor shortages and low insurance reimbursement rates that led to a Chapter 11 restructuring. 

鈥淲hen it became clear that a restructuring was necessary to put the company on the best long-term path to deliver on its mission, we worked day and night 鈥� to keep its existing facilities open so the company could continue serving patients,鈥� the statement says.

The statement adds that Blackstone was never involved in specific clinical treatment decisions and had sought to increase pay, reduce caseloads and improve training and operations. 

If an individual center or an entire network is accused of fraud or found to have abused patients, the investment managers who made decisions to maximize profit can鈥檛 be held accountable. Just like the debt, liability accrues to the 鈥減ortfolio company鈥� that owns the actual centers.  

By 2022, CARD had in states with lower Medicaid reimbursement rates and made that put others out of business, shrinking from 250 centers to 100. In June 2023, it filed for bankruptcy and was bought by a group of private investors recruited by its founder.

According to 社区黑料鈥檚 dataset, in 2019, CARD billed Medicaid more than $13 million. In 2024, its Medicaid receipts were slightly less than $2 million.

Private equity鈥檚 structure shields investors and ABA network owners from liability

With corporate headquarters in Farmington, Michigan, Centria Healthcare was founded in 2009 as a pediatric nursing provider. When one of its early patients needed ABA, the company created an autism-focused division. Today, it owns centers in 11 states. 

Because the company is privately owned, its finances are largely shrouded in secrecy. But, according to the investor intelligence service Pitchbook and data gathered for the Center for Economic and Policy Research, Centria was purchased in 2016 by Martis Capital, a private equity firm specializing in acquiring North American healthcare providers. Over the next three years, Centria expanded to nine states. 

As part of a 2018 , the Detroit Free Press reported that Michigan鈥檚 attorney general was looking into claims that Centria had engaged in improper billing and service provision. The story was based on interviews with former company executives, documents obtained by reporters and allegations detailed in a defamation lawsuit the company filed against some of the past employees. 

The paper also reported that two Michigan counties had after local mental health officials cited the company for billing and care issues and an employee was abusing a child. 

Martis Capital did not respond to a request for comment.  

In a statement to the newspaper, Centria CEO Scott Barry vigorously denied the claims: “Whatever these allegations are, yes, they’re very outrageous, but they’re not true. And we’re trying to do a good job to help kids and help families and help our community.”

At the time, the company was in line for an $8 million job-creation grant secured with the backing of the state鈥檚 lieutenant governor, described by the Free Press as a longtime advocate of autism therapy. Five weeks after then-Lt. Gov. Brian Calley made the recommendation, a key company investor hosted a party kicking off Calley鈥檚 gubernatorial bid. Guests donated more than $100,000 to his campaign, the paper reported.      

The grant was put on hold while the state investigation unfolded. In March 2019, the state closed the probe, saying that while it had noted potential billing irregularities, there wasn鈥檛 enough evidence to merit criminal complaints. The grant was not reissued. 

Three former executives later sued Centria, resurfacing their allegations. Both lawsuits were eventually dismissed by the parties.

In a statement to 社区黑料, Centria CEO David Harbour said the company focuses on quality and access.

鈥淥ur work is grounded in a commitment to ethical care, clinical quality and supporting children with complex needs 鈥� including families who may have struggled to find services elsewhere,鈥� Harbour wrote. 鈥淲e strive to identify the needs of children, families and the broader healthcare system as it continues to evolve 鈥� delivering ethical, individualized care that supports the unique needs of each child and family we serve.”

But Centria doesn鈥檛 have to report whether the scandals had any impact on its bottom line. 

鈥淸Private equity firms] have nothing to lose if something goes bankrupt,鈥� says Rosemary Batt, one of the authors of the Center for Economic and Policy Research report and a professor emeritus at the Industrial and Labor Relations School at Cornell University. 鈥淚f a company gets caught in fraud, it鈥檚 just the cost of doing business.鈥�

In 2019, Centria was sold to a different private equity fund, Thomas H. Lee Partners, for $415 million. Since then, according to 社区黑料鈥檚 analysis, the company has been the country鈥檚 largest Medicaid biller, bringing in more than $440 million during our six-year window. That鈥檚 more than twice as much as the second-largest ABA company by Medicaid revenue, Lighthouse.

Thomas H. Lee did not respond to a request for comment. 

Ryan Leitner, a researcher at the Private Equity Stakeholder Project and the author of a on the ABA industry, worries that states鈥� efforts to crack down on Medicaid abuses won鈥檛 address the underlying cycle that allows investment funds to pass off a business that they鈥檝e saddled with problems.      

鈥淎 great place to start is the concept of joint liability between these [investment] firms and the company that they own and operate,鈥� says Leitner. 鈥淵ou need to have assurances that the care is going to meet some kind of benchmark, that there’s going to be some kind of joint liability if there is a problem.鈥�   

Some states, he adds, are trying to give their attorney general or another regulator the ability to stop the sale of a healthcare facility if they determine the company won鈥檛 run it properly or if a private equity firm has problems elsewhere. 

Private equity providers gravitate toward high-reimbursement states 

Writing in the January 2026 issue of the American Medical Association journal JAMA Pediatrics, a group of researchers , one showing the prevalence of children with autism diagnoses and the other assigning states 鈥済enerosity scores鈥� assessing their insurance rules regarding autism. 

Using a commercial deal tracker, they identified 574 autism service delivery sites acquired by private equity between 2015 and 2024, which they overlaid on the maps. The upshot: The states with the highest rates of diagnosis and the most generous benefits have the largest concentration of private equity-owned ABA centers. 

Home to some of the first acquisitions, Colorado, with 6 million residents, had 38 private equity-owned centers, the third-largest concentration in the country and a likely undercount, the researchers noted. Only California, home to more than 39 million people, and Texas, which has 32 million residents, had more private equity-owned ABA centers 鈥� 97 and 81, respectively. 

In February, the Department of Health and Human Services’ Office of the Inspector General released the fourth of eight state audits, finding that Colorado鈥檚 Medicaid spending on ABA mushroomed from $60 million in 2019 to $163.5 million in 2023. 

The auditors examined claims made in 2022 and 2023, finding at least $78 million in improper payments, plus an estimated $207 million in 鈥減otentially inappropriate鈥� claims. 

In Wisconsin, they found $18 million in improper payments in 2021 and 2022, plus $94 million more in potentially inappropriate payments. In Maine in 2023, $45 million in claims were improper and $22 million potentially so. In Indiana, a total of $56 million were improper in 2019 and 2020, with another $76 million potentially improper.

In Colorado, the investigators examined monthly billing records for 100 children, finding improper and potentially improper claims in every case. Seven facilities could not supply individual patients鈥� diagnoses or referrals.

Two providers 鈥� including one that auditors said 鈥渨as purchased by a nationwide ABA company that subsequently closed all of its ABA facilities in Colorado鈥� 鈥� did not respond to requests for records from state and local investigators. 

In the 96 months auditors examined, providers didn鈥檛 describe the services in some claims; four providers didn鈥檛 submit any treatment notes at all. One facility routinely said a child had engaged with peers even though the therapy was delivered at home with no other children present.          

Numerous bills described unallowed 鈥渃ustodial care,鈥� such as bathing, dressing and eating. In 67 months, facilities billed for one-to-one therapy but described group activities. 

ABA companies in Colorado

In May, the Colorado General Assembly took up legislation aimed at . At an , state officials testified that they believed there were between 410 and 500 clinics but could not say with precision because, unlike day cares, summer camps and similar facilities, autism therapy centers are not required to register with the state.  

In 2025 alone, officials received 35 reports of endangerment, including physical abuse by staff, medication mistakes, inappropriate restraint and a registered sex offender working at one center. But because ABA providers and facilities are unregulated, the state lacked jurisdiction to investigate. 

It might be the tip of the iceberg, the state officials warned lawmakers, because many participants can鈥檛 tell their families when something is wrong. At least a third of Colorado children in ABA are nonverbal, and more than 18% are age 3 or younger. 

The bill would create a behavior analyst licensing board and require the state Department of Human Services to craft standards for clinics. The board would consist of three credentialed behavior analysts, one assistant 鈥� or technician 鈥� and one member of the public. It would grant licenses to people who have been given credentials by organizations created by the ABA therapists associations.

To proponents of ABA, many of whom have nursed concerns that private equity is sullying the public profile of their industry, the bill was a huge win. But to many in the disability community, it was one more step in the wrong direction. They feared that new standards would enshrine a treatment they oppose, crowding out public support for alternatives that may be more effective and humane.       

Two parents submitted imploring legislators to oppose or amend the bill. Both cited ABA’s eugenicist roots and research on its harms.  

鈥淎utistic adults often compare ABA to gay conversion therapy, because the goal is often to make autistics appear less autistic, rather than helping them live safely and comfortably as themselves,鈥� wrote Boulder parent Jenny Thamer. 鈥淚n fact, both practices were developed by the same founder.鈥�

Among other changes, she asked lawmakers to appoint a licensed mental health professional and an autistic adult 鈥渨ho provides lived experience鈥� in place of two of the three analysts on the board; to require discipline for practitioners who engage in harmful punishments, including physical restraint and seclusion 鈥� mostly outlawed in Colorado schools 鈥� and to remove references in the bill to ABA as 鈥渂ased on scientific research.鈥�

鈥淭his bill will have lasting consequences for autistics for decades,鈥� Thamer concluded. 鈥淚 respectfully urge you not to expand this system without strong protections, independent oversight and meaningful representation from the autistic people most often harmed by these practices.鈥�

On June 2, Gov. Jared Polis signed the bill without her recommended changes. 

Graphic design by Eamonn Fitzmaurice

This investigation was produced with support from the Education Writers Association Reporting Fellowship program.

From her experience, such so-called listening sessions are often pro forma events, staged more to assuage parents than to actually brainstorm change. 

This one had been called hastily, after a handful of caregivers had complained about persistent problems in their children’s classrooms. 

The meeting was scheduled for the day after Memorial Day, after the end of the Colorado district’s 2022-23 school year. Many families would likely have already left town for summer vacation. 

Worried no one would show up, Thamer and a couple other parents put together an anonymous online survey they could present if attendance was low. 

They need not have feared. Some 50 district parents came, cautiously optimistic that Superintendent Rob Anderson would hear their pain. 

鈥淚 have to give him credit,鈥� says Thamer. 鈥淗e listened to every single caregiver story without interrupting, without rushing people. Like, he was there for it.鈥�

The meeting was scheduled to last an hour, but went on for more than four, as families described repeated phone calls from school staffers demanding they pick up their child midday, kids too anxious to go to school, trauma caused by punishments 鈥� and, in nearly every case, schools鈥� lack of interest in parents鈥� ideas.

As it happened, Anderson鈥檚 own child received special education services. 鈥淚 could understand not just in a way a superintendent could understand,鈥� he recalls, 鈥渂ut as a parent could.鈥� 

While people talked, administrators and the school board president took notes on poster-sized pads stuck to the walls. At the end of the meeting, the parents presented the leaders with the results of their survey, which drew 65 responses.

Anderson listened. And then he promised to create an autism advisory team made up of parents, community members and staff with a goal of using feedback from autistic people 鈥� who usually are not consulted about their own conditions 鈥� to change the district鈥檚 approaches. Thamer, whose child received special education services, was asked to co-chair the team. 

A year later, Boulder Valley implemented what is likely the nation’s first 鈥� and only 鈥� neurodiversity policy. Adopted by the school board in 2024, it commits district schools to using 鈥渟trategies to affirm a student’s identity, rather than trying to 鈥榝ix鈥� or 鈥榗ure鈥� them.鈥� The policy applies to all kids, not just autists 

It鈥檚 a work in progress 鈥� in part because the policy calls for a sea change in how Boulder schools have approached educating autistic students. Intending to provide good services, the district 鈥� like a handful of mostly affluent school systems across the country 鈥� had invested heavily in hiring practitioners of an intervention called applied behavior analysis. 

Commonly referred to as ABA, the therapy was pioneered in the 1960s by Ole Ivar Lovaas, the UCLA psychologist who created LGBTQ conversion therapy. Both use a system of rewards and punishments to condition a person to act and appear 鈥渘ormal.鈥� Lovaas’ approach was quickly recognized as a human rights violation when applied to LGBTQ people, but not to autistic kids.

Lovaas did not see autistic children as fully human, which he believed justified using electric shocks, slaps and the withholding of food, among other 鈥渁versives,鈥� to 鈥渆xtinguish鈥� atypical behaviors. In a trial now regarded as dangerously flawed, he claimed to have 鈥渞ecovered鈥� 鈥� cured 鈥� nine of 19 children by subjecting them to repeated 1-on-1 drills for up to 40 hours a week.

The Lovaas Method, as ABA was originally known, is now considered the gold-standard autism intervention. Parents are typically urged to enroll their children as quickly as possible after diagnosis, as young as 2, to give them their best shot at a 鈥渘ormal鈥� life.  

Over the last decade, as laws were enacted requiring insurance coverage of autism diagnosis and therapy, the rate at which children have been identified as autistic has tripled. To serve them, a very profitable and largely unregulated treatment industry has mushroomed, pulling in nearly $2 billion a year from Medicaid alone.     

For-profit ABA is particularly strong in Colorado, in large part because of the state鈥檚 history of offering relatively generous benefits for people with disabilities. Because of ABA’s dominance 鈥� and the accompanying perception that it is the most effective way of treating autistic children 鈥� school districts are increasingly turning to practitioners to staff their special education programs, whether or not it is the proper approach for a particular child.      

Modern practitioners defend the intervention, saying ABA no longer subjects children to physical punishment. Yet documentation of its harms is mounting, as researchers 鈥� including autistic adults who underwent ABA as youngsters 鈥� gather evidence that the therapy has caused widespread PTSD. Autistic children may no longer be subjected to electric shocks or slaps to the face 鈥� and the word “aversive” may sound kinder than “punishment” 鈥� but they are routinely denied food, toys and comfort items, as well as adult attention, a strategy practitioners industrywide call 鈥�.鈥� ABA providers still frequently restrain children or confine them in isolation 鈥� practices recognized as so dangerous and traumatic as to be illegal in most circumstances in Colorado schools.

At the listening session, Thamer presented the superintendent with the results of the survey, which echoed what he had heard from parents in person. One-fourth felt the need to shorten their child鈥檚 school day because teachers could not provide a full day鈥檚 support, and nearly half had unenrolled or considered withdrawing their children. 

One-third of respondents said they had been asked to pick their kids up early from school for behavioral reasons 鈥� some frequently. A fourth said their children had been excluded from field trips and other activities. And 13% had out-of-school suspensions and 9% in-school suspensions.

Some 16% were aware their child had been subject to physical restraint or seclusion 鈥� likely a wild undercount, given the number of parents at the in-person meeting who said their kids were restrained several times a week. Historically, Colorado did not require schools to report restraint until two years ago, and still doesn鈥檛 mandate data collection on seclusion. 

More than 40% said schools focused on fixing behavior rather than uncovering the reasons for it; paid more attention to students’ 鈥渓agging neurotypical skills鈥� than to their capabilities; and used inappropriate instruction strategies. 

The families鈥� experiences were common, but the opportunity to share and be believed was novel, says Thamer. Many of the caregivers at the listening session were meeting one another for the first time. Many had assumed they were alone in rejecting guidance from the district鈥檚 supposed experts, or that no one would believe the 鈥済old standard鈥� in treatment was actually making things worse for their children. 

Just sitting in a room with so many other people sharing the same experiences was cathartic. 鈥淚 had tears hearing other people’s stories,鈥� Thamer says. 鈥淧arents carry a lot of trauma from advocating for their kids.鈥�

‘Daddy, help! Daddyyyy!’ 

One of the parents present was Sarah Piril盲. In 2019, she had come home from work to hear her 5-year-old screaming in the basement. He was working with two technicians from a local private ABA center who, in an effort to stop a meltdown, had barricaded him in a room and turned their backs on him.  

This was not a new experience for P, who is being referred to by his first initial to protect his privacy. He had been through this rewards-and-aversives cycle at home, in private childcare centers 鈥� which were quick to show the family the door 鈥� and even public school-based early childhood education. As he got bigger, so did his meltdowns.          

But on this day, Piril盲 says, she heard something very different in P鈥檚 screams. 

鈥淒addy, help,鈥� he shrieked. 鈥淒addyyyy!鈥� 

She bolted down the stairs and instantly recognized that her son wasn鈥檛 being stubborn. He was terrified.

A series of realizations crystalized in an instant, she recalls. P was being punished, over and over, for not understanding what was expected of him.

In the process, he had learned to fear interactions where he could become overwhelmed and lose control. And his parents, whom he needed to keep him safe, had invited the people meting out the punishment into his life.

In schools, isolating or confining children is known as seclusion and restraint. The psychological and physical harms are . Most states have laws limiting the practices to rare episodes in which students pose an immediate threat to themselves or others.  

Yet P鈥檚 therapists were using the tactic on purpose, in the belief that after enough repetitions 鈥� delivered under the guise of benign therapy 鈥� it would 鈥渆xtinguish鈥� some of the boy鈥檚 autistic traits.

On the surface, the goal seems perfectly rational: Grownups were trying to teach P that following instructions brings rewards. But when he didn鈥檛 comply, they鈥檇 double down, sensing defiance. The stricter the adult, the more dysregulated the child鈥檚 response. 

Piril盲 knew ABA practitioners often describe the moment she was witnessing as an 鈥渆xtinguishment burst鈥� 鈥� a last willful attempt by children to get their way by ratcheting up negative behavior. If she went to P鈥檚 aid, in the therapists鈥� eyes, she would be guilty of setting back their hard work.   

She faced a horrible dilemma: follow the therapists’ advice and let the moment play out, or listen to her gut and defy experts who could document her poor judgment in a file with P鈥檚 name on it.  

In the moment, she chose her son, scooping him up and letting him cry.

She had no way of knowing how hard it would be, even after telling the boy鈥檚 private therapists she would no longer tolerate ABA鈥檚 strategies, to keep P out of the therapy. 

Over the next seven years, the district would move him to five schools, not counting distance learning during COVID and a year when P was so traumatized that Piril盲 homeschooled him. In all but one of the schools, he was subjected to ABA.

But she had an unlikely ally. The behavior technician who had stood nose-to-nose with Piril盲 in her basement is a man named Blake Ross. And that confrontation marked a watershed moment for him, too.

The core epiphany Piril盲 had during the episode was that P鈥檚 meltdown had been perceived by the adults as a choice, when in fact it was an involuntary stress response 鈥� the fight-or-flight instinct that鈥檚 a normal part of the human nervous system. Everyone has it, but it鈥檚 especially easy to trigger in a child with an acutely sensitive neurotype. 

Ross adored P. He was devastated to realize the boy was scared of him. 鈥淭here are protocols for stuff like this,鈥� he recalls. 鈥淲e were following them, and it was making things worse.鈥�

In the ensuing weeks, Ross and Piril盲 came to an understanding. The family couldn鈥檛 meet the boy鈥檚 needs alone, and Ross was committed to finding a better way to help. Together, they started trying to understand how entrenched P鈥檚 fight-or-flight responses were, and what would happen if they developed strategies to help his nervous system avoid that traumatic response. 

Things really clicked during third grade when, with help from Ross, Piril盲 started homeschooling P mid-year. With their strategies finally working, the following year Piril盲 searched for a classroom where the adults would try what she called 鈥渘euro-informed accommodations.鈥�   

In the meantime, seeking the flexibility to use their new approach with other kids, Ross and his wife, Jenn Snow, also an ABA provider, had started their own autism therapy practice. They met with Piril盲 and the members of P鈥檚 prospective school special educators to talk about their work.  

鈥淟uckily, we found a team that would actually try it,鈥� says Snow. 鈥淎nd to magnificent effect.鈥�

A data-minded mom literally charts a new course

Before she quit her job to manage P鈥檚 needs, Piril盲 was an engineer and data strategist. Both ABA and special education are supposed to be data-driven. The theory behind ABA 鈥� the analysis being applied, as it were 鈥� is that therapists record a child鈥檚 responses to behavioral drills, routines and tasks, and then use the information to refine their tactics.

An individualized education program, the legal document that spells out how special education will meet a child’s needs, is also supposed to contain quantifiable goals and measures of progress, as well as information on behavior, adult time spent delivering services and the amount of time the student spends in a segregated classroom rather than integrated with typically developing peers. 

All special education parents quickly accumulate boxes of IEP-related documents, but Piril盲 had more: reports P鈥檚 schools sent home when he was physically restrained or isolated, forms announcing he had been suspended and messages asking her to come pick him up early. 

Because P, like many autistic kids, often refused to go to school, Piril盲 tracked his attendance. She also recorded how often he met the school鈥檚 behavior goals, his reading and writing achievement, how much time he spent in different classrooms and how many special ed services he received. 

In January 2025, after P had been enrolled in a new district school willing to work with her ideas, Piril盲 put 340 pages of IEPs and other documents 鈥� 4,000 data points collected over eight years 鈥� into a database. The results were striking.

When P was being treated with ABA, he achieved the school鈥檚 behavioral goals 25% to 50% of the time. When he was in a classroom where the adults were willing to try Piril盲鈥檚 neuro-informed strategies, his success rate was 75% to 100%.

When he was allowed to spend fewer hours and days in the school environment, his attendance actually stabilized 鈥� and his reading and writing scores shot up. As P鈥檚 fight-or-flight episodes subsided, he grew more willing to work on his least-favored tasks. As adults listened to him when he advocated for himself, he spoke more frequently.  

Piril盲 created a presentation for P鈥檚 teachers and aides, with two dozen charts showing how his IEP and ABA interventions fluctuated in effectiveness. There was a one-year window 鈥� labeled 鈥渁utistic burnout鈥� 鈥� when P was restrained 20 times, sent home another 20 times and suspended three times. 

But there were also slides listing which specific, neuro-informed strategies were in place when things were going really well: 鈥淧hysical management is to be avoided entirely鈥�; 鈥淧roactive is better than reactive鈥�; 鈥淧鈥檚 words must work or he will stop using them鈥�; 鈥淔lexibility from you = flexibility from P.鈥�

At the start of the last school year, the boy鈥檚 teachers stopped pushing ABA, Piril盲 says. But when she gave them a draft IEP written from a nervous system response lens, the educators in charge of the planning process rejected it.

Everybody on the IEP team agreed with the support plan, she says. But one team member, an ABA practitioner employed by the district, said they needed to rework it to conform with ABA鈥檚 structure. 

In Boulder Valley classrooms, what that has historically meant is that when a student exhibits a problematic behavior, educators must create a hypothesis for why it鈥檚 occurring. These hypotheses assume the child is choosing to misbehave, e.g., to get attention or to avoid an activity they don鈥檛 like. Then the therapists and teachers create goals that outline the steps of an ABA strategy for addressing the student’s actions.

鈥淭he [lead therapist] said the way I wrote it from a nervous system response perspective was much more helpful,鈥� says Piril盲. 鈥淏ut then [she] also said that she can鈥檛 use that structure, that she wasn鈥檛 able to structure an alternative path for families like mine that specifically request non-ABA approaches.鈥�  

The format of a support plan may seem like a small thing to someone who has not struggled to get their child an atypical IEP, Piril盲 says. But to her, it suggests the adults in the district are not ready to step away from something that鈥檚 not working.  

A shaky substitute for real special ed       

In 2022, the Colorado General Assembly took up a bill to allow families to request an ABA therapist of their choosing be allowed to accompany their child to school. Legislators ended up passing a dramatically amended law requiring districts to have a policy addressing the question. 

The debate, however, revealed that much of the time, schools and families were using private ABA therapy to make up for gaps in special education, childcare and disability services writ large 鈥� something also highlighted in federal audits of Medicaid spending in Colorado and several other states.   

Many of the therapists and industry representatives testified that their clients didn鈥檛 have time for both ABA and school, attended schools that had declared students鈥� needs too profound to manage or said that because they were understaffed, they could support autistic students for only a few hours a day. 

The parents who urged passage of the bill said they needed ABA to close a caregiving gap. Several said schools and preschools were quick to demand they pick their kids up midday 鈥� sometimes threatening to call the police if they didn鈥檛.

鈥淪chools are happy to abbreviate their day and make this someone else鈥檚 problem,鈥� said one. 鈥淎nd I just don鈥檛 think that鈥檚 right.鈥� 

Other parents said their kids were behind academically because they split their time between a therapy center and school. 

A lack of school staff with autism expertise and of out-of-school caregiving options for families are real problems, says Julie Reiskin, co-executive director of the Colorado Cross-Disability Coalition. But behavioral therapy is not intended to address those problems. 

鈥淲e need to have childcare and schools that are not calling parents, that can keep their kid through the whole day,鈥� she says. 鈥淏ut if that’s the need, then that’s what we should be funding, not one specific kind of therapy. 

鈥淲e could do it for a lot less money than this,鈥� adds Reiskin. 鈥淎nd maybe the kids will also be having more fun.鈥� 

Lindsey Trott told lawmakers there are more effective methods for helping students than ABA, but that schools lack the resources to use them. She鈥檚 now an occupational therapist, but as a teenager in the late 1990s, she was hired by a family that was implementing the Lovaas Method in their home with their nonverbal 4-year-old.

For 10 months, three days a week after school, Trott said in an interview with 社区黑料, she would sit with the boy and perform what are known in ABA as 鈥渄iscrete trials鈥� 鈥� repetitive drills of tasks like making eye contact or copying a structure made of blocks. She rewarded his compliance with a fruit snack or a cartoon break.

鈥淎fter a couple of months of working with me, when I would show up at the door, he would cry and run away,鈥� says Trott. 鈥淗e made no progress.鈥� 

In hindsight, what she thinks the family really needed was respite care. 鈥淎t the end, I felt more like I was there supporting the mom,鈥�  she recalls. 鈥淚 would stay and she would tell me things. She was sad and frustrated.鈥�        

That experience was a catalyst. In search of solutions, Trott went on to earn a master’s degree in special education and then two degrees in occupational therapy. When she was training, she shadowed a veteran OT, as the specialists are typically referred to in schools. 

They drove to several small gyms, where the experienced OT stood alongside kids doing simple gymnastics, talking to them about what they were doing. 

鈥淔or the first time, I saw nonverbal kids having fun,鈥� says Trott. 鈥淎nd I felt something about what I was seeing.鈥� 

All people regulate their emotions or nervous systems by what鈥檚 known as 鈥渟timming鈥� 鈥� making repetitive motions or noises. In contrast to things neurotypical people do unconsciously, like twisting a strand of hair, autistic peoples鈥� stims can be dramatic, such as pacing or rocking. Schools and therapists often attempt to stop stims.  

Occupational therapy鈥檚 descriptions of this are much closer to Piril盲鈥檚 ideas about the nervous system than to ABA鈥檚 concepts. Proprioceptive input 鈥� what OT refers to as 鈥渉eavy work,鈥� like jumping or other activities that engage muscles 鈥�  calms nerves and enables self-regulation. Vestibular input 鈥� sensory information the brain receives from the inner ear when a person swings or spins, among other motions 鈥� facilitates balance and movement.

If schools taught children about their nervous systems, lots of students鈥� needs would be met, not just the autistic kids鈥�, Trott believes: 鈥淚f we had a special ed teacher for every grade level and we had an OT for every campus, schools could look very different.鈥�

A 74 analysis of Medicaid billing claims revealed that spending on ABA just for children with this public, safety net healthcare now totals $2 billion a year. If that money were added to schools鈥� annual budgets, every district in the country could add one full time and one half-time occupational therapist. 

Neurodiversity training goes only so far

One of the first things Boulder Valley leaders did with the input from its Autism Advisory Team was to put together mandatory neurodiversity training for every staff member in the district. 

In a departure from typical practice, a training video was created using input from community members, says Michelle Brenner, director of special education for the district. Two of the four presenters in the video are autistic. Trainers emphasize that understanding what it means to be neurodiversity-affirming is good for everyone. 

The with a discussion of fight-or-flight and other autistic behaviors, which appear when a student feels physically unsafe or 鈥� something that is much harder for a neurotypical person to anticipate 鈥� socially unsafe.

鈥淲hen a student engages in those behaviors, often they are trying to tell us, 鈥業 feel unsafe all the time,鈥� 鈥� explains a speech-language pathologist. 鈥淭hat is the autistic experience.鈥� 

Then, an autistic high school teacher, Wren Roberts, describes what it is like to go through life in a state of hyperarousal. Indeed, she confesses that she feels unsafe talking on camera. 

鈥淚 have spent my entire life learning to hide it,鈥� she explains. 鈥淭hat鈥檚 called masking.鈥� 

Just as existing with a continually activated nervous system causes mental health issues, she notes that autistic people who mask experience high rates of depression, anxiety, insomnia and suicidal ideation.  

Up next in the video, an autistic man who volunteers in a district afterschool program outlines how a neurotypical person can figure out whether a student is feeling unsafe, and why. Finally, a high school teacher reminds the audience that while this cycle is often pronounced for autists, 鈥淥ther students are likely feeling the same way.鈥� 

As progressive as this seems compared with most other districts鈥� approaches, the mandatory training was relatively simple, says Shannon Gamble, Boulder Valley鈥檚 director of multi-tiered systems of support. Her specialty is differing strategies that are used to help students struggling with literacy or other skills.  

District leaders have created an internal data dashboard tracking how often students are restrained, how many are restrained repeatedly, whether teachers and therapists have looked for the 鈥渞oot causes鈥� of repeated problems and other indications that changes are being implemented and whether they are working. 

The training is a start, Gamble says. 鈥淎 big part of what needs to shift is mindset and understanding, and the way that we view each other and our students.鈥� 

Some families want their children to continue to receive ABA in school. But to others, who continue to push against it, the pace of change can feel glacial, they say.

鈥淥ur families come in and they’re like, ‘All right, why don’t you just go tell people to do this thing?’ ” says Gamble. “There’s things we can do right away. We can change [the language on] a form, right?鈥�  

Altering mindsets is a longer-term proposition, she continues: 鈥淚t’s going to take more than us just telling people what to do 鈥� especially things like neurodiversity, where many of our educators were taught in a way that maybe is not what our neurodiversity philosophy is telling them we believe.鈥�

Because district leaders had invested in what they thought was the best intervention for students, a number of the people leading its special education efforts hold some of ABA鈥檚 highest credentials. The persistence of their beliefs is visible in district materials.  

For example, families point to an educator training created more than a year after adoption of the neurodiversity policy that makes numerous rewards-and-consequences recommendations even as it acknowledges trauma鈥檚 role in children鈥檚 behavior. Forms distributed to classroom aides have grids for charting ABA interventions.    

A outlining the neurodiversity policy and resources also links to that outlines Boulder Valley’s ABA strategies: 鈥淭he behavior analyst is responsible for the implementation of skill acquisition and behavior support strategies aligned with current best practices from the field of applied behavior analysis (ABA) as well as responsibilities and duties within the school special education collaborative team.鈥�

Restraint and seclusion

In 2022, the U.S. Department of Education to avoid restraining and isolating students with disabilities unless a child鈥檚 behavior poses 鈥渋mminent danger of serious physical harm to themselves or others.鈥� Not only are the practices dangerous and abusive, it said, but there is no evidence they help modify disability-related behaviors. 

They are also discriminatory, the agency warned. Students with disabilities are three times more likely to be physically restrained or confined than their non-disabled classmates. Often, they face discipline because they lack proper services. 

In practice, however, it is devilishly difficult to get schools to move away from restraint and seclusion. Over the last couple of years, in several states that of even just preschoolers and early elementary age children, education administrators have lobbied statehouses to repeal the bans.  

Disability advocates push back, saying schools need to do more to support educators who are left without effective alternatives. As a result, when seclusion is prohibited, schools often simply rebrand the spaces where children are confined as time-out rooms. 

How does Boulder Valley stack up? 

Brenner and Gamble say the district鈥檚 internal data shows small improvements since the adoption of the neurodiversity policy, including a 鈥渟light reduction鈥� in the number of autistic students who are repeatedly restrained and secluded and a dramatic drop in the number subjected to formal threat evaluations under Colorado鈥檚 school safety protocol.

But in terms of collecting data on restraint, Colorado鈥檚 history is tangled. The state鈥檚 first restrictions on when a child could be physically controlled were intended to address solitary confinement and punishment in juvenile detention centers. 

The practices were supposed to be rare in schools, but the state didn鈥檛 collect any data that would allow it to measure compliance. In 2022, the Colorado General Assembly passed a law requiring districts to begin reporting by the end of the 2024 school year. 

It did not, however, address seclusion as a specific form of restraint 鈥� which all but a handful of districts interpreted as a mandate to report only episodes when a child was physically or mechanically controlled. Legislators rejected a 2025 attempt to clarify the law.

For the 2024-25 academic year, Boulder Valley reported no instances of either restraint or seclusion to the state. It did, however, of 鈥渄etrimental behavior鈥� 鈥� conduct that has a negative impact on the welfare or safety of other students or staff 鈥� among children with disabilities. Students with IEPs make up 15% of the district鈥檚 student body, but comprise one-third of those disciplined. 

While ABA practitioners鈥� stances vary, they often don鈥檛 think they are restraining a child but rather 鈥� much as took place in Piril盲鈥檚 basement 鈥� believe they are engaging in a therapeutic strategy that is to the child鈥檚 benefit.   

In 2010, the Association for Behavior Analysis International opposing 鈥渋nappropriate鈥� restraint and seclusion but supporting the interventions when used by practitioners as part of a formal plan: 鈥淲hen used in the context of a behavior intervention plan, restraint in some cases serves both a protective and a therapeutic function. These procedures can reduce risks of injury and can facilitate learning opportunities that support appropriate behavior.鈥�

In May 2025, 社区黑料 reported that the Arizona Autism Charter Schools 鈥� a network of ABA schools whose founder was chosen by President Donald Trump to oversee special education 鈥� restrained and secluded students at unusually high rates even though state law restricted the practice to emergencies.    

Often, when autistic children are sent to 鈥渂lue zones鈥� or 鈥渃ool-down corners,鈥� schools fail to see and report it as seclusion. The distinction that鈥檚 lost: a space students can retreat to of their own volition when overwhelmed 鈥� and leave when calmer 鈥� is different from seclusion.

The fact that the district has adopted a neurodiversity policy but also proclaims ABA will remain in place infuriates Piril盲. If you ask her, there鈥檚 no reason state and local officials can鈥檛 do their own version of her analysis of which strategies contributed to P鈥檚 dysregulation and which enabled him to stay calm and engaged. They鈥檙e just choosing not to.  

‘The most important message’

One of the first things Jenny Thamer did as co-chair of the Autism Advisory Team 鈥� a role she played for two years before moving on 鈥� was to send out a second survey, consisting of a single, open-ended question: 鈥淧lease tell us the most important message(s) you or your child want educators to know.鈥�

The replies were consistent: 

鈥淚t is our job as adults to figure out why [kids] are not doing well. Children should never be left to figure it out on their own.鈥�

鈥淢y child does not need to make eye contact to be listening. He is not avoiding instruction by not making eye contact.鈥�

鈥淢y child may look fine on the outside to you, but inside they are almost paralyzed with anxiety.鈥� 

鈥淢y child may communicate differently, but that doesn鈥檛 mean he doesn鈥檛 want to be involved.鈥�

Anderson, the superintendent, says he鈥檚 committed to fully implementing the district’s neurodiversity policy. True recognition of the array of ways in which people experience Boulder Valley鈥檚 schools will benefit every student and educator, he says, autistic or not.   

鈥淭he idea that we understand the challenge and the needs of a neurodiverse community, and that we are locking arms to meet those needs, that鈥檚 good for all kids,鈥� he says.    

鈥淭his is really hard work. I鈥檓 not here to tell you we鈥檝e solved the problems. But these things aren鈥檛 hidden anymore. They鈥檙e not whispered.鈥�

This investigation was produced with support from the Education Writers Association Reporting Fellowship program.

Diana Diaz-Harrison, whose son is autistic, said that in she hopes to continue her efforts to help others launch autism charter schools throughout the country. Her schools, she said in remarks captured on , are a testament to what happens 鈥渨hen parents like me are empowered to create solutions.鈥�

鈥淢y vision is to expand school choice for special needs families 鈥� whether through charter schools, private options, voucher programs, or other parent-empowered models,鈥� she said in a statement to 社区黑料. .

The five-school network uses a controversial intervention that attempts to train children to appear and behave like their neurotypical peers. Created by the researcher behind LGBTQ conversion therapy, applied behavior analysis, or ABA, is widely depicted as the gold standard despite scant independent evidence of its effectiveness and mounting research documenting its harms. 

Diaz-Harrison opened the network鈥檚 first school in 2014 as a free, public alternative to private schools for autistic children, which are popular in Arizona but typically charge tens of thousands of dollars a year in tuition. Her Arizona charter schools are a 501(c)3 nonprofit financed by state and federal per-pupil funds. ABA is specifically endorsed by Arizona education officials as a strategy to use with autistic students.

In the time since those charters opened, ABA has grown to be a national, multi-billion-dollar industry, with for-profit companies tapping public and private insurance to pay for as much as 40 hours a week of one-on-one therapy. The intervention uses repeated, rapid-fire commands that bring rewards and punishments to change a child鈥檚 behavior and communication style.

A 74 investigation last year showed that most data supporting ABA’s effectiveness is drawn from research conducted by industry practitioners. Independent analyses, including a years-long U.S. Department of Defense review, found little evidence the intervention works. Former patients who underwent the therapy as children reported severe, lasting mental health effects, including PTSD.

Diaz-Harrison told 社区黑料 the therapy is both valuable and sought-after. 鈥淔or the autism community, specifically, many families seek schools that integrate positive behavioral strategies,鈥� she says. 鈥淭he evidence supporting behavioral therapy is extensive and well-established. It has been endorsed by the U.S. surgeon general and the American Academy of Pediatrics as an effective, research-backed approach for individuals with autism.鈥�

During her visit, McMahon told students and staff she was eager to tell President Donald Trump about the schools. 鈥淗e doesn鈥檛 believe any child, whether they have neuro-difficulties or any other problems, should be trapped in a school and not have the facilities that they need,鈥� she said. 

Since Trump鈥檚 second inauguration, he has issued numerous orders that have alarmed disability advocates and the autistic community. Though both edicts contradict longstanding federal laws, in March he ordered the closure of the Education Department and said responsibility for special education will be transferred to the U.S. Department of Health and Human Services.

About half of the Education Department鈥檚 staff has been fired, including most of the people responsible for investigating what had been a backlog of some 6,000 disability discrimination complaints. Though it鈥檚 unclear whether Trump and McMahon may legally disregard special education funding laws and allow states to spend federal dollars as they see fit, both have said they favor giving local officials as much decision-making power as possible.

Meanwhile, HHS Secretary Robert F. Kennedy Jr. has stoked fear in the autistic community by announcing a new effort to tie autism to vaccines or other 鈥渆nvironmental toxins鈥� 鈥� a hypothesis discredited by dozens of studies. The man he appointed to head the study has been cited for practicing medicine without a license and prescribing dangerous drugs to autistic children. 

Last week, the new head of the National Institutes of Health announced that an unprecedented compilation of medical, pharmaceutical and insurance records would be used to create an autism 鈥�disease registry鈥� 鈥� a kind of list historically used to sterilize, institutionalize and even 鈥渆uthanize鈥� autistic people. HHS later walked back the statement, saying the database under construction would have privacy guardrails.

Among other responsibilities, the offices Diaz-Harrison will head identify strategies for improving instruction for children with disabilities and ensure that as they grow up, they are able to be as independent as possible. The disability community has raised concerns that the administration is retreating from these goals.   

Advocates have said they fear the changes pave the way for a return to the practice of separating students with disabilities in dedicated special ed classrooms rather than having them attend class with typically developing peers. The Individuals with Disabilities in Education Act guarantees special education students the right to instruction in the 鈥渓east restrictive environment鈥� possible.          

Families鈥� preferences vary widely, with some parents of autistic children refusing any form of behavior therapy, while others want their kids in settings with children who share their needs. Many insist on grade-level instruction in general education classrooms 

Diaz-Harrison has a master’s degree in education and worked as a bilingual teacher in California early in her career. From the late 1990s until she began supporting her son full time, she worked as a public relations strategist and a reporter and anchor for the Spanish-language broadcast network Univision. 

In 2014, frustrated with her son鈥檚 school options, she who applied for permission to open what was then a single K-5 school serving 90 children. The network now has about 1,000 students in all grades and features an online program. 

At the end of the 2023-24 academic year, of the network’s students scored proficient or highly proficient on Arizona鈥檚 annual reading exam, while 4% passed the math assessments.      

In December 2022, the network won a $1 million , an award created by Jeff and Janine Yass. The billionaire investors have a long track record of donating to Republican political candidates and organizations that support school choice. 

One of the award’s creators, Jeanne Allen, is CEO of the Center for Education Reform. The center nominated Diaz-Harrison for the federal role. 

Yass award winners were featured at the 2023 meeting of the American Legislative Exchange Council, or ALEC, a conservative forum where state lawmakers are given model bills on education and other policies to introduce in their respective statehouses. 

Diaz-Harrison has partnered with a Florida autism school to create a national to help people start schools like hers throughout the country. She told 社区黑料 the effort has so far supported teams of hopeful school founders from Louisiana, Texas, Florida, Alabama and Nevada. 

Parents of young autistic children and autistic adults often disagree about ABA. Told by their pediatrician or the person who diagnosed their child as autistic that they have a narrow window in which to intervene, families fight to get the therapy. Adults who have experienced it, however, report lasting trauma and have lobbied for research 鈥� much of it now at risk of being defunded by Kennedy 鈥� into more effective and humane alternatives.