As the U.S. government intensifies efforts to probe autism’s causes, a quiet shift is underway in how behavioral treatment is delivered. A growing number of autism-therapy providers are adopting a franchise model, positioning it as an alternative to private-equity ownership that has reshaped — and at times roiled — the sector.
Applied behavior analysis (ABA) remains the best-studied, most widely used behavioral approach for managing autism symptoms, according to U.S. public-health guidance. The Centers for Disease Control and Prevention (CDC) describes ABA as an evidence-based behavioral treatment and notes it is broadly accepted in clinics and schools.
Autism diagnoses have continued to climb. New CDC surveillance data show that among U.S.
8-year-olds in 2022, about 1 in 31 (3.2%) were identified with autism, up from 1 in 36 in 2020. The agency attributes prevalence differences across regions to factors including screening and service access rather than a single known cause.
National Care Shortage
Yet while diagnoses rise, access to care has not kept pace, creating what advocates describe as a national crisis in autism treatment. The Behavior Analyst Certification Board (BACB), which credentials ABA practitioners, lists more than 70,000 Board Certified Behavior Analysts (BCBAs) nationwide, but experts estimate demand exceeds capacity by a wide margin.
In many regions, families face waitlists stretching six months to two years, leaving children without early intervention during the most critical developmental window. A 2024 study by the Council of Autism Service Providers found that over 80% of ABA organizations report being unable to meet local demand due to staff shortages, reimbursement pressures, and burnout. Rural and low-income areas are disproportionately affected, as providers cluster in major metro markets where insurance coverage and staffing are more stable.
Health economists warn that the shortage of qualified clinicians and registered behavior technicians (RBTs) is driving inequities in care and undermining federal efforts to expand autism services through Medicaid and private-insurance mandates.
Shift in Business Models
At the federal level, the administration has put fresh emphasis on autism-cause research, with Health and Human Services officials setting aggressive timelines and launching new data initiatives, moves that have drawn both support and sharp criticism from medical and advocacy groups for elevating unproven hypotheses.
While science policy dominates headlines, the business of therapy has been reshaped by finance. Over the past decade, private equity (PE) firms poured money into autism services and broader pediatric therapy, a trend now meeting tougher state scrutiny and uneven outcomes. In 2023, the Center for Autism and Related Disorders (CARD), once one of the nation’s largest providers and formerly backed by Blackstone, filed for bankruptcy before being sold in a court-approved transaction. State lawmakers and regulators in several states have since moved to more closely review PE’s role in healthcare.
Against that backdrop, franchise operators are pitching a different route to scale. Success On The Spectrum (SOS), founded in 2015 by entrepreneur and autism mom Nichole Daher, markets itself as the first U.S. ABA-therapy franchise. Daher, whose daughter is on the autism spectrum, created the model to combine standardized clinical protocols with quality monitoring and centralized support aimed at reducing turnover and maintaining consistency across sites.
According to the company’s Franchise Disclosure Document (Item 1) and independent franchise-registry databases, SOS began offering franchises in late 2018, making it the first known ABA-therapy provider in the United States to do so. Other major ABA brands, such as CARD, BlueSprig, and Hopebridge, expanded through corporate ownership rather than franchising. The next-closest competitor, Hi-5 ABA, did not begin franchising until March 2019, confirming SOS’s early-mover status in the field.
Industry trade coverage has since highlighted the emergence of autism-therapy franchises, including SOS, as an option for clinicians and investors wary of PE ownership. (Reuters could not independently verify which company was the first to trademark the term “ABA franchise,” but public records confirm SOS’s earliest filing dates.)
Other brands have entered the space with franchise offerings or similar networked models, underscoring a broader shift toward templated operations designed to expand capacity and reduce administrative burden at the clinic level.
Proponents of franchising say the model can expand geographic access faster than single-site practices while avoiding the debt loads and cost-cutting incentives sometimes associated with buyouts. Critics caution that franchising is no guarantee of quality and that evidence of superior outcomes versus other ownership structures is limited; performance still hinges on staffing, supervision, and payer policy. Independent analysts note investor interest in behavioral health remains high even as deal structures evolve.
Clinical debates also persist. While ABA is widely regarded by U.S. agencies as evidence-based, researchers emphasize variability in outcomes and the need for individualized, ethical implementation, especially amid concerns raised by some autistic self-advocates. Recent reviews cite benefits from early, intensive, high-fidelity programs while calling for more rigorous, long-term data.
The Bottom Line
With autism prevalence at record levels and federal research efforts accelerating, business models for delivering therapy are in flux. Whether franchising can meaningfully alleviate supply shortages without replicating the pitfalls seen in some PE-backed roll-ups will depend on execution, workforce capacity, and payer dynamics over the next few years.
