The Twilight Zone: Welcome to Autism Monopoly
You unlock this door with the key of desperation. Beyond it lies another dimension—an exploitative dimension not of hope, but of profit margins. A dimension where compassion is a line item and therapy hours are currency. You are now entering... the Twilight Zone.
Meet Linda. She’s a parent like so many others. A warrior, they say—one of those fierce mothers fighting for her autistic child in a world that offers precious little beyond promises and paperwork. Linda doesn’t know it yet, but she’s about to step into a twisted version of a game you might be familiar with. This isn’t Monopoly the way you knew it. No, in this version, Linda doesn’t play for fun. She plays for survival. And the rules? They’re written by private equity firms, who just so happen to own all the properties on the board.
But first, a little backstory: The Autism CARES Act, hailed by politicians with broad smiles as a victory for autistic individuals and their families, funds little in the way of direct services for autistic people. Instead, it pours a vast majority of its money into the coffers of one solution: Applied Behavior Analysis, otherwise known as ABA therapy. ABA is the only fully funded therapy under the Act, the “gold standard” they say. But as Linda will soon discover, gold is not the prize she’s after in this game.
Linda is now about to throw the dice.
She lands on “ABA Therapy Clinic,” a space that was once owned by a small, independent provider. But that was before the rise of private equity. Now, every clinic on the board has been absorbed into one mega-corporation or another. Shore Capital. Webster Equity. KKR. They’ve all set up shop on the board, each one ruthlessly vying for monopoly control over autism services. Their goal isn’t to provide care—it’s to increase therapy hours, drive up billing rates, and ultimately, squeeze as much profit from Linda’s child as they can.
Linda’s son, Sam, has been prescribed 40 hours of ABA therapy per week. Forty hours. Just imagine. That’s a full-time job, but not for the PE firms—no, no, that’s Sam’s job. Linda quietly wonders if it’s a therapy schedule or indentured servitude for a child, but those thoughts are fleeting, drowned out by the relentless ticking of the system’s clock.
Each week, Linda moves forward, paying $200 per session, then $400, then $600. The game board shows no mercy. The dice land again. And again, she lands on another therapy clinic, but this one offers “enhanced services.” For just $800 more, Sam can participate in even more ABA hours, complete with data-driven outcomes, progress charts, and endless behavioural drills that strip away any semblance of autonomy from him. The firms at the table rub their hands together in glee. You see, their profit model works on volume, and if Sam doesn’t meet the company’s definition of progress, he just needs more therapy, more sessions, and more time in their care.
Linda’s bank of emotional reserves is running low. But the PE firms? They are thriving. They’ve grown so large that the original ABA provider is just a memory, swallowed whole by “revenue maximisation” tactics. The firms continue to merge and acquire one another, turning autism services into a financial empire. Every time Linda passes “Go,” she doesn’t collect $200. Instead, she gets another bill for hours of therapy Sam doesn’t even need. It’s not about him; it’s about keeping the profit margins healthy.
She lands on “Audit” and receives a notice that Sam’s therapy hours are being scrutinised. The PE firms have introduced new policies requiring parents like Linda to justify every single hour of service. Why? Because insurance companies, forever in step with the profits-first model, are tired of paying for therapy that doesn’t show a return on investment. The audit sends Linda spiraling into a bureaucratic nightmare of appeals, forms, and evaluations, all while Sam continues his 40-hour weeks of behavior modification.
“What does he need?” Linda asks the therapist one day. The therapist looks apologetic but helpless. “It’s what the model says he needs. Forty hours is the gold standard.”
Gold standard. Linda repeats that phrase to herself. But for whom? Sam isn’t thriving. He’s not a happier, healthier child; he’s a ghost, living in a world that demands he behave “normally.” The therapists aren’t the problem—they’re trapped too, cogs in a wheel controlled by the firms whose sole concern is squeezing out just a little more revenue from children like Sam.
Linda rolls the dice again. This time she lands on “Special Research Initiative.” A smiling banker hands her a card that says “Congratulations! The Autism CARES Act has allocated $10 million for more research into the causes of autism. No direct services provided.”
Linda stares at the card. Research? Causes? Sam doesn’t need research into why he exists; he needs a life with dignity and respect. But the rules are clear—only ABA gets funded, and the rest? Well, it’s nice to know there’s money for a better future… just not in Sam’s lifetime.
The game stretches on. Linda’s resources dwindle. Sam is growing older but still caught in the cycle. More hours. More therapy. Less Sam.
One day, as Linda moves past “Go” for the 100th time, she notices something odd. The board has no end. It keeps going, looping in on itself like some cruel version of the M.C. Escher painting, where the stairs keep climbing but never reach the top. Sam is still a child in the game, but in reality, he’s nearing adulthood. And as Sam approaches 21—the magic age when services dry up—the PE firms celebrate. They’ve squeezed out all the profit they can. The game is over for Sam, but there’s always another child ready to enter the system.
You see, in this version of Monopoly, Linda never had a chance. And Sam? Sam was never the real winner. In a world where “autism services” are monopolised by private equity, children are merely pawns. For them, there is no Boardwalk. No hotels. No golden future. There is only therapy. And profit.
The lesson? If you find yourself in a system where your child’s value is measured by therapy hours, you may be playing someone else’s game. A game where the rules are written in profits and the human cost is hidden between the lines. But don't worry—you’ve just passed “Go” into the Twilight Zone.
Final thoughts …
Private equity firms have been steadily gobbling up sectors of the medical industry, and “autism services”—specifically ABA therapy—are no exception. ABA is often the only therapy funded under the Autism CARES Act, and nearly every child receiving an autism diagnosis in the US is funneled into ABA programs, whether or not they need it. This therapy, dubbed the “gold standard” of care, isn’t necessarily because it’s the best for all children but because it has become a financial cash cow for investors.
PE firms see ABA as a “recession-proof” industry due to the overwhelming demand for “autism services,” and the structure of ABA—requiring long hours of therapy—makes it highly profitable. The more hours of therapy prescribed, the more billable services PE firms can collect, driving up profits. This profit-driven model pushes children into rigid, one-size-fits-all therapy plans, regardless of their individual needs or preferences. In a world where the mantra is “if it’s for the children, no expense should be spared,” the reality is that this expense is often less about care and more about maximising revenue.
The sad truth is that autistic children become commodities in a capitalist machine, their diagnoses setting them on a path of relentless therapy hours that fuel the bottom lines of these firms. These are real children, whose futures are shaped not by their needs but by the financial interests of those running the system.