Article defending private-equity involvement in autism services retracted

An article that proposed potential benefits of private equity firms investing in autism service providers has been removed from the journal in which it was published.

The article, “Private equity investment: Friend or foe to applied behavior analysis?” was originally published in the International Electronic Journal of Elementary Education as part of a January 2023 special issue devoted to applied behavior analysis (ABA) for autism.

ABA is the most widely used therapy for autism, and companies that provide it have faced a flood of interest from private equity firms in the past decade.

The sole author of the article, Sara Gershfeld Litvak, “decided to retract the article due to her commitment to scientific integrity and ethical values,” following “a rigorous review process,” according to the undated retraction notice on page 266 of the special issue. Litvak is founder and CEO of the Behavioral Health Center of Excellence (BHCOE), a company that offers accreditation for organizations that provide ABA services, and she co-founded the Autism Investor Summit, an annual meeting focused on the business side of autism services. She is also an advisory board member for Calex Partners, a firm that provides advice on mergers and acquisitions for autism-related businesses.

The original retraction notice did not mention any specific issues with the article, which is no longer available on the journal’s website. A correction notice to the issue’s introduction, published 4 October, says that the editors retracted Litvak’s article “due to the use of Artificial Intelligence (AI) that led to numerous inaccuracies within the reference and the body of the paper.” A close examination of a PDF copy of the article obtained by Spectrum and Retraction Watch revealed that nearly two-thirds of the article’s references appear to not exist.

Litvak did not respond to an email request for comment and is on “personal leave” from BHCOE, according to an autoreply message. The journal’s editor-in-chief deferred questions to the special issue’s editors, who said they “do not have anything additional to add beyond the retraction notice and erratum to the introduction article.”

Of the 36 references in Litvak’s article, the DOI hyperlinks given for 18 of them either link to a different article or return an error message stating that the DOI is “not found,” Spectrum and Retraction Watch’s analysis shows. The article titles provided in 22 of the references do not appear in the cited journals’ table of contents or in Google search results. An additional three references appear to contain errors, such as an incorrect author or year of publication.

The ABA services market — and private-equity investment in service providers — has been expanding over the past decade, amid an apparent rise in autism prevalence and changes in U.S. federal and state laws that began compelling insurance companies to cover autism treatment. The field has had its growing pains, and investors’ growing involvement has been controversial: Some private-equity-backed ABA firms have provided substandard services for children or even engaged in fraudulent billing, according to reports.

In her article, Litvak argued that concerns about the quality of care and ethics should not be “isolated to the ownership or oversight of the organization.” She included many positive points about private-equity involvement in ABA — often citing the nonexistent references. For example, one sentence that cited a source Spectrum and Retraction Watch could not locate stated that “Investment capital in ABA-based therapy has resulted in some benefits such as increased innovation, increased access to care, and greater adherence to regulations and guidelines.”

A report published in July by the Center for Economic and Policy Research appears to be the only work that has cited Litvak’s paper, according to Google Scholar. The report’s authors noted that Litvak’s article “conflated” for-profit and private-equity-owned companies, and that much of the evidence it cited was from the 2000s, before private equity became involved in behavioral health. Litvak’s article “does not address private equity ownership, despite its title,” they wrote.

Researchers have found that artificial-intelligence chatbots such as ChatGPT often fabricate citations when asked to write portions of scholarly articles, and they also make mistakes when citing real sources. Retraction Watch has previously reported on a preprint written using ChatGPT that was withdrawn — and later reappeared — after researchers noticed it contained fake references. Guillaume Cabanac, professor of computer science at the University of Toulouse in France, has documented even more egregious signs of undisclosed ChatGPT use in the literature, such as the phrase “regenerate response,” found in the chatbot’s web interface.

Update, 10/19/23, 1915 UTC:

This article has been updated to include a mention of a correction notice published by the journal on 4 October 2023. We have also updated the response from the special issue’s editors. And the number of references in Litvak’s articles with apparently erroneous DOI hyperlinks is 18, not 17 as originally stated.

This article is a collaboration between Retraction Watch and Spectrum, an editorially independent publication covering autism research and funded by the Simons Foundation. Retraction Watch co-founder Ivan Oransky is the editor–in–chief of Spectrum.

Like Retraction Watch? You can make a tax-deductible contribution to support our work, follow us on Twitter, like us on Facebook, add us to your RSS reader, or subscribe to our daily digest. If you find a retraction that’s not in our database, you can let us know here. For comments or feedback, email us at [email protected].