Pediatric Therapy Dealmaking Holds Steady in 2026, Despite a Slower Third Quarter

A Challenging Operating Environment Has Not Halted M&A Activity

Acquisition activity in the U.S. pediatric therapy industry has remained relatively stable in 2026, even as providers and investors navigate a challenging business environment. Rising operating expenses, reimbursement pressures, higher borrowing costs, and greater regulatory oversight continue to influence the sector. Nevertheless, the number of announced transactions during the first nine months of the year remains consistent with historical levels.

Research conducted by Mergium Advisors identified 35 announced mergers and acquisitions involving pediatric therapy providers through September 2026, matching the approximate annual average for the first nine months of the year since 2020.

The findings suggest that consolidation remains an important characteristic of the industry, although acquisition activity slowed during the third quarter.

The research encompasses companies providing applied behavior analysis (ABA), occupational therapy (OT), physical therapy (PT), and speech therapy (ST), as well as pediatric mental health services offered alongside these therapies. Transactions involving businesses focused exclusively on technology, diagnostic devices, pharmaceuticals, accreditation, or other ancillary activities are excluded.

Third-Quarter Activity Moderates Following a Stronger First Half

The first half of 2026 accounted for most of the year’s announced transactions. Thirteen deals were identified in the first quarter, followed by 14 in the second quarter. The remaining eight were identified in the third quarter.

Despite the quarterly slowdown, the cumulative total of 35 transactions through September remains in line with the historical average for the corresponding nine-month period from 2020 through 2026.

Third-quarter figures should also be considered preliminary. Some acquisitions completed during Q3 may not be publicly announced until the fourth quarter, a reporting pattern observed in previous years. As a result, the number of transactions attributed to Q3 2026 could increase modestly as additional announcements become available.

The distinction between quarterly and year-to-date activity is important. While the latest quarter shows a reduction in transaction volume, the broader nine-month figures do not indicate a comparable decline relative to the sector’s historical transaction levels.

Private Equity-Sponsored Operators Remain a Major Source of Acquisition Demand

One of the most notable features of pediatric therapy M&A continues to be the participation of private equity-backed companies.

Of the 35 transactions identified during the first nine months of 2026, 21 involved private equity-backed acquirers, representing 60% of the total.

These buyers, which generally operate established therapy platforms supported by institutional investors, continue to account for a substantial portion of acquisition activity.

“While the latest quarter shows a reduction in transaction volume, the broader nine-month figures do not indicate a comparable decline relative to the sector’s historical transaction levels.” – Luis F. Lopez, Ph.D., Mergium Advisors

The remaining transactions involved other buyer categories, including private equity firms making direct investments, strategic acquirers, and other investor-backed organizations.

The significant participation of private equity-sponsored operators highlights their continuing role in the consolidation of pediatric therapy services. However, the distribution of buyers also demonstrates that acquisition activity is not limited to a single ownership or investment model.

Acquisition Interest Extends Beyond ABA-Only Providers

Although ABA remains an important component of the pediatric therapy acquisition market, transaction activity during 2026 has been broadly distributed across different therapy specialties.

Mergium Advisors classified the 35 transactions announced through September into three groups based on the services provided by the acquired companies.

The data reveal two important characteristics of the acquisition market.

First, companies offering ABA services were involved in 23 transactions, equivalent to approximately 66% of the total. This includes both ABA-only providers and organizations combining behavioral therapy with other pediatric services.

Second, 25 acquired companies, or approximately 71% of the total, offered at least one of the three traditional pediatric therapy disciplines: occupational, physical, or speech therapy.

The overlap reflects the presence of multidisciplinary providers offering several therapy services under a single organization.

These results illustrate the diversity of acquisition targets. While specialized ABA providers continue to participate in the M&A market, companies offering OT, PT, and ST, either independently or in combination with ABA, also represent a substantial portion of transaction activity.

Clinics and Schools Lead Among Service Delivery Settings

The settings in which acquired companies deliver services provide another perspective on the composition of the pediatric therapy M&A market.

Among the 35 acquisition targets identified through September 2026, clinic-based therapy was the most common delivery model, followed by services provided in schools.

At the same time, the presence of home-based and telehealth services illustrates the range of operating models represented in acquisition activity.

One of the notable transactions identified during 2026 involved Golden Steps ABA, acquired by Gemspring Capital. With 45 clinics, Golden Steps ABA was the acquisition target with the largest reported clinic footprint in Mergium Advisors’ 2026 transaction research.

Acquired Operations Span Multiple U.S. Markets

Pediatric therapy acquisitions during 2026 have not been confined to a handful of geographic markets.

An analysis of the operating footprints of acquired companies shows transaction activity involving businesses with operations across numerous states.

The states with the greatest concentration of acquired operations during the first nine months of 2026 included North Carolina, Virginia, Texas, Indiana, Oklahoma, New York, Michigan, Maryland, Florida, and Arizona.

This geographic analysis considers the states in which acquired companies provided services, rather than simply the locations of their corporate headquarters.

“For pediatric therapy owners, investors, and industry participants, the principal takeaway is that consolidation remains active across multiple clinical specialties, operating models, and geographic markets.” – Luis F. Lopez, Ph.D., Mergium Advisors

That distinction is particularly relevant for pediatric therapy businesses operating multiple clinics or providing services across state lines. A single acquisition may therefore involve operations in several states.

The geographic distribution of acquired operations illustrates the nationwide reach of pediatric therapy M&A activity and the participation of providers serving different regional markets.

Outlook: A Market That Remains Active but Warrants Monitoring

The decline in third-quarter transaction volume raises questions about the pace of acquisitions during the remainder of 2026. However, the year-to-date figures suggest that the sector has maintained a level of M&A activity comparable to its historical average.

The ultimate number of transactions attributed to Q3 may also change as additional announcements emerge during the fourth quarter.

For pediatric therapy owners, investors, and industry participants, the principal takeaway is that consolidation remains active across multiple clinical specialties, operating models, and geographic markets.

Whether transaction activity accelerates, stabilizes, or slows further will become clearer as the final quarter of 2026 unfolds.

AT A GLANCE