01The Client

A growing Applied Behavior Analysis (ABA) therapy provider serving children with autism, ages 7 and under, across three states — Minnesota (Twin Cities metro priority), North Carolina, and Nebraska. Multiple brick-and-mortar clinic locations with plans to open 3 to 4 additional clinics in 2026. The buyer is a parent searching for early intervention for a young child.

Client name and brand assets withheld at our discretion. The numbers and approach below are exactly as run.

02The Problem

ABA therapy sits inside Google’s most heavily restricted ad categories which is healthcare combined with services targeted to children. Most agencies don’t take this work because the policy hurdles alone burn weeks of timeline before a single click is bought. The constraint that defines this category: you cannot use the word “autism” in keywords or ad copy without explicit category approval. For an autism therapy provider, that is the entire vocabulary of their service.

When the client came to us, they had no dedicated Google Ads manager and were running a Performance Max only structure at roughly $6,400 per month. The trajectory tells the story:

Lead volume collapsed from 40 to 5 over four months while spend stayed flat. By September the account was effectively dying. PMAX was buying impressions on placements that had nothing to do with parents looking for ABA therapy for a young child.

03What We Did

1. 1

   Unlock the restricted category in 14 days

   We escalated through our agency Google rep, restructured the account to satisfy sensitive-category compliance review, and got the explicit approval to run “autism” in keywords and ad copy. Two weeks from kickoff to greenlight. That alone is the gate most agencies never get past.

2. 2

   Tear down PMAX, rebuild on Search

   We tested several campaign types on the way in like PMAX, Display, Search and the data was unambiguous. Search drove the qualified intake. PMAX was buying noise. We retired the original PMAX structure, kept lean Display for retargeting, and made tightly themed Search campaigns the workhorse: state-segmented non-brand campaigns, separate Brand defense per state, and Careers campaigns to support hiring as new clinics open.

3. 3

   Geographic discipline

   Three core state targets were Minnesota with Twin Cities priority, North Carolina, and Nebraska. Surgical negative geo lists removing every county outside the active service radius. No spend bleeding into states the client doesn’t serve, even at the metro edges.

4. 4

   Scale budget against improving CPL, not against gut

   We raised the budget in lockstep with conversion-rate improvements: $6.4K → $11.9K → $13.9K → $18.7K → $19.8K monthly. Every step up was justified by the previous step’s cost-per-lead improvement. Spend tripled while cost-per-lead fell.

5. 5

   Lead the work with category expertise

   The strategy was driven by Matt, our senior media buyer. His prior experience advertising inside the autism-services and pediatric-healthcare space is the reason this account turned around so quickly. He knew which campaign archetypes survive sensitive-category review, how parents of children 7 and under actually search for early intervention, and which signals separate qualified intake from referral noise.

04Results

What this looked like in the business

The qualified-lead rate, confirmed by the client’s downstream CRM tracking, quadrupled in December and held through Q1. Combined with the cost-per-lead reduction, that put the qualified-cost-per-lead in a different financial bracket entirely.

Knock-on effect on organic search: the site went from 1 keyword in Google’s top 3 organic positions to 4, and the count of keywords stuck on page two-plus dropped from 92 to 10. Cleaner site architecture, sharper audience targeting, and Google rewarding both.

Business outcome: the client is opening 3 to 4 additional clinics in 2026.

05Why This Matters For Other Restricted-Category Brands

Most agencies decline restricted-category accounts because the policy work is harder and the wins less guaranteed. Healthcare, legal, finance, addiction recovery, autism services — these are categories where compliance is half the job and creative intuition is the other half. We built our practice around the harder cases.

If your account has been disapproved, restricted, or is just stuck on a fraction of the budget it should support, that is exactly the kind of work we do.