Autism is a term that is reasonably new in the modern lexicon. While the term autism was first coined in 1912, a neurological presentation that has similar characteristics to what we call autism has likely been around for a very long time in human history. However, this type of neurological presentation (and associated behaviors) was exceedingly rare in the past. I mean, the 2-in-10,000 kind of rare.

Has Autism Increased Just Due to Better Diagnosis?

Yes, we are better at diagnosing, but this does not explain the jump from 2 in 10,000 to 1 in 31 in just 50 years. There are people that will tell you that we have always had 1 in 31 children with autism in the human population . . . that 3% of people have always been autistic, despite the fact that there is no epidemiological evidence to support this statement.

No one challenges the real rise in life-threatening food allergies in children over the last 50 years. We can track hospital and ER admissions, the results of validated laboratory tests, and deaths from anaphylaxis to objectively conclude that the rate of life-threatening food allergies has grown exponentially in recent decades.

With autism, the diagnosis is subjective and based on a set of criteria used by a diagnostician who employs personal judgement to determine a positive/negative diagnosis. What’s more, the diagnostic criteria have changed over time, making the waters muddier. There has never been an objective diagnostic test like a blood test that would help make the diagnosis indisputable and thus easier to track prevalence over time. As a result, the conventional narrative is that we’ve always had this much autism, it’s just that we “missed” them. We didn’t diagnose them.

[As an aside, there is now a blood test that has been developed to help identify children with autism more objectively. This should help.]

If You're Over 40, How Many Kids with Autism Did You Know When You Were a Kid?

Autism--the word, the experience, the diagnosis, the awareness--burst onto the scene in the 1980s and became more generally known thanks to the film Rain Man in 1988. Before that, most people had never heard of it. Ask anyone over 40-years-old if they remember children with autism in their elementary, middle or high schools.

Most people will tell you that they don’t remember knowing anyone with autism or even anyone with a set of symptoms that looked like autism but was called something else. And if they did, it was one person that they knew of . . . in their whole life. But ask that 40-year-old how many children they know with autism today, and they can probably count several . . . maybe more than a dozen that they know of personally.

When I was in middle school, I volunteered at a special-education program that would run fun events for elementary-aged children with special needs. This was in the late 1980s. That organization served dozens of children with special needs in my area. There was not one child with autism served by that organization. Not one. Nor were there any children who had behaviors or patterns like looked like autism and were just called something else. There were children with Down Syndrome, cerebral palsy, spina bifida, brain injuries. But no autism. No children with features of autism—no stimming, no echolalia or scripting, no sensory defensiveness, no elopement. It wasn’t present in my community.

Remember, about 40% of children with autism are severe enough that you would not miss the outward, objectively observable signs mentioned above. I’m not saying autism didn’t used to exist before the 1980s. It did. It’s just that it wasn’t present in most communities, and it certainly wasn’t present in every classroom the way it is today.

Ask someone over 40:

• When you were growing up, did you know any children in your community that were nonspeakers?
• When you were growing up, did you know any children in your community that stimmed, flapped their hands or banged their head (commonly recognizable behavioral characteristics of moderate to severe autism)?

Most people today know someone with autism, and usually several people. It is so common now that it has become completely normalized, and people act as if it has always been like this. And you will find article after article in the legacy media (New York Times, Washington Post, NBC, ABC, CBS, NPR) that will tell you that “There’s no true increase in autism, we’re just better at diagnosing.”

While it is true that we are definitely better at diagnosing autism today then in 1980 or 1990, it still does not account for the total increase. Every time someone brings up the idea of “diagnostic substitution”—the idea that autism has always been here, but that we just called it something else (like “intellectual disability”), I share this publication (see chart at left: Figure 1. Nevison, C.D., Blaxill, M. Diagnostic Substitution for Intellectual Disability: A Flawed Explanation for the Rise in Autism. J Autism Dev Disord 47, 2733–2742 (2017).) based on IDEA data to illustrate how diagnostic substitution accounts for *some* but not all new cases.

And certainly not the skyrocketing growth rate of ASD since 1990. The rates of autism are rising dramatically, no matter how much you try to explain it away.

It’s an epidemic. We must acknowledge this.

What Are the Statistics?

The statistic for autism in the 1970s was 2 in 10,000. That sounds about right. That fits my experience. I didn’t have 5,000 people in my sphere of influence, but I would have needed to have approximately 5,000 people in my world in order to know one person with autism. I did know several people with Down syndrome, which is found in about 1 in 1,000 children (much less common than the 1 in 31 children diagnosed with autism today). This is the experience of pretty much anyone I talk to who is over 40 years old.

Today, the CDC puts the prevalence of autism at 1 in 36 children. Our research puts the number closer to 1 in 31, and in some geographies, such as California, the rates can be as high as 1 in 22. Even if “autism” with a different name has been around for a very long time, we are seeing an absolute explosion in the number of children receiving this diagnosis every year.

If we widen the aperture beyond autism and include diagnoses like ADHD and learning disabilities, the number of children in the United States today who are “neurodivergent” (more on this term below) is estimated at 20%.

The Cost of Autism

Something is creating an increase in this neurological presentation in humans.

We did not have 20% of humans in any society at any time in recorded human history with this distinct cluster of neurological and neurobehavioral symptoms. It just wasn’t there. I don’t care what Stephen Silberman’s book Neurotribes says. Let the epidemiologists be the experts on this. They will tell you that autism was not always 1 in 31 children, or 1 in 22 children in California, no matter how loose the diagnostic criteria.

In no history in any universe ever would this be true, especially when you consider that at least 40% of people diagnosed with autism are considered moderate/severe and at least 27% are considered “profoundly” autistic (ranging by geography with 38% of children with autism in South Carolina being labeled “profoundly autistic”). Profoundly autistic is described as children who were “more likely to have self-injurious behavior or epilepsy and require around-the-clock supervision.” They didn’t “miss” all these kids with moderate/severe autism when they did their research in 1970 and found 2 in 10,000. Taking the growth rates from the last few decades and projecting forward, we will be at 1 in 16 children (and 1 in 10 boys) diagnosed with autism by 2033.

By 2033, our society will be asked to provide round-the-clock care and support for about 1 in 48 children (those who are severe/profoundly autistic, about 1/3 of those diagnosed with autism) and the rest of the children with autism will still need substantial care and support beyond what a typical child needs. How will parents work? Who will pay for that care? What will happen to these children when they become adults and there are no parents to care for them? This isn’t some far off scenario. This is less than 10 years away.

It is estimated that upwards of 85% of adults with ASD are unemployed. At present, our society is not equipped to support this population of impacted children, and even more so as they age and no longer have family to support them and care for them. Further, when a parent must stay home to care for a child with autism, that parent is unable to earn income they would otherwise be able to earn and needs to be supported by a spouse or family members.

A paper published in Science, Public Health Policy, and the Law in December 2023 estimated that the total population-wide ASD cost in the U.S. would reach $5.54 trillion/year by 2060. Yes, that is a T. It says TRILLION. For perspective, the GDP of the United Kingdom in 2023 was about £2.27 trillion (or $2.8 trillion U.S. Dollars). Read this next sentence slowly and let it sink in: In 2060, the cost of autism in the U.S. will be double the current GDP of the United Kingdom.

Why Is This Happening?

Maybe it’s time to take a moment and stop dismissing people who are raising the alarm bells about the escalating rates of autism. Maybe it’s time to take a moment to try and understand *why* this might be happening.

Before we can understand why autism is increasing, we must first understand what autism is.

What is autism, really?

Because our society at large doesn’t really understand what autism is, we are unwittingly perpetuating the autism epidemic and ignoring the true and urgent needs of people with autism.

Some people call the neurological presentation or cluster of symptoms that we call autism “neurodivergence” or they might identify with the term "neurodivergent". Neurodivergent is a new term (that was coined in the oughts, building on the concept of neurodiversity) that includes people with autism, ADHD, some learning disabilities, and other neurodevelopmental or chromosomal conditions that impact the way a person’s brain works.

Most scientists agree that what we call "neurodivergence" is developmental (something that develops in utero or in the early years of life), although there is much debate about whether this “something that develops”, is due to genes (believed to be static, intractable) or environment (often actionable) or both. Depending on the specific condition, genes or environment may be more or less at play.

I would contend that the neurological presentation that we call autism, in most (but not all) cases, develops over time from myriad contributing environmental factors from pre-conception onwards. Usually, it is multi-generational and specifically involves influences pre-conception through the first few years of life and is due to a combination of genetics and a cumulative and synergistic load of environmental stressors. For some children (like those with Rett syndrome, fragile X or Down syndrome), a genetic or chromosomal component may feature prominently. For others, environmental factors play a larger role.

For example, there are certain genetics that might make an individual more vulnerable to developing autism, but interestingly, these may also be the same genetics that make one more vulnerable to developing Parkinson’s, depression, cancer, anxiety, or other conditions. This may have more to do with a person’s ability to methylate, detoxify, and process the environmental stressors that are a part of living in the modern world (but were not present in the pre-industrial age). Here and here are some good papers on that subject.

How Does Autism (or Most Cases of Neurodivergence) Develop?

When a fetus or child is developing and confronted with toxic or stressful assaults (heavy metals, psychological and physiological stress, petrochemicals, artificial light, endocrine disruptors, fungal, bacterial or viral infections, trauma and more), the child will always prioritize survival over development.

If a child has a finite amount of energy that their body has to work with on a daily basis, that energy will be shunted to survival needs (removing toxins, repairing damaged DNA, managing inflammation, mounting an immune response to combat chronic infections) over developmental needs (speech, vision, sensory processing, motor development). Read chapter 10 of Offspring: Human Fertility Behavior in Biodemographic Perspective for a solid explanation of this concept. It also explains why so many couples in the modern industrial world have trouble conceiving children.

So What Is Autism?

If we are going to use the term neurodivergence, I think it is extremely important that we understand what autism is and how it develops before we allow the term neurodivergent to be swept up into the boiling cauldron of American identity politics that is so divisive and charged in this socio-political climate.

The use of the term “neurodivergence” is well intentioned and extremely helpful for people who identify with this term. I also think the efforts made in recent years to understand the wide-ranging perspectives of people with autism is absolutely critical, especially those who are nonspeakers/not reliable speakers that have learned to communicate through spelling/letterboards.

While Autism Speaks, the largest and most well-funded autism NGO, hasn’t done a darn thing to help us understand why we are witnessing an autism epidemic, I will say that it has done a good job teaching people to be aware, sensitive and respectful of the needs of people who have autism. We still have a lot of work to do in this category, but awareness and educational campaigns have done a good job of explaining things like how:

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