What RFK Jr. Gets Right—and Wrong—About Autism
By Jill Escher
Editor’s Note: As the father of a 41-year-old autistic man, it is hard to comprehend why some people are upset by RFK’s attempt to do something about the problem. That in no way undermines my son’s humanity. There are problems with the fact that my low-functioning son is defined by a term that includes Elon Musk, who is on the opposite end of the spectrum. On the other hand, while I accept my son for who he is, if I could wave a magic wand and make my son “normal,” I would do it in a heartbeat. Why is there a fear of being “normal” today? Why is being normal somehow considered a threat to those who fall outside of that category? Moreover, like so many big problems the Trump administration has taken on, I’m glad to see something being done about the frequency of autism. Whether it be inflation, the border, DEI, fair trade, or autism, attempting to address the problem should be lauded. All these issues will be very difficult to solve. Those who criticize often do so, offering nothing in return but to run down those who try to make things better. Maybe the embarrassment of backing a President who had to be hidden from view, to one who dynamically tackles problems, is just too much for some people to handle.
Is it really an epidemic? Are rates increasing? Answering these questions and more
The April 16 autism press conference featuring Health Secretary Robert F. Kennedy Jr. had the media and internet in a frenzy. Did he offend people with autism, or was he at long last shining a light on harsh, neglected realities? Was he right to call the stunning increase in autism cases an epidemic, or was that unscientific scaremongering?
Some people, including Sen. Elizabeth Warren, raged. Other people, particularly parents of the severely affected, cheered. But mostly, people were confused. And who can blame them? The truth about autism can seem as easy to grasp as a mound of warm Jell-O.
So it’s worth some quality time to closely examine the main bones of contention. After all, a hell of a lot is at stake. Probably the future of our country is at stake. Because if the new CDC autism prevalence estimate of 1 in 31 8-year-olds signals truly escalating rates, the implications for public health, research, safety-net services, and our economy are simply massive.
As someone who has labored in the trenches of autism for two decades, in the realms of both research and advocacy, I offer this little FAQ for your consideration.
Was RFK Jr. right to call autism an “epidemic”?
Score a point for the health secretary here. A half century of troves of very rich data from multiple sources across multiple systems and examining all levels of autism emphatically point to a true increase in autism rates. Despite rampant speculation about “just noticing it better,” the research does not support this conjecture, though it could explain some effects around the higher-functioning edge. Some key data points to consider:
- Even limited to cases of autism with intellectual disability, or ID (formerly called mental retardation, and meaning IQ of 70 or under), childhood autism rates have skyrocketed, from about 0.01 percent to 0.05 percent of children in the 1960s based on early studies to about 1.28 percent of 8-year-olds in 2022, per the latest CDC data.
- Even in 4-year-olds, who tend to have greater impairments than those diagnosed later in childhood or adulthood, prevalence has more than doubled over a short period, reaching 2.93 percent for the recent 2022 surveillance, up from 1.34 percent in 2010, when the CDC began tracking preschoolers.
- Autism cases in our most populous state, California, have exploded. Its developmental disability system—which serves only significantly disabling forms of autism—has seen autism cases rise from about 4,000 in 1989 to about 206,000 in 2024. That’s a 51-fold increase over 35 years, while caseloads of ID and other categories remained fairly flat.
- Careful epidemiology in the state of New Jersey conducted by the respected Rutgers University researcher Dr. Walter Zahorodny (who gave invited remarks at the RFK Jr. press conference confirming the existence of a true increase) has reflected sweeping increases in autism prevalence in the state, to the point that in some regions, about 7 percent of 8-year-olds have autism. Dr. Zahorodny told me the case definitions did not change over time.
- Autism cases are up sharply in special education across all states. To be eligible for special education, a student must demonstrate significant impairments that interfere with learning, and they require specialized instruction as a consequence. For example, in California, cases grew from about 4,000 in 2000-21 to about 167,000 in 2023-34, while cases of ID remained steady. In 2019, Massachusetts reported that its schools were serving four times as many students with autism as they did 15 years prior. In Minnesota, autism cases surged exponentially beginning in the 1991 school year, with the researchers finding “diagnostic substitution does not largely explain the increasing trends.”
- The largest U.S. study of autism prevalence in hospital and medical care systems shows rising autism prevalence across birth cohorts. Autism in adults over the age of 65 was shown to be extremely rare, in the range of .02 percent, compared to rates of about 3 percent for children aged 5 to 8 in 2022. When RFK Jr. says he’s never met anyone his age with significant autism, he’s not wrong. The data, especially from the robust California developmental disability system, show they hardly exist.
- Autism rates are skyrocketing in our adult Medicaid and Social Security safety-net systems, where the disorder is by definition limited to more severe cases. In Medicaid, the prevalence of young adults with autism more than doubled from 2011 to 2019. For SSI, we see staggering autism growth of 336.6 percent from 2005 to 2019, while cases with ID and other mental disorders decreased by 45 percent.
- Further evidence it’s not a game of diagnostic switcheroo: The CDC has found that the prevalence of children with developmental disabilities generally, including ID, has increased over time.
The word epidemic is appropriate to describe the ascension of autism, Alexander MacInnis, MS, an independent epidemiological researcher who has published on California autism data and who has a daughter with profound autism, told me. “Epidemic has a definition, and not just for infectious disease,” he said. “It can be a disorder where more cases are occurring than what you would expect based on history. We have massively increased birth cohort prevalence from every data source I can find showing very consistent increases, even within studies, which removes bias. Overall we see about a 7 percent increase in autism cases per birth year. Does this meet the definition of an epidemic? It does.”
But Scientific American just told me there’s no true increase in autism.
The media loves to cherry-pick a few old studies to defend the idea that there’s been no true increase in autism. A perfect example is this recent gem from Scientific American citing and mischaracterizing papers that are plainly irrelevant.
For example, it points to a 2015 study on special education enrollment for the idea that autism’s increase was only caused by diagnostic shifts away from ID to Autism Spectrum Disorder (ASD). That paper was not an epidemiological study on autism increase over time but instead intended to look for hints of common molecular origin for comorbid conditions. It was conducted by geneticists, not epidemiologists using proper tools of that trade, and performed a clumping of all ages 3 to 21, which is meaningless to determine autism rates over time. In any event, the study found that a large percentage of the autism increase was not accounted for by declining ID, and many states did not reflect this trend at all, including the most populous states, California and Texas. Furthermore, the data is now 15 years old, and autism rates have clearly continued surging over that time.
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Image Credit: YouTube Screenshot KPRC Houston
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