It is an interesting information for other bloggers.
But they need to remember that there is a difference between literally "how much time did it take to type the words" (which is a task that many may procrastinate with) and "how much time did it take to gather the information for the article" (which is probably a background process that took much longer).
Thank you for writing this detailed post! Let me add two minor suggestions.
First, NIH needs to focus research dollars on the profound end of the autism spectrum and heavily scrutinize study proposals that fail to deliberately consider profundity. Kids with level 1 autism who are fine in a general education classroom just aren’t the same as level 3 kids who need a high-intensity special ed setting, but it’s much easier to recruit level 1 kids and make over broad claims about your results.
Second, all of these programs need a fast-track approval process for genetic diagnoses with autism as a secondary diagnosis. Kids with, say, Angelman Syndrome aren’t going to stop needing a high amount of services. Genetic screening these days is cheap enough that private insurance encourages it and provides fast-track approvals for kids with genetic disorders.
In the last four years of my work as a family therapist, I have had nine cases where the families have come in with an autism diagnosis, and not one met the DSM-4 criteria, let alone Kanner's original criteria. Only two cases barely met DSM-5 ASD criteria, and even then, the children met it at the time of testing years ago, but not presently.
At a health conference in China last year someone congratulated the Minister for Health on the country's low autism rate. "That's a reporting anomaly," he replied. It's a diagnosis many physicians are still unfamiliar with”.
I'm a psychologist and was practicing during the period the autism criteria changed. It really was startling, and was not just a matter of clinicians and parents taking advantage of the new definition to get more services for kids who were having problems of some kind. Clinicians I knew started murmuring about some of their adult patients maybe being "on the spectrum." Friends of mine started wondering whether they were "on the spectrum." I wondered whether *I* was on the goddam spectrum. I am one of the go-to therapists in my town for super-smart oddballs, and most of them have diagnosed themselves as autistic. The way it looks to me is that most of them do have some unusual wiring, but there are a lot of different kinds of unusual wiring, and not everything has a name. And it's quite a stretch to say that what's going on with these people is essentially the high IQ version of what's going on with a non-verbal adult who spends the day in the corner staring at a twirling paperclip.
Also, wanted to ask you about the evidence that tylenol during pregnancy increases the risk of neurological disorders in the kids. Scott Alexander believed that enough to put avoiding painkillers in Tier 1 of his advice for pregnancy. And I looked at a GPT-generated summary of research, and came away thinking that the risk from tylenol in pregnancy was real. Upshot of the research was that tylenol in pregnancy increased the risk of neurodevelopmental disorders by about 20%. What do you think about that? And if the effects real, seems plausible that giving tylenol to small children could increase the risk further.
Some people have tried to cope about this to save the hypothesis by saying that there's some sort of genetic moderator present, but I don't think they realize that means that the estimate goes towards the population one.
If the rate of autism hasn't gone up, there should be some hard evidence (not anecdotes) of the multitudes of undiagnosed or misdiagnosed seniors.
Or do want to claim it's all overdiagnosis? In that case, why is there a rise of low-functioning autism as well, with no comparable drop in other diagnoses such as ID?
The rise of autism has occured globally since the 1980s in many countries with very different health systems, different policies, and different incentives. How many modern, industrialized countries, on which we have good data, have seen a drop in their autism rates over the last thirty years? Or even a stable rate?
Unless you recognize that environmental factors are at play here (not vaccines, obviously, since that hypothesis was thoroughly examined and disproven years ago), you'll have to keep torturing and explaining away the data.
As noted in the article you're commenting on, readers were expected to have read the linked prior article. You didn't read it. Everything you said was addressed there.
I'll link it again. Do not be ignorant in my comments section again.
I have read it in the past, actually, and I didn't find it to be convincing, especially not as to explaining the global, simultaneous rise.
You even admit yourself in the post that there might be a true increase, but attribute it to factors like older parents. You also agreed with someone in the comments that assortative mating can be a factor.
So you have no problem acknowledging that there might be a true increase, so long as it's attributed to factors you deem acceptable. This seems like motivated reasoning.
The rise isn't identical everywhere, so your first point is a non-point.
Before the DSM-III, autism was not commonly known and diagnosis was rare and idiosyncratic due to the extremely high standards for diagnosis. And yes, before the DSM-III, nowhere had diagnosis incentives.
You don't understand the background of this phenomenon even though you've had the chance to read about it.
It's not identical, but we've seen a similar increase in many countries at around the same time period (the UK, Canada, several European countries, Japan - studies provided in the first link.)
The DSM-III was published in 1980, yet the rates remained low in many places and only started increasing in the 1990s and 2000s.
And the causality isn't clear here at all. Was autism not commonly known in the past because of the high standards of diagnosis? Or was it not commonly known in the past because it was actually rare?
The conclusion: "It evidenced that there has been a rise in ASD over time, that methodological differences cannot account for a significant amount of the variability between prevalence estimates and that changes in diagnostic criteria are not sufficient to explain the observed increase in ASD."
Many parents of children diagnosed with "Autism" want an expansion of diagnoses.
Currently, every child is just labeled "autistic" without any distinctions. Older subcategories and alternative diagnosis have been eliminated.
If the relevant authorities are willing to invest the time & political capital to create two dozen more accurate diagnosis, you could more easily sell these reforms to parents.
insisting that it all matched up with increasing rates of tylenol usage was the funniest part to me. We’ve been taking more and more tylenol as a society??? Really??? Actually??? In 2025 as compared with 2015???
Call it what you will.... if you get out of the academic world and into an elementary classroom you'll see there is a profound change in the children.
Arguing over what to call it is much less important than fixing it.
The trump administration is admitting there is a problem. Let's get together and look at everything with fresh eyes and find out why our children are having these issues.
You wrote all this in one hour? You must be more autistic than me. (I mean that as a great compliment.)
It is an interesting information for other bloggers.
But they need to remember that there is a difference between literally "how much time did it take to type the words" (which is a task that many may procrastinate with) and "how much time did it take to gather the information for the article" (which is probably a background process that took much longer).
Thank you for writing this detailed post! Let me add two minor suggestions.
First, NIH needs to focus research dollars on the profound end of the autism spectrum and heavily scrutinize study proposals that fail to deliberately consider profundity. Kids with level 1 autism who are fine in a general education classroom just aren’t the same as level 3 kids who need a high-intensity special ed setting, but it’s much easier to recruit level 1 kids and make over broad claims about your results.
Second, all of these programs need a fast-track approval process for genetic diagnoses with autism as a secondary diagnosis. Kids with, say, Angelman Syndrome aren’t going to stop needing a high amount of services. Genetic screening these days is cheap enough that private insurance encourages it and provides fast-track approvals for kids with genetic disorders.
Fully agreed!
There is so much policy that has to change if we're to deliver adequate care to the kids who really need it.
In the last four years of my work as a family therapist, I have had nine cases where the families have come in with an autism diagnosis, and not one met the DSM-4 criteria, let alone Kanner's original criteria. Only two cases barely met DSM-5 ASD criteria, and even then, the children met it at the time of testing years ago, but not presently.
At a health conference in China last year someone congratulated the Minister for Health on the country's low autism rate. "That's a reporting anomaly," he replied. It's a diagnosis many physicians are still unfamiliar with”.
I'm a psychologist and was practicing during the period the autism criteria changed. It really was startling, and was not just a matter of clinicians and parents taking advantage of the new definition to get more services for kids who were having problems of some kind. Clinicians I knew started murmuring about some of their adult patients maybe being "on the spectrum." Friends of mine started wondering whether they were "on the spectrum." I wondered whether *I* was on the goddam spectrum. I am one of the go-to therapists in my town for super-smart oddballs, and most of them have diagnosed themselves as autistic. The way it looks to me is that most of them do have some unusual wiring, but there are a lot of different kinds of unusual wiring, and not everything has a name. And it's quite a stretch to say that what's going on with these people is essentially the high IQ version of what's going on with a non-verbal adult who spends the day in the corner staring at a twirling paperclip.
Also, wanted to ask you about the evidence that tylenol during pregnancy increases the risk of neurological disorders in the kids. Scott Alexander believed that enough to put avoiding painkillers in Tier 1 of his advice for pregnancy. And I looked at a GPT-generated summary of research, and came away thinking that the risk from tylenol in pregnancy was real. Upshot of the research was that tylenol in pregnancy increased the risk of neurodevelopmental disorders by about 20%. What do you think about that? And if the effects real, seems plausible that giving tylenol to small children could increase the risk further.
The acetaminophen-autism/other NDD connection doesn't hold up between siblings discordant for in utero exposure: https://x.com/cremieuxrecueil/status/1779615432015536300
Some people have tried to cope about this to save the hypothesis by saying that there's some sort of genetic moderator present, but I don't think they realize that means that the estimate goes towards the population one.
Typo thread:
"it's consistent with the the"
"officials will need to paid stricter"
"he needs to be propose"
Thank you. Fixed.
I'll chalk those mistakes up to moving fast!
Great article, with some amount of bravery. You are fighting a battle against the ignorant and, in some cases, the stupid.
The most likely reason for the appearance of an increase in autism is a broadening of the diagnosis profile. All other 'explanations' lack proof.
You've cherry-picked the evidence here, ignoring most epidemiological and administrative data, in addition to common sense observations.
https://www.ncsautism.org/blog//autism-explosion-2024
If the rate of autism hasn't gone up, there should be some hard evidence (not anecdotes) of the multitudes of undiagnosed or misdiagnosed seniors.
Or do want to claim it's all overdiagnosis? In that case, why is there a rise of low-functioning autism as well, with no comparable drop in other diagnoses such as ID?
The rise of autism has occured globally since the 1980s in many countries with very different health systems, different policies, and different incentives. How many modern, industrialized countries, on which we have good data, have seen a drop in their autism rates over the last thirty years? Or even a stable rate?
Unless you recognize that environmental factors are at play here (not vaccines, obviously, since that hypothesis was thoroughly examined and disproven years ago), you'll have to keep torturing and explaining away the data.
Don't lie in my comments section.
As noted in the article you're commenting on, readers were expected to have read the linked prior article. You didn't read it. Everything you said was addressed there.
I'll link it again. Do not be ignorant in my comments section again.
https://www.cremieux.xyz/p/whats-the-deal-with-autism-rates
I have read it in the past, actually, and I didn't find it to be convincing, especially not as to explaining the global, simultaneous rise.
You even admit yourself in the post that there might be a true increase, but attribute it to factors like older parents. You also agreed with someone in the comments that assortative mating can be a factor.
So you have no problem acknowledging that there might be a true increase, so long as it's attributed to factors you deem acceptable. This seems like motivated reasoning.
It fully explains the rise the world over.
I said there can be a small real component. It is generally too small to detect in explicit causal decomposition.
You have poor reading comprehension skills.
Everyone in many industrialized countries had the exact same incentives around the 1980s and 1990s?
Yet those same incentives didn't exist in all those different health systems and cultures in the 1960s and 70s?
The factors you've pointed out don't explain the global rise. Especially the sudden change in pace.
The rise isn't identical everywhere, so your first point is a non-point.
Before the DSM-III, autism was not commonly known and diagnosis was rare and idiosyncratic due to the extremely high standards for diagnosis. And yes, before the DSM-III, nowhere had diagnosis incentives.
You don't understand the background of this phenomenon even though you've had the chance to read about it.
It's not identical, but we've seen a similar increase in many countries at around the same time period (the UK, Canada, several European countries, Japan - studies provided in the first link.)
The DSM-III was published in 1980, yet the rates remained low in many places and only started increasing in the 1990s and 2000s.
And the causality isn't clear here at all. Was autism not commonly known in the past because of the high standards of diagnosis? Or was it not commonly known in the past because it was actually rare?
Edit: also see a systematic review and meta-analysis of over 100 studies on this subject- https://discovery.ucl.ac.uk/id/eprint/10178142/
The conclusion: "It evidenced that there has been a rise in ASD over time, that methodological differences cannot account for a significant amount of the variability between prevalence estimates and that changes in diagnostic criteria are not sufficient to explain the observed increase in ASD."
Isn't there also an ADHD epidemic, for the same reasons?
France has low prevalence overall but an increasing trend as well: https://www.brighterstridesaba.com/blog/countries-with-no-autism/ How do you explain this?
Many parents of children diagnosed with "Autism" want an expansion of diagnoses.
Currently, every child is just labeled "autistic" without any distinctions. Older subcategories and alternative diagnosis have been eliminated.
If the relevant authorities are willing to invest the time & political capital to create two dozen more accurate diagnosis, you could more easily sell these reforms to parents.
insisting that it all matched up with increasing rates of tylenol usage was the funniest part to me. We’ve been taking more and more tylenol as a society??? Really??? Actually??? In 2025 as compared with 2015???
Call it what you will.... if you get out of the academic world and into an elementary classroom you'll see there is a profound change in the children.
Arguing over what to call it is much less important than fixing it.
The trump administration is admitting there is a problem. Let's get together and look at everything with fresh eyes and find out why our children are having these issues.
17 Autism risk factors: low Vitamin D, virus, vaccine, mercury etc. - many studies
https://open.substack.com/pub/hlahore/p/17-autism-risk-factors-low-vitamin?
And nothing causal? Fascinating.
8 PROVEN causes of Autism are mentioned in the substack link
Name one.
2. Advanced Paternal Age PROVEN 600% if over 45 years old
4. Low Birth Weight/Prematurity PROVEN 400%
6. Prenatal Valproate Exposure STRONG 520%
7. Air Pollution Exposure During Pregnancy STRONG 46%
8. Severe Maternal Infections During Pregnancy MODERATE 60%
9. Prenatal Pesticide Exposure (Organophosphates) MODERATE 330%
> Advanced Paternal Age
That's true, but it's tied to mutation accumulation and the large share of autism cases driven by de novos.
The rest are not proven and multiple are actually debunked (e.g., LBW/prematurity and maternal infections). I actually have an article on the maternal infection idea: https://www.cremieux.xyz/i/140634154/misinterpreted-immunological-assumptions
Interesting, but RFK can’t read and the Tylenol pills being red freaked him out so we’re just going to ban acetaminophen instead. That should fix it.
Abolish Psychiatry. Thats how.