Autism: The Real Reason It’s Going Up

Summary

Podcast Summary: Science Vs – "Autism: The Real Reason It’s Going Up"

Episode Information:

• Title: Autism: The Real Reason It’s Going Up
• Host: Wendy Zuckerman
• Producer: Meryl Horne
• Release Date: June 19, 2025
• Description: This episode delves into the increasing rates of autism diagnoses worldwide. It examines various theories behind the rise, including genetics, environmental factors, screen time, and changes in diagnostic criteria, providing a comprehensive analysis backed by scientific research.

---

1. Introduction

[00:00] Wendy Zuckerman:
Wendy introduces the episode, announcing a short hiatus until September and inviting listeners to submit ideas for future topics. She sets the stage for the episode's focus on the rising rates of autism diagnoses, highlighting recent CDC reports that have thrust this issue into the public eye.

Notable Quote:
"Rates of autism have been going up and up for decades. But then a couple of months ago, the CDC released the latest numbers catapulting this issue into the spotlight." [00:00]

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2. Rising Autism Rates and Initial Reactions

[00:57] Robert F. Kennedy Jr.:
RFK Jr. emphasizes the alarming increase in autism diagnoses, referring to it as an epidemic.

Notable Quote:
"This is an epidemic." [01:33]

[01:05] Wendy Zuckerman:
Presents the CDC data showing a 15% increase in autism diagnoses over two years, with current rates at one in 31 children, a fivefold increase since 25 years ago. She notes that the rise is not confined to the U.S. but is a global phenomenon affecting countries like Japan, Canada, Australia, and various European nations.

---

3. Possible Causes Explored

a. Genetics

[06:35] Robert F. Kennedy Jr.:
RFK Jr. underscores genetics as a significant factor, stating that 70-90% of autism risk is inherited.

Notable Quote:
"Genetics is sort of the elephant in the room that you can't ignore." [05:49]
"It's somewhere between 70 to 90%." [06:35]

[06:39] Meryl Horne:
Highlights the substantial role genetics play, noting that while specific genes are not fully identified, the inherited component is undeniably large.

b. Advanced Parental Age

[07:21] Meryl Horne:
Explains that older parental age, particularly mothers over 40, slightly increases the likelihood of having autistic children. However, she notes that this factor alone cannot account for the significant rise in autism rates.

Notable Statistics:

• Overall Autism Rate: 3.2% (1 in 31 children)
• Autism Rate for Mothers Over 40: Increased to 5.6% [07:59]

[09:01] Robert F. Kennedy Jr.:
Acknowledges that older parental age contributes to autism rates but insists it doesn’t account for the majority of the increase.

Notable Quote:
"It's certainly going to contribute some portion, but it's not explaining the lion's share." [09:01]

c. Environmental Toxins

[11:10] Meryl Horne:
Discusses the potential link between environmental toxins and autism, including air pollution and heavy metals. However, she points out that pollution and heavy metal exposure have generally decreased over recent decades, conflicting with the rising autism rates.

[11:34] Robert F. Kennedy Jr.:
Criticizes the focus on environmental toxins, particularly vaccines, asserting that vaccines do not cause autism.

Notable Quote:
"Vaccines do not cause autism, full stop." [12:01]

d. Screen Time

[14:45] Meryl Horne:
Explores the hypothesis that increased screen time may be linked to higher autism rates. She cites studies suggesting that excessive screen exposure in early childhood might be associated with the development of autistic traits.

Notable Study:
A pilot study involving nine families reduced screen time from an average of 5.5 hours to 5 minutes daily, resulting in decreased autism-related behaviors such as improved social skills and reduced repetitive behaviors [16:16].

Counterpoints:

• Karen Heffler: Emphasizes that screen time studies show mixed results and that the correlation does not necessarily imply causation. Additionally, some children might already exhibit autistic traits, leading parents to increase screen usage rather than screens causing autism [20:29].

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4. Changing Definitions and Diagnostic Criteria

[23:33] Meryl Horne:
Introduces the concept that the rising autism rates may be largely due to expanded diagnostic criteria and increased awareness rather than an actual increase in prevalence.

Notable Quote:
"Yeah, I think it accounts for most of it. And I think all of us worry that we're consuming plastics and things that we, you know, that we wouldn't choose to eat or breathe, but that can't account for most of what's gone on." [35:59]

[24:10] Robert F. Kennedy Jr.:
Rejects the notion that changes in diagnostic criteria are responsible for the increase, maintaining that the rise is genuine.

Notable Quote:
"Doctors and therapists in the past were not stupid. They weren't missing all these cases. The epidemic is real." [24:19]

Katherine Lord:
A UCLA professor, acknowledges the expanded definitions but argues that this accounts for most of the increase in diagnoses.

Notable Quote:
"Basically, yeah, I think he's wrong." [35:59]

---

5. Research Findings on Autism Increases

Maureen Durkin's Research:

[32:08] Meryl Horne:
Discusses epidemiological research by Maureen Durkin, which differentiates between severe and mild autism cases over time.

Findings:

• Severe Autism Rates (2000-2016): No increase; slight decline [33:08].
• Mild Autism Rates: Significant increase, accounting for the majority of new cases [33:35].

Visual Representation:
Meryl references a graph presented by Durkin, illustrating that while severe cases have plateaued or declined, milder cases have surged, supporting the argument that expanded diagnostic criteria are the primary driver behind the rising autism rates.

Katherine Lord's Input:
Confirms that the majority of the increase is due to better detection and broader definitions, not an actual rise in severe cases.

---

6. Counterarguments and Alternative Views

Robert F. Kennedy Jr.:
Continues to assert that environmental toxins are the main cause, dismissing the expanded definitions and better diagnostic practices as insufficient explanations.

Autistic Perspectives:

• Dina Gassner: An autistic advocate, argues against stigmatizing language and emphasizes the positive outcomes of better recognition and support for autistic individuals.

Notable Quote from Dina Gassner (through Meryl Horne):
"We're seeing this rising, you know, army of these really neurodivergently intact, healthy, well-adjusted autistic kids that are coming up. And that's a good thing." [40:50]

---

7. Personal Accounts and Impacts

Dina Gassner's Story:

[37:32] Robert F. Kennedy Jr.:
Shares a personal experience of misdiagnosis with bipolar disorder before being correctly identified as autistic, highlighting systemic issues in diagnosis.

Notable Quote:
"I was completely dysfunctional. You know, I could not. I just wasn't a human being for that timeframe. And so I finally found a doctor who was actually treating my children who said, I think you might want to reevaluate where you are. And he saved my life." [37:53]

Impact of Misdiagnosis:

• Leads to inappropriate treatments (e.g., unnecessary medication like lithium).
• Increases autism diagnoses indirectly by identifying previously undetected cases.

---

8. Conclusion

[40:57] Meryl Horne and Wendy Zuckerman:
Conclude that the apparent autism epidemic is largely a result of changed diagnostic criteria, increased awareness, and broader definitions rather than a true rise in autism prevalence. They emphasize the importance of recognizing and supporting the growing autistic population rather than viewing it as a tragedy.

Final Remarks:

• Katherine Lord: Affirms that the increased diagnoses are beneficial, allowing individuals to understand themselves and access necessary support.
• Robert F. Kennedy Jr.: Expresses a positive outlook on the rising autistic population, celebrating increased visibility and community formation despite his earlier assertions.

Notable Closing Quote:
"We solved the case of the so-called autism epidemic." [40:58]

---

Key Takeaways:

• Rising Autism Rates: Significant increase in diagnoses over recent decades, now at 1 in 31 children.
• Primary Cause: Expansion of diagnostic criteria and heightened awareness, rather than an actual rise in autism prevalence.
• Genetics: Remains a major factor, accounting for 70-90% of autism risk.
• Environmental Factors: Mixed evidence; no definitive link established between environmental toxins or increased screen time and autism.
• Changing Definitions: Broader definitions now include milder forms of autism, contributing to the higher diagnosis rates.
• Gender and Racial Diagnosis: More balanced recognition across genders and racial groups, correcting previous biases.
• Personal Impact: Accurate diagnoses improve access to support and community for autistic individuals and their families.

---

Notable Quotes with Timestamps:

• "This is an epidemic." – Robert F. Kennedy Jr. [01:33]
• "Genetics is sort of the elephant in the room that you can't ignore." – Robert F. Kennedy Jr. [05:49]
• "Vaccines do not cause autism, full stop." – Robert F. Kennedy Jr. [12:01]
• "We're seeing this rising, you know, army of these really neurodivergently intact, healthy, well-adjusted autistic kids that are coming up. And that's a good thing." – Dina Gassner [40:50]
• "We solved the case of the so-called autism epidemic." – Meryl Horne [40:58]

---

Conclusion: The Science Vs episode "Autism: The Real Reason It’s Going Up" presents a thorough examination of the rising autism diagnoses, debunking the myth of an actual epidemic and attributing the increase to improved diagnostic practices and broader definitions. Through expert interviews, research findings, and personal stories, the episode emphasizes the importance of understanding autism in its varied forms and the positive outcomes of increased recognition and support.

Transcript

[Wendy Zuckerman]

Wendy hi, I'm Wendy Zuckerman and you're listening to Science Versus. This is our last episode for a little bit. We're going to take a short break until September while we work on new episodes. So that means if you have an idea, something that you want us to versus, you've got to tell us. There's a lot of ways to do it. You can do it on social media, Instagram, TikTok, there's an email address. It's all in the show notes. So if you've got an idea, something that we have to versus, please let let us know. We absolutely love hearing from you. Now on with the show. Today's episode is all about autism because we're asking why do so many folks have it these days? Rates of autism have been going up and up for decades. But then a couple of months ago, the CDC released the latest numbers catapulting this issue into the spotlight.

[Robert F. Kennedy Jr.]

A brand new report out today from the Centers for Disease Control finds a dramatic rise in autism diagnosis among children.

[Wendy Zuckerman]

An alarming spike in the number of children diagnosed with autism. New data just released shows a 15% jump in just two years. The CDC report found that one in every 31 kids looked like they now had autism, which is nearly five times more common than it was 25 years ago. And the rates in boys were even higher. Health and Human Services Secretary Robert F. Kennedy Jr. Says this is an epidemic.

[Robert F. Kennedy Jr.]

This is part of an unrelenting upward trend prevalence two years ago. The answer is very clear and this is catastrophic for our country.

[Wendy Zuckerman]

And it's not just in the U.S. in Japan, Canada, Australia, Europe, rates of autism have been going up too. And now there is this huge fight brewing as to what's behind this. Why do so many people have autism these days? RFK Jr reckons this is coming from.

[Robert F. Kennedy Jr.]

An environmental toxin and somebody made a profit by putting that environmental toxin into our air, our water, our medicines, our food.

[Wendy Zuckerman]

There's all these different theories about what's causing this, from vaccines to pollution and a whole bunch of other stuff.

[Robert F. Kennedy Jr.]

Can more screen make your child autistic? A new study says yes, it might be microplastics, the forever chemicals living in an area with high levels of air pollution may be linked with a woman's chance of having a child with autism.

[Wendy Zuckerman]

But then there are folks saying, whoa, whoa, whoa, whoa, there's actually a much simpler explanation here and it all has to do with how we diagnose autism in the first place. So who's right? What is going on here? At a recent press conference, RFK Jr. Said that we're gonna start to have answers on the root cause of this epidemic by the end of the year. But Christmas has come early because today on the show we are going to find out what's happening when it comes to the rise in autism. There's a lot of fingers pointing at lots of different things.

[Robert F. Kennedy Jr.]

More screens, toxin, microplastics.

[Wendy Zuckerman]

But then there's science. Science versus autism is coming up just after the break. This is the way it feels to move through summer in Lululemon Iconic align softness without the front seam for our smoothest look and feel ever.

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[Wendy Zuckerman]

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[Meryl Horne]

This.

[Wendy Zuckerman]

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[Meryl Horne]

Hey, Wendy.

[Wendy Zuckerman]

All right, Meryl, can you just tell me what exactly is autism? I just feel like people kind of throw it around, diagnosing their friends with it. Their friends, children with it. You know what I mean? What are we talking about here?

[Meryl Horne]

Well, it can show up for different people in different ways, but generally a lot of autistic people will have a harder time communicating. So that's a big theme. And then there's other stuff that shows up a lot too. Like you might have really specific intense interests or a harder time when your routine is disrupted. Or more intense reactions to really annoying stimuli like really bright lights or loud noises. That kind of a thing.

[Wendy Zuckerman]

Uh huh. And then our big question of this episode is why do so many more people have it these days?

[Meryl Horne]

Yeah. What is going on? When I started talking to scientists about autism in general about what causes autism, there is one thing that came up right away.

[Robert F. Kennedy Jr.]

Genetics is sort of the elephant in the room that you can't ignore.

[Meryl Horne]

Genetics.

[Wendy Zuckerman]

Yeah.

[Meryl Horne]

So this is Professor Brian Lee, epidemiologist at Drexel University. And he said that a huge part of whether somebody will be autistic is just passed down to you. It's in your genes. And we know this from looking at studies on families. So like, if we know if one sibling has autism, the other siblings are more likely to also have it. And then if you look at identical twins who basically have, you know, the same DNA, it's like even more likely that if one identical twin has it, the other is really likely to have it too. And so based on all of that, scientists have kind of figured out how much of autism is inherited.

[Robert F. Kennedy Jr.]

And it's somewhere between 70 to 90%.

[Meryl Horne]

Whoa, that's huge. 70 to 90%?

[Robert F. Kennedy Jr.]

Yeah, yeah.

[Meryl Horne]

And we don't really know like all of the genes that are involved. Like sometimes it might be that there are like hundreds of genes that are kind of all working together to up that chance that someone will have autism. Other times it'll just be like one particular kind of genetic quirk. But yeah, genetics is huge.

[Wendy Zuckerman]

Uh huh. I guess in the context of this rise in numbers that we're seeing, though, genetics can't explain why so many folks would be diagnosed with autism now. Right? I mean, cause why would we suddenly have so many more autism genes in the population?

[Meryl Horne]

Well, actually there is one thing that's changed. So parents are having kids at older ages now in and that might be introducing genetic changes that can like up the chance that their kids will be.

[Wendy Zuckerman]

Autistic and so older. How, how, how old are we talking here?

[Meryl Horne]

Well, Brian has studied this and so he did like a back of the envelope calculation with the latest numbers for me. Okay. So Overall in the US about 3.2% of kids are autistic. So that's kind of like the baseline chance on average for autism.

[Wendy Zuckerman]

Yeah. So one in 31 kids.

[Meryl Horne]

Yeah, it works out to 3.2%.

[Wendy Zuckerman]

Okay.

[Meryl Horne]

But if you're a mom over 40, we think that the chance goes up from 3.2% to something like 5.6%.

[Wendy Zuckerman]

Mm, that's not nothing. And then what about, what about the other side of this? The spur, the sperm?

[Meryl Horne]

It's actually a smaller increase for, for the dads, but yeah, it still goes up a little bit.

[Wendy Zuckerman]

Uh huh. So could this explain why we're seeing higher rates of autism across the country and around the world?

[Meryl Horne]

Well, a lot more people are having kids later in life. Like the, the percentage of births to women who are older than 40 has basically tripled since 1990, but overall it's still a really small percentage of like total births. It's like 4% of all the births in the US are from moms in their 40s.

[Wendy Zuckerman]

Uh huh.

[Meryl Horne]

I asked Brian, like at the end of the day, how much does he think this older parent thing can really explain the increase in autism cases?

[Robert F. Kennedy Jr.]

It's certainly going to contribute some, some portion, but it's, it's not explaining the lion's share.

[Wendy Zuckerman]

It's not going to explain the lion's share. Okay, so what else could explain the lion's share? We've got like the meerkat's share covered, lion's share still out the open.

[Meryl Horne]

Right. So that's the big question because yeah, genetics might like kind of set the stage for whether or not someone will have autism. But there is this idea that maybe you need like a trigger to actually make it happen. And scientists have been finding lots of things that might sort of be that trigger and up the chance that someone will have autism. A lot of the things we're finding kind of come into play when someone's a fetus. So things that happen during pregnancy, in utero. So like if a mom gets an infection, if there's birth complications, taking certain medications while you're pregnant, like there's an anti seizure medication that will up the chance that someone will have autism. But like a lot of that stuff doesn't really explain why autism would suddenly be more common in the last few decades. Right.

[Wendy Zuckerman]

Oh, cause pregnant folks aren't taking more of those meds.

[Meryl Horne]

No. Yeah. Experts told me they didn't think that this stuff would make a huge dental. There's maybe one exception to this which is that if you're born prematurely, like very prematurely, you're more likely to have autism. And there are more premature babies that survive now, so maybe that's contributing a little bit to the rise. But the researchers I've talked to say that like, oh no, this is such a small proportion of people with autism that like that, that really can't explain these huge rises that we are seeing either.

[Wendy Zuckerman]

Okay, so then what about these things in our environment? The stuff, I guess RFK Jr talks about environmental toxins, which he said could be in our air or our medicines. And I suppose we could put plastics in there too. What do we know here?

[Meryl Horne]

Yeah, we asked RFK's team about what specific environmental toxin he was talking about and a spokesperson told us that, quote, everything is on the table. So I asked Brian about this. When RFK Jr. Was talking about why autism is so pervasive, he said, quote, this is coming from an environmental toxin. What do you make of that?

[Robert F. Kennedy Jr.]

I know of his weird conspiracy theory type attitudes on vaccines, and I'm wondering if that's code for we need to do another vaccine study. And if that's what he means, I would be very horrified because that would be a tremendous waste of money to go basically beating a dead horse at this point. Vaccines do not cause autism, full stop.

[Wendy Zuckerman]

It has been studied. It has been taken seriously. It has been studied. And various different vaccines, various ingredients in vaccines. And no, we cannot see a link here, but there are other potential things that are in our air and our water that probably weren't 25 years ago, right?

[Meryl Horne]

Yeah. No. And there is a lot of research looking into other stuff that, you know, is in our environment and might be linked to autism. Brian said that one kind of hot area of research is air pollution. Like, a big review just found that there might be a link between being exposed to certain types of air pollution during pregnancy and the kid later having autism.

[Wendy Zuckerman]

Oh, how would that happen?

[Meryl Horne]

So pollution are these tiny little particles that we breathe in, and it could be that they're getting past the placenta and into the brain as it's developing and then maybe kind of changing the brain, like maybe through oxidative stress or neuroinflammation. But the kind of pollution that's linked to autism has generally been going down over the last couple decades in the U.S. so, like, that doesn't explain why it's been going up. And it's sort of similar with heavy metals, which is something a lot of people on the Internet are worried about right now. There is some research that says maybe getting exposed to lead, for example, might up the odds for autism. But lead and other heavy metals have generally been going down.

[Wendy Zuckerman]

Oh, okay, so plastics. Plastics have been going up, right?

[Meryl Horne]

Yes, plastics have been going up. And there are a lot of studies that have looked at a potential link between plastics and autism. So researchers will look at the blood or pee from a pregnant person and look for chemicals like phthalates or pfaffs or forever chemicals. And then they'll ask, like, are the kids who are exposed to more of this stuff in utero, are they more likely to show signs of autism later, after they're born?

[Wendy Zuckerman]

Yeah, yeah, yeah, yeah. And what do they find?

[Meryl Horne]

A few studies say yes, but the vast majority of them find no connection.

[Wendy Zuckerman]

Mmm. So, okay, there's no smoking gun here thus far for the lion's share because maybe increases cases here or there. But we are looking for something that could really explain, like, quite a large number of People now being diagnosed with autism that were not before screens is the other thing being thrown out. What do we know here?

[Meryl Horne]

Yeah, I looked into screens and was surprised that there actually was some research on this. Why? Why would you? I don't know. People blame everything on screens. And I was just like, eh, I don't really buy it. But then like. Let me tell you what happened though, when I talked about it with this researcher.

[Wendy Zuckerman]

Uh huh.

[Karen Heffler]

I'm Karen Heffler. I'm a researcher at Drexel University.

[Meryl Horne]

And unlike me, Karen was like, well, it actually makes total sense to look into screens, particularly when you look at the timeline here.

[Karen Heffler]

How has the world changed over this period of time? Babies, Children used to be first exposed in the 70s at about four years of age. That's the first time they watched any television. By about 2006 it was at 4 months of age.

[Meryl Horne]

But it's not just that the timing fits here. There is some evidence linking screens to autism. Like there are studies that have found that kids who are exposed to more screen time when they're really little, maybe like a few hours every day when they're one or two, those kids are more likely to either show autistic traits later or even be diagnosed with autism later in life.

[Wendy Zuckerman]

Mm. And that's not that much screen time? One or two hours, right?

[Meryl Horne]

Yeah. Like some studies find even that much might make a difference. And then Karen did this really interesting pilot study looking at whether getting families to like cut down on screen time might decrease their autism symptoms.

[Wendy Zuckerman]

Right.

[Meryl Horne]

It was really, really tiny. So they only had nine families. But I thought it was interesting cause the what they had them do was pretty dramatic. So they chose families with autistic kids who are watching a lot of screen time. So before the study started, the screens were on for an average of five and a half hours every day.

[Wendy Zuckerman]

Wow. Yeah.

[Meryl Horne]

Then during the study it was six months long. They got them to cut it down to like five minutes of screen time a day.

[Wendy Zuckerman]

Not even a full episode of Bluey.

[Meryl Horne]

No, exactly. And so she looked to see if this had an effect and it seemed like it did work. Like the kids had a decrease in some autism related behaviors by the end of the study, specifically in social skills and repetitive behaviors. So before the study, the children at.

[Karen Heffler]

The beginning, a lot of them didn't really pay attention to their parents. They might be spinning wheels on a car or lining up items, or just distracted with sensory like flapping or looking at lights, not really interested.

[Meryl Horne]

And then after basically no screen time.

[Karen Heffler]

The eye contact got better. They wanted to be with the parents. They started paying attention to people.

[Wendy Zuckerman]

Mm, that feels promising.

[Meryl Horne]

Yeah. But then Karen told me about something that really changed the way that I thought about the study.

[Wendy Zuckerman]

Uh huh.

[Meryl Horne]

So cutting down on screens was a big part of the study, but it.

[Karen Heffler]

Wasn'T just turning off the screens. We met with them for one hour every week and worked on strategies to help them engage their children socially. So eye contact. So if a baby coos or babbles, then the parent would smile back or maybe, you know, imitate the child. Or we would suggest that they hold interesting items to their children up to their eyes, and if they, if the child looked at them, then say, oh, great looking. Oh, I love to see your eyes. Really? Positive reinforcement.

[Wendy Zuckerman]

And so from other studies, do we know that that kind of positive reinforcement with a kid with autism helps them? Like, would you expect to see these results if you forget the screenshot and you just do the positive reinforcement?

[Meryl Horne]

Yes. I have a very satisfying study for you now because Karen told me about a study where they basically did that.

[Wendy Zuckerman]

Oh, okay.

[Meryl Horne]

So this one was a larger, proper, randomized, controlled trial with about 100 really young kids. And they had started to show some signs of autism. And what they did in the trial kind of reminded me of a lot of the things that Karen did in her study. Cause it was like teaching the parents how to pay attention to their kids, really closely responding to them and interacting with them.

[Wendy Zuckerman]

Right.

[Meryl Horne]

But they didn't tell them anything to do with screens.

[Wendy Zuckerman]

Perfect. Great. Okay, so then what happened?

[Meryl Horne]

Well, fewer of those kids were diagnosed with autism later.

[Wendy Zuckerman]

So then, so what do you think? How much do you think screens are playing a role here in this so called autism epidemic?

[Meryl Horne]

Well, it is a little tricky. Cause like, there are also other explanations why we might see a link between screen time and autism.

[Wendy Zuckerman]

Right.

[Meryl Horne]

Like, we know that a lot of kids who are autistic really enjoy watching screen. So maybe it's just that someone's already autistic and then maybe their parents, like, put the TV on more for them because they see that they're really happy. But like, that's not to say that screens are totally innocent here because, like, you can also imagine that, like, maybe there's a kid who is already on the autism spectrum and is watching like hours and hours of screen time every day instead of interacting with other people. Maybe they're more likely to end up with an autism diagnosis because their social skills aren't getting like a workout.

[Wendy Zuckerman]

Mm, that makes sense. But I think, bottom line, you don't seem to think there's evidence that screens are really behind this, this epidemic.

[Meryl Horne]

You know, maybe a little bit, but it's really hard to say how much.

[Wendy Zuckerman]

Okay, so here's where we're at. I don't know. I feel like we have not gotten that lion's share of these cases yet. I mean, we've, there's spring, there's more meerkat dinners here, but we're missing something big still.

[Meryl Horne]

Yeah, yeah. That's what we're gonna look at after the break. Something big. Hey, guys, it's Selena Gomez.

[Wendy Zuckerman]

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[Meryl Horne]

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[Meryl Horne]

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[Robert F. Kennedy Jr.]

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[Wendy Zuckerman]

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[Robert F. Kennedy Jr.]

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[Wendy Zuckerman]

Welcome back. Today on the show autism. What is causing the rise in cases? We talked about how there's a lot of things people pointing the finger at from plastics, which is maybe it plays some role here, but it's definitely not a slam dunk. Vaccines are a no. Screens are a maybe. People having kids when they're older, playing some role here, but not that much. Meryl, you've promised me something big. Yeah, the lion's share. I feel like we've earned it.

[Meryl Horne]

Yes, well, so one idea is that this actually just has to do with the way we're, like, deciding who has autism and who doesn't, and that basically.

[Wendy Zuckerman]

We'Ve decided a whole lot more people who would otherwise not be classified as having autism. Now all of a sudden, eh, you can join the party as well.

[Meryl Horne]

Yeah, yeah. And, you know, this is something that RFK Jr really rallied against. In his speech. He said that the idea that we are somehow, like, not catching all these cases in the past is, like, actually kind of insulting to the doctors who were practicing back then.

[Robert F. Kennedy Jr.]

Doctors and therapists in the past were not stupid. They weren't missing all these cases. The epidemic is real.

[Meryl Horne]

So to get to the bottom of this, I decided to call up a scientist who has been diagnosing autism for decades. This is Katherine Lord, professor at ucla.

[Wendy Zuckerman]

Did you ask her if she was stupid?

[Meryl Horne]

Yeah, that was my first question. Actually. My first question was about something else.

[Wendy Zuckerman]

Okay.

[Meryl Horne]

I was told by one of your colleagues that you are the diagnostic queen when it comes to autism.

[Katherine Lord]

Oh, dear. Well, I. With other people, not single handedly, by any means. I worked to develop the most commonly used diagnostic instruments that people use when they diagnose autism. That's where that came from.

[Meryl Horne]

She's also the diagnostic queen because she's been in this field through the, like, absolutely wild changes that have happened over the past few decades when it comes to how we. How we do this, how we diagnose autism, which I know it kind of sounds like a snooze fest, but it's, you know, it's actually the story of, like, how our understanding of what autism is has evolved. So let's start in the 1960s. Back then, we weren't even sure if autism was its own thing or if it was part of schizophrenia.

[Robert F. Kennedy Jr.]

Oh.

[Meryl Horne]

And this is kind of what we thought autism looked like then.

[Katherine Lord]

I mean, I think in the 60s, a person with autism would often be not verbal, like, not talking, and would be quite severely intellectually disabled. We were very focused on things like flapping your hands and looking at your fingers and the things that you can see right away.

[Wendy Zuckerman]

Mm.

[Meryl Horne]

This is when Catherine got into the field as an undergrad and she loved working with autistic kids and finding ways to connect with them, even, you know, when they weren't verbal. But then sometimes a kid would come in who would really challenge the Idea of what someone with autism was like. Like, Catherine remembers this one kid, oh.

[Katherine Lord]

I saw this little boy who had all kinds of language that just poured out of him. And in those days we had them parents sit in another room and watch us. And so he was not happy about that at all. He was about 4 and he had a lot of repetitive language and his nose was running and he started talking about, I don't want to be a rainbow, I don't want to be a reindeer, I don't want to be a reindeer. Running reindeer, I don't want to be a reindeer. And what he was talking about was he was crying and his nose was running and he had these phrases and he was trying to figure out how to say, you're making me cry. And people were like, boy, I don't know if he could be autistic. And he was as autistic as you could be.

[Wendy Zuckerman]

So wait, what made him, what else about him made it clear that he had autism?

[Meryl Horne]

Well, now we know that, like it's not necessarily that you don't have any language at all, but you know, the way he used language was really different. Like he would often repeat phrases over and over again. And so yeah, it's like not as simple as we thought. And so that was the 1960s, but that's kind of like limited definition of autism. Stuck around for a really long time.

[Wendy Zuckerman]

That you needed these severe traits.

[Meryl Horne]

Yeah, like really severe traits. And it was often accompanied by intellectual disability. But then even in 1980, this is when you see autism get its own entry in the dsm, which is the like bible for diagnosing psychiatric conditions. So now it's like it's not part of schizophrenia anymore. We got that right. But the description of autism is pretty intense. Like it says, quote, this disorder is extremely incapacitating, unquote.

[Wendy Zuckerman]

Uh huh.

[Meryl Horne]

But then there's kind of a turning point. The next version of the DSM comes out in 1987. So by then scientists had started to think about autism as like a looser kind of collection of traits. Like we still think that having trouble communicating is like a hallmark of autism, but maybe it's also that you're really interested in a specific thing.

[Katherine Lord]

So getting very focused on something, you know, that could be anything. I mean, it could be the same things other kids are interested in. So, you know, dinosaurs, but it also could be Scottish clans. Or we had somebody who loved newspaper editors. He was an expert on who were the editors of the major newspapers and could recite that. So it's, it's and it's not bad to have an interest. It's just that not being able sometimes to rein it in if other people are not so interested.

[Wendy Zuckerman]

So this is. I mean, the late 80s is exactly when Rain man came out.

[Meryl Horne]

Yeah.

[Wendy Zuckerman]

Right. And I mean, I'm sure with 20, 25 eyes, that movie does not hold up well. But it does show how much the image of autism, at least in the public's imagination, changed so much already by then. You know, he was a character that was a genius in some respects. I mean, like, he could memorize the phone book. Right?

[Meryl Horne]

Yeah. And just generally, we end up getting to this place where just because you're autistic doesn't mean that you're incapacitated. Like, it used to be described. Like, in some cases, you might be better at things than neurotypical people.

[Wendy Zuckerman]

And so we can see this expanding and expanding definition of autism, and they're.

[Meryl Horne]

Also kind of going along with this. We used to think that Asperger's syndrome was something different, right?

[Wendy Zuckerman]

Oh, yeah.

[Meryl Horne]

And now that's been rolled right up into autism spectrum disorder. It's all part of the same thing.

[Wendy Zuckerman]

Aha. Okay.

[Meryl Horne]

But I feel like this idea of what autism is is still changing right now. It's like the tectonic plates are still shifting, and in, you know, another 50 years, it could just look different again.

[Wendy Zuckerman]

So what. What is the sort of suggestion here is that this autism epidemic, these new cases of autism, it's actually just because we have changed our definition of autism, we're not just capturing these folks who have real difficulty verbalizing, communicating, maybe also happen to have severe intellectual disability. We're now opening up the definition to include folks who are neurodivergent in more subtle ways.

[Meryl Horne]

Yeah.

[Wendy Zuckerman]

And. But that would mean you should be able to see that in the data. Right? And, yeah, RFK Jr says that most of the new cases are, quote, severe, which would go against this idea that, oh, it's just our changing diagnosis. Right.

[Meryl Horne]

Yeah, he's kind of like, no, now is when we're seeing all these severe cases. Like, he painted this really dark picture where he called this a tragedy and said that, quote, autism destroys families.

[Robert F. Kennedy Jr.]

Most cases now are severe. So about 25% of the kids who are diagnosed with autism are non verbal, non toilet trained.

[Meryl Horne]

And, yeah, that's, like, in pretty stark contrast to this idea that autism is actually just going up because of this definition kind of expanding.

[Wendy Zuckerman]

Yeah. So who's. Right? I mean, do we. Do we have any numbers here?

[Meryl Horne]

So a couple researchers told me, like, oh, you have to talk to Maureen Durkin because you just presented this work at this huge autism conference that looks at that exact question.

[Wendy Zuckerman]

Oh, cool.

[Meryl Horne]

So, yeah, she's an epidemiologist at the University of Wisconsin, Madison. Hi, Meryl, can you hear me okay? Hi, I can hear you. Great. So Maureen basically found a new way to like, dig into the data to look at what kind of kinds of autism cases are the ones that have been going up.

[Wendy Zuckerman]

Great, great.

[Meryl Horne]

So she did this. These are 8 year old kids from across the country. And the kind of timeframe she's looking at was from 2000 to 2016. And what she does is kind of divide autism cases up into different buckets where on one end you have what people might think of as like severe autism. So this is somebody who needs a lot of help when it comes to stuff like going to the bathroom, getting dressed, communicating their needs, that kind of thing. They're like day to day functioning.

[Wendy Zuckerman]

Yeah.

[Meryl Horne]

And so actually, let's start there and find out like what Maureen saw when she looked at at those kids. Over time, this group did not increase at all. It did not. In fact, it declined a slight bit.

[Wendy Zuckerman]

Whoa.

[Meryl Horne]

But it didn't increase.

[Wendy Zuckerman]

Did not increase. Mm, mm.

[Meryl Horne]

And when she looked at what cases were going up, it was a totally different group of kids.

[Katherine Lord]

The biggest increase was those with no.

[Meryl Horne]

Actual measurable functional limitations. Oh, yeah. The biggest increase was in that group because that was a very small group in 2000. Yeah. So, right. So these are kids who are autistic who don't actually need any more help than neurotypical kids in their day to day life. And then Maureen also saw a rise in kids who maybe need like a little bit more help. And this research isn't out in a journal yet. It's in peer review now. But she presented it at this conference. So let me show you this graph that she presented there that kind of made a big splash.

[Wendy Zuckerman]

Uh huh.

[Meryl Horne]

So this is looking over time from 2000 to 2016.

[Wendy Zuckerman]

Oh, yeah. And you can see really clearly that the severe cases, they have dropped a tiny bit, maybe barely statistically significant. She got the error bars there. But it's really these milder forms. That's what's. That's the lion's share, Meryl.

[Meryl Horne]

Yeah, we found it.

[Wendy Zuckerman]

We found it, we found it.

[Meryl Horne]

So I asked Maureen, and so these were the cases that we were kind of missing decades ago. It appears that. Well, we know that's true, that as the definition of autism has expanded over time, we're including a wider spectrum. We did reach out to RFK's team to ask them what they made of this research. They didn't address that question, but instead, they doubled down on the idea that there is an environmental toxin that's causing this. I also asked Katherine Lord about this. If we are labeling more people today with this label, how much does that really matter when it comes to explaining why it looks like autism has gone up?

[Katherine Lord]

I mean, I think it accounts for most of it. And I think all of us worry that we're consuming plastics and things that we, you know, that we wouldn't choose to eat or breathe, but that can't account for most of what's gone on.

[Meryl Horne]

So in a press conference recently, Health and Human Services Secretary Robert F. Kennedy Jr. Basically kind of pooh, poohed this idea that it is just about changing diagnosis. Um, so is he wrong?

[Katherine Lord]

Basically, yeah, I think he's wrong.

[Meryl Horne]

And there are other things that might explain why we're seeing more and more cases of autism. Like, it's become standard to screen kids when they go to the pediatrician for autism. There's also just more awareness. A lot of researchers told me they think that could be playing a role here.

[Wendy Zuckerman]

Right? Yeah.

[Meryl Horne]

And that leads me to the final thing I wanted to mention, because, like, now that we've got this bigger understanding of autism, of what it can be, it's really shifted the picture of what an autistic person could look like. So in the past, there was a strong bias towards diagnosing boys with autism.

[Robert F. Kennedy Jr.]

The hardest thing was that if you're female, you're not autistic, because it's very, very rare.

[Meryl Horne]

So this is Dina Gassner, a researcher at Drexel University. And, yeah, she told me that she's autistic, and she wasn't diagnosed until she was 40. And she said that for so long, doctors had this idea that autism was pretty rare in girls, where today you see that ratio sort of leveling out. And it also used to be more common to get diagnosed with autism if you were white, but those numbers are also leveling out. So now in the US White kids are not more likely to be diagnosed with autism compared to other racial groups. And it's not necessarily that, you know, these people weren't getting any diagnosis at all. In a lot of cases, they were getting misdiagnosed with something else. This happened to Dena.

[Robert F. Kennedy Jr.]

I was misdiagnosed with bipolar.

[Meryl Horne]

Oh, wow.

[Robert F. Kennedy Jr.]

And that is not uncommon. Bipolar and personality conditions are often diagnosed in autistic women before they get their right diagnosis. And the Problem with that is the medications that come with that.

[Meryl Horne]

Yeah. So for Adena, even though she never had bipolar, she was put on lithium. What did the lithium feel like?

[Robert F. Kennedy Jr.]

Oh, I was completely dysfunctional. You know, I could not. I just wasn't a human being for that timeframe. And so I finally found a doctor who was actually treating my children who said, I think you might want to reevaluate where you are. And he saved my life.

[Wendy Zuckerman]

Gosh.

[Meryl Horne]

Yeah. Researchers have told me that this is actually kind of a common thing that, you know, a parent will take their kid in to get diagnosed with autism, and then they'll walk away with their own diagnosis that was missed years ago.

[Wendy Zuckerman]

Oh, right. Which goes back to this idea that genetics is so important to this epidemic that we're seeing, because now instead of one case, you have two cases.

[Meryl Horne]

Yeah. But, you know, like, it's funny, we keep using that word, epidemic to describe what's going on, and I don't think that's actually the right word to describe, like, the rising cases. I mean, lots of scientists have told me that, like, the real epidemic here is that we are failing so many autistic people who need better services, that there's an epidemic. There are, but the idea that the rising cases is in and of itself a tragedy or an epidemic. I asked Dina about that. How do you feel about the fact that we are seeing more and more people being diagnosed with autism today?

[Robert F. Kennedy Jr.]

I think it's fantastic.

[Meryl Horne]

Yeah. So for Dina, it was like the start of really understanding who she was and also helped her find a community of other autistic people and also other moms of autistic kids, since her son is autistic too.

[Robert F. Kennedy Jr.]

I was seeing that mothers of autistic kids were often abandoned by their. Their girlfriend network. And we need nurturing and we need community. And so I started a group called Margarita Moms, and we drank margaritas and we went to see Magic Mike. And, you know, we. We. And our rule was, you're not allowed to talk about your child, but you can talk about your undiagnosed was. But, you know, and, you know, and we had fun. And so we're seeing this rising, you know, army of these really neurodivergently intact, healthy, well adjusted autistic kids that are coming up. And my grandma jeans get all fired up. Like, I'm like, oh, that's so awesome. Let me see your child dancing to Taylor Swift. It's joy. It's autistic joy that's coming out of this newer population. And so that's why much of our community is pushing back on these highly stigmatizing languages, assigning tragedy mindsets to this population. When we experience access to communication, unconditional love, and meaningful usable supports. We have healthy, well adjusted, but autistic people. And that's a good thing.

[Wendy Zuckerman]

Yeah. Well, we've solved the case of the so called autism epidemic.

[Meryl Horne]

Yep.

[Wendy Zuckerman]

Merry Christmas. Thanks, Meryl.

[Meryl Horne]

Thanks, Wendy.

[Wendy Zuckerman]

That's science versus. So science versus is going to be on a little break until September while we work on new episodes. And I thought to celebrate this last episode of the season, I would invite the team to our citations chat.

[Meryl Horne]

Yay.

[Wendy Zuckerman]

Hi, everyone.

[Meryl Horne]

Hi. Yay. No, Anna baby.

[Wendy Zuckerman]

Anna baby's here too. How many citations are in this week's episode? 68. Katie, what was your favorite moment of the season?

[Meryl Horne]

I think my favorite moment of the.

[Wendy Zuckerman]

Season has to be method. Ooh, Matt, I just laugh. It's my new vocal stem. I say it at least like a couple times a week for sure. So, Michelle, favorite moment.

[Meryl Horne]

I really loved bird flu and learning about manure lagoons. That was just the weirdest fun fact in the world.

[Wendy Zuckerman]

Vlad, I just have to pick the.

[Meryl Horne]

Fact that we finally made our episode on squirting.

[Wendy Zuckerman]

Of course. It was just a delight and it was a long time coming. Ooh.

[Meryl Horne]

Meryl, I have to say the carnivore diet episode last week was just so fun. Something about the top. It was just so like, bro y and hardcore. I just like it really made my dopamine flow.

[Wendy Zuckerman]

All right then, to cap us off for this season. We'll be back in September. Ways to get in touch to pitch us ideas are all in the show notes. Please do that. The citations link to the transcript. It's also in the show notes. But to cap us off. All right, everyone, let's say primal.

[Meryl Horne]

Primal. Primal.

[Wendy Zuckerman]

Is there a better word? Is there a better science word?

[Meryl Horne]

Peer reviewed literature.

[Wendy Zuckerman]

Thank you so much for listening and we will see and you will hear us very, very soon. Thanks, guys. Bye. Bye, boy.

[Meryl Horne]

Bye.

[Wendy Zuckerman]

This episode was produced by Meryl Horne with help from me, Wendy Zuckerman, Aketti Foster. Keys, Michelle Dang and Rose Rimler. We're edited by Blythe Terrell. Fact checking, research assistance and consulting by Erica Akiko Howard. Mix and sound design by Bobby Lord. Music written by Emma Munger. So Wiley, Peter Leonard, Bumi Hidaka and Bobby Lord. A special thanks to the researchers that we reached out to, including Professor Karen Pearce, Professor David Mandel, Professor Deborah Bilder, Professor Frederic Bonnet Briol, Dr. Helen Tager Flusberg, Dr. Isabella, Delilah, Catherine Byrne, Professor Sven Bolte and Dr. Whitney Warsham. Special thanks also to Lynn Keys and Bella Viseka, Chris Souter, Elise and Dylan, Jack Weinstein and Hunter Joseph, Lavelle Wilson and the Zuckerman family. Science Versus is a Spotify Studios original. Listen to us for free on Spotify or wherever you get your podcasts. We are everywhere. If you are listening on Spotify, then follow us and tap the Bell icon so you get notifications when new episodes come out. We'll be back in your ears in September and I'm Wendy Zuckerman and I'll back to you then.