Tylenol and Autism: What’s True and What Isn’t

Summary

Podcast Summary: Short Wave – "Tylenol and Autism: What’s True and What Isn’t"

Date: September 24, 2025
Host: Sydney Lupkin (NPR)
Guest: Dr. Helen Tager Flusberg (Professor Emerita, Boston University; Founder, Coalition of Autism Scientists)
Duration: ~16 minutes

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Episode Overview

This episode of "Short Wave" critically examines a recent government announcement linking acetaminophen (Tylenol) use during pregnancy to increased autism risk. Host Sydney Lupkin interviews Dr. Helen Tager Flusberg—an accomplished autism researcher—to unpack what’s actually known (and not known) about the science behind these claims. The conversation also dives into the complexities of autism diagnosis trends, the evidence (or lack thereof) for Tylenol and autism, and the administration’s comments about autism and new “treatments.”

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Key Discussion Points and Insights

1. The FDA Announcement and Political Context

[00:28 - 01:32]

• The U.S. president, joined by Health Secretary Robert F. Kennedy, Jr. and Dr. Mehmet Oz, claimed that acetaminophen used in pregnancy raises autism risk and called for drug label changes.
• The same announcement recommended Leucovorin (folinic acid, a form of vitamin B) as an autism treatment, though it's not FDA-approved for such use.
• Dr. Tager Flusberg and much of the scientific community were blindsided by what they saw as “extremist” and unsupported claims.
  • Quote: “This has been the most devastating week of my career. I had no idea how extremist the perspective would be.”
    (Helen Tager Flusberg, 01:32)

2. Autism Rates: What’s Really Going On?

[04:00 - 05:31]

• Autism prevalence in the US has shifted from 1 in 150 children (25 years ago) to 1 in 31 (most recent CDC data).
• Dr. Tager Flusberg attributes this increase to:
  • Greater public and clinical awareness of autism.
  • Expanded diagnostic criteria and services.
  • The allowance of double diagnoses (e.g., ADHD and autism), which wasn’t permitted until about a decade ago.
    • Quote: “Even up until 10 years ago, if you had ADHD, you would not be allowed...to have a second diagnosis of autism... We know that in children, up to half of them may not only have autism, but also meet diagnostic criteria for ADHD.”
      (Helen Tager Flusberg, 04:22)

3. The Science Linking Acetaminophen (Tylenol) and Autism

[05:31 - 08:57]

• Over 40 observational studies have found a small statistical association between prenatal acetaminophen use and autism. However:
  • Observational studies can’t establish causality.
  • Many confounding factors exist: Maternal health, genetics, and other underlying conditions may affect both acetaminophen use and autism risk.
  • The data are “noisy”: Reliance on maternal recall about OTC medication is imprecise.
    • Quote: “...there’s a small association. But we cannot, from these kinds of observational data, make any claims about causality.”
      (Helen Tager Flusberg, 06:35)
    • Quote: “The data we have on the actual use of acetaminophen is what I call noisy data. Okay. It's not the highest quality.”
      (Helen Tager Flusberg, 08:13)

4. Leucovorin (Folinic Acid) as an Autism Treatment?

[08:57 - 12:29]

• Leucovorin, a form of folinic acid (B vitamin), is under discussion as a potential autism treatment.
  • It’s FDA-approved for offsetting chemotherapy toxicity, not autism.
  • Evidence supporting its effectiveness for autism is limited to a few small-scale, preliminary studies.
  • No clear data on which symptoms might improve or appropriate dosing.
  • The rush to promote it for autism jumped normal regulatory steps and was met with skepticism by autism scientists.
    • Quote: “Picking out Lucavorin was an easy target. I’ve been in this field for decades now, Sydney. We have seen this story play out so many times...”
      (Helen Tager Flusberg, 11:28)
• There are real risks in self-prescribing supplements with no guidelines:
  • Quote: “...since there’s no guidelines at all on dosage for Leucovorin. If I was a mom and buying this tomorrow, I’d have no idea how much to give. I’d be relying on guidance from some other mom to tell me.”
    (Helen Tager Flusberg, 12:03)

5. Tylenol Use in Pregnancy: Dangers of Overcorrection

[12:29 - 13:31]

• The administration claimed there are “no downsides” to avoiding Tylenol. Dr. Tager Flusberg strongly disagrees:
  • Pregnant women need to treat conditions like fever and infection; untreated fever during pregnancy is itself a known risk factor for autism and other complications—far higher risk than that posed by Tylenol.
  • Avoiding Tylenol may lead people to seek even less safe alternatives.
    • Quote: “If you're a pregnant woman and...you are running a fever...the downside of not taking Tylenol is...you are prolonging the time... you are running a fever. Infection during pregnancy and stress...increase the risk for autism well above the level of risk that’s posed by Tylenol.”
      (Helen Tager Flusberg, 12:40)

6. The Administration’s Framing of Autism

[13:31 - 15:31]

• The administration described autism in a way Dr. Tager Flusberg calls “appalling” and “callous,” failing to recognize the diversity of autism or the humanity and love within autistic families.
  • “Profound autism,” representing about 25% of the autistic population, often involves greater challenges, but that’s not the whole picture.
  • The rhetoric ignored autistic people who function at very different levels and misrepresented the disorder.
    • Quote: “They simply don’t see these people with disabilities as having any humanity, as being loved by their family. But importantly, profound autism represents a quarter of the population and the rest...are functioning at very different levels. And he was not speaking about them at all.”
      (Helen Tager Flusberg, 14:33)

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Notable Quotes & Memorable Moments

• “This has been the most devastating week of my career.”
  (Helen Tager Flusberg, 01:32)
• “You can’t take a simple one-to-one relationship and make any kind of causal connection.”
  (Helen Tager Flusberg, 07:40)
• “The data we have on the actual use of acetaminophen is what I call noisy data. Okay. It’s not the highest quality.”
  (Helen Tager Flusberg, 08:13)
• “We have seen this story play out so many times...small scale study, promising findings...then the randomized controlled trials...there’s no, there there’s.”
  (Helen Tager Flusberg, 11:38)
• “Profound autism represents a quarter of the population and the rest...are functioning at very different levels...It’s very painful to see autism so misrepresented.”
  (Helen Tager Flusberg, 14:33)

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Timestamps for Key Segments

• [00:28 – 01:32]: Recap of government announcement
• [04:00 – 05:31]: Changes in autism rates and contributing factors
• [05:31 – 08:57]: Detailed look at the Tylenol-autism research landscape
• [08:57 – 12:29]: Discussion on Leucovorin (folinic acid) as an autism treatment
• [12:29 – 13:31]: Risks of avoiding Tylenol during pregnancy
• [13:31 – 15:31]: Critique of administration rhetoric about autism

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Conclusion

This episode powerfully rebuts oversimplified claims about Tylenol and autism, emphasizing the limits of current research and the importance of perspective in autism discourse. Dr. Tager Flusberg warns against both unsupported medical guidance and stigmatizing language, reinforcing calls for evidence-based policy and compassion for autistic people and their families.

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(For full context and expert nuance, listeners are encouraged to hear Dr. Tager Flusberg's insights in the episode.)

Transcript

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[Sydney Lupkin]

You're listening to SHORTWAVE from npr. Hi shortwavers. Sidney Lupkin in the host chair today.

[Unidentified Guest / Interviewee]

Thank you very much.

[Sydney Lupkin]

You probably heard the news this week.

[Unidentified Guest / Interviewee]

Effective immediately, the FDA will be notifying physicians at the use of, well, let's see how we say that acetaminophen, acetaminophen, is that okay, which is basically commonly known as Tylenol during pregnancy can be associated with a very increased risk of autism.

[Sydney Lupkin]

The president, flanked by Health Secretary Robert F. Kennedy, Jr. And head of the Centers for Medicare and Medicaid, Dr. Mehmet Oz, said the common painkiller was to blame for rising autism rates. They said they would update the drug's label, and they also said they would work to update the approval for a vitamin B drug, Leucavorin, as a treatment for autism.

[Unidentified Guest / Interviewee]

That's one of the things that I'm very, very happy about.

[Sydney Lupkin]

But the lack of scientific evidence for this new guidance has experts worried.

[Helen Tager Flusberg]

This has been the most devastating week of my career. I had no idea how extremist the perspective would be.

[Sydney Lupkin]

Helen Tager Flusberg is a professor emerita at Boston University in the Department of Psychological and Brain Sciences, and she's the founder of the Coalition of Autism Scientists. Autism is a developmental disability caused by differences in the brain.

[Helen Tager Flusberg]

It impacts the development of a child's cognitive, language, communication and social abilities, and it often impacts their sensory processing, their sensory sensitivities.

[Sydney Lupkin]

But it's a spectrum. The symptoms can vary. And when it comes to the cause, there are some things scientists know and some things they don't. For instance, we know that exposure to air pollutants and pesticides are linked to higher rates of autism in the population. But for any individual person with autism, it's impossible to say exactly what caused their autism. Today on the show, we'll unpack what this latest announcement means for pregnant people and families with autism. You're listening to Short Wave, the science podcast from npr.

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[Sydney Lupkin]

So, Helen, if we look at the official data coming from the Centers for Disease Control and Prevention about autism, we can see that 25 years ago, the prevalence was 1 in 150 children. But the latest count is that it's 1 in 31 children. So what's going on there? What, what context do we need to understand that?

[Helen Tager Flusberg]

First of all, the awareness of autism has radically changed. 25 years ago, when people asked me what I did, many of them had never heard of autism. Now we take more subtle impairments in social communication or behavior differences. And Even up until 10 years ago, if you had ADHD, you would not be allowed, according to the diagnostic manual, to have a second diagnosis of autism. And in this case, that's really surprising and of course, going to make a huge difference because we know that in children, up to half of them may not only have autism, but also meet diagnostic criteria for adhd. But I think most important, what we know has changed radically is the availability of services, diagnostic services and intervention services.

[Sydney Lupkin]

So let's dive into sort of the research on acetaminophen and autism. Can you give us a sense of the landscape of the research that's out there? Linking the two or not linking the two.

[Helen Tager Flusberg]

Okay. So we have well over 40 studies, I think, at this point, that are what we call observational. And we can also then try and link it to whatever data we have available on whether mothers took Tylenol and how much Tylenol, and when, if those data are available and we can ask the question. So if we have. I'll be simplistic here. We have 100 children diagnosed with autism, okay. And 60 of those mothers reported having taken Tylenol during pregnancy, and 40 of them didn't. And then when we look at the patterns, we see that more of the children diagnosed with autism, their moms took Tylenol in pregnancy. It's not a huge difference, but it is there. And that's why we say there's a small association. But we cannot, from these kinds of observational data make any claims about causality. But then we could take it a step further and ask the question, are mothers of autistic children more likely to be sick to have those health conditions? Are they more likely to have pain? These might both be related to genetic predispositions or especially in and of itself, the more prone to poor health that I think we know, maternal health is an important risk factor, not just infections, but also other health conditions that they might have. So we see that these moms who are taking Tylenol may well be different in lots of different ways. So you can't take a simple one to one relationship and make any kind of causal connection.

[Sydney Lupkin]

So one follow up question that I have is, you know, because acetaminophen is usually over the counter, does that make it a challenge to get good data because there's not always a medical record for a cash purchase at cvs?

[Helen Tager Flusberg]

I think you hit on an extremely important point. Even the very best study can only rely on what mothers report. They all rely on sort of retrospective report. Maybe at the end of the pregnancy. Mothers are asked, did you take Tylenol during your pregnancy? And the further away they are from the time when they took the pregnancy, the less likely they are to remember. The data we have on the actual use of acetaminophen is what I call noisy data. Okay. It's not the highest quality.

[Sydney Lupkin]

Wow. So the other item that came up during this week's news conference was leucovorin, or folinic acid as a possible autism treatment. But it isn't currently FDA approved for that. It's usually used to counteract the toxic effects of chemotherapy. And gsk, the maker of the original brand name product says it will work on submitting a supplemental new drug application to get this added to the label. Is there any evidence that this can help people with autism? How hopeful should people be here?

[Helen Tager Flusberg]

Okay, so I don't think anyone would think that it's going to be helpful for every individual with autism. That said, there have been a couple of small scale studies and these small scale studies have had some promising preliminary findings. At this point, I can't tell you exactly which symptoms we could expect to see change if you put a child on leucovorin. I think the idea of giving a drug for conditions that it wasn't originally thought, I mean, that happens all the time in medicine. But now the plan is for the FDA to jump over 27 intermediate steps which they put in place for any other drug recommendation.

[Sydney Lupkin]

So just to recap, you don't think that leucomorin should be taken to treat autism?

[Helen Tager Flusberg]

Not yet. I think what we do want are the kinds of clinical trials that the FDA typically requires before they provide approval for any medication. Now, you actually don't need a prescription. It's a folinic acid. It's a kind of variant of a B vitamin. And you can buy it, and most especially you can buy it through all the wonderful places and companies that sell supplements through the wellness influences. And these are, you know, a significant part of the whole Maha movement. And that's why none of us cynics in the field was surprised to see that of anything, everything. In terms of promising intervention, picking out Lucavorin was an easy target. I've been in this field for decades now, Sydney. We have seen this story play out so many times. You know, there's a small scale study, promising findings for some new drug treatment for autism. Everybody climbers to Hubbard. And then they actually run the randomized controlled trials and there's no, there, there's.

[Sydney Lupkin]

Are there harms of taking it?

[Helen Tager Flusberg]

So, yes, since there's no guidelines at all on dosage for leucomorin. If I was a mom and buying this tomorrow, I'd have no idea how much to give. I'd be relying on guidance from some other mom to tell me. Because physicians right now are not recommending leucovorin as a treatment for autism.

[Sydney Lupkin]

So going back to autism and Tylenol, during the press conference, President Trump also said there were no downsides to avoiding or not taking Tylenol. Is that the case?

[Helen Tager Flusberg]

No. There are downsides to not taking Tylenol. If you're a pregnant woman and you are running a fever, you have a serious infection. The downside of not taking Tylenol is that you are prolonging the time that you are running a fever. And, and infection during pregnancy and stress during pregnancy, we do know, increase the risk for autism well above the level of risk that's posed by the Tylenol. I'd also say the downside is women will turn to an alternative way to treat their pain and fever. And those alternatives are surely less safe than Tylenol.

[Sydney Lupkin]

At the heart of a lot of this administration's actions, including around certain vaccines, is also this idea that autism is inherently bad. As an autism researcher, what do you think about that characterization?

[Helen Tager Flusberg]

So certainly back in April, Secretary Kennedy gave his first press conference, and the language that he used to describe autism was simply appalling yes, he's talking in some ways about people with profound autism. I study profound autism and I'm under no illusions. It is very complicated. It can be very difficult. It's a huge challenge, especially for the individual who's profoundly autistic. But the impact on the family can also be huge. But at no time did he speak with any humanity or recognize the love that the family members have for their profoundly autistic person. And then we had a repeat performance yesterday, not only by Secretary Kennedy, but this time by President Trump. They simply don't see these people with disabilities as having any humanity, as being loved by their family. But importantly, profound autism represents a quarter of the population and the rest of the population are functioning at very different levels. And he was not speaking about them at all. But they, too, have autism. And so it's as if he's ignoring that. There's enormous variability in the expression of this disorder. So, yes, it's very painful to see autism so misrepresented and represented in such a callous way.

[Sydney Lupkin]

Helen, thank you so much for coming on the show.

[Helen Tager Flusberg]

Oh, it's my pleasure.

[Sydney Lupkin]

This episode was Produced by Burleigh McCoy, edited by Brent Baughman, and fact checked by Tyler Jones. The audio engineer was Patrick Murray, Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Sydney Lupkin. Thank you for listening to Short Wave from npr.

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