Health Conditions
A Question for the New MAHA Commission: What’s Behind Sharp Rise in Autism Among Blacks, Hispanics?
In little more than 20 years, autism has shifted from a condition diagnosed mainly among higher-income whites to one that increasingly burdens lower-income and minority families. Understanding that trend can help advance our understanding of the root causes of the neuroinflammation that leads to autism.
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Like many Americans, I am overjoyed by the confirmation of Robert F. Kennedy Jr. as our new secretary of Health and Human Services. I am grateful to President Donald Trump for supporting him and for establishing a Make America Healthy Again (MAHA) commission to address the root causes of America’s escalating health crisis.
The MAHA commission will focus initially on the rise in childhood chronic diseases, including the dramatic increase in autism prevalence, which has climbed from 1 in 10,000 during Trump and Kennedy’s childhood to 1 in 36 today.
This latter statistic is from the Centers for Disease Control and Prevention (CDC) Autism and Developmental Disabilities Monitoring (ADDM) network published in 2023, which reported on 8-year-olds born in 2012.
The rise in autism is not happening in a vacuum but rather in the context of increasing childhood rates of many other autoimmune and hyperreactive immune system disorders, including asthma, severe food allergies, attention-deficit/hyperactivity disorder or ADHD, diabetes and pre-diabetes.
However, more than any other condition, autism has captured parents’ attention — and it was the issue that drew Kennedy to his work on children’s health in the early 2000s.
Despite my gratitude for the new federal commitment to addressing childhood chronic disease, I can’t help but wonder if the professed MAHA goal of seeing results within two years is feasible — at least with respect to autism, given that the median age of diagnosis is 4 years old.
I would like to suggest that U.S. Department of Education Individuals with Disabilities Education Act (IDEA) data, specifically for 3- to 5-year-olds, can provide a useful metric of progress in a relatively short time (albeit more realistically in three to four years than in two years).
These data are published annually within one year of the completed school year, in contrast to the approximately 3-year lag of the biannual CDC ADDM reports. IDEA tends to be erratic in some states and lacks some of the important details provided by ADDM, e.g., on the percentage of co-occurring intellectual disability.
However, the 3- to 5-year-old IDEA data are broken down by race/ethnicity and provide a generally reliable bellwether of trends to come in the ADDM reports.
Figure 1. Autism Spectrum Disorder (ASD) prevalence among 3- to 5-year-olds. Data are based on ASD counts from U.S. Department of Education Individuals with Disabilities Education Act annual reports from 2000-01 to 2023-24 and are aggregated across all U.S. states.*
The most recent 3- to 5-year-old IDEA data have largely recovered from COVID-19-era disruptions and show an ongoing rise in autism among all races, with increasing divergence along race/ethnicity lines. By 2023-24, the nationwide rates among Hispanic and Black children appear to exceed those among whites by about 55% and 70%, respectively.
In little more than 20 years, autism has shifted from a condition diagnosed mainly among higher-income whites to one that increasingly burdens lower-income and minority families.
In general, those families are less able to afford the alternative treatments not covered by insurance or the special diets that wealthier families have used to heal their child’s co-occurring medical conditions, which can translate into improved behavioral symptoms.
My recent conversation with a friend who teaches special education in a Title I school illustrates the extent of the problem. My friend noted the critical shortage of teachers and therapists nationwide to work with children with special needs. These are high-burnout jobs that can be overwhelming for teachers, who have high caseloads with intense behaviors that need to be managed.
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Schools often don’t have a good way to address student needs because they focus on a behavior/psychological model that doesn’t address underlying physical health issues. Many children simply don’t feel well. Their stomachs hurt, they have allergies, sensory issues, eczema, sleep disorders and headaches.
To compound the problem, public schools often feed children a diet of processed food loaded with sugar, corn syrup solids, genetically modified organisms or GMOs and more. Teachers resort to using junk food as a reward to incentivize and manage behavior. This only makes kids feel worse. Children are grazing all day, which is not good for their digestive system, and in many cases are dealing with appetite suppression brought on by their ADHD medication.
It is difficult for effective teaching to happen in such an environment, as many of these children need to be physically healed before they can be asked to sit quietly in a classroom to learn.
One would expect Democrats, who care about social justice and children, to strongly support efforts to address the heartbreaking situation and growing inequalities described above. Yet all 47 Democratic senators voted against Kennedy.
Many furthermore made unkind and unfair accusations against him during his confirmation hearings. Among those accusations, none was more off base than the claim that the CDC would have figured out what is causing autism by now (more than 35 years after the steep rise began in the late 1980s) if only Kennedy hadn’t sowed seeds of doubt about “settled science.”
In fact, one has only to skim the 2023 CDC ADDM report to grasp its striking lack of curiosity about what is causing the rise in autism. The report presents devastating results yet manages to fill eight pages of text without ever addressing the key question: Why is this happening?
A new CDC ADDM report is due out this spring on 8-year-olds born in 2014. If the IDEA data are any guide, the ADDM report will show an ongoing rise in autism with increasing disparities by race/ethnicity.
With Kennedy now at the helm, we can hope for a more meaningful analysis of why these trends are occurring. A priority for this analysis should be to explain why autism prevalence among Black and Hispanic children has gone in a relatively short time from lagging white prevalence to substantially exceeding it. Understanding that trend can help advance our understanding of the root causes of the neuroinflammation that leads to autism and offer valuable insight into how we can reduce children’s risk going forward.
*Note: the IDEA data include 3- to 5-year-old children in early education programs but exclude 5-year-olds in kindergarten. Denominators are roughly estimated by state based on National Center for Education Statistics data.
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