Donald Trump’s Health Secretary Robert F. Kennedy Jr. is about to release a report about the possible causes behind the rising numbers of people with autism.
RFK Jr. has long said the cause may be common childhood vaccines such as the measles, mumps and rubella jab – a claim that the vast majority of scientists say is wrong.
The report will also blame other factors, including women taking paracetamol during pregnancy, and having low levels of the prenatal vitamin folic acid, according to The Wall Street Journal.
RFK Jr. has also previously said that the rise must be due to something harmful in the environment.
In April, he launched an inquiry involving “hundreds of scientists” to find out what that environmental factor may be, culminating in the forthcoming report. “By September, we will know what has caused the autism epidemic and we’ll be able to eliminate those exposures,” he said at the time.
Most medical bodies recommend paracetamol as one of the few pain relievers it is safe to take during pregnancy. And last year a large study found such use was not linked with a higher risk of autism, ADHD or intellectual disability.
Low folic acid is not recognised as causing autism, but it does raise the risk of the birth defect spina bifida, when the spine does not form properly in the womb. Women are advised to take prenatal vitamins containing folic acid from three months before conception if possible, and until they are three months pregnant.
Most scientists are sceptical of RFK Jr’s environmental theory of autism, however, what could be the real explanation?
RFK Jr. is right that autism diagnosis rates have been rising, in the US and in most western countries, for several decades.
In the UK, the rate of diagnosed cases of autism among children has increased by eight-fold over the past 20 years, according to a study of GP records. It is now thought that about one in 100 people are affected.
It may seem on the face of it that increasing exposure to some environmental toxin is an obvious suspect. But experts say there is a more compelling explanation – that diagnosed cases have risen because the definition has broadened.
Autism once meant having severe deficits in language and social interactions. Those affected may have been unable to speak or look after themselves.
Doctors now use the term autism to cover a much broader range in abilities.
The shift has been driven by several changes in the way autism is defined that expanded the term to include people with milder symptoms.
For instance, in 1994, the chief US psychiatry manual, which also influences UK doctors, introduced a new diagnosis called Asperger’s syndrome that was essentially a milder form of autism.
In 2013, the next edition of the book removed that term and folded Asperger’s into autism spectrum disorder.
“I am partly responsible for the explosion in rates,” Professor Allen Frances, a psychiatrist involved in the 1994 update, recently wrote in The New York Times.
Professor Frances believes broadening the criteria meant some people are being misdiagnosed as autistic, and for them, the label isn’t always helpful.
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“Our intentions were good, but we underestimated the unintended consequences of adding the new diagnosis,” he said.
A UK study from 2007 found that the rate of autism was the same in older adults as in younger adults and in children – as long as the same diagnostic criteria are used for each age group. However, none of the adults had received an autism diagnosis before the study.
This supports the idea that autism just wasn’t being recognised at the same rate as it is today, said Professor Dorothy Bishop, an autism specialist at the University of Oxford.
Reduced stigma around autism
Other possible contributors to the rising case numbers are the reduced stigma around the term. Many people at the milder end of the spectrum now don’t see autism as a disorder at all, instead seeing it as just a different way of interacting with the world, a form of neurodiversity.
“As more people talk about [it], and are diagnosed as autistic, others recognise and identify their own autistic traits and experiences,” said Mel Merritt, head of policy and campaigns at the National Autistic Society.
“Greater understanding and research also means more medical professionals can recognise autism, whereas in the past particularly women and girls may have been misdiagnosed.”
Another driver could be parents seeking autism diagnoses for children if they are having difficulties at school, either in their work or friendships.
Although it can take years to get the right help, a diagnosis can eventually lead to more support, such as extra exam time and the ability to take breaks from lessons.
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Could there be some environmental factor that is also contributing to the rise in cases, as well as the expanding definition? That cannot be ruled out with 100 per cent certainty, said Professor Bishop. “One has to be cautious.”
But it’s unclear how RFK Jr’s team could have uncovered new evidence about this in the past five months. “Kennedy’s coming along, as if nobody’s ever touched these subjects before,” she said. “It’s terribly annoying.”
We don’t know yet exactly what RFK Jr’s report on autism will say.
But Professor Frances predicted that vaccines will yet again bear the brunt of the blame. “RFK Jr. is using the completely unproven pretext of environmental toxins to support his wildly wrong conspiracy theory about vaccines,” he told The i Paper. “This is madness.”
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