What happens in the USA to disabled people reverberates in Canadian policies and classrooms (Part 3 – Autism Epidemic?)

In the last post in this series, I wrote about assumptions Robert F. Kennedy was asserting as facts. These included the idea that people in the USA are less healthy than in the past. I said that stating this as an absolute fact reminded me of how Autism Speaks promoted for years that there was an increasing “autism epidemic.” At the very least, both assertions miss a lot of subtleties and complexities that make them less than reliable as facts.

The phrase “autism epidemic” is misleading and not supported by epidemiological evidence, even though the prevalence of diagnoses has risen substantially. What is wrong with framing the increase in diagnosis as the increase in autism?

1. Confuses the prevalence of autism with the prevalence of autism being a new situation.

Using the phrase “autism epidemic” implies a sharp, recent surge in new cases or the rate of cases being identified now being higher than in the past. Long-term studies show that most of the rise in autism prevalence reflects diagnostic and systemic, not a new wave of brain pathology (2, 3, 9, 16). Adult surveys using modern tools often find rates similar to those in children, suggesting many autistic people were previously missed, not newly “created” (9, 10).

2. Ignores diagnostic and category changes

Research consistently shows that increases in identified autism are driven by:

• Broader diagnostic criteria and spectrum concepts (DSM-III → DSM-IV → DSM-5) (2, 3, 9. 16)
• Diagnostic substitution (children once labeled with intellectual or language disorder now labeled autistic) (9, 16) 
• Autism added as a special‑education category only in the 1990s, making later school counts look like “explosions” (3) 

These factors alone can produce several‑fold rises in prevalence without any true surge in incidence (2).

3. Overstates environmental or vaccine causes

“Autism epidemic” rhetoric is often coupled with claims of toxins or vaccines as the main drivers. Large bodies of work show no causal or even correlational link between vaccines and autism, and very few robust non-genetic environmental risk factors overall (1, 5, 9. 10, 12).

4. Ableist and stigmatizing implications

Scholars argue that “epidemic” language frames autistic people as a danger or scourge, fueling cure‑oriented and anti-vaccine movements and obscuring the need to support autistic lives here and now (3, 5, 14, 15).

In conclusion, rising autism diagnoses largely reflect changing definitions, better recognition, and service systems—not a new, toxin‑driven epidemic. Describing autism as an “epidemic” is scientifically inaccurate and socially harmful, and shifts attention away from access, inclusion, and support for Autistic people.

Citations:

1. Fombonne, E. (2025). The autism ‘epidemic’: misinterpretation, misinformation and conspiracy. European Journal of Epidemiology, 40, 981 – 994. https://doi.org/10.1007/s10654-025-01316-8.
2. Fombonne, E. (2001). Is there an epidemic of autism?. Pediatrics, 107 2, 411-2 . https://doi.org/10.1542/peds.107.2.411.
3. Gernsbacher, M. (2005). Three Reasons Not to Believe in an Autism Epidemic. Current Directions in Psychological Science, 14, 55 – 58. https://doi.org/10.1111/j.0963-7214.2005.00334.x.
4. Machado, C., Estévez, M., Rodríguez, R., & Leisman, G. (2017). Letter re: The autism “epidemic”: Ethical, legal, and social issues in a developmental spectrum disorder. Neurology, 89, 1310 – 1310. https://doi.org/10.1212/wnl.0000000000004405.
5. Bottema‐Beutel, K., Kapp, S., Sasson, N., Gernsbacher, M., Natri, H., & Botha, M. (2023). Anti-ableism and scientific accuracy in autism research: a false dichotomy. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1244451.
6. Roman-Urrestarazu, A., & Van Kessel, R. (2022). Inaccurate prevalence estimates impacts autism policy: A letter to the editor in relation to “Global prevalence of autism: A systematic review update” by Zeidan et al. (2022). Autism Research, 15, 1184 – 1186. https://doi.org/10.1002/aur.2734.
7. Chiarotti, F., & Venerosi, A. (2020). Epidemiology of Autism Spectrum Disorders: A Review of Worldwide Prevalence Estimates Since 2014. Brain Sciences, 10. https://doi.org/10.3390/brainsci10050274.
8. Talantseva, O., Romanova, R., Shurdova, E., Dolgorukova, T., Sologub, P., Titova, O., Kleeva, D., & Grigorenko, E. (2023). The global prevalence of autism spectrum disorder: A three-level meta-analysis. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1071181.
9. Fombonne, E. (2020). Epidemiological controversies in autism. , 171. https://doi.org/10.4414/sanp.2020.03084.
10. Gabis, L., Attia, O., Goldman, M., Barak, N., Tefera, P., Shefer, S., Shaham, M., & Lerman-Sagie, T. (2021). The myth of vaccination and autism spectrum. European Journal of Paediatric Neurology, 36, 151 – 158. https://doi.org/10.1016/j.ejpn.2021.12.011.
11. Qiu, J., & Hania, A. (2025). Red flags in global autism data: a forensic analysis of prevalence patterns and official aid dependencies. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1575940.
12. Davidson, M. (2017). Vaccination as a cause of autism—myths and controversies. Dialogues in Clinical Neuroscience, 19, 403 – 407. https://doi.org/10.31887/dcns.2017.19.4/mdavidson.
13. Basu, S., & Parry, P. (2013). The autism spectrum disorder ‘epidemic’: Need for biopsychosocial formulation. Australian & New Zealand Journal of Psychiatry, 47, 1116 – 1118. https://doi.org/10.1177/0004867413509694.
14. Bennett, M., Webster, A., Goodall, E., & Rowland, S. (2018). Exploring the Identity of Autistic Individuals: Reconstructing the Autism Epidemic Myth. , 17-35. https://doi.org/10.1007/978-981-13-3359-0_2.
15. Mann, B. (2019). Autism Narratives in Media Coverage of the MMR Vaccine-Autism Controversy under a Crip Futurism Framework. Health Communication, 34, 984 – 990. https://doi.org/10.1080/10410236.2018.1449071.
16. Leonard, H., Dixon, G., Whitehouse, A., Bourke, J., Aiberti, K., Nassar, N., Bower, C., & Glasson, E. (2010). Unpacking the complex nature of the autism epidemic. Research in Autism Spectrum Disorders, 4, 548-554. https://doi.org/10.1016/j.rasd.2010.01.003.
17. Lord, C., Brugha, T., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E., Jones, R., Pickles, A., State, M., Taylor, J., & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. Nature Reviews Disease Primers, 6, 1-23. https://doi.org/10.1038/s41572-019-0138-4.
18. Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism Research, 15, 778 – 790. https://doi.org/10.1002/aur.2696.
19. Bottema‐Beutel, K. (2023). We must improve the low standards underlying “evidence-based practice”. Autism, 27, 269 – 274. https://doi.org/10.1177/13623613221146441.
20. Caldwell-Harris, C., McGlowan, T., & Beitia, K. (2023). Autistic discussion forums: insights into the topics that clinicians don’t know about. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1271841.