The government’s autism program is controversial – but it also brings important opportunities

The latest conversation about autism is intense, with a strong response to Robert F. Kennedy’s proposed plan and the latest statistics on the rise in autism prevalence. However, of all the noise, the most critical challenges facing families during autism journey are overlooked. Let me explain it: Imagine being diagnosed with a severe medical condition (e.g., type 2 diabetes) based solely on a questionnaire filled out by your doctor without any lab tests or biomarkers. Will you accept it? That is, how do we diagnose autism spectrum disorder today.

Autism is a neurodevelopmental condition defined entirely by observable behaviors – difficulties such as social interaction, language delays, and repetitive movements. In other words, you are considered autistic because you behave in some way. Where is the biology in this definition? This is not to ignore the importance of behavioral assessment – ​​crucial – but it should not be the only tool to guide autism diagnosis and care.

Our ability to define autism biology has been limited for years. This is no longer the case.

Interaction of multiple systems

According to the CDC, “There are not only causes of ASD. Many different factors have been identified, so it may make children more likely to have ASD, including environmental, biological and genetic factors.” That’s the consensus of science – it reflects our understanding of many complex conditions: Causality is rarely singular, but rather rooted in the interactions of multiple systems. For many years, we have pinned our hopes on genomics. But despite the promise, no single “autism gene” appears. Genetics alone cannot explain the rise in the incidence of autism diagnosis – our genes simply won't change anytime soon.

So what else can we objectively measure? The answer lies in the nongenomic aspects of the equation: our biology, our metabolism, and how our bodies cope with environmental exposure. Today, we finally have the tools to track these dynamic systems over time, revealing measurable patterns and biological features that help decode autism at the molecular level. Just as blood sugar provides objective measures for diabetes diagnosis, we now have the ability to define the biological pathways for autism.

No family should wait for more than a year

Families today often endure long and exhausting journeys to get a diagnosis, waiting for a year many times. The benefits of early identification and intervention are well documented, but autism is still diagnosed as too late.

Nevertheless, biochemical testing has little effect in the diagnosis process in terms of autism and many other neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD). At best, it's an afterthought. That always confuses me. Autism is estimated to be more than 50% to 80% hereditary, meaning there are many risk factors in the conception long before behavioral symptoms appear. However, we continue to rely solely on observable behaviors, which limits our ability to detect autism in the earliest years of brain development, most of the growing years.

This is one of the reasons why the median age for autism diagnosis in the United States is still about 4 years, and the waitlist date for diagnostic evaluation is extended. There is a better way. I think the future of autism care must begin at birth – by screening each newborn's risk biomarkers.

Call for polarization discussion

Unfortunately, like many debates in the public sphere today, conversations surrounding government proposals related to autism have quickly become polarized, and in polarization, meaningful opportunities are being lost. A recent flash point is the use of the term “epidemic” to describe autism, which has been criticized by many experts. But refuting the word does not mean refuting reality. The increase in the number of autism diagnoses puts real pressure on families, school systems, and healthcare providers, which should attract serious concern. We can and must focus on the most important truth: the impact of increasing prevalence of autism is real and needs to be addressed.

We should seize this moment and move towards dialogue and action. The government’s focus on environmental contributors to autism has great potential. The shift to healthier foods, cleaner air and water, and reducing toxic exposure will bring broad public health benefits to overall health. The medical and scientific communities should welcome this momentum wholeheartedly and match innovation.

Now, new technologies allow us to measure biological markers of neurodevelopmental status with precision and objectivity. These innovations will not replace clinicians’ expertise or behavioral assessments, which will complement and enhance. Behavior is important. The same is true for biology.

Let's not miss this moment. Let's meet – clear, scientific, and determined to build a better path forward for people with autism and their families.

Photo: Mariadubova, Getty Images

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