Science
RFK Jr. wants an answer to rising autism rates. Scientists say he’s ignoring some obvious ones
This week, the Trump administration announced that it was taking “bold action” to address the “epidemic” of autism spectrum disorder — starting with a new safety label on Tylenol and other acetaminophen products that suggests a link to autism. The scientific evidence for doing so is weak, researchers said.
Health and Human Services Secretary Robert F. Kennedy Jr. said federal officials “will be uncompromising and relentless in our search for answers” and that they soon would be “closely examining” the role of vaccines, whose alleged link to autism has been widely discredited.
Kennedy has long argued that rising diagnoses among U.S. children must mean more exposure to some outside influence: a drug, a chemical, a toxin, a vaccine.
“One of the things that I think that we need to move away from today is this ideology that … the autism prevalence increase, the relentless increases, are simply artifacts of better diagnoses, better recognition or changing diagnostic criteria,” Kennedy said in April.
Kennedy is correct that autism spectrum disorder rates have risen steadily in the U.S. since the U.S. Centers for Disease Control began tracking them, from 1 in 150 8-year-olds in 2000, to 1 in 31 in 2022, the most recent year for which numbers are available.
But physicians, researchers and psychologists say it is impossible to interpret this increase without acknowledging two essential facts: The diagnostic definition of autism has greatly expanded to include a much broader range of human behaviors, and we look for it more often than we used to.
“People haven’t changed that much,” said Alan Gerber, a pediatric neuropsychologist at Children’s National Hospital in Washington, D.C., “but how we talk about them, how we describe them, how we categorize them has actually changed a lot over the years.”
Defining ‘autism’
The term “autism” first appeared in the scientific literature around World War II, when two psychiatrists in different countries independently chose that word to describe two different groups of children.
In 1938, Austrian pediatrician Hans Asperger used it to describe child patients at his Vienna clinic who were verbal, often fluently so, with unusual social behaviors and at-times obsessive focus on very specific subjects.
Five years later, U.S. psychiatrist Leo Kanner published a paper about a group of children at his clinic at the Johns Hopkins Hospital in Baltimore who were socially withdrawn, rigid in their thinking and extremely sensitive to stimuli like bright lights or loud noises. Most also had limited verbal language ability.
Both Asperger and Kanner chose the same word to describe these overlapping behaviors: autism. (They borrowed the term from an earlier psychiatrist’s description of extreme social withdrawal in schizophrenic patients.)
This doesn’t mean children never acted this way before. It was just the first time doctors started using that word to describe a particular set of child behaviors.
For the next few decades, many children who exhibited what we understand today to be autistic traits were labeled as having conditions that have ceased to exist as formal diagnoses, like “mental retardation,” “childhood psychosis” or “schizophrenia, childhood type.”
Autism debuted as its own diagnosis in the 1980 third edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Assn.’s diagnostic bible. It described an autistic child as one who, by the age of 2½, showed impaired communication, unusual responses to their environment and a lack of interest in other people.
As the decades went on, the DSM definition of autism broadened.
The fourth edition, published in 1994, named additional behaviors: impaired relationships, struggles with nonverbal communication and speech patterns different from those of non-autistic, or neurotypical, peers.
It also included a typo that would turn out to be a crucial driver of diagnoses, wrote cultural anthropologist Roy Richard Grinker in his book “Unstrange Minds: Remapping the World of Autism.”
The DSM’s printed definition of autism included any child who displayed impairments in social interaction, communication “or” behavior. It was supposed to say social interaction, communication “and” behavior.
The error went uncorrected for six years, and the impact appeared profound. In 1995 an estimated 1 in every 500 children was diagnosed with autism. By 2000, when the CDC formally began tracking diagnoses (and the text was corrected), it was 1 in every 150.
Reaching underserved communities
In 2007, the American Academy of Pediatrics recommended for the first time that all children be screened for autism between the ages of 18 and 24 months as part of their regular checkups. Prior to that, autism was diagnosed somewhat haphazardly. Not all pediatricians were familiar with the earliest indicators or used the same criteria to determine whether a child should be further evaluated.
Then in 2013, the fifth edition of the DSM took what had previously been four separate conditions — autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder — and collapsed them all into a single diagnosis: autism spectrum disorder.
The diagnostic criteria for ASD included a broad range of social, communication and sensory interpretation differences that, crucially, could be identified at any time in a child’s life. The term was no longer limited only to children whose development lagged noticeably behind that of their peers.
Since that definition was adopted, U.S. schools have become more proactive about referring a greater range of children for neurodevelopmental evaluations. The new DSM language also helped educators and clinicians better understand what was keeping some kids in disadvantaged communities from thriving.
“In the past, [autism was] referred to as a ‘white child’s disability,’ because you found so few Black and brown children being identified,” said Shanter Alexander, an assistant professor of school psychology at Howard University. Children of color who struggled with things like behavioral disruptions, attention deficits or language delays, she said, were often diagnosed with intellectual disabilities or behavioral disorders.
In a sign that things have shifted, the most recent CDC survey for the first time found a higher prevalence of autism in kids of color than in white children: 3.66%, 3.82% and 3.30% for Black, Asian and Latino children, respectively, compared with 2.77% of white children.
“A lot of people think, ‘Oh, no, what does this mean? This is terrible.’ But it’s actually really positive. It means that we have been better at diagnosing Latino children [and] other groups too,” said Kristina Lopez, an associate professor at Arizona State University who studies autism in underserved communities.
The severity issue
An autism diagnosis today can apply to people who are able to graduate from college, hold professional positions and speak eloquently about their autism, as well as people who require 24-hour care and are not able to speak at all.
It includes people who were diagnosed when they were toddlers developing at a noticeably different pace from their peers, and people who embraced a diagnosis of autism in adulthood as the best description of how they relate to the world. Diagnoses for U.S. adults ages 26 to 34 alone increased by 450% between 2011 and 2022, according to one large study published last year in the Journal of the American Medical Assn.
Kennedy was not correct when he said in April that “most cases now are severe.”
A 2016 review of CDC data found that approximately 26.7% of 8-year-olds with autism had what some advocates refer to as “profound autism,” the end of the spectrum that often includes seriously disabling behaviors such as seizures, self-injurious behavior and intellectual disability.
The rate of children with profound autism has remained virtually unchanged since the CDC started tracking it, said Maureen Durkin, a professor of population health science and pediatrics at the University of Wisconsin-Madison. Indeed, the highest rate of new diagnoses has been among children with mild limitations, she said.
For many researchers and advocates, the Trump administration’s focus on autism has provoked mixed emotions. Many have lobbied for years for more attention for this condition and the people whose lives it affects.
Now it has arrived, thanks to an administration that has played up false information while cutting support for science.
“They have attempted to panic the public with the notion of an autism epidemic as a threat to the nation, when no such epidemic actually exists — rather, more people are being diagnosed with autism today because we have broader diagnostic criteria and do a better job detecting it,” said Colin Killick, executive director of the Autistic Self Advocacy Network. “It is high time that this administration stops spreading misinformation about autism, and starts enacting policies that would actually benefit our community.”
This article was reported with the support of the USC Annenberg Center for Health Journalism’s National Fellowship’s Kristy Hammam Fund for Health Journalism.
Science
49ers coach Kyle Shanahan shows performance-enhancing smelling salts aren’t just for players
Football leans on tradition, providing convenient cover for the NFL’s lenient stance on smelling salts, ammonia crystals that players believe enhance performance when inhaled.
Does the olfactory exhilaration also enhance play-calling, amplifying one’s grasp of X’s and O’s?
Kyle Shanahan apparently believes so.
The San Francisco 49ers coach was caught by a Fox television camera moments before a playoff game Sunday against the Philadelphia Eagles taking several whiffs from a small packet before handing it to an assistant.
Earlier this season, the San Francisco Chronicle reported that 49ers players created a system to make sure everyone has immediate access to smelling salts during games. General manager John Lynch and Shanahan are users, according to the story, which stated that Shanahan “isn’t opposed to the occasional whiff.”
Is the NFL OK with this? The answer is a qualified yes.
Ahead of the 2025 season, the league’s head, neck and spine committee recommended that teams end the longtime practice of providing smelling salts to players. The decision was prompted by a U.S. Food and Drug Administration warning about the potential side effects of inhaling ammonia, which include lung damage and masking signs of a concussion.
Players all but panicked. George Kittle, the 49ers All-Pro tight end, jumped on an NFL Network broadcast to proclaim that smelling salts were crucial to his performance.
“I’m a regular user of smelling salts, taking them for a boost of energy before every offensive drive,” he said. “We have got to figure out a middle ground here, guys. Somebody help me out.”
The NFL came to his rescue, saying smelling salts — also known as ammonia inhalants, or AIs — were not banned. Teams could no longer provide them, but players could bring their own. It’s a compromise that may or may not pass the smell test. Either way, it’s not just the 49ers using them.
An ESPN Magazine piece in 2017 reported that “just a few minutes into the game, the Cowboys have discarded so many capsules that the area in front of their bench looks like the floor of a kid’s bedroom after trick-or-treating.”
Bottom line, legions of NFL players believe AIs enhance performance. They do so by irritating the linings of the nose and lungs, triggering a reflex that increases breathing rate and blood flow, fostering alertness.
Their effectiveness was discovered long before football was invented. Craft beer drinkers know Pliny the Elder as the inspiration for his namesake double IPA. The noted Roman naturalist and historian was indeed an early expert in fermentation, yet he also wrote about “sal ammoniac” — yes, smelling salts — in his encyclopedic work “Natural History,” published in 79 A.D.
Their popularity spread through Europe until, in Victorian tradition, they were used to rouse ladies after fainting spells. Later they were used in battle, with British medics supplying World War II soldiers with a whiff of the substance that doctors say triggers the body’s “fight-or-flight” response.
These days, the Federal Aviation Administration requires that U.S. airlines carry smelling salts onboard in case a pilot needs to be awakened after fainting. Blocking and tackling on a flight, however, remains strictly forbidden.
The NFL’s middling position isn’t curious. Experts say it’s an attempt to reduce liability in case of concussions or other medical complications. But it is their constant use that concerns doctors.
“The use of smelling salts in sports is definitely not their intended use,” Dr. Laura Boxley, a neuropsychologist at Ohio State’s Wexner Medical Center, told NPR. “What’s happening with some athletes is they’re using them with much higher frequency than their intended use.”
Given the relative safety of the sidelines, Shanahan isn’t in danger of a brain-rattling concussion. Shortly after the NFL ceased supplying AIs, he was asked by a reporter whether he had concerns about their prevalence.
“I mean, I don’t,” Shanahan replied with a grin. “If someone gives me one, I’ll take a smell of the salt. I’m not too worried about it. I like to take one to wake myself up and lock myself in.”
Science
AI windfall helps California narrow projected $3-billion budget deficit
SACRAMENTO — California and its state-funded programs are heading into a period of volatile fiscal uncertainty, driven largely by events in Washington and on Wall Street.
Gov. Gavin Newsom’s budget chief warned Friday that surging revenues tied to the artificial intelligence boom are being offset by rising costs and federal funding cuts. The result: a projected $3-billion state deficit for the next fiscal year despite no major new spending initiatives.
The Newsom administration on Friday released its proposed $348.9-billion budget for the fiscal year that begins July 1, formally launching negotiations with the Legislature over spending priorities and policy goals.
“This budget reflects both confidence and caution,” Newsom said in a statement. “California’s economy is strong, revenues are outperforming expectations, and our fiscal position is stable because of years of prudent fiscal management — but we remain disciplined and focused on sustaining progress, not overextending it.”
Newsom’s proposed budget did not include funding to backfill the massive cuts to Medicaid and other public assistance programs by President Trump and the Republican-led Congress, changes expected to lead to millions of low-income Californians losing healthcare coverage and other benefits.
“If the state doesn’t step up, communities across California will crumble,” California State Assn. of Counties Chief Executive Graham Knaus said in a statement.
The governor is expected to revise the plan in May using updated revenue projections after the income tax filing deadline, with lawmakers required to approve a final budget by June 15.
Newsom did not attend the budget presentation Friday, which was out of the ordinary, instead opting to have California Director of Finance Joe Stephenshaw field questions about the governor’s spending plan.
“Without having significant increases of spending, there also are no significant reductions or cuts to programs in the budget,” Stephenshaw said, noting that the proposal is a work in progress.
California has an unusually volatile revenue system — one that relies heavily on personal income taxes from high-earning residents whose capital gains rise and fall sharply with the stock market.
Entering state budget negotiations, many expected to see significant belt tightening after the nonpartisan Legislative Analyst’s Office warned in November that California faces a nearly $18-billion budget shortfall. The governor’s office and Department of Finance do not always agree, or use the LAO’s estimates.
On Friday, the Newsom administration said it is projecting a much smaller deficit — about $3 billion — after assuming higher revenues over the next three fiscal years than were forecast last year. The gap between the governor’s estimate and the LAO’s projection largely reflects differing assumptions about risk: The LAO factored in the possibility of a major stock market downturn.
“We do not do that,” Stephenshaw said.
Among the key areas in the budget:
Science
California confirms first measles case for 2026 in San Mateo County as vaccination debates continue
Barely more than a week into the new year, the California Department of Public Health confirmed its first measles case of 2026.
The diagnosis came from San Mateo County, where an unvaccinated adult likely contracted the virus from recent international travel, according to Preston Merchant, a San Mateo County Health spokesperson.
Measles is one of the most infectious viruses in the world, and can remain in the air for two hours after an infected person leaves, according to the CDPH. Although the U.S. announced it had eliminated measles in 2000, meaning there had been no reported infections of the disease in 12 months, measles have since returned.
Last year, the U.S. reported about 2,000 cases, the highest reported count since 1992, according to CDC data.
“Right now, our best strategy to avoid spread is contact tracing, so reaching out to everybody that came in contact with this person,” Merchant said. “So far, they have no reported symptoms. We’re assuming that this is the first [California] measles case of the year.”
San Mateo County also reported an unvaccinated child’s death from influenza this week.
Across the country, measles outbreaks are spreading. Today, the South Carolina State Department of Public Health confirmed the state’s outbreak had reached 310 cases. The number has been steadily rising since an initial infection in July spread across the state and is now reported to be connected with infections in North Carolina and Washington.
Similarly to San Mateo’s case, the first reported infection in South Carolina came from an unvaccinated person who was exposed to measles while traveling internationally.
At the border of Utah and Arizona, a separate measles outbreak has reached 390 cases, stemming from schools and pediatric centers, according to the Utah Department of Health and Human Services.
Canada, another long-standing “measles-free” nation, lost ground in its battle with measles in November. The Public Health Agency of Canada announced that the nation is battling a “large, multi-jurisdictional” measles outbreak that began in October 2024.
If American measles cases follow last year’s pattern, the United States is facing losing its measles elimination status next.
For a country to lose measles-free status, reported outbreaks must be of the same locally spread strain, as was the case in Canada. As many cases in the United States were initially connected to international travel, the U.S. has been able to hold on to the status. However, as outbreaks with American-origin cases continue, this pattern could lead the Pan American Health Organization to change the country’s status.
In the first year of the Trump administration, officials led by Health Secretary Robert F. Kennedy Jr. have promoted lowering vaccine mandates and reducing funding for health research.
In December, Trump’s presidential memorandum led to this week’s reduced recommended childhood vaccines; in June, Kennedy fired an entire CDC vaccine advisory committee, replacing members with multiple vaccine skeptics.
Experts are concerned that recent debates over vaccine mandates in the White House will shake the public’s confidence in the effectiveness of vaccines.
“Viruses and bacteria that were under control are being set free on our most vulnerable,” Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health, said to The Times.
According to the CDPH, the measles vaccine provides 97% protection against measles in two doses.
Common symptoms of measles include cough, runny nose, pink eye and rash. The virus is spread through breathing, coughing or talking, according to the CDPH.
Measles often leads to hospitalization and, for some, can be fatal.
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