Untitled by Mimzy. Licensed by Pixaby

In April, the Centers for Disease Control generated headlines when it reported that autism now affects one in 31 American children, up from 36 in 2022 and a 2006 estimate of one in 110.  Secretary of Health and Human Services Robert Kennedy responded by promising to track down the “environmental toxins” that have turned a supposedly “preventable disease” into an epidemic that “dwarfs” the Covid pandemic. By contrast, many medical authorities have interpreted the increase as an artifact of broader diagnostic criteria, greater public awareness, and increased screening. Others suggest the increase is real but dispute Kennedy’s claim about the magnitude and causes.[1]

The polarized response to the CDC report, however, threatens to obscure our broader understanding of the cultural, environmental, historical, and institutional factors that shape both autism’s incidence and its meaning. While the neurological differences associated with autism likely have deep biological roots, the way autism is recognized, described, evaluated, and responded to is very much a product of culture, history, and institutional frameworks.

What we now call “autism” is not just an age-old biomedical reality. It is also a cultural construct, assembled over time through layers of observation, classification, and interpretation, and filtered through the differing scientific, social, emotional and moral assumptions prevailing in various societies through the ages. Cultural context determines which traits are pathologized, which are celebrated, and which are simply ignored. In some cultures, avoiding eye contact is considered polite, while in others it is a red flag. Behaviors labeled autistic in one society may be seen as eccentricity or even giftedness in another.

What we understand as autism today is the product of evolving cultural attitudes about difference, normality, and disability. This is not to deny a real neurological base for many of these behaviors, nor to discount environmental factors. Chemical pollutants—airborne particulates, endocrine-disrupting compounds, pesticides—have all been linked to increased autism risk. Nutritional deficiencies in pregnancy and early childhood may also play a role, as may maternal metabolic conditions like obesity and gestational diabetes. These exposures, acting during critical windows of brain development, may subtly alter neural circuitry in ways that heighten sensitivity to social, sensory, and cognitive stressors. And as today’s children experience more screen time, less unstructured play and interaction with peers, and earlier academic pressure than previous generations, this may exacerbate traits that become problematic in overstimulating or inflexible environments.

In the United States, however, such contextual factors are often overlooked. The American model of diagnosis and treatment heavily favors biological explanations—rooted in genetics and brain imaging—over social, cultural, or relational ones. Clinicians are trained to identify codifiable disorders; insurers reimburse for diagnosable conditions; research grants disproportionately fund genetic studies over sociocultural ones.

This biomedical model has real benefits—it has driven research, legitimized neurodivergence, and improved access to services. But it also narrows our view. It risks over-pathologizing differences, underplaying environmental contributors, and overlooking the importance of community, culture, and support systems in shaping outcomes.

Toward a More Integrated and Human-Centered Approach to Autism

The dominant American model tends to frame autism primarily in biological, genetic, or neurological terms. While such explanations have yielded important insights, they also risk portraying autism as fixed and unchangeable—something to be managed rather than understood and accommodated. As a cultural construction, autism is not simply a universal neurobiological fact an experience shaped by how societies define normalcy, support difference, and distribute care. To move forward, we need a more integrated and humane framework—one that takes into account the neurological distinctiveness of autism while also recognizing its variability, plasticity, and responsiveness to context. This means broadening the scope of scientific inquiry to include not only genes and brain scans, but also the environments in which children grow, the relationships that shape development, and the social systems that allocate support.

Only by embracing complexity—biological, developmental, cultural, and relational—can we build a public health and educational framework that protects vulnerable developmental windows, affirms neurodiversity, and ensures that those who think and feel differently are not just “managed,” but understood, supported, and valued in a pluralistic society. Autism is not a disease to be eradicated but a way of being in the world—a developmental difference shaped by biology, environment, and experience. It comes with challenges, but also with insight, creativity, and perspective that can enrich families, communities, and cultures.

This reframing doesn’t deny the reality of suffering or romanticize neurodivergence. Rather, it recognizes that meaningful support must begin with truly listening to the experiences, voices, and needs of autistic individuals themselves. In this spirit, our institutions, policies, and practices should no longer ask: “How can we change the autistic person?” but instead, “How can we change the world to better include and uplift him or her?”

Because autism exists on a broad and diverse spectrum, no single description—or intervention—can capture the full range of experiences. One person on the spectrum may be nonverbal and require round-the-clock care, while another may hold a Ph.D. and still struggle with sensory overload, anxiety, or social nuance. This variability is a defining feature of the condition. It reflects the wide range of ways in which autistic traits—such as differences in communication, social interaction, sensory processing, and behavior—manifest across individuals and across the lifespan.

For this reason, any meaningful approach to autism must begin with individualization. Support systems must move beyond generic programming to meet people where they are, adapting interventions to reflect not only severity of need, but also personal strengths, preferences, communication styles, and cultural context.

In education, this means that two students with the same diagnosis may require very different supports—one might need assistive technology to communicate, while another benefits most from sensory-friendly classrooms and flexible schedules. In clinical care, some individuals may thrive with behavioral therapies, while others will require trauma-informed counseling, medication management, or occupational supports. In the workplace, one person may need a quiet space and modified hours, while another may benefit from mentorship and clear, structured feedback.

Moreover, to truly individualize support, autistic voices must be central in the design of care. Whether through self-advocacy, family input, or person-centered planning, those receiving support must be empowered to help shape it. Respecting autonomy, building trust, and tailoring environments are not just best practices—they are ethical imperatives.

Autism is a spectrum not just of needs, but of humanity. It demands a flexible, responsive, and deeply personal approach—one that treats autistic individuals not as diagnostic categories, but as whole people, deserving of care that reflects their uniqueness.

A society that embraces autistic people as they are—not as problems to be fixed, but as people to be known—will be a society better attuned to the full range of human possibility. In the end, perhaps the real question is not what autism is, but what kind of society we are willing to build around it.

[1] For a careful fact check of the competing claims, see https://www.factcheck.org/2025/04/rfk-jr-misleads-on-autism-prevalence-causes/

A leading authority on the history of families, children, and the life course, Steven Mintz is professor of history at the University of Texas at Austin and the author and editor of 17 books, including the forthcoming The American Child: The Transformation of Childhood since World War II (with Peter N. Stearns).  A past president of the Society for the History of Childhood and Youth and of H-Net: Humanities and Social Sciences Online, he has  been a visiting scholar at Harvard, a fellow at Stanford’s Center for Advanced Study in the Behavioral Sciences, and a CCF national co-chair.