Questioning Answers

Elevated microbially-derived metabolites in autism: a possible diagnostic screening test for a distinct ASD phenotype

2026-06-05T13:52:04.922+01:00

A quick entry to note that a new paper which yours truly had a small role to play in has been recently published: https://www.nature.com/articles/s41380-026-03620-5

There's been some media around it e.g. https://nypost.com/2026/05/27/health/new-urine-test-could-diagnose-autism-in-children-study/ and how after several years of collaborative research, some potentially important findings in relation to gut bacterial metabolites present in urine *might* be important to some autisms. I've stressed *might* because there's still more to do in this area and indeed, work is still continuing.

There's a couple of things that are standout in the new paper including (i) how mass spectrometry really is a top-notch method in relation to the science of metabolomics https://pharmaceutical-journal.com/article/research/in-search-of-biomarkers-the-science-of-metabolomics-in-pharmacy (particularly when one more than system are independently at work), (ii) gut and yeast related metabolites present in urine are detectable and potentially quite important to some autisms and perhaps beyond as part of that gut-brain axis, and (iii) the Easter egg in the paper was around how some autisms seemed to be linked to various previously undetected inborn errors of metabolism (most screens of IEM via the baby blood spot measurement are done with mass spectrometry too).

I'm not going to bore you with the details particularly when the rather fantastic Dr Jim Adams is going to be hosting a talk about it in the coming days - register here: https://us06web.zoom.us/webinar/register/3617798965724/WN_RBm7QCaFRceTq1EjU8HFsQ#/registration If you're so inclined, register and have a watch.

Childhood autism in Northern Ireland: 6.2% for 2025/2026 (still relentlessly increasing)

2026-05-14T09:49:12.218+01:00

The school-aged autism prevalence rate in Northern Ireland for 2025/2026 is 6.2% https://www.health-ni.gov.uk/sites/default/files/2026-05/asd-children-ni-2026.pdf

Last year - 2024/2025 - it was 5.9%.

The prevalence rate of autism in boys in Northern Ireland for 2025/2026 is 8.6%. Last year (2024/2025) it was 8.3%.

The sustained upwards trend of childhood autism continues. It's now 1 in 16 if my maths are correct. 1 in 16 school-aged children in Northern Ireland has a diagnosis of autism. An avalanche of children presenting with clinically relevant autism and being diagnosed as such. And even more needs waiting in the wings as per the huge waiting lists for autism assessment.

Reasons? Well 'all better awareness' is something best left for the 1990s. It would be a brave (or stupid) person who takes up that gauntlet. 'Expanding diagnostic criteria' will probably have played a role, but bear in mind these figures have already included the change in data collection that happened in 2019/2020 which accounted for this.

No, there is something else driving this tsunami of disability. And there's no such thing as a genetic epidemic...

Prof Uta Frith on autism: "why I no longer think autism is a spectrum" and a whole lot more

2026-03-06T14:04:00.001+00:00

Uta Frith: why I no longer think autism is a spectrum https://www.tes.com/magazine/teaching-learning/general/uta-frith-interview-autism-not-spectrum

I often find that as people age/mature and maybe start to take their foot off often powerful careers, they tend to say more of what they actually think rather than what the 'trends' say they should think.

I think the same applies to this interview with the very famous Uta Frith and some of her views on autism now, particularly in the context of the singular description of autism now moving to something a little more 'plural' (sounds very familiar).

A few choice phrases: "... people still hang on to the idea that there is something that unites all the people who are diagnosed as autistic. I don’t believe that any more." Can't argue with that as the old 'autism community' which was often used by some very vocal people to give the impression that 'everyone agrees with me' gives way to the plural autisms communities. The diagnostic criteria for autism still unite all, but the expression of those core symptoms and their meaning and effects do not.

Further: "I think at least we have two big subgroups: the people who are diagnosed in early childhood - usually before age three or age five, depending on things like their intellectual abilities and language - and another group, diagnosed much later." Yes, one of many 'partitions' that subdivide the very heterogeneous autism label. There's lots more across symptoms intensities, developmental trajectories and also importantly, different aetiologies. The plural autisms.

"Now, I think the people in the second group really do have problems. I would definitely not say they are “making it up”. But I would say that these are problems that can perhaps be treated much better than under the label of “autism”. I would fight for that label to be limited to the first group." That is a big statement unlikely to make too many friends among certain people/groups. But I think she's right, as per the seemingly now redundant label of 'social (pragmatic) communication disorder' remaining underused and how autistic traits don't necessarily mean autism (see the ICD-11 autism criteria for what else it might mean).

And finally: "The masking idea has no scientific basis, yet everybody, including the researchers and the clinicians, has been enamoured with this idea." Not me. And certainly not Prof Fombonne and his 'poor fit' description. Indeed, even the 'science' on autism and masking isn't too sure: e.g. Camouflaging and autism: Conceptualisation and methodological issues (and that's putting it mildly).

Indeed her 'shredding' of masking / camouflaging in the context of autism is particularly welcome and a bit of wake-up call to various academics, some of whom have seemingly forgotten what (a) autism is, and (b) what scientific evidence is. It might also be worth their while looking up Hacking's 'Looping Effects' too. Mind you, they also tend be the same people who would happily study autism and include those who 'self-diagnose' as all part of a homogenous group. Even many people with autism are getting a bit sick of that (see here) as per the words: "Self-diagnosis “muddies the water”". If you'd care to see the ICD-11 autism diagnosis boundary conditions, you'll also see what other conditions may well be included in such 'self-diagnosing' studies including personality disorders and schizophrenia spectrum disorders. Nobody seems to be running to self-diagnose with them.

There'll be blood boiling about this piece from someone who knows more than most about autism but on many points, she's probably right.

2025: the year of plural autisms, folate chemistry and when curiosity about autism returned

2025-12-26T13:33:00.001+00:00

Spectrum 2025: Year in review https://www.thetransmitter.org/spectrum/spectrum-2025-year-in-review/

A 'what happened in 2025' feature that covers the main elements of autism in 2025 including: (1) we're heading back to asking the questions of 'how and why?' about autism rather than falling back on some pseudo-religious neurobabble, (2) US policy on autism has been driving lots of focus particularly on folate chemistry - cerebral folate deficiency (CFD), folate receptor autoantibodies (FRAAs) and leucovorin (folinic acid) - and some autisms, and (3) the year that the plural autisms finally emerged into the mainstream. That last one is particularly close to my research heart: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/from-autism-to-the-plural-autisms-evidence-from-differing-aetiologies-developmental-trajectories-and-symptom-intensity-combinations/4D9B0B35DCF03FDBA4E001F7DC9B02D6

2025 has been a pivotal year for autism as the 'lack of curiosity' of the past few years (in some quarters) has given way to more people asking important questions. It's no longer about whether 'identity first language' trumps 'person first language' (indeed, whole swaithes of identity related stuff has been shown for what it really is) or whether other such meaningless word policing is important to many people's lives, but what can actually help people with autism and their parents/carers, particularly those with severe and/or profound autism. Indeed, mention of those words 'severe' or 'profound autism' is only going to accelerate as the old 'autism is autism' mantra dwindled further in 2025 and as 'people' or 'person' become primary, rather than their diagnostic label.

There's lots of hope for 2026 that things will continue at a similar pace.

Maternal autoantibody related (MAR) autism goes mainstream

2025-12-17T20:21:00.003+00:00

"MARAbio Launches First-Ever Blood Test For Maternal Autoantibody Related Autism" https://www.marabio.com/test-launch

Woah.

Just when you thought 2025 couldn't bring anything else to the world of the autisms (plural), a press release which was kinda expected but is now an actuality.

MAR autism - maternal autoantibody related autism - has been on the research menu for a while. Quite a few scientific papers have found it and indeed, found the specific autoantibodies (to foetal tissue) that seem to be pathogenic for risk of this type of autism. And it's not just testing either, as some science has talked about the ways-and-means to 'avert' the effects of those antibodies too and impact on offspring autism risk. This has been years in the making.

"Commenting on the potential impact of this launch for providers and families, noted clinician and autism researcher Richard E. Frye, MD, PhD, said, "With MARAbio's test now available, particularly for those families already touched by autism, we now have access to meaningful insights into this particular and prevalent cause of autism, including the likelihood of MARA in future children. It's an exciting advancement that brings science and compassionate healthcare together in a truly impactful way."

It should perhaps be noted that the research into other types of autoantibodies - folate receptor autoantibodies - by Dr Frye and others has also been an achievement unlocked in 2025. Indeed, both these streams of research and now clinical practice, whilst so far distinct, point to a pivotal role for immune functions and their effects across quite a few autisms. And that should provide some important clues for future work on 'how and 'why' and what to do about it.

And yet more evidence for those plural autisms which is music to my research ears...

"It will recommend practical, evidence-based approaches to prevention and early intervention..."

2025-12-04T20:12:00.003+00:00

Review launched into mental health, autism and ADHD services https://www.gov.uk/government/news/review-launched-into-mental-health-autism-and-adhd-services

The offical government announcement on the review into mental health, autism and ADHD services launched by the UK Government today. It looks like the important issues to "look at rising demand for mental health, ADHD, and autism services and what is driving it" are actually being taken seriously. That sentence on action as well, around intervention and, dare I say it, prevention, is also quite the change of tack from previous administrations.

Of course it all boils down the how much the various diagnoses are costing in terms of education, healthcare and social care and benefits given the massive rises in those diagnoses and what they mean for lots of different outcomes. For example, a childhood autism rate for 2024/2025 approaching 6% in Northern Ireland combined with the recent APMS data telling us that the adult autism rate in England has been static at 1% for nearly two decades is a case in point. It would be naive to think lack of money and lack of resources isn't the primary driving factors behind such a review given what this government has already tried to do when it comes to cutting costs.

But an opportunity is an opportunity.

"My aim is to test assumptions rigorously and listen closely to those most affected, so that our recommendations are both honest and genuinely useful. We owe it to children and families, young people and adults to provide government with advice that is proportionate, evidence-based, and capable of improving people’s lives."

I don't think anyone can really ask for more than that sentence from the head of this new review. Indeed it seemingly follows the changes to US policy particularly around autism, where people are actually starting to ask questions about 'how and why' rather than sticking with the usual babble (neuro) and other fluff that has contributed to some people not wanting to ask questions about important conditions which affect many peoples' lives.

"Autism (examined using ADOS) has remained stable in prevalence since 2007, at about one in a hundred adults (0.8%)."

2025-11-27T20:12:00.000+00:00

"Autism (examined using ADOS) has remained stable in prevalence since 2007, at about one in a hundred adults (0.8%)." https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24

Data released today (27th November 2025) from the Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4.

It puts pay to the idea that there is any sort of equivalence in child and adult rates of autism (and that there ever has been). Said equivalent child autism rate is currently anywhere between 2-6% of school-aged children depending on what data you use.

We knew this of course, from the data from Tromans et al: e.g. Characteristics and primary care experiences of people who self-report as autistic: a probability sample survey of adults registered with primary care services in England https://pubmed.ncbi.nlm.nih.gov/39277196/ (based on self-report) and more.

It tells us, yet again, that the massive increase in autism prevalence is being driven by new childhood cases (autism is a childhood neurodevelopmental disorder so not really surprising). And also no, there aren't 'missing millions' of adults with undiagnosed autism as per what Adamou et al reported when they actually assessed adults who presented at clinic: Enhancing Adult Autism Diagnostic Pathways: The Role of Clinical Triage in Efficient Service Provision https://pubmed.ncbi.nlm.nih.gov/40363963/ (and proved that triage works).

So then, a question: what is causing huge numbers of children to present with and be diagnosed with autism?

Well, only yesterday, some evidence that the words 'it's all genetic' are not a great explanation: e.g. As rates of ASD and ADHD rise, genetic contributions fall: Evidence for widening diagnostic criteria https://pubmed.ncbi.nlm.nih.gov/41292638/ which opens the door to issues like (a) widening diagnostic criteria and/or (b) environmental - non-genetic - factors 'causing' more autism. Or both?

Oh and keep in mind that despite the dogma, autism is not universally a lifelong condition for everyone e.g. https://pubmed.ncbi.nlm.nih.gov/31632036/ which may well partly explain why the adult autism rate is and has been so static for so many years...

Prenatal folic acid and multivitamin supplementation and offspring autism risk: umbrella-ified review

2025-11-18T21:01:00.002+00:00

"Maternal prenatal folic acid and multivitamin supplementation are associated with a reduced risk of ASD [autism spectrum disorder] in offspring. These findings have important public health implications, suggesting that prenatal supplementation could help mitigate the risk of ASD in children." https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0334852

The results of an umbrella review that included 8 other systematic reviews or meta-analyses which themselves included over 100 studies which included several million mother-child pairs. In short, top tier evidence.

"Prenatal folic acid and/or multivitamin supplementation was associated with a 30% reduced risk of ASD in offspring (RR = 0.70, 95% CI: 0.62, 0.78; GRADE: highly suggestive). Subgroup analysis by supplement type showed that maternal prenatal multivitamin supplementation reduced the risk of ASD by 34% (RR = 0.66, 95% CI: 0.55–0.80; GRADE: highly suggestive), while folic acid supplementation was associated with a 30% reduction in ASD risk (RR = 0.70, 95% CI: 0.60–0.83; GRADE: highly suggestive)."

And yet again, folate metabolism and autism.

The same folate metabolism and autism that is also US health policy now in terms of some autisms being potentially linked to cerebral folate deficiency (CFD) and/or folate receptor autoantibodies (FRAAs) meriting use of leucovorin (folinic acid). The difference being that in those areas - CFD and FRAAs - folic acid may not be the optimal supplement to use, as per why folinic acid (and perhaps even methylfolate) is instead being suggested for some children/adults with autism. Whether that might also translate into similar issues with folate metabolism for mums-to-be too as, being a risk factor for offspring autism, remains to be seen.

Nutritional factors being important to at least some autisms? Who'd have thunk that?

Folinic acid (leucovorin) and autism: what kept you?

2025-09-24T12:12:00.000+01:00

A Closer Look at the Drug Trump Is Touting for Autism: https://www.wsj.com/health/wellness/autism-leucovorin-science-research-0a666a8d

As the dust settles from what has been quite a monumental week for autism policy over on the US side of the Pond, particularly the new guidance on the use of leucovorin (folinic acid) for some autisms, some important questions emerge...

Science has known about the potential connections between some autisms and cerebral folate deficiency (CFD), those folate receptor autoantibodies and the usefulness of folinic acid for some autisms for a while. I talked about them back in 2012: Don't panic! Folate receptor autoantibodies and autism https://questioning-answers.blogspot.com/2012/01/dont-panic-folate-receptor.html So why did it take so long for such research to be government evaluated and considered worthy of such a move from 'bench to bedside'? What were previous administrations doing and what stopped this 'bench to bedside' move happening years ago?

I'm sure the answer is going to be complicated. Not least to include certain attitudes to autism (the autisms) from some certain quarters, what sorts of medicines are potentially indicated for said autisms (and whether there is monetary value attached to their usage) and the important need for as-near-as-possible solid science (particularly in the context of safety).

But it now appears there is more a 'pipeline' moving forwards, whereby similarly important biological mechanisms and related interventions can seemingly be quickly evaluated across the autisms. Indeed it again brings to mind the work on other medicines such as suramin and also the very promising results for CM-AT e.g. Pancreatic Replacement Therapy for Maladaptive Behaviors in Preschool Children With Autism Spectrum Disorder https://pmc.ncbi.nlm.nih.gov/articles/PMC10690476/ Also too, potentially important are the writings from the US FDA not so long ago about other intervention options for some autisms and the need for more controlled study e.g. Biological therapies need definitive randomized controlled clinical trials https://www.science.org/doi/10.1126/scitranslmed.adg2970 something that also seems to be a priority for the current US administration as older, less fruitful avenues of study will inevitably be replaced.

I think we have turned a corner in our understanding of the autisms and indeed, the desire to see safe and effective intervention options that help to remove at least some of the disability associated with the autisms. And where the US leads in policy around autism, other countries are sure to follow.

Northern Ireland: 5.9% of school-aged children with autism in 2025

2025-05-15T13:19:00.003+01:00

It's here... The prevalence of autism (including Asperger’s Syndrome) in school age children in Northern Ireland 2025 https://www.health-ni.gov.uk/sites/default/files/2025-05/asd-children-ni-2025.pdf

In 2023 the estimated prevalence rate for school-aged children was 5%. They missed 2024 but now in 2025 the rate is 5.9%. Read that back to yourself: 5.9%

And for boys... well, in 2023 the rate was 7.3% of school-aged boys with autism. In 2025, it's 8.3% of boys with autism. Again, read once more: 8.3% of boys.

No doubt there will be some who talk about 'better awareness' or 'expanding diagnostic criteria' as the cause(s) of the increase. The current iteration of the DSM diagnostic manual (DSM-5) came into being in 2013. The current iteration of the ICD diagnostic manual (ICD-11) came into being in 2018. Ask yourself: is it really so difficult to think that there may be a real increase in both autistic behaviours and autism diagnoses? Y'know, could part of the increase in autism be real? I believe the data suggest yes, it is part real. And probably quite a lot part real too.

"Majority in UK now ‘self-identify’ as neurodivergent"... read that back to yourself a few times.

2025-05-04T17:59:00.001+01:00

"Majority in UK now ‘self-identify’ as neurodivergent" https://www.thetimes.com/uk/science/article/self-diagnose-neurodivergent-99l9kl8v5

Read that back to yourself a few time particularly the words 'majority' and 'neurodivergent'.

Namely that if a majority of people are calling themselves 'neurodivergent', that means that a minority of people must be 'neurotypical'. So more people are 'diverging' from the 'typical' but still managing to be a majority of people or something?

That sound you just heard? That's the sound of neurobabble crashing and burning yet again...

Are there 'millions missing' when it comes to adult autism?

2025-05-03T10:48:00.001+01:00

Enhancing Adult Autism Diagnostic Pathways: The Role of Clinical Triage in Efficient Service Provision https://www.mdpi.com/2077-0383/14/9/2933

The Adamou paper sees the important peer-reviewed light of day having spent some time as a preprint.

It took 60 people referred to the "specialist adult Autism Service in West Yorkshire, UK, from November 2021 to August 2022" with suspected autism. Triage teams assessed them for autism including information from multiple sources and concluded that: "No clinical diagnoses of ASD were confirmed in the assessed sample."

This is an important paper requiring further follow-up. It tells us that there are perfectly good models of autism assessment triage that are available to healthcare systems such as the UK National Health Service (NHS) which can be used to work through the massive backlog of people awaiting an autism assessment (mostly children but adults as well).

It also tells us that the stories that there are 'millions missing' in terms of adults with undiagnosed autism are probably not all accurate. Indeed, other evidence has come to a similar conclusions based on 'actual reporting' rather than 'we think there may be many undiagnosed people' estimated reporting: Characteristics and primary care experiences of people who self-report as autistic: a probability sample survey of adults registered with primary care services in England https://pubmed.ncbi.nlm.nih.gov/39277196/ "A total of 4481 of the 623 157 survey participants included in the analysis self-reported autism, yielding a weighted proportion estimate of 1.41% (95% CI 1.35% to 1.46%)."

You don't need to be a rocket scientist to see the disparity between childhood autism diagnoses (~5%) and adult diagnoses (~1%) to see where the growth in numbers is coming from. Indeed, if one assumes that autism may be either prodromal for some and/or indeed, not universally lifelong for some, those stats make even more sense...

2025: Estimated 1 in 31 8-year old children in the US have autism

2025-04-16T21:06:00.000+01:00

It's here...

Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years — Autism and Developmental Disabilities Monitoring [ADDM] Network, 16 Sites, United States, 2022 https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm

Loads of details to sift through in the paper but the headline is that an estimated 1 in 31 8-year old children in the United States (US) in 2022 has autism.

It also provides some details about 4-year olds too and the rather ominous data that in some States, the rate of autism in 4-year olds was higher than that in 8-year olds suggesting that more (estimated) prevalence increases are on the horizon in future prevalence studies. Northern Ireland data for school-aged autism stood at 1 in 20 with autism in 2022-23 (there was no data for 2023-24) so there's a possible inkling of how far it may go and even surpass....

Other information: "Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability." So it looks like profound/severe autism is probably more prevalent than the 26% figure previously independently reported by the CDC ADDM. This is another important point because this highlights how the type of autism we've been seeing increasing over the last 30 years or so - the recent press conference held by the US HHS Secretary suggested the increase began back in 1989 - isn't the type of autism that is typically missed. And indeed, it looks like the severity profile of those being diagnosed is getting more and more severe, more and more complicated, after each round of ADDM data.

There's been a fair few media column inches about this already with much more to go. Yet again, the tired argument of 'all better awareness' has been dragged out of the cupboard under the stairs as a primary explanator for the latest figures. Well, better awareness probably does play some role but I'm not sure that its as much as some people believe. Indeed, if you are genuinely convinced that assessment professionals and diagnosticians have previously been so bad at identifying autism - for literally decades - and only now have 'woken up' to what autism looks like, I have some magic beans to sell you...

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The autisms. Now published.

2025-03-21T20:37:00.000+00:00

I hope readers might indulge me in this short post as I link to our new paper - March 2025 new - discussing movement from the singular autism label to something a little more real-world: the autisms. From autism to the plural ‘autisms’: evidence from differing aetiologies, developmental trajectories and symptom intensity combinations https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/from-autism-to-the-plural-autisms-evidence-from-differing-aetiologies-developmental-trajectories-and-symptom-intensity-combinations/4D9B0B35DCF03FDBA4E001F7DC9B02D6

Those who know of my incessant droning on about the plural autisms as an attempt to try and accomodate the massive heterogeneity covered under the diagnostic label autism won't be surprised by this publication. The logic is simple: based on three primary 'vectors' covering differences in aetiologies, differences in developmental trajectories and differences in symptom intensities there may be some way to 'compartmentalise' the autisms, hopefully helping both research and practice. The next step is how to organise those autisms...

I'd like to thank my co-authors on this paper and our collaborative efforts to get this paper written and published. I'd also like to thank both the editor and editorial staff at the British Journal of Psychiatry too, who've done a sterling job in helping us to mould this paper into what it became. I'd also like to thank our peer-reviewers - all six of them - who with annonymity, provided some great feedback to us. No, there was no 'Reviewer 2', just lots of really great observations that led to some great discussions and a much better paper as a result.

We're not claiming to know all the answers when it comes to tackling the heterogeneity around the autisms. Just offering one among many potential solutions designed to spark further debate and science. Enjoy.

“You don’t die from autism...". Actually, people do.

2025-03-19T10:48:00.000+00:00

“You don’t die from autism, but from exclusion, and that’s what we’re trying to change” https://en.protothema.gr/2025/03/18/dimitris-papanikolaou-you-dont-die-from-autism-but-from-exclusion-and-thats-what-were-trying-to-change/

Actually people do die from autism. Indeed, one of the biggest killers of particularly young children, often with severe/profound autism and/or who are non-verbal, is a deadly triad: autism, wandering/elopement and drowning. It's killed many people. It's not a topic some like to talk about but, when children and adults are dying, we should be talking more about including an important word: prevention. That deadly triad also happens worldwide including here in the UK: https://www.itv.com/news/granada/2024-01-25/luke-was-such-a-beautiful-soul-says-grieving-mum-of-boy-found-in-river

There are various other ways that a diagnosis of autism seems to be a risk factor for early mortality: suicide, diagnostic overshadowing (particularly for those who are non-verbal), the effects from various over-represented comorbidity such as epilepsy (including epilepsy as part of syndromic autism), and more. Another important issue that overlaps with the risks from autism is that of assissted dying, a topic that is currently being discussed here in the UK: Euthanasia and physician-assisted suicide in people with intellectual disabilities and/or autism spectrum disorders: investigation of 39 Dutch case reports (2012-2021) https://pubmed.ncbi.nlm.nih.gov/37218567/

As a collective, such issues tell us that autism is, for some, a diagnosis people die from. To say otherwise erases those deaths.

1 in 20 school children with autism in the Republic of Ireland: same as in Northern Ireland (for now)

2025-03-12T11:30:00.002+00:00

"Percentage of children diagnosed with autism rises threefold in less than a decade." https://www.irishtimes.com/ireland/education/2025/03/11/one-in-20-irish-schoolchildren-diagnosed-with-autism-a-threefold-rise/

"About one in 20 schoolchildren are being diagnosed with autism, a threefold increase in less than a decade, Department of Education figures show."

And: "Official records show the department has moved from using an estimated autism prevalence rate of 1.5-1.6 per cent among schoolchildren several years ago to 5 per cent."

The Republic of Ireland is now matching Northern Ireland in the (estimated) school-aged childhood autism rate, now at 1 in 20 children in both countries. The caveat being that Northern Ireland is due to report soon on their latest autism in childhood statistics (the 1 in 20 stat is from two years ago).

If it was any other diagnosis where in less than 10 years the rate increased 3-fold, there would be a scramble to find out 'why?' But for various reasons there hasn't been that urgency when it comes to autism. That is, until it hits home with the realisation that there aren't enough specialised school places, or when healthcare for children who often have quite complex needs isn't available or as widespread as it should be, or when social care is basically next to zero and also when governments start asking people to pay more in their taxes to cover financial and resource shortfalls. Then people take note.

Such increases in autism rates are visible worldwide. Arguments like 'it's all better awareness' are exposed for what they are: bluff. And who suffers most? The children who can't access the education, healthcare and social care they need. And their families who also feel the strain.

And believe it or not, someone actually said to the media that the threefold increase in autism is actually a 'good thing': "A threefold increase in the number of children being diagnosed with autism is a “good thing”, an expert in the condition has said." I wonder if they would say the same when knowing about the dreadful statistics around the deadly triad that is autism, wandering/elopement and drowning? Because I wouldn't.

US CDC plans to study autism and vaccines: treading carefully

2025-03-09T12:53:00.001+00:00

Two important pieces of news went head-to-head recently:

US CDC plans study into vaccines and autism, sources say https://www.reuters.com/business/healthcare-pharmaceuticals/us-cdc-plans-study-into-vaccines-autism-sources-say-2025-03-07/

Second person dies in US measles outbreak https://www.bbc.co.uk/news/articles/cm2nzyjgrwxo

How do we find the middle ground when successful population-wide public health measures like vaccination are pitted against lingering concerns about possible side-effects for a minority? Is there any middle ground that can be reached that will satisfy most and importantly, not interfere with a population-wide medical regime that saves lives?

An interesting quote is also included in that Reuters news piece from the potential next new head of the US National Institutes of Health (NIH): "I don't generally believe there is a link, based on my reading of the literature," Bhattacharya said. "But we do have a sharp rise in autism rates, and I don't think any scientist really knows the cause of it. I would support a broad scientific agenda based on data to get an answer to that."

This is a tricky area to navigate.

Minus any scaremongering, and bearing in mind that rubella vaccination has for example, probably prevented cases of autism: Congenital rubella syndrome and autism spectrum disorder prevented by rubella vaccination--United States, 2001-2010 https://pubmed.ncbi.nlm.nih.gov/21592401/ the idea that immune functions and mitochondrial issues *might* show involvement for some: Developmental regression and mitochondrial dysfunction in a child with autism https://pmc.ncbi.nlm.nih.gov/articles/PMC2536523/ probably does need further study. The 'Hannah Poling case' provided a roadmap for further investigations, and as Time magazine mentioned: "The case of Hannah Poling, the 9-year-old Georgia girl who, in 2008, received a $1.5 million award when the court agreed that vaccinations contributed to her later-onset autism, rocked the medical community and only worsened the anti-vax panic. But Poling was a special case; she was suffering from an underlying disorder of the mitochondria, or the energy-processing organelle in the cells. This made her vulnerable to any oxidative stress that could, in theory, be caused by vaccines". The question therefore should be whether the Poling case was a 'one-off' or something more widespread, particularly in the context of a diagnosis of regressive autism potentially with mitochondrial disorder as part of that clinical profile?

Going back to rubella and autism - based on the work of Stella Chess and others - another area that might also need more investigation is when vaccines fail to provoke a suitable response in terms of titer levels: Autistic children exhibit undetectable hemagglutination-inhibition antibody titers despite previous rubella vaccination https://pubmed.ncbi.nlm.nih.gov/1036494/ and why. This set within the context that various immune-related findings have been discussed in the context of autism down the years.

There aren't any specific details at the moment around what plan the CDC (potentially) have for re-looking at this issue and who is going to be undertake such research work. Such work, if it actually goes ahead, is going to need to tread a fine line that balances the undoubted population benefits of vaccination against the idea that no medicine is without potential harms to some.

Lying and autism: another sweeping generalisation stripped away

2025-03-04T13:54:00.005+00:00

Exploring lie frequency and emotional experiences of deceptive decision-making in autistic adults https://journals.sagepub.com/doi/10.1177/13623613251315892

"Fifty-eight non-autistic and fifty-six autistic university students matched on age and gender completed self-report measures of their general lying patterns, how often they lied in the past 24 hours, and whether they would lie across hypothetical scenarios with differing beneficiaries (self, other, group) and motivations (protective, beneficial)."

Results: "The groups did not significantly differ in their general lying behaviour or frequency of lies told over 24 hours."

Another sweeping generalisation about autism peels away. Unless they were lying?

Also: "Future research may benefit from examining autistic deception across numerous social situations as more general lie frequency measures may be insensitive to nuanced population differences."

I'm not sure about the term 'autistic deception' because I don't think deception comes particularly easily to many people with autism, particularly children. I know some would have us believe that 'masking' and 'camouflaging' are widespread across autism, but as per Fombonne's excellent article on that topic: "Because of its association with intended deception, the term camouflage has poor fit with the autism world" https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13296

Indeed, I'm inclined to believe that the ability to lie - which is quite an important cognitive feat - is probably one of a number of important parameters to suggest that autism as a diagnosis for some is not a static entity. And indeed, for an even smaller some, may not be a lifelong persisting entity based on this and other skills acquisitions...

RRBs accompanying autism are not benign

2025-02-27T20:00:00.002+00:00

A world away from the kum-by-yah and TikTok-ing of restricted and repetitive behaviours (RRBs) accompanying a diagnosis of autism, a real-world perspective...

""Rhianan - who was autistic - became "fixated" on things due to her condition, and said: "Her being groomed was huge and I saw her change and it had a huge impact on her."" https://www.bbc.co.uk/news/articles/c4g77e57q17o

And more detail: "... downloaded bomb manuals, guides on guerrilla warfare and media glorifying white supremacy and Nazism."

She was the youngest girl in the UK to be charged with terrorism offences.

'Fixation' aka RRBs (repetitive and restricted patterns of behaviour) as part of a diagnosis of autism are not benign. And for this young woman, and many others like her who have similarly come to the attention of anti-terrorism services e.g. ‘Staggeringly high’ number of autistic people on UK Prevent scheme https://www.theguardian.com/uk-news/2021/jul/07/staggeringly-high-number-of-people-with-autism-on-uk-prevent-scheme the onus should be on early identification and treatment/intervention of such issues. To not do so leaves the person vulnerable and more widely, it makes society vulnerable.

Genes and environment and regression

2025-02-23T12:25:00.003+00:00

Pathogenic variants in chromatin-related genes: Linking immune dysregulation to neuroregression and acute neuropsychiatric disorders https://onlinelibrary.wiley.com/doi/10.1111/dmcn.16276

Interesting article: "We report eight children with de novo pathogenic DNA variants in chromatin-related genes: MORC2, CHD7, KANSL1, KMT2D, ZMYND11, HIST1HIE, EP300, and KMT2B." Chromatin is a chemical soup of DNA and proteins that condense DNA so it can fit into the cell nucleus. A sort of biological suitcase if you like.

So: "All children experienced infection or vaccine-provoked neuroregression or abrupt-onset neuropsychiatric syndromes. Most had delayed development (n = 6) before the first regression, and four had immune deficiency or autoimmunity (n = 4). At a mean age of 4 years 2 months (range 1–8 years), symptoms included infection-provoked autistic/language regression (n = 6), cognitive decline (n = 3), gait deterioration (n = 3), or abrupt-onset anxiety, obsessive-compulsive disorder, and/or tics (n = 5)."

The authors talk about how chromatin dysregulation may very well play a role in some "autistic regression and abrupt-onset neuropsychiatric syndromes". That infection and vaccine-provoked neuroregression is mentioned is important and illustrates how natural and 'acquired' infection (yes, a vaccine is all about provoking the immune system into formulating a response to a target disease) can impact on development, behaviour and cognition. I might add that this is not the only route from such exposures to behavioural consequences as per the work on mitochondrial issues e.g. Clinical presentation of mitochondrial diseases in children with progressive intellectual and neurological deterioration https://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2009.03488.x

Implications? As I've said before, regression in previously acquired skills is not a typical part of development. When it occurs, the onus is on medical professionals to seek answers and conduct the appropriate examinations to determine potential causes and where possible, mitigate them. Again in the context of autism, there are examples of how to do this e.g. Developmental regression and mitochondrial dysfunction in a child with autism https://pmc.ncbi.nlm.nih.gov/articles/PMC2536523/ bearing in mind the need to keep an open mind. And minus any hype.

"Phenotypic divergence between individuals with self-reported autistic traits and clinically ascertained autism"

2025-02-08T09:43:00.003+00:00

Phenotypic divergence between individuals with self-reported autistic traits and clinically ascertained autism https://www.nature.com/articles/s44220-025-00385-8

So: "These findings highlight the need for a differentiation between clinically ascertained and trait-defined samples in autism research."

Quite a bit to take away from this study. Not least that if you are going to include the 'self-diagnosed' in your autism study, you perhaps need to say so in the title, abstract and body text, and potentially conduct separate analyses of any findings based on formally diagnosed with autism vs. self-diagnosed with autism. No, you can't honestly say your study is 'about autism' if not everyone in your cohort has received a formal professional diagnosis of autism. Sorry.

Further: "Despite having comparable self-reported autistic traits, the online high-trait group reported significantly more social anxiety and avoidant symptoms than in-person ASD participants."

This is another important point and so beautifully fits in with the ICD-11 diganostic description of autism, highlighting how there are 18 boundary conditions that can 'look like autism' but aren't autism. In this case, how the self-reported (in this cohort) may well have features that whilst looking like autism are more likely to stem from an anxiety or personality led disorder: https://icd.who.int/browse/2024-01/mms/en#437815624

I know such studies aren't going to make an iota of difference to those chained to the 'anyone can self-diagnose autism (replace with other behaviourally defined condition that doesn't have an objective diagnostic marker yet)' mindset. But for everyone else who does believe in science and the value of expert assessments, yet more proof that autistic traits are no longer the exclusive domain of a diagnosis of autism and the only way to tease out autism from 'condition(s) that manifests autistic traits' is via a comprehensive, expert-led assessment.

Prevent closed Southport killer case 'prematurely'

2025-02-05T18:57:00.000+00:00

Prevent closed Southport killer case 'prematurely' https://www.bbc.co.uk/news/articles/c0rqxpg2ryvo

"[Rudakubana's] potential ASD [autism spectrum disorder] and 'special interest', which frequently are combined, are part of the reasons that make him susceptible to being drawn into terrorism."

Some initial 'answers' are starting to emerge following the heinous crime in Southport in 2024 but there'll be more. Not that these should be any surprise given what we already know about the issue of autism and susceptibility to extremism and radicalisation e.g. Autism spectrum disorder, extremism and risk assessment https://onlinelibrary.wiley.com/doi/full/10.1002/cbm.2330

The news report also includes this really strange quote: "The officer also noted that Rudakubana had been diagnosed with an autism spectrum disorder (ASD), and said the way to address his "vulnerabilities" may lie outside of the Prevent scheme." This is strange because the state already knew Prevent was dealing with 'staggeringly high' numbers of autistic people: https://www.theguardian.com/uk-news/2021/jul/07/staggeringly-high-number-of-people-with-autism-on-uk-prevent-scheme and already learning how to 'manage' such vulnerabilities.

The fact that this important aspect of this particular offence is at last seeing some 'daylight' is welcomed. It forms a part of the wider inquiry into what happened in Southport and, importantly, how such a horrific crime came to be. One would hope lessons will be learned for the future safety of the general public.

From the embers of Spectrum 10K, an autism 'neuroimmune' phoenix may rise...

2025-01-31T12:14:00.001+00:00

Statement from the Spectrum 10K research team, 30th January 2025 https://www.autismresearchcentre.com/projects/spectrum-10k/

It looks like Cambridge have decided that Spectrum10K - with the "intention had been to create a database with 10,000 DNA samples related to autism health research" - is to call it a day.

Various voices, from several different autisms communities (note the plurals), had raised concerns about the initiative and particularly, what the endgame was. The PEAPOD studies gauged opinions from various of those autisms communities and well, ultimately I think the organisers probably thought it just wasn't worth the efforts.

Will it be missed? For some, no. For others, particularly those allied to the genetics ilk, perhaps.

But from out of the embers comes a potential phoenix as we're told that "there are now other very large health and genetic databases in the UK and internationally that have become available as a resource for autism health research. This means that we no longer need to collect new DNA samples as we can use existing health and genetic databases to better understand the health challenges faced by autistic people."

More specifically one of the potential new aims seems incredibly sensible: "Whether autistic people experience greater prevalence and severity of neuroimmune conditions, and – if so – why". I'll stick my neck out here and say that this is probably more likely to yield actionable results in the form of both data on such 'neuroimmune conditions' and the ways to treat said conditions and their likely impact on the presentation of autism. Of course I am biased around the importance of somatic health conditions and autism... Bridging the Gap Between Physical Health and Autism Spectrum Disorder https://pmc.ncbi.nlm.nih.gov/articles/PMC7335278/

"Personality disorder diagnosis 'turned my life upside down'"

2025-01-28T12:51:00.000+00:00

Personality disorder diagnosis 'turned my life upside down' https://www.bbc.co.uk/news/articles/c3w8517wd02o

"For some, the diagnosis of a personality disorder can be a route to treatment and understanding. But others have said their diagnosis has led to mistreatment and stigma."

There is an awful lot of stigma around the diagnosis of personality disorder. Borderline personality disorder (BPD) in particular, carries lots of stigma despite an estimated 1-3% of the population living with the condition.

The reason(s) for the stigma are complex but probably in part relate to the symptoms of BPD - emotional instability, disturbed patterns of thinking or perception, impulsive behaviour, intense but unstable relationships with others - and much like in other psychatric conditions, the 'fear' around something like BPD and (exaggerated) perceptions of 'unstableness' for those with a diagnosis.

This article talks about an important topic on the potential 'misdiagnosis' of personality disorder, often delivered when complex cases come to clinical attention. 'Autism' is also mentioned in this news piece, as a potential alternative diagnosis - "is now waiting for an autism assessment" - and illustrates some important points, not least that there is sometimes significant overlap between the presentation of BPD and some phenotypes of autism.

It's a difficult topic to discuss in some quarters, and science is still 'feeling its way through' such overlap and the hows-and-whys. The recent paper by Zavlis & Tyrer: The interface of autism and (borderline) personality disorder https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/interface-of-autism-and-borderline-personality-disorder/65B36665CFAE841DC852F68996AD9ED6 provides a really good 'where we're at' appraisal of this topic, not least highlighting that there is overlap and that needs to be taken into account when assessments are done.

I'm also coming around to the idea that in amongst the huge heterogeneity that is 'the autisms' for some, autism - a childhood developmental disorder - may well 'morph' into something more approaching a personality disorder. We know, for example, that in an estimated in 1 in 10 cases, autism 'progresses' to schizophrenia: Diagnostic progression to schizophrenia: A nationwide cohort study of 11 170 adolescents and young adults with autism spectrum disorder https://pubmed.ncbi.nlm.nih.gov/36057134/ It stands to reason that other 'progressions' are potentially possible, and certainly would account for some occasions of overlap between the two conditions. More study - minus hype, hesitency, or neurobabble - are required.

"Detecting noncredible symptomology in ADHD evaluations using machine learning"

2025-01-27T13:43:00.001+00:00

Detecting noncredible symptomology in ADHD evaluations using machine learning https://www.tandfonline.com/doi/full/10.1080/13803395.2025.2458547

"Diagnostic evaluations for attention-deficit/hyperactivity disorder (ADHD) are becoming increasingly complicated by the number of adults who fabricate or exaggerate symptoms."

A natural consequence of having a behavioural defined condition with as yet, no objective biological test or tests. This is not a new topic by any means - Feigning ADHD? - but an incresingly important one. Most people don't fabricate or exaggerate but there will always be grifters, and in some cases grifters who either go 'shopping' for their diagnosis and/or utilise the various online resources that provide information on 'how to get a diagnosis' (typically, but not universally, wrapped in the neurospeak of neurobabble). Such an issue also aligns with the knowledge that some diagnostic providers are themselves not always 'accurate' in their diagnostic decisions: ADHD: Private clinics exposed by BBC undercover investigation https://www.bbc.co.uk/news/health-65534448

We've also seen this issue increasing in importance in research and particularly in amongst the various 'online' based psychology studies e.g. https://pubmed.ncbi.nlm.nih.gov/39582239/ where some studies don't even appear to have asked basic screening questions for their chosen cohorts (a sign of particularly bad science).

It looks however, like AI might be another tool in the arsenal to combat such 'noncredible' issues drawing on analysis of self-report responses during the assessment procedure. In this case, authors concluded: "unsupervised ML [machine learning] can effectively identify noncredible symptom reporting using scores from multiple symptom validity tests without predetermined cutoffs." As such technology gets more advanced, it will make it even easier to spot such noncredible situations.

But then the next question: why? Why would someone chose to feign symptoms to get a diagnosis? I know some people will talk about the 'advantages of a diagnosis' but this really isn't a credible answer for many occasions, outside that is, of potential access to some extremely powerful medicines. No, there's probably lots of other explanations which, drawing on the available studies on why people 'self-diagnose', means issues such as group belonging - particularly disability group belonging, the influence of social media and indeed, the presence of other psychopathology also exert potentially powerful influences.