Peter J. Hotez, “Reframing Autism: Considerations for a Biomedicine Roadmap,” Rice University’s Baker Institute for Public Policy, December 10, 2025, https://doi.org/10.25613/DF00-H990.
On Sept. 22, 2025, the White House and Department of Health and Human Services (DHHS) gave a briefing on what President Donald Trump and the DHHS secretary believed were the causes of autism and an “autism epidemic” in America. [1] The announcement perplexed the millions of Americans living on the autism spectrum and their families (like mine) who support them. After months of buildup in which the DHHS secretary promised to disclose the true causes of autism and identify new potential actions or interventions, both the briefing and its accompanying White House’s “Autism Action Plan” failed to deliver.[2]
The new plan would fund $50 million in much needed new autism research. However, its major thrust places a laser focus on the prenatal use of Tylenol (acetaminophen) as a cause of autism and leucovorin as a treatment. This contradicts very strong scientific evidence that has found no causal link between acetaminophen use during pregnancy and autism. It also dismisses the very real risks of allowing high fevers to occur in pregnancy, which could lead to neural tube and other congenital defects. Moreover, there are significant limitations of using leucovorin therapeutically except in rare instances.
The White House’s Autism Action Plan also neglects or does not adequately address three essential aspects:
Such missteps were not without context. The September briefing came after a series of inaccurate public statements from the DHHS secretary, in which he either misunderstood or misrepresented the range of neurodiversity occurring with ASD, using disparaging language to describe those living with autism and questioning their contributions to civil society. The secretary also proposed creating lists or registries of autistic individuals, making the U.S. government’s autism leadership appear incurious or unsympathetic.
A key take-home message from this working paper: An improved, more meaningful, and helpful government and policy agenda is needed to begin a national plan for those living with ASD or their families. In this paper, I will outline the steps needed to reframe autism and neurodiversity in America and advance such a roadmap. First, I will summarize essential background information on the genes involved in ASD neurodevelopment, the geographic differences in global autism, and the known prenatal environmental triggers. I also will examine data on the prevalence of autism in recent decades and if there is an “epidemic” as alleged by the U.S. government, or if use of such a term still has relevance considering all we have learned about neurodiversity. Finally, I will outline an alternative and evidence-based framework for understanding the causes of autism and shaping public policies to help those living on the autism spectrum and their families. This would involve convening three groups of experts to help identify gaps and potential solutions:
ASD and neurodiversity have emerged as key themes for humanity. We need a realistic and helpful roadmap for this aspect of American life that respects the dignity of those who are or are caregivers for individuals with ASD.
View the full paper (PDF).
[1] U.S. Department of Health and Human Services. President Trump, Secretary Kennedy Announce Bold Actions to Tackle Autism Epidemic. September 22, 2025, https://www.hhs.gov/press-room/hhs-trump-kennedy-autism-initiatives-leucovorin-tylenol-research-2025.html, accessed October 15, 2025; Stein R. RKF Jr. calls autism an ‘epidemic’ and launches effort to find ‘environmental’ cause. NPR. April 17, 2025, https://www.npr.org/2025/04/17/nx-s1-5366846/rfk-jr-calls-autism-an-epidemic-and-launches-effort-to-find-environmental-cause.
[2] The White House (@WhiteHouse). “President Donald J. Trump, @SecKennedy, @DrOzCMS, @NIHDirector_Jay, & @DrMakaryFDA announce the Autism Action Plan. Make America Healthy Again.” Twitter (now X). September 22, 2025, https://x.com/WhiteHouse/status/1970238866394099891?lang=en.
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