Autism rates have risen since the CDC first started measuring them in 2000
Diagnostic expansion may be diverting resources from children who need them most
STUDY: Liao L et al, JAMA Pediatrics 2026
STUDY TYPE: Editorial
FUNDING: Independent
Background
This editorial examines the mechanisms behind the sharp rise in autism rates and the real-world costs it may be imposing on children with the most severe impairments.
The Study
The authors — a child psychiatrist and a leading autism epidemiologist — identify five drivers of overdiagnosis:
- Diagnostic substitution from intellectual disability
- Clinicians stretching criteria to unlock services
- Misapplication of standardized tools
- Broadening of diagnostic thresholds
- Cultural “looping effects” in which autism becomes an identity category that people adopt.
They cite data showing that close to half of children diagnosed in community settings did not meet autism criteria when re-evaluated by a research team, and that perceived functional impairment has increased in later birth cohorts even among children with similar symptom profiles.
The authors aren’t arguing that autism is rare or overblown — they’re arguing that a spectrum diagnosis has stretched far enough that a child with profound autism, who doesn’t speak and self-injures, barely registers in the public imagination alongside a child with quirky social habits.
That gap matters clinically. Resources — evaluators, therapists, school supports — are finite, and better-resourced families are better at navigating systems to obtain milder diagnoses, leaving the most impaired children with less.
Practice Implications
- Autism has shifted from a categorical disorder to a spectrum of traits, which makes diagnosis more difficult.
- To make the diagnosis, use standardized instruments, get input from relatives, and look for impairment from the autism itself.
- Search here for standardized instruments for adults (eg, Social Communication Questionnaire Lifetime; Autism-Spectrum Quotient; Empathy Quotient; Ritvo Autism Asperger Diagnostic Scale-Revised; Social Responsiveness Scale-2; Camouflaging Autistic Traits Questionnaire; Adult Repetitive Behaviors Questionnaire-2; Modified Girls Questionnaire for Autism Spectrum Condition Scale for Adult Women).
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
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