The Autism Spectrum: Science, Support, and the Latest Research
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Welcome to the WebMD Health Discovered podcast. I'm Dr. Neha Batak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Today, we're going to talk about autism, a neurodevelopmental condition with a broad spectrum of characteristics. The condition is often linked to confusing and sometimes polarizing headlines.

Recent U.S. data from the CDC's Autism and Developmental Disabilities Monitoring Network indicate that about 1 in 31 children were identified with autism spectrum disorder in 2022, a slight increase from the 2020 estimate of 1 in 36.

For all its visibility and presence in mainstream conversation, basic questions about autism still cause confusion among parents, caregivers, and even clinicians. Questions like, what causes

What causes autism? What role do genetics, prenatal factors, and better screening play? Why do vaccines continue to be part of the discussion, contrary to all the scientific evidence?

Why are autism diagnoses rising? How early can we spot the signs? And does a late diagnosis change what support is possible? Why do some people with autism thrive while others need round-the-clock care? We'll also explore life outcomes.

after a diagnosis, where parents can turn to for state-funded early intervention services, how occupational and speech therapy build on a child's strengths,

and why caregiver burnout is real and preventable with respite programs and peer support. Whether you're a parent noticing subtle differences while observing your child, a teacher puzzling over a student's behavior, or an adult wondering if you might be on the spectrum,

This conversation offers practical steps, credible resources, and a reminder that meeting each person where they are is the first tool of truly compassionate care. Joining me today to explore this topic are two incredible guests. My first guest is Dr. Suma Jacob.

Dr. Jacob is a distinguished child adolescent adult psychiatrist, as well as a neuroscientist who's widely recognized for her research in neuroendocrinology and neurodevelopmental disorders across the lifespan. Welcome to the WebMD Health Discovered podcast. Wonderful.

Wonderful to be here, Neha. Thank you so much for taking some time to have this really important conversation. And before we jump into our topic, I'd love to ask about your own personal health discovery, whether it's your research or the work that you do with patients. What was your aha moment when it comes to autism and the research that you do?

One of the most impressive things that I learned and remember to this day comes with experiences as a clinician and with children that I've known, which is it takes a lot more effort to improve a weakness than

than to amplify or leverage a string or window of openness with kids that have neurodevelopmental challenges. And I can give you a quick example. Parents were having trouble helping a child learn to read in order to use assisted technology to communicate. And they figured out that when their child was jumping on a trampoline, if they put the words on the wall, that they quickly learned to sight-read

And it was a way of finding a space when they were happy or having fun or something they love to do and pairing it with learning. So that's something that I always carry with me. That's really a powerful anecdote. So thank you so much for sharing that. Can you help us define autism or autism spectrum disorder?

It is a neurodevelopmental condition, meaning that it starts very, very early in life, and it relates to persistent challenges in social communication and interaction, along with repetitive patterns of behavior, restricted interests, or activities that someone wants to do most of the time or almost all of the time. It's considered a spectrum because

because of the severity and specific characteristics of autism. And this can vary very widely. And that breadth of the characteristics and what shows up with severity is the reason that it really needs to be on a spectrum. Some people say when you've met one person with autism, you've met one person with autism. I

I'd love to dig into that piece a little bit more, the spectrum piece of it and the variability across the spectrum. Can you talk to us a little bit about what that range can look like? One of the ways I look at it because of my training and development is autism can present or be diagnosed very, very early and up in through adulthood and even some people in their older age. And

Part of that variability is if an individual cannot verbally speak or communicate, can also have intellectual disabilities or challenges to individuals where they're verbally fluent, don't have intellectual challenges or intellectual strengths. That can be picked up at any time in life. And so you can have...

people that are incredibly successful, brilliant computer scientists and business people to individuals who need full-time care and assistance with caregivers. And that full range of life-to-life daily function is seen in something like autism spectrum. Given the wide range of presentations that you've described, that's

Then the question is, are there unifying pieces that allow you to consider someone that you're going to diagnose with autism as being somewhere along on that spectrum?

Yes. So there is unifying language in terms of social communication and our social communication can be verbal or nonverbal. So picking up nonverbal cues, noticing when others are subtle differences in their communication about what they want to do could be unifying.

wide range of abilities. And then insistence on sameness or wanting things to be the same or patterns of behavior to be consistent was something that even in the earliest definition of autism in the 1900s was picked up. And so there's a wide range of all of these things and people who

figure out ways to compensate for this to some level. And still, when they're under stress or life gets difficult, they fall into their most innate patterns of behavior.

So then let's just dig into that piece a little bit more. When we're thinking about common signs and symptoms that are sort of unifying, we have some that are in that social and communication category. So can you talk to us a little bit about what those signs and symptoms look like? One way to think about it is in very early childhood, joint attention. So a

Autistic individuals often are so excited by what they see and the details of what they see. That's what they're focused on. Social communication, adding to that, is if a child sees an airplane and is super excited about it, they often look at the airplane, look back at the parent or caregiver or other people with them to see how they're responding to it, and then go back and look at it, and they go back and forth.

Autistic individuals are so absorbed in what the actual thing that they're focused on is that they don't do this back and forth checking and have the bandwidth often as more people are in the room to track all that social information.

That's really helpful. And then the other piece that you are mentioning is in that behavioral sensory category. So can you talk to us about some of those signs and symptoms? So some of those is incredible nuance and detail in picking up sensory information. For example, the overhead fluorescent lights, hearing that.

at all times, texture, how things feel, having that really be in the foreground rather than the background and often can lead to discomfort

or focus on wanting things to be a certain way so it doesn't create discomfort. Routines are like that, wanting to go the same way so it's predictable instead of all the stress that comes when unpredictable things show up. There are lots of things. And even if it's something you love doing, wanting to know it's there and that you could do it in the way you want to do it without other people interrupting you. Really helpful. So then if someone is concerned, how...

early in a child's development would you start noticing these patterns? I think you can notice some of these patterns very early. The challenging things are in development, there are different phases of what infants or young children are mastering. So babies are, it's arousal and then slowly back and forth, motor, physical, all these changes.

So often caregivers can pick up something atypical. And traditionally, clinicians always give a wide range of individual differences. Some kids are laid on certain developmental milestones. So that's what clinicians are like, don't worry, we'll see. But over time, we've noticed that certain kids or children or even infants are

when they lag in looking and communicating and smiling and cooing and back and forth,

the kind of baby talk that caregivers have, those kind of things can be picked up fairly early. And parents should go to their pediatrician or clinicians. But universally, a lot of parents later with children with neurodevelopmental syndrome, some even genetically identified with more severe developmental delays, they even say that it takes a long time to figure it out because

because clinicians and pediatricians often want to track and see how things are. But I think parents or caregivers should work with professionals and keep being persistent. If they have a gut feeling something is off or...

or not the way that they see other kids. Often parents with their first child really struggle with this because once they have more than one child, they remember they have an anchor to compare. And so that's another piece of working with professionals or keeping an eye on the playground if something looks atypical.

And it strikes me as we're talking, I think a lot of our listeners are potentially hearing a lot more about autism, maybe in their lived experiences, are sharing time, community with children that are diagnosed with autism, hearing about cases where adults are being diagnosed with autism. So can you talk a little bit about that?

this question of cases increasing. Are cases increasing? Is this just an artifact of us being better at diagnosing? Can you talk us through a little bit of that question? So being involved with watching neurodevelopmental assessments and how we track it clinically, we've gone through a period where we've gotten

really good at assessment and picking things up very early, as I mentioned to you. So the data shows that increased assessment services, because some things you can pick up but not know what to do, and we do have early intervention services, as well as destigmatizing autism spectrum has increased the numbers. That's what we have the most data for. Of course,

Clinicians and scientists are looking for if there are other patterns where there's increase in numbers beyond that. But we really see that the number of parents seeking services or caregivers or teachers reaching out has increased tremendously. And even adults, when they feel like they've had concerns for a long time and they hear about it from other people and then seek help.

assessments and services, that's brought a lot of adults into diagnostic settings. That's really helpful. And I'd like to just take a minute to focus on a few things that I think a lot of people are hearing. And so I'd just love you to help guide us with regard to where the science is when it comes to a link between autism and

and vaccines or autism and other environmental factors. Can you help us understand where is the science when it comes to some of these other factors that people often see linked together? So there's been a long-term search for looking at

what causes and contributes to autism. There's a large amount and consistent amount of data disproving any connection with vaccines. When it was initially introduced, there were some people promoting that vaccines could be linked and later it was shown that it was falsified data. And so as

At the time, there were large, large studies looking into this. And from all of that evidence, there seems to be no connections with vaccines. And I just want to state that. One of the challenges is kids get their shots at these various periods between 12 to 18 months. And that's when some of these symptoms and signs come along and change.

Parents are really attuned to watching their children around this time and these changes. Now, as scientists, we are often open and critical thinking and always challenging the state of what the field says. So we continue to do a lot of research on this. Research has shown strong genetic ties to autism, but also environmental factors are being looked into, like prenatal exposures,

And very, very early childhood exposures to environmental factors or labor and delivery, all of those things in combined are still being explored. Thank you so much. It's important for us to lay out with humility that there's always something more to learn, but that there's very strong evidence that has been studied, the research when it comes to vaccines and

autism doesn't seem to be there, but that there are other factors that are being explored. Let's then turn to diagnosing autism. If a parent or a loved one is concerned about their child, or even if you in adulthood are wondering and seeking answers, where do you go? Can you operationalize that a little bit for us?

So one of the things that's unique about autism in early childhood is there are often links within the educational setting as well as going to the pediatrician and clinical primary care settings for parents to get assessments as well as early services. So state by state, this is different.

Many places have assessments for children under three, under five, linked to school services. There are often state-funded programs where assessments can be done and there can be some in-home services provided.

So families should definitely reach out, look online, talk to their pediatrician or healthcare provider. In addition, through the medical system, there are ways of getting assessments as well. The earlier, the better. Adults who are interested in learning more, there are fewer resources because the education resources cap at the early 20s. And then adults often need to work with their parents

physician or clinical psychologist or therapists or other folks that can help them look for someone who will do appropriate testing and assessment for adults and help them see what it is. There are other things like ADHD, anxiety, many other kinds of neurodevelopmental disorders as well, learning differences that

can overlap or look like autism spectrum. So working with a professional with this is really helpful. That's really, really important information. And I'm kind of curious about something that I think might be two sides of the same coin. You mentioned this earlier. So there has been a lot of de-stigmatizing around autism diagnosis. And at the same time,

that this is a spectrum of behavior. So in some ways, how do you think about whether or not we're medicalizing a spectrum of behavior that might not have been thought of as autism?

You know, I was thinking about the pros and cons of using the medical system. Almost all the things that we have, like hypertension or even things like substance use or substance disorders or however you frame it, have spectrums.

Autism was one of the first that really highlighted the spectrum element. But there's so many things where you can have a range of signs and symptoms. And really when it crosses over into the medical system is when it's really impairing function or decreasing quality of life or creating a lot of suffering for the individual or family members.

And at that point, the medical system can offer a range of treatments, interventions, or help in figuring out what to do next.

There are many people that have certain conditions that figure out ways to work around it, and it isn't impacting their lives in a way that they can't live the quality of life they want to live. And that's sort of the other range of when you think of something at a full spectrum, it's something like depression.

People at risk for diabetes could control their risk by diet, exercise, so many things. But at some point, the data in terms of their blood labs or how they're physically functioning may mean that they need to do something more and work with a professional to

And so in some ways, I think that that's with all spectrum of health care, both mental health as well as physical health. That's sort of the frame. I see it as a pro and helpful and sometimes in destigmatizing things that are diseases and disorders. People always feel like there's something wrong with them. And many things, they're both positive and negative outcomes of any of the challenges we have.

I love that frame. I think it's as a primary care provider, really interesting. And when it comes to something like diabetes or high blood pressure, we're monitoring as early as we can so that we can intervene as early as we can. And you mentioned early

early intervention, as well as an important piece of caring for someone with autism, particularly as it relates to when it's impacting your daily activities or your quality of life. So can you talk a little bit about why is it so important to talk to your provider and start thinking about this as early as possible? And then what are some of the interventions that help?

So the earlier you get a sense of whether some of these things are challenges and difficult in terms of social communication or getting stuck in certain patterns of behavior, the sooner you have access to potential behavioral interventions, like there's occupational therapy for sensory things, physical therapy, speech and language, a lot of things that early childhood neurodevelopment

mental programs offer. But then also there's social skills training. There are even programs that help how to deal with a worker group or vocational training situations.

And again, the earlier the better. In any of these neurodevelopmental conditions, people later in life who get diagnosed much later sometimes have regrets because they said, if I knew that earlier, I would have thought about a different kind of job or career that fit my strengths versus some of my challenges. So that's the true benefit of early intervention. It opens up doors and possibilities for

that you may not see if you make choices based on avoiding some of the difficult situations because of the spectrum and the signs that come along. So I'd love to then shift gears to thinking about caregivers and family members that might be identifying that a loved one might have signs and symptoms consistent with autism or they're already caregiving for someone with autism. First off,

Let's start with some of the destigmatizing pieces that you mentioned. How can we destigmatize our language, how we talk to and about our loved one that we're concerned about? So, you know, stigmatizing, I often think, again, as we were talking about medical conditions as a whole, is othering individuals, families or group who don't fit into a

cultural or group ideal or expectation. And we all have aspects of ourselves that could be stigmatized. But with autism in particular, the challenge is this wide range of abilities, as well as the timing of when it's picked up.

So adults, autistic individuals have stated that they have preferences for what they're called. And this changes very quickly. So often I think it's really important to ask what they prefer. So some individuals want to be called autistic. Others have a person-centered preference.

preference of saying an individual with autism. And this is changing quite quickly. So I really think it's important to ask. And sometimes you can't ask, like in written materials, you may state why and when you're using a specific category or term or language. And then you may all, some people even use more than one to include people with different preferences as well.

That's really helpful. I think, again, it's very much the preference of the person that you're speaking with, but important to sort of consider just how we speak about these types of conditions. Do you have any other tips for family members and caregivers that are struggling to care for someone? Because as you mentioned, that it is quite a spectrum and things can shift over the course of the lifespan. So how do you sort of

address this or think about this with a caregiver that may be, let's say, on the spectrum of burnout, may be someone who is experiencing burnout?

Yeah, I think, again, thinking about lifespan changes, burnout's really important. If an individual is caring for someone who's a child and it's 24-7, they need support. There are support programs, and especially there's online supports for caregivers. I highly encourage people to...

to get that. The other perspective is looking down the line, children become teenagers and then adults and what you are doing shifts over that time because of all those changes. So again, we're

getting help from professionals, peers, support groups, of thinking ahead of how to increase independence and quality of life for the individual, but also maintain your own energy of support and get other people to help you support. Respite care is something that caregivers often need when they need a break. How do they get that care and support? So

it's a long process. And I think talking to other people and hearing about that road and trying to plan for that makes a huge difference for families. I'm also curious about expectation setting with regard to your goals of functionality, let's say. So can you talk a little bit about

how one's starting point, does it influence what you can expect about developmental shifts and changes over the course of a lifespan? I think this is one of the most challenging things. Clinicians or any experts don't have crystal balls to see into the future. And all the individual differences and strengths of individuals mean that there's potential. So

So there are certain things like basic care that people can be very creative in how to teach kids. In some ways, the fun thing about early intervention is there's more plasticity or flexibility in learning when you're younger. And so I want families and caregivers to be open to try new things, but also accepting the autistic individual with where they are.

is also so important because that other piece of seeing them as whole, unique, special individuals is essential. So it's a tight balance between offering things for potential as well as doing the best you can to support them for who they are.

For anyone listening today, do you have any advice that they can take and start incorporating into their lives today if they're concerned about a loved one that may be showing signs and symptoms of autism? I think it's important to seek resources and learn from what is available with the community, but also be patient with that individual because they need to have the motivation to

to want to learn more, to seek information and to get help. So again, this varies greatly if you're working with someone who's an adult versus a child. With children, you often try to put them in environments where they can thrive. And that's sort of what I encourage parents to do.

With adults, you often have to meet them where they are and work with them step by step by what motivates them, what they want to get out of it. And that's sometimes being more patient and being a supporter alongside the adults is important. Thank you so, so much for this conversation. Really helpful.

It was so informative speaking with Dr. Suma Jacob, a clinician working with patients and their families on the realities of autism throughout the lifespan and across different groups. To go even deeper into the research around autism and what's on the horizon, we spoke with Dr. Karen Parker. Dr. Parker is the inaugural Trung Tan Broadcom Endowed Professor

chair of the Major Laboratory Steering Committee and associate chair for research strategy and oversight in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. She shares valuable insights about what is driving the increase in numbers. Let's hear what she has to say about the rising price.

prevalence. Some of the things that I see as a researcher that we certainly have improved recognition and screening, right? So pediatricians are now really robustly trained to recognize autism. Teachers recognize autism. There's been better public education and awareness campaigns and media coverage. And autism was also redefined to include a broad

range of individuals with milder symptoms. So that also increases the diagnostic numbers. There's better access to services. So families and care providers may be motivated to go and seek that diagnosis. The costs of genetic screening have

come down a lot. So more people are identified with these autism susceptibility genes, which can then yield an autism diagnosis. And a couple other things are that girls have historically gone undiagnosed. So there was a JAMA paper last fall showing that there was a

300% increase in the past decade of girls being diagnosed. I think there's also a greater awareness that girls can present differently in terms of behavioral symptoms. One of my favorite analogies that a clinician once told me is that when boys line up trains,

Everyone thinks, oh my gosh, autism. But when a girl lines up dolls, it's a tea party. And so there really needs to be a better sense about how symptoms could present differently in boys and girls. And I think that's beginning to be very recognized.

And then also there's an increase in diagnosis in underserved communities. So in that same JAMA study, there was an increase in autism diagnoses in Hispanic populations by about 300%, and that also increased in other underserved communities. And then there's other things like advanced parental age. So people are able to have children later in life, but that's also associated with increased autism risk, as well as preterm births.

So those are, I think, a bunch of the different reasons driving this increase in the numbers. A couple weeks ago, the CDC just came out with a new statistic that there is one in 31 children in the U.S. are now diagnosed with autism. So Dr. Parker,

How close are we to identifying reliable biological indicators that could eventually assist in diagnosing autism? I think we're getting pretty close. There's a variety of different groups working on this across the world. And so the big issue is really how do we bridge that

gap between academic science, where the vast majority of this work happens, into commercializing these sorts of diagnostic solutions. And I think that's where we are with a lot of these different, more basic science diagnostic studies going on now. We're getting close, getting it out of the lab and into the world.

You published a small pilot trial about six years ago focused on improving social function in autism. What were some of the key findings from that study? So it was a double-blind randomized placebo-controlled trial, which is the sort of gold standard of clinical trials, looking at giving vasopressin to a subset of these children with autism, and the other subset in the trial was given placebo.

And people didn't know if they were on placebo or on vasopressin. And what we showed in this trial was that vasopressin improves social functioning after four weeks of treatment. And we used different outcome measures. So parents saw the improvement.

Clinician evaluation showed improvement in even the children themselves. Performing lab-based tests of socio-emotional functioning also showed this improvement. And then in a subset of kids in the trial, we also showed...

that restricted repetitive behaviors were reduced and anxiety was also reduced. And because autism has these two core diagnostic features, so we were looking at social functioning, but we also saw that vasopressin reduced symptoms at the second core behavioral feature, repetitive behaviors.

that vasopressin is important in mammalian social behavior, particularly for males. And when I got into doing this work, I was really interested in that because autism is male-biased in prevalence. And so there was this work showing early on in a species called prairie voles

that it was critical for social bond formation and also male parenting. And so after that, our lab did work looking at various animal models showing that vasopressin levels in cerebral spinal fluid were reduced significantly.

in a monkey model. And then we translated this work to multiple cohorts of individuals with autism showing that vasopressin was low in children with autism, that the lower your cerebral spinal fluid vasopressin concentrations, the greater your symptom severity. And then we published a small trial showing that in neonatal infants, many months to years before the behavioral symptoms of autism first manifest,

vasopressin levels were already low, basically at birth in children with autism.

Looking into the future, what are some of the biggest unanswered questions in autism research that you're most excited to explore? We already know that early intervention is critical. So we need to diagnose autism as early as possible for the existing therapies, which are behavioral, to be maximally beneficial. So the goal would be, can we, instead of diagnosing children at a

mean age of four, can we identify children that are at risk and get them into behavioral therapy when they're 12 months of age, for example? Thank you so much for being with us. Today's conversation clarifies that autism is neither a single presentation nor a childhood-

only condition. It's a condition on a spectrum that impacts lifelong neurodevelopmental milestones. We also addressed the rising prevalence, which in part reflects better screening, broader diagnostic criteria, and greater recognition in girls and previously underserved communities. Research continues to look at environmental exposures

that might also play a part. The take-home message is action-oriented. Trust your gut if developmental milestones feel off.

Press for a formal evaluation and start evidence-based interventions like speech, occupational therapy, and social skills training as early as possible. For adults seeking answers, a comprehensive assessment can open doors to workplace accommodations, social coaching, and community support.

Caregivers, remember that burnout is real. Build in respite time, connect with peer groups, and plan for each new life stage. Above all, focus on leveraging strengths, whether that's learning to read words while jumping on a trampoline or channeling a special interest into a fulfilling career later in life. Because amplifying what goes right often moves the needle farther than

than trying to fix every perceived weakness. Thank you so much for joining us. We hope these insights empower you to ask questions, seek resources, and celebrate every individual's unique pathway on the autism spectrum.

To find out more information about our guests, please make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at webmdpodcast at webmd.net. This is Dr. Neha Parthak for the WebMD Health Discovered Podcast.