By Jill Escher
A new paper published in the Journal of Autism and Developmental Disorders makes the case that the rising prevalence of autism in the U.S. poses a substantial threat to the American economy. Because the paper was written by notorious anti-vaxxers and is based on the steadily increasing birth-year prevalence of autism, it has already come under fire by critics.
The study, Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States, by Mark Blaxill, Toby Rogers and Cynthia Nevison, concludes that future costs of autism could be $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060. They say, “the future costs of autism loom so large that, rather than responding with a sense of urgency as one might expect, policymakers thus far have generally failed to engage with the policy implications at all…. We hope this paper will serve as a wakeup call for the public health emergency that the societal cost of autism represents to the economic future of the U.S.”
While I agree with the noble intentions, I admit that when I saw the list of authors, my heart sunk. Both Blaxill and Rogers are known for pushing the nonsensical, disproven, and downright dangerous vaccine hypothesis of autism, a sin that, to me, makes them irredeemable and unworthy of inclusion in a scientific journal like JADD.
But even a broken clock is correct twice a day, and such is the case with this paper.
The authors engage in an analysis that is vitally important and long overdue. Indeed, I often wonder why projections like this, on a subject of such monumental and obvious importance, are not published almost daily. They base their analysis on the birth year prevalence of autism — the most critical parameter for services planning — using California Department of Developmental Services (DDS) data, which reflect only the more severe portion of the spectrum. To account for milder cases, they used other ASD prevalence literature to estimate a full prevalence. Some might object to this method, but their estimates rang true to me. At Autism Society San Francisco Bay Area, for example, some time ago we compared DDS autism (strict definition), to Dept. of Education autism (broad definition), and found DDS rates were about 30-50% of the education rates. While their projections will strike many people as too high, many newer studies from industrialized countries already showing a 3% autism rate among schoolchildren, and new data from New Jersey are showing even higher rates, including an estimate of 10% of all boys in a large school district affected by ASD.
A figure from the paper showing three scenarios for future growth in US total ASD prevalence.
To project future costs, they applied an estimates of costs per individual, based on many factors including community care, respite care and day care programs, individual productivity loss, parent productivity loss, education, early intervention, and medical costs. They then projected the future size of the ASD population based on three scenarios, which they called Base Case, Low, and Prevention. They also included different indices for inflation. Many of the cost assumptions used in this study were clearly superior to previous studies, for example, an oft-cited study by Buescher et al. from 2014 vastly underestimated adult ASD loss of productivity, and no study has ever fully accounted for the vast costs of supported housing.
As the mother of two autistic children who have already cost our family and the taxpayers millions of dollars (and they are still young!), who is familiar with countless severe autism cases that cost $300k-$600k per year, and who knows how adult autism costs can vastly outstrip childhood costs (thanks, parents), I buckled my seatbelt for the results.
A figure from the paper projecting total costs of autism in the U.S.
The paper paints a dire picture. As mentioned above, about 40 years, societal costs of autism increase to $5.5 ± 1.2 trillion by 2060, accounting for inflation. This may seem shocking and unrealistic to many readers, but based on all I know about the dramatic growth in our population disabled by autism, the inevitable loss of parent support, and the attendant costs, it seems entirely reasonable to me. I challenge everyone to try a simple back-of-the-envelope exercise: if in the future 5% of the population has autism (entirely possible), and each case costs an average of $200k per year (entirely conservative for the mod-severe cases), that’s $3.28 trillion per year.
A major weakness in the analysis was the “Prevention Scenario” in which future costs were projected based on “what might be possible if strategies for reducing ASD risk are identified and addressed in the near future.” As I think everyone knows, at this time there is no way to prevent autism. But the authors use the observation that autism in the DDS is declining among wealthier white families, and thus “suggesting that wealthy parents have been making changes that effectively lower their children’s risk of developing ASD.” No, it’s far more likely that wealthier families are not entering their children into the system because they access services through insurance and school districts instead. My hunch is that the authors were attempting a wink-wink nod-nod to imply, “if only we stopped vaccinating infants the rates of autism would decline and we’d save trillions of dollars!”
If this is the case, let me be clear: not only is there no evidence that vaccines cause autism, it is impossible that vaccines cause autism, since no post-natal insult can cause the prenatal transcriptional dysregulation that is clearly at the heart of autism. If anything vaccines prevent serious infectious diseases that can cause brain damage. People, get your children vaccinated.
In the end, despite my misgivings, the authors’ message is urgent and spot-on: there is little doubt that “the costs of autism represent a serious threat to the economic future of the U.S.”
Jill Escher is President of the National Council on Severe Autism.
Disclaimer: Blogposts on the NCSA blog represent the opinions of the individual authors and not necessarily the views or positions of the NCSA or its board of directors.