IDEA Challenges

In The Politics of Autism, I write about social services, special education, and the Individuals with Disabilities Education Act. 

Project 2025 proposed to turn IDEA into a "no strings" block grant, effectively gutting the law and destroying protections that disability families have long relied upon. During the 2024 race, Trump denied any connection to the project, but now he proclaims it, praising OMB director Russ Vought "of Project 2025 fame."

Trump and Vought are now accomplishing their goal of ravaging the law. Instead of shifting it to a block grant, they have tried firing most of the staff who enforce it. 

Ashley White at The Hill:

​​​A clear pathway for addressing these challenges can be seen in the Science of Reading Act, which seeks to align federal literacy funding with evidence-based practices “to ensure state literacy plans reflect these evidence-based approaches.” However, there is no “Science of Special Education” movement generating bipartisan legislation. There is no House committee unanimously passing a bill to strengthen IDEA’s core protections. Instead, there is silence — or worse, erosion.

States, meanwhile, are left holding the bag. Some have stepped up, investing state dollars to fill the federal gap. Others have not. The result is a patchwork of protections that varies wildly depending on where a child with a disability happens to live. This is precisely the inequity IDEA was designed to prevent. The staffing crisis compounds the challenge. Across the country, districts report critical shortages of special education teachers, school psychologists, speech-language pathologists, and related service providers. Caseloads have ballooned. Timelines for evaluations are missed. Individualized Education Programs are written but not implemented with fidelity. And in too many cases, the procedural protections that remain on paper have become aspirational rather than operational.

For families, the lived experience of special education in 2026 often feels like navigating a system designed to say no. Due process remains available in theory, but in practice, it is expensive, adversarial, and inaccessible to the families who need it most. The asymmetry of power between school districts and individual families has only grown as federal oversight has receded.

Predatory Providers

 The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   Insurance mandates and Medicaid spending have contributed to the growth trend.

Christopher Weaver and Anna Wilde Mathews at WSJ:

The autism-therapy industry, once a tiny corner of pediatric care, has exploded into a multibillion-dollar business, fueled by rising diagnoses, new providers entering the market and laws requiring insurers to cover more services. It has also attracted predatory providers who bill for phantom services, pad hours and charge steep fees for care delivered by low-wage workers with minimal training.

The billing abuses run wide. Aetna said the number of investigations that found likely fraud or abusive billing by autism-therapy providers in its private-plan business shot up by 300% between 2024 and 2025—and is on track to rise by another 50% this year.

...

Autism-therapy spending has become one of the fastest-growing healthcare expenses for many private insurance plans, insurers, employers and auditors say. The boom has also made the therapy one of Medicaid’s fastest growing segments, according to a Journal investigation published in March. Medicaid claims data showed providers billed as much as $340,000 per patient a year, the Journal reported.

In the private insurance sector, annual spending on hands-on autism therapy for about 40 large employers covering 3.5 million people doubled to $108 million from 2021 to 2025, according to claims data analyzed by the Health Transformation Alliance. The coalition, which helps companies including Walgreens and American Express track and manage medical spending, said that reflects more patients, more hours of service and higher prices.

...

Most of the therapy is delivered by behavior technicians, who in many states need little more than a high-school degree and often earn as little as $20 an hour. By the end of 2025, about 535,000 people were registered as behavior technicians in a federal database of healthcare providers, an increase of 457% from 2019, an analysis by the Journal found.

The front-line workers are overseen by behavior analysts, more highly trained professionals who often have master’s degrees and licenses and can supervise multiple technicians.

 

Neurodiversity and Governance

In The Politics of Autism, I discuss the neurodiversity movement.   

Dana Lee Baker, "Lead Kindly Light: Neurodiversity, Autism, and Good Governance," Administration and Society Volume 58, Issue 4, https://doi-org.ccl.idm.oclc.org/10.1177/00953997261435918

Abstract

Human neurodiversity matters. Neurodivergence and neurodiversity are fundamental characteristics of the (human) population. The essential nature of this diversity means that the quality of government and governance is unavoidably affected by approaches taken to neuroinclusion in the cultural, political, and economic spaces of current societies. Public administration cannot avoid being both entangled with the construction of neuroinclusion and affected in practice by neurodivergence and neurodiversity. Using the case of autism politics and policy, this article explores selected examples of contestations in policy narratives, neuroethical policy gaps, and persistent myths surrounding neurodiversity and neuroinclusion affecting the practice of contemporary public administration.

Concluding thoughts:

The title of this article quotes a hymn written in 1833 with a first stanza that concludes, “I do not ask to see the distant scene; one step enough for me” (Newan, 1833).1 Although found in a message about faith, both working scientists and issue stakeholders struggle with time and progress in the manner these words reflect. Scientists and issue stakeholders work toward the potential for a better world. Turning attention to the light of transformational scientific discovery or social progress made manifest through perfected moral sentiment in public law almost always involves long-term acceptance of slow-deliberate effort toward a destination not witnessed by those who begin a journey. The formation of neuroethical policy gaps as exemplified in the autism politics of the twentieth and early 21st centuries raises the question of how to take next steps in public policy and interpretation of neuroscience, especially in moments where glimpses of the distant scene come into view. Incremental policymaking dominates most public policy making and defines periods in which sustained, supported progress can be made. Although the need for and attraction of punctuations in policy equilibriums exist, periods of normal policy operations also may allow for pubc administration innovation, including the testing of better practices.

As stated at the beginning of this article, realities of human neurodiversity and neuroinclusion matter, particularly as new findings disrupt our favorite stories about ourselves. They are also material. In recognizing neuroethical policy gaps, public administration can better aim for the clarification of democratic ideals in practice. In the context of the autism policy subsystem, worthy focus on ideals suffers if underlying assumptions about the brain misdescribe human neurology. Although realizing the goal of clarification will necessarily take some time, good practice of public administration requires that policy terms cannot fall into the category of “it meant something different every time she heard it” (Proehl, 2016, p. 86). With practice, we prevail. With patience and understanding, democratic intentions materialize.

Externalities: Spreading Measles

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.  A top antivaxxer is HHS Secretary RFK Jr. He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

 Teddy Rosenbluth at NYT:

A measles outbreak in Utah has sickened more than 670 people, including many children whose parents have chosen not to vaccinate them. But new data shows that people who can’t be vaccinated for various health reasons are also falling ill.

Since the outbreak began last summer, measles has infected 23 babies under age 1, the age when children typically receive the first dose of the measles, mumps and rubella shot. Twelve pregnant women have also been infected, including one who passed the virus on to her newborn, according to data from the state health department.

While the state keeps only limited data on the number of immunocompromised residents who have fallen ill, pediatric infectious disease doctors also say they have cared for several immunocompromised children hospitalized with measles infections.

These patients still represent a minority of the unvaccinated people who have been sickened. Still, these findings are concerning because many of the groups who can’t get the vaccine are also at high risk of developing severe complications from the virus. Pregnant women, for example, are 10 times more likely to die from measles than those who are not pregnant. The virus can also cause women to miscarry or go into labor prematurely.

Young children are more likely to suffer severe complications from the virus. And babies who contract measles before their first birthday are at much higher risk of developing a rare condition called subacute sclerosing panencephalitis that can occur years after an initial infection. Dr. Andrew Pavia, a pediatric infectious disease specialist in Utah, described the complication — which can cause seizures, motor issues and eventually death — as “one of the most horrible things I’ve witnessed.”

Measles 2025. Authors: Lien Anh Ha Do, M.D., Ph.D. and Kim Mulholland. Published June 25, 2025. N Engl J Med 2025;393:2447-2458 DOI: 10.1056/NEJMra2504516. VOL. 393 NO. 24

When measles outbreaks occur, persons with compromised immunity, such as malnourished children, immunocompromised persons (e.g., persons who have human immunodeficiency virus [HIV] or are receiving cancer treatment), and pregnant persons are particularly vulnerable. Persons with HIV who are not immune to measles are at increased risk for more severe measles infection with pneumonia or encephalitis.

 

In a series of 23 pediatric cancer patients in China who had measles infection, 5 underwent ventilation, 1 had liver failure, and 4 died. These outcomes occurred even though 20 of the 23 patients had been vaccinated (including the 4 who died) and 21 had been treated with intravenous immune globulin.19

 Malnutrition and measles have a historical link, particularly in the context of humanitarian relief efforts. The bidirectional relationship between measles and malnutrition was described decades ago.20 Malnutrition is a primary contributor to death in 45% of fatal measles cases.21 Measles is worse in children who are already malnourished, and postmeasles effects can lead to malnutrition in children who were not malnourished before they were infected with measles.13 Measles can lead to or exacerbate vitamin A deficiency22 or a persistent nutritional deficit.23 Malnourished children have a poor response to measles vaccine and other vaccines.24,25

Although measles virus is not teratogenic, measles in pregnant persons can lead to fetal loss, intrauterine growth retardation, and premature delivery.26 The case fatality rate among pregnant persons with measles can range from 5% in areas where measles is endemic, such as in Asia and in sub-Saharan Africa, to 20 to 30% among fragile populations, such as refugee populations.27

 

1,983 Measles Cases

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.  A top antivaxxer is HHS Secretary RFK Jr. He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

From CDC:

As of May 28, 2026, 1,983 confirmed* measles cases were reported in the United States in 2026. Among these, 1,974 measles cases were reported by 40 jurisdictions: Alaska, Arizona, California, Colorado, District of Columbia, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York City, New York State, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming. A total of 9 measles cases were reported among international visitors to the United States.

There have been 30 new outbreaks** reported in 2026, and 93% of confirmed cases (1,847 of 1,983) are outbreak-associated (517 from outbreaks starting in 2026 and 1,330 from outbreaks that started in 2025).

 Jessica McDonald at Factcheck.org:

When asked by a senator on April 22 what he was doing to reduce the number of measles cases and improve the MMR vaccination rate, Kennedy responded, “Improve the MMR. We promote the MMR. We have advised every child to get the MMR. That’s what we do.”

In the same hearing, Democratic Sen. Michael Bennet of Colorado similarly asked, “Are you taking the position, as your CDC director has taken, that the measles vaccine is vital to keeping American children healthy in this country? Are you taking that position today? That has not been your position.”

“That’s my position. I — we promote the measles vaccine,” Kennedy said. “The measles vaccine prevents measles in 97% of the people who take it. I’ve always said that. That’s what the science says.”

Kennedy had often noted the MMR vaccine’s effectiveness. But prior to last month, we could not find a single instance in which Kennedy offered vigorous, unqualified support for the vaccine, without including or later adding inaccurate or misleading information that might cause someone to rethink vaccination.

Workplace Experience

 In The Politics of Autism, I discuss the employment of people on the autism spectrum.

 A release from NEXT for Autism

:A new national survey from NEXT for AUTISM, a leading nonprofit dedicated to transforming services for autistic adults, offers one of the first comprehensive looks at workplace experience from the perspective of autistic employees themselves – revealing the everyday practices that support autistic employees – and the gaps that stand in the way.

Based on responses from more than 400 currently or recently employed autistic adults across the U.S., the data finds that the most important factor shaping success for autistic employees isn't workplace policy – it's their direct manager.

 ta shows that employees are turning to managers, not HR, as their primary point of trust: 49% report disclosing their autism diagnosis to a manager or supervisor, compared to 44% who disclose to HR. Simultaneously, nearly 8 in 10 respondents say their manager trusts them, and that relationship shapes whether employees feel safe communicating how they work, accessing support, and contributing fully at work.

The report, Inside the Autistic Workforce: A National Survey of Autistic Employees on Their Workplace Experience – and What Employers Need to Know, was developed by NEXT for AUTISM in partnership with Sago and funded by the Anita Bhatia Foundation for Tomorrow. It captures insights from autistic employees working across industries – from data scientists and occupational therapists to bartenders, paramedics, and overnight restockers – and offers a clear blueprint for the conditions that help autistic employees contribute, perform, and stay at work. Uniquely, the survey was developed in collaboration with autistic and neurodivergent staff, advisors, and subject-matter experts to ensure that the questions and analysis reflected authentic workplace realities.

The findings challenge long-held assumptions about disclosure, accommodations, performance, and retention. They show that the conditions shaping workplace experience are often neither complex nor costly, but instead rooted in how managers communicate, build trust, and adapt to individual needs.

"Managers are the difference between success that's sustainable and success that quietly drains," said Gillian Leek, CEO of NEXT for AUTISM. "Autistic employees are already contributing across the workforce, but too often they're doing it while managing challenges that go unseen. When managers build trust and make it easier for employees to communicate how they work, that's when organizations get the full value of the talent they've hired."

Key findings from the survey include:

Many Autistic Employees Are Contributing at a Cost
While many respondents report strong workplace outcomes, the findings reveal a critical tension: performance is often sustained through significant, invisible effort.72% feel fairly compensated

• 70% say their role matches their abilities
• 73% feel supported and respected at work

At the same time:80% report masking and emotional exhaustion as a challenge
More than half cite sensory demands and communication overload as highly challenging

For many autistic employees, doing well at work doesn't come without a cost. Masking behaviors—suppressing natural responses, scripting interactions, and managing sensory overload—can consume as much mental energy as the job itself.

Managers Are the Difference Between Stability and Chronic Strain
Throughout the data, one factor stands out above all others: the direct manager.

Managers shape whether employees feel safe disclosing their diagnosis, asking for support, and working in ways that align with their strengths. In practice, this makes managers – not policies – the front line of inclusion, retention, and performance.

The practices autistic employees associate with effective managers: empathy, active listening, clear communication, willingness to accommodate, and consistent follow-through – are the fundamentals of competent leadership. In return, managers are rewarded with loyal, dedicated, and creative employees.

The Hidden Gap in Workplace Support
The survey highlights a gap between the availability of workplace support and employees' ability to access it.

• 41% don't know what supports are available without disclosing
• 36% are unfamiliar with the range of workplace accommodations once hired
• 31% are unfamiliar with legal rights to reasonable accommodations

As a result, many employees manage challenges independently, even when support is available. Nearly 7 in 10 respondents report relying on support outside of work to navigate workplace expectations and sustain employment.

Notably, respondents report turning to social media for workplace guidance and support at rates comparable to therapists and professional support providers.

Workplace Experiences Are Not Equal
Certain groups consistently report more acute challenges. Autistic women face a workplace environment that is consistently less responsive to how they communicate and what they need:54% are unsure how or when to disclose (vs. 32% of men)
53% feel safe being themselves at work (vs. 73% of men)
48% fear being labeled/stereotyped (vs. 35% of men)

A Clear Path Forward for Employers
The survey findings show that hiring is just the beginning. What shapes whether autistic employees contribute fully and stay in their jobs is the day-to-day reality of how workplaces actually operate. The report offers employer recommendations that can make an immediate difference:

• Equip managers to communicate clearly, build trust, and adapt to different working styles
• Make support visible before employees have to ask for it
• Build clear expectations, flexibility, and predictable structures into everyday work
• Listen to your autistic employees and treat their feedback as data, not complaints

"These are the fundamentals of how good workplaces operate," said Leek. "When organizations get this right, they don't just support autistic employees, they create environments where all people can succeed."

The full report is available at NEXTforAUTISM.org/SurveyReport. A companion infographic is available.

Study Finds No Link to Common Antidepressants

  In The Politics of Autism, I discuss various ideas about what causes the condition.  Dozens of potential causes and correlates have been the subject of scientific and medical research.

Chan J, Zhong A, Lam J et al.

Maternal and paternal antidepressant use before and during pregnancy and offspring risk of neurodevelopmental disorders: a systematic review and meta-analysis

The Lancet Psychiatry, 13, 472-484

A release from The Lancet Psychiatry:

• Meta-analysis of 37 studies totalling more than half a million pregnancies with antidepressant use found no significant link between common antidepressant use during pregnancy and autism/ADHD in children after adjusting for the mother’s mental health and other factors.
• Before accounting for confounding factors, the study found a small association between antidepressant use during pregnancy and autism or ADHD in children. However, this link was also seen with antidepressant use in mothers before conception and in fathers during pregnancy, suggesting the association reflects parental mental health and genetics rather than the medication itself.
• Authors say doctors and patients should weigh the benefit and risks of antidepressant use for moderate to severe depression in pregnancy with the potential harms of a depression relapse. They highlight that supporting good mental health for both mothers and fathers is beneficial for a child’s neurodevelopment.

Current evidence does not support a causal link between the use of almost all antidepressants during pregnancy and an increased risk of neurodevelopmental disorders, including autism and attention-deficit/hyperactivity disorder (ADHD), in children, according to a systematic review and meta-analysis published in The Lancet Psychiatry journal.

Previous meta-analyses looking at the use of antidepressants during pregnancy and risk of neurodevelopmental disorders in children were conducted nearly a decade ago and limited by small study numbers and a lack of controlling for additional factors. This new meta-analysis provides the best evidence to date that the small increase in risk of autism or ADHD in the children of women who used antidepressants when pregnant identified in many studies is not caused by the medication.




“We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children. While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse. Therefore, for women with moderate-severe depression, doctors and patients must carefully weigh the potential risks and benefits of continuing antidepressant treatment during pregnancy against the potential harms of untreated depression,” says author Dr Wing-Chung Chang, University of Hong Kong.

He continues, “Although our study found a small increase in the risk of autism and ADHD in the children of women who had used antidepressants during pregnancy, it also found that this risk disappeared when we accounted for other factors. The increased risk was also seen in the children of fathers who took antidepressants and of mothers with antidepressant use before, but not during, pregnancy. Together, this suggests that it is not the antidepressants themselves causing an increased risk in autism and ADHD but it is more likely to be due to other factors, including genetic predisposition to conditions such as ADHD, autism, and mental health conditions.”

Authors pooled data from 37 studies which included more than 600,000 pregnant women taking antidepressants and almost 25 million pregnancies with no antidepressant use.

Before controlling for key factors such as mental health conditions, the analysis found that antidepressant use by the mother during pregnancy was associated with a 35% increased risk of ADHD and a 69% increased risk of autism. However, this became greatly reduced or non-significant in analyses that better controlled for confounding factors. Use of antidepressants during pregnancy by the father was associated with a 46% increase in the risk of ADHD and a 28% increase in the risk of autism.

Among studies with analyses restricted to mothers with mental health disorders, all selective serotonin reuptake inhibitors (SSRIs) were found to not be associated, only amitriptyline/nortriptyline remained associated with increased ADHD and autism risk. Amitriptyline/nortriptyline are currently considered second or third options as treatments for depression and are often prescribed for treatment-resistant depression. Therefore, women treated with these may have more severe, chronic, or complex underlying mental health conditions than those receiving more common antidepressants, which could be influencing the association between amitriptyline/nortriptyline and increased ADHD and autism risk.

The study found no difference in risk between high and low doses of antidepressants.

“The evidence suggests a link between either parent having a mental health condition and a slightly higher risk of ADHD or autism. In addition to genetic factors, this link could be explained by the home and social environment as ongoing family stress, changes in how the family functions, and differences in how parents behave and care for their children may influence neurodevelopment. There is a need to ensure both parents have access to support and treatment for mental health conditions; for their own sake and to support neurodevelopment of their child," says Dr. Joe Kwun-Nam Chan, University of Hong Kong.

The researchers note some limitations of their study, including that data on important factors such as socioeconomic status, lifestyle risk factors and low birth weight was lacking in the studies. Additionally, there was only a small number of studies looking at antidepressant use in specific trimesters or exact doses and dose changes, which makes it harder to draw conclusions about these. Finally, women who are prescribed antidepressants tend to have more severe depression than those who are not, so some bias may remain even after controlling for mental health status.

Writing in a linked Comment, Lisa Vitte, Emmanuel Devouche and Gisele Apter from University Rouen Normandy (France), who were not involved in the study, say, “Chang and colleagues’ study adds knowledge and confirms some of the pre-existing knowledge on the use of antidepressants during pregnancy: that they should continue to be taken as they protect maternal mental health and do not harm fetal development. This result is of considerable impact after many contradictory and controversial studies.

Police Stops and Stress

In The Politics of Autism, I discuss interactions between police and autistic people. When cops encounter autistic people, they may not respond in the same way as NT people, and things can get out of hand. Among other things, they may misinterpret autistic behavior as aggressive or defiant. Training could help.

 Webb, L., Chatterjee, A., Holingue, C. et al. Police Stops Among Adolescents With Intellectual and Developmental Disabilities: Implications for Traumatic Stress. J Autism Dev Disord (2026). https://doi.org/10.1007/s10803-026-07361-w

Abstract

Purpose

The present study examines differences in police stops, features of those stops, and stress outcomes between youth with and without intellectual and developmental disabilities (IDD).

Methods

Data from Wave 6 (age 15) of the Future of Families and Child Wellbeing Study (FFCWS), a national sample of urban-born youth in the U.S., was analyzed in 2025 (n = 3,444). Logistic regression models first examined associations between IDD diagnosis and direct police stops. Negative binomial regressions and linear regressions were then conducted among the subsample of youth who reported a direct police stop (n = 918) to examine the associations between IDD diagnosis and officer intrusiveness, perceptions of procedural justice, emotional distress during the direct stop, and police-initiated post-traumatic stress (PI-PTSS).
Results

Youth with IDD diagnoses did not have significantly greater odds of experiencing a direct police stop than youth without IDD. However, among youth with a direct police stop, youth with IDD diagnoses reported higher emotional distress during direct police stops and higher PI-PTSS than youth without IDD.
Conclusion

These findings indicate that direct police stops may have more detrimental effects on stress and mental health of youth with IDD compared to youth without IDD. Policy reform, officer training, and additional research are needed to safeguard the mental health and wellbeing of youth with IDD.

Literature on Older Autistic Adults

In The Politics of Autism, I write about the everyday struggles facing autistic people and their families.  The struggles of autistic adults have not received enough scholarly attention.

Nicholas, D.B., Nelson, H., Shafai, F. et al. Examining the Lived Experiences of Older Autistic Adults: A Synthesis Review of Qualitative Literature. J Autism Dev Disord (2026). https://doi.org/10.1007/s10803-026-07343-y

This review reflects literature published from 2013 to 2024, with a focus on aging, older adulthood and autism. Themes in this literature addressed ways of being and sense of self (Hickey et al., 2018; Hwang et al., 2017; Moseley et al., 2020), relationship with others (Hickey et al., 2018; Mason et al., 2019; Hwang et al., 2017, 2023), pathways to meaning and enjoyment (Hickey et al., 2018; Hwang et al., 2017, 2023; Mason et al., 2019; Moseley et al., 2020; Waldron et al., 2022), and daily life at home or in the community (Hickey et al., 2018; Hwang et al., 2017, 2023; Mason et al., 2019; Moseley et al., 2020; Waldron et al., 2022). Notably, positive experiences and outcomes generally related to personal experience and meaning-making, whereas negative outcomes consistently were associated with healthcare challenges and service gaps.

The literature highlighted gaps in services and service provider knowledge about aging with autism (Barber, 2015; Heijnen-Kohl et al., 2022; Mansour et al., 2024; Moseley et al., 2020). Stigma and bias were noted to result in negative experiences with healthcare professionals (Mansour et al., 2024; Moseley et al., 2020), barriers to accessing supports (Moseley et al., 2020) and reduced individualized service provision (Hwang et al., 2023). Inaccurate diagnoses negatively impacted treatment plans and eligibility for needed services (Mansour et al., 2024), resulting in an overall dearth of systemic support (Barber, 2015; Hwang et al., 2017; Mansour et al., 2024; Moseley et al., 2020).

Reflecting on such gaps, improved support across the lifespan was strongly recommended, including the need to cultivate greater trust among autistic people in their healthcare providers, based on findings that earlier experiences influence later engagement and trust (Moseley et al., 2020). Training for service and healthcare providers was advocated (Trollor et al., 2022), with attention to processes of aging, autism and the experiences of older autistic adults (Barber, 2015; Heijnen-Kohl et al., 2022; Moseley et al., 2020).

The Employment Situation

 In The Politics of Autism, I discuss the employment of people on the autism spectrum.

Kelly Field at The Hechinger Report:

Today’s college graduates are entering one of the tightest job markets in years, as companies scale back entry-level hiring amid economic uncertainty and the explosion of artificial intelligence. Just under a third of 2025 graduates — and fewer than half of 2024 graduates — have found full-time employment related to their education, according to one recent report.

The market is even tougher for young adults with autism, who have long had one of the highest rates of joblessness among individuals with disabilities. Even before the hiring slowdown, more than 30 percent of autistic college graduates were unemployed, and about a quarter of those who did have jobs were in office- and administration-support roles, one study found.

One key reason: Autistic students often have trouble navigating traditional hiring processes, including interviews, which favor neurotypical candidates.

To help autistic students like Myers land jobs, some colleges are offering career-readiness classes and one-on-one career coaching; some are also working with employers to make their hiring and employment practices more inclusive. Drexel, which began providing career prep to students in its autism support program in 2017, has one of the oldest programs.

Some major corporations have also stepped up, forming partnerships with colleges to recruit neurodivergent students for internships and jobs.

...

It’s difficult to say how many students with autism are enrolled in college, in part because many students choose not to disclose their diagnosis to campus disability services — a prerequisite to receiving accommodations. The best estimate is that there are somewhere between 135,400 and 286,254 autistic college students, according to research by Bradley E. Cox, founder of the College Autism Network and an associate professor of higher, adult and lifelong education at Michigan State University.

"The Science Is Beautiful but the Industry Is Very Ugly"

The Politics of Autism includes an extensive discussion of autism service providers.  Private equity firms now own many of them.   Insurance mandates and Medicaid spending have contributed to the growth trend.

 Sarah Kliff and Margot Sanger-Katz at NYT:

A New York Times investigation has found that this rapid expansion has played out with little regulatory oversight and brought allegations of children being harmed by profit-motivated practices. In interviews, dozens of current and former clinic workers described how clinics frequently overprescribe hours — even recommending that some families remove children from school so they can receive more therapy.

Marquisha Richards worked at two private-equity-backed chains in Texas. She said she became disillusioned about how financial considerations repeatedly drove care decisions. “The science is beautiful, but the industry is very ugly,” she said.

Nationwide, Medicaid spending on autism therapy nearly tripled between 2020 and 2024. In some states it grew much faster: Colorado Medicaid now spends more on autism therapy than on all emergency department visits. North Carolina, which spent $121 million in 2022, projects it will spend over $1 billion next year.

...

Autism treatment did not become big business until the mid-2010s, after state laws began requiring insurers to cover it. Medicaid soon followed, and the industry boomed.

In North Carolina, the number of clinics owned by autism therapy providers grew from 61 in 2019 to 409 in 2026, according to data compiled by Daniel Arnold, a health economist at Brown University.

...

The clinics are enticing to health care investors: Demand is high and payment rates far exceed labor costs.

Medicaid often pays about $70 per hour ($83 in North Carolina) for therapy largely provided by workers with high school diplomas who earn around $20.

Private equity firms have acquired at least 500 clinics over the past decade. “There’s just huge opportunities to grow these businesses and help increase access to care,” said Jon Krieger, a managing partner at Calex, a financial firm that assists with autism clinic mergers and acquisitions. He estimates the market could grow to $90 billion.

...

Nationally, clinic visits have grown longer since private equity entered the business, from a median of four hours in 2019 to 5.5 hours in 2024, according to an analysis of 34 million Medicaid claims by the health data firm Trilliant.

1,952 Measles Cases

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.  A top antivaxxer is HHS Secretary RFK Jr. He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

From CDC:

As of May 21, 2026, 1,952 confirmed* measles cases were reported in the United States in 2026. Among these, 1,943 measles cases were reported by 40 jurisdictions: Alaska, Arizona, California, Colorado, District of Columbia, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York City, New York State, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming. A total of 9 measles cases were reported among international visitors to the United States.

There have been 29 new outbreaks** reported in 2026, and 93% of confirmed cases (1,815 of 1,952) are outbreak-associated (487 from outbreaks starting in 2026 and 1,328 from outbreaks that started in 2025).

For the full year of 2025, a total of 2,288 confirmed* measles cases were reported in the United States.

Hundreds have died from a serious outbreak in Bangladesh. Simon Ellery at CBS:

The CDC says most U.S. outbreaks begin when an unvaccinated traveler brings the virus home from a country experiencing a large outbreak.

According to the CDC, Mexico, Guatemala, parts of South Asia (where Bangladesh is) and Africa are experiencing worrying outbreaks.

CBS News medical correspondent Dr. Céline Gounder said Monday that this summer will bring a major challenge for U.S. health officials as thousands of fans visit for the soccer World Cup championship, which is being jointly hosted by the U.S., Mexico and Canada.

"My biggest concern for the World Cup is actually measles. It's not hantavirus, it is not Ebola. Measles is what has me concerned," Gounder said, noting outbreaks of the highly infectious disease "in different parts of the world."

 

Minnesota Fraud Charges

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.   Scams plague the world of autism. Some involve shady or abusive providers.

The Minnesota investigations started under the Biden administration.

Sarah Kliff and Ernesto Londoño at NYT:

The Justice Department plans to announce criminal charges on Thursday against 15 people for attempting to defraud Minnesota Medicaid and other social service programs in the state of more than $90 million, according to documents prepared to be filed in court and obtained by The New York Times.

Among the defendants are an owner and an employee of autism clinics, who are charged with submitting $46.6 million in fraudulent claims to Medicaid, the public health plan that covers low-income people. Additional defendants will be charged with filing bogus claims to Medicaid for other services, including those that assist disabled people with obtaining housing and living independently.

President Trump focused attention on fraud in Minnesota after news reports and a social media video from a conservative content creator last year. Administration officials cited fraud among the reasons for sending hundreds of federal agents to Minnesota to crack down on illegal immigration.

That operation set off fierce protests and led to the killings of two American citizens early this year. It also prompted the resignation of several experienced fraud prosecutors at the U.S. attorney’s office in Minnesota, hobbling investigations that had been underway for months.

In March, the White House started a broad initiative to combat fraud nationwide, an effort being led by Vice President JD Vance. Last week, Mr. Vance announced plans for the federal government to withhold $1.3 billion in federal payments to California because, he said, the state had failed to combat Medicaid fraud.

Fraud in Minnesota’s generous social safety net programs has been a concern for years. In 2022, it became a major scandal after federal prosecutors charged dozens of people accused of stealing hundreds of millions of dollars from a Covid-era program created to feed low-income children.

Since then, state and federal officials have uncovered significant fraud in several other programs run by state agencies. To date, the vast majority of people charged with wrongdoing are of Somali ancestry, a fact that Mr. Trump has noted with derision.

The new Justice Department charges focus on two autism clinics, Smart Therapy in Minneapolis and Star Autism in St. Cloud, Minn. The court documents describe one defendant, Shamso Ahmed Hassan, as having an ownership stake in both companies. It says that the other, Hanaan Mursal Yusuf, was an employee of Smart Therapy.

The charges describe a scheme where the two defendants along with unnamed co-conspirators “paid illegal cash kickbacks of approximately $300 to $1,500 per child” to families that enrolled their children in autism therapy services. The companies then billed Medicaid millions to treat those children for autism, according to the prosecutors’ charges.