How autism became a political battleground What would Elon Musk think?

“It’s turning out that we understood a lot more than a lot of people who studied it, we think.” Donald Trump, flanked by Robert F Kennedy Jr, had launched into one of his customary preambles during Monday’s press conference on the supposed link between Tylenol use in pregnancy and autism. “And I say we think,” he continued, “because I don’t think they were really letting the public know what they knew.” Having arrived at the lectern 45 minutes late, by way of apology he told gathered hacks that he had in fact been “waiting for this meeting for 20 years”.

What was happening 20 years ago? In 2005, his wife Melania was pregnant with his fifth and final child, Barron. At that time, parents were still reeling from the bogus claims of Andrew Wakefield, whose notorious 1998 Lancet paper on the links between the MMR vaccine and autism had sparked a global panic.

But Trump’s timeline is more specific, more fascinating, than all that. “I want to thank the man who brought this issue to the forefront of American politics along with me, and we actually met in my office. Is it like 20 years ago, Bobby?” he went on. A bit of digging reveals a rich seam suggesting what that conversation might have entailed: in June 2005, RFK Jr, then an environmental attorney, published an article in Rolling Stone claiming to have identified a conspiracy between the government and the pharmaceutical industry to conceal the autism risks of thimerosal, a mercury-based preservative used in some vaccines. It was retracted in 2011, after substantial errors were found — but to read it today is to recognise again the despicable “they” that Trump namechecked in Monday’s conference.

“They” is the medical establishment which is accused, in the cases of both Tylenol and childhood vaccinations, of declining to “let the public know” that their pharmaceuticals caused autism. To be clear: his Tylenol claims are not supported by evidence. In RFK’s Rolling Stone article, which one can imagine being fanned out on the coffee tables of Trump Tower 20 years ago, Kennedy claimed the Centers for Disease Control and Prevention (CDC) — the institution which, in his second life as health secretary, he has been at war with — “paid the Institute of Medicine to conduct a new study to whitewash the risks of thimerosal”. He accused “powerful lawmakers in Washington” of assisting drug companies, a “chilling case study of institutional arrogance, power and greed”. The CDC’s archives refer to several studies debunking the link between autism and therimosal dating back to 1999. Nevertheless, in RFK’s screed it was a “moral crisis” that involved unaccountable manufacturers cutting costs and lining the pockets of venal politicians. In the intervening two decades, as Monday proved, nothing has convinced RFK that this evil dynamic has changed. Mistrust, paranoia and conspiracy theories were already very much in the cultural bloodstream 20 years ago; then, as now, RFK was leading the crusade.

And just as they were two decades ago, people with autism again find themselves at the centre of a culture war. The ostensible reason for this, as Trump mentioned in Monday’s presser, is the dramatic growth in the prevalence of the condition: “When you go from [one case in] 20,000 to 10,000, and then you go to 12, you know there’s something artificial. They’re taking something.” But the CDC’s picture of incidence is much more complex than this: these figures, which are a CDC estimate, are caveated as not being representative of the entire country.

As neurologist Suzanne O’Sullivan wrote in her book The Age of Diagnosis, the explosion is certainly related in part to the massive expansion of autism’s diagnostic criteria. Children who in former decades would never have met classification thresholds are now being diagnosed according to an ever-growing list of common behaviours: social awkwardness, difficulty in keeping friends, being fidgety or hypersensitive. As O’Sullivan showed, these relatively functional patients joining treatment waiting lists has made both care and public understanding of the condition more difficult for those with severe forms: those with very limited or no speech, major cognitive delays, or who need constant supervision. Yet this compelling explanation for the modern “epidemic” of autism does not seem to trouble Trump. Nor RFK: in Monday’s press conference, he dismissed this theory as a “canard”.

What does trouble Trump and his MAHA/MAGA acolytes is the way autism as a “problem” interacts with their other political bogeymen. The attendant fantasies are those of Trump’s America: perfidious progressive institutions trampling on families, the corruption of children, the parallels with failed masculinity (you only need look to the gamer spaces from which Tyler Robinson is said to have emerged to understand this latter link). On Monday, Trump conjured the pitiful image of “a little child, a little fragile child” about to be pumped with a “vat of 80 different vaccines”. When Barron was an infant, Trump said he had done things “the old-fashioned way”, meaning “one shot at a time”. The multiple-vaccine procedure looks, the President said with a straight face, “like they’re pumping into a horse”. The villain here is a sort of mad scientist, egged on by liberal institutions and deluded by medical orthodoxy into obscene acts of child cruelty. But just as autism becomes once again a flashpoint for the Right, it represents something altogether different for the Left.

Why? At the same time as diagnostic definitions were expanding in the 2000s, the concept of “neurodiversity” was becoming mainstream, creating a new frontier in civil rights and demanding societal accommodations instead of a search for a “cure”. Inevitably, it was swept up in other internet-bound identity causes of the time; so it is that the influx of milder, modern cases are tonally connected with LGBTQIA+ social justice warriors. Coupled with the fact that autistic individuals are more likely to identify as queer, and it is easy to see why this shapeshifting condition is once again front and centre of the culture wars at this political moment.

One wonders what Elon Musk makes of it all. The most famous autistic person in the world was, remember, in the arena during Trump’s teaser for his autism announcement at Sunday night’s memorial for Charlie Kirk, when his sometime political paramour said: “I think we found an answer to autism. How about that? Autism … we won’t let it happen anymore.” I doubt Musk, being a data nut, was sold on the Tylenol thesis — but the announcement may have rankled on a personal level. In a 2022 Ted talk, Musk described a “rough” childhood in which “social cues were not intuitive” — yet he also described his brain chemistry as a blessing: “I found it rewarding to spend all night programming computers, just by myself.” Musk is a figurehead for the Silicon Valley nerds in the Goldilocks zone of neurodiversity. These are the powerful few with what Wired in 2001 called “Geek Syndrome” — socially awkward, perhaps, but with exceptional aptitude for STEM; these are also the people who will be responsible for the forthcoming AI revolution, something that in turn will be of unimaginable financial value to the government. How might they respond to Trump’s language around the condition?

At a time when autism is once more the focus of the culture wars, Musk will be among millions of people who find their medical history being booted around as a political football — again with the justification of dubious science. It seems that conservative America, as Trump said of himself, continues to have “very strong feelings about autism”. Without a doubt, the topic merits committed and consistent research, but what this administration lacks, as this week’s Tylenol announcement showed, is clarity: clarity on the problem of overdiagnosis, on RFK’s decades-long history of scientific misdirection, and on why the spectre of autism itself has become such a fascination at this ultraconservative moment. Without this, panic and junk policy seem inevitable.

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