An article in the Weekend Australian on April, 2023, titled, Autism to cost budget $8.25bn: will the safety net break? was captioned with:

Autism to cost budget $8.25bn: will the safety net break? The number of children being diagnosed with autism and supported by the NDIS is rising alarmingly.

This article heralded the headlines also in the Weekend Australian the following week titled: PM, states to rein in unsustainable NDIS.

The National Disability Insurance Agency (NDIA) Board released the NDIS Annual Financial Sustainability Report Summary (AFSR) on October 8, 2021. Estimates indicated that there would be 670,400 participants in the scheme at the end of June 2025 (of which 633,600 are under the age of 65 years), and 859,300 at the end of June 2030 (of which 798,300 are under the age of 65 years).

These figures are significantly higher than estimated by the Productivity Commission in 2017. This is believed to be not only as a result of increased access to the scheme, but also the result of increased retention: that is, the NDIS recipients are not leaving the scheme as soon as it was anticipated they would. The same report estimated that total participant costs would be $29.2 billion in 2021-22, growing to $41.4 billion in 2024-25, and $59.3 billion in 2029-30 (on an accrual basis).

Extrapolation of these figures, quoted in the first Weekend Australian article, indicates that the NDIS is anticipated to ‘cost the budget $34bn in 2022-23 – including $8.25bn for those with autism as a primary diagnosis – rising to almost $90bn in the next decade’. More than a third (35 per cent) have autism as their primary diagnosis.

According to the NDIS funding amounts, autistic people receive an average of $32,800 per year. Children under the age of seven are paid an average of $16,700 per year. The article states the reason for the increase is that autism is being increasingly diagnosed, rather than increasing in incidence.

The data is very clear that the incidence of autism has risen dramatically since the 1980s. The seminal paper of Eric Fombonne (1999) placed the incidence prior to 1989 at 4/10,000 with a year-by-year increase to an average of 7.2/10,000 from 1989 to 1999. CDC data gives an incidence in the USA of 1/10,000 in 1970, jumping to 1/1,000 by 1995, with an almost exponential increase from 1/500 in 1999 to the latest figures of 1/54 in 2016. It is said to now be around 1/36.

It is certainly true that some of this increase is artifactual, as a result of changing diagnostic criteria, hence increased awareness by medical practitioners, teachers, and parents alike, and increasing likelihood to attain a diagnosis to be able to access funding through NDIS to assist in managing these children. Many are now diagnosed as being autistic or having autistic trait who historically would simply have been labelled ‘quirky’ or ‘eccentric’.

However, any teacher who has been in the classroom setting for 30 years or more, or any general practitioner who has been treating families for more than 30 years, will be able to clearly say that the actual incidence in their classrooms or practices has increased dramatically over that time, so much so that many teachers spend much of their time now in behavioural management rather than teaching.

When I went through medical training in the early 1980s, to see a child with autism it was necessary to go to specialised autism schools: these days, every family have either had an autistic child themselves or in their extended family, or have friends with an autistic child: they are now commonly seen in society and the more severe cases are unmistakable.

Autism tends to run in families. Interestingly however, it is more a ‘horizontal inheritance’ where siblings or cousins will be affected, with only mild autistic trait, some other mental diagnosis or ‘eccentricity’ in parents and grandparents: it is apparently worsening as we come down through the generations from the 1990s onwards.

There was a push in the 2000s to identify the genetic basis for autism, and despite intense efforts, no specific autism genes were identified, but over 40 genes that appeared to predispose, now expanded to over 100. Further research has identified numerous SNPS or point changes in DNA, often related to oxidative function, nutrient metabolism, and detoxification pathways, such that Autism Panels have been developed to look for those and guide intervention. However, having those SNPS alone does not necessarily result in autism.

It has been said that ‘the genes load the gun but the environment pulls the trigger’. The field of epigenetics, or the effect of the environment on gene expression and hence body function, has exploded in the past 20 years. In many cases, it seems that the effect of the environment (as in factors external to the genes) is in fact more important than the genes themselves. It would seem that autism is a result of ‘multiple hits’ on a predisposing genetic profile.

Since the 1980s, there have been many significant changes to environmental factors impacting on our bodies. The significant shift in diet, from whole, simple foods to highly processed convenience foods, with higher refined carbohydrate and sugar intake and numerous food additives has significantly increased the burden of obesity, diabetes, and cardiovascular disease for example. Numerous studies attest to the positive effect in these disorders and now also in dementia of changing to a Mediterranean-style diet high in vegetables, fruits, nuts, seeds, legumes, and whole grains. It should be no surprise then, that specific dietary change may have a positive effect in autism.

Since 1980 there has been a marked increase in the use of antibiotics and paracetamol in young children, with paracetamol being routinely recommended before vaccination and for any fevers. Antibiotics are the most common drug prescribed during pregnancy and there have been numerous studies linking maternal and early-life antibiotic use to increased risk of later autism, including a recent study indicating a 50 per cent increase after the use of antibiotics in early childhood.

Other studies have observed an increased risk of the development of ASD in the children following high maternal use of paracetamol, in at least one study, a three-fold increase.

Another marked environmental change over that time frame has been the dramatic increase in the use of herbicides and pesticides in large-scale agriculture. From the late 1970s to 2016, there was a 100-fold increase in the frequency and volume of application of herbicides worldwide, with further increases expected in the future.

Included in these herbicides is a chemical has an effect on the shikimate pathway in plants and bacteria, blocking the production of aromatic amino acids which are essential to human health. It also binds and removes minerals such as calcium, magnesium, manganese, copper, and zinc, resulting in nutrient-deficient plants. A diet low in added herbicides and pesticides will reduce the load of this and other chemicals, and improve mineral nutrition and may also have a positive impact in autism.

Another major environmental change over this time has been the increasing introduction of technology and electromagnetic field pollution by non-natural, non-human microwaves, with the result that children are often introduced to playing on a mobile phone while very young, spending more time inside on computers and related devices and less and less time outside playing.

While autism presents as a neurodevelopmental and behavioural disorder, and thus fell into the Diagnostic Services Manual (DSM) as a psychiatric disorder, it is in fact a neurological and metabolic disorder. Children and adults with Autism Spectrum Disorder (ASD) suffer concomitant physical and metabolic dysfunctions at a much higher rate than neurotypical children and adults. Children with ASD have a higher incidence of concomitant Inflammatory Bowel Disease, Precocious Puberty and Mitochondrial Disease amongst many others, while adults with ASD have increased incidence of Parkinson’s Disease and Dementia.

There is increasing research into the Gut-Brain Axis and Endocrine-Brain Axis: that the brain is not chopped off at the neck, but is involved when there is metabolic derangement and leaking of the gut wall and the blood-brain barrier, allowing toxins and other substances for example to enter the brain, activate the brain immune cells (microglia) and result in brain inflammation and dysfunction. Indeed it is believed that it is via alterations in gut microbiotica that early antibiotic use increases the risk for the development of autism. The predisposition of those with ASD to gut issues appears to be intimately associated with the cognitive challenges we observe with ASD.

Given all of this, it should be of no surprise that interventions geared to understanding and minimising the effects of underlying genetic points of weakness, the environmental load from foods, chemicals, antibiotics, toxic minerals, gut bacterial imbalance, and electronic equipment, and electromagnetic fields, in the hands of trained functional medicine practitioners, typically result in at least some amelioration of symptoms. In many documented cases nationally and internationally, there is actual reversal of the autism diagnosis.

It is correct that the medical system and NDIS in particular will collapse under this increasing load if not addressed as it is not sustainable. It is also apparent from the data that the current interventions, while supportive and improving management, are not inherently treating underlying causation. There is thus an urgent need to review the issue of children’s neurodevelopmental disorders from another perspective.

I would propose that this perspective should include a greater consideration of nutritional and other environmental factors, against the background of each child’s unique genetic patterns and transmitted transgenerational toxins and infections and gut microbial patterns. Targeted approaches addressing these factors bring hope for change for this predominantly environmental disorder.

Dr Robyn Cosford (retired) Professor of Nutritional and Environmental Medicine, Chair, Director Childrens Health Defense Australia Chapter. www.revayalife.com