Kids Matter!
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Kids Matter!
The Autism Surge is Real with Jill Escher
In this episode, Jill Escher, mother to two profoundly autistic young adults and autism advocate, talks about the TRUE rise in autism, including profound(severe) autism, and possible causes for this rise.
Jill Escher, JD, MA, is president of the National Council on Severe Autism, founder of Escher Fund for Autism (a fund that supports autism programs and research), secretary and past president of Autism Society San Francisco Bay Area, and a housing provider for adults with autism and intellectual disabilities. Her work has been published in The Free Press, Environmental Epigenetics, Biology of Reproduction, Environmental and Molecular Mutagenesis, and the Journal of Autism and Developmental Disorders. She is a former lawyer and is the mother of two children with nonverbal profound autism, Jonathan, 26, and Sophie, 18. More info: jillescher.com.
Contact: info@ncsautism.org
Cover art by Charlotte Feldman
Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.
Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.
Alisa Minkin:Jill Escher, JD Ma is President of the National Council on Severe Autism, founder of Escher Fund for Autism, a fund that supports autism programs and research secretary and past presidents of autism society, San Francisco Bay Area, and a housing provider for adults with autism and intellectual disabilities. Her work has been published in the Free Press, environmental Epigenetics, biology of Reproduction, environmental and Molecular Mutagenesis, and the Journal of Autism and Developmental Disorders. She's a former lawyer and is the mother of two children with nonverbal profound autism. Jonathan 26 and Sophie 19. You can reach her at. Jill escher.com. J-I-L-L-E-S-C-H-E r.com. That's her website. So I'm so honored to be speaking to you today, Jill. I I, I've been waiting for this for a long time, and when the minute I heard about you, I was like, I need, I need to talk.
Jill Escher:Thank you so much for having me. I'm very flattered.
Alisa Minkin:There's not a lot of people out there. I don't know anyone out there who's doing what you're doing actually. And so we're, we're gonna get into what that is. But this is very timely. Autism is in the news everywhere, and I feel like it's like frothing over the top and it's super hyped, and we're hearing about this, this, you know, rise in autism, but it's very controversial and I don't want controversy and polarization. I wanna get to the nitty gritty details. And so I wanna start with just how do we know how much autism there is? How do we measure it?
Jill Escher:Yes, indeed. There's nothing, not controversial in autism. Nothing, like every single issue needs to be like, as you said, frothy and bubbly and bursting with controversy and it's a crazy world to be in. I found myself in it twice over. and I try to do my best to figure out what the heck is going on here, but yeah, one of the hottest issues is of course, that of prevalence. Prevalence, meaning, the number of people with autism. capita, especially when that number is considered by birth year. So the number of people, born in like 1960 or 19 70, 19 80, who have autism according to all the data, vastly lower than the number of people autism born in, for example, 2000, 2010, even 2020. Why is that? The I would say the mainstream media and some vocal proponents in the autism community, and even in the autism research community. Point to expanding diagnostics as a factor or diagnostic shifts, like what used to be mr. Or intellectual disability is now called autism. They'll point to very high functioning cases now be included that we wouldn't have noticed before. So they point to all kinds of other
Alisa Minkin:thing.
Jill Escher:which I consider to be mostly smoke and mirrors of an actual increase in. Children who have neurodevelopmental pathology. That's the nub of the issue. Is there more neurodevelopmental pathology now today than there was, let's say 30, 40, 50 years ago, 20 years ago, or our kids today, basically just the same as they always were, but we're just categorizing and labeling people different. That's the question. And what we see continuously over and over again in the media, and again, sometimes even in the scientific literature, but I would say that scientific literature is very questionable. Is. The idea that it's not a change in our children. Our children's brains are basically the same as they've always been. But we are now just so sensitive and we have all these diagnostic instruments and, we're more like attuned to neurodevelopmental difference than we were before. That's actually not true, but that's where it goes. So I'm you said oh, Jill, there's not a lot of people like you out there. And that's true. I am very emphatic. About the fact that we have overwhelming evidence from countless studies. Over the course of at least three decades over, over many countries, several continents showing the same thing, and there has never been a study that attributes these dramatic increases in autism. And we're talking about. 60 or 70 fold increases in autism. Not doubling, not like tripling, not like quadrupling 60, folding, whatever you call that. 70 folding even, maybe even more than that in autism. These aren't, all, these are gargantuan changes, in the population. And people like, oh, there studies show, research shows that it's because of changing diagnostics you like. No, that's speculation. That's conjecture. That's a kind of rationalization for what's happening. Show me the data that shows that's happening because there is no data that's showing that's happening. And in fact, the data shows quite emphatically. Even when you're comparing apples to apples the more severe kinds of autism, then to the more severe kinds of autism now we still see an enormous increase. So yes it's a very hot topic. It became hotter last year in 2025 because RFK Junior was appointed HHS secretary and he got up there in April of 2025, I think it was. Yes. And said. We are now seeing autism rates of one in 31 children according to the CD, C, and he was saying, this is real. When I was a kid, I didn't know anybody with autism, and I disagree with him about many things. Make that clear. But. He was spot on this particular thing, and there was so much backlash. Everyone's oh, he's he's a scare monger. He's not, he doesn't know how to read data. He's, he, of course there were a lot of, kids with autism when he was young and we just didn't label them and blah, blah. It was all blah, blah, blah, explosion. Against what he said, but again, like I don't think he's right about a lot of things, but I think he was right about that. In fact, the data's really clear when you look at autism cases by birth year, he was born I think in the late forties, I wanna say, by every available measure, autism was about one in, one to five in 10,000 cases. And now it's 150 times that you know.
Alisa Minkin:It's like one in 30, something like that,
Jill Escher:And now we're
Alisa Minkin:which is insane. It's over 3%.
Jill Escher:it's insane. Yeah, I think people prefer a happier story too. People don't want to think that there's all this stuff going on with our kids and there's all this neurodevelopmental disorders, that we didn't have before. I think people want their, in my inclination, my inclination is to choose the happy story. That's a default human preference, but unfortunately we see that's not true.
Alisa Minkin:That's a really good summary. And you mentioned the eight year olds, because my sister actually asked me, well, how do, where do we get this data from? I wanna know what I can trust. What is this data coming from? And I think one of those is that survey of eight year olds at the CDC releases every couple years.
Jill Escher:Yes, the predominant the source
Alisa Minkin:Mm-hmm.
Jill Escher:Childhood prevalence information in the us. So since 2020. Through 2022. So there have been every other year surveillance between those 22 years, by the C, DC, and it's changed over time. It started with fewer sites, so they don't like sample the entire entirety of children across the us. They sample sites. Like eight to 12 different sites per cycle, for example. And then they they do a pretty thorough job of it, of looking at eight year olds in those particular sites. And then they mush them together to get an average. And so the one in 31, for example is an average. It started at one in 150 in the 2020 surveillance. So you can see it's gone up quite a bit. But we've, what we've also noticed is when they started actually looking at the IQs of the kids, that even when the kids had intellectual disability, which is IQ of 70 and under even when the kids had intellectual disability, we still see a very dramatic increase in autism over, I think it was just 16 years of surveillance. It increased about fourfold. So it's really quite a lot. Even if you take, limit it to the more severe cases. And then
Alisa Minkin:And that was mm-hmm.
Jill Escher:Sorry, go ahead.
Alisa Minkin:I'm sorry. I was gonna say that that was, to me, the most damning thing that we're saying there's more severe autism. Don't tell me that. This is not just expanding to milder cases. We're seeing more severe autism. And what I had seen, I had saw, seen a chart where it looked like the rate of intellectual disability diagnosis is going down as autism is going up. And that was the explanation.
Jill Escher:stupid study that has had nothing to do with prevalence.
Alisa Minkin:Hmm.
Jill Escher:was a study. Oh my God. This is, here's what happens in the real world, Elisa. What happens in the real world is some dumb reporter or some dumb. Some, somebody writing a paper, they will literally go onto Google and they will, so they will Google in like autism prevalence over time, images and then like one, and one of those images that invariably pops up is a graph from a 2015 study that was done not according to any viable, epidemiological standard, and really had nothing to do with prevalence over birth year, over time, like nothing. But nevertheless, there's this really sloppy graph that shows like this. It's like this like a
Alisa Minkin:Right.
Jill Escher:possibly could be attributed by a decrease in intellectual disability. And it's preposterous it deserves. No, not just because something is published in the scientific literature doesn't mean. That it, a lot of crap gets published a lot of crap, and it doesn't mean that it's a valid reflection of, actual data. The people who did that study, they were like geneticists. They weren't even epidemiologists who had a clue, how to even conduct, one of these population studies they were looking for. It was a study to look at genetic. Questions. It wasn't even a study to look at prevalence. So it's it's just mind boggling how naive, people are. And how gullible they are. How well they read something, in the New York Times and say, oh, it was in the New York Times. It must be true. It,
Alisa Minkin:How do we know?
Jill Escher:10.
Alisa Minkin:But we're in a post COVID period, and the good side of what otherwise is a bad thing is that we now know not to trust blindly. Right,
Jill Escher:Is definitely, yeah. More skepticism about science now among people. And I, that can be good and bad,
Alisa Minkin:right, right. Well, we, we need to be critical. We need to be critical thinkers. We really, really do.
Jill Escher:yes, be critical. Exactly.
Alisa Minkin:So I saw a graph in a piece that you wrote, which looked like it had that same piece, but with a larger piece of the graph showing that intellectual disability diagnosis has been relatively stagnant. So it's not really going down. I wanna make this clear. The, the diagnosis of intellectual disability is not dropping as autism rises. It just isn't.
Jill Escher:correct.
Alisa Minkin:I wanna make that clear.
Jill Escher:There might be some cases where intellectual disability has fallen somewhat. Now does that account for the increase in autism in any of these cohorts? No. There are also some other reasons why intellectual disability rates might fall a bit. For example. Increased termination of pregnancies when a genetic defect is found. Better, maternal care better, maternal nutrition. There might be reasons that have nothing to do with autism, right? Where the, why those rates might go down over time. But again even if all of that decrease, and again, which is usually subtle, if it exists, even if all of it was because you were diagnostic shifting to autism, it wouldn't come not even close to explaining, the skyrocketing rates of autism. Yes.
Alisa Minkin:How much is more severe autism going up and how do we know that?
Jill Escher:Okay. It depends on how you find severe.'cause, like severe is not really a technical scientific term. It's a
Alisa Minkin:Or profound is the new,
Jill Escher:yeah. Profound is a is a slightly better, clearer definition. We equate severe autism to autism with intellectual disability. But and profound autism. It has this squishy definition, but it's slightly more restricted in that involves IQs under 50. Both my kids would fall into that, my nonverbal kids. And it involves, very profound functional limitations such that an individual would require pretty much 24 7 care. So it's a more restricted definition. I, it's not a perfect, no definition is perfect in autism, but as I said when, okay let's go back in time. autism was being researched in. Fifties in the sixties, in the seventies, in the eighties, and they were done according to a standard. That's not so different from what's in the DSM today. Yeah, maybe it wouldn't include those with IQs maybe over 80 or so. But it would certainly, and in fact a lot of these studies did IQ testing and found that a lot of these kids had IQs, for example, in the seventies. Back then, as I said, the rate was like 0.01 to about 0.05 per percent, so one to five in 10,000 kids. So it was very rare back then, and you'd have to argue that clinicians literally missed like 80% of the autism with intellectual disability cases, like during that time, if not more. That's not possible. That is an impossible thing. presume to make the case that we haven't seen autism increase over time. You would have to attribute to researchers over several decades, such stupidity, such ignorance that it would it would. it wouldn't pass the smell test. So yeah, the increase in autism, as I said, autism rate, you know what, some more severe autism, now is about 1.28 if percent. So let's say it was 0.05 in the sixties or the seventies, and it's now 1.28 for autism with intellectual disability for children according to the CDC,
Alisa Minkin:Common.
Jill Escher:grown a lot.
Alisa Minkin:It's really common, and I'm just gonna say this is anecdotal, but as a pediatrician, just over the past 10 years, I am seeing more and more autism, including classic autism. And if you are looking at the 8-year-old data, right, you're not looking at these people who are diagnosed as adults or teenagers. You're looking at kids who were diagnosed by age eight.
Jill Escher:No, it gets worse because the CDC also in recent years has been looking at age four.
Alisa Minkin:Oh.
Jill Escher:we're also seeing. same pattern. It's following the same kind of stepwise increase in the four year olds, right? And to get a diagnosis by age four, you usually have to have a more severe presentation.'cause if you're talking and you're babbling and you're pointing and you're playing, you might not be diagnosed till later with like high functioning autism. When the more social impairments come out. Those social impairments might not be apparent by age four, but the other impairments. Are Right. The ones that are more obvious, right. And the more severe kids. So yeah. When the CDCs looked at four year olds, same thing. I think it's like a threefold increase over 14 years. Oh gosh. I should be remembering these things that it's on my blog. You can, it can check
Alisa Minkin:We have to link to all these, all these places. Your blog, your
Jill Escher:I should have checked this. But
Alisa Minkin:some great pieces there.
Jill Escher:another strong indication that the increase is real.'cause you're looking at little kids, little tiny kids preschoolers, right?
Alisa Minkin:Right. And it, it's part. Part of the distrust we have right now is we're facing reality. We see this with our own eyes, and then we're told, no, it's not a thing.
Jill Escher:It's a gas it's epic gaslighting. It really is, and I think that people are just. Too lazy to sit down and do the analysis. And all they do these days is cut and paste. And when you look at some of the stories, like they come out the Washington Post or the New York Times, they'll go to quote unquote experts who've been the leading deniers of autism for 20 years and who just haven't changed their tune despite, increasing evidence for a true increase. I don't know, it's. A weird psychological thing that people are just not afraid to go against. The conventional wisdom. People aren't afraid to hop off the island no matter how much data you throw at them. I'm probably like that too, about certain things. It's human nature, the reporters. Again, are truly there. There, there's almost no one worthy of the name investigative reporter in the realm of autism. Now. No one, there's no one doing good work. At least in the mainstream media that I have seen, they're all kind of copying each other and each other's talking points. It's very frustrating and it really does hold back science. And so that's why I'm like, RFK Junior has his problems, but he's saying there's something going on. This is not good for us. This is not good for America. This is not good for kids. figure it out. Unfortunately, he's a fan of the vaccine hypothesis, which I definitely disagree
Alisa Minkin:Right. Right.
Jill Escher:So that's it's too bad. I feel like, he has the ball and he is running to the end zone. He's doing great. And then he just fumbles the ball, like he just fumbles and just doesn't pick it up again.
Alisa Minkin:He has a long history of being in the anti-vaccine world.
Jill Escher:I know,
Alisa Minkin:It's not surprising and it, it's unfortunately, you know,'cause the next question is, well then what's causing this? And they keep saying it's genetics, but he says himself and he's right. Genetics doesn't cause a rise like this. And we can no longer use, by the way, use the epidemic word. I took it out of my title by the way, because apparently it's not pc. You can't say epidemic because then it applies, it's a disease.
Jill Escher:Oh, I guess we just have to say it's a neurodiversity now, because that's, that's the cool thing. Listen, I'm a truthy kind of person.
Alisa Minkin:me too.
Jill Escher:I feel like there is a place in the world for euphemism. is a place in the world for. Using nice words and for toning things down. But when we're talking about core scientific facts, that's not a place for that. We have to be talking about what we actually see and what's actually happening.'cause we can't solve a problem unless we identify the problem. So what's happening? And this seems to be, the$64 billion question in autism. There are a lot of big clues already about what's happening. We already know, and you and RFK Junior is right. Autism has been proven over and over again to not be strongly genetic. And people say that's wrong, Jill. You're wrong. You're wrong. You haven't, you read all the papers? Yes, I've read all the papers. The papers show very clearly that only maybe about 10% of autisms have a likely genetic cause. It might actually be lower than that, although some people say it might be a little higher than that. I'm giving it 10% at the highest end, 15%. The problem is not that autism is genetic, but that autism is highly heritable. And what people do and what even scientists do is they confuse the two concepts. So heritability is a weird concept that it is a little bit hard to explain, but it's basically anything that. Causes a trait that comes from the PA via the parents, like through, through basically their germ cells, rather than something that happens in utero or something that happens postpartum to the child. Okay, so an environmental cause would be, for example, let's say I take thalidomide when I'm pregnant, right? My child is born without limbs. that a genetic cause? It was not. It was caused by this stupid drug that I took that stopped the growth of limbs in my child. That's an environmental cause that happened in utero. say my child is born but then suffers hypoxia for some reason, some aspiration of something, right? And that causes loss of oxygen to the brain and therefore cognitive impairment. that's not genetic. That's something that is, environmental. It's caused after birth. Now what? What happens is, I think we have oversimplified what heritability means. Genetics is obviously a big part of heritability, but there are other things that can influence heritability and that's what's not being studied yet. The biggest thing in that realm is something called epigenetics or something called very similarly transcriptional regulation. This is a little, these are big words and I know people are like. Big science words and they don't like it, but it, the big words actually mean something pretty simple. Your DNA has nucleotides, these numbers, right? These molecules in a row. And when those molecules are in a certain row, they call, they're a gene, right? And that gene might code for a certain protein that becomes whatever, my cheek or my lip or my hair, whatever. It's pretty clear that if you have a defect, a mutation in that gene, that can lead to like defective hair or defective skin or whatever, right? But it's not that simple. Biology is not that simple because the gene might say something, but the way that gene is expressed, how that gene moves. From Gene to the protein, there are a lot of different steps things can go awry in those steps and those steps. I'm gonna simplify it. My molecular biology friends will yell at me, but let's call that transcription. Okay, just to be simple. So in the process of transcription, something is going wrong. this in my mind is the number one question in autism research, and it receives very little attention compared to how clear it seems to be playing. Clearly it seems to be playing a role. So what we are pretty sure is happening. With autism and is that when the brain is being formed, even from the earliest stages of brain development in the early months when the brain is being formed, the neurons. The transcription, right? That's responsible for the development of all the brain stuff, that, that is going awry. Something is going wrong in the earliest days, weeks, and months of brain development. Not necessarily because there is a genetic defect, but because there is an expression defect often. Figuring that out would, think leapfrog autism research over its current impasse. So that's what I focus on. That's where I put my philanthropic, money. That's where I do my science advocacy to try to get those questions answered. And it's very complex. I can go into a little bit of it if you want, but otherwise I'll.
Alisa Minkin:I would, I would, I would stop. It's very interesting. I would stop now. I just wanna say a few things. First of all, I think they've expanded the percentage that they're describing to genetics, but I'm putting that in quotation marks because you already explained that genetics is really complicated, right? We have genetics, we have epigenetics, we have genetics that's heritable and genetics. That's not heritable. When you talk about, say, a spontaneous mutation. So there's many different paths and we have to stop talking about autism and talk about autisms anyway, which they are starting to talk about. It's really heterogeneous, I think personally. I think that's the biggest problem. There is no cure because there is no one autism.
Jill Escher:Obviously Yeah. Clearly. Clearly. And it's a huge issue that. From a biological point of view, it's not all the same thing. From a causation point of view, it's not all the same thing from a functional point of view, do you call a phenotypic? You know the profile. Not all the same thing. So in terms of what treatments, help, not all the same thing. So yeah, it's really, we're in this horrible place where so many different things are thrown into one basket because they have some, sometimes very you know, overlapping, characteristic.
Alisa Minkin:And what do we know about vaccines and autism? I just wanna spell that out a little more please. This drives me crazy.
Jill Escher:such a hot topic. Like I thought, oh, oh, this topic's gonna die down. But of course now it's being reinvigorated in a very substantial way. The CDC, RFK Junior has been populating. The CDC with people who have been proponents of the vaccine theory and we've seen changes in some of their advisory committees. We've seen changes on the website. The CDC D'S website now says, oh, we don't know autism. It might be caused by vaccines. We can't count it out.
Alisa Minkin:You can never disprove a negative.
Jill Escher:That. Okay. So it's like this is not good. Okay. So people say Jill and I have, I wanna say like I have good friends who believe that vaccines cause their children, AU Children's Autism people. I really love people I really respect, and I don't tend to get angry with them at all because I feel like. There is mostly an 80 to 90% void of explanation, we, people are not wrong to throw darts at it. People are not wrong to try to make sense of it. I really am not, I, there's some people I'm angry with, but not the moms and dads.
Alisa Minkin:right.
Jill Escher:We know. That autism isn't caused by vaccines for a lot of reasons. I'll go through a couple of them. First of all, the epidemiological studies of which there are many do not show an increased rate of autism in those who've been vaccinated with various vaccines. A lot of those are from studies overseas where they have really big and solid data sets and they're not showing this association. The more important reason, however, I think, is that there's just not the biological plausibility, as I said, autism as we can see in, for example, postmortem brains, or we can see in MRIs, or we can see in animal models, or we can just see by looking at the natural history, of autism in a child, not brain damage, So let's say. My kid eats brain chips when he's 12 months old, probably my kid may have done. He put everything in his mouth. And so does Sophie. Brain chips. A brain chip paint chips.
Alisa Minkin:Oh,
Jill Escher:Oh my gosh. I'm tired. Okay, that would be interesting. Paint chips.
Alisa Minkin:When had in it, you mean?
Jill Escher:Yeah, with leaded paint, let's say no, the kids eating leaded paint chips, right? would cause brain damage, Because lead can cause neuro very serious neurological damage, and you would be able to see that. Same thing with a mercury exposure. The mercury exposure could cause neurological damage that you can see on the level of pathology, in the say postmortem tissue, maybe even el, blood samples, whatever. This is not what we see with autism. I'm not saying oh, maybe, there are some cases where someone had a bad RA vaccine reaction, right? And something went on immunologically. Maybe you know that could happen in some cases, there's just no way that this could account for the kind of increase we're seeing, first of all, from a temporal level. Obviously the biological plausibility isn't there. As I said, autism is something that we see starting very early in development even before. Well before birth. So you know that the brain continues to develop after birth and might happen this cascade of neurological development that looks like regression, right? Because the brain's developing and it's wiring and it's pruning, and it's so dynamic. My goodness, those first years are so dynamic. And, something might look okay, but then maybe as the brain's developing, the neurons are not quite connected or not quite pruning correctly. And then that looks like regression. Like my daughter actually had language, right? She had non, it was non-functional language. She had language when she was a toddler, and she could recite lines from a book. Now she has zero language. Was that regression or was that just an artifact of this ongoing abnormal brain development? I would argue it's the latter. But I guess one, one other thing I wanna say about about vaccines is people say there's a temporal association. Between the
Alisa Minkin:Direction.
Jill Escher:and the increase in autism that we're seeing. And that's not actually true. We're not seeing, the autism increase did not increase when, a kind of a stepwise way with the of new vaccines. It just didn't, it can't explain it from that point of view either. I have some graphs, which I can share with you on that, but it just doesn't make any sense. We have to look for other exposures actually dovetail with the data that we're seeing.
Alisa Minkin:So back to the$64 billion question then, Are potential causes that would be increasing over time? I mean, to me it's, it sounds environmental. And when we say genetic epigenetic can be influenced by environment. Or changes in the parents' environment, right? I don't think this is explored enough and it drives me crazy. I.
Jill Escher:My argument is very simple. My argument is there's nothing happening to our kids, right? There's no exposure. That's happening to our kids in utero or postnatally is causing autism. It's not the Tylenol right, that you're taking, it's not the three glasses of wine you had. It's not that you had a c-section, it's not, that there was a vaccine or Tylenol, after birth, like. It's not any of that. We can see that really clearly. We have a lot of studies on these kind of exposures, and none of them, to the extent they have any explanatory value. The association is so small that it's questionable if you know there's any association at all. So my argument is simple, the exposures that matter are not to the kid. The exposures that matter are to the parents. And to their germ cells. So girls, we have or had a pool of oocytes and those started as primordial germ cells when we were embryos. They grew through these very complex, know, developmental pathways into, basically oocytes and follicles in our ovaries. Those hung out. Those just hung out in us. Like ever since we were born. We're born with all of our eggs basically, except for the last stage of myosis. so those kind of hung out in us. So whatever we're exposed to eggs may be exposed to as well. And look, I make a little over shape. Same thing for the males, although the males develop very differently. Males are born not with their sperm obviously, but they're born with what are called spermatic oal stem cells. So they're born with the cells that ultimately develop into sperm after puberty. So my argument is, look at the exposures to the parents and their germ cells. that could in some cases. Transfer over into the embryo that those exposures will make an epigenetic, maybe even a genetic, we'll make a change in our germ cells that will then carry over post conceptually the embryo. So I've been that's what I've been writing papers on. The kind of research I've been funding have been on that. Question, like what are the exposures to the parents that can have this effect? And one exposure where we see this very clearly in the animal models and I don't have the human studies because the human studies don't exist, is general anesthesia. So I'm not saying, oh, don't get your wisdom teeth pulled. I'm not saying that at all.'cause I feel like general anesthesia is by and large likely. benign. And it's obviously not only benign, it's a vital not medicine. It's a vital tool, in medicine and surgery. So I'm not anti anesthesia by any stretch of the imagination. It saves lives, countless lives every day. But it's very toxic and it's very neurotoxic. And it's epigenetically incredibly powerful. And we have seen in every animal study on the subject, this is in rats and in mice, that a parents exposure to general anesthesia can increase the odds of neuro neurodevelopmental pathology in their offspring. The biological plausibility is absolutely there. What's not there, however, is the political will look into questions like this
Alisa Minkin:Why? I'm sorry, but why?
Jill Escher:I think that it's just so far off the radar of what. People think about when they think about autism risk. The NIH just funded$50 million in autism research to look at gene environment interactions, but mostly funded at other stuff as well. But what they were looking at was really exposures to the fetus. Not to the parent's germ cells. And as I said, we already know that exposures to the fetus are not having much of an effect.
Alisa Minkin:How do we know that? I'm sorry, but I, how do we know that
Jill Escher:know do we know that exposures to the fetus? Because
Alisa Minkin:not?
Jill Escher:studies,
Alisa Minkin:There are already.
Jill Escher:so many, there's just hundreds of studies on different exposures to, you name the exposure, it's been studied, whether it's some do come up quite positive. Like for example, valproic acid. Is an example of a fetal exposure that can absolutely increase the risk for autism and intellectual disability. Extreme prematurity, another one where absolutely there's an increased risk for autism. I mentioned thalidomide earlier. That's one where we saw. That exposure to the fetus can increase the risk for basically all kinds of impairments, but including an autism presentation. Another one is certain infections like rubella, fetal rubella syndrome. Even like heavy drinking that causes fetal alcohol spectrum disorder, which sometimes will have autism features associated with it. So there's there's different fetal exposures where, yeah, that does increase the risk of autism. But none of these can explain the increasing prevalence we see in autism in the population. So we have to look for other things. likelihood of finding other fetal exposures that explain the increasing risk. Increasing rates of autism is very low, and that's why I argue look, instead at the parents' exposures that would explain the heritability of autism. would explain the transcriptional dysregulation that I talked about earlier, like what is causing the genes to not operate properly? If it's happening at the level of. The germline genetic genome, that would absolutely explain it. It would explain, the increasing prevalence over time, depending on the exposure. even one thing that's really interesting in the animal models with this exposure to general anesthesia is that it would even explain the higher prevalence in males. what we see consistently in the animal models is that the males are far more likely to exhibit these abnormalities than the female offspring whose parents had this exposure. It's should we study it? Yeah. Do I know I'm right? No, I don't know. I'm right. Here's the thing. No, it is a science. We, we, no one knows what's causing this, but my only point is that it's obviously a very solid, very plausible hypothesis. It deserves research attention. Unfortunately, the major funders are not interested. Because they think about genetics.
Alisa Minkin:Right, and it is connected to genetics, just not in the way that we're used to.
Jill Escher:Yes. It is a quasi genetic explanation. Absolutely.
Alisa Minkin:And, and I'm still back on environmental because I'm not convinced that we're not having some of autism related to environmental exposures. Not necessarily just to the parents. I don't know. I know there've been studies of parental exposure to the mother, I think while pregnant. So it is fetal exposure. Have found increased rate of neurodevelopmental disorders. And by the way, I wish they would just look for neurodevelopmental disorders and not just autism, because I think one cause can cause A DHD and autism and intellectual disability and
Jill Escher:agree.
Alisa Minkin:it's not looked at that way. We have to, we have to look at this as the more complex issue that it is and that's problematic. I think people just want simple answers to complex questions, but it's like you said, we need to get to the truth. We're not gonna get anywhere with the wrong answers.
Jill Escher:exactly. Exactly. Yeah. I don't know. Do Elisa do you have some of your own hypotheses about. What might be contributing to autism risk.
Alisa Minkin:So I have always been saying that it's a complex interplay of genes environment and, and epigenetics. I think it's not one thing. I think it's many things and like I said, the same cause could be causing a different outcome, which is why you'll see in families that there's often a family history, not just of autism, but A DHD, anxiety, depression, and a lot of other things. I know someone who got his autism diagnosis after his profoundly autistic twins were diagnosed with a genetic anomaly that he had as well, and yet he's an Ivy League lawyer.
Jill Escher:Oh, interesting. Wow.
Alisa Minkin:Right. It's not the same.
Jill Escher:That shows you about the, what they call the variable penetrance. Of genes, right? Sometimes you can have this genetic defect and no problems. Sometimes you have it and you have a full on syndrome,
Alisa Minkin:Right. And it's, it's not even just genetics, it's the interplay of everything. It's incredibly variable. That's why it's so frustrating to me, and I wanna get to, we have a few minutes left, Elise. We're doing great though. I, I wanna get to where I wish more money was spent because we are not going to find one answer. We should definitely find out, say if there's something with anesthesia so we can have it be safer or whether some people are more vulnerable like a subgroup. I would love to have that research so we can prevent that. If that's a thing, but meanwhile, what we're not funding right, is services.
Jill Escher:Oh my God. Yeah, let's do a whole other 10 hours on that. Yeah, I have two passions. One of my passions is causation and the other passion is. Screwing our heads on about what's needed for, lifespan care for a very disabled population. This has been that was the genesis of National Council on severe autism, right? That we weren't paying attention to this issue. In fact, a lot of the attention in the autism advocacy world was really going to. Kind of EU euphemism, neurodiversity, a prettifying. Autism romanticizing. Autism, normalizing autism. Instead of emphasizing how debilitating you know this is and how serious this long-term need is going to be. A lot of us were just like, this is crazy. We have to write this ship. Yeah. Obviously it's a very complicated subject. It entails federal policy and state policy. But I will say this, there's a saying that politics is downstream of culture, and I believe that to be true, and the culture has not yet come to grips with how big this epidemic is and how much we need to do to, especially as the parents age and
Alisa Minkin:I.
Jill Escher:How much we need to do to prepare for it and serve these individuals over their lifetimes. It's very damaging. Every time we see news that like autism prevalence isn't really increasing or autism is just neurodiversity, or autism is a gift, every time we do that, we are reducing our sense of urgency about this critical. Public health disaster. Yeah it I, I come in as like the not fun person at the party who's okay, all you guys are celebrating, neurodiversity, hey, I have bad news for you. Do you see that guy hitting his head a hundred times a day? Do you see that girl who's smearing feces? Do you see that girl who's, eating like my daughter, eating sticks and nails and leaves and toys? Do you see that kid who's eloping and drowning in the pond? Do you see the kid who's climbing outta the second floor window? Do you see the kid who's. Bashing his hands through the window. Do you see the kid is beating up on his parents? Do you see that mom covered in black and blue? I'm that person that no one wants to hear about. But it's absolutely vital that you know these authentic realities. Get into the national conversation because we aren't gonna be able to change politics if we can't change the national conversation. That was really a, an important piece of NCSA, which was to counter, these unicorns and rainbows narratives that had taken over au autism world.
Alisa Minkin:It's really, really true. And Simi, that's the problem with the denialism, right? To me, I just see it as, we don't want to deal with, we're gonna kick the can down the road until we can't anymore.
Jill Escher:Until, yeah, exactly. It's going to be that. It's going to be kick it until the ERs are so overwhelmed, That there's. The, that the crisis is so obvious that something has to happen. I do feel that like an alcoholic, like we have to hit rock bottom, for
Alisa Minkin:No,
Jill Escher:happen. Yeah.
Alisa Minkin:don't say that.
Jill Escher:a lot.
Alisa Minkin:You have to be the unpopular person right now and scream.
Jill Escher:Yeah, I'm very unpopular, but I'd rather be unpopular and honest than be popular and playing along with a false narrative
Alisa Minkin:And you know what's very frustrating is the autism advocacy group as a whole is so split into factions.
Jill Escher:you think. Yeah. Yeah, it's true. It's true. We, what I'm hoping and I am in touch with leaders of other significant autism organizations, we do talk about let's figure out where we agree. Let's at least figure out where we agree and let's move forward with a policy agenda. On that, put aside differences that we have, but let's find where in the Venn diagram we all meet and let's work on that, that we do talk about that. And I do feel like that should be like, we have a moral duty do that, We might not be able to do everything, but at least let's find common ground and fight like hell in that common ground. I hope we get, I hope that this is 2026 progresses, that this becomes our reality, that we are, that there's more cooperation. And yeah, it's it's absolutely of paramount importa, nothing matters more to autism families than there is some sort of roadmap ahead, right?
Alisa Minkin:In a future for their children, even when we're gone.
Jill Escher:For their children that they can die. Knowing that is, that, that safety net for our kids is real, And it's solid. And their kids won't be abused and their kids won't be neglected, and their kids will have people who care about them. And, they can lead in a rich and rewarding life, within whatever bounds they might have. That's important. And that has to be our paramount goal.
Alisa Minkin:I agree a hundred percent, and I'm hearing other whole podcast episodes because it's another whole podcast episode about
Jill Escher:Yeah.
Alisa Minkin:happens when you fall off that cliff at age 22 and you no longer are entitled to school services, where you're gonna live, what you're gonna do. I, we cannot possibly cover that and I'm, I'm gonna have to do another episode. I'm gonna have to do that.
Jill Escher:Yeah it's big. And I'm happy to come back or have somebody else from NCSA, come back and give us our perspective on the policy priorities here, because, clearly the policies need to change to meet the needs and meet the realities.
Alisa Minkin:Yeah, and I, and I wanna end on a positive note because, you know, we can talk about neurodiversity, you know, getting in the way of trying to deal with the reality. Or you can say, Hey, we're in a world now that is starting to get autism, all of autism. Right, and so that's a good thing. The very fact that it is so prevalent means I think everybody knows somebody with a kid with autism or a grandchild with autism, or a neighbor with autism. It is so prevalent, and if we can all just get together, I'm like very kumbaya, very optimistic because there is such a tremendous need and if everybody sees it, maybe we can, you know, get a grip on reality and do something about it. So I'm hopeful that we will.
Jill Escher:I am hopeful too. It would take, it will take political pressure. At the end of the day, our it's gonna take money. It's gonna take some policy changes that aren't money, but it's also gonna take money. And that means changing things at the federal level basically.'cause the states aren't gonna keep coughing it up. that's where we have to apply political pressure over a long period of time. As I say, a marathon, not a sprint.
Alisa Minkin:Absolutely. Well, I wanna thank you so, so much for doing this with me. It was worth the wait.
Jill Escher:Oh yeah. Thanks. It was so nice to meet you and thank you for having me. And I'm sorry that it got a little scientifically complicated.
Alisa Minkin:No, no, no. You were, you were in the zone. I have a sophisticated audience. I believe you're in the zone. All right. Thank you so much. I.
Thank you for listening to Kids Matter. Raising Healthy, happy Children Takes a village, and I'm grateful you are part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build a supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no explanation for your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child's ped. This podcast is for informational purposes only and does not constitute medical. For any medical concerns or decisions. Reach out to your child's healthcare professional.