1 in 31 Is Not the Story

The CDC's Autism and Developmental Disabilities Monitoring Network released data showing 1 in 31 eight-year-olds in the United States were identified with autism spectrum disorder in 2022 (n=8,854 of 274,857 children; CDC ADDM Network, April 15, 2025; surveillance year 2022; https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm). That's up from 1 in 36 in 2020 (CDC ADDM Network, 2020 surveillance year).

I'm one of those numbers. Diagnosed sometime around age three, in 1977 or 1978. Back then it was "plain old garden variety" autism – before the spectrum, before Asperger's got folded in, before the DSM decided we were all one thing with severity specifiers.

The prevalence isn't rising because autism is spreading. It's rising because we're finally looking.

The six-fold gap

Here's what the numbers actually say: prevalence ranged from 1 in 103 in Texas (Laredo; n=47 of 4,856) to 1 in 19 in California (n=807 of 15,212) (CDC ADDM Network, 2022; https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm). Same country. Same surveillance year. Same diagnostic criteria. Six times the identified rate.

That's not autism varying by geography. That's screening, diagnostic access, and service availability varying by geography.

In California, someone is watching. In Laredo, they're not. Or they are, but the services aren't there, or the family can't afford the evaluation, or the pediatrician doesn't recognize it, or the school system is under-resourced, or Spanish-language screening tools are inadequate, or all of the above.

1 in 19 isn't an epidemic. 1 in 103 isn't lucky. Both numbers are measuring the same thing – how well we identify autistic kids – and one jurisdiction is failing at it.

The racial shift nobody's talking about

For years, prevalence data showed White children identified at higher rates than Black, Hispanic, Asian, and Native children. The research called it a disparity. What it actually was: diagnostic access following wealth and insurance.

2022 flipped it. Asian or Pacific Islander (38.2 per 1,000; n=627), American Indian or Alaska Native (37.5 per 1,000; n=32), Black (36.6 per 1,000; n=2,024), Hispanic (33.0 per 1,000; n=2,289), and Multiracial children (31.9 per 1,000; n=396) were identified with ASD at higher rates than White children (27.7 per 1,000; n=3,132) (CDC ADDM Network, 2022; https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm).

That's not new autism. That's old autism finally being seen. Screening in languages families actually speak. Providers who don't dismiss concerns as "cultural differences." Schools serving populations that have been under-identified for decades.

The disparity didn't go away. It reversed direction. Which means the original disparity was never about who was autistic – it was about who got diagnosed.

Boys still three times the rate

Among eight-year-olds, boys were more than three times as likely as girls to be identified with ASD (n=6,732 boys vs n=1,868 girls; 3.4:1 ratio; CDC ADDM Network, 2022; https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm). That ratio has been stable for years.

Part of that is real – autism does appear more frequently in boys. Part of it is diagnostic criteria built on how autism presents in boys: the narrow interests everyone can see, the meltdowns that disrupt a classroom, the social withdrawal that reads as "odd."

Autistic girls mask better, earlier, longer. We learn to mirror. We study social scripts. We suppress the stims that would give us away. By the time we're eight, a lot of us have learned to look "normal enough" that nobody's checking.

The three-to-one ratio isn't wrong. But it's incomplete. And every year it stays stable while adult women are getting diagnosed in their thirties and forties, it's a reminder that the surveillance net was designed to catch one kind of autistic kid and misses the rest.

1 in 31 is not the story

The story is the range. The story is the six-fold gap. The story is the racial reversal that proves the disparity was never biological, it was systemic.

1 in 31 is an average. Averages hide everything that matters.

What matters is Laredo at 1 in 103 and California at 1 in 19. What matters is the kid in Laredo who needed an evaluation three years ago and never got one. What matters is the girl who's masking her way through second grade because the screener was built for boys.

The prevalence is rising. It will keep rising until every jurisdiction is screening as well as California, until providers recognize autism in girls as often as boys, until families have access to evaluation regardless of income or language or immigration status.

When we hit 1 in 19 everywhere, we'll know we're finally counting all of us.

Until then, the number isn't rising because there are more autistic people. It's rising because we're getting harder to ignore.

Source: CDC Autism and Developmental Disabilities Monitoring (ADDM) Network, Community Report on Autism 2025 (surveillance year 2022; released April 15, 2025). 16 sites: Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas (Austin and Laredo), Utah, Wisconsin.