April is National Autism Acceptance Month, a time dedicated not just to understanding and accepting Autism Spectrum Disorder (ASD) but also to evaluating the latest research and identifying the best medical treatments and policies to support individuals and families. As a physician and researcher, I see this as an opportunity to critically analyze the growing body of data on autism prevalence, causes, and interventions and to explore how personalized precision medicine approaches can make a meaningful difference.

The prevalence of ASD has increased dramatically, with current estimates indicating that approximately 1 in 36 8-year-olds in the U.S. are diagnosed with the condition. A recent study published in JAMA Network Open analyzing electronic health records and insurance claims data from over 12.2 million people (2011–2022) found that autism prevalence has risen over time by 175%.¹

This surge in cases raises urgent questions: What environmental and biological factors are driving this increase? How can we move beyond symptom management to address the root causes? What role can precision medicine and targeted interventions play in improving outcomes for those with ASD? And how can we begin reversing the trend of ASD diagnoses?  

These are the questions we must explore, not just this month, but in our ongoing efforts to advance autism care.

Investigating Factors in Autism

Emerging research points to a range of exposures and factors that could impact neurodevelopment and metabolic function, particularly during pregnancy and early childhood, leading to ASD. Key areas of concern include genomic, biological, and environmental factors. These factors may contribute to neuroinflammation, oxidative stress, and altered brain signaling, all of which are implicated in ASD. Understanding these influences is crucial to developing preventative strategies and targeted interventions that can support children and families affected by autism.

Potential Contributors to Autism

1. Air Pollution – Prenatal exposure to air pollution has been associated with an increased risk of autism, especially in boys. Studies suggest that pollutants like nitrogen oxides and particulate matter can disrupt fetal brain development.²
2. Pesticides – Exposure to certain pesticides during pregnancy has been linked to a higher likelihood of ASD in offspring. These chemicals may interfere with neurodevelopmental processes.³
3. Heavy Metal Exposure – Heavy metals, such as mercury, lead, aluminum, and cadmium, have been linked to autism spectrum disorder (ASD). While the exact role of heavy metals in autism is still being investigated, research suggests that they may contribute to the development and severity of the disorder.⁴
4. Gut-Brain Axis Disruptions – Many children with ASD exhibit gut microbiome imbalances (dysbiosis), often linked to early antibiotic use, diet, or environmental toxins. Leaky gut syndrome may allow inflammatory molecules to enter the bloodstream, affecting brain function.^5,6,7
5. Impaired Methylation and Detoxification Pathways – Genetic factors play a significant role in ASD, with several dozen autism susceptibility genes identified in the past decade. These account for 10–20% of ASD cases.⁸ Some genetic mutations impair methylation—a key process for detoxification and neurotransmitter production.⁹ Also, reduced glutathione levels (a major antioxidant) impair the body’s ability to clear toxins, leading to neuroinflammation.¹⁰

The Case for Precision Medicine: Symptom Reversal in Twins

An article published in June 2024 in the Journal of Personalized Medicine detailed a case of autism symptom reversal in non-identical twins through a personalized lifestyle and environmental intervention.¹¹ Both twins were diagnosed with severe Level 3 ASD at 20 months of age. Symptoms included:

• Non-verbal communication delays
• Repetitive behaviors and rigidity
• Severe gastrointestinal dysfunction

Personalized Intervention: A multidisciplinary intervention approach was implemented, focusing on:

• Personalized dietary changes aimed at eliminating inflammatory foods
• Targeted probiotic therapy designed to restore gut health
• Methylation support by optimizing folate and B vitamins
• Heavy metal detoxification
• Reduction of environmental toxin exposure

The results were promising. Twin 1’s ATEC (Autism Treatment Evaluation Checklist) score dropped from 76 to 32 showing a dramatic improvement, while Twin 2’s ATEC score fell from 43 to just 4, indicating near-complete symptom resolution. Improvements remained stable for at least six months at the last assessment. This case underscores the potential for targeted interventions to significantly improve, or even reverse, autism symptoms in some individuals.

A Shift Toward Personalized, Preventative Autism Care

While there is no one-size-fits-all cure for ASD, several personalized interventions may enhance quality of life. Autism research is rapidly evolving, and while genetics play a role, modifiable environmental and lifestyle influences cannot be ignored. The June 2024 case study suggests that precision medicine approaches can lead to significant symptom improvements.

As we recognize National Autism Acceptance Month, we should advocate for personalized, root-cause-focused strategies to better support individuals with autism and their families. By understanding environmental triggers and implementing tailored interventions, we can move beyond symptom management and explore the potential for long-term, meaningful recovery, and reduce the prevalence rates.

In Solidarity,

1. Grosvenor LP, Croen LA, Lynch FL, et al. Autism Diagnosis Among US Children and Adults, 2011-2022. JAMA Netw Open. 2024;7(10):e2442218. doi:10.1001/jamanetworkopen.2024.42218 ↩︎
2. Rahman MM, Shu YH, Chow T, Lurmann FW, Yu X, Martinez MP, Carter SA, Eckel SP, Chen JC, Chen Z, Levitt P, Schwartz J, McConnell R, Xiang AH. Prenatal Exposure to Air Pollution and Autism Spectrum Disorder: Sensitive Windows of Exposure and Sex Differences. Environ Health Perspect. 2022 Jan;130(1):17008. doi: 10.1289/EHP9509. Epub 2022 Jan 18. PMID: 35040691; PMCID: PMC8765363. ↩︎
3. Xu Y, Yang X, Chen D, Xu Y, Lan L, Zhao S, Liu Q, Snijders AM, Xia Y. Maternal exposure to pesticides and autism or attention-deficit/hyperactivity disorders in offspring: A meta-analysis. Chemosphere. 2023 Feb;313:137459. doi: 10.1016/j.chemosphere.2022.137459. Epub 2022 Dec 2. PMID: 36470360; PMCID: PMC9839607. ↩︎
4. Dou, J.F., Schmidt, R.J., Volk, H.E. et al. Exposure to heavy metals in utero and autism spectrum disorder at age 3: a meta-analysis of two longitudinal cohorts of siblings of children with autism. Environ Health 23, 62 (2024). https://doi.org/10.1186/s12940-024-01101-2  ↩︎
5. Fattorusso A, Di Genova L, Dell’Isola GB, Mencaroni E, Esposito S. Autism Spectrum Disorders and the Gut Microbiota. Nutrients. 2019 Feb 28;11(3):521. doi: 10.3390/nu11030521. PMID: 30823414; PMCID: PMC6471505. ↩︎
6. Tiwari, R., Raju Nandikola, J., Jothinathan, M. K. D., Shaik, K., Hemalatha, G., Prasad, D., & Mohan, V. K. (2025). The gut–brain axis in autism spectrum disorder: microbiome dysbiosis, probiotics, and potential mechanisms of action. International Journal of Developmental Disabilities, 1–17.
   https://doi.org/10.1080/20473869.2025.2462915 ↩︎
7. Taniya MA, Chung HJ, Al Mamun A, Alam S, Aziz MA, Emon NU, Islam MM, Hong SS, Podder BR, Ara Mimi A, Aktar Suchi S, Xiao J. Role of Gut Microbiome in Autism Spectrum Disorder and Its Therapeutic Regulation. Front Cell Infect Microbiol. 2022 Jul 22;12:915701. doi:10.3389/fcimb.2022.915701. PMID: 35937689; PMCID: PMC9355470. ↩︎
8. Geschwind DH. Genetics of autism spectrum disorders. Trends Cogn Sci. 2011 Sep;15(9):409-16. doi: 10.1016/j.tics.2011.07.003. Epub 2011 Aug 18. PMID: 21855394; PMCID: PMC3691066. ↩︎
9. Stoccoro A, Conti E, Scaffei E, Calderoni S, Coppedè F, Migliore L, Battini R. DNA Methylation Biomarkers for Young Children with Idiopathic Autism Spectrum Disorder: A Systematic Review. Int J Mol Sci. 2023 May 23;24(11):9138. doi: 10.3390/ijms24119138. PMID: 37298088; PMCID: PMC10252672. ↩︎
10. Bjørklund G, Tinkov AA, Hosnedlová B, Kizek R, Ajsuvakova OP, Chirumbolo S, Skalnaya MG, Peana M, Dadar M, El-Ansary A, Qasem H, Adams JB, Aaseth J, Skalny AV. The role of glutathione redox imbalance in autism spectrum disorder: A review. Free Radic Biol Med. 2020 Nov 20;160:149-162. doi: 10.1016/j.freeradbiomed.2020.07.017. Epub 2020 Jul 31. PMID: 32745763. ↩︎
11. D’Adamo CR, Nelson JL, Miller SN, Rickert Hong M, Lambert E, Tallman Ruhm H. Reversal of Autism Symptoms among Dizygotic Twins through a Personalized Lifestyle and Environmental Modification Approach: A Case Report and Review of the Literature. J Pers Med. 2024 Jun 15;14(6):641. doi: 10.3390/jpm14060641. PMID: 38929862; PMCID: PMC11205016. ↩︎