I've spent my life in high tech, and one thing that field teaches you — painfully, if you're paying attention — is that you can't solve a problem you don't understand. One of my smartest bosses had a simple line he'd ask in every meeting:
"What problem are we trying to solve here?"
It drove people nuts in the moment, but it saved us from burning time and money on the wrong thing.
When it comes to public health, that discipline almost never shows up. Numbers appear in headlines, people panic, and before we've even agreed on what the problem is, we're hunting for villains and demanding solutions. Autism is a perfect example of that dynamic. With autism, I'm not sure people even know what we're talking about as a basic definition of the word. It's treated more like a continuum than a specific condition — which makes it nearly impossible to have a useful conversation about what, if anything, needs to be done.
The Part Everyone Can See
Here's the obvious part, the one nobody debates: there's a very small, clearly defined portion of the population that reaches adulthood unable to live independently. They often cannot speak or communicate reliably. They need full-time support — in institutions, in group homes, or from families who give their lives to caregiving.
That's real. That's measurable. And that's where public health should focus.
The Bell Curve of Humanity
Everything beyond that? It gets murky. Autism is now treated as a "spectrum," which in practice has become a net thrown over anyone who doesn't sit neatly in the statistical middle. Quiet kid. Hyper-focused adult. Someone who hates small talk but will spend 12 hours perfecting a musical phrase, a mathematical proof, or a business plan.
Pick anyone you admire — in music, in art, in sports, in science, in business — and I can almost guarantee that today they'd get caught somewhere on this ever-expanding continuum. And that's the problem. We've confused difference with disorder. We've convinced ourselves that any deviation from "normal" is a problem to be diagnosed, categorized, and, eventually, "managed." Scientists who don't want to go to an office will study anything and come up with solutions — especially if there's funding attached.
Exceptionalism and the Cost of Labels
Think about it: Picasso, relentless in his revisions; Mozart, consumed by structure and sound; Stevie Wonder, blind but exploding with musical architecture; Tom Brady, obsessing over mechanics until mastery became inevitable. In today's system, every one of them could be slotted into a diagnostic bin. And the list could wrap around the earth ten times over throughout our history.
That doesn't make them broken. It makes them human. And it should scare anyone who cares about what happens when systems start treating outliers as defects.
Where the Real Problem Lives
Let's use the actual clinical definitions to cut through the confusion:
Level 1 autism — "Requiring Support" — describes people who can speak well, live independently, hold jobs, and manage daily responsibilities. They may struggle with social nuance or have sensory sensitivities, but these rarely prevent independent functioning. This isn't a public health crisis. It's human variation.
Level 2 — "Requiring Substantial Support" — is where the system breaks down. It's so vaguely defined that it becomes a catch-all for anyone who doesn't fit neatly into Level 1 or Level 3. In practice, this is where exceptional performers who don't conform to social norms get swept up and pathologized. Think of a software engineer whose intense focus on code quality gets labeled as "rigid thinking requiring substantial support," or a student marked Level 2 simply for preferring to work alone rather than in groups.
Level 3 autism — "Requiring Very Substantial Support" — describes individuals who are nonverbal or have extremely limited language, cannot live independently at any stage of life, and require 24/7 supervision. This is a small, clearly defined group with profound needs. This is unquestionably a public health issue.
And Level 2 is where we should all pay attention. Vague, subjective categories that pathologize people who simply think or behave differently have a dark history. The Nazi doctors didn't start with obviously disabled individuals — they started with people who were deemed "unfit" or "abnormal" based on subjective judgments about behavior and social conformity.
Here's the thing about real conditions: they're obvious. If someone is overweight, we all know it. We might debate whether they're plump or obese, but nobody mistakes a healthy-weight person for overweight. Severe autism works the same way — it's unmistakable. The fact that we need elaborate diagnostic criteria and lengthy evaluations to determine if someone "has autism" should tell us something about what we're actually measuring.
Here's an uncomfortable question: when schools suggest a Level 2 diagnosis for a kid who can't focus, are we looking at a neurological condition, or are we looking at a child responding normally to stressed-out, overscheduled parents? Sometimes the most logical explanation doesn't require any vaccines, environmental toxins, or genetic mutations — just basic family dynamics.
And where do we draw the line? Lots of people can't balance a checkbook and need their spouse to handle the finances. Are they Level 2 autistic because they require "substantial support" with executive function? The criteria become so elastic that ordinary human limitations start looking like pathology.
The Global Numbers
Look at the data and you see the same thing, everywhere:
Severe autism — the kind that no one can miss — shows up in 0.3% to 0.5% of the population.
That's three to five people per thousand, whether you're in the United States, Sweden, Japan, or India.
The U.S. isn't an outlier. Small differences between countries are almost entirely about how aggressively they measure.
If this were about vaccines, Twinkies, or whatever other theory is trending this week, you'd see spikes that match those patterns. You don't.
IQ and Pseudo-Science: A Preview
None of this should surprise anyone who knows the history. IQ tests themselves have a dark history, but their development into eugenics was even darker, and their final destiny in the hands of Nazi doctors shows what the real public health issue is here: pseudo-science. (I wrote about IQ tests in detail in Debunking the Bunk of IQ Tests.)
Eugenics wasn't born in Nazi Germany — it was invented here, in the United States. For decades, it was mainstream policy. States sterilized tens of thousands of people they labeled "defective" or "unfit to reproduce." IQ testing was one of the tools they used, a pseudo-scientific veneer to justify cruelty.
Germany didn't invent this insanity. They imported it. And what started as a bad idea wrapped in "science" became one of the darkest chapters in human history when it was taken to its logical extreme.
Where This Leaves Us
Strip away the noise and here's what you're left with:
Severe autism is real. It's rare. It's stable across decades and continents.
Everything beyond that — the broad, blurry middle — is not a public health crisis. It's a research question, an educational challenge, and a reminder that not every variation in human wiring is a problem to be solved.
Conclusion
Autism isn't an epidemic. It isn't a wave sweeping through a generation of children. It's a complex spectrum of human wiring, with a very small, very clear subset that demands public health attention and resources. The rest is noise — noise that keeps us from talking clearly, honestly, and usefully about what matters.
We have enough real problems in society without spending time and resources chasing ghosts. Let's focus on the people who genuinely need help and stop pathologizing everyone who doesn't fit the mold.