Autism Answers Back

What Responsible Research Looks Like (And Why This Paper Isn’t It)

AABfetussurveillance This Isn’t Screening. It’s Sorting

This week, Molecular Psychiatry published a troubling study that claims an association between congenital malformations (CMs) and later autism diagnoses. The authors used 14 years of national birth registry data from Israel, matching 2,099 autistic individuals with non-autistic controls and found that those later diagnosed with autism were more likely to have been born with malformations, especially in the circulatory and urogenital systems.

They argue that these differences — visible at birth or via prenatal ultrasound — could serve as early “red flags” for autism. They call for more frequent developmental assessments for infants with these markers. And they suggest that their findings might guide future research into the genetic, epigenetic and hormonal origins of autism.

At no point do they say the word “prevention.” They don’t have to.

The logic is already there: autism is framed as the downstream result of visible error. If a child is born with certain body differences, their chances of being autistic rise. If we can see those differences earlier — ideally prenatally — we can flag them. If we can flag them, we can act.

Who’s Doing the Flagging

And it becomes even more alarming when you look at who’s doing the flagging. None of the authors appear to have direct clinical experience working with autistic people. The lead author, Rony Cleper, is based in the Department of Epidemiology and Preventive Medicine at Tel Aviv University. His specialty is population-level data — not autism, not care, not lived experience. The second author is a statistician. One is affiliated with a medical center, but his role in autism care is not evident. The senior author, Raz Gross, is a psychiatrist — but his work on autism has focused on risk modeling and comorbidities, not support, identity or inclusion.

This is a paper about autism, but it was written by people who don't appear to understand what it means to be autistic.

Deficit Logic in Disguise

The paper draws on decades-old deficit assumptions. It refers to “abnormal embryogenesis,” “male vulnerability,” and biological deviation. It cites the Extreme Male Brain theory without critique. It treats congenital differences as pathological signals rather than natural variation. Most importantly, it frames autism not as an identity, but as a condition best detected early — ideally before diagnosis is even possible.

The study’s conclusion presents these congenital markers as “useful.” But useful to whom? Not to autistic people. Not to our families. Not to our communities. These markers are only “useful” to institutions that want to monitor, sort and manage risk. They are “useful” to systems that treat autism as a problem to predict and preempt.

And when a study like this appears in a high-impact journal under the banner of psychiatry and epidemiology, it doesn’t just reach fellow researchers. It travels downstream — to screening protocols, to funding decisions, to policy papers, to prenatal counseling conversations.

The Myth of Neutral Detection

The authors justify the study by appealing to a familiar rationale: early detection is necessary because early intervention improves outcomes. But they never say what kind of outcomes. They don’t ask what kind of interventions. And they don’t examine what happens when a child is flagged at birth — not because of behavior or need, but because of anatomy. In their logic, detection is good because intervention is good. But detection is not neutral. And for many of us, it has never been safe.

The Silence Is the Harm

The paper includes standard IRB approvals — but no ethical reflection on how this data might be used downstream. There is also no examination of how their funding sources frame autism. One of the authors received support from Autism Speaks — a group with a long record of promoting autism as a tragedy to be prevented, not a community to be supported. That matters. Because when a paper proposes congenital markers for autism, and one of the funders is known for eugenics-adjacent messaging, the silence becomes part of the harm. It doesn’t say how findings like these have historically been used to shrink populations.

In Iceland, prenatal screening for Down syndrome now results in nearly 100% of detected cases being aborted. That country didn’t ban Down syndrome. It eliminated births through early detection and pressure to act. That’s what we mean by “erasure.” And when studies like this propose congenital risk markers for autism — without naming or guarding against that outcome — they open the same door, whether they intend to or not. It doesn’t mention what happened in Iceland, where near-total prenatal screening of Down syndrome led to near-total erasure. And it doesn't ask whether autism might be next. There is no language of care, consent or consequence. There is no community review, no participatory design, no attempt to imagine how autistic people might interpret or be impacted by this work.

The Questions They Didn’t Ask

A responsible study begins with curiosity — not just about data, but about consequences. Here are the questions these researchers should have asked but didn’t:

The absence of these questions is not a minor omission. It’s the foundation of a pattern. Research about autistic people that never includes autistic perspective doesn’t just miss the point. It becomes part of the problem.

What Responsible Research Would Have Looked Like

It would have said: these data must never be used to justify selective termination. It would have asked: how can we ensure that detection does not become erasure? It would have named the history of how birth difference has been used to marginalize disabled lives. It would have grounded its framing in lived experience, not just embryonic theory.

That didn’t happen. Instead, autism is rendered legible through anatomical deviation. Malformation becomes pretext. Risk becomes reason. And the people most affected by that shift — the autistic people whose futures hang in the balance — are left entirely out of view.

What We Call It

This isn’t responsible autism research. It’s unethical — surveillance at scale, authored by those who study us without ever knowing us.

Autism doesn’t begin with congenital difference. But discrimination often does.

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