Since the enactment of the Combating Autism Act in 2006, and its reauthorization under the Combating Autism Reauthorization Act of 2011, federal agencies, in partnership with the community, have made significant strides in addressing many of the pressing needs of individuals and families affected by autism spectrum disorder. In the period covered by this report, from 2010-2013, federally-funded programs and projects have increased knowledge about how prevalent ASD is in the U.S. population and how early in life ASD can be detected. While CDC most recently estimated the prevalence of autism in U.S. children at 1 in 88, they also found evidence suggesting that more children are being diagnosed by age 3 and potentially may be gaining the opportunity for early intervention.⁶⁴ NIH research resulting in new and improved instruments for identifying children with ASD at increasingly young ages and a strengthened evidence base for early behavioral treatments, as well as efforts by ACF, CDC, HRSA, and the Department of Education to expand outreach to underserved populations, has also yielded new opportunities for improving skills and reducing disability both before school age and once a child enters the education system.

Federally-supported research is also revealing more about how autism develops and what risk factors may be involved. Recent studies supported by NIH have uncovered distinct differences in the brain development of infants who later are diagnosed with ASD, while studies supported by NIH, DoD, and EPA have identified potential contributions to ASD risk from diverse environmental risk factors including nutrients, air pollutants, pesticides, and paternal age. NIH- and HRSA-supported studies of conditions that often co-occur with ASD such as gastrointestinal disorders, sleep disruptions, and epilepsy are contributing to interventions strategies, and panels of experts, such as those convened through the HRSA Autism Intervention Research Programs, are rapidly assembling guidelines to help individuals with ASD, families, and practitioners address these needs in the context of daily living. NSF supports several basic and applied science projects encompassing topics related to ASD in its neuroscience and cognitive sciences portfolios and Research in Disabilities Education Program, as well as projects exploring computer simulation and robotics technologies that may have applications in helping people with ASD and other disabilities acquire important communication and social skills.

The Department of Education's efforts to develop and evaluate educational interventions, as well as provide guidance for schools on how to make school environments safe and conducive to learning for students with disabilities, are improving the ability of schools to meet the needs of students on the autism spectrum. Through comparative analyses of the effectiveness of therapies and interventions for children and adolescents with ASD, AHRQ is similarly providing communities with valuable guidance on the evidence base of such therapies as computer assisted care and mental health therapeutics.

Federal efforts at agencies such as CMS and HRSA are also identifying and evaluating best practices among services and supports across the states, and agencies including DoD, HRSA, SAMHSA, and NIH are developing practitioner training and disseminating information to individuals and families affected by ASD through toolkits, websites, and telehealth delivery systems to reach more isolated parts of the community. The Autism NOW website, supported by the Administration for Community Living, offers videos and toolkits on a range of issues spanning from early interventions to relationship building, employment, and family supports and training.

To ensure continuing coordination among federal agencies and between federal and private partner organizations, the Interagency Autism Coordinating Committee provides strategic guidance and a forum for public input into federal planning efforts, helping federal agencies and members of the public work together toward meeting the needs of the autism community. While the collaborative efforts of federal and state agencies and community partners have resulted in many research advances and improvements in services over the past 7 years, all acknowledge the growing needs of the community and the work that remains to be done. Continued collaborative efforts between the public and private sectors will be essential to drive the innovations that will lead to improved identification, interventions, services, and policies that will enhance the lives of people with ASD and their families.