In October 2019, at a time when she was surging in the competition to become the Democratic nominee for president, Elizabeth Warren took a question from a nine-year-old child. The child, who was attending a LGBTQ ‘town hall’ event sponsored by CNN, was concerned about feeling safer at school. Warren was kind and supportive and her comments were received well by the audience at which it was directed. For a broader audience it included a swipe at Betsy DeVos, Donald J. Trump’s Secretary of Education.
Several months later, as she was sinking in the polls, Warren returned to this encounter. At the end of January 2020, asked at another town hall about the dearth of LGBTQ history in public education, she pledged to a crowd in Iowa that as president,
“I’m going to have a secretary of education that this young trans person interviews on my behalf, and only if this person believes that our secretary or secretary of education nominee is absolutely committed to creating a welcoming environment, a safe environment, and a full educational curriculum for everyone will that person actually be advanced to be secretary of education.”
No-one would question Warren’s devotion to inclusivity. She was very well informed about the issues and will have known before making her pledge that the integration of minority histories into public school curricula in the USA is very well advanced. At university level, one would be hard pressed to find a history course that is not devoted to a minority or oppressed population. Many, however, were wise to question the wisdom of offering a veto to a child, aged nine, on a cabinet-level appointment.
For many centrist Democrats, and all Republicans, Warren’s willingness to double down on the promise showed weakness, her pandering to an interest group that was vocal and disproportionately influential in the Democratic primary process. She was parroting the views of the Human Rights Campaign, a large and influential LGBTQ lobbying and advocacy group.
In marked contrast, for many voters Andrew Yang’s persistent support for autism intervention showed strength and resolve. It felt genuine to voters of both parties, inspired by his own experience as the parent of an autistic son. It resonated with every parent like him, worried about a child’s future and how he or she would be treated not just at school (although certainly there, where bullying is omnipresent), but afterwards.
By the most authoritative and sympathetic estimation, advanced by UCLA’s William’s Institute, 0.7% of the US population identifies as trans, including 150,000 youths aged between 13 and 17. As they enter the workforce, laws that protect their rights are essential. Transgender discrimination in the workplace is an important concern, but the matter of autism and employment is of a different order of magnitude. By some estimates, nine in ten autistic adults in the USA are unemployed or underemployed. Those in paid work tend to be paid very poorly. The problem is acute and it is very quickly becoming more substantial. According to the US Centers for Disease Control and Prevention (CDC), in 2014, 1.68% of children born in 2006 had been diagnosed as on the autism spectrum. This is 1 in 59 births, rising from 1 in 150 for children born in 1992. Emerging data suggest the number is rising still, and will soon reach 2%, or 1 in 50 births across all fifty states.
According to the American Psychiatric Association, gender dysphoria is a psychiatric condition that ‘involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify’. There may be a link between autism and gender dysphoria. According to Eric Butter, a professor of pediatric psychology and director at Nationwide Children’s Hospital, writing for the autism advocacy group Autism Speaks,
“Some studies have found [that transgender individuals] have a higher rate of autism diagnosis, with estimates ranging from 6 to 13 percent. Other studies have found people with autism likewise have a higher rate of gender dysphoria or gender variance. They are also often dealing with other commonly co-occurring mental and physical health issues. Given this observed higher rate of gender variance among children with ASD [Autism Spectrum Disorder], it is important that evaluations for autism routinely assess for gender variance and that clinical evaluations of youth referred for gender variance also screen for autism.”
Autism is a not a psychiatric condition, it is a neuro-developmental disorder that results in impaired communication, social interaction and a range of restricted, repetitive behaviours. Awareness that there may be a higher rate of autism in the transgender community suggests further study is warranted, but autism and gender dysphoria are separate issues and should not be conflated. Many children diagnosed with autism lack the ability to speak or communicate effectively about any matter, including gender variance.
Parents of autistic children quickly become single-issue voters. When Yang withdrew from the race, many looked again at Warren, who once taught children with speech and language difficulties. She was committed intellectually to the rights of those with disabilities. Bernie Sanders, similarly, was committed to providing additional federal funding to support disabled students in schools. Amy Klobuchar could claim a distinguished legislative record on autism. She was Democratic sponsor of the 2014 ABLE act, six years after, as a new senator, she had co-sponsored the Americans with Disabilities Amendment Act (ADAAA) 2008. In 2017, she co-sponsored ‘Kevin and Avonte’s Law’, named after two autistic boys who died after wandering. The law provided funding for technology and training for the carers of autistic and vulnerable children and adults. Klobuchar speaks regularly about disability and mental health, recounting stories of her father’s alcoholism and her infant daughter’s reliance on a feeding tube. However, she has been criticized by disability advocates for not consulting adequately with their community when crafting her ideas and policies.
Several of these ex-candidates will be hoping for a role in Joe Biden’s administration. Biden can claim to have a track record on autism. In 2014, the Obama administration passed the Autism Cares Act, which reauthorized and expanded the provisions of the Combating Autism Act of 2006. Under the Affordable Care Act, Obamacare, autism screening was mandated for all children aged 18 to 24 months during ‘well visits’ to a doctor. Additionally, health insurance companies were required to pay for autism services for all children with a diagnosis, which the CDC has estimated costs between $17,000 and $21,000 per year per child. In the same year, Achieving a Better Life Experience (ABLE) 2014 was enacted, allowing for the creation of tax-free savings accounts for the disabled. A huge range of goods and services can be purchased using an ABLE account, including regular living expenses using a debit card that can be linked to the account.
Trump, on the other hand, notoriously mocked a disabled reporter at a campaign rally in 2015. He has regularly advanced the notion that vaccination is linked to autism, including as a presidential candidate, although he stopped short of proposing a commission to investigate the matter once he was elected. Yet, his tax law of 2017 was beneficial for parents of disabled children who were putting away money for a child’s higher education, for example in a tax-advantaged college saving’s account (a ‘529’ account). Transfers from a regular 529 to an ABLE account are now authorized, up to $15,000 annually, a small source of consolation to parents coming to the realization that their child will not be able to attend college. Additionally, up to $10,000 can be spent annually from a regular 529 account on private school tuition, including special education, rather than saved for college.
In October 2019, Trump signed the Autism CARES Act 2019, a further re-authorization of the 2006 and 2014 laws, that commited $1.8 billion to fund research and education activities at government agencies. One of the bill’s sponsors, Senator Chris Smith of New Jersey, a Republican, announced that the new law “will fund critical biomedical autism research as well as the development of best practices to enhance the lives of persons with autism”.
The CNN town hall at which Elizabeth Warren made her offer to a child was later the scene of protests by those who wished to highlight the plight of black transgender women. The candidate on stage at that time, Pete Buttigieg, a white gay man, responded sympathetically, that he did wish to “acknowledge what these demonstrators are speaking about, which is the epidemic of violence against black trans women”. Buttigieg was borrowing the language of the Human Rights Campaign, to signal his fellowship. The growth of autism in the USA might more accurately be described as an epidemic. A substantial and rapidly growing demographic, the parents and families of autistic children, and young people with autism voting for the first time, may eventually have a great impact upon American politics. Autism transcends party politics, and Democrats cannot count on the votes of the autism community as they can those of the LGBT community.