During the recent White House news conference linking Tylenol use during pregnancy to rising pediatric rates of autism, one of the president’s side comments caught my attention: He said that there is “virtually no autism” among the Amish. Since the Amish are a relatively isolated community and tend to avoid many modern technologies, there has been growing interest in whether autism exists within Amish populations, and what light that might shed on the condition. The truth is, very little systematic data has been collected on this topic to date.
My research group at the University of Maryland School of Medicine has been studying the health of the Lancaster, Penn., Amish community for more than 30 years. Although we have not specifically investigated autism, Amish people have shared with us accounts of people within their community who appear to have autism.
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Furthermore, one 2010 study that attempted to systematically assess autism prevalence found that 1 in 271 Amish children from Indiana screened positive for autism in a sample of 1,899 children, while the Centers for Disease Control and Prevention currently estimates that 1 in 31 American children has the condition. That sounds like a very big difference, but direct comparisons between this rate and those in the general population are challenging. The only thing we know for certain is that the true prevalence of autism among the Amish remains unknown.
The Indiana study relied on a household survey, whereas national estimates often draw from large catchment areas using multiple data sources, including medical records, educational records, and Medicaid claims. In the general population, increased awareness of autism, improved screening practices, and expanded access to services have all contributed to higher diagnostic rates. These factors may not apply equally to the Amish.
Cultural differences in caregiver reporting may also influence screening outcomes. Autism screening tools often include questions about social interactions and behaviors in structured settings such as schools. Amish schooling differs significantly from mainstream education: Schools typically go only through the eighth grade, are housed in one-room buildings, and are taught by a single teacher — often a young, unmarried Amish woman. These differences in educational context, along with potential differences in parental perceptions and reporting styles, may affect how behaviors are interpreted and reported.
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Taken together, these factors underscore the complexity of making cross-cultural comparisons in autism prevalence. They also highlight the need for culturally sensitive research approaches that account for differences in lifestyle, education, and healthcare access. Expanding autism research in underrepresented populations like the Amish may offer valuable insights into both the genetic and environmental contributions to neurodevelopmental conditions.
Related questions have also emerged, such as whether Amish families vaccinate their children or use medications like Tylenol. In Lancaster, some Amish families do choose to vaccinate, while others do not. Tylenol is commonly used by many Amish in this community.
Current research in the field suggests that autism is now understood to have no single cause. While genetics play a significant role, other factors are also important. Prenatal influences — such as advanced parental age, maternal infections, and pregnancy complications — have been associated with increased risk. Environmental exposures, including pollution, may contribute, particularly in genetically susceptible individuals.
While some studies have reported weak associations between autism spectrum disorder and acetaminophen use during pregnancy, others have not. Even if such an association exists, it may not be causal; for example, the underlying factor could be the fever or infection that prompted acetaminophen use in pregnant women.
There are many other fascinating aspects of Amish health. My group at the UMD School of Medicine has been studying approximately 43,000 individuals in the Lancaster, Amish community. Nearly all of these individuals are descendants of a relatively small group of founders — estimated at around 500 — who immigrated to the area in the early 1700s. This founder effect has resulted in reduced genetic diversity compared to the general population. Based on sequencing data from more than 7,200 Amish people in our research, my colleagues and I estimated in a recent study published in the American Journal of Medical Genetics that the Amish have only 14% as many genetic variants compared with a group of 7,200 individuals outside of the Amish community.
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This reduced genetic diversity has led to an enrichment of certain disease-causing variants that are rare in other populations. For example, 13% of Lancaster Amish carry a pathogenic variant in the APOB gene associated with familial hypercholesterolemia, a form of dangerously high cholesterol that greatly increases their risk for early heart disease. Additionally, 2.5% carry a pathogenic variant in the KCNQ1 gene, which increases the risk for long QT syndrome, which can cause sudden cardiac death in young people. Interestingly, the Amish are also enriched for protective variants, such as one in the APOC3 gene that accelerates triglyceride breakdown and reduces heart attack risk.
The Amish lifestyle is also believed to have a significant impact on health. In a study I co-authored in 2020, our team found that the Lancaster Amish have a relatively low prevalence of type 2 diabetes, hypertension, and high cholesterol — despite the high frequency of familial hypercholesterolemia — compared to non-Amish individuals of European ancestry in the U.S.
Moreover, despite the Amish having limited access to health care, their mortality rates are comparable to those observed in European ancestry participants of the Framingham Heart Study. The one caveat of this 2012 study, which I led, was that it was conditional on survival to age 50 and didn’t account for early deaths due to, say, complications from childbirth, which may be higher in the Amish community. We speculated that the physically active Amish lifestyle and other aspects of Amish life, such as strong social connectedness, may contribute to these health benefits.
Taken together, these findings highlight the importance of studying unique populations like the Amish to gain insights into both genetic and environmental contributions to health and disease. The combination of a distinct genetic background and lifestyle offers a rare opportunity to uncover novel risk and protective factors. As research continues to evolve, expanding investigations into neurodevelopmental conditions such as autism within the Amish may yield valuable discoveries that inform broader public health understanding and interventions.
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Braxton Mitchell, Ph.D., M.P.H., is a professor of medicine and vice chair for research in the Division of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine.