Among the most prevalent and pernicious problems affecting children is autism spectrum disorder (ASD), which affects up to 1 in 68 children in the United States.1 A neurodevelopmental disorder of varying severity, the considerable prevalence of this disorder has resulted in a quest for a better understanding of causation and risk factors. In this issue of Pediatric Research, Hisle-Gorman et al.2 report results of an elegant epidemiologic study aimed at identifying prenatal, perinatal, and neonatal conditions associated with ASD.

Utilizing a case-cohort study approach of the Military Health System database, the authors identified ASD risk factors among 8760 children diagnosed with ASD, matched with 26,280 controls.2 Similar to other epidemiologic studies of this issue,3–5 an association of ASD and multiple prenatal and postnatal risk factors were observed.2 These findings support the notion that the roots of ASD are multifactorial. As such, without a specific risk factor or condition to target, global approaches are needed for risk factor mitigation, and to support the care and evaluation of these special children.

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