Autism spectrum disorder (ASD) and autism are general terms for a group of developmental disabilities that cause impairments in social skills and communication, and are often characterized by certain atypical behaviors. Autism spectrum disorders include autistic disorder, Asperger disorder, and pervasive developmental disorder-not otherwise specified. These conditions have overlapping symptoms that differ in terms of onset, severity, and nature. ASDs are referred to as "spectrum disorders" because they encompass a range of behaviorally defined conditions. The complex nature of these conditions creates diagnostic challenges; there are no consistent genetic or biologic markers to facilitate diagnosis. Autism has been linked to abnormal biology and chemistry in the brain; however, the cause or causes of these abnormalities remain unknown. According to the Centers for Disease Control and Prevention (CDC), as many as 1 in 110 eight-year-olds currently have an autism spectrum disorder, with boys affected more than four times as often as girls. This represents an increase from past autism rates, and has generated public interest in the causes of autism. The increased prevalence has also focused attention on the demand for effective treatment and support services for individuals with these conditions. In addition, some have questioned whether the current rates of ASD reflect increased awareness and diagnosis, a true increase in the incidence of ASD, or a combination of these factors. For many, autism is a lifelong illness whose symptoms often manifest before age three. Autistic children and adults generally display a unique set of symptoms, but common traits associated with autism include difficulty talking, repeated behaviors, and aversion to loud noises. ASD impedes an individual's communication skills, making it difficult to learn or to integrate socially. There are no medical treatments for autism itself; however, medications and behavioral therapy can help mitigate certain symptoms. While there is currently no known cause or cure for autism, research to determine the cause or causes may identify risk factors, some of which may be modifiable. Other studies may determine optimal methods of screening and diagnosis, identify the most effective mental and behavioral health therapies, and find the best medical treatments for individuals with ASD. The federal government has a role in the financing (through Medicaid and State Children's Health Insurance Programs) and delivery (through funding of developmental disabilities programming in schools, Title V Maternal and Child Health funding, and other sources) of treatment for ASD. The number of cases and their appropriate diagnosis and treatment affect federal and state expenditures. As such, Congress has shown interest in financing research on ASD prevalence, causes, and optimal treatment for individuals with ASD. This interest in ASD surveillance and research has been demonstrated through inclusion of autism research provisions in the Children's Health Act (CHA, P.L. 106-310 ) in 2000, enactment of the Combating Autism Act in 2006 (CAA, P.L. 109-416 ), and the recent enactment of the Combating Autism Reauthorization Act (CARA, P.L. 112-32 ) by the 112 th Congress. This report presents an overview of the CAA and CARA, Department of Health and Human Services (HHS) funding and activities under the CAA and CARA, other federal activities related to autism, and selected issues for Congress. The precursor to the CAA was the Children's Health Act of 2000 (CHA), which addressed a number of child health issues. Title I of the CHA authorized the Secretary of HHS (the Secretary) to conduct certain activities relevant to autism and developmental disabilities. It established funding for autism surveillance at CDC and established the National Center on Birth Defects and Developmental Disabilities. Under the CHA, the National Institutes of Health (NIH) was authorized to expand and intensify its autism research efforts and to establish Centers of Excellence for autism research. The CHA also established an Autism Coordinating Committee to coordinate research within NIH, and authorized funds for HHS to establish and implement an information and education campaign for health care providers and the general public. Enacted in 2006 and subsequently reauthorized by the Combating Autism Reauthorization Act of 2011, the CAA is intended to address growing concern about the increasing prevalence of autism spectrum disorders, and to stimulate research into possible autism causes and treatments. It authorized funding from FY2007 through FY2011 for autism research, screening, early intervention, and education. CARA reauthorized this funding through FY2014. The CAA authorizes the Secretary to expand, intensify, and coordinate existing ASD research activities; to expand surveillance and epidemiological research; to increase awareness of ASD; and to provide access to screening and early intervention services. It authorizes expanded research activities at NIH, and created the Interagency Autism Coordinating Committee (IACC) to coordinate all federal autism research efforts (this expanded the mission of the Autism Coordinating Committee described above). At CDC, the CAA authorizes surveillance and establishes ASD awareness programs. At the Health Resources and Services Administration (HRSA), the CAA authorizes expanded federal efforts in autism education, early detection, and intervention. The CAA also required a report to Congress on implementation and progress four years after enactment, which was provided to Congress on January 7, 2011. CARA requires a report to Congress two years after enactment. The following sections summarize the programs and funding authorized under the CAA and subsequently reauthorized by CARA. The CAA authorizes CDC to award competitive grants for the collection, analysis, and reporting of state-level epidemiological data on ASD and other developmental disabilities. CDC must establish guidelines for reporting these data, in collaboration with other public and private entities. CDC is also required to coordinate the federal response to potential or alleged clusters of ASD or developmental disabilities (DD). The CAA also requires CDC to award grants or cooperative agreements for the establishment of regional centers of excellence in the epidemiology of ASD and other developmental disabilities. The purpose of the centers of excellence is to collect and analyze information on the number, incidence, correlates, and causes of ASD and other DD. The centers are required to collect and report data according to the guidelines established by CDC. In addition, centers are required to develop an area of special research expertise (such as genetics, epigenetics, or environmental epidemiology), and to identify suitable cases and controls for research into potential causes or risk factors for ASD. The CAA authorizes the Secretary to provide grants for projects designed to (1) increase awareness of ASD; (2) reduce barriers to screening and diagnosis; (3) promote evidence-based interventions for individuals with ASD or other developmental disabilities; (4) train health care professionals to use valid, reliable screening tools; and (5) provide early intervention if needed. The Secretary must use an interdisciplinary approach that also focuses on specific issues for children who are not receiving early diagnosis and interventions. These activities are carried out through HRSA. The Secretary must, subject to funding, provide information and education on ASD to increase public awareness of developmental milestones; promote research into the development and validation of reliable screening tools; promote early screening of high-risk individuals; increase the number of individuals who are able to diagnose or rule out ASD; increase the number of individuals who are able to provide evidence-based interventions; and promote the use of evidence-based interventions for high-risk individuals. The Secretary must, subject to funding, collaborate with a number of federal programs for low-income individuals to provide culturally competent information regarding ASD and developmental disabilities, in collaboration with the Department of Education and the Department of Agriculture. These programs include Head Start; Early Start; Healthy Start; programs under the Child Care and Development Block Grant Act of 1990; Medicaid, including the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT); the State Children's Health Insurance Plan (CHIP); the Maternal and Child Health Block Grant; Individuals with Disabilities Education Act Parts B and C; and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The CAA authorizes the Secretary to require states to designate a lead agency responsible for disseminating the information described above available to individuals in the state. This information may be provided through toll-free numbers, Internet websites, mailings, or other means, as determined by the governor of each state. In addition, the Secretary, through the states, must promote and assist the development and use of screening tools. The Secretaries of HHS and the Department of Education must provide for the collection, storage, coordination, and public availability of screening tools and educational materials. The CAA also authorizes the Secretary to fund grants to expand existing interdisciplinary training and leadership programs (authorized in Title V of the Social Security Act). The Secretary must also promote best practices in autism screening and diagnosis. The CAA authorizes the Secretary of HHS to expand, intensify, and coordinate ASD research activities at NIH, and to consolidate existing program activities if necessary. It directs NIH to investigate the cause, diagnosis, early detection, prevention, services, supports, intervention, and treatment of ASD. The CAA also authorizes the Interagency Autism Coordinating Committee (IACC) at NIH to coordinate all ASD research, screening, intervention, and education efforts within HHS. Members of the IACC are appointed for a term of four years and may be reappointed once. Members must include representatives of the following: Administration for Children and Families (ACF), CDC, Centers for Medicare and Medicaid Services (CMS), HRSA, NIH, HHS Office on Disability, Substance Abuse and Mental Health Services Administration (SAMHSA), and the Department of Education. No fewer than six members, or one-third of the committee (whichever is greater) must be non-federal public members, including people with autism, parents of people with autism, and leaders of national autism organizations. The IACC is required to meet at least twice per year in public session. It is responsible for formulating and annually updating the strategic plan for ASD research, and presenting those recommendations to the Secretary and to Congress.