Autism is among the most clearly genetically determined of all cognitive-developmental disorders, with males affected more often than females. We have analyzed autism risk in multiplex families from the Autism Genetic Resource Exchange (AGRE) and find strong evidence for dominant transmission to male offspring. By incorporating generally accepted rates of autism and sibling recurrence, we find good fit for a simple genetic model in which most families fall into two types: a small minority for whom the risk of autism in male offspring is near 50%, and the vast majority for whom male offspring have a low risk. We propose an explanation that links these two types of families: sporadic autism in the low-risk families is mainly caused by spontaneous mutation with high penetrance in males and relatively poor penetrance in females; and high-risk families are from those offspring, most often females, who carry a new causative mutation but are unaffected and in turn transmit the mutation in dominant fashion to their offspring.human genetics ͉ neurodevelopmental disorders ͉ population genetics A utism Spectrum Disorder (ASD) (Online Mendelian Inheritance in Man accession no. 209850) is characterized by language impairments, social deficits, and repetitive behaviors; can occur either sporadically (simplex) or in a familial (multiplex) pattern; occurs far more commonly in males; and has an overall incidence of Ϸ1 in 150 births (1). Monozygotic (MZ) twins show Ͼ70% concordance (2), higher with broader diagnostic criteria, and much higher than observed in dizygotic (DZ) twins, strongly suggesting that autism is genetically determined. Children with affected siblings have a higher risk than the general population, suggesting that autism can be inherited at least partially from preexisting genetic variants in parents.Autism is likely to involve many genes. Linkage studies find no single locus of major effect but rather a very minor increase in allele sharing over the entire genome among concordant sibs (3-9). Cytogenetic studies (10), and more recently copy number analyses (9,11,12), support the idea that many loci may contribute to the disease.Sibling and DZ concordance rates are perhaps one-tenth of MZ concordance rates, and this discrepancy, plus the suggestion of a large number of risk loci, has led many to expect that autism is attributable to complex multigenic interactions rather than simple dominant or recessive mutations. However, our current knowledge of genetic factors in autism suggests otherwise. Most of what we know about heritable risk factors comes from monogenic disorders, including fragile X syndrome (13-15), Rett syndrome (16), and tuberous sclerosis (17). Furthermore, cytogenetic findings and, more recently, copy number analysis point to a higher incidence of spontaneous mutation in children with sporadic autism (11), presumably occurring in a parental germ line.An alternate to the multigenic interaction hypothesis is worth considering; most cases of autism are due to de novo mutation in the parental germ li...