(UK) Ninefold increase in autism "should be celebrated as sign of civilised society" :expert

July 21, 2025, Guardian:  Why the antagonism over the rise in autism diagnoses? It’s actually good news 

A ninefold increase is the result of huge advances in our understanding – and brings the hope of fulfilling lives to many more people

Soaring rates of diagnoses in various illnesses such as cancer and diabetes have stimulated a debate about whether medicine has an “overdiagnosis” problem. The claim is that individuals may be prematurely diagnosed with conditions that, although meeting criteria for a disease, will never cause symptoms or death during a patient’s lifetime.

Discussions of this problem in the world of physical medicine have mainly been described as compassionate, arising from concerns that many so-called diagnoses might be unnecessary (does being pre-diabetic really mean you are ill?) or even harmful (the worried well being driven to seek needless and possibly damaging surgical interventions). Now that there are ever-more sensitive screening tests, and access to predictive genetic information, are doctors handing out too many unnecessary sicknotes?

When attention turns to the possibility of overdiagnosis in the world of psychological medicine, however, the tone changes. Even those on the side of compassion display a greater level of cynicism, with subtle (or not so subtle) hints about unearned or pointless diagnoses. There is reference to “diagnostic creep” and the “medicalisation” of normal human variation. Mental illness has been described as just an inability to deal with ordinary distress and anxiety. Weighing in on the back of this are those with much more trenchant opinions. “We’ve fetishised mental illness, so we all want it,” reads one recent headline, with the associated article describing a mental illness diagnosis as a “sicknote from life”.

Increases in diagnoses such as attention deficit hyperactivity disorder (ADHD) have been blamed on “sharp-elbowed, middle-class parents” trying to avoid the blame for bad parenting, and the support for children with special education needs as an “unaffordable racket”, caused by a system that is “patently easy to game”.

Autism is clearly in the crosshairs, targeted because of the 787% increase in diagnoses between 1998 and 2018. What better evidence is there that there is too much diagnosing going on?

Those worried about the rise rarely note that, in the 1980s, after a painstaking UK-based investigation of a large range of developmental disorders, there was a deliberate recalibration of autism’s diagnostic criteria. This was because too many children in need of help were being missed by the then overly narrow definition of the condition. More recently, there has been an emerging awareness that even this more inclusive approach had missed large numbers of marginalised groups, especially women and girls. In conjunction with this, we are seeing a more sympathetic public awareness of autism, and how it presents. So this much-vilified increase is actually a long-needed correction of a longstanding bias, which had overlooked many in need of support.

Discussions about overdiagnosis in physical medicine refer to the problem of unnecessarily pathologising mild, preclinical conditions. This is also being identified as a problem in the field of autism. In a strange throwback to the anti-psychiatry era of the 1960s and 1970s, the “compassionate” voices urge against the damage caused by “medicalising” or “biologising” autism (even though it is clearly a brain-based, highly heritable condition). Apparently it could be harmful to tell people they are suffering from an incurable brain disorder.

Indeed, couching an autism diagnosis in such inaccurately negative terms could well be harmful. Those who work in the autism field would not recognise (or tolerate) it. More widely, it sets aside the stunning advances made in the understanding of autism that have been achieved by those very biologisers, such as geneticists and neuroscientists, who have been criticised. Do we really want to go back to the time when the blame for autism was laid at the doors of emotionally cold “refrigerator mothers”? . . .

Paradoxically, there is clear evidence that, in the world of autism, a diagnosis can often be positively received. For parents who have been seeking explanations for their young child’s difficulties, possibly for months if not years, a diagnosis of autism can offer a longed-for explanation, a gateway to knowledge and understanding, and the membership of a community that can offer help and support.

In psychological medicine, it is claimed that widening the definition of atypical behaviour (“diagnostic creep”) has resulted in over-generosity in handing out “unearned” diagnoses. If you have a job, can drive a car, can make eye contact, then you aren’t autistic enough.

Anyone who has been through a full autism assessment (having perhaps already waited five years to get there) will attest to the lengthy, complex and rigorous procedures involved. It is not a perfect system – the problem of underdiagnosis has already been mentioned – but it is certainly not a system that can easily be “gamed”.

The concepts underpinning the claims of overdiagnosis in physical medicine do not play out well in the field of autism. The almost-ninefold increase in diagnosis of this condition should not be taken to reflect a worrying trend towards “a culture of wide-eyed acceptance of mental health gobbledegook”. Rather, it should be celebrated as a sign of a civilised society recognising the struggles that some of its fellow citizens face and acknowledging their need for recognition and support. Indeed, it could be taken as a welcome outcome of initiatives to destigmatise all forms of mental illness.

Perhaps most importantly, an autism diagnosis is almost universally seen as a gateway to understanding, of positive benefit to self-identity and self-esteem. This is not something that should be rationed or withheld. The overdiagnosis brigade, be they compassionate or outraged, seem to have misunderstood autism and its diagnosis. Autism is not a diagnostic fad but a reflection of human diversity and the world’s need to accommodate it – denying that does far more harm than any so-called overdiagnosis ever could.

 This article was amended on 21 July 2025. The quote from Robin Ince related to his diagnosis with ADHD, not with autism as an earlier version indicated. The main image, which was previously of Robin Ince, has been replaced accordingly.

Prof Gina Rippon is emeritus professor of cognitive neuroimaging at the Aston Brain Centre, Aston University, and the author of The Gendered Brain