Is the huge rise in autism diagnoses really good news? We’re not so sure | Autism

Professor Gina Rippon too easily rejects real concerns concerning overdiagnosis of conditions such as autism and medicine of normal behavior (why antagonism on the rise of autism diagnoses? This is in fact good news, July 21). She observes correctly that there has been an surprisingly significant increase in diagnostic rates since 1998. She also properly noted that, before the 1980s, autism was rarely diagnosed due to its “too narrow” definition.

However, by arguing that many children have therefore missed the help they needed, it draws the wrong conclusion. It does not mention that other diagnoses were available for these children, including social anxiety, hyperactivity disorder of attention deficit and learning disorder, among others. Children who need help have been frequently diagnosed with one of them and with sufficient reliability to provide help in available resources. In addition, it is well known that the diagnosis of autism in itself does not indicate any type of specific intervention.

Rippon also hosts the arrow diagnostic rates, assuming that this somehow explains the behavior of those who gave it. However, autism is only a descriptive diagnosis. The diagnostic criteria include a large group of behavior, so that two people with diagnosis cannot display any common behavior. The common underlying psychological or neurological anomaly, if you exist at all, is simply not known. I remember my clinical career in the mental health services for children and adolescents (CAMHS) who were questioned by the parents of a boy with a diagnosis of autism: “We know that he is autism, but why does he behave as he does?” The only available explanation would be an individual assessment of the child concerned and parameters that trigger all behavioral difficulties.

Rippon ends by saying that high autism diagnosis rates are simply a reflection of human diversity. However, in doing so, it inadvertently reflects what the persons concerned about the overdiagnosis really say. It is precisely because We welcome the human diversity that we wonder why such high diagnostic levels are necessary to understand it.
Dr Richard Hassall
Knaresborough, North Yorkshire

As there are so many references to a “bad old past” in the article by Gina Rippon, I thought it could be useful if I started some of the errors that she expresses. I worked as an academic psychiatrist from the 1960s to the 1990s, including as a psychiatrist from a school for autistic children. First, the increase in diagnostics was even higher than Rippon suggests. In the first edition of my Manuel, published in 1986, I give the prevalence of three to four per 10,000 children. It is now at least 100, an increase of 30 times. Secondly, the climb is almost entirely entirely due to a redefinition of the condition. Asperger’s so-called syndrome has been abolished as diagnosis and merged into the “autistic spectrum disorder”. Third, I do not recognize the supposed difficulty of diagnosing girls with this condition. Admittedly, I did not hesitate to do it when it was indicated.

Whether the redefinition of autism is good or bad news, me, like many others, I find it difficult to say. In addition to the change in definition, a reduction in stigma and a greater desire to attend the relevant services. On the other hand, the mental health services of children are overwhelmed and many parents are frustrated by their inability to obtain what they consider, quite unrealistic, as an aid that changes their life. Rather than looking for a final diagnosis, many would be better served by encouragement to see their problematic children as “different” and requiring education adapted to their particular forces and difficulties.
Philip Graham
Professor emeritus of child psychiatry, London University College

Gina Rippon presents the astonishing increase in autism diagnoses as proof that more members of marginalized groups benefit from a diagnosis. It is true that the growing number of people suffer from mental distress, and evidence links this to increased poverty and inequalities. It is also true that access to services and well-being generally requires a psychiatric diagnosis.

But it is completely unjustified to describe autism as an incurable neurodevelopmental brain disorder, except in the case of a small number of individuals who will need life support and can never live independently. The extension of autism diagnoses to potentially include billionaires like Elon Musk, as well as celebrities and other people with a successful career, is not supported by evidence. In fact, despite Rippon’s demand for “amazing progress”, no neuronal or genetic factor sufficiently robust to facilitate diagnosis or predict the response to treatment has never been found.

In addition, there are important drawbacks to frame diagnostic labels as identities to be celebrated. The experiences described by many people who now claim to be autistic are better explained as the consequences of the lack of intimidation and individualism that characterize daily life today, the effects of what sociologists call “victim cultures”, influence invites social media and the contribution of abuses and other undesirable experiences to the distress of all forms.

We do not yet need another way of individualizing and merchanting the roughly unequal impacts of these social pressures. Instead, we must fundamentally transform our deeply unequal society, dismanting the myths that make inequalities seem inevitable.
Dr John Crommy
Honorary professor of mental health and psychology, University of Nottingham