The Diagnostic Surge and Expert Dissent
UK autism diagnoses increased 787% between 1998 and 2018, with the rise greater for women than men. In the US, cases rose 175% between 2011 and 2022, primarily among 26- to 34-year-olds. In both countries, childhood rates have also increased. Dame Uta Frith argues the autistic spectrum "has come to its collapse" because the term is now too accommodating. She claims the label has moved from a "precise, clinical" term to a "vague, culturally amplified identity category." Frith, who helped establish the spectrum concept with Lorna Wing and Judith Gould, says many adults diagnosed today are so different from children with obvious learning disabilities that they do not merit the label. This concept of a "continuum" grew from the work of Wing and Gould, who interviewed 900 teachers and observed 132 children in Camberwell to show autism was more widespread than previously thought. Frith also identifies a subgroup of people with anxiety and hypersensitivity who used to be called neurotic. She specifically noted that presenter Chris Packham, who has Asperger syndrome, shows a "blatant contraindication" to autism because of his communication skills. Frith argues that many people diagnosed as adults differ so significantly from the autistic individuals whose conditions become obvious in early childhood that they do not merit the label at all, especially when social media influences their self-perception.
Review Findings and the Masking Conflict
Wes Streeting commissioned an independent review into mental health, ADHD, and autism. The review attributed rising diagnosis rates to "socio-cultural changes in awareness [and] recognition" and broader diagnostic concepts. The authors stated that if present trends continue, the risk of misdiagnosis and overdiagnosis will increase, though they did not conclude overdiagnosis occurs "at scale."
| Proposed Subgroup | Characteristics |
|---|---|
| Type 1 | Intellectual disability and language delay |
| Type 2 | No intellectual disability |
Mary Doherty, an Irish anaesthetist and founder of Autistic Doctors International, disputes Frith’s view that "masking" is a non-scientific concept. Frith dismisses studies that measure masking through items like "I copy body language" as unreliable because subjective experience is not a reliable metric. Doherty says that trying to cover autistic traits by copying others leads to exhaustion. She argues that denying autistic identity damages people who are already at risk of mental health problems. In the south-east of England, one mother says she feels her daughter’s needs are lost because the term now applies to so many children. She says the term has become "unrecognisable" and that it is unhelpful to children with a "classically autistic inability to cope" with school environments.
Redefining the Spectrum
Simon Baron-Cohen says the term "autism" acts as a "sledgehammer" because it covers too many people. He notes that the 2013 decision to remove Asperger syndrome from the diagnostic manual caused the prevalence of autism to increase overnight. This change folded two major subgroups into one category. Baron-Cohen proposes moving to more precise subgroups to help research and resource allocation.
| Diagnosis History | Detail |
|---|---|
| 1981 | Wing created Asperger syndrome category |
| 2013 | Asperger syndrome removed from DSM |
Baron-Cohen notes that research shows most autistic people have at least six diagnoses. These often include ADHD, dyslexia, dyspraxia, anxiety, gastrointestinal pain, or epilepsy. Frith’s earlier research showed autistic minds respond more to visual cues than words. In 1989, she developed the theory of Weak Central Coherence, which posits that autistic people fixate on detail rather than broad themes. This research helped form the "Triad of Impairments" alongside Wing and Gould, which identifies social skills, reciprocal language, and social imagination as core issues. Subsequent diagnostic criteria added that autism usually involves sensory issues like heightened or lowered sensitivity to sound, light, texture, heat, and cold. The diagnostic expansion has created a divide between those with intense needs and those who use the label to explain personality difficulties. Baron-Cohen suggests that subgroups must still receive equal access to resources and cultural esteem to avoid "othering" individuals.
