Autism Being over diagnosed?

I would reject anything which claims 'over-diagnosis' outright.

There are clear descriptors and diagnostic processes for almost every recognised condition, disease, and disorder. In the case of Autism it's the ICD or the DSM. If a doctor is diagnosing people with Autism outside of those processes then it's malpractice. Pure and simple. So either Dr. Pemberton is accusing his peers of malpractice on a massive scale, or he is not fit to be a Doctor due to a lack of understanding of his field.  

Now, where the interview has some points is the area of people paying some mickey-mouse outfit to diagnose them with autism. This I believe is a legitimate point. We have a name for this though - malpractice. These organisations are not acting ethically and if they are Doctors they should in my opinion be struck off.

Likewise is manipulation of evidence. One would hope that the processes present might be able to catch and identify manipulation of information by patients. Presumably that is the point of family members also reporting as part of the process. Likewise, one would assume that all clinicians take an approach which include differential diagnosis. That I cannot speak to. If however, there is evidence of manipulation in these forms then yes again they have a point. 

There are descriptors in the ICD which do preclude a diagnosis of autism if someone has a different diagnosis that could better explain their challenges and support needs. As an example if an individual has a diagnosis of, or their challenges can be better explained by developmental learning disorders, the ICD-11 states that they ought not to be given a diagnosis of Autistic Spectrum Disorder. Now, I can imagine how this would feel to some people and I imagine there would be an uproar from some here about the overlap and boundaries. And in fairness, the ICD does consider those overlaps and tries to make the issue clear. 'Autism spectrum disorder may be diagnosed in individuals with disorders of intellectual development if deficits in initiating and sustaining social communication and reciprocal social interactions are greater than would be expected based on the individual’s level of intellectual functioning.' In short - you can only have both conditions if the social impacts are more pronounced than would be otherwise expected in IDD.  [Side note, I despise the descriptor Intellectual Development Disorder I use it solely because it's the ICD's terminology.]


If we separate out malpractice though, then there is no overdiagnosis. And in fact I would argue that this in not what he was claiming.

The interview instead was claiming, in my view at least, that there are individuals out there who are misrepresenting the facts or carrying out widespread malpractice such that it undermines legitimate diagnosis.

That is something I feel we should all be worried about. By all means, I think inclusivity is important. However, it does highlight some challenges we face in appearing legitimate to politicians and policy-makers. If they see a wide range of people either self-diagnosing or purchasing a diagnosis with no evidence, they may begin to simply claim that Autism is not a condition and not disabling. In the worst case they may even begin to claim that autism isn't real and that the diagnosis should be banned. If there's a big enough weight of people who can be pointed to that are 'faking' that's all politicians need to deny support and adaptations to those who are autistic.

Again I feel the need to point to the simple idea that inclusivity is important. I wouldn't try to police other people's opinions on themselves. My brain personal runs very black and white. You are or you aren't. If a friend claims they are autistic but don't yet have a diagnosis, I will internally disbelieve their claim unless they have evidence like a high score on the AQ50, CAT-Q, RAADS-R or suchlike. In public, I'll accept them and point them toward support of course. 

With radicals like RFK Jr. in the USA making wild claims like adults not be able to have autism, or that autism is something that can be outgrown, I do think we need to be cautious and defend against those who are manipulating diagnosis processes. It doesn't take much for a politician to get an idea in their head and push ahead despite how ill conceived an idea they might be - see the welfare 'reforms' that Labour are trying to push through.

I would reject anything which claims 'over-diagnosis' outright.

There are clear descriptors and diagnostic processes for almost every recognised condition, disease, and disorder. In the case of Autism it's the ICD or the DSM. If a doctor is diagnosing people with Autism outside of those processes then it's malpractice. Pure and simple. So either Dr. Pemberton is accusing his peers of malpractice on a massive scale, or he is not fit to be a Doctor due to a lack of understanding of his field.  

Now, where the interview has some points is the area of people paying some mickey-mouse outfit to diagnose them with autism. This I believe is a legitimate point. We have a name for this though - malpractice. These organisations are not acting ethically and if they are Doctors they should in my opinion be struck off.

Likewise is manipulation of evidence. One would hope that the processes present might be able to catch and identify manipulation of information by patients. Presumably that is the point of family members also reporting as part of the process. Likewise, one would assume that all clinicians take an approach which include differential diagnosis. That I cannot speak to. If however, there is evidence of manipulation in these forms then yes again they have a point. 

There are descriptors in the ICD which do preclude a diagnosis of autism if someone has a different diagnosis that could better explain their challenges and support needs. As an example if an individual has a diagnosis of, or their challenges can be better explained by developmental learning disorders, the ICD-11 states that they ought not to be given a diagnosis of Autistic Spectrum Disorder. Now, I can imagine how this would feel to some people and I imagine there would be an uproar from some here about the overlap and boundaries. And in fairness, the ICD does consider those overlaps and tries to make the issue clear. 'Autism spectrum disorder may be diagnosed in individuals with disorders of intellectual development if deficits in initiating and sustaining social communication and reciprocal social interactions are greater than would be expected based on the individual’s level of intellectual functioning.' In short - you can only have both conditions if the social impacts are more pronounced than would be otherwise expected in IDD.  [Side note, I despise the descriptor Intellectual Development Disorder I use it solely because it's the ICD's terminology.]


If we separate out malpractice though, then there is no overdiagnosis. And in fact I would argue that this in not what he was claiming.

The interview instead was claiming, in my view at least, that there are individuals out there who are misrepresenting the facts or carrying out widespread malpractice such that it undermines legitimate diagnosis.

That is something I feel we should all be worried about. By all means, I think inclusivity is important. However, it does highlight some challenges we face in appearing legitimate to politicians and policy-makers. If they see a wide range of people either self-diagnosing or purchasing a diagnosis with no evidence, they may begin to simply claim that Autism is not a condition and not disabling. In the worst case they may even begin to claim that autism isn't real and that the diagnosis should be banned. If there's a big enough weight of people who can be pointed to that are 'faking' that's all politicians need to deny support and adaptations to those who are autistic.

Again I feel the need to point to the simple idea that inclusivity is important. I wouldn't try to police other people's opinions on themselves. My brain personal runs very black and white. You are or you aren't. If a friend claims they are autistic but don't yet have a diagnosis, I will internally disbelieve their claim unless they have evidence like a high score on the AQ50, CAT-Q, RAADS-R or suchlike. In public, I'll accept them and point them toward support of course. 

With radicals like RFK Jr. in the USA making wild claims like adults not be able to have autism, or that autism is something that can be outgrown, I do think we need to be cautious and defend against those who are manipulating diagnosis processes. It doesn't take much for a politician to get an idea in their head and push ahead despite how ill conceived an idea they might be - see the welfare 'reforms' that Labour are trying to push through.

you got me thinking about those doing the diagnosis if they are not properly trained or misinterpret what the diagnostic criteria is then that could throw up some misdiagnosis..

I was deeply offended by the video at first but looked at it like well if people are being over diagnosed then that takes away resources from those that do need help, but you are right if there is 'over diagnosis' or malpractice then that needs looking at..

I have black and white thinking too and i see people sometimes talking about  self diagnosing ADHD and AUT i tend not to believe it.

The only worry for me is the government taking this seriously and attempting to move the criteria of what autism is