The Royal College of Psychiatrists, which represents
34,000 doctors around the world, respond to a
controversial article in the Daily Mail authored by their former
President, which claimed parents chase diagnoses to 'avoid
their own failings'.
“There is only one thing in life worse than
being talked about, and that is not being talked about.” In recent
times, neurodevelopmental conditions have not had to worry about
falling victim to Oscar Wilde’s warning.
Former President of the Royal College of
Psychiatrists Mike Shooter grabbed headlines recently by suggesting
that neurodevelopmental conditions like Autism Spectrum Disorders
(ASD), Attention Deficit Hyperactivity Disorder (ADHD) and
Intellectual Disabilities (ID) in children are being “vastly, and
dangerously, over-diagnosed”. He says that parents are seeking out
diagnoses like a “badge of honour”.
Rather than allow this to act as a deterrent
to anyone thinking of seeking support, I’m keen that this attention
should be used to highlight the importance of improved diagnoses
and support for people with such conditions.
Neurodevelopmental conditions are a group of
conditions that are linked to the development of the brain and the
effects these have on functioning. ASD, ID and ADHD are the 3 most
First off, with apologies to those of you who
need no reminder, I’d like set out what some of these often
intimidating neurodevelopmental terms mean:
What is Autism Spectrum Disorder (ASD)?
ASD, also known as Childhood Autism, Asperger
Syndrome or Atypical Autism is a lifelong neurodevelopmental
condition, often diagnosed in childhood.
Characteristics vary in each person, but
generally people with ASD have difficulties, of different degrees,
with communicating, social skills and repetitive behaviours.
ASD affects at least 1% of children and young
What is Attention Deficit Hyperactivity Disorder (ADHD)?
ADHD is also a lifelong neurodevelopmental
condition often diagnosed in childhood. It can present through
attention difficulties, hyperactivity and impulsivity.
ADHD affects 1-2% of children and young
Why are claims of over diagnosis emerging?
In the US, more children and young people are
diagnosed with ASD and ADHD than would be expected, in comparison
to recognised prevalence rates.
This may be partly due to how diagnosis
criteria are interpreted, with diagnoses rates varying
significantly between states.
The US insurance-based health care system is
also likely to be a factor, as care is only funded if linked to a
diagnosis, along with US society’s preference to label behavioural
difficulties or normal range differences as neurodevelopmental
But does this hold true in the UK?
On the whole, no.
Fewer people are diagnosed than expected,
given prevalence rates of such conditions. Rather than a UK
epidemic of over-diagnosis, neurodevelopmental disorders are
probably being under-diagnosed or are being under-recognised.
Absence of routine screening and demand for
diagnostic assessments often exceeding the capacity of local
services, leading to long waits for diagnosis, are likely to
contribute to this.
Diagnoses aren’t straightforward.
They can entail a lengthy process, lasting
A wide range of evidence should be used,
including a history of symptoms, observing the individual in
usual settings such as home or school and specialist assessments
e.g. speech and language therapy or psychological assessments.
Characteristics of people with ASD, ADHD or ID
vary by age, developmental level and severity.
For example, in ASD, children’s symptoms may
disappear when they are supported to manage the demands of daily
life. Likewise, symptoms can come to the fore when children are in
Under the strain children experience when
moving schools, often with little support, it is easy to imagine
symptoms of ASD or ADHD becoming more prominent.
Given the complexity of such diagnoses,
RCPsych recommends that diagnoses are made by child and adolescent
psychiatrists and their multidisciplinary colleagues.
Are diagnoses helpful? Or are they a “middle-class
parent’s way of dodging responsibility for how their child has
While UK diagnoses are below recognised
prevalence rates, not all children or young people with
neurodevelopmental conditions can or should be identified.
Some people do not want a label, while others
have milder difficulties that can be self-managed or are below the
thresholds for a diagnosis.
Over-diagnosis of these conditions can occur
due to evidence presented being biased towards a diagnosis, or
diagnostic confusion because of the presence of other
Parents might seek ASD and ADHD diagnoses when
they are not the best or only explanation for a child’s
This is often a result of parents’ and
professionals' understanding of a child’s behaviours or the
avoidance of stigma relating to other diagnoses e.g. attachment or
These require management of the wider
environment around the child such as parenting, rather than placing
the difficulty mostly within the child and their
Diagnoses are not a solution in themselves but can lead to
Accurate diagnoses based upon best available
evidence can help explain traits and symptoms and lead to
But, a diagnosis of ASD or ADHD is no “way
out” for parents, and certainly not for their children.
National Autistic Society research finds only
16% of people with ASD have full-time jobs.
More than 60 percent rely on their family for
all their financial support and nearly 40 percent still live with
Neurodevelopmental conditions have significant
impact on the lives of young people and their families.
Children with autism are more likely to be
excluded from school and experience bullying, with lasting
A diagnosis in itself will not dissolve the
numerous life-long challenges faced, but it can offer a path
In the words of the National Autistic society
“a diagnosis is often the only hope parents and children have of
getting a half-decent education with teachers who understand their
condition and challenges.”
Mike Shooter’s emphasis on supporting children
early is important.
However, too much focus on over-diagnosis is a
considerable distraction from the early intervention, education and
support that is essential for children with ASD, ID and ADHD to
lead fulfilling lives.
The impact that neurodevelopmental conditions
can have on the lives of young people and their families should not
Where a diagnosis is suspected by an
individual, their family or professionals, it should be taken
seriously, screened and assessed appropriately.
That diagnoses of autism in this country are
becoming linked with the “sort of middle-class parent” Mike Shooter
targets is not a symptom of parents seeking a way out.
It is indicative of the current dearth of
support, where too often children and young people only receive
support when it is secured by their sharp elbowed parents.
Children with ASD, ID and ADHD deserved to be
supported, regardless of how pushy their parents are.
Dr Mark Lovell is Consultant Child and
Adolescent Intellectual Disability Psychiatrist and member of the
Royal College of Psychiatrists’ Child and Adolescent Intellectual
Disability Psychiatry Network.
This blog first appeared on
Mental Health Today.