How do you respond to “why is everyone diagnosed with ASD and ADHD nowadays”?

[Soniadvn]

Hi, just wondering if anyone has ever encountered this question? I tried my best to explain that they have improved their diagnosis in recent years, especially for women and girls, but people seem to be sceptical of it. not sure if they have encountered someone who’s trying to use these as an excuse but it sort of hurts the major population of those who genuinely have problems going through life with these diagnosis.

 

[Outdated]

I didn't vote because it's a much more complex question than it first seems.

I do think there's a lot of over diagnosis, autism currently seems to be a common "catch all" phrase that doctors can bandy around when they're not really sure what conditions people actually have. Even in this forum there's quite a few people that might also have autistic traits but for whom autism is probably the least of their problems.

I have also noticed a bit of a difference in trends between those who were diagnosed as adults and those who were diagnosed as children. Those who were diagnosed as adults tend to be a lot more successful in life.

I think it's to do with standard psychology of teenagers. All of us, myself included, struggle with adapting to the responsibilities and demands of being an adult. If during this phase a teenager has a handy excuse for why they're failing then they'll latch on to that excuse instead of trying harder to adapt. You'll hear variations of these excuses from unsuccessful teenagers all the time:

It's not my fault, it's because I'm black.
It's not my fault, it's because I'm gay.
It's not my fault, it's because I was abused as a child.

Many years ago I used to train apprentices and I've probably heard every excuse there is, anything starting with "It's not my fault" gets short shrift from me.

 

[Judge]

First one might consider that the CDC considers us as roughly a 1.8% of the population in the US. That doesn't constitute "everyone". (Just a possibility of one in every sixty eight persons.)

As for ASD, it was a decision of the DSM-V in May of 2013. When they abandoned Aspergers Syndrome to adopt a standard of Autism Spectrum Disorder, levels one, two and three.

Effectively making the diagnostics process much broader than it was previously.

Though not everyone in the global community adheres to that particular standard, one primarily used within the US. There are others, like the ICD-11 used in Europe and other places globally. And there are still others who prefer to "freelance" the diagnostics process altogether, for better or worse. Then factor in the unfortunate reality that not every "medical professional" necessarily knows what they are doing.

As for whatever public perception might be, frankly their uptake in such matters doesn't count. As for all those medical professionals we rely on to be so correct, they all require malpractice insurance- and for good reason. So if and when the public expects the diagnostic process to be inherently flawless, under the circumstances I find that in itself to be laughable.

For what it's worth, personally I suspect there are many more of us than are being presently accounted for, even with past and present advancements in the field of autistic diagnoses.

 

[Progster]

I find it hard to answer the poll question. Before last night, it would have been a clear 'no.' But last night I saw a BBC documentary which exposed some private ADHD testing clinics which were apparently giving diagnoses of ADHD after a Zoom meeting of just about 40 minutes, with a psychologist, not a psychiatrist. Compare that to an NHS assessment that takes a full 3 hours. The documentary said that there was a huge increase in people seeking assessments, about 5 times as many compared to a few years ago. So awareness is a double-edged sword... on the one hand, people might be more aware of the struggles people face with ADHD, but on the other hand, it encourages clinics like the one in the programme, which does lead to over-diagnosis IMO.

This programme looked at ADHD clinics, it didn't mention ASD, though I can imagine there might be similar ones for ASD too, idk.

 

[Outdated]

But last night I saw a BBC documentary which exposed some private ADHD testing clinics which were apparently giving diagnoses of ADHD after a Zoom meeting of just about 40 minutes, with a psychologist, not a psychiatrist.

There seems to be a lack of regulation and oversight of mental health practitioners in a lot of countries, I live in a place that's quite heavy on regulation and so there's less issues in this regard. If I hadn't gone through a government recognised professional autism diagnostic centre I would not have got my pension. A report from a single therapist would be ignored because of what it is - one person's opinion.

There is also another factor involved, to some degree all people suffer hypochondria. If we read about symptoms of a condition and we relate to some of those symptoms we automatically start wondering if we also have this same condition. Poorly written documentation combined with a lot of people's lack of self awareness means that a lot of people will convince themselves that they are autistic of that they are attention deficit simply because they read about it and some of it feels familiar. It takes a strong mind to resist those impulses when reading up on mental health issues.

 

[Slime_Punk]

I'm going to go with option 2: I don't think there's an overdiagnosis, but I think that as acceptance of both grow, we're going to find all of the people who fit into those two categories, or both (I'm in the 'both' category).

Nowadays, everyone who's seen a psychologist or doctor has been diagnosed with something, so one could argue that the over-diagnosis problem isn't just limited to neurodivercity, but sometimes I like to entertain ideas of neurodivercity simply being the next evolution in humanity, since cases seem to be on the rise.

But again, more diagnoses clearly equate to more recognized cases, so it's a complex question for sure. We might not ever know the answer, but I think that if more people get the help they need, the better off we'll all be.

 

[Richelle-H]

From an early age, I knew I was different. I quickly accepted it and made no attempt to hide it. I never wanted to be like all the boring people I was forced to interact with every day growing older. I never learned to mask my contempt or boredom and still cannot do that effectively. These facts never interfered with the progression of my life. In fact, if someone had not called me out saying they thought I had Asperger's, I would not be here now. Validation of who I was always came from within and I do not feel that a formal diagnosis changed me anymore than life tends to change each of us.

I never apologize for who I am. I tend to think that the human race as a whole would be better off if more of the population were on the spectrum. Maybe what people perceive as over diagnosis is just nature taking its course. I also have never locked myself to any particular decade, deciding to pick and choose what appealed in each successive era.

The question for me is moot, and just for the record, I have a much younger outlook than the average NT of my age group.

 

[Progster]

There seems to be a lack of regulation and oversight of mental health practitioners in a lot of countries, I live in a place that's quite heavy on regulation and so there's less issues in this regard. If I hadn't gone through a government recognised professional autism diagnostic centre I would not have got my pension. A report from a single therapist would be ignored because of what it is - one person's opinion.

There is also another factor involved, to some degree all people suffer hypochondria. If we read about symptoms of a condition and we relate to some of those symptoms we automatically start wondering if we also have this same condition. Poorly written documentation combined with a lot of people's lack of self awareness means that a lot of people will convince themselves that they are autistic of that they are attention deficit simply because they read about it and some of it feels familiar. It takes a strong mind to resist those impulses when reading up on mental health issues.

I worried about the validity of my diagnosis, after I had it, because it took the form of an interview with just one person, a neuropsychiatrist, after which I received the diagnosis. But he was recognised by the NHS and I was told by my GP that the diagnosis was valid... I had to have a referral from an NHS GP to see him, it wasn't like the ones in the documentary where no GP referral was required at all. Edit: I sought diagnosis not out of curiosity, but because I had a burnout and needed support.

There seem to be two kinds of adults being diagnosed - those who have traits, but are generally successful in life and need explanations for difficulties, closure and understanding, rather than support. They just want to know if they are on the spectrum or not. Then there are those who don't make it, who burn out or have a great deal of trouble keeping relationships and employment. These people need more support.

A few years ago, when I was a child, only those needing a great deal of support were diagnosed, but because of increased public awareness, a lot of people who just want to know if they are on the spectrum have sought a diagnosis. This has lead to more people being diagnosed for sure. I think that both cases are valid - if an otherwise successful person wants to know if they are on the spectrum because they want an explanation for difficulties they might have had as a child, at a time when only very few rare cases were diagnosed for example, then they should be able to do so. But this might lead to a situation similar to that described in the ADHD documentary where people are being diagnosed who really shouldn't be, and over-diagnosis.

Many more children are being diagnosed than in the past. Some develop solid masking abilities and go on to be successful in life, but with some strong traits, like the first kind of adult I mentioned. Others have more difficulties and need more support and are more like the second kind as adults. Of course, some have comorbids and are ASD2 or ASD3 and continue to need a lot of support throughout their lives.

 

[Progster]

Also, IMO the curiosity/seeking closure type of adult diagnoses I mentioned (particularly older adults) in my above posts are more likely to be ASD1, whereas the burnout type that don't 'make it' are more likely to be ASD1 at the more severe end, or perhaps with comorbids, or ASD2. Many ASD2s were diagnosed as kids, but not necessarily with ASD. ASD3s were diagnosed as kids.

 

[Outdated]

It's interesting about both the differences and the similarities between the way our countries operate. I self referred to an autism diagnostic centre. I just walked through the door and made an enquiry and 2 really nice ladies came and talked to me for about half an hour. They both agreed that I was probably on the spectrum and they put me on the waiting list.

My appointment came up 10 months later, but part of my nature shone through here. I was deliberately chasing a pension, it's the only reason I wanted a diagnosis, I already knew I was weird. To get the pension I had to pass a test, and I always pass tests. So I did a bit of what my father would call "bunging on an act" and scored ASD2. Aced it!

Yet in order to get the pension I still needed a referral note from a GP. Go figure.

 

[Outdated]

To get the pension I had to pass a test, and I always pass tests. So I did a bit of what my father would call "bunging on an act" and scored ASD2. Aced it!

I recommend this as advice to women too. I think a lot of women are misdiagnosed because in general they tend to be a lot more self conscious and more worried about being embarrassed than men are. When you need to, let it all hang out.

 

[Progster]

To get the pension I had to pass a test, and I always pass tests. So I did a bit of what my father would call "bunging on an act" and scored ASD2. Aced it!

Yes, where 'passing' means unmasking, rather than exaggerating symptoms.

 

[trustinnerwisdom]

Hi, just wondering if anyone has ever encountered this question? I tried my best to explain that they have improved their diagnosis in recent years, especially for women and girls, but people seem to be sceptical of it. not sure if they have encountered someone who’s trying to use these as an excuse but it sort of hurts the major population of those who genuinely have problems going through life with these diagnosis.

It easier to diagnose someone as ADHD than to realise if they are an empath, highly sensitive person or PTSD (or CPTSD). Or other more unknown diagnoses.
And in Sweden it can take more than 3 years in queue to get a diagnose.

 

[Hotwire]

That's a really hard one because in the past, a lot of people didn't know about autism until it affected them. Mostly the higher end was seen as ADHD with "unexplained" behavior issues. I was the only kid in the entire neighborhood to get diagnosed with autism and that's how it became more known. Even though quite a few kids had been diagnosed with ADD or ADHD, they didn't really know about autism.

I think it is a mixture of being too broad now but also expanding awareness. So it might look like everyone and their mom is being diagnosed but it's relative to the lack of awareness before imo.

 

[Luca]

I respond the same way I respond when people say "all young people are gay nowadays." I'm gay, and I'm autistic. So this is the example I'm going to use here.

It's not so much that it is being overdiagnosed or it's "trendy" to be diagnosed with it, it's that there is much more awareness and (hopefully) acceptance now, and a lot more documentation, research, and statistics on it, so people know autism exists way more now than they did in, say, the 1980s and 1990s (exactly the same as LGBTQ+ identities.)
For what it's worth, I was not comfortable identifying as a lesbian when I was growing up, because it was so taboo at the time and literally no one talked about it.
Things are different now. A lot of people are more comfortable being openly themselves then they were ten, twenty, thirty years ago, and that includes autistic people as well.
Autism was not talked about when I was a kid either. It was seen as a badge of shame so no one I knew openly identified as autistic and they certainly didn't disclose their diagnoses. They would get the crap kicked out of them on the playground if they did.

1.8% of the population is autistic, and 4.5% of the population falls *somewhere* under the LGBTQ+ umbrella (which isn't just gay or trans people, also includes bisexual, pansexual, polyamorous, and asexual, etc people.)
That is still an EXTREMELY slim minority compared to the rest of the population. Most developed countries have a population of tens of millions or more. There are more billionaires in America than there are autistic people, lol...

Of course, there are always going to be people on social media who are NOT really autistic, and just say that they think they are because they are "quirky" or "have a hard time fitting in." If those people pursued a formal diagnosis, they would likely be told that they were not autistic. So they are not really contributing to "overdiagnosis" either. They may be contributing to the conversation though, for better or for worse.

Hope that makes sense...

 

[AprilR]

I always thought this is bc medical science is advancing. Same with people in the old ages dying from"unknown diseases" as opposed to cancer

 

[tazz]

In the UK there are different routes to getting an "official" diagnosis and not all of them are explained by GPs very well (and often not at all). For example, it is possible to self-refer - but essentially this is just a first step and the agency you refer yourself to will do the preliminary checks just like a GP would, before determining if an assessment is justified. The advantage of this is that the self-referral will be to a specialist autism support group who will likely understand autistic traits much better than a GP.

Also, if you get to the point where you are referred to an NHS psychiatrist, you can use your "right to choose" to insist on being diagnosed by the NHS agency of your choice - they don't have to be local. The NHS has set up contracts with a lot of private agencies to help clear the backlog of adults waiting for assessments. So you may be able to find a private organisation that has been commissioned by the NHS to do assessments, and cut your wait time from years to months. This is still an NHS diagnosis, it will be free, and will qualify you for NHS post-diagnostic services (if you're actually diagnosed with autism of course).

Back to the original question...

I don't have any specific info about autism, but I did read a very good article recently (sadly I can't find the reference) about ADHD and "why is everyone diagnosed with ADHD these days". It seems that what happens is that most of the "studies" are essentially people phoning up parents and asking things like "has your child ever been treated for ADHD". What's happening is the parent takes their child to the GP with various symptoms. The GP says "I think it's ADHD but to be sure you'd have to get assessed and the wait time is 2 years, or I can just prescribe these ADHD medications now and we can see if that helps." So when asked "has your child ever been treated for ADHD" the parent taking part in the research says "yes". If they are asked whether their child has ever taken any ADHD medication, they answer "yes". And so on. The research (often done for the purposes of newspaper articles) is then published with the headline "Dramatic rise in ADHD". But the meta-study I read indicated that actual diagnosed cases have not risen anywhere near as much.

Maybe something similar is happening with autism which makes it look like, according to the mainstream media, there is a dramatic rise, but actually it's just in the headlines a lot - while the actual trend of diagnosed cases is following a different trajectory that "the masses" are not really aware of.

I also agree with a lot of what's already been said: changes in diagnostic criteria and classification, more awareness of the condition, and so on.

Regulation in the UK is a bit odd. Pretty much anyone can call themselves a psychologist. But they can't do an official diagnosis for the NHS. For that you need a specialist psychiatrist. I'm basing this on what my GP and psychologist told me - so quite anecdotal evidence there.

I think people are regurgitating the phrase "everyone's got xxx these days" without thinking about it, to the point where it's self-reinforcing. Autism has reached that stage it seems.

 

[Neonatal RRT]

This discussion is one of the main reasons why we need the neurologists on board with this. As we gain more convincing evidence that there are hallmark brain anatomical and physiological markers, genetic markers, and even immunological markers associated with autism, it puts autism into a category of a "medical condition" that has secondary psychological and psychiatric components.

The problem that I am seeing is that despite having the Diagnostic Statistical Manual available to psychologists and psychiatrists, there is a huge discrepancy in testing and diagnostic methodology, leaving it open to more subjectivity and bias. Having actual medical criteria may help solidify and validate the diagnosis.

Is autism being over or under diagnosed? Probably both depending upon one psychologist's interpretation versus another. Is the community, at large, more aware of autism? Yes, and may account for more people being diagnosed, as well as, more people seeking a diagnosis. Are there more people being born with autism? Likely, and for a few reasons. One, our culture has transitioned quite a bit over the past 50 years. With the advent of birth control pills for women, combined with more women seeking higher education and careers, women are choosing to have their children later in life, often in their 30's, even 40's, as opposed to their late teens and 20's. These same women are also getting married later, meaning older male partners. Age of the parents is highly associated with autism. The genetic data from the Autism Genome Project has made this very clear. Clearly there is "genetic autism", associated with families (grandparents, cousins, fathers, siblings, etc), however, old sperm and eggs are highly associated with autism, as well as, a long, long list of other chromosomal defects and birth defects, mild and severe. Sorry, it just is a fact. It's literally my job to deal with the consequences in the neonatal unit that I have worked in for over 35 years. Combine that data with the fact that the intrauterine environment also plays a huge part, and for context, this means the hormonal milieu, the build up of toxins in the mother's body, exposures to infectious agents, and inflammatory mediators. All of which occur in the older mother. People gain weight as they enter their 30's and 40's, more people are obese, have diabetes and hypothyroidism, estrogen, progesterone, and testosterone imbalances, most often resulting in elevated estrogens. We tend to eat a lot of foods that are packaged in boxes, bags, and cans, full of artificial this and that, preservatives, etc, creating stress on the body in the form of toxins and inflammatory mediators. Most people don't have a lot of whole foods in their diets anymore. All of which have associations with autism.

This is our world right now, so expect more autism.

 

[Misty Avich]

Tl;Dr but I have noticed autism is being overdiagnosed nowadays. It's like if a child is shy, or has stability issues due to poor parenting, they're diagnosed with ASD.
I bet if I were at school now half the class would be diagnosed with ASD.
I do miss the days when autism meant autism and not just introvert. I don't feel autistic but I was diagnosed as on the spectrum just because I was a timid child who didn't like loud noises and was anxious and a bit socially awkward. But I had ADHD, and my mother had anxiety and depressive disorder, plus my parents used to fight a lot so I think that might have had an impact on my behaviour at home too.
Otherwise I was quite 'normal', was naturally sociable, articulate (but not 'little professor'), didn't rock or flap (despite being highly anxious), didn't have hyperfocus or narrow interests, played with toys in a non-peculiar way, could understand facial expressions, made normal eye contact, reached all my milestones at the average stages as a baby/toddler, wasn't bothered about rigidity or routine (didn't mind things happening spontaneously as long as it wasn't disappointing), and probably more I can't think of right now.
Most of my thinking styles and behaviours and struggles were due to ADHD and anxiety. But because autism can mean anything now, I got slapped with the label even though it has never actually matched up with me whenever I read about it anywhere (in books, on forums, etc).

 

[annO]

I have also noticed a bit of a difference in trends between those who were diagnosed as adults and those who were diagnosed as children. Those who were diagnosed as adults tend to be a lot more successful in life.

It sure does seem that easy on the surface. I believe that there are loads of adults on the spectrum living unsuccessful lives in poverty and living on the streets. We won't ever hear about the unsuccessful people that will never get diagnosed or helped.