There Is No Over- or Under-diagnosis of ADHD or Autism, Just a Confused Cacophony of Opinions

Editor’s Note: This article originally appeared on our affiliate site, Mad in the UK.

Selma was taken into care as a two-year-old following severe neglect. Both her parents had substance misuse problems. After failed foster care placements, she was placed in a residential children’s home at age eleven. Diagnosed with an attachment disorder when she was five, at age twelve, presenting with impulsive and disorganised behaviour, she was diagnosed with Attention-deficit/hyperactivity disorder (ADHD). At fifteen, she stopped attending school. Shortly thereafter, she was diagnosed with autism. Now, 23-years-old, in the intervening years she has also been diagnosed with an anxiety disorder, post-traumatic stress disorder, obsessive compulsive disorder, and is questioning her gender identity. She considers herself “multiply neurodivergent.” She is prescribed several different psychiatric medications.

Jordan is a 32-year-old comedian who was diagnosed with ADHD a year ago. He knew many fellow comedians who had received the diagnosis and who, like him, were energetic, quick witted, and lived a hectic, somewhat disorganised, lifestyle. He paid for an assessment and discovered that he had ADHD. A diligent student who achieved well at school but often acted as the “class clown,” he was popular, sociable, and hard working. He now considers ADHD his “superpower.” Jordan recently stopped taking the dextroamphetamine he was prescribed because he believed his creativity had declined since beginning to take it.

Sarah, a successful 44-year-old musician, who regularly performs in front of live audiences was diagnosed with autism three years ago. A shy person, she believes the diagnosis provided her with an explanation for why she was often late, had trouble in relationships, and had that nagging feeling that everyone around her was thriving, while she was not. She was now wondering if there was more to what she was experiencing than just autism. Recently, she felt confused, was crying a lot, and didn’t know why. She now wonders if she also has bipolar disorder.

Adam is an 18-year-old overweight boy diagnosed with autism when he was 4-years-old. He has significant learning difficulties and attends a special school. He is pleasant most of the time but is prone to outbursts in which he can become aggressive. He needs help with many activities of daily living. He is an only child and his mother, a single parent who adores him, worries about what will happen to him when she passes away.

Whilst the above cases are fictional, they are based on real life clinical and personal stories I’ve encountered. I often wonder what any of the myriad of cases like these, have in common in terms of their histories, level of functioning, and clinical needs—let alone the way they experience the world—to justify classifying them in the same psychiatric categories. In the outpatient child and adolescent mental health clinic in the UK national health service where I worked until recently, our manager announced that 80% of our patients are “neurodivergent.”

Rates of diagnosing ADHD and autism have risen exponentially, alongside the growing popularity of the concept of neurodivergence. Some argue that there is an epidemic of over-diagnosing, while others suggest that we have been under-diagnosing for decades. But maybe the issue is not over or under diagnosis. Rather, it is the culture of psychiatric diagnosis, or even deeper—the morphing of medical categories into identities.

ADHD and autism, like most psychiatric labels, are social constructs rather than biological facts. Like a will-o-the-wisp, evidence of their existence as tangible, measurable conditions found in the hardwiring of the bodies and brains of those labelled, disappears into thin air upon close examination. However, the belief there is a neurological basis to these conditions and that the population can be divided into a “neurodiverse” oppressed and misunderstood grouping and an ableist “neurotypical” oppressor grouping, is prevalent.

Australian sociologist Judy Singer first coined term neurodiversity in 1998 in a thesis documenting the emergence of a new “disability and social movement” led by ‘autistic’ individuals. She captured the zeitgeist of the “decade of the brain”—a 1990s initiative launched by American President George H. W. Bush to raise public awareness of, and support for, brain research. The hope was that such research would unlock the secrets of the mind and create new ways of understanding and treating mental disorders. The seduction implied in understanding the self through neuro accounts survived, despite the billions of dollars of subsequent research essentially drawing a blank. No unique, characteristic, and reliable findings in genetic, neuroanatomical, neurofunctional, or neurochemical investigations have been discovered. This is why all assessments for conditions like ADHD and autism rely on subjective interpretations drawn from things like questionnaires or observations. There is no hard biological data like a blood test or brain scan. Crucially, there is no neuro in neurodiversity.

Take neuro out of neurodiversity and we are left with the only reliable statement we can make about the human condition in general: that there is diversity. We are all unique. Ultimately, we are all neurodiverse, making the concept, and its sub-categories (like ADHD and autism), painfully useless at differentiating and classifying different types of people.

The vacuum of evidence coupled with the zeal of new converts has encouraged the neurodiversity envelope to keep expanding. Depending on which definition you use it can now can include, not just ADHD and autism, but bipolar disorder, schizophrenia, dyspraxia, dyslexia, epilepsy, psychopathy, sociopathy, Tourette’s syndrome, oppositional defiant disorder, and sometimes the whole umbrella category of mental disorder/illness.

Within the neurodiversity movement, there are a variety of different voices presenting their own views as the only authentic representation and criticising any definition, theory, or practice that has not been developed by “neurodiverse” people. Hostility to a material scientific approach is thus promoted and the public narrative on ADHD, autism, and neurodivergence is infused with scientism, meaning faith-based claims masquerading as scientific ones.

As neurodiversity swallowed up ADHD and autism, they were no longer viewed as just disorders to be treated and/or supported but, rather, identities to be valued. Conflicting interests resulted in contradictory versions arising. Many parents felt that these are disorders needing treatment, while activists claimed these are natural differences needing validation. Some saw them as empowering identities; others felt stigmatised and disempowered. Many live out these contradictions seeing it as a specific difference, yet expecting others (such as employers) to make accommodations to them as if they have a disability/disorder.

This confusion of constructs has reached a peak where the neurodiversity balloon is so full of hot air it may be close to bursting. Trust in agency, free-will, relationships, family, geographical communities, or social class antagonisms, dissolve into the haze of cult-like online, neuro-deterministic communities detached from material reality and absorbed in creating exclusionary language and using pseudo-activist concepts to silence critics. Meanwhile, demand for services becomes so overstretched that those, like Adam, with considerable clinical and other support needs, are at risk of losing out.

A determined effort to end the neurodiversity mystification is long overdue.