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Who's read 'Age of Diagnosis' (overdiagnosis in Long Covid, ADHD, Lymes, autism, cancer screening)

437 replies

FrodoBiggins · 27/05/2025 23:42

Inspired by another thread, has anyone read/ listened to Suzanne O’Sullivan's new book Age of Diagnosis? I just finished it and found it so interesting. She's a high profile consultant neurologist.

Touches on Long Covid, Autism, ADHD, Lymes disease (all in terms of diagnostic debates) and also Huntingdons genetic testing and Cancer/ Alzheimers screening (along what benefits there are of knowing of a risk/ certainty of future illness, especially if there is no cure).

I'll quote from a review:

"in her outstanding new book O’Sullivan offers a third possibility; that variance in bodily and mental health is being unnecessarily medicalised and pathologised: “We are not getting sicker – we are attributing more to sickness.”
She describes a trinity of “overs”. Overdiagnosis, where a medical problem is treated when treatment might not be needed; overmedicalisation, where non-medical behaviours are turned into the business of doctors; and underlying both, overdetection: we are ever better at identifying signals of disease, sometimes earlier than necessary, when those indicators may not end up presaging the disease itself. Alongside balanced analysis of the epidemiological data on prostate and breast cancer, O’Sullivan examines the growth in behavioural conditions such as autism and ADHD. The tone is not sneering or dismissive, as debunkings of bad science so often can be. O’Sullivan is instead full of compassion, care and grace."

I believe it was also the Radio 4 Book of the Week. The full review quoted from above is here: https://www.theguardian.com/books/2025/mar/12/the-age-of-diagnosis-by-suzanne-osullivan-review-do-no-harm?CMP=Share_AndroidApp_Other

Has anyone else read it? Thoughts?

The Age of Diagnosis by Suzanne O’Sullivan review – do no harm

A doctor’s brilliant study of the dangers of overdiagnosis, from ADHD to long Covid

https://www.theguardian.com/books/2025/mar/12/the-age-of-diagnosis-by-suzanne-osullivan-review-do-no-harm?CMP=Share_AndroidApp_Other

OP posts:
fedup1212 · 29/05/2025 09:51

isolate34 · 29/05/2025 09:11

You're right about only a psychiatrist can diagnose adhd, however (and I do have adhd so not being snarky!), stimulants used to treat adhd can be used by people without it and they will 'work', as in it will increase a person's focus, concentration, enable them to get shit done, have energy etc, it's why they are used recreationally, including studying for exams or working long hours. They are stimulants and will affect a person's brain in similar ways regardless of having adhd or not. I do think that private diagnosis of adhd is a bit risky as medication is handed out quite freely, and they are controlled stimulant drugs.

Actually I read that that is not always the case and stimulant may actually have the opposite effect on someone who takes them who does not have ADHD.

fedup1212 · 29/05/2025 09:49

TheAgileGoldPoet · 28/05/2025 10:11

I think they were talking about adult ADHD, which is 100% being diagnosed in an hour by numerous private clinics.

Here's just one from a quick Google search, there are many others.

https://www.berkeleypsychiatrists.co.uk/lp/adhd-assessment#book

Adult ADHD assessment - 60-90 minutes.
Virtual - £745, in-person £1,045.

"The assessment typically takes 60 minutes"

So, really not hard and really not that expensive despite what other posters may claim.

Sorry but you do realise the NHS assessments aren’t really any different?

My DD was privately diagnosed due us being at breaking point. School agreed. She had her appt, she had her QbTest, filled out screening questionnaires both from us as parents and school being the second setting.

I sent all the diagnostic information over to our local NHS ND pathways and it was accepted due to it meeting NICE and departmental guidelines.

Private assessments are not invalid. My DD is on medication now and is doing so much better.

Riaanna · 29/05/2025 09:40

WhereIsMyJumper · 29/05/2025 09:36

I haven’t shifted the original quote. The original quote is an absolute statement. It doesn’t say “usually, NT people can navigate complex situations with ease” or sometimes they can, or that it’s most situations.
You yourself have made a blanket statement of “absolutely NO NT person will be worried by that statement”
How can you be so sure of that?
Do you really think it is IMPOSSIBLE that ANY NT person has self diagnosed when they don’t actually have any condition at all?

You did. You added ALL several times 😂

And, no, I absolutely do not think any NT person is actively self diagnosing ADHD or anything else. Do they have ADHD? Who knows. But there’s something going on.

BlueTitFly · 29/05/2025 09:38

@WhereIsMyJumper judging by the responses I had from the poster you are addressing earlier, I don’t think this is worth your energy!

WhereIsMyJumper · 29/05/2025 09:36

Riaanna · 29/05/2025 09:24

No I don’t think they will. And the fact that you keep shifting the original quote says it all.

I haven’t shifted the original quote. The original quote is an absolute statement. It doesn’t say “usually, NT people can navigate complex situations with ease” or sometimes they can, or that it’s most situations.
You yourself have made a blanket statement of “absolutely NO NT person will be worried by that statement”
How can you be so sure of that?
Do you really think it is IMPOSSIBLE that ANY NT person has self diagnosed when they don’t actually have any condition at all?

BlueTitFly · 29/05/2025 09:36

I also think this.

If a child is struggling do you do this.

  1. find fault with the support in place
  2. find fault with the environment
  3. find fault with the child and diagnose them

I think it’s extremely, extremely important that 1 and 2 are seriously considered first before you do 3.

The issue is that people are not addressing 1 and 2 and jump to 3.

Riaanna · 29/05/2025 09:24

WhereIsMyJumper · 29/05/2025 09:18

Don’t be ludicrous. You seriously think that not ONE NT person will be worried by that statement?
Someone linked info upthread about the rise in people seeking diagnoses based on TikTok videos.

You talk over people sometimes? You have a junk drawer? You don’t navigate every single complex social situation with ease? You must have ADHD.

Or maybe, you’re a perfectly normal but occasionally flawed human being.

No I don’t think they will. And the fact that you keep shifting the original quote says it all.

WhereIsMyJumper · 29/05/2025 09:18

Riaanna · 29/05/2025 09:10

No NT person will be reading that and thinking I must be ND.

Don’t be ludicrous. You seriously think that not ONE NT person will be worried by that statement?
Someone linked info upthread about the rise in people seeking diagnoses based on TikTok videos.

You talk over people sometimes? You have a junk drawer? You don’t navigate every single complex social situation with ease? You must have ADHD.

Or maybe, you’re a perfectly normal but occasionally flawed human being.

isolate34 · 29/05/2025 09:11

SENNeeds2 · 28/05/2025 08:57

a neurologist can not diagnose or treat adhd - only a psychiatrist can - and adhd meds don't work if you don't have adhd - so I am wondering why someone who can't legally diagnose or treat adhd patients has weight to her opinion. if nd's showed up on neurolgist scans it would make life easier ... maybe she could stay on her side of the fence and research into that if she has interest in the subject.

You're right about only a psychiatrist can diagnose adhd, however (and I do have adhd so not being snarky!), stimulants used to treat adhd can be used by people without it and they will 'work', as in it will increase a person's focus, concentration, enable them to get shit done, have energy etc, it's why they are used recreationally, including studying for exams or working long hours. They are stimulants and will affect a person's brain in similar ways regardless of having adhd or not. I do think that private diagnosis of adhd is a bit risky as medication is handed out quite freely, and they are controlled stimulant drugs.

Riaanna · 29/05/2025 09:10

WhereIsMyJumper · 29/05/2025 08:58

You are completely missing my point.
Tell me that not ONE person will interpret that sweeping statement as “I don’t find all complex social situations easy therefore I must be ND”

No NT person will be reading that and thinking I must be ND.

WhereIsMyJumper · 29/05/2025 09:09

KabukiNoh · 29/05/2025 08:37

It’s a shame this thread has proved so divisive and many seem to stick so rigidly to their viewpoint and don’t have the theory of mind to consider other things may be true at the same time. Diagnosis of neurodiversity was only a small part of this book and one aspect of a wider discussion about the meaning and consequences of ‘diagnosis’.

The author isn’t claiming to be an expert and better diagnostician than all those specialists in cancer, long covid etc. It doesn’t disqualify her from discussing wider themes that are seen across the field of medicine (though clearly some posters think it should). Obviously people’s views are shaped by their own experiences, but it should be equally obvious that other people may have different experiences which are also valid.

These threads always go the same way. Nuance is always lost. Some People are extremely defensive of and attached to their diagnoses. And that’s fine. They can feel like that, nobody is going to take their diagnoses away from them.

But what about people who may think “ah, I could have been seriously let down by the medical establishment here. Maybe I don’t have {insert condition} after all”

It’s like Dr Chatterjee said on his podcast when he interviewed the author - he spent 6 weeks with a woman who had been diagnosed with 20 different conditions including Fibromyalgia, IBS to name a few. He spent 6 weeks with her and by the end of it, she was pain free and was completely off all medication within a year.
He got absolutely lambasted by people on social media who also suffered from fibromyalgia. As if him curing this woman was somehow a threat to them.

WhereIsMyJumper · 29/05/2025 08:58

Riaanna · 29/05/2025 08:38

Which is not what you just said so already the quote has been altered significantly which takes me back to my original point - comparatively they can.

You are completely missing my point.
Tell me that not ONE person will interpret that sweeping statement as “I don’t find all complex social situations easy therefore I must be ND”

Riaanna · 29/05/2025 08:38

WhereIsMyJumper · 29/05/2025 08:33

It wasn’t me that originally mentioned it. The poster said the author had mentioned it in her book:

This is a strong point made in the book, the author cited an ADHD charity website which says that "neurotypical people can navigate socially complex situations with ease"

Which is not what you just said so already the quote has been altered significantly which takes me back to my original point - comparatively they can.

KabukiNoh · 29/05/2025 08:37

It’s a shame this thread has proved so divisive and many seem to stick so rigidly to their viewpoint and don’t have the theory of mind to consider other things may be true at the same time. Diagnosis of neurodiversity was only a small part of this book and one aspect of a wider discussion about the meaning and consequences of ‘diagnosis’.

The author isn’t claiming to be an expert and better diagnostician than all those specialists in cancer, long covid etc. It doesn’t disqualify her from discussing wider themes that are seen across the field of medicine (though clearly some posters think it should). Obviously people’s views are shaped by their own experiences, but it should be equally obvious that other people may have different experiences which are also valid.

WhereIsMyJumper · 29/05/2025 08:33

Riaanna · 29/05/2025 08:32

Can you source the page please so I can read where it actually says that.

It wasn’t me that originally mentioned it. The poster said the author had mentioned it in her book:

This is a strong point made in the book, the author cited an ADHD charity website which says that "neurotypical people can navigate socially complex situations with ease"

Riaanna · 29/05/2025 08:32

WhereIsMyJumper · 29/05/2025 08:28

I think you have misunderstood that poster. I’m sure she knows that social anxiety and ASD isn’t the same thing.

The point being made was the comment on the ADHD charity website that ALL NT people can navigate ALL complex social situations with ease. Which is absolutely not the case. And could lead many people who sometimes struggle socially to believe they have ADHD when they don’t.

I knew a guy who was, and still is, on the waiting list for an ADHD assessment. So not officially diagnosed. But he lives his life as if he was. And tells everyone he has ADHD. In fact, it comes up every single time he does or says something he thinks is linked to it when from what I can see, they’re perfectly normal behaviours. You see on here all the time “I have undiagnosed ADHD” - what does that even mean? Surely if it’s not been diagnosed then you can’t be certain you have it. These people sometimes go years believing they have ADHD. What happens if they get assessed and they don’t have it? They have to unpick years of thinking about themselves.

I really do think people should at least give the podcast a go that was linked further upthread. It’s thought provoking. And keep an open mind.

Can you source the page please so I can read where it actually says that.

WhereIsMyJumper · 29/05/2025 08:28

Riaanna · 29/05/2025 07:02

You realise social anxiety and ASD, ADHD are not the same thing? Lots of ASD people don’t give it any thought at all. It doesn’t mean they don’t have significant difficulties socially. I think you need to consider that your starting point here is fundamentally not understanding the conditions you’re talking about.

I think you have misunderstood that poster. I’m sure she knows that social anxiety and ASD isn’t the same thing.

The point being made was the comment on the ADHD charity website that ALL NT people can navigate ALL complex social situations with ease. Which is absolutely not the case. And could lead many people who sometimes struggle socially to believe they have ADHD when they don’t.

I knew a guy who was, and still is, on the waiting list for an ADHD assessment. So not officially diagnosed. But he lives his life as if he was. And tells everyone he has ADHD. In fact, it comes up every single time he does or says something he thinks is linked to it when from what I can see, they’re perfectly normal behaviours. You see on here all the time “I have undiagnosed ADHD” - what does that even mean? Surely if it’s not been diagnosed then you can’t be certain you have it. These people sometimes go years believing they have ADHD. What happens if they get assessed and they don’t have it? They have to unpick years of thinking about themselves.

I really do think people should at least give the podcast a go that was linked further upthread. It’s thought provoking. And keep an open mind.

Riaanna · 29/05/2025 07:02

FrodoBiggins · 29/05/2025 00:57

Do you think NT never worry about or overthink those things? Do you think all ND people experience all of those thoughts all of the time? (Genuinely)

I would have thought most people would do some of those in some situations sometimes, with a high degree of variability.

From my experience (and my own head really is the only one I can see into so i accept it's a small sample size!) I would say i have overanalysed all of those things on various occasions, especially highly stressful/public ones. Plus the classic "am I doing something weird with my mouth?" "Am I looking at this person's right eye? How do you look at both eyes at once is that even possible? Oh no I have completely zoned out to what they were saying" and not to mention my old favourite "am I boring this important person with my boring voice" (I'm from Birmingham).

Edited

You realise social anxiety and ASD, ADHD are not the same thing? Lots of ASD people don’t give it any thought at all. It doesn’t mean they don’t have significant difficulties socially. I think you need to consider that your starting point here is fundamentally not understanding the conditions you’re talking about.

Toootss · 29/05/2025 06:37

Do you think NT never worry about or overthink those things? Do you think all ND people experience all of those thoughts all of the time? (Genuinely)
As a ND person with social anxiety I experienced those thoughts all of the time unless alone or with family. Assumed most people felt like that - also had no friends to relax with as people steered past me.
Being diagnosed and medicated at 65 has been brilliant. I am more relaxed, understand my ‘failings’ and can socialise better but in a cautious way that suits me. Just a shame I can’t have a rerun of my life with the knowledge.

BlueTitFly · 29/05/2025 06:32

My DD (14) is now at secondary school. I was concerned about her behaviour at primary, she was definitely trying to ‘rule the roost’ at home.

At one point ADHD was discussed with a teacher, but looking back I’m glad I didn’t pursue this.
I put in some extremely clear but kind behaviour strategies.

DD now has a very solid group of friends, is enjoying Duke of Edinburgh, no attendance issues, is revising and is on a high flight path.

If I had pursued the ADHD diagnosis I think this could have caused me to ‘excuse’ or not feel confident around the behaviour - and DD would have continue to rule. Ultimately leading to confusion (no boundaries), poor attendance (she would have chosen not to attend school) and no attempt to revise or learn in favour of social media/screens.

BlueTitFly · 29/05/2025 06:14

@Bowies

But if you compare globally, the UK does have one of the higher rates of Autism recognition and diagnosis. France is seen as being very behind.
I’d also say the UK does not come off favourably when it comes to mental health statistics. France is ‘better’ than the UK.

When I taught many years ago, there was not so much knowledge of ASD/ADHD. I taught children who probably now would receive that diagnosis, but I had no TA (primary) - and the onus was on me - as a teacher - to differentiate and ensure I gave the right support, with very clear behaviour policy and a visible, supportive headteacher.
I can remember enjoying teaching, not being bogged down by computer based activities and paperwork. I think behaviour was better, I can’t remember dealing with any extreme behaviours, I can’t remember any exclusions. I taught in an area with poverty.

The shift I’ve seen is - as soon as a child is upset or misbehaves (even at age 2) it’s almost presumed they have ASD or ADHD.

The teacher then treats the child as having a ‘difficulty’, tells the parents this and there tends to - almost a fear of not being quite sure what to do - and parents who have to navigate an extremely complex system with long waiting lists and insufficient funding.

The shift is from being : the way the teacher is dealing with a situation (therefore the teacher needs address the behaviour) to putting ‘fault’ on the child.

I think this is extremely damaging and could be resulting in the high exclusion rates and causing difficulties now in secondary schools.
I think a global comparison is important because - across the globe our rates would be considered one of the ‘better’ countries in terms of diagnosis. The big question is - is it working? Are we comparatively better off educationally/mental health as a result of our ‘better’ global rates of diagnosis.

NormaMajors1992coat · 29/05/2025 06:00

Sorry I forgot to tag the OP @FrodoBiggins🤦‍♀️

NormaMajors1992coat · 29/05/2025 05:59

I mean my sample size is also one (me). And while I sympathise with your experience of overanalysing things on various occasions, especially stressful ones, that doesn’t sound the same to me as being permanently on guard and watchful, and having this relentless questioning and doubting and commentary all the time, through every second of every social interaction, including with friends and family. Every single social interaction, all the time. Making mistakes most of the time, and when you haven’t made a mistake, suspecting that you have and haven’t noticed but everyone else will have. Having a vague feeling that there are whole layers of meaning in a conversation that everyone else gets but you don’t. Coming away from every social occasion with relief, even ones with friends and family, and never thinking - I enjoyed that. Best case scenario is - I think that went ok, I might have gotten away with it. More usual is a sleepless night of panic, remembering and going over and over all the mistakes.

The particular ND of my experience is autism and that has persistent deficits in social communication and social interaction as one of its diagnostic criteria. It is a defining characteristic of the condition. Symptoms have to cause clinically significant impairment in social functioning. So I’m not sure of the point of your post really. You seem to be suggesting that NT people sometimes overthinking things is comparable with the social difficulties of autism, which is pretty mind blowing tbh. Not to mention dismissing an autistic person’s account of their difficulties as within the range of normal. It’s not. If it were within the range of normal it wouldn’t be autism 🤷‍♀️

Bowies · 29/05/2025 04:36

FrodoBiggins · 29/05/2025 00:57

Do you think NT never worry about or overthink those things? Do you think all ND people experience all of those thoughts all of the time? (Genuinely)

I would have thought most people would do some of those in some situations sometimes, with a high degree of variability.

From my experience (and my own head really is the only one I can see into so i accept it's a small sample size!) I would say i have overanalysed all of those things on various occasions, especially highly stressful/public ones. Plus the classic "am I doing something weird with my mouth?" "Am I looking at this person's right eye? How do you look at both eyes at once is that even possible? Oh no I have completely zoned out to what they were saying" and not to mention my old favourite "am I boring this important person with my boring voice" (I'm from Birmingham).

Edited

But OP you are referring to random thoughts that pop into mind especially in heightened stress situations, it’s missing the point and not at all what @FrodoBiggins was describing.

FrodoBiggins · 29/05/2025 00:57

NormaMajors1992coat · 28/05/2025 16:08

Everything’s relative though, isn’t it. A NT person might not feel that the social situation they are in is easy. But that’s not the same as someone who has that same tricky situation to deal with whilst also trying to calculate whether their eye contact is within normal limits and when they should make eye contact next, and did they not understand that remark because it referred to something they don’t know about, or because it was sarcasm, or humour, or did they mishear it, and are they expected to reply or can they get away with a little smile, or would a laugh be better, and is it time to make eye contact again yet and what should they do with this empty glass and don’t forget - don’t just blurt something out, check first that it’s appropriate and maybe use one of those smalltalk phrases you looked up before coming out. And maybe make a bit of eye contact now. But not too much.

Do you think NT never worry about or overthink those things? Do you think all ND people experience all of those thoughts all of the time? (Genuinely)

I would have thought most people would do some of those in some situations sometimes, with a high degree of variability.

From my experience (and my own head really is the only one I can see into so i accept it's a small sample size!) I would say i have overanalysed all of those things on various occasions, especially highly stressful/public ones. Plus the classic "am I doing something weird with my mouth?" "Am I looking at this person's right eye? How do you look at both eyes at once is that even possible? Oh no I have completely zoned out to what they were saying" and not to mention my old favourite "am I boring this important person with my boring voice" (I'm from Birmingham).

OP posts: