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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:
NormaMajors1992coat · 28/05/2025 16:08

FrodoBiggins · 28/05/2025 15:59

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". I can't say I know many people who would describe themselves that way even if some might be good at making it look easy! The AIBU section of this site tells you that people manage complex situations in a complex way and people's definitions of the "right" way to behave very wildly!

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.

limecola · 28/05/2025 16:06

@FrodoBiggins Yes I agree its very misleading to make those kinds of statements especially to young people, its no surprise so many people feel defective. I will have to read the book, it sounds very interesting.

FrodoBiggins · 28/05/2025 15:59

limecola · 28/05/2025 15:26

@WhereIsMyJumper Yep absolutely, I think we all have our difficulties and it often isn't easy to see other peoples private struggles because we all mask in our way.

I was following some adhd accounts on youtube and they were doing ADHD vs NT person content where the NT person was like a genius on a smart drug at all times and I literally know nobody in real life who is like that. I think social media has some really harmful messaging around neurodiversity and people forget that content creators are primarily trying to generate clicks and income rather than being focused providing realistic or balanced information.

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". I can't say I know many people who would describe themselves that way even if some might be good at making it look easy! The AIBU section of this site tells you that people manage complex situations in a complex way and people's definitions of the "right" way to behave very wildly!

OP posts:
NormaMajors1992coat · 28/05/2025 15:58

WhereIsMyJumper · 28/05/2025 15:11

And that’s where it becomes murky. I don’t think the needs of NT children are more important. But I don’t think the needs of ND children are more important, either. I’m all for an environment that allows as many students to thrive as possible.

Most of the things you mentioned, I wouldn’t even class as an inconvenience myself. I have no problem parking further away from a shop, or not eating peanuts around someone with an allergy. The fact that I have no problem with it means it isn’t an inconvenience. I wouldn’t class this type of adjustment as an inconvenience in a school, either. No nuts in my son’s lunch box? Literally no bother
DS has to wait longer to use the toilet? Again, absolutely no issue there at all.
But if those ‘adjustments’ were to impact negatively on his education, then I would have a problem with them.

If they don’t and shouldn’t, then I will be quiet and get back in my box. My opinion may be clouded somewhat by him being moved out of a classroom on a regular basis through no fault of his own

ETA: I don’t think I would have been as understanding as you on wasting £200 on tickets for a show I couldn’t see, though. And I’m sure there are plenty of ND people that would feel the same way and would have felt potentially quite distressed by the noise and commotion

Edited

It was a bit annoying and the DC were disappointed - but the bottom line is, do I think adults with learning difficulties should be allowed to go to the theatre to see a great show like The Lion King? Yes, I do. And in that case someone has to sit next to them and there’s no reason that it shouldn’t have been us on that occasion. It’s just the luck of the draw and part of living in an inclusive society.

I don’t think the needs of ND kids should trump those of NT kids btw. This whole discussion came out of a PP saying that they didn’t mind ND kids getting diagnoses and support, as long as it helped and “most importantly”, as long as it didn’t affect any NT kids. I am trying to argue that everyone counts and that the needs of disabled kids should not be secondary to those of NT kids.

WhereIsMyJumper · 28/05/2025 15:30

limecola · 28/05/2025 15:26

@WhereIsMyJumper Yep absolutely, I think we all have our difficulties and it often isn't easy to see other peoples private struggles because we all mask in our way.

I was following some adhd accounts on youtube and they were doing ADHD vs NT person content where the NT person was like a genius on a smart drug at all times and I literally know nobody in real life who is like that. I think social media has some really harmful messaging around neurodiversity and people forget that content creators are primarily trying to generate clicks and income rather than being focused providing realistic or balanced information.

It’s extremely harmful messaging. It’s sending a message that if you’re not completely ‘together’ at all times and skipping through life with not a care in the world, then there is something wrong with you.
It plays in to people’s fears of being rejected from the tribe and not being see as being like everyone else.

My DS tells me I am weird all the time (in a sweet way) and I tell him I agree. I am weird. But all the best people are. Perfection is boring, anyway.

limecola · 28/05/2025 15:26

@WhereIsMyJumper Yep absolutely, I think we all have our difficulties and it often isn't easy to see other peoples private struggles because we all mask in our way.

I was following some adhd accounts on youtube and they were doing ADHD vs NT person content where the NT person was like a genius on a smart drug at all times and I literally know nobody in real life who is like that. I think social media has some really harmful messaging around neurodiversity and people forget that content creators are primarily trying to generate clicks and income rather than being focused providing realistic or balanced information.

WhereIsMyJumper · 28/05/2025 15:16

limecola · 28/05/2025 15:10

I haven't read this but I might. As someone with more than one ND diagnosis and more than a little life experience I have come to the conclusion that most of us are struggling, flying by the seat of our pants and feeling like we lack some secret to life that others seem, from the outside to have. The people who are organised, confident, have clarity and motivation on tap are the one's who are different and unique.

I am not saying we shouldn't have diagnosis that this isn't helpful personally or that there aren't times when medication might be useful but I do think that people with what is currently considered "neurodiverse" traits are increasingly quite the norm.

I one hundred percent completely agree with this.
I often wonder if the people who seem to have it together really do underneath it all. The most organised and motivated people I know are generally fuelled by anxiety. So maybe we all struggle in some way!
And I am NT! Albeit, a lazy and unorganised one Grin

WhereIsMyJumper · 28/05/2025 15:11

NormaMajors1992coat · 28/05/2025 15:04

For starters, NT kids aren’t a universally advantaged group of people.

Sure - but I don’t think it’s particularly controversial to argue that as a group, people with disabilities are disadvantaged in life compared to people without disabilities. For every NT child who has a difficult home life or divorced parents or lives in poverty or whatever, there will be an ND child in a similar situation only also with a disability.

Secondly, what level of inconvenience do you think is reasonable to make adjustments for ND kids?

I think it’s impossible to describe or quantify in a general way, but I don’t think it’s none at all. If I were trying to solve this problem my starting point would not be that the needs of one set of children are inherently more important than those of another set, and that disabled kids can only be supported if the effect on other kids is zero. Just like I think disabled people should have their larger toilet cubicles even though it means fewer cubicles I can use and a longer queue for me. I think they should be able to park right next to the supermarket even though that means I have to walk further. I think it’s fair enough to ban peanuts in a school where someone has an allergy, even though I like eating peanuts. I didn’t mind when we spent £200 on tickets to The Lion King and were sitting next to some adults with learning difficulties who made a lot of noise and had to be brought in and out all the time so we couldn’t really see or hear what was going on. They have as much right to exist and go to the theatre as I do. ND children have as much right to an education as NT children. There should not be an assumption that their needs fit around those of NT children need because NT children are more important.

And that’s where it becomes murky. I don’t think the needs of NT children are more important. But I don’t think the needs of ND children are more important, either. I’m all for an environment that allows as many students to thrive as possible.

Most of the things you mentioned, I wouldn’t even class as an inconvenience myself. I have no problem parking further away from a shop, or not eating peanuts around someone with an allergy. The fact that I have no problem with it means it isn’t an inconvenience. I wouldn’t class this type of adjustment as an inconvenience in a school, either. No nuts in my son’s lunch box? Literally no bother
DS has to wait longer to use the toilet? Again, absolutely no issue there at all.
But if those ‘adjustments’ were to impact negatively on his education, then I would have a problem with them.

If they don’t and shouldn’t, then I will be quiet and get back in my box. My opinion may be clouded somewhat by him being moved out of a classroom on a regular basis through no fault of his own

ETA: I don’t think I would have been as understanding as you on wasting £200 on tickets for a show I couldn’t see, though. And I’m sure there are plenty of ND people that would feel the same way and would have felt potentially quite distressed by the noise and commotion

limecola · 28/05/2025 15:10

I haven't read this but I might. As someone with more than one ND diagnosis and more than a little life experience I have come to the conclusion that most of us are struggling, flying by the seat of our pants and feeling like we lack some secret to life that others seem, from the outside to have. The people who are organised, confident, have clarity and motivation on tap are the one's who are different and unique.

I am not saying we shouldn't have diagnosis that this isn't helpful personally or that there aren't times when medication might be useful but I do think that people with what is currently considered "neurodiverse" traits are increasingly quite the norm.

NormaMajors1992coat · 28/05/2025 15:04

For starters, NT kids aren’t a universally advantaged group of people.

Sure - but I don’t think it’s particularly controversial to argue that as a group, people with disabilities are disadvantaged in life compared to people without disabilities. For every NT child who has a difficult home life or divorced parents or lives in poverty or whatever, there will be an ND child in a similar situation only also with a disability.

Secondly, what level of inconvenience do you think is reasonable to make adjustments for ND kids?

I think it’s impossible to describe or quantify in a general way, but I don’t think it’s none at all. If I were trying to solve this problem my starting point would not be that the needs of one set of children are inherently more important than those of another set, and that disabled kids can only be supported if the effect on other kids is zero. Just like I think disabled people should have their larger toilet cubicles even though it means fewer cubicles I can use and a longer queue for me. I think they should be able to park right next to the supermarket even though that means I have to walk further. I think it’s fair enough to ban peanuts in a school where someone has an allergy, even though I like eating peanuts. I didn’t mind when we spent £200 on tickets to The Lion King and were sitting next to some adults with learning difficulties who made a lot of noise and had to be brought in and out all the time so we couldn’t really see or hear what was going on. They have as much right to exist and go to the theatre as I do. ND children have as much right to an education as NT children. There should not be an assumption that their needs fit around those of NT children need because NT children are more important.

WhereIsMyJumper · 28/05/2025 15:01

Whatafustercluck · 28/05/2025 14:57

Then the school's handling of the situation is definitely wrong, I'd agree. But I don't think this is commonplace. Most adjustments made for ND children work as well for NT children. That child belongs in a specialist provision. The problem is that there are insufficient places available and an ineffective system in place to deal with cases like this.

So in my son’s case, we did mention it to his teacher and she said they do it for ‘health and safety reasons’ and we didn’t press further.
I haven’t forced the issue because, and maybe this is extraordinarily selfish of me, it doesn’t seem to affect DS in a negative way. BUT - that is only because he is very bright and very relaxed. Not much bothers him. I am very lucky that he is this way. However, if he was missing out on valuable time catching up with reading or working on areas he needed to in order to ‘catch up’ - or if he was upset by it (he is only young) then I may feel differently.

I agree that setting clearly isn’t good for the child in question. And that the funding isn’t there to place her where she needs to be. But in the meantime, what is the answer? Surely it isn’t to let almost the whole class suffer as a result?

Whatafustercluck · 28/05/2025 14:57

WhereIsMyJumper · 28/05/2025 14:54

Yes, it has happened at my DS’ school and on a regular basis.

Then the school's handling of the situation is definitely wrong, I'd agree. But I don't think this is commonplace. Most adjustments made for ND children work as well for NT children. That child belongs in a specialist provision. The problem is that there are insufficient places available and an ineffective system in place to deal with cases like this.

WhereIsMyJumper · 28/05/2025 14:54

Whatafustercluck · 28/05/2025 14:50

I've literally never seen or heard of this happening. Yes, some children disrupt and they're usually removed from the situation. Keeping them in the classroom and removing the rest of the class benefits nobody. Is this an actual example of something that is commonplace?

Yes, it has happened at my DS’ school and on a regular basis.

WhereIsMyJumper · 28/05/2025 14:53

Navyblueberries · 28/05/2025 14:47

The answer to this is for schools to get more funding and for teachers to have more support staff in the classroom if needed. I've been told that my child would have had more help years ago but the money isn't there any more.
It's not about pitting children against each other.

I agree, you cannot put NT up against ND and have a debate over which group is more ‘advantaged’ or more deserving of education than the other.

For starters, there is a wide range of different needs all under the ND banner that often contradict one another
And there will be NT kids struggling too but for different reasons - unhappy home life or bullying, for example.

Surely the answer is to make school as accessible as possible for the many, not the few. To allow as many students to thrive as possible - whether NT or ND.

Whatafustercluck · 28/05/2025 14:50

WhereIsMyJumper · 28/05/2025 14:40

Exactly this!
So let’s say a reasonable adjustment would be more frequent toilet breaks. Fine, that inconveniences nobody as long as it is well managed and not too disruptive.

But to move an entire group of kids out of the class because they cannot send out the one kid that is disrupting everyone else? That’s not reasonable.

I've literally never seen or heard of this happening. Yes, some children disrupt and they're usually removed from the situation. Keeping them in the classroom and removing the rest of the class benefits nobody. Is this an actual example of something that is commonplace?

WhereIsMyJumper · 28/05/2025 14:50

Whatafustercluck · 28/05/2025 14:44

What kind of changes to the school environment enable nd kids to cope, whilst being detrimental to the nt kids? Do you have some examples? Because the kind of reasonable adjustments I'm aware of tend to improve outcomes for all. Similarly, strategies and methods used to assist nd children can also benefit others.

I’ve listed them several times in previous posts.
If reasonable adjustments improve outcomes for all, then I am all for them.
Another poster has detailed her experience of this also.

Navyblueberries · 28/05/2025 14:47

WhereIsMyJumper · 28/05/2025 14:36

So in a class of 30 kids.
3 suffer because they cannot cope with the school environment
They change the environment so they can cope. But now the other 27 kids can’t.
Is that fair?

The answer to this is for schools to get more funding and for teachers to have more support staff in the classroom if needed. I've been told that my child would have had more help years ago but the money isn't there any more.
It's not about pitting children against each other.

Whatafustercluck · 28/05/2025 14:44

WhereIsMyJumper · 28/05/2025 14:36

So in a class of 30 kids.
3 suffer because they cannot cope with the school environment
They change the environment so they can cope. But now the other 27 kids can’t.
Is that fair?

What kind of changes to the school environment enable nd kids to cope, whilst being detrimental to the nt kids? Do you have some examples? Because the kind of reasonable adjustments I'm aware of tend to improve outcomes for all. Similarly, strategies and methods used to assist nd children can also benefit others.

WhereIsMyJumper · 28/05/2025 14:40

Allthegoodnamesarechosen · 28/05/2025 14:33

‘ inconvenienced’ is an interesting word, though, isn’t it? It implies something like having a choice of peas or French beans, which would not ‘inconvenience’ anyone, everyone just chooses the one they prefer.

My neighbour’s DGC was ‘inconvenienced’ by the ND boy who was sat next to her, who fidgeted, jumped up and down in his seat ( jolting her every time) ran out of the building and climbed the fence, thus triggering an evacuation, hummed and chattered so she couldn’t hear the teacher….but he has a right to an education. And it seems DGD doesn’t, or not as much right.

NDN is now paying for DGD to go to a private school where her ‘needs ‘ for a peaceful what would have been considered ‘ normal’ classroom experience are not set aside for a one way interpretation of equality. nDN doesn’t go on holiday. To pay for it, so DGD is ‘lucky’.

Now- shout at me 🪖

Exactly this!
So let’s say a reasonable adjustment would be more frequent toilet breaks. Fine, that inconveniences nobody as long as it is well managed and not too disruptive.

But to move an entire group of kids out of the class because they cannot send out the one kid that is disrupting everyone else? That’s not reasonable.

WhereIsMyJumper · 28/05/2025 14:36

StepAwayFromGoogling · 28/05/2025 13:14

So what is your point? Children with SEN should continue to suffer because you were able to cope with the school environment? Or that they should continue to suffer because it might affect the already-advantaged NT children?

So in a class of 30 kids.
3 suffer because they cannot cope with the school environment
They change the environment so they can cope. But now the other 27 kids can’t.
Is that fair?

Navyblueberries · 28/05/2025 14:36

My thoughts are, everyone has known my child is probably autistic since he was 3 years old and referred for speech therapy. At 8 years old and in year 3 we are still on a waiting list for an NHS diagnosis, he was referred through school in year 1.

So it's laughable to me for someone to suggest autism gets diagnosed too early!

Allthegoodnamesarechosen · 28/05/2025 14:33

NormaMajors1992coat · 28/05/2025 11:45

I’m all for diagnosing if it helps the individual child cope better… and more importantly isn’t to the detriment of NT kids.

Well done, I guess, for admitting an opinion that I’m sure many on the thread share but few would dare to express. That ND kids may have their diagnoses and support as long as NT kids are not inconvenienced. Because ensuring no detriment to NT kids is more important than helping ND kids to cope.

‘ inconvenienced’ is an interesting word, though, isn’t it? It implies something like having a choice of peas or French beans, which would not ‘inconvenience’ anyone, everyone just chooses the one they prefer.

My neighbour’s DGC was ‘inconvenienced’ by the ND boy who was sat next to her, who fidgeted, jumped up and down in his seat ( jolting her every time) ran out of the building and climbed the fence, thus triggering an evacuation, hummed and chattered so she couldn’t hear the teacher….but he has a right to an education. And it seems DGD doesn’t, or not as much right.

NDN is now paying for DGD to go to a private school where her ‘needs ‘ for a peaceful what would have been considered ‘ normal’ classroom experience are not set aside for a one way interpretation of equality. nDN doesn’t go on holiday. To pay for it, so DGD is ‘lucky’.

Now- shout at me 🪖

WhereIsMyJumper · 28/05/2025 14:29

NormaMajors1992coat · 28/05/2025 12:55

I also am all for reasonable adjustments where possible. But. I do think before some adjustments are made it should be looked at whether it affects ANYONE adversely. Whether ND or NT.

This is great but not what the PP whose comments I was addressing said. Their view is that the needs of an already advantaged group are more important than the needs of the less advantaged group. The DC with disabilities can have some help only if the DC without disabilities are not affected. Heaven forbid anyone who is not disabled is inconvenienced by an adjustment for those who are, or is asked to put a disabled person’s needs ahead of their own. It’s similar to other views seen on here quite a lot - cf also “I am all for helping poor kids and they should be allowed to go to university of course, but can’t believe that my brilliant privately educated child has had their Oxbridge place taken from them by someone from a state school”.

For starters, NT kids aren’t a universally advantaged group of people.

Secondly, what level of inconvenience do you think is reasonable to make adjustments for ND kids?
Moving an entire 30-strong group of kids out of a classroom and disrupting their education several times a week because one ND child is throwing things around a classroom?
Or how about the thread on here a few months ago where a woman was told she should disrupt HER NT child’s life by removing her from the school where she was being molested by an ND child?
Do we stop sports day because some kids are in a wheelchair?

We are asking and expecting very, very young children (including those with conditions that the poster you quoted mentioned) both ND AND NT to understand and empathise with something that is adults can’t even agree with. They’re being expected to mould their whole school experience around a small percentage of kids. That makes no sense to me. I don’t know what the answer is, but surely it’s not to make everyone have a miserable time of it

Locutus2000 · 28/05/2025 14:28

RedBeech · 28/05/2025 09:27

Thank you. I saw that documentary and thought it was appallingly misleading. It had a mission before it began. Nothing exploratory or investigative. It sought proof of its pre-planned outcome. Total confirmation bias.

Bit like this book then.

WhereIsMyJumper · 28/05/2025 14:18

TheAgileGoldPoet · 28/05/2025 11:55

ADHD in particular has suffered with the rise of misleading and inaccurate posts on SM, with hashtagADHD being viewed billions of times on Tiktok.

With studies showing that more than 50% of the most popular videos being misleading or inaccurate

.https://chadd.org/attention-article/adhd-on-tiktok/

And experts in ADHD saying so, it's astonishing to me that some people want to claim it isn't a trend.

Reducing a complex neurodevelopmental condition to '10 signs you have ADHD' on social media, most of those 10 things being experiences that the majority of the population experience, IS a trend and IS a problem when those people seek a diagnosis and get one from a shitty private clinic. Or are just self-identifying and going through life claiming a condition they don't have.

In 2024, the most searched conditions in the UK on the NHS websites were COVID with 3.7 million searches and second, ADHD with 3.6 million.

'Increased awareness' doesn't mean anything other than that people are bombarded with information telling them they might have a condition, and I include MN in that, where posts with extremely scant information are met with a reply of 'sounds like ASC/ADHD'.

'Increased awareness' doesn't mean increased understanding or literacy in the MH or ND conditions being mentioned.

And it is, and will continue to be damaging.

It bemuses me that many, many MN posters were understandably concerned about the rapid rise in children and adults identifying as trans/non-binary, often supported by diagnosis and treatment by medical practitioners and saw that as a damaging sociological trend influenced by social media but deny it happening when it comes to ADHD for instance.

Absolutely this!!!
And if I had a child with, or I had a genuine case of ADHD I would be livid at this trend! The pressures it puts on an already overstretched healthcare system, not to mention the people with genuine cases having to join increasingly long waiting lists and to add to it, the stigma is probably worse now than it was before