‘Interesting’ article on overdiagnosing in Times.

[Soontobe60]

Just putting this here for discussion.
https://www.thetimes.com/article/9f82545c-57f5-4db2-8a47-9a8cc2304243?shareToken=c0f809004b0c59cf1b96f6b6eb6129c3

is it not reasonable to ask (a) what is neurotypical and where does it become neurodivergence? and (b) why are there so many more people now who either have more difficulty with the world than people in previous generations did, or have more severe levels of need?

a) That's what we have diagnostic criteria for, assessed with instruments like ADOS.

b) The world is brighter, louder, and generally shittier for autistic people than it was. People who used to cope now can't. In the last decade, advertising billboards with paper stuck to them have been replaced with backlit moving computer displays everywhere. You go to a bus stop, the advert moves and changes where it previously stayed still. Shops play music interspersed with adverts, frequently loudly as at branches of River Island. You use a website, there's adverts all over websites, moving and covering the screen. Forty years ago, people didn't have the internet at work, many didn't have computers at work. Thirty years ago, home internet was in its infancy. People add noise to public places by using phones without headsets to watch videos and listen to music, a development of the last twenty years. Making calls in public didn't happen thirty years ago.

a) That's what we have diagnostic criteria for, assessed with instruments like ADOS
These diagnostic criteria aren't set in stone. They have changed significantly in the past and will continue to change. Our understanding of Autism is still rudimentary and there is much we don't know.

There is huge disagreement in the scientific community about where the line between ND and NT should be drawn and whether the criteria for ASD and ADHD have now been drawn so wide that they encompass a huge proportion of society. There is no brain scan or genetic test that can be run for these conditions so we use highly subjective testing largely based on behavioural observations and self reporting to 'diagnose' people. The obvious danger is that people treat this diagnosis in the same way that they treat one for something like cancer or diabetes where definitive physical tests are run and there is much more scientific certainty about what we are actually dealing with.

Society has changed but I don't for one second believe that this accounts for the explosion in ASD and ADHD. Personally I believe that the whole idea that there is a massive distinction between NT and ND is nonsense. In the ADOS testing you mention there are thresholds. It is totally possible that someone just misses out on meeting the criteria for a diagnosis whilst the next person just meets it. Those two people could very well have a hell of a lot more in common with each other than they would have with people that score very highly or very lowly on the test. I know the phrase 'everyone is on the spectrum' is hated now but I think that there is a much bigger area of grey than lots of people are willing to accept. We should be much more science led in this area rather than leaning into identity politics.

The legal rights for children to have an education are because children are entitled to civil rights under international human rights conventions that the UK has has signed.

The number of children needing EHCPs is irrelevant to their right to support in their education. Rights aren't contingent on the number of people who need them.

By contrast, there is no internationally-recognised right to a State pension. The State pension eats £111 billion of taxpayer money per year. The State pension system was designed when people lived shorter lives, it has become unsustainable, people admit that it has become unsustainable, and yet successive Govts refuse to abolish the triple lock.

If there's not enough money to fund the support needs of kids with EHCPs, the State pension is a great place to make savings.

This just isn't true in the way you imply. No international law can compel a country to bankrupt itself delivering a gold standard SEN education. This country could significantly scale back SEN provision and still meet it's international human rights obligations.

We don't come anywhere near gold standard so your argument doesn't apply.

Ok but if we passed a law tomorrow saying food is a human right and therefore all food will be free, would this be workable? Children have a right to an education, but not the best education money can buy which is exactly tailored to their wants and needs. If that was a civil right then it would apply to non-SEN children as well, and obviously it doesn’t because right now their education is really suffering due to SEN funding.

The number of EHCPs will always be relevant so long as they cost money. If you won’t work for free, then why should a teacher or SLT? The system runs off money and we are sadly massively lacking in this at the moment. The state pension is the same as the higher rate of DLA or PIP, and yet with DLA and PIP it is seen as an additional benefit, not the amount they have to live off.

Most people are good people and are happy to contribute to things like SEN. I know I am. But I’m not happy to contribute to SEN if it means my own children’s education is going to suffer while the school budget is allocated to one-to-ones and therapists. Everyone thinks the area they have a vested interest in is the most worthy one, but the system cannot exist to support one thing while neglecting others. SEN has more than its fair share.

If at 11 billion a year from the core budget plus 30% of council tax doesn’t meet a standard deemed acceptable by you, then we are never going to. That expenditure is already far too high, and Labour have said no more money can be diverted to SEN.

No, my argument really does apply. All childrenhave a right to an education but there is no human right to an excellent or even potentially adequate education. This is true for disabled and non disabled children. This is why children up and down this country go to schools that have been rated as inadequate by OFSTED. The idea that international law has somehow set a minimum standard for SEN education is plainly wrong.

No, my argument really does apply. You only need to look at the patchy SEN provision provided by other countries signed up to the Human Rights Convention to see that they can't mandate countries to provide SEN education to any specific standard. It just

what on earth do schools do

The LA is ultimately responsible for ensuring special education provision detailed, specified and quantified in F of the EHCP is provided. That includes ensuring there is sufficient funding. If schools need more funding to provide the provision, they should work with and support the parents to enforce the pupil’s EHCP. LAs can and do provide further funding when faced with enforcement action because LAs know lack funding/resources/staffing/other DC having EHCPs is not a lawful defence for breach of section 42 of the Children and Families Act 2014. The LA's duty is absolute despite what some LAs think.

Case law (yes, I know that isn’t international law) sets out that whilst there isn't a duty to provide the best possible provision, there is a duty to provide what is reasonably required and what is appropriate, not just what is adequate.

LAs can and do provide further funding when faced with enforcement action because LAs know lack funding/resources/staffing/other DC having EHCPs is not a lawful defence for breach of section 42 of the Children and Families Act 2014.

And as such they go bankrupt, leaving them less able to provide than ever.

https://www.theguardian.com/uk-news/2025/mar/03/a-ticking-time-bomb-the-neglected-crisis-of-send-education-in-england

That isn’t the problem of the individual child with an EHCP and also isn’t a defence.

LAs could start by not spending exorbitant amounts of money on representation to defend indefensible cases often against unrepresented parents when they know the vast, vast majority of appeals are going to be upheld.

You want science? Have a peer-reviewed journal paper. link.springer.com/article/10.1007/s10803-006-0073-6

"Everyone is on the spectrum" implies that 100 autistic people and 100 NT people taking the AW50 and graphing the results would show most people very close to the threshold line. That's not the case. Very few people are near the threshold.

A screening test isn't a definitive diagnostic, so the presence of a small number of false positives (NT people above 26) is acceptable because those false positives will be winnowed out later in the diagnostic process. A false negative, by contrast, means a missed diagnosis. Despite AQ50 literally being designed to err on the side of false positives, the number of NT scores above 26 is low.

The distribution of NT and autistic teens on the probability density chart looks like two peaks with a dip in the middle where the threshold is. This is not what diagnostic uncertainty looks like.

Since when has a race to the bottom been aspirational?

£11bn a year is less than 10% of the State pension bill. You could start increasing education funding by abolishing the Triple Lock.

It's batshit to deprive kids, who are our future workforce, of appropriate education whilst triple locking pensions.

There isn't an international binding human rights convention anywhere that says that free food is a right, so stop making false comparisons.

not the best education money can buy which is exactly tailored to their wants and needs

That isn't what EHCPs do. They don't come close to it.

Well yes, and it should be. Spending the same amount on SEN as we do pensions would be utter madness. Do you think every area of spending should be exactly equal, or do you think some things cost more than others but that doesn’t mean they’re underfunded? For example do you think we should spend as much on transport as we do on benefits? Because if not, transport is ‘underfunded’?

This belief that absolutely every penny should automatically go to SEN because if it goes to anything else ‘it proves they’re not spending enough on SEN as there’s money for X’ is madness.

She or he is making salient points and you should address them rather than attacking the poster.

On cancer, I think one of the issues is that we have put too much emphasis on finding treatments rather than early diagnosis, when its well known that the earlier the diagnosis is, the better the outcomes are.

It's not about being aspirational. The point is the UN army isn't gonna march in because some comp in Hackney made Jack and Sarah share a 1-1 TA

The total amount spend on legal defence by councils is less than 1% of the SEN budget.

The amount spend on representation, which actually goes beyond just legal teams, is still a considerable amount of money.

The state pension is the same as the higher rate of DLA or PIP

No it isn’t. The new state pension for 24/25 is £221.20 per week. Enhanced daily living and enhanced mobility PIP and HRM/HRC DLA is £108.55 + £75.75 per week.

It’s nowhere near enough money to plug the gap. You don’t seem to be aware of the sums we are discussing.

Asking whether we should aim to be worse because other countries are isn't a personal attack. Nice try.

I work in IT apart from one person older than me in his mid-50s everyone I know who has been diagnosed is in their 20s.

However there are many others I've met who are clearly ND. They just manage and rely on others to the social and client interaction for them.