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

[FrodoBiggins]

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?

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?

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.

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.

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

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

@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.

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.

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!

@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.

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.

Absolutely!

Comparatively they can.

Yes but the original message is missing this very important nuance. The original message is that ALL NT people can navigate ALL complex situations with ease. Compared to someone who is ND, yes they can. But the message doesn’t say this and it leads to more people believing there is something wrong with them when there isn’t.
Im NT (as far as I know) and I certainly don’t find all social situations easy to navigate - and definitely not the complex ones. I don’t think anyone can say that they can do that!

And this is the crux, really. Where do you draw the line between NT and ND? I would assume it’s when those difficulties have a real and meaningful impact on your life and cause you severe distress. In fact, that’s how the DSM V interprets the line, too.
There is a world of difference between uncomfortable and distressing

I guess as a society, we all have to run along together as best we can. Sometimes you will be inconvenienced and sometimes you won’t. That goes for both NT and ND people. It’s hella annoying to be sat next to a parent with a screaming baby on a plane for example. But they deserve to be there as much as I do. (Happened to me recently!)

It was me that made that point originally but interestingly, the more we have discussed it the more it seems that we actually agree with each other… once you get in to the nuance.

I have never seen a diagnostic criteria for adhd, ASD etc that says it’s a condition where you don’t find all scenarios easy all of the time.

@WhereIsMyJumper

I think finding social situations complex is not not ‘wrong’ or ‘bad’. Some people are extremely empathetic or ‘look before they leap’.
Instead of having a limited sensitivity towards the needs, thoughts and gestures of others - it could be an extreme awareness - which, when channeled in the right way, could result in real benefits to society : creative ways of thinking, better ways of debating, pushing barriers, challenging ingrained beliefs etc.

At the start of the DSM V, there is a sort of overarching criteria for a condition to meet for it to be classed as a mental disorder. That applies to every single condition listed within.

It states that

A Mental Disorder is a syndrome characteristic by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviour (e.g. political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above

But again. That’s not what the original quote said. It said all NT people can navigate ALL complex social situations with ease. Which isn’t true. And could lead people to thinking there is something wrong with them just for being a bit awkward sometimes

My point here being that being uncomfortable in social situations is not the same as experiencing ‘clinically significant disturbance’ or ‘significant distress or disability’

"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?" @WhereIsMyJumper

None of these things are reasonable adjustments.

The first of your examples would be a crisis response that mainstream classrooms use (usually because they haven't put in reasonable adjustments). The second appears to be a safeguarding failure suggested by random members of an anonymous forum. The third is also not a reasonable adjustment and would be a fundamental misunderstanding of the law. There are plenty of ways to include physically disabled children in sports days.

Ok so if by definition, a reasonable adjustment can only be considered reasonable if it doesn’t impact on the education of any other child in the class then I am all for them.

It's like you said in a previous post - all about nuance. Who does it impact? How big is the impact? What is the cost? Does the adjustment actually solve the problem?

Quite a lot of reasonable adjustments are free and easy - like being allowed to wear ear defenders, being let out the classroom 5 minutes early etc

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.

They definitely have as much right to be there as everyone else. However while they have the right to enjoy the show however they wish I have the right to do the same. And while I would never want them to leave, I would ask the staff to move me and if they couldn’t I would request a refund. And I would expect to be given it. I have in fact asked for refunds at the cinema before for similar reasons and have been given one. Even if I was NT I would expect to be given a refund if for any reason you cannot see or hear the show at all.