To find the growing narrative of over diagnosis (autism, adhd and mental health) upsetting and draining

[Frazzlesforever]

There seems to be a drip drip of press headlines and change in the conversation that too many people are getting diagnosed. And that some parents are being too pushy to get extra help or trying to get be benefits etc.

As the parent of a high masking autistic girl I had to push for diagnosis although the school just saw a highly compliant, quiet anxious child. My daughter is now extremely mentally unwell through not coping in school, has had to drop out of school missing her gcses, emergency CAMHs involvement - devastating for her and us.

She is exactly the type of child who would fall under the radar. Just an anxious child with over anxious parents. Apparently seeming to cope until she just couldn't. Surely if anything we need better understanding and support for these types of children not less. Otherwise we also risk kicking the problem down the road To severe problems in adulthood. - poor mental health/outcomes etc.

I agree to a point.

Not all people with the same diagnosis will need the same support. However a diagnosis can recommend types of support, so means that the support given meets the needs of the person, not a once size fits all.

There may also be some things that can't be gained without diagnosis, eg funding at uni to buy equipment that will help the student.

You do not need a formal medical diagnosis to get reasonable adjustments in school or university in the UK
. Under the Equality Act 2010, rights are based on having a disability or impairment that has a substantial, long-term impact on your education, not on having a specific label.

Key points to know:

• Focus on Impact, Not Diagnosis: Support is "needs-led," meaning the school or university must provide adjustments based on the challenges you face, such as mental/physical health issues or learning difficulties.
• Definition of Disability: You are covered if you have a physical or mental impairment with a "substantial and long-term adverse effect" on daily activities.
• Proactive Duty: Schools and universities have a legal duty to make adjustments as soon as a need is known, even without a formal diagnosis.
• Providing Evidence: While a diagnosis isn't necessary, sharing information about your functional needs (e.g., from a doctor or teacher) helps educators understand what support to offer.

Haven't RTFT

Someone said earlier that over diagnosing can't be a thing because you either have it or don't which I agree with. It's coming more to light now and more people are seeking diagnosis and getting support which is great.

I do believe however, more companies are setting up to make money from the NHS waiting lists and I do believe some are staffed by individuals that aren't always appropriately qualified. I say some, not all. And that is from speaking to people personally where the assessor has taken one small thing they'd said and applied it across all areas of their life multiple times to make a clinical judgement. This isn't to say that the individual isn't neurodiverse, but it does mean the assessment isn't accurate. I think there needs to be better policing over who is or isn't allowed to provide an assessment, and whether they are suitably qualified when a person may have other potential diagnoses with overlapping symptoms

OP, I'm sorry you had that experience and i hope your daughter gets the support she needs now to feel better in herself again 💐

I agree with this; when all someone has is a hammer then everything looks like a nail. Many assessors are simply not qualified to consider differential diagnoses (or comorbidities).

Your use of the idea that all those listed have some kind of 'neurodiversity' implies that there are brain markers for those things. For some there may be. For others there are not. Schizophrenia for example. No biological markers. Schizophrenia is literally a made up thing etymologically meaning 'split mind'. Coined by Bleuler - a psychiatrist. No biological markers.

This post is really spreading misinformation as fact. How was the DSM formed? It was written by men. In a room. What symptoms shall we list for this diagnosis. What shall we make the cut off? Ok, yes 5 of the above. All agreed? Ok great, next. In comes the pharmaceuticals. Now called antipsychotics, the greatest marketing change ever. Used to be tranquilisers. Yes let's tranquilise them. Let's not ask them what the matter is, let's tranquilise them. Oh no hang on, that's maybe not nice, let's call them antipsychotics. Sshh. Stop causing trouble.

Psychiatry originally gained traction under pressure from the courts - can you please medicate and stop these crazy women. Cue the DSM. And the drugs. And the money. Follow the money. Literally men in a room.

It can be helpful in some ways as a way of thinking about experience but it has some serious flaws. And a fascinating history.

Anyone who agrees to be assessed for a diagnosis, needs to know where the whole concept comes from. And that includes children, particularly teenagers. And parents of children.

This post is a little polemical but you can see the issues this topic raises.

No it's not

Our prisons are also filled with people who are functionally illiterate, ex armed forces, victims of child abuse, trauma/adhd symptoms are similar. It isn’t as simple as ‘diagnosis is useful’ because there are a raft of social issues contributing to more people feeling they need a diagnosis. Almost zero evidence exists to justify the idea that a huge % of our population is suddenly disabled/pathologically impacted by neurological/neurobiological difference, or has always been.

It is

You do not need a formal medical diagnosis to get reasonable adjustments in school or university in the UK
. Under the Equality Act 2010, rights are based on having a disability or impairment that has a substantial, long-term impact on your education, not on having a specific label.
Key points to know:

• Focus on Impact, Not Diagnosis: Support is "needs-led," meaning the school or university must provide adjustments based on the challenges you face, such as mental/physical health issues or learning difficulties.
• Definition of Disability: You are covered if you have a physical or mental impairment with a "substantial and long-term adverse effect" on daily activities.
• Proactive Duty: Schools and universities have a legal duty to make adjustments as soon as a need is known, even without a formal diagnosis.
• Providing Evidence: While a diagnosis isn't necessary, sharing information about your functional needs (e.g., from a doctor or teacher) helps educators understand what support to offer.

I don't really understand why people focus on over diagnosis of neurodiversity in a way that we would never talk about an over diagnosis of cancer despite cancer rates also increasing.
There isn't a quota - if people either meet the criteria for a condition or they don't.

@Dragonflytamer Well it's pretty obvious why... Cancer is a discrete illness. You either have it or you don't. It can be verified with pretty much absolute certainty with scans/biopsy. Whatever your theories about neurodiversity are I think most would agree that it is multifactoral and there isn't a single test to confirm or deny its existance in a person. Furthermore we are doing loys of research into cancers and we are asking the questions about the environmental risk factors. The question should be the other way round. Why aren't we doing a lot more to research why there is such a huge increase in neurodiversity, paediatric mental health problems and serious behavioural disorders?

NHS taskforce disagrees with you. Treatment for adhd can be life changing.

I agree. It’s upsetting and draining. There are more people being diagnosed. More people need more help. We cant stick to the same numbers and hope the box fits. Our population is much bigger tjan before.

Schizophrenia is no different from autism in terms of biological markers. For both it is a complex picture of brain differences.

Autism is literally a made up thing etymologically meaning “self-admiration” Coined by Bleuler - a psychiatrist.

Legally yes you are correct. A diagnosis materially can change the outcome of a request for adjustments. See last paragraph.

Wow. I did not know that. Really interesting, thanks.

yes and it’s unsurprisingly quite complex separating trauma and other factors from neurodevelopmental differences. I’ve worked with fostered children who had diagnoses of ASD/ADHD and Audhd. Often amongst other serious issues. When reading through their case histories, it’s clear they’ve experienced a long history of serious neglect and deep trauma in many cases. I wonder sometimes and have sat in with highly specialised clinicians who’ve had similar concerns, about the accuracy of some historical diagnoses of BPD, ASD, ADHD etc. Often the question needs to be what happened to you, rather than what’s wrong with you.

Adjustments are based on evidence of need and how a student normally works not a diagnosis.

But it’s the lack of diagnosis that is often why they’re there hence the findings of the NHS taskforce that we need to be better at diagnosis, and why dealing with the under diagnosis that we have is so important,

From a professional standpoint, I have concerns about the diagnostic process and criteria for ASD/ADHD- and indeed the over-medicalisation of a range of symptoms/behaviours into diagnosing mental health conditions. For instance, some providers are diagnosing ADHD in adults after a single hours consultation, with no collateral history. They won’t be wrong every time, but there is concern about this and I think it is right that there is.

I don’t think anyone is suggesting all diagnoses are of ADHD or ASD are incorrect- and I do think the process for getting children diagnosed in this country is far too long, leaving children in need of support without it.

However there is evidence we are over-medicalising and the criteria is now becoming really very broad, that there is concern that it is going to lead to over diagnosis. I think it’s a reasonable question to raise.

That's odd because I work with children and know quite a few who have been assessed for Autism/ADHD and not been given a diagnosis, so does my anecdata cancel out your anecdata?

Maybe your GP mates are extremely competent and only referring people for an ADHD assessment who actually have significant ADHD indicators.

Well my ableism bingo card is full now.

• people don’t believe adults need a diagnosis if they aren’t autistic enough
• we should all shut the fuck up and not seek diagnosis if we have managed to survive til middle age
• we only do it because apparently we get loads of money
• everyone masks
• everyone is on the spectrum
• a diagnosis is a get out of jail free card
• all money should be allocated to the ‘severe’ cases
• its an excuse to get out of things
• we are too lazy to learn to do things.

I think that’s everything covered

You really need to read the NHS Taskforce report . We are under diagnosing and not treating ADHD is costing the economy £17 billion. Only 15-25% get medication.

I do worry about the over medication in mental health though as opposed to other treatments but decent therapy can be hard to find.

No but doctors often assume it’s a MH issue and don’t look any further.

My other thoughts would be how does the GP even remember who they put forward?

My own experience is child was put forward 2019 by the time he got to top of the list 2024 he was a teen who didn't want to know. And never actually went for the assessment.

Is the GP really tracking that down 5 year later?

Attachment disorders from severe neglect in childhood can present very similarly to ASD/ADHD, as can FASD. Someone trained just to assess ASD or ADHD is unlikely to know enough to diagnose appropriately.

Exactly this! They don’t even read your most up to date notes when you’re sat in front of them and minions upload letters to your records not GPs themselves. GPs will never read the report. My NHS diagnoses aren’t even on my system I have to remind them every time if relevant.