Autism is now used to describe people with an extremely wide range of abilities and support needs.
Some autistic people need lifelong help with communication, personal care, and everyday activities, while others live independently, work, study, and may not receive a diagnosis until adulthood.
Dame Uta Frith, one of the most influential researchers in the history of autism science, argues that putting all these people under one diagnostic label may now create problems.
In an editorial published in the journal Psychological Medicine, the UCL professor says the modern autism spectrum may have become so broad that greater diagnostic precision is needed.
Autism was described very differently when doctors first identified it in the 1940s. Early descriptions focused on a relatively small number of children who showed major differences in social interaction, communication, and behavior from a young age.
Over the following decades, doctors and researchers recognized that autistic characteristics could appear in many different forms. Diagnostic definitions gradually expanded to include people without intellectual disability or major language difficulties, and autism eventually became grouped under the single diagnosis of autism spectrum disorder, or ASD.
The word “spectrum” is intended to recognize this diversity. However, Frith argues that the range may now be so wide that the same diagnosis can refer to people whose lives, difficulties, development, and support needs are very different.
Autism diagnoses have also risen dramatically. Frith notes that British research in the 1960s estimated autism in roughly four children out of every 10,000, while current figures suggest that around one in 57 UK schoolchildren is identified as autistic.
This increase does not necessarily mean that autism itself has suddenly become dozens of times more common. Greater public awareness, reduced stigma, improved services, changes in diagnostic rules, and better recognition of people who would previously have been missed can all increase diagnosis rates.
Frith also raises more controversial possibilities. She suggests that broader interpretations of diagnostic criteria, online discussions, self-identification, and a wider cultural tendency to explain personal difficulties through medical labels may influence who seeks and receives an autism diagnosis.
Her argument is particularly important because there is no single blood test, brain scan, or genetic test that can determine whether someone is autistic. Diagnosis is based on developmental history, behavior, interviews, observations, and professional judgment.
This does not mean autism diagnoses are simply subjective or unreliable. Clinicians use established diagnostic criteria and assessment methods, but judgment becomes especially important when a person’s characteristics overlap with other conditions or are less obvious.
Anxiety, depression, attention-deficit/hyperactivity disorder, trauma-related difficulties, personality differences, and other conditions can sometimes produce experiences that overlap with features considered during an autism assessment. A careful evaluation therefore needs to consider alternative explanations as well as the possibility that several conditions may exist together.
Frith draws attention to differences between people diagnosed in early childhood and those diagnosed as teenagers or adults. Early-diagnosed people are more likely to have obvious developmental differences from a young age and may also have language, learning, or intellectual difficulties.
People diagnosed later are often described differently. Many have average or high intelligence and may first come to clinical attention because of anxiety, depression, ADHD, social difficulties, exhaustion, or other problems.
Some recent research has reported genetic and developmental differences between groups diagnosed at different ages. Frith argues that such findings should encourage scientists to investigate whether the current autism spectrum may contain different groups that need to be understood separately.
She also discusses the growing idea of masking, in which autistic people consciously or unconsciously hide characteristics to fit social expectations. Recognition of masking has helped explain why some people, particularly those diagnosed later, may have been overlooked, but Frith worries that concepts without clear boundaries can also make diagnosis harder to define precisely.
The debate is closely connected with neurodiversity. This movement has helped challenge stereotypes and encouraged society to view differences in thinking and behavior with greater acceptance rather than automatically treating them as defects.
At the same time, Frith points to a difficult question for medicine. If autism covers both people with profound lifelong disabilities and people who mainly understand it as a neurological difference or identity, a single medical label may struggle to communicate what kind of help an individual actually needs.
Her proposed answer is not simply to remove diagnoses from people or deny support. Instead, she argues for clearer subgroups, greater attention to individual needs, better diagnostic precision, and stronger recognition of people with the most severe difficulties.
The editorial deserves careful interpretation because it is an argument and analysis rather than a new clinical trial proving that autism is widely overdiagnosed. Frith draws on decades of research and changing diagnostic trends, but the paper itself cannot establish how many current diagnoses, if any, are incorrect.
There are also reasonable arguments on the other side. Broader definitions may have allowed many people who were previously misunderstood or unsupported to finally receive explanations and appropriate help, especially women, adults, and people without intellectual disability.
The strongest part of Frith’s argument is therefore the call for better precision rather than a simple claim that fewer people should be diagnosed. A diagnosis is most useful when it helps explain a person’s difficulties and guides meaningful support, and very broad categories can sometimes hide important differences between individuals.
The editorial was published in Psychological Medicine. It raises a difficult but valuable question for autism research: whether one spectrum can continue to describe an increasingly diverse population while still giving doctors, researchers, autistic people, and families the information they need.
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Source: University College London.
