For those who consider science a purely rational endeavor based solely on facts, the case of autism and autism spectrum disorder (ASD) should prove instructive. It demonstrates that social pressure can and does influence medical diagnosis – quite effectively in some cases. The proof is the explosion in the diagnosis of ASD.
Autism is a lifelong neurodevelopmental condition. It is generally believed to be present at birth, and is characterised by difficulty communicating as well as repetitive behavior, narrow interests and sensory issues – think Dustin Hoffman’s character in the movie, Rain Man. It is usually diagnosed in children before age five. The precise cause of this condition, which affects nearly two per cent of children, is unknown, although it is thought to be a complex interaction of genetic inheritance and environmental factors.
Because there are no absolute diagnostic criteria for autism – no laboratory test, genetic marker or brain scan is definitive – there is room to include behavioral and psychiatric conditions that share some of the characteristics of classic autism, absent the full clinical picture. These related conditions, often diagnosed later in childhood or early adulthood, are what comprise the spectrum disorder.
The dilemma here is the classical scientific disagreement between ‘lumpers’ and ‘splitters’. Lumpers group conditions together by finding underlying similarities, thus establishing broad categories. Splitters focus on creating narrow categories bound by subtle differences in clinical profiles. This problem, common to many scientific and academic disciplines, was famously alluded to by Charles Darwin in a letter to a colleague in 1857, when he wrote, ‘It is good to have hair-splitters and lumpers’.
Dame Uta Frith is a splitter. The emeritus professor in cognitive development at University College London, and a world expert in the understanding of autism, feels the current explosion in the number of young people being diagnosed with autism, or related ASD, has become unsustainable.
As she explained in a recent interview with TES:
‘That definition [of autism] is a different matter because we have made it more inclusive… Nothing is a neat category, and we wanted to include the not-so-typical cases. And so we widened the criteria, and the idea came about that autism isn’t just a single category; it is a spectrum.’
She then goes on to state:
‘But it makes a medical diagnosis completely meaningless. With the purely categorical approach, you had a very rare number of cases that were quite precisely defined, and then lots of people who just missed that. It was felt this wasn’t quite right, which is how we came to a spectrum-based approach. But that still wasn’t enough. Because of various cultural factors, the spectrum has gone on being more and more accommodating. And I think now it has come to its collapse.’
There is merit to her argument. According to the Institute for Fiscal Studies, the number of children in England who required Education, Health and Care Plans for ASD nearly tripled between 2015 and 2025. This dramatic increase means more specialised staff, more funding and longer waiting lists. A recent government report revealed there were 13 times as many people waiting for an autism assessment in September 2025 as compared to April 2019.
A similar phenomenon has occurred in America. Pace University in New York reported that 37 per cent of students had a registered disability in 2024; in 2015 the school reported five per cent. At Hampshire College in Massachusetts and Scripps College in California, disabilities have also more than tripled in a decade.
The trend is most acute at prestigious American universities. At Harvard, Cornell and the University of Chicago, government data show that 21 per cent of students registered as having disabilities in 2024. In 2015, the figures were under three per cent at Harvard and Chicago, and six per cent at Cornell.
The UK, at least, is beginning to admit that something isn’t right here, and that it cannot be the case that millions of people suddenly have a serious neurological condition. In December, health secretary Wes Streeting ordered a review into soaring mental-health diagnoses, with a particular emphasis on autism and ADHD.
The lines between autism and ASD must be drawn somewhere, whether by diagnosis or societal fiat. Things have already gone too far, and we are beginning to see the consequences of a generation who have been told they are mentally disabled, and need extra help to live their lives.
Take the case of Aidan Parisi, a 27-year-old Columbia University student, who was suspended from campus in 2024 for organising an event in support of Hamas. He demanded to remain in his college housing on the grounds that it would be a challenge to find somewhere that would accept his ‘emotional-support rabbit’. What will become in the real world of those like him who, if and when they get a job, will likely find themselves deprived of their emotional-support rabbits? Unless they find sinecure positions in academia, will they be consigned to their parents’ basements?
Dame Firth thinks this call has gone too far. ‘I’ve been quite swept up by the autism-spectrum idea, and it’s only in the past 10 years or so that I have felt things have gone too far, and very slowly I have come to say, “No, this is not right”.’
