What’s Behind the Rise in Mild Autism? - The Atlantic

Not long ago, autism was considered rare, but now it’s fairly common: Autism diagnoses in children have increased nearly fivefold across the United States in the past couple of decades, from one in every 150 8-year-olds in 2000 to one in every 31 in 2022. Adult diagnoses have also gone up rapidly in recent years.<br>According to many researchers, a significant portion of this growth comes from a rise in diagnoses of milder forms of autism—cases in which people may have a normal to high IQ and typical speaking abilities but struggle with social interactions or have intense interests. Severe autism, in contrast, is generally associated with low IQ, little or no verbal speech, and a probability that the person will need some form of lifelong care or supervision. A study published last year found that the prevalence of autism with “mild, borderline, or no significant adaptive challenges” increased from 2000 to 2016, but that the frequency of cases involving “moderate to profound challenges” decreased slightly. And the likelihood that an autistic person also has an intellectual disability has declined meaningfully since the 1980s, from about 70 percent to about 30 percent.<br>I spoke with five researchers and clinicians who say they’re concerned about the possibility that too many people are being diagnosed with mild autism. They say that some individuals who have received these diagnoses might instead have anxiety or another mental illness. Others might not have any diagnosable mental-health condition, and may be incorrectly perceiving their typical social struggles as a sign that they have a disorder. “Some of those people absolutely have autism,” Catherine Lord, a clinical psychologist at UCLA who specializes in autism, told me. But some people who think, “Maybe this is the answer to why I feel different or I’m not happy,” may simply be mistaken, she said. This overdiagnosis trend, these experts say, can hurt both people incorrectly classified as mildly autistic and those with more severe forms of autism.<br>To be sure, researchers don’t know what the average expected number of autism cases in a given population should be. Generally, to be considered autistic, a person must have exhibited social difficulties and repetitive behaviors—such as hand-flapping and spinning—from before the age of 5. But no brain scan or blood test can diagnose the condition, so clinicians must rely on a person’s own account—or their parent’s account—of their challenges. A recent study found that nearly half of the children who had been given an autism diagnosis in one clinic did not meet the criteria for autism when they were reevaluated in another clinic. Diagnoses can be especially off for kids with visual or hearing impairments or other disabilities. In adults, autism diagnoses are inaccurate about 20 percent of the time, even with rigorous tests, Lord said.<br>Read: Accommodation nation<br>Some of the inconsistency in diagnosis can be explained by the constraints of the health-care system: Ideally, psychiatrists and psychologists take into account interviews with a patient’s teachers and parents—or, in the case of adults, their siblings and friends. But clinicians may not have the time to devote that much attention to their patients, and they don’t want to miss any cases. Lord said that many professionals therefore diagnose patients based solely on the patient’s stated symptoms or history. The diagnostic criteria, too, are somewhat unclear: Bad eye contact, for example, can be a symptom of autism, but it can also be a sign of schizophrenia, ADHD, social anxiety, or depression, Eric Fombonne, a professor emeritus of psychiatry at Oregon Health and Science University, told me. The Diagnostic and Statistical Manual of Mental Disorders states that autism causes “impairments,” but what constitutes an impairment can be subject to interpretation.<br>Some of the experts I spoke with also told me that more people seem to be seeking out an autism diagnosis now than they did in the past. Having a precise label for social challenges or feelings of alienation can feel freeing and relieving. Unlike, say, those for schizophrenia or bipolar disorder, an autism diagnosis has become desirable to some people, Uta Frith, an emeritus psychology professor at University College London who was one of the first people to study mild autism, told me. She said that there’s been “a big increase in the demand for the diagnosis.” According to Fombonne, autism “has become chic.” Lord said that she, too, has seen more patients asking whether they should be diagnosed with autism, and many of them have relatively mild symptoms. Lord gave an example of a type of person she sees who has a high IQ, may be depressed or anxious, and is questioning their gender or sexuality. “So somebody really trying to figure themselves out,” she said. They “may be somewhat socially awkward, often have friends, but feel like there’s something...