Autism in children may be overdiagnosed and wrongly branding socially anxious children with the condition could have “harmful implications”, researchers have said.
Experts said that behaviours such as difficulty maintaining eye contact or “toe-walking” — walking on the balls of the feet — which are often seen as signs of autism in children, do not always indicate a developmental disorder.
They also questioned current methods of diagnosing the disorder, citing a study that found nearly half of children diagnosed do not meet the criteria for autism when reassessed by specialists.
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Latest government data shows that there are more than 166,000 autistic pupils in schools in England, an 8 per cent increase since 2020.
The NHS lists avoiding eye contact, not responding to their name, repetitive movements and reduced engagement in play as signs of autism in young children.
Lester Liao, a pediatrician at Montreal Children’s Hospital in Canada, and Eric Fombonne, director of autism research at Oregon Health & Science University in Portland, US, reviewed findings of various studies for an opinion piece published by the journal JAMA Pediatrics.
They wrote: “Overdiagnosis leads to resource dilution. There are only so many public sites and professionals for evaluation of autism and therapeutic intervention. Overdiagnosis diverts resources from children with the most significant challenges.
“Importantly, it is often those who are better resourced, whether in terms of cultural capital or functional capabilities (eg, the capacity to speak and self–advocate), who can navigate the medical system to ensure milder diagnoses receive support.
“This leaves the most vulnerable — those who cannot self–advocate and exhausted families caring for their children full–time — without the support they need.”
Liao and Fombonne argued that the “expansion of the term autism” and an increase in diagnoses left those with more severe challenges caused by the condition overlooked.
They claimed that the Autism Diagnostic Observation Schedule, a standardised 40-60 minute assessment used by clinicians, may be “interpreted incorrectly”.
“For example, poor eye contact may be due to inattention or social anxiety rather than to limited social reciprocity,” they added.
Citing a different study, the experts said that almost half of children who received an autism diagnosis did not meet the criteria when they were re-evaluated by an autism research team.
Liao and Fombonne warned that overdiagnosis could create a “self-fulfilling prophecy” where children labelled as autistic may have fewer opportunities to develop social and behavioural skills.
They wrote: “A child who is socially withdrawn is permitted to isolate, minimising habituation to social circumstances and decreasing social opportunities, thereby reducing social practice. The same applies to behavioral rigidities or sensory aversions. There is a risk of attributing all the child’s troubles to autism, as opposed to, say, a circumstance, thereby reinforcing one’s concept of the child.
“This does not allow a child to develop their full capacity. There’s a significant difference between a child who has difficulty doing something and a child who utterly cannot. A spectrum does not negate this.”
Last month, a government inquiry found that children and young adults are “incentivised” to get diagnosed with ADHD and autism and there has been a “medicalisation of distress”.
The interim report found that there are “institutional incentives” to seek a mental health diagnosis as it is the “gateway” to unlock access to special adjustments at school and work.
It said there was “credible evidence of increasing psychological distress” behind a recent rise in mental health diagnoses, but added that normal difficulties may also “increasingly be interpreted primarily through a medical lens”.