There has never been greater awareness of autism, ADHD and neurodivergence.
For many people, this represents important progress. Children and adults whose difficulties may previously have been misunderstood, dismissed or attributed to behaviour, personality, anxiety or poor motivation are increasingly able to access assessment, understanding and appropriate support.
But alongside this progress, another conversation is taking place: are we at risk of diagnosing too readily?
This question sits at the heart of The Age of Diagnosis by neurologist Dr Suzanne O’Sullivan, which was featured as BBC Radio 4’s Book of the Week. O’Sullivan explores the growth of diagnosis across medicine and considers whether greater recognition of illness and difference is always beneficial — or whether, in some circumstances, the boundaries between variation and disorder have become increasingly blurred.
Autism and ADHD form an important part of that discussion.
The concern about overdiagnosis
One of the central ideas explored by O’Sullivan is what has been described as “diagnosis creep”: the possibility that the threshold between what is considered typical human variation and what is considered a diagnosable condition can gradually shift.
This is particularly relevant to autism and ADHD because many associated characteristics exist across the general population.
Most people occasionally struggle to concentrate. Many people procrastinate, become overwhelmed, prefer routine, experience sensory sensitivities or find particular social situations difficult.
Experiencing individual traits associated with autism or ADHD, however, is not the same as meeting diagnostic criteria for a neurodevelopmental condition.
At the same time, we must recognise the other side of this history. Autism and ADHD have also been significantly under-recognised in particular populations, including girls and women, people who mask or compensate effectively, and individuals whose academic or professional success has obscured the extent of their difficulties.
The challenge, therefore, is not to diagnose more people or fewer people.
It is to diagnose accurately.
A diagnosis should explain more than a collection of symptoms
This is where we believe high-quality neurodevelopmental assessment becomes particularly important.
At Gold Standard Psychological Assessments, we do not believe an autism or ADHD assessment should begin with the assumption that a diagnosis will be the outcome.
Our responsibility is to ask a much broader clinical question:
What best explains this person’s experiences, difficulties, strengths and developmental profile?
That requires us to look beyond whether somebody recognises themselves in a list of autistic or ADHD characteristics.
Neurodevelopmental assessment should consider when characteristics began, whether they have been consistently present across development, how they manifest across different environments and relationships, and whether they cause clinically meaningful differences or impairment.
Crucially, clinicians must also consider alternative and co-occurring explanations.
Anxiety, trauma, depression, attachment experiences, learning differences, sleep difficulties, environmental stress, personality, developmental stage and other psychological or medical factors can sometimes produce experiences that overlap with features associated with autism or ADHD.
Sometimes more than one explanation is relevant.
A thorough assessment therefore involves clinical curiosity rather than diagnostic confirmation.
Why multidisciplinary assessment matters
The debate raised in The Age of Diagnosis reinforces something fundamental to our philosophy at Gold Standard Psychological Assessments: a diagnosis should never rest on a single questionnaire, appointment or observation.
Questionnaires can be extremely useful clinical tools, but they are not diagnoses.
An ADOS-2 assessment alone does not diagnose autism.
A high score on an ADHD questionnaire alone does not diagnose ADHD.
Instead, we bring together information from multiple sources. Depending upon the assessment, this may include a detailed developmental history, direct clinical assessment, standardised measures, information from parents or partners, school or workplace information where appropriate, specialist observation and multidisciplinary clinical discussion.
We then consider all of that evidence against recognised diagnostic criteria.
The purpose is not to accumulate enough evidence to justify a predetermined diagnosis. It is to actively examine evidence for and against different possible explanations.
We must be prepared to say “no diagnosis”
A genuinely independent diagnostic service must be comfortable with uncertainty — and with concluding that someone does not meet diagnostic criteria.
People often arrive for assessment after months or even years of wondering whether they may be autistic or have ADHD. Some have completed online questionnaires, consumed large amounts of social-media content or strongly identified with the experiences of neurodivergent people.
Those experiences deserve to be listened to seriously.
But seeking an assessment cannot guarantee a diagnosis.
If our multidisciplinary clinical opinion is that the evidence does not support autism or ADHD, our responsibility is to explain that sensitively and transparently.
Equally, where the evidence clearly supports a diagnosis, concerns about societal overdiagnosis should never prevent an individual from receiving one.
Clinical caution must work in both directions.
Diagnosis should be useful
Perhaps one of the most important questions raised by the wider debate about diagnosis is:
What is the diagnosis for?
At its best, diagnosis can provide an explanation for lifelong experiences that previously made little sense.
It can reduce self-blame. It can help families understand a child differently. It can inform appropriate educational or workplace adjustments. It can guide treatment and support. And, for some people, it can fundamentally change the way they understand themselves.
But a diagnostic label should not become the entirety of someone’s identity or imply that every difficulty they experience is explained by that diagnosis.
This is why our reports aim to go beyond a diagnostic conclusion.
We want someone reading their assessment years later to understand not simply whether they met criteria, but why the clinical team reached that conclusion, what their individual profile looks like, where their strengths lie, what they find difficult and what support may genuinely help them.
A diagnosis should withstand scrutiny
The current discussion surrounding autism and ADHD diagnosis makes rigorous assessment more important, not less.
A neurodevelopmental diagnosis may follow someone through childhood, education, university, employment, healthcare and adulthood. It may be referred to by clinicians, schools and employers — and potentially across different healthcare systems and countries.
That means we have a responsibility to make sure that the evidence underpinning it is robust.
At Gold Standard Psychological Assessments, our response to concerns about overdiagnosis is therefore not to become reluctant to diagnose.
Nor is it to assume that increasing numbers of people seeking assessment must mean that diagnoses are being given incorrectly.
Our response is to raise the standard of assessment.
To take comprehensive developmental histories.
To use validated assessment tools appropriately.
To seek information from multiple sources wherever possible.
To consider differential diagnoses.
To involve appropriately qualified professionals.
To discuss complex cases within a multidisciplinary team.
And, above all, to retain clinical judgement rather than treating diagnosis as the automatic outcome of an assessment.
Because the question should never be:
“How do we prove this person has autism or ADHD?”
It should be:
“Having considered all of the available evidence, what is the most accurate and clinically meaningful explanation for this person’s experiences?”
In an age of diagnosis, we believe that distinction matters more than ever.