These guidelines risks exposing children to unnecessary harm
These guidelines illustrate the big muddle that now characterises the diagnosis of autism. We span the entire human spectrum from people with severe learning difficulties to future Einsteins. If we are to believe that their social communication profile shares the same neurological basis, then we need evidence for what this is. We don't have any, which has led to the continuous mutation of constructs that now characterises the field. Once social communication is medicalised in the era 'marketing' we should not be surprised that the boundaries for the condition continues to expand (Timimi et al, 2010). But what is 'autism' remains as elusive as ever. We are told not to exclude capacity for affection, normal play, difficulties getting resolved etc. The only way to be sure that someone has 'autism' is to have an 'expert' diagnose this. This is an admission that the process to affirm a diagnosis is entirely subjective, dependent on trust in the opinions of self appointed professionals who refer to themselves as 'experts' (and so decide what is and isn't autism), with no objective evidence to support the proposition that there is some identifiable and specific neurological problem recognisable as being synonymous with 'autism'.
Making transparent that 'autism' is an ideological not scientific construct is important for more than just academic reasons. Autism is being conceptualised as a lifelong problem. It focuses on 'what's wrong' and the implications of labelling people who don't fit the mainstream 'mould' with a life long condition associated in the common culture with 'disability' and continuing problems is profound and not considered as a possible source of harm by the guideline authors. This is of great concern. There should be clear evidence that having a diagnosis of autism improves outcomes compared to those of similar intellectual functioning levels who don't get a diagnosis. Until we have this evidence we should not assume a diagnosis is a good thing and the place of diagnosis should be viewed with a healthy scepticism.
Psychiatric diagnoses have failed to establish their scientific credibility or their clinical utility. Our continued attachment to pseudoscience with the accompanying 'trick' that something can become 'evidence based' by saying it is, using technical language and quoting the odd paper is no longer excusable. It is time we as a profession held those who make claims about the scientific/evidence based basis for their constructs to account. We have no evidence that explains aetiology or demonstrates pathophysiology or has some biological markers for currently used psychiatric diagnoses including autism and there is little clinical utility as psychiatric diagnosis has a close to a zero effect size impact on treatment choice in comparative studies.
We can no longer avoid these conclusions: Formal psychiatric diagnoses are not valid, use of psychiatric diagnosis increases stigma, using psychiatric diagnosis does not aid treatment decisions, long term prognosis for mental health problems has got worse since using diagnostic based constructs, it imposes Western beliefs about mental distress on other cultures and therefore is institutionally racist, and most importantly alternative evidence based models for organizing effective mental health care are available (See Timimi, 2011 'No More Psychiatric Labels' campaign). These guidelines are dangerous, pseudoscientific and they should be withdrawn.
Timimi S, Gardiner N, McCabe, B. (2010) The Myth of Autism: Medicalising Men's and Boys' Social and Emotional Competence . Basingstoke: Palgrave MacMillan.
Timimi, S. (2011) No More Psychiatric Labels: Campaign to Abolish Psychiatric Diagnostic Systems like ICD and DSM.
Competing interests:
No competing interests
02 November 2011
Sami Timimi
Consultant Child and Adolescent Psychiatrist
Lincolnshire Partnership NHS Foundation Trust and University of Lincoln
Rapid Response:
These guidelines risks exposing children to unnecessary harm
Making transparent that 'autism' is an ideological not scientific construct is important for more than just academic reasons. Autism is being conceptualised as a lifelong problem. It focuses on 'what's wrong' and the implications of labelling people who don't fit the mainstream 'mould' with a life long condition associated in the common culture with 'disability' and continuing problems is profound and not considered as a possible source of harm by the guideline authors. This is of great concern. There should be clear evidence that having a diagnosis of autism improves outcomes compared to those of similar intellectual functioning levels who don't get a diagnosis. Until we have this evidence we should not assume a diagnosis is a good thing and the place of diagnosis should be viewed with a healthy scepticism.
Psychiatric diagnoses have failed to establish their scientific credibility or their clinical utility. Our continued attachment to pseudoscience with the accompanying 'trick' that something can become 'evidence based' by saying it is, using technical language and quoting the odd paper is no longer excusable. It is time we as a profession held those who make claims about the scientific/evidence based basis for their constructs to account. We have no evidence that explains aetiology or demonstrates pathophysiology or has some biological markers for currently used psychiatric diagnoses including autism and there is little clinical utility as psychiatric diagnosis has a close to a zero effect size impact on treatment choice in comparative studies.
We can no longer avoid these conclusions: Formal psychiatric diagnoses are not valid, use of psychiatric diagnosis increases stigma, using psychiatric diagnosis does not aid treatment decisions, long term prognosis for mental health problems has got worse since using diagnostic based constructs, it imposes Western beliefs about mental distress on other cultures and therefore is institutionally racist, and most importantly alternative evidence based models for organizing effective mental health care are available (See Timimi, 2011 'No More Psychiatric Labels' campaign). These guidelines are dangerous, pseudoscientific and they should be withdrawn.
Timimi S, Gardiner N, McCabe, B. (2010) The Myth of Autism: Medicalising Men's and Boys' Social and Emotional Competence . Basingstoke: Palgrave MacMillan.
Timimi, S. (2011) No More Psychiatric Labels: Campaign to Abolish Psychiatric Diagnostic Systems like ICD and DSM.
Competing interests: No competing interests