Autism is not a scientifically valid or clinically useful diagnosisBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5105 (Published 16 August 2011) Cite this as: BMJ 2011;343:d5105
- Sami Timimi, consultant child and adolescent psychiatrist1
Szatmari provides little evidence to support the validity of autism spectrum disorders (ASDs) as a diagnosis.1 Two ex-services users, both diagnosed with an ASD, and I concluded in our recent book that ASD is not a valid diagnosis.2 The prevalence of ASD increased from 4.5 to 160 per 10 000 in just four decades, with no biological evidence to support this construct emerging. The high ratio of affected males to females needs to be accounted for, but no link to the X or Y chromosomes has been found. Evidence for only a small proportion of the assumed total genetic risk has been found, and even this seems to be related more to general learning difficulties. Neuroimaging studies have consistently failed to replicate findings, and sample heterogeneity (reflecting IQ differences) is a common problem. No methodologically sound and replicated research shows that particular interventions (educational, psychological, social, or pharmacological) specifically and differentially help people with any form of autism. Until specific treatments are found we cannot and should not assume that the diagnosis has any clinical value.
We concluded that to open up a constructive approach to the group who attract the “autism” label, we must first remove the artificial distraction created by such a limiting approach to these people’s lives. The task of good clinical care is to take each individual and their family’s narratives into account and find creative possibilities for change and for more hopeful potential stories that can emerge instead of the stigmatising “lifelong disability” script a diagnosis can lead to.
Cite this as: BMJ 2011;343:d5105
Competing interests: None declared.