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Clinical Review State of the Art Review

Autism spectrum disorder: advances in diagnosis and evaluation

BMJ 2018; 361 doi: (Published 21 May 2018) Cite this as: BMJ 2018;361:k1674

Rapid Response:

Re: Autism spectrum disorder: advances in diagnosis and evaluation: Nothing to see here folks!

Further to my letter of 21 May [1] in which I noted that the ASD figures for England were just within Zwaigenbaum and Penner's 1-1.5% range for the global incidence of autism [2] as of January 2017, the figure had risen by January 2018 (published today) to 1.64%, that is from 1 in 67 to 1 in 61 (8,735,098 children/142,988 with an ASD diagnosis) [3,4,5]]. It is important to emphasise that this is a 9.4% rise not in the new in-take but for the entire 15 year cohort, and is therefore huge.

Again, it is to be stressed that these figures are incomplete, and that according to a report by Norman Lamb MP to the All Party Parliamentary Group on Autism earlier this month unacceptable waiting times exist across the country for a diagnosis [6]. It is very unfortunate that this report only focuses on the shortage of diagnostic capacity, and not on the causes of this vast increase.

Lamb's report may go some way to explaining why the English figures lag those in Scotland (2.2%) and Northern Ireland (2.9%), although I have heard stories of long delays in these places too. In 2009 based on 2004 survey Baron-Cohen posited that for every 3 children with a diagnosis there were 2 without [7] but with pressures described by Lamb who is to say that position has not deteriorated since then (I note the situation as described in my previous letter in SW London with each borough apparently awaiting nearly 300 new cases per year and there were twice as many cases as diagnostic capacity [1])?

With government always resistant to acknowledging special educational needs and the evident long delays in diagnosis, the continued complacency and inertia in addressing the causes of this explosive rise are truly disturbing. Another question might be why does it so often fall to me and not to the government or the professionals to calculate and publish these percentages and ratios?

[1] John Stone, 'Re: Autism spectrum disorder: advances in diagnosis and evaluation', 21 May 2018,

[2] Zwaigenbaum L, Penner M, 'Autism spectrum disorder: advances in diagnosis and evaluation', BMJ 2018; 361 doi: (Published 21 May 2018)

[3] National Statistics, 'Schools, Pupils and their Characteristics' main text: January 2018,

[4] National Statistics, 'Special Education Needs in England' January 2018 National Tables table 8

[5] National Statistics, 'Special Educational Nees in England' January Additional Tables table G

[6] National Autistic Society, 'Autism diagnosis postcode lottery exposed (18 July 2018)',

[7] Baron-Cohen et al, 'Prevalence of autism-spectrum conditions: UK school-based population study', The British Journal of Psychiatry Volume 194, Issue 6 June 2009 , pp. 500-509,

Competing interests: No competing interests

26 July 2018
John Stone
UK Editor
London N22