Why are autism and ADHD diagnoses rising? Less context, more labels

In recent years, we have seen a sharp increase in autism diagnoses and other psychiatric classifications. An important part of this can be explained by the fact that less and less attention is paid to context in society and care.

Fragmented society with pressure, information, and less support — When stable frameworks and social support weaken, differences in context sensitivity more quickly become problems that appear as diagnoses.

Two structural causes

Society has become more complex:
In the past, religion or ideology offered clear frameworks
Now there is an abundance of information, especially through social media
this requires more context sensitivity from each individual
The informal safety net has been weakened:
both parents work
grandparents are less available
Neighbors hardly play a role anymore
people who have difficulty contextualizing are more likely to fall by the wayside

Consequence

The number of people with context blindness remains relatively constant, but:

In the past, they were supported by clear frameworks and a strong social network
now they get into trouble more often
as a result, they are more likely to be diagnosed with a psychiatric label, such as autism

Critical note

More diagnoses does not automatically mean that there is "more autism" or "more depression". It could just as easily point to a society that takes less account of differences in context sensitivity.

Empirical research supports this. In the United Kingdom, recorded autism diagnoses rose by 787% between 1998 and 2018; the researchers attribute that rise mainly to broader recognition and application of the diagnosis, not to a real increase — with the steepest rise among adults and women.⁴ For ADHD, standardised criteria show no evidence of a real increase over three decades.⁵ The estimated global prevalence of autism remains around 1%.⁶

Conclusion

Overdiagnosis occurs when we contextualize too little. The more we integrate context into care and society, the less there is a need for psychiatric labels.

References

Fabiano, F., & Haslam, N. (2020). Diagnostic Inflation in the DSM: A Meta-Analysis of Changes in the Stringency of Psychiatric Diagnosis from DSM-III to DSM-5. PubMed 32736153
Roman-Urrestarazu, A., Yang, J. C., van Kessel, R., et al. (2022). Autism incidence and spatial analysis in more than 7 million pupils in English schools: a retrospective, longitudinal, school registry study. PubMed 36302393
Ormel, J., et al. (2022). More Treatment but No Less Depression: The Treatment-Prevalence Paradox. PubMed 34959153
Russell, G., Stapley, S., Newlove-Delgado, T., et al. (2022). Time trends in autism diagnosis over 20 years: a UK population-based cohort study. PubMed 34414570
Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. PubMed 24464188
Zeidan, J., Fombonne, E., Scorah, J., et al. (2022). Global prevalence of autism: a systematic review update. PubMed 35238171