Over the past decade, there has been an extraordinary rise in the demand for autism and ADHD diagnoses and services across the UK. The Nuffield Trust recently reported that the NHS is struggling to meet this growing need, leading to significant delays in assessment and treatment (Nuffield Trust, 2024). While this surge may seem sudden, it reflects deeper changes in public awareness, diagnostic practices, and societal attitudes towards neurodiversity. This article explores why demand has increased, the impact on individuals and families, and what needs to change to address this ongoing crisis.
“There Was No Autism or ADHD in My Day!”: A Look Back at the History and Misconceptions
It’s not uncommon to hear statements like, “There was no autism or ADHD when I was a kid,” often delivered with a knowing nod and a sense of nostalgia for simpler times. In fact, I’d never heard of Autism or ADHD myself until I was at University – and that was a decade before my own diagnosis! But where did these conditions really come from, and why do they seem to be everywhere now? Let’s clear up some of these misconceptions.
A Brief History of Autism and ADHD:
Autism was first described in the 1940s by Austrian psychiatrist Leo Kanner, who noticed a group of children displaying distinct social and communication differences. Around the same time, Hans Asperger, another Austrian researcher, described a similar condition, later named Asperger’s Syndrome. Back then, these were rare and mostly seen as childhood conditions (Kanner, 1943; Asperger, 1944).
ADHD has roots dating back much further, with early descriptions of children exhibiting as “fidgety philanderers” in the 18th century (Crichton, 1798). The term “ADHD” itself didn’t appear until the late 20th century, when researchers started distinguishing it from other behavioural disorders and recognised the role of executive function and attention regulation.
So, Where Did Autism and ADHD Come From? In reality, autism and ADHD have likely always existed; we just didn’t have the language or understanding to identify them. Instead of being diagnosed, children who were quiet and preferred routines might have been labelled as “shy” or “eccentric,” while those with hyperactivity and impulsivity were called “naughty” or “daydreamers.” As our understanding has evolved, we’ve become better at recognising and diagnosing these conditions across the lifespan.
While science points to genetic and environmental factors, there are plenty of myths and misconceptions about the origins of autism and ADHD. Some people might jokingly claim it’s caused by “too much screen time” or “modern parenting,” while others might suggest it’s a result of “chemicals in our food.” The truth is, our understanding of neurodevelopmental conditions has evolved, but it’s easier to blame new trends than to acknowledge how much we’ve learned about the brain in recent decades.
Comments like “there was no autism or ADHD in my day” often reflect a lack of awareness about how our understanding of neurodevelopmental conditions has progressed. In the past, there was limited research, fewer diagnostic tools, and a tendency to dismiss behaviours that didn’t fit societal norms.
The reality is that autism and ADHD have likely always been part of the human experience. It’s our knowledge that’s changed, not the prevalence of the conditions. As we continue to learn more, we’re better equipped to support the diverse ways people’s brains work.
Why Is Demand Increasing?
Several key factors contribute to the increasing amount of diagnoses, and subsequent rising demand for autism and ADHD services in the UK:
1. Greater Awareness:
Public awareness of autism and ADHD has grown substantially, partly due to media representation, advocacy efforts, and social media platforms where neurodivergent voices share their experiences. This heightened visibility has led more individuals — including adults who may have been missed as children — to seek assessments and support (Russell et al., 2021).
2. Broader Diagnostic Criteria:
Over time, the diagnostic criteria for autism and ADHD have expanded. For instance, autism was once thought to be rare and predominantly affected boys with severe symptoms. Today, we understand it as a spectrum that can present in many ways, including in girls and adults who may display more subtle traits (Fletcher-Watson et al., 2023). Similarly, ADHD is now recognised to affect both genders and can persist into adulthood, rather than being seen solely as a childhood disorder.
3. Systemic Delays:
While demand has increased, the healthcare system has struggled to keep pace. The NHS is facing unprecedented caseloads, leading to long waiting times for assessments and treatment. In some areas, children may wait over two years for an autism diagnosis, while adults seeking ADHD assessments can face similar delays (Children’s Commissioner, 2024).
The Impact on Individuals and Families
The consequences of delayed diagnosis and treatment are profound. Without timely support:
Children may struggle academically, facing challenges in school environments that do not accommodate their needs. They might be labelled as “troublemakers” or “underachievers,” which can impact their self-esteem and future prospects.
Adults may face difficulties in the workplace, often misunderstood by colleagues or managers. They might struggle with time management, social interactions, and meeting job expectations, leading to job instability or burnout.
Families experience ongoing stress and frustration as they navigate complex referral processes and fight for the support their loved ones need. The emotional toll of feeling dismissed or ignored can be overwhelming.
Keeping Up with Demand
The demand for autism and ADHD services is unlikely to decrease. As awareness continues to grow and diagnostic criteria evolve, the need for support will only increase. In many autistic and ADHD communities, self-diagnosis is often accepted and even validated, especially given the long waiting times for formal assessments in the UK. Self-diagnosis can be a powerful tool for individuals who recognise neurodivergent traits in themselves but face barriers in accessing clinical diagnosis. It allows people to better understand their experiences and seek support, even in the absence of an official label.
However, the growing acceptance of self-diagnosis also highlights the urgent need for systemic changes. Improved funding, streamlined referral pathways, and better training for healthcare professionals are essential to ensure timely access to formal assessments. Without these changes, many individuals may continue to rely on self-diagnosis as the only accessible option, missing out on the comprehensive support they need.
If as a society we embrace a more inclusive approach and invest in neurodivergent services, we can do our best to ensure that all individuals and families receive the care they deserve, regardless of whether their diagnosis is self-identified or clinically confirmed.
References:
Children’s Commissioner. (2024). Autism diagnosis delays: A growing concern.
Fletcher-Watson, S., & Russell, G. (2023). Diagnostic expansion and co-occurring conditions in autism and ADHD. Journal of Child Psychology and Psychiatry.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child.
Nuffield Trust. (2024). NHS faces unprecedented demand for autism and ADHD services.
Paloma Health. (2024). Innovative solutions for faster autism assessments.