Coping with the increase in diagnoses of ADHD and autism

The final report of the Independent Review into Prevalence and Support for Mental Health Conditions, Autism and ADHD has been published (see previous post about interim report). As I’ve mentioned before (eg. see previous post), specialist neurodiversity services (although the review does not want to use the term ‘neurodiversity’) tend to be separated from general mental health services. This was partly because general psychiatrists did not want to be, even had concerns about being (see another previous post), involved with such assessments and treatment, particularly initially when the concept of adult ADHD expanded from its origin in the 1990s. So referrals for ADHD and autism tend to be separated off into specialist services creating vast waiting lists. Both ADHD and autism were originally childhood diagnoses, which have been extended into being also adult diagnoses, usually made in retrospect. I think the review could have emphasised more how such adult diagnoses have been developed over recent years from what were originally seen as primarily childhood diagnoses. Putting ADHD and autism together in the paradigm of neurodiversity only really developed from the 2010s, at least partly by online communities.

The review proposes more integration of services for ADHD and autism with general services by developing what it calls a shared needs assessment and prioritisation framework, both for commissioning and delivery. This includes what it calls closing treatment gaps by investing in services for those with severe, complex and enduring needs. Such changes will be delivered through implementation of a new cross-governmental mental health strategy, which I have been pointing out is needed to deal with the current fragmented and dysfunctional nature of services (see eg. previous post).

It will be interesting to see how willing and able already hard-pressed general services are in taking on responsibility for also dealing with referrals for neurodiversity. At least it should mean than assessments and formulations will be more comprehensive, rather than focused on merely filling out screening questionnaires. For children and adolescents it may lead to a shift to a more familial focus, rather than just on the child.

The review fudges what I think is the fundamental issue of the neuro-turn in popular and academic culture for our understanding of neurodiversity and mental health conditions (see eg. previous post). The increasing biologisation of the self means that people diagnosed with ADHD or autism tend to see themselves as having different kinds of brains. Neurodiversity tends to mean neurological diversity in common parlance (see eg. last post). The report does little to counter such thinking, although it does recommend commissioning a national public information and education campaign to help people better understand, support and accommodate neurodevelopmental conditions and manage their mental health. However, it does not really say what the content of such a national public campaign will be. In fact, the report says that “[n]eurodevelopmental conditions describe differences in the development of the brain and nervous system” when there is no clear such evidence. Of course personal development is mediated by the brain but that does not mean it is necessarily caused by it. Conceptually it doesn’t really make sense to blame ADHD and autistic brains for our personal nature, which of course is embodied in the brain and the body more generally but is also embedded in the environment. It is important to try and understand the reasons for why we think, feel and act as we do, but they cannot be proven or demonstrated in naturalistic terms. People are more than their brains, and are being misled about the nature of ADHD and autism. 

The review concludes that continuing as we are is unsustainable. How much it will lead to any real changes, or provide recommendations for government to make real changes, remains to be seen.