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BMJ. Jan 24, 2004; 328(7433): 226.
PMCID: PMC318517
Diagnosis of autism
Current epidemic has social context
Sami Timimi, consultant child and adolescent psychiatrist
Ash Villa, Sleaford, Lincolnshire NG34 8QA ; stimimi/at/talk21.com
Editor—In their article on the diagnosis of autism Baird et al completely ignore context.1 They focus on an explanation within the child for the rapid rise in rates of diagnosis, implying that the only cultural factor affecting this has been low rates of recognition in the past.
The immaturity of children may be a fact of biology, but the meaning ascribed to this immaturity is a fact of culture. Without any tangible evidence of organic pathology and any biological tests to substantiate our hypothesis of a neurological dysfunction, the boundaries of the disorder can expand endlessly and are dependent on the subjective opinion of the person making the diagnosis.2
Our notions of child development are culture bound and too often create a blueprint of age dependent expectations that ordinary parents fear our children cannot meet, rather than a set of required behaviours that our children must master if they are to be considered fully human. And why the over-representation of boys?
In my clinical practice I often come across children and adolescents who are labelled autistic. When I focus on their abilities I often find much about them that does not fit the autistic discourse. Once I reopen the question of diagnosis many adolescents ask me to officially “undiagnose” them, which their parents are usually very pleased about.
We can and should do better than this relentless medicalisation of children and must become more competent at integrating medical theory with other perspectives, otherwise we will soon have a grown up generation of children (mainly boys) who have become unnecessarily convinced that they are somehow deficient and incapable.
Notes
Competing interests: None declared.
References
1. Baird G, Cass H, Slonims V. Diagnosis of autism. BMJ 2003;327: 488. (30 August.) [PMC free article] [PubMed]
2. Timimi S. Pathological child psychiatry and the medicalization of childhood. Hove: Brunner-Routledge, 2002.
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