The Fonagy report revealed and implications for autism, ADHD and mental illness

"ADHD and autism at risk of over-diagnosis, says government review" https://www.bbc.co.uk/news/articles/crkg7n1ypj24o 

One of many media headlines around the final Fonagy review into autism, attention-deficit hyperactivity disorder (ADHD) and mental health conditions seeing the light of day today: https://www.gov.uk/government/publications/independent-review-into-mental-health-conditions-adhd-and-autism-final-report 

And as expected, as the various media leaks have noted, the headline is that there's a 'risk' of quite a bit of overdiagnosis, particularly when it comes to autism and ADHD and that the explosion of private sector assessment services is probably going to see some much needed regulation. The days of your average Joe or Josephine waving their 'I have an assessment certificate' without suitable professional qualifications and experience are numbered it seems. Indeed, shortly following the publication of the report, the CQC here in Blighty said they were probably going to oblige: https://www.cqc.org.uk/news/cqc-regulate-autism-and-adhd-diagnostic-assessments and with it multiple websites no doubt removed unevidenced words like 'neuroaffirming' and the like.

Obviously there's lots of nuance around such headlines. Lots of nuance. And lots of different opinions about the report and how the media have covered it. But there's quite a few positives too:

• We should, hopefully, eventually see a move towards less 'autism or ADHD assessments' to something a little more comprehensive like a 'behavioural, neurodevelopmental and psychiatric assessment' combined, complete with non-assumptions. This on the basis that there is no doubt that people are genuinely suffering but that the ICD-11 already tells us that 'autistic or ADHD traits are not the sole domain of a diagnosis of autism or ADHD' https://icd.who.int/browse/2025-01/mms/en#437815624. 
• We should see other diagnostic options - less socially desirable but probably more fitting for some - being assessed and diagnosed e.g. https://www.psychiatrictimes.com/view/when-the-wrong-diagnosis-is-the-most-dangerous-prescription . 
• And we should hopefully see more action around how autism - probably autisms (plural): https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/from-autism-to-the-plural-autisms-evidence-from-differing-aetiologies-developmental-trajectories-and-symptom-intensity-combinations/4D9B0B35DCF03FDBA4E001F7DC9B02D6 - are more likely 'autisms plus' rather than being a standalone condition: https://pmc.ncbi.nlm.nih.gov/articles/PMC13512144/ just like many people (including me) have been saying and what that means for those more comprehensive assessments. Same probably goes for ADHD(s) too.

There's more besides across the report and various media too.

"Not everyone with ADHD and autism traits needs a diagnosis, major review finds" https://www.independent.co.uk/news/uk/home-news/adhd-autism-overdiagnosis-mental-health-streeting-welfare-b3063507.html which brings us full circle back to the idea that concepts like the 'broader autism phenotype (BAP)' were really good explanations of subthreshold autism(s). That autistic traits are very much part of the human experience outside of just being 'pathological'. Obviously, what turns autistic traits into autism is because traits begin to manifest well outside of the 'typical' in both severity and persistence and, importantly, also interfere with day-to-day life. That's why gold-standard tools like ADOS do a great job of highlighting the 'outside of typical' but it is clinical opinion - professional clinical opinion - that makes the final judgement call on 'interfering with day-to-day life' and onwards the diagnosis or not. The other side of this is recognition that autistic traits are NOT now considered the sole domain of a diagnosis of autism. Even if some autistic traits may be deemed 'atypical', if the pattern of presentation of those traits (and others) is better fitting of something else, well, then it's either that something else or potentially autism plus that something else that should be diagnosed. Again also apply to ADHD.

And finally: "There are weaknesses in the data. Evidence about the true level of autism relies on surveys that have not been done for nine years, so the review team have had to estimate what has happened since." https://www.bbc.co.uk/news/articles/crn8wyl4n42yo This refers to the observation that we don't actually know how many kids and young people have autism here in England or the UK. Well, that's not entirely accurate...

Take for example, Northern Ireland, who have been collecting data on school-aged autism diagnoses for nearly 20 years. Their latest report: https://www.health-ni.gov.uk/sites/default/files/2026-05/asd-children-ni-2026.pdf puts the school-aged autism rate for 2025/2026 at 6.2% (8.6% in males). Of course this is administrative data so perhaps not the same as other kinds of data. But I would have thought that education departments aren't likely to hand out important diagnoses like autism if they didn't have to because they end up costing them money. And government bean counters don't like spending money if they don't have to.

The publication of the Fonagy review is a Red Letter Day. For lots of reasons. Not least recognition that behavioural, neurodevelopmental and psychiatric disorders are really, really disabling. And we need to do a lot more to accurately assess and diagnose so that targeted help and support and intervention can be suitably provided.

The end of the (science) road for 'neurodivergent'?

Mapping Clinical Diagnoses Associated With Neurodiversity and Neurodivergence in Mental Health Research: A Scoping Review https://pubmed.ncbi.nlm.nih.gov/42747846/

"While neurodivergence and neurodiversity are valuable for capturing lived experience, their lack of specificity may introduce substantial heterogeneity in research focused on clinical categories."

Pretty much says what many - particularly professionals - have been thinking for a while: by all means use your (non-evidenced) 'neurodivergence' in your social media and pop psychology articles and the like but when it comes to using such (non-evidenced) terms in science and particularly in objective, supposedly replicable science, maybe think again.

And more: "prioritizing precise diagnostic descriptors in clinical practice and research involving clinically defined conditions, while reserving neurodivergent for studies and contexts focused on self-identification and identity." Indeed.

There's been numerous times when 'neurodivergence' and other neuro-prefixed malarkey have been used in 'supposed' science, typically under the auspice of 'community preference' or with some 'we shouldn't use words like disorder' in mind. It's of course noble to help try and reduce stigma but typically doesn't actually fit in with what science is supposed to be along lines of objectivity and importantly, accuracy and reproducibility. 

My main beef with something like 'neurodivergence' (aside from not actually being rooted in any science) is that people seem to make up what it actually includes and importantly, doesn't include. You've probably seen the AI slop 'umbrellas' trying to convince people that conditions like autism, ADHD, schizophrenia, and more are somehow 'united' in some new and alternative 'way of thinking'. Its neuroBS of course but it doesn't stop some. And when it comes to the 'deviant' ways of thinking, things like the various -philias for example, you won't typically find them mentioned, despite their perhaps being the archetypal 'neurodivergences'. Same goes also for still highly stigmatised but life-changing diagnoses like personality disorders and more too, which again aren't typically the nice socially-acceptable face of neurodivergence.

But it appears that time is being called on such neuroshenanigans and how science is about accuracy and objectivity and not the neurofashion de jour. All of this added to a bit of sea change in various opinions around what some elements of academia seem to be trying to pass off as science.

Next up: how the self-diagnosis of conditions like autism and ADHD have also been included and passed off as 'autism' and 'ADHD' by some 'science'. And that's also definitely mudded the waters of certain studies and their findings. Hold on to your neurohats...

"an identity rather than a disorder": how some people are (wrongly) framing ADHD and more

"Some people now regard ADHD [attention-deficit hyperactivity disorder] as “an identity, rather than a disorder”, with the result that many obtain assessments from poor quality private providers, which lead them to “believe they have a condition needing treatment”, said the psychiatrist Dr Marios Adamou, the founder of the UK Adult ADHD Network." https://www.theguardian.com/society/2026/aug/18/great-adhd-myth-rising-diagnosis-without-treatment

If there is one voice who is 'tellin' it like it is' in the context of serious and disabling neurodevelopmental disorders like ADHD and autism, that voice is psychiatrist Marios Adamou. 

And not only is he talking sense in the media, he's also got the research record to back it up in terms of his studies on triage models of adult autism assessment (see here), bringing reality to bear on the concept of 'masking' across various neurodevelopmental disorders such as ADHD (see here) and autism (see here) (hint: it's probably not compatible with said disabilities), the hows-and-whys people seek ADHD and autism assessments (see here) and what can happen when professionals say 'it 'aint ADHD or autism' (see here). 

And I for one, want to hear a lot more of his professional and research-informed opinions over and above the neurobabble - often impossible neurobabble - that some have spouted in these days of (social media) trainers and coaching. Reality is re-entering the room. And not a moment too soon, particularly for those who are genuinely disabled by what are disabling behaviourally-defined neurodevelopmental disorders (and the c**p they've had to endure at the hands of identity politics and its purveyors).

Next up: the conversations needed around who is actually qualified to assess for and diagnose ADHD or indeed, related diagnostic labels like autism (see here) (hint: probably not someone who just as a certificate in one or more assessment tools but no clinical qualifications, skills and experience) and just how forensic assessments need to be (see here), particularly keeping mind that ADHD and/or autistic traits are probably not the sole domain of a clinical diagnosis of ADHD and/or autism according to the ICD-11 diagnostic criteria. Oh, and as per our recent contribution to autism science, an appreciation that autism (and ADHD and more) are rarely stand-alone conditions (see here) thus introducing yet more clinical complexity. If in doubt, seek out an expert.

Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis?

Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis? https://www.cambridge.org/core/journals/psychological-medicine/article/autism-spectrum-disorder-has-it-lost-its-meaning-and-is-it-leading-to-misdiagnosis/AF834026D004D42B1963BEA515495AC6

A new paper from Prof. Uta Frith that is already making some media headlines including "Academic warns that ‘almost magnetic attraction’ to having condition means term is being misused." This follows recent previous headlines based on what she's said. Now, there'll all in a science paper.

And what a paragraph this is: "Among drivers for the increase in prevalence are cultural changes, such as the desire for inclusion, harm avoidance, reliance on self-report, and the acceptance of masking. These have all led to a lowering of the diagnostic threshold. Furthermore, the popularity of the concept of autism boosted numbers via self-diagnosis and a search for identity."

That's going to be absolute garlic to some (particularly where (neuro)marketing, training and other livelihoods are part-and-parcel of the social media age in which we live). But actually, she's probably right as per what's been said by quite a few other notable people and what the data seem to be telling us. By saying that I actually also believe we are seeing a part real increase in (childhood) autism as per what various stats from various geographies have been telling us for quite a few years.

Talk about 'masking' - it's actually reputation management - and the myriad of 'self-diagnosing' - but not self-diagnosing other less palatable conditions which very much overlap with autism - are receiving some well-deserved scrutiny these days. Not least in the context that according to the ICD-11 criteria, autistic traits are not the sole domain of a diagnosis of autism on the basis of those boundary conditions that accompany clinical descriptions, and to decipher what is what takes (medical) professional and multidisciplinary examinations and not some random who just holds a certificate on one or more autism assessment - that's assessment not diagnosis - instruments. 

When eminent people such as Prof. Frith are writing an article like this, it's probably time to start listening. That won't make an iota of difference to some who are already invested in stuff like 'self-diagnosis is 100% valid' and the like. But for everyone else, a correction is starting to happen and happen not a moment too soon. And too her media quote: "Splitting up the spectrum would ultimately prevent misdiagnosis" is already happening as per the rise and rise of profound autism and the realisation that 'heterogeneous' is not just a word.

Next up: the Fonagy review is probably due to report soon here in Blighty (https://www.gov.uk/government/collections/independent-review-into-mental-health-conditions-adhd-and-autism) and what its found around autism, ADHD and more. I can probably guess that they won't be disagreeing with Prof Frith...

"In 2024, the prevalence reached 21.1‰ among boys": Autism in France

Part of the title to this post - "In 2024, the prevalence reached 21.1‰ among boys" - represents a detail from a recent paper titled: Epidemiology of Autism Spectrum Disorders in French Children Aged 8 https://link.springer.com/article/10.1007/s10803-026-07433-x

Alongside the observation that 21.1 per 1000 boys aged 8 years old may have autism in France (registry-based prevalence), the additional headline is that "ASD at age 8 increased markedly ranging from 2.1‰ in 2003 to 13.5‰ in 2024." 

Around a third of kids with autism also had an intellectual (learning) disability and about a fifth had comorbid attention-deficit hyperactivity disorder (ADHD) according to this data. Oh and the sex ratio was 5:1 boys:girls.

I dunno. Is it perhaps time to starting worrying about how many children are presenting with clinically relevant behaviours leading to being diagnosed with a serious neurodevelopmental disability like autism? Y'know worrying to the extent that the old 'all better awareness' is basically a call for inaction rather than action around hows-and-whys? Worrying about what those figures mean for children (and no, they weren't 'masking' or other stuff), their families, education and healthcare systems and society more widely when it comes to adult outcomes like social care and employment et al?

Added to data from other geographies such as Northern Ireland (see here) where over the last 5 years, they've registered an increase in school-aged autism from 4.2% in 2019/2020 to 6.2% in 2025/2026 and now affecting 8.6% of boys, it's getting a bit concerning don't you think?

'Profound autism' defined: moving closer to compartmentalising the heterogeneous 'autisms'

 A short post to bring a new paper to your attention: Developing a consensus research definition for profound autism using a modified Delphi method https://link.springer.com/article/10.1186/s13229-026-00727-y 

Follows on from the INSAR conference proceeding that moved things on from the previous US CDC definition that moved things on from the Lancet introduction.

Highly likely that there'll be more honing of the term and what it covers but the reasons for not using it (or using some other word salad) are getting smaller and smaller and smaller...

Elevated microbially-derived metabolites in autism: a possible diagnostic screening test for a distinct ASD phenotype

A quick entry to note that a new paper which yours truly had a small role to play in has been recently published: https://www.nature.com/articles/s41380-026-03620-5

There's been some media around it e.g. https://nypost.com/2026/05/27/health/new-urine-test-could-diagnose-autism-in-children-study/ and how after several years of collaborative research, some potentially important findings in relation to gut bacterial metabolites present in urine *might* be important to some autisms. I've stressed *might* because there's still more to do in this area and indeed, work is still continuing.

There's a couple of things that are standout in the new paper including (i) how mass spectrometry really is a top-notch method in relation to the science of metabolomics https://pharmaceutical-journal.com/article/research/in-search-of-biomarkers-the-science-of-metabolomics-in-pharmacy (particularly when one more than system are independently at work), (ii) gut and yeast related metabolites present in urine are detectable and potentially quite important to some autisms and perhaps beyond as part of that gut-brain axis, and (iii) the Easter egg in the paper was around how some autisms seemed to be linked to various previously undetected inborn errors of metabolism (most screens of IEM via the baby blood spot measurement are done with mass spectrometry too).

I'm not going to bore you with the details particularly when the rather fantastic Dr Jim Adams is going to be hosting a talk about it in the coming days - register here: https://us06web.zoom.us/webinar/register/3617798965724/WN_RBm7QCaFRceTq1EjU8HFsQ#/registration If you're so inclined, register and have a watch.

Childhood autism in Northern Ireland: 6.2% for 2025/2026 (still relentlessly increasing)

The school-aged autism prevalence rate in Northern Ireland for 2025/2026 is 6.2% https://www.health-ni.gov.uk/sites/default/files/2026-05/asd-children-ni-2026.pdf 

Last year - 2024/2025 - it was 5.9%.

The prevalence rate of autism in boys in Northern Ireland for 2025/2026 is 8.6%. Last year (2024/2025) it was 8.3%.

The sustained upwards trend of childhood autism continues. It's now 1 in 16 if my maths are correct. 1 in 16 school-aged children in Northern Ireland has a diagnosis of autism. An avalanche of children presenting with clinically relevant autism and being diagnosed as such. And even more needs waiting in the wings as per the huge waiting lists for autism assessment.

Reasons? Well 'all better awareness' is something best left for the 1990s. It would be a brave (or stupid) person who takes up that gauntlet. 'Expanding diagnostic criteria' will probably have played a role, but bear in mind these figures have already included the change in data collection that happened in 2019/2020 which accounted for this. 

No, there is something else driving this tsunami of disability. And there's no such thing as a genetic epidemic...

Prof Uta Frith on autism: "why I no longer think autism is a spectrum" and a whole lot more

Uta Frith: why I no longer think autism is a spectrum https://www.tes.com/magazine/teaching-learning/general/uta-frith-interview-autism-not-spectrum

I often find that as people age/mature and maybe start to take their foot off often powerful careers, they tend to say more of what they actually think rather than what the 'trends' say they should think.

I think the same applies to this interview with the very famous Uta Frith and some of her views on autism now, particularly in the context of the singular description of autism now moving to something a little more 'plural' (sounds very familiar).

A few choice phrases: "... people still hang on to the idea that there is something that unites all the people who are diagnosed as autistic. I don’t believe that any more." Can't argue with that as the old 'autism community' which was often used by some very vocal people to give the impression that 'everyone agrees with me' gives way to the plural autisms communities. The diagnostic criteria for autism still unite all, but the expression of those core symptoms and their meaning and effects do not.

Further: "I think at least we have two big subgroups: the people who are diagnosed in early childhood - usually before age three or age five, depending on things like their intellectual abilities and language - and another group, diagnosed much later." Yes, one of many 'partitions' that subdivide the very heterogeneous autism label. There's lots more across symptoms intensities, developmental trajectories and also importantly, different aetiologies. The plural autisms.

"Now, I think the people in the second group really do have problems. I would definitely not say they are “making it up”. But I would say that these are problems that can perhaps be treated much better than under the label of “autism”. I would fight for that label to be limited to the first group." That is a big statement unlikely to make too many friends among certain people/groups. But I think she's right, as per the seemingly now redundant label of 'social (pragmatic) communication disorder' remaining underused and how autistic traits don't necessarily mean autism (see the ICD-11 autism criteria for what else it might mean).

And finally: "The masking idea has no scientific basis, yet everybody, including the researchers and the clinicians, has been enamoured with this idea." Not me. And certainly not Prof Fombonne and his 'poor fit' description. Indeed, even the 'science' on autism and masking isn't too sure: e.g. Camouflaging and autism: Conceptualisation and methodological issues (and that's putting it mildly).

Indeed her 'shredding' of masking / camouflaging in the context of autism is particularly welcome and a bit of wake-up call to various academics, some of whom have seemingly forgotten what (a) autism is, and (b) what scientific evidence is. It might also be worth their while looking up Hacking's 'Looping Effects' too. Mind you, they also tend be the same people who would happily study autism and include those who 'self-diagnose' as all part of a homogenous group. Even many people with autism are getting a bit sick of that (see here) as per the words: "Self-diagnosis “muddies the water”". If you'd care to see the ICD-11 autism diagnosis boundary conditions, you'll also see what other conditions may well be included in such 'self-diagnosing' studies including personality disorders and schizophrenia spectrum disorders. Nobody seems to be running to self-diagnose with them.

There'll be blood boiling about this piece from someone who knows more than most about autism but on many points, she's probably right.

2025: the year of plural autisms, folate chemistry and when curiosity about autism returned

Spectrum 2025: Year in review https://www.thetransmitter.org/spectrum/spectrum-2025-year-in-review/

A 'what happened in 2025' feature that covers the main elements of autism in 2025 including: (1) we're heading back to asking the questions of 'how and why?' about autism rather than falling back on some pseudo-religious neurobabble, (2) US policy on autism has been driving lots of focus particularly on folate chemistry - cerebral folate deficiency (CFD), folate receptor autoantibodies (FRAAs) and leucovorin (folinic acid) - and some autisms, and (3) the year that the plural autisms finally emerged into the mainstream. That last one is particularly close to my research heart: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/from-autism-to-the-plural-autisms-evidence-from-differing-aetiologies-developmental-trajectories-and-symptom-intensity-combinations/4D9B0B35DCF03FDBA4E001F7DC9B02D6

2025 has been a pivotal year for autism as the 'lack of curiosity' of the past few years (in some quarters) has given way to more people asking important questions. It's no longer about whether 'identity first language' trumps 'person first language' (indeed, whole swaithes of identity related stuff has been shown for what it really is) or whether other such meaningless word policing is important to many people's lives, but what can actually help people with autism and their parents/carers, particularly those with severe and/or profound autism. Indeed, mention of those words 'severe' or 'profound autism' is only going to accelerate as the old 'autism is autism' mantra dwindled further in 2025 and as 'people' or 'person' become primary, rather than their diagnostic label.

There's lots of hope for 2026 that things will continue at a similar pace.

Maternal autoantibody related (MAR) autism goes mainstream

"MARAbio Launches First-Ever Blood Test For Maternal Autoantibody Related Autism" https://www.marabio.com/test-launch

Woah. 

Just when you thought 2025 couldn't bring anything else to the world of the autisms (plural), a press release which was kinda expected but is now an actuality.

MAR autism - maternal autoantibody related autism - has been on the research menu for a while. Quite a few scientific papers have found it and indeed, found the specific autoantibodies (to foetal tissue) that seem to be pathogenic for risk of this type of autism. And it's not just testing either, as some science has talked about the ways-and-means to 'avert' the effects of those antibodies too and impact on offspring autism risk. This has been years in the making. 

"Commenting on the potential impact of this launch for providers and families, noted clinician and autism researcher Richard E. Frye, MD, PhD, said, "With MARAbio's test now available, particularly for those families already touched by autism, we now have access to meaningful insights into this particular and prevalent cause of autism, including the likelihood of MARA in future children. It's an exciting advancement that brings science and compassionate healthcare together in a truly impactful way."

It should perhaps be noted that the research into other types of autoantibodies - folate receptor autoantibodies - by Dr Frye and others has also been an achievement unlocked in 2025. Indeed, both these streams of research and now clinical practice, whilst so far distinct, point to a pivotal role for immune functions and their effects across quite a few autisms. And that should provide some important clues for future work on 'how and 'why' and what to do about it.

And yet more evidence for those plural autisms which is music to my research ears...

"It will recommend practical, evidence-based approaches to prevention and early intervention..."

Review launched into mental health, autism and ADHD services https://www.gov.uk/government/news/review-launched-into-mental-health-autism-and-adhd-services 

The offical government announcement on the review into mental health, autism and ADHD services launched by the UK Government today. It looks like the important issues to "look at rising demand for mental health, ADHD, and autism services and what is driving it" are actually being taken seriously. That sentence on action as well, around intervention and, dare I say it, prevention, is also quite the change of tack from previous administrations. 

Of course it all boils down the how much the various diagnoses are costing in terms of education, healthcare and social care and benefits given the massive rises in those diagnoses and what they mean for lots of different outcomes. For example, a childhood autism rate for 2024/2025 approaching 6% in Northern Ireland combined with the recent APMS data telling us that the adult autism rate in England has been static at 1% for nearly two decades is a case in point. It would be naive to think lack of money and lack of resources isn't the primary driving factors behind such a review given what this government has already tried to do when it comes to cutting costs. 

But an opportunity is an opportunity.

"My aim is to test assumptions rigorously and listen closely to those most affected, so that our recommendations are both honest and genuinely useful. We owe it to children and families, young people and adults to provide government with advice that is proportionate, evidence-based, and capable of improving people’s lives." 

I don't think anyone can really ask for more than that sentence from the head of this new review. Indeed it seemingly follows the changes to US policy particularly around autism, where people are actually starting to ask questions about 'how and why' rather than sticking with the usual babble (neuro) and other fluff that has contributed to some people not wanting to ask questions about important conditions which affect many peoples' lives.

"Autism (examined using ADOS) has remained stable in prevalence since 2007, at about one in a hundred adults (0.8%)."

"Autism (examined using ADOS) has remained stable in prevalence since 2007, at about one in a hundred adults (0.8%)." https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24

Data released today (27th November 2025) from the Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4.

It puts pay to the idea that there is any sort of equivalence in child and adult rates of autism (and that there ever has been). Said equivalent child autism rate is currently anywhere between 2-6% of school-aged children depending on what data you use.

We knew this of course, from the data from Tromans et al: e.g. Characteristics and primary care experiences of people who self-report as autistic: a probability sample survey of adults registered with primary care services in England https://pubmed.ncbi.nlm.nih.gov/39277196/ (based on self-report) and more.

It tells us, yet again, that the massive increase in autism prevalence is being driven by new childhood cases (autism is a childhood neurodevelopmental disorder so not really surprising). And also no, there aren't 'missing millions' of adults with undiagnosed autism as per what Adamou et al reported when they actually assessed adults who presented at clinic: Enhancing Adult Autism Diagnostic Pathways: The Role of Clinical Triage in Efficient Service Provision https://pubmed.ncbi.nlm.nih.gov/40363963/ (and proved that triage works).

So then, a question: what is causing huge numbers of children to present with and be diagnosed with autism? 

Well, only yesterday, some evidence that the words 'it's all genetic' are not a great explanation: e.g. As rates of ASD and ADHD rise, genetic contributions fall: Evidence for widening diagnostic criteria https://pubmed.ncbi.nlm.nih.gov/41292638/ which opens the door to issues like (a) widening diagnostic criteria and/or (b) environmental - non-genetic - factors 'causing' more autism. Or both?

Oh and keep in mind that despite the dogma, autism is not universally a lifelong condition for everyone e.g. https://pubmed.ncbi.nlm.nih.gov/31632036/ which may well partly explain why the adult autism rate is and has been so static for so many years...

Prenatal folic acid and multivitamin supplementation and offspring autism risk: umbrella-ified review

"Maternal prenatal folic acid and multivitamin supplementation are associated with a reduced risk of ASD [autism spectrum disorder] in offspring. These findings have important public health implications, suggesting that prenatal supplementation could help mitigate the risk of ASD in children." https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0334852

The results of an umbrella review that included 8 other systematic reviews or meta-analyses which themselves included over 100 studies which included several million mother-child pairs. In short, top tier evidence.

"Prenatal folic acid and/or multivitamin supplementation was associated with a 30% reduced risk of ASD in offspring (RR = 0.70, 95% CI: 0.62, 0.78; GRADE: highly suggestive). Subgroup analysis by supplement type showed that maternal prenatal multivitamin supplementation reduced the risk of ASD by 34% (RR = 0.66, 95% CI: 0.55–0.80; GRADE: highly suggestive), while folic acid supplementation was associated with a 30% reduction in ASD risk (RR = 0.70, 95% CI: 0.60–0.83; GRADE: highly suggestive)."

And yet again, folate metabolism and autism. 

The same folate metabolism and autism that is also US health policy now in terms of some autisms being potentially linked to cerebral folate deficiency (CFD) and/or folate receptor autoantibodies (FRAAs) meriting use of leucovorin (folinic acid). The difference being that in those areas - CFD and FRAAs - folic acid may not be the optimal supplement to use, as per why folinic acid (and perhaps even methylfolate) is instead being suggested for some children/adults with autism. Whether that might also translate into similar issues with folate metabolism for mums-to-be too as, being a risk factor for offspring autism, remains to be seen.

Nutritional factors being important to at least some autisms? Who'd have thunk that?

Folinic acid (leucovorin) and autism: what kept you?

A Closer Look at the Drug Trump Is Touting for Autism: https://www.wsj.com/health/wellness/autism-leucovorin-science-research-0a666a8d

As the dust settles from what has been quite a monumental week for autism policy over on the US side of the Pond, particularly the new guidance on the use of leucovorin (folinic acid) for some autisms, some important questions emerge... 

Science has known about the potential connections between some autisms and cerebral folate deficiency (CFD), those folate receptor autoantibodies and the usefulness of folinic acid for some autisms for a while. I talked about them back in 2012: Don't panic! Folate receptor autoantibodies and autism https://questioning-answers.blogspot.com/2012/01/dont-panic-folate-receptor.html So why did it take so long for such research to be government evaluated and considered worthy of such a move from 'bench to bedside'? What were previous administrations doing and what stopped this 'bench to bedside' move happening years ago?

I'm sure the answer is going to be complicated. Not least to include certain attitudes to autism (the autisms) from some certain quarters, what sorts of medicines are potentially indicated for said autisms (and whether there is monetary value attached to their usage) and the important need for as-near-as-possible solid science (particularly in the context of safety).

But it now appears there is more a 'pipeline' moving forwards, whereby similarly important biological mechanisms and related interventions can seemingly be quickly evaluated across the autisms. Indeed it again brings to mind the work on other medicines such as suramin and also the very promising results for CM-AT e.g. Pancreatic Replacement Therapy for Maladaptive Behaviors in Preschool Children With Autism Spectrum Disorder https://pmc.ncbi.nlm.nih.gov/articles/PMC10690476/ Also too, potentially important are the writings from the US FDA not so long ago about other intervention options for some autisms and the need for more controlled study e.g. Biological therapies need definitive randomized controlled clinical trials https://www.science.org/doi/10.1126/scitranslmed.adg2970 something that also seems to be a priority for the current US administration as older, less fruitful avenues of study will inevitably be replaced.

I think we have turned a corner in our understanding of the autisms and indeed, the desire to see safe and effective intervention options that help to remove at least some of the disability associated with the autisms. And where the US leads in policy around autism, other countries are sure to follow.

Northern Ireland: 5.9% of school-aged children with autism in 2025

It's here... The prevalence of autism (including Asperger’s Syndrome) in school age children in Northern Ireland 2025 https://www.health-ni.gov.uk/sites/default/files/2025-05/asd-children-ni-2025.pdf

In 2023 the estimated prevalence rate for school-aged children was 5%. They missed 2024 but now in 2025 the rate is 5.9%. Read that back to yourself: 5.9%

And for boys... well, in 2023 the rate was 7.3% of school-aged boys with autism. In 2025, it's 8.3% of boys with autism. Again, read once more: 8.3% of boys.

No doubt there will be some who talk about 'better awareness' or 'expanding diagnostic criteria' as the cause(s) of the increase. The current iteration of the DSM diagnostic manual (DSM-5) came into being in 2013. The current iteration of the ICD diagnostic manual (ICD-11) came into being in 2018. Ask yourself: is it really so difficult to think that there may be a real increase in both autistic behaviours and autism diagnoses? Y'know, could part of the increase in autism be real? I believe the data suggest yes, it is part real. And probably quite a lot part real too.

"Majority in UK now ‘self-identify’ as neurodivergent"... read that back to yourself a few times.

"Majority in UK now ‘self-identify’ as neurodivergent" https://www.thetimes.com/uk/science/article/self-diagnose-neurodivergent-99l9kl8v5

Read that back to yourself a few time particularly the words 'majority' and 'neurodivergent'. 

Namely that if a majority of people are calling themselves 'neurodivergent', that means that a minority of people must be 'neurotypical'. So more people are 'diverging' from the 'typical' but still managing to be a majority of people or something? 

That sound you just heard? That's the sound of neurobabble crashing and burning yet again...

Are there 'millions missing' when it comes to adult autism?

Enhancing Adult Autism Diagnostic Pathways: The Role of Clinical Triage in Efficient Service Provision https://www.mdpi.com/2077-0383/14/9/2933

The Adamou paper sees the important peer-reviewed light of day having spent some time as a preprint.

It took 60 people referred to the "specialist adult Autism Service in West Yorkshire, UK, from November 2021 to August 2022" with suspected autism. Triage teams assessed them for autism including information from multiple sources and concluded that: "No clinical diagnoses of ASD were confirmed in the assessed sample."

This is an important paper requiring further follow-up. It tells us that there are perfectly good models of autism assessment triage that are available to healthcare systems such as the UK National Health Service (NHS) which can be used to work through the massive backlog of people awaiting an autism assessment (mostly children but adults as well). 

It also tells us that the stories that there are 'millions missing' in terms of adults with undiagnosed autism are probably not all accurate. Indeed, other evidence has come to a similar conclusions based on 'actual reporting' rather than 'we think there may be many undiagnosed people' estimated reporting: Characteristics and primary care experiences of people who self-report as autistic: a probability sample survey of adults registered with primary care services in England https://pubmed.ncbi.nlm.nih.gov/39277196/ "A total of 4481 of the 623 157 survey participants included in the analysis self-reported autism, yielding a weighted proportion estimate of 1.41% (95% CI 1.35% to 1.46%)." 

You don't need to be a rocket scientist to see the disparity between childhood autism diagnoses (~5%) and adult diagnoses (~1%) to see where the growth in numbers is coming from. Indeed, if one assumes that autism may be either prodromal for some and/or indeed, not universally lifelong for some, those stats make even more sense...

2025: Estimated 1 in 31 8-year old children in the US have autism

 It's here...

Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years — Autism and Developmental Disabilities Monitoring [ADDM] Network, 16 Sites, United States, 2022 https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm

Loads of details to sift through in the paper but the headline is that an estimated 1 in 31 8-year old children in the United States (US) in 2022 has autism.

It also provides some details about 4-year olds too and the rather ominous data that in some States, the rate of autism in 4-year olds was higher than that in 8-year olds suggesting that more (estimated) prevalence increases are on the horizon in future prevalence studies. Northern Ireland data for school-aged autism stood at 1 in 20 with autism in 2022-23 (there was no data for 2023-24) so there's a possible inkling of how far it may go and even surpass....

Other information: "Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability." So it looks like profound/severe autism is probably more prevalent than the 26% figure previously independently reported by the CDC ADDM. This is another important point because this highlights how the type of autism we've been seeing increasing over the last 30 years or so - the recent press conference held by the US HHS Secretary suggested the increase began back in 1989 - isn't the type of autism that is typically missed. And indeed, it looks like the severity profile of those being diagnosed is getting more and more severe, more and more complicated, after each round of ADDM data.

There's been a fair few media column inches about this already with much more to go. Yet again, the tired argument of 'all better awareness' has been dragged out of the cupboard under the stairs as a primary explanator for the latest figures. Well, better awareness probably does play some role but I'm not sure that its as much as some people believe. Indeed, if you are genuinely convinced that assessment professionals and diagnosticians have previously been so bad at identifying autism - for literally decades - and only now have 'woken up' to what autism looks like, I have some magic beans to sell you...

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The autisms. Now published.

I hope readers might indulge me in this short post as I link to our new paper - March 2025 new - discussing movement from the singular autism label to something a little more real-world: the autisms. From autism to the plural ‘autisms’: evidence from differing aetiologies, developmental trajectories and symptom intensity combinations https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/from-autism-to-the-plural-autisms-evidence-from-differing-aetiologies-developmental-trajectories-and-symptom-intensity-combinations/4D9B0B35DCF03FDBA4E001F7DC9B02D6

Those who know of my incessant droning on about the plural autisms as an attempt to try and accomodate the massive heterogeneity covered under the diagnostic label autism won't be surprised by this publication. The logic is simple: based on three primary 'vectors' covering differences in aetiologies, differences in developmental trajectories and differences in symptom intensities there may be some way to 'compartmentalise' the autisms, hopefully helping both research and practice. The next step is how to organise those autisms...

I'd like to thank my co-authors on this paper and our collaborative efforts to get this paper written and published. I'd also like to thank both the editor and editorial staff at the British Journal of Psychiatry too, who've done a sterling job in helping us to mould this paper into what it became. I'd also like to thank our peer-reviewers - all six of them - who with annonymity, provided some great feedback to us. No, there was no 'Reviewer 2', just lots of really great observations that led to some great discussions and a much better paper as a result.

We're not claiming to know all the answers when it comes to tackling the heterogeneity around the autisms. Just offering one among many potential solutions designed to spark further debate and science. Enjoy.