I mentioned that there would be more posts coming from The Preventing Overdiagnosis 2025 International Conference. Dr. Lundström gave a terrific talk at the meeting about work – both clinical and academic – that he and his colleagues are doing. Some of the issues discussed here are specific to Sweden. Still, I think the underlying message is important to everyone – and is perhaps even more timely than when I first asked him to write for Sensible Medicine. It seems to me that whether one thinks rates of neurodevelopmental disorders have increased or have stayed stable has little to do with actual data.
Adam Cifu
During the last decades, there has been a dramatic increase in the number of autism spectrum disorder (ASD) and ADHD diagnoses. To understand the rise in the prevalence and the consequences, several interrelated medical and societal developments must be acknowledged. Five are probably most critical.
ASD and ADHD are today considered the extreme end of a distribution of traits, with no clear demarcation between individuals with and without a diagnosis, and with waxing and waning symptomatology.
Diagnostic substitution across psychiatric disorders accounts for as much as one-third of the increase in ASD and likely a substantial proportion for ADHD.
Access to school support or special education services, as well as family and social support, is often contingent upon receiving a diagnosis, whether or not this complies with national regulations. In line with this, a study from Australia reported that up to 20% of clinicians had assigned an ASD diagnosis to individuals not actually meeting the diagnostic threshold, in order to grant access to societal services.
The decreased stigma surrounding diagnostic labels may be a driving force for parents to seek diagnostic evaluations.
A prospective population-based twin study found that while the number of ASD and ADHD symptoms remained stable, the number of registered ASD cases increased steadily over a 10-year period. In a related fashion, our group has shown that considerably fewer symptoms now appear to be required for a clinical diagnosis of ASD or ADHD. The average number of autistic symptoms among children aged 6–12 clinically diagnosed with ASD has decreased by 50% over the same decade, and for ADHD, the corresponding figure is 60% among 10–15-year-olds. We have also shown that the reported negative mental health effects of these ASD and ADHD symptoms have increased by approximately 50% compared to 10 years ago. Thus, all else being equal, having relatively mild autistic and/or ADHD traits today seems to be more impairing in terms of mental health and functioning than it was ten or twenty years ago, although the reasons for this change remain unknown.
When these points are taken together, it seems reasonable to assume that much, or even most, of the rise in ASD and ADHD prevalence reflects changes in diagnostic practice and ascertainment rather than a genuine increase in neurodevelopmental disorders.
At the same time, scholars have expressed concern about the widening gap between diagnostic prevalence and epidemiological expectations. As diagnostic boundaries expand, individuals with relatively minor functional differences increasingly come to inhabit the category of ‘neurodevelopmental disorders’. Those whose experiences fall near diagnostic thresholds highlight a central tension in diagnostic expansion: the same classification that can grant access to needed support in childhood may later restrict participation in adult life. When institutions such as schools, employers, or licensing authorities use diagnoses to manage access and eligibility, these categories become both gateways and barriers, sources of inclusion and exclusion that persist over time.
Between 2023 and 2025, a pilot project was conducted within Child and Adolescent Psychiatry in Region Skåne, Sweden, focusing on individuals who sought to have their ASD and/or ADHD diagnoses reassessed. The project stemmed from the observation that healthcare services in the region—and across the country—regularly receive requests from individuals who no longer wish to retain these diagnoses. Currently, there is no established clinical pathway for handling such requests.
Beginning in 2023, individuals aged 16 years and older, residing in the region and wishing to have their ASD and/or ADHD diagnoses reassessed, were invited to participate in the pilot project. The initiative was a collaboration between the regional public healthcare provider (Region Skåne), Lund University, and the University of Gothenburg. It aimed to evaluate the need for and potential structure of a routine for reassessment of ASD and/or ADHD diagnoses. Seventy-four individuals were included, with the first fourteen participating in voluntary qualitative interviews exploring their motivations and rationales for seeking reassessment. Participants were between 17 and 30 years of age.
The interviews revealed a wide range of experiences and perspectives among participants who sought reassessment of their ADHD and/or autism diagnoses. Interviewees described a persistent duality. Their diagnoses had once provided access to essential forms of support, but later came to limit opportunities in education, employment, and healthcare. Several participants recalled that the diagnosis initially functioned as a practical tool, opening doors to educational accommodations, financial aid, or social assistance that might otherwise have been inaccessible. At the same time, the same classification later became an obstacle in adult life, resurfacing in settings such as job applications, higher education, or military recruitment.
Many recounted how parents or teachers initiated their original assessments in response to behaviours seen as problematic or unusual. Some accepted these early efforts as well-intentioned, while others remembered feeling confused or pressured into a process that did not reflect their own understanding. Several participants noted that behaviours leading to diagnosis, such as restlessness or withdrawal, could also be understood as responses to difficult life circumstances, including trauma, stress, or unstable home environments. The assessment process itself was often described as opaque and adult-driven, leaving little room for the child’s own perspective
The consequences of receiving a diagnosis were described as both enabling and limiting. On one hand, some participants gained access to resources and support that improved their school situation and well-being. On the other hand, some participants described how the diagnosis had diverted attention from more pressing issues, led to unwanted interventions (such as medication or school segregation), or contributed to stigmatization and a sense of being fundamentally different or deficient. Several participants reported that their diagnosis continued to follow them into adulthood, shaping others’ perceptions and limiting opportunities.
In conclusion, the rising prevalence of ASD and ADHD diagnoses in Sweden appears to reflect shifts in diagnostic practice and societal incentives rather than an actual increase in underlying neurodevelopmental traits. The experiences of individuals seeking to reverse their diagnoses underscore the enduring social and institutional power of diagnostic labels outside of the health care system, highlighting the need for reflective, ethically grounded approaches to assessment, follow-up, and re-evaluation in psychiatric care.
Sebastian Lundström, Katalin Niklasson, Michelle Nilsson, Maria Råstam, Allan Lidström, Peik Gustafsson, Rose-Marie Lindkvist, Sophia Eberhard & Lena Eriksson
Sebastian Lundström (sebastian.lundstrom@neuro.gu.se) is a clinical psychologist and a professor in child and adolescent psychiatric sciences. He is affiliated with the University of Gothenburg and Lund University in Sweden and is clinically active in Region Skåne, Sweden. All authors are involved in the re-assessment project described above; KN, MR, PG, and SE are affiliated with Lund University, AL and LE are affiliated with the University of Gothenburg, and MN is the representative for the organization, the Swedish Partnership for Mental Health
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“ The most damning statistic: boys are more than twice as likely as girls to be diagnosed with ADHD. Doctors have made boyhood into a disease.
Similarly, the youngest children in any given classroom are far more likely to be diagnosed with ADHD than their older classmates; relative immaturity is now a psychiatric condition. If your kid was born in August and pees standing up, go ahead and start stockpiling amphetamines now.”
Much more, including a closer look at the inexcusably ridiculous diagnostic process, here:
https://gaty.substack.com/p/synthetic-children
The findings described surprise me not at all...!