Autism used to be a disability now it's an identity - Dr Renee Hoenderkamp

As frontline doctors, we must resist pressure to rubber-stamp requests driven by anxiety or identity-seeking, writes the NHS GP

As a GP, I regularly see parents of teenagers who present not with profound language and developmental differences, but with anxiety, social awkwardness, or a sense that life has not unfolded as hoped. The request is familiar: “We want an autism assessment.”

The young person is bright, verbal and capable of relationships, yet the family believes a formal label will explain the unease and unlock understanding or identity. This has become routine.

It stands in stark contrast to the autistic children I have known across decades of practice. Those patients were often non-verbal, profoundly non-social, frequently with intellectual disability, and severe adaptive challenges.

Autism then is not a subtle trait or cultural affiliation. It is a disability that shaped every aspect of daily life and requires intensive, lifelong support. That is the condition I was trained to recognise. What I see now is far more elastic.

Recent comments from pioneering psychologist Professor Dame Uta Frith crystallise the unease many clinicians feel. She argues the autism spectrum has become too wide, risking confusion and misdiagnosis.

Rates have soared from roughly four in 10,000 children in the 1960s to figures approaching one in 30 in some recent data. Greater awareness and reduced stigma play a part, but so do broader diagnostic criteria, social-media self-identification, and a cultural preference for medical explanations of ordinary difficulty.

Autism has entered popular culture; for some, the label has become desirable. When you create a diagnosis that most people have, it is likely not a medical issue.

This matches what I observe. Anxious teenagers and even middle-aged adults who “didn’t quite achieve what they wanted” seek assessment not because they show the core, disabling features of classic autism, but because the diagnosis offers a framework for disappointment or distress, an explanation of personality.

Social media amplifies simplified checklists. “Neurodiversity” rhetoric frames autism as difference rather than disorder, reducing stigma for some while encouraging people to medicalise personality, temperament, or the normal turbulence of adolescence.

We have lost sight of the boundaries of normal. Shyness, intense interests, preference for routine, difficulty with small talk, or heightened sensitivity once sat within the wide range of human variation. Today they are increasingly pathologised. The medicalisation of everyday struggles extends beyond autism to anxiety, ADHD, and other labels. When every deviation from an idealised smooth path becomes a candidate for diagnosis, ordinary resilience erodes.

Overdiagnosis carries real costs. Stretched resources are diverted from those with profound autism who need intensive therapies and long-term care. A mild or incorrect label can become a self-fulfilling prophecy, shaping identity in limiting ways. It may delay proper help for co-occurring anxiety or social difficulties that respond better to targeted psychological support. Diagnosis shapes treatment, expectations, and self-concept. Getting it wrong helps no one.

None of this denies the reality of autism or the struggles of those who meet proper thresholds, including milder presentations with significant impairment. Accurate diagnosis remains essential, and greater awareness has rightly helped previously missed individuals. The problem is the expansion of the diagnosis until it risks losing clinical meaning, coupled with cultural incentives that make the label attractive.

As frontline doctors, we must resist pressure to rubber-stamp requests driven by anxiety or identity-seeking. We need clearer diagnostic precision, honest talk about normal human variation, and willingness to treat distress without immediately attaching a neurodevelopmental stamp. Parents and young people deserve support for anxiety or unmet expectations. That support does not always require an autism diagnosis.

Autism at its core is a serious developmental condition that can disable. When the same term is applied to the anxious teenager who feels out of place, we dilute its meaning and medicalise ordinary life. We owe both groups better: rigorous diagnosis for those who truly need it, and the freedom to be human, flawed, anxious, imperfect, without a clinical label for those who do not.