Autism is soaring— and the ‘medicalization of misbehavior’ bears blame

Two weeks ago, a team of American researchers published a major report documenting an astonishing rise in the diagnosis of autism.

In just over ten years, between 2011 and 2022, the investigators found that annual autism diagnoses tripled among children 5 to 8 years of age, with smaller but still substantial increases among older age groups.

How come?

The researchers offered no explanation.

Autism is a spectrum.

On one end you may have an individual who is profoundly impaired, nonverbal, barely functioning.

On the other end, you have Temple Grandin, a best-selling author and animal scientist.

Elon Musk has diagnosed himself as being on the autism spectrum, and who am I to question Elon Musk?

The rise in diagnosis appears to be occurring all across the spectrum.

Experts have suggested many possible causes.

Exposure to endocrine disruptors, substances that mimic the action of female hormones, has been linked to a higher risk of autism, as has exposure to other environmental toxins.

But the preferred answer from mainstream clinicians is that increased awareness and improved screening, as well as the simplification of the diagnostic criteria for autism spectrum disorder which took place in 2013, are the main drivers of the increase in diagnosis.

I’m not buying it.

I have been a family doctor for more than 30 years.

OK, maybe increased awareness and screening have played a role, and without a doubt the 2013 changes in the rules for diagnosis do make it easier to say that a kid is on the autism spectrum.

But my first-hand experience tells me that something else, something big, is being overlooked.

Here is my take on what’s happening.

Imagine an 8-year-old boy who is defiant.

He’s rude.

Disrespectful.

He talks back.

Twenty years ago, the boy’s teacher would have spoken to the parents.

The teacher would have said, “Your son’s behavior is totally unacceptable. I need you to teach your son what is expected, the basics of what’s required in a public school classroom.”

Now imagine the same boy, same classroom, same school, today.

The teacher today is likely to say, “Your son doesn’t seem to understand social norms. He appears to have what we call a deficit in social-emotional reciprocity. He may be on the autism spectrum. Have you thought of having him evaluated?”

In the new edition of my book “The Collapse of Parenting,” I call this problem the medicalization of misbehavior.

I am not suggesting that it’s the only explanation for the rise in diagnosis.

It’s not.

But it’s definitely a big part of the story. 

I have seen this with my own eyes, not only in my own patients, but in my visits to more than 500 schools over the past 23 years.

In other words: That kid doesn’t really have autism. He is now being diagnosed as being on the autism spectrum, but actually he is just a snotty kid whose parents don’t know how to parent.

Why did this change occur?

Multiple reasons.

First: It takes courage for a teacher to tell a parent that the parent has to do a better job of parenting. It’s easier just to suggest a psychiatric diagnosis.

Second: If a child gets diagnosed as being on the spectrum, the school will get more money from state and federal programs, such as the Individuals with Disabilities Education Act. So schools have a financial incentive to get more kids diagnosed.

Third: Once parents have bought into the idea that their kid’s problems are due to autism, they don’t see their kid’s problems as their problem anymore.

And the more outrageous the child’s behavior, the more likely is that reaction.

The teacher calls the parent, only to be told to call the prescribing psychiatrist instead.

I’ve seen that.

But think about the downside.

As a family doctor, and as a father, I am convinced that one key requirement for success in life is to take responsibility for your own actions.

The end result of the medicalization of misbehavior is a shift of responsibility away from the child, and the parents, to the medical/counseling/psychiatric complex.

Imagine what happens if that 8-year-old boy spits at the teacher.

Any effort to discipline the child for such unacceptable behavior will result in the teacher being reprimanded: “Justin can’t help it. He’s on the spectrum. You had no right to discipline him.”

I say to parents: Have the courage to take responsibility for your kid.

Push back against the medicalization of misbehavior. Resist the pharmaceutical/counseling complex. 

Transform your snotty kid into a young gentleman or lady.

It can be done. I’ve seen it done.

You have to do it, for the sake of your kid.

Leonard Sax, MD, PhD is a family doctor and psychologist and the author of “The Collapse of Parenting” (Basic Books).