Has autism become too broad to be useful?
Peer reviewed | Editorial
The definition of autism may have become so wide that it risks confusion and even misdiagnosis, according to a new editorial by UCL Professor Dame Uta Frith, whose pioneering research in the 1960s and 70s lay the foundations for how we understand autism.
Autism is currently diagnosed as Autism Spectrum Disorder (ASD) - a single condition that includes a huge range of people, from those needing round-the-clock care to those who live independently.
In Dame Uta’s editorial, published in Psychological Medicine, she argues that this “spectrum” may now be too broad to be useful.
“Autism wasn’t always defined this way – a sort of catch-all diagnosis for a huge variety of conditions,” she said.
“When it was first identified in the 1940s, it referred to a small group of children with severe difficulties in social interaction, communication and behaviour. Over time, the definition has widened to include people with milder traits and no language or learning problems.
“Today, anyone of any age or intelligence level can be diagnosed with autism if they meet certain criteria.”
The number of people diagnosed with autism has increased dramatically. In the 1960s, in the UK, about 4 in 10,000 children were diagnosed. Today, it’s around 1 in 57 schoolchildren in the UK - a more than 40-fold increase.
In the paper, Dame Uta, Emeritus Professor of Cognitive Development (UCL Institute of Neurology) suggests several reasons for this rise:
- Greater awareness and less stigma
- Broader interpretation of diagnostic criteria
- More people identifying with autism online
- Self-diagnosis and social media influence
- A cultural shift toward explaining everyday life problems via medical labels
In a career spanning more than 50-years Dame Uta has researched the cognitive underpinnings of autism, longer than nearly anyone else.
With her colleagues she developed two landmark theories about how autistic minds might develop differently to neurotypical minds.
- Theory of Mind deficit (mentalising problems): The idea that autistic people may find it harder to infer other people’s thoughts, beliefs and intentions.
- Weak Central Coherence: This theory proposed that autistic cognition tends to focus on details rather than the bigger picture. Autistic individuals may excel at noticing fine details but find it harder to integrate them into a broader, contextual understanding.
She, along with colleagues at UCL, was also among the first to explore the neural basis of these differences using newly available brain scanners in the 1990s.
Two very different groups?
In her new paper, a key argument made by Dame Uta is that not all autism diagnoses look the same. The latest research now shows a big difference between people diagnosed in childhood and those diagnosed later (as teenagers or adults).
- Early-diagnosed individuals often show clear signs from a young age and may have language or learning difficulties.
- Late-diagnosed individuals are more likely to have average or high intelligence and may also have conditions like anxiety, depression, or ADHD.
Some studies even suggest these groups may have different genetic patterns, raising the possibility that they are not the same condition at all.
Could this lead to misdiagnosis?
In the paper, Dame Uta, warns that expanding the definition of autism may lead to overdiagnosis, where people are given an autism label even when another condition might explain their difficulties.
“This matters because diagnoses shape treatment, identity, and support. A wrong diagnosis can lead to the wrong help - or no help at all,” she said.
Dame Uta also points out that:
- There is no biological test for autism
- Diagnosis often depends on judgement and self-report
- Concepts like “masking” (hiding difficulties) can make the criteria even broader
The role of culture and identity
She said: “Autism is no longer just a medical term - it has become part of popular culture. Social media, films, and online communities have helped people share experiences, but they have also spread simplified or misleading ideas.
“At the same time, the idea of “neurodiversity” has encouraged people to see autism as a difference rather than a disorder. While this helps reduce stigma, it also creates tension: if autism is not a disorder, why use a medical diagnosis?”
What needs to change?
The paper calls for a rethink of how autism is defined and diagnosed. Instead of one broad “spectrum,” it suggests:
- Splitting autism into clearer subgroups
- Focusing on individuals’ specific needs
- Prioritising support for those with the greatest difficulties
- Improving diagnostic precision to avoid confusion and misdiagnosis
Dame Uta said: “The time has come to examine whether the autism spectrum has become too broad. Without greater precision, we risk misunderstanding people’s needs and misdirecting care.”
Professor Dame Uta Frith was awarded a Damehood in 2012 for her pioneering, foundational contributions to clinical science and the understanding of autism and dyslexia.
Journal
Psychological Medicine
Method of Research
Commentary/editorial
Subject of Research
People
Article Title
Autism Spectrum Disorder: Has it lost its meaning and is it leading to misdiagnosis?
Article Publication Date
3-Aug-2026
Study: Male circumcision just after birth does not increase autism risk
New analysis finds no circumcision-autism link
In a cohort of nearly 3,000 boys followed from birth into childhood, young boys who were circumcised just after birth did not have a higher risk of autism, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
Two observational studies published over a decade ago—one in 2013, another in 2015—suggested a possible circumcision-autism link. Media coverage following comments by administration officials last year resurfaced the earlier research.
The new study, published online August 3 in JAMA Pediatrics, examined data from a nation-wide ongoing child health study known as the ECHO (Environmental influences on Child Health Outcomes) Cohort study. The analysis found no link between circumcision and autism: Boys circumcised just after birth did not have a higher risk of autism compared to uncircumcised boys in the cohort.
“Parents have been concerned about this potential circumcision-autism connection, but hopefully these findings may help allay their fears,” says senior author Monica McGrath, ScD, MHS, research professor in the Bloomberg School’s Department of Epidemiology and director of the Environmental influences on Child Health Outcomes Data Analysis Center, also at the Bloomberg School.
Circumcision rates have been declining in the U.S. At the same time, the number of autism diagnoses in children in the U.S. has increased dramatically in recent decades. According to Centers for Disease Control and Prevention reports, roughly one child in 150 had an autism diagnosis in 2000, but as of 2022 the CDC reported a prevalence of one child in 31 among 8-year-olds. It’s not clear whether there has been an actual increase in autism prevalence or if the higher numbers reflect more awareness, more testing, and subsequent diagnoses.
Public discussion last year around a possible circumcision-autism link prompted McGrath and her colleagues in the ECHO Cohort study to perform their own analysis.
“We knew we had the data to help investigate this question,” McGrath says.
The analysis included 2,771 boys who had been enrolled at 14 different ECHO sites across the U.S. About 66% (1,840) were circumcised before maternity hospital discharge, and about 7% (192) had a documented or parent-reported autism diagnosis at a mean age of 3.8 years.
Among the boys with neonatal circumcision, the risk of autism diagnosis was 6% (108/1,840). The autism risk among uncircumcised boys was higher at 9% (84/931), and after adjusting for likely confounding factors such as parental age and family history of autism, there was no significant association.
The researchers also looked at acetaminophen exposure in the neonatal period. It was too uncommon (<5%) to permit analysis of its potential association with autism.
“We observed no association between circumcision and autism in boys, but it remains important to evaluate the safety of common medical procedures,” McGrath says.
She and her ECHO study colleagues are continuing to evaluate other factors that may explain the rise in autism diagnoses.
“Neonatal Medical Male Circumcision and Child Autism Diagnosis” was co-authored by Monica McGrath, Xiuhong Li, Lisa Jacobson, Bennett Leventhal, Judy Aschner, Brennan Baker, Karla Cardoso Garcia, Aisha Dickerson, Amy Elliott, Jody Ganiban, Amanda Goodrich, Daniel Horton, Melinda Jarnecke, Sarah Keim, Brian Lee, Courtney Lynch, Mark Klebanoff, Abdul-Manaf Mutaru, Ruby Nguyen, Rebecca Schmidt, Hyeong-Moo Shin, Lauren Shuffrey, Jonathan Slaughter, Annemarie Stroustrup, Zhaozhong Zhu, Aaron Tobian, and Kate Grabowski, for the ECHO Cohort Consortium.
Support for the research was provided by the National Institutes of Health.
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