Academics, clinicians, students, service users and members of the public came together in a packed Wolfson Lecture Theatre at Denmark Hill to debate whether the rise in diagnosed neurodivergence was due to increased awareness and recognition of hitherto undiagnosed people.
The motion, titled "Coming out of the shadows: This house believes that the global rise in diagnosed neurodivergence reflects an increased awareness of hitherto undiagnosed people" was introduced by Professor James MacCabe. Speakers for the motion were Dr Elizabeth Weir from the University of Cambridge and Dr Jessica Ecclaes from the University of Sussex, and against the motion were Dr Al Santhouse from the Maudsley Hospital and Professor Terry Brugha from the University of Leicester. The debate was chaired by Professor Francesca Happé, from the IoPPN.
The Maudsley Debates, now in their 26th year, are free, public debates on issues of public interest relating to mental health. Our past debates, all 61 of them, are available free online. Summaries of most Maudsley Debates are also carried in the British Medical Journal. This was one of the best attended and most engaging debates we have held. The next one will be on the impact of artificial intelligence on mental health, and will be held on 10 December.
Professor James MacCabe, Professor of Epidemiology and Therapeutics
As with all Maudsley Debates, attendees were encouraged to vote on the motion prior to the debate, and again afterward to understand how the debate swayed the opinions and views of those in the room. The initial vote showed strong support for the motion.
Dr Weir spoke first for the motion, detailing the rise in diagnosis and the various explored causes behind it including historical under recognition of women and girls with ADHD or autism. She was followed by Dr Santhouse speaking against the motion, suggesting alternative factors behind the rise in diagnoses including disparities in diagnosis rates between areas with differing socioeconomic status, and a shift away from the concept of "disorder" being required for diagnosis. Dr Eccles countered for the motion, highlighting the importance of diagnosis opening doors for people, drawing upon lived experience, clinical expertise and academic findings, and pointing out that the fact that we were even having the debate in itself was indicative of the disadvantages faced by neurodivergent people in obtaining a diagnosis. The argument against the motion was concluded by Professor Brugha who emphasised that though awareness may be part of the picture in understanding a rise in ASD and ADHD diagnosis, there are many interlinking factors that should be considered, drawing upon comprehensive epidemiological population level findings in this area, and bringing attention to the broadening of diagnostic criteria for autism in recent decades.
The floor was then opened for audience members to pose questions or share their reflections to the panel, chaired by Professor Happé.
The audience were really engaged, and we could have taken questions all evening! Questions covered a wide range of topics, from the role of trauma, the challenges of getting developmental history in the autism diagnostic process, to the difficulty judging if the 'impairment criterion' for diagnosis is met. All the speakers gave important facts and perspectives to address the questions raised.
Professor Francesca Happé,
Professor MacCabe concluded the evening by holding a second vote on the motion, with the audience vote shifting significantly from a strong majority in favour, to around 40% in favour and 40% against the motion by end of the debate.
The recording of this debate, along with recordings of previous Maudsley Debates can be found here.
