Neurodiversity to gender dysphoria: a problem of over-diagnosis?

Recorded at the Battle of Ideas festival 2024 on Saturday 19 October at Church House, Westminster.

ORIGINAL INTRODUCTION

In many areas of life, an explosion of diagnostic labels seem to have expanded far beyond straightforward medical prognosis. Medicine seems to have become tangled up with fashionable identities, and a zeitgeist that stresses vulnerability and victimhood. How do such trends affect medical ethics, let alone reliable medical interventions?

One such example is the jokey aphorism ‘we’re all neurodiverse now’ – from the lawyer of the QAnon Shaman blaming his client’s behaviour on his autism to rising diagnoses among students. In workplaces and university campuses, neurodiversity awareness is ubiquitous, with more and more people identifying as ‘on the spectrum’. According to some estimates, as many as 20 per cent of the global population are neurodivergent, spanning everything from severe autism to dyslexia and ADHD. Particularly among women, there has been a sharp increase in ADHD diagnoses in the last year, with record numbers of prescriptions for ADHD medicine in 2024 – the UK is in fact suffering from an ADHD medicine shortage because of increased demand.

Elsewhere, there is contention over the explosion of young people who self-identity as gender dysphoric. A readiness to accept social transitioning in what has been described as social contagion amongst teenage girls has led to the conclusion that anyone declaring themselves gender-confused is in need of medical intervention, whether psychotherapeutic, biomedical or surgical. Advocates of transgender medicine argue against medical ‘gatekeeping’, demanding access to hormones and surgery as part of a patient’s bodily autonomy. However, some mental-health practitioners in the UK and US have testified that they face ideological pressure to put dysphoric patients on a medical pathway. In a 2021 study, 55 detransitioners of a group of 100 stated that they were not given an adequate professional evaluation before receiving clearance for medical transition. What’s more, some gender-critical commentators suggest that there is pressure to misdiagnose the confusions of puberty, same-sex attraction and broader mental-health issues as simply gender dysphoria.

Central to the debate is the premise that doctors, nurses and therapists are obliged to act in a patient’s best interests. But is it always clear what these interests are? Should individuals and their families get the final say? Is the rise in diagnoses due to an actual rise in numbers, expanding definitions, or clinicians and therapists getting better at identifying symptoms? Or are we over-diagnosing the likes of neurodiversity and gender-dysphoria, even pathologising behaviour which in the past may have been described as shy, socially awkward or perhaps a bit quirky? Do medical diagnoses help people understand their difficulties in interacting with the world by giving them a vocabulary and practical accommodations that help manage and alleviate debilitating discomforts? And what are the implications for medical ethics and health policy, when diagnoses have become so closely linked to understanding our identities?

SPEAKERS Dave Clements writer and policy advisor; contributing co-editor The Future of Community

Dr Jennifer Cunningham retired community paediatrician; board member, Scottish Union for Education (SUE)

Dr Az Hakeem consulting psychiatrist; author, Trans and Detrans

Sophie Spital speaker; writer; former editor, Triggernometry

CHAIR Sally Millard director of finance; co-founder, AoI Parents Forum