Pressure on Diagnostic Services In recent years, adult autism diagnostic services have come under exceptional pressure. Referral rates have surged, far outpacing clinical capacity, and exposing systemic limitations in provision. The consequences are stark. An NHS-funded diagnostic service in Oxfordshire, for example, recently closed its waiting list after estimating that it could take until 2043 to process its backlog of over 2,000 patients. For individuals referred before 20

In recent years, increasing attention has been devoted to the phenomenon of autism diagnosis in adolescence and adulthood . Waiting lists for assessment have grown rapidly. In England, for example, the average waiting time for an autism diagnosis reached 300 days , substantially exceeding the 91-day target recommended by NICE (Fagg & Woodhead 2023). The rising demand for assessment reflects a broader shift in public awareness and clinical practice. Public discussion often pre

In recent decades, clinicians and researchers have become increasingly aware of a form of extreme social withdrawal lasting at least six months, known as hikikomori [ 1 ]. The term was coined in the late 1990s by Japanese psychiatrist Saitō Tamaki to describe individuals who withdraw almost entirely from social life, isolating themselves within their home – often in a single room – refusing school or work, and avoiding face-to-face relationships. While some remain connected t

Autism has long been described as a lifelong neurodevelopmental disorder/condition. Core behavioural features, typically emerging in infancy or early childhood, have been assumed to persist throughout the lifespan. The research, however, suggests that within the vast heterogeneity of autism , not all individuals follow a single, fixed trajectory. Various reports have documented the presentation of " acquired autism " ( regression ) following a period of typical development.

How Research on “Frank” Autism Undermines a Persistent and Harmful Meme With a few friends, I have started working on a project that may be seen as controversial but feels deeply important to those of us who live with the consequences of how autism is constantly redefined, reframed, and repackaged online[ 1 ]. We decided to start small—by analysing the memes that circulate endlessly across social media—and then follow the discussion wherever it leads us. When I looked at a li

A Simplification That Simplifies Nothing The 5 th  edition, published in 2013, set out to simplify and modernise the nosology of autism-related disorders, replacing the DSM-IV’s cluster of Pervasive Developmental Disorders (PDDs) — Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, Rett’s Disorder [ 1 ] and PDD-Not Otherwise Specified (PDD-NOS) — with a single diagnosis: Autism Spectrum Disorder (ASD). The intent was, in principle, laudable: a spectrum

The question of how stable an autism diagnosis is over time has long been debated. While many families and clinicians view an autism diagnosis as lifelong, research suggests that diagnostic stability—how consistently a diagnosis persists over time—depends heavily on which diagnostic framework is used. Emerging evidence indicates that before the introduction of the broader ASD category in the DSM-5  (APA 2013), autism diagnoses were more stable and predictable. Before DSM-5: D

Autism has undergone a remarkable transformation in recent decades. Once thought of as a rare and narrowly defined childhood condition,...

In most cases, ASD is diagnosed between 15 and 30 months. Some children exhibit typical early development, only to lose acquired language and social skills between 15 and 30 months. These cases qualify as regressive autism. However, there are instances of late onset autism where individuals appear to develop typically until adolescence or even adulthood before displaying symptoms consistent with autism. In such cases, an identifiable neurological insult, such as, e.g, herpes

Regression in autism, often seen within the first two years of life, represents a distinct subtype of autism that has sparked considerable scientific interest. While the exact causes of regression are still not fully understood, current research points to a combination of genetic, environmental, metabolic, immune, and neurological factors.

Complex developmental path s Regression  in autism refers to the loss of previously acquired developmental skills—such as spoken language, social interaction, play behaviour, motor coordination, or toileting skills. For example, a toddler who once used several words regularly might suddenly stop speaking, or a child who previously engaged in play with others may withdraw socially. What makes regression distinct from general developmental delay is that the child initially reac

The claim that autistic individuals lack Theory of Mind (ToM)—the ability to understand that others have thoughts, emotions, and...

Theory of Mind (ToM) is a critical aspect of social cognition and undergoes significant developmental changes from infancy to adulthood. This development follows a trajectory marked by key milestones, with notable differences between autistic and non-autistic individuals. Infancy and Early Childhood ToM development begins in infancy, where social interaction plays a vital role. Infants depend on caregivers to regulate affective states, which in turn helps in the gradual acqui

Theory of Mind (ToM) refers to the ability to attribute mental states—such as beliefs, intentions, and emotions—to oneself and others, enabling social understanding and interaction (Green et al. 2015; Poletti et al. 2012). It consists of two primary components: cognitive ToM (reasoning about thoughts and beliefs) and affective ToM (reasoning about emotions), which interact but function separately (Shamay-Tsoory 2011; Sprung et al. 2022). Conceptual and Terminological Challeng

Theory of Mind (ToM) has been applied not only to humans and animals but also to Large Language Models (LLMs) like ChatGPT. The extent to wh

The theory of mind  (ToM) has been instrumental in shaping research in psychology, neuroscience, and artificial intelligence, providing a theoretical framework for investigating the cognitive processes underlying social interaction and communication. Social cognitive deficits appear to be a core cognitive phenotype of many clinical conditions (Cotter et al. 2018). Early work in social cognition focused on the central role of ToM impairments as a hallmark feature of ASD  (Baro

How Comparisons with Down Syndrome Have Changed Premack and Woodruff's seminal study in 1978 introduced the concept of theory of mind...

Alexithymia is considered a “sub-clinical phenomenon” (Silani et al. 2008) and doesn’t identify a personality disorder  per se  but is a personality trait that is dimensional in nature (Taylor et al. 1991). Alexithymia is not a symptom of autism, but rather an independent construct that frequently co-occurs with autism. Although alexithymia has similar symptoms , it is distinct from autism – it is neither a necessary nor sufficient feature for an autism diagnosis, and there a

The connection between alexithymia and ASD was initially explored in the 1990s through clinical studies on individuals with eating disorders, specifically anorexia nervosa (AN).   The studies revealed the co-occurrence of eating disorders with deficiencies in social competence and identified some traits that were considered typical of ASD, [ 1 ]   such as empathy problems, as well as some features considered typical of alexithymia, such as difficulty verbalising emotions, ide

Imitation as a Social Tool in Autism Though the broken mirror hypothesis  predicts that autistic individuals should show severe impairments in understanding and imitating actions, so far the research evidence is inconclusive and some research studies have found no such impairments (e.g., Beelen et al . 2018). In fact, many autistic individuals are excellent mimics, able to take another person’s way of speaking, moving, etc. (Tantam 2009). We can see ‘echolalic behaviours’ in