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.

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

Over the past two decades, research on autism has expanded at an extraordinary pace. Studies on prevalence, lived experience, and...

In the past two decades, our societies have become more fluent in the language of mental health. Public campaigns  encourage people to...

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.

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

‘Autistic individuals always say what they think / or what they want to say’ There is a common misconception that autistic individuals...

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

After examining sensory perception in autism in the first book , the newly released second instalment focuses on communication and language in autism. Communication is a two-way process, and it takes two people to mess up a conversation. Not all the problems are caused by autistic children. Non-autistic people have a lot to learn about the ways autistic individuals use verbal and non-verbal language to communicate. Autistic children do not lack the desire to talk to others bu

Challenges in diagnosing Diagnosing Narcissistic Personality Disorder (NPD) can be difficult as individuals with this disorder often resist admitting any flaws or seeking help. Their inflated ego and lack of insight into their behaviour can make diagnosis a challenge. On the other hand, diagnosing ASD can be complex due to its wide range of symptoms, varying presentations, and overlaps with other conditions. ASDs without intellectual disability are often diagnosed late in lif

Overlapping symptoms and differences Narcissistic Personality Disorder (NPD) and ASD are two distinct condition. However, they share certain symptomatology that can lead to difficulties in differentiating between the two. NPD Note : The term "narcissism" comes from the Greek myth of Narcissus, a guy who fell in love with his own reflection in a pool of water. While the concept has been around for centuries, it wasn't officially recognized as a personality disorder until the 2

Overlaps, prevalence and comorbidity Overlapping symptoms It is now recognised that ASD and personality disorders (PDs) have a variety of factors in common. However, the exact nature of the relationship between ASD and the PDs remains unclear. Differentiating between ASD in adolescence and adulthood and PDs can often be challenging due to the similarity in symptomatology. For instance: -      PDs belonging to cluster A, such as schizoid or schizotypal, exhibit odd behaviours

Two Spectra or Continua? Autism and schizophrenia are two complex neurodevelopmental disorders/conditions that have been extensively studied in the field of psychiatry. Although ASD and schizophrenia share some overlapping symptoms and risk factors, they are distinct neurodevelopmental conditions with different diagnostic criteria and clinical presentations. Historical Note Both autism and schizophrenia have a long history, but their understanding and diagnostic criteria have

Prevalence and comorbidity Comorbidity , or the coexistence of two or more disorders, is common in both autistic individuals and people with psychotic disorders. Psychosis and bipolar disorder are two commonly occurring psychiatric disorders that affect autistic individuals throughout their lives (Ghaziuddin & Ghaziuddin 2021; Foss-Feig et al. 2021; Jutla et al. 2021; Vaquerizo-Serrano et al. 2021; Bitsika et al. 2021). In fact, the prevalence of these disorders is significan