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Are autism and ADHD overdiagnosed? Underdiagnosed? Misdiagnosed? What’s really going on? The UK government commissioned a report last year to address exactly those issues and it’s finally here. The Fonagy report was published on 9th Oct and spans over 600 pages. That’s a long document, and there have already been a lot of takes on this report. Some have said that it confirms that overdiagnosis isn’t happening and that this is welcome, while others have framed it as an attack on neurodivergent people. It suggests that we should be moving to a needs-led system, plus diagnosis. What does that really mean? We sat down with James Barnes who luckily for us has put the time into understanding this report to ask him what he thinks, and where we go from here. James wrote a thorough response to the report on his Substack The Between Us which can be read here. James’s website is here. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

Dr Lester Liao is a Developmental Paediatrician at the Montreal Children’s Hospital and Assistant Professor at McGill University, where he is Director of the Formation of the Professional as Healer Course and Creator and Director of the Doctor as Person Fellowship. He is an Associate Member at the Institute of Health Sciences Education. He is particularly interested in the role of philosophy and culture in shaping the practice of medicine. He has become increasingly concerned about overdiagnosis of autism, and in this interview he explains why. He tells us why he thinks so many children are being diagnosed with autism, and how a diagnosis can harm as well as help. Lester’s paper on overdiagnosis with Eric Fombonne- Liao L, & Fombonne E. (2026) Autism Overdiagnosis and Its Harmful Effects. JAMA Pediatr. 180(7):711–712. doi:10.1001/jamapediatrics.2026.0400 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

How does the meaning of words change over time - and what are the implications when those words are clinical terms? Nick Haslam is an academic psychologist, and his work has looked at the expansion of psychological terms like ‘trauma’, ‘abuse’ and ‘bullying’. He suggests that these concepts expand over time, becoming both less extreme (vertical expansion) and broader (horizontal expansion). In this interview, we talk about how that applies to neurodiversity. We discuss how formal terms like ‘ADHD’ have expanded, but also how the emergence of informal terms like neurodivergence have increased the number of people who think that perhaps their difficulties in life are due to their differently wired brains. Nick is at pain to point out noting semantic shifts like this isn’t about judgement, it’s simply an observation. How we use words changes over time - and this has implications for clinical practice. Nick is a prolific researcher and we have just selected a few, free-to-access examples of his work here. Here’s a recent paper about concept creep. Here is some of his work about the mixed blessings of biogenetic explanations. Article in The Conversation about the way that the conversation on social media has shifted over time, with autism and ADHD now dominating. Finally, the two papers by Lucy Foulkes and colleagues, mentioned by Dani and Nick, about the prevalence inflation hypothesis, and the Barry Mason paper about Safe Uncertainty. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

Nabeelah got in touch with us because she was concerned. She has an autistic 6-year-old whose autism has been obvious since she was very young and who is minimally speaking. She felt that children like her daughter were invisible. Her family’s priorities are not represented in the conversation about neurodiversity and it’s more than that, she thinks that we are lacking the language that we need to describe important differences between autistic people. The word ‘autism’ is being used to mean too many different things. In this heart-felt episode, Nabeelah told us about the early signs of difference she saw in her daughter and how little support there is available. She looked for early intervention, only to be told by a speech and language therapist that she herself was the early intervention. She sought help in online groups, only to be told she was ableist for wanting to help her daughter stop using nappies. She told us of her daughter’s difficulties - pica, toileting, elopement - and how she doesn’t see organisations or researchers prioritising the needs of families like hers. She told us of how difficult it is even to describe her daughter’s challenges, because all of the language has been problematised. She told us of her love for her daughter and how joyful life with her could be. Nabeelah isn’t denying the reality of anyone’s struggle – but she’s saying that some people are being missed. There has been a re-centring of the autism discussion, away from the severely disabled, and yet we don’t have the words to describe the problem. This conversation is a valuable insight into the world of the families of severely autistic children, and a wake-up call for anyone who might have assumed that, at this end of the spectrum, needs are being met and families supported. Here’s a link to the study Nabeelah mentions which looked at the underrepresentation of those with intellectual disabilities in autism research. For a discussion of PACT and other similar early intervention approaches briefly touched upon in the episode, start here.For information about the Cambridge Attention, Learning and Memory centre click here. Our episode with Amy Lutz, mentioned in this interview - parent of a severely autistic adult child and disability historian. And finally, here is a link to some research on developing the consensus definition for profound autism. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

“I would love if the phrase nature vs nurture disappeared from the planet. I think it’s really held back a lot of progress. It’s nature and nurture. If we think of science as nature and nurture we are going to make progress a lot faster than if we keep dividing it into separate things because that’s just not how the world works.” Robert Wright Are you confused by the nature vs nurture debate? Are you unsure what it really means to say that ‘autism is genetic’, and why people say that there is ‘missing heritability’ in autism? You wouldn’t be alone. The science of behavioural genetics seem to get more complicated the more closely we look. That’s why when the National Autistic Society stated that ‘autism is genetic’, we wanted to know more. It just seemed too straightforward to be true and we weren’t sure how the evidence matched up. So we were delighted when we found Bob Wright, a paediatrician whose work speaks to exactly this. Bob could not be better placed to help us to understand, drawing on his knowledge not only of paediatrics and neurodevelopment, but also of genetics and the emerging field of exposomics. In this episode, we asked Bob whether the National Autistic Society were right to make this statement, what he thinks they might be missing, and why he thinks that the question of the genetics of autism is far from resolved. He uses stories to bring these ideas to life - look out for the yellow flanked chickens! Bob described himself as an exposomic scientist. Exposomics, in contrast to (but in many way complimentary to) genomics, was first introduced by Christopher Wilde in his seminal paper in 2005. It is the science of the environmental exposures throughout a person’s lifetime and how these relate to health. For Bob, it offers a promising new area of research and knowledge development that could help us both to understand autism better but also perhaps offer hope to families of profoundly autistic children. Bob has a talent for making complex ideas digestible, using stories that really helped Naomi and I begin to get a handle on this topic. We hope that this conversation will resonate with many of you or at least will start some new conversations! Find more from Bob on his Substack page, including in The Miseducation of Autism Heritability and On the Origins of a Specious Argument about Autism Part 2: Twins, where you can find more details of the chicken story and more. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

When Helen Minnis was tiny, she was affectionately referred to as ‘a nightmare baby’. As an adult, she has a diagnosis of ADHD. She counts herself lucky, because her parents had each other, they had enough money, they had community support - and so they were well enough resourced to look after her. It could have been very different. All of this is very relevant to what Helen researches now. ‘Double jeopardy’ refers to the interaction between neurodivergence (which Helen defines as those who are at the extreme ends of the normal distribution) and childhood adversity. The combination of temperament and environment, and the complex and bidirectional relationships between the two. In this far-ranging interview, Helen tells us about her research and why she thinks this is such an important area to study. We talk about the children for whom parenting really makes a difference, and how it frequently goes unacknowledged that every child is different and each parent has a different task. This interview goes from the research to the personal and practical. Helen’s empathy for parents and children shines through throughout. We hope you enjoy it. One of Helen’s academic papers on double jeopardy with her colleague Ruchika Gajwani- Gajwani, R., & Minnis, H. (2023). Double jeopardy: implications of neurodevelopmental conditions and adverse childhood experiences for child health. European child & adolescent psychiatry, 32(1), 1–4. Robert Plomin is the behavioural geneticist mentioned in the podcast who uses the phrase ‘parents matter but they don’t make a difference’. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

Big announcements this week in the UK autism world. The National Autistic Society have declared that they are stating definitively that autism is genetic and that we can all stop looking for answers elsewhere. The question, they say, is resolved. This statement has been very positively received, with many sharing it and heralding it as a great step forward. But is the science really as cut and dried as this would suggest? One thing is clear, they are not making this announcement because of a scientific breakthrough. There has not been a new development in autism research which has finally resolved the issue of what causes autism. They have based this on a review of 83 different research studies, but the outcomes of these studies are nowhere near as straightforward as the statement suggests. In this episode, Naomi and Dani ask some questions about what ‘autism is genetic’ really means - and why the NAS are saying it now. What is meant by autism, in this context, and what is meant by ‘genetic’? It’s an area that is rife with misinformation and misunderstandings - does the NAS statement resolve any of that? Where do we go from here? Thanks for listening to Let's Talk Neurosense: the psychology of neurodiversity! Subscribe for free. Here are a few more links to topics discussed in this episode. * Journal articles about the heritability of vitiligo and the familial recurrence. * A Substack article by Robert Wright explaining the importance of gene/environment interactions * The National Autistic Society News page and their What Causes Autism? page with a tab for Article Sources (found towards the bottom of the page) * Marriage (and divorce) is heritable. * Autism and polygenic risk factors, explained. * The trouble with Twin Studies * Cambridge study autism and genetics * Link to the BPS Understanding Psychosis and Schizophrenia document, which provides a succinct summary of the literature referred to in the episode around inequality, poverty, racism and discrimination (Section 6.3, pg. 44) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

What does lived experience really mean? Should lived experience be given the same status as scientific studies? Could it sometimes be used as a shield, preventing ideas from being challenged? Have clinicians historically ignored lived experience, and how can we redress the balance? Talking about these questions is difficult, and Paul Hutton knows that directly. When he started posting about the complexities of working with lived experience on LinkedIn, he was surprised by the strength of the response he got. As a result, we invited him on to the pod. In this conversation, Paul told us why he thinks it could be dangerous to use lived experience to form general beliefs about the world, but also thinks it’s essential that lived experience is listened to, and used to generate new hypotheses. He highlights the importance of empirical evidence - and also how evidence-based practice has historically ignored lived experience. We discussed how difficult professionals find it to challenge something framed as lived experience, and how this is sometimes exploited by researchers and those who do not want their ideas to be scrutinised. This episode, like the previous one with Susie Colbert, explores some of the parallels (and differences) between what has been happening in neurodiversity, and what has happened already in the field of psychosis. Paul brings a great depth of research and clinical knowledge. We hope you enjoy the conversation. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

Susie brings a number of unique and valuable perspectives to the topic of neurodiversity and joins Naomi and I this week to to help us kickstart season 3. As well as working clinically as a psychologist and having her own diagnosis of dyslexia, Susie works as a tutor on one of the UK’s clinical psychology training programmes. She is also part of the British Psychological Society’s working group supporting researchers using the Power Threat Meaning Framework (PTMF), a non-diagnostic alternative to working with emotional distress. Susie reports having found her dyslexia diagnosis incredibly helpful over the years, yet she also believes, as someone committed to evidence-based practice and to interrogating ideas, that dyslexia deserves the same critical eye (or as she might put it- ‘critique-ical’ eye) as any other diagnosis or psychiatric construct. Together we examine the conceptual overlaps between neurodivergent presentations, psychosis and other psychiatric presentations, as well as areas of difference. We talk about what it means that dyslexia now sits under the neurodiversity umbrella and the various implications of understanding things the way we do currently, as well as posing the question- ‘what’s the alternative?’ Here is a link to the Understanding Psychosis and Schizophrenia document mentioned in the episode. We’re committed to keeping Let’s Talk Neurosense free, but if you enjoy the podcast and would like to support our work, you can buy us a coffee here- This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

The Channel 4 documentary The Great ADHD Myth? has sparked a national conversation, and it’s a heated one. For some, it was a much needed balance to the dominant narrative, while for others it was a biased and dangerous polemic. One of the contributors to the Channel 4 programme, Child and Adolescent Psychiatrist Dr Sami Timimi, argued in his book that the onus should be on those making claims about ADHD having a neurobiological cause to provide robust supporting evidence for such claims. The evidence often cited, he argues, is often overstretched and misinterpreted. Is he right? In this episode, we grapple with some of these issues. Naomi and I consider whether the documentary could have been framed differently, how diagnostic thresholds have changed and what this means for the research, the evidence behind claims that ADHD is a brain-based condition, how we talk about ADHD, and why all this matters. Here are some links to research and other sources referred to in the episode. Here is a link to webpage for Cambridge University’s Centre for Attention, Learning and Memory (CALM), and an ACAMH (Association for Child and Adolescent Mental Health) interview with a representative from CALM summarising their research as having “so far revealed that behavioural problems, patterns of cognitive difficulties and neural profiles do not align with specific diagnoses”. There’s also this ACAMH paper’s podcast. Naomi spoke about this NYT article, and the RDoC and HiTOP research. This is the 2025 meta-analysis on brain imaging research we discussed. And for the clinical applications, journal article discussing differences between the ICD-11 and DSM-5 diagnostic criteria for ADHD, and posing the question, amongst other dilemmas and uncertainties- “do we threshold impairment against the average peer or the hypothetical potential of the individual?”. Episode of the podcast series Navigating Neuropsychology examining a detailed case study of a young woman, described as being extremely bright, and therefore whose “areas of personal weakness”, which were not considered to be low for her age group, contributed to her ADHD diagnostic decision. This episode offers a detailed exploration of how diagnosticians might consider differential diagnosis, and the uncertainty often involved with diagnostic assessments, but also shows how such uncertainty can quickly become lost following assessment, as seen in the title of the episode where the clinical case is introduced as a young adult with type 1 diabetes, mental health, and ADHD. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

The Channel 4 documentary The Great ADHD Myth? has polarised discussion, with one side saying that it was unbalanced and unscientific, while others say that it is a necessary challenge to the dominant narrative. ADHD UK raised concerns about it from before the programme aired, and in this special episode we sat down with Chris Benson, Education Lead for ADHD UK, to find out what he thought. Chris brings decades of experience in education as well as the lived experience of his own late diagnosis and having a daughter with ADHD and an autistic son. In this episode we talk about the reactions to the documentary, how Chris understands ADHD and his own experience, and the implications of all of this for children who are struggling at school. Here are some more information about the research and researchers referred to in this podcast. Long form NYT article about ADHD and the research. Hypercurious podcast featuring Edmund Sonuga-Barke, Anne-Laure Le Cunff and Eleanor Dommett talking about the neuroscience and controversies in ADHD research. Large-scale studies showing that those with a diagnosis of ADHD have a higher risk of road traffic accidents and that taking ADHD medication reduced the risk of suicidal behaviour, substance misuse and criminality. Recent study (mentioned by Dani in the podcast) which indicates that stimulant medication may not actually be working on attention, but may instead increase vigilance and make tasks more rewarding. Longitudinal study following up children who took ADHD medication which showed that childhood treatment did not improve longer term outcomes in adolescence such as grades, arrests or psychiatric hospitalisations. Large-scale study which found that taking ADHD medication in childhood was associated with shorter adult height and higher BMI. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

The Guardian called it the most controversial show of the year. Amnesty International called on Channel 4 to make multiple changes before broadcast. ADHD UK complained to Ofcom. There was widespread fury on social media, with people arguing that the question posed in the Channel 4 documentary press release - is ADHD a neurodevelopmental disorder, or a social construct - was a dangerous one that could harm marginalised people. It is fair to say that the documentary The Great ADHD Myth? polarised people before anyone had seen it. And so when we had the opportunity to sit down with Lucy Johnstone, a consultant clinical psychologist who appeared in the documentary, we seized it with both hands. Lucy has a long history of thinking critically about the psychiatric classification system, but it is only more recently that she has started writing about neurodiversity. We asked her what she thought of the programme, what she made of the reaction and where she thinks we go from here. She told us about the importance of lived experience, about a lifetime spent asking difficult questions and why she thinks that the conversation about ADHD is preventing us from talking about the things that really matter. The blog series on neurodiversity Lucy wrote with John Cromby is here and her book A Straight Talking Introduction to Psychiatric Diagnosis can be found here. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

In the 1990s, Janyce Boynton was working as a speech and language clinician when she started using facilitated communication with a young non-speaking girl, Betsy. Through facilitated communication, Betsy started to make allegations about abuse at home. These were reported to the authorities and things quickly started to escalate. What happened next changed the course of Janyce’s life. Betsy was removed from her home and court proceedings were started. As part of the court process, controlled testing of facilitated communication was ordered by the judge. The results were clear. Betsy was not the author of the allegations. They were influenced by Janyce, without her being aware of it. Their story is told in the Prisoners of Silence documentary. In this fascinating interview, Janyce tells us what happened, and how she made the fateful decision to turn towards the evidence. She told us why she has felt that it’s imperative to continue sharing her story and informing people about the harm that can be done by facilitated communication. She explains how the illusion of facilitated communication is created and why it can appear so compelling. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

Aleida Verhoeven understands disability from many angles. She’s autistic herself and also has other disabilities. But in addition, she works in Australia’s National Disability Insurance Scheme as the equivalent of a case manager, primarily with autistic people. She tells us about the situation in Australia, where, as she puts it, they have some of the highest disability spend in the world, yet some of the poorest outcomes. We discuss the reasons why that might be, and Aleida explained how she sees a misalignment between what autistic people need and what is being provided. Aleida has some very forthright opinions and this conversation was an insight for Dani and I into how things work over the other side of the world. We hope you enjoy this episode. Thanks for reading Let's Talk Neurosense: the psychology of neurodiversity! Subscribe for free to hear about each new episode. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com

Richard has spent his whole career working with autistic adults. He initially worked in a diagnostic assessment service before moving into his current role in an intensive support team for autistic adults. He is a prolific poster in online discussions about neurodiversity, and has written about some of this on his Substack. In this interview, Richard explained how his experience has enabled him to look beneath behaviour and the formal diagnostic criteria to identify underlying processes common amongst autistic people. He tells us how he thinks that those who criticise concepts such as masking miss the serious impact on autistic people’s lives. He talks about how he feels that better awareness and less stigma has enabled more people to come forward for diagnostic assessment, and how he sees this as a positive change. Join Naomi, Richard and I as we wrestle with some of the big questions, such as whether masking is unique to autism, the specificity and reliability of an autism diagnosis, how funding and resources should be allocated and whether we should be talking about diagnosis at all. We certainly don’t agree on everything, but I do think we manage to hold space for different perspectives and put some of the popular ideas in neurodiversity discourse under the spotlight. Do let us know what this episode brings up for you. Thanks for listening to Let's Talk Neurosense: the psychology of neurodiversity! Subscribe for free to receive new posts and support the podcast. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit neurosense.substack.com