On the over-diagnosis of autism [NOT vaccines]

Dr. Allen Frances, Autism Rates Have Increased 60-Fold. I Played a Role in That. NYTimes, June 23, 2025. Opening paragraphs:

Robert F. Kennedy Jr., secretary of health and human services, is correct that reported autism rates have exploded in the last 30 years — they’ve increased roughly 60-fold — but he is dead wrong about the causes. I should know, because I am partly responsible for the explosion in rates.

The rapid rise in autism cases is not because of vaccines or environmental toxins, but rather is the result of changes in the way that autism is defined and assessed — changes that I helped put into place.

Three and a half decades ago he chaired a task force which added Asperger's disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Based on careful studies, our task force predicted that the addition of Asperger’s disorder would modestly increase the rate of children given an autism-related diagnosis. Instead, the rate increased more than 16-fold, to one in 150 from an estimated one in 2,500 in the span of a decade. It has been climbing more gradually ever since and is one in 31 today. Our intentions were good, but we underestimated the enormous unintended consequences of adding the new diagnosis.

The resulting explosion in cases included many instances of overdiagnosis — children were labeled with a serious condition for challenges that would better be viewed as a variation of normal. It also sowed the seeds of conspiracy theories and anti-vaccine beliefs as people wondered how to explain the rising cases.

Many large studies have come to the same conclusion: Vaccines don’t cause autism. The role, if any, of environmental toxins is still to be determined, but there is no known environmental factor that can explain the sudden jump in diagnoses. The changes we made to the diagnosis in the D.S.M.-IV can.

Why did autism-related diagnoses explode so far beyond what our task force had predicted? Two reasons. First, many school systems provide much more intensive services to children with the diagnosis of autism. While these services are extremely important for many children, whenever having a diagnosis carries a benefit, it will be overused. Second, overdiagnosis can happen whenever there’s a blurry line between normal behavior and disorder, or when symptoms overlap with other conditions. [...]

There's much more at the link.