Autism Diagnosis Is Expanding — At a Cost
Autism may be overdiagnosed — and, Liao and Fombonne argue, that children with the greatest needs may be paying the price.
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By
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Kerri Miller
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April 23, 2026
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Clinical Scorecard: Autism Diagnosis Is Expanding — At a Cost
At a Glance
| Category | Detail |
|---|
| Condition | Autism Spectrum Disorder (ASD) |
| Key Mechanisms | Overdiagnosis due to diagnostic substitution, clinician boundary stretching, and changes in diagnostic criteria. |
| Target Population | Children receiving autism diagnoses in community settings. |
| Care Setting | Clinical and community settings. |
Key Highlights
- Nearly 50% of children diagnosed with autism did not meet criteria upon reevaluation.
- Concurrent intellectual disability in autism has decreased from 70% to 30% over four decades.
- Resource allocation is a central concern, potentially disadvantaging children with significant challenges.
Guideline-Based Recommendations
Diagnosis
- Improve differentiation between autism and co-occurring psychiatric conditions.
- Avoid mechanical use of standardized tools without considering confounders.
Management
- Ensure equitable access to evaluation and treatment resources.
Monitoring & Follow-up
- Regularly reassess diagnostic criteria and thresholds to reflect current understanding.
Risks
- Overdiagnosis may divert resources from children with the most significant challenges.
Patient & Prescribing Data
Children diagnosed with autism, particularly those with milder or ambiguous presentations.
Better-resourced families may secure diagnoses and services more easily, amplifying disparities.
Clinical Best Practices
- Clinicians should be cautious in applying autism diagnoses, considering the full clinical picture.
- Diagnostic processes should prioritize accurate identification of autism to optimize resource allocation.
References
