Historical diagnostic failure, not conceptual collapse: A response to Frith

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Doherty, M., Henderson, J., Hill, H., Rabenstein, K., Lang, J., Grosjean, B., Dakin, C., Wijetilleka, S., & Shaw, S. C. K. (2026). Historical diagnostic failure, not conceptual collapse: A response to Frith. Psychological Medicine, 56, Article e305. https://doi.org/10.1017/s0033291726105996

Publication date: 1 Jan 2026 Added to AutiHub: 4 Oct 2026 Type: Article Article language: English
Publisher source (DOI) Full text OpenAlex source

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Authors

Publication authors
9
Publication authors identified as autistic
9 / 9 (100.0%)
  1. Mary Doherty *
  2. James Henderson *
  3. Hannah Hill *
  4. Kai Rabenstein *
  5. Jason Lang *
  1. Bernadette Grosjean *
  2. Catherine Dakin *
  3. Sajini Wijetilleka *
  4. Sebastian C. K. Shaw *

Abstract

We disagree that the autism spectrum has lost its meaning, that cultural factors have driven diagnostic inflation, or that differences between early-and late-diagnosed individuals now justify division into separate categories (Frith, 2026).These claims conflate several distinct problems and risk real-world harm.Autistic Doctors International (ADI) numbers over 1,500 autistic medical doctors worldwide, demonstrating that autism is not incompatible with a medical career.Some were diagnosed as young as 3 years (Shaw et al., 2023), meeting Frith's criteria for the core group, yet by their professional profile are indistinguishable from colleagues she places in the other.Her taxonomy cannot accommodate this.Some had childhoods where differences were conspicuous; others built careers of apparently effortless competence while quietly managing demands their neurotypical colleagues never had to consider.Yet across differing profiles they find commonalitiessensory differences, pattern recognition, and the exhaustion of life among a non-autistic majorityacross what Frith frames as an unbridgeable divide.That common phenomenology extends further still.A published exchange between one of us and a nonspeaking autistic undergraduate who communicates by independent typing found the experience of being perceived as a fraud spontaneously recognized across profiles Frith's framework would separate (Doherty, 2026a).The extent of this shared phenomenology deserves rigorous investigation, not premature taxonomic foreclosure.Frith insists on 'disorder', presented as scientific precision.This is a value-laden choice with consequences.An ADI membership survey found members viewing autism as a disorder were almost three times more likely to have attempted suicide than those who did not (Shaw et al., 2023).Autistic shamethe internalized sense of defectiveness arising from lifelong exposure to neuronormative expectations, where difference is misread as deficitis a barrier to disclosure among autistic psychiatrists (Doherty, 2026b).This matters beyond the individual.Where shame impacts self-recognition or disclosureincluding among researchers and cliniciansit shapes science: the questions asked, the experiences centered, the expertise recognized.How we name, frame, and shame these difficulties has consequences reaching well beyond diagnostic manuals, into consulting rooms, classrooms, and workplaces where autistic people spend our lives (Doherty et al., 2026).What Frith characterizes as loosening of criteria is the correction of a systematic bias.For decades, diagnostic criteria reflected white male presentations, often with co-occurring intellectual disabilitythus excluding most autistic people.The category was never a pure one later contaminated; it was always incomplete.Late diagnoses among women and people without intellectual disability are evidence of historical diagnostic failure: people rendered invisible by narrow criteria, not invented by wider ones.Many spent decades misdiagnosed with depression, bipolar disorder, schizophrenia, or personality disorders, treated with pharmacotherapy that never addressed the underlying neurodevelopmental reality.The most substantive point Frith offers rests on the finding that polygenic profiles differ between early-and late-diagnosed autistic people (Zhang et al., 2025), the later-diagnosed group showing stronger genetic correlation with ADHD, major depressive disorder, and PTSD.She reads this as misclassification, an inference requiring scrutiny.Polygenic correlations do not establish the direction or mechanism of association: they are also consistent with these conditions being downstream consequences of unrecognized autism.Frith rejects the concept of masking, yet it is robustly associated with elevated anxiety, burnout, depression, and suicidality, and the genetic profiles of masking and compensation have not been examined.A large-scale integrative study found elevated depression and ADHD polygenic scores across autistic people without intellectual disability generally, not only late-diagnosed subgroups (Fleury et al., 2025).Zhang's findings cannot bear the weight of misclassification, Frith asserts.

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Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 28 Oct 2026 01:01.

Cited references
9
With a DOI
8
Without a DOI, from raw bibliography text
1
5 / 9 (55.6%) cited references include at least one author identified as autistic.
References with data to complete
0 / 9 (0.0%)
References with detected author names
9 / 9 (100.0%)
Without detected author names
0
Without a structured title
0
Without a stable identifier
1
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
326
From DOI or external metadata
326
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
51 / 326 (15.6%) names are linked to an author already present in AutiHub. 275 / 326 (84.4%) names are not yet linked.
Names linked to a person identified as autistic
22 / 326 (6.7%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 22 / 51 (43.1%). Distinct people identified as autistic: 16 / 318 (5.0%).
  1. Julia Cook , Laura Hull , Laura Crane , William Mandy (2021). Camouflaging in autism: A systematic review . Clinical Psychology Review, 89(102), 102080. Elsevier BV.
    Type: Article DOI: 10.1016/j.cpr.2021.102080 OpenAlex: https://openalex.org/W3198172085
    Crossref OpenAlex
  3. Fleury (2025). InovAND: a multiscale resource to explore genetics, brain imaging and clinical data in autism . medRxiv.
    Type: Preprint
    Crossref
  6. Xinhe Zhang , Jakob Grove , Yuanjun Gu , Cornelia K. Buus , Lea K. Nielsen , Sharon A. S. Neufeld et al. (2025). Polygenic and developmental profiles of autism differ by age at diagnosis . Nature, 646(8087), 1146. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1038/s41586-025-09542-6 OpenAlex: https://openalex.org/W4414690425
    Crossref OpenAlex
  8. Uta Frith (2026). Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis? Psychological Medicine, 56, e240-e240. Cambridge University Press (CUP).
    Type: Article DOI: 10.1017/s0033291726105376 OpenAlex: https://openalex.org/W7172422998
    Crossref OpenAlex