SINGAPORE: People are Googling symptoms for themselves, or their children, arriving at conclusions derived from an algorithm. They then present to their healthcare providers with a diagnosis to be confirmed, rather than a problem to be understood.
The cohort seeking diagnosis has evolved from children with severe, debilitating functional impairment who could not learn, could not socialise and could not manage the basic activities of daily life, to people whose difficulties are real but whose framing may not be.
The diagnoses of neurodevelopmental disorders such as ADHD and autism have increased at a pace that cannot be explained by improved detection alone.
According to the Australian Bureau of Statistics, the number of Australians with autism increased by 42 per cent in just four years, from 205,200 in 2018 to 290,900 in 2022.
The Medical Journal of Australia showed that by 2022-23, approximately 470,000 Australians were being prescribed ADHD medication. This is an increase of about 300 per cent in 10 years.
A 2023 study in the Journal of Child Psychology and Psychiatry tracking nearly 9000 Australian children found that ADHD diagnoses increased significantly between two birth cohorts while hyperactive and inattentive behaviour scores remained unchanged.
The diagnostic threshold has dropped and some of what is being captured may be nothing more than a child who is the youngest in their class, a gifted child bored into inattention, or a developmental phase that will resolve itself with time. These are not conditions, they are childhood.
People use terms as “a touch of the tism” if they have a strong interest in something, are a little quirky or are sometimes socially awkward. A professional once told me that a child did not meet the threshold for further assessment but that she believed he was nonetheless on the spectrum because he was, in her words, precise and pedantic. She also said that with time and maturity, he would likely grow out of it.
Autism is not a vibe check. Autism is a neurodevelopmental disorder – not shorthand for being quirky, awkward or really into something. There are marked differences in communication, sensory experiences, thinking, routines, focused interests and a wide range of support needs. These differences impact day-to-day functioning significantly.
They are not impairments that go away when a child reaches adulthood.
We are in the midst of a feedback loop with identifiable victims. Those who receive a diagnosis they don’t need are labelled with a fixed condition instead of a manageable difficulty. Those with genuine and severe presentations, for whom diagnosis was never in question, now find themselves in an overcrowded category that no longer reliably signals the severity of their need. And broader culture has lost its tolerance for ordinary human struggles.
Social media has played a significant role in the evolution of a cultural environment in which self-diagnosis and identity-based pathologising has become socially rewarding by creating a visibility and community around diagnosis. This demand flows on to clinicians operating under time pressure and loosened criteria who accommodate it.
There is a cultural cost of pushback, particularly among a profession that is based on the therapeutic relationship. A large part of a clinician’s professional identity is built around validating and supporting the patient so there is pressure to agree in order to keep them engaged and to avoid complaint or the appearance of dissent from prevailing norms.
Actively sought knowledge requires effort and tends to lead people towards primary and authoritative sources such as their healthcare provider. Passively absorbed content is algorithmically served, optimised for engagement rather than accuracy, and consumed without the critical frame that comes from genuinely wanting to understand something.
It produces people who feel informed but have absorbed a flattened, dramatised, symptom-focused version of complex clinical concepts. It is pattern recognition without the clinical training that tells you what the pattern actually means.
A diagnosis is not a checklist. It is the differential weighing of symptoms against alternative explanations, developmental history and impairment across multiple domains coupled with clinical judgment that is built from exposure to the full range of presentations. It is more nuanced than a 90-second video. A checklist is a bad diagnostic tool in the hands of someone who is also the subject of the assessment.
The weight of proximity to an experience now confers more authority than training, research and clinical exposure to thousands of cases. So the feedback loop goes like this: social media drives demand, clinicians accommodate it and pushback is costly because lived experience is elevated above clinical judgment. This makes the loop self-reinforcing and resistant to correction.
Neither side is acting in bad faith. Platforms create and spread a narrative in an effort to raise awareness and reduce stigma. The passive absorption of this information creates an illusion of expertise where individuals arrive at conclusions about themselves or their child. The current emphasis of lived experience over professional qualifications makes the clinician’s considered pushback indistinguishable, to the patient, from dismissal.
The pre-internet era had plenty of professional gatekeeping that caused harm. Access to information is genuinely valuable but passive absorption is a different and problematic by-product. Lived experience emerged for good reasons in contexts where professionals dismissed patient experiences, but it has overcorrected.
What has become lost as a result for individuals is a difference between a condition to be accommodated and a difficulty to be worked on. This distinction matters enormously for how a life unfolds and the beliefs people form about their own capacity and whether struggle becomes a signal to seek help or a reason to try harder.
For people with severe and genuine presentations, expanded diagnostic criteria no longer reliably directs resources, clinical attention or urgency towards those who need it most. The cost of this diagnostic inflation has resulted in a culture where we have confused fluency in the language of distress with the capacity to move through it. Knowing the vocabulary of your challenges is not the same as being resilient.
The awareness campaigns that were designed to reduce stigma have overshot and created a generation for whom pathology is not something to overcome, but a load-bearing identity. Hyperawareness is now generating its own pathology. People aren’t failing to notice mental health, they are noticing it everywhere. Including where it isn’t.
The solution is not returning to an era of dismissal and underdiagnosis, but rather restoring the clinical rigour that protects everyone. When everyone is diagnosable, the word stops meaning anything and the people who most need it to mean something are the ones who pay the price.