The Good Doctor’s version of autism masks a grimmer truth about severely failed children | Martha Gill

To the optimist, it may seem like we are finally emerging from a dark age when it comes to children with neurological and learning disabilities. After decades of tireless campaigning, the lives of people with ADHD, autism and dyslexia are getting better and better. We’ve come a long way since the playground smears of the 1990s and 1970s that emotionally withdrawn “refrigerator mothers” caused autism.

The speed and scale of the change have even alarmed some experts. A new concern has emerged: overdiagnosis. This has been the case for the past twenty years, for example an increase of almost 800% the number of children diagnosed with autism and ADHD diagnoses has also exploded. The fear of smearing children with these labels once kept the numbers low, but are we now applying them too liberally?

Meanwhile, a recent report revealed that almost a third of the children are now eligible for extra time in exams – two in five of those at private schools. This led to a new discussion: is special treatment really justified in all these cases?

But in the midst of these public conversations, which essentially ask whether advocacy has gone “too far,” you get stories like this.

Images of it appeared last week via the BBCfrom a school in North East London, showing autistic children being pushed into padded rooms, thrown to the floor, restrained by the neck or left alone, sitting in vomit.

About forty children with learning difficulties and serious mental disorders were locked in these ‘calming rooms’ for hours, usually without food or water. Left alone, many found themselves injuring themselves.

This story was not an outlier. These scandals surface regularly. In 2022, a security review found evidence of “significant and varied” emotional abuse three special schools in Doncaster – excessive force, physical neglect, bullying and a “serious” violation of “sexual boundaries with children and young adults,” many of which were non-verbal. Vinegar had been poured over the open cuts and children were locked outside in freezing temperatures.

How can we think that destigmatization has gone too far when the treatment of autistic children reflects the worst excesses of the Victorian era?

In untangling the mystery, it is helpful to view our progress as two tracks. For those with milder conditions, things have indeed improved. Schools have often become more inclusive in recent decades, taking into account different skills and efforts to combat bullying.

But this wave of progress has left a large and important group behind. For children with serious learning difficulties, life does not improve nearly as quickly.

Why? Progress is largely driven by advocacy. But since the late 1980s and 1990s, it has been hugely influenced by the neurodiversity movement, which seeks to reduce discrimination through recognisability.

It posits that all of our unique brains fall within a spectrum of neurological differences, and that those with so-called disorders are only at one end of a continuum. People with autism or ADHD are therefore recognizable – they have characteristics that we all share to some extent. The term ‘neurodivers’ has since been expanded to include people with many different atypical traits and personalities.

Positive portrayals of autism in pop culture have focused on high-functioning people whose condition might give them particular strengths, such as the character Dr. Shaun Murphy in TV series. The good doctor.

These efforts have been extremely successful. Encouraging us to interact with autistic people and respect them for their abilities seems to have reduced discrimination and bullying.

But it has also left a group out in the cold: children who do not function well, who have limited communication and who have difficulty with daily life.

For example, a common symptom of severe autism is something called “intense vocalization,” but the public has not been taught to associate it with autism or treat it with acceptance.

Here’s one mother interviewed by a psychiatric magazine earlier this year. “Society has the wrong view of autism,” she says. “They don’t think about severe autism, like (my son) did. They think about, you know, The good doctor. And that really leaves my son out of the conversation.”

Another mother of a son with “profound” autism explained that she often had to correct people. “They will often ask if he is a scholar or has some talent.”

To compound the divisions, political change is increasingly driven by high-functioning advocates from the autistic community, allowing policy to be even further targeted at this group. As the number of people diagnosed expands to include milder cases, those who struggle most are becoming a smaller and smaller part of the cohort. Samples of those diagnosed in a group of Western countries in the 1990s show that around 50% had severe autism. In the mid-2000s this was around 11%.

As a result, perceptions and policies are distorted. A movement to include autistic children in schools has improved outcomes for those with average or high cognitive skills. In the meantime, funding for special schools and housing support has collapsed, leaving families in crisis. Parents are repeatedly called upon to pick up their children from schools that cannot safely manage their behavior, and overbooked disability programs leave them as the sole caregiver.

How to tackle the gap? For starters, talk of greater diversity and inclusion should not overshadow the plight of children with more serious conditions. Last month, Conservative leader Kemi Badenoch claimed that allowances for autistic people had gone too far, with them being given “privileges and protections” and “potentially receiving better treatment or equipment at school”. But stories of progress, or even “too much” progress, miss a bigger, grimmer picture. For many, stigma and abuse are still at truly dangerous levels.

Martha Gill is an Observer columnist

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