A prominent psychiatrist has expressed deep remorse over his role in transforming the landscape of autism in America—a change that saw US autism rates leap from 1 in 2,000 children in the 1980s to approximately 1 in 31 today. The surge, he says, is largely attributable to expanded diagnostic criteria introduced in the 1990s and further broadened in the 2010s, with far-reaching consequences for families, public health policy, and social attitudes across the globe—including in Thailand.
The revelation was made by a leading Duke University professor, who led the team that revised the influential Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994. The team’s decision to expand the definition of autism, officially recognizing milder forms such as Asperger’s syndrome, was intended to ensure children with social and communicative challenges could access support. Yet, the psychiatrist now feels “riddled with guilt” over the “unintended consequences,” including what he calls “labeling children with a serious condition for challenges that would better be viewed as a variation of the normal” (Daily Mail).
This seismic shift matters greatly to Thai readers because the global redefinition of “autism” has not only influenced diagnostic practices and prevalence statistics in Western countries, but also shapes policy and public perception here in Thailand. As local clinicians, educators, and parents grapple with rising autism numbers and the need for appropriate support, understanding the roots of the “autism epidemic” is vital.
In the 1980s, autism was a rare diagnosis in the US. But after the DSM was updated in 1994 to include Asperger’s disorder and then further revised in 2013 under the “autism spectrum disorder” (ASD) label, rates soared as more children—and later adults—were brought within the diagnosis. The professor explained, “What we did was introduce something called Asperger’s disorder, and that evolved into autism spectrum disorder, which can be ever so much more mild … and therefore very much more common.”
A key driver, he admitted, was pressure from child psychiatrists, pediatricians, and parents to relax criteria that had left many struggling children without access to services, as health insurance and school-based interventions were mostly reserved for those with an official autism diagnosis. The intention, he said, was compassionate. However, said the psychiatrist, “our well-meaning but misguided efforts” led to an enormous increase in the rate—one that outpaced their own modest predictions. He emphasized that “many people who have normal social awkwardness, eccentricities, [or] difficulties relating to people … would previously never have been considered a mental disorder” are now being diagnosed with ASD.
This changing diagnostic landscape also interacted—with tragic results—with the rise of the anti-vaccine movement. The explosion in autism diagnoses coincided with a now-debunked 1998 study that falsely linked the MMR (measles, mumps, rubella) vaccine to autism, and this coincidence fueled skepticism and parental fears. The psychiatrist stated, “I knew the problem was definitional and increased assessment … not vaccines,” but the myth gained traction, resulting in falling vaccination rates and a resurgence of preventable diseases (Centers for Disease Control and Prevention).
In Thailand, similar concerns periodically surface, with online communities sometimes echoing international vaccine skepticism, and parents seeking clarity about what rising autism numbers mean. Thai health officials and specialists routinely stress that no scientific evidence exists linking vaccines to autism (World Health Organization).
Even today, prominent political figures in the US and elsewhere—such as current and former candidates for major office—continue to stoke debate by calling for investigations into the “true causes” of autism, including possibilities like environmental toxins, certain medications, or even prenatal ultrasound scans. This ongoing uncertainty reflects the public’s confusion and concern.
Diagnosis of autism remains complex. As the Duke professor observes, “There is no biological test; symptoms vary greatly in nature and severity; clinicians don’t always agree; different diagnostic tests may come up with different conclusions; and the diagnosis is not always stable over time.” Indeed, a 2020 review found that among those diagnosed, as many as 20% also had anxiety disorders and 11% had depressive disorders, raising questions about overlap and possible misdiagnosis (National Institutes of Health).
These findings have significant implications for Thailand. Over the past decade, Thailand has reported steadily increasing rates of autism diagnosis, with public health officials attributing much of this rise to greater awareness, improved screening, and better access to developmental assessment among young children (Bangkok Post). Schools and community centers in Bangkok, Chiang Mai, and provincial capitals now frequently run early intervention programmes, and the Ministry of Public Health has prioritized ASD in its annual health screenings.
However, some local psychiatrists and pediatricians worry that a broader ASD definition might lead to overdiagnosis, a theme echoed by Western experts. One senior psychiatrist at a leading Bangkok hospital noted, “Diagnosis should not be quickly finalized, especially in young children. Social differences must be carefully distinguished from a true disorder needing intervention.” This careful approach aligns with the American expert’s view that “diagnoses in kids, particularly, should be written in pencil, because they are so often unreliable and unstable. Instead, there’s a tendency that once a diagnosis is made, it gets on medical charts … forever, and it can haunt someone for the rest of their life who had a misdiagnosis of autism early in their life, and who changed self-expectations and external expectations as a result.”
Thai society’s response to children and adults on the autism spectrum has undergone considerable change in the last two decades. Once a largely hidden population, Thais with autism are increasingly visible: on television, in special education classrooms, and in workplaces through supported employment programmes. Yet cultural perceptions vary regionally and among generations, with some families still wary of labels, fearing discrimination or limiting opportunities for their children.
Importantly, the global “autism epidemic” narrative shaped by Western diagnostic trends is not without critics. Some Thai child development experts, referencing Buddhist principles of individuality and acceptance, urge caution in overpathologizing social difference. “We must help every child reach their potential, regardless of a label,” one prominent educator in Chiang Mai observed in a recent panel discussion.
Looking forward, experts call for balanced policy and clinical judgment. There is a growing international movement—including in Thailand—toward “dimensional” rather than “categorical” understanding of neurodevelopmental differences. That is, instead of treating autism as a strict yes-or-no diagnosis, clinicians assess a wide range of social, communicative, and behavioral traits, tailoring support and intervention to each individual’s needs (Elsevier). Thai policymakers and practitioners may wish to watch for upcoming revisions of the DSM and International Classification of Diseases (ICD), as these will likely influence local standards and insurance practices.
For Thai parents and educators, the most practical advice remains: monitor children’s development with guidance from qualified professionals, seek second opinions if in doubt, and advocate for early, individualized intervention rather than focusing solely on a diagnosis. Building a supportive environment at home, in schools, and communities can help all children—whether or not they fit a medical label—thrive.
Opinion remains divided globally and in Thailand about whether the broadening of ASD criteria was a blessing, ensuring services for those previously overlooked, or a mistake that medicalized normal variation. Wherever one stands, understanding this international context can help Thai readers and society better navigate the complexities of childhood development, education, and social care for those on or near the autism spectrum.
Sources: Daily Mail, CDC, WHO, NIH PMC, Bangkok Post, ScienceDirect.