“Something must be done.” Yes, but not this. A reply to Uta Frith

Uta Frith no longer thinks that autism is a spectrum. She explained this view in an interview with the TES (the magazine formerly known as the Times Educational Supplement). Let’s examine her argument.

Increasing diagnosis and demand

The prompt for Frith to abandon her long-held view that autism is a spectrum is that an increasing number of people are being diagnosed with it. But that in itself is not a reason to reconsider our understanding of autism. The increase in diagnosis could be (in my view, incorrectly) explained by an increase in autism itself, or (in my view, correctly) explained by a combination widening diagnostic criteria, a greater awareness of autism, more positive portrayal of autism (by autistic people and our allies), and an increasingly distressing society pushing more and more autistic people to seek help via a diagnosis.

As the interview points out, more and more autistic schoolkids are getting Education, Health and Care Plans (EHCPs). I believe that in addition to the reasons above, an underfunded school system is meeting fewer and fewer children’s needs, so more are reaching for a way of getting extra help. Think of schools funding as the sea, schools as harbours and kids as boats. The further the funding tide goes out, the more boats are left stranded.

The TES article states that this rise in EHCPs for autistic children “has placed unprecedented strain on schools”. Wrong. It is under-funding from successive governments that has placed unprecedented strain on schools.

It also claims that the rise has “led the government to include autism as a focus of an independent review into rising demand for services for mental health, ADHD and autism”. That is true in the sense that the government has commissioned a review into whether autism, ADHD and mental health conditions are ‘over-diagnosed’ as a way of squirming out of its responsibilities. What the article fails to mention is that the announcement of this review came very shortly after the government’s own ADHD Taskforce reported that ADHD is not over-diagnosed but under-diagnosed. The government responded with a new review in an attempt to get a different answer.

Theorising autism as deficit

Frith is emeritus professor in cognitive development at the Institute of Cognitive Neuroscience at University College London (UCL) and is described by the TES article as “the person who pioneered much of the research that underpins our current understanding of autism”. For sure, she deserves credit for pioneering work in the field, but her decades of work also include developing highly pathologising theories of autism that have been discredited and superseded by more progressive academics and activists, particularly those who are themselves autistic.

In 1970, Frith wrote an article titled “Studies in pattern detection in normal and autistic children” (Journal of Experimental Child Psychology. 10 (1): 120–135. doi:10.1016/0022-0965(70)90049-4). Perhaps we can forgive her counterposition of ‘autistic’ and ‘normal’ on the grounds that there was nowhere near the level of criticism of this framing then than there is now.

Fifteen years later, Uta Frith co-authored with Simon Baron-Cohen and Alan Leslie the 1985 paper ‘Does the autistic child have a “theory of mind”?’ (Cognition, 21, 37–46. 10.1016/0010-0277(85)90022-8), which argued that autistic children lack the ability to attribute mental states to themselves and others. Damian Milton countered this in 2012 (On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27 (6). pp. 883-887) by pointing out that non-autistics can have difficulty understanding how autistic people think. If there is a problem of understanding others’ minds, it arises between people of different neurotypes rather than just inside autistic people’s brains. He called this the ‘double empathy problem’. In 2019, Gernsbacher and Yergeau set out ‘Empirical Failures of the Claim That Autistic People Lack a Theory of Mind’ (Arch Sci Psychol. 2019; 7(1): 102-118. Doi:10.1037/arc0000067) and concluded that “the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.”

Frith’s 2026 TES interview shows that she has not broken with this deficit approach to autism. She insists that it has “some pathology in the brain” and that despite some people’s objections to the term, it is a “disorder”.

She also argues that it is characterised by “distinct problems in social communication and interaction” and that being able to “interact smoothly with you in conversation” is a contraindicator of autism.

By definition, social communication and interaction involve at least two people. So, when there is a problem with them, it is a problem between two (or more) people, not a problem in one of them. Moreover, social communication and interaction happen in specific circumstances. So, an autistic person has ‘distinct problems in social communication and interaction’? In what context? When trying to get a word in edgeways in a one-sided encounter with an authority figure? In misreading the facial expression of someone they have never met before? In an interaction with a person who lacks the skill of social interaction with an autistic person? Or do they only have ‘distinct problems in social communication and interaction’ in some settings, but, for example, communicate and interact with few problems with their family, close friends or other autistic people?

Frith also states that autistic people have “an additional problem with what’s called repetitive, restrictive behaviours” such as “narrow interests”. Why assume, without explanation, that this is a problem? If Alan Turing had not had a narrow interest in cracking codes, the Second World War might have gone on longer and killed many more people.

Frith says that her “lifetime’s work has been to try to explain how you could have these particular difficulties”. I don’t want to dismiss that lifetime of effort nor the insights it has produced. However, a holistic examination of this would consider not just how (or whether) autism causes these ‘difficulties’, but how society makes autistic traits into difficulties.

For example, some autistic people use repetitive movements to process and regulate. Unless these are self-harmful movements, this is not a difficulty or problem unless society refuses to accept it – which, unfortunately, it often does.

Alongside this, Frith revives long-since-debunked myths that autistic people don’t get irony and humour. She suggests that “being able to read between the lines in a conversation” is a skill that autistic people lack, rather than suggesting that not saying what you think but expecting people to hear it anyway might be a flaw in non-autistic communication.

She notes that an autistic person might have “poor reciprocal interaction … in eye contact or body language”. In other words, if an autistic person does not act in the same way that a non-autistic person does in a conversation, it is the autistic person’s reciprocal interaction that is poor. The non-autistic person who, presumably, is not reciprocating the autistic person’s body language or gaze elsewhere than in the other person’s eyes? They, it seems, do not have “poor reciprocal interaction”. It is the autistic person who must reciprocate, not the non-autistic person.

It may be that, at least for some people, autism does include deficits. However, we will discover this by objective study, not by assuming in advance that every trait of autism is a deficit just because it is atypical.

The spectrum

Frith explains that autism came to be understood as a spectrum because “Nothing is a neat category, and we wanted to include the not-so-typical cases.“ But she now states boldly that “The spectrum has collapsed”, without offering any convincing evidence for this.

Frith argues that, “We’re all neurodiverse; we can accept this because all our brains are different. But it makes a medical diagnosis completely meaningless”. If she is arguing that neurological diversity is natural and valuable, and is therefore better categorised by descriptive labels rather than medical diagnoses, then I would agree with her. But the rest of what she says strongly implies that this is not what she means. And in that case, her argument makes as much sense as saying that, “We are all physically diverse. But that makes any diagnosis of any physical condition meaningless.”

Frith argues for identifying “meaningful subgroups”, which begs the question “subgroups of what?”, to which the only answer can be “the autistic spectrum”, the very thing she declares to have “collapsed”.

She argues that there are “two big subgroups: the people who are diagnosed in early childhood – usually before age three or age five, depending on things like their intellectual abilities and language – and another group, diagnosed much later.” Of all the potential criteria for dividing autistic people into two groups, age of diagnosis is one of the least convincing. Some of us were diagnosed later in life because society did not understand autism as it does now when we were at school. Some are diagnosed later because we are women or girls, often misdiagnosed with something else before finally being recognised as autistic. Age of diagnosis can depend on where you live.

For Frith, the later-diagnosed group are simply “highly anxious” and “hypersensitive”. For her, the fact that an increasing number of these people are being identified as autistic is “just frightening”, although she does not explain what she is scared of. While reassuring us that she does think that we “really do have problems” and are not “making it up”, she wants to exclude us from the definition of autism.

I am not convinced that Frith’s two subgroups are as meaningful and distinct as she claims. I wonder which subgroup she thinks that Jason Arday would fit into. He was diagnosed with autism and global developmental delay at age 3, did not speak until he was 11 and could not read or write until he was 18. Today, he is Cambridge University’s youngest Black professor.

Frith no longer believes that “there is something that unites all the people who are diagnosed as autistic”, despite the criteria that everyone must meet in order to be diagnosed. She does not comment on the various theories that try to explain autistic commonalities, for example monotropism: the proposal that what all autistic people have in common is that we tunnel our attention into a small number or highly-aroused interests, while non-autistic people allocate their attention in a more diffuse way.

A mainly male condition?

I do agree with Frith that ‘masking’ is not an adequate explanation for why fewer girls and women are diagnosed than boys and men (although I don’t agree that it has no scientific basis). But I don’t agree with her conclusion that the only alternative explanation is that more males than females are autistic. (She actually says that “There are just diseases that are more common in males and diseases that are more common in females”, which seems irrelevant given that autism is not a disease.)

That conclusion does not account for the fact that girls are diagnosed significantly later than boys. It is not because we become autistic at a later age – after all, as Frith acknowledges, autism is lifelong. Research by Swansea University showed that it takes an average of six years longer to diagnose autism in girls than in boys; that three quarters of autistic boys, but only half of girls, received their diagnosis before the age of ten; and that the average age of diagnosis was between four and six for boys and between 10 and 12 for girls. So, if you took a snapshot of eight-year-olds, you would capture most of the autistic boys but less than half of the autistic girls.

I would argue that our society sees autism in men and boys more than it does in women and girls. Hans Asperger initially only studied boys, so it is perhaps not surprising that at first, he thought that the syndrome that was later named after him affected only boys. More recent theories have reinforced the tendency to see autism in males more than females, most notoriously Simon Baron-Cohen’s Extreme Male Brain theory of autism, which I believe that Frith endorsed.

This challenges Frith’s assertion that there is no cultural bias against identifying girls and women as autistic, and that autistic girls and women have not been unjustly overlooked.

Issues at school

Frith asserts that “Those who are intellectually impaired and are diagnosed early cannot very easily be accommodated in mainstream. They tend to have very challenging behaviour.” I think that is an unacceptable generalisation, and that if mainstream schools find it difficult to accommodate them, then mainstream schools need to become more inclusive.

She accepts that her other subtype – those who have good language and might have been diagnosed with Asperger syndrome when it was still a distinct diagnosis – can benefit from mainstream education. However, mainstream schools “have to be concrete in telling them what you want them to do” and “can’t assume they understand norms of behaviour, as other children do”. Maybe that’s because the “norms of behaviour” are neurotypical and/or illogical norms; and maybe concrete communication is good practice with all kids.

Then, having argued for two subgroups, Frith introduces a third: “the extended spectrum”; those who are “hypersensitive”. She accepts that these children are likely to stop going to school, and rightly calls on schools to “find ways to build trust with these pupils”. However, her recommendation is to “Work on building resilience” – teaching the children to put up with unbearable environments rather than changing those environments.

Frith argues that “teachers often intuitively know what a child needs, even without a diagnosis”. True, but why only mention teachers? What about teaching assistants, speech and language therapists and other education workers? She then proposes that teachers, “Together with parents … work out what the needs are and act on them straight away”. Why not together with parents and the children? This seems to me to be yet another example of an academic denying autistic people agency.

I do agree that allowing educators to meet the needs of kids immediately is preferable to waiting a long time for a diagnosis, but I also think that cutting waiting times for diagnosis would be preferable to waiting a long time! And to enable educators to meet those needs would involve measures such as reducing class (and school) sizes, scrapping high-stakes testing, creating a more benign sensory environment, and making the curriculum more flexible – none of which Frith proposes.

Frith also takes issue with autistic schoolchildren using ear defenders and similar equipment, claiming that, “As far as I know, there hasn’t been any research into finding out whether these sensory adjustments actually improve lives.” A quick use of a search engine reveals that yes, there has been such research. It would have been wise of both Frith and the TES to have carried out this simple check before pronouncing on the issue.

Understanding autism

Frith is right to point out that our knowledge of the neurological basis of autism is limited, and to argue that it is important to consider and reconsider our developing understanding of it. Nothing that I write here is intended to reprimand her for casting doubt on the sacred cow of the autistic spectrum.

However, I do think that her argument in this interview undoes some of the progress that we have made in understanding autism and seeks to return us to a more rigid definition that does not encompass the differences between autistic people as well as our commonalities.

It may be that at some future point, we do come to the conclusion that there is a better label than ‘autism’ (which, after all, literally means ‘selfishness’, which is inaccurate and unpleasant), or that there may be better labels for different groups of people currently identified as being on the autistic spectrum. But if and when we do that, it will be on the basis of scientific advance and political progress – not, as Uta Frith proposes, on the basis that underfunded schools simply can’t help all these kids.

Uta Frith is right to argue that “The current situation is dire, and something must be done.” But what she proposes is not it.