The Good Doctor’s version of autism masks the reality of badly failed children | Martha Gill

To the optimist, it may seem as though we are at last emerging from a dark age when it comes to children with neurological and learning disorders. After decades of tireless campaigning, life for those with ADHD, autism and dyslexia is getting better. We have come a long way from the playground slurs of the 1990s or the 1970s idea that emotionally withdrawn “refrigerator mothers” caused autism.

In fact, the speed and scale of the change has alarmed some experts. A new worry has emerged: over-diagnosis. Over the past 20 years, for example, there has been a near 800% rise in the numbers of children diagnosed with autism, and ADHD diagnosis has similarly exploded. Fear of tarring children with these labels once kept numbers down, are we now applying them too liberally?

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

But amid these public conversations, which at the root ask if advocacy has gone “too far”, you get stories like this one.

Footage emerged last week, via the BBC, from a school in north-east London, showing autistic children being shoved into padded rooms, thrown to the floor, restrained by the neck or left alone, sitting in vomit.

Some 40 kids with learning disabilities and severe mental health disorders had been confined in these “calming rooms” for hours, most often without food and drink. Left alone, many were seen to be injuring themselves .

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

How can we think destigmatisation has gone too far, while the treatment of autistic children echoes the worst excesses of the Victorian era?

While untangling the mystery, it is helpful to think of our progress as two-track. For those with milder conditions, things have indeed improved. Schools have often become more inclusive over the decades, making allowances for different abilities and efforts to combat bullying.

But this tide of progress has left behind a large and important group. For children with severe learning difficulties, life is not improving nearly as fast.

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 relatability.

It argues that every one of our unique brains fall along a spectrum of neurological differences, and those with so-called disorders are merely at one end of a continuum. People with autism or ADHD are therefore relatable – they have traits we all share to some extent. The term “neurodiverse” has since broadened further to include people with many different atypical traits and personalities.

Positive portrayals of autism in pop culture have concentrated on high-functioning people whose condition might give them particular strengths, such as the character Dr Shaun Murphy in TV’s The Good Doctor.

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

But it has also left a group in the cold: children who are not high functioning, who have limited communication and who struggle with daily life.

A common symptom of severe autism, for example, is something called “intense vocalisation”, but the public has not been taught to relate it to autism or to treat it with acceptance.

Here’s a mother interviewed by a psychiatry journal earlier this year. “Society has the wrong view of autism,” she says. “They’re not thinking about severe autism, like [my son] has. They’re thinking 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 she often had to correct people. “They’ll often ask if he has some savant or particular talent.”

To compound the split, political change is increasingly driven by high-functioning advocates from the autistic community, which may tilt policies further towards this group. Then, as the numbers of people diagnosed expand to include milder cases, those who struggle the most make up a smaller and smaller proportion of the cohort. Samples of those diagnosed in the 1990s in a group of western countries show some 50% had severe autism. In the mid-2000s, it was about 11%.

As a result, perceptions and policies are skewed. A movement to include autistic children in schools has improved outcomes for those with average or high cognitive abilities. Meanwhile, funding for special schools and residential support has cratered, leaving families in crisis. Parents are repeatedly called to pick up their children at schools that cannot safely manage their behaviours, over-booked disability programmes leave them as the sole carer.

How to address the gap? For a start, talk of increased diversity and inclusion should not overshadow the plight of children with more severe conditions. Last month Conservative leader Kemi Badenoch claimed that allowances for autistic people had gone too far: they were accorded “privileges and protections”, and “may well get better treatment or equipment at school”. But tales of progress, or indeed “too much” progress, miss a larger, grimmer picture. For many, stigma and abuse is still at truly dangerous levels.