A Critique of Sami Timimi’s Interview on SEND, Autism, and ADHD

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	Forwarded this email? Subscribe here for more The Problem with “Invented Labels" A Critique of Sami Timimi’s Interview on SEND, Autism, and ADHD David Gray-Hammond Oct 18   READ IN APP   In a recent TES interview, psychiatrist Sami Timimi argued that diagnostic labels such as autism and ADHD are “invented,” lacking neurological basis, and that the real problem lies not within children’s brains but within their relationships and environments. He paints the SEND system as a commercial marketplace where distress is medicalised and sold back to parents in the form of branded diagnoses. At first glance, some of this may sound reasonable. Anyone who has worked in the field of neurodiversity knows that over-medicalisation exists, that services are under-resourced, and that children’s distress is too often pathologised when it might better be understood as a signal of environmental mismatch. But beneath these legitimate concerns lies an ideology that risks doing far more harm than good; particularly for neurodivergent learners whose needs are already misunderstood and marginalised. Timimi’s position is not new. It echoes a long tradition of Szaszian psychiatry, a school of thought originating with Thomas Szasz’s claim that “mental illness is a myth”. Szasz argued that psychiatric diagnoses were moral judgements disguised as medicine, a way of policing behaviour that society found undesirable. Timimi takes that framework and applies it to autism, ADHD, and other SEND categories, suggesting that these labels are not neurological differences but arbitrary social constructs that disable rather than support. It’s a seductive narrative: simple, provocative, and seemingly compassionate. Yet it collapses under the weight of lived experience, contemporary research, and a neurodivergent-competent understanding of human variation. It offers undertones of malingering children and parents rather than a meaningful path to reform. Upcoming Events Monotropism Live Discussion Neurodivergent & LGBTQIA+ The Szaszian Mirage Let’s start with the philosophical roots. The Szaszian view treats diagnosis as a social fiction, a convenient label to explain away behaviours society struggles with. Timimi’s version of this argument suggests that because we have not found a single, definitive “autism gene” or a uniform neurological signature for ADHD, these diagnoses must therefore be invented. But this is a false binary. The absence of a singular biomarker does not prove the absence of neurological difference. Human variation rarely fits such simple categories. There is extensive evidence that autistic and ADHD populations show consistent patterns in brain connectivity, sensory processing, executive functioning, and attention regulation. The diversity within these groups does not invalidate the existence of the group; any more than the diversity within humans invalidates the category itself. Moreover, the lived experiences of autistic and ADHD people testify to enduring, embodied differences that are not reducible to relational context. You can adjust the classroom lighting, improve teacher-pupil relationships, and provide trauma-informed care, all good and necessary things, yet many will still experience sensory overload, monotropic attention, or executive dysfunction. These are not simply by-products of environment; they are intrinsic ways of processing the world. The Szaszian ideology therefore oversimplifies. It frames distress as purely contextual and difference as purely relational. It confuses the critique of how we define disorders with a denial that difference exists at all. The Neoliberal Undercurrent Beneath Timimi’s anti-diagnostic rhetoric runs a quiet but familiar current: neoliberal logic. Neoliberalism thrives on individualisation. It shifts responsibility away from systems and onto persons or relationships. By claiming that diagnoses are the problem, Timimi unwittingly lets institutions off the hook. If autism and ADHD are invented, then the solution is not more resources, not smaller classes, not systemic reform. It's better relationships, better parenting, better teaching. This is the moral alchemy of neoliberalism; turn social and structural failings into private troubles. His critique of the “mental-health industrial complex” rightly identifies the commodification of diagnosis, but he misdiagnoses the disease. The marketisation of distress is not caused by recognising neurodevelopmental difference. It is caused by austerity, by competitive funding models, by governments that demand proof of pathology before releasing support. When a parent fights for an autism diagnosis, they are rarely doing so because they want a label; they are doing so because the label unlocks resources, accommodations, and legal rights that otherwise do not exist. Remove the label without transforming the system, and you remove the only remaining pathway to support. In this sense, Timimi’s rhetoric aligns, perhaps unintentionally, with cost-cutting agendas that seek to shrink SEND provision under the guise of reform. It allows policy-makers to say, “We’re not denying support; we’re rejecting labels”. But the result is the same; children lose access to help they are entitled to. Denying the Neurological: A Dangerous Erasure Timimi claims that there is “no evidence to support that there is something specific and characteristic that is neuro-based to differentiate people”. This is a sweeping statement, and one that cannot withstand scrutiny. Neuroscience has not provided a single, simple cause for autism or ADHD, but that’s not because none exists; it’s because human neurology is complex, dynamic, and varied. Both conditions are polygenic and involve multiple interacting systems. The absence of a singular marker is not absence of difference, it’s evidence of diversity within diversity. To suggest otherwise is to erase decades of work in developmental neuroscience, genetics, and cognitive psychology. More importantly, it erases the lived realities of neurodivergent people who experience their difference in sensory, cognitive, and emotional ways that persist across contexts. There’s also a subtle irony in Timimi’s position. He argues that these diagnoses are socially constructed and thus not real; but all categories of human difference, gender, class, race, even childhood, are socially constructed. Construction does not equal illusion. A thing can be both socially constructed and materially real. The fact that we interpret neurodivergence through cultural lenses does not mean there is no underlying neurobiological variation. When professionals deny the neurological basis of these differences, they inadvertently re-pathologise the very children they claim to liberate. Instead of being neurologically different, the child becomes “badly parented”, “traumatised”, or “poorly socialised”. The focus shifts from understanding to blame. The Consequences for Learners In the real world of classrooms and care systems, this rhetoric has tangible effects. Many autistic and ADHD children already fight to have their needs recognised. They face teachers who dismiss their difficulties as laziness, parents who are told to discipline more, and local authorities that question their entitlement to support. Imagine now those same professionals armed with Timimi’s assertion that autism and ADHD have no neurological basis; that these are “invented” labels. What incentive remains to provide reasonable adjustments? What justification exists for an Education, Health and Care Plan when the category itself is called into question? This is not an abstract philosophical problem, it’s a practical one. If the medical legitimacy of neurodivergent categories collapses, so does the legal infrastructure of support. We already see echoes of this in schools that prefer in-house SEND support over EHCP's, or that resist referrals because “we don’t believe in labels”. These positions often masquerade as compassion while functioning as austerity. They replace evidence-based support with moral judgement and personal responsibility. Diagnosis as Access, Not Oppression Timimi argues that diagnosis disables by turning difference into disorder. There is truth in that. The pathology paradigm, the belief that difference equals defect, has harmed generations of neurodivergent people. However, abolishing diagnosis entirely does not solve that problem; it merely removes one of the few tools neurodivergent people have to access understanding, community, and accommodations. Diagnosis, when approached through a neurodivergent-competent lens, is not a mark of pathology but a map of difference. It identifies how a person’s neurology interacts with their environment, what supports might reduce distress, and how society might adapt to meet diverse needs. Crucially, diagnosis can open doors to community. For many Autistic and ADHD adults, receiving a diagnosis (or self-identifying after careful reflection) was the first step toward finding people who think and feel like them. These communities, both online and offline, provide the very relational support Timimi claims is missing. The autistic and ADHD communities are not symptom clusters. They are cultural, creative, mutually supportive ecosystems. Within them, individuals share strategies, develop language for their experiences, and challenge internalised shame. When Timimi dismisses diagnostic labels as inventions, he overlooks this entire relational dimension. He seems to imagine diagnosis as an isolating act, a medical branding, when in fact, for many, it is a gateway to belonging. If relationships improve outcomes, as he argues, then dismantling the structures that lead people into community is counterproductive. Diagnosis does not prevent relationships; it often creates them. Over-Medicalisation: A Problem Misunderstood It is possible, and necessary, to acknowledge that children are being over-medicalised without concluding that neurological difference is fictional. Over-medicalisation arises not because autism and ADHD are unreal, but because systems have become dependent on diagnostic confirmation to justify any kind of support. Teachers see struggling pupils and are told to “wait for a diagnosis”. Parents fight for years for assessment because funding streams are tied to categories. Professionals diagnose because without the right code, a child receives nothing. The problem is not the diagnosis itself; it is the scarcity model built around it. Timimi’s solution, abolish or de-emphasise labels, treats the symptom, not the cause. If you remove diagnosis without restructuring the funding and accountability systems that make diagnosis necessary, you simply leave children unsupported. A genuinely transformative approach would integrate both worlds: recognise neurodivergent difference while also addressing environmental stressors, relational trauma, poverty, and systemic inequality. Neurodivergence and environment are not competing explanations; they are interdependent. The Pathology Paradigm in Disguise Timimi presents his ideas as an escape from pathology, but his framework remains trapped within it. By insisting that children’s struggles are products of environment, he still implies there is something wrong that must be fixed, only now the problem lies in relationships and context rather than neurology. The pathology has merely migrated from brain to system, and when the child can not be moulded to the system, the pathology then returns to them in the form of guilt and blame. A neurodivergent-competent approach moves differently. It begins with the premise that variation is normal and inevitable. It asks how environments can flex to meet that variation rather than demanding that people fit pre-defined norms. The difference between these paradigms is subtle but profound. In Timimi’s model, we still diagnose problems, we just diagnose them in different places. In the neurodivergent-competent model, we move beyond diagnosis as judgement entirely and toward collective adaptation. In other words; the goal is not to deny difference, but to redesign systems around it. The False Promise of Abolition There’s an appealing simplicity in the idea of abolishing diagnostic labels. Without them, perhaps we could focus on children as individuals rather than categories. But in practice, abolition without structural change entrenches inequity. Diagnosis, imperfect as it is, functions as a shield in systems that still demand evidence of impairment before providing support. Removing that shield while leaving those systems intact leaves the most vulnerable children exposed. Furthermore, for many neurodivergent people diagnosis is not merely a bureaucratic event but an existential one, a way of naming lifelong experiences of difference, confusion, and exclusion. It offers narrative coherence. To tell those people that their label is invented is to erase their self-knowledge and advocacy. The way forward is not diagnostic nihilism but diagnostic transformation; from pathology to identity, from exclusion to inclusion, from disorder to difference. Community as Medicine Timimi is right about one thing, relationships matter. Human beings heal and grow through connection. But connection is not built by denying identity; it is built by recognising and honouring it. Autistic and ADHD communities provide a form of social medicine that psychiatry rarely acknowledges. Within these spaces, people share language for sensory experiences, executive struggles, and emotional intensity. They teach each other to find safety, to rest, to set boundaries, to advocate. These are the very relational interventions Timimi claims are lacking, and they exist precisely because people found each other through diagnostic identity. Diagnosis, in this sense, is not a cage but a compass. It points toward others navigating similar terrain. It transforms isolation into solidarity. When professionals dismiss diagnosis as an “invented brand”, they ignore this collective healing process. They also silence a generation of neurodivergent advocates who have redefined what it means to be Autistic, ADHD, dyslexic, or otherwise divergent. These communities are not victims of medicalisation; they are survivors of it, reclaiming language and identity for themselves. The Evidence for Difference For completeness, let’s briefly touch on the science Timimi rejects. Genetic studies have identified hundreds of variants associated with autism and ADHD, not single causes, but clusters that influence neurodevelopmental trajectories. Twin studies show high heritability estimates for both conditions. To deny a neurological basis outright is not scientific scepticism; it is ideological commitment. The better conversation is not whether neurobiological differences exist, but how we interpret them. Are they pathologies to cure, or variations to accommodate? Do they define identity, or merely influence it? These are rich, nuanced questions, and they cannot be answered by pretending difference does not exist. Toward a Neurodivergent-Competent Future A neurodivergent-competent approach would look very different from both biomedical reductionism and Timimi’s anti-diagnostic stance. It would begin by affirming that neurological variation is part of human diversity. It would then examine how environment, relationships, and systemic inequality interact with that variation to produce either wellbeing or distress. Instead of abolishing diagnosis, it would reframe it as a tool for understanding, a starting point for dialogue, not a verdict. Teachers and clinicians would be trained to view neurodivergence as a relational phenomenon that requires both personal and systemic adaptation. Policy would shift from “prove your deficit” to “show your difference”. Funding would flow based on need and context, not on deficit labels. Most importantly, neurodivergent people themselves would be central to defining what support and flourishing look like. Their lived experience, the very thing Timimi’s rhetoric dismisses, would guide practice. A Note on Compassion and Complexity It’s important to recognise that Timimi’s intentions are not malicious. His critique comes from frustration with a broken system, one that too often reduces children to codes, parents to case managers, and teachers to gatekeepers. On that point, we can agree. But good intentions do not neutralise harmful outcomes. In the name of protecting children from over-medicalisation, his narrative risks stripping them of recognition, validation, and access to support. The world does not need fewer diagnoses; it needs fewer pathologising interpretations of them. It needs systems that treat diagnosis as one piece of a larger ecological picture, one that includes poverty, trauma, sensory environment, pedagogy, and belonging. Conclusion: The Danger of Simple Stories Timimi’s argument offers the comfort of simplicity in a world that is anything but simple. It promises liberation from labels, from psychiatry, from medicalisation. But liberation built on erasure is no liberation at all. Autistic and ADHD people exist; not as inventions, not as brands, but as real, living expressions of human neurodiversity. Their differences are shaped by biology, yes, but also by culture, environment, and history. Their distress is real, and their joy is real. To insist that these differences are unreal because we cannot measure them with a single brain scan is to mistake the limits of science for the limits of humanity. Children do not need fewer words to describe themselves; they need better ones. They do not need professionals to tell them their brains are myths; they need adults who will listen, believe, and adapt. The future of inclusive education lies not in denying difference, but in designing for it. Diagnosis, community, and relational care are not enemies. They are interdependent. The label can open the door; the community can provide the belonging; the relationship can sustain the growth. Remove any one of these, and the structure collapses. If we want to improve outcomes for neurodivergent children, we must hold all three. Read Next: Helen Edgar (Autistic Realms) Neurodivergent Pride Store Buy David A Coffee This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Upgrade to paid You're currently a free subscriber to David Gray-Hammond. For the full experience, upgrade your subscription. Upgrade to paid   Like Comment Restack   © 2025 David Gray-Hammond Unsubscribe