Annie Swanepoel

Summary: A significant minority of women experience perinatal depressive or anxiety disorders, perhaps because mothers now attempt in isolation a role humans evolved to perform collectively. We argue that this evolutionary mismatch may be one contributing factor, complementing their multifactorial, biopsychosocial aetiology. We outline clinical, service and policy implications.

The neurodiversity movement has gained considerable momentum in recent years, asserting that conditions such as attention‐deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) represent natural variations in human neurodevelopment rather than pathological disorders (Baron‐Cohen, 2017). This perspective has found increasing resonance among people with lived experience, advocacy groups and a growing number of clinicians. Yet, it has also attracted criticism for lacking a rigorous scientific foundation, leaving it vulnerable to the charge that it is more ideological than evidence based (Sonuga‐Barke & Thapar, 2021). We argue that evolutionary psychiatry provides precisely the scientific framework that the neurodiversity movement needs. By asking why ADHD and ASD have persisted across human history, and answering through the mechanisms of natural selection, evolutionary theory transforms neurodiversity from an advocacy position into a scientifically grounded account of human variation.

Summary: Self-harm among young people is rising worldwide and spreads through peer networks. We apply Tinbergen’s four questions – a framework from evolutionary biology applicable to all biological phenomena – to argue that group self-harm may be an ancient ritual process that has become dangerous when severed from the cultural structures that once contained it.

Summary: Obsessive–compulsive disorder (OCD) is being missed in children with severe intellectual disability. Their compulsive behaviours are routinely attributed to autism spectrum disorder or dismissed as challenging behaviour, without systematic consideration of OCD. I argue that this misattribution is predictable, consequential and correctable. The key diagnostic tool is the ego-dystonic/ego-syntonic distinction: OCD rituals are distressing to the child and a change from their baseline, whereas autistic repetitive behaviours are typically comforting. When this distinction is applied, and OCD is treated with modified exposure and response prevention and selective serotonin reuptake inhibitors, outcomes can be transformative. A dedicated evidence base for this population is urgently needed.

Children and young people who present with behaviour that challenges on a background of intellectual disability commonly present to paediatricians for support. This paper gives a structure to explore the possible biological, psychosocial and environmental underlying problems and suggests ways to assess and address these.

Background: Children with intellectual disability (ID) are more susceptible to adverse effects from standard psychiatric medications, often necessitating the use of off-label treatments. In the limited studies to date, Clonidine has displayed evidence of benefit in treating attention-deficit/hyperactivity disorder (ADHD), sleep onset difficulties, behaviors that challenge, and tics. Methods: This naturalistic study involved a cross-sectional survey completed by 4 consultant psychiatrists, detailing 50 children with ID treated with Clonidine over a 3-year period. Data collected included treatment indications, dosage, and retrospective Developmental Disabilities Modification of Children’s Global Assessment Scalescores to evaluate functioning before treatment and again 6–12 months later. Results: Among children who remained stable on Clonidine, ordinal regression analyses revealed that total Clonidine dose, level of ID, concomitant medications, and comorbid diagnoses significantly predicted improved functioning at 2 months, which was sustained after 1 year of treatment with Clonidine. Conclusions: Clonidine is useful to treat ADHD, sleep difficulties, tics, and behaviors that challenge. Clonidine was generally well tolerated and appears to be an effective treatment option for children with ID. This will inform the clinical practice of both pediatricians and psychiatrists who support and treat children with ID.

Objectives: This study explores psychiatrists’ perceptions of Attention-Deficit Hyperactivity Disorder (ADHD) through the lens of evolutionary psychiatry, a growing field that reframes mental disorders in the context of adaptation and survival. Evolutionary theories suggest that traits associated with ADHD, such as impulsivity, hypercuriosity and novelty-seeking, may have been adaptive in ancestral environments, though they manifest as maladaptive in structured modern contexts. Method: A bespoke 10-item questionnaire was developed to assess psychiatrists’ attitudes following a presentation on evolutionary perspectives of ADHD by an expert. The questionnaire allowed rating in 5-point Likert fashion and was followed by a free text box for qualitative analysis. Basic descriptive statistics and One-Way ANOVA pairwise comparisons between groups was used to test for statistical significance. A p value of <0.05 was deemed statistically significant. Results: Forty-two participants, including 21 consultants and 19 psychiatry trainees completed the questionnaire. All participants rated their comprehension of the presentation as high/very high. Most strongly agreed that the information presented could improve psychiatry and therapeutic outcomes. However, consultants with more than 10 years of experience were less likely than trainees to report optimism about the practical applications of evolutionary frameworks. Qualitative feedback emphasized the relevance of evolutionary perspectives in clinical practice, particularly in reducing stigma and enhancing therapeutic engagement with patients and families. Conclusions: While the results from this study were positive, limitations include the small sample size and lack of prepresentation baseline data. However, this study has formed part of the first step in investigating the perceptions and attitudes of psychiatrists on evolutionary perspectives on ADHD.

Recent developments driven by people with attention-deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) have highlighted that far from being disorders, ADHD and/or ASD can be seen as natural variations in neurodevelopment. The neurodiversity movement acknowledges that people with ADHD and/or ASD have specific strengths, that can help them outperform neurotypical individuals in certain situations and that these conditions should therefore not be seen as disorders. This view is supported by evolutionary science, which can be used as a framework to understand ADHD and/or ASD as natural variations that were not eliminated by natural selection due to their benefit to the individual and group in certain situations. The evolutionary perspective supports neurodiversity as relevant and important in helping our species thrive.