I wonder how much the explosion of autism and adhd diagnoses is in the furtherance of fraud? I know people who had their kids diagnosed with ADHD or autism so they could get government largess.
First. Diagnostic criteria widened. Schools and pediatricians screen more aggressively. ADHD in particular used to be underdiagnosed in girls and quieter kids. Autism went from a narrow, severe category to a broad spectrum. That alone produces big numbers without any fraud at all.
Second, incentives. This is where things get uncomfortable. Once a diagnosis unlocks IEPs, extra school funding, SSI, Medi-Cal waivers, respite care, therapy billing, transportation, even housing preferences, you create moral hazard. Most parents are acting in good faith, but the system quietly rewards over-diagnosis and maximal labeling. Schools get money. Providers get paid. Parents get services. No one is strongly incentivized to say no.
Third, outright fraud. Minnesota is not about parents gaming the system with a borderline ADHD diagnosis. It’s provider-side fraud on an industrial scale. Shell clinics. Kickbacks. Billing for services never provided. Coaching families on how to answer diagnostic questions. Using autism services as a cash machine because reimbursement is generous and oversight was lax. That is criminal behavior, not diagnostic drift.
The uncomfortable truth is that all three interact. Diagnostic inflation creates noise. Incentives lower the social stigma of stretching the label. That makes it easier for bad actors to hide massive fraud inside what looks like compassionate public spending. When oversight finally kicks in, it looks like an “autism fraud scandal,” even though most autistic kids and families did nothing wrong.
The forward-looking problem is political. Any attempt to tighten standards or audit spending will be framed as cruelty toward disabled kids. Meanwhile, taxpayers lose trust, and genuinely disabled families get hurt when programs are gutted after scandals. We’ve built systems that confuse care with cash flow, then act shocked when people exploit them.
What happened to the attitude that it was shameful to take welfare?
It didn’t disappear. It got overwritten.
For most of the 20th century, taking welfare carried moral weight because communities were tighter and the state was thinner. If you took aid, someone knew. Often a clerk, a caseworker, a neighbor. And the implicit story was temporary help in a bad season, not an identity. Shame worked as a social brake. It wasn’t cruelty. It was a signal that independence mattered.
Three big shifts killed that norm.
One, welfare became rights-based rather than emergency-based. Aid stopped being framed as “for when things go wrong” and became “something you’re entitled to.” Once something is a right, shame no longer fits. You don’t feel bad exercising a right.
Two, the welfare state professionalized and anonymized. Digital intake. Third-party advocates. Diagnoses instead of discretion. You’re no longer asking another human being for help. You’re checking boxes in a system. Shame needs human eyes to function.
Three, moral language flipped. Dependence used to be associated with failure or misfortune. Now it’s associated with victimhood and justice. If accepting benefits means you were wronged by structures, then refusing them looks like false consciousness. Shame gets reassigned to the person who questions the system, not the person who draws from it.
There’s also a status angle people avoid talking about. Middle-class and elite fraud is normalized. If a corporation maximizes credits or a college kid stretches a disability accommodation, it’s “smart.” That moral logic trickles down. Once elites treat the state as something to be gamed, insisting on shame for the poor collapses.
The problem is that shame disappeared without being replaced by anything functional. Responsibility, reciprocity, and exit expectations all weakened. The result isn’t dignity. It’s permanent dependency for some, quiet resentment for others, and fertile ground for fraud.
You don’t get a healthy system by reviving old-fashioned humiliation. But you also don’t get one by pretending incentives don’t shape behavior. The hard work is rebuilding norms around contribution and time-limits without demonizing people who genuinely need help. That’s much harder than declaring everything a right and calling questions “hate.”
