When clinicians write books leavened with patient vignettes, they often highlight the drama of making diagnoses. But in his new book, “Back to Normal,” the clinical psychologist Enrico Gnaulati explores the opposite preoccupation—_un_doing or avoiding diagnoses such as A.D.H.D., biopolar disorder, and autism-spectrum disorders. Too many children get too many psychiatric labels, he argues, often to no good end at all.

At one point in the book, Gnaulati introduces readers to Joseph, a hot-tempered thirteen-year-old who often raged against his mother, one night hurling expletives and bashing the wall, only to ask, a half hour later, for a grilled-cheese sandwich. Although a child psychiatrist determined that the boy was bipolar and prescribed medication, Gnaulati saw him and insisted otherwise. To him, Joseph was just struggling with normal developmental issues, such as “ambivalence young adolescents feel about growing up,” and did not need drugs. The family apparently agreed, and the boy improved with therapy.

The rates of diagnosis for A.D.H.D., bipolar disorder, and autism-spectrum disorders (A.S.D.) have soared in recent years. The numbers defy any single explanation, though many doctors point to possible causes such as complications during pregnancy and childbirth, genetic mutations, and greater public awareness. Gnaulati, by contrast, makes much of everyday factors, such as too much caffeine and too little sleep, too much academic pressure and too little exercise, too much parental hovering or, on the other hand, too little attention. He revels in the somewhat obvious, such as the child with “delayed language skills” whose full-time babysitter, it turned out, speaks no English. Yet he also widens the aperture to include well-known systemic issues, such as financial incentives for doctors and access to special education, which underlie what he calls a “dragnet” of diagnosis. Much of this is compelling. Gnaulati’s more sweeping claims about gender and evolution, however, may leave readers asking what role his version of “common sense” or intuition should play in diagnosing the culture, let alone the individual child.

Gnaulati’s appeal to level-headedness at times hits the mark. His take on A.D.H.D., for instance, is mostly persuasive when grounded in descriptions of stressed-out parents, teachers, and clinicians. Symptoms such as “distractibility, forgetfulness, problems with follow-through,” and “difficulty waiting one’s turn” can be hard to distill from normal childhood struggles, he argues. Schools that require kids to sit still for long periods and follow rigid directives, even in kindergarten, can make some children seem disordered. Academic pressure and an emphasis on test scores may also predispose teachers to view “a struggling student as a disabled student.” Clinicians, too, are in the hot seat. With little time for extensive assessments, they may sometimes incline toward convenient diagnoses and prescriptions, such as stimulants for A.D.H.D. Doctors may also fail to get a second evaluation—say, from a teacher—which can reveal how a child’s behavior depends on context.

Financial incentives also shadow this terrain in ways that surely lead to more labeling. Most notoriously, at least one of the doctors who has argued for broadening the definition of bipolar disorder in children has also received large payments from pharmaceutical companies. This work has likely contributed to higher rates of diagnosis, and greater use of drugs with worrisome side effects. Yet it can be hard to disentangle the money from the merits. Services, too, can play a confounding role. As Fred Volkmar, of the Yale School of Medicine, told me, “children that don’t need services don’t need labels.” (As Gnaulati notes, diagnoses are often required to obtain funding for educational services and other forms of support.)

Gnaulati’s emphasis on intuition, however, also has a dark side. This is most apparent in how his discussion of autism-spectrum disorders, which he believes are overdiagnosed, shades into questionable claims about gender and the brain. Drawing on work by the British psychologist Simon Baron-Cohen, he suggests that A.S.D. may represent an extreme form of the “male brain.” By this he means a tendency to be less empathetic, to have restricted interests, and to be fascinated with how systems work, tendencies that Baron-Cohen has said may be linked to prenatal testosterone exposure. Gnaulati suggests that clinicians and teachers, many of whom are women, fail to accommodate “traditionally masculine” behavior, and, on the margins, pathologize it. He doesn’t argue that all people labelled autistic don’t deserve the label. But his skepticism flares when it comes to male children who fall into a gray area toward the mild end of the spectrum. “Highly intelligent boys,” he writes, “who happen to be introverted by temperament are probably the subpopulation of kids who are most likely to be erroneously labeled autistic.”

No one really knows what causes autism, and more boys than girls have been diagnosed with the disorder. But the extreme-male-brain theory does not rank high on most experts’ list. (“Simon is very creative,” Volkmar told me, diplomatically). The evidence that prenatal testosterone exposure shapes individuals’ empathy levels—or causes them to develop autism-spectrum disorders—remains messy, at best. Baron-Cohen’s ideas, based on the assumption that testosterone might play a role in shaping intellectual interests and career choices, became a flashpoint in the 2005 debate over why more men than women become academic scientists. So it is a bit odd for Gnaulati to use this theory, with no acknowledgement of its history, to worry about undervaluing boys’ “mental gifts.” Some psychological differences do exist between the sexes, but they tend to be less stark than Gnaulati suggests. Worse, he hardly acknowledges that girls might be introverted, brainy, or passionate about ideas. And he barely mentions that they might also fall on the autism spectrum. In other words, his approach to how boys and girls differ will diverge from many readers’ own experience and intuition.

So it would be nice if he offered strong evidence for his ultimate claim, that boys are at higher risk of being mislabeled. Alas, he does not. In discussing the chances of a “false diagnosis,” he cites a large national study of children between the ages of three and seventeen. The study found that almost forty per cent of children who had ever been diagnosed with A.S.D. did not have the disorder at the time of the investigation, according to their parents. This could mean that they were incorrectly labeled in the first place, although the authors mention other possibilities as well, and stress that they didn’t have data to explain the change. They note specifically, however, that boys were no more likely than girls to have shed the A.S.D. label. To whatever extent the research captured errors in diagnosis, the phenomenon looked the same in both genders. Gnaulati never mentions this.

Even when dealing with A.D.H.D., Gnaulati has a tendency to reach beyond the evidence. In particular, he resurrects an old evolutionary claim, popularized in the nineteen-nineties, that “A.D.H.D. traits such as distractibility, impulsivity, and aggressiveness,” which today can be maladaptive, helped our hunter-gatherer ancestors to survive. “Restlessness, constant visual scanning, and being amped up for quick and aggressive action happen to be attributes of fine hunters,” Gnaulati writes. “If Ritalin had been around 150,000 years ago and taken in mass quantities, our survival as a species might have been uncertain.”