Autism diagnosis in Wales: The case of governance-driven medicalisation in care pathways

The medicalisation of autism has traditionally been framed as a process driven by professional expansion or parental advocacy. However, in state-managed healthcare systems, medicalisation is increasingly structured through governance and policy mechanisms. This paper examines governance-driven medicalisation in Wales, where neurodevelopmental (ND) care pathways regulate autism diagnosis through standardisation, eligibility criteria and administrative oversight. Drawing on a qualitative case study of a socioeconomically deprived health board in South Wales, I explore how ND pathways function both as engines of medicalisation and as institutional gatekeeping mechanisms. Findings demonstrate that standardised assessment tools, referral thresholds and multidisciplinary panels reshape professional discretion and mediate parental access to diagnosis, reinforcing administrative rather than purely clinical decision-making. By engaging with theories of medicalisation, expertise and clinical governance, I show how the redistribution of diagnostic authority among healthcare professionals, educators and policymakers contributes to the administration of autism services. Comparisons with the U.S. context further illustrate how governance structures shape medicalisation in distinct but functionally similar ways. This study extends medicalisation theory by showing that in state-run systems, policy frameworks – not just medical professionals – play a central role in structuring diagnosis, access and service provision.