Neurodiversity 6 of 7: Autism & ADHD

These two types of neurodiversity are among the most common. They are sometimes confused, and up until recently it was believed that they could not occur together – that the diagnosing specialist had to choose to place a person in either the one category or the other. We have since learnt that most people with either one of these actually have strengths and challenges from both, so separating them in categories is more of an intellectual exercise than a real experience. For most neurodivergents, the lived experience is much more nuanced and varied than the simple descriptions in the DSMIV, but, for the sake of understanding this, let’s dive deeper into what they mean.

Autism Spectrum Disorders (ASD)

The differences in brain function and sensory sensitivity in autistic people create unique challenges for them. This is a list of the most common challenges, although not all:

1. Social interaction. Autistics struggle navigating social interactions, and often don’t understand social cues, non-verbal communication, implicit information and the intention behind non-direct communication.

2. Communication. Autistics find it difficult to express themselves and communicate verbally, especially about their emotions. Some autistics are non-verbal (they don’t speak at all), and many autistics speak normally in their daily lives but “go non-verbal” when they are stressed – they lose access to their words when they are overwhelmed (not fun).

3. Sensory sensitivity. Autistics are highly sensory – meaning their systems need sensory input but are also at increased risk for overstimulation. This can result in a dysregulated relationship with their sensory selves, often struggling to feel when they are hungry or thirsty, and being disconnected from emotions and intuitions.

4. Routines & transitions. Autistics have a strong preference for routines, predictability and structure in their daily lives because this makes them feel safe in an overwhelming world, and they struggle with changes and transitions.

5. Executive function. Autistics can sometimes struggle with functions like planning ahead, managing time and prioritizing tasks.

6. Emotional regulation. Autistics find it hard to manage and express their emotions, keep themselves regulated and behave in socially appropriate ways wih their emotional reactions, and to understand and empathize with others.

Of course, having a unique brain also means there are unique strengths and abilities, less commonly spoken about:

1. Attention to detail. Autistics are much better at discerning detail and subtle changes in their environment. They recognize patterns much more easily and are able to hold a multitude of data points in their minds about a certain problem, allowing processing on a much deeper level.

2. Memory & problem-solving. Deeper processing means better problem- solving, and autistics have much better memory about things they are interested in and a higher capacity for systematic and logical reasoning.

3. Novel perspectives. Autistics can see new connections between existing ideas to create novel approaches and easily find ways to improve efficiency of existing systems.

4. Hyperfocus. Autistics focus much more deeply on subjects they are interested in, go into flow state much more easily and are much more productive when they have the freedom to work in a hyperfocused state.

5. Creativity. Autistics come up with creative solutions to problems much more easily because they often have wider perspectives, new unique ways of looking at things, and out-of-the-box thinking. When connected to their sensory selves, they have deep and layered creative expression.

6. Integrity. Autistics are very honest and straight-forward people. They prefer direct clear communication, and have an intense drive toward truth and fairness, giving them a sincerity and authenticity not often found in the neurotypical world.

When you research autism, you may come across “high-functioning” and “low- functioning” labels. Low-functioning autism occurs together with an intellectual disability, and high-functioning autistics have normal intelligence levels. These labels are outdated though, because they often lead to the assumption that “high-functioning” autistic adults who live lives that look “normal” from the outside do not have many challenges and do not need support or resources to cope, which is very far from the truth. Instead, we now use Levels:

Level 1: Autistic symptoms do not interfere too much with a person’s work or relationships right now

Level 2: Autistics need some level of daily external support to maintain a functioning lifestyle

Level 3: Autistics need a lot of daily external support for basic functions and cannot live alone

Interestingly, and contrary to popular belief, most autistics (60-80%) are level 1 or 2, meaning they live lives that look quite ordinary from the outside, and their challenges are likely only known to those who live closest to them. That does not mean they do not struggle daily with a huge load of internal challenges, and they also need a lot of support, especially during stressful times or times of change.

Autism is often accompanied by other neurodivergent states like ADHD, dyslexia or OCD, and many autistics are born with other conditions too, for example developmental delay, intellectual impairment, Cerebral Palsy, Down Syndrome and other genetic disorders like Fragile X syndrome or muscular dystrophies. It is these other conditions that contribute to an autistic person functioning at level 3, and is not necessarily due to the autism itself. Because historically only the most disabled of people received support, the generally accepted view of autistim is enmeshed with these other conditions, and it is almost inconceivable to many people that an autistic child can look and act like any other, and grow up to be an adult with only subtle hints at neurological differences, that can only be seen by those who know what to look for.

Attention Deficit (Hyperactivity) Disorder (ADHD or ADD)

Just like in autism, the differences in brain function and sensory sensitivity in ADHD people create unique challenges for them:

1. Focus & attention. ADHD’ers don’t actually struggle focusing at all, they only struggle focusing on subjects that they are not interested in, or when they are in a stress response because of external pressure, or when they are in an overstimulating environment. Their brain prioritizes interesting and stimulating subjects to focus on, rather than boring ones.

2. Hyperactivity & impulsitivity. Hyperactivity can be physical (struggling to sit still) or mental (struggling to keep the brain focused on one thing and drifting off into more interesting fantasy worlds). ADHD’ers need movement, whether that movement is physical or mental, to keep their brains stimulated and to keep their energy moving through their systems. Forcing them to sit still or do one boring task too long will create a build-up of energy that often becomes a stress response or emotional outburst.

3. Executive function. ADHD’ers often struggle a little more than autistics with planning tasks, thinking ahead, managing their time, predicting how long tasks will last and prioritizing which tasks need to be done first. This can be so challenging that it’s very hard work to prepare a simple meal or clean up the house, without constantly getting distracted and forgetting half of what needs doing. Just like autistics, they could be geniuses in their special field of interest, but completely unable to care for their household when they are stressed.

4. Sensory sensitivity Just like autistics, ADHD’ers are also highly sensitive and need to manage their sensory needs very closely (prevent overstimulation while also stimulating their brains enough to stay engaged).

5. Emotional regulation. Just like autistics, ADHD’ers struggle to keep their emotions balanced, which is understandable given their sensitivity and their challenges with every-day life.

Interestingly, ADHD’ers have exactly the same strengths and abilities that autistics have, even though their challenges are a little different. They also have much more detailed pattern recognition and creative problem solving skills, in all the same ways that autistics do.

Autism and ADHD very often occur together. 50-70% of autistics also have ADHD, and there are generally more neurodivergents that fit into both categories than there are in each category alone. This often confuses research, and there is so much more research to be done. Having both sometimes feels like having two largely opposing preferences in your brain – you need silence for processing but you also need socializing and fun to keep your brain stimulated, you want to move around all the time and hate sitting still but all that movement overstimulates your system, you have a desperate need for structure and routine but working every day in the same routine is the worst thing you could do to your creative faculties.

Masking

Neurodivergents who are closer to level 1 or 2 are likely to be diagnosed later in life, or live to late adulthood without every knowing they are neurodivergent. I realized I am neurodivergent at the age of 33, and only because I dove deep into the research to learn more for my patients. Looking back now, there were many signs when I was a child, but they were so subtle they could easily go undetected to even the most educated psychologist nowadays. I was really good at masking – at hiding things. Many neurodivergents learn very quickly during childhood that their way of thinking and experiencing the world is different from the rest, and being too different as a child is a threat to your survival. You naturally do everything you can to hide your differences, and frantically try to learn how to ‘be normal’. The school system trains you to think in neurotypical ways, and leaves no room for out-of-the-box thinking or solving problems in unique ways. Neurodivergent kids learn to feel ashamed of being different, and many end up masking their uniqueness so well they even hide it from themselves.

What is seen on the outside, and what is felt on the inside is usually very different. Since we are neurodivergent from birth, how we develop is influenced hugely by what happens around us. In my opinion, the current picture we have of ASD or ADHD – the way it looks from the outside – is formed by a combination of:

• the natural differences in how our brains work
• the natural differences in how our sensory systems work
• the trauma we experience as a result of being different and being highly sensory
• the way our environment has shaped how we express or mask our true selves
• the coping mechanisms we develop to survive

All these things create a combination of behaviours we use to interact with the world. Can you understand how a neurotypical health professional who observes the outside behaviour of a neurodivergent person will struggle to understand and discern which of our behaviours are neurodivergence and which are as a result of trauma or coping mechanisms? Can you see how easy it is for adults to pass neurodivergent tests if they mask too much?

The good news is that many of our struggles can be healed and improved: those parts that are as a result of trauma, environmental influences or coping mechanisms. There is nothing we can do to change the way our brains and sensory systems work (and most neurodivergents will tell you they wouldn’t change that for the world), but there is much that can be done to help ourselves find much easier ways to deal with life than our early childhood trauma responses dictate.

Read the next article in the series: Neurodiversity 7 of 7: Myths & misconceptions about neurodivergents