#ADHD and #ASD do they make a good couple?

It is not uncommon for ASD and ADHD to be given as a dual diagnosis. I’ve been considering if, when they occur together, rather than being comorbid, they in fact complement or compensate for each other. The classical symptoms of ADHD include distraction, impulsivity and hyperactivity. The classic symptoms of ASD include obsession/hyperfocus, a love of routine and predictability and a tendency for social isolation. Clearly this is stereotypical but I am simplifying here for a moment, while I explore an idea.

I have ADHD and my mind flies around, bursting with ideas. I can be impulsive, with a tendency to blurt and easily gets overexcited. I also have autistic traits, awaiting diagnosis. My autistic side loves predictability, hates excessive demands and prefers solitude and quiet contemplation. These two might seem contradictory, but they act as moderators for each other. They coexist at the same time, although sometimes one or other may be slightly dominant. Sometimes they conspire to get me in a panic. Overall I think they help each other.

My ASD hyperfocus helps my ADHD to get focused and stick to a task. On her own my ADHD gets so excited about something that she wants me to leap around shouting, or alternatively she gets bored and wanders off. My ADHD is bursting with ideas and darts off in unexpected directions to bring back a fresh perspective. This helps my ASD to open up and not get too stuck in a rut. My ADHD has a tendency to blurt what I’m thinking before I’ve assessed the situation. My ASD might not be great at assessing the situation either, but has sufficient inhibition and dislike of making a fuss to make me bite my tongue. My ASD gets tired easily, especially when it comes to auditory processing and is another way she calms down my ADHD from throwing me into excessive social peril. Together ADHD and ASD love to think and create. ASD helps my ADHD to stay on track and not run off chattering inanely to the nearest person, so they can work together. ASD needs ADHD’s bright ideas and energy. ASD can get the quiet she needs if ADHD is kept occupied with some exciting revelations to chew on. ASD has some awesome topics that she wants to work through and ADHD is only to happy to bounce these around and see what she can make with them. She can also spot when ASD is overthinking and pull her out of her ruminations.

ADHD doesn’t like to be too constrained by rules and routines. She finds them too boring. She might get into trouble. ASD craves predictability and likes to do things correctly. She might sometimes miss out on opportunities. ADHD and ASD are good together, like Howard Moon and Vince Noir.


Neurodiversity and Human Evolution

This may sound like rather a grand title, but bear with me, as I take you down a train of thought.

ADHD medicines-stimulants such as Concerta- can have significant benefits in terms of being able to concentrate for longer periods of time, and therefore may increase productivity and the ability to fit in with the expectations of society. I have found that Concerta improves my verbal and auditory processing. Normally I prefer to read and write rather than listen and speak, because that is where my processing strengths are. Listening is very hard for me, as my mind gets stimulated and charges off along a thought train. Concerta has helped me to concentrate on listening. I feel more relaxed in social situations-less stressed and anxious- because I am not worried about being able to keep track of conversations, or of being able to speak coherently, and am less exhausted by it all. Since taking Concerta I have noticed a tendency to become more hyperfocused. This can be very useful for completing tasks. However I have noticed I seem to have less control over what I get focused on. I’ve also noticed more difficulty with transitioning from one task to the next, tending to get stuck in a rut, and more difficulty in being organised- my planning and time management seems worse. I wondered if this is because, having reduced my ADHD distractibility, it is showing some of my autistic traits more strongly. Then a significant idea occurred to me. What if Concerta reduces the positive benefits of ADHD as well as the negative?

If in ADHD we have a tendency for a ‘butterfly’ mind, flitting around; this is useful for creative thinking and in being aware of many things at once, of multitasking, or at least jumping around mentally, so that it is easier to leap to the next task, or to have it pop into awareness, interrupting the focus, but also preparing us to move on when necessary. Having the ADHD traits reduced also means the ‘random’ ideas that pop up are less likely to occur, reducing potential for creativity. These effects are not necessarily helpful for a writer. It seems that my ADHD contributes to my writing skills. I have heard it said that there is a fine line between ADHD and high creativity. Concerta is useful for improving my reading and listening focus-for taking in specific information, and I have found some improvement in both verbal and written discussions. However I feel that there is something missing-something has been lost in the process. This is interesting as it reminds me of what happens in the brain in the process of learning to read. Pre-literate societies, and dyslexics, have better skills in the area of taking in information from the broader environment. This means they are able to notice details and changes in the environment that those with high reading skills might miss. In hunter-gatherer societies those who would be diagnosed dyslexic by a literate society have the advantage.

The process of learning to read causes changes in the brain, increasing skill in one area, but at the price of another. The skill of reading also changes our perception in a more philosophical sense. Reading is a process of understanding abstract symbols, and it immerses us in an exclusively human realm. It shifts our reflections from the natural world around us, to the world of human thought. We see the world in terms of human words, symbols and ideas, and less in terms of the more-than-human world around us. As we read, we are prompted to focus on our own internal thoughts and reflections on the abstract information in front of us. We gain an enormous capacity for obtaining knowledge and communicating with our fellow humans, but at the expense of a different skill and connection. We lose our universal ‘language’.

Developing verbal skills may have a similarly dramatic effect on the brain. Autistics have described the change in their experience of the world in the process of being trained to become verbal. There is a loss of sensory immersion and intensity, where previously this aspect of perception was incredibly rich. As the mind is trained to develop the verbal reasoning skills, the sensory capacity and perception is altered. This resonates with what we know occurs in normal development in young children. Babies have a much greater number of synaptic connections than adults. There is a process of ‘pruning’, where rarely used synaptic connections in the brain are reduced and frequently used ones are strengthened. This allows more efficiency in the areas that, through early life experience, the brain finds to be most useful or important.

Most people have little memory of their experiences as pre-verbal babies, so that we are unable to recall what effect this process had on us at an age where we might be able to articulate this experience. Semantic memory is the process in which the hippocampus in the brain assembles a collection of information from various areas in the brain. This can be stored as a memory. Before semantic memory, episodic memory stores isolated information in various areas of the brain and the ability to associate or differentiate collections of memories is limited. When semantic memory develops, abstract thought and language development become possible. Verbal reasoning is used for abstract thought, which is a means to categorise and integrate experiences-to make links between events, and also to separate them. The capacity to differentiate and to link the meanings of events allows us to construct a map of reality. Verbal reasoning increases our ability to build expectations and responses that sustain across a greater time frame, therefore we build lasting memories and associations and a sense of time. This focus on the inner thought processes and on communication diverts some focus from the timeless, present-in-the-moment sensory experience that connects us to the world around us. Our primary connection begins to transfer from sensory immersion to the realm of human communication. In literate societies the next great leap in this process is in learning to read.

In highly populated, literate societies, where humanity is the dominant species, we are expected to use abstract thought and communication, living and interacting almost exclusively in the human realm, to a very high degree for most of our lives. There is little respite from this ongoing experience, and little consideration that anyone might want respite from this.

To a neurotypical extrovert this is an alien concept that appears to serve little purpose. But what if there is a point and a purpose? What if we are missing something by not considering this? Evolution can only take place where there is room for change and adaptation. Clearly the dominant culture has been highly successful and therefore self-perpetuating, but could it be the individuals on the fringes, the ‘misfits’, who have the skills or awareness to sense where change is needed in order for humanity to evolve and adapt to the future environment? Those who are highly adapted to the dominant culture are less likely to be able to detect adaptive problems in the system that will become significant to the majority, in time. It has been said that autistics have a feeling of living in a bubble or jar, disconnected or isolated from the majority. What if everyone else is living in a bubble, but for neurotypicals that bubble is so large they are unaware of it, until some great event bursts through it and forces change? Those outside a particular bubble cannot know what it feels like to live within it, but they can also see what occurs outside of it, that the bubble inhabitants are oblivious to; even when prompted, the ‘bubble-ees’ may only see outside as if through a veil, cushioned by the apparent security and permanence of the bubble. War, climate change, inequality and injustice, disability and pain, do not really exist for us until the bubble is burst.

Those with the capacity for different styles of thinking and perception may not have the advantage in the current mainstream way of life, but may become humanity’s most valuable assets in the coming future. Aside from communication, diversity and creativity are the hallmarks of being human, and the reason we are masters of adaptation.