#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.

Autistic

I hear you,
but I hear not what you say.
I see you,
but my eyes see thoughts elsewhere.
I look at you,
but your soul burns into me.
I feel you,
but your soft touch is too strong.
I hold onto you,
but I squeeze you too hard.
I want to speak,
but the words will not come.
I speak to you,
but my words make no sense.
I reach out,
then I retreat.
I live this life
of intensity,
sensitivity.
Please,
be patient with me.

© Janey Colbourne 2016

My Review of “Elemental Island”

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This is an adventure story set amongst an isolated community living on an island. The beginning sets the scene in a world where technology and culture has developed differently. Life is comfortable and safe, for all in the community, and society is technologically advanced, except in one respect, that of flight, which is forbidden. Astie is a bored and frustrated 11 year old who longs for something new and different to happen in her predictable life. Little does she know how much her life is about to change when she meets a new boy on the beach who has come from the mainland. Intrigue and suspense unfold as she tries to help him, and ultimately forgotten truths about the island’s history are revealed. The story turns the tables by creating a scenario where the majority of the population have Asperger’s syndrome (without actually ever mentioning that term; in this story “Asperger’s” is normal, not a syndrome). It cleverly challenges our perception of what we call “normal” and how we define something as a disorder. Whilst remaining entirely a fictional adventure story it prompts a questioning of assumptions we as a society take for granted. What would life be like for autistics living in a world that accepts and accommodates their needs as normality? The main character Astie has difficulty fitting in with her peers and conforming to adults’ expectations. She is given a diagnosis of Social Syndrome. Is it wrong to label those who are innately different as having a “syndrome”? The reversal of the usual scenario starkly highlights how it is a struggle for people who experience the world differently to find acceptance and recognition. I had a little difficulty with this story initially as it seems in the beginning to perpetuate stereotypes such as all autistics dislike physical contact, or are not interested in creative careers such as fashion. However it was interesting to conceive of a world where these sorts of qualities are the norm. Nevertheless I soon became gripped by the plot and engaged with the development of the characters. My 11 year old daughter was similarly gripped by the story and we are both keen to read more by this author. It is refreshing to read fiction for an older child’s age range that portrays Asperger’s as normality. This fills a niche that was previously lacking for me. It is a good book that can engage both adult and child. This book succeeded at that for us.

Janey Colbourne 2016

To those who fear labelling: on diagnosing neurodiversity

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A “label” is not a diagnosis. Not having a diagnosis does not protect a child from labels. They are already labelled, “Weirdo”, “Nobody likes you”, “Cry baby”. Denial does not make a thing go away. What about later in life? Does a diagnosis hold you back? That depends on how you use it. Knowing yourself leads to better choices in life, working with your strengths and accepting your own nature. We do not have to be limited by a diagnosis, in fact it can be liberating to be acknowledged. It is a starting point for meeting your needs. The diagnosis does not have to define your entire being, it is a “label” in the sense that it is a generalisation, but in reality individuals are infinitely varied. Diagnoses are convenient umbrella terms to help us categorise and describe particular issues that people have. How it affects someone depends on many factors. In this day and age a diagnosis should mean accommodations at work. Once we have a diagnosis we can choose whom we disclose that to, except in regards to certain legal or health and safety circumstances.

Lack of a diagnosis does not make feelings go away. It makes feelings confusing. Why do I feel different? What’s wrong with me? Why can’t I do it? I must be inadequate. In fact, undiagnosed developmental issues can lead to mental health problems, and even put life at risk, due to lack of support and a lifetime of misunderstanding: “Why can’t you be like your sister?”, “How many times have I told you?”, “What do you mean you didn’t hear me?”, “What’s the matter now?”, “Just eat it and stop fussing”, “Look at me when I’m talking to you!” Anyone with a neurodevelopmental disorder, such as ASD or ADHD, will know what I’m talking about and unless they’ve been extremely lucky, they will have heard or thought some of these things at some point in their lives, most especially so if they have been undiagnosed. Would you tell someone with depression not to seek diagnosis and help because of the stigma? Of course not. Although they might choose not to share with everyone they meet, it is their right to be fully informed and to make their life choices based on that. There is no refusal to assess for dyslexia, because assessment leads to correct support and enhances the child’s ability to fulfil their potential. It is accepted that this is not a character flaw or anything to be embarrassed about. The benefits of support outweigh any concerns about future stigma, because lack of support is a greater risk to lifetime success.

So, to those who express concern about “labels”, what do you really fear? I suggest you take a look at your own prejudice. To say a child should not have a diagnosis is to perpetuate ignorance and in fact to participate in maintaining stigma. To say it in front of that child is to imply that there is something to be ashamed of, and to imply that they should not be asking for help when they need it. Those who have ASD do not generally perceive themselves as having a disorder, they do not want to be “cured” of being themselves, only understood and supported in their areas of difficulty, whilst having their strengths celebrated. It is in fact neurodiverse adults speaking out and being unashamed that is leading to greater understanding of what is really going on for them. It is particularly important to raise awareness of invisible “disabilities”, so easily misunderstood and judged. Online communication has been a real liberation for many nonverbal autistics. I’m not suggesting we use children as flags of pride. In this age of the internet I think it is important to protect our children’s personal privacy and identity until they are of an age to decide for themselves. This is a whole different kettle of fish to seeking a diagnosis on their behalf. Their peers already know them and judge them. To return to the dyslexia analogy, children in classrooms everywhere are fully aware of who has dyslexia, they see the tools used to help manage it, it is part of life. These children now growing up will have greater understanding and awareness. This is where prejudice begins to be tackled. It is time to extend that awareness. We cannot dispel myths and ignorance by hiding. At one time a dyslexic or short-sighted child may have been treated as stupid, lazy or ignorant, until understanding of the issue led to the tools they needed. Self-management is not the whole story however, and the downside of seeing diversity as pathology is that the child is seen as having or being the problem, and therefore treatment should all be directed at them. At the moment the onus is on the ASD child and the ADHD child to learn to manage in an alien world, to hide themselves and suppress their urges. It is a good thing to learn to manage ourselves and our emotions and to consider others, but for these children there is so much pressure to fit in, it is akin to a left-hander being forced to write with their right hand. Fighting your own nature takes a lot of energy and effort, it is a daily performance. Many do have a certain amount of success at this, in which case they may remain undiagnosed, and their parents’ concerns dismissed, all the while feeling like a foreigner who doesn’t belong, an actor who has to keep pretending, wishing that someone would really understand them, and putting on a brave face until they get home and melt down. The relief when they discover there are others who feel like them is palpable.

If we do not shy away from diagnosis, as cultural understanding and awareness grows, and as we begin to see just how many people really have these natural variations in brain function, perhaps we might no longer perceive it as pathological. I am sure those who fear labels have the best of intentions. Indeed they are often people working in this field. Unless there is overt and severe difficulty in functioning, they may think the diagnosis would do more harm than good. Perhaps they too believe that these conditions are not a pathology, that these children have much to offer the world and that they should not be subjected to prejudice. But I don’t believe we can get to that point without working through it. Denial will never break through that ignorance. Diagnostic criteria and support methods cannot evolve if we don’t use those processes. It is all very well to say a child doesn’t need a label, they just need to accept themselves as they are and celebrate their differences. This is true, but the education system is not set up for these children. Noisy, crowded, overstimulating, modern life is accentuating difficulties for children with sensory issues, although they also benefit from technology in other respects, such as for communication. Perhaps in the past those sensory needs were less of an issue. Perhaps these children are the canaries in the mine. They have greater sensitivities to what is pathological in society, in education, in work and in social life. Their needs may reflect what we all need but are less consciously aware of: the need to move our bodies around; to express ourselves; to have quiet time; to be in nature and recharge our senses. As a society we really need this. There may be things they need to learn from us, but we have things to learn from them. As a species we are evolving to embrace diversity, as manifest in the fight for equality and against prejudice in its many forms. Perhaps this is an antidote in a time of increasing homogeneity of lifestyle and culture, along with loss of species and habitat across the globe. Rather than enforcing uniformity, it is time to celebrate difference. Until we do that we cannot find our commonality. It is time to celebrate neurodiversity.

© Janey Colbourne 2016