Autism and ADHD: Neurological Cousins3 min read

October is ADHD Awareness Month!

In the six months or so leading up to the assess­ment in which I was diag­nosed as autistic, I had first “self-diagnosed” with ADHD. A friend sug­gested it to me, and the more I read, the more I related, and the more every­thing in my life that hadn’t made sense for 28 years fell into place.

It took prob­ably a year and a half post-assessment before I really started looking into the autism side of my diag­nosis. In my written report, my (very excel­lent) psy­chol­o­gist had sug­gested that doing so may help me to under­stand myself better. She was spot on!

Having immersed myself in ADHD lit­er­a­ture before switching over to reading about autistic people, I like to believe that I have a pretty good grasp of what char­ac­ter­izes each con­di­tion, but like with many neu­ro­log­ical dis­or­ders, there is a lot of overlap.

“Attention deficit” is not entirely accu­rate…

Like autism, ADHD is char­ac­ter­ized mainly by what diag­nos­ti­cians have observed, rather than what the person actu­ally expe­ri­ences. Challenges with focusing, hyper­ac­tivity, and impul­sivity are the most notice­able traits, but for many ADHDers, these aren’t actu­ally their pri­mary chal­lenges, and many say that ADHD is a mis­nomer.

ADHDers have what has been called an “interest-based ner­vous system.” We might have dif­fi­culty con­cen­trating on some­thing dif­fi­cult or unin­ter­esting, but we can also hyper­focus on the things that we’re really into. The real expe­ri­ence of ADHD is not a deficit of atten­tion, but an inability to reg­u­late it.

Hyperactive on the out­side; rest­less on the inside.

Hyperactivity in ADHD often changes as we grow into adults, and we are instead more likely to have rest­less thoughts. Along with that comes impul­sivity, the other “defining” trait of ADHD.

Between the rest­less thoughts and dif­fi­culty con­cen­trating, it’s easy to just do without thinking. ADHDers say things we would prefer to take back imme­di­ately; we’re prone to buying things without thinking it through first; and we are very much at risk of forming addic­tions.

Executive func­tioning is at the core

However, like autism, the cri­teria in the DSM for ADHD con­sist mainly of what psy­chol­o­gists have observed, rather than what the person actu­ally expe­ri­ences. Challenges with focusing, hyper­ac­tivity, and impul­sivity may be the most notice­able traits, but the core traits under­lying these have to do with our exec­u­tive func­tioning system of the brain.

ADHD expert Dr Thomas E Brown divides the exec­u­tive func­tions that are impaired in ADHD into the fol­lowing “clus­ters:”

  1. Activation: Organizing, pri­or­i­tizing, and acti­vating to work.
  2. Focus: Focusing, sus­taining, and shifting atten­tion to tasks.
  3. Effort: Regulating alert­ness, sus­taining effort, and pro­cessing speed.
  4. Emotion: Managing frus­tra­tion and mod­u­lating emo­tions.
  5. Memory: Utilizing working memory and accessing recall.
  6. Action: Monitoring and self-regulating action.

Challenges with these areas will prob­ably be familiar to autistic readers, even those who aren’t also diag­nosed with ADHD. As neu­ro­di­ver­gent cousins, we expe­ri­ence quite a bit of overlap in traits.

For example…

We both hyper­focus on what inter­ests us. ADHDers may expe­ri­ence more dif­fi­culty con­cen­trating on what doesn’t interest them. Autistics may dive a little deeper into our spe­cial inter­ests, and these inter­ests may last a much longer time.

We both have sen­sory sen­si­tiv­i­ties. ADHDers are easily dis­tracted by extra­neous stimuli that others are able to filter out. Autistic people may or may not be as easily dis­tracted as ADHDers, but depending on whether they are hyposen­si­tive or hyper­sen­si­tive to a par­tic­ular sense, they are able to hear or see things that others miss.

We both have chal­lenges with emo­tional reg­u­la­tion and low frus­tra­tion tol­er­ance. The under­lying rea­sons may be dif­ferent. ADHDers dealing with rest­less­ness may have less patience for some­thing aggra­vating. Autistic people may lash out when expe­ri­encing sen­sory over­load.

And we both stim! ADHDers jiggle their legs, twiddle their thumbs, doodle while taking notes, twirl their hair, and are con­stantly on the move to relieve the ten­sion of hyper­ac­tivity. Autistic people stim for a wider variety of rea­sons, and autistic stim­ming seems to be a little bit less like “typ­ical” fid­geting (e.g., hand flap­ping).

There is much more overlap, but when you’re diag­nosed with both, it can be hard to sep­a­rate the two. In fact, I once read that ADHD could be con­sid­ered part of the autism spec­trum given how often they co-exist. Perhaps one day we’ll see ADHD as an autistic “pro­file.”

Until then, it’s all neu­ro­di­ver­gence to me!

This article is also pub­lished at the author’s blog, NeuroInsurgent.

Ren Everett

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1 Comment

  1. Thanks Ren:

    I imagine this post will get a lot of people thinking.

    Especially with all the sim­i­lar­i­ties.

    And how impor­tant it is to put peo­ple’s expe­ri­ences at the heart of every­thing.

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