Table of contents:
High Functioning Autism Adults Characteristics – Putting together ADHD and Autism feels like the scariest diagram to make out of the #misdiagnosismonday series. I think this feels harder to tease out because I’m trying to tease it out in my own mind! Writing it out as a category for an article is one thing – but my own brain experience is very different.
My desk is always a mess because of my executive work struggles related to Autism or ADHD? Is the reason my email inbox says 1967 unread emails (mostly spam, but maybe something important hidden in there) due to ADHD or Autism? My impulsiveness, failure to close drawers, constant agitation, tendency to interrupt people or the fact that I am always looking for my keys, phone, and credit cards Autism or ADHD?
High Functioning Autism Adults Characteristics
Even with mental training, when it comes to my life experience, I struggle to tease out what is. I believe this story speaks to the confusion and chaos that is Autism-ADHD. It turns out that in my state of confusion, I am in good company. Research points to the fact that this is incredibly convoluted and difficult to distinguish clinically between the two.
The Art Of Masking: Autistic Women Who Mask
Autism is characterized by difficulties with neurotypical social interactions and communication; and the tendency to self-regulate through repetition and routine (eg, preferences and limitations, stereotypes, and repetitive behaviors).
Autism is the fastest growing condition, and the prevalence rate is about 2.8% (among Children 3-17) (National Survey of Children’s Health).
ADHD is characterized by difficulty in controlling attention and difficulty with hyperactivity / impulsivity (American Psychiatric Association 2013). ADHD is estimated to have a prevalence of 5-11% (Allely, 2014; Visser et al., 2014)
Understanding the genetic and phenotypic (trait expression) overlap of ADHD/Autism is relatively new. Until recently, if the patient had symptoms of both conditions, the doctor had to choose the most appropriate diagnosis. Until DSM-5, a diagnosis of Autism or Asperger precluded a diagnosis of ADHDTaurines et al., 2012. Fortunately this has been improved in DSM-5–both conditions can be diagnosed. So, in the history of things, considering the overlap of ADHD/Autism is relatively new.
Autistic Burnout Symptoms
While co-occurrence is common, it is also common to see high ADHD traits within Autistics or high Autistic traits for an ADHDer. A person may not meet the criteria of both and still have important overlapping characteristics. I suspect that “Pure ADHD” or “Pure Autism” are the exception, not the norm.
There are various hypotheses about this common co-occurrence. Leitner et al., 2014 hypothesize that they share a common genetic etiology.
This hypothesis is supported by twin studies that indicate significant genetic overlap (approximately 50-72%). This theory suggests genetics explains why ADHD / Autism often occurs within individuals and families at such a high rate (Leitner et al., 2014; Rommelse et al., 2010).
Moreover, the evidence points to a strong neurobiological overlap. Sokolova et al., 2017 points out that biological pathways related to attention control (inattention and difficulty in changing tasks) may be important factors in understanding the genetic overlap between these conditions.
Thalamocortical Connectivity Is Associated With Autism Symptoms In High Functioning Adults With Autism And Typically Developing Adults
ADHD and Autism, classified as neurodevelopmental conditions, affect the way the brain processes sensory input and cognitive processes. Both affect executive function, attention processes, and sensory processing. Following are some of the overlapping features.
Functional challenges are a core feature of both ADHD and Autism. Challenges may include difficulties in organizing tasks, consistency of objects, memory, focus, decision-making and attention control.
Both groups often struggle to pick up social cues but often for different reasons. For an ADHDer, this may be related to inattention and impulsivity. For Autistic, it is often related to difficulty with intuitively picking up social cues / body language / understanding pretense and difficulty with task switching (social communication involves considering several tasks at once).
Interoception, the “eighth sensory system,” refers to the ability to perceive internal signals. For example, signals related to elimination, hunger, thirst, and emotions are all examples of interoception. Interoception is important to the ability to regulate emotions.
Comorbid Ocd And High Functioning Autism Spectrum Disorder
Individuals with poor interoception will have more difficulty registering and responding flexibly to their internal states and emotions. While results among ADHDers are more mixed*, there is research suggesting that both ADHDers and Autistics struggle with interoception at a higher rate than the general population.
Partly related to interoception, ADHD and Autistics often have a perception of changes in time, sometimes called “time blindness” (Carmelo et al., 2020).
Sensory sensitivity is common to both ADHD and Autism and relates to the way the brain processes sensory input.
Impulses (repetitive movements) for control are common in both Autistic and ADHDers. Additionally, ADHD fidgeting can look a lot like the agitation seen in the context of Autism.
Autistic Mirroring, Masking, And “unstable Personality”, By Jillian Enright
Hyper-fixation and hyper0focus (especially because they are around our passions and special interests, i.e., interest-based nervous system) are common among ADHDers and Autistic people. Hyperfocus, as seen in the context of ADHD, can look like hyper-fixation. ADHD preferences can be seen a lot like Autistic special interests.
Due to factors such as brain circuits (very sensitive amygdalas), interoception problems, very tight nervous system, and sensory processing, both ADHDers and Autistics can struggle to control and relax intense emotions.
In addition to having shared brain circuits, characteristics, and symptoms, we also have similar psycho-social risks and experiences.
Addiction is common among both ADHDers and Autistics and may involve a tendency to self-medicate, relax an overactive nervous system, control sensory experiences, or may occur in the context of co-occurring depression/anxiety.
Autism In Adults Signs That May Have Been Missed As Kids
Self-harming and suicidal behavior was high among both groups. The risk may be magnified in ADHDers and Autistics with other borderline identities. Self-harm may occur as an attempt to control sensory overload or may be used as an attempt to control difficult emotions.
Both ADHDers and Autistics tend to struggle with eating disorders; Anorexia appears to be more common than Bulimia among Autistics, while rates of anorexia and Bulimia are approximately equal among ADHDersBleck et al., 2015.
ADHD girls may be more prone to bulimia than Autistic girls. ADHD girls are 5.6 times more likely to have bulimia than the general population. Biederman et al., 2007. Similarly, Bleck et al., 2015 found that ADHD had a higher prevalence of eating disorders (4.2%) than the non-ADHD population (2.0%). ) and was 2.8 times more likely to to have an eating disorder.
While rates vary, most researchers agree that approximately 23% of people diagnosed with anorexia nervosa are autistic. However, many agree that this may be an underrepresentation due to the fact that ASD is often underdiagnosed within this population (Westwood and Tchanturia).
Pdf] Speech And Prosody Characteristics Of Adolescents And Adults With High Functioning Autism And Asperger Syndrome.
Both groups had increased rates of peer victimization. This occurs at higher rates among ADHD/Autistics with additional borderline identities.
Autistics and ADHDers are more likely than neurotypicals to be genderqueer, and genderqueers are more likely to have ADHD or be autistic than cisgender people. Those who do not identify the gender they were assigned at birth are 3-6 times more likely to be autistic than cisgender people (ADHDers (Warrier et al., 2020). In a study done by Strang et al. 2014. Gender variance was found to be 7.59 times more common among Autistics and 6.64 times more frequent among ADHDers (Strang et al. 2014.
Similarly, Autistics tend to be more heterosexual than the general population (Sarris). While the general population has 4.5% (Gallup poll), the rate of 15-35% identified as LGG. And the percentage of LGB is 2 to 3 times higher (than the general population) among Autistics. Several studies indicate that Autistic men are more likely to be heterosexual than Autistic women (Dewinter et al., 2017; George and Stokes, 2018). Similarly, Barkley, R. A., Murphy, K., & Fischer, M. (2008) found that ADHDers were more likely to identify as asexual and more likely to identify as bisexual than non-ADHDers.
Both groups have a higher risk of having emotional disorders such as depression and anxiety. According to one study, 79% of Autistics met the criteria for a mental condition that occurred at least once in their life (Lever and Geurts). Co-occurring mood disorders are also common among ADHDers. While ADHD children represent only 3-7% of the population, they comprise 50% of children receiving psychiatric treatment (Smith et al., 2002).
What Is High Functioning Autism?
Depression coexists with adult ADHD in 9%-50% of cases and complicates the assessment and management of ADHD (McIntosh et al., 2009). Furthermore, Almeida et al., 2007 found a higher rate of ADHD in a group of adults who participated in outpatient psychiatric care. While it is estimated that ADHD affects 4.4% of the adult population, the percentage of adults receiving outpatient psychiatric care is 8.5% for men and 21.6% for women.
Due to the high degree of overlap and tendency for individuals to have both ADHD and Autistic traits, it can be difficult to distinguish between the two. Here are some considerations that clinicians should consider when working with clients with suspected ADHD/Autism.
In order to remove the condition A of Autism (social difficulties), you need to spend time here teasing the nature of social difficulties, because the list of criteria for Autism looks like ADHD social difficulties and vice versa. While both groups experience social difficulties, they are different in nature. Here are some things to consider:
Many of the items in Criterion B for Autism can look like ADHD (sensory perception, special attention can look like hyper-fixation.
