If you're an adult who's only recently started making sense of
your neurodivergence, you've probably lived through a lot of
shifting stories about yourself. Now, there are many reasons why
an autistic or audio HD person might go missed for years.
In the last video, we explored how ADHD can lead to diagnostic
overshadowing of autism. Today, I want to look at the
flip side. What happens when autism
actually hides the ADHD? I'm Doctor Megan Anna Neff, an
autistic ADHD clinical psychologist and founder of
Neurodivergent Insights. I'm in the thick of researching
and writing my next book, Audi HD Unlocked, and this series
lets me share what I'm learning in real time as I work on this
project. Now, while it is more common to
see the ADHD diagnosis come first and to over shadow the
autism, the reverse can also happen.
This was actually my experience. Autism was discovered 1st and
because I'm more autistic dominant and look very focused
it was harder to see the ADHD layer.
There is a growing body of research that suggests that many
people are living at this intersection of autism and ADHD
where traits can blend and mask one another.
And when that happens, we don't always fit neatly into either
autism or ADHD stereotypes alone.
We also know that missed or delayed recognition of ADHD and
or autism is linked with higher rates of depression, lower
quality of life, and more functional impairment.
Functional impairment is the clinical terminology we use that
basically means greater struggles with life's daily
tasks and basic activities of daily living.
And then when we're able to more accurately understand our
neurology and understand the bodies and the brains that we're
working with, it isn't that it magically solves everything.
I'll be the first to attest to that.
I still live with several mental health conditions and still need
to work pretty hard to be an OK human in life.
Now, that said, self understanding can have a pretty
significant impact in how we understand ourselves, how we
talk to ourselves, the narratives we might carry, and
also the accommodations and the supports that we're able to
build or that we're able to access.
So it's not a magic pill, but it's certainly for many of us
can be a critical and pivotal time when our life begins to
make sense and we can start to build lives that work a bit
better with our neurology. OK, so in the last video, we
explored six ways that ADHD can hide autism.
So here in this video, we're going to talk about six ways
that ADHD may be hiding behind the orderly structure of an
autistic neurology. First, we'll look at how
rigidity or a strong drive for structure and predictability can
compensate for or hide ADHD. Now many autistic people will
build very detailed routines or checklists or rituals to feel
regulated and safe. The autistic brain makes very
precise predictions. Our prediction maps of what's
going to happen moment to moment are more precise than alistic
brains. But the big take away here is
that because of the precision of our prediction maps, it means
that we are living with innately more uncertainty than alistic or
non autistic brains as we move through the world.
So one of the ways that we compensate for this is by baking
predictability into our routines and into our lives.
It helps to settle a lot of the free floating anxiety or angst
that many of us experience when we don't have that.
From the outside this person can look highly organized and
disciplined so they rarely get quoted as an ADHD person if they
have have created a lot of predictability into their lives
as a way to self soothe their autism.
Now inside those structures might be someone who is
compensating for profound distractibility struggles with
time perception and working memory challenges.
These are all classic ADHD experiences that might not get
coded as ADHD because the compensation looks so adaptive
or functional. In fact, this actually overlaps
with some of the newer things that we're learning about ADHD
masking. So recent work on masking and
camouflaging suggests that ADHD people also mask and camouflage
and compensate. So many ADHD and Audi HD adults
will use elaborate strategies to keep life stitched together in
ways that make our underlying attention differences harder to
spot. So in a sense, the Audi HD
person may be using the strength of one of our neurologies to
mask the other. In other words, towards the
autistic structure that looks like having it all together can
itself be a kind of camouflage that makes ADHD harder for
teachers, clinicians, partners, or even ourselves to see.
Now, another way that ADHD can get hidden behind autism is
around how anxiety and meltdowns and shutdowns show up.
And just to be clear, anxiety is not part of the diagnostic
criteria for autism. But lots of us do have it, and
lots of us have experiences like sensory overwhelm and social
uncertainty that show up as a sort of free floating anxiety.
And then in general, people just are a bit more aware or familiar
with the concept of autistic shutdowns and meltdowns than
ADHD ones. So for example, when an ODD HDR
hits cognitive overload, they might freeze or withdraw or go
into kind of a low speaking mode.
And then clinically shutdowns in someone with a known autism
diagnosis could often be assumed to be purely sensory or social
overload. So that withdrawal makes sense
from an autism lens. And the ADHD side, the cognitive
overwhelm from the mental noise from the racing thoughts, tasks
switching, chaos, or from simply time slipping and all of the
dozens of half started projects, the weight of all of that, that
can also lead to a shutdown, but that might get missed.
So all of that cognitive noise and overwhelm, these can also be
things that tip the nervous system into a state of hypo
arousal or shutdown or meltdown. However, if the narrative is
that the shutdown or the meltdown is due to autistic
sensory processing or social overwhelm, then the ADHD
cognitive overwhelm piece might get missed.
If no one is thinking to ask about the ADHD layer, then all
of that cognitive noise that also contributed to that
shutdown or meltdown remains a bit invisible and the support
gets focused on only half of what's happening.
Similarly, executive functioning struggles might be seen purely
through an autistic inertia lens.
So autistic inertia that speaks to that experience of getting
stuck in a certain state and then finding that unusually hard
to either Start, Stop, or switch tasks.
And that might hide some ADHD related executive functioning
struggles. So internally the person might
be juggling both an ADHD style task paralysis.
So this is related to things like trouble deciding what to do
next or prioritizing steps or initiating.
And the person might also be experiencing autistic difficulty
with state changes and something called transition costs.
So autistic inertia, this is about state transitions.
So the switch cost of moving from one activity or one
internal state to another one. And then ADHD task paralysis
that is more about that executive functioning.
Things like prioritizing, choosing or initiating when the
path forward is unclear or overwhelming or emotionally
loaded. Now in Audi HD, both can
actually be operating at once and so you might struggle to
start the task due to ADHD paralysis and executive
functioning challenges. And you also cannot easily shift
out of or into the task because of autistic inertia.
So it can feel kind of like being frozen from two different
directions at the same time. And then of course they can also
hide one another. Special interests can hide
novelty seeking or ADHD attention patterns.
So from the outside a person may appear deeply consistent and
routine bound because perhaps they're always returning to the
same topics or activities and that's going to look like
classic autism. But potentially within those
interests there might be some intense novelty seeking.
Or a person might be constantly starting new sub projects or
bouncing between ideas and yet still struggling to follow
through. So, for example, I often
describe it as if I have a special interest solar system.
So for example, psychology and philosophy are some of my
special interests, and they're my special interest solar
systems. So within that, I find that I
often need to visit different planets in order for it to stay
new and interesting and to keep my attention.
And So what I experience is a pretty interconnected, woven
together special interest ecosystem or solar system, which
provides a sort of quieter novelty that is deeply
regulating for me and restores me because it's all happening
within the same solar system. For example, I'm often exploring
something related to psychology. It can look like I'm doing the
same thing over and over, but if you look more closely, you can
actually see how I'm hopping between different projects or
I'm pop in between different theories within psychology and
I'm doing a lot of novelty seeking within my solar system.
So essentially one of my working theories is that what some of us
experience is something like this, where autism holds the
monotropic orbit, especially when it's a special interest,
while ADHD keeps us moving within it.
And it can create a sort of intense sustained focus inside
our interest solar systems. And if those interests line up
with school or work, that hyperfocus may not show up as a
problem. Which is one more reason the
ADHD can get missed, since it's often the hyper focus on less
acceptable or less helpful things that alert people to the
ADHD in the 1st place. It's the hyper focus on the
screens and the struggle with focus at school that will often
lead to an ADHD assessment or evaluation.
Next, quiet ADHD is missed more commonly within the general
population, and certainly more common among the autistic
population. ADHD can present as more
daydreamy, or more of that internal distractibility, or
more mental restlessness rather than the visible hyperactivity
that many people think of when they think of ADHD.
So if an autistic person has primarily inattentive ADHD, they
may be particularly vulnerable to their ADHD going unseen,
especially as clinicians might never systemically screen for
ADHD once autism is on the chart, especially if the person
does well in structured or high interest settings.
And last but not least, let's talk about monotropism and how
that can further hide ADHD. So autistic monotropism is that
tendency to anchor in deeply on a narrow channel and that can
look like excellent focus to an observer.
And in many ways it is my monotropism.
My restricted interest is my most dominant autistic trait,
which is partly why I think it was so hard for me to see the
ADHD. So what's often missed is that
outside that narrow channel of deep focus, attention can
fragment quite quickly. So there's a lot of tasks
outside of that monotropic vortex that go unfinished.
Switching between domains can be extraordinarily hard, and then
reengaging after interruption can feel really, really
difficult. And so if a person is highly
monotropic, that is not going to get necessarily coded as ADHD
again, especially if their interests are around school or
work, because it's going to look like that person has Immaculate
focus. Now, here's a pattern that I've
noticed for myself. And when I've surveyed our
community, many people report also having some experience like
this. O the pattern that I find myself
falling into is something that I call defensive monotroic mode.
Ometimes I will drop into Dee monotroic flow simly for the joy
of it. But I also notice that sometimes
I go into that state defensively.
I am so overwhelmed by the ADHD ping a thoughts.
I'm so overwhelmed by all of the life tasks that is on my To Do
List that I'm really struggling to get traction with.
And So what I will do as almost a form of avoidance from that
overwhelm is I will find something that is deep and
intense enough that I can get lost and absorbed in it, that I
can anchor into it as a way to escape the ADHD overwhelm of all
of the pingy thoughts and all of the pingy tasks that are half
finished. So for example, I might
disappear into research or into writing or into very specific
questions and I will get lost there for hours.
And I will do that as a way to block out the stress of all of
the unanswered emails that are piling up and all of the pings
and the texts and the chores and the life tasks that are just so
much more difficult for me to engage with and that are just
pinging in my brain when I'm not in deep focus.
And so because the deep focus is one of the few places that I
actually experience calm and relief from that I go back to it
over and over and over. The problem with this cycle that
I've created for myself is that when I reemerge from the deep
focus, there are then even more pingy thoughts and pingy tasks
that are just waiting for me from when I initially left them.
So that makes the reentry even more overwhelming and tempts me
to go into even more avoidance where I can just disappear back
into deep focus again. So that's where it quickly
becomes a vicious cycle where I escape to deep focus to avoid
the overwhelm and simultaneously more tasks are piling up.
And then when I attempt to reemerge, I'm overwhelmed and I
go back to my deep focus as a way to calm myself from that
overwhelm. So this vicious cycle, it is
attention dysregulation. But on the outside it can look
impressive. It can look like self-discipline
or productivity rather than attention dysregulation.
People in my life will ask me quite often how I'm able to do
as much as I'm able to do to write books and articles and
create trainings or record and edit videos like this.
And the answer is partly because there is a lot in my life that
I'm avoiding. I'm avoiding things like
ordering new contact lenses, which I desperately need, or
ordering medication, or making medical visits or chores, or
cleaning, or not cooking, or struggling with parenting tasks.
There's a lot of the life tasks that I struggle quite
significantly with that my spouse sees, and I'm quite
privileged in having a spouse that helps me accommodate those
things. But those are things that most
people wouldn't see unless you're behind closed doors and
you live with me and you see how much I struggle at doing those
basic tasks. And this is part of that
dysregulation of attention where I'm able to regulate my
attention on the things that interest me, but it comes at the
cost of things that perhaps are a bit more hidden.
And so that's not going to necessarily look like classic
ADHD unless you're asking my spouse or my children the right
questions. So a lot of my professional
productivity comes on the flip side of my deep procrastination
and difficulty with engaging in life's daily tasks.
And so if that is one way that the Audio HD person is avoiding
the overwhelm of ADHD, and if it functions in our society in a
way that society rewards it because it looks productive,
that's not going to look very ADHD.
But the person may be still struggling significantly with
executive functioning, but in ways that might not be as
visible to others. So essentially, when autism is
known but ADHD is not, all this can create a kind of explanatory
gravity where everything orbits around the autism and ADHD
remains unnamed even though it's also shaping the person in his
daily life. And again, diagnostic
overshadowing is what happens when traits that could belong to
multiple conditions are automatically attributed to the
diagnosis that's already on the chart or already known.
This can mean both autism and ADHD hiding one another, but it
can also involve, and I'd argue more often, it involves actually
when a mental health diagnosis is overshadowing both the autism
and the ADHD. So for example, if a person is
already diagnosed with anxiety, autistic sensory overload might
get labeled as anxiety and only the anxiety is treated and the
autism is missed. Or if PTSD is already diagnosed,
then ADHD, internal restlessness, and hyperactivity
might be attributed to the PTSD and the underlying ADHD is
missed. Or if there is a known diagnosis
of bipolar ADHD, impulsivity or hyperactivity could get folded
into manic or hypomanic symptoms and the ADHD never gets
assessed. So overshadowing can happen all
over the place. And for autistic ADHD years,
it's really common first of all for us to have Co occurring
mental health conditions. And it's actually really common
for those to be the things that are overshadowing both the
autism and the ADHD. Now when this happens, support
can really miss the mark. For example, a child might
receive behavior plans that are targeting oppositional behavior
when what they actually need is sensory accommodations to help
with transitions. Or maybe a person has handed out
ADHD focused strategies, but without recognition that their
autistic need for predictability and sensory regulation is also
something that needs to be addressed.
Overshadowing also ends up stretching out the time before a
person hears a story about themselves that actually fits.
And in that it can deepen a lot of the shame as many of us are
left wondering why things feel so incredibly hard for us that
appear easy for other folks. I think we're at an exciting
time in the research and in the conversation among our community
where we're learning more about how these two neurologies
interact because it's not as neat as they simply stack on top
of each other. And part of how they interact
means that it can lead to a lot more diagnostic overshadowing of
both conditions. One of the ideas that I am
exploring in this book is to look at what does it look like
to map our unique audio HD signature because there's so
many different ways that ADHD can present, so many different
ways that autism can present, and thousands of ways the audio
HD can show up. And when the audio HD traits are
are understood as part of a distinct neurology with its own
signature, with its own coherent nervous system, I think we can
start to more deeply understand ourselves and have a bit more
compassion for the ways that we've perhaps been doing the
best that we could with the conditions that we had.
Now, if this feels like this might be part of your story, it
might be worth bringing both lenses into the conversation,
autism and ADHD, perhaps into the conversation with clinicians
or into your own self study so that you're not left living with
only half of your story or half of your neurology known.
If you're looking for a place to get started, I will link to
several articles in the show notes, including articles on
ADHD screeners, autism screeners, and other places
where you can start some of your own self study.
Now, screeners are not the same thing as an assessment, but they
are a great data point and it's a great place that many of us
end up starting when we're starting to have the
conversation with ourselves or with a provider on whether or
not an ADHD or an autism diagnosis fits.
I will see you in the next video and until then I hope they are
able to stay kind and curious with yourself but also with the
other people that are in your life.