1 00:00:00,520 --> 00:00:03,680 If you're an adult who's only recently started making sense of 2 00:00:03,680 --> 00:00:06,720 your neurodivergence, you've probably lived through a lot of 3 00:00:06,720 --> 00:00:10,000 shifting stories about yourself. Now, there are many reasons why 4 00:00:10,000 --> 00:00:13,280 an autistic or audio HD person might go missed for years. 5 00:00:13,640 --> 00:00:16,800 In the last video, we explored how ADHD can lead to diagnostic 6 00:00:16,800 --> 00:00:20,280 overshadowing of autism. Today, I want to look at the 7 00:00:20,280 --> 00:00:22,640 flip side. What happens when autism 8 00:00:22,640 --> 00:00:26,440 actually hides the ADHD? I'm Doctor Megan Anna Neff, an 9 00:00:26,440 --> 00:00:29,400 autistic ADHD clinical psychologist and founder of 10 00:00:29,400 --> 00:00:32,240 Neurodivergent Insights. I'm in the thick of researching 11 00:00:32,240 --> 00:00:36,000 and writing my next book, Audi HD Unlocked, and this series 12 00:00:36,000 --> 00:00:39,400 lets me share what I'm learning in real time as I work on this 13 00:00:39,400 --> 00:00:42,080 project. Now, while it is more common to 14 00:00:42,080 --> 00:00:45,720 see the ADHD diagnosis come first and to over shadow the 15 00:00:45,720 --> 00:00:48,840 autism, the reverse can also happen. 16 00:00:49,040 --> 00:00:53,200 This was actually my experience. Autism was discovered 1st and 17 00:00:53,200 --> 00:00:57,520 because I'm more autistic dominant and look very focused 18 00:00:57,720 --> 00:01:00,120 it was harder to see the ADHD layer. 19 00:01:00,120 --> 00:01:03,280 There is a growing body of research that suggests that many 20 00:01:03,280 --> 00:01:07,240 people are living at this intersection of autism and ADHD 21 00:01:07,480 --> 00:01:10,360 where traits can blend and mask one another. 22 00:01:10,720 --> 00:01:14,000 And when that happens, we don't always fit neatly into either 23 00:01:14,000 --> 00:01:18,320 autism or ADHD stereotypes alone. 24 00:01:18,880 --> 00:01:24,280 We also know that missed or delayed recognition of ADHD and 25 00:01:24,280 --> 00:01:27,840 or autism is linked with higher rates of depression, lower 26 00:01:27,840 --> 00:01:31,520 quality of life, and more functional impairment. 27 00:01:31,520 --> 00:01:35,080 Functional impairment is the clinical terminology we use that 28 00:01:35,080 --> 00:01:38,280 basically means greater struggles with life's daily 29 00:01:38,280 --> 00:01:41,400 tasks and basic activities of daily living. 30 00:01:41,400 --> 00:01:44,480 And then when we're able to more accurately understand our 31 00:01:44,480 --> 00:01:48,000 neurology and understand the bodies and the brains that we're 32 00:01:48,000 --> 00:01:51,720 working with, it isn't that it magically solves everything. 33 00:01:51,720 --> 00:01:53,360 I'll be the first to attest to that. 34 00:01:53,360 --> 00:01:56,800 I still live with several mental health conditions and still need 35 00:01:56,800 --> 00:01:59,520 to work pretty hard to be an OK human in life. 36 00:01:59,520 --> 00:02:02,760 Now, that said, self understanding can have a pretty 37 00:02:02,760 --> 00:02:06,200 significant impact in how we understand ourselves, how we 38 00:02:06,200 --> 00:02:09,639 talk to ourselves, the narratives we might carry, and 39 00:02:09,639 --> 00:02:12,280 also the accommodations and the supports that we're able to 40 00:02:12,280 --> 00:02:13,960 build or that we're able to access. 41 00:02:14,200 --> 00:02:17,720 So it's not a magic pill, but it's certainly for many of us 42 00:02:17,720 --> 00:02:21,720 can be a critical and pivotal time when our life begins to 43 00:02:21,720 --> 00:02:25,240 make sense and we can start to build lives that work a bit 44 00:02:25,240 --> 00:02:28,080 better with our neurology. OK, so in the last video, we 45 00:02:28,080 --> 00:02:30,520 explored six ways that ADHD can hide autism. 46 00:02:30,840 --> 00:02:33,240 So here in this video, we're going to talk about six ways 47 00:02:33,240 --> 00:02:37,960 that ADHD may be hiding behind the orderly structure of an 48 00:02:37,960 --> 00:02:40,480 autistic neurology. First, we'll look at how 49 00:02:40,480 --> 00:02:44,840 rigidity or a strong drive for structure and predictability can 50 00:02:44,880 --> 00:02:49,200 compensate for or hide ADHD. Now many autistic people will 51 00:02:49,200 --> 00:02:53,760 build very detailed routines or checklists or rituals to feel 52 00:02:53,760 --> 00:02:57,240 regulated and safe. The autistic brain makes very 53 00:02:57,240 --> 00:03:01,000 precise predictions. Our prediction maps of what's 54 00:03:01,000 --> 00:03:04,960 going to happen moment to moment are more precise than alistic 55 00:03:04,960 --> 00:03:07,800 brains. But the big take away here is 56 00:03:07,800 --> 00:03:12,160 that because of the precision of our prediction maps, it means 57 00:03:12,160 --> 00:03:16,560 that we are living with innately more uncertainty than alistic or 58 00:03:16,560 --> 00:03:19,400 non autistic brains as we move through the world. 59 00:03:19,880 --> 00:03:22,560 So one of the ways that we compensate for this is by baking 60 00:03:22,560 --> 00:03:25,480 predictability into our routines and into our lives. 61 00:03:25,800 --> 00:03:29,720 It helps to settle a lot of the free floating anxiety or angst 62 00:03:29,720 --> 00:03:31,800 that many of us experience when we don't have that. 63 00:03:32,000 --> 00:03:36,080 From the outside this person can look highly organized and 64 00:03:36,080 --> 00:03:41,400 disciplined so they rarely get quoted as an ADHD person if they 65 00:03:41,400 --> 00:03:44,360 have have created a lot of predictability into their lives 66 00:03:44,360 --> 00:03:46,720 as a way to self soothe their autism. 67 00:03:46,960 --> 00:03:50,720 Now inside those structures might be someone who is 68 00:03:50,720 --> 00:03:54,240 compensating for profound distractibility struggles with 69 00:03:54,240 --> 00:03:56,560 time perception and working memory challenges. 70 00:03:56,840 --> 00:04:00,760 These are all classic ADHD experiences that might not get 71 00:04:00,760 --> 00:04:04,960 coded as ADHD because the compensation looks so adaptive 72 00:04:04,960 --> 00:04:07,320 or functional. In fact, this actually overlaps 73 00:04:07,320 --> 00:04:09,800 with some of the newer things that we're learning about ADHD 74 00:04:09,800 --> 00:04:12,600 masking. So recent work on masking and 75 00:04:12,600 --> 00:04:16,959 camouflaging suggests that ADHD people also mask and camouflage 76 00:04:17,000 --> 00:04:20,040 and compensate. So many ADHD and Audi HD adults 77 00:04:20,040 --> 00:04:23,760 will use elaborate strategies to keep life stitched together in 78 00:04:23,760 --> 00:04:27,080 ways that make our underlying attention differences harder to 79 00:04:27,080 --> 00:04:29,480 spot. So in a sense, the Audi HD 80 00:04:29,480 --> 00:04:34,480 person may be using the strength of one of our neurologies to 81 00:04:34,480 --> 00:04:36,800 mask the other. In other words, towards the 82 00:04:36,800 --> 00:04:40,440 autistic structure that looks like having it all together can 83 00:04:40,440 --> 00:04:44,280 itself be a kind of camouflage that makes ADHD harder for 84 00:04:44,280 --> 00:04:47,840 teachers, clinicians, partners, or even ourselves to see. 85 00:04:48,160 --> 00:04:52,160 Now, another way that ADHD can get hidden behind autism is 86 00:04:52,160 --> 00:04:55,200 around how anxiety and meltdowns and shutdowns show up. 87 00:04:55,360 --> 00:04:58,680 And just to be clear, anxiety is not part of the diagnostic 88 00:04:58,680 --> 00:05:02,200 criteria for autism. But lots of us do have it, and 89 00:05:02,200 --> 00:05:06,080 lots of us have experiences like sensory overwhelm and social 90 00:05:06,160 --> 00:05:11,120 uncertainty that show up as a sort of free floating anxiety. 91 00:05:11,400 --> 00:05:14,520 And then in general, people just are a bit more aware or familiar 92 00:05:14,520 --> 00:05:17,600 with the concept of autistic shutdowns and meltdowns than 93 00:05:17,600 --> 00:05:21,680 ADHD ones. So for example, when an ODD HDR 94 00:05:21,720 --> 00:05:26,720 hits cognitive overload, they might freeze or withdraw or go 95 00:05:26,720 --> 00:05:28,760 into kind of a low speaking mode. 96 00:05:29,280 --> 00:05:31,680 And then clinically shutdowns in someone with a known autism 97 00:05:31,680 --> 00:05:35,560 diagnosis could often be assumed to be purely sensory or social 98 00:05:35,560 --> 00:05:38,560 overload. So that withdrawal makes sense 99 00:05:38,560 --> 00:05:42,160 from an autism lens. And the ADHD side, the cognitive 100 00:05:42,200 --> 00:05:45,840 overwhelm from the mental noise from the racing thoughts, tasks 101 00:05:45,840 --> 00:05:49,760 switching, chaos, or from simply time slipping and all of the 102 00:05:49,760 --> 00:05:54,000 dozens of half started projects, the weight of all of that, that 103 00:05:54,000 --> 00:05:56,640 can also lead to a shutdown, but that might get missed. 104 00:05:56,720 --> 00:06:00,160 So all of that cognitive noise and overwhelm, these can also be 105 00:06:00,160 --> 00:06:03,480 things that tip the nervous system into a state of hypo 106 00:06:03,480 --> 00:06:07,680 arousal or shutdown or meltdown. However, if the narrative is 107 00:06:07,680 --> 00:06:10,240 that the shutdown or the meltdown is due to autistic 108 00:06:10,240 --> 00:06:14,000 sensory processing or social overwhelm, then the ADHD 109 00:06:14,000 --> 00:06:16,680 cognitive overwhelm piece might get missed. 110 00:06:17,160 --> 00:06:21,360 If no one is thinking to ask about the ADHD layer, then all 111 00:06:21,360 --> 00:06:24,280 of that cognitive noise that also contributed to that 112 00:06:24,280 --> 00:06:28,680 shutdown or meltdown remains a bit invisible and the support 113 00:06:28,680 --> 00:06:31,120 gets focused on only half of what's happening. 114 00:06:31,240 --> 00:06:34,680 Similarly, executive functioning struggles might be seen purely 115 00:06:34,680 --> 00:06:36,880 through an autistic inertia lens. 116 00:06:37,240 --> 00:06:40,240 So autistic inertia that speaks to that experience of getting 117 00:06:40,240 --> 00:06:44,240 stuck in a certain state and then finding that unusually hard 118 00:06:44,240 --> 00:06:47,640 to either Start, Stop, or switch tasks. 119 00:06:48,000 --> 00:06:52,000 And that might hide some ADHD related executive functioning 120 00:06:52,000 --> 00:06:54,480 struggles. So internally the person might 121 00:06:54,480 --> 00:06:58,160 be juggling both an ADHD style task paralysis. 122 00:06:58,160 --> 00:07:01,400 So this is related to things like trouble deciding what to do 123 00:07:01,400 --> 00:07:04,200 next or prioritizing steps or initiating. 124 00:07:04,440 --> 00:07:07,840 And the person might also be experiencing autistic difficulty 125 00:07:07,840 --> 00:07:11,240 with state changes and something called transition costs. 126 00:07:11,800 --> 00:07:15,840 So autistic inertia, this is about state transitions. 127 00:07:16,040 --> 00:07:19,880 So the switch cost of moving from one activity or one 128 00:07:19,880 --> 00:07:24,680 internal state to another one. And then ADHD task paralysis 129 00:07:24,680 --> 00:07:27,600 that is more about that executive functioning. 130 00:07:27,600 --> 00:07:31,680 Things like prioritizing, choosing or initiating when the 131 00:07:31,680 --> 00:07:35,360 path forward is unclear or overwhelming or emotionally 132 00:07:35,360 --> 00:07:38,200 loaded. Now in Audi HD, both can 133 00:07:38,200 --> 00:07:41,240 actually be operating at once and so you might struggle to 134 00:07:41,240 --> 00:07:44,720 start the task due to ADHD paralysis and executive 135 00:07:44,720 --> 00:07:48,120 functioning challenges. And you also cannot easily shift 136 00:07:48,240 --> 00:07:52,520 out of or into the task because of autistic inertia. 137 00:07:52,760 --> 00:07:55,960 So it can feel kind of like being frozen from two different 138 00:07:55,960 --> 00:07:59,920 directions at the same time. And then of course they can also 139 00:07:59,920 --> 00:08:03,040 hide one another. Special interests can hide 140 00:08:03,040 --> 00:08:06,640 novelty seeking or ADHD attention patterns. 141 00:08:07,640 --> 00:08:12,720 So from the outside a person may appear deeply consistent and 142 00:08:12,720 --> 00:08:15,840 routine bound because perhaps they're always returning to the 143 00:08:15,840 --> 00:08:19,040 same topics or activities and that's going to look like 144 00:08:19,040 --> 00:08:22,120 classic autism. But potentially within those 145 00:08:22,120 --> 00:08:25,400 interests there might be some intense novelty seeking. 146 00:08:25,680 --> 00:08:28,760 Or a person might be constantly starting new sub projects or 147 00:08:28,760 --> 00:08:32,320 bouncing between ideas and yet still struggling to follow 148 00:08:32,320 --> 00:08:35,240 through. So, for example, I often 149 00:08:35,240 --> 00:08:39,559 describe it as if I have a special interest solar system. 150 00:08:39,919 --> 00:08:44,039 So for example, psychology and philosophy are some of my 151 00:08:44,039 --> 00:08:46,840 special interests, and they're my special interest solar 152 00:08:46,840 --> 00:08:49,640 systems. So within that, I find that I 153 00:08:49,640 --> 00:08:53,640 often need to visit different planets in order for it to stay 154 00:08:53,880 --> 00:08:56,480 new and interesting and to keep my attention. 155 00:08:57,240 --> 00:09:01,360 And So what I experience is a pretty interconnected, woven 156 00:09:01,360 --> 00:09:05,560 together special interest ecosystem or solar system, which 157 00:09:05,560 --> 00:09:09,840 provides a sort of quieter novelty that is deeply 158 00:09:09,840 --> 00:09:13,440 regulating for me and restores me because it's all happening 159 00:09:13,440 --> 00:09:17,320 within the same solar system. For example, I'm often exploring 160 00:09:17,320 --> 00:09:20,680 something related to psychology. It can look like I'm doing the 161 00:09:20,680 --> 00:09:24,080 same thing over and over, but if you look more closely, you can 162 00:09:24,080 --> 00:09:27,080 actually see how I'm hopping between different projects or 163 00:09:27,080 --> 00:09:30,120 I'm pop in between different theories within psychology and 164 00:09:30,120 --> 00:09:33,520 I'm doing a lot of novelty seeking within my solar system. 165 00:09:33,880 --> 00:09:38,000 So essentially one of my working theories is that what some of us 166 00:09:38,000 --> 00:09:40,800 experience is something like this, where autism holds the 167 00:09:40,800 --> 00:09:44,280 monotropic orbit, especially when it's a special interest, 168 00:09:44,360 --> 00:09:47,320 while ADHD keeps us moving within it. 169 00:09:47,720 --> 00:09:52,120 And it can create a sort of intense sustained focus inside 170 00:09:52,120 --> 00:09:55,640 our interest solar systems. And if those interests line up 171 00:09:55,640 --> 00:09:59,760 with school or work, that hyperfocus may not show up as a 172 00:09:59,760 --> 00:10:02,480 problem. Which is one more reason the 173 00:10:02,480 --> 00:10:07,000 ADHD can get missed, since it's often the hyper focus on less 174 00:10:07,200 --> 00:10:11,080 acceptable or less helpful things that alert people to the 175 00:10:11,080 --> 00:10:13,600 ADHD in the 1st place. It's the hyper focus on the 176 00:10:13,600 --> 00:10:17,080 screens and the struggle with focus at school that will often 177 00:10:17,080 --> 00:10:20,120 lead to an ADHD assessment or evaluation. 178 00:10:20,440 --> 00:10:25,160 Next, quiet ADHD is missed more commonly within the general 179 00:10:25,160 --> 00:10:28,640 population, and certainly more common among the autistic 180 00:10:28,640 --> 00:10:32,240 population. ADHD can present as more 181 00:10:32,240 --> 00:10:35,960 daydreamy, or more of that internal distractibility, or 182 00:10:35,960 --> 00:10:39,680 more mental restlessness rather than the visible hyperactivity 183 00:10:39,840 --> 00:10:42,280 that many people think of when they think of ADHD. 184 00:10:42,560 --> 00:10:46,840 So if an autistic person has primarily inattentive ADHD, they 185 00:10:46,840 --> 00:10:50,720 may be particularly vulnerable to their ADHD going unseen, 186 00:10:51,320 --> 00:10:54,560 especially as clinicians might never systemically screen for 187 00:10:54,560 --> 00:10:58,520 ADHD once autism is on the chart, especially if the person 188 00:10:58,520 --> 00:11:01,400 does well in structured or high interest settings. 189 00:11:02,000 --> 00:11:05,000 And last but not least, let's talk about monotropism and how 190 00:11:05,000 --> 00:11:09,920 that can further hide ADHD. So autistic monotropism is that 191 00:11:09,920 --> 00:11:15,480 tendency to anchor in deeply on a narrow channel and that can 192 00:11:15,600 --> 00:11:18,360 look like excellent focus to an observer. 193 00:11:18,640 --> 00:11:22,480 And in many ways it is my monotropism. 194 00:11:22,480 --> 00:11:26,880 My restricted interest is my most dominant autistic trait, 195 00:11:27,040 --> 00:11:29,880 which is partly why I think it was so hard for me to see the 196 00:11:29,880 --> 00:11:32,240 ADHD. So what's often missed is that 197 00:11:32,280 --> 00:11:37,040 outside that narrow channel of deep focus, attention can 198 00:11:37,040 --> 00:11:40,560 fragment quite quickly. So there's a lot of tasks 199 00:11:40,800 --> 00:11:44,400 outside of that monotropic vortex that go unfinished. 200 00:11:44,680 --> 00:11:48,560 Switching between domains can be extraordinarily hard, and then 201 00:11:48,560 --> 00:11:52,520 reengaging after interruption can feel really, really 202 00:11:52,520 --> 00:11:55,040 difficult. And so if a person is highly 203 00:11:55,040 --> 00:11:59,560 monotropic, that is not going to get necessarily coded as ADHD 204 00:11:59,560 --> 00:12:02,800 again, especially if their interests are around school or 205 00:12:02,800 --> 00:12:05,960 work, because it's going to look like that person has Immaculate 206 00:12:05,960 --> 00:12:07,640 focus. Now, here's a pattern that I've 207 00:12:07,640 --> 00:12:09,520 noticed for myself. And when I've surveyed our 208 00:12:09,520 --> 00:12:13,040 community, many people report also having some experience like 209 00:12:13,040 --> 00:12:15,440 this. O the pattern that I find myself 210 00:12:15,440 --> 00:12:19,240 falling into is something that I call defensive monotroic mode. 211 00:12:19,400 --> 00:12:23,760 Ometimes I will drop into Dee monotroic flow simly for the joy 212 00:12:23,800 --> 00:12:27,960 of it. But I also notice that sometimes 213 00:12:27,960 --> 00:12:29,880 I go into that state defensively. 214 00:12:29,880 --> 00:12:33,240 I am so overwhelmed by the ADHD ping a thoughts. 215 00:12:33,400 --> 00:12:36,640 I'm so overwhelmed by all of the life tasks that is on my To Do 216 00:12:36,640 --> 00:12:39,160 List that I'm really struggling to get traction with. 217 00:12:39,560 --> 00:12:42,960 And So what I will do as almost a form of avoidance from that 218 00:12:42,960 --> 00:12:47,120 overwhelm is I will find something that is deep and 219 00:12:47,120 --> 00:12:51,440 intense enough that I can get lost and absorbed in it, that I 220 00:12:51,440 --> 00:12:55,720 can anchor into it as a way to escape the ADHD overwhelm of all 221 00:12:55,720 --> 00:12:59,080 of the pingy thoughts and all of the pingy tasks that are half 222 00:12:59,080 --> 00:13:01,000 finished. So for example, I might 223 00:13:01,000 --> 00:13:05,160 disappear into research or into writing or into very specific 224 00:13:05,160 --> 00:13:08,800 questions and I will get lost there for hours. 225 00:13:09,160 --> 00:13:13,080 And I will do that as a way to block out the stress of all of 226 00:13:13,080 --> 00:13:16,520 the unanswered emails that are piling up and all of the pings 227 00:13:16,520 --> 00:13:21,480 and the texts and the chores and the life tasks that are just so 228 00:13:21,480 --> 00:13:24,480 much more difficult for me to engage with and that are just 229 00:13:24,880 --> 00:13:27,200 pinging in my brain when I'm not in deep focus. 230 00:13:27,360 --> 00:13:31,160 And so because the deep focus is one of the few places that I 231 00:13:31,160 --> 00:13:35,080 actually experience calm and relief from that I go back to it 232 00:13:35,080 --> 00:13:38,880 over and over and over. The problem with this cycle that 233 00:13:38,880 --> 00:13:42,280 I've created for myself is that when I reemerge from the deep 234 00:13:42,280 --> 00:13:47,200 focus, there are then even more pingy thoughts and pingy tasks 235 00:13:47,200 --> 00:13:50,600 that are just waiting for me from when I initially left them. 236 00:13:50,840 --> 00:13:55,200 So that makes the reentry even more overwhelming and tempts me 237 00:13:55,200 --> 00:13:58,760 to go into even more avoidance where I can just disappear back 238 00:13:58,760 --> 00:14:01,080 into deep focus again. So that's where it quickly 239 00:14:01,080 --> 00:14:05,160 becomes a vicious cycle where I escape to deep focus to avoid 240 00:14:05,160 --> 00:14:09,360 the overwhelm and simultaneously more tasks are piling up. 241 00:14:09,520 --> 00:14:12,920 And then when I attempt to reemerge, I'm overwhelmed and I 242 00:14:12,920 --> 00:14:16,880 go back to my deep focus as a way to calm myself from that 243 00:14:16,880 --> 00:14:19,440 overwhelm. So this vicious cycle, it is 244 00:14:19,440 --> 00:14:22,720 attention dysregulation. But on the outside it can look 245 00:14:22,720 --> 00:14:26,080 impressive. It can look like self-discipline 246 00:14:26,080 --> 00:14:29,280 or productivity rather than attention dysregulation. 247 00:14:29,680 --> 00:14:33,000 People in my life will ask me quite often how I'm able to do 248 00:14:33,000 --> 00:14:36,880 as much as I'm able to do to write books and articles and 249 00:14:37,760 --> 00:14:40,840 create trainings or record and edit videos like this. 250 00:14:41,040 --> 00:14:45,160 And the answer is partly because there is a lot in my life that 251 00:14:45,160 --> 00:14:47,720 I'm avoiding. I'm avoiding things like 252 00:14:47,720 --> 00:14:51,200 ordering new contact lenses, which I desperately need, or 253 00:14:51,200 --> 00:14:55,320 ordering medication, or making medical visits or chores, or 254 00:14:55,320 --> 00:14:59,360 cleaning, or not cooking, or struggling with parenting tasks. 255 00:14:59,360 --> 00:15:02,160 There's a lot of the life tasks that I struggle quite 256 00:15:02,160 --> 00:15:06,040 significantly with that my spouse sees, and I'm quite 257 00:15:06,040 --> 00:15:09,040 privileged in having a spouse that helps me accommodate those 258 00:15:09,040 --> 00:15:11,240 things. But those are things that most 259 00:15:11,240 --> 00:15:13,840 people wouldn't see unless you're behind closed doors and 260 00:15:13,840 --> 00:15:17,840 you live with me and you see how much I struggle at doing those 261 00:15:17,840 --> 00:15:20,120 basic tasks. And this is part of that 262 00:15:20,120 --> 00:15:24,000 dysregulation of attention where I'm able to regulate my 263 00:15:24,000 --> 00:15:26,560 attention on the things that interest me, but it comes at the 264 00:15:26,560 --> 00:15:29,200 cost of things that perhaps are a bit more hidden. 265 00:15:29,560 --> 00:15:32,560 And so that's not going to necessarily look like classic 266 00:15:32,560 --> 00:15:36,520 ADHD unless you're asking my spouse or my children the right 267 00:15:36,520 --> 00:15:38,720 questions. So a lot of my professional 268 00:15:38,720 --> 00:15:42,960 productivity comes on the flip side of my deep procrastination 269 00:15:42,960 --> 00:15:45,840 and difficulty with engaging in life's daily tasks. 270 00:15:46,200 --> 00:15:50,760 And so if that is one way that the Audio HD person is avoiding 271 00:15:50,760 --> 00:15:55,400 the overwhelm of ADHD, and if it functions in our society in a 272 00:15:55,400 --> 00:15:58,000 way that society rewards it because it looks productive, 273 00:15:58,200 --> 00:16:00,120 that's not going to look very ADHD. 274 00:16:00,440 --> 00:16:03,840 But the person may be still struggling significantly with 275 00:16:03,840 --> 00:16:06,240 executive functioning, but in ways that might not be as 276 00:16:06,240 --> 00:16:08,800 visible to others. So essentially, when autism is 277 00:16:08,800 --> 00:16:12,920 known but ADHD is not, all this can create a kind of explanatory 278 00:16:12,920 --> 00:16:17,120 gravity where everything orbits around the autism and ADHD 279 00:16:17,120 --> 00:16:20,560 remains unnamed even though it's also shaping the person in his 280 00:16:20,560 --> 00:16:22,640 daily life. And again, diagnostic 281 00:16:22,640 --> 00:16:25,760 overshadowing is what happens when traits that could belong to 282 00:16:25,760 --> 00:16:29,480 multiple conditions are automatically attributed to the 283 00:16:29,480 --> 00:16:32,280 diagnosis that's already on the chart or already known. 284 00:16:32,280 --> 00:16:36,360 This can mean both autism and ADHD hiding one another, but it 285 00:16:36,360 --> 00:16:40,840 can also involve, and I'd argue more often, it involves actually 286 00:16:40,840 --> 00:16:44,320 when a mental health diagnosis is overshadowing both the autism 287 00:16:44,360 --> 00:16:48,400 and the ADHD. So for example, if a person is 288 00:16:48,400 --> 00:16:51,800 already diagnosed with anxiety, autistic sensory overload might 289 00:16:51,800 --> 00:16:55,720 get labeled as anxiety and only the anxiety is treated and the 290 00:16:55,720 --> 00:16:59,680 autism is missed. Or if PTSD is already diagnosed, 291 00:16:59,920 --> 00:17:03,360 then ADHD, internal restlessness, and hyperactivity 292 00:17:03,520 --> 00:17:07,040 might be attributed to the PTSD and the underlying ADHD is 293 00:17:07,040 --> 00:17:09,359 missed. Or if there is a known diagnosis 294 00:17:09,359 --> 00:17:13,560 of bipolar ADHD, impulsivity or hyperactivity could get folded 295 00:17:13,560 --> 00:17:17,520 into manic or hypomanic symptoms and the ADHD never gets 296 00:17:17,520 --> 00:17:20,160 assessed. So overshadowing can happen all 297 00:17:20,160 --> 00:17:22,720 over the place. And for autistic ADHD years, 298 00:17:22,920 --> 00:17:25,440 it's really common first of all for us to have Co occurring 299 00:17:25,440 --> 00:17:28,600 mental health conditions. And it's actually really common 300 00:17:28,600 --> 00:17:31,360 for those to be the things that are overshadowing both the 301 00:17:31,360 --> 00:17:35,560 autism and the ADHD. Now when this happens, support 302 00:17:35,560 --> 00:17:39,280 can really miss the mark. For example, a child might 303 00:17:39,280 --> 00:17:43,160 receive behavior plans that are targeting oppositional behavior 304 00:17:43,240 --> 00:17:46,640 when what they actually need is sensory accommodations to help 305 00:17:46,640 --> 00:17:50,320 with transitions. Or maybe a person has handed out 306 00:17:50,720 --> 00:17:54,680 ADHD focused strategies, but without recognition that their 307 00:17:54,680 --> 00:17:59,560 autistic need for predictability and sensory regulation is also 308 00:17:59,560 --> 00:18:01,000 something that needs to be addressed. 309 00:18:01,480 --> 00:18:04,720 Overshadowing also ends up stretching out the time before a 310 00:18:04,720 --> 00:18:08,480 person hears a story about themselves that actually fits. 311 00:18:08,840 --> 00:18:13,080 And in that it can deepen a lot of the shame as many of us are 312 00:18:13,080 --> 00:18:17,240 left wondering why things feel so incredibly hard for us that 313 00:18:17,240 --> 00:18:20,200 appear easy for other folks. I think we're at an exciting 314 00:18:20,200 --> 00:18:23,680 time in the research and in the conversation among our community 315 00:18:23,680 --> 00:18:26,240 where we're learning more about how these two neurologies 316 00:18:26,240 --> 00:18:31,280 interact because it's not as neat as they simply stack on top 317 00:18:31,280 --> 00:18:33,520 of each other. And part of how they interact 318 00:18:33,520 --> 00:18:36,880 means that it can lead to a lot more diagnostic overshadowing of 319 00:18:36,880 --> 00:18:39,440 both conditions. One of the ideas that I am 320 00:18:39,440 --> 00:18:43,120 exploring in this book is to look at what does it look like 321 00:18:43,120 --> 00:18:47,040 to map our unique audio HD signature because there's so 322 00:18:47,040 --> 00:18:50,640 many different ways that ADHD can present, so many different 323 00:18:50,640 --> 00:18:53,880 ways that autism can present, and thousands of ways the audio 324 00:18:53,880 --> 00:18:57,280 HD can show up. And when the audio HD traits are 325 00:18:57,360 --> 00:19:01,600 are understood as part of a distinct neurology with its own 326 00:19:01,600 --> 00:19:05,600 signature, with its own coherent nervous system, I think we can 327 00:19:05,600 --> 00:19:08,640 start to more deeply understand ourselves and have a bit more 328 00:19:08,640 --> 00:19:11,720 compassion for the ways that we've perhaps been doing the 329 00:19:11,720 --> 00:19:14,040 best that we could with the conditions that we had. 330 00:19:14,720 --> 00:19:17,080 Now, if this feels like this might be part of your story, it 331 00:19:17,080 --> 00:19:20,640 might be worth bringing both lenses into the conversation, 332 00:19:20,640 --> 00:19:25,200 autism and ADHD, perhaps into the conversation with clinicians 333 00:19:25,200 --> 00:19:29,200 or into your own self study so that you're not left living with 334 00:19:29,200 --> 00:19:33,160 only half of your story or half of your neurology known. 335 00:19:33,240 --> 00:19:35,560 If you're looking for a place to get started, I will link to 336 00:19:35,560 --> 00:19:39,560 several articles in the show notes, including articles on 337 00:19:39,560 --> 00:19:42,960 ADHD screeners, autism screeners, and other places 338 00:19:42,960 --> 00:19:45,400 where you can start some of your own self study. 339 00:19:45,440 --> 00:19:49,120 Now, screeners are not the same thing as an assessment, but they 340 00:19:49,120 --> 00:19:53,520 are a great data point and it's a great place that many of us 341 00:19:53,520 --> 00:19:55,680 end up starting when we're starting to have the 342 00:19:55,680 --> 00:19:58,560 conversation with ourselves or with a provider on whether or 343 00:19:58,560 --> 00:20:01,920 not an ADHD or an autism diagnosis fits. 344 00:20:02,240 --> 00:20:05,360 I will see you in the next video and until then I hope they are 345 00:20:05,360 --> 00:20:09,960 able to stay kind and curious with yourself but also with the 346 00:20:10,120 --> 00:20:11,560 other people that are in your life.