(This article is cross-posted to adhdsolutions.net)
Like most people who remember the 1970s, I believed at one time that people with a certain diagnosis (I’ll tell you what it is later) were social outcasts with severe intellectual impairment. You couldn’t talk to them, and they wouldn’t even look at you. If they talked at all, it was a deep-dive into the minutiae of their obscure favorite topic. They probably also had some freakish talent they acquired at age two instead of doing normal toddler things. At least this is how it was depicted in popular culture.
In reality, there’s immense variability in what this condition can look like. Many people overlook articles with "autism" in the title because they believe it can’t possibly apply to them. Oops, there, I said it. But don’t leave me yet. It might just apply to you.
At the 10,000 foot level, autism (more accurately referred to as Autism Spectrum Disorder, or ASD) is simply a difference in the way we socialize, and an affinity for patterns and consistency. Come down to 5000 feet, and we see that intuitive understanding of how to connect with people is missing. I say “intuitive” because while autistic individuals may have learned social rules, have lots of friends or even be extroverted, their interactions are often guided by an internal database of learned information rather than an innate understanding. Repetitive patterns in the way we move or speak, or the things we do, are in the picture here as well. We like our routines, and we like what we like – perhaps to the exclusion of everything else. Some may call us “quirky”.
On the ground, ASD can manifest in a plethora of ways. Maybe that’s why it's so often misunderstood and misdiagnosed. The outward-facing effects can be muted when ADHD is also present. For example someone with both ADHD and autism (sometimes called AuDHD) might crave organization but be unable to maintain a clutter-free home. Unmet needs like this often lead to emotional dysregulation. We either withdraw or explode. So we’re diagnosed with depression, or bipolar disorder, or borderline personality disorder. Maybe we feel anxious because we don’t understand what’s expected, and are diagnosed with generalized anxiety disorder. Some of us love rituals, so we’re labeled with obsessive compulsive disorder. Dr. Theresa Regan, neuropsychologist and Certified Autism Specialist, says “you have to look at the big picture. “ Perhaps the diagnostic criteria would be met for these conditions. But does a diagnosis of ASD explain it better?
Autism is a spectrum disorder, meaning that individuals may require varying levels of support, from minimal to significant. For example, Raymond Babbit in the 1988 movie Rain Man had high support needs. Conversely, someone with lower support needs might exhibit traits that are barely discernable, at least on the outside. Inside, they’re really struggling.
Some of you may object to the phrasing I chose earlier when describing ASD at a high level. Why not use the same language as the DSM-5, you ask? Because to me, and someone just beginning their autism journey, terms like "deficits in social-emotional reciprocity” and “rigid thinking” likely don’t resonate even though the concepts might apply. “I have friends and my thinking is just fine, thank you very much!” Reactions like this are what continue to drive stigma and misunderstanding.
I want to apologize to all the people I invalidated years ago when they shared their autism diagnosis with me. “But you have no trouble with eye contact,” I said. “You’re so empathetic, you can't possibly have autism.” Statistically, it has been estimated that between 20 and 50% of people with ADHD have coexisting ASD. How odd that I’d been an ADHD specialist for so long and only had one autistic client! Well, actually, it’s not odd. It’s not possible, and it’s not true. I just didn’t know. Fortunately, ASD is becoming more understood. My hope is that other mental health professionals recognize what they don’t know, and choose to begin their learning journey.
It is not the intent of this article to delve deeply into symptomatology and treatment. Or to explain DSM-5 terminology. I simply wanted to open your eyes, and your heart, to help you consider whether autism may be part of your picture. Or the picture of someone you love.