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Jackie Schuld Art Therapy Blog

Where Are We With Our Understanding of Combined Autism and ADHD?

I woke up this morning incredibly frustrated.


Last night I read more chapters in the book “ADHD: From A to Z.” Normally books bring me more clarity, but at this point in my life, more information seems to be confusing me.


I was recently diagnosed with ADHD and autism. I already knew I was autistic, I just didn’t know I had ADHD. As I’ve sought to understand ADHD, it has been incredibly confusing. Some parts are relatable, and then many others are the opposite of my experience. This is why I never considered I could be ADHD.


There’s a simple explanation for this: ADHD is going to present differently when you are autistic. It’s not like being diagnosed with two completely separate medical conditions that have nothing to do with each other. That would be like finding out you have poor vision and one leg is shorter than the other. It’s more like finding out you have poor vision and something is up with your optic nerve.


We cannot examine ADHD and autism as separate conditions. We cannot write out all we know about ADHD and all we know about autism, combine them, and magically have what it looks like to be ADHD and autistic.


There is an interplay between ADHD and autism that cannot be denied. Having both of the conditions inevitably impacts the other. It impacts what characteristics do and do not show up as well as the severity of characteristics.


Photo of a collage with a black and white mandala in the center by artist Jackie Schuld.
Collage by Jackie Schuld

My psychologist told me that my ADHD likely helps me to not be so myopic in focus (a classic autistic trait). She also explained that my autism helps me to be extremely organized, timely, and routine-focused - something that ADHD people frequently struggle with. In essence, these two conditions are “softening” the impact of the other.


I’ve also heard people argue that autism and ADHD can be like a fight in their brain. I don’t know enough to claim that as my experience. I asked my psychologist for more information about autism and ADHD within one person, and she had no further resources for me. She is writing a book because she knows there needs to be more resources.


What does it mean to be on the cusp of new mental health developments? It must be exciting for her to write about such things.


But what does it mean to be living in those new developments? What does it mean to be diagnosed as something that has so little educational information, let alone science? What does it mean to be something that the majority of medical and mental health providers know nothing about? What does it mean to be diagnosed with something we barely understand?


As an autistic writer and therapist who specializes in autism, it can feel especially uncomfortable. What does it mean to write about these topics when I know the combination of theories, lived experiences, and science will rapidly evolve our understanding of neurodiversity to the point that anything I write today will be obsolete in 20 years?


It can make you want to chuck everything out the window. Like throwing all the paint bottles out because do we even know the scientific components of the paint inside (the art therapist in me couldn’t resist an art simile). Why bother even writing? What do we really know? It can cause me to devolve quickly into self-doubt and questioning.


Luckily though, I can usually catch myself before I utterly decompensate. Essays like this one help me to slow down and think this through. To remind myself what I do know. What I do know is this:


I know what autism characteristics look like now. I have the best understanding I possibly can from all of the available books and research, combined with my own personal experiences and those of my autistic clients. I cannot predict what the future will look like, but I can say “This is what we know now.”


And why does that matter?


Because it does change things. Learning about these things has advanced my life in multiple ways:


  • Understanding why my brain functions the way it does

  • Learning what parts of myself I cannot change (like how many thoughts enter my mind). I cannot tell you how much energy I wasted in my life trying to change this about myself.

  • Learning how to externally work with the parts of myself that I cannot change (like adjusting my schedule to have more breaks and downtime because I know my energy levels are drastically impacted by social engagements)


I could write dozens of essays on the positive impacts… oh wait, I have. I’ve written over 150 essays about autism. Learning I was autistic led to massive impacts on my well-being and overall happiness.


Thus, the current state of knowledge about neurodiverse conditions has helped me immensely. If our theories advance and change in 20 years, that won’t change how much the current knowledge helped me. We do the best with what we have.


When it comes to autism and ADHD, we don’t know much. When my psychologist explained some aspects of ADHD to me, I said to her, “But I thought those are just autism traits, too.”


Frankly, no one knows yet. There are even theories that ADHD will be absorbed into autism, like autism is one big pie and ADHD is a tiny piece of it. That might be. We don’t know… yet.


As a writer and therapist, this is where I lie awake at night worrying, “Am I miseducating people? Am I misleading people? Am I saying things that are going to be proven incorrect?”


The reality is I’m intentionally doing my best. I’m doing my best with the information we have. No one really knows. If anyone says they know without a doubt - run. There simply isn’t enough science, lived experiences, and collective research to say with any definity.


We’re all doing our best with theories and ideas. And that is fine - as long as we acknowledge that is what we’re doing. As long as we don’t claim to know more than we actually know.


In my writing about autism and ADHD, I’m naming what is clear and what is not. I’m clearly stating the gaps in knowledge. I’m not trying to fool anyone.


Do I think being diagnosed with ADHD changed anything for me? Yes, in that it sure made me confused as hell. It made me wonder, “Am I different from other autistic people without ADHD? And how so? Am I misunderstanding what autism is?”


In my work as a therapist, I’ve developed a list of autism characteristics that I divide into six categories. When I work with a newly identified autistic, we go through this list together to help them understand their autistic identity. I suddenly wondered, what if I’m misleading them? What if I’ve embedded ADHD traits in this list that don’t belong there?


But here’s the thing: My list resonates SO STRONGLY with autistic people - ESPECIALLY the autism characteristics that have overlapping characteristics with ADHD (such as having a lot of thoughts at once or being able to hyperfocus).


So maybe, some of our “autistic” traits qualify us to also use the label of “ADHD.” However, that doesn’t actually change anything for me. When I step back and look at the new knowledge gained from my ADHD diagnosis, a new label didn’t change what I already understood about myself. Every ADHD characteristic my psychologist named, I already knew and I had understood through an autistic lens. It didn’t change what I see in myself. It also didn’t change how I see myself. I already knew I was a different neurotype. I had already reframed myself from “broken brain” to “fine as I am.”


The only difference I can maybe imagine is medication. An ADHD diagnosis gives me access to medication if I want it. I’ve always been a little jealous of ADHD individuals - that they have some pill to “cope” with some of their challenges. No such singular pill exists for autism. Except pills do exist for singular symptoms. For example, I take anti-anxiety medication to help with my gastrointestinal pain that is related to autism.


So maybe it’s also possible that there is another medication (ADHD medication) that could help with a singular autistic characteristic: focus.


Here’s the thing, every autistic experiences variable characteristics. We experience different intensities across time. Right now, I benefit from medication for my gastrointestinal pain. I know many autistics that don’t need this. Right now, I don’t think I need any medicinal help focusing, I’m able to get to all of the important tasks to keep my life/work running. I know many autistics that still struggle with that and might benefit from medication.


This essay reflects where I’m at in my current understanding of combined autism and ADHD. I’m toying with the idea that I am fundamentally autistic, and some of those traits qualify me as ADHD. If some of those traits give me problems, I have access to some medication.


Apart from that, I still have A LOT of questions.


I want to know if ADHD actually does alter autism. Does combined ADHD and autism have a common set of characteristics? Does it really matter to know you’re ADHD and autistic? Or is it that your particular expression of autism just has some characteristics that overlap with the label of ADHD?


I hope to know A LOT more within a year’s time. That is both exciting and terrifying. It means holding the unknown within me, and still moving ahead with the writing and therapeutic work that I am doing.


I wish I could be like Edison. I wish there was some experiment with lightbulbs that I could just try over and over. Throw out all the bad ideas, and then be absolutely sure when the light turns on.


Being in the field of psychology, I have to accept that will never be my reality. I have to accept that my best will always carry the possibility of being flawed or wrong. It’s a weird reality to hold, but one that I think is worth holding.


The benefits of what I know about autism are far too great to abandon. The life that is breathed back into people once they see themselves through a neurodiverse lens is so beneficial, that it is worth it, even if we don’t 100% know everything.


I’m willing to stand on the cusp and eagerly watch the new research, theories, and lived experiences pour in. Please let me know of any resources you know, for I’m eagerly waiting.

 

Thank you for reading. If you’d like to read more, sign up for my FUNletter. If you would like to explore your autistic identity with an autistic therapist, you can learn more about my therapy services here.

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