Is ADHD Really Anxiety?

There are a few traits that are almost completely co-morbid with autism: chronic anxiety and ADD/ADHD. If you have autism, you have anxiety and attention problems.

Autism, though, isn’t the only thing where anxiety and attention problems are co-morbid. The same is true of post-traumatic stress disorder (PTSD). When you have PTSD, you are in a state of constant anxiety and constant hyper-vigilance. Hyper-vigilance means you are constantly actively keeping close tabs on the environment. Your attention is drawn to every little thing, to anything you catch out of the corner of your eye.

This hyper-vigilance sounds an awful lot like ADD/ADHD. Hyper-vigilance is actually how I would describe my ADD. It’s not that I have a hard time paying attention–rather, I have a hard time not paying attention to literally everything around me. To the person I’m directly in front of, it’s going to appear that I am having a hard time paying them attention, though.

If we understand ADD/ADHD as hyper-vigilance, this could then easily explain why many with ADD/ADHD can pay close attention to video games, for example. After all, many video games simulate conditions in which hyper-vigilance is needed to succeed.

Obsessive focus on an area of interest could also be understood as hyper-vigilance. Hyper-vigilance will also require hyper-focus if and when the “danger” is located. When there is no actual danger, that hyper-focus could manifest itself in a variety of other ways, including obsessive interests.

Hyper-vigilance comes out of anxiety, and we autistics are full of anxiety. In our case, the anxiety stems from our constantly being bombarded by sensory input. We’re overstimulated, and oftentimes that stimulation doesn’t get integrated well. It should not be surprising if an intense environment should result in hyper-vigilance within that environment. Anxiety is the intermediary.

While I myself do not use any kind of medication, and we do not use medication on our son, I do understand why some might want to medicate themselves or their children. The typical medication is for ADD/ADHD–things like Ritalin–because that’s the most problematic behavior. However, if my suspicions are correct, we are very much treating the symptoms of anxiety rather than dealing with the deeper cause–the anxiety itself.

Since we cannot rewire the brain, we cannot treat the ultimate cause (and we with autism probably wouldn’t want to do that, anyway, since that wiring is part of who we are as human beings), but anti-anxiety medications may go a long way toward eliminating at least the co-morbidity of ADD/ADHD. They would also likely alleviate some of our social issues, which stem from that anxiety.

The general rise in ADD/ADHD and the high prevalence of it in the U.S. can, I believe, based on this thesis, be traced to the fact that our school system is making our children far more anxious than ever before. But that’s a whole other set of issues. I will say, though, that rather than putting more children on Ritalin and related drugs or anti-anxiety medications, perhaps if our schools treated students as ends in themselves rather than as means to achieve testing outcomes to make administrators look good and justify their 6-digit salaries, there wouldn’t be nearly as many children with ADD/ADHD.

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Sharing a Co-Morbidity Doesn’t Mean Autism Doesn’t Exist

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My wife shared this image on Facebook. The things surrounding “autism” are all things that can be co-morbid with it. For example, I have general anxiety disorder–meaning I have anxiety all day every day–but I don’t have Tourette’s. Not everyone who has general anxiety disorder has autism, of course, but if you are autistic, you have general anxiety disorder. And not everyone with Tourette’s is autistic, but a higher percentage of autistics have Tourette’s.
 
There are those who think that having daily rituals is having OCD. Having rituals is not really quite OCD. Rituals are a way to create order in life, and is therefore something you will find autistics doing at much higher rates than, again, the non-autistic population. True OCD would involve someone who cannot leave a room without turning the light switch on and off exactly 15 times each time, or who gets “fascinated” by a shoe for 30 minutes straight. Or it may involve being unable to stop thinking about something all the time–such as sharks, for example, or in my case, self-organizing scale free network processes. The benefit of having what one could call “OCD thinking” is that one can become a scientists or scholar, and then you’re actually paid for what you can’t stop thinking about. You can get a Ph.D. with that way of thinking.
 
Of course, if you’re always thinking about certain things, if your brain is always running at 150 mph, you may have a hard time paying attention. My own hyperactivity is mostly in my thoughts, but Daniel has a hard time sitting still unless he’s involved in his obsessions. Which simply means his hyperactivity is internalized.
 
These things themselves come from the fact that the autistic brain is dominated by positive feedback. Complex systems like the brain have a combination of positive and negative feedback. Negative feedback helps to keep things in equilibrium. The thermostat for your heater/AC uses negative feedback to keep the temperature the same. If you had a positive feedback thermostat, the hotter the room became, the hotter the heater would try to make the room. Things go faster the faster they go. Hyperactivity then occurs because you’re getting overstimulated. This can then push over into a situation where you become overwhelmed by the situation. Reactions to this can include extreme escape behaviors, banging your body against a wall while becoming non-responsive, or having an outright meltdown where you cannot control your actions. The overstimulation occurs in no small part because we also have sensory integration disorder. That means we have a hard time separating out visual input from sound from touch from all of the rest of our sensory input. I experience it as a feeling that my mind is being crumpled up like a piece of paper and everything goes black.
 
I also come with some extreme sensitivities. I cannot stand to have my wrists touched. I jump every time someone does that. I want to remove my skin to get away. But I try to downplay my reactions because people will just think it’s “weird.”
 
Autism is a fundamental structural difference in the way the brain is wired and works. It results in a very distinct set of behaviors. Yet, it is a spectrum, and that spectrum goes from truly debilitating (what is now called Autism 3) through “high-functioning” (Autism 2) to Asperger’s/Autism 1 and, I would argue, ADD/ADHD. Yes, most of the elements which are often co-morbid with autism can be found elsewhere. I have a slight tendency toward manic-depression, but there are certainly people with manic-depression who aren’t autistic, and there are people with crippling depression who aren’t autistic. Yet, those are found among autistics at much higher rates.
 
Those who like to throw around the argument that “autism” is a “mere label” are really just trying to downplay some very concrete elements of reality. There are some things that are “mere labels,” and some things that absolutely are not. Having structural and biochemical differences in my brain that result in my mind being very different from non-autistic people isn’t a label. It’s an acknowledgement of that reality. I’ve enjoyed the giftedness and even the OCD that has come with it. I couldn’t have gotten my Ph.D. without it. And yet, my sensitivities and “weird” behaviors have definitely affected various aspects of my life. One of the best things to have happened to me was for me to realize I was autistic and to get officially diagnosed. It cleared up why I was argumentative (have ODD), why I couldn’t understand why everyone else wasn’t as rational or couldn’t see all the complex patterns I could see. It cleared up why I have all my sensitivities, why I think the way I do, why I avoid being in the middle of large groups of people, why I have blackout and movement seizures, why I have a delay in my response to people, and why I can get confused if people don’t give me the processing time I need.
 
The benefit of knowing I am autistic goes beyond that. Now I’m no longer just that weird person who doesn’t like to socialize who inexplicably alternates between being wonderfully kind and friendly to appearing to be rude (from failing to notice things going on or being confused about a given situation). Those behaviors are now able to be explained. Which doesn’t mean I shouldn’t have someone say, “Hey, so and so said hi to you.” I do. It helps. Nor does it mean I shouldn’t have certain behaviors pointed out to me, because when they are, I become more conscious of them and the fact that they may make non-autistic people uncomfortable, so I should try to change that behavior. At the same time, there’s always a degree to which we cannot help our behaviors. In a room full of autistic people like me, the non-autistics would stand out and it would be their behavior which would seem out of place. And if we insisted they fit in, they would seem socially awkward and would have an extremely difficult time fitting in.
 
The long and short of it is that autism is a real thing with real behavioral and cognitive differences in those of us who have it. It’s important people know Daniel is autistic. That way people can understand that if he’s in a situation with a lot of people where he’s being completely overwhelmed that he’s not an out-of-control brat who just need some strong discipline to straighten him up, but actually cannot integrate what is going on, positive feedback is dominating, and he’s so completely overwhelmed he shuts down until he resets (in a closed system like the brain, positive feedback doesn’t run away forever, but rather creates cycles). I want people to understand that. I want people to adjust their expectation and to make room for “odd” behaviors so they can reap the benefits of our existence.

Reflections on Being a Student on the Spectrum

Having taught 2nd grade summer school Reading and Math, and now working as a sub, I cannot help but reflect upon my own elementary school education. I was always considered to be a very intelligent child by pretty much everyone, including my teachers. Any bad grades were considered to be laziness on my part.

One area in which I struggled throughout my years as a student was math. I particularly had a very hard time with word problems. I also had some problem with certain areas of multiplication, and fractions made no sense whatsoever to me until I took high school chemistry. I failed 8th grade math, made a C in Algebra 1 (Freshman), Cs and Bs in Geometry (Sophomore), a B in Algebra II (Jr), and an a in Calculus and in Trigonometry and Analytical Geometry (Sr). In college, I made a C in Calculus I, and I failed Calculus II so miserably that I managed to make a fairly low F even doing all of the extra credit.

Math in elementary school has now gone almost completely over to word problems. When I was in elementary school, tests would have almost all numerical problems, and only about 2 word problems. That meant I could miss the word problems (which I almost inevitably did) without failing the test. But today, the quizzes I have had to give involved nothing but word problems. Meaning there’s a very good chance that I would have been failing math well before 8th grade.

While there is no question that we need to teach children how to formulate problems (which is what word problems do), it doesn’t make a lot of sense to teach formulating math to children who cannot add, subtract, multiply, or divide. That is, you absolutely must have the mathematical skill in place before you can move on to mathematical reasoning and formulation of problems. The latter may be most important overall, but you cannot skip establishing the foundation.

Now it may be that this way of doing things is the best way for certain students. I won’t deny that possibility. But it’s coming at the expense of other children. And if this is true, then the way I was taught it came at the expense of the kinds of students who do well in the way math is taught today. There are trade-offs. In this particular trade-off, I would have been the one traded, from doing well enough in math to pass to failing very much earlier on.

Another thing I have noticed about education today is that it’s designed to be much more social. There’s more group work and “shoulder partners” and sitting together on a rug and so on. None of this is exactly inviting to anyone on the spectrum, and I certainly wouldn’t have liked school nearly as much if it had been run like it is today.

Indeed, though I was perhaps seen as highly intelligent but quirky (to put it nicely) as a child in the 1970s, I think there is little doubt that in the current school environment that I would have been identified as having something “wrong” with me. I would have been seen as refusing to participate and I probably would have had some quite negative reactions to a lot of this forced sociality (something perfectly fine for neurotypicals, who don’t find it forced at all). I would have likely been identified as having ODD, if not Asperger’s/autism. I probably wouldn’t have been identified as having ADD/ADHD, because I was never outwardly hyperactive (inwardly, I’m in a dead run almost all the time), but I would have likely been sullen and I wouldn’t have liked the classroom environment at all.

In other words, I think I would have done worse in school today than I did in the 1970s.

If it’s true that I would have done worse under the way teaching is done today, then we may have some explanation for why none of the education reforms we’ve tried have ever worked to improve scores. It’s because while the reforms help some children learn better, it ends up acting as an impediment to others. It also may explain the “rise” in ADD/ADHD and autism, since the way students are taught today seems to draw out many of their identifying factors.

But we ought to be a little disturbed that someone like me would probably no do well in today’s system. The system I went to school in put me on the path to succeeding in college and graduate school. I fear that this system would have had me identified as a problem student and perhaps even having the autism I do in fact have. That is a problem because even though there is a lot of rhetoric around people with disabilities being able to succeed, the fact is that nowadays we are put on a pathway to “succeed” outside of a college trajectory–mostly because we are left unprepared to go. My brother, who has dyslexia, was discouraged from going to college in high school–and he now has a B.A., an M.A., and an M.F.A. You cannot tell me that autistic children aren’t discouraged, directly or indirectly, from going to college.

What is worse is that, if I am right that the majority of advancements in the world were made by autistics, then we are doing a terrible disservice to the world at large by creating an educational system that educates perfect copiers well, but leaves reformers/inventors/creators on the sidelines.

Oppositional-Defiance Disorder, ADHD, and Autism

Anyone who has a child with ADHD should read Diane M. Kennedy’s The ADHD /Autism Connection. This is perhaps especially true if your child has been diagnosed with both ADHD and ODD (Oppositional-Defiance Disorder), since if you combine the behaviors of ADHD and ODD, you get the behaviors of someone with Asperger’s.

Of those with ADHD, 50-65% are also diagnosed with ODD. This would mean that if 3-7% of children have ADHD, and about half of those have ODD, and if children with that combination really have Asperger’s, then around 4%of the general population (including those officially diagnosed with Asperger’s) have Asperger’s.

For those not familiar with ODD, Kennedy lists the behaviors as “stubbornness, defiance, arguing, ignoring rules, hostile behaviors, temper tantrums, and an unwillingness to compromise” (55).

She also quotes the DSM-IV-TR as defining ODD as

a recurrent pattern of negative, defiant, disobedient and hostile behavior toward authority figures that persists for at least 6 months and is characterized  by the frequent occurrence of at least four of the following behaviors: losing temper . . . arguing with adults . . . actively defying or refusing to comply with the requests or rules of adults . . . deliberately doing things that will annoy other people . . . being touchy or easily annoyed by others . . . being angry and resentful . . . or being spiteful or vindictive. (cit. pg. 55)

Let’s face it. I’ve been accused of being stubborn, my parents complained that I was always argumentative and that I liked to aggravate people, and I’m easily annoyed by what I perceived to be peoples’ endless idiocies. I fight against being angry and resentful. Fortunately, I have never been spiteful or vindictive. But given the fact that I exhibit all the rest, I would be diagnosed as having ODD — except that I have Asperger’s, and these behaviors are already included in my syndrome.

Kennedy also cites Lorna Wing on the ways we with autism use language, with Wing saying we have a “tendency to talk on . . . or to ask repetitive questions regardless of the answers, or most irritating of all, to engage in arguments that are endless because the child always finds a new objection to whatever is suggested” (cit. 50). Kennedy also points out that these are typical of children with ADHD as well.

Now, I want you to think about some of the things listed. What kind of world would be live in if we didn’t have people who questioned authority, argued, defied rules, asked repetitive questions, and always found new objections to whatever answers are given? This sounds like the definition of every philosopher, entrepreneur, inventor, scientist, and artist who ever existed. Meaning, these “irritating” features are what are necessary for there to have been any kinds of advancements beyond that of the chimpanzee troopes.

So we again see a list of traits that are presented as negative, but are in fact positive from a social standpoint, since without them there could not have been complex human societies. To have complex order, you have to have not just order, but a little bit of disorder as well.

On (Not) Getting Disability When You Have the Hidden Disability

Over the past several months, I have been trying to get Disability from Social Security. Today I have been denied for the second time. Let me quote the most recent rejection letter:

You said you are disabled because of autism, aspergers, hip displasia, flat feet, anxiety, sensory integration disorder, and memory loss. However, your current symptoms are not severe enough to be considered disabling.

Apparently being unable to stand for long periods of time because of ever-increasing pain from flat feet, being unable to do physical labor because of constant and ever-increasing pain from hip displasia, being diagnosed with general anxiety disorder by the psychologist they sent me to, and all of the issues associated with autism/Asperger’s, including short term memory loss issues and sensory integration disorder, doesn’t make you disabled.

Those who have been following this blog know many of the problems I have had with getting and keeping jobs. If I even get a job after the interview, I cannot seem to hold on to it for long. Literally, the longest I ever had a job was a little over a year and a half. I had two such jobs. One of them I left because I was moving from Hattiesburg, MS to Dallas; the other was at UNT-Dallas, where my contract wasn’t renewed.

All of the problems I have had with remaining employed have stemmed from my autistic behaviors. The problem is that, if autism is a hidden disability, it seems to be so hidden with me that for the longest time very few people, except those who knew me very, very well, would even believe I as on the spectrum When you meet me, I’m often articulate, I can be charming under the right conditions, I’m highly educated (Ph.D.), and I’m highly intelligent. I can fake it for a fair amount of time. Enough for many to think I’m merely a little introverted.

The problem is what happens over the long term, or if I’m not in ideal conditions. If it’s too loud, too bright, too crowded, I start to feel overwhelmed. My anxiety–which I have learned really never goes away, but only waxes and wanes like the tides–increases, and as my anxiety increases, I become increasingly irritable. Over time, you will see me “goofing off,” which really means I’m writing something down to get it out of my head so I can continue to concentrate on work. But of course, you can’t do anything non-work-related on company time (except gossip, of course, which I don’t do and which takes up far more time than it did for me to write the one line of poetry I needed to get out), so I get in trouble. What they don’t realize is that I’m actually doing what I need to do to ensure I can dedicate the maximum amount of time and concentration to work. But how do you explain that to anyone?

The letter I received goes on to state that

Although you said you have various limitations caused by your symptoms, the evidence does not show that your ability to perform basic work activities is as limited as you indicated. We do not have sufficient vocational information to determine whether you can perform any of your past relevant work. However, based on the evidence in file, we have determined that you can adjust to other work.

I find all of this very curious. And it indicates there is something wrong with the way disability is determined, such that autism is almost always going to be discounted as disabiling. The fact of the matter is that my “ability to perform basic work activities” such as editing, proofreading, and writing is not limited at all. I can do that kind of work, and likely similar work, such as data entry.

But work isn’t just “show up, do your work, leave.” If work were like that, the unemployment rate among all but the most severely autistic would be 0%. Rather, depending on how it’s measured, the unemployment rate among autistics is 20%-80%–the latter for all autistics, and 20% for people who are “mildly” autistic. Why is that? It’s because work is primarily social, and when the requirements of employment are being able to be social and not be “socially awkward” that autistics face high unemployment.

My disability only becomes apparent over time, and few would even recognize it as “disability.” It gets interpreted as inattentive, goofing off, having a bad attitude, and sometimes even lazy (I was always working on projects growing up and was always told I was lazy). Each of these are neurotypicals misinterpreting the way I think and behave. In other words, my disability is only invisible to the degree that non-autistics misinterpret my expressions and actions. And even if I tell them what to expect, can we really expect them to always remember not to interpret my interactions with them through the same lenses they use for practically everyone else?

In other words, how can I get Disability if my disability is invisible? How can I get Disability if the people who are giving it out don’t really believe it’s a thing, but is just made up, is just problems with your “personality,” or whatever else they may believe when faced with someone who behaves as I do?

And I know it’s not just me. My guess is that most autistics face these issues on a daily basis, and not just when it comes to work. But where are the advocates for us? I know there are advocates out there, but I’m talking about public advocates, someone people know, out there talking about these things.

Here is where my articulateness, intelligence, and education may be able to come in handy. I’m actually a good public speaker. Perhaps, if I could find the right venues, I could use these very traits that make me an even more invisible member of the invisible disability bring greater visibility to these very issues.

Unless someone does this, how much of a chance do we have to thrive in this world?

 

Improving Executive Function

Tali Shenfield’s Child Psychology Blog has a post on improving executive function. I have written on executive function before (here and here and here and here) but this post goes into greater detail about all the things affected by executive function, including:

  • achieving goals we set
  • achieving goals others set for us
  • short term memory
  • planning
  • organization skills
  • emotional self-regulation

Shenfield also points out that executive functioning is on a gradient, meaning a 12 year old could have the emotional maturity of a 9 year old. Or, as I’ve told my wife, Daniel (8) has the emotional maturity of his brother, who is 5, while his cognitive abilities are much more advanced. But with executive functioning essentially making him “act 5,” most people don’t realize how advanced he is in many other ways.

I have issues with all of the above listed, which shouldn’t surprise anyone. At the same time, once I have all my ducks in a row and I have said I’m going to do something, you can take it to the bank that it will get done. In the end, I can achieve goals I set or other set for me because for me it’s a matter of integrity to do what I say. Deadlines loom large for me, and that helps me overcome at least that issue–when a clear deadline is actually set.

Executive Functioning, Creativity, and Autism

New research has shown that creativity mostly takes place in the cerebellum, while the executive functioning of the frontal lobe actually restricts creativity.

One of the features of autism (and ADD/ADHD) is impaired executive functioning. Among the things executive functioning does, according to Web MD:

  • Manage time
  • Pay attention
  • Switch focus
  • Plan and organize
  • Remember details
  • Avoid saying or doing the wrong thing
  • Do things based on your experience

When your executive functioning is impaired, you have difficulty with the above abilities. I recently wrote about the problems people with autism have with the last one on the list. The inability to make use of prior knowledge, then, is an executive functioning problem. While this seems to contradict my claims in the previous post, the place where concepts are formed — the hippocampus — is also a place where executive functioning takes place. And there are impairments with the hippocampus in those with autism — in particular, there are issues with oxytocin, about which I have written before. And as we have seen before, GABA is also involved. Those “unwanted” thoughts are the source of creativity.

All of this points to a brain that is structurally and biochemically different from more typical brains. And the connection between executive functioning and creativity also explains why autistic people tend to be very creative.