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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When I Tell You “My Son Has Autism”

If my son is behaving in a way that you don’t like or which you think is dangerous for himself or others, and I say to you, “My son is autistic,” that does not mean:

  1. That I am excusing or justifying or even defending his behavior.
  2. That you should just keep doing what you’re doing like I said nothing.
  3. That you know more about what to do in that situation than I do, even if you’re an expert (you may be an expert in whatever activity we’re doing, but you’re not an expect in doing it with an autistic child).

Rather, what it means is:

  1. You should shut up and listen, because
  2. You are almost certainly doing something that is completely ineffective, or
  3. You are doing something that will make things worse, which could mean
  4. You are creating an even more dangerous situation.

When a parent of an autistic child is telling you that their child is autistic, it’s usually because there is a situation occurring in which what is being said and done will make things worse, not better. While threats (of not doing the activity, for example) may work with neurotypical children, they don’t work with autistic children. They either won’t care or, worse, they will care a great deal and be pushed toward having a meltdown over it.

If you are actually concerned about safety, and a parent tells you that their child is autistic, it’s time for you to shut up and listen, because it’s clear to the parent that whatever you’re doing or saying is making things more dangerous. You don’t dismiss us, and you certainly don’t double down.

We parents of autistic children know what works. It’s your job to seriously shut up and listen. I cannot emphasize this enough: S.T.F.U. and LISTEN!

Now, once you are listening, once you are paying attention, you will be told how to solve the problem. More likely, the parent will have a better solution once you explain to the parent what you need from their child. And if you want to actually have a positive interaction with an autistic child, don’t threaten, don’t raise your voice–literally don’t do anything you think would work, because you’re wrong.

Rather, calmly address the child and use reason to explain to them why they shouldn’t do what they’re doing. They will listen. And they will give you the behavior you want. Because while the autistic child may often appear like they’re not behaving rationally, the fact is that they respond to reason better than a neurotypical child does.

So, please, the next time someone tells you, “My child is autistic,” just shut up and listen. The person isn’t looking to make excuses. They’re trying to help you understand. And they’re trying to help you solve the problems occurring with their child.

Meltdowns

Daniel is 8 and he hasn’t had a meltdown in probably 3 years. That doesn’t mean he doesn’t get frustrated–or loud–but he has it under control, and I can immediately redirect him. Daniel being verbal helps, though he wasn’t verbal until he was about 3.5 yrs old.

While Daniel is able to avoid having meltdowns, there are children out there who are no more autistic than Daniel who are still having meltdowns in their teens. It’s one thing if the child is so severe that they cannot speak and otherwise have extreme difficulty communicating–the frustration of trying to communicate and having your body refuse to cooperate is without question extremely frustrating. But there’s honestly no excuse for someone who is verbal to be having constant meltdowns (which isn’t to say that we won’t have our very, very bad days).

There are several things we did with Daniel that resulted in him no longer having meltdowns. One thing we would do was hold him until he calmed down. We would also repeat his name and try to sooth him by encouraging him to tell us what happened. Afterwards, we would talk to him about what frustrated him and ask him if his reaction seemed reasonable given the situation. He always agreed it wasn’t.

We also told him that if he felt a meltdown coming on, to squeeze our hands or to count down with us from ten. We introduced these at the same time that he was agreeing the causes of meltdowns were unreasonable.

The bottom line is that we always held Daniel accountable for everything he did, even during a meltdown. We made him apologize to anyone he may have harmed during the meltdown and clean up any mess he made. We helped him communicate rather then have a meltdown, and helped him to reason through his frustrations. Autistics can be reasoned with–perhaps more so than non-autistics–and so if you’re using reason with them, their meltdowns should becoming less and less intense and coming on less and less often.

What cannot be done is to accidentally reward them for having meltdowns. Never give in. Never avoid what may lead to a meltdown, as they will learn that having a meltdown will get them out of uncomfortable situations (or simply situations they don’t want to be in). Make them talk about it (if they’re verbal, of course). While it’s true that once you’ve crossed over a certain point, the person is no longer entirely in control of what they’re doing, since the world has become extremely chaotic and confusing, the fact of the matter is that autistics are in fact in control of themselves up to the moment they have their meltdown. If that weren’t the case, it wouldn’t be possible to reduce the number and intensity of meltdowns through reason and various calming techniques.

It has been my experience that older children especially will actually use meltdowns to get themselves out of things they don’t want to do–such as go to the store, stay home, apologize to someone, go to class, or even be around someone in particular. If you give in because they have a meltdown, that will tell them that meltdowns will get them what they want. While I do not think you should punish a child who has had a meltdown the same way you would punish a child who threw a temper tantrum (since they are hardly the same thing), there should still be consequences for the meltdown, as already mentioned–apologies, cleaning up the mess, etc.

Too often we find ourselves tempted to offer the “autism excuse” to justify ongoing meltdowns or other behaviors. Somehow excuses are only offered for the most problematic behaviors that we can in fact learn to control, while we are held responsible for “minor” things that are in fact more emblematic of autism and less under our control. When that happens, we mostly end up being pitied rather than taken seriously. We aren’t given accommodations for reasonable things and given excuses for the most outrageous ones. This benefits no one–especially not us.

The Struggle With the Daemon

I recently finished reading The Struggle with the Daemon: Holderlin, Kleist, Nietzsche by Stefan Zweig. For someone on the spectrum who is himself a literary writer (or, at least, I try to be), this book very much felt like it ought to have been titled The Struggle with Autism, especially as each of the three artists’ sections felt like an aspect of my personality was being emphasized–albeit, much more intense versions of me (I’ve managed to avoid descending into a final state of insanity, and I’ve never felt suicidal–though it’s my understanding that the last is an all-too common feeling among autistics).

Holderlin would seem the hardest case to make among the three, except many of his feelings as described by Zweig seem my feelings as well. Getting caught up in an obsession, and feeling like the rest of the world is a terrible imposition on your work is a very autistic way of being in the world–at least, from my experience.

Kleist, on the other hand, just screamed “autism” from Kleist’s description. For one, Kleist wandered all over Europe, and autistics are known to be avid wanderers (which can be a major problem when the wanderer is a child). “He was reserved to excess, and kept everything locked up within himself. He did not express his passions either in looks or in spoken words” (158). Zweig says

he remained mute, not from dumbness or sloth, but from overpowering chastity of feeling; and this silence, this dull, brutalising, oppressive silence, which he would maintain for hours when in company, was his most salient characteristic–that and absence of mind, a confusion which obscured his clarity of intellect. When talking, he would suddenly break off and stare into vacancy (158)

He could not converse unconstrainedly in an exchange of the small talk of ordinary life. Convention and customary obligations were repugnant to him, so that many assumed there must be something “dour and sinister” in this unusual companion; while others were wounded by his harshness and cynicism and bluntness when, as happened now and then, pricked by his own silence, he threw of all constraints. (159)

“Those who did not know him intimately believed him cold and indifferent. His intimates, on the other hand, were afraid of the fires that consumed him” (160).

If you’re autistic, perhaps especially if you have Asperger’s, this may sound quite familiar to you. If you know someone with Asperger’s, this also may sound familiar to you. Zweig’s description of Kleist throughout the book only reinforce my original conclusion (based on the above quotes) that Kleist had Asperger’s.

I have already written about my belief that Nietzsche had autism, and Zweig’s description only confirmed my beliefs. However, there is something quite interesting that Zweig pointed out that sounded quite personally familiar–and I would be interested if my autistic readers have had the same experience.

What makes Nietzsche’s transformations so peculiar is that they seem retrogressive. If we take Goethe as the prototype of an organic nature in harmony with the forward march of the universe, we perceive that his development is symbolical of the various stages of life. in youth he was fiery and enthusiastic; as a man in his prime he was actively reflective; age brought him the utmost lucidity of mind. His mental rhythm corresponded in every point with the temperature of his blood. As with most young men, he began in chaos and ended his career in orderly fashion, as is seemly with the old. After going through a revolutionary period he turned conservative, after a phase of lyricism he became a man of science, after being prodigal of himself he learnt how to be reserved.

Nietzsche took an opposite course. Instead of aspiring to an ever more complete integration of his ego, he desired complete disintegration. As he advanced in years he became increasingly impatient, vehement, revolutionary, and chaotic. His outward aspect was in strident opposition of the customary evolution of a man. While his university companions were still delighting in the usual horseplay of undergraduates, Nietzsche, though but twenty-four years old, was already a professor, aspirant to the chair of philology at Basel, that famous seat of learning. At twenty-four, Nietzsche’s intimates were men of fifty and sixty years of age, sages such as Jakob Burckhardt and Ritschl, while his closest friend was the most celebrated artist of the day–Richard Wagner. (288-289)

Zweig goes on and on about the staid, scholarly Nietzsche, then notes that when he was thirty, he resigned from his position with a pension, went to live alone in Switzerland and northern Italy, and transformed himself into the writer of Zarathustra–a transformation that ended with Nietzsche’s loss of sanity. His life is the reverse of Goethe’s.

Now let me give a brief of my own life. In grade school, I wore dress slacks and button-down shirts. In high school, I started wearing jeans, but they were dress jeans. I went to college to major in recombinant gene technology, then attended graduate school in molecular biology. During grad school, I started wearing t-shirts and listening to contemporary rock (alternative music–I started in with the grunge scene with Nirvana’s In Utero, when I was around 22). It was around this time that I started reading Nietzsche, and I also started writing more fiction and poetry, and myself growing more and more chaotic.

I dropped out of grad school, had two massive anxiety attacks, started writing Hear the Screams of the Butterfly to deal with all of my emotional issues, and also took a year of undergrad English classes to get into a graduate program in Creative Writing. While there I was quite bohemian in my lifestyle. If there was a reversal, it was when I started my Ph.D. program in the humanities, where I started off doing creative writing, but ended up with a scholarly dissertation. After graduating, I met my future wife, got married, had three children, and have lived the past decade wasting my scholarly and writing talents in looking for gainful employment. I’ve also grown more radical in my politics, and I think more daring in my art.

Now, do not get me wrong. I would trade nothing for my wife and children. In that I’m a happy Goethe, so to speak. However, an inability to go “full Goethe” in the sense of his life development, has meant considerable employment difficulties. At the same time, I have been fortunate in also not going “full Holderlin/Kleist/Nietzsche” either. I’m instead in an uncomfortable truce, neither giving in to my obsessions nor being able to live a “normal” life.

The scientist I was in college became the artist became the artist and interdisciplinary scholar–became more and more interdisciplinary, unspecialized, going in the opposite direction of most people. I’ve grown less conservative over time, less satisfied with life, more radical. That is, from order to chaos. Nietzsche is a model for my own changes, though I certainly had no intention to follow that model–it just seems a natural development. Yet, I struggle against that development, and thus (mostly) keep it under control. The forces of order and the forces of chaos are always in a constant struggle within me. I continue to alternate between art and scholarship. If anything, my family is what keeps the struggle just barely on the side of order.

Older Fathers and Autism

We have known for a while that there was a correlation between having an older father and having an increased likelihood of having autism. It was once thought that this was because of an increase in de novo mutations in sperm, but recent research says that that can only account for 20% or so of autism cases.

If it’s not new mutations, what’s the explanation?

The authors of the linked piece suggest that perhaps it’s because men with autistic traits marry later in life. In my case, that was certainly true. I started dating very late in life, and I only met my wife when I was 33. My daughter was born when I was 35. My autistic son, Daniel, was born when I was 38. And Dylan was born when I was 40. Dylan does not have autism, but he did have a language delay and he has a degree of OCD, and it seems he has perfect pitch (a trait found in many autistics and their near-relatives). I of course am on the Asperger’s end of the spectrum.

Getting into the kinds of relationships that result in children is difficult at best for us on the spectrum. Some, like Temple Grandin, choose celibacy because these relationships are so complex and difficult. Many solve the problem by marrying someone else on the spectrum. And I’m willing to bet those are also delayed relative to when most people marry and have children.

It will be interesting to see a study on this, to see if it holds up. But given the nature of people on the spectrum, and given the fact that autism is genetic and thus completely heritable, it wouldn’t surprise me in the least if the explanation were simply that autistic people tend to marry and have children later in life.