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.

Autism and the Emergence of Art

Around 30,000 years ago, extremely detailed, realistic art emerged in cave paintings. Believe it or not, there are many scholars out there who believe this occurred because the artists were autistic.

Lead author of the paper, Professor Penny Spikins from the Department of Archaelogy at the University of York, said: “Detail focus is what determines whether you can draw realistically; you need it in order to be a talented realistic artist. This trait is found very commonly in people with autism and rarely occurs in people without it.”

Which itself raises some interesting issues regarding the history of art and the proliferation of realism during periods such as the Renaissance.
A related article also suggests that human societies really took off only after they learned to tolerate the presence of people who thought and behaved differently. Oddly, we seem to be losing that trait even as we are gaining acceptance of people who merely look differently.
Either way, it’s obvious that autism has been around for a very long time indeed. The idea that autism may be adaptive for humans at the level of group selection is something I myself have suggested. It would appear that autistics are important for the development of artistic styles and a concentration on extreme realism. Of course, that means that during artistic periods dominated by iconoclasm, such as we saw in Modernism and Postmodernism, select against autistic artists. It is likely, though, that we will again have our day.

Who is up for another autistic-lead renaissance?

 

 

The Mesolimbic Reward Pathway

The mesolimbic reward pathway is a neural system that helps people be more social. The larger it is, the most social a person is. Perhaps not surprisingly, it’s smaller in people with autism.

What this pathway seems to do is make social interactions pleasurable. Again, the larger it is, the more pleasurable one’s social interactions are going to be. That is, you get rewarded for being social. While it’s likely social interactions aren’t actually made painful by having a smaller pathway, social interactions simply aren’t as pleasurable. If you’re not being rewarded for something, how likely are you to do it?

The authors point out that they haven’t untangled cause and effect quite yet on this. Do more social interactions cause the mesolimbic reward pathway to increase, or does its size increase social interactions?

This makes me wonder, though, why it is that many of us on the spectrum find pleasure in certain things–more so, it seems, than do others? For example, my clipboard gives me pleasure. I use it to do most of my writing. My books give me pleasure. I’m very happy just looking at them in my library. Is there a pathway in the brain for object-pleasure? Or does the mesolimbic reward pathway make social interactions so much more pleasurable that neuroptyicals prefer social interactions over the pleasure things give them?

A Clash of Cultures

Do you have trouble keeping secrets? Do you find you typically tell the truth, even when it’s socially inconvenient? Do you tend to over-share with everyone, including complete strangers? Are you direct and to the point–to the point that people often think you’re rude? Are you unsure what is or is not acceptable joking? Or what is or is not an acceptable comment? Are you unsure why people want to talk about the same daily nonsense and don’t understand why they don’t want to talk to you when you’re the one with something interesting to say?

If this sounds like you, you may be part of a small bioculture people call “autistic.” I say “bioculture” because it recognizes the fact that culture has its roots in human biology, in neural structures. All of the normal things neurotypical humans do are part of the broader underlying human culture, of which there are many variations. Those underlying patterns on which cultures develop–which include keeping secrets, having privacy, being indirect, engaging in small talk, and understanding the social rules of appropriate comments and jokes–are simply not the natural patterns of autistic people.

I want you to imagine for a moment a culture of autistics. Imagine, if you will, a culture where everyone means what they say and say what they mean, sugarcoat nothing, are always direct, rarely if ever lie, consider fixing problems to actually be a demonstration of empathy, engage in almost nothing but in-depth conversations about a wide variety of topics, do not typically fear death, value rationality and evidence above everything else, simultaneously respect other’s privacy while also being an open book themselves, consider science fiction, fantasy and video games to be the height of culture, are science and fact-oriented, and almost everyone has perfect pitch.

How would you feel? If you’re on the spectrum, it sounds like heaven. (Would we be as anxious as we are now?) But if you’re not, how socially awkward would you be? Remember what I said about if we pathologized neurotypical behavior.

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.

The Freedom To Do and Be

Wednesday night I attended a talk at Southern Methodist University by Deirdre McCloskey, an economist at the University of Chicago. She is the author of a series of books–The Bourgeois Virtues, Bourgeois Dignity, and Bourgeois Equality–in which she argues that economists have misunderstood the driving force of economic growth and widespread wealth. It’s not savings, and it’s not capital investment–rather, it’s ideas. And it’s a specific set of ideas: treating people equally, equality under the law, and respect for people who engage in business. She argued last night that when people are given the freedom to do what they want to do and be who they want to be, that freedom results in the creation of wealth.

This made me wonder how much wealth the world has lost because autistics are not allowed to do what they want to do, and to be who they are.