Asperger’s / autism vs ADHD (Attention Deficit) ~ My perspective

(Beginning note 1: this is the post that I began Monday night–yes, three full nights ago–that I had no reason not to think to myself, yeah; I’ll bang the rest of this out tomorrow in between meetings, no problem.  Little did I know that it wouldn’t be nearly that simple; my brain would be kidnapped by Nicotine Withdrawal Elves overnight, which, “they” don’t tell you, essentially makes the brain feel like it perpetually just woke up.  Therefore, this post is the product of sheer perseverance, if nothing else.  It’s probably not my best writing.  But please be gentle with me; it’s a miracle I got it done.  Seriously, I can’t explain how hard I’ve worked on this over the past three days just to write something coherent enough to hit “publish”; you probably wouldn’t believe me, and I probably wouldn’t blame you.)

(Beginning note 2: this post is about my experience of being considered for possible ADHD, and my ultimate rejection of that label for myself, and my reasons why.  It sort of morphed into an informative compare-n-contrast, much like the post of a similar nature I did on Asperger’s/autism vs Borderline Personality.  The definitions and trait sets used throughout this post are based on the textbook profiles of classic ADHD and classic Asperger’s/autism (with more of a classic Asperger’s bent).  I’m not trying to speak for anyone or paint generalizations, and I’m not taking into consideration the potential combinations or hybrids of the two; I’m operating from the basis of straight-up Asperger’s/autism and straight-up ADHD.)

Lots of Beginning notes.  Sorry about that.  OK, here we go…

For several years, I saw a counselor, a very nice guy with a talented listening ear that made me feel very comfortable.  During one of our sessions, he thought that I might have ADHD, or Attention Deficit Hyperactivity Disorder.

That was old news for me; my mum first came to suspect that theory back in 1994, just before I turned 17.

Incidentally, that was also the first year that the US had heard the term Asperger Syndrome.  But nobody posed the question because hardly anyone knew much about it, it was virtually “unheard of” in females, and besides–ADHD was all the rage, the celebrity disorder grabbing all the news headlines.

That’s not to say that celebrity figures were getting diagnosed with ADHD–that, I couldn’t tell you, because I never cared much about what celebrities were doing. To me, they had always been in the “right” place at the “right” time–that is, if one wanted to be famous, which I never cared much for, either.

Rather, it was the condition of ADHD itself that was the celebrity.  That’s not surprising; after all, “there was a drug for that”, and the US consumes something upwards of half the world’s prescription drugs, or so I’ve read. I wouldn’t doubt that, either.  It seems quite plausible to me.

Asperger’s, however, had no drug treatment available.

So, in a country run by drug lobbyists, it’s not hard to do the math.  In fact, it’s quite easy to see how ADHD overshadowed Asperger’s.

That’s just my theory, anyway.  Take it for what you will.

Regardless, since ADHD got the attention, that’s what crossed everyone’s minds.  A diagnosis can only be rendered if it enters one’s mind first.  You can’t render a diagnosis you don’t think of.

So when my counselor brought it up a few years ago, I thought, well, that’s believable.  It wouldn’t be the first time someone suggested it.

But something didn’t seem quite right.  I had a fairly extensive background in Functional Neurology, and I knew my way around the brain and its pathways.  I was pretty familiar with the clinical presentation of ADHD and many other neurological issues (except for, I must admit, Asperger’s/autism; in that area, I knew little, and our classes never covered it very thoroughly.  The irony is thick by now, isn’t it?).

I did know, however, that I didn’t fit the ADHD profile.  I knew that wasn’t quite the answer.  I could certainly control my attention span, the differentiating factor in ADHD vs other conditions.

For shizz and giggles, I took the ADHD Quiz from Psych Central.

I scored “moderately” likely to have ADHD, with “moderate” symptoms.

Well, that’s cool and all, but let’s take a closer look.  (Note: when I say “Asperger’s/autism”, it means only Asperger’s/autism–and the explanations of the traits themselves, and not anything else–no other neurological, psychiatric, or neurodivergent condition.  When I say “cases”, I’m referring to instances, not the idea that anybody is a “head-case”, nor any insinuation that Asperger’s/autism is a pathology–because it isn’t.  And lastly, if I say “we/us/etc”, it’s shorthand for “people on the Asperger’s/autism spectrum” so that I don’t have to keep typing it out, which would bore everyone to tears, including myself.  It’s not, however, any implication that I’m speaking in generalizations, trying to speak for everyone/anyone else, or even speaking for/about myself this time.  I’m just speaking in super-detached, academic, impersonal terms, with some of the usual My Own Experience + Observation thrown in every so often.)

The quiz asks about whether or not one has difficulty sustaining their attention while doing something.

Nope.

I answered the question that reads, “How often are you easily distracted by external stimuli, like something in your environment or unrelated thoughts?” with an affirmative (sometimes) response, but there’s a problem: the quiz doesn’t ask–or consider–the reason why.

I might be easily distracted, or I might not.  It depends on what I’m doing, how much I like what I’m doing, and what the would-be distracting factor is.  If I like what I’m doing, and I like it a lot more than whatever else is vying for my attention, then I can stay focused, for the most part.

Asperger’s/autistic people can have problems staying focused, but that’s mostly because in most cases the nervous system is extra-sensitive (except in cases where it’s less sensitive).  Everything punches through, and its effect is typically amplified.

For ADHD, it’s different.  From what I know, ADHD can’t sustain their attention, even when they want to.

In Asperger’s/autism (without anything else going on), one typically can.  In fact, there can be a tendency to hyperfocus, a trait that is so prevalent on the spectrum that it’s part of the diagnostic criteria, but consistent with the ADHD profile.

On the ADHD quiz, there’s a question involving difficulty listening to someone because it seems like your mind is somewhere else.  Yeah, I know that it’s common in Asperger’s/autism, just as it is ADHD and yeah, I know what it looks like.

The ADHD pattern becomes self-explanatory; it’s that whole disorganized-cortex/can’t-pay-attention thing.  But for Asperger’s/autism, it’s more of an auditory processing thing.  The Aspie/autistic person might actually be hanging on every word the speaker is saying, but there might be a delay in deciphering the message.  The attention may be intact but comprehension may take a few extra seconds.

Another area where the two neurotypes differ is in that of attention to details; Asperger’s/autistic people have been accused of being too detailed, whereas for ADHD, there are often mistakes made because a detail (or several) was overlooked.

There’s a question on the quiz about how often one forgets to do something they do “all the time”, such as paying a bill.  Well, that gets a little murky, because it’s open to interpretation.  To me, “all the time” means at least once a day, or very close to it.  The average bill, on the other hand, is only paid once a month.  There’s a big difference between once a day (the time-measurement-unit of most of the components of my routine) and once a month (something that only occurs monthly might not even cross my mind much at all).

It’s not that I’m an “airhead” for not remembering, nor am I “flighty” or unreliable.  It’s just not something that’s in my daily routine.  And for me, if something is not in my daily routine, it gets a spot on The Calendar, at which point I will obsess over it for fear of forgetting about it.  That doesn’t sound very stereotypical ADHD to me; in fact, that resembles several firsthand accounts written by Aspies.

In a related topic, another ADHD quiz question asked about losing important items.  Here is another instance in which Asperger’s/autism and ADHD demonstrate some overlap, although for (I strongly suspect) different reasons.  For both, the common denominator is likely to be executive function.  It’s just that I think the specific flavor is different (as I believe is the case for most of these characteristics), as influenced by nuances in brain wiring.  In plain-Jane Asperger’s/autism, it’s more likely another manifestation of the executive function errors that tend to occur when a regular routine is breached.  The criteria for ADHD, on the other hand, don’t place the same emphasis on the reliance upon a routine.

The slam-dunk for me, though, is a question like this:

“How often are you unable to play or engage in leisurely activities quietly?”

That’s where someone displaying an Asperger’s/autistic profile and someone displaying an ADHD profile will diverge, by definition of each condition.  Asperger’s/autism spectrum criteria describe “abnormal levels of intensity of interest, blah, blah, blah” and autistic people (and/or their parents) often describe how they (or their children) play(ed) in their room quietly and angelically for almost-unnaturally long periods of time, happiest being alone.  This contrasts from the classic ADHD profile, in which one of the most commonly cited descriptors is the inability to play quietly.  And for ADHD, there is no mention of being content, even relieved, to be alone.

“Difficulty waiting your turn” is another phrase that comes up during an ADHD screening.  Someone on the Asperger’s/autism spectrum might answer this question in the affirmative, but again, it’s probably going to take on a different face.  An Aspie/autistic person might appear to have a tough time waiting their turn, but given the rest of the clinical picture, it’s probable that they’re “stimming” (engaging in a self-soothing or focus activity).  This might give the impression of being restless when really they’re probably a little nervous or self-conscious about what they’ll do or how they’ll perform, etc, when their turn comes.

One of the most common traits of ADHD is the finishing of people’s sentences for them, usually in the form of blurting out the answer.  Based on my experience and what I’ve read from other Aspergian/autistic people, we can fall under that same spell, too.

Here again, I think there are similarities.  And here again, I think the details are unique.  For true-blue ADHD, the common theme of lack of inhibition comes into play, and this falls right along those lines and into that pattern.  For plain-Jane Asperger’s/autism, it’s more of a brain-racing-a-mile-a-minute but (which sounds like ADHD and the two probably do share this is common, but they likely diverge from there because) the Asperger’s/autistic brain is fairly well-focused…in fact, probably hyper-focused.  Except that the topic of focus could be shifting rapidly and the (textbook) Asperger’s/autistic brain is trying to keep up with itself.  It’s not that the autistic brain moves too slow–just the opposite; it moves too fast, faster than conversation can accommodate.  So the autistic brain risks forgetting thoughts it wants to express before it forgets about them.  Although the out-blurting feels like an executive function error or a lack of inhibition, my theory is that it’s actually more likely to be a rapid, split-second executive decision, done purposefully but self-consciously (we’re not rude or thoughtless people, after all), and not without slight pangs of regret or shame, marked by a wry grin or a sheepish apologetic smile.

I think that the question about “talking excessively” probably follows a similar vein.  Talking excessively could be a simple matter of excess energy, coupled with a lack of inhibition.  Or maybe there’s a little (or a lot of) nervousness mixed in.  Or maybe a sharing of a special interest.

What the ADHD quiz is getting at is more of an excess energy, combined with a slight inhibition impairment; after all, that’s the neurological pathway theme involved and the accompanying clinical profile.  But the quiz does not specify this, which makes a lot of us Aspie/autistic peeps answer “yes”, when really the answer, in this context, would be no.  The Aspergian/autistic profile will display eerily similar behavior, but with a completely different underlying theme; the spectrum theme is one of the “special interest” “pedantic” presentation I’ve talked about before and then again.

I have a theory.  I could be wrong.  But it’s a theory.  I think that what happened to me (the whole “you probably have ADHD”) is happening to a lot of people, and many who are on the Asperger’s/autism spectrum.  I think that sometimes it stems from a lack of recognition of what Asperger’s/autism looks like in anyone not precisely matching the Asperger’s/autism spectrum diagnostic criteria or with anything less than a PhD-in-Medicine/Psychology-level understanding of these criteria such that they can decipher the medical jargon.  Not that a terminal degree guarantees competence, of course–in fact, the result is often the opposite; it is we, the laypeople, who are broaching the subject with professionals, some of whom have the gall to pat us on the head and deny that we’re onto something.

And I think that a huge part of the reason for this is twofold:

1 – ADHD has approved medications, whereas Asperger’s/autism does not, and I’ve seen puh-lenty of instances where a condition was ignored and shoved under the rug until–poof!–a drug to treat it magically appeared.  The only reason we even have Asperger’s/autism as a named condition at all is because the pro-pharma forces were not nearly so entrenched and had not gained momentum yet.  Asperger’s/autism was characterized before the existence and validation of a condition depended upon the money to be made by selling the drugs to treat it.

2 – The ADHD quizzes don’t help matters; they ask questions about traits that are common to both conditions (and probably others in addition to those two) without qualifying the questions or answers.

For example, a question about fidgeting could be more of a restlessness and inability to control oneself (ADHD) or a desire to relieve tension or anxiety (Asperger’s/autism).  I am a pretty textbook case (male phenotype and all) of Asperger’s/autism and yet, I scored moderately high on the ADHD quiz even though I don’t have ADHD at all.  I’m sitting at an “advantage” (in terms of being familiar with brain pathways and clinical profiles), if you will, because I have a neurology background and some formal training in this area.

Guess what?

It still didn’t make me any “better” at detecting Asperger’s/autism in a real live adult.  I couldn’t even see it in myself?  So obviously the Asperger’s/autism spectrum diagnostic criteria wording sucks donkey eggs.  And the education out there for professionals about Asperger’s/autism sucks donkey dinosaur eggs.

So much for my “advantage”.  Meh.

So anyway, the ADHD quiz is written with a wide net, to catch a lot of fish.  And they don’t elaborate on the “why”s behind the answers; it’s merely “how often do you exhibit this behavior that’s common to several neurological conditions?” and they leave it at that.  Meanwhile, the Asperger’s/autism spectrum quizzes are not written with that same wide net.  They won’t catch as many fish.

(To play on phrases and have some nostalgic fun,) they certainly wouldn’t be able to tell a freshwater fish in a saltwater world.  😉

***

(Image Credit: Dave Lord)

❤

❤

❤