AS and ADHD: A bold hypothesis

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Hello everyone, this is my first post here. Nice to meet you all. I have been reading the forums for some time, and now decided to create an account since I would like some input on the matter that has been in my mind lately. Firstly I want to apologize in advance, for english is not my first language and I will probably make some mistakes. Sorry about that.

This is a table that I made with the shared symptoms and similarities between ADHD and AS.

(To view the images, please remove the space in "ht tp". I had to do it this way since I am a new user and the anti-spam system won't allow me to post images. I am not posting spam so hopefully it will be ok...)

ht tp://s22.postimg.org/huidbh775/table.png

ADHD and AS share many core and secondary symptoms. I think we might be in front of two interpretations of the same disorder. Autism is a spectrum and there is a massive diversity within the group of people in it and the symptoms they present. I am suggesting ADHD might be an Autism Spectrum Disorder too. It is estimated that 50-70% of people with AS also meet diagnosis criteria for ADHD. Since both disorders are so broad in the symptoms they may present or not present, and there is such a noticeable overlap between both, I am just inclined to think that there is no reason to think of them as different, unrelated disorders. I think they both belong in a complex continuum (or a multidimensional system of continuums). I see them as two different “random” aggrupation of symptoms, which might be subtly differentiated on the gravity of certain symptoms, but nevertheless overlap in a high percentage. Different “tendencies” of the same root issue, in a similar way as ADHD has been divided in three subtypes (hyperactive, inattentive and combined). I have been diagnosed with ADHD for quite some time and I can assure you no one fits nicely in just one category. In a similar way, I believe we might be making another big mistake trying to break down something as big as autism into little pieces, when we still clearly lack the understanding behind the phenomenon necessary to do this in an effective manner. The fact that they recently decided to include AS as a ASD combining it with high functioning autism supports this whole idea. As there is such a big diversity in the symptoms of autism, there is an even bigger diversity among the personalities and other unaffected brain traits of each individual. Based on this, I think such a big overlap in two disorders that are deemed different, is too important to ignore.

I have read from several Aspies that they think the essence of their syndrome is not effectively encapsulated in the DSM definitions and diagnosis criteria. I do not find this unexpected at all, because it has to be hard to come with precise definitions when you can only observe from the outside. They probably describe what they can see, which may not necessarily be the primary symptoms of autism, only the most evident to identify from the outside perspective. For example, the notion that Aspies lack empathy, are egocentric and uninterested in no social relationship whatsoever doesn’t seem to be true in all cases, from what I have been reading on this forums. This seems to be more of a consequence of being rejected many times, and the fear/anxiety developed upon it.

My point is that we still understand little about autism and we may be making mistakes when attempting to define it.

I, for instance, feel just in the middle of AS and ADHD. I meet the criteria for both. And I have noticed that some symptoms described differently in ADHD and AS may be alluding to the same thing. For example, might someone with ADHD be more easily distracted due to high sensitivity to stimuli? Might someone with AS feel overloaded with big amounts of sensory stimuli going on because it constantly distract them to a point the can no longer even think or relax? Might people with AS have trouble picking on social cues because they are distracted by every single detail in the surroundings (sensory overload) and are unable to stay focused in facial/body language or figurative/abstract speech? Might inattention be a consequence of the brain constantly processing to much sensory input?

ADHD is known to be caused, partly, by a malfunction of dopamine and noradrenaline. One of these malfunctions is the lack of dopamine in the mesolimbic pathway (and specifically the nucleus accumbens) of the brain. This is known to be the reward system, which mediates for anticipatory reward (motivation) and consummatory reward (pleasure). It is believed that this deficit of dopamine causes the impulsive behavior, and makes the subject more propense to addictive behavior, in seek of covering the dopamine deficit. With addictive behavior I don’t mean necessarily drugs or gambling. It could be playing videogames, reading novels compulsively, researching about an interesting subject 24/7, etc. I think it could explain the OCD symptoms and perfectionism too: one seeks to do everything in the most perfect manner in a desperate attempt to feel gratification (aka dopamine). So maybe this impulsivity might be the cause of narrow/intense interests? Another possible cause for this behavior would be to shut down from stimuli overload by focusing intensely in a single thing. Does any of this click for you guys?

I would see ADHD as milder than AS, with less evident sensory problems and therefore less issues with social life and communication. On the other hand, Autism does involve sometimes cognitive impairment, which may be seen in ADHD (a mild version of it of course). ADHDers are said to perform worse than they "should" on IQ tests, and when given stimulants, they perform better. However healthy people also perform better when given stimulants. Shouldn't then ADHD be considered some sort of mild cognitive impairment?

So, if sensory and social issues are the most evident, probably one would get diagnosed with AS. If, on the contrary, cognitive impairment or hyperactivity are more predominant, the diagnose would be ADHD.

I have learned about some Aspies that learn to cope with their communication difficulties and end up learning to "act" as it is expected of them, and therefore look normal to most eyes. However this implies a heavy drain of energy, since it does not come naturally. I am diagnosed with ADHD and I do this, too. I am happy when a friend (my only friend) comes to visit, but 2 days with him and I am desperately wishing that he leaves to be alone again and rest. This might be an example of how personality, and support from environment may change the way an autistic person develops.

About impulsivity, aggressive behavior, etc... which is sometimes seen in ADHD, this may also depend on personality to an extent. Added to that, those who have a greater social impairment might tend towards anxious or depressive behaviors, while those whom don't have such an impairment might discharge frustration in a different manner, such as defying the authority, violence, etc. From what I have read, Aspies can also be impulsive, for example sharing their feelings with someone they like/fall in love too quickly and messing up the relation, outbursts of talking of their favorite subjects, and such. I think the way impulsivity is expressed may vary greatly depending on personality.

Here is a graph I made to better Illustrate my theory. Of course it is just representative and far from realistic, since I would probably need of more dimensions than I can comprehend to display all the variables affected and their relationship.

ht tp://s16.postimg.org/494zniktx/AS_ADHD.png

Well, i think this pretty much sums up what I had in my head. And I want to say that by no means I am sure of what I am suggesting; it's just that, a suggestion. I might have not researched enough and might be making some obvious mistake, but that is the main reason I am writing this, because I want to know more. I think the best way of getting a better understanding of AS/ASD is from the inside, talking directly with you guys, which I am sure know a lot of yourselves.

And if you believe I am wrong in my hypothesis, please help me understand the key differences between both disorders I am failing to see. Every input is welcome.

AS and ADHD are frequently found within the same person. They are frequently co-morbid with each other.

To have one doesn't preclude you from having the other.

The key, for the diagnostician, is to diagnose which disorder is the primary one--since, like you stated, the symptoms overlap with each other.

Thank you for your quick response!

I agree with what you say, partly. I already knew they are highly comorbid, but I believe this might be a mistake. What I am trying to suggest is that ADHD may be an Autism Spectrum Disorder too, therefore sharing an underlying cause with AS. ADHD describing one tendency, and AS, another. I am questioning the validity of the definitions we have right now.

And I would like to know if someone shares my opinion or if not, why so.

I feel I have ADHD, but I was never officially diagnosed with it, probably because I was rather shy at school and people seem to tie ADHD with being an extraverted class clown, which is just another stereotype.

I don't sense that ADHD should be on the Spectrum. I find many people with it and things like dyslexia are actually quite social, and, perhaps, succeeds much better in the social than the academic realms.

With Aspergers, the opposite is often true.

I was the shy type, too. But that was after a certain age. Until age 6 or so I was a hyperactive little beast, according to my family.



That may be the case for Asperger's specifically, but less so for Autism as a whole. Lets remember that there is an intellectual disability present as a central symptom of Autism. Most low-functioning autistics display quite a low IQ. Maybe, ADHD could be that same cognitive impairment, albeit in a much milder form. As I wrote, there is a big amount of diversity within the Spectrum, and there could be different symptoms with different severities. Maybe there are aspies with no cognitive impairment whatsoever, and thus not qualifying for an ADHD diagnosis, then others with mild cognitive impairment which would qualify, and lastly the ones with severe cognitive impairment which would not be called aspies but low-functioning autistics. This makes sense to me because we are talking of a spectrum disorder, and since both extremes of mental disabillity are present (Aspergers and low-functioning Autism) it is logical to think that the intermediate stages can exist, too.

And the same applies in the inverse manner. I think a disorder with little sensory/social impairment but mild-to-moderate cognitive impairment/difficulties, could very well exist within the spectrum.

I just can't wrap my mind around so many obvious similarities, as a natural pattern observer. Coincidence? I think not!

Last edited by Lagar on 02 Mar 2016, 12:58 pm, edited 1 time in total.

I am the outlier opinion here but I think there should be more subcatogories of autism not less. The mistake with Aspergers was making it a seperate diagnoses instead of a sub catagory of autism. The original mistake was compounded when they eliminated the Aspergers diagnosis. The sub categories should revolve around dominent traits in the individual autistic such as severe touch sensitivity.

In nearly every condition and situation in life we use subcatagories to clarify things, while far from perfect this is often helpful and most accept this. But with Autism most want to stamp out any catogories. People who describe themselves as a subcatorgory are often accused of not wanting to associate with other Autistics, the idea of catagories is widely viewed as causing disunity in thr Autism community. Just another way autism is viewed and treated differently.

I agree. When I said that Asperger and ADHD may be the same underlying disorder, I didn't mean to imply that they should both just be called ASD. I think classifying is positive, because it allows to develop different treatment methods for different necessities within the diversity of the spectrum. I would not want ADHD to disappear and be called ASD, but to be included as a subcategory of ASD, in the case my hypothesis was correct of course. Clearly there is much studying yet to be done about Autism and the different ways it may affect every individual.

Most people with ADHD do not have a cognitive impairment.

The hyperness associated with low-functioning autism has to do with sensory sensitivity. Perhaps that is so with people with ADHD at times.

I don't believe that the engine which people with ADHD operate under, wherein they seem to be propelled by a motor, inevitably exists in autism.

It's true that both are neurologically-based disorders, and are usually present from early childhood, at the latest.

There could be a relationship between the two, though not, I believe, a direct ones. Maybe like 2nd or 3rd cousins rather than brothers/sisters.

Other people might have a different take on it, though.

I, myself, probably have both.

Interesting. This engine you talk about, as I understand it, is a product of a hyperactive mind. It could be that putting so much pressure over the brain, and specifically its dopaminergic system, could end up wearing it down by means of a down-regulation (or even damage) of the dopamine receptors. A similar phenomenon happens with addicts to cocaine and other strong stimulants. Their dopaminergic system gets screwed up and then they have trouble thinking, focusing, remembering... etc. This would explain that most people with ADHD calm down at certain age and physical hyperactivity becomes, in most cases, a feeling of inner restlessness which resembles a mild-but-chronic anxiety, somewhat. And this down-regulation of dopamine might cause or exacerbate the inattentive symptoms.

And maybe, some people are lucky enough to have more resilient brains which can withstand the fast paced work they are demanded to perform. Or maybe they aren't hyperactive to that point, and their brain does not suffer as much. Personally, when I was a child I was a hyperactive thinker. Hundreds of thoughts, theories, conclusions, assaulted me almost simultaneously, and I couldn't slow down even if I wanted. I could think really fast... and now it is the opposite. I have trouble remembering stuff, problems concentrating, brain fog... I spent a few years of my adolescence thinking I had a brain tumor because the change was so drastic that I could perceive it clearly.

Plus, I have read about some severe autistics which are mostly fine until certain age, and then they begin forgetting what they already knew. This might also make sense with a possible dopamine down-regulation.

Anyway, this just speculation based on my own experience, so it should not be taken too seriously. Maybe it makes sense to other people too, though.

Lastly, I think that "cognitive impairment" is somewhat relative. For me, something that makes you score a lower IQ than the one you should is an impairment. I'm not meaning mental retardation per se, just more like something that is an obstacle to intelligence/functioning of the brain. I'd say most inattentive ADHDers, at least the severe ones, would consider themselves impaired. I surely do.

In any case, I very much appreciate your input, my friend. I'll keep thinking on what you wrote.

Indeed, it is correct that some autistic people lose whatever skills they had acquired by, say, age 2 1/2. I would say most, though, seem impaired from late infancy.

I have seen cases where the skills were regained; I have seen them when they weren't regained.

In the DSM-IV, the people whose skills are not regained were said to have childhood disintegrative disorder. Nowadays, under the DSM-V, most of these people would be diagnosed with Autism Spectrum Disorder, Level 3.

I am one of those who was impaired from the start. I didn't acquire speech until age 5 1/2. I was hyperlexic, though, reading rather well before I began to speak. I couldn't write until age 6, though.

I was never a hyperactive thinker, except within simple things, like arithmetic. I was never a theoretician. I knew lots of facts, but I didn't think critically as a child. At this point, I consider myself, in the absence of an official diagnosis, even at age 55, as having inattentive ADHD. I really don't possess the so-called motor; I'm more the apathetic type.

I was diagnosed with autism, which was, until the 1990s, Kanner's autism exclusively, when I was about aged 3.

So adults with ADHD lose the hyperactivity part, while adults with AS can be hyperactive throughout their lives?

But hyperactivity doesn't always mean bouncing off the walls. In an adult hyperactivity can mean restlessness, short attention span, and impulsive behaviour. I have impulsive behaviour. I know some things I do annoy people and why it would annoy them (just by looking at facial expresssion and body language and putting myself in their shoes), but I still have to do it, due to impulsive urge. I'm also very affectionate, like a Down's Syndrome person.

As a child, though, I'm sure I had Bipolar. Sometimes I was easy to get on with, other times I was really hyperactive, and other times I would whine and cry and throw tantrums. It wasn't caused by environment or diet. It was like an imbalance in my brain. It faded away during puberty, although I have mood swings as an adult too, but not enough to reach the Bipolar criteria.

I don't know a lot about Bipolar. I know a woman with Bipolar, and she's also very socially awkward, but very extraverted; always yakking away to people and attracting men (sexually) and women (friendly).

But conditions like Bipolar, ADHD, Fragile-X, etc, can still affect a person's social skills, even if they are social. I've met people who have conditions other than ASD, but are affected socially in SOME areas, depending on their condition. A girl at work has learning difficulties (low IQ) but not autistic, but often misses social cues like body language, and can be rather self-centered, although she doesn't mean to.

It usually gets better--but some adults don't actually totally lose the "hyperactivity" component of their ADHD--whether or not they have AS.

I think it would be a horrible mistake to include ADHD in the ASD umbrella. A lot of people with ADHD are socially normal and a lot of autistic people don't have ADHD traits. What could work is creating an even broader umbrella that includes ASD and ADHD. I don't even believe autism or ADHD is one disorder. I think it's a bunch of random and uncategorized disorders with similar symptoms.

AS and ADHD are related in many ways. But I think all disabilities and mental illnesses are connected to each other in some way. I think they are two different disorders with some similarities.

I was diagnosed with both of them but to be honest they are both so intermingled, I wouldn't know where one ends and the other begins.