What is AuDHD? 5 important things to know when someone has both autism and ADHD
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You may have seen some new ways to describe when someone is autistic and also has attention-deficit hyperactivity disorder (ADHD). The terms “AuDHD” or sometimes “AutiADHD” are being used on social media, with people describing what they experience or have seen as clinicians.
It might seem surprising these two conditions can co-occur, as some traits appear to be almost opposite. For example, autistic folks usually have fixed routines and prefer things to stay the same, whereas people with ADHD usually get bored with routines and like spontaneity and novelty.
But these two conditions frequently overlap and the combination of diagnoses can result in some unique needs. Here are five important things to know about AuDHD.
1. Having both wasn’t possible a decade ago
Only in the past decade have autism and ADHD been able to be diagnosed together. Until 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the reference used by health workers around the world for definitions of psychological diagnoses – did not allow for ADHD to be diagnosed in an autistic person.
The manual’s fifth edition was the first to allow for both diagnoses in the same person. So, folks diagnosed and treated prior to 2013, as well as much of the research, usually did not consider AuDHD. Instead, children and adults may have been “assigned” to whichever condition seemed most prominent or to be having the greater impact on everyday life.
2. AuDHD is more common than you might think
Around 1% to 4% of the population are autistic.
They can find it difficult to navigate social situations and relationships, prefer consistent routines, find changes overwhelming and repetition soothing. They may have particular sensory sensitivities.
ADHD occurs in around 5–8% of children and adolescents and 2–6% of adults. Characteristics can include difficulties with focusing attention in a flexible way, resulting in procrastination, distraction and disorganisation. People with ADHD can have high levels of activity and impulsivity.
Studies suggest around 40% of those with ADHD also meet diagnostic criteria for autism and vice versa. The co-occurrence of having features or traits of one condition (but not meeting the full diagnostic criteria) when you have the other, is even more common and may be closer to around 80%. So a substantial proportion of those with autism or ADHD who don’t meet full criteria for the other condition, will likely have some traits.
3. Opposing traits can be distressing
Autistic people generally prefer order, while ADHDers often struggle to keep things organised. Autistic people usually prefer to do one thing at a time; people with ADHD are often multitasking and have many things on the go. When someone has both conditions, the conflicting traits can result in an internal struggle.
For example, it can be upsetting when you need your things organised in a particular way but ADHD traits result in difficulty consistently doing this. There can be periods of being organised (when autistic traits lead) followed by periods of disorganisation (when ADHD traits dominate) and feelings of distress at not being able to maintain organisation.
There can be eventual boredom with the same routines or activities, but upset and anxiety when attempting to transition to something new.
Autistic special interests (which are often all-consuming, longstanding and prioritised over social contact), may not last as long in AuDHD, or be more like those seen in ADHD (an intense deep dive into a new interest that can quickly burn out).
Autism can result in quickly being overstimulated by sensory input from the environment such as noises, lighting and smells. ADHD is linked with an understimulated brain, where intense pressure, novelty and excitement can be needed to function optimally.
For some people the conflicting traits may result in a balance where people can find a middle ground (for example, their house appears tidy but the cupboards are a little bit messy).
There isn’t much research yet into the lived experience of this “trait conflict” in AuDHD, but there are clinical observations.
4. Mental health and other difficulties are more frequent
Our research on mental health in children with autism, ADHD or AuDHD shows children with AuDHD have higher levels of mental health difficulites than autism or ADHD alone.
This is a consistent finding with studies showing higher mental health difficulties such as depression and anxiety in AuDHD. There are also more difficulties with day-to-day functioning in AuDHD than either condition alone.
So there is an additive effect in AuDHD of having the executive foundation difficulties found in both autism and ADHD. These difficulties relate to how we plan and organise, pay attention and control impulses. When we struggle with these it can greatly impact daily life.
5. Getting the right treatment is important
ADHD medication treatments are evidence-based and effective. Studies suggest medication treatment for ADHD in autistic people similarly helps improve ADHD symptoms. But ADHD medications won’t reduce autistic traits and other support may be needed.
Non-pharmacological treatments such as psychological or occupational therapy are less researched in AuDHD but likely to be helpful. Evidence-based treatments include psychoeducation and psychological therapy. This might include understanding one’s strengths, how traits can impact the person, and learning what support and adjustments are needed to help them function at their best. Parents and carers also need support.
The combination and order of support will likely depend on the person’s current functioning and particular needs. https://www.youtube.com/embed/pMx1DnSn-eg?wmode=transparent&start=0 ‘Up until recently … if you had one, you couldn’t have the other.’
Do you relate?
Studies suggest people may still not be identified with both conditions when they co-occur. A person in that situation might feel misunderstood or that they can’t fully relate to others with a singular autism and ADHD diagnosis and something else is going on for them.
It is important if you have autism or ADHD that the other is considered, so the right support can be provided.
If only one piece of the puzzle is known, the person will likely have unexplained difficulties despite treatment. If you have autism or ADHD and are unsure if you might have AuDHD consider discussing this with your health professional.
Tamara May, Psychologist and Research Associate in the Department of Paediatrics, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The 6 Pillars Of Nutritional Psychiatry
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Dr. Naidoo’s To-Dos
This is Dr. Uma Naidoo. She’s a Harvard-trained psychiatrist, professional chef graduating with her culinary school’s most coveted award, and a trained nutritionist. Between those three qualifications, she knows her stuff when it comes to the niche that is nutritional psychiatry.
She’s also the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) & Director of Nutritional Psychiatry at MGH Academy while serving on the faculty at Harvard Medical School.
What is nutritional psychiatry?
Nutritional psychiatry is the study of how food influences our mood (in the short term) and our more generalized mental health (in the longer term).
We recently reviewed a book of hers on this topic:
This Is Your Brain On Food – by Dr. Uma Naidoo
The “Six Pillars” of nutritional psychiatry
Per Dr. Naidoo, these are…
Be Whole; Eat Whole
Here Dr. Naidoo recommends an “80/20 rule”, and a focus on fiber, to keep the gut (“the second brain”) healthy.
See also: The Brain-Gut Highway: A Two-Way Street
Eat The Rainbow
This one’s simple enough and speaks for itself. Very many brain-nutrients happen to be pigments, and “eating the rainbow” (plants, not Skittles!) is a way to ensure getting a lot of different kinds of brain-healthy flavonoids and other phytonutrients.
The Greener, The Better
As Dr. Naidoo writes:
❝Greens contain folate, an important vitamin that maintains the function of our neurotransmitters. Its consumption has been associated with a decrease in depressive symptoms and improved cognition.❞
Tap into Your Body Intelligence
This is about mindful eating, interoception, and keeping track of how we feel 30–60 minutes after eating different foods.
Basically, the same advice here as from: The Kitchen Doctor
(do check that out, as there’s more there than we have room to repeat here today!)
Consistency & Balance Are Key
Honestly, this one’s less a separate item and is more a reiteration of the 80/20 rule discussed in the first pillar, and an emphasis on creating sustainable change rather than loading up on brain-healthy superfoods for half a weekend and then going back to one’s previous dietary habits.
Avoid Anxiety-Triggering Foods
This is about avoiding sugar/HFCS, ultra-processed foods, and industrial seed oils such as canola and similar.
As for what to go for instead, she has a broad-palette menu of ingredients she recommends using as a base for one’s meals (remember she’s a celebrated chef as well as a psychiatrist and nutritionist), which you can check out here:
Dr. Naidoo’s “Food for Mood” project
Enjoy!
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Think you’re good at multi-tasking? Here’s how your brain compensates – and how this changes with age
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We’re all time-poor, so multi-tasking is seen as a necessity of modern living. We answer work emails while watching TV, make shopping lists in meetings and listen to podcasts when doing the dishes. We attempt to split our attention countless times a day when juggling both mundane and important tasks.
But doing two things at the same time isn’t always as productive or safe as focusing on one thing at a time.
The dilemma with multi-tasking is that when tasks become complex or energy-demanding, like driving a car while talking on the phone, our performance often drops on one or both.
Here’s why – and how our ability to multi-task changes as we age.
Doing more things, but less effectively
The issue with multi-tasking at a brain level, is that two tasks performed at the same time often compete for common neural pathways – like two intersecting streams of traffic on a road.
In particular, the brain’s planning centres in the frontal cortex (and connections to parieto-cerebellar system, among others) are needed for both motor and cognitive tasks. The more tasks rely on the same sensory system, like vision, the greater the interference.
This is why multi-tasking, such as talking on the phone, while driving can be risky. It takes longer to react to critical events, such as a car braking suddenly, and you have a higher risk of missing critical signals, such as a red light.
The more involved the phone conversation, the higher the accident risk, even when talking “hands-free”.
Generally, the more skilled you are on a primary motor task, the better able you are to juggle another task at the same time. Skilled surgeons, for example, can multitask more effectively than residents, which is reassuring in a busy operating suite.
Highly automated skills and efficient brain processes mean greater flexibility when multi-tasking.
Adults are better at multi-tasking than kids
Both brain capacity and experience endow adults with a greater capacity for multi-tasking compared with children.
You may have noticed that when you start thinking about a problem, you walk more slowly, and sometimes to a standstill if deep in thought. The ability to walk and think at the same time gets better over childhood and adolescence, as do other types of multi-tasking.
When children do these two things at once, their walking speed and smoothness both wane, particularly when also doing a memory task (like recalling a sequence of numbers), verbal fluency task (like naming animals) or a fine-motor task (like buttoning up a shirt). Alternately, outside the lab, the cognitive task might fall by wayside as the motor goal takes precedence.
Brain maturation has a lot to do with these age differences. A larger prefrontal cortex helps share cognitive resources between tasks, thereby reducing the costs. This means better capacity to maintain performance at or near single-task levels.
The white matter tract that connects our two hemispheres (the corpus callosum) also takes a long time to fully mature, placing limits on how well children can walk around and do manual tasks (like texting on a phone) together.
For a child or adult with motor skill difficulties, or developmental coordination disorder, multi-tastking errors are more common. Simply standing still while solving a visual task (like judging which of two lines is longer) is hard. When walking, it takes much longer to complete a path if it also involves cognitive effort along the way. So you can imagine how difficult walking to school could be.
What about as we approach older age?
Older adults are more prone to multi-tasking errors. When walking, for example, adding another task generally means older adults walk much slower and with less fluid movement than younger adults.
These age differences are even more pronounced when obstacles must be avoided or the path is winding or uneven.
Older adults tend to enlist more of their prefrontal cortex when walking and, especially, when multi-tasking. This creates more interference when the same brain networks are also enlisted to perform a cognitive task.
These age differences in performance of multi-tasking might be more “compensatory” than anything else, allowing older adults more time and safety when negotiating events around them.
Older people can practise and improve
Testing multi-tasking capabilities can tell clinicians about an older patient’s risk of future falls better than an assessment of walking alone, even for healthy people living in the community.
Testing can be as simple as asking someone to walk a path while either mentally subtracting by sevens, carrying a cup and saucer, or balancing a ball on a tray.
Patients can then practise and improve these abilities by, for example, pedalling an exercise bike or walking on a treadmill while composing a poem, making a shopping list, or playing a word game.
The goal is for patients to be able to divide their attention more efficiently across two tasks and to ignore distractions, improving speed and balance.
There are times when we do think better when moving
Let’s not forget that a good walk can help unclutter our mind and promote creative thought. And, some research shows walking can improve our ability to search and respond to visual events in the environment.
But often, it’s better to focus on one thing at a time
We often overlook the emotional and energy costs of multi-tasking when time-pressured. In many areas of life – home, work and school – we think it will save us time and energy. But the reality can be different.
Multi-tasking can sometimes sap our reserves and create stress, raising our cortisol levels, especially when we’re time-pressured. If such performance is sustained over long periods, it can leave you feeling fatigued or just plain empty.
Deep thinking is energy demanding by itself and so caution is sometimes warranted when acting at the same time – such as being immersed in deep thought while crossing a busy road, descending steep stairs, using power tools, or climbing a ladder.
So, pick a good time to ask someone a vexed question – perhaps not while they’re cutting vegetables with a sharp knife. Sometimes, it’s better to focus on one thing at a time.
Peter Wilson, Professor of Developmental Psychology, Australian Catholic University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Menopause: 50 Things You Need to Know – by Dr. Felice Gersh
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Can you list 50 important facts about the menopause? If not, you’ll surely find things to learn in here.
The book is divided into three main sections:
- What to expect in perimenopause
- What to expect in early menopause
- What to expect in late menopause
Each section comes with an alarming array of symptoms, ranging from perimenopause fatigue and acne to late menopause tooth loss and vaginal prolapse. This is not to say that everyone will experience everything (fortunately), but rather, that these are the things that can happen and should not arrive unexpected.
Helpfully, of course, Dr. Gersh also gives advice on how to improve your energy and skin health, as well as keep your teeth and vagina in place. And similar professional insights for the rest of the “50 things you need to know”.
The style is like one big (182 pages) patient information leaflet—thus, very clear, explaining everything, and offering reassurance where possible and also what things are reasonable cause for seeking personalized medical attention.
Bottom line: if menopause is in your future, present, or very near past, this is an excellent book for you.
Click here to check out Menopause: 50 Things You Need To Know, and know them!
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CBD Oil’s Many Benefits
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CBD Oil: What Does The Science Say?
First, a quick legal (and practical) note:
CBD and THC are both derived from the hemp or cannabis plant, but only the latter has euphoriant psychoactive effects, i.e., will get you high. We’re writing here about CBD derived from hemp and not containing THC (thus, will not get you high).
Laws and regulations differ far too much from place to place for us to try to advise here, so please check your own local laws and regulations. And also, while you’re at it, with your doctor and/or pharmacist.
As ever, this newsletter is for purposes of education and enjoyment, and does not constitute any kind of legal (or medical) advice.
With that in mind, onwards to today’s research review…
CBD for Pain Relief
CBD has been popularly touted as a pain relief panacea, and there are a lot of pop-science articles out there “debunking” this, but…
The science seems to back it up. We couldn’t find studies refuting the claim (of CBD as a viable pain relief option). We did, however, find research showing it was good against:
Note that that latter (itself a research review, not a single study, hence covering a lot of bases) describes it matter-of-factly, with no caveats or weasel-words, as:
“CBD, a non-euphoriant, anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects”
As a quick note: all of the above is about the topical use of CBD oil, not any kind of ingestion
CBD for Anxiety/Depression
There’s a well-cited study with what honestly we think was a bit of a small sample size, but compelling results within that:
A study published in the Brazilian Journal of Psychiatry tested the anxiety levels of 57 men in a simulated public speaking test.
Compared to placebo…
- Those who received 300mg of CBD experienced significantly reduced anxiety during the test.
- Those who received either 150mg or 600mg of CBD experienced more anxiety during the test than the 300mg group
- This means there’s a sweet spot to the dosage
There was also a clinical study that found CBD to have anti-depressant effects.
The methodology was a lot more robust, but the subjects were mice. We can’t have everything in one study, apparently! There is probably a paucity of human volunteers to have their brain slices looked at after tests, though.
Anyway, what makes this study interesting is that it measured quite an assortment of biological markers in the brain, and found that the CBD had a similar physiological effect to the antidepressant imipramine.
CBD for Treating Opioid Addiction
There are a lot of studies for this, both animal and human, but we’d like to put the spotlight on a human study (with the participation of heroin users) that found:
❝Within one week, CBD significantly reduced cravings, anxiety, resting heart rate, and salivary cortisol levels. No serious adverse effects were found.❞
This is groundbreaking because the very thing about heroin is that it’s so addictive and the body rapidly needs more and more of it. You might think “duh”, but most people don’t realize this part:
Heroin is attractive because it offers (and delivers) an immediate guaranteed “downer”, instant relaxation… with none of the bad side effects of, for example, alcohol. No nausea, no hangover, nothing.
The problem is that the body gets tolerant to heroin very quickly, meaning your doses need to get bigger and more frequent to have the same effect.
Before you know it, what seemed like an affordable “self-medication for a stressful life” is very much out of control! Many doctors have personally found this out the hard way.
So, it’s ruinous:
- first to your financial health, as the costs rapidly spiral
- then to your physical health, as you either suffer from withdrawal or eventually overdose
Consequently, heroin is an incredibly easy drug to get hooked onto, and incredibly difficult to get back off.
So CBD offering relief is really a game-changer.
And more…
CBD has been well-studied and found to be effective for a lot of things, more than we could hope to cover in a single edition here.
Some further reading that may interest you includes:
- CBD against Diabetes in mice / in vitro / in humans
- CBD against neurological diseases (in general, in humans)
- CBD against arthritis in mice / in humans
- CBD specifically against the pain of rheumatoid arthritis / of osteoarthritis
Let us know if there’s any of these (or other) conditions you’d like us to look more into the CBD-related research for, because there’s a lot! You can always hit reply to any of our emails, or use the feedback widget at the bottom
Read (and shop, if you want and it’s permitted where you are):
10 Best CBD Oils of 2023, According to the Forbes Health Advisory Board
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Chetna’s Healthy Indian – by Chetna Makan
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Indian food is wonderful—a subjective opinion perhaps, but a popular view, and one this reviewer certainly shares. And of course, cooking with plenty of vegetables and spices is a great way to get a lot of health benefits.
There are usually downsides though, such as that in a lot of Indian cookbooks, every second thing is deep-fried, and what’s not deep-fried contains an entire day or more’s saturated fat content in ghee, and a lot of sides have more than their fair share of sugar.
This book fixes all that, by offering 80 recipes that prioritize health without sacrificing flavor.
The recipes are, as the title suggests, vegetarian, though many are not vegan (yogurt and cheese featuring in many recipes). That said, even if you are vegan, it’s pretty easy to veganize those with the obvious plant-based substitutions. If you have soy yogurt and can whip up vegan paneer yourself (here’s our own recipe for that), you’re pretty much sorted.
The cookbook strikes a good balance of being neither complicated nor “did we really need a recipe for this?” basic, and delivers value in all of its recipes. The ingredients, often a worry for many Westerners, should be easily found if you have a well-stocked supermarket near you; there’s nothing obscure here.
Bottom line: if you’d like to cook more Indian food and want your food to be exciting without also making your blood pressure exciting, then this is an excellent book for keeping you well-nourished, body and soul.
Click here to check out Chetna’s Healthy Indian, and spice up your culinary repertoire!
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Peace Is Every Step – by Thích Nhất Hạnh
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Mindfulness is one of the few practices to make its way from religion (in this case, Buddhism) into hard science. We’ve written before about its many evidence-based benefits, and many national health information outlets recommend it. So, what does this book have to add?
Thích Nhất Hạnh spent most of his 95 years devoted to the practice and teaching of mindfulness and compassion. In this book, the focus is on bringing mindfulness off the meditation mat and into general life.
After all, what if we could extend that “unflappability” into situations that pressure and antagonize us? That would be some superpower!
The author offers techniques to do just that, simple exercises to transform negative emotions, and to make us more likely to remember to do so.
After all, “in the heat of the moment” is rarely when many of us are at our best, this book gives way to allow those moments themselves to serve as immediate triggers to be our best.
The title “Peace Is Every Step” is not a random collection of words; the goal of this book is to enable to reader to indeed carry peace with us as we go.
Not just “peace is always available to us”, but if we do it right: “we have now arranged for our own peace to automatically step in and help us when we need it most”.
Bottom line: if you’d like to practice mindfulness, or practice it more consistently, this book offers some powerful tools.
Click here to check out Peace Is Every Step, and carry yours with you!
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