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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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including lowering the risk of a having a heart attack or stroke, while also silencing “food noise”.
As demand for semaglutide increases, so are claims that taking it is “cheating” at weight loss or the “easy way out”.
We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.
Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.
How does it work?
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better.
GLP-1 gets secreted by cells in your gut when it detects increased nutrient levels after eating. This stimulates insulin production, which lowers blood sugars.
GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.
GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.
Some studies have found less GLP-1 gets released after meals in adults with obesity or type 2 diabetes mellitus compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.
GLP-1 has a very short half-life of about two minutes. So GLP-1RA medications were designed to have a very long half-life of about seven days. That’s why semaglutide is given as a weekly injection.
What can users expect? What does the research say?
Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).
A large group of randomised controlled trials, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.
Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections led to 6–12% greater weight loss compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.
Higher doses of semaglutide are prescribed for obesity than for type 2 diabetes. fcm82/Shutterstock Weight reduction due to semaglutide also leads to a reduction in systolic and diastolic blood pressure of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in triglyceride levels (a type of blood fat) and improved physical function.
Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a 20% lower risk of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.
Who is eligible for semaglutide?
Australia’s regulator, the Therapeutic Goods Administration (TGA), has approved semaglutide, sold as Ozempic, for treating type 2 diabetes.
However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.
The TGA has approved Wegovy to treat obesity but it’s not currently available in Australia.
When it’s available, doctors will be able to prescribe semaglutide to treat obesity in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.
What else do you need to do during Ozempic treatment?
Checking details of the STEP trial intervention components, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.
Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of moderate-to-vigorous physical activity, like brisk walking, dancing and gardening each week.
STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.
Trial participants also exercised for 150 minutes a week. Elena Nichizhenova/Shutterstock A review of obesity medication trials found people reported they needed less cognitive behaviour training to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and avoiding things that trigger eating.
But what are the side effects?
Semaglutide’s side-effects include nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.
In one study these led to discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.
More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.
To reduce risk or severity of side-effects, medication doses are increased very slowly over months. Once the full dose and response are achieved, research indicates you need to take it long term.
Given this long-term commitment, and associated high out-of-pocket cost of medication, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.
Read the other articles in The Conversation’s Ozempic series here.
Clare Collins, Laureate Professor in Nutrition and Dietetics, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Only walking for exercise? Here’s how to get the most out of it
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We’re living longer than in previous generations, with one in eight elderly Australians now aged over 85. But the current gap between life expectancy (“lifespan”) and health-adjusted life expectancy (“healthspan”) is about ten years. This means many of us live with significant health problems in our later years.
To increase our healthspan, we need planned, structured and regular physical activity (or exercise). The World Health Organization recommends 150–300 minutes of moderate-intensity exercise – such as brisk walking, cycling and swimming – per week and muscle strengthening twice a week.
Yet few of us meet these recommendations. Only 10% meet the strength-training recommendations. Lack of time is one of the most common reasons.
Walking is cost-effective, doesn’t require any special equipment or training, and can be done with small pockets of time. Our preliminary research, published this week, shows there are ways to incorporate strength-training components into walking to improve your muscle strength and balance.
Why walking isn’t usually enough
Regular walking does not appear to work as muscle-strengthening exercise.
In contrast, exercises consisting of “eccentric” or muscle-lengthening contractions improve muscle strength, prevent muscle wasting and improve other functions such as balance and flexibility.
Typical eccentric contractions are seen, for example, when we sit on a chair slowly. The front thigh muscles lengthen with force generation.
When you sit down slowly on a chair, the front thigh muscles lengthen.
buritora/ShutterstockOur research
Our previous research found body-weight-based eccentric exercise training, such as sitting down on a chair slowly, improved lower limb muscle strength and balance in healthy older adults.
We also showed walking down stairs, with the front thigh muscles undergoing eccentric contractions, increased leg muscle strength and balance in older women more than walking up stairs. When climbing stairs, the front thigh muscles undergo “concentric” contractions, with the muscles shortening.
It can be difficult to find stairs or slopes suitable for eccentric exercises. But if they could be incorporated into daily walking, lower limb muscle strength and balance function could be improved.
This is where the idea of “eccentric walking” comes into play. This means inserting lunges in conventional walking, in addition to downstairs and downhill walking.
In our new research, published in the European Journal of Applied Physiology, we investigated the effects of eccentric walking on lower limb muscle strength and balance in 11 regular walkers aged 54 to 88 years.
The intervention period was 12 weeks. It consisted of four weeks of normal walking followed by eight weeks of eccentric walking.
The number of eccentric steps in the eccentric walking period gradually increased over eight weeks from 100 to 1,000 steps (including lunges, downhill and downstairs steps). Participants took a total of 3,900 eccentric steps over the eight-week eccentric walking period while the total number of steps was the same as the previous four weeks.
We measured the thickness of the participants’ front thigh muscles, muscle strength in their knee, their balance and endurance, including how many times they could go from a sitting position to standing in 30 seconds without using their arms. We took these measurements before the study started, at four weeks, after the conventional walking period, and at four and eight weeks into the eccentric walking period.
We also tested their cognitive function using a digit symbol-substitution test at the same time points of other tests. And we asked participants to complete a questionnaire relating to their activities of daily living, such as dressing and moving around at home.
Finally, we tested participants’ blood sugar, cholesterol levels and complement component 1q (C1q) concentrations, a potential marker of sarcopenia (muscle wasting with ageing).
Regular walking won’t contract your muscles in the same way as eccentric walking.
alexei_tm/ShutterstockWhat did we find?
We found no significant changes in any of the outcomes in the first four weeks when participants walked conventionally.
From week four to 12, we found significant improvements in muscle strength (19%), chair-stand ability (24%), balance (45%) and a cognitive function test (21%).
Serum C1q concentration decreased by 10% after the eccentric walking intervention, indicating participants’ muscles were effectively stimulated.
The sample size of the study was small, so we need larger and more comprehensive studies to verify our findings and investigate whether eccentric walking is effective for sedentary people, older people, how the different types of eccentric exercise compare and the potential cognitive and mental health benefits.
But, in the meantime, “eccentric walking” appears to be a beneficial exercise that will extend your healthspan. It may look a bit eccentric if we insert lunges while walking on the street, but the more people do it and benefit from it, the less eccentric it will become.
Ken Nosaka, Professor of Exercise and Sports Science, Edith Cowan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sun-Dried Tomatoes vs Carrots – Which is Healthier?
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Our Verdict
When comparing sun-dried tomatoes to carrots, we picked the sun-dried tomatoes.
Why?
After tomatoes lost to carrots yesterday, it turns out that sun-drying them is enough to turn the nutritional tables!
This time, it’s the sun-dried tomatoes that have more carbs and fiber, as well as the nominally lower glycemic index (although obviously, carrots are also just fine in this regard; nobody is getting metabolic disease from eating carrots). Still, by the numbers, a win for sun-dried tomatoes.
In terms of vitamins, the fact that they have less water-weight means that proportionally, gram for gram, sun-dried tomatoes have more of vitamins B1, B2, B3, B5, B6, B9, C, E, K, and choline, while carrots still have more vitamin A. An easy win for sun-dried tomatoes on the whole, though.
When it comes to minerals, sun-dried tomatoes have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while carrots are not higher in any mineral.
Looking at polyphenols, sun-dried tomatoes have more, including a good healthy dose of quercetin; they also have more lycopene, not technically a polyphenol by virtue of its chemical structure (it’s a carotenoid), but a powerful phytochemical nonetheless. And, the lycopene content is higher in sun-dried tomatoes (compared to raw tomatoes) not just because of the loss of water-weight making a proportional difference, but also because the process itself improves the lycopene content, much like cooking does.
All in all, a clear and overwhelming win for sun-dried tomatoes.
Just watch out, as this is about the sun-dried tomatoes themselves; if you get them packed in vegetable oil, as is common, it’ll be a very different nutritional profile!
Want to learn more?
You might like to read:
Tomatoes vs Carrots – Which is Healthier? ← see the difference!
Enjoy!
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Yoga Nidra Made Easy – by Dr. Uma Dinsmore-Tuli and Nirlipta Tuli
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We’ve reviewed books about yoga before, and about sleep. This one’s different.
It’s about a yogic practice that can be used to promote restful sleep—or just be a non-sleeping exercise that nonetheless promotes relaxation and recuperation.
While yoga nidra is as somatic as it is psychological, its corporeal aspects are all explored in a lying-down-on-one’s-back state. This isn’t a book of stretches and poses and such—those are great, but are simply not needed for this practice.
The authors explain, step-by-step, simply and clearly, how to practice yoga nidra, and get out of it what you want to (there are an assortment of possible outcomes, per your preference; there are options to choose along the way).
A lot of books about yoga, even when written in English, contain a lot of Sanskrit terms. This one doesn’t. And, that difference goes a long way to living up to the title of making this easy, for those of us who regrettably don’t read even transliterated Sanskrit.
Bottom line: if ever you struggle to relax, struggle to sleep, or struggle to find your get-up-and-go, this book provides all you need to engage in this very restorative practice!
Click here to check out Yoga Nidra Made Easy, and learn this restorative tool for yourself!
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Bored of Lunch – by Nathan Anthony
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Cooking with a slow cooker is famously easy, but often we settle down on a few recipes and then don’t vary. This book brings a healthy dose of inspiration and variety.
The recipes themselves range from comfort food to fancy entertaining, pasta dishes to risottos, and even what the author categorizes as “fakeaways” (a play on the British English “takeaway”, cf. AmE “takeout”), so indulgent nights in have never been healthier!
For each recipe, you’ll see a nice simple clear layout of all you’d expect (ingredients, method, etc) plus calorie count, so that you can have a rough idea of how much food each meal is.
In terms of dietary restrictions you may have, there’s quite a variety here so it’ll be easy to find things for all needs, and in addition to that, optional substitutions are mostly quite straightforward too.
Bottom line: if you have a slow cooker but have been cooking only the same three things in it for the past ten years, this is the book to liven things up, while staying healthy!
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The Blood Sugar Solution – by Dr. Mark Hyman
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The main purpose of this book is combating metabolic disease, the amalgam of what’s often prediabetes (sometimes fully-fledged diabetes) and cardiovascular disease (sometimes fully-fledged heart disease).
To achieve this (after an introductory section explaining what the sociomedical problems are and why the sociomedical problems are happening), he offers a seven-step program; we’ll not keep those steps a mystery; they are:
- Boost your nutrition
- Regulate your hormones
- Reduce inflammation
- Improve your digestion
- Maximize detoxification
- Enhance energy metabolism
- Soothe your mind
Thereafter, it’s all about leading the reader by the hand through the steps; he also offers a six-week action plan, and a six-week meal plan with recipes.
The style is very sensationalist (too sensationalist for this reviewer’s personal taste) but nevertheless backed up with hard science when it comes to hard claims. So, if you don’t mind wading through (or skipping) some early chapters that are a bit “used car salesman” in feel, there’s actually a lot of good information, especially in the middle of the book, and useful practical guides in the middle and end.
Bottom line: if you want a good comprehensive science-based practical guide to addressing the risk of metabolic disease, this is that.
Click here to check out The Blood Sugar Solution, and look after yours!
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