E25. ADHD and Friends (Autism, Trauma, and OCD)

0:00

Welcome to ADHD Crash Course! Today we're going to finish the conversation we started last week, which was ADHD and friends; ADHD and other diagnoses that have similarities that can be confused for ADHD and that can co-occur with ADHD.

0:40

Last week we talked about depression, anxiety, and bipolar disorder. This week, we're going to look at the similarities between ADHD and autism, ADHD and trauma, and ADHD and OCD (obsessive compulsive disorder).

We're going to start with ADHD and autism. You can be diagnosed with both ADHD and autism, and ADHD and autism also share some traits and some similarities. One little blip that I wanted to put in here, before I start talking about autism, is that when I was in occupational therapist training, we were taught person-first language. This meant that somebody would be a "person with autism", they weren't an "autistic person". The thinking was, you are a human, you're not defined by any diagnosis.

1:24

There has been a shift in the autism community where some people really are embracing autistic versus person with autism, because they feel like that's more true to who they are and really is central to their identity. However, that seems to not be a consensus. I think that seems to be the trend, but I have heard feedback on both sides. Being somebody who is not speaking to a specific person, I am going to continue in this talk with a person with autism.

If you are in my life, and you prefer me to refer to you in different way, I will definitely do that. I know for me as a person with ADHD, I prefer person-first language, but it won't offend me if somebody tells me that I am ADHD. I mean, it's not grammatically correct, but I can roll with it.

2:07

ADHD and autism can both impact social skills. The general idea is for different reasons, but it can look similar. With ADHD, a lot of times we're missing really important feedback, right? We're missing some of these social cues that we're getting in our environment, maybe because of inattentiveness. Combine that with impulsivity, and sometimes a difficulty inhibiting responses and that have a big social impact.

2:33

With autism, you also have a big impact socially. This being said, with autism that difficulty socially can often be about interpreting those kind of nebulous, difficult to explain things like nuance, language, body language, and even eye contact can be challenging.

2:49

Some autism approaches teach eye contact, but this is a very tricky skill. First of all, because many people with autism don't feel comfortable holding that kind of eye contact. Even when it's taught, though, there is a pretty narrow window between what we find a comfortable amount of eye contact and when we cross over to an uncomfortable amount. It's a matter of seconds, it's not, you know, a 30 second hold.

Research says between three and five seconds is what we're used to holding with eye contact, and anything that's really outside of that range feels uncomfortable. So, even if we're looking at eye contact alone, and not taking a look at some of the other challenges with interpreting language, nuance, irony and body language, this can be very impactful.

3:36

Things that are pretty difficult to teach can be impacting people with autism and how they relate socially. Sensory issues show up with both ADHD and autism. These can be pretty disruptive when you're looking at your day to day functioning.

Emotional dysregulation is an issue for both people with ADHD and autism. ADHD always has some impact on executive functioning skills. With autism, there can definitely still be an impact on executive functioning skills, but things like memory are actually sometimes pretty strong in someone with autism, which is often not the case with people with ADHD.

4:10

Now, we can't say all people with ADHD love novelty and all people with autism prefer structure and order, but in general those trends are there. Definitely, with ADHD you see a lot of us really thrive in novelty and change, and that is very often the opposite with autism.

4:28

Okay, so moving on to ADHD and trauma. I know I'm kind of a broken record here, but ADHD and trauma can occur together and one can look like the other. ADHD can cause traumatic experiences. It can lead to striking out and struggling, especially not knowing this is your brain, that this is what's going on with you. Even if you know and you don't really have the right tools and the right support, that can be so difficult and it can be traumatic to a person.

4:55

Then trauma can impact your ability to pay attention. What we see with ADHD and trauma is they're very often showing up in pretty similar ways. How is that? Well, they can both cause inattention. They can both cause restlessness or hyperactivity and they can affect sleep and emotional regulation.

When we look at trauma and that emotional regulation piece, this can be tricky, because with trauma you have that heightened state of the nervous system. You're going to have irritability and reactivity, which looks a lot like impulsivity.

5:29

If you're still with me, you're probably noticing patterns. You probably noticed them a while ago. Getting to the bottom of what's going on with mental health is no small thing. What do we have to judge? We have behavior, but we don't necessarily have the cause for the behavior. That is the whole process of differential diagnosis. Somebody highly trained is trained to tease that out.

5:52

As an occupational therapist, when I was working in pediatrics, I often used standardized assessments. Third parties, reimbursers, schools, people want to have numbers on where someone is functionally, what happens with therapy, and the kind of progress they're making.

They want numbers. Even in these assessments, when I would have very clear numbers, I would include "this is how this child showed up today" in my assessment, because even if you're measuring something that seems really cut and dry, it's not.

Maybe that child had a situation at home that impacted what they did that day or how cooperative they were. Maybe they were totally capable of doing something, but they just weren't willing to.

6:29

A lot of those tests don't really filter out that. If that's true for occupational therapy, in what are often motor assessments, visual motor assessments, or perceptual assessments, how much more true is that for mental health?

On any given day, that's just how that person shows up that day, which is why it's so important that you are a part of the team when it comes to your mental health. Alright, that's my soapbox, so I'm going to move on.

Moving on to ADHD and OCD, or obsessive compulsive disorder. Now at first glance, a lot of people think that this seems like polar opposites. Just like that misconception that a lot of people have, that ADHD always includes hyperactivity, or it always means you can't pay attention, other misunderstandings surround OCD.

With OCD, you have obsessions, and these are intrusive thoughts. They're usually unpleasant, they're not controllable. Then you have the compulsion, this behavior that relieves some of that buildup of anxiety that comes from these thoughts. Of course, the well known stereotype with OCD is someone who is super neat, organized, and clean.

Some people even use that lightly or as some kind of a synonym meaning, "Oh, I'm just so organized or rigid or whatever." However, OCD is not about being "orderly and neat". There's all kinds of compulsions, cleaning is one of them, but that experience of cleaning as a compulsion is an unscratchable itch. This is not a pleasant experience.

7:46

That leads me to two of the compulsions that sometimes can share space with ADHD behaviors. One of the things that show up sometimes with people with OCD is hoarding behaviors. That can also show up with ADHD as well. The thing about ADHD is often people acquire a hoard for different reasons, like they might have some impulsive spending, they might have difficulty making decisions and letting things go.

What we find really frequently with ADHD, is if they have that hoard, is that they're distracted by it, they're not comfortable with it. It adds to the distraction and adds to their overwhelm. Being able to undo the hoard can be very difficult because of executive functioning skill deficits.

8:25

I had a client who I worked with virtually, and we would use a blanket to cover up areas of a room that she was cleaning out so she wasn't visually overwhelmed. That strategy worked for her, so she could just focus on one thing at a time because that visual input was so distracting for her and overwhelming. It would shut her down.

The dynamic with OCD is different. A lot of times with OCD, a hoard has more to do with acquiring things, really valuing things, having a hard time letting go of things, and being attached to them. This is not necessarily as haphazard as the acquisition of things with ADHD, it's often the inability to release things and attaching a lot of sentimental or emotional value to them.

9:03

Another compulsive behavior that you can see both with ADHD and OCD is what you call body focused repetitive behaviors. That's kind of like the biting the nails, picking cuticles, picking skin, or pulling hair. Although the behavior is the same, what's underlying it for ADHD is often different than what's underlying it for OCD. With ADHD you have this combination of attention to irregularities in your skin like a bump that you're messing with in combination with impulsivity, so you start this and can't stop. You also have sensory issues and sometimes these picking at skin or doing some things is actually somehow regulating. There's even some theory that it's tied into a dopamine seeking behavior. With OCD, it's more of what we talked about before, relief of that anxiousness, and in an intrusive thought the release of that anxiety.

9:53

A while ago I was speaking to somebody and they mentioned that a relative was a "picker". You know, my whole world is ADHD. Half my family has ADHD, many of my friends have ADHD, and of course, my work life is all about ADHD. I just thought that she meant the same thing that we're talking about, that body focused repetitive behavior, but she was talking about a picker in the "antique collector sense".

Which I'm sure is probably what the majority of people use that word for, but it became a very confusing exchange with the way I misinterpreted that! Okay, on that note, I do believe we need to wrap things up here. Today, we talked about the similarities and differences between ADHD and autism, ADHD and trauma, and ADHD and OCD.

10:33

My intention with these two episodes was just to build awareness. This is nowhere close to a complete discussion. Like I said last week, I picked certain things to focus on when I was talking about similarities and differences, but it's just the beginning.

There's so much more to say and there's so much more to understand. So, thank you so much for joining me for this episode of ADHD Crash Course! As always, I know that there are plenty of places you can spend your time and I'm happy that you spent it here with me today.

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