#One thing that sucks about having multiple conditions with multiple overlapping symptoms is that you will be feeling so bad you're Worried™

[b-blushes]

argh pain and suffering on planet earth, i'm gonna ask for a lift for my plans on friday and if i can't get one i will cancel in advance. posting it here because it is a sad decision for me to make and if i don't hold myself to it, i'll be forcing myself to go anyway even though i know it's bad to :P

[meta-squash]

Your ADHD procrastination post has really stroke a nerve with me. I've had the same issue for years, but thought it's normal for everyone. Since about a year or so, I've been wondering if I may have an undiagnosed ADHD along diagnosed conditions. If it's not too personal, how else ADHD manifests in you? I hope it's okay to ask. I love hearing women's stories about ADHD because they are much different than the stereotypical image of it...

It’s not too personal! (FYI I go by they/them pronouns, but I am afab; it’s all good though!) Also, this got VERY long, I’m sorry! I’m verbose and have a lot to say, apparently.

So I personally have a weird relationship with ADHD. I was diagnosed with it (or some sort of attention deficit thing) when I was in like 3rd or 4th grade. I was briefly medicated but I think I was on Ritalin (I forget) and my child body couldn’t handle it; I was a zombie during the day and then when it wore off at night I was Evil and freaked out and wanted to fight everything. So I went off it pretty quick and didn’t get medicated after, presumably because my parents thought my ADHD wasn’t bad enough.

The reason they probably thought that is because my brother has Really Bad ADHD. Like, all the classic stereotypical symptoms and characteristics to the extreme: never shuts the fuck up, really damn loud all the time, extremely high energy, can learn pretty much anything in about 5 seconds but can’t actually hang on to an interest really (now that he’s an adult he can, but not as a kid), can’t sit still or pay attention in class, doesn’t finish homework, etc etc. I was able to mask mine and function enough to get through school just riding pretty much on my humanities grades alone. It sucked a lot but I somehow did it. I had an IEP (Individual Education Plan, which is a US school thing for kids with learning disabilities and such that allows for accommodations and assistance in school) but it didn’t do much except I think give me extra time on math tests because of my dyscalculia (I was in Special Ed Math my whole grade school career). My mother is an OT but I also think that (as you said) ADHD in afab people often manifests differently than in amab people, so I guess my parents just didn’t know what to look for and that’s why I never really got the same help as my brother.

I like to jokingly categorize ADHD into two distinct but overlapping types: Fast ADHD and Mush Brain ADHD. Fast ADHD (in my opinion; this may vary from person to person) is the classic stereotype symptoms. Fast ADHD’s focus problem is too much happening all at once. Lots of thoughts and ideas flying by and you get distracted mid-thought with another thought, or your train of thought gets really crazy but is super fast so your reply to someone’s comment might not make much sense to anyone else because they weren’t privy to your brain’s journey, or you go down a focus worm-hole and sit and do One Thing all day and forget to surface for things like food/water/bathroom. Fast ADHD has more energy (though when paired with depression that usually manifests as restlessness or anxiety) and is quicker to pick up new things. Mush Brain ADHD is kind of the opposite. Thoughts take longer, or you think of something and then it almost immediately disappears (for example, scrolling a website, seeing something that you want to google, you scroll for like 5 more seconds and think “wait, I completely forget what I was going to look up”). With Mush Brain ADHD it’s harder to have conversations because thought-to-mouth time is slower, rather than (with Fast Brain) lots of stuff is going on up there. Mush Brain often feels like, well, mush and like you can’t really form thoughts very well if you want to do stuff. It’s like you’re trying to focus on thinking a thought but it just slides away. Another way I’d describe it is having thoughts but it’s like they’re on a blackboard and they’re being erased as you think them, so they end up mostly smears. Obviously, this is just based on my own experiences as a Mush Brain ADHD person while my brother has Fast Brain ADHD, so this might be different for other people.

Both have lots of overlaps: executive dysfunction (that’s the big one), insomnia, auditory processing problems, hyperfixation (which is not a bad thing! I love my hyperfixations! They’re fun!), absolutely crap organizational skills, constantly losing things, really bad perception of time, detachment from the world (like you drift off into your own daydream, or things feel distant, but not quite the same as depersonalization/dissociating),  difficulty making choices, sensory processing disorder, crap abilities with money, rejection sensitive dysphoria, and often comorbid mental illnesses like depression, OCD, anxiety, dyscalculia/dyslexia, etc.

 Oh, and a lot of ADHD characteristics also overlap with depression characteristics (and a lot of people with ADHD have comorbid depression, so it really doesn’t help).

But I can tell you about my own experiences with some of these.

The Big One which is basically what that schrodingers motivation post is about, is executive dysfunction. People also call it procrastination (it only kind of is) or inertia. Basically, executive dysfunction is where the difficulty lies in starting the task. You want to do something, but you just can’t get going to do it. You get sort of paralyzed. It even happens with things you like. For example, when I made that post, there was a short (just over 100 pgs) book I wanted to read before the end of the day. It’s a good book! It’s on my reading list! I want to read it! But I just sat on my computer and watched dumb youtube videos because that’s what I was already doing and executive dysfunction makes starting tasks really hard. This happens to me a lot. It can happen with reading a book, or getting up to go to the store and buy groceries, or making a meal, or watching a movie. The movie-watching one happens to me a lot. Basically it’s the brain struggling to switch tasks; you’re scrolling tumblr, and that’s what your brain is focused on, and it doesn’t know how to switch from doing that to doing your bio homework or folding the laundry or whatever the task may be. This happens with ���bigger” or more complex tasks too, like starting an art project or starting a new book, because your brain has to figure out all the components of that task (I need these items for my project and this amount of time and I need to use them in this order) which is overwhelming, or it needs to comprehend how “big” the task is (how much time/concentration should I try and commit to in order to read this book) which is sometimes hard to gauge. Oh, also this can happen if you’re interrupted in the middle of a task, whether it’s to do another thing or just to answer a question or something; it’s hard to get back to it because it’s another kind of switching tasks. Aside from the blackboard-being-wiped-thoughts, this is my biggest ADHD problem. I can go more into how I dealt with executive dysfunction in college and now if you want!

Auditory processing issues is another thing that I deal with, although to a lesser extent than some people. It just means it’s harder for your brain to process sounds/talking. Part of this, for me, is because if someone is talking to me but there’s other noises (music, other conversations, general loudish ambiance) going on around us, my brain treats them all as equally important and I can’t focus in on the person talking. Another part for me is in my experience I seem to process conversation different from explanation. If I’m talking back and forth with someone about something and it’s not terribly important, I’m fine. If they’re trying to explain something to me, give me instructions, or read a passage of text to me, it just does not stick in my brain. If I’m helping my best friend with her grad school applications, I have to read the sentence she’s asking me check, I can’t have her read it to me. If she does read it to me, I’ve realized that I try to imagine the words as text in my head so I comprehend it better (it doesn’t always work). Auditory processing issues means that a lot of my conversations in public with people who are not my close friends (and therefore easier to pick out from the noise because familiar and/or easier to predict because familiar) are filled with a lot of me going “what?” Retail conversations with customers are slightly easier because there’s at least a mild “script” that they’ll stick to, usually.

Another one I experience is organizational problems. This one was bad enough that I actually went to a tutor-like thing to help me with it for most of grade school. Basically, I had no ability to organize tasks like doing homework or other activities, so things would get forgotten/lost/never even written in the calendar/etc. I couldn’t do projects because I couldn’t (and still kinda can’t) organize far enough into the future. I didn’t know how to break the project down across multiple days or weeks and make it manageable without totally forgetting pieces of it. I’d forget to write down homework when the teacher wrote it on the board, or I’d write it down but forget to do it. Or I’d do it but misplace it or leave it at home. My perception of time was also really crap; I couldn’t read an analogue clock until I was in maybe 6th grade? Even now I sometimes have trouble. It was hard to know how much time I had to allot to certain projects because I didn’t really have good perception of how hours fit in the day and how much time until homework is due and stuff. (Which meant lots of finishing things in class minutes before I had to turn it in and stuff. Once in uni I completely forgot to do an Entire Essay; luckily it wasn’t a class I needed to graduate.)

Along with this is losing EVERYTHING. I misplace things CONSTANTLY. I’ll put something that’s in my hand down to get a cup of tea or something, or even just to like, move a blanket, and I’ll forget where I put it. I’ve solved this problem with Important Things (wallet, phone, and keys always go next to my bed, for example, and rarely move from there if they’re not in my pocket. All important papers go in my Important Papers Folder as soon as soon as possible) but I lose regular stuff all the time. I’ll be working on an art project, I’ll put my glue stick down to reach for a piece of paper, and lose the glue stick in the time it takes to pull the paper towards me. The other day I was brushing my teeth and I put the toothbrush cover down to say hello to the cat and forgot where I had put it down once I had followed her to the next room. When things have a Place it’s easier, but I’ve learned to live with going “Where the FUCK did I put this thing? I had it a second ago!” at least once a day.

The “Mush” in “Mush Brain” is another big one for me. I don’t know if this has, like, a name? Or anything? It’s just what I call it. The best description for it would either be that blackboard description from above, or like you’re struggling to get to a thought through a lot of mud. Oftentimes I’ll have a sort of concept of a thought but not something full, and I know it’s there, but I can’t get to it. This is really apparent when I’m trying to remember a synonym for something, or trying to elaborate on certain concepts or pull ideas from texts. It doesn’t happen all the time. I was an English lit major in uni, so this affected me a lot back then. It’s sort of a similar feeling to reading the same sentence over and over and not registering the words, except it’s in your own brain instead. This kind of goes away for me when I’m writing/typing. Writing this out is easy (minus me forgetting the word executive dysfunction for like 5 minutes) but if you were asking me to explain this aloud I would struggle, probably. This is probably because I can stare at what I’ve written to see what’s missing or edit my thoughts, which I can’t do while I’m speaking, and also can’t do to other people’s interactions with me.

Just a general inability to focus is also one I struggle with. It goes with the “mush brain” to an extent but I think it’s different. It’s more like my brain doesn’t want to, well, focus on anything. If I’m just messing around on my laptop, that means I end up clicking back and forth between tabs endlessly because nothing is holding my interest. If I’m trying to read or do anything “intellectual” or “academic” it means I just can’t get myself to read or I can’t keep my thoughts on what I’m trying to write no matter how hard I try. Nothing holds my interest for long enough, it’s like brain restlessness. I try and concentrate on doing something, watching something, reading something, and my brain just slides away from it.

Rejection sensitive dysphoria is something I experience on a more minor level. It’s something that also overlaps with anxiety and depression. Basically, it’s a really intense emotional reaction to (perceived) rejection. For example, if my best friend says something to me with a certain tone or gets mad at me for doing something minor, my brain just goes “She hates you! She doesn’t want to be friends with you! You should isolate in your room and never speak to anyone again because you’re so annoying and terrible!” I know that’s mostly incorrect (although I also know I’m quite annoying and that’s another ADHD characteristic; knowing you’re annoying someone in some way and having no idea how to stop) so I can fight it but sometimes I do end up holing up in my room for a little bit. Things like criticism (whether towards you or towards, like, an essay or something) can also trigger this reaction. So can things like having an expectation that you’ll be good at something, and then failing at it or just not being as good as you’d hoped. (I developed a sort of defense mechanism for this one of never expecting to be good at things and never expect higher than a C in a class.) It also can come with a sense of feeling inferior around people doing similar things. It happens to me a lot here on tumblr, actually, because I’ll write a meta about something, and then read someone else’s good meta on the same thing, and feel like I’m an idiot and they’re really smart and nothing that I wrote was insightful or good. It happened to me in uni a lot too. It also happens to me kind of...secondhand, now. What I mean is, my best friend/roommate is extremely smart. Like genuinely one of the smartest people I know and an incredible thinker, straight A’s at uni in a degree she created, etc. She still gets imposter syndrome herself and feels like she’s not smart, and when she says she’s not smart, I feel bad for her but I also feel really terrible about myself, because if she thinks she’s stupid, then what am I? But again, it’s an overreaction to perceived rejection. It still sucks though.

There’s some evidence that ADHD comes with a whacked out sleep schedule. And not just insomnia (although that too, I know this because it’s 7am and I haven’t slept yet lol), but also Delayed Sleep Phase Disorder. Which basically means that most people’s circadian rhythms start slowing down so they’ll go to sleep around like 11pm-1am-ish, give or take. ADHD circadian rhythms are shifted so often we start getting tired around 3am or even 4 or 5am. (This is different from insomnia, btw, with DSPD you can fall asleep fairly easily, you just get tired later in the night; with insomnia it’s an inability to or difficulty in falling asleep quickly.) I always thought I’d just gotten my dad’s night owl genes, but it’s more likely that it’s the ADHD. I also have at least mild insomnia and it takes me a million years to fall asleep a lot of the time.

Hyperfixations are the Fun part of having ADHD (in my opinion). They can get in the way sometimes but they’re also really comforting and nice. Hyperfixations happen when you find an interest and it’s basically all you want to think or talk about, and you relate to the world through it, and you want to learn everything about it. It’s also a characteristic of autism. I’m not autistic, so I don’t know if there are major differences between ADHD hyperfixation experiences and autism ones. Anyway, often hyperfixations stick with you for a good amount of time, depending on the strength, and then you might find something else to focus on. Some of my hyperfixations have lasted a few months, some up to 4 years. A lot of ADHD people rotate through the same or similar ones. For example, a hyperfixation I had back in 2011-2014/15ish was Les Miserables. I then found a different thing to hyperfixate on. This past year I have returned to Les Mis. Hyperfixations are usually pretty cool, because it’s usually something you really like and enjoy learning about or doing and it’s kind of like the thing your brain would rather be doing/focusing on.

Personally, I’ve lived so long without ADHD medication that I’m fairly functional without it just due to coming up with personal adaptations and stuff. The thing that I have the hardest time with/that upsets me the most is the Mush Brain part, which also gets worse when my depression gets worse. I really would love to have clear, quick thoughts whenever I want. It’s frustrating to hold a conversation or try to write creatively and quickly when it takes forever for thoughts to fully crystallize in my brain and then come out my mouth or fingers. Right now I don’t have very good health insurance (all blame to covid layoffs) so I can’t really do the meds thing but I often wish I could. My ADHD is definitely not as intense or severe as some people’s. I have friends, and also my brother, who struggle a lot more than I do, and with different things

Holy hell this was so long. Feel free to message me if you have any questions! Or if you want me to elaborate on some of the things I do to deal with stuff.

[autistalk]

Comorbidity: Awesome word, less awesome thing.

Comorbidity is a hell of a drug. I'm Corey, and this is Autistalk.

In a previous post I used the term "an oroborus of bullshit," and while it was completely accurate in that context, I'm slightly disappointed I didn't save it for this one. It is, after all, pretty much a perfect definition of comorbidity. But if we're trying to be slightly more appropriate about things, comorbdity is simply the presence of multiple conditions. That's it! Fairly simple, right? But comorbodity is pretty much the bane of my existence.

While these conditions don't have to be related, more often than not they feed into each other. Anxiety, autism, depression, ADHD, OCPD... not the most cheerful of combinations, but one I've seen far too often. See, the thing is that no mental illness exists in a vacuum, and a lot of them tend to have issues that are similar, or at the very least, overlap. I get anxious because I'm depressed, and I get more depressed because I'm anxious. "Vicious cycle" doesn't even begin to cover it. But, for as much of a pain as comorbidity is, being aware of it can be quite helpful when it comes to figuring out issues.

See, for a lot of people on the spectrum (and for a lot of disabled people in general), they get the one diagnosis, and that's it. You don't need another one, because all of your problems can be wrapped up in one little box. Slap a puzzle piece ribbon on it, and you're done, right? Unfortunately, that myopic point of view can do far more harm than good.

My younger brother was diagnosed at a very early age, but when I was younger knowledge of Autism wasn't anywhere near as widespread. I was "smart but lazy," "a bad kid," all that jazz. It didn't help that I tested in the 99th percentile, or that my survival responses to Autism typically involved overcorrecting in an effort to seem "normal." There was nothing to diagnose that couldn't be solved with discipline.

I was diagnosed with ADD when I was around 10 or 11, and that lasted about eight months. A long-term bad reaction to Adderall and unwillingness to put me on Ritalin had people exploring other diagnoses, and eventually I was tested for Aspergers. That diagnosis fit almost all of my symptoms, and made sense with my family's history, so that was pretty much it. I assumed the ADD was just a misdiagnosis, and spent the next thirteen years referring to it as one. No one bothered correcting me there, so why would I think any differently? Besides, you needed meds for ADD, amd clearly the meds didn't work on me.

But I've always had issues with my attention span. There's only so much that can be explained by the autistic tendency to hyperfocus. Frankly, I should have been clued in all of the times I stopped being interested in a special interest in order to hyperfocus on something utterly trivial, like the number of bumps in my ceiling, or loops in my bedroom rug. Just one of those weird 'tism quirks, or at least that's what I told myself.

It wasn't until I had to get a copy of my medical records when I was 22 that I discovered I was still technically diagnosed with ADD. It threw me off, because I had spent so long accepting one thing as part of my life, and learning to be okay with that, while assuming that another thing had nothing to do with me!  Autism had become a large part of my self-identity, and I'd spent 11 years coming to terms with that. I researched the hell out of it, and learned as much as I could about what my condition entailed, coping mechanisms, and what sort of things I could expect. Obviously, all the answers weren't out there- It's A Spectrum (TM), and Autism presents uniquely to each person. When I couldn't find answers, or the ones I found didn't work, I figured it was just because I was unlucky with a condition that is even now not fully understood. It didn't even occur to me that I had only been asking part of the question.

Most of my coping mechanisms still relate specifically to Autism. While there's no real "main diagnosis" there, it's still the one I tend to mentally default to, in large part because of the massive overlap Autism has with many other mental illnesses. But these days I'm learning more about the other stuff I have going on, and I'm finding new techniques that are really helping me out. If someone had sat me down when I was eleven and said "Hey, you have this, but you also have this, and here's how that's gonna suck," I'd probably have been a lot better adjusted. If you're young and on the spectrum, it's worth taking a look at your habits and behaviors to see if there might be something else going on. Autism in particular has a pretty high comorbidity rate, so it definitely doesn't hurt to think about it. If you're in a position where you have a doctor you trust, consider talking to them about it! If not, maybe do some research on your own. A lot of people only put stock in professional diagnoses, but it's worth noting that most of those only come about because you or someone close to you notices things. You're not gonna go in for a physical and have them be "oh, by the way, looks like you've got some depression right around there" while they're checking your tonsils. If you already have an idea, or list of things going on, it can help you and your doctor to narrow things down.

So, readers, what are your thoughts on comorbidity? Do you have multiple conditions? I'm willing to bet that almost all of you have a good ol' case of Sensory Processing Disorder - believe it or not, while that's so common in Autistic folks it's often thought of as a given, it's not universal! If you have any feedback, or anything you'd like AutisTalk to cover, drop us a line in the ask box, submission page, Twitter, or gMail. 

[tracygehlert-blog]

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