Diagnostic labels as group membership. A sequel

In My Humble Opinion
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Anxiety is a slippery beast, because it can be a characteristic of some other condition, or its own condition.

My diagnosis yonks ago was Anxiety Disorder Not Otherwise Specified, and I think it was spot on. My anxiety manifests in all kinds of ways and changes frequently. Generalized anxiety, yes. Night terrors, yes. Social anxiety pretty much always. I once went through this heinous 2-3 month cycle of intrusive thoughts around a very specific image and situation after seeing a graphic photo in the news. I relived the same moment over and over in vivid detail every night and was getting no sleep. Unfortunately I have a really vivid imagination (good for writing, I guess.)

You know how I got though it? I designed my own exposure intervention. I sat down and journaled about it in excruciating detail in the most upsetting way possible and I did it over and over and over until it didn’t bother me any more. I later did the same thing after a brief altercation I had with a cyclist where I wasn’t sure who was at fault. I was agonizing over it and I couldn’t let it go. So I just sat down and let the worst fears and feelings manifest. Yes, this means you are a piece of shit and are worthless and deserve a lifetime in prison etc. And I looked at it and realized how disproportionate my reaction was to reality and that it was probably unrelated trauma. And then it didn’t bother me so much anymore.

This week I’m obsessing over what it might be like to die. It started when I read an article about Nazi Germany.

My anxiety is a lot better than it used to be.

Oh but I’ve read people with ADHD and autism have a harder time setting this kind of thing aside. Because we have a tendency to hyperfixate on things. I have very very powerful tendencies toward hyperfixation for days or weeks. Sometimes it’s helpful, like when I’m writing a novel, sometimes it’s neutral, like the time I spent obsessed with the 1996 Mt Everest disaster, and other times, it’s hell.

So when you look at my anxiety, it probably would have been there independent of ADHD but it’s also clearly exacerbated by ADHD. I’ve also read that people with ADHD have a greater tendency to recall random negative events from the past. Fold that into PTSD.

I do believe these things can exist discretely, such as having different causes, but I think by nature they are interdependent.

But to answer your question @Dinsdale the DSM is pretty agnostic to the cause of a disorder, and it would be unusual and against standard practice for a psychologist to diagnose someone of anything if they didn’t meet the required criteria. That would include comorbid diagnoses. Someone would have to meet the criteria for both disorders to receive both diagnoses.

It used to be you could not be diagnosed with both ADHD and autism. Clinicians had to pick one. That is no longer the case. It actually turns out the comorbidity of ADHD and autism is extremely common.

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By the classification system currently used. And to some degree it is academic but is the attention difficulty common in autism actually ADHD? My sense is that bread and butter ADHD is very divided attention thus flipping one to another as center stage, while autism is more very focused attention just not on what parents and teachers want to attention to be focused on. In any case I think meeting the same superficial criteria is not the same thing as being the same thing …

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ADHD is less a deficit of attention and more an issue of attention regulation. In my experience, I’m fortunate to be genuinely interested in a lot of things, which is one reason I did well academically, but I am extremely attentive to things that have hooked me emotionally or intellectually (I do not get to control what those things are.) I am extremely inattentive to everything else.

I have the capacity to fixate on writing, if I’m in a certain mental state, for sixteen hours a day several weeks to a couple months. When I’m in this state everything else seems less important to me. In contrast, I have a hard time sitting through dinner with my family, and I can’t sustain attention on board games or tabletop games for much longer than an hour. If I’m thinking deeply about something, such as posting here, I will lose hours at a time that feel like minutes, and if my husband speaks to me I really won’t process what he said, and if we decide suddenly to watch a movie I will realize twenty minutes into the movie I am still thinking about the thing I was writing about and have no idea what’s going on.

That’s kind of a mixed blessing. I love being able to focus that intently and fortunately I love my work so I can fall into flow state at work very quickly (it takes two hours to get started, but anyway.) On the other hand, I can get fixated and hooked on some unhealthy things, and even the writing sprints backfire when I end up neglecting literally everything else.

Now I’ve hung around enough people with ADHD to understand the pattern of innattention vs hyperfixation is fairly typical. The intensity is on the unusual side. Particularly with my writing. The reason I was unable to finish my novel for eleven years is because I hyperfixate on the details and I have a very very hard time letting it go. And I have rewritten that thing and changed little passages over and over and tweaked and rewritten it so many times I’ve been unable to let it go. For a person with ADHD I have some glaring abnormalities, one of which is an extreme attention to the detail of my work and an inability to get past the details.

Yet at the same time, outside of writing I am a very high level conceptual thinker. Go figure.

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I agree. People on the lower-functioning end of the spectrum almost always have multiple comorbid conditions, usually rare genetic mutations that couldn’t be diagnosed until very recent years.

Interesting that I would see this thread after coming from Facebook, where a FBF mentioned that she and her husband had attended an educational fair over the weekend (she’s on her local school board) and people were telling her what a delight it was to meet her son. She said, “It was nice to hear that, because that hasn’t often been the case.” I know her son had autism and some nonverbal learning disabilities (and I knew something was “wrong” before he was a year old; he had hyperlexia) but when ADULTS who just met you are telling you they don’t like your child, well……Wow.

He just started 7th grade at an arts-oriented charter school.

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And they’re able to post on Reddit? I’ll have to check it out, FWIW.

My young-adult relative who has PDD-NOS and has the intellect and maturity of maybe a 10 to 12-year-old does not even appear to be aware of the existence of social media, and her parents want to keep it that way.

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Heh. Having been on that train, I can tell you that adults don’t usually tell you they don’t like your child. What they do is don’t tell you that it’s a delight to meet your child, or really say much at all about the kid, or praise your kid’s math skills instead of anything else about the kid. And you know exactly what that means, because as an adult, you generally do tell a parent when their child is a pleasure to be around.

(And in fact they probably don’t dislike your child. There are a couple of other kids I know who are a handful, and not exactly a delight although I can see they’ll probably grow out of some of the less good parts of their personality, but I do like them.)

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Yes, my guess is most of the posters there are about average intelligence. There’s nobody there who seems to have a severe cognitive deficit, but most of them seem to require some supportive care and are not living independently.

I understand wanting to keep kids from social media. But sometimes I think autistic kids with higher support needs may feel very isolated and so it’s possible that technology and yes, even social media could be the best thing that’s ever happened to them.

I did post there once and they helped me work out what would be an appropriate Autistic Pride Day observation for my son. Mostly it’s just like another birthday. He gets cookies and a present related to his special interest. They helped me work through the ambiguities he might eventually feel about being autistic and so ultimately we decided to keep it really low key, not overly social involving other family and not pushing him to feel any particular way about it.

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That’s true, but I’m not sure my relative even knows she’s different. She’s that low-functioning.

Children actively avoiding a child is one thing (and something I was all too familiar with in my younger years) but ADULTS doing this, or even pulling their own kids away from someone is quite another.

I started this thread quite a while back.

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I think this is really very relevant to the OP.

Social media has been a lifesaver for my kid. She gets to virtually hang out and have a community with a bunch of other kids who love math, and even though she doesn’t usually post herself (part of her anxiety issues) she has the sense that these other kids are like her.

I’ve also seen (as I’ve mentioned before) online communities that bond by basically simultaneously complaining to each other all the time and gatekeeping, and those I think are much less healthy and can promote a sort of spiraling mentality. A lot of autism discourse I see online falls into that category. I’m glad to know that r/spicyautism is more welcoming.

Adults were usually very nice to my kid and didn’t avoid her, and I think did in fact like her. But they also didn’t light up in the way that adults light up when a kid is being charming. And that’s totally fair. There are kids that make me light up and kids that don’t as well, although I like to think I’m equally nice to all the kids I’m around. (The first time I saw an adult light up like that about her – her middle school math teacher at parent-teacher conference – I about fell out of my chair.)

There were a couple of parents who in retrospect did pull their kids away, but I also can’t blame them for that. My kid was even worse than she is now (which is still not great) at the give and take of social relationships, and if it’s damaging to one’s child to feel like she is the one who is giving all the time and getting rebuffed in return – or getting social signals which translate as being rebuffed, even if that’s not what the kid meant – then I’d be the last person to say that they should continue the relationship. (Fortunately for her as well as for the other kids, that hasn’t been every child, but there have been a couple.)

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Totally.

I’m lucky that adults tend to adore my son. He’s exuberant and smiley and precocious, plus he has an adorable kid voice.

Kids have a hard time with him.

I’ve had a hard time sometimes trying to play with him, it can be genuinely demoralizing to be constantly told “no” or to have something you’re working on destroyed or snatched away (I haven’t seen him do that in a while, at least.) I’ve said before I’ve never seen a kid take play so seriously. It has gotten better with time but he’s not at the level of other kids or understanding what makes playtime fun for everyone.