Are you neurodivergent?

[fintangel]

Have you been diagnosed with, or do you suspect you might have ADHD or ASD or a combination or both?

YABU = yes
YANBU = no, I’m definitely neurotypical

Im NT

but DS, DD and DH are ND but only DS has diagnosis.

I’m ASD level 1, so is my youngest child. I strongly suspect my father was too.

Broadly I agree with you that school is relatively high demand but lots of children can mask through school and the 'good student' illusion is well known. It's also totally possible that teachers in the past completely missed inattentive ADHD symptoms or masked ASD symptoms. This is still true today to some extent. Report Cards aren't necessarily helpful in these cases. It can be complicated to unpick retrospectively. Like the poster on this thread suggesting that pretending to enjoy a nightclub was masking ASD when I would guess that most teenagers were doing the same. Where does peer pressure and the desire to fit in end and masking start. We all mask.

School and childhood are hard. As ADHD/ASD traits are experienced by the entire population then trying to assess decades later whether someone'straits as a child crossed into clinically significant impairment is virtually impossible when ultimately you are relying on a lot of self reporting which is notoriously unreliable. Family members will suffer the same time bias and are likely to want to support their loved ones in ascertaining a diagnosis they feel would help them.

Hypertension is a policy judgement too. There is no biological 'break point' for either that dictates what the threshold should be. The impact of a diagnosis is relevant though. Very few people tie their identity to having hypertension. The treatment for hypertension is relatively low cost and low risk. You aren't considered disabled if you have hypertension and it isn't considered a permanent condition like ADHD is. If I lower my blood pressure then I don't have hypertension anymore, if I manage my symptoms better or I am in low demand environment where my traits aren't exacerbated as much so I no longer reach the clinical threshold then not many people look for a reassessment to have their diagnosis removed. This would attack many people's core identities which is worrying in itself.

Simply put, there is a far less at stake if we are overdiagnosing hypertension. There is also a clear objective test to decide if someone does or doesn't have hypertension and most importantly of all the threshold hasn't recently been lowered amid great controversy amongst experts.

Some doctors think the rules are too rigid but many believe we are medicalising normal variation and presenting a false binary. There is such an insane contradiction in having a threshold where people can just miss out and be considered NT and then someone who has been subjectively assessed as just meeting the threshold is deemed ND and lumped together with those with very high needs in one umbrella of ASD. It's bonkers! Surely we should just accept that ND traits are prevelent and to some extent 'normal'. We should raise the threshold for diagnosis but offer support to those who are struggling despite not meeting the criteria for a diagnosis? This is a far more sensible approach.

No, if all the child had to do was play in the soft play then their ADHD would not be causing an impairment to them and therefore not be clinically significant. That's how low demand environments work. My whole argument is that you are pretending that we are somehow able to separate people from their environments. This isn't possible and diagnosis is basically an assessment of how someone's environment is interplaying with their ND traits. This is what decides the level of impairment. Not the actual pure biological extent of their traits. We have no real way of measuring that.

Autism isn’t normal, it’s not over diagnosed and you can’t mange away autism. You’re talking ableist nonsense. Oh and re raising the threshold- you mean shut women and girls back out of the diagnosis process again. No thanks.

Nope. And me. . I def wouldn’t say I am ND but if I am, I haven’t noticed and it’s had no impact anyway 🤷‍♀️

Masking in school is common, but masking in a setting all day means unmasking afterwards. My 6 year old is waiting for assessment, she is high masking in school, does well academically, social, has friends and is very well behaved in school, but as soon as school finishes she is a different person. At home she regularly has big meltdowns, can be violent, can bolt when outside of overwhelmed, won’t take instruction well, sensory issues, bad sleeper, doesn’t respond to typical discipline, toileting issues. I’m no expert but if someone can mask the entire time so doesn’t have/didn’t have any significant difficulties as a child then they probably aren’t autistic.

Many experts and professional bodies disagree with you in terms of whether it's being overdiagnosed. Accusing people of ableism doesn't make this any less true. It is absolutely not ableist to desire accuracy of diagnosis. Your emotional reaction highlights the issues I have mentioned around people internalising their diagnosis. If I suggesting you didn't the threshold for diabetes or hypertension changed would it illicit this kind of response?

Also autistic traits are completely normal. It is the severity of the traits and level they impair you that makes the difference. It's not binary.

It's different for ADHD as you have to be able to prove that the traits exist in more than one setting. Being disregulated at home isn't sufficient even if you argue it's a reaction to the masking taking place elsewhere. Many adults are trying to get an ADHD diagnosis but lots would struggle if they had to evidence the ADHD traits in multiple settings when they were younger. The evidence threshold isn't that high though so there is a lot of reliance on self reporting and relatives' accounts. The whole diagnosis process is a mess.

Was diagnosed but now think I'm probably not ND.

I’m neurodivergent. I don’t have autism or ADHD.

Autism and ADHD are only two of many conditions that come under the category of neurodivergence.

That's interesting, do you mind explaining why you think that? We're you diagnosed as a child or pursue your own diagnosis as an adult?

I think we we are actually agreeing on several things (1) ADHD traits are dimensional (2) impairment is context-depended (3) ineveitably there are people who fall just below the diagnostic threshold who would benefit from treatment and support - psychiatrists know this. (4) The diagnosis threshold is man-made (like in many other diagnoses) because there is no objective test for ADHD.

None of the above is controversial.

Where I don’t agree with you is your conclusion that because certain environments result in lower levels of impairments, that means the impairments are caused by the environment. Correlation does not necessarily equate to causation.

Clinicians take different environments into account and also consider alternative explanations - both of these factors are formal parts of the diagnosis process.

Apart From anything else, there is a substantial body of scientific evidence, accumulated over decades and across countries, showing that ADHD is associated with messurable differences in brain structure, development and function at a group level.

https://pmc.ncbi.nlm.nih.gov/articles/PMC13404203/

Yes - ADHD

Yes - I was diagnosed with Inattentive ADHD last year, at 52 but have struggled all of my life with issues which I now realise are ND problems. I suspect very much that I also have ASD.

If point 2 is a point of agreement then I struggle to understand how you can claim:

Where I don’t agree with you is your conclusion that because certain environments result in lower levels of impairments, that means the impairments are caused by the environment. Correlation does not necessarily equate to causation
There is clearly a gene-environment interaction like most things in life. We know there is a hereditary basis to ADHD and some people have a genetic tendency to experience more ADHD traits but we equally know that most people have ADHD traits and that environment plays a huge part in how these traits are expressed and their intensity. So what is the difference between an NT person with ADHD traits and someone that has diagnosable ADHD? It's all about the level of impairment in their daily life. This is hugely dependent on environment as we agreed in point 2. So sometimes environment does cause someone to tip onto diagnosable territory because their traits are exacerbated by their environment. They wouldn't be so impaired if they had a less challenging environment and sometimes made scientifically backed changes around diet, sleep and stress management.

Clinicians absolutely can't and don't assess ADHD patients in a way that accounts for the different environments they live in. There is no recognition that someone could no longer require a diagnosis if their level of impairment decreased.

The measurable changes in the brain are similar to other measurable differences in the brain associated with traits such as kindness, intelligence, extraversion etc. We don't label everyone with a collection of these kinds of traits as ND. Brain scans show differences at a population level but they are far too inconsistent at an individual level so can't be used as a diagnostic tool. It therefore can't really be used as incontrovertible evidence that ADHD is driven by these brain differences otherwise they would be more prevelant in those with ADHD and less prevelant in those who supposedly don't have it. As it stands there is far too much overlap which substantiates my claims further that ND/NT is absolutely not binary and we need to avoid overmedicalising normal human variance.

This!

From the NICE guidelines for ADHD, section 1.3 Diagnosis - note the several instructions to consider different ‘settings’.

“a full clinical and psychosocial assessment of the person; this should include
discussion about behaviour and symptoms in the different domains and
settings of the person's everyday life”

and further down in the same section:

“For an ADHD diagnosis, symptoms of hyperactivity, impulsivity or inattention
should:
1.3.4 • meet the diagnostic criteria for hyperkinetic disorder in DSM‑5 or ICD‑11 (but
exclusion based on a pervasive developmental disorder or an uncertain time
of onset is not recommended) and
• cause at least moderate psychological, social, or educational or occupational
impairment based on interview or direct observation in multiple settings and
• be happening often, occurring in 2 or more important settings including
social, familial, educational or occupational settings.

Regarding your comments about the differences in neurobiology - the existence of brain plasticity neither proves nor disproves the cause of the differences in neurobiology. We do know that on average people with ADHD show measurable differences in brain structure and function compared to control
groups.

Yep. Asperger's, which now comes under the autism umbrella. Diagnosed aged 34.

You are misunderstanding what I mean about high demand and low demand environments. A high demand environment in one setting can exacerbate how traits are expressed in other environments. For example there is very robust evidence about how children with difficult home lives are more likely to show more intense ADHD symptoms in other settings including school. The demands of some of these settings can lead to executive function depletion and literally reshape the brain so that characteristics associated with ADHD are more significant. This will mean symptoms bleed into other settings.

Yes, but kinder people on average show different brain structure and function as do those that are more extrovert etc. There are a whole host of other traits that are associated with different brain structures and connectivity. It's not about brain plasticity. They have observably different neurobiology in the same way that those with ADHD have at a population level have noticeable differences. Very few people have a completely typical NT brain because we all have different traits and they cause observable differences in the brain in lots of cases. Every brain is unique and there is a huge overlap between scans of ND and NT individuals. The science simply doesn't support the idea that there is a ND and NT brain and it's in anyway binary.

Yes, I have ADHD (diagnosed).

Agree with PPs your poll results will be skewed by virtue of the fact that fewer neurotypical people will click on the thread on the basis that they may assume the thread doesn't apply to them.

“Clinicians absolutely can't and don't assess ADHD patients in a way that accounts for the different environments they live in.”

” There is no recognition that someone could no longer require a diagnosis if their level of impairment decreased.“

Because it never goes away and you’re born with it.

Hmm not really. There are plenty of life events that can be evidenced. Self medicating, MH struggles, struggles in schools, exam results, impulsive behaviour….

Most experts and professionals don’t and the data doesn’t support over diagnosis. Quite the reverse. A few misogynistic people like yourself with a nasty little hobby horse to bang on about don’t speak for data, the profession as a whole or reality.