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5 Signs You Have Autism AND ADHD + how to spot it EARLY in children | Dr Becky Quicke

What are the common signs of AuDHD? How to spot AuDHD in kids and babies? Why AuDHD women have been missed for so long?

Dr. Becky QuickeguestAlex Partridgehost
Mar 31, 202549mWatch on YouTube

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Transcript

  1. 0:00 – 1:41

    Trailer

    1. BQ

      AuDHD, this window of capacity is really quite narrow, and it's so easy for children to become either completely overwhelmed, overstimulated, or underwhelmed. And I'm actually talking about babies even here.

    2. AP

      Dr Becky Quicke is a clinical psychologist with over two decades of experience in assessing girls for ADHD and Autism. She's a committed advocate for neurodiverse children and adults with a specialized interest in modernizing the assessment for AuDHD women.

    3. BQ

      Toddler tantrums versus meltdowns and overwhelm, they really are different. Our aim at Autistic Girls is to help families if their child is AuDHD to understand that, what that means, so that they can kind of work it out together rather than the child kind of developing ways of trying to shut that down-

    4. AP

      Mm

    5. BQ

      ... not feel it, you know, mask. When a child comes to understand themselves, and actually even just giving the diagnosis, it can actually change things really significantly.

    6. AP

      Loyal listeners and viewers, I can't thank you enough for tuning in. If you've ever felt broken or different, I hope this helps in your search for answers and community. And do you know what would really help me in return? By clicking the follow or subscribe button wherever you're listening. It might not seem like much, but at ADHD Chatter, it means a huge deal, and with this, I can book more incredible guests and keep the self-discovery fire alive for all of us, myself included. Just one click of a button goes really far. And remember, you have always been enough. [upbeat music] Dr Becky, what an honor to have you in the studio. Thank you so much for joining us.

    7. BQ

      Oh, thank you for, for having

  2. 1:41 – 3:35

    What is it about AuDHD that even you still can't get your head around

    1. BQ

      me.

    2. AP

      What, what is it about the dual diagnosis AuDHD that someone like yourself who's worked so closely with it still doesn't make sense to you?

    3. BQ

      [laughs] Um, I think in my, in my professional life, so as a clinical psychologist assessing people, um, ah, and I hope this doesn't sound arrogant, but I don't ever feel like, "Oh, that doesn't make sense." Like, [laughs] that's my... I kind of... That's my thing that actually it, it does always make sense. So when... So we do a screening call with people, and, um, they'll start to describe their experiences, and I'm always thinking, "Oh, yeah, that makes sense."

    4. AP

      Mm.

    5. BQ

      "Oh, yeah, that I can... I get that. Yeah, that makes sense." So there isn't anything, I think, when I'm working professionally, um, but personally, there are often times where, I mean, 'cause I'm, I'm obviously in a different mode-

    6. AP

      Mm

    7. BQ

      ... in my personal life, and, um, sometimes I kinda think... So my partner is autistic, and, um, it's only recently that we're kind of like, "Oh, actually, you're also inattentive ADHD." It's not hyperactive impulsive, but it's inattentive. [laughs]

    8. AP

      [laughs]

    9. BQ

      So until we made that realization, and now it's... that's really helpful. But until then, a lot of stuff didn't make sense-

    10. AP

      Mm

    11. BQ

      ... because he likes things to be really, um, kind of quite exact and quite precise, and then he would make a lot of careless errors, and my brain would be like, "What's going on?"

    12. AP

      [laughs]

    13. BQ

      [laughs] So yeah, I guess... But that's, that's how it is, isn't it-

    14. AP

      Mm

    15. BQ

      ... in our personal lives. Like, in my professional life as a clinical psychologist, I'm focused. I'm thinking. I'm making sense, helping people to make sense of things. I'm trying to understand. Um, and so it kind of does make sense, but then, yeah, in my personal life, I sometimes am like-

    16. AP

      Yeah, yeah. No

    17. BQ

      ... it might be different.

  3. 3:35 – 4:52

    Signs of AuDHD to look out for

    1. AP

      [laughs] Is, is there anything that y- you might see in a assessment, like someone comes to you, you're, you're going through the assessment for, say, autism or ADHD, and they'll say that they do a particular thing, and that rings AuDHD bells to you?

    2. BQ

      Yeah. Um, so that will quite often come up in, obviously, in the screening assessments. So, ah, there's, there's a few things that ring bells, but not necessarily, um, about their, the actual diagnostic criteria. Let me explain. So they might say, um, th- there's... They might say, um, ah, they might say something that like, oh, I, I kind of, um, I do like to have things predictable. I really have that preference, predictability and routines. But then actually sometimes I really don't, and so I don't understand, like, which is it? So that happens. That's a, that's a, a very-

    3. AP

      Mm

    4. BQ

      ... very common one. Or sometimes I really love, you know, going out and social inter- you know, being with people, then sometimes actually I can't see anybody for a long period of time. So, you know, those kind of things come up, and I'm like-

    5. AP

      Mm

    6. BQ

      ... "Oh, okay, what's kind of going on here?"

    7. AP

      Very much like that internal conflict, like a-

    8. BQ

      Yeah

    9. AP

      ... tug of war, one p- pulling him, them in a different direction.

  4. 4:52 – 6:51

    How has the diagnosis for AuDHD changed since you've been practicing medicine

    1. BQ

      Yeah.

    2. AP

      Through your career, has the diagnostic criteria process changed for autism and ADHD?

    3. BQ

      In the past... Well, I've got a few things that I think that have changed quite a lot. In the past, first of all, um, with adults, people who had autism diagnoses were seen within learning disability services.

    4. AP

      Mm.

    5. BQ

      Um, so I've worked in learning disability services, and that's where people would be referred to. Um, but a lot of those people with autism didn't have, um, a, a, a cognitive learning disability at all. So at, um, and I don't think that's happening. That's, I think that's shifted. That's changed. And I think that this, uh, quite a big shift, and I think this is sort of building and building, is that, um, a lot of diagnostic assessments in the past have been based primarily on observation, um, so observing how somebody behaves rather than actually getting to understand their internal experience. So I do think in the past sort of few years we're starting to, thank goodness, starting to understand that actually how someone behaves doesn't necessarily-

    6. AP

      Mm

    7. BQ

      How they're experiencing the world. And so I think there's been a real shift from kind of observational assessments.

    8. AP

      Mm.

    9. BQ

      It just makes me feel really uncomfortable, the thought of just observing someone. Yeah, it doesn't sit with me, but also I just don't think it's that helpful. Um, so moving towards more collaborative discussions where we are... And this is, this is absolutely our ethos at Autistic Girls and Autistic Women, where we're, we're trying to, um, understand somebody's internal experiences. 'Cause, you know, there's lo- lots of reasons why people might not express that, um, and not feel comfortable-

    10. AP

      Mm

    11. BQ

      ... in certain situations to express how they're experiencing the world.

    12. AP

      Mm.

    13. BQ

      It might not come out sort of ex- in external behavior, as it were.

  5. 6:51 – 11:22

    How to spot AuDHD in kids

    1. AP

      That internal experience that you're describing, what, what could that feel like for a child? And how could a parent look out for presentations of that feeling?

    2. BQ

      So AuDHD, um, there is a very [laughs] narrow kind of, um, window of capacity. Actually, it used to be called... Well, it's c- often referred to the window of tolerance, but I put that on LinkedIn recently, and someone really helpfully shared that they describe it as the window of capacity.

    3. AP

      Mm.

    4. BQ

      So this window of capacity is really quite narrow, um, and it's so easy for children to become either completely overwhelmed, overstimulated, um, or underwhelmed. And I'm actually talking about babies even here. Uh, or underwhelmed, so not having enough stimulation. So it might be that you notice that your baby absolutely loves the, you know, the, the toys. You get these... Even when the baby's on the... Lying on their backs and these toys with these [laughs] flashing lights, and it's all, you know, amazing. And the baby might be absolutely engaging with that and thinking that's amazing, um, kicking their legs. But then actually having significant difficulties regulating. And as a parent, the baby is crying and crying and crying. And so it's a- it's kind of even at that early age, and I've ex- I've experienced that myself as a parent-

    5. AP

      Mm

    6. BQ

      ... so I can kind of talk about that, that it's really, really tricky to get that, that balance of giving enough stimulation but not overstimulating. So kind of p- fast-forward into kind of toddlerhood and, and preschool and into school, that, that is a, that's definitely a really, really tricky area I think-

    7. AP

      Mm

    8. BQ

      ... for, for parents. Yeah, and I guess as a, as a child experiencing that, you know, that's really, really difficult. You know, wanting that stimulation, getting excited about things, but then feeling completely overwhelmed, um, and then dysregulated.

    9. AP

      Mm.

    10. BQ

      And often that can come out i- in behav- They become angry and, um, outbursts. You know, it's a really, really difficult, um, thing to... for, for chi-

    11. AP

      Mm

    12. BQ

      ... children and parents to kind of manage, and that's a really key AuDHD thing, I think.

    13. AP

      At that super young age that you're describing-

    14. BQ

      Mm

    15. AP

      ... the child might be contending with this internal tug of war, like, uh, but they don't have the verbal skills yet to articulate that.

    16. BQ

      Mm.

    17. AP

      How might that frustration show before they have the ability to verbalize those feelings?

    18. BQ

      Um, definitely in, in ba- with babies it's distress, crying.

    19. AP

      Mm.

    20. BQ

      It is, it's distress. And, and for parents, um, you know, they're... how they... It, it, it's tricky to help to regulate a, a baby that becomes that overstimulated. Um, so it's about kind of managing that and letting there to be a little bit of stimulation, but actually, um, making sure that's not very much and creating an environment where then you drop the stimulation so that the body doesn't become totally dysregulated. Because, um, an autistic and AuDHD body, and, and ADHD to, to a certain extent as well, is a very permeable in terms of sensory. The s- the sensory stimulation just kind of comes in from the outside world. Um, and it's... And like I say, the body's very permeable and it feels it really intensely.

    21. AP

      Mm.

    22. BQ

      Um, and so obviously until a baby, child is able to develop their own ways of regulating, then they become, um, yeah, very dysregulated.

    23. AP

      Mm.

    24. BQ

      And then it can be, um, expressed similarly. You know, todd- It's... This is really... It's, it... I think this is really interesting thing about toddler tantrums versus meltdowns and, and, uh, you know, overwhelm. Um, and they are different. They really are different. I think that's... And it's really... I guess it's tricky for parents to know, and a lot of parents feel like, oh, this is, you know, toddler tantrums, it's the terrible twos, and things like that. But actually, um, what parents have described to me, um, is it's different. It's really quite, it's quite extreme.

    25. AP

      Mm.

    26. BQ

      Um, and it's really very distressing for some parents, um, and obviously for, for the child themselves to be feeling such, um, extreme-

    27. AP

      Mm

    28. BQ

      ... kind of overwhelm.

  6. 11:22 – 14:49

    Can the two conditions (both ADHD and Autism) mask each other?

    1. AP

      Is it possible for the two conditions, the ADHD and the autism, to mask each other? Like they almost cancel each other out-

    2. BQ

      Mm

    3. AP

      ... and therefore you get missed, you don't get picked up, you don't get diagnosed until you're an adult?

    4. BQ

      Yeah, that definitely happens a lot. Yeah, they, they can kind of... I mean, that happens. We get women who come in for screening call and assessment, and absolutely that's been their experiences. Um, they kind of, "Oh, I'm not, I'm not one and, and I'm not the other, and I..." You know, but actually quite often, um, they're both. But there is quite a lot of talk of them kind of als- almost canceling each other out and it not being shown, but also I think it's really important to say that they intensify each other as well.

    5. AP

      Mm.

    6. BQ

      Um, so I always think that, like- [laughs] ADHD almost like in, can really intensify the autistic experience and it can be, you know, it can really kind of almost put a rocket underneath things

    7. AP

      Mm

    8. BQ

      ... um, and intent- in- intensify the, the emotional experiences

    9. AP

      Mm

    10. BQ

      ... or, and it can make it very, very difficult, or they can, um, it can actually, they can work beautifully together. I mean, some, some people have said, um, that it works really well and actually it me- it's meant that they're able, you know, they're... They are able to develop strategies to organize themselves, but actually it doesn't come e- it's not in- easy or intuitive to, to be-

    11. AP

      Mm

    12. BQ

      ... to be organized, and actually the attention does get pulled, and it's hard to regulate the attention, but, but actually they really want to have that sense of-

    13. AP

      Mm

    14. BQ

      ... kind of feeling organized and things being predictable. And so a- some people talk about them working beautifully together, and I think that's really important to talk about. Um, though it can be experienced, um, there can be difficulties, but actually we do get some women who come through and, um, and have an assessment, and they, they're not experiencing a lot of distress because they've created a life that really works for them, and actually they've kind of worked the two together. Someone like that historically would not receive a diagnosis even though we can see, you know, we've done the assessment, we can see actually having that collaborative assessment with them, that that's how their brain works-

    15. AP

      Mm

    16. BQ

      ... that's how they experience the world, and actually they do reach criteria for autism and ADHD.

    17. AP

      I suppose it must be quite hard if you've got these sort of predisposed stereotypes of what-

    18. BQ

      Mm

    19. AP

      ... ADHD and autism are or is to be those two. 'Cause you might think, "Well, I- I'm... My opinion of ADHD is, is like the, the naughty boy, very energetic, very chaotic, impulsive, disorganized." If you're also ordered and organized, but you are impulsive sometimes, you might think, "Well, I don't relate to the, the stereotypical view that I have of ADHD," or, "I don't relate to the stereotypical view that I have of-

    20. BQ

      Mm

    21. AP

      ... autism-

    22. BQ

      Mm

    23. AP

      ... therefore I can't be both." And that must just compound this feeling of confusion-

    24. BQ

      Yes

    25. AP

      ... and, and not belonging.

    26. BQ

      Yes.

    27. AP

      I mean, it comes up s- so many times on this podcast, this feeling of being broken and feeling-

    28. BQ

      Mm

    29. AP

      ... misunderstood.

    30. BQ

      Mm.

  7. 14:49 – 17:14

    Why is it important for a person to receive a diagnosis as quickly as possible?

    1. AP

      So I suppose how i- important is it for someone to get diagnosed with AuDHD as early as possible-

    2. BQ

      Mm

    3. AP

      ... and what are the sort of consequential effects on the developing brain of someone who is made to feel broken and confused or misunderstood in their early years?

    4. BQ

      What comes to mind for me as the kind of overwhelming thing is, is shame.

    5. AP

      Mm.

    6. BQ

      Um, with shame being I am wrong, rather than... You know, guilt is I have done something wrong, shame is I am wrong.

    7. AP

      Mm.

    8. BQ

      Because there are so many, um, like you say, messages from, from people, from school, from family members, and so yeah, it has a massive impact. Um, I've worked with a lot of children, and m- and obviously adults [laughs] who were children who've experienced that, and the shame is very, very toxic. When a, when a child, um, comes to understand themselves, and actually even just giving the diagnosis, it can actually change things really significantly. Um, you know, we've had parents say that, "We haven't had any meltdowns after that diagnosis." Doesn't mean that... I'm not saying like you get a diagnosis and everything's-

    9. AP

      [laughs]

    10. BQ

      ... absolutely perfect. But to know that there's a reason and, and you can understand and explain these experiences, there's nothing wrong. You're not, you're not wrong. You are absolutely right.

    11. AP

      Mm.

    12. BQ

      Um, 'cause that's the message we give to, you know, give to these girls. There's abs- you know, absolutely nothing wrong with them. It just almost, the shame dissipates and kind of goes, you know, really sub- subsides, um, and that has... And that obviously is a, is a hugely positive thing. So if that doesn't happen and the shame continues, then you start to get towards people, people understandably not being able to tolerate those high levels of shame, and so having to develop what we'd call psychological defenses, so defense mechanisms to not feel that shame. Either massive, um, doing things to avoid those feelings-

    13. AP

      Mm

    14. BQ

      ... or projecting those feelings into other people. Projection is, is a defense mechanism. Um, but doing things as they grow older, into teenagers, adolescents, young adulthood, to not feel that shame, and that's when that becomes potentially problematic.

  8. 17:14 – 25:00

    Tiimo advert

    1. AP

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    2. BQ

      Mm

    3. AP

      ... or not understanding why you feel different. I mean, if you feel different, right, you're probably gonna put in so much effort into trying to be, quote, unquote, "normal."

    4. BQ

      Mm.

    5. AP

      Masking, and therefore you're going to be hanging out with people that might not be good for you.

    6. BQ

      Mm.

    7. AP

      Or you're gonna be getting into relationships that might not be a good fit or starting a hobby that isn't aligned with who you really are because you don't know who you are.

    8. BQ

      Mm. Yeah.

    9. AP

      And if you're s- doing that, you're gonna quit the hobby. You're gonna leave that job. You're gonna end that relationship. And all of this, this cycle of sort of starting and stopping things, abandoning stuff-

    10. BQ

      Mm

    11. AP

      ... it's just gonna perpetuate that inner critic-

    12. BQ

      Mm

    13. AP

      ... that says that you're, you don't belong or you're, you know, you're, you're broken or useless, these horrible things-

    14. BQ

      Mm

    15. AP

      ... that the community purport to, to think about themselves. I think th- and as soon as you... The earliest you can-

    16. BQ

      Mm

    17. AP

      ... you can recognize that you are who you are, you're not broken, that you're just different, you can stop... peel back that mask-

    18. BQ

      Yeah

    19. AP

      ... and, and stop a lot of that damage from happening.

    20. BQ

      Yeah, and there's, and there's, um... I mean, I've talked about shame there and the kind of emotional development, but there's lo- there's lots of other ways actually that an early diagnosis can really pr- can be extremely helpful. So without it, y- and like you say, living a, a, a life that's not aligned with who you really are, you can't really understand your needs, um, and therefore, you know, create a, a life and be, be in relationships that, um, align with your needs. And we know that, um, especially with girls, there's a l- lot of so- social vulnerability, um, with autistic girls in, in particular, but I think that, one, and th- th- that's, um, and that it's a complex thing and lots of reasons why that is. Um, but without that awareness, you can't then know what you need, what, what... S- so situations that are pro- that are probably gonna be difficult-

    21. AP

      Mm

    22. BQ

      ... and what to do about that and, and talk to... as a, a you- a younger child, you know, talk to parents or talk to friends about that or with yourself kind of work out actually what do you need. You know, without that awareness, you're kind of, um, behaving in a way to, like I said before, to kind of avoid those, those difficult feelings of feeling different and-

    23. AP

      Mm

    24. BQ

      ... feeling shame. And so your behavior f- is fueled by fear really and anxiety, um, like you say, to kind of fit in and do those-

    25. AP

      Mm

    26. BQ

      ... things, rather than being, um, fueled by what's, what works well for me, what feels good.

    27. AP

      Mm.

    28. BQ

      So then you, then you don't learn t- to know what does it feel like to feel good, what feels nice, what feels easeful, what f- you know, what works for me. Um, and so quite often if, if, um, women, you know, come to us l- later on and have a later diagnosis, it's really... is, is like you say, peeling back-

    29. AP

      Mm

    30. BQ

      ... those layers, um, and working out. I mean, a, a lot of women will say, "I don- I just, I don't know what I need," and you know, so there's a real process there. I mean, the diagnosis is often a first step, and then it's, it's kind of peeling back that layers whether, whether it's with a, um, with themselves and kind of that exploration and that discovery of themselves and community and being connected with other, other people who are similar or whether they have support through a therapist or a coach. Um, so yeah, there's... Yeah. We feel really passionate about, um, helping girls and assessing girls to understand themselves. That's, you know, that's where it all began. We actually started out just assessing girls. That's what our service was, and then women got in touch saying, "Oh, you know, I love that you have a focus just on girls. How about women? Are you assessing women?"

  9. 25:00 – 30:27

    How women react after you diagnose them with AuDHD

    1. AP

      It's such a brilliant moment. I remember when I got my diagnosis age 34, you know, lots of emotion. You must have been in front of lots of women when y- you've told them, I imagine in some cases, finally, [laughs] you know, after so many years that they are AuDHD-

    2. BQ

      Mm

    3. AP

      ... and the emotional reactions that you might see in those moments. Do any stand out?

    4. BQ

      Mm. Yeah, and the women and girls and, and parents. Um, yeah, it, it really varies. Um, so for some people, I mean, I... the word that comes to mind is relief, and, and that is predominantly what, what we experience, I think, for girls and women. Although, um, um, I'm just thinking as a piece of, um, uh, research with people who had had a diag- have a diag- have had a diagnosis, and they talked about feeling grief relief, so grief and relief. So there's the, there is the relief, but then there's the grief.

    5. AP

      Mm.

    6. BQ

      This is, I'm talking about women here. Um, actually, it's, uh, parents can experience that as well even it, with young girls actually, because there's been a period of time of not understanding. But yeah, absolutely relief. Um, and, um, uh, what's coming to my mind actually is, um, some of the girls are, and this is just, um, I just think it's amazing and it's really quite exciting that they, um, I remember one parent saying, um, 'cause they told their, their daughter that, that, you know, we diagnosed autism and ADHD, and they said that she squealed with joy.

    7. AP

      [laughs]

    8. BQ

      And I was just-

    9. AP

      Mm.

    10. BQ

      Yeah. And we get that. We, we, some, so sometimes it's actual real excitement, "This is who I am, and it just makes sense," and like just that, if you think of the impact of that, uh, you know, on the trajectory-

    11. AP

      Mm

    12. BQ

      ... of that, of that child. Um, but it's not, it's not all like that. It's, um, so with, with some families, it's, the- there can be such a mix of emotions. Um, there can be guilt, you know, that, "I've not known this, and, and if I'd have known this, I might have done these things back, uh, differently." Um, oh, it really varies. And that, but actually a really, um, significant thing that I've noticed, I don't know what the percentage is actually, I haven't got, I haven't kind of done the numbers, but quite a significant percentage of girls after our assessments have then, or their parents have then taken them out of mainstream education.

    13. AP

      Hmm.

    14. BQ

      [laughs] Which some people might think, "Well, that's not a, that's not a good, um, outcome." But actually, the assessment and a diagnosis has made them sort of, made them realize, um, that their daughter is burnt out in quite a s- serious way. Quite often that's, um, common. And the, and the educa- uh, the, that mainstream education at that moment in time is, is just really not, not working. So whether it's homeschool or on- online schooling, and this is not ea- you know, this is really not easy. Um, so that, um, you know, is a difficult process. However, for those girls, I guess the families are kind of coming together and going, "Okay, this isn't working. Um, we need to look at something that, that will work." So I have noticed that.

    15. AP

      Mm.

    16. BQ

      It's l- literally be- been within weeks.

    17. AP

      Yeah. Gosh, I mean, school can be a trauma factory, can't it, for neurodivergent children? Um-

    18. BQ

      Yeah. And I think it's that realization that actually this is, this is too traumatic-

    19. AP

      Mm

    20. BQ

      ... for this, um, girl right now.

    21. AP

      Does justice sensitivity come, come into this conversation in terms of you get a diagnosis for the people-

    22. BQ

      Mm

    23. AP

      ... who are slightly later, and say they're in 30s, 40s, 50s, 60s, 70 years old, and they get this diagnosis, can they get really angry at the fact that they've haven't been picked up sooner?

    24. BQ

      Mm. Yeah. Yeah, that can happen as well. Definitely. And we have assessed women in their 70s, which, and all the way through.

    25. AP

      Mm.

    26. BQ

      Um, yeah, absolutely. Um, that's definitely, I, I hear that a lot actually, real anger at s- uh, their, it could be people- [laughs]

    27. AP

      Mm

    28. BQ

      ... situations, uh, establishments, you know. Um, yeah, real, real frustration and, and, and anger. I've noticed with the women we've assessed that I think there's a phase, and it's only a small number of weeks, it's not a long time, but there's a short phase where I think actually I would recommend no recommendations. So we do make recommendations on reports, but I think there's a, there's a phase of kind of just letting it sort of settle and re- and just kind of almost everything settling and becoming reordered a little bit really, and then working out from there, "Okay, actually this is what I need to, you know, potentially need support with." Or actually for some people, we're all goods actually. This, that's just-

    29. AP

      Mm

    30. BQ

      ... kind of the piece, the, the missing jigsaw piece that I needed and, um... But I think that, that those first few weeks, it, there, it is a real cauldron, a real melting pot of, of emotions, and it's kind of letting that settle a little bit and then working out where to go from there.

  10. 30:27 – 34:02

    Why have women been missed for so long

    1. AP

      Do you think that, like, there is a contributing factor behind why so many women have been missed for so long?

    2. BQ

      There's a number of things, I guess, that impact how women, um, and we've been talking about masking, but kind of pre- present themselves. Um, and I think a significant factor is about social conditioning. Um, and, um, and, and there are ... and but I think it really impacts, um, well, it definitely really impacts boys and men as well, but the gender sort of stereotypes, um, which, which happen so early on. I mean, it's, it's blown my mind as a parent to see other parents who I really like and respect as even with babies and young children talking about, "Oh, that sort of typical, typical boy. He's always moving. He's always running around." And, "Oh, yeah, she's a girl. She's sat, yeah, sat, you know, drawing. I wish my, I wish my boy would do that." And so girls from a really young age, I'll just focus on, on girls because that's my, my personal experience and obviously professional experience, um, learn that, that that's apparently not okay. And, and there are lo- obviously girls, well, just girls generally, we don't have to even talk about ADHD and ... but, um, very, very active girls, but you kind of learn that that's, you're not meant to do that.

    3. AP

      Mm.

    4. BQ

      Um, and so yeah, definitely the, the kind of social conditioning of, of girls being good and, um, I'll be honest, like obedient, doing what you're told, all that kind of good girl programming has a massive impact. Um, and, and actually, you know, so a lot of girls kind of become, you know, very, very good girls, um, and sort of switch everything off or kind of learn how to not show their, their true selves.

    5. AP

      I can just imagine, you know, the, the sort of young girl, say, who might feel that need to move, want to move, desire to-

    6. BQ

      Mm

    7. AP

      ... to be more active, but, "Stop fidgeting."

    8. BQ

      Mm.

    9. AP

      "Sit still." And so they keep it inside.

    10. BQ

      Mm.

    11. AP

      And that hyperactivity quite quickly works its way to their, to their head, to the thinking, to the brain. That-

    12. BQ

      Yeah

    13. AP

      ... those, those highly caffeinated squirrels come back, and the anxiety comes, and then you get misdiagnosed with an anxiety disorder-

    14. BQ

      Yeah

    15. AP

      ... when you're 15, 16 because you were told that moving is wrong [laughs] and impolite, and that's not how-

    16. BQ

      Yeah

    17. AP

      ... young girls should behave.

    18. BQ

      And also with AuDHD, moving, you know, like it's just, yeah. I'm just, so I'm just thinking about how education system requires children to just sit still, and it's just bizarre.

    19. AP

      Mm.

    20. BQ

      But yeah, so moving and, and being potentially told off for because you're hyper- uh, 'cause you're ADHD is the worst thing for an autistic child who doesn't want that attention, doesn't want that, that, you know, doesn't want the, the teacher pulling attention-

    21. AP

      Mm

    22. BQ

      ... to them, people looking at them. Like it's that combination of like, oh, that so really, really make sure you kind of develop strategies to, to not, um, move, sort of fidget slightly, but like you say, all kind of internally-

    23. AP

      Mm

    24. BQ

      ... um, kind of keep yourself stimulated-

    25. AP

      Mm

    26. BQ

      ... keep your brain stimulated.

    27. AP

      Speaking of trauma factories at school, like I think-

    28. BQ

      [laughs] Trauma factories. That's funny.

    29. AP

      As it was from, you know, so many people I've spoken to on this podcast-

    30. BQ

      It's really funny

  11. 34:02 – 41:01

    How does trauma interlink with AuDHD

    1. AP

      how does trauma interlink with AuDHD, and is a child that is AuDHD more susceptible to experiencing trauma?

    2. BQ

      Mm. Um, it's a huge topic. I feel like we could have a whole podcast just on that-

    3. AP

      [laughs]

    4. BQ

      ... to be honest. Um, yeah, it's, it's, it's a, it's a complex one because I guess it depends on the family environment, and I do think that there are some intergenerational kind of patterns around not, not being diagnosed. So parents, so hypothetically, you know, parents who are neurodivergent and not diagnosed and, and, and struggling, creating an environment where potentially, um, they struggle to regulate their emotions and so could be shouting, could be aggressive, or could shut, shut down other, other way, could shut down and kind of withdraw. And so that then impacts the, the child-

    5. AP

      Mm

    6. BQ

      ... and their relationship with their parent because that's the kind of, that we're social mammals and we learn about ourselves, about others, and about the world from our caregivers. We're not born ... We, we're born as very vulnerable beings, and we learn it all through our, through those sort of, through the, those, um, caregivers. And so if there's an environment where there's, there's undiagnosed, um, neurodivergence, um, that can then have an impact on the child, so they could experience trauma in that way. I've worked with lots of families, um, prior to, to these assessment services. I've lot, worked with a lot of families like, like that. Um, and then it depends, I guess, whether the child then learns to understand themselves or n- if not, stays in that environment and then, you know, talking before about the feeling of shame and sort of, um, doing things to not feel those feelings. So those can be, there can be trauma in the fam-

    7. AP

      Mm

    8. BQ

      ... family environment. Um, but also we were talking before, weren't we, about social vulnerability-

    9. AP

      Mm

    10. BQ

      ... and experiencing different, um, having different experiences that potentially put someone in a, a situation where they might ex- um, experience trauma. Um, so yeah, [laughs] it's a really, really complex topic. Um, and in assessment it's quite, um, it's quite important to- ... unpick all of that. Um, and I'm, and I mean really kind of focus in and take the time to unpick that rather than just saying, "Oh, actually, you know, you've experienced trauma, um, even, even development." So, um, early years trauma is called developmental trauma, so in those first early years. You know, you've experienced that early developmental trauma, or you've experienced trauma through your life, so actually how you're experiencing the world can be explained by that, so we won't diagnose you. That, you know, it's just really-

    11. AP

      Mm

    12. BQ

      ... not okay I think to, to not take the time and un- unpick it. Because there are, there are differences. So in terms of, um, so, uh, you know, in terms of social, um, relationships, if someone's experienced trauma, then there's, um, likely to be kind of mistrust within that relationship. It's, it's different, um, from somebody who's autistic and struggling with relationships, and that's more about, around, um, social cues and kind of... There's, there's differences. Now, somebody obviously can have, can have been experienced trauma-

    13. AP

      Mm

    14. BQ

      ... and been autistic, and so both can be there. Um, but it's about, it is about unpicking it. And actually, there are some really, um, helpful tools for clinicians. One of them's called the Coventry Grid, which actually, um... And this is, it's been developed for children. Um, really need something for adults. But, um, around when something, um, indicates trauma and when something's autism, and actually it goes through in detail all-

    15. AP

      Mm

    16. BQ

      ... the different things, and it, it's different. So it's important to kind of work out, you know, what it might be-

    17. AP

      Mm

    18. BQ

      ... or, or both really.

    19. AP

      Well, so in terms of, like, experiences that could look like a child is presenting as AuDHD compared to how a child might be presenting in a response to a trauma, are those two presentations similar?

    20. BQ

      Yeah. It, it, it can on the surface look similar. I think that's what's-

    21. AP

      Mm

    22. BQ

      ... what's tricky. You know, so I've worked with a, a lot of children who've experienced trauma, that's kind of been my, uh, majority of my career to date, and I'm going to be completely honest. I look back to, you know, 10, 15 years ago, and I think, "Oh, gosh, there are some that I s- I've now with, you know, with my work now, I look back and think, "Gosh, I actually wonder whether, you know, that child might have been neurodivergent." And there is research to show now that, um, in terms of, um, children who are in foster care, looked after children, there's a high percentage of neurodivergent children.

    23. AP

      Mm.

    24. BQ

      And, and those are the services I used to work in and, and really don't think that we, um, we were aware of that, um, in, in the past, so... And I know that that's kind of changing. What's quite telling is, is in the interactions actually. So, um, it, it does, it does feel very different when you're with somebody-

    25. AP

      Mm

    26. BQ

      ... who, um, has experienced a lot of, um, relational trauma. Um, so they might be more wanting to, um, kind of, um, have control over you, um, and kind of dominate and have control over you, and, and that kind of gives them that sense of control. Whereas somebody who's, um, autistic or AuDHD, it's, it's not about being in control over another person.

    27. AP

      Mm.

    28. BQ

      They're not mistrusting and anxious within that relationship, um, which understandably happens when someone's experienced relational trauma.

    29. AP

      Mm.

    30. BQ

      Um, it's more about actually the environment and having things kind of, um, predictable and kind of, um, having that preference, the sameness and, and-

  12. 41:01 – 47:47

    Why a healthy family dynamic is vital for an AuDHD child

    1. AP

      How important is it to have, I suppose, like, a healthy family dynamic, uh, if you are an AuDHD child? I s- I suppose, what, what would your definition be-

    2. BQ

      Mm

    3. AP

      ... of a healthy family dynamic, and why, why would, why is it so important?

    4. BQ

      Um, I think probably the most important word is trust. Developing that, that trust. Um, it's where, like I said before, um, children learn about themselves, about other people, and about the world within those, uh, those, um, key caregiver relationship. [laughs] I'm using a very kind of-

    5. AP

      [laughs]

    6. BQ

      ... um, yeah, uh, not medical term.

    7. AP

      Yeah.

    8. BQ

      But, yeah, that goes-

    9. AP

      Yeah, sure

    10. BQ

      ... kind of, 'cause it could be-

    11. AP

      Mm

    12. BQ

      ... it could be a, you know, mother, fa- it could be anybody really, but the caregiver. So developing that model of, um, who they are, you know, and, um, and, and how they are with other people and the world through those relationships. And so it's where we, um, as children develop, um, hopefully, this is why it's a really healthy, this is what I would say is a healthy, um, family dynamic I guess, is that sec- that security, that secure base it's called in psychological terms, of a place to feel, um, that you can kind of go to, where you trust and, and y- like I say, feel safe-

    13. AP

      Mm

    14. BQ

      ... and so the body can kind of y- you know, relax and, and, um, be taken care of. Um, so and that's just, oh- Yeah. Apps, oh, it's essential for e- that's every child. That's, that's a-

    15. AP

      Mm

    16. BQ

      ... a healthy family dynamic. And it changes over time because obviously how you, how that dynamic is as a, as a young child shifts. 'Cause as you get into adolescence, it's actually, you've got a phase of where there is the, the kinda relationships are still really important about developing a sense of self, but actually starting to shift towards the, the child, the adolescent, you know, doing that themselves and in interactions with their peers and, and more kind of outward-facing, and then coming back into the family unit.

    17. AP

      Mm.

    18. BQ

      It's kind of, kind of both really. Um, but yeah, it's, I mean, it's, it's obviously a healthy family dynamic is important for-

    19. AP

      Mm

    20. BQ

      ... absolutely everybody. Um, and I think that the, with, um, children who are AuDHD, where things are tricky out in the world, even if things are, are not tricky at home, and actually are really nice and healthy and, and relaxed and secure and safe and trusting and all that kind of stuff, the world can be re- can be really, can be really difficult. And so I guess what I would, um, see as being really healthy is, is working that out together, you know? And, um, and parents kind of, um, being able to, um, support them to, you know, if there's changes that are gonna be made, you know, thinking ahead. I mean, there's, it's [laughs] it's a lot of pressure on parents.

    21. AP

      Mm.

    22. BQ

      But yeah, being aware of, of things that are gonna change and, and letting them know and say, "This might be difficult. What could you do?" And kind of problem-solving together really.

    23. AP

      Mm-hmm. It's really interesting because you, uh, you would hope as a child if you are AuDHD, and you're s- you're, you know, struggling at school, masking, super exhausted, and you kind of look forward to going home because that's your safe space. That's where you're gonna get respite from that anxiety, that, that need to mask because it's your safe environment. But y- there must be environ- situations where, say, you have an Au- AuDHD child, and the concept of thinking differently and, and it just isn't accepted-

    24. BQ

      Mm

    25. AP

      ... in the family. Maybe even the parents are undiagnosed-

    26. BQ

      Mm

    27. AP

      ... ADHD, AuDHD, but they just, they just have an unwillingness to confront that.

    28. BQ

      Mm.

    29. AP

      That lack of openness and willingness to confront and accept neurodiversity, how could that-

    30. BQ

      Mm

  13. 47:47 – 49:42

    ADHD item segment

    1. AP

      Becky. I wanna reveal your ADHD item-

    2. BQ

      Okay

    3. AP

      ... which is underneath that cloth.

    4. BQ

      [laughs]

    5. AP

      [laughs] I ask all my guests to bring in an item that most represents ADHD, or maybe this is AuDHD actually today, but we'll, we'll find out. [laughs]

    6. BQ

      Oh, this is AuDHD.

    7. AP

      This is AuDHD.

    8. BQ

      Yeah.

    9. AP

      Fantastic. Um, your AuDHD item is some tomatoes. [laughs]

    10. BQ

      Yes.

    11. AP

      I'm gonna hand those to you.

    12. BQ

      Oh, right.

    13. AP

      And yeah, be careful they don't-

    14. BQ

      [laughs]

    15. AP

      ... explode. [laughs] Um, why does-

    16. BQ

      Ooh, juicy tomatoes

    17. AP

      ... tomatoes represent AuDHD? I'm fascinated.

    18. BQ

      Yeah. So tomatoes, the fruit that doesn't belong in a fruit salad.

    19. AP

      Controversial, but I like it. [laughs]

    20. BQ

      And so you see tomatoes-

    21. AP

      Mm

    22. BQ

      ... they don't belong in ... They're a fruit that don't belong in fruit salad, but als- they're, they're often hanging out with the vegetables.

    23. AP

      Mm.

    24. BQ

      But they, they're, they're not accepted. They're [laughs] not accepted there either.

    25. AP

      [laughs]

    26. BQ

      They're not a vegetable. So they don't belong anywhere, and that is such a common thing that women say to us at the very, very beginning of their, their journey, and I think that's been a reason for the late diagno- well, one reason for the late diagnosis because it, it's like, "I'm, I don't fit with, you know, the kind of autistic community, and I don't fit with the ADHD community. I don't belong anywhere." And that's been a ... A- and, and actually that's because AuDHD is a, I think it's a third. It's, it's, it's a, it's a thing of its-

    27. AP

      Mm

    28. BQ

      ... of its own really. And so yeah, like the tomatoes, a lot of women we assess [laughs] don't belong-

    29. AP

      Yeah

    30. BQ

      ... in the fruit salads-

Episode duration: 49:42

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