Devastating Consequences Of Undiagnosed AuDHD | Dr Mark Rackley, The AuDHD Expert

1. 0:00 – 3:09

   Trailer

   1. SPSpeaker0:00

      When you have an ADHD brain and an, a brain that has autism, there's internal suppression. It is, in part, influenced by shame. There's no point in me asking for help because I'm not going to be understood. I'm going to be judged. People are going to tell me I'm too much. "What's wrong with you?" Like, "Why can't you figure that out?" All of that fear of communicating your needs and telling somebody, "Hey, this is what's going on for me," creates an internal suppression where the person then pushes the words down. They become afraid to expose themselves. You leave yourself in a really vulnerable place. Dr. Mark Rackley is an AuDHD specialist.

   2. APAlex Partridge0:36

      With more than two decades of experience helping people with ADHD and autism.

   3. SPSpeaker0:40

      He's back by popular demand-

   4. APAlex Partridge0:42

      To help you process your late AuDHD diagnosis.

   5. SPSpeaker0:45

      Like ADHD and autism, it's never static. What your morning will look like as opposed to mid-morning, afternoon, post-lunch, early evening, evening, nighttime, it'll all change.

   6. APAlex Partridge0:55

      What reactions do you get from people? Uh, if you say, "Actually, look, there's more going on here. I know we said you have ADHD, but actually there's also autism," what reactions at that stage do you see?

   7. SPSpeaker1:04

      I tread very carefully with this. Very, very carefully because...

   8. APAlex Partridge1:09

      Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favor? Can you hit the subscribe button? And I'll repay the favor by continuing to book the best and most exclusive conversations on this topic. Please enjoy the episode and always remember, you're not broken, just different, and you have always been enough. [upbeat music] So to start with-

   9. SPSpeaker1:34

      Mm

   10. APAlex Partridge1:34

       ... if someone has AuDHD or suspects that they have AuDHD, what would they learn if they stuck around for the next 45 minutes or so?

   11. SPSpeaker1:44

       [lip smacks] I'm hoping that they'll learn a bit more about the l- the living with and the understanding of what this is. [clears throat] 'Cause it's still fairly new. Like, we're only doing the dual diagnosis since 2013, so we're only 13 years in, which in psychology years really isn't much. So I'm hoping if you stick around, which I hope you do, that you're going to learn a bit about, uh, what this looks like in your life, how, um, it can behave, how it, um, is understood. And I say that word specifically because there's a lot of misunderstanding, I feel, around what this is. But also, um, people can feel very confused or lost in terms of what is this. So the, the main thing is I am hoping by the end of this episode, you will feel hopeful if you recognize yourself in this conversation, that, yes, there's hope for me in being able to actually understand and live with this.

   12. APAlex Partridge2:54

       It's so interesting. I think at the moment, I log onto social media, I go onto Instagram, TikTok, so many people are speaking about AuDHD. So many people are recognizing themselves in the AuDHD conversation.

   13. SPSpeaker3:08

       Mm-hmm.

   14. APAlex Partridge3:08

       If

2. 3:09 – 4:53

   How common is AuDHD

   1. APAlex Partridge3:09

      we zoom out a little bit, how common is ADHD in conjunction with autism?

   2. SPSpeaker3:14

      The figures, they're very high actually, Alex. So they, they rate between one in two and one in three. So the overlap is very, very high, that if you have one, you'll have the other. So, it, it, it's, it's very common, but also, um, because they can... Uh, and the more I'm learning about it, I find with my job, um, I sometimes think I shouldn't have gone to university to become a psychologist. I should've just sat with people for six years. [laughs]

   3. APAlex Partridge3:43

      [laughs]

   4. SPSpeaker3:43

      And that's how, and that's how I would've learned everything. 'Cause honestly, like, you can, you can read all the books and you can read all the research, and that's super useful. But actually sitting with somebody for an hour every week over the course of however long you're with them, and they tell you their story in terms of, "This is my life. This is what happened this week." [clears throat] And when we bring in the diagnosis of ADHD into that person's life, and then they're telling you what it's like to live with it, like, I find that's where I learn everything. I, I honestly, I learn so... I feel sometimes I should be paying my patients.

   5. APAlex Partridge4:21

      [laughs]

   6. SPSpeaker4:21

      Like, I learn so much. It's like c- it's like, um, certified profess- CPD point. Like, it's... I learn so much a- about the, the, the living with. And that insight to me is invaluable. So, so in this conversation, like, I'll be pulling in all that knowledge, which is not from books, but it's from all the listening that I've done for people who are actually living with this, which I feel is invaluable.

   7. APAlex Partridge4:48

      If you pulled in all of that experience that you've had speaking to your

3. 4:53 – 7:18

   What AuDHD actually feels like

   1. APAlex Partridge4:53

      clients, how would you summarize the AuDHD experience? What does it actually feel like to live with AuDHD?

   2. SPSpeaker5:00

      There's a, there's a great expression, uh, I feel which, which sums it up brilliantly, which is, uh, sometimes it's too much, and then sometimes it's not enough.

   3. APAlex Partridge5:09

      Right. [laughs]

   4. SPSpeaker5:09

      And I think that's a great description, which is sometimes it's too much. And that's the, the ADHD piece, which is like kinda the overstimulation, the, uh, impulsivity, the lack of attention, lack of focus. And sometimes it's, it's not enough, where it's the stuff that is i- in, on the, uh, uh, autism side, which is, well, the, you know, the, the, the shutting down, the difficulty managing the social situations, getting overwhelmed, finding that you're, um, you're, you're understimulated. And then swinging back in then to the ADHD of, of overstimulation. So, so I think that's a great way to describe it. Sometimes it's too much, and sometimes it's not enough. And that's the massive contradiction because it, it, it, it sits into very different spaces in terms of what's going on in the brain when it's, um, it's kicking off. And of course, like, like ADHD and, and autism, it's never static.So what your morning will look like as opposed to mid-morning, afternoon, post-lunch, early evening, evening, nighttime, it'll all change. So you'll never have the same day [laughs] . It'll constantly fluctuate depending on what's going on. Yeah.

   5. APAlex Partridge6:19

      I spoke to somebody who said that they found that having AuDHD, for them, was life-threatening.

   6. SPSpeaker6:26

      Yeah.

   7. APAlex Partridge6:26

      And, like, in the context that they s- said that to me, it was retrospectively after they had found out about it.

   8. SPSpeaker6:33

      Mm-hmm.

   9. APAlex Partridge6:33

      Because living with a brain that had so many internal tussles and, and tugs of war and contradictions and internal confusions led them to be hugely anxious and overwhelmed and almost filled with shame and guilt at not being able to do what they were told by outside sources should be very mundane things, like cleaning your flat or getting to work on time. The internal contradictions almost created an overwhelm that paralyzed them sometimes into taking any action, and the guilt and the shame that compounded over accumulating so much evidence, so much external feedback from partners, from bosses, from random people sometimes.

   10. SPSpeaker7:17

       Mm-hmm.

4. 7:18 – 10:44

   The shame of being AuDHD

   1. APAlex Partridge7:18

      Do you find that's quite a common emotion sometimes? Having AuDHD, can that fill people with a lot of shame and guilt?

   2. SPSpeaker7:24

      Definitely. One of the, one of the big things with that is, um, guilt says there's a problem, and shame says you're the problem. So when you have all that kind of internal conflict going on and, and, and that's becomes part of your identity, then you will start to internalize that, which is, "Well, what is wrong with me?" Like, "Why can't I?" Like you're like, "Why can't I just do the things that other people seem to find so easy?" And that's a very common thing I hear, a really common thing. Like, "Why can't I get the joke?" Like, "Why do I find small talk is like I'm being murdered slowly?"

   3. APAlex Partridge8:01

      Mm-hmm. Yes.

   4. SPSpeaker8:02

      Like, like, w- why do I find these things so hard? Or, or why do I find the, the, uh, the... When somebody's eating muesli beside me and I'm losing my mind.

   5. APAlex Partridge8:11

      [laughs]

   6. SPSpeaker8:12

      Like, like, what's, like, what's wrong with me?

   7. APAlex Partridge8:14

      Mm. Yeah.

   8. SPSpeaker8:15

      And, and it's not that there's something wrong with you, is it's, it's what's, what's going on in your brain. But then if other people are giving you the feedback, like, "What's wrong with you?" Like, like, you sh- you shouldn't... And the, the narrative in that is, "You shouldn't have a problem with that because that's not a problem." And if we kind of boil it down, we think, okay, well, in, in the relativity of problems, is somebody eating muesli beside you a big problem? Well, no, that's not the same as, like, going broke and getting evicted from your house. Like, it's not that. But it's still a problem for that person. So but if you're being told, like, "Well, like, that's not a problem," but then you can't change the problem or you don't know what to do and it's still happening, then that can become deeply stigmatizing, deeply shameful, and it can leave the person very confused, which is like, well, "Well, why can't I just override that?" Because what you get with the, uh, AuD- or the ADHD brain is you'll keep getting the same response. So you can't think your way through it. You'll... It will keep happening because the brain is responding to these situations. So if you're getting that over and over again, you're having to mask or you're having to, to find a way to cope with that, then when it can become life-threatening, Alex, is, like, the person can become very hopeless. And when, when hopelessness kicks in, that's when the person is, is possibly at risk of becoming suicidal. Because where, where they go to is, "I can't live like this. And if I can't live like this, then, well, what's the point in living?" So and that's not dramatic. That really is not dramatic. That's, that's, that's the reality, that if you're trying to live a life and you've got all of these challenges and you don't know what it is and you have no solutions, then this is where psychologically it can bring the person. Yeah.

   9. APAlex Partridge10:06

      If someone's listening or watching and they relate to what you just said, they feel like that describes them, they h- they suspect they have AuDHD, like maybe they've got an Au- a, an ADHD diagnosis or maybe they've got an autistic diagnosis, but they think that there's more there. Their diagnosis doesn't quite paint the total picture of what they're experiencing.

   10. SPSpeaker10:25

       Mm-hmm.

   11. APAlex Partridge10:25

       Perhaps they, okay, the ADHD explains why I crave stimulation, but I get overstimulated simultaneously, and it can create this internal tsunami, I suppose, of confusion. If someone's at that stage and they're really having a, an internal tug of war, an internal crisis of identity,

5. 10:44 – 18:27

   How to manage AuDHD

   1. APAlex Partridge10:45

      what advice would you give to someone in th- at that stage?

   2. SPSpeaker10:48

      I think it's very important to recognize that, um, when you're dealing with the brain, you are dealing with an independent organ that works like all the organs independently of you. So your heart works independently of you. Your, like your, your, your lungs do. Lots of them do. Your brain is the same. So when you have a, an ADHD brain and an, a brain that has autism, then, um, it's just doing its thing, and it doesn't care about you. It's not trying to hurt you, and it's not trying to make your life difficult, but it's wired a certain way. So it's just functioning the way that it's wired. So I would say f- recognizing first and foremost that when you're living with autism, ADHD, then you are trying to find a way to survive in the world with a brain that's, in some cases, working against you. And by trying to survive, it's hard. It is hard. Because, um, the brain is not going to miraculously change the way it reacts to things. It's just going to do it. So first and foremost, I would say that. Secondly, what I'd say, too, is, is recognizing that it's not hopeless-That you can find ways and strategies and support to be able to help yourself to manage your brain while living in an environment or coping in environments where your brain isn't naturally going to feel comfortable in those environments. It might, might, might really struggle. But by learning to, to recognize the triggers, and by learning to have some very healthy coping mechanisms, then you can have such a better quality of life where you're, you're working with your brain in terms of navigating that, as opposed to just getting overwhelmed the whole time and then feeling, um, like we were saying a few minutes ago, where you're feeling hopeless, that, well, like, what can I do? And how on Earth is this going to change? Yeah. 'Cause it- the ADHD brain doesn't change, but what changes is how you navigate then with the knowledge you have of being able to modify and, um, cope with your specific triggers.

   3. APAlex Partridge13:08

      The navigating piece, I think, is so important-

   4. SPSpeaker13:10

      Mm

   5. APAlex Partridge13:10

      ... whether it's just ADHD or autism or the dual diagnosis-

   6. SPSpeaker13:14

      Mm

   7. APAlex Partridge13:15

      ... AuDHD.

   8. SPSpeaker13:15

      Mm.

   9. APAlex Partridge13:15

      Like, looking back and seeing the life that you've led, often, you said earlier, high masking, maybe very confused, maybe with rejection sensitivity dysphoria, and then you realize that there's more to the picture. There's perhaps another diagnosis too. Do you have any stories that might demonstrate somebody who's gone on that journey? Perhaps they've got ADHD or they've got autism, and then at some point in their life, a little bit later, they realize that there's something else going on too.

   10. SPSpeaker13:43

       Yeah, I do actually. It, um... There were so many cases I was thinking of, um, when, uh, you, you asked this. But, um, I think the one particular patient where, um, initially, in the, um, in the case, we had no diagnosis. And as I was listening to them talking about their lives, I thought, "Hmm, this feels like there's, there's ADHD here." And, um, we got the patient assessed, and sure enough, it was, uh, came back positive for ADHD. And, uh, with this particular patient, we started them, uh, well, the, the psychiatrist started them on medication. Then I was doing all the psychological work around, um, helping them to understand what's happening in their, their brain, how they're navigating life, and how, um, how we can live with this. And, and what was wonderful is wh- when we were doing all of that, lots of stability kicked in. Lots. Stability in relationships, stability in, um, lots of different parts of their lives. But then, um, when we kinda got all of the ADHD stuff kinda settled, um, this whole new batch of problems came along. [laughs]

   11. APAlex Partridge15:04

       [laughs]

   12. SPSpeaker15:05

       And we were like, "What's that?"

   13. APAlex Partridge15:07

       It's like Whac-A-Mole.

   14. SPSpeaker15:08

       Yeah.

   15. APAlex Partridge15:08

       You, you sort the ADHD-

   16. SPSpeaker15:09

       It really was. Yeah

   17. APAlex Partridge15:10

       ... and then the autism pops up.

   18. SPSpeaker15:11

       And, oh, it pops up, it pops up here. It's like, "Okay, we've got that." And then I was thinking, "That doesn't look like, uh, ADHD." And when I got the patient to tell me a bit more, so, like, "W- w- what's happening here?" And they were saying that, um, "Well, like, when I'm in company, I'm constantly, um... I'm, I'm, I'm out of sync. Um, I don't get the jokes. Um, when I... When there's silence, I find the silence insufferable. Like, the silence really, really bothers me. Um, I, I find the, the, the beginnings of the conversations really hard. The small talk is, is very, very difficult. Or when I get on a topic that I find, I, I run with that topic," but it didn't sound like hyperfocus. It sounded more like kind of rigidity of thought around a specific thing. And this, this, this new set of symptoms, um, was, was causing this particular patient a lot of distress. And so me and their psychiatrist kinda got our heads together, and we both said, "I think this is autism." And we had to present that to the patient and say, "Well, listen, I know we gave you an, an ADHD [laughs] diagnosis."

   19. APAlex Partridge16:32

       "There's more going on here."

   20. SPSpeaker16:33

       Yeah. "But we think there's more going on here." And it made so much sense-

   21. APAlex Partridge16:37

       Mm

   22. SPSpeaker16:37

       ... when we kinda explained it all because, um, again, this patient had so much knowledge of ADHD at this stage. They were living with it. It was settled. But they were hugely confused and also it was leading to quite a lot of distress, Alex, about kinda what's happening here. And they, they couldn't understand, like, "Is this my ADHD?" But it wasn't. It was, um... It, it was in, it's in- really interesting with the brain, and this, this is not uncommon, you know, which is, um, say, when, when we're, we're looking at a patient and, say, if we think they have anxiety but we think they have ADHD as well, then what we'll do first is we'll, we'll get their anxiety settled 'cause we, we, we want to see, well, if we settle the anx- if we, if we create a brain that's not anxious, then what should happen then is the ADHD will start screaming at us. But if we go in thinking this is ADHD, it might just be anxiety. So we have to kinda get the brain in one place to get it settled and to, to get those symptoms managed. But then once we have them settled, then anything that's underlying, like as in Alice's Whac-A-Mole, they all start popping up.

   23. APAlex Partridge17:47

       Yeah.

   24. SPSpeaker17:48

       So it wasn't unusual that we had the ADHD settled-

   25. APAlex Partridge17:52

       [laughs]

   26. SPSpeaker17:52

       ... and all of a sudden the autism went, "Hello." [laughs]

   27. APAlex Partridge17:56

       You must see a lot of different reactions when you diagnose someone with ADHD or autism. But when they have already perhaps gone through a process of-Understanding a diagnosis, looking back at their whole life, I imagine-

   28. SPSpeaker18:11

       Mm-hmm

   29. APAlex Partridge18:11

       ... and adding color-

   30. SPSpeaker18:13

       Mm-hmm
6. 18:27 – 20:45

   How people react after AuDHD diagnosis

   1. APAlex Partridge18:27

      that is autism. Like, what reactions do you get from pe- people? Like, if you say, "Actually, look, there's more going on here. I know we said you have ADHD, but actually there's also autism," what reactions at that stage do you see?

   2. SPSpeaker18:39

      I tread very carefully with this. Very, very carefully because, um, it's a- they're big words that have big meaning, and also there's a lot of confusion around what this means. And w- my... When you, when you diagnose a patient with ADHD, it, it's a bit like the title of your book, which is, ah, Now It All Makes Sense. So there's almost a sense of it all fits in and it make, you know, makes sense in terms of their life and the challenges they've had. Like, they get it. They get it. I find with autism, it's a bit more, um, like, well, I know what autism is, but I don't really know what it is. Because autism feels a bit more, um, it feels a bit more vague, and it feels a bit more, um, well, well, I can see the H- the, the ADHD in my life, but I don't know where the autism fits in. So there can be confusion, I find. Um, sometimes there's, again, a sense of relief if the, the person understands their ADHD and then they're- you explain the, the autism piece. And also I suppose as well, um, what you hear a lot is when, when the person, the patient's already kind of got to a place of acceptance with their ADHD, and they're working with it and they're telling people and they're out and proud and, you know, they're, they're really embraced it. It's part of their identity. And then so when you present autism to them, they're like, "Okay." So they accommodate it so well because they're already working from that really healthy space where their, uh, the neurodiversity is, i- is integrated into their life. They're managing it really well. And it's funny. Wi- with some patients, they'll often say, "Well, what's the point in me getting assessed? 'Cause if, if the autism's there and you explain it to me, then, then I can just... I can..." There's almost a confidence, which is, "Well, I can, if I can live with my ADHD, I can live with that."

   3. APAlex Partridge20:42

      Yeah.

   4. SPSpeaker20:43

      So it's fascinating to watch.

7. 20:45 – 29:35

   How to process a late AuDHD diagnosis

   1. APAlex Partridge20:45

      Yeah. And I guess you said you go towards accepting the diagnosis, and I guess, like you said, they've already accepted the ADHD, but then they find out they've got autism, too. Is there a process? Are there general stages someone goes through before they reach acceptance when they hear, "You have AuDHD"?

   2. SPSpeaker21:01

      Yeah. [laughs] There's a... You see a whole range of emotions, Alex. Like, the, sometimes, uh, the, the one I see the most is anger. So a lot of anger around, "Well, why do I have this?" And of course we can't explain why. It's like it's the genetic gamble of life, eh? Um, but we can explain it's got an 80% genetic loading. There's probably a parent that has it or a grandparent that has it. Com- It c- it, it, it can come down through the generations. But we can't explain why you have it. So it's, it, there could be a lot of that, like, the... And it's understandable, like, "Why me? Why is my brain wired like this?" If it's a... 'Cause I work with teenagers and I work with adults. With teenagers, um, it's interesting with them because, um, there's far more, uh, people being diagnosed with ADHD and, and Au- Au- ADHD now. So there's a bit more of an acceptance within that because, um, there's lots of talk around it and also, um, there's a, there's a lot more understanding within the peer group. With, with, with adults it's, it's qui- quite a different reaction really. Um, there can be a lot of fear, which is, "Well, how am I gonna tell people this? What's my life gonna look like?" Um, sadness because they might have had decades now where they've been living with this and it's caused chaos in their lives. Some of them are looking at failed careers or failed relationships. So there can be a lot of sadness around the consequences and the damage it's caused. So you have to process all of that. So you're processing sadness, you're processing anger, you're processing fear. And essentially what you get, want to, to get the patient to is a place of, yes, accepting the diagnosis, but accepting that this isn't... You know, we're not giving you a fatal diagnosis here. This isn't going to ruin your life. There's so much hope in this, and we can help you to live well with this. And I think that's so important because, like, when you're working with, with, with, with your patients with, with these conditions, you're not gonna give them false hope because there's no point in giving them that. You're giving them real hope. And like I was saying earlier, you're giving your real hope based off the fact that, well, you've seen X number of patients, so you've done this with so many times before and you know they can go on and have very good lives. So you're speaking from a place of confidence, but also a s- a place of experience. And then, and, you know, that patient doesn't necessarily believe you because the change hasn't happened. But you can provide enough hope that, "Listen, it's coming, and if you just bear with us, um, this will look different." Yeah.

   3. APAlex Partridge23:44

      Do you have any stories that stand out? Do you have any patients who perhaps have gone through that journey themselves of gearing towards acceptance?

   4. SPSpeaker23:54

      Yeah, absolutely. So, um, again, another patient where, um, there was a lot of chaos, a lot of chaos, and, um, life was very, very difficult. Very, very difficult. And, um-Like, very challenging relationships. Um, um, this particular patient, uh, was an, an adolescent patient, not going to school, um, very difficult relationships with their parents. So lots of things were, were, were very, very hard for them at the time. And, um, and there was self-harming. Was, it was, it was, it was very, very tricky. And, um, once we got the diagnosis in place, and we got the parents on board, and we got the school on board, and we got all the support mechanisms in place that everybody knew what was happening, but also everybody knew how to support this young person, then, um, the change was dramatic. This young person went back to school, no surprise, smashed their GCSEs, smashed their A-levels, and headed off to uni.

   5. APAlex Partridge25:04

      So what, I guess, was, is when you have the awareness piece, suddenly everything falls into place.

   6. SPSpeaker25:09

      Everything falls into place. And also, the, the thing w- w- w- especially when you're... Well, it's the same when, actually, when you're working with adults. But when you're working with teenagers, it's, it's, it's, it's, it's inherent in the work. Which is, you're sharing all the knowledge. Because the, the, the, the young person is existing in a, in a, in multiple different systems. So you're sharing the knowledge with the school, you're sharing the knowledge with the parents. You're asking the parents to share the knowledge with other people that might need to know. So you're, you're, you're, you're creating a support network for the, for the young person. So they don't have to explain themselves. They don't have to work as hard. Everybody's part of their support team. And what that does is then in, in multiple different areas of that young person's life then, they've got... They, they know, "I'm held, and I've people there who are watching me and helping me because they, they want me to, to succeed." So when you, when you create that space, uh, I've multiple, multiple times I've seen that work.

   7. APAlex Partridge26:12

      You mentioned a sensitive topic, self-harming.

   8. SPSpeaker26:15

      Mm-hmm.

   9. APAlex Partridge26:16

      And th- that case, I guess that adolescent-

   10. SPSpeaker26:21

       Mm

   11. APAlex Partridge26:21

       ... was self-harming, would you say, to self-medicate the internal tussle that came with, with feeling different?

   12. SPSpeaker26:29

       Yeah. So with that particular case, there was, um, unfortunately, like, just to go all technical for a second [laughs]

   13. APAlex Partridge26:37

       Which I love. [laughs]

   14. SPSpeaker26:39

       [laughs] Yeah. The, I, I always go into full on, uh, nerd, n- nerd mode when I come-

   15. APAlex Partridge26:46

       Yeah, you're in the right place

   16. SPSpeaker26:46

       ... talk to you. Yeah, I love it.

   17. APAlex Partridge26:47

       [laughs]

   18. SPSpeaker26:48

       Um, when you're dealing with, say, AuDHD, um, you're dealing with a neurodevelopmental disorder. So it's, the, the person's born with it. Their brain is wired that way. However, it's not a mood disorder. They're separate things completely. Any one of us can have a mood disorder completely. Uh, but not any one of us can have AuDHD. You're either born with that or you're not. So lots of people with AuDHD or separate ADHD and separate autism, they're not gonna have a mood disorder, i.e. anxiety, depression, OCD, whatever. They're not gonna have those. But depending on how the AuDHD's be- is being managed in their life, then it can facilitate this. Which means then the person can end up with very bad anxiety or very bad depression. So in this particular case, that's what we had. We had very bad anxiety, very bad depression. So that young person was trying to cope with that, which is really hard. So one of the coping mechanisms they employed was to cut their skin. Now, that's a very, very common one with, um, this was in my experience, and we'll talk about this a bit later, um, with young people, uh, and kinda older teens. You don't see it so much in adults because they tend to move on to d- or the, or other coping mechanisms then. But with teenagers, because they don't have access to lots of the things adults do, like alcohol and drugs or whatever, um, that's why self-harming is so prevalent, and it works. So if you cut the skin, then the brain will release adrenaline. It will release endorphins. It will release opiates, pain relief, to the source of the cut. So it will change how you feel. You will get that release of chemicals in the body which will help to, you to feel a little bit more, uh, calm or will change the stress. So, so that, that's, that's why, that's why, um, young people use it. But what can happen then is, like any behaviors that the brain, um, um, is exposed to, it can create this loop of behavior, which is, "Well, when I feel like this, this is what I do." Which then is the, kind of how people get, get trapped in addiction. So the young person can then end up self-harming a lot if they don't have other coping mechanisms that they can employ that help them to, to feel less distressed or overwhelmed. So they go back to self-harming again and again. But totally treatable, I want to say, by the way. Completely treatable, yeah.

   19. APAlex Partridge29:21

       So people self-medicate to deal with some of the internal chaos that comes with the confusions of having AuDHD. But on top of that, what do you think are the biggest risk of undiagnosed AuDHD?

8. 29:35 – 30:36

   Tiimo advert

   1. APAlex Partridge29:35

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9. 30:36 – 32:42

   Risks of undiagnosed AuDHD

   1. APAlex Partridge30:36

      to the episode. On top of that, what do you think are the biggest risk of undiagnosed AuDHD?

   2. SPSpeaker30:41

      I think there's two actually, Alex. Um, I think the first one would be that the undiagnosed AuDHD, uh, leads to a mood disorder, i.e. depression or anxiety, where I know that person is struggling with the symptoms of depression or anxiety. So things like, uh, restlessness, not being able to sleep, low mood, changes in appetite, um, low self-esteem. The concentration goes out the window. So can you imagine like you've got a brain that's already trying to cope with AuDHD and we chuck that into the mix? Like that, like that person can become very, very mentally unwell as a result of developing kind of a secondary, uh, problem that the brain's trying to deal with. And then I would think the second major risk factor there is then, okay, well, how are you gonna cope with all of that? So when you're dealing with all of those symptoms of AuDHD, symptoms of anxiety, symptoms of depression, h-h-how on earth are you going to resource yourself to be able to cope with all of those symptoms? And unfortunately, it's not unco- uncommon, and we know this, that just ADHD on its own can lead to addiction problems because of the impulsivity, the emotional dysregulation, and also the difficulties with dopamine. So I think the second risk would be developing an unhealthy coping mechanism, so to try and manage all of that. So something like alcohol or drugs or one of the more kind of behavioral ones like, uh, gambling or sex addiction or one of those, because the person now is in a very, very fragile place where they've got all of these things happening in their life and then they're trying to cope with all the challenges that brings. Yeah.

10. 32:42 – 35:45

    The risks of AuDHD monotropism

    1. APAlex Partridge32:42

       On the autism side, we've had a couple of guests talk about monotropism.

    2. SPSpeaker32:46

       Mm-hmm.

    3. APAlex Partridge32:46

       This theory that many autistic people have a very narrow lane thinking, like a very laser focused ability to think about one particular thing for-

    4. SPSpeaker32:57

       Yeah

    5. APAlex Partridge32:57

       ... a long period of time, and that can serve them very well.

    6. SPSpeaker33:00

       Mm-hmm.

    7. APAlex Partridge33:01

       But sometimes when that laser is targeted at something unhealthy-

    8. SPSpeaker33:06

       Mm

    9. APAlex Partridge33:06

       ... like an addiction or something that makes them feel better, can that be potentially paired with the impulsivity that comes with ADHD to create a risky environment for someone with AuDHD?

    10. SPSpeaker33:18

        Yeah, definitely. Definitely. 'Cause the thing with, um, with, with any kind of addictive relationship, an addictive relationship is formed. So it's something that the, the brain now associates, well, when we feel like this, this is what we do. And when we do this particular type of behavior, then we get rewarded with dopamine or adrenaline or whatever gets released. So when the addictive relationship then gets formed, then the person gets urges. So when they are feeling distressed or overwhelmed, then they get the urge to, "Hey, we know something that's going to help relieve that." And then the person then is at the mercy of that urge in terms of, well, do I give into that urge or do I, do I create an intervention where I, I make a different choice? But it's very hard when you're in a, an addictive relationship with somebody to make a different choice because you might not have discovered what that is yet, or be resilient or strong enough to be able to, to, to, to take that option. So if you, like you were saying there, the, um, if you mix the very kind of single-mindedness of, of autism and say, I'm gonna use an example. Say if that's, I don't know, alcohol or, or, or cannabis or whatever it is, then yeah, you, you, you... it becomes your, your... you form that relationship, you form that, um, that, that addictive relationship with that. And then once that's formed, then it can be very, very hard for that person then to get out of that because, um, when you're in an addictive relationship with whatever it is, whatever substance it is or behavior it is, it works. So people who are addicted to these things, and they're not idiots, they're very clever people, but the addiction overtakes them, and they get into this very, very dense, unfortunately destructive place where then the, the, the action is, um, repeated again and again which, um, entrenches the person sadly into that addictive, uh, addictive relationship.

    11. APAlex Partridge35:30

        I saw a piece of content, Mark, on, on social media.

    12. SPSpeaker35:33

        Mm-hmm.

    13. APAlex Partridge35:33

        One of the top comments was, um, someone said, I thought quite brilliantly, they said, "My ADHD drives me out for an adventure. My autism drives me home."

    14. SPSpeaker35:44

        Mm-hmm.

11. 35:45 – 39:49

    How to live successfully with ADHD and Autism

    1. APAlex Partridge35:45

       Do you think autism and ADHD, do you think they can actually be a good coupling in some ways?

    2. SPSpeaker35:51

       Yeah, I do. I really like that expression, uh, because I, I, I was just thinking like if you, if you like to use that, that, that, that expression, uh, your, your-ADHD will say, "Hey, let's, let's go on an adventure."

    3. APAlex Partridge36:06

       [laughs]

    4. SPSpeaker36:06

       Like an exciting and impulsive adventure. "Hey, let's, let's do this," something. And then your autism will, will go, "Well, let's do it safely." [laughs]

    5. APAlex Partridge36:14

       [laughs] Put the brakes on a little bit there.

    6. SPSpeaker36:16

       Yeah, let's not do something crazy-

    7. APAlex Partridge36:17

       [laughs]

    8. SPSpeaker36:18

       ... outrageous.

    9. APAlex Partridge36:19

       Yeah.

    10. SPSpeaker36:19

        So it's like, yeah, you get that kind of rush of excitement and adrenaline, and it's like, "Yeah, yeah, let's do this." And the autism piece goes, "Yeah, but let's just, like, let's, let's, let's keep it safe." So absolutely, yeah, absolutely. Like, they can, they can, they can sit alongside each other really nicely, really nicely. And, uh, like you got that, that piece there you just described, which is the kind of the maybe the over-stimulated piece of the ADHD, which can take you anywhere, but then there's no brakes. And then thankfully with the, the under-stimulation that can happen with the autism, it's like, "There's the brakes. We've had enough now. Let's, let's, let's, let's call it a day." So yeah, they can sit alongside each other really, really nicely. And then, you know, with the ADHD, you can have the, you know, the, the distractibility, whereas with the autism it can kind of keep you a bit more focused-

    11. APAlex Partridge37:14

        Mm

    12. SPSpeaker37:14

        ... sometimes. So, uh, yeah. I mean, d- again, I think that's a really important point is it's not always that they're clashing with each other and they're, like, they're causing chaos. They can actually sit alongside each other really nicely, too.

    13. APAlex Partridge37:28

        We did have a guest on, Mark, that said having AuDHD is sometimes like having two siblings that hate each other-

    14. SPSpeaker37:36

        [laughs]

    15. APAlex Partridge37:36

        ... like d- dragging each other along the floor by their hair. Um, so I do wonder, like, why is it that sometimes the two conditions can coexist in harmony in someone, but perhaps someone else, the two conditions exist in absolute chaos?

    16. SPSpeaker37:54

        Yeah. Again, I love these examples. Who's coming up-

    17. APAlex Partridge37:56

        [laughs]

    18. SPSpeaker37:56

        These are great examples, eh? I'm from a family of five, so my head's going, "Oh, yeah, I know-

    19. APAlex Partridge38:01

        [laughs]

    20. SPSpeaker38:01

        ... I know that." [laughs] Um, thing about siblings is siblings, you can... You, y- you love each other, and you hate each other, and there's all... You, you can be super bonded, and then you fall out. So, so it's not just the fact that they're, they're, you, you're coexisting. It's how you interact. That's the key piece, really. It's, it's the interaction between the siblings. It's not the fact you're all living in the same house. And I think with, with AuDHD, it's the same thing. It's like they're all living in the same brain, but it's how they interact with each other is, is the key piece because that's never the same. It's always dynamic. It's always based off of loads of variables that are happening at that given point, which then facilitates the inter- interaction. So, so yeah, there'll, there'll be moments where it's like two siblings pulling [laughs] at each other-

    21. APAlex Partridge38:58

        [laughs]

    22. SPSpeaker38:58

        ... and kind of in conflict. But then in another time, there'll be the two siblings hugging each other and telling, telling each other that they, they, they, they love each other. So, so yeah, y- you can have these wild contradictory states with, with the, with the symptoms because, um, they're, they're never going to be static as like, like, like... And it's like any relationship. Like, there'll be moments in a relationship where, you know, it's full of love and peace and, and, and it's wonderful, but like your new book is about, you just live with RSD, just that, and see what happens. 'Cause when that kicks off, that's not bringing peace into your relationship. That's bringing conflict.

    23. APAlex Partridge39:43

        Gosh, yeah, throw RSD in, and suddenly both siblings, I think, are gonna have a-

    24. SPSpeaker39:47

        That's one symptom. Just one.

12. 39:49 – 41:54

    Is AuDHD hard to communicate

    1. SPSpeaker39:49

       [laughs]

    2. APAlex Partridge39:49

       Do you think it's hard to communicate these internal confusions to the outside world? If you're someone who's living with these siblings, whether they get on or not, it's gonna be a confusing experience. Do you think it's hard to put words to the feelings of living with, as someone with AuDHD?

    3. SPSpeaker40:06

       Definitely, yeah. There's a thing where, uh, uh, uh... So in, in psychology, one of the symptoms, um, that, that any one of us can struggle with is suppression, where we push things down, and we, we, we, we suppress them. So suppressing emotions, suppressing things that we find difficult. And, and suppression is a, it's a, it's a defense mechanism because we're, we're defending against the, the, the, the, uh, real challenges that that particular thing is, is causing us. So what you get with AuDHD is there's internal suppression, and the internal suppression is in part, um, influenced by shame, which is, "Well, there's no point in me asking for help because I'm not going to be understood. I'm going to be judged. People are going to tell me I'm too much. People are going to tell me, like, 'What's wrong with you?' Like, why can't you figure that out?" So all of that stuff, all of that fear of communicating your needs and telling somebody, "Hey, this is what's going on for me," creates that internal suppression, where the person then pushes the words down, and they become afraid to expose themselves through the communicating of what's going on. And so when you do that, you leave yourself in a really, really vulnerable place 'cause now you're isolated. You're trying to cope on your own. But communicating your needs becomes far more frightening to expose yourself, so you'll suffer with the internal suppression instead, which is tragic but... Really tragic. Yeah.

    4. APAlex Partridge41:46

       I think, Mark, just to finish, because I know you live and breathe AuDHD as, as part of your profession and, and job, and

13. 41:54 – 44:39

    New groundbreaking AuDHD research

    1. APAlex Partridge41:54

       are there any groundbreaking studies, any exclusive AuDHD new science, new information that will blow us away here today?

    2. SPSpeaker42:03

       Yeah. They're, they're looking at the, the-neurology of the brain, like kind of what the wiring, 'cause we know with, uh, with ADHD and autism that, um, the, the brain is wired a certain way. But what happens if you've got both coexisting inside the one brain? And they're doing some research at the moment, and what they're thinking is, this is in its infancy, by the way, is they think with AuDHD that there's a, a wiring that's underlying that that's causing that. So almost like a, a, a, a, a Foundation wiring that's here. And if you have that particular type of wiring in your brain, then there's a very high chance then what that brain is going to, to, to produce as a result of that wiring is AuD- ADHD. And that's fascinating.

    3. APAlex Partridge43:01

       See if there's a marker like that. Do you think it's possible to test for it o- objectively?

    4. SPSpeaker43:08

       Yeah, they're looking at trying to do that. So they're gonna ... Looking at the, um, the f- the, the frontal parts of the brain again. In terms of, um, what they're doing, it's they're separating out the, the part of the brain that, that fires up or, or that they're studying when you've got, um, a, a, a brain that has autism and a brain that has ADHD. And if you bring them both together, and this i- this is the amazing thing with, with tech, that we can see this and we can watch it, is that, well, if you bring the two together and the person has a dual diagnosis, then currently what they're thinking is there's a piece of the brain that's active which is not when you have the two separate conditions co- um, in, in, in the brain when they coexist. This is what they're, they're researching now, which would be amazing because then, like, if that's the case, then, um ... 'Cause Au- AuDHD isn't a formal diagnosis yet, of course. You know, you still have to assess for both separately. But I think if they're able to establish that, and that becomes, um, a way of understanding this, then I think that will be the thing that will jump this into a formal diagnosis which will have its own research. Yeah.

    5. APAlex Partridge44:26

       Amazing. Well, the future's looking very bright.

    6. SPSpeaker44:28

       Yes.

    7. APAlex Partridge44:29

       We're going to-

    8. SPSpeaker44:29

       We're getting there

    9. APAlex Partridge44:30

       ... move on.

    10. SPSpeaker44:31

        Takes a while in psychology. We're a bit slow.

    11. APAlex Partridge44:32

        We're going, yeah.

    12. SPSpeaker44:33

        At glacial speed.

    13. APAlex Partridge44:34

        ADHD-

    14. SPSpeaker44:34

        But we do get there [laughs]

    15. APAlex Partridge44:35

        ... doctors at the forefront of it all. Guests like yourself bringing the exclusives.

14. 44:39 – 51:10

    Audience questions

    1. SPSpeaker44:39

       Yeah.

    2. APAlex Partridge44:39

       The most unpredictable part of the show, Mark-

    3. SPSpeaker44:41

       Yes

    4. APAlex Partridge44:41

       ... is the part where I read out some questions from the audience.

    5. SPSpeaker44:44

       Yeah.

    6. APAlex Partridge44:44

       I put out a post asking for AuDHD questions.

    7. SPSpeaker44:47

       Amazing.

    8. APAlex Partridge44:47

       And the three top questions I'm gonna read out now. From The Washing Machine of Woes, and it's called The Washing Machine of Woes 'cause, for me, it represents memory loss because I always forget my clothes in the machine. However, the Tiimo app, which is the sponsor, does help me. The first question, Mark.

    9. SPSpeaker45:01

       Yes.

    10. APAlex Partridge45:01

        Out of the washing machine, the third most requested [laughs]

    11. SPSpeaker45:06

        [laughs]

    12. APAlex Partridge45:06

        The countdown, three, two, one.

    13. SPSpeaker45:07

        It's a lot of washing this time. [laughs]

    14. APAlex Partridge45:08

        Yeah. Got to test my ability to count down from three here.

    15. SPSpeaker45:11

        [laughs]

    16. APAlex Partridge45:11

        Number three.

    17. SPSpeaker45:12

        Yeah.

    18. APAlex Partridge45:12

        "When I wake up, some days I feel like the ADHD wins and takes over. Other days, I feel like the autism wins and takes over. Is this normal to feel like one condition takes over a whole day or even a week?"

    19. SPSpeaker45:26

        Yes. Absolutely, absolutely. Because the, the nature of AuDHD is, remember, it's dynamic. And I want to use just the example of, of RSD. So if you have RSD, which is, say, problematic, um, depending on the situation, you'll probably have that RSD lingering for a week, if not longer, okay? Depending on what you're dealing with. And you might not necessarily ... If that's kind of really kicking off, then the autism traits might be kind of really suppressed as a result of the RSD being so dominant and active. And if you have another week where, you know, everything's okay and it's not kind of so challenging and it's all right, but then you have maybe, um, a lot of, um, sensory challenges in that week, or things are, um, very social for you, then you might fi- find that you get a bit more, um, of a, a, an ASD burnout or that a, um, the, the more social challenges of ASD are more active. So really just depends on the context and what's happening, but also factors that can influence it too are sleep, your diet, exercise, all of that stuff. So what you're dealing with there is, you know, okay, we've got AuDHD, but then we also have a brain. And so how is that brain that week? And if that brain is, say, loaded up with caffeine or it's hungover from alcohol or anything else, then that's massively gonna exacerbate what happens to that brain that week. So yeah, absolutely. It's completely ... I don't like using the word normal 'cause I don't know what that means. Um, but we would expect to see this, yeah. [laughs]

    20. APAlex Partridge47:16

        Can hormones play a part here? Um, for example, and forgive me if this isn't your area of expertise.

    21. SPSpeaker47:23

        Mm-hmm.

    22. APAlex Partridge47:23

        But i- if, if a, if a woman enters the luteal phase and estrogen drops off, and the focus decreases, couldn't the autistic traits perhaps be elevated there and maybe the ADHD traits were muted a little bit?

    23. SPSpeaker47:36

        Hmm. So what, what we know about hormones is, especially estrogen and progesterone, which are the two main ones, of course, when a woman is going through the perimenopause, menopause, is, um, they drop. And we know that they're responsible for all kinds of things. Those are such powerful hormones in terms of what they influence. So they're responsible for things like emotional regulation. They affect your dopamine levels. So yeah, absolutely. Yeah. Because you're not just dealing now with an AuDHD brain. Because it's been, uh, affected by the reduction in those very powerful hormones, then that has a knock-on effect, and that knock-on effect is, um, it's all chemical and physical in terms of it playing out in the, in the body, but also psychologically how that person is coping. Yeah

    24. APAlex Partridge48:25

        Fantastic. Thank you, Mark. That's gonna be a, a part of a big, much bigger conversation I'm having on the podcast, how hormones i- impact the AuDHD experience.

    25. SPSpeaker48:32

        Amazing, yeah. That's great, though, 'cause it's a, it's a big area.

    26. APAlex Partridge48:37

        Massive. Number two, two comes after three, right? [laughs]

    27. SPSpeaker48:41

        [laughs]

    28. APAlex Partridge48:41

        On the countdown. [laughs] Right, number two, the s- the second most requested-

    29. SPSpeaker48:46

        I was thinking about that one just now [laughs]

    30. APAlex Partridge48:47

        I know, yeah, yeah, yeah, yeah. [laughs] I think my, uh, my ADHD one there over my autism perhaps. I would describe my life as consistently inconsistent. Does this seem to be the case for most people with AuDHD?
15. 51:10 – 56:15

    How to help an AuDHD friend/family member

    1. APAlex Partridge51:10

       If someone is listening who knows someone who has AuDHD and is really-

    2. SPSpeaker51:15

       Mm

    3. APAlex Partridge51:15

       ... struggling with various aspects of it, how can that person help the person that they know who has AuDHD?

    4. SPSpeaker51:22

       That's a great question. Love that. So I'm gonna use the example of my office. So my office is set up a certain way. The light is low. There's ... It's very quiet. There's not a whole lot to look at in my office. It's not bare, but it's not over-stimulating. So the reason I do that is because I want my patients, especially my patients with AuDHD, autism, uh, ADHD, to come into a space that feels relaxing and that isn't going to stimulate their nervous system. So why I'm using that example is create the space. So if you're going to support somebody, you need to be stable. You need to be the stable environment, which means that no overreactions. No, "What?" None of that. No, none of that 'cause the person's already going to be feeling quite vulnerable in, in, in, in talking to you. So you need to be a very stable person, very, very stable in terms of making sure that you're not going to over-stimulate them by the way you deal with the conversation. What I ... So what I do, I always, I always watch the tone of my voice. So I deliberately lower my voice so that the person feels comfortable, and I try not to, to, to have it too high. The other thing I would say as well is ask before acting. So don't do something before you ask. So ask the person, "What do you need? How is this conversation going for you?" So ask before taking any kind of action in terms of what the, the, the, the, the conversation, uh, where the conversation is going. And the final thing I would say with that is when you're having the conversation, it's about the other person. It's not about you. So don't make the conversation about yourself. It's all about them. So keep the focus on them because there's, there's enough stigma, there's enough sense of shame that the person is holding. So what you don't want to do in any way is make them, uh, feel in the conversation that, um, "Well, I don't have a problem with that," or, or, or, "Oh, well, what's, what's, what's going on there?" None of that. It's all about them, so keep the focus on them.

    5. APAlex Partridge53:45

       What about if the person who has AuDHD is a child, and there's a parent watching? 'Cause I saw a piece on social media that said if a child has AuDHD, and it was actually focused on the RSD piece, and the child is being very explosive or is getting very emotional in response to perhaps very benign things, that the parent shouldn't respond or shouldn't match the level of emotion that the child is giving. Because in doing so, you, you're giving a signal that it's okay to have those big feelings, and you're not worried about them. Is that good advice, or is that not good advice?

    6. SPSpeaker54:27

       I think it's, yeah, it is good advice. So, so if a child is showing big emotions and they're, they're dysregulating, the parent wants to be the, the container for that. So if y- if a parent raises the energy, then what that can do for the child is, instead of helping them to be able to kinda come down, it, it overstimulates the big emotion that's already kicking off. So by, by, by being that very stable, very calm, very, um, approachable, I would say, too. So the language needs to be, "I appreciate you're having a hard time. I know this is really difficult, and I'm here for you, and I'm not going anywhere." The, the message that sends to the child is that, that the parent is, is present, is safe. And when they're able to bring the feelings down with the, with the, the, the, uh, the parent present, then the parent can then start to communicate with the child when they're able to talk. But when, when a, when a, a, a child is kicking off with all that big energy, then the, the en- the, the energy and the emotion is blocking any kind of rational conversation or even, uh, behavior that the child can use, uh, effectively. The other thing I'd say with that, too, Alex, is of course, um, like, what's hugely important is that the parent keeps the child safe. Because when a child is, is hugely emotional, they're not necessarily thinking consequentially in terms of what they could do. So they could easily harm themselves accidentally. So it's just really important just to keep that calm and just to keep the child safe as well.

    7. APAlex Partridge56:12

       That's really helpful. Thank you, Mark.

    8. SPSpeaker56:14

       Pleasure. Always.

16. 56:15 – 57:24

    A letter to my younger self

    1. APAlex Partridge56:15

       And just before we finish, I'm going to deliver you a letter that was written by the previous guest-

    2. SPSpeaker56:20

       Oh, lovely

    3. APAlex Partridge56:20

       ... where they wrote a letter to their younger self.

    4. SPSpeaker56:23

       Amazing. Thank you so much. As I take out the mic. [laughs]

    5. APAlex Partridge56:27

       [laughs]

    6. SPSpeaker56:27

       "Dear guest, thank you for attempting to read this letter. My handwriting is terrible." It's not. Honestly, it's not at all.

    7. APAlex Partridge56:35

       [laughs]

    8. SPSpeaker56:35

       "Uh, my message to my younger self is simple. The goal is not to be normal. The goal is to accept yourself and be true to who you are."

    9. APAlex Partridge56:43

       That's lovely.

    10. SPSpeaker56:44

        Yeah. Very, very simple, but also very, um, very positive. And I, and I think that that's a, that's a really good mantra, which is, um, in this letter to, to their younger self, they put normal in air quotes. Because-

    11. APAlex Partridge57:00

        What is-

    12. SPSpeaker57:01

        What is normal? How do you define that? So acceptance is far better than normality, yeah.

    13. APAlex Partridge57:05

        Absolutely. Whoever wrote this, great.

    14. SPSpeaker57:07

        Yes.

    15. APAlex Partridge57:08

        Mark, thank you so much for this incredible AuDHD master class, on behalf of everyone grappling to understand the many internal contradictions and tussles that come with having AuDHD. Thank you so much.

    16. SPSpeaker57:20

        Thank you, as ever, for having me. [upbeat music]

Episode duration: 57:25