What Female Autism REALLY Looks Like (It's not what you think)

1. 0:00 – 1:20

   Trailer

   1. GRGina Rippon0:00

      Autistic girls and women get very anxious, so they devise this really exhausting technique of camouflaging and masking. They hate being othered, rejected, called weird, which unfortunately is very [laughs] characteristic in their lives.

   2. APAlex Partridge0:13

      Professor Gina Rippon is a revolutionary autism specialist

   3. GRGina Rippon0:17

      Having written multiple books on the topic

   4. APAlex Partridge0:19

      Gina Rippon PHD shares the ultimate guide to live as a woman with neurodiversity

   5. GRGina Rippon0:23

      The autistic brain doesn't seem to be very good at generating rules, so that if you put a person in a situation where the same thing happens over and over again, you can see brain activity changing. Something's coming in the visual system, and there's a message passed to the frontal areas of the brain saying, "Don't need to pay attention to that." Every time they see this sight or hear this sound, it's as though they've never experienced it before.

   6. APAlex Partridge0:43

      Who do you think has it worse, autism, men or women?

   7. GRGina Rippon0:46

      Well, I would say-

   8. APAlex Partridge0:49

      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. A quick trigger warning before we start. References to suicide are made from the beginning. [upbeat music] Gina, welcome.

   9. GRGina Rippon1:18

      Thank you very much for having me.

2. 1:20 – 4:57

   Why Gina wrote ‘The Lost Girls Of Autism’

   1. APAlex Partridge1:20

      You've written a fantastic book entitled The Lost Girls Of Autism. Why was it important for you to write this book?

   2. GRGina Rippon1:28

      That's a good question. Um, and I think I start the book with a confession that effectively this-- it wasn't the book I set out to write. I was asked to write a book about, in quotes, "sex differences in autistic brains." Um, the basis for that request was that as everybody knew autism was a characteristically male problem, we neuroscientists should be focusing on trying to explain why, you know, whether men were particularly vulnerable or women were- had some kind of protective effect. So I-- it was actually a standard neuroscience book. So to start with, I thought, well, I'll, I'll have a look at the evidence there is about sex differences in autistic brains. [lips smack] Um, and brain imaging had been around for about thirty years, and autism has always fascinated neuroscientists. And so a lot of the work right from the beginning has been looking at autistic populations and trying to work out why they experience the world differently, why their behavior led them to get an, an autism diagnosis. And when I did the survey, and it was of o- of over one hundred and twenty different studies, huge consensus, that classic picture that you would get from a neuroscience study was underactivity in those parts of the brain which support social behavior. Um, and that fitted in very nicely with the picture we had of autism from way back i-in the nineteen forties, that, uh, autistic individuals were characteristically loners, weren't interested in social activity, et cetera. So the story fitted in nicely, and I thought, well, if I'm gonna write about-- a book about sex differences in the brain, I need to find out whether this was true of all of the people they were looking at. Um, and it was only when I then went back into the details of all of these papers, over a hundred and twenty of them, that I realized that nobody was actually looking at autistic females anyway. Over seventy percent of the studies were only done on males. And what was also slightly worrying was that academic language, they all talked about, you know, the autistic brain or autistic youth show this characteristic pattern. None of them actually reported, i-if you went right into the tiny little details or the footnotes, you could find out that they were looking at quite small numbers at that stage, sort of maybe twenty or thirty autistic males and one or two autistic females who were just either, uh, discarded as making, you know, the data difficult to look at. But nobody said, "This is only characteristic of this part of the autistic population," which made me think, A, it's gonna be a very short book. [laughs]

   3. APAlex Partridge4:06

      [laughs]

   4. GRGina Rippon4:07

      Um, but B, I ought to find out how this happened. Um, was this just true of us neuroscientists? Had we just bought into the idea that autism was a male thing, and therefore only looked at, um, autistic participants? Or was this a more general problem in the autistic world? Um, to which the answer was yes.

   5. APAlex Partridge4:25

      [laughs]

   6. GRGina Rippon4:26

      Um, so I discovered that, you know, the public perception of autism and educational teachers' understanding of autism, clinicians' understanding of autism, the very tests used to identify autism, to diagnose autism, were all had what I called the male spotlight problem. They were all looking for male individuals who fitted a particular pattern of either diagnostic criteria or just a belief of what autism was like.

   7. APAlex Partridge4:55

      So interesting. And what

3. 4:57 – 7:06

   What female autism looks like

   1. APAlex Partridge4:57

      do the findings of that research show us? Is, I mean, is there a difference in how autism shows up in women versus men?

   2. GRGina Rippon5:03

      Uh, that is emerging now, but also the neuroscience community said, "Oh, you know, now we've got some autistic females, we can look at their brains." And the key issue there is again to do with social behavior, but paradoxically, they seem to respond in a very different way if you put them in a scanner and recreate a, a, a social cognition task of some kind. They respond much more powerfully to negative social experiences in particular. So the picture that we'd had of sort of very little social concern, if you like, being expressed by the social brain, uh, was not true of the population of, of late diagnosed autistic females in particular, because a key characteristic was autistic women were being identified and diagnosed, but only much, much later in, sometimes in twenties, thirties. The oldest person I spoke to was seventy-two. Given that it's a neurodevelopmental condition which is supposedly present from birth-There is something going wrong there

   3. APAlex Partridge6:03

      Gosh, yeah, I bet, I bet that particular woman had a lot to process and unpack

   4. GRGina Rippon6:07

      Well, yeah, I mean, and, and what she said was what so many of the people I spoke to, and also in the, the, the many books, um, that came out about that that was one of the, the changes, these really powerful personal testimonies from late diagnosed autistic women saying, "This is the story of my life to this point when I was diagnosed as being autistic. What a change it made." And almost always says, "At last my life made sense." And certainly that's what the 72-year-old [laughs] said. All the... You know, because these are not people who have, having not been diagnosed as autistic, have lived a, you know, wonderfully fulfilled, a potential achieving life. They've, they've suffered all their lives or they've had difficulties, difficulties with relationships, difficulties with, you know, workplace, et cetera. And suddenly somebody says, "This could be why you experience the world you do and why you treat people the way you do, you behave towards other people," and all of that suddenly made sense, so.

   5. APAlex Partridge7:05

      When

4. 7:06 – 8:54

   The link between autism and depression

   1. APAlex Partridge7:06

      I was researching this episode, Gina, I heard you say a truly devastating and heartbreaking statistic, and that's that women with autism are nine times more likely to die by suicide. Why do you think that is?

   2. GRGina Rippon7:19

      Well, I think that's the end consequence, if you like, the end product of one of the things that has emerged as very characteristic of autistic girls and, and women, is that they get very anxious that they shouldn't, uh, people shouldn't know they're autistic. I mean, unconsciously, certainly when they're younger, that's what's going on. So they devise this really exhausting technique of camouflaging and masking, where they desperately try and fit in with everybody. They hate being othered, hate being rejected, called weird, et cetera, which unfortunately is very characteristic [laughs] in their lives. The statistics on bullying is also pretty awful. Um, and so they go through their lives having all sorts of mental health crises, being either told, "Actually, no, you haven't got a problem." You know, particularly parents trying to get a diagnosis for their daughters. "She's shy, she'll grow out of it," et cetera. Uh, sort of devastating consequences of, of secondary, the experience [laughs] at secondary school education with all sorts of other conditions like eating disorders. What people I spoke to call the diagnostic bingo, where you go through every other label other than autism, are given inappropriate support, inappropriate medication, et cetera. That's what your life has been, um, and you just don't see any end to it, then suicide may be the solution, and suicide ideation is very high.

   3. APAlex Partridge8:44

      With the masking, I think that's just so relatable, and I heard you say girls with autism, they learn to hide in plain sight by camouflaging to fit in.

5. 8:54 – 11:22

   What age to girls start masking

   1. APAlex Partridge8:54

      What age do you think that starts? And is there a correlation with when they are perhaps, uh, they experience bullying for the first time?

   2. GRGina Rippon9:01

      Uh, it starts, we're now beginning to realize, it, it, it was a sort of self-report in late diagnosed autistic women. But if you now start looking, particularly in primary schools, there's some work being done at the moment, um, I think they're identifying girls as young as, as five and six, um, who want to avoid being called weird or othered, et cetera. And obviously they didn't describe it as camouflaging. But you can see what's happening. And there was a, a lovely study done some time ago watching, um, friendship groups in playgrounds, um, and there was always a feeling that girls didn't have the characteristic autistic loner problem, you know, characterized by the little boy standing on his own in the corner of the playground. They, you could see them being part of groups, but if you studied them really carefully, they were kind of hanging around on the edge of these groups. They weren't really part of them, so they would kind of move from group to group. So it starts very young. Um, and the camouflaging, which is trying to blend in, and the masking, which is hiding who you really are, which cause all sorts of identity issues, and you become the, you know, the class clown or the, you know, athletic star or the-

   3. APAlex Partridge10:12

      Yes

   4. GRGina Rippon10:13

      ... the drama queen.

   5. APAlex Partridge10:14

      Yeah, yeah. [laughs]

   6. GRGina Rippon10:14

      Literally. Um, all of that starts very early.

   7. APAlex Partridge10:17

      Do you have any stories, any anecdotes, any people that you know who perfectly encapsulates that struggle?

   8. GRGina Rippon10:24

      Um, yes. I mean, in terms of how they describe their lives, I mean, I, I... Sounds a bit odd, um, recommending other books. There's this huge tranche of personal testimonies, which in fact I recommend at the end of the book and say, "You should read these because you will see yourself in these pages." Um, I mean, I, I think there was, uh, Odd Girl Out was perhaps one of the first ones where people report literally, you know, the, the troubles they'd had. Sometimes they start with, "You know, today was the beginning of the rest of my life 'cause today was the day I was told [laughs] I was autistic." Um, those kind of stories. Uh, Katie Wilde, I think it was, where she talks about the fact that her autism diagnosis saved her life. 'Cause effectively what she'd been through and the difficulties she'd had, um, were leading her towards taking her own life, until she found somebody who realized that what she was presenting was actually autism.

   9. APAlex Partridge11:21

      You mentioned

6. 11:22 – 14:44

   Why autistic girls are bullied

   1. APAlex Partridge11:22

      bullying. I- if we just sort of rewind and focus on that, which I'm sure is gonna be relatable to a lot of the listeners and viewers, what do you think a typical autistic girl would be bullied for?

   2. GRGina Rippon11:36

      Well, it's, it's quite intriguing actually, 'cause I also talk to, um, sometimes, uh, uh, school friends of autistic girls, and quite young children pick up on the fact that some of the children in their class experience the world differently. And this is not the kind of overt, already identified by the teachers special needs children. These are children who just don't quite get the joke, or who insist on monopolizing a conversation, or... And-A- anybody who doesn't fit in, I mean, anybody who's been bullied, uh, will recognize [laughs]

   3. APAlex Partridge12:17

      Yes

   4. GRGina Rippon12:17

      ... w- what it's about, particularly in schools. Um, and particularly, and I hesitate to say this, it seems to be very characteristic female bullying. Uh, it was called relational bullying, where it's not the kind of physical bullying you get with taking somebody's lunch money or whatever.

   5. APAlex Partridge12:34

      You mean female-on-female bullying?

   6. GRGina Rippon12:36

      Yes. Yeah. And it's, it's the sort of subtle bullying where you're, you, you're made aware of the fact that other people don't like you by some kind person telling you, "By the way, I heard so-and-so saying this about you. Isn't that awful?" kind of thing, and which actually characterizes a lot of, um, social media bullying at the moment, which is slightly worrying. So I think, I think the bullying starts very early. A lot of the problems that are being emerging with, uh, girls who seem to have survived primary school, the transition to secondary school, characterized by all sorts of problems which aren't identified as autism, such as eating disorders and self-harm. That's an area where there's a lot of this sort of relational bullying, 'cause it's a time at which there's regrouping of, of social groups which, you know, form and, uh, un-form in weeks, et cetera. And so if you don't understand the rules, then you fall into all sorts of social elephant traps. [laughs]

   7. APAlex Partridge13:35

      Yes, yes. Is, is bullying the major motivator for masking? And you, you're so scared of feeling othered, or is there more going on there?

   8. GRGina Rippon13:44

      I, I think that's, that is a great question. That's certainly something that, um, people report, uh, in their experience. That's very commonly reported. Um, high lev- a very high percentage of, of autistic girls and women report being bullied. But I think the other thing which is interesting in, in terms of the whole why, why masking, why camouflaging, et cetera, is the kind of gendered socialization issue. When it is, um, evident that girls are socialized different [laughs] from boys, I think I- that's a statement one could make.

   9. APAlex Partridge14:20

      Yes.

   10. GRGina Rippon14:20

       Um, and very often that, that girls, um, encourage to fit in-

   11. APAlex Partridge14:24

       Yes

   12. GRGina Rippon14:24

       ... not to stand out, not to seem different, to be compliant, et cetera. So there is that additional pressure where, you know, you, you want to do what you're told.

   13. APAlex Partridge14:35

       Yes. And if you then adapt and you mask and you change who you are, you become one of those chameleons we spoke about earlier.

7. 14:44 – 17:33

   The emotional toll of masking

   1. APAlex Partridge14:44

      What's the toll? What does, what does that do to someone's mental health or self-esteem over time?

   2. GRGina Rippon14:48

      Oh, I, I, it's, it's certainly the association between high levels of camouflaging and, and really quite devastating mental health conditions is, is very strong. Um, because it, it, I mean, one of the issues when it became clear that the whole diagnostic process was missing a large group of individuals, most of whom were female, there was a certain amount of defensive, you know, "Well, um, that's because they weren't picked up by our wonderfully, you know, gold standard autism tests-

   3. APAlex Partridge15:21

      Yes

   4. GRGina Rippon15:21

      ... et cetera." And then when the idea of camouflaging emerged, then there was a bit of, "Well, you know, so they were hiding the fact that they were autism, autistic." And this was a feeling that this was somehow adaptive. But actually, it wasn't, because almost all of the reports are that, you know, "I spent all my time trying to work out how to, you know, fit in with the popular girls, et cetera. It never quite worked." So the kind of low self-esteem that was associated with that is devastating.

   5. APAlex Partridge15:50

      Mm.

   6. GRGina Rippon15:51

      Um, and there is also the neuroscience evidence about how bullying behavior over long periods of time can actually change the brain. So you've got, again, this sort of self-fuling, fulfilling prophecy that you become much, um, more sensitive to-

   7. APAlex Partridge16:07

      Yes

   8. GRGina Rippon16:07

      ... s- negative social events.

   9. APAlex Partridge16:09

      Mm-hmm.

   10. GRGina Rippon16:09

       And so all of that, huge self-esteem. And it is exhausting. I mean, there is this classic story about little girls who are apparently perfect in school, you know. The teachers say, "Oh, she's never any problem when she's with us." Subtext.

   11. APAlex Partridge16:23

       [laughs]

   12. GRGina Rippon16:24

       Um, but that she goes home, and she, you know, turns into a snarling tiger cub and can't cope and screams. And, and then when they get older, they will say literally, if they've managed to survive a social event, they, they literally can go into a kind of almost trance for, like, two or three days. They have to stay in bed, can't get out of bed, burnout. And it can be physical as, as, as, as well as mental. So I think that's, that is the cost.

   13. APAlex Partridge16:50

       Mm.

   14. GRGina Rippon16:50

       Um, and that feeds into the, you know, the devastating consequences with suicide. You know, if you're told all your life that there's nothing wrong with you [laughs] but-

   15. APAlex Partridge16:59

       Yes, yes

   16. GRGina Rippon17:00

       ... your experience of life is that that is not the case, then... And the identity issue too. If you spend all your life pretending to be somebody else, you then have quite a crisis of, "Am I doing this because it's me or because this is, I've always done this? Or have I learned to do this, or is this who I really am?"

   17. APAlex Partridge17:17

       Yes. Is there a, an additional tragic outcome and consequence to masking? If you have such low self-esteem because you've been told that who you really are is defective and broken so many times, can that make

8. 17:33 – 18:38

   Autism and abusive relationships

   1. APAlex Partridge17:33

      you vulnerable later in life to getting involved in an abusive relationship?

   2. GRGina Rippon17:38

      Yes. Yeah, yeah. Um, I mean, not necessarily that later in life, unfortunately. Certainly, there's, um, a big... Because again, if you have some kind of drive, however, wherever it comes from, to be, uh, to belong to a group or an individual or for somebody to appear to, uh, uh, validate your, your existence, as it were, then you will hang on to that. And you, first of all, if you haven't had the social experience 'cause you've been excluded, you don't recognize the kind of red flags about that really isn't normal [laughs] in a relationship. But also, you will put up with a lot, because if it matters so much to you that you are seen as a-Part of a couple, if you like, or, or, or whatever the relationship is, then you will actually put up with a lot in order to maintain that relationship

   3. APAlex Partridge18:27

      I suppose the, the more horrific the experience of that woman, the bigger the reaction she receives when she gets the diagnosis. What

9. 18:38 – 23:13

   How women react to a diagnosis

   1. APAlex Partridge18:38

      reactions typically have you observed when a woman gets that diagnosis eventually?

   2. GRGina Rippon18:43

      Well, quite often the people I've spoken to have been post-diagnosis, and the, the first response almost invariably is, "At last my life makes sense. Um, I've found my tribe." But the second response reported is grief. You know, "My life would have been so different if somebody had recognized why I was struggling and put into place some kind of support early on." 'Cause it is a neurodevelopmental condition, so the earlier you can find a way of supporting an individual, even if it's only via an explanation, i- it's really important.

   3. APAlex Partridge19:16

      Do you think that women, autistic women, deserve an apology from the medical community?

   4. GRGina Rippon19:22

      [laughs] Um, that suggests that there was something deliberate perhaps, and, you know, I'm not into the kinda conspiracy theory. I think it was a self-fulfilling prophecy. Um, very firm statements very early on about, um, what was characteristically autistic. There was-- I mean, being male is, is still not a, a diagnostic criteria. [laughs]

   5. APAlex Partridge19:50

      Yes. [laughs]

   6. GRGina Rippon19:50

      But the, or everything kind of conspired. The case studies that were being collected, I mean, Kanner and Asperger allegedly the fathers of autism, um, Kanner had 11 children that he described in intense detail, and that was the basis of what he, what he described as his picture of autism, which is still really there. I mean, it's been tinkered with and in- increased in various ways over the years. But the, the core problem of it being a social problem, um, remains a, a characteristic of autism diagnosis. He had eight boys and three girls. Didn't comment on the fact that, you know, there were fewer girls than boys, and eight-three, you know, isn't really not that much [laughs] different. Um, Asperger on the other, other hand, only had, um, four boys in the kinda seminal paper where he laid out what he thought autis- autism or autistic psychopathy was. Um, and he did make a f- a, a focus on the fact that it was characteristically male. He talked about extreme male intelligence, which, as we know, played out later in-

   7. APAlex Partridge20:57

      Yes

   8. GRGina Rippon20:57

      ... a different kind of theory.

   9. APAlex Partridge20:58

      [laughs]

   10. GRGina Rippon20:59

       Um, and he did make the statement that, um, he'd never seen a full-blown case of autism in girls. As we also know, which we might get into or might not, uh, history tells a completely different story. Uh, but his focus, you know, did kind of put the stamp that this is more characteristically male. Um, and the other story is another s- trend of, of gender differences that, um, troubled boys are more likely to act out, so you got quite a lot of overt physical violence perhaps, or head banging, disruption in the classroom. So much more identifiable as, as problematic. Whereas girls-

   11. APAlex Partridge21:41

       Mm

   12. GRGina Rippon21:42

       ... being p- quiet and polite, the fact that they stood in the corner and never said anything to anybody-

   13. APAlex Partridge21:47

       Yes

   14. GRGina Rippon21:47

       ... wasn't perceived by a overstretched teacher as a problem there, [laughs] probably a relief.

   15. APAlex Partridge21:53

       [laughs]

   16. GRGina Rippon21:53

       Wish we had more like that. Um, so they were missed. You know, so, so I think that's as-- And then when they got to the case where we've got lots and lots of case studies, we need to make sure we have a more consistent and, in inverted commas, objective picture of what autism is, then you started developing psychometric tests. And the two so-called gold standard tests emerged, which were the observational tests, watching children play or talking to adults about how they dealt with situations, or interviewing the carers, parents, family of, of children or, or, again, adults. Um, those became the gold standard. And of course, they were being devised by looking at the already identified populations, most of whom were male. [laughs] So inve- inve- invariably, the tests then picked that up, so they were very good at, at, at id- or they were-- they had very detailed ways of identifying what an autistic individual looked like, which was characteristically male.

   17. APAlex Partridge22:55

       Mm.

   18. GRGina Rippon22:55

       And they had these, you know, wonderful algorithms, and you got so many points for this, and deducted for that, and this was, you know, if you got a score above X, yes, you're autistic, et cetera. Uh, whereas girls kept failing these tests because they didn't look like autistic boys. [laughs]

   19. APAlex Partridge23:11

       This might sound like a loaded question.

10. 23:13 – 24:44

    Is female autism harder than male autism

    1. APAlex Partridge23:13

       Who do you think has it worse, autism, men or women?

    2. GRGina Rippon23:16

       I-- Well, I would say that females, particularly late diagnosed females, I would say that, wouldn't I? [laughs] But I think, I think evidence supports it, because, um, most of their, you know, early lives in particular, they have a problem, but they are dismissed as, you know, th- this isn't y- y- your, you know, either you're being a drama queen or girls don't get autism, et cetera. Um, and yet the problems they have don't go away. It's not as though if you give them the label, they'll have the problem. If you don't give them the label, they won't have the problem. Doesn't work that way. [laughs] So they have a problem, and they, because they're not given one of the aspects of a diagnosis, which, you know, people will say is a double-edged sword, it might give some kind of validation for the fact that you are suffering. Um, I mean, other people will talk about labels and people, you know, becoming the label they've been given. I think there is a much more powerful argument for diagnosis, saying it gives-- it helps you understand that if you are struggling, it's-Because of perhaps how your brain functions differently, et cetera, but also because, you know, the world isn't maybe designed to fit you. Um, and that's something that's not your fault. It's, it's the world's fault-

    3. APAlex Partridge24:35

       Yes

    4. GRGina Rippon24:35

       ... if you like. Um, so I, I think the wo- women get a double whammy, I think, or, or, um, women on average-

    5. APAlex Partridge24:42

       [laughs]

    6. GRGina Rippon24:42

       [laughs] get a double whammy.

11. 24:44 – 26:05

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    1. APAlex Partridge24:44

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12. 26:05 – 33:12

    Why plans changing causes panic

    1. APAlex Partridge26:05

       of the women I've spoken to on this topic, and I certainly relate to this trait, is really struggling when plans change at the last minute. And for example, in my story, every Monday, I sit down at my computer, and I edit the latest episode of this podcast because the episode goes out every Monday night, and that's my routine. I really enjoy sitting down sort of 2:00 till 6:00 PM. That's my Monday routine. Recently, a couple of weeks ago, my dog got ill, and I had to take him to the vet.

    2. GRGina Rippon26:33

       Okay.

    3. APAlex Partridge26:33

       And obviously, he's my priority, but it really put me in a spiral of panic-

    4. GRGina Rippon26:39

       Mm

    5. APAlex Partridge26:39

       ... because something had interrupted my typical routine. And I heard you speak about this, and you've done a study to show that when the, the pattern in an autistic person's life gets interrupted, it does scientifically induce a panic?

    6. GRGina Rippon26:56

       Yes. I mean, the, the, the study I did was much more about how particular patterns of brain activity change, uh, but it relates to the whole idea of what we call a predictive brain, that our, the, our brains actually function to make the world predictable for everybody. You know, this is ... You know, so everybody, the idea is that you're bombarded with huge amounts of information, vast amounts of information, and if you were s- paying attention to all of it, you'd very quickly go into [laughs] meltdown. So the brain is trying to make your world predictable by constantly monitoring the environment, f- getting feedback about what's going on, saying, "You don't need to worry about that because when that happens, it's ... You know, you don't need to concern with yourself. But if this happens, then you do need to pay attention." So we now think of the brain's activity as a bit like one of a- an AI system, a self-generating, rule-gathering, rule-generating system, which makes the world nice and predictable for us, so we can, we can co- It's not, not rigid, that the, the healthily functioning predictive brain is not rigid. It allows for a bit of leeway. Um, but generally it means that you can steer through your life. Most of us have a routine of some kind, like Monday morning, you know, whatever. Um, and most of us get annoyed if it's interrupted in some way, but we can generally cope 'cause you think, "Oh, I'll do it tomorrow. You know, it doesn't matter. I know it, it doesn't matter if I don't do that." The autistic brain seems not to have that kind of function, in two ways. First of all, it doesn't seem to be very good at generating rules, so that if you put a person in a situation where the same thing happens over and over again, and you can see that in the brain. Generally, the brain, you can see brain activity changing, almost as though there's a, right, you know, something's coming in the visual system, and there's a message passed to the frontal areas of the brain saying, "Don't need to pay attention to that," and gradually that part of the brain's activities will reduce. Whereas if you put an autistic person in a situation like that, they never seem to get the idea that, you know, things, things can come predictable. It's, it's like every time they see this sight or hear this sound, or even in a social situation, it's as though they've never experienced it before. And of course, that puts you on high alert because the other thing is, you know, the brain's trying to say, you know, "Save your resources for when you really need them." But if every time something happens, you really, really need them, then you think, um, you know, eventually things get really, really alarming, really unpredictable. And that could be the basis of something that isn't looked at so much, uh, in autism because the kind of social presentation is characteristic, is what we call really is, um, uh, restricted interests, repeated patterns of behavior. It could be spinning, head, head banging, um, hand flapping, et cetera, or very, very focused interests on a particular, very narrow, unusual, obscure sort of knowledge. It's almost as though your brain can't help you make the world predictable. So if you can surround yourself with nice predictable movements, like hand flapping, for example, that can help you calm down because effectively, your brain is always on high alert unless there is something which helps you calm down. And-Although the work I've been doing is very much the kind of much more nerdy, technical end [laughs] , um, that it, it is clear that you can apply that not just to sights and sounds and ex- explain why autistic individuals have problems with bright lights or, or loud sounds, but also with social situations, which by definition almost are unpredictable. Um, so you can say, well, the world isn't predictable. They, they, they go into high alert. They've found ways, and this sort of stimming or self-stimulating behavior is actually helping them calm down because they say, you know, everything's going wrong, the school bus is on a different route, um, or the, the plane's delayed, et cetera. Um, and so if you can start to introduce something predictable into your world, be it hand flapping or spinning or, or whatever, or even, um, uh, skin picking or the girls-- some of the girls I've spoken to, their school cardigans always look like lace 'cause they pick at them under the table 'cause they're hiding-

    7. APAlex Partridge31:25

       Yes [laughs]

    8. GRGina Rippon31:26

       ... the fact that they're stimming, et cetera. So I, I think that, that, the, the whole resistance to change and these kind of repetitive behaviors and why you do them is, has not been so much the focus. It's always been the s- social behavior 'cause that's how it presents. But I think that's something that, um, i- i- is why there is this kind of panic, um, and why social situations, if you ... it's, it's, you know, it's a bit like a phobia. You're so anxious that something will go wrong in this situation that you actually don't engage with the situation-

    9. APAlex Partridge31:59

       Mm. Yes

    10. GRGina Rippon32:00

        ... um, because you think, you know... And then, of course, it becomes reinforcing 'cause you obviously haven't experienced-

    11. APAlex Partridge32:05

        Yes [laughs]

    12. GRGina Rippon32:05

        ... whatever it was that might have made you panic. Um, so you become more and more withdrawn, and then you get the picture, the kind of isolated person.

    13. APAlex Partridge32:14

        So interesting. The stimming is, is relaxing. I think for me, my weekly routine is a stim-

    14. GRGina Rippon32:20

        Yes

    15. APAlex Partridge32:20

        ... but on a much larger scale.

    16. GRGina Rippon32:22

        Yes.

    17. APAlex Partridge32:22

        So the idea of being able to just move my Monday podcast editing to the Tuesday, for me, is unfathomable because Tuesday, no, that's already booked up with-

    18. GRGina Rippon32:30

        Yes

    19. APAlex Partridge32:30

        ... going to the gym.

    20. GRGina Rippon32:30

        And the world is now completely different. You know, everything's changed. Yes. There was a, a, a story, um, about a, a very young girl, I think she was called Anne, and she used to go into complete panic when she was put in one of the, um, playrooms at the nursery, and it had, um ... it was a wallpaper with lots and lots of little teddy bears on it. I mean, and, and they weren't moving. But when she went into this room, um, and she was moving, she wasn't getting the feedback that, you know, the, the wallpaper isn't moving, it's you. So she was just surrounded by hundreds and hundreds of little teddy bears crawling over the wall, which unsurprisingly led to a certain amount of panic.

13. 33:12 – 43:36

    AuDHD (when you have ADHD and autism)

    1. APAlex Partridge33:12

       Gina, many of the autistic girls that we've spoken about in this episode likely also have ADHD, or at least ADHD traits. In fact, the, the, the studies suggest 50 to 70% of autistic individuals have ADHD, uh, and 30 to 80% of children with ADHD have autistic traits. And so I suppose if we zoom out just a little bit, from your understanding, what do you think the differences are between ADHD and autism?

    2. GRGina Rippon33:42

       To some extent, bearing in mind that until 2013, um, you could only be diagnosed with autism or ADHD, they, they didn't co-occur. So there was already a feeling that they were almost, um, mirror images of each other, which when you read the descriptions of them, kind of makes sense. Um, I mean, clearly most of my experience of, of, of conditions like this is, is in autism, but obviously, as you say, uh, there's a large number of, of individuals have, autistic individuals have ADH trai- ADHD traits. Now, that kind of brings up the whole issue of what you actually mean by having ADHD or autism, because, um, it's certainly the case that autistic individuals could have, um, unusual patterns of attention. Does that actually mean they are ADHD as well? Uh, uh, I think, I think that's, that's the issue, bearing in mind these are both conditions, well, all such conditions are really judged on how people present, not necessarily how they experience the difficulty, but how they present-

    3. APAlex Partridge34:53

       Yes

    4. GRGina Rippon34:53

       ... when there's a clinician-

    5. APAlex Partridge34:54

       Yes

    6. GRGina Rippon34:54

       ... testing them. I think what's interesting is that the ... for example, if you had an autistic indivi- individual who also, um, wasn't quite as, uh, if you scored them on a test, you know, they, they did show a certain amount of s- maybe social spontaneity, for example. So very often there are tests within, you know, social behavior where, uh, autistic individuals would score highly on rigidity. You know, you are, "This is how I always behave. This is how I expect my day to be," et cetera. Whereas an ADHD individual might have much more spontaneous, "No, I'm terribly disorganized. I don't plan. I don't have a schedule," et cetera. Um, but each of those, um, you know, there's not an absolute, you know, you are always like this or always like that. So there could be a huge amount of variability within both the autistic individual or group of individuals and ADHD individuals, where you sort of strayed slightly, um, you were slightly more spontaneous than a full-blown autistic assessment might suggest. Um, but that actually also indicates problems with the diagnosis itself, because it is based on the idea that these are so-called pervasive developmental disorders, so you are always socially rigid or always disorganized and spontaneous, which any autistic or ADHD [laughs] individual would tell you is just never the case. So in a way, it could be that, you know, on another day or with another clinician, if you had high levels of ADHD traits, you might have got a diagnosis of ADHD and not autism.Um, so I, I, I think it, it says a lot about the insistence that these, this is a kind of set pattern of behavior, because it's not. Um, so people who have a clear picture of what it's like to be autistic are quite surprised if they find that somebody can be spontaneous, or they're not as upset by something changing as the pattern that you have in your head of what they should be like. So it, I, I think it illustrates quite clearly that we don't really know exactly what autism is or exactly what ADHD is.

    7. APAlex Partridge37:09

       Yes. [laughs]

    8. GRGina Rippon37:09

       Um, which a kind of weaselly way of saying that, you know, I, I, I, I'm sure there are high levels of ADHD traits in autistic individuals, 'cause you're looking at the same patterns of behavior, bearing in mind. It's not as though they're a completely different set of behaviors which would get you diagnosed as ADHD. They are referring to the same behavioral repertoire. Um, and it's, it's a bit like, um, somebody I spoke to who talks about a bit like a mixing desk where, you know, you can crank up the volume or, this would demonstrate how little I know about m- mixing desks, but, or you can, uh, change the tone or, or, or the frequency of the signal or whatever at any one time, and that would be the same of people's brains [laughs] and also of their behavior. Um, and I think it's interesting that now we're looking at the emergence of a condition which the individuals who feel that they, um, present with that condition call AuDHD, where there is a kind of co-occurrence of, of the symptoms. Um, it, I, I use that term advisedly-

    9. APAlex Partridge38:15

       [laughs]

    10. GRGina Rippon38:15

        ... signs. Um, which, which might get you on one day have got you diagnosed as autistic and another day diagnosed as ADHD, and I, I do think that could be the case. So the fact that there's now a feeling that there's a separate condition which, uh, incorporates some aspects of autism and some aspects of ADHD is intriguing. But I think it actually talks about the variability, because otherwise it's assumed that if y- if you're always autistic, then, then you can only be autistic. The fact that on another day you might appear, present as more ADHD actually tells you about the variability of these patterns of behavior that clinicians are observing.

    11. APAlex Partridge38:56

        That's so interesting. I think, depending on what time of day it is, if I had my autism assessment in the morning, I might not get that diagnosis. If I had my ADHD assessment in the evening, I probably wouldn't get that diagnosis. For example, on a day when I come up to London, in the morning I'm full of energy. I'm driven by a motor. I'm super excited to get on the train, come up here, meet the guest, do these interviews, go into problem-solving mode. If I had my ADHD assessment during that presentation, I imagine I would score very highly-

    12. GRGina Rippon39:28

        Mm

    13. APAlex Partridge39:28

        ... and even probably low on the autism score.

    14. GRGina Rippon39:31

        Yes.

    15. APAlex Partridge39:31

        However, when I get home, my social battery completely disappears. I almost go non-verbal, lie on the sofa, really can't do any socializing, but also very happy to be on my own. And if I had my autism assessment at that time of day, perhaps I would-

    16. GRGina Rippon39:43

        That's what, yep

    17. APAlex Partridge39:43

        ... wouldn't get the ADHD diagnosis.

    18. GRGina Rippon39:45

        Yeah, you answered your question. [laughs]

    19. APAlex Partridge39:47

        You're almost like your own yin to your own yang.

    20. GRGina Rippon39:49

        Yeah, yeah.

    21. APAlex Partridge39:49

        And it can be very exhausting, very confusing.

    22. GRGina Rippon39:51

        Yes. It, I think the confusion is, is relevant because if you, say, had an ADHD assessment, then, you know, you may find out all about it and think this is, this is, oh, yes, that describes me, and then you might think, but that doesn't really describe me, or that describes me on a Tuesday and not a Wednesday or whatever. So you then start to get confused, and I think that's an issue. But it's also quite interesting that, that the ADHD symptoms could mask the autism symptoms or the other way around. Um, and so we come back to this idea that, um, but in that case, this is not a, it's not a deliberate choice. It's, it's a, it, it can be a conscious choice in that I want to, you know, belong to this popular girls group, so I'll behave in a way that hopefully will get me included. Um, but it could be that, that, that, um... So, so that's a kind of individual choice, but it's something that clinicians to be awa- need to be aware of, so that, you know, because these questions are very prescriptive. You know, how do you deal with situ- You know, I always get anxious before a, a social event. Yes, no. But it could be, well, it depends what the social event is or if, you know, where, what I have to do to get there. And so there's always kind of qualifications, um, which might reveal more about, you know, the fact that there is, you know, attentional difficulties, social difficulties, you know, difficulties with being spontaneous or, or, or et cetera. So I, I think all of these are people seeking explanations. If the term autism, um, isn't, doesn't really capture how you feel you experience the world, and the term ADHD doesn't, uh, capture that, then the idea that you might be able to put them together and call them AuDHD, but then we might get, you know, 10 years down the line where we have type 1 AuDHD, [laughs] type 2 AuDHD-

    23. APAlex Partridge41:45

        Yes. [laughs]

    24. GRGina Rippon41:45

        ... or whatever. Yeah.

    25. APAlex Partridge41:47

        I certainly score highly on the autism questionnaire, but also the ADHD questionnaire, and it, I feel like it can create a huge amount of frustration internally. I fantasize about having a tidy flat or an organized wardrobe or a, or being able to go to the supermarket and buy a week's worth of shopping and plan seven meals in a row. But the other half of my brain just, just completely collapses and falls into an overwhelming paralysis, and I'm unable to do it, and it's almost like, I had a guest describe it as an internal tug of war, like a push and pull-

    26. GRGina Rippon42:19

        Yes. Yeah, yeah

    27. APAlex Partridge42:19

        ... constantly fighting against-

    28. GRGina Rippon42:20

        Yes

    29. APAlex Partridge42:20

        ... yourself, and-

    30. GRGina Rippon42:22

        Right
14. 43:36 – 45:46

    The key to thriving with autism

    1. APAlex Partridge43:36

       What do you think the key is that will enable somebody to cope, whether they are autistic, ADHD, or AuDHD? What do you think is the one key that will enable that person to live in harmony with their difference?

    2. GRGina Rippon43:53

       What, just the one? [laughs]

    3. APAlex Partridge43:54

       [laughs]

    4. GRGina Rippon43:54

       God. Well, I think, I think self- self-awareness, self-understanding.

    5. APAlex Partridge44:00

       Mm.

    6. GRGina Rippon44:00

       However you achieve that, even if it's, you know, by a diagnosis or by informing yourself. I mean, one of the good things about, uh, you know, the internet is there are a lot of amazing resources out there. Some of them are not, you know, as helpful as you might like, but it, it does mean that you can very instantly find out that, yes, I have this experience too, and this is what I, I do about it. So self-awareness, um, self-reassurance, I think that's really powerful. Um, and I think this is the basis of a lot of sort of therapeutic interventions. You know, it doesn't matter that this happens, um, it happens to everybody, or here's a way of dealing with that. So but that, of course, is then, you know, putting the burden on the individual. I think the other thing that, with any of these issues, is what kind of workplace, whatever, adjustments could be made, um, or could you ask for, you know, uh, in order to make life better for you. Um, but that's, you know, again, it's, it's, it's the, the individual bearing the burden as opposed to the workplace saying, "How can we be more inclusive? Um, and what changes might, might, might, might make life easier for you?"

    7. APAlex Partridge45:18

       Yes, yeah. So super fascinating. I speak to a lot of women in this conversation, and they have the coping strategies in place. They have that scaffolding around them through experience. They understand what helps and aids them, or at least removes the friction in some areas of their life. But then perhaps at certain stages of the month and the hormonal cycle, things start to shake.

    8. GRGina Rippon45:40

       Yes.

    9. APAlex Partridge45:40

       The foundation becomes a bit unstable. Sometimes the, the scaffolding completely collapses.

    10. GRGina Rippon45:45

        Mm.

    11. APAlex Partridge45:45

        So what

15. 45:46 – 54:29

    How hormones impact autism

    1. APAlex Partridge45:46

       is going on? When, when the hormone cycle, when the woman goes through that, how is that affecting the traits-

    2. GRGina Rippon45:51

       Yeah

    3. APAlex Partridge45:51

       ... of the autism?

    4. GRGina Rippon45:53

       I, I think that's, that's a great question. Um, and in fact, i- it's, we're not very well informed about that, partly because we haven't been looking at autism in women, um, and, and the relationship between hormone fluctuations and behavior, um, which is, you know, clearly being studied in, in things like, um, uh, premenstrual disorders, et cetera. So we, we have an understanding of how hormonal changes will affect behavior. I mean, the word hormone means drive to action, so obviously things will happen, things will change. Um, sometimes we've been a bit protective about, use the word advisedly, weaponizing women's biology against them because, you know, if you give the impression that, you know, you're some kind of biologically unpredictable because of these hormone cycles. So, so hopefully that, that's slightly behind us anyway. Um, but I think that's absolutely right. And I think, again, because a lot of the time, although I've sort of, you know, talk about how autism presents itself and we don't have a biomarker, I mean, I'm very much of the, you know, we are a, a biological script playing out on a social stage.

    5. APAlex Partridge47:02

       Yes.

    6. GRGina Rippon47:02

       So I do think, however we characterize it, um, the autistic brain ex- leads the, its owner to experience the world differently. So there are biological effects which will change our behavior, and then how we interact with the world will then, um, change our brains. So ignoring biology, we do that at our peril, and I think that's very true of, of hormones. I mean, having focused on the brain in all my research career, you know, I might like to come back as an endocrinologist and, and have a look at hormones as well. But I think, I think that's absolutely right, and I think because there are thresholds, I mean physical thresholds as well. You may have the scaffolding in place, but we know that the kind of masking, camouflaging, et cetera, can be exhausting, which is okay when you're physically at your best, um, or not being challenged physically. But if that changes, then the scaffolding is no longer fit for purpose. Um, and it, I'm, I'm finding it m- more recently since I wrote the book and, and have been, uh, you know, having interviews with people, et cetera, that the whole issue of perimenopause and the menopause for late diagnosed women, I think is, would be a really interesting area to look at because these are women who, on the surface, have looked quite successful. Maybe they've had a career, they've got a family, um, and then, you know, maybe early 40s or something, things suddenly start to get difficult. They, um, they find things more challenging. They become emotionally much more volatile. Can't think of, you know... The life around them doesn't appear to have changed, but it's very much, it appears to be associated with the perimenopause, and I think-Anecdotally and in terms of evidence base, it's increasing. There is a relationship between the ap- the perimenopause and the appearance of, of, of, or the eventual identification of, of autism-

    7. APAlex Partridge48:57

       Right

    8. GRGina Rippon48:58

       ... in women.

    9. APAlex Partridge48:58

       Yes. Do you have any real-life stories of women that you know who have gone through this? And because for some people, their scaffolding might be their sobriety, or it might be keeping depression at bay, or it might be trying to, like, maintain some social connection so they are less anxious, but perhaps when they hit menopause or come into perimenopause, that falls away. Perhaps they relapse, perhaps their addiction wins-

    10. GRGina Rippon49:24

        Yes

    11. APAlex Partridge49:24

        ... or even worse.

    12. GRGina Rippon49:25

        Yes.

    13. APAlex Partridge49:25

        Do you know any women who have been through this?

    14. GRGina Rippon49:28

        Well, yes. I mean, uh, there's some... An, an in- individual I spoke to who's, who was hit very badly at menopause, to the extent I think she was bedridden for almost a year, had to that point been a very successful individual. Um, she'd been quite successful in, um, in business as an engineer, as she ran her own business. Uh, she was part of the armed forces at some point, had a family, um, had moved countries, et cetera. So a long list of achievements, and then hit this, or as she would now describe it, a physical wall, where she actually, um, physically couldn't get out of bed, but had no explanation for that because everything else she'd been doing, there wouldn't, hadn't been some kind of trauma or crisis in her life. Um, and I think, and I, I, I don't know any personal stories of addiction, but I think that's certainly something that, you know, emerges again. Um, perhaps obsessions, uh, OCD is another presentation where somebody, "Oh, you're not autistic, you've got OCD," et cetera-

    15. APAlex Partridge50:36

        Yes

    16. GRGina Rippon50:36

        ... kind of thing. So those, those kind of things, because they will change the threshold. I mean, how we cope, anybody who's had any kind of long-term stress and suffered from the physical consequences of that. In a way, it's almost like, uh, somebody... In fact, another person I spoke to, she said, "I now realize in my early 20s that I was suffering from an equivalent of post-traumatic stress disorder because of, uh, my experiences at, at school." Um, and you know, really invisible struggles that she'd had and had got no help with and assumed there was something wrong with her, just meant her trying to camouflage, which was hugely a chronic stress situation, which, you know, it eventually caused what we now call PTSD, effectively.

    17. APAlex Partridge51:25

        We speak a lot on this podcast about that early trauma and those many, many more criticisms somebody who perhaps is neurodivergent, ADHD, autism, will receive, 20,000 extra micro criticisms, early year rejections from their peers, comments like, "You know, you're too sensitive. Why are you so weird? You're too much," thousands of comments like that.

    18. GRGina Rippon51:47

        Yes.

    19. APAlex Partridge51:47

        Even a non-verbal, like an eye roll-

    20. GRGina Rippon51:50

        Right, yeah. That's-

    21. APAlex Partridge51:52

        ... that they pick up, they pick up on it.

    22. GRGina Rippon51:52

        Mm.

    23. APAlex Partridge51:53

        And it, over the years, creates a traumatic response, and it makes you very fearful of criticism or rejection as an adult-

    24. GRGina Rippon52:00

        Yes

    25. APAlex Partridge52:00

        ... and it turns you into a fawn, a, a people pleaser, a perfectionist, or someone who just won't approach awkward conversations because it feels safer to hide and to not let, you know, stand up to that friend who's walking over you, or you-

    26. GRGina Rippon52:12

        Yeah

    27. APAlex Partridge52:12

        ... won't apply for that promotion, or you'll stay in that abusive relationship because it just feels safer to protect yourself-

    28. GRGina Rippon52:18

        Yes

    29. APAlex Partridge52:18

        ... from any, any conflict or combative-

    30. GRGina Rippon52:21

        Mm
16. 54:29 – 57:58

    Groundbreaking new autism research

    1. APAlex Partridge54:29

       any groundbreaking new research, new studies that show anything insightful in the ADHD autism space that we might not have heard here before-

    2. GRGina Rippon54:38

       Okay

    3. APAlex Partridge54:38

       ... particularly in the female sector?

    4. GRGina Rippon54:40

       Well, I think for me, the key breakthroughs which I'm looking at is, um-Looking at relationship between patterns of camouflaging and response to social situations in the scanner. So we're now looking at the areas of the brain which are most activated by self-reference, s- self-esteem, et cetera, the frontal areas of the brain. Putting somebody in a scanner and, um, demonstrating how much more reactive they are in what I would call the chameleon [laughs] autistic individuals, most of whom are female, um, than they are in the canner-type, uh, uh, autistic individuals. So it is starting, we are starting to get a pattern of ... You know, as a neuroscientist, I find this exciting. So we actually say, "This is how the brain is working." I mean, I'm not saying, you know, we're born with a brain like this, because looking at adult females in the scanner, if they're individuals that we know have suffered much higher levels of bullying throughout their lives, then i- that's ... Are we looking at that in the scanner? As opposed to we are born with a brain which is much more socially sensitive, um, for example. Or both, you know? You ... Not, not either or. So this is the classic nature versus nurture interaction. Please don't say, "Is it nature or is it nurture?" It's never, very rarely one or the other. It's almost invariably both. So I think those are exciting. Um, I think the predictive brain work that we talked about earlier is, could prove really exciting for a big-picture approach to understanding why autistic individuals experience the world differently, and I think that's also giving a better perspective, because you've listened to autistic individuals, what is it you find difficult about the world? Um, let's see if our scanner can, um, mirror that in some way. As opposed to the old approach was, "You're autistic. This is how you experience [laughs] the world. I'm gonna put you in the scanner and give you a task, which you'll, you know, I'll know you're bad at, and, and, and we'll scan your brains accordingly." So I think that general shift, um, in getting the individuals you're scanning to be part of the questions you ask, somewhat shame- [laughs] shamefacedly admitting that's probably is something new, I think that's exciting. But the camouflaging work, I think, is really interesting.

    5. APAlex Partridge57:04

       Very interesting. So it is i- sort of shifting it from the subjective to the objective in terms of, uh, the, the quantitative understanding.

    6. GRGina Rippon57:11

       Well, in a way, it's, it's hoping that you're doing both, because, I mean, the issue about, you know, are gold standard autistic tests were demonstrated to be more objective so that everybody came up with the same, you know, wherever you went to have your autism assessment, you'd get the same answer. Clearly not the case, because the clinicians are interpreting what they see. So in a way, you could say we're never gonna be truly objective, so wouldn't it be better to harness the subjectivity and find a way of regulating that in a particular way? Um, which, you know, i- in a way, is the whole history of psychology research [laughs] trying to, trying to get away from the subjective and then saying, "Actually, maybe the subjective is, is, is more relevant." So I, I, I think that, that would be part of it.

    7. APAlex Partridge57:57

       I want

17. 57:58 – 1:03:22

    Audience questions

    1. APAlex Partridge57:58

       to move on to the audience questions, which are in the washing machine of woes.

    2. GRGina Rippon58:04

       [laughs]

    3. APAlex Partridge58:04

       If I can reach it. And it's called the washing machine of woes because, for me, a washing machine represents memory loss, because I always forget my clothes in the machine after the cycle has finished. And I do always ask all of my guests, to make me feel less alone, do you forget your clothes in the washing machine after the cycle's finished?

    4. GRGina Rippon58:24

       What, you mean leave them in there?

    5. APAlex Partridge58:25

       Do you leave them in there, yes.

    6. GRGina Rippon58:26

       Um, no. I'm, I'm afraid I'm more of a let's get them out and ideally hang them on the line. [laughs]

    7. APAlex Partridge58:34

       [laughs] Oh, God. Now I feel terrible. [laughs]

    8. GRGina Rippon58:36

       Do you mean you only discover them when you go in with the next load of washing and the other one's still in there, or-

    9. APAlex Partridge58:41

       Yes. I-

    10. GRGina Rippon58:41

        Right. Okay

    11. APAlex Partridge58:41

        ... yeah, go to fill it up again, and I haven't emptied the previous load, and it needs another cycle.

    12. GRGina Rippon58:45

        Right.

    13. APAlex Partridge58:45

        It's the ADHD tax. It's that extra money you spend on more water, more electricity bills-

    14. GRGina Rippon58:51

        Right

    15. APAlex Partridge58:51

        ... 'cause you have to run another cycle.

    16. GRGina Rippon58:52

        Okay.

    17. APAlex Partridge58:52

        I have been using the Tiimo app, um, and they do really help me remember to empty my washing machine, but I'm still a work in progress.

    18. GRGina Rippon59:01

        Right. Okay.

    19. APAlex Partridge59:02

        This week, Gina-

    20. GRGina Rippon59:04

        [laughs]

    21. APAlex Partridge59:04

        ... somebody has written in to the washing machine of woes and asked, "What are some of the biggest weaknesses that come with having both autism and ADHD, and what are the strengths?"

    22. GRGina Rippon59:19

        Ooh, how long have we got? [laughs] Um, I think the weaknesses, you might say that, um ... This comes back to masking.

    23. APAlex Partridge59:26

        Yes.

    24. GRGina Rippon59:27

        Uh, it, it, it might n- not allow you to present in a way that people would understand. So they would think, "I don't ... What, what are you on about? You're always very sociable," and, you know, um, or, "You're always very organized and tidy," et cetera. So, uh, neither of those are really weaknesses. Having both could cause that problem. Um, I think the strengths is really important, because in a way, the, for example, um, n- not being socially very, very rigid, actually not being panicked, if you like, coming back to our predictive brain. You know, if your predictive brain wasn't very, very rigid and said, "Unless it's exactly like that, I can't cope," if your predictive brain wasn't perhaps as predictive as it could be but was enough to say, "Okay, let's shift that from Monday to Tuesday, and nothing bad is gonna happen." [laughs] So if that was the ADHD making your predictive brain a bit more elastic, that would be a strength of having both. Um, I mean, people with both might say they wish they didn't have either.

    25. APAlex Partridge1:00:34

        Yes.

    26. GRGina Rippon1:00:35

        Um, but in a way, given that they're both neurodevelopmental, you'd never know, because you've always had them [laughs] as it were.

    27. APAlex Partridge1:00:41

        Yes.

    28. GRGina Rippon1:00:42

        You didn't suddenly have a, have a, have a problem. So I think, I think the strengths, um-An autistic person having ADHD traits could allow them to be more recognizably accepted by the social world. Um, but there would still be, you know, this effort going on. Whereas the ADHD person with autistic traits might find that although they're, they had five lots of thoughts in their brain at the same time, the autistic [laughs] person in their brain might allow them to pursue maybe one or two, or maybe all five of them, but maybe focus on one or two, allow them to focus more. So they would go into depths in things, um, that would help them p- produce and, and not fail as they often feel they do.

    29. APAlex Partridge1:01:37

        Do you think, Gina, that somebody with autism has a heightened sense of pattern recognition than somebody without autism? And if they do, are they able to detect somebody's intentions? Are they able to spot somebody who's not being genuine? Are they better at spotting liars?

    30. GRGina Rippon1:01:56

        I, I think the evidence certainly suggests that autistic thinking makes them better pattern seekers, much more creative. I think it was... I can't remember. It was Temple Grandin said, "If, if there wasn't autistic thinking, we'd all still be living in caves being nice to each other."
18. 1:03:22 – 1:03:44

    A letter to my younger self

    1. GRGina Rippon1:03:22

       To my younger self, you don't need to rush it. Take your time. Breathe. Enjoy the journey. Life is precious. Great thoughts. [laughs]

    2. APAlex Partridge1:03:32

       Lovely ending. Lovely. Gina, on behalf of everyone grappling to understand their brain, thank you so much.

    3. GRGina Rippon1:03:39

       Thank you. Thank you very much. Very interesting. [laughs] [upbeat music]

Episode duration: 1:03:45