Why might someone seek an AuDHD assessment? A conversation with Dr Richard Wilkes

A Conversation with Dr Richard Wilkes (Counselling Psychologist)

The core team at Autism Positive are very excited to be collaborating with Richard to provide AuDHD assessments to young people (12 and over) and adults. Richard has a history of working in Adult Psychology Services, principally working with complex presentations of depression, anxiety, trauma, personality disorder and psychosis. He is trained in all major assessment measures for Autism (ADOS, ADI-R and DISCO) and ADHD diagnostic assessment and currently co-leads a NHS Autism and ADHD service team.

In this conversation blog, we speak with Richard about what signs often get missed when considering a diagnosis of AuDHD. We explore why anxiety, depression, and burnout so often accompany AuDHD, as natural responses to years of effort, masking and self-doubt. We also talk honestly about the nerves that so many people feel before an assessment; the fear of being misunderstood and the hope for validation. 

What are some signs that may have been missed that suggest an adult / YP may have AuDHD?

That is a really good question because Autism and ADHD can make a person ‘look’ more neurotypical, with the hyperactivity of ADHD taking them into more social situations than autism alone would usually assume, and the difficulty in concentrating may make an AuDHD person’s more autistic need for predictability harder to maintain. Equally, that predictability which makes autistic individuals’ seek and adhere to rules can make them sometimes appear less impulsive than we would usually associate with ADHD.

This is perhaps where a major sign is with AuDHD being missed, a deep sense of needing order in routine and living spaces, but a great deal of difficulty and inconsistency in achieving it. This can be reflected in a feeling of push and pull, people with AuDHD may really want to go to a party, but be deeply anxious about knowing how to behave and what to say when they get there: socially there can be an enthusiasm and energy to be involved, but also a recognition that doing so might not follow a predictable path.

Anxiety can be a part of both neurodiversities, and it tends to be somewhat different from the anxieties of the neurotypicals. ADHD can leave people feeling that they have neglected things and scared for the consequences, or that there is much to plan and organise with a mind that only holds a few things, whereas Autism often leads to anxiety with the world and people continuing to be less predictable: trains don’t run on time, people change their minds, loved foods change ingredients.

Because such anxieties, and preferences and thinking, are different from a considerable proportion of the population, a sense of difference is common to both ADHD and Autism. People will often feel that this has always been the case, throughout childhood, and that other people may have a ‘rule book’ or ‘special powers’ that the other doesn’t.

Autism and ADHD are further potentially reflected by someone not having lived a life that might be supposed of them: a bright person not achieving well in exams, or being able to maintain a household when living on their own. If certain areas of your life are well maintained and serviced, but other areas, vast tracks are neglected and chaotic, this could be a sign of either presentation.

What is the link between ADHD, anxiety, depression or burnout? 

This is really interesting because there isn’t a link ‘as such’ (depression, anxiety or burnout are not part of the diagnostic criteria for either) but they often go hand in hand.

Hopefully, what I have said about missed signs reflects on why depression, anxiety and burnout occur more frequently in both conditions. It is a lot of effort for those with autism to change, adapt or mask in social environments, where often people describe having to minutely observe the speech, action and behaviour of others to fit in, frequently being exhausted by doing so; or having to re-orientate to a world that has not worked as it stated it would (trains being on time). There can be anxiety about ‘getting it wrong’ and being picked on or humiliated socially and the need to continue to engage with an unpredictable world and encoded social environment can feel entrapping and depressing.

For ADHD, the potential for things to have been forgotten, or put off, or done with mistakes of inattention, can be anxiety provoking and the strain of continuing to have to make lists, maintain a diary, and put things in places they’ll be remembered, can feel exhausting and straining, leading to burnout if repeated and repeated without room for creativity and escape. This can lead to depression, with having jobs and opportunities that don’t manifest sufficient interest or reward and that, if neglected (many with ADHD have been sacked or disciplined) build towards feelings or failure or hopelessness.

 What would you say to someone who is feeling nervous about being assessed?

 I’d say how very understandable that is. The prospect of diagnosis can feel like a potential validation, or conversely, an anxious threat to a very personal sense of oneself that has developed around neurodiversity.

In order to work with this, I would consider what it is a person would want beyond this, is it help with social situations? Is it help with organisation? Is it an understanding of a sense of difference? Because all of this can be informed by an assessment process, by telling the story that has led to the question of neurodiversity or considering differential diagnoses. It will also, as far as it is able to, consider solutions to the difficulties a person may present with; if someone isn’t neurodiverse it doesn’t mean that an assessment can’t be very helpful for understanding their difficulties in the world.

I would also be mindful that the scope of the assessments we undertake is according to the medical definitions of ADHD and Autism. These are particular definitions of neurodiversity which some groups consider to be too limited. This is an interesting and challenging position and communities welcome those self-identifying. This can be very helpful in finding like minded company and conversations and regardless of diagnosis or not, a greater and stronger sense of self can be achieved on the journey.

Nerves can of course, come from the possibility of shame and embarrassment from the assessment process. This is completely normal and natural, and at autism positive, we actively adapt a non-judgemental and normalising position, very much identifying that struggles and difficulties are common to all of us.

If you are considering an AuDHD assessment for yourself or supporting someone who is, feel free to get in touch with us via our contact form on the website https://autismpositive.co.uk/contact-us/ or email us at autism@talktherapyuk.com

We’d be happy to answer your questions and guide you through our comprehensive AuDHD assessment.