ADHD + multiple diagnoses

Question 1

Statistics of the association between ADHD + autism

Answer 1

• Up to 85% of individuals with autism exhibit significant ADHD symptoms (Leitner, 2014)
• Prevalence of ADHD in general pop is around 5-10%, indicating a higher likelihood of ADHD symptoms among those with a diagnosis of autism (APA, 2013)

Question 2

Definition of ADHD

Answer 2

Attention Deficit/Hyperactivity Disorder (ADHD) is defined by a combination of symptoms of:
- Inattention
- Hyperactivity/impulsivity

Question 3

Does ADHD have subtypes + are there 2 condtions?

Answer 3

Diamond (2005): ADHD with hyperactivity is a separate disorder from ADHD purely inattentive (‘ADD’)
- Different neurological profiles:
-ADD -> working memory + processing speed
-ADHD -> inhibitory control
- Different patterns of comorbidity
- Different patterns of social impairment
But mixed evidence from other studies

Question 4

Are different diagnoses distinct?

Answer 4

Kaplan et al. (2001)
- Sample of 179 children, all had dyslexia and/or ADHD
- Comprehensive assessment for ADHD, dyslexia, DCD + psychiatric disorders
- Comorbidity the norm, not the exception. So if you have a single diagnosis, the chances are that some important needs are not formally recognised

Question 5

Definition of autism

Answer 5

Defined by deficits in social functioning + communication, and in repetitive behaviours/restricted interests

Question 6

What is Specific language impairment (SLI)?

Answer 6

Diagnosed in children when language does not follow typical developmental course
- Not due to hearing loss, physical abnormality, acquired brain damage
- Normal development in other areas
- Problems with language structure + with non-word repetition

Question 7

What are the chances that children have ASD + SLI together?

Answer 7

SLI prevalence: 7%
ASD prevalence: 1%
Predicts comorbid 7 per 10,000

Question 8

Describe the comorbidity of SLI + ASD

Answer 8

• Many children with ASD have language problems similar to SLI
• Kjelgaard & Tager-Flusberg (2003): poor nonword repetition + use of verb inflections; 76% ASD with LI
• Loucas et al (2008): epidemiological sample, cases with ASD + normal nonverbal IQ + impaired performance on a langauge battery: 57% ASD with LI

Question 9

What ‘causes’ disorders?

Answer 9

A single cause approach is too simple when looking at disorders such as dyslexia, SLI + autism so identifying risk factors is a more fruitful approach

Question 10

What is masking/camouflaging in ADHD?

Answer 10

Involves hiding or modifying one’s natural behaviour to conform to social norms or reduce stigma (Livingston et al, 2020)

Question 11

Why does masking occur?

Answer 11

People with ADHD mask to fit into social environments, avoid negative judgements, or manage expectations (Hull et al, 2022)

Question 12

How is mental health relevant to masking?

Answer 12

Masking can hinder accurate diagnosis + lead to underdiagnosis or misdiagnosis, especially in girls + adults of both sexes with ADHD who may present atypically (Russell et al, 2019)

Question 13

What are common masking behaviours in ADHD?

Answer 13

Suppressing impulsive actions, imitating neurotypical peers, or actively monitoring body language + speech patterns to appear more socially acceptable (Livingston et al, 2020)

Question 14

What are the gender differences with masking in those with ADHD?

Answer 14

Studies indicate females with ADHD are more likely to engage in masking due to higher societal expectations for social conformity (Quinn & Madhoo, 2014)

Question 15

What is the prevalence for masking in those with ADHD?

Answer 15

Hull et al (2022) found over 60% of adults with ADHD reported frequent camouflaging behaviours which may explain high rates of late diagnosed ADHD in adults

Question 16

How accurate is diagnosis in people who mask?

Answer 16

Underdiagnosis + misdiagnosis: Masking can lead to diagnostic overshadowing where the individual’s symptoms are minimised or misinterpreted as other conditions (e.g. anxiety, Russel et al, 2019)

Delayed diagnosis: Study by Kooij et al, 2010 showed adults who mask ADHD symptoms often experience a delay in diagnosis of 10+ years, compared to those who do not mask

Females with ADHD are more often diagnosed with anxiety or depression due to masking, leading to a 50% increased likelihood of a delayed ADHD diagnosis compared to males (Quinn & Madhoo, 2014)

Question 17

What are the mental health consequences of masking in those with ADHD?

Answer 17

Increased anxiety + depression: Adults with ADHD who regularly mask have 1.5x higher risk of developing anxiety disorders compared to those who do not (Livingston et al, 2020)

Self-criticism + low self-esteem: Long-term masking is correlated with lower self-esteem + increased likelihood of self-critical thoughts (Russell et al, 2019)

Statistics on mental health impact: Hull et al (2022) reported 70% of ADHD adults who frequently mask report chronic stress compared to 45% of non-maskers, underscoring the mental health toll of sustained camouflaging behaviour

Question 18

What is burnout?

Answer 18

Quinn + Madhoo (2014) found women with ADHD who mask regularly are vulnerable to burnout: emotional + cognitive fatigue

Imposter syndrome: Hull et al (2022) noted 65% of adults with ADHD who mask experience imposter-like feelings (feeling like they are faking their was through social + professional settings) which can further exacerbate mental health challenges

Adults who mask are twice as likely to report feeling disconnected from their own identity, often feeling as though they are ‘living a lie’ (Russell et al, 2019)

Question 19

What are the social + identity impacts of masking?

Answer 19

Social isolation: Nearly 60% of DHD adults who mask report avoiding social situations, leading to feelings of loneliness (Livingston et al, 2020)

Identity confusion: 40% of ADHD adults who mask report identity confusion, struggling to separate their authentic self from their masked behaviours (Russell et al, 2019)

Developmental cascade: This prolonged identity struggle contributes to a cycle of mental health challenges, where masking intensifies isolation + internal conflict, leading to further mental health issues (Livingston et al, 2020)

Question 20

What are the implications of masking?

Answer 20

Improved diagnostic tools: Clinicians are encouraged to ask targeted questions about coping strategies + social interactions to uncover potential masking (Hull et al,2022)

Diagnostic interviews: Utilising more holistic assessments that consider gender differences + masking behaviours may improve diagnostic accuracy (Quinn + Madhoo)

Educational implications: Awareness of masking can inform teacher training, helping educators identify ADHD traits in students who might go unnoticed (Livingston et al, 2020)