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

0:00Dr Mark Rackley:Good sleep is everything. That's why OLLI's Science Back Support is made with a blend of melatonin and L-theanine for both kiddos and grown-ups. So when your mind won't switch off, you've got something that can help. Erasing thoughts and restless nights won't stand a chance. Find OLLI's sleep solutions for the whole family at OLLI.com. That's O-L-L-Y dot com. When you have an ADHD brain and a brain that has autism, there's internal suppression. 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.

0:39What's wrong with you? Like, why can't you figure that out? Follow 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. They become afraid to expose themselves. You leave yourself in a really vulnerable place. Dr. Mark Rackley is an ADHD specialist with more than two decades of experience helping people with ADHD and autism. He's back by popular demand to help you process your late ADHD diagnosis. 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, night time, it'll all change.

1:19What reactions do you get from people? 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? I tread very carefully with this, very, very carefully, because... 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 favour? Can you hit the follow button? And I'll repay the favour 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.

1:56so to start with if someone has audi hd or suspects that they have audi hd what would they learn if they stuck around for the next 45 minutes or so i'm hoping that they'll learn a bit more about the the living with and the understanding of what this is because 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 what this looks like in your life how it can behave how it is understood and I say that word specifically because there's a lot of misunderstanding I feel around what this is but also 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.

3:18It's so interesting. I think at the moment, I log onto social media, I go onto Instagram, TikTok. So many people are speaking about ADHD. So many people are recognizing themselves in the ADHD conversation. If we zoom out a little bit, how common is ADHD in conjunction with autism? The figures, they're very high actually, Alex. So they rate between one and two and one and three. so the overlap is very very high that if you have one you'll have the other so it it's it's very common but also um because they can 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 have just sat with people for six years and that's how i would have learned everything because honestly like you You can read all the books and you can read all the research and that's super useful.

4:16But 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. 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 honestly I learn so I feel sometimes I should be paying my patients like I learn so much it's like see it's like um certified professional CPD point like it's I learn so much about 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.

5:12If you pulled in all of that experience that you've had speaking to your clients how would you summarize the Audie HD experience what does it actually feel like to live with Audie HD? There's a great expression I feel which sums it up brilliantly which is sometimes it's too much and sometimes it's not enough. Right and I think that's a great description which is sometimes it's too much not such the adhd piece which is the kind of the over simulation the impulsivity the lack of attention like a focus and sometimes it's it's not enough where it's the stuff that is in on the autism side which is well the you know the the shutting down the difficulty managing the social situations getting overwhelmed finding that you're um you're understimulated and then swinging back in then to the ADHD of overstimulation.

6:08So 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 sits into very different spaces in terms of what's going on in the brain when it's kicking off. And of course, like ADHD and autism, it's never static. so what your morning will look like as opposed to mid-morning afternoon post-lunch early evening evening night time it'll all change so you'll never have the same day it'll constantly fluctuate depending on what's going on yeah i spoke to somebody who said that they found that having audi hd for them was life-threatening and in the context that they said that to me it was retrospectively after they had found out about it.

6:58Because living with a brain that had so many internal tussles 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.

7:41Do you find that's quite a common emotion sometimes, having all ADHD? Can that fill people with a lot of shame and guilt? Definitely. One of the big things with that is 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 that 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, 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?

8:20like why do I find small talk is like I'm being murdered slowly like like 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 like like what's like what's wrong with me and and it's not that there's something wrong with you 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 shouldn't and 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 usually 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 well, that's not a problem, but then you can't change the problem or you don't know what to do when it's still happening, then that can become deeply stigmatizing, deeply shameful.

9:23And it can leave the person very confused, which is like, well, why can't I just override that? Because what you get with the ADHD brain is you'll keep getting the same response. So you can't think your way through it. 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 find a way to cope with that, then when it can become life-threatening, Alex, it's like the person can become very hopeless. And when hopelessness kicks in, that's when the person is possibly at risk of becoming suicidal.

10:04Because where they go to is, I can't live like this. and if I can't live like this then 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 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 you can bring the person yeah if someone's listening or watching and they relate to what you just said, they feel like that describes them. They suspect they have ADHD. Maybe they've got an ADHD diagnosis, or maybe they've got an autistic diagnosis, but they think that there's more there.

10:44Their diagnosis doesn't quite paint the total picture of what they're experiencing. 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 an internal tug of war, an internal crisis of identity, what advice would you give to someone at that stage? I think it's very important to recognize that 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.

11:27Your lungs do. Lots of them do. Your brain is the same. So when you have an ADHD brain and a brain that has autism, then 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 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 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 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.

12:43It might really struggle. But by learning 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 working with your brain in terms of navigating that, as opposed to just getting overwhelmed the whole time and then feeling, like we were saying a few minutes ago, where you're feeling hopeless that, well, what can I do? And how on earth is this going to change? Yeah, because 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 cope with your specific triggers.

13:32The navigating piece, I think, is so important, whether it's just ADHD or autism or the dual diagnosis or DHD. 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?

14:08Yeah, I do actually. There are so many cases I was thinking of when you asked this. But I think one particular patient where initially in the case, we had no diagnosis. And as I was listening to them talking about their lives, I thought, this feels like there's ADHD here. And we got the patient assessed and sure enough, it came back positive for ADHD. and with a particular patient we started them well their psychiatrist started them on medication then I was doing all the psychological work around helping them to understand what's happening in their brain how they're navigating life and how we can live with this and what was wonderful is when we were doing all of that lots of stability kicked in lots stability in relationships stability in lots of different parts of their lives.

15:16But then when we kind of got all of the ADHD stuff kind of settled, this whole new batch of problems came along. And we were like, what's that? Like whack-a-mole. Yeah, it really was. And then the autism pops up. It pops up here. It's like, okay, we've got that. And I was thinking, that doesn't look like ADHD. And I got the patient to tell me a bit more. So what's happening here? And they were saying that, well, like when I'm in company, I'm constantly, I'm out of sync. I don't get the jokes. When there's silence, I find the silence unsufferable. like the silence really really bothers me um i i find that 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 hyper focus it sounded more like kind of rigidity of thought around a specific thing.

16:33And this new set of symptoms was causing this particular patient a lot of distress. And so me and their psychiatrist kind of 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 ADHD diagnosis. There's more going on here. Yeah, but we think there's more going on here. And it made so much sense when we kind of explained it all because, 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 was leading to quite a lot of distress, Alex, about kind of what's happening here.

17:17And they couldn't understand, like, is this my ADHD? But it wasn't. It was really interesting with the brain. And this is not uncommon, you know, which is say when 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 get their anxiety settled because we want to see well 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 kind of get the brain in one place to get it settled and to get those simpsons managed but then once we have them settled then anything that's underlying like the nens whack-a-mole they'll start popping up yeah so it wasn't unusual that we had the adhd settled and all of a sudden the autism went hello 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, and adding color and context to their whole history with an understanding of they have ADHD, but then now you're telling me there's something else and I've got to go back and start the processing all over again with this new paintbrush that is autism like what reactions do you get from people people 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 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 my when you when you diagnose a patient with adhd it's a bit like the title of your book which is ah no it all makes sense so it'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 vague and it feels a bit more, well, I can see the ADHD in my life, but I don't know where the autism fits in.

19:58So there can be confusion, I find. Sometimes there's, again, a sense of relief if the person understands their ADHD and then you explain the autism piece. And also, I suppose as well, what you hear a lot is 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 they really embraced it. It's part of their identity. And then so when you present autism to them, like, okay. So they accommodate it so well because they're already working from that really healthy space where the neurodiversity is integrated into their life.

20:49They're managing it really well. And it's funny, with some patients, they'll often say, well, what's the point of me getting assessed? Because if the autism is there and you explain it to me, then there's almost a confidence, which is, well, I can live with my ADHD. I can live with that. Yeah. So it's fascinating to watch. 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 ADHD?

21:25Yeah. You see a whole range of emotions, Alex. Sometimes the one I see the most is anger. It's a lot of anger. around, well, why do I have this? And of course we can't explain that. It's like, it's the genetic gamble of life. We can explain it's got an 80 % genetic loading. There's probably a parent that has it or a grandparent that has it. It can come down through the generations. But we can't explain why you have it. So it could be a lot of that. And it's understandable, like, why me? Why is my brain wired like this? because I work with teenagers and I work with adults. With teenagers, it's interesting with them because there's far more people being diagnosed with ADHD now.

22:18So there's a bit more of an acceptance within that because there's lots of talk around it and also there's a lot more understanding within the peer group. with adults it's quite a different reaction really there can be a lot of fear which is well how am I going to tell people this what's my life going to look like 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.

23:03And essentially what you want to get the patient to is a place of, yes, accepting the diagnosis, but accepting that this isn't, 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 when you're working with your patients with these conditions, you're not going to 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 given your real hope based off the fact that well you've seen X number of patients 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 place of experience and then that patient doesn't necessarily believe yet because the change hasn't happened but you can provide enough hope that listen it's coming and if you just bear with us this will look different.

24:08Do you have any stories that stand out? Do you have any patients who perhaps have gone through that journey themselves of gearing towards acceptance? Yeah, absolutely. So again, another patient where there was a lot of chaos, a lot of chaos, and life was very, very difficult. Very, very difficult. and very challenging relationships. This particular patient was an adolescent patient, not going to school, very difficult relationships with their parents. So lots of things were very, very hard for them at the time. And it was self-harming. It was very, very tricky. and 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 so everybody knew what was happening but also everybody knew how to support this young person then 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 the last guess is when you have the awareness peace suddenly everything falls into place everything falls into place and also the thing especially when you're well it's the same way actually when you're working with adults but when you're working with teenagers it's inherent in the work which is you're sharing all the knowledge because the young person is existing 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 and in multiple different areas of that young person's life then they've got they know I'm held and I have people there who are watching me and helping me because they want me to succeed.

26:28So when you create that space, multiple, multiple times I've seen that work. You mentioned a sensitive topic, self-harming, and that case, I guess that adolescent was self-harming, would you say, to self-medicate the internal tussle that came with feeling different? Yeah, so with that particular case, there was unfortunately, like just to go all clinical for a second which I love I always go into full-on nerd mode when I come into talk to you when you deal with, say, odd ADHD you're dealing with a neurodevelopmental disorder so 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 but not any one of us can have odd ADHD you're either born with that or you're not so lots of people with odd ADHD or separate ADHD, separate autism they're not going to have a mood disorder i.e.

27:39anxiety, depression, OCD, whatever they're not going to have those but depending on how the old ADHD 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, I suppose in my experience, and we'll talk about this a bit later, with young people and kind of older teens.

28:25You don't see it so much in adults because they tend to move on to their 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 you to feel a little bit more uh calmer 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 to kind of help people get get trapped in addiction so the young person can then end up self-harming a lot if they don't have other cope mechanisms that they can employ that help them to feel less distressed or overwhelmed.

29:38So they go back to self-harming again and again. But totally treatable, I want to say, by the way. Completely treatable, yeah. So people self-medicate to deal with some of the internal chaos that comes with the confusions of having all-DHD. But on top of that, what do you think are the biggest risk of undiagnosed all-DHD? My sincerest apologies for interrupting your hyperfocus, but a quick word from our sponsor. Like many in the new year, we want to turn over a new leaf looking to be more productive, more organized, and never late. Well, Timo app is here to help. Timo wasn't named app of the year in 2025 for no reason.

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31:00Back to the episode. On top of that, what do you think are the biggest risks of undiagnosed or ADHD? I think there's two, actually, Alex. I think the first one would be that the undiagnosed or ADHD 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 restlessness, not being able to sleep, low mood, changes in appetite, 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 odd ADHD and we chuck that into the mix? like that person can become very very mentally unwell as a result of developing kind of a secondary 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 going to cope with all of that so when you're dealing with all of those symptoms of odd adhd symptoms of anxiety symptoms of depression, how on earth are you going to resource yourself to be able to cope with all of those symptoms?

32:17And unfortunately, it's not 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 to try and manage all of that. So something like alcohol or drugs or one of the more kind of behavioral ones like 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.

33:06On the autism side, we've had a couple of guests talk about monotropism, this theory that many autistic people have a very narrow lane thinking, like a very laser focus ability to think about one particular thing for a long period of time, and that can serve them very well. but sometimes when that laser is targeted at something unhealthy 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 all dhd yeah definitely definitely because the thing

33:49with any kind of addictive relationship. An addictive relationship is formed. So it's something that 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 and 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 take that option so if you like you were saying there the um if you mix the very kind of single-mindedness of autism and say i'm going to use an example say if that's i don't know alcohol or or cannabis or whatever it is then yeah it becomes your you form that relationship you form 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 when you're in an addictive relationship with whatever it is whatever substance it is or behaviour it is it works so people who are addicted to these things 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 action is repeated again and again, which entrenches the person sadly into that addictive relationship.

35:53it i saw a piece of content mark on on social media and 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 do you think autism and adhd do you think they can actually be a good coupling in some ways yeah i do i really like that expression um because i was just thinking like let's use that that expression your your ADHD will say hey let's let's go on an adventure like an exciting and impulsivity part hey let's do this and then your autism will go well let's do it safely put the brakes on a little bit let's not do something crazy or outrageous 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 beast 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 that kind of that maybe the over stimulated piece of the adhd which can take you anywhere but then there's no breaks and then thankfully with the the under stimulation that can happen with the autism.

37:21It's like, there's the breaks. We've had enough now. Let's call it a day. So, yeah, they can sit alongside each other really, really nicely. And then with the ADHD, you can have the distractibility, whereas with the autism, it can kind of keep you a bit more focused sometimes. So, yeah, I mean, again, I think that's a really important point is it's not always that they're clashing with each other and they're causing chaos, they can actually sit alongside each other really nicely too. We did have a guest on, Mark, that said having Audie HD is sometimes like having two siblings that hate each other, like dragging each other along the floor by their hair.

38:04So I do wonder, 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. Yeah. Ken, I love these examples. Who's coming up? These are great examples, eh? I'm from a family of five, so my head's going, oh, yeah, I know that.

38:29Think about siblings. Siblings, you can love each other and you hate each other and you can be super bonded and then you fall out. So it's not just the fact that 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 odd adhd 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 interaction.