Do you have AuDHD (Autism & ADHD)? 10 Signs | Dr. Samantha Hiew

0:00Autism in women doesn't look the same as what we conventionally know as autism. There are so much nuances that we do not know how to cater for. Because while psychiatry is looking at these traits and seeing if people match these traits, we are humans who actually fit into a totally different box. Dr. Samantha Hiew is a highly specialized female ADHD and autism expert with a PhD in medical sciences. With a glowing background in the science of neurodiversity, She's using her vast knowledge to help you feel seen and understood. If we want to do well in our relationships, there needs to be a very careful assessment on the power dynamics inside each relationship.

0:38If we go into relationships expected to be safe, expecting to be nurtured, to be helped, there's a chance that one person is going to do more of the emotional labor. But can you both be responsible for how you feel and then actually come to an agreement that actually both look after each other's energy?

0:53Dr. Samantha Hiew:Is there a warning sign that someone might be about to have a meltdown or is it quite specific to if there is an unexpected gear change? A lot of the time. Quick one before I get distracted. I just wanted to say a very brief thank you to all of my listeners. Thank you for tuning in and thank you for subscribing and following the podcast. It really, really helps. At ADHD Chatter, my mission is to ask the world leading experts the hard questions to give you access to the most pioneering advice the world has to offer. And with an aim to help you feel seen. Following and subscribing helps me on my mission to book these incredibly insightful guests and to give you these incredibly insightful interviews.

1:31Dr. Samantha Hiew:Remember, you're not broken, just different, and you have always been enough.

1:38Dr.

1:39Dr. Samantha Hiew:Samantha Hugh. Hi, Alex. Thank you so much for joining us today to talk all about ADHD, which is the dual diagnosis of autism and ADHD. Just to set the foundation, Samantha, you've spoken to lots of people with autism and ADHD. Could you tell us a common struggle that they all might deal with? Yeah. So thanks for asking that question. Thanks for having me back. It's so lovely to see you again. So there is a broad diversity of experiences, obviously, in the ADHD community, whether that differences is in gender or life stages and context but there seems to be a unifying trait in terms of our challenges in shifting gears you know switching gears from like whether from a broader term of needing freedom and craving freedom but actually need routine at the same time and that shifts between like being quite inflexible and rigid to being more flexible and that can be seen like say when you have a plan in mind and then something happens that changes that plan and you find it really hard to change gears you know and that difference in what is expected of you to be more flexible when you have like that like short moment of notice that is the bit that i notice even myself in everyone that has you know is audi hd you know and i find it quite validating because some people might show it in terms of like yeah changing plans or you know like it can manifest as time blindness when you're doing something and you're like oh actually i need to move to the other thing now but then you know you're still focus on doing that thing so it's such a it's such a common point i think i mean and if someone's forced into that position like if if there is a last minute plan which is completely out of the person's control if they are essentially forced to change gear like a train's cancelled and suddenly they're not going to be where they wanted to be or someone cancels dinner plans or someone knocks on their door without them realizing what can that look like in someone with audi hd if they're forced to change gears yeah so with all the hd you have both the autism and the adhd traits so when you are in that adhd chaos then if someone tells you oh something's changed last minute you know can you like get this structure in you can feel really overwhelmed and say if you're in more of that rigid you know autism everything's planned controlled then if someone tells you actually can you be more flexible you know there's this change and you're going to shut down if that is repeatedly repeatedly asked of you and your nervous system is trying to work out what to do because there is a collision between like just control and chaos and in that collision we sometimes just don't know who we are you know and why we can't just switch you know as easily as as other people and these collisions can that you said shutdown is that the same as a meltdown it's a bit different because with shutdown it's not externalized it's more internalized when you shut down you tend to not be able to verbalize sometimes it can be situational mutism where you suddenly don't know what to say but then you feel like being by yourself and you need to be you know just think it over or process it whereas a meltdown is more oh it's more externalized it can look like rage can you know look like outbursts in can look like frustration you know because that is quite different i feel and the presentation of this meltdown is there any specific warnings that that might be up and coming like is there a warning sign that someone might be about to have a meltdown or is it quite specific to if there is an unexpected mood gear change it's it's um a lot of the time it comes like a tsunami because all of these little triggers have already happened so long before the actual meltdown and because um if you add you know effective empathy where we are absorbing you know demands and requests and messages without actually acting or reacting to it in the moment and then that kind of builds up and we're trying to adapt because all the HDs are massive shapeshifters I believe that we are trying to either give people what they need from us or try and hide from it it feels as though like okay so there's one way that we're expected to act here and then you try to give that way but over time when that accumulates inside you, that outburst can be very surprising to people.

6:48Because that outburst can be a mixture of internalized inner critic, or it could also be sensory overwhelm. Because there is a level of sensory overwhelm that can come with needing to deal with all these thoughts and emotions and also then having to deal with the people who are asking those things of you. So the meltdown can come as a surprise.

7:13Dr. Samantha Hiew:Do you think with these meltdowns and the confusions that might come with a mind that has many contradictions, do you think people with ADHD mask more than somebody who might just be ADHD or just autistic? Yeah, I do believe that. I think actually all the HDs have a very plastic brain and our internal environments are so in flux and it's always responding to what is happening outside of us. And because of that, from a very, very young age, we have learned to have to rapidly think on our feet, you know, how to be normal. and that can be as simple as oh you go into a classroom you can't hear what people are saying because you have auditory processing differences and you're trying to just look like you understand you know maybe verbal instructions don't work for you and then you are trying to look like i got that you know but then you didn't understand anything and you don't know what to do and so there is this like internal stress response that's going on but over time though like that makes you think like oh i need to just adapt to be able to survive and that survival response is so strong that the very being you know of being the odhd neurotype and the way of being will predispose us to trauma on our nervous system and that trauma causes us to mask camouflage adapt, become what is needed in order to survive.

8:47And then we get the later in life diagnosis, where actually what I found is that the identity piece is so center to our late diagnosis journey, because then we wonder, who are we underneath this mask?

9:05Dr. Samantha Hiew:It sounds like a very effective strategy to fit in, in the short term. But ultimately, this higher propensity to mask sounds very exhausting. Do we see people with ADHD go through this cycle of social interactions, overthinking, and then a burnout? Do you see that more in the ADHD community? Yeah, I ran the ODHD Women's Survey to listen to our collective voices. And many, the predominant result that came back was around how we may not always be able to work out what people's intentions are. And then that in itself is quite anxiety provoking because you don't know what people need from you. You don't know what to do in order to give, you know, to be the right way in order to be accepted.

9:58And because ADHD women also are wired to look for social rewards and are wired to mask, actually, that can be very, very confusing. And over time, you know, people can end up adopting this mask that in their words, they have said that the mask has become them. And they don't even know who they are anymore. Or, you know, then there is that people who are also mislabeled early on and get mismedicated quite heavily, you know, and then they get to the age of 40 or 50s and they're like, I want to stop my medication. And I was like, well, just check with a psychiatrist because there are, you know, obviously changes that are going to happen to you if you've been on a medication for so long and then not.

10:51people really want to dig deep and find out who they are.

10:53Dr. Samantha Hiew:You mentioned all-DHD women, Samantha, and I know that 85 % of people that listen to this podcast are women, a community who have been let down and missed for so long. With ADHD and autism in mind, all-DHD, why do you think so many all-DHD women have been missed for so long? It's such a good question, because the fact that people didn't diagnose both ADHD and autism together, it was not believed to be a co-occurring condition until 2013. So the diagnostic criteria that we're using is still very much gender biased and also biased towards the childhood experience. And at the moment, every time you go for a diagnosis, most clinics would only provide one or the other.

11:46but not do a dual diagnosis assessment. And we know very recently, after Gina Ripon published her book, The Lost Girls of Autism, that autism in women doesn't look the same as what we conventionally know as autism, which is very much catered to the child, the white boy experience, the young Sheldon, and also Big Bang Theory. So, yeah, so there are so much nuances that we do not know how to cater for. Because while psychiatry is looking at these traits and seeing if people match these traits, we are humans who actually fit into a totally different box. And actually, it was nice to know recently that there is a box actually that looks like us.

12:38And when I found out about the ADHD experience, it was more just that we have different brain dynamics. But we also are now known to be an entirely different class of autism subtypes. There was a paper that was released in July where they looked at 5 ,000 children and looked at the genes, the variants in autistic children. And they found that there were at least four different subtypes of autism. And the first one is around social and behavioral challenges. those who could develop mental health challenges, but then do not necessarily show developmental delay. And they may actually reach development around the same time as those without autism.

13:26And it's funny because it is now known as a subtype of autism. But what we conventionally know is more the broadly affected autism, fifth in a type. So the social and behavioral challenges one, they make up about 34 % of the population, Whereas the broadly affected, the autism that we know that has repetitive behavior, interests, social communication challenges, and mental health, depression, anxiety, they make up 10 % of the population. which is so interesting because the people like us who were able to mask and hide our challenges because it's all internalized but then we developed like really quite severe challenges around social and mental health you know but we've been flying under the radar for so long you know so many people have struggled needlessly because we were just waiting for the science to catch up and not only that we were waiting for the clinics to catch up with what it means to live you know as a human who perhaps have not only autism not only adhd but odhd and mental health uh differences you know and the thing is this shows that there needs to be a shift from looking at people through these traits that are perhaps now quite obsolete to looking at us as humans with nuances through a trauma-informed lens and an intersectional lens.

14:56Dr. Samantha Hiew:So the injustice continues. So many adults have potentially been going to their doctors and that doctor might be assessing them based off a criteria that is woefully out of date at best and inaccurate at worst. How far off do you think we are from seeing these four subtypes being taken into account when people go for an assessment? Well, I think there needs to be different fields and disciplines coming together in order to really bring this to the fore. Because there are the scientists who are studying this in the lab. There are the lived experience, you know, people who live with ADHD and autism.

15:38And then there are people who treat and diagnose, you know, those of us, but we don't speak to each other. So having medium like yours, being able to broadcast to these different groups will kind of spark this curiosity. I had to advocate so hard for myself to get the autism diagnosis, which took seven months. And in that seven months, I was invalidated three times. and they kept saying that my autism was down to trauma because i was also going through like life changes like separation and divorce and relational trauma so there was a lot on my plate and then they chose to then see it as trauma because i could hold a conversation you know we were talking about autism i'm like yay you know talk to me anytime and they said i was um I look professional I was like high achieving so then that was also something that was used against me you know because I then looked like I could hold eye contact you know because I was talking about something I'm so intensely interested in but I've also known of men who fly below the threshold you know where they're assessed and they're like oh you show a lot of autistic traits or like but then you don't fulfill the clinical threshold so that's where it gets really interesting because we're looking at the clinical threshold for autism but then what if the person's ADHD?

17:08Dr. Samantha Hiew:This might be an oversimplified question, Sam, based off what you've just said about these new four subtypes. But if someone's listening and they are ADHD or they suspect that they're ADHD, but they have their suspicions that they might be all ADHD, are there some common traits that might be a sign of all ADHD? Yeah. So I think we talked about the shape-shifting one because there are four different subtypes. So I only talked about two of them before, which is the social behavioral challenges, the first group. And then there's a broadly affected autism, the 10%. And then there is the mixed ASD with the developmental delay.

17:48So these children tend to start off in life with a delay in speech and walking. But they also may have some level of mental health challenges. And then there are those that maybe show a milder form of autism that has some of the general autistic traits, but don't actually have mental health challenges, which is really interesting. Because then you can actually tell the difference. This paper specifically did not look at the gene variants from the start. They looked at how people behave across different developmental timelines, you know, and they degroup these people. So it's interesting because within the neurodiverse community, you get those who say, oh, but I don't have a mask.

18:28And then they're like, I'm always very literal. And then you get those who are like, yeah, we're going to adapt to whatever comes. We're just going to shapeshift and be someone else just so that you can love us and be with us. And then you get that broad diversity that you're like, okay, then who am I? Then when you start doing the research and you start grouping people to different groups, then actually, this is really interesting because what the paper showed, I think it was published in Nature Genetics, It showed that if you look at how these people go through life, what is different about them is that the gene mutations that arises will differ through their developmental timelines.

19:12Some of these groups, they only develop these mutations later in life when their life circumstances actually call for those changes to happen. so actually in at least two of those groups whatever you do in your life from moment to moment is going to determine how you present you know and that changes everything because when you think about neurodevelopmental conditions it's not just in the brain it exists in the body and you know it's not just mental health conditions that we call we have we also have physical co-occurring conditions i think how these physical co-occurring conditions manifest you know is actually a result of what you do on a day-to-day basis.

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21:07Dr. Samantha Hiew:What are some key life events you mentioned there? Like some key life events, I don't know if trigger is the right word, but key triggers, key life events that could bring more ADHD-specific traits to the surface? Definitely any life transitions that can activate your stress response and whether it's when you come to think about stress what causes stress can be mental, physical psychological and yeah or emotional so maybe you move country and then suddenly you have a diet of big beans and potato chips whereas maybe previously you could have more nourishment. That's what happened to me when I moved halfway around the world at age 23.

21:54I went from being very well nourished to living on a diet that was a student diet and that massively changed everything. What your social circle might have changed, suddenly you're adopting a heavy drinking lifestyle, partying, you're not having as much sleep, that causes stress to the system and say you're going through a life, a huge life transition, like maybe pregnancy after childbirth, that impacts your hormones. And also if you're going through a divorce, like I did, it was massively, actually really tough and that affects everything. So there's this physical, emotional stress, you know, it's like there's so much in there, you know, and I feel like once we know what we're dealing with.

22:41Then we know actually what the situation is doing to us and we can then make adjustments.

22:48Dr. Samantha Hiew:Do you see any common clashes between the ADHD side of the brain versus the autistic side of the brain? For example, I think that I perhaps crave stimulation but get easily overstimulated or I really like working in a clean environment but I struggle to maintain that cleanliness and to me that's a sign i'm not all dhd diagnosed i suspect i would get an autistic diagnosis too if i went for one but do you think there are some glaringly obvious clashes within the mind of someone who has all dhd yeah absolutely it's like um it's so interesting because i looked into the brain dynamics of um someone with all dhd and you are at one point really valuing you know this calm stability but you also crave excitement and changes you know and it's like your brains and your body your nervous system is constantly trying to work out what it's going to need so at any one time you could be under stimulated or over stimulated and yeah you almost go in search for that change when you have stability and then when you have stability um and when you have change you crave calm you know it's definitely yeah a challenge for my life so fascinating so interesting and and when these clashes happen can that be too much in certain moments in other words can that cause like a paralysis like a physical paralysis in the person who might be dealing with those clashes yeah there's just certainly can like it's overwhelmed of there's all these signals coming from everywhere what do i do you know i from what i have learned anyway about odhd i think um it was like highly agreed that we need external accountability to be able to like move forward especially when you're trying to make decisions yes i actually famously used my va to make decisions for two years without asking you to do any admin i was like what do you think of this what do i do here you know it's like you're constantly trying to work out oh what to do you know and what is the right way and actually a lot of this journey has been going deeper and understanding how to trust myself it's um yeah but then having a coach is so it's so great like because then they've helped you figure out what you want yeah i always struggle to think what i want for dinner like what i want to eat it's such an exhausting thought process yeah and i feel like there's a lot of shame in these behaviors like as a grown adult i should be able to decide what i want to eat i should be able to remember that parking ticket i should be able to do x y or z that society has sort of taught me is what a person of 36 years old should be able to do do you think within the audi hd community there is a heightened level of shame yeah certainly because that shame you think about it is something that we that arise in us not from here but from day one from how we were raised so that shame can come from the people around us you know in the way that they made us feel and in my work as somebody who trains mental health professionals on the intersectional lens because that shame can also come from cultural control where people expect you know all the members of that culture to act a certain way and if people go out of line in that then they could be blamed for reasons then the ADHD individual doesn't even understand.

26:20So over time, that shame can manifest as archetypes that look like perfectionist, people-pleasing, lone wolf, hyper-independent. It's all these adaptive strategies that we end up actually just becoming a different person that actually ends up working against who we are. So then shame can turn into internalized ableism, where we expect ourselves to be okay with things, to not ask for support, and also then expect the people around us to be perfect. And that can cause problems in relationship, because whatever shame that we bring into every part of our lives can affect us.

27:04Dr. Samantha Hiew:there's like this higher propensity to to be perfect and and you almost feel a bit different probably more different i imagine than than a singular diagnosis someone with all dhd might feel more different and therefore there's this greater internal need to mask and fit in if someone sees through that if someone sees through the perfect version that you're trying to put out in the world and and criticizes you whether that's a real one or a perceived one is the reaction to a perceived or real criticism or a rejection heightened as well in someone with ADHD? Yeah, because we're also dealing with the biology of being born with an ADHD neurotype where we are more sensitive to threat detection, you know, and pattern detection actually before trauma occurs and then threat detection afterwards and we have that like a more strengthened activation of the anterior insula and the default mode network without being able to tap into the prefrontal network you know the prefrontal cortex to figure out what that criticism or message actually means so while you're ruminating and charging the rsd in you your brain isn't really necessarily able to tap into that rational thinking and actually this is why they do that you know a b and c then that rsd can feel like but i don't deserve that because actually i mean really well you know this is what i mean although this is my facade you know and that's the facade everyone sees and you feel misunderstood all the time you feel like what am i doing doing this you or can I just crawl into a hole?

28:52It's difficult. And my journey now is to bring out that internal state to the front and just try and integrate this, what people see and what is actually happening inside me. So that I guess in the end, so many people I speak to in an NT community are talking about authenticity. You know, to be able to be ourselves on purpose and actually being loved for us, it's invaluable.

29:19Dr. Samantha Hiew:and with someone with audio hd sort of dealing with all these complexities that we're discussing is that type of person it's going to sound are they hard to live with are they what challenges might come with a person like that for example in a romantic relationship i guess it's it really goes down to do you trust yourself do you accept yourself and do you accept yourself are you compassionate towards your traits or are you ashamed of them because the self-shame can then be transferred to our partners where we then expect them to nurture us but not take personal responsibility so between human to human anyway human to human relationships i feel like they're first especially when it comes to neurodivergence there needs to be an alignment in where we stand in our values and what we value to be true what we value you know to happen you know in our personal relationships because when our values are aligned we feel safer we're happier with each other but yeah when that isn't aligned then there are potentially you know challenges that can occur from that to begin with but then also then how do you what do you bring into that relationship Are you radically accepting yourself or are you expecting someone to support you through what you haven't worked out?

30:54Dr. Samantha Hiew:And how would someone support someone with ADHD in a relationship? Is it simply about approaching it with curiosity rather than judgment? Is it reassuring them that their behavior can be confusing but it's not their fault? It's an interesting one because my view on relationships now is very, very different. And you're probably not going to get it from like any books because it's from real experience. I feel like, you know, eternally, if we want to do well in our relationships, there needs to be a very careful assessment on the power dynamics inside each relationship. If we go into relationships expected to be safe, expecting to be nurtured, to be helped, then there's a chance that one person is going to do more of the emotional labor you know but can you both like be responsible for how you feel and then actually come to an agreement that actually there are times when you just can't you know control how you come across some of the actions may look like you go from zero to a hundred but there's a real reason behind it you know can you both look after each other's energy you know and be responsible for your own because ultimately no matter what we want to do for the other person, if we don't have the energy to do it, then we won't do it.

32:13You know, and eventually resentment builds and then one person's carrying more of the labor than the other. And what do we do? You know, because we know that from my research, all the HD women say they mask even in personal relationships. And when that happens, I talked about the science behind masking where our frontal lobes are gradually trying to work out what to do with the actions that we see. And already our frontal lobe isn't always working that well, so it adds an extra load. And then our salience network is looking for threads on differences in gestures, differences in tones, and what to associate with that.

32:55The RST heightens, the default network spirals. And then we try to look like we're okay with that. Hello, what do you want for dinner? and then like you are unaware that this masking is causing you so much duress inside and we try to overcome biology but at the end of the day if something that you're doing isn't aligned with the internal autonomy then it's not going to work you are going to gradually feel more stress and when you are at a certain life stage like i am we just don't really have the bandwidth for extra stress like this you know and and then that's why i say ultimately relationships need to be fair and understanding our way of being has really helped me like figure out how to do this i'm still trying to find and create that kind of relationship so not perfect so the sensitivities

33:50Dr. Samantha Hiew:to rejection i can see it causing problems in relationships your partner could come home from work and the door slams slightly heavier than is normal um or you sense a slight change in their tone of voice when they ask you what you want for dinner it's easy to jump to the conclusion that they hate you that's the that's the seriousness and the visceralness of rsd sometimes and the anxiety that that can create especially if you're masking so much you almost want to unmask in front of your partner because that's what you should feel safe to do but there's this anxiety that what if they don't like the authentic version of you?

34:27Dr. Samantha Hiew:What if the version of you that they've fallen in love with has been an illusion and the true you, the one that's desperate to come out, is scared of what they might think of it? I think there's an anxiety there that you want to unmask in a relationship, but at the same time, there is a fear of your partner not liking what comes out. Oh yeah, absolutely. Especially as the research really shows us that people mask in their relationships you know even the closest ones and you know to an extent I think it depends how much you want that relationship and why do you want that relationship for and does it fulfill like the stability you know kind of help you feel more safe or does it make you feel alive and you're hoping you know the person will see you in a certain light and in my experience it is so much better to own up with who you are from the very beginning because then you're not hiding anything and if people aren't aligned they can just go and if they are then you know that that really helps but that also then means that there are less chance of you going into a relationship with anyone because because you kind of are looking for the person who can actually take you exactly as you are and that that depends on where you are with your own self right to confess to your partner early on who you really are requires a self-awareness of you knowing yourself who you are right and what if someone's listening to this and they think i'm adhd or i'm autistic and then they hear a conversation like this and suddenly they get thrown into this thought process of oh my god maybe now i'm or dhd or maybe i have been masking my whole life i have no idea who I really am?

36:14Dr. Samantha Hiew:How does someone start their own personal journey of self-awareness? How do they start understanding who they really are? So that's a really interesting question, because if you meet somebody and you own up with who you are at that time point, then you kind of attract people who are at, well, they say the same level of wounds, but also maybe the same level of awareness because they say people also leave relationships when their partners are no longer on the same growth timeline as them. You know, some people leave when they realize they don't want to be this person anymore and my partner isn't able to let that go and then I've got to leave, you know.

36:51Personally, I think that actually the people that come to you at certain time points of your life will meet you in the self-awareness that you know about yourself at that time, you know and that can either help you go on that journey or stop it very quickly right and for me my journey really started from understanding my biology because for a really long time I was trapped in my head I thought if I can just figure out what this is you know I find out about the science of ADHD and how we come to be then I'll crack it you know and then it came to a point where I was eating all the right things, I was taking all the right supplements, and I was all right, but my relationship wasn't really working because I didn't know how much stress I was unknowingly bringing upon myself by, I guess, masking in a relationship.

37:51But also we were both masking because we both wanted to be accepted. And we're potentially both ADHD. So how you knew about yourself, my journey in self-awareness, is that ADHD or ADHD is a mind-body relational paradigm. And it's not enough to just know about your mind or your body. You need to know how to foster these relationships and keep them and nurture them. And right now, to be fair to anyone, I feel like we need to be able to understand what drains us, what fills our cup, and also be fair to the other person, you know, what we expect and want. because the other person may also be navigating what drains and fills their cup.