The truth about ADHD and autism: how many people have it, what causes it, and why are diagnoses soaring?
It was in the mid-90s that the concept of neurodiversity as a formal philosophy and organised movement started to take shape. Thanks to the internet, autistic individuals and those with other conditions could connect and begin sharing their experiences: the things they had in common, as well as how their lives differed from each other. A recurring theme in their online discussions was the feeling of marginalisation, and being pushed to the sidelines in a society that confined itself to traditional ways of being. The phrase "neurological diversity" began to feature in their online conversations, which was later followed by the term "neurodiversity" in magazine articles that decade.
Neurodiversity shares many similarities with biodiversity. It promotes acceptance and validates the diversity of human brains. It suggests that a loosely defined majority are thought to be neurotypical, with brains functioning in a generally similar manner. In contrast, those who are seen as neurodivergent have brains that are constructed and work in distinct ways.
Some individuals who don't fit the typical norm may be diagnosed with a variety of conditions, and more often than not, multiple conditions can occur simultaneously in the same person. There isn't a comprehensive list, but autism and ADHD are quite common, just like dyslexia, which is a learning disability that impacts reading and writing, and dyspraxia, a condition that causes problems with movement and balance.
Research into neurodivergent minds, their implications on technological advancement, ethics of data collection, and ensuring that studies yield outcome that are beneficial to those with neurodiverse conditions.
Intertwined with the notion of neurodiversity is a significant change that adopts a social model of disability. This perspective suggests that the challenges many neurodivergent people face don't arise from something being "wrong" in the brain, but rather from the mismatch that occurs when a neurodivergent individual navigates a world designed primarily for so-called neurotypical people. As a result, the obstacles they encounter can be alleviated, ideally eliminated, by modifying society to be more inclusive.
There has certainly been a shift in approach and attitude," believes Professor Francesca Happé of the Institute of Psychiatry, Psychology and Neuroscience, King's College London. "We now focus on alleviating the symptoms associated with autism, such as anxiety and depression, sleep disturbances and epilepsy, learning difficulties and communication issues, rather than aiming for a complete cure or treatment for the condition itself.
However, the man's main concern was that some parents prefer to accept the risk of their child contracting a potentially life-threatening condition rather than having an autistic child.
I had a real moment of understanding about the stigma around autism," says Botha. "One of the most significant aspects of neurodiversity has been giving neurodivergent people a way to see themselves as fundamentally deserving of respect, regardless of how others perceive disability.
They are classified as neurodevelopmental disorders: a product of how the brain develops in the womb or early childhood, and many of them can co-exist.
Take a step back 40 years and doctors estimated that about four or six out of every 10,000 people were autistic. However, current records indicate that approximately 1-3% of the world's population are autistic.
ADHD cases have also seen a significant increase. Those affected often have trouble concentrating; they might act on impulse and find it challenging to sit still. In the UK, diagnoses of ADHD in secondary school boys have more than doubled over the past two decades alone. Meanwhile, in adults under 30, the number of diagnoses has risen by 20 times. More people are now being diagnosed with ADHD for the first time in adulthood.
In the UK, the consistent increase in autism diagnoses is often referred to as a "surge", a term typically associated with rising diseases that are contracted through infection, implying that autism itself is expanding in prevalence. However, some professionals in the field are sceptical about this interpretation, suggesting that the rise is instead attributed to changes in the criteria used to diagnose autism.
Receiving a diagnosis of autism when you display "persistent deficits" in social communication and interaction, alongside restricted patterns of behaviour, such as lining up toys, insisting on following a daily routine, and having an intense focus on specific things.
Some individuals are extremely sensitive to bright lights, specific sounds, smells, flavours or textures, while others may be less sensitive and tend to seek out particular types of stimulation, or find it difficult to notice when they are hungry, unwell or in discomfort.
I believe the main reason for the increase in cases is due to advancements in diagnosis, recognition, and public awareness," says Dr. Cathy Manning, a psychologist at the University of Birmingham. "It's not necessarily that there are more autistic individuals than before, it's just that we’re now properly identifying and recording those conditions.
Individuals are frequently overlooked for numerous reasons. The widespread misconception that autism disproportionately affects males (the condition is four times more prevalent in males than females) is one such factor. Educators might spot the boy who consistently lingers around the periphery of the playground while his peers engage in football, but they often neglect the girl who strives to blend in by mimicking a classmate's mannerisms. Such coping mechanisms exist in both sexes and are inherently detrimental.
Autistic individuals tell us it's extremely draining and can chip away at your sense of identity," says Happé, "because you've built friendships, but they don't feel genuine, because they're based on your social facade rather than who you truly are.
Identical forces are in operation in the case of ADHD. In the late 1990s, diagnosis required that the condition had begun before the age of seven and that there was evidence of "impairment" in various situations. The age limit has now been moved up to 12 and it is enough that children show "symptoms" in some areas. Until 2013, ADHD and autism were officially distinct conditions; you could only be diagnosed with one or the other.
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The case involved eight boys and three girls, all displaying symptoms described by the doctor as "autistic disturbances". The first person to be diagnosed with autism was one of the boys, Donald Triplett, who was five years old at the time. The doctor, Tanner, observed that Triplett "seemed to be living in his own world", had a remarkable ability to memorise a vast array of pictures from an encyclopaedia, and was fascinated by spinning anything he could get his hands on. When asked to subtract four from ten, Triplett's response was a particularly interesting one: "I'll draw a hexagon."
Kanner wasn't aware of the causes at the time. He noted that the children he was assessing "came into the world" with a natural inability to form social connections as they normally would. However, he also pondered the intriguing fact that all of these children's parents were extremely intelligent, yet few could be considered "warm-hearted". Kanner further observed that the children's closest relations tended to be people primarily focused on abstract pursuits such as science, literature, or the arts, with a limited genuine interest in others; he described three of their marriages as "dismal failures".
“, a term which graphically describes children being taken away from their families in a physically violent manner.”
Those who failed to meet Kanner's specific criteria, yet exhibited repetitive conduct and struggled with social interactions, communication, and imagination.
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The concept of Attention Deficit Hyperactivity Disorder, which combines difficulties with attention and hyperactivity into one diagnosis, was clarified in the 1980s. Healthcare professionals look for a consistent pattern of behaviour that has been evident since the child was under the age of 12 and which has a detrimental impact on their functioning or developmental progress, encompassing issues such as struggling to concentrate and acting on impulse, as well as having trouble sitting still when required.
a connection between the frontal brain regions that control attention and thought processes and deeper areas involved in learning, movement, reward processing and emotional regulation.
Consuming alcohol and tobacco during pregnancy, and giving birth before time and brain damage to the baby.
While some genetic variations influencing the disease are rare and have a significant impact, there are many others, potentially numbering in the thousands, which have a relatively small effect individually. These lesser variations are widespread in the population and, when combined in varying degrees by different individuals, may lead to a diagnosis in some cases but not others.
In 2022: "We don't want 'cures' for autism; we want to be able to continue being autistic."
Morgan James Morgan, a PhD student at the University of Surrey, specialises in the genetics of autism. He himself has autism, as does his daughter. "I understand why people are concerned," he says. "Their concerns are genuine, but I'm not convinced that this should prevent us from carrying out research into this area, which is so crucial for grasping what's happening."
Morgan says part of his research is focused on understanding the complexities of autism. "One autistic individual can be vastly different from another," he says. "You could develop support based solely on an individual's presenting characteristics, but it would be more beneficial to understand why one person differs from another, and it appears that a significant amount of this variability is influenced by genetic factors."
It's just one of the areas of debate. Some fear the social model of disability overlooks neurodivergent individuals with obvious medical needs. "There are groups of parents who feel very left behind because their children's circumstances are so vastly different from those who are spearheading today's neurodiversity movement," remarks Professor Patricia Howlin, a co-founder of the journal Autism. Approximately 30% of autistic individuals are unable to communicate verbally. A significant number experience seizure disorders. A smaller number are reliant on having a tube inserted directly into their stomach for nutrition.
It's all about the autism spectrum," says Howlin. "At one end of this spectrum, there are autistic people who are incredibly talented in fields like science or the arts, while at the other end, there are those who require assistance with everyday tasks. Some are excessively sensitive to any hint of interference or treatment, whereas others, particularly families or care providers, feel they really need support and intervention.
Support in education is crucial, Happé remarks. If a teacher isn't aware a child is autistic, the child may appear to be being rude when they're simply being 'direct' in their autistic way. Clear information about changes to routines is beneficial, as are visual schedules, timers that mitigate sudden transitions, and familiarity with children's sensitivities. 'Many strategies that benefit autistic children are advantageous for all children,' Happé points out.
Improving the environment is essential for those with ADHD, states Dr Max Davie, a consultant paediatrician in London and ADHD UK trustee who has the condition himself. He likens the brain to a constantly hungry state, with chronic under-stimulation being a major issue. Dr Davie stresses that people need to understand ADHD and how to react to it. He believes building positive relationships is crucial, saying that taking away rewards or privileges, such as a child's Xbox, when they're distressed can be counter-productive. The expert adds that it's vital to maintain good physical and mental health - "make sure you get plenty of sleep, keep your mood stable, and get adequate exercise - this will improve brain health and allow you to manage your ADHD more effectively."
Autism and ADHD are distinct conditions, yet they share some common underlying factors, including shared characteristics and the types of treatment that are effective. For both conditions, creating an environment that is as supportive as possible is crucial, but it's only one aspect of the solution. "It is also about creating an atmosphere where you feel understood and valued," says Davie. "People who comprehend you and are flexible enough to adjust to your needs are particularly helpful."
Where to get help
If you are experiencing any of these difficulties and need assistance, please refer to:
adhduk.co.uk
additudemag.com
autism.org.uk
autistica.org.uk
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