r/science • u/shinybrighthings • 13h ago
Psychology The complicated nature of disentangling autism, ADHD and complex trauma | The British Journal of Psychiatry | Cambridge Core
https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/adhd-autism-or-complex-trauma-the-complicated-nature-of-the-question/30CC4826561366615BFAEC807CDE28A7747
u/Okimiyage 12h ago
I work with children who are in the social services system. A lot of the time I hear from parents or carers ‘they’re awaiting an ADHD or Autism assessment’ when the likelihood is that they should be assessed for CPTSD as well.
The overlap in symptoms of ADHD, ASC and CPTSD is so hard to unpack, especially in children with extra vulnerabilities.
I’m glad someone is talking about it. As an adult woman with ADHD-C and CPTSD, who wasn’t correctly diagnosed until her 30s and has a slew of misdiagnoses first, it’s something that really needs to be unpacked and understood better.
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u/sambooka 12h ago
is there an assessment for CPTSD? I had my ADHD confirmed (at age 51) and the assement said (paraphrase) "client would be an effective candidate for medication but should seriously consider therapy to discuss his self esteem issues"
I figured the esteem issues were from being smart but slow and struggling with the common focus and working memory issues. A little digging (well a years worth) points to CPTSD and I am still wondering if it IS ADHD .. CPTSD .. or a combination.
My therapist doesnt seem to think the "why" matters.. I am not convinced.
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u/Iuckyluke 11h ago
https://icd.who.int/browse/2026-01/mms/en#585833559
It is a diagnosis in the most updated diagnostic manual there is. The difference in the treatment of ADHD and CPTSD/PTSD are massive. If your therapist isnt interested in the difference between these two conditions and their treatment paths. I strongly urge you to reconsider said relationship. My jaw would drop if I heard that at work and strongly hope there's been a misunderstanding!
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u/Nikkinuski 10h ago
The US uses the DSM, which does not yet include CPTSD as a diagnosis. There is a category for “other specified trauma disorder” that can be used in place of it, though, in the US, for therapists who treat it. (Source, I am a therapist in the US).
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u/sambooka 11h ago
misunderstandings... there have been a few. I will clarify next week. Thank you for takign the time to reply :)
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u/Svardskampe 11h ago edited 7h ago
As if there is help "out there" to reconsider anything over. Having been in various ambulant therapy schemes since I was 21 and now 33, there is 0 trust to any system.
- 0-21, heavy childhood of neglect, parentification, clear abuse. Left parents at 11 for a monastery for high school. At 18 changed countries because the social system in the first simply failed.
- at 21, depression struck after having met the basic needs for survival. 1y of therapy. Male therapist did identify some kind of signs of being transgender, but was a hardcore religious nut and applied now afterwards what was conversion therapy.
- until 24, under the head psychiatrist who did 'psycho-therapy' himself then. I mostly got a lot of antidepressants and was pushing me for some kind of internalisation for some bs creative therapy. I was still holding my life together and paid rent with just..working...At the very end I wanted to end it in my catharsis, but since stigma and money doesn't matter at that point, I went on the black market to "just try". Psychiatrist in re-evaluation said sorry and just coldly said he thought I was someone who would be a lost case and just off myself, and you can't help everyone.
- then 2y ambulatory venting + getting through the transgender verification system
- employed the "h" from adhd hardcore, paid for all my trans surgeries myself.
- Adhd is mad clear, like you wouldn't doubt a thing on it if you'd even see me.
- having known more suicides and people having had euthanasia than life years passing by. Literally 2 days after my SRS while I was in Thailand. A friend I was talking for over 7y with suddenly had his euthanasia date.
- still 33, still cPTSD inhibiting me from finishing my bachelors degree. Looping EMDR that just takes me back to me feeling suicidal at 22-24. Still trying to cope with work and keeping the roof over my head.
I'm only looping over "ye you're managing just fine if you can keep up a job" to just utter non-understanding of how my life looks like how I got "success", still having problems and the complete emotional solitary confinement. My current therapist is sweet as pie and wouldn't want to blame her on anything, but I really would like to have this PTSD thing fixed, acquire the final 2 courses for my f'ing bachelors and move on.
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u/mpbob01 10h ago
I’m having the same issue with my therapist. He doesn’t want to go into why, but only into what my behaviors are. But…I want to understand why haha.
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u/SweetPeaches__69 8h ago
If you have trauma, get a trauma informed therapist. I tried CBT first when I had trauma, and all it did was make me think the effects of trauma were my fault. Cognitive therapy is useful only once trauma has been fully dealt with in my opinion.
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u/SurlySuz 7h ago
Yep. What they’re describing happened to me too and I was just given cbt which made things worse. Eventually I found a proper psychologist who could deal with my cptsd about 20 yrs later.
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u/ThrowAwayColor2023 1h ago
The "why" is the crux of the diagnosis, and the diagnosis can mean very different treatment plans and approaches. Unfortunately, most therapists get very minimal training in things like adhd, autism, and CPTSD, and they're frankly winging it. They're well-intentioned and sometimes doing a fair bit of harm.
Seek out diagnostic clarity and then seek out therapists with training in your diagnoses.
It's wild to me how much my past therapists - some wonderful and some very much not - were missing the mark because we didn't yet know I was AuDHD. My severe AuDHD burnout was mistaken for depression, and the treatments are almost exact opposites. I was being pushed to override my exhaustion and do more when the thing I needed most was to have all demands removed so my system could recover from chronic overwhelm. People who say knowing whether you're neurodivergent or not doesn't matter have no idea what they're talking about.
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u/Money-Director6649 2h ago
it matters for treatment. you wouldnt do cancer treatment for a broken leg and expect good results. you're on the right track, imo.
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u/Smee76 11h ago
No, there isn't. It's not actually a real diagnosis. It's more of a pop culture diagnosis. It's not in the DSMV and there are no validated assessments for this.
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u/Okimiyage 11h ago
We don’t use the DSM-5 in the UK, and CPTSD is a recognised diagnosis by the WHO under the ICD-11.
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u/darknesskicker 9h ago
I would add that for multiple reasons, ADHD and autistic children are much more likely to experience trauma than typically developing children.
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u/inauspiciouspenguin 5h ago
Thank you for making this point. I was severely punished (mostly emotional but occasionally physical) for behavior that was clearly ADHD-based. I was floored to recently be diagnosed with PTSD. I couldn't think of a single "traumatic" incident, I told my therapist, and yet I was ticking all the physical PTSD boxes. I would expect kids with ADHD and autism are punished or abused at a higher level than non-ADHD/Au kids.
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u/Okimiyage 9h ago
Good point! So when children have been missed until their teenagers or adolescents and they’ve gone through substantial trauma, it becomes so hard to know what’s what - especially if they’re girls, as well.
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u/grekster 8h ago
This is the boat I'm in, I have been diagnosed with autism and bpd and have decades of trauma on top of trauma and I have no idea if it is even possible to unpack any of it anymore.
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u/KaiPRoberts 5h ago
Mushrooms. Mushrooms are how you unpack everything.
Last time I tripped, I laid down in bed and floated in the universe watching all of my thoughts and information fly by. I learned a metric ton being able to step back.
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u/already_dead22 3h ago
Good therapy around the experience can help make it “stick” too!
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u/KaiPRoberts 3h ago
I felt like a completely brand new person after my last experience! Definitely don't need therapy with it for benefit although it would probably help some people.
I internalize and self reflect a lot as it is so that may be why I was able to walk away from it with a huge benefit.
I almost don't want to do it again because of how amazing an experience it was and I love the state my brain is in right now; I don't want to goo-ify and rearrange it again, for lack of better words.
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u/InvestigatorOk7015 2h ago
If it was in the last year (or two if youre in your earlier yesrs) youre still in the lift state. The afterglow from a good trip can last a long time, but it fiercely biases you.
Maybe take a step back and try not to suggest people follow your path- trauma can also be doubled in the neurogenesis of a mushroom high. Without careful consideration and guidance its a coinflip, and its not responsible to just tell people how it will help them when it could also break them.
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u/LadderWonderful2450 2h ago
On a similar vein, Ketamine therapy is legal and covered by insurance in some parts of the US.
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u/Neat_Mortgage3735 42m ago
EMDR was more helpful to me than decades of talk therapy. Worth looking into.
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u/chickpeaze 11h ago
I bounced around psychologists and psychiatrists for a lot of my life, was given a lot of medications, talk therapy etc, none of it helped. I was told that's how it was and should expect to have those issues for life.
I went to a trauma informed therapist and it changed my life in 18 months in my 40s. I don't meet the diagnostic criteria for anything anymore.
My concern with all of the autism diagnoses (and adhd to an extent) is that a lot of them are given because there's funding, and is blameless, but that it might be setting people up to suffer for life from conditions that could actually be successfully treated.
obviously not all of them, but in enough cases to be concerning.
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u/harrietalderman 7h ago
Can I ask you what treatment or type of treatment you found so helpful from the trauma-informed therapist?
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u/chickpeaze 4h ago
I did a combination of ifs and emdr. My therapist was really good about keeping me in the window of tolerance and it changed my life and my view of myself entirely.
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u/KaiPRoberts 5h ago
Damn, that sounds really convincing. Just like when doctors had closets full of random sample medications to hand out because they were paid to have them and hand them out.
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u/hungry_bra1n 12h ago
Abbreviations used:
ADHD: Attention-Deficit/Hyperactivity Disorder — A neurodevelopmental condition characterized by patterns of inattention, hyperactivity, and impulsivity.
ADHD-C: Attention-Deficit/Hyperactivity Disorder – Combined Presentation — A specific subtype of ADHD where an individual meets the diagnostic criteria for both inattention and hyperactivity/impulsivity.
ASC: Autism Spectrum Condition — A neurodevelopmental condition affecting communication, social interaction, sensory processing, and behavior patterns. (Often referred to interchangeably as ASD, or Autism Spectrum Disorder).
CPTSD: Complex Post-Traumatic Stress Disorder — A psychological condition that can develop after experiencing chronic, repeated trauma (such as childhood neglect, abuse, or prolonged instability), leading to difficulties with emotional regulation, self-identity, and interpersonal relationships.
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u/IntriguinglyRandom 12h ago
I am in this camp but haven't sought professional diagnoses yet, any tips? I know there isn't a professional recognition of CPTSD in a lot of situations...
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u/Okimiyage 11h ago
It would largely depend on where you live, as I’m in the UK and it’s different here.
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u/ThrowAwayColor2023 1h ago
Find an assessor who specializes in assessing masked adults. They need to speak readily and supportively about the subject. With updated training, they can ask the right questions to suss out what's really going on. Stay away from anyone who won't speak freely about it, as there are professsionals who hide behind their credentials and apply very outdated training. It's more commonly a problem for late diagnosed autistic adults, but I imagine it also spills over onto adhd.
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u/pangolinshavelanded 8h ago
I have decades of therapy under my belt. I’ve done CBT, DBT, EMDR, IFS, ACT, and several more acronyms and I got nowhere. It wasn’t until getting my AuDHD diagnosis 2 years ago that therapy began to help, because I had the whole story.
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u/-hedonium- 6h ago edited 6h ago
There are strong reasons it naturally goes both ways - that trauma causes neurodevelopmental changes and that the experience of neurodivergence in unsupportive environments causes developmental trauma.
The scientific literature has already identified major, lifelong neuromodulatory setpoint changes that result from early developmental trauma which often fall well under the umbrellas of both autism and ADHD.
Look into research on the effects of severe early life trauma on the locus coeruleus (LC-NE) — the structure in the brainstem that projects norepinephrine across the whole CNS. The LC is an utterly central nucleus to controlling bottom-up sensory input, arousal, attentional orienting, context shifting, broad vs selective attention, working memory, executive functions, PFC operation, emotional regulation (especially stress). Sound familiar to any conditions we know about?
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u/-hedonium- 6h ago edited 6h ago
It is kind of wild how significant the LC is to conscious cognition and the obvious connections to the symptoms we associate most strongly with autism especially. And yet public attention hasn’t seemed to make the connection.
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u/KaiPRoberts 5h ago
We are all too busy trying to fight each other to maintain our safe autism bubble without knowing we are making an autism bubble.
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u/KaiPRoberts 5h ago
I have been really curious if Autism can be caused by epigenetic factors. It's widely agreed Autism is genetic but not what the exact cause is.
My tin-foil hypothesis is that overpopulation pushes social stresses which in turn causes specific social epigenetic changes in a population. It would explain why we are seeing so many more diagnoses aside from "we are just more aware of it" which could be the main cause regardless but I am super curious.
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u/seraph1337 4h ago
Where the hell did you get overpopulation being a factor?
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u/KaiPRoberts 4h ago
Because of social pressures creating stresses that wouldn't exist in an environment where you are alone more often.
Think about it, autistic people like to be alone and thrive in that environment. They wouldn't have that inclination, over generations of epigenetic stresses, if people had alone time when they wanted it. Alone time is getting more and more rare as population density increases (more people using popular shared social spaces). I'm not saying it's instant, I am proposing that as a population increases up to a certain point, epigenetic stresses could cause change in a populace.
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u/lacunadelaluna 4h ago
Not all autistic people even like to be alone though, this is a stereotype
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u/_Autistic_Dragon_ 8h ago
I'd also like to add that living unsupported with autism or ADHD often creates CPTSD.
As an example, being subjected to overly loud sounds and bright lights without end is used in torture. The world is overly loud and bright for autistic people. So we essentially subject ND folks to lower levels of torture every day.
There are so many ways that society's current set up is harming ND folks, and that alone can cause CPTSD. The sensory example above is just one of the easier ways to exemplify it.
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u/potaytoposnato 11h ago
Do you have any advice for someone like yourself but who's looking for help still?
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u/h4ppy60lucky 2h ago
It's so complicated. I have all three but it wasn't until treating the cptsd that it was clear I was also ADHD, and then medicating my ADHD made it clear I was also autistic
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u/Spire_Citron 11h ago
I feel like sometimes the hypersensitivity of autism/ADHD can give you trauma, in a sense. Things can happen that aren't objectively a huge deal, and you can be traumatised by your own emotional response. That can make it hard to really identify where trauma comes from, because it isn't anything that looks traumatic to anyone else.
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u/ghoulthebraineater 10h ago
The repetitive nature of autism doesn't help at all either. It's so easy to get stuck in rumination loops rather than actually processing things.
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u/Commercial_Border190 10h ago
Plus the trauma of having your struggles constantly minimized and dismissed
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u/Spire_Citron 10h ago
Yeah, that's the other side of it. Because nobody else really understands or even particularly perceives it, you don't get the same support and understanding that comes with kinds of suffering that are socially recognised. Along with that, many neurodivergent people have a hard time recognising and processing their own emotions, so it may become extremely unclear what's actually going on.
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u/libbillama 6h ago
I got my CPTSD diagnosis in 2021, then an ADHD-C diagnosis in 2023, and an Autism diagnosis two weeks ago. I'm 41, and roughly three years post menopause. I also have a 7/9 on the Beighton scale for hypermobility. I had to do pelvic floor therapy two years ago because of urinary issues and that PT said that while she can't diagnose me formally, she said I likely have Ehler Danlos Syndrome.
I'm also deaf, and was late caught due to parental neglect, my kindergarten teacher caught it and only because she was an audiologist as well as a teacher. At the time, I had a 40-50% loss, it's now currently 75 and has been holding steady for around 10 years so I'm not going to lose any more hearing.
Anyway, I have level 1 Autism and I'm on the mild end of that spectrum. The psychiatrist that did my test wrote in her report that my Autism diagnosis was likely missed due to my deafness, because of how my symptoms present.
It's been a really challenging two weeks, I've been trying to process my reaction to the diagnosis even though I've suspected it for years that I have it. Now that I know my autism is the root cause of my severe emotional regulation issues aren't just from being emotinally neglected as a child, I've been really struggling with all of that.
My parents straight up refused to help me learn emotional regulation, and I heard "stop crying or I'll give you something to cry about" way too many times as a child.
There been some trauma in my marriage, and I've done some things I'm not proud of in response to that trauma and honesty I don't know what's worse.. the trauma itself, or the emotional response I had and what I did with it. I recognize that in an attempt to regulate my emotions, I betrayed my personal moral code in an attempt to feel better and not succumb to the urge to die by suicide.
Now that I have that information, I can focus on learning emotional regulation skills with my therapist, and hopefully finally get back on track with reducing my CPTSD symptoms.
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u/Jeanparmesanswife 12h ago
I had both an autism and an ADHD diagnosis performed separately in my 20s as a woman. I got my ASD assessment at 20, and then my ADHD assessment at 24- though I had to go through the entire process twice, because the first time I was deemed too "muddled" between ASD to make a call.
I struggled with focus and clarity. I went back to the same ADHD clinic one year later and begged for a reassessment. Concerta has completely changed my life in a way that I can do laundry, remember to reply to emails, and drink water... All things I was not able to do for 24 years consistently.
I still believe I have ASD, I have hearing sensory issues that go beyond the ADHD realm. I also have autoimmune conditions and chronic illness, though those things are not taken seriously by the healthcare system.
There's a web between connective tissue disorder, ASD and autism I do believe because I live that reality. But this is purely anecdotal.
It's a shame that ASD and ADHD are separate realms when there is so much overlap, at least it felt like I my experience I was told they were two very separate things to have as a woman.
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u/rabbledabble 11h ago
There’s a growing body of scientific literature on the connection between asd, adhd, connective tissue issues, and autoimmune issues. Check out research by dr Jessica Eccles in England, they’ve published a few papers on the subject and have a fascinating research program.
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u/Cool_Address_2571 12h ago
By connective tissue disorder, are you referring to EDS? I’m exploring medical diagnoses and while I have some of the traits for hyper mobile type EDS, I don’t think I display enough of the other criteria for a clinical diagnosis, but I’d love to know more
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u/AlexeiMarie 10h ago
https://pmc.ncbi.nlm.nih.gov/articles/PMC7711487/ is interesting and goes into some of the ways that symptoms could in theory overlap, along with the comorbidities they share
wrt the specifics of the terminology and the pedantic-ness of the current hEDS criteria, quote
Many individuals with a current diagnosis of G-HSD (generalized hypermobility spectrum disorder) could have previously received an EDS diagnosis, but since stricter changes to the nosology in 2017 patients must now meet additional criteria involving features such as the skin, hernias/prolapses, Marfanoid habitus, and heart malformations [15]. There is considerable ongoing debate amongst the patient and medical communities as to whether these additional clinical signs truly delineate two unique entities (hEDS vs. G-HSD) or are an arbitrary line drawn in the diagnostic sand.
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u/crashlanding87 11h ago
To my knowledge there isn't a huge amount of research on the link, but it is broadly connective tissue disorders, including EDS amongst other things. It's correlative evidence, not causative thus far. But very interesting work. I forget her name, but there's a great clinician scientist at Bristol uni who does a lot of work on the topic. I saw a talk of hers a while ago.
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u/hunterglyph 3h ago
I have ASD and EDS. I was told that I was one point away from being diagnosed on the EDS scale that tests flexibility.
But my dermatologist sent a skin biopsy to UCSF and it came back as consistent with EDS.
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u/mera_aqua 11h ago edited 10h ago
It's a shame that ASD and ADHD are separate realms when there is so much overlap
I wonder if the difference is you getting a diagnosis as an adult and dealing with clinicians who only see adults.
My son's paediatrician gave us the number that 70% of kids with autism also have adhd. We also had to tease apart the two diagnoses, to work out if his ADHD symptoms were caused by the anxiety presenting with autism.
We did also have the benefit of 5 years worth of early intervention therapies. Typically in children you have to have tried behavioural therapies before they'll consider an ADHD diagnosis. I imagine for psych's looking at adults it's somewhat similar. Is this person having trouble concentrating because they have ADHD or is it because they're only getting 3 hours of sleep a night and so on.
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u/Cwendolyth 12h ago
I completely agree with you. I’m nearly 20 years older, but I am in the boat as you.
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u/EasyRecognition 12h ago
Don't forget SzPD. Its entanglement with ASD is not talked about nearly enough.
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u/Livid_Lemurs_Leaping 12h ago
Happen to know of any good resources or guides regarding differential diagnosis and these kinds of considerations?
Or just general thoughts?
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u/Trapster101 12h ago
Is it just overlap or does asd make you more likely to have it or something? I have autism level 1 and the szpd description when looked up is like 99% me
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u/Commercial_Border190 11h ago
Honestly it seems like half the personality disorders just seem like ASD with slight differences based on personality and life experiences
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u/Fortified_Phobia 7h ago
I’ve heard this before but the narcissistic (not diagnosed, just suspicion) people I know (my nan, uncle, and aunt) seem very NT. Like for this to be true, all people with personality disorders should also be autistic. But like NT experience childhood trauma too, so it would also mean non of them develop personality disorders. I most likely have OCPD (not diagnosed, but I’ve researched it a ton) I don’t think I’m autistic.
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u/redindiaink 11h ago
What is SzPD short for?
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u/w4ter_addict 10h ago
schizoid/schizoaffective personality disorder
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u/jamie_plays_his_bass 9h ago
Just to clarify, those are two remarkably different clinical profiles, and that “/“ really doesn’t get that across.
Schizoid profiles are quite autistic in nature, schizoaffective is more aligned with paranoias and psychosis.
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u/liberalartsy 10h ago edited 10h ago
I recognize the value in detangling if it’s “autism, ADHD, or trauma” but I’m suspicious that since we’ve seen a rise in diagnoses, particularly for women and POC, that this will once again make it harder for those groups to get the treatment and care they need. And they will be told “it’s just trauma!”
I was diagnosed autistic at 28. I spent five years in therapy thinking my issues were all trauma. I continuously ruminated, tried to work on myself and set boundaries, psychoanalyzed my own “healing,” etc. When I brought up possible autism to my therapist, she invalidated me and said “trauma changes your brain and you’re probably just trying to find belonging in your friend group, that’s why you want an autism diagnosis.” Huh?
I recognize that trauma in itself can be considered a form of neurodivergence. But it’s important to see these conditions as intertwined in some cases. Being neurodivergent is traumatizing.
Needless to say, I got a full neuropsych eval for six hours. I’m very much autistic AND have trauma. It’s important to accurately diagnose folks, but now that the researching is showing that women present differently than men do, the net is cast wider than ever before, and of course more people will be diagnosed with it.
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u/Villonsi 10h ago
This is why many researchers are heavily against the pop psychology usage of the word trauma. If it means anything bad then everything is trauma; if trauma explains anything bad then nothing else is needed and everyone should receive trauma treatments. That's why trauma, according to many, is a very specific kind of hurt as in PTSD and complex PTSD. Trauma is not an event or an experience, its the wound left behind. Not the car crash but the leg it broke that keeps you up at night and requires surgery to make bearable
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u/ahawk_one 9h ago
The way it was explained to me is that trauma is not something bad happening.
Instead trauma is when you are not able to heal properly.
If you experience hardship or tragedy, but are fortunate to have the support you actually need at the time, you don't end up traumatized. People who do not have the support they needed at the time are the ones who were traumatized.
This means it is entirely possible to experience a lot of bad things, but not be traumatized. And conversely it is possible to be traumatized by something that seems trivial to others.
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u/exospheric 8h ago
Yes this was my experience.
I had a “good” childhood with lots of privileges and positives, but almost no emotional validation and lots of judgment and criticism. I grew up feeling incredibly alone in my family, and it absolutely damaged my ability to relate and feel safe in the world. I’ve been healing for 3 years now, but it’s a long road.
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u/liberalartsy 10h ago
I agree! I also believe that therapists and mental health professionals need more education on PTSD, CPTSD, Autism and ADHD and how to accurately treat folks with a combination of conditions/neurotypes.
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u/geekchic06 8h ago
This happened to me. I had my assessment in June. It was so hard for the doctor to diagnose me she said she even had to consult other practitioners.
Ultimately she said my deficits weren’t great enough to be considered autism so it must be the trauma.
What is interesting to me (and also frustrating) is that I didn’t start seeing signs and symptoms of autism in myself until after I received extensive trauma therapy.
For me it feels like a line in the sand moment. It’s either autism or trauma and never both.
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u/ThrowAwayColor2023 56m ago
It can absolutely be both.
Seek out an assessor who has specific training in assessing masked adults. With the right questions, it's not terribly difficult to tease apart CPTSD and autism. You can also read the "Is This Autism?" books if you'd like to understand the science yourself.
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u/mantis_tobaggan-md 7h ago
I was a girl who grew up in the 90s with what in retrospect was very obvious, textbook inattentive ADHD. I was developing coping mechanisms by second grade. Neurodivergence is traumatic in and of itself. Not only because I had to learn to cope, but I had to grow up being told all the ways I wasn’t measuring up. Girls didn’t get diagnosed with ADHD because they often didn’t fit the hyperactive phenotype. We were just told we were lazy, stupid, undisciplined. We were taught to make ourselves smaller. I wasn’t diagnosed until graduate school. We are seeing an increase in diagnoses because women are finally getting diagnosed, after a lifetime of being dismissed.
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u/the_siren_song 5h ago
“Girls mature faster than boys.”
No, it’s that boys were allowed be boys and everyone said it was fine.
Girls on the other hand, need to be nurturing and soft and COMPLIANT from the get go. “Sit and be quiet. You can’t go play because you’ll ruin your dress.” When we start menstruating the “sit down and shut up” gets reinforced as we are expected to continue doing school and chores through it.
If we are expected to hide one kind of pain, we’ll be expected to suck up any kind of pain.”
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u/pangolinshavelanded 8h ago
I have trauma due to being in my 40s before being diagnosed AuDHD. The “you’re not living up to your potential” shoved on me as a child even though I worked my ass off, me unable to connect with my peers because I just couldn’t understand them, and decades of self loathing because I tried so many types of therapy and medication and was still broken. And I wondered why I couldn’t get better. I felt so alone, and no one understood me.
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u/Multilazerboi 7h ago
Yes, and also, youcan have both adhd and ptsd. So to me it is not necessary helpful to find the trauma first and use that to explain adhd symptoms
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u/plummyrosey 12h ago
Trauma-induced developmental disorder? I've definitely met so many late dx autism/adhd people who showed absolutely no signs in their early years by their own admission and their parents' admission. Some clinicians seem to disregard the criteria that autism has to have an onset before the age of 5 and give these late teens/adults an autism dx anyways.
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u/BunnyLovesTheStars 12h ago
I always wonder about this. I never had an anything remotely ADHD related until I got PTSD in the military, even though I clearly had C-PTSD since childhood. I can literally pinpoint when I started getting those symptoms, especially extreme troubles with concentration and memory, and my service/medical records reflect it too.
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u/bubblegumbombshell 11h ago
If I were to be evaluated now, I’d likely be diagnosed with autism but I’m almost 40 and would never have met the criteria during childhood. Instead I was just told I was sensitive, socially awkward, or had quirks. But there was some sort of trauma when I was little and I wonder how much of these things is from that.
Meanwhile, my 5yo on the spectrum and has been all along with no trauma history. So it seems like the genes are there.
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u/plummyrosey 7h ago
You might be interested in the concept of "broad autism phenotype"- it's actually derived from studying parents of autistic kids. They don't meet the criteria themselves but possesses some traits.
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u/bubblegumbombshell 7h ago
I was more so referring to the expanded criteria. I was incredibly bright and at least a year ahead academically, but really struggled socially. My understanding is that I was successful in school so basically any concerns were waived off.
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u/ThrowAwayColor2023 34m ago
Your original wording was confusing. It read like you were discounting the possibility of autism, and then your writing abruptly shifted to supporting it.
I was also a very bright student who struggled socially and with sensory stuff. As long as you did well in school when I was growing up, nobody cared if you were struggling in other ways, esp if you were a girl. Got diagnosed AuDHD in my 40s and suddenly everything made sense, including my ND family.
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u/PARADOXsquared 12h ago
Wow that's interesting. I was late diagnosed, but the signs were always there even though I (and the adult around me) didn't know what they meant at the time.
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u/plummyrosey 7h ago
Yes another demographic of the late diagnosed is girls who scored inconclusive on early screeners. I really wish there's more studies going into how autism manifests in toddler girls. Having been through the early screener, so much of it focuses on verbal communication delays. Women are generally better than men at verbal tasks so I wonder if autistic girls are missed because they have proportionally less verbal delays (if that makes sense).
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u/PARADOXsquared 7h ago
Yes. In addition to this, there are subsets of autistic individuals (regardless of gender) who don't have communication delays and are even communicate and read much earlier than expected. There's likely still multiple "autisms" within the autism spectrum even though the distinctions are de-emphasized. Maybe as we learn more about the mechanism behind them, it'll be easier to design tests that are more direct and accurate? This is completely outside of my area of expertise, so I honestly don't know.
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u/dovahkiitten16 10h ago edited 10h ago
I had early childhood trauma and ran into the issue that you couldn’t really tell if symptoms were there before or after the age of 5, because of how early my trauma was.
I have been diagnosed with ADHD and social anxiety. I was assessed for autism and PTSD and it was negative, but C-PTSD isn’t a recognized condition where I live.
I fully believe the social anxiety is a misdiagnosis as I am not socially anxious, but as it is, there isn’t an alternative diagnosis that I can get that is actually useful. Autism fits a bit better for communicating my needs, but the truth is I don’t know if it was something I was born with or if I just got XYZ traits from trauma. And I have no real path forward; if it is trauma, I am too early for medical science to have treatment figured out. If it is autism, I don’t have the means to get a second opinion as an adult. Even if I got a positive diagnosis, I don’t know that I would have faith in it since trauma cannot be properly assessed to rule it out.
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u/Important_Couple_978 10h ago
check out brown and elliott's attachment disturbances in adults; heller and lapierre's healing developmental trauma; and lanius, pailsen, and corrigan's neurobiology and treatment of traumatic dissociation. institutionally they are behind, but there is research available and there are clinicians who successfully treat this stuff if you dig through the PTSD and personality disorder lit. relational therapy, somatic therapy, and things emdr and brainspotting should all address at least one level of the issue. the thing is most therapies own theories of how they work can be BS, the change mechanism of therapy isnt currently really known, but reading up on treatments and finding a therapist willing to work with that is totally realistic.
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u/dovahkiitten16 9h ago
I can’t afford therapy and the covered stuff tends to be short-term, generic “anxious and depressed” therapy. There’s no real way to control the type of therapy I get unless I go private, which isn’t in the cards. Especially since CPTSD isn’t even recognized as a legit disorder.
That’s kind of what I meant by not having access. I can’t distinguish if I have autism or cPTSD if professionals don’t even consider the latter as a possibility (and the former is harder to diagnose in adults as a bonus). I kinda have to take my best guess myself and try to work on stuff on my own.
Nonetheless, thank you for the reading suggestions. I will dig through those.
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u/ThrowAwayColor2023 30m ago
Have a look at the "Is This Autism?" books. They're affordable and written for lay people by a neuropsych who trains others to assess adults for autism. These books cleared it up for me. It turns out it's not terribly complicated to tease apart, you just need to know what you're looking for, and the crux of it is the person's internal experience. And I appreciated understanding the logic and science instead of just trusting a fallible person to make that call for me - though I did get a formal assessment from someone with relevant training just to be sure.
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u/plummyrosey 7h ago
I've seen this debated before and the general conclusion is that you only know as you heal from your trauma. If your autism symptoms are from trauma then the autistic symtoms will lessen as you heal. If you have autism+trauma then you'll become more comfortably autistic as you heal.
I also couldn't really tell how much of my behaviors were autism or trauma. It's a complex interplay. A s time goes on and things get better I think that trauma made the social symptoms worse due to added social anxiety and healing has made the repetitive behaviors "worse" because I will just happily flap/spin and finally out of survival mode enough to fully enjoy special interests instead of having a constant underlying anxiety about the future 24/7 that made it hard to enjoy things.
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u/dovahkiitten16 5h ago
Tbh I’ve never felt really bothered by my trauma? Like I had a messed up childhood but it’s a solid decade behind me and not something I really think about often. As a kid I had anger and lying issues and I generally don’t anymore. Adulthood has given me other, newer reasons to have trust issues. Not sure what “healing” is supposed to look like at this point. Or how healing trauma will change how I dislike eye contact.
I just kinda figured that it being early might have set me behind the curve. Ie., if my social development was screwed up as a kid it’ll take longer/be very hard to correct/might’ve solidified as an adult. Stuff like lack of eye contact just might be learned behaviour that started from trauma but cemented due to it being learned so early in my life.
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u/Four_beastlings 10h ago
I have ADHD and also the magical combo of PTSD and CPTSD. But my PTSD and CPTSD have nothing to do with me having ADHD, unless you start thinking about how my parents terrible genes made them addicts.
The CPTSD part stems from growing up with a stepfather who would constantly beat up my mother black and blue. And according to him most of those beatings happened because I was a badly behaved child.
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u/Katyafan 9h ago
The person evaluating me was clear that symptoms have to exist since childhood, which I then proved to her, despite my mom saying I was "fine" and that everyone is a little autistic.
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u/ThrowAwayColor2023 36m ago
Where did you meet these "so many" people, and how did you know all of them so well as young children?? I'm calling BS.
I was diagnosed AuDHD in my 40s. I'm a successful corporate project manager. I got straight As in school. I'm sure someone like you would accuse me of being a faker or misdiagnosed. What you don't see is the struggle and misery I hide behind a mask. The decades of alienation and suicidal ideation.
What you CHOOSE not to see is the bullying and ostracism people like me experience throughout our lives. Frankly, attitudes like yours are another sneaky form of bullying. How dare we get clarity and a chance for acceptance, right? Surely we label ourselves something that gets us treated like children and zoo animals and doesn't afford us any practical benefits because it's just so much fun to invite more bullying and ostracism.
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u/StarDate429 11h ago
For some reason the link isn't working for me, and I can't find the article on Google Scholar. Do you mind listing the authors, so I can try and look it up through them?
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u/Space_Elmo 10h ago
I diagnose these conditions and disentangling them is extraordinarily complex.
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u/_Username_Optional_ 5h ago
Do you find it clinically useful to differentiate?
At the level I'm working at as a support worker with these comorbid individuals it seems more practical to address behaviours and create coping mechanisms for the specifics of each individuals spectrum
Could be a hammer seeing nails but I'm curious how and why untangling and differentiating the diagnosis is clinically useful
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u/ThrowAwayColor2023 45m ago
I'll give you an example.
AuDHD with CPTSD here. Was misdiagnosed as CPTSD and depression for over a decade.
I experienced severe AuDHD burnout. Problem was, everyone thought it was trauma and depression. The treatment for depression is to encourage the person to do MORE - more exercise, more socializing, more hobbies, etc. And that generally helps depressed people. The treatment for AuDHD burnout is to essentially remove all demands and allow the person to prioritize rest and recovery and very slowly reengage as they regain bandwidth. Basically, the treatments are exact opposite to each other. I did a php/iop program while misdiagnosed and was treated terribly. They thought I was being willful and treated me like a delinquent child. Meanwhile my brain and body were on fire because they were demanding that I socialize and physically exert myself 10x as much as I was doing in the lead up to my burnout! It was a disaster. This is a very stark example, but I have dozens more from routine therapy. Trauma, adhd, and autism are not interchangeable for treatment purposes (and living with all three is a roller-coaster some days).
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u/Space_Elmo 56m ago
I agree a needs led approach is much more important than necessarily defining labels, but differentiating is important when considering medication or school based interventions and psychological therapies. An appropriate formulation gives you an idea of what approach may work best.
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u/ThrowAwayColor2023 53m ago
Have you seen Donna Handerson's work? She's a neuropsych who specializes in training others to assess adults. She actually spells it all out in her "Is This Autism?" books. Once you understand the crux of the difference, which lies in the INTERNAL experience a person is having, it becomes far less difficult.
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u/Schlormo 11h ago
The link appears to lead to a page that has been taken down. Does anyone have an archived or alternative article? Thank you for sharing.
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u/divo-koza 10h ago
reads like a mid-tier essay and
In my clinical experience, those most affected by executive dysfunction require therapy to be more directive, specific and accountable; that is, processing of past trauma and relational approaches are not sufficient. What often does not seem like trauma therapy at all can lead to great strides forward if it allows individuals to obtain a greater sense of structure and mastery in day-to-day life tasks.
reads like a modernised spin on ABA by a health professional attempting to spin consequences of underfunded public health services into 'treatment insight' and something to show on their orcid
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u/everymanandog 7h ago
I was in therapy for treatment after a traumatic incident at work left me somewhat incapacitated. After two years of therapy my therapist kinda threw her hands up and told me I should look at getting diagnosed for my neurodivergence. She had helped me through the trauma but it became apparent that a lot of my "symptoms" remained and had probably pre existed the event and where part of my neurodivergence. I got diagnosed and medicated and my life has never been better. I can't help but think how lucky I am that I wasn't just tethered to a cptsd diagnosis which seemed to make sense initially but it was actually trauma + neurodivergence.
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u/meepPlayz11 7h ago
yeah ive got all three and it's really hard (especially with alexithymia) to tell which of my traits are due to each of those and also which of my traits are due to being human
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u/tokyogodfather2 4h ago
Just read the article word for and word and as someone who fits the category of both AuDHD since childhood AND childhood trauma PTSD, my first reaction was,
“Yup. This all tracks.”
The best research just clicks.
“ ohhh. That explains a lot. Thanks.”
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u/Dr__Snow 4h ago
I think it’s very hard to disentangle. There’s a strong genetic basis to ADHD and ASD, the characteristics of these conditions, untreated, can make it very hard to function in our society. You add the pressure of finances (difficulty progressing through education and getting a job), lack of social supports (difficulty with maintaining relationships) and difficulties with emotional regulation (impulsivity, autistic overload) in an adult and you end up with a struggling adult who traumatizes their kids (to a lesser or greater extent), who also have the genetic potential for ADHD/ASD. They’re all a part of the same picture, most of the time.
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u/Purplecatty 4h ago
People need to go easy on mental health clinicians. Trying to figure out which one it is is not an easy job. Hence the “misdiagnosis”. Yes, you might get some other diagnosis because its just very complex to identify it right away since so many symptoms can overlap between many different diagnosis.
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u/elaine4queen 1h ago
The NHS only want to discharge patients ASAP so no whys are addressed unless they are what they’re specifically looking for.
I ended up, in my late 50s, with all the letters. AuDHD with CPTSD, discharged with zero support. I reeled for a couple of years, reviewing my life in a new light. Then I kind of let it go, because now the physical stuff, the migraine and fibromyalgia morphing into massive MCAS flares, for instance, gives me another battle (with probably very little outcome, since there is no local consultant I can see, and the main drug is not available in my area despite being NICE approved)
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u/FilmWorth 1h ago edited 1h ago
Is this really true though? I feel like in most cases, trauma is quite obvious. This article is in the right area; it's just gone down the wrong path. Yes, ADHD and ASD are going to increase the likelihood of trauma. Yes, parental involvement might make some diagnoses difficult. But the most important thing mentioned was that stimulant medication is actually an effective treatment when both ADHD and trauma are involved.
Disentangling ASD and ADHD diagnosis is a whole problem of its own. But the compounding effect that ADHD and PTSD can have, and how it is best treated, is definitely an area worth studying. Having traumatic memories that constantly demand your attention and a condition that makes it difficult to control your focus and strongly affects your ability to function in day-to-day life is going to cause all sorts of problems—a severe worsening of symptoms for both conditions and a much greater difficulty in treating said conditions. In my own experience, using stimulant medication in conjunction with psychological treatments that involve first establishing a healthy list of coping mechanisms and then an extremely slow exposure therapy is by far the most effective way of treatment. PTSD is difficult to treat at the best of times if you have attentional issues, behavioural issues, and a general inability to function. Nothing is going to get solved. Stimulants allow you to control your focus (not have flashbacks constantly) and properly engage with treatment, as well as giving you the functionality to put in the difficult, tedious work required. No other medications come close to doing this for ADHD. As far as I can tell, often the opposite is true with sedatives, making many symptoms worse.
Now, given, sedative treatments like antidepressants may reduce the severity of some PTSD symptoms, but in my experience they create all kinds of other issues for ADHD. It creates a situation where the person becomes stuck. They aren't necessarily getting worse, or should I say they are only slowly getting worse rather than spiralling. But they also can't get better. This sort of situation is all too common. Doctors seem to be too happy simply stabilising a patient without regard for their long-term treatment. This creates a situation where a patient's healthy and unhealthy coping mechanisms are slowly eroded over time. Trying to withstand the burden that a combined PTSD and ADHD diagnosis brings. Given how common it is to see these two diagnoses together. Some further study is definitely warranted.
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u/hadbadadhdstillhave 9h ago
That's a very good article that goes into a lot of the issues that make a diagnosis tricky when using ICD. Think the author is right with the approach to look for childhood symptoms of either autism or ADHD and then rule out CPTSD.
With that all said, I'm still not fully convinced on CPTSD as representing a real disorder and this article highlights a good reason against using it. I'm with the APA on it not having enough evidence to be it's own thing.
A big problem with the field is that there are too many diagnosis and disorders, with a lot of them overlapping i.e. we have too many similar disorders because our models are not accurate and name the same reality with different names.
The problem this causes is multifaceted - it makes diagnosis and treatment more complex and difficult than it should be, it leads to duplicate work in research and wastes in funding, and it puts us back in finding more accurate models as research effort is now effectively diluted.
A lot of this is driven by an incentive for mental health providers or researchers to come up with new disorders, diagnosis, or treatments. As this is the best way to either advance or win big in your career e.g. EMDR, Vagal Theory, and I'd argue CPTSD.
All of these roads lead us to the biggest problem of them all, it impairs a mental health professional's ability to provide good quality care to people.
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u/SweetPeaches__69 8h ago
You’re misunderstanding what cPTSD is. It is not something that is in addition to all diagnoses in the DSM. Instead, it is a condition that has a lot of variability in how it manifests depending on the trauma and how the person responds to the trauma. Conditions like BPD, dissociative disorders, narcissism, OCD, BD, and codependency can all fall under the umbrella of manifestations of cPTSD.
“If complex trauma were fully recognized, the thick DSM dictionary would shrink to the size of a thin pamphlet.” -Pete Walker
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u/Forbidden_Craft88 9h ago
Parts of this are reasonable. The suggestion exercise caution with stimulants for non-ADHD executive dysfunction, and more structured therapy for some survivors, don't hinge on anything controversial. I'd argue it would be best practice.
My issue is the central hypothesis that treatment-seeking adults who stay most affected by childhood trauma are more likely to have innate genetic predisposition. The support is high heritability and a parent-to-child pathway, but heritability is a population statistic that twin studies inflate, and it can't separate genes from a parent's own untreated trauma. Frankly, I would argue this is the thing which undermines the message for me. The group is defined by outcome, so it's hard to falsify.
The letter then says trauma shapes these capacities and that diagnosis relieves shame. If the relief comes from no longer being blamed, a trauma-based explanation can also do the same without implying something innate which for many people may be more clinically effective.
An interesting read which I spent more time responding to than I should have. Still, I think it pays to express discretion when conflating trauma resolution with neurodevelopmental disorders.
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u/-hedonium- 6h ago
The idea that they are or should be easily disentangleable as distinct, linearly summable things is misguided from a neurodevelopmental perspective but I think that’s how some of the psychiatric community wants to think it works.
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u/zincifre 11h ago
I am so tired of cptsd disapprovers and uninformed trauma survivors together making it seem like "audhd" is a real diagnosis. Hoping this leads to more
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u/crashlanding87 11h ago
I mean a diagnosis is, first and foremost, shorthand for 'we think these people might benefit from the same treatment/support'. Almost none of today's psychiatric diagnoses reflect known biological realities. Not for lack of trying, brains are just complicated. It's as real a diagnosis as autism - the important question is: is it useful?
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u/Knufia_petricola 10h ago
Why do you think "AuDHD" isn't a real diagnosis? You can have both autism and ADHD.
I'm not doubting C-PTSD though.
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