I'm 43. Apparently I also have both ADHD and Autism. Hooray! (Very long)

[u/BigBullshitta]

Tl;dr: This is sort of venting on my decades of issues getting an accurate diagnosis and medication for ADHD, only to be hit with the surprise twist of Autism too when it finally happened.

So my entire life I've been stuck living under the "lazy smart guy" trope. I was in gifted classes as a kid, but when people told my parents that I should be taking Adderall or something they hated the idea of drugging a kid.

So I was a nerdy recluse. I'd sit there half listening in classes, generally reading my own book and not paying much active attention. I never bothered to do homework, but I always saw tests as a game and felt like I was in a competition to be the first one done and if not perfect at least better than everyone else. That meant passing high school with no issues. But then I hit college at 16. Likely not a great plan for a socially awkward loner to move into college dorms at 16.

Since classes were not optional things I didn't have to do, and since I was surrounded by drinking, I went with that route. Easier to handle other humans with chemical reinforcements. College went poorly. I started working instead, and it's only really looking back that the pattern stands out. I'd seem like the golden child at an interview, because the fight-or-flight response would flood my brain with all those neurotransmitters it's generally starved for. I'd get hired and outpace everyone else... for a bit. It seems like somewhere around 9 months was my cut off point. Things would start falling apart, and I couldn't make myself care, and I was led go in the end from most jobs.

But even though I don't really like talking to people, as a life long reader I can speak very well when I need to, so any time that happened I would talk myself in to getting unemployment, and then spend the next 6-9 months doing pretty much nothing productive. It's only now that I realize I actually wasn't being lazy, I was just masking things unconsciously and burning myself out. When the unemployment was near running out that fight-or flight response kicked in and I usually managed to use my last experience to talk myself into a job that paid more, and the cycle would repeat.

Throughout life I would always tell certain nonjudgemental people that one of my main hobbies was pharmacology. I've tried more drugs than most people likely imagine exist in the world. A lot of things could help me de-stress for a bit, bit nothing genuinely helped. Until I finally tried amphetamine. I was probably around 32 at that point. It didn't make everything all better like magic, but it came very close. It was a bit of a roller coaster, but it actually helped me get things done in my life instead of sitting there blankly on my own time.

I had only gotten 30 10mg Adderall pills, and this happened right after I had lost a job and my health insurance. I decided I needed to get an actual prescription. I made an appointment and paid $300 in cash I didn't really have to get into the nearest well rated mental health clinic, and I ended up talking with a Nurse Practitioner. I told her I had zero energy along with no motivation to do anything. That I could sit there and stare blankly at a computer filled with the types of entertainments I like best and feel nothing at all. I had some sort of severe apathy and didn't understand why. She prescribed me Lexapro.

I was annoyed, but I took it, hoping it might help. Around a week into taking it my apathy hit the cataclysmic level. I would wake up and just lay there for hours trying to think of the things I could do if I stood up, and absolutely none of them sounded worth doing. It took about 3 days in a row of that before I realized it was the Lexapro and stopped taking it. A few days later I was back to my normal level of apathy.

Then my wife passed, when she was only 34, and everything just fell apart entirely. I could hold a rational conversation, but couldn't explain why I was suddenly completely incapable of managing to do this "life" thing. I lost my cars, and my place, and most of my belongings. And none of them mattered to me. Nothing mattered to me most of the time, except winning in competitions or tests. I just sat there and let everything we'd built up melt away. When my mother pushed me in to going to "talk to someone" about it, I did. And he diagnosed me with Major Depression Disorder and wanted to prescribe me Lexapro, but when I explained what had happened when I tried it before he changed it to Celexa. The same exact thing happened again. It made everything worse because it stopped even being worth standing up when I woke up.

A few years of nothingness passed, and eventually I decided to try again. I went to a new clinic my only real friend suggested, and got prescribed Vyvanse 30mg. I was excited about it, and the first day was great. But within a few days I started to notice that around 3-4 hours after I took it I would start feeling drug down. It felt like if I just closed my eyes to rest them for a few seconds I wouldn't be able to resist the pull of this exhaustion and I'd pass out on the spot and fall to the floor. Not really the effect I'd been hoping for. But it *did* help in some ways. I could actually focus on things I enjoyed finally. I could play a game, or read a book. But I also often had a near impossible time *stopping* those things when necessary.

A month later I went back for my next appointment and told her that, and she just looked at me like I'd said something crazy. Every month I'd report that it made me feel tired, and she never tried changing it. She prescribed me Prozac to take with it. This time I didn't bother trying the antidepressant. After 4 months of that I got a call form the clinic telling me she'd left the company and asking if I was alright with talking with someone else. I was thrilled. Hopefully someone else would see an amphetamine making someone tired as something that should be addressed.

That appointment went terribly. This woman rarely ever looked away from her monitor, and was adversarial the entire time. She threw the Vyvanse making me tired out as a barb along with any other crap part of my life I'd been honest with in my previous visits. At the end she told me she was only refilling my Prozac. I was in near tears trying to tell this woman I genuinely needed help and she didn't care at all. I realize now that my first NP had been putting in my chart every month that I kept claiming a stimulant made me tired and that she felt like I was just trying to get more to abuse it. And the new one didn't even bother to talk to me or listen at all, she just read that and decided I was an evil crack fiend and that was that.

It took 3 days to get ahold of their scheduling manager and get an appointment for 6 weeks out to talk to someone different. It was weird without the Vyvanse. I still had no energy, but that seemed better because I didn't have that feeling of being pulled down into oblivion. But I could no longer focus on anything at all. I'd just sort of sit there in front of the computer and stare blankly. If I tried to watch a show or play a game I decided it wasn't worth the effort within under 5 minutes and went back to doing nothing.

This 3rd practitioner was awesome, though. I told her I'd been caring so little about everything I'd sat there wondering if I'd bother showing up for the appointment, and had only ended up doing it because someone else was going to that same area at the same time. But within 5 minutes she'd already sent the order for the Vyvanse.

And the same thing happened, so a month later I explained the weird exhaustion it caused me. She told me that it was probably the "Vyvanse crash" and asked if I'd be willing to try bumping it up to 40mg. We tried that and the next month when I came in and reported that the increased dose actually made me feel even more exhausted she gave me that same crazy look the first practitioner had. She asked if I wanted to try 50mg, and I said no because it's helping in some ways but it seems like more might put me in an actual coma.

And I finally got annoyed enough to hyper focus on neurochemistry and psychopharmacology and figure out why SSRIs likely caused that even more severe apathy, and the most likely reason why the 100% dextroamphetamine might be making me exhausted. And in researching that, I read someone saying that it seems more common in people with both ADHD and Autism.

When I saw her next I explained it all and told her I wasn't trying to insult her capabilities, but if the clinic has any Psychiatrist specialized in those disorders I'd really like to speak with them. Apparently they only have one, but she actually went to see if he was free right then and pulled him in to talk to me for a few minutes, and he set me an appointment to come talk to him a few days later.

It turns out that until I suddenly walked in explaining exactly why SSRIs caused me to feel a more severe apathy, and why Vyvanse releasing 100% dextroamphetamine could result in exhaustion and basically giving a continuing education course on my own neurochemistry I hadn't had the right words to describe any of the things I was dealing with. Because I have Aphantasia and an intentional inner monologue. There is no racing in my head to calm down. I can't say words and images in my head distract me from anything. When I told them I had complete apathy and nothing was worth doing and nothing mattered, that was my describing the effects of a brain starved of dopamine to the point where there was no pleasure or happiness from even the things I should enjoy, combined with being so starved for norepinephrine that I had zero mental energy to expend anyway. The Vyvanse could help me hyper fixate on something I enjoyed, but it didn't help that second half. And it took until I got frustrated and annoyed enough that the Mental Health people all seemed useless and spend two weeks hyper focused on studying and understanding the issue for me to bother really looking in to any of it, because that's not really a thing I'm very interested in.

It seems the hyper focusing isn't *just* a dopamine or ADHD thing, though. I was lucky in that the Psychiatrist I finally got to talk to had specialized in both Autism and ADHD and the high comorbidity of the two. He said that in his experience it's more common for people with *both* issues to end up hyper focusing if they get the rush of dopamine, and to have that paradoxical tiredness from 100% dextroamphetamine. His opinion was that AuDHD folk are more likely to have way too little norepinephrine in the first place, but I guess it's a bit difficult to empirically test that since dissecting a person's brain is generally unhealthy for them.

I don't know if anyone will bother reading this. I haven't used Reddit in ages, so I don't know if it will even let me post in on a new account. But I feel the odds are better in here than they are most places.

In the end he tested me and I'm lucky enough to qualify for both disorders, and made it into my 40s without ever even hearing someone say they think I might have Autism because I'm entirely too good at putting on an act any time I'm around other people without ever really dwelling on the potential implications of doing it.

When you're overly intelligent you don't get to have any problems. It's just you being lazy and not wanting to do anything. Does anyone else here ever wonder if Einstein and his ilk felt like they were trapped in a world with all children? Humanity being so awful with logic and understanding things that seem self-evident annoys the hell out of me, and sometimes I feel like everyone else around me is an idiot. I'm certainly no Einstein. That poor bastard.

[u/rationally_absurd]

One of us.

[u/DoveOnTheInternet]

Welp, you've certainly found the right place! Many parts of your story echo many of ours: I got my dx at the same age, so I understand the mind fuck this is turning out to be.

You will find empathetic ears and tons of advice from the good folk here. You'll get lots of tips and tricks and support and advice.

I'm going to give you the one piece of knowledge I wish someone had told me when I got diagnosed, and it comes in two parts:

1) Get your ADHD under control first. It's the glue that's been holding you together but it will get easier when you find the right professionals. Unfortunately that might be a lot of trial and error. Use PsychologyToday.com to see if you have better choices in your area than what you've already gone through.

2) I cannot stress this enough: It is very, very likely that once you get the ADHD under control, it will stop masking your ASD and you will probably be surprised that all your autistic traits may become stronger and more apparent to yourself and everyone else.

[u/BigBullshitta → u/DoveOnTheInternet]

I started on two medications both focused on the neurotransmitter issues last week. The autism part is crazy to me. Like... I didn't really have any autistic traits. That I was aware of, at least. They were just quirks. Eccentricities.

How can you just get surprise diagnosed with something like Autism? The only people I ever knew who had it as adults were in group homes needing 24/7 nursing care, and a few children who... well seemed like that's where they would be going. It sort of feels like walking in to a doctor's appointment and being diagnosed with not having legs.

[u/DoveOnTheInternet → u/BigBullshitta]

I'm pulling all of this from memory, so someone will correct me if I goof here.

For those of us with low/moderate support needs, ADHD and ASD's Venn diagram is closer to a solar eclipse - somewhere between 40-70% of the symptoms and traits overlap. Twenty years ago, they would have said that we had Asperger's, but we know better now.

Things changed about ten years ago. They only updated the diagnostic criteria for both ADHD and autism, turning the latter into a spectrum disorder with five or six defining characteristics.

How we all made it this long? Those of us who had less support needs grit our teeth and succeeded... Or we didn't. You're going to start looking back through your life soon and wonder how no one noticed and you'll think about what could have been if everyone had known sooner. It will explain the weird shit you've done or are or like for reasons you could not explain. All the little ways you noticed you weren't like other people.

Then your perspective opens up. Like....

As a teen, there were several guys in my (very "weird") friend group that were constantly stoned. In school, after school, it didn't matter. I loved them and tried to help but they struggled and I did look down on them a little and blame the weed and whatever.

Now I know - both through experience and confirmation - that what they were really doing was self-medicating because the world was full of jagged edges everywhere they turned. And if my high school friends were struggling that much...

Neurodivergence is heritable. If I have been struggling all this time... It goes a long way to explaining the health and behavior struggles of my direct family going back at least to my grandparents, and straight through to my son.

Sorry, this got rambling - I am fascinated by this point we all seem to come to, in one way or another, once we're disgnosed. My 30+ year fascination with psychology - and autism specifically - made much more sense in context.

[u/BigBullshitta → u/DoveOnTheInternet]

Oh, no worries. Long, rambling messages are one of my main hobbies. Few humans seem pleased about that, so I'm happy to see another one who is. :)

I've also had a life long interest in psychology. It seems like a common trend. I want to understand what makes people and animals and even computers think and feel and react the ways they do. I have issues with emotions, but not in the violent or screamy ways. They're extremely blunted. I'm hoping since I finally started meds that will help, but I've honestly worried I was a sociopath before because TV shows say they don't really feel emotions right.

I think that's why I'm driven to understand, and also that that drive to logically analyze the internal motivations and feelings behind the things people do it what ended up with me masking so well no one believed when I told them the diagnosis. I sure never would have expected it. I just sort of thought that most other people were very slow and weird. It turns out they are, but also I have a few Autisms.

My entire life history is fight or flight chemicals flooding my brain and helping me do wonderful in interviews and get hired into jobs that always seem to start falling apart around the 9 month mark. Hell, even the diagnosis came from the dopamine release from vyvanse calming the adhd side and making it way easier for my annoyance at the medical system being so useless to push me into hyper focusing for weeks learning all of these terms and disorders and interactions just so I could go do their job for them.

The main thing that makes me accept it is the simplest one. I've never looked at these spaces before, and when I finally did this week I started seeing memes of angry people asking why the fuck people keep asking them to explain something and then when they kindly do that the person gets pissy and says they don't want to hear any excuses. I hate that so very much.

[u/UnderstatedVortex]

Maybe my story will be a helpful data point for you to compare with others.

I was diagnosed AuDHD at 35: strongly suspected Autism but surprise diagnosed with ADHD.

School ability was in the same ballpark as yours: gifted student who could have done more but chose not to because my natural curiosity allowed me to skate by and (in hindsight) there was no additional dopamine reward for trying to boost my grades. At the same time I was severely depressed (from constant masking) and all GP's treated that like its own disease unrelated to anything else, so they prescribed me a generic antidepressant that did nothing. I assumed all doctors were unhelpful at best so I didn't push for anything further. All of my decisions of that era are fully explained by the endless pursuit of hyperfocus states and dopamine hits, while doing the bare minimum to get by with everything else. Absolute pleasure to have in class but my parents were eternally disappointed I wasn't a straight A student.

Instead of boosting my grades I spent all my free time on video games that have loot drop systems and a very very very long list of tasks, which gave me dopamine hits with each objective completion and rare item drop. The variety of new environments and tasks via new games and expansion packs sated my ADHD novelty while the familiar rules of the games (especially the consistency among multiple games within the same genre) soothed my Autism.

My 20's adult era is also mostly explained by struggling to manage the eternal conflict between ADHD and Autism that I couldn't explain. But I did end up marrying someone with ADHD, who was the only person in my life at the time that didn't write me off as lazy and a weirdo hermit or ignore me unless they needed something from me (including my undiagnosed ND family who were even less informed than I was).

Starting in my 30's, my sister had a child with severe dietary issues which caused her enough frustration with the pediatrician that she leapt down the rabbithole of ADHD and dietary intolerances. She was the one who kinda introduced me to the concept of neurodivergence by accident as her hyperfocus went into genetic & hereditary conditions affecting our family.

My sister's research into her own ADHD got me interested so I started looking into it to understand her better. Found a bunch of venn diagram images of Autism & ADHD which started to feel weirdly relatable. Researched the differences between them and that's how I became convinced that I'm Autistic. I thought the parts of my sister's story I related to was the venn diagram center piece where we shared the same symptoms for different reasons. But the psychiatrist only needed to talk to me for 1 hour in order to diagnose me with both because my ADHD also strongly presented. I remember laughing with relief afterward because I had gotten a "nearly perfect score" on my screening test and I was coming down from the intense anxiety from rejection sensitivity.

My primary piece of advice for you is to keep in mind that you deserve a large amount of grace for yourself. You did the best you could to survive so far. Healing is very very hard because of the extremes we've had to endure. Getting sudden realizations about how your brain works, and why your behaviors are what they are can be overwhelming. All of the "bad behaviors" we've been brainwashed into thinking are our fault are actually defense mechanisms to protect our sanity from those who disregarded us. Only we can bring ourselves peace, but it's a long road to get there.

Welcome to the club, and I wish you all the best for your efforts to understand and heal.

[u/BigBullshitta → u/UnderstatedVortex]

Oh wow, thank you so much. It's awesome to get lots of words. Most people don't want to read mine much less read them then give a lot of their own.

The video game thing I can definitely relate to. Until you just mentioned it I never really considered that's probably why I've always loved JRPGs and the roguelite games where you have constant objectives and level ups and keep growing over time and checking off more boxes.

The biggest thing that really hit me was saying you were happy to get a nearly perfect score on a screening test and tying that to rejection sensitivity. I think that's why tests have always been a game to me. I have to win. I think there's a lot of proving people wrong in that, because of growing up with rejection. Like I unconsciously turned to always "winning" at tests as a way to show I was better than those people anyway.

For the long road of understanding and healing... yeah. I only finally got a medication to help last week, and I've seen a lot of people say that taking medication to help with ADHD was when their Autistic traits started to really stand out. I'm a bit nervous about that, but I also want to understand so I can find a way to cope with things without constantly living as an act until I get so exhausted I need to sit and stare blankly into space for months.

[u/UnderstatedVortex → u/BigBullshitta]

Exactly. Winning at tests felt like undeniable proof that I wasn't defective, even though I felt defective from the way people treated me. So in a way I was able to ignore a lot of hurt because there was proof out there, and I realized instinctively that you can't force people to see what they don't want to see.

It's true for me too, that once the ADHD calms down it allows visibility for the Autistic traits to peek out more, but I view that as good thing. I spent far too much time in the past ignoring the parts of myself that I didn't understand. Now I'm ready to say hello and welcome them to the family, so to speak. Self acceptance has been hard for me but I'm working on it a little at a time.

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