ADHD & BEing Misdiagnosed

Pen and Harvey discuss the high rate of misdiagnosis for people with ADHD, including likely reasons for it and common comorbid conditions.
 Note: Around the 38 minute mark, Harvey mentions & reclaims the r-slur. If that's something that makes you uncomfortable, go ahead and skip forward 40 seconds or so and you should be fine.

Featuring: Say "wahoo" in the fun voice; well-meaning clinicians can still be wrong; ADHD Is A Brain Condition, Not A Behavior Issue; When I say mood swings, I'm talking theme-park level here; Secondary diagnoses are real, but oof; We talk about dopamine again; A really bad take on autism from an article I wanted to like

Referenced/Related Links from this episode:

• https://www.additudemag.com/slideshows/adhd-misdiagnosis/ ADDitude article on common misdiagnoses (includes the bias & inaccurate part on autism)
• https://www.additudemag.com/mental-health-diagnosis-adhd-comorbidities/ Another article on common comorbidities, not directly referenced in the episode, but still useful information

Suicide Hotline & Resources for Trans People: 

https://translifeline.org/

USA Suicide Prevention: 

https://suicidepreventionlifeline.org/

Internation Suicide Hotlines: 

https://www.opencounseling.com/suicide-hotlines

Suicide Hotline & Resources for LGBTQ+ Young People: 

https://www.thetrevorproject.org/


Ways to support Black Lives Matter and find anti-racism resources:

https://linktr.ee/blacklivesmatte

Resources to support AAPI (Asian-American & Pacific Islander) communities:

https://www.advancingjustice-aajc.org/

https://stopaapihate.org/

Resources for US Immigrants:

https://www.informedimmigrant.com/

Resources to Support Undocumented Immigrants in the US:

https://immigrationjustice.us/

Transcript

Harvey: 0:00

Hi, friends. Among other things, this episode addresses the comorbidity between ADHD and autism, and also some of the ways that that gets really complicated. It should be noted that, around the 38 minute mark, I reclaim the r-slur. Now, this is something that I am allowed to do because I am autistic, however, if hearing that slur makes you feel uncomfortable or upset, which is totally understandable, just be forewarned that that's going to happen, and feel free to skip past that point. Enjoy the episode!

Pen: 0:46

Hello, and welcome to Beyond Introspection: a podcast where we talk about mental health, neurodivergence, and how it impacts literally every aspect of our lives.

Harvey: 0:53

All of them.

Pen: 0:54

I'm Pen.

Harvey: 0:55

And I'm Harvey.

Pen: 0:56

And in this episode, we are going to be talking about ADHD and misdiagnosis.

Harvey: 1:02

Which to my understanding is very common.

Pen: 1:05

Yes, yeah, it's actually--it's really, really common, much like comorbidity is common. Which, those two, as you might be able to imagine are linked.

Harvey: 1:15

Hmm, who'd'a thunk it?

Pen: 1:16

Yeah, who would have thunk it? Apparently not a fair number of clinicians, which... weird take, but okay.

Harvey: 1:25

That seems concerning.

Pen: 1:28

It's, uh--some of this is, like, it's not that i've seen a lot of things where clinicians are like, "No, actually, I don't think that there's much misdiagnosis," it's just that the misdiagnosis happens so consistently in the first place, that it's like, okay, maybe the understanding that you are working off of for what ADHD is and how it looks is flawed, and y'all need to take a minute to reexamine that.

Harvey: 1:54

Maybe you're doing a bad job

Pen: 1:56

Sometimes, even when you're well-meaning. But--ooh--ooh, that's... yeah, that's a lot of things, huh?

Harvey: 2:03

Impact versus intent applies to a lot of things, but I think, before we get into this emotionally exhausting, probably, episode, Pen.

Pen: 2:15

Harvey.

Harvey: 2:15

Tell me about your Wahoo! Moment of the Week.

Pen: 2:19

You...

Harvey: 2:20

Me?

Pen: 2:20

You know I'm gonna make you redo that so you say "wahoo" in the fun voice.

Harvey: 2:24

Oh. Tell me about your Wahoo! Moment of the Week.

Pen: 2:27

Thank you so much. Yeah, I literally only remembered we were gonna do this when we were talking before I hit record. So, give me a second to think.

Harvey: 2:38

I have--oh! Go ahead.

Pen: 2:41

The library that I work at, we are in the process of weeding the nonfiction, getting rid of things that haven't been checked out in ages, or just are irrelevant. And for one reason or another, comics and comic books, a lot of them are in nonfiction. In part, I think just because, like, the Dewey Decimal System doesn't actually have a fiction versus nonfiction category. Like, just, fiction is kind of in the 900s, we just put it in a different place because that does make more sense.

Harvey: 3:10

Sure.

Pen: 3:11

So comics just fall into being in the nonfiction section, which I imagine is part of the reason that they don't always get checked out.

Harvey: 3:16

That is sort of bizarre, yes.

Pen: 3:19

But one of them that we were getting rid of is a Calvin and Hobbes anthology that is actually a copy of the same one I used to read when I was a kid. The original one that I got into Calvin and Hobbes with, so I took it home, and now I have it, and i've been rereading it, and it--it's cool

Harvey: 3:35

So that's why you mentioned Calvin and Hobbes in the Discord the other day. Yeah. I understand so many more of the jokes now in my 20s than I did when I was eight. That seems about right. I remember my mom also reading me Calvin and Hobbes books when I was a kid. I have a very clear memory of being, I think, seven or eigh,t and having heatstroke...

Pen: 3:55

Oh! Oh, no.

Harvey: 3:56

...the day before school started, and laying on my couch, and my mom reading a Calvin and Hobbes anthology to me. And I fell asleep and woke up fine the next day.

Pen: 4:07

I'm glad you woke up fine.

Harvey: 4:08

But I would--well, yeah, I didn't die, as you can see.

Pen: 4:12

I do, I see. I see you, alive.

Harvey: 4:15

Yeah!

Pen: 4:16

There's a picture in one of my mom's scrapbooks of me age, like, seven or eight sitting in a toy box that one of my mom's friends, like, made when I was born. So, you know, big enough for me to sit in, which I was kind of laying it in my carebears one--nightgown, so that's how you know it was a while ago, just reading this anthology.

Harvey: 4:39

Yeah, that'll do it. All right.

Pen: 4:41

What's your Wahoo! Moment of the Week?

Harvey: 4:44

I have several.

Pen: 4:45

W-hey! That's nice! I think last time we did this, you were like, "I'm depressed."

Harvey: 4:50

I'm still depressed. That hasn't changed.

Pen: 4:52

I mean, me, too.

Harvey: 4:53

I missed a dose of my antidepressants last night, so I'm extremely tired, but, you know, like, good things have happened, and I'll just--since there are several, I'll go through them real quick. I got my first dose of the COVID vaccine.

Pen: 5:08

Yeah!

Harvey: 5:09

Because I have a[snapping] underlying condition!

Pen: 5:12

Congratulations on vaccination. We believe in science here.

Harvey: 5:15

We do believe in science here, to a degree. We take science with a grain of salt because science is more biased than people give it credit for.

Pen: 5:22

We absolutely consider the ways that science can be flawed, but we aren't antivax.

Harvey: 5:27

No. Vaccines are safe and effective.

Pen: 5:33

Please.

Harvey: 5:34

That is not debatable.

Pen: 5:35

That's not--this is not a debate that we're gonna have.

Harvey: 5:37

Um, I just got back, today, actually, from seeing my boyfriend, which was nice, because I hadn't seen him in about a month and a half, so I was like, oh, boyfriend time. So I got cuddles, and that was nice. I've also been talking to this guy. I'm polyamorous, by the way, I don't think I've ever mentioned that on the podcast. But I'm poly. And there's this guy I've been talking to named Devyn, who is very, very cool. We're having a virtual date on Friday.

Pen: 6:09

Oh, fun!

Harvey: 6:10

Yes. And I--I'm probably going to be meeting up with him at the end of April, because by that time, I will--we will both be both fully vaccinated.

Pen: 6:21

That's radical.

Harvey: 6:22

And the last thing. I've been having a bit of a rough two weeks, as Pen knows. I'm intentionally being vague about this, but something happened in my life that was just really rough on me. It was something that I really hoped would go well, and it just didn't go the way that I wanted it to. But I did learn through that experience that I have more people that I knew in my life that are going to be here for me. So even though I am, like, wildly depressed right now, like, at a lower low than I've been in a long time, there are a lot of good things to think about.

Pen: 6:56

Oh, that's great, buddy. Love that. Love that for you.

Harvey: 7:00

Okay! [clap] Let's get sad.

Pen: 7:02

It's not sad. I'm gonna be frustrated. You can believe that. But it's not necessarily a sad--a sad one.

Harvey: 7:11

"Sad" as an umbrella term. Thank you!

Pen: 7:14

Seasonal Affective Depression as an umbrella term.[Laughter] Thank you for laughing. Okay, so ADHD and misdiagnosis. I--this is stuff that I have been kind of learning about more in the past year or so. I remember it was last spring when I first learned that it's actually pretty common for ADHD and bipolar disorder to be misdiagnosed as each other.

Harvey: 7:41

Yeah.

Pen: 7:41

And I remember learning that and being like, are you kidding me right now? Are you okay?

Harvey: 7:46

Oh, right, because at the time, didn't you have both a diagnosis of bipolar II and ADHD?

Pen: 7:50

Yep. I was originally diagnosed with bipolar type II by my second psychiatrist, who was better than my first psychiatrist.

Harvey: 7:58

Didn't prescribe you any, you know, life-threatening medications without the proper tests.

Pen: 8:03

Yeah, she was actually the one who brought up like, "Oh, so you've been getting the blood tests?" And I was like, what? And she was like, "So we're gonna get you off that medication. That's some messed up stuff." And I was like, yeah, it is, ma'am. Thank you. She, you know, we talked and she listened to me about like, the mood instability that I had and brought up, "Hey, has anyone ever talked to you about potentially a bipolar diagnosis, specifically type II?" and she like, talked me through that and talked me through the different medications that could be used. And legitimately, like, that was very good. She listened to me and told me what was going on. We had conversations about the medication and everything. Like, that was very useful.

Harvey: 8:44

Alexa, play "Lithium" by Evanescence.

Pen: 8:47

Yes. The problem is that she was wrong.

Harvey: 8:53

Yep.

Pen: 8:54

And it was not because she wasn't listening to me. It's because of a lot of complicated factors.

Harvey: 9:00

So many. So, so, so many.

Pen: 9:02

But yeah, it was only last year that I learned that things like, you know, mood shifts that, honestly, it was me learning about some of the symptoms of ADHD that I had never heard of before, primarily the ones that have to do with emotional regulation. Because, surprise, surprise, they're not the ones that people talk about.

Harvey: 9:22

Which, like, if you know anything about the brain, if you are into neurobiology, biology, psychology, it's not a hard leap to be like, oh, yeah, no, that makes sense, why ADHD would result in emotional dysregulation. But good God, the--the fact that it just never gets talked about.

Pen: 9:42

Like, here's the thing, and we've talked about this on this podcast before, that ADHD is literally caused by, like, there's some things that are up in the air, but it is a deficiency of dopamine.

Harvey: 9:53

Right. And really, you can reverse engineer that from figuring out what Adderall does, but--

Pen: 9:58

Like--the wild thing? it's caused by lack of dopamine.

Harvey: 10:05

Right.

Pen: 10:05

That's not how we talk about it. We don't say, like,

"ADHD: 10:08

a brain condition that's caused by a lack of dopamine." And, like, from there, like, a lack of dopamine, does that affect your emotions? Of course it does.

Harvey: 10:17

Yeah.

Pen: 10:17

That is not even close to a logic leap, but we don't talk about it like that's the case.

Harvey: 10:22

So much of ADHD is just kind of predicated on effects on the frontal lobe. and a large part of what happens in--a large part of emotional regulation, it happens in the midbrain, and then also parts of the forebrain, the frontal lobe. And all of those are dependent on dopamine. But to your point, Pen, I'm realizing--I had never thought about it that way, that it's not talked about as, like, a brain thing. I think ADHD is definitely, now that you pointed it out, more and more talked about in behavioral terms. And the behaviors do matter. But that doesn't mean that we can just, like, eschew the source.

Pen: 11:01

I think that's--that is my issue with a lot of it, is like, yeah, we should absolutely talk about behavior in ADHD, because that's how it manifests.

Harvey: 11:09

Right.

Pen: 11:09

We don't talk about it like there's an underlying reason, though. We talked about the behaviors like they're all separate things that just, like, pop up, and we can deal with them one at a time. Like, we don't really discuss it like, okay, so all of these behaviors are caused by the fact that this is a brain condition that you are born with.

Harvey: 11:28

The behavior is posited as the problem, rather than a symptom of the problem.

Pen: 11:33

Yeah. And that's just--that is a fundamentally flawed way of discussing ADHD.

Harvey: 11:38

And it's also going to lead straight into victim blaming. And in my mind, it's deeply rooted in that "pull yourself up by your bootstraps" Western ideology,

Pen: 11:46

Which is a--something that is so messed up, and also so common that, you know, neurodivergent people here is like, you pull yourself up by your bootstraps thing, and it has been, you know, very validating, and in some ways, kind of liberating to learn, like, yeah, I can put in all the effort that I want. There's nothing I can ever do to force my brain to produce more dopamine, so some things are just going to be harder for me throughout my entire life. Pretty messed up that that was a liberating and validating realization.

Harvey: 12:20

Yeah, that should sort of just be, like, the basis for--for how one experiences ADHD.

Pen: 12:28

Yeah, but because it's not, and because we don't talk about ADHD like it's something that's inherently going to affect your mood. Even though, if you look at the underlying thing, there's literally no way it wouldn't. Because of that, I didn't know. Despite, like, I brought up ADHD to my psychiatrist, Jada--

Harvey: 12:53

Jada Butler!

Pen: 12:54

Yeah!--as a potential thing to get screened for a year before I learned this. Like, I looked into it, I looked into ADHD, I saw the way that affected me, and I didn't come across any information that made me--like, that was based on how ADHD and bipolar disorder gets misdiagnosed each other until another year had passed, which tells you a lot of things, including that, even if you take the research into your own hands, that doesn't mean that it's going to be good information that's readily available.

Harvey: 13:30

Well, yeah, I was gonna say, I mean, somebody has to produce that knowledge and--

Pen: 13:34

Make it accessible.

Harvey: 13:35

Make it accessible. And the accessible information about ADHD is so just based on that behavioral view of it.

Pen: 13:46

Which is flawed. But all of that to say, when I learned that ADHD--it--it was a fundamental change in how I viewed my own ADHD as well. Because I had thought of it as something that is more based in, like, executive dysfunction and just kind of how my brain works and different from like, my anxiety and depression that, you know, just hurt me. Like, I didn't think of my ADHD as something that hurt me in that way. But learning that the mood swings that categorized a lot of the stress and pain of my, especially later, teenage years are far more than likely directly linked to my ADHD was really--like, that hit kind of hard. Like, oh, okay. So I don't think that my bipolar diagnosis--I'm not 100% sure that it has been removed exactly from my file. I have no idea how all of that fits. But, like, I had that conversation with my psychiatrist, and I was like, hey, I learned this, and she was like, "Oh, yeah, that totally makes sense. And especially when you're in--like, you're in college, and you're under a lot more stress, your mood, like, shifts a lot." I was like, you right, though, Jada.

Harvey: 15:01

Yuh.

Pen: 15:03

And like, regardless of whether or not I have bipolar disorder, she didn't take me off of lamotrigine, which I had originally been put on because it helps treat bipolar disorder, because it's a mood stabilizer, and an anticonvulsant. Brains are so weird.

Harvey: 15:18

Right? It's got to be a neurotransmitter thing.

Pen: 15:21

Probably. She didn't take me off of that because, like, one, there's no real need to. Like, lamotrigine doesn't mess with you, really. It's pretty lowkey kind of medication, not many side effects, thank God.

Harvey: 15:37

And given that, probably, if she took you off, you know, your body might have had a worse reaction to, you know, just not taking it cold turkey, which I doubt she would have done, like--

Pen: 15:49

No, I don't--

Harvey: 15:50

Jada Butler is a good psychiatrist, from what I understand. But it's probably still easier on your body and brain.

Pen: 15:57

And if nothing else, like, even if it's not treating bipolar disorder, it is a mood stabilizer. That's--like, yeah--

Harvey: 16:04

Like, those are helpful.

Pen: 16:05

I don't know exactly how much it's doing for me, but if it's stabilizing my mood, even like 5%, that's--thanks. Because my mood is very unstable. I have a lot of mood changes, and they are fast. And that's actually fits in really easily with going over to how bipolar and ADHD get misdiagnosed as each other. Because we all kind of have an understanding that bipolar disorder is categorized by mood swings.

Harvey: 16:35

And really dramatic ones, too.

Pen: 16:37

Yes.

Harvey: 16:39

I think we've done a pretty good job talking about sort of the scope of mental illness and just, like, how significant it can get. So when we're talking about mood swings, we're not talking about just, like, you know, like your average day--like, everybody experiences mood swings. That is something that happens, or even the mood swings that you experience with depression. Bipolar, whether it is type I or type II is really characterized by those super intense depressions. And in the case of bipolar I, those high manias and, in the case of bipolar II, something called hypomania, which is still mania but less.

Pen: 17:15

Yeah, but it's, like--it is extreme. And it's also prolonged.

Harvey: 17:20

Yes.

Pen: 17:21

And, very, very importantly, often is not triggered by anything in particular, except just your brain.

Harvey: 17:29

Just happens. Also runs in families.

Pen: 17:31

Yes. And that's like, those are all very significant things about bipolar disorder, and very significant in differentiating it between ADHD. With ADHD, your mood can swing in really intense extremes. And this does happen to me. Yeah. But it is one always triggered by something. There is always something that happens. And we've talked about, like, RSD - rejection sensitive dysphoria - before. That is one example of ADHD mood swing happening.

Harvey: 18:01

Yeah. And those mood swings happened with me and RSD as well.

Pen: 18:04

But, like, that, something happens when you have a really intense negative reaction to it that is not necessarily--what, equivalent to or appropriate to?

Harvey: 18:15

It's disproportionate.

Pen: 18:16

Yeah, disproportionate.

Harvey: 18:17

Possibly irrational.

Pen: 18:18

Yes. And that is triggered by something specifically. And also with ADHD, sometimes after, like, a very small change happens, like, maybe you listen to one song or just a little bit of time passes, or you just, like, sit somewhere comfortable, it can be pretty much anything, your mood can change right back to feeling good, very, very quickly. That, like, positive to negative thing can happen almost instantaneously, which is not at all what bipolar disorder is like.

Harvey: 18:51

No, to my understanding, you don't really go straight from intense depression to mania. It's sort of like, you have those intense depressive episodes, you kind of stabilize for a little bit, and then you start working your way up into that mania.

Pen: 19:06

And they last for quite a while.

Harvey: 19:07

Yeah, that's--that's my understanding, that those periods--like, I believe, with hypomania, like, you need to experience at least one period of mania for, like, a week or more.

Pen: 19:18

Yeah, it has to be, like, minimum several days of experiencing this thing consistently. That's not what ADHD mood swings are like. No. It can be like half an hour, it could be several hours. Probably isn't going to be more than a day or so, except in the cases of how ADHD can kind of mimic depression.

Harvey: 19:38

Yeah, real--real--real quick aside. I was just gonna say, if you've heard about the symptoms of mania or hypomania, and they sound familiar to you, what I will say is that experiencing hypomania does not necessarily mean that you have bipolar. I experience occasional periods of hypomania, but they're usually pretty short lived. In any case, I'm--like, I don't believe I have bipolar disorder. But yeah, just so you know, hypomania is--is a symptom you can experience without having bipolar.

Pen: 20:11

Yeah, totally. Some of my ADHD, mood swings that have been characterized more heavily by irritability, and like, kind of this... feels like sort of itching under my skin a little bit, like, just very--it's intense, and it's not quite distress. It's not happy. It's just a lot.

Harvey: 20:33

Bothersome.

Pen: 20:34

Yeah. that I thought was hypomania. Turns out it doesn't last nearly long enough to be categorized for bipolar type II. But that was something that I did experience, and was part of the reason that I was diagnosed with that. So, you know, if that sounds familiar to you, it's not necessarily bipolar, but I would definitely encourage you to, like, if you have a psychiatrist or therapist, to talk to them about it. Do your own kind of research, if that would help you out, like, whether or not--like, whatever diagnosis, it ends up being. I think it's great to know these things about yourself, and to also figure out ways to help deal with that.

Harvey: 21:14

And at the end of the day, like, regardless of the diagnosis, like, those symptoms are still happening to you, and they still matter.

Pen: 21:20

Absolutely. Whether or not you perfectly fit in with the DSM requirements for a particular diagnosis doesn't change how you're actually feeling and what you're experiencing.

Harvey: 21:30

Yeah, I mean, DSM requirements are bull hockey,

Pen: 21:34

Yeah, there's a lot of messed up stuff in DSM requirements.

Harvey: 21:37

Anyway, do you want to talk about ADHD and depression?

Pen: 21:39

Yeah. I actually have some fun--well, I say fun--I have some facts--

Harvey: 21:46

Facts.

Pen: 21:48

--that I got from ADDitude.

Harvey: 21:50

Yes, we love ADDitude.

Pen: 21:52

Oh, I'm gonna get somewhere with it. Give me a minute to get to--I'm gonna get there in a minute with autism and ADHD.

Harvey: 22:03

Ope.

Pen: But depression and ADHD: 22:04

here's a quote from ADDitude."Clinical depression is common in adults with ADHD. Experts estimate that depression exists in approximately 47% of adults with ADHD, and 14% of children, but depressive symptoms don't always indicate a full blown comorbid condition." And that. That is the part I want to talk about. That was something that I realized very recently about myself. Way back when I first got into therapy, I was diagnosed with major depressive disorder. I was doing very badly. My therapist, Charlie--remember Charlie? The tummy guy?

Pen: 22:39

Yeah, tummy man. He did not do a bad job in diagnosing me

Harvey: 22:39

Tummy man! with depression. I was doing horribly. And like, probably, I did qualify for the diagnosis. Here's the thing in ADHD and

comorbidity: 22:53

difficulty dealing with ADHD symptoms can cause secondary depression and Generalized Anxiety, as well as some other things. Obviously, some of the comorbid diagnoses like bipolar disorder or autism, those are [not] caused secondary because that's not really how those work.

Harvey: 23:11

Right.

Pen: 23:12

You don't just develop autism. That's not--that's not really how it go.

Harvey: 23:19

Nope, nope, nope.

Pen: 23:20

But things like depression and anxiety, oart of the reason that they're so comorbid with ADHD is, when people with ADHD don't have the tools or the support to deal with their symptoms, it's--it's incredibly stressful, and it's compounding. Like, the mood instability that is just a part of ADHD, as well as, like, society's inherent ableism that means that, like, the way my brain works doesn't fit with any of the models that I'm expected to be a part of. I can't consistently pay attention like I need to. My sensory processing issues are just going to exist no matter what, and some of the adjustments that I need, like, sometimes wearing headphones, or having lights be lower, or being able to take breaks, or juggle like three different projects at once, or get up and move around. When I'm not allowed to do those things--just--good luck. There's--there's nothing I can do to make myself not feel depressed and anxious, and then potentially qualify for these disorders that are, in reality, linked to my ADHD. And if I was being treated well and recognized for my ADHD, which did not happen until I was 20, and I was originally diagnosed with generalized anxiety and major depressive when I was 14 or 15, so going five to six years without any of my ADHD symptoms being properly recognized for what they were, and certainly not being treated for ADHD, meant that those things got more intense.

Harvey: 24:56

Ee-yup.

Pen: 24:56

Would I have been diagnosed with those things if I'd been diagnosed with ADHD at the beginning? I think so. If I had been diagnosed with ADHD and properly treated when I was much younger, then maybe not. I'll never know. But as it is right now, I definitely have depressive swings. I'm in one right now, folks. I don't think it is depression so much as it is linked to ADHD and how that affects my mood, and particularly, its instability.

Harvey: 25:24

Yeah, no. And that makes sense. And I think maybe the way that you would figure that out is just trying to identify, really, the source of the depression. Like I know, in my case, you know, autism and depression have some comorbidity, not a lot, but some. But in any case, even if I wasn't autistic, like, I have depression, I totally do. Um, and the thing about that is that, yes, there are triggers, but also my depression comes apropos of nothing, sometimes. My anxiety, in particular, just comes apropos of nothing. I actually don't know if I still meet the criteria for GAD, but I know that I experience panic. And kind of the crux of panic disorder is that the panic attacks come from nowhere, and then also, it's a vicious cycle, because you become afraid of having another panic attack and whatnot. All of this to say, my depressive symptoms are more identifiable as depression, I think precisely because of the lack of cause.

Pen: 26:25

Yes, that is-- that is huge thing, like, some of the intensity and instability that comes with ADHD, there is still a trigger for it. It's because my brain does not have the tool, dopamine, to deal with things sometimes. And so it's a lot more intense for me to try and process it, because I'm just lacking the tools for something. But I'm still trying to process something. Or it's not a direct trigger, so much as it is, things just stacked up on top of each other. Eventually, when you are stressed by so much of your life - because of society's inherent ableism - and also just because things are hard sometimes, like whether or not the society was inherently ablest, I still don't have to dopamine, that's still gonna--that's still gonna do something to me. And when that stacks on top of each other, sometimes you get into a more depressive state. Maybe you can't figure out the one thing, but if you've been feeling stressed for quite a while, and that follows through to a more depressive episode, there's still that trigger coming from somewhere.

Harvey: 27:24

Right.

Pen: 27:26

And, looking at it, my anxiety and my depression were very directly caused by stress. Yeah, there we go.

Harvey: 27:35

And my anxiety and depression are exacerbated by stress, but even when I'm not experiencing stress, like, if I'm on summer or winter break, like, I still end up feeling depressed and anxious. That's just an always for me.

Pen: 27:48

Yeah. And that's, like, there was no way I wasn't going to meet the criteria for generalized anxiety disorder. I don't meet that criteria now--

Harvey: 27:56

Right.

Pen: 27:56

--because of changes in my life that have made it just not be--like, when I get stressed, it doesn't trigger into that anymore, which is so nice.

Harvey: 28:06

I bet!

Pen: 28:07

Other side of that, my social anxiety comes from absolutely nowhere. It's there. This is something that I feel quite confident is not linked directly to my ADHD because it's just--it just happens. It doesn't matter what I do, like, I'm taking a medication for it now that changes it, and that is my big clue that it is not inherently linked to the ADHD is, like, it was very consistent, and I could, like, try and make it better, but it was really hard, and then I took Lexapro, and it changed the things, and I was like, oh.

Harvey: 28:38

Yeah. And I realized, you've mentioned before that you being on antidepressants didn't actually help your depression, but it did for me. So that's--but getting on Adderall seemed to make it better.

Pen: 28:52

Yeah. Adderall affects my depression a lot, which made me--like, it was kind of an imposter syndrome thing for a while and like worried me a little bit, like, oh, wow, when I first take this, like, the mood boost I get, like, I feel like that's not supposed to be what happens. One, I got a increase of dopamine. It made me feel better.

Harvey: 29:12

Dopamine is involved in the reward center. Something good happen, make brain go."Ohhh, dopamine!"

Pen: 29:19

Which is not what my brain naturally does. This is very annoying.

Harvey: 29:23

No, you literally just, like, you took a hit of speed. And you were like, ohhh.

Pen: 29:28

And it worried me, it doesn't know. And like, yeah, my depression is better now that I'm on Adderall, because depression is linked to - wait for it- dopamine!

Harvey: 29:38

Dopamine!

Pen: 29:39

Yeah, I have less depression because I have a neurotransmitter. I hear those are good for your brain.

Harvey: 29:46

They are, generally speaking. Too much or too little of any of the neurotransmitters cause problems, but--because--excessive dopamine, I believe is related to, oh...

Pen: 29:56

Schizophrenia, right?

Harvey: 29:58

Yes. Schizophrenia and/or Lou Gehrig's disease, I think. Wait, no, not Lou Gehrig's... Parkinson's.

Pen: 30:07

I believe you.

Harvey: 30:09

It's--it's one of those two, or both. But there's a--there's a thought that I wanted to share about clinicians and misdiagnosis. And I think--I think what I do want to say is that misdiagnosis, especially with disorders that get so muddy, like they do with ADHD, does not necessarily mean that the clinician is doing a bad job. It can mean thatm but not always.

Pen: 30:37

Yeah, definitely.

Harvey: 30:38

The thing about mental health is--it's--it's not like physical health. Now--now, of course, I imagine with doctors who work in, you know, the medical field with, like, physical bodies, physical ailments, I'm sure there is a level of guesswork that they have to do, but those symptoms are so much more visible. Like, you can--you can see a rash, you can hear a cough. So that makes certain, you know, physical illnesses a little more easy to detect. And well, there are, you know, neurocchemical indicators of mental illness. The fact of the matter is, most psychiatrists and most therapists do not have access to that kind of technology. And also, we live in the United States, we can't afford it.

Pen: 31:27

It's starting with just, like, brain scans, and that kind of thing, and testing with that is not necessarily, like, the first step I think most people would take anyway.

Harvey: 31:38

No, and especially because, you know, a deficiency in a neurotransmitter could have zero implications, or it could have several different implications. And then you also have to consider, well, we can't just look at one neurotransmitter, because with things like depression, serotonin and norepinephrine are both implicated in that disorder. So all of this to say, I think, maybe, part of why misdiagnosis happens so often is because with mental health care, so much more guesswork has to be done, entirely because you have to take information that you get from self report and potentially from peer report, and then, essentially, like, make an educated hypothesis.

Pen: 32:22

Yeah. And that's real. And, you know, that's not to say that everything is just simple with physical diagnosis or that there aren't invisible, like, physical disabilities and that sort of thing.

Harvey: 32:33

Because there totally are, but there are some very different--but there are some ways in which the treatment and identification of mental health versus physical health is different.

Pen: 32:44

Oh, yeah, absolutely. And like I said, like, my second psychiatrist who diagnosed me with bipolar disorder, she listened to what I was saying, she took me very, very seriously. One potential thing is, perhaps if she had been more aware of how commonly ADHD and bipolar disorder are comorbid, or how often they get misdiagnosed. And this was something--recently, someone that we know was officially diagnosed with ADHD.

Harvey: 33:12

Yes!

Pen: 33:13

She was screened for bipolar disorder and ADHD together.

Harvey: 33:18

Oh, she was?

Pen: 33:18

Yes.

Harvey: 33:19

Oh, she didn't tell me that.

Pen: 33:20

Uh, yeah, because--I think, frankly, it was because the psychiatrist had ADHD, so he had some experience with that. Like, that is one potential way to help with that, is to screen things, you know, are very commonly comorbid together, so you have a better idea of like, okay, so is it this, or is it this? Like, if we're looking at all the symptoms together? Which one of these makes the most sense?

Harvey: 33:41

I'm just realizing, curious that I was at one point evaluated for ADHD, but not for autism, despite how comorbid they are. Anyway.

Pen: 33:51

You know what? How about we get into that?

Harvey: 33:53

Oh, sure.

Pen: 33:54

Um, so from the same ADDitude article - that I will link in the description - that I got some information about depression and also anxiety--quickly on anxiety, anxiety has passed depression as the biggest mental health problem on college campuses.

Harvey: 34:11

Uh-oh!

Pen: 34:11

Yeah. It often doesn't stand alone. It's a hallmark symptom of ADHD, affecting 30% of children and 53% of adults with ADHD.

Harvey: 34:19

Oh, wow.

Pen: 34:20

Yeah. So depression and anxiety, literally 50/50 chance if you have ADHD.

Harvey: 34:25

Yeah. Um, and I just--I need to put that into perspective as somebody who, you know, studies epidemiology and understands the rates of things. When you start getting into the 40s and 50 percents, of things that is extremely high.

Pen: 34:41

Yeah, it's ridiculous.

Harvey: 34:43

It's dramatic.

Pen: 34:43

Like, that's the thing with depression, anxiety and being secondary. Being caused because you aren't able to deal with the ADHD symptoms, but--

Harvey: 34:53

Which makes sense, why--why the--why.

Pen: 34:55

Why the rate is so dramatic.

Harvey: 34:57

Yes.

Pen: 34:57

Yeah, definitely. So autism, which is very different, because you don't just--the autism is not a secondary diagnosis.

Harvey: 35:06

Nope!

Pen: 35:08

That's--much like ADHD, and how it's just the way that your brain works, that's where we're at. So this-- here is the--let's--let's talk about--first the--the statistic:"Studies show that 30% to 50% of individuals with autism manifest ADHD symptoms. Roughly two thirds of individuals with ADHD show features of autism." So, like, yeah, again, the overlap is pretty massive there which we've talked about.

Harvey: 35:42

Yeah, I know I mentioned in the autism episode that approximately a third of folks with one are also diagnosed with the other, and that doesn't even consider everyone who displays symptoms.

Pen: 35:54

Exactly. Like, that is the thing, like, if we're just looking at where there are overlaps in the symptoms, that's ridiculous. Like, you do not have ADHD. I do not have autism. We have a level of symptom overlap that is sometimes just dramatically, likem hilarious.

Harvey: 36:14

You know what we should do? We should definitely--because my boyfriend, I think we mentioned this in the last episode, but my boyfriend is also--my boyfriend is autistic and he has ADHD. So I think--I think, genuinely, it might be

Pen: 36:26

Yes. interesting if the three of us sit down and compare symptomology. I would--I would love to. We should have--we should have him on sometime.

Harvey: 36:34

Yes, we should. I'm going to make a note of that . Anyway.

Pen: 36:37

You should, 'cause I'll forget. I'm well-meaning but, oof. Okay, so here's the quote from ADDitude, that proves that, you know, one, there's a lot of different authors of the articles, and some of them are, like, you know submitted from a lot of different sources, and also that bias comes in pretty much everywhere.

Harvey: 36:57

Yeah.

Pen: 36:58

And that ableism is a complex thing, and--so here's the quote.

Harvey: 37:05

Yes.

Pen: 37:07

"Trouble reading social cues and acting appropriately in social situations are hallmark symptoms of autism spectrum disorder (ASD). With autism rates on the rise, parents may fear the worst when their child struggles socially." Harvey's pointing a finger gun at my laptop, and they're right to do it. "But this is a big one for children with ADHD, too, though it usually isn't considered until a diagnosis has already been made." That's real. Social situations being an issue, like, where that is, that's real. The other part what do you... "If your child has trouble making friends, ask yourself: is it because they're overly fixated on an unusual interest, or is it because they're always interrupting and speaking over others? The former may be due to ASD, the latte, ADHD. An individual can have both conditions."

Harvey: 37:54

Bite, bite, bite, bite, bite, bite, bite, bite!

Pen: 37:58

One, the bias in that and portraying autism as a worst case scenario is incredibly messed up. I put this in here as an example of, like, yeah, I love ADDitude, like, a lot of their stuff I'm very into. I source it for a reason. This article? I do not trust the person writing this. This is a bad take about autism. That's not--

Harvey: 38:23

Like, okay, sorry for being a retard, I guess, like...

Pen: 38:26

That is--

Harvey: 38:27

We can cut that out.

Pen: 38:28

That is a horrible take. It is not--this is not how we should be talking about autism. It's also not the reality.

Harvey: 38:36

Yeah. If we--if we do keep that bit in, do want to clarify i'm allowed to reclaim the r-slur. Anyway.

Pen: 38:43

Yes, like, that's--that's real. And then I really don't like the, like, "Is it because they're overly fixated on an unusual interest, or is it because they're always interrupting and speaking over others?" and portraying those as, like one of them is only autism, and one of them is only ADHD, and the only reason they would overlap is because your kid has both." What are you talking about?

Harvey: 39:06

Yeah, because i was gonna say, hyperfixation is a hallmark of ADHD, and not knowing how to take your turn in a conversation is a hallmark of autism. What on earth are they on?

Pen: 39:20

Yeah this--I put this in here and--here's the kind of

miserable thing: 39:25

that article is the same one that I got the stuff from depression and anxiety from.

Harvey: 39:32

Bite, bite, bite, bite, bite, bite, violence, bite.

Pen: 39:35

So it's--like, kind of--it's incredibly unfortunate, especially because we're running out of time, that I don't have a better one in talking about ADHD and autism and how they've overlapped, and i'm very sorry about that.

Harvey: 39:45

But this is useful for doing a critique.

Pen: 39:48

Exactly. And, luckily, we have talked about ADHD and autism overlapping before in a way that isn't riddled with bias and bigotry.

Harvey: 39:58

Yeah. Jesus Christ, that is--

Pen: 40:00

Yeah, that's--that's...

Harvey: 40:04

Like, I feel like i've been hit by a car.

Pen: 40:06

I'm very sorry to blindside you with that. Like, that is a really crappy thing to say. It's also straight up inaccurate. That is not--a commonality between ADHD and autism is not being good at reading social cues.

Harvey: 40:27

Right.

Pen: 40:29

That doesn't mean something's wrong with you. Also, let's not paint neurodivergence as something that is wrong.

Harvey: 40:38

Listen, I can make friends. I have plenty of friends. They just have to let me talk about Sonic the Hedgehog.

Pen: 40:44

I love it when you talk about Sonic the Hedgehog.

Harvey: 40:45

Thank you.

Pen: 40:46

And that's--that's also things, like, trying to diagnose either ADHD or autism by whether or not your kid is good at making friends is, like, let's take that carefully, because that tends to fall into a blame thing, or looking at your child as having something wrong with them.

Harvey: 41:06

And then you're also--you're also legitimizing kind of the --the bias and the discrimination that children are taught because we live in an inherently ableist society, rather than questioning sort of the source.

Pen: 41:23

Yeah. Like, it's pointed out as, "Oh, well, there's something, like, going wrong with this kid, because they're not making friends," instead of,"So this is how this kid exists, and the children around them don't understand that." These are very different ways of looking at it, and that is a very, very big problem with society, with parents and teachers, with clinicians, like--this is the source of a lot of where the bias can come from, especially because we tend to look at ADHD and autism as things that are diagnosed in childhood, and not considering some of the implications of that, and, particularly, when you are diagnosed as an adult, and it's like, "Oh, okay. So my whole, like, antisocial thing, where everyone said I hated people. Really?

Harvey: 42:09

Really now?

Pen: 42:10

Is that--cool. Cool. Good to know that none of you knew what you were talking about.

Harvey: 42:14

So we're just not gonna examine that one, huh?

Pen: 42:16

So we're not gonna think about that one? We're just gonna let y'all get away with that? The answer is no.

Harvey: 42:20

Now, we don't have time[Harvey and Pen, in unison] to unpack all of that.

Pen: 42:24

John Mulaney, Kid Gorgeous. But, yeah, yeah. If we had more time, I would talk more positively about the--about some of the comorbidity in ADHD and autism. But--and also, like, a little bit more on some of the diagnoses and misdiagnoses, but I think as, like, a broader overview of where there's comorbidity, and also how this misdiagnosis happens and so frequently, I think i've hit most of what I was going for.

Harvey: 42:56

Great!

Pen: 42:57

Do you have any thoughts, Harv-and-a-half?

Harvey: 43:01

Harv-and-three-quarters...

Pen: 43:01

But not two Harvs.

Harvey: 43:03

Aw. Well, I don't have anything, like. substantive to say, so to put a positive spin on the--

Pen: 43:10

Please?!

Harvey: 43:11

To put a positive spin on the ADHD-autism comorbidity thing, if you are autistic and you have ADHD, you are so sexy, and swag, and epic, and cool.

Pen: 43:25

You--you are two times as funny as anyone else. That is a thing that we've legitimately talked about, is like neurotypical people are very--neurodivergent people are very good at being funny.

Harvey: 43:35

Yes, because--I think because my--you know, my amateur opinion of that is probably because we have to question social norms so it's easier for us to break them.

Pen: 43:46

Exactly. I was just thinking about this earlier, is like, you know, the thing where, like, humor comes from breaking expectations and it's like that's all i'm allowed to do.

Harvey: 43:53

Also, bonus points if you're gay.

Pen: 43:57

Yeah, like, Harvey and I have a lot of, like I just said Harvey, and I have a lot of overlaps in our symptoms. I think that's very cool of us.

Harvey: 44:05

We're very sexy and cool and--no, I can't say that on the podcast. Anyway.

Pen: 44:11

I think we're pushing it with saying sexy twice. Oh, no! Three times!

Harvey: 44:15

Oh, no!

Pen: 44:17

Yeah, no, and honestly, like, I think that you are a very, like, you get--you get along with people really well, as a general rule. Like, I would say you're a very charming and charismatic person.

Harvey: 44:26

Some of it is because i've been masking my entire life but we don't have time to unpack that.

Pen: 44:32

And that's--that's stuff.

Harvey: 44:35

But, yeah, I do get along pretty well with people.

Pen: 44:37

You are a very cool person. You're also, legitimately, the funniest person I've ever met in my life.

Harvey: 44:42

Which--it makes me very happy every time you say that.

Pen: 44:45

I say it a lot.

Harvey: 44:47

They do, and it makes me very happy.

Pen: 44:49

But yeah, like, the ways that our symptoms overlap, I think, really help our friendship along, and make it, like, a very cool thing and, like, I've heard from other people that our friendship is just nice for them to like, see, and that it's cool. So you know, those kind of symptoms that are, like, "concerning" to see in your child, don't start with that kind of take, you're not going to be treating your child well as a result, if that's where you're coming from. And also, sometimes it means that your child makes really, really good friends.

Harvey: 45:23

Yeah. God forbid your neurodivergent kid becomes friends with other neurodivergent people.

Pen: 45:29

It's improved my life dramatically.

Harvey: 45:31

Oh, God, me too.

Pen: 45:32

Night and day.

Harvey: 45:34

Do you have any last thoughts you want to share before I wrap us up here?

Pen: 45:36

Um, just generally that, like, though this is a frustrating thing, the common misdiagnosis, it comes from a lot of different places, and it is genuinely a complicated thing. And also, if you are someone like me, who has ADHD and has been misdiagnosed in the past, and would have really benefited from being examined more properly, and, like, you feel that, because I certainly feel it, that's okay, and you are valid in that, and I hope that this gives you, like, some vindication, because I know that that can feel really good. And if you're someone, like, again, as always, if any of this kind of echoes in you, like, you're--you're kind of feeling it and you haven't been diagnosed with anything or whatever, I absolutely encourage you to do research, if that's the kind of thing that helps you. If you have a therapist or psychiatrist, to talk to them about it. If you don't, I recommend therapy to pretty much everyone. So yeah, by all means, like, you get to take yourself seriously, and whatever you're feeling, you're feeling it, no matter where it comes down to.

Harvey: 46:41

Very nice way to wrap that up.

Pen: 46:43

Thank you, I do my best.

Harvey: 46:45

So, let me first say, we really appreciate the audience that we have here. Those of you--we notice those of you who listen consistently, and it makes us really happy. So--so we're glad to have y'all. We've seen the really tangible ways in which we can make an impact, and we want to keep doing that. So what I want to ask, as one of the cohosts of this podcast is, if you've got some time, in the next week or so, share this podcast with a friend of yours, just one. That would mean a lot to us, and it would be great to get some more reach for more folks to know who we are and for more--for more folks to possibly find themselves.

Pen: 47:28

Yeah, and--and with that, it would be really, really awesome if you have the time and inclination for you to send us a message on social media or email us, so that, like, one, if you have any questions or any feedback, or, like, a particular thing you would like us to talk about, that we know that because we want to be able to do things that are beneficial and that our listeners would really enjoy. And also because you know, this is something--this is a labor of love. This is a passion project. We do have other things going on in our lives, and we both love doing this. We don't need praise and adoration in order to do it, but it really does help to have that engagement from people.

Harvey: Let me put it this way: 48:10

if you want to make me in Pen happy stim, send us a message.

Pen: 48:15

That's a good way to put it. I love that.

Harvey: 48:17

So, stick around for just a few moments, we'll tell you a little bit more about how this podcast is run and our Patreon Woo! Say wahoo. Wahoo!

Pen: 48:26

Thank you!

Harvey: 48:28

Beyond Introspection is an independently-run podcast by Pen Novus and Harvey LaFord. Music by Girl Lloyd. You can find us on Twitter and Instagram at ByndPodcast or you can email us at beyonddotpodcast@gmail.com. That's beyond d-o-t podcast, no spaces. We publish on Buzzsprout, iTunes, Spotify or wherever you get your podcasts. You can find the links to our social media and email in the podcast description.

Pen: 48:54

We also have a Patreon. You can find us at patreon.com/beyondintrospection. That's all one word. We also have links to it on our site and on our social media. Our podcast is entirely independent, so we pay for hosting fees and transcript service subscriptions out of pocket. This is a passion project that we're really happy to do, and any support you're able to give us would really make a difference. On our

Patreon there are four tiers: 49:13

$2, which gives you access to test audio and other bloopers;$5 which will give you access to bonus episodes that will make in the future, on topics like how angry we are Freud, our frustrations with our respective fields of studies and even guest episodes; $10 will get you a direct line and priority access to request episode topics and new bonus content; and $15, which will give you access to monthly AMAs--that's ask me anything for those who don't know--where we can answer questions ranging from the podcast process and we figure out what to record, more in depth questions about our neurodivergences, and more. All of those tiers will include benefits from lower tiers of course. And also just to note, unlike our regular episodes, Patreon bonus content is likely to include swearing, so if that's not your vibe, please know that ahead of time. We'd also love it if you're able to share this podcast with people you know. Our only advertising is word of mouth and we want to reach as many people as possible.

Harvey: 50:10

Got feedback for us? Want to request an episode topic? Just feel like saying hello? Feel free to reach out on social media, or via email. We'd love to hear from everyone. Take care of yourselves.