NEURODIVERGENCE
FASD
Foetal alcohol spectrum disorder (FASD) is a lifelong neurodevelopmental disability caused by prenatal alcohol exposure, which disrupts the development of the foetus’ brain and central nervous system. It is an umbrella term for a range of effects, including physical, mental and behavioural issues. There is no safe amount of alcohol consumption during pregnancy and FASD is 100% preventable.
FASD is a white-matter disorder of the brain. It causes midline and interconnectivity problems, affecting processing speed and the linking of information. It is the primary cause of the person’s presentation. According to Professor Raja Mukherjee, leading FASD expert and clinician, if alcohol damages the parts of the brain involved in social communication, the presentation is autism; if alcohol damages the parts of the brain involved in inhibitory control, the presentation is ADHD.
Read the NICE guidelines on FASD at https://www.nice.org.uk/guidance/qs204.
For detailed clinical and other information about FASD across the lifespan, watch the videos making up Raja and Neil’s FASD Book Club, at https://nationalfasd.org.uk/learn-more/resources/raja-and-neils-fasd-book-club/.
For research on FASD and the transition to adulthood, read Siann Gault et al. (2023) ‘Transitions into adulthood for people with fetal alcohol spectrum disorder: a scoping review of promising practices’, Children and Youth Services Review 155, available at https://www.sciencedirect.com/science/article/pii/S0190740923004358
Autism
Autism is a lifelong neurological difference. Prevalence among the general population is uncertain, but estimated at around 1%, though for a number of reasons this is likely to be an underestimate. The prevalence among adopted children and young people is higher than among the general population, with 11% of children surveyed by the Adoption Barometer in 2023 having a diagnosis. The reasons for this higher prevalence are not fully understood.
Recently, there has been a recognition that the presentation in girls and women may be different from that in men and boys, in particular due to social masking, and that there is significant underdiagnosis of autism in women, as evidenced by a significant rise in the number of women being diagnosed in adulthood.
For more information, go to www.autism.org.uk or https://www.nhs.uk/conditions/autism.
For an exploration of positive autistic traits, go to www.facebook.com/reel/1487924862516794.
PDA
Pathological demand avoidance (PDA) is most commonly understood as a profile on the autism spectrum characterised by an intense and involuntary, anxiety-driven need to control situations and avoid everyday demands. It is not formally recognised in the DSM-5 as a standalone diagnosis, but is recognised by clinicians as a distinct presentation of autism.
PDAers often resist demands such as waking up, getting dressed, washing and even eating. They may use creative avoidance strategies, such as negotiation, distraction, role-play or humour, rather than simple refusal.
These behaviours are often misunderstood as laziness or defiance, or as a result of parenting failures. It is easy to see that, as the child progresses through the education system, it may be more and more difficult for their difficulties to be correctly identified and supported. These often sophisticated strategies mean the young person appears socially engaged but may mask the fact that they lack understanding of social norms or hierarchies.
For more information about PDA, go to www.pdasociety.org.uk
ADHD
Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong neurological difference traditionally characterised by persistent patterns of inattention, hyperactivity and impulsivity that can affect daily functioning and development. Current diagnosis distinguishes between two types: hyperactive and inattentive, recognising a presentation common in girls and women and which may previously have been missed or misunderstood. People with the inattentive type may experience ‘internal hyperactivity’, with a mind that is constantly busy. This may present as daydreaming or inertia.
Once again, the word ‘disorder’ implies a flaw in willpower, character or even parenting, focusing on behaviour and, in school, often an inability to comply with the demands of the system and the curriculum, with its long periods of sitting and regular transitions between subjects that offer varying levels of interest to the young person.
For more information, go to https://adhduk.co.uk or https://www.nhs.uk/conditions/adhd-children-teenagers
Alex Partridge hosts a podcast on ADHD and other neurodivergent conditions with discussions with clinicians and lived-experience advocates. It’s available on Spotify.
AuDHD
This is a term commonly used by neurodivergent people to describe a dual diagnosis of autism and ADHD. It is only since 2013 that such a diagnosis has been clinically possible. Before that, auDHDers were stuck with an incomplete diagnostic picture based on whichever diagnosis they were given first.
People with a dual diagnosis have described it as having a brain that is running two different operating systems at once, one driven by a need for organisation and structure, and the other driven by a need for novelty. This can lead to all the difficulties associated with negative outcomes among autistics, including a feeling of being somehow ‘wrong’ and failing, leading in the worst cases to autistic burnout and shutdown; accompanied by all the negative outcomes associated with ADHD.
Within the auDHD community, there is an emerging conceptualisation of auDHD as a completely separate and distinct neurodivergent identity, rather than simply autism + ADHD.
To find out more about auDHD, go to https://embrace-autism.com/audhd
Alex Partridge often discusses auDHD with his guests on his podcast:ADHD Chatter.