ADHD & autism walk into a bar...

Dear reader,

Some days I feel like there are two completely different women living within me.

One is a highly qualified research fellow working at a prestigious university and the other is a debauched Courtney Love (90s era).

If autistic Hannah walked into a bar, she’d order a glass of water and leave as quickly as possible. ADHD Hannah would order a Blue Wicked and a shot of tequila and dance all night on the tables.

This is what it can be like when ADHD and autism coexist (AuDHD)— two very different women in one mind and body. According to a scientific literature review, 50 to 70% of individuals with autism spectrum disorder condition (ASD) also present with attention deficit hyperactivity disorder condition (ADHD).

It's a complex experience that can be hard to understand, even for those of us who it affects. One of us is ordered, quiet and likes routines, the other is a chaotic risk-taker who makes impulsive decisions we often regret.

Lately, my ADHD side has been particularly dominant, leading to a series of mishaps. Let me share some recent misadventures with you.

For the past two weeks, I’ve been unwittingly applying a creamy face wash to my face, mistaking it for my Vitamin C moisturiser. The two products share a similar consistency and inhabit nearly identical glass pots on my shelf, but obviously, they are very different. Even as my skin grew increasingly dry and burned (despite a distinct lack of sunshine), I attributed it to the impending winter. This oversight, discovered much later, is a peak ADHD moment.

But the chaos doesn't end with skincare. The other day, I attempted to make myself a cup of tea no less than three times. Each time, I returned to the kettle to find a full cup of over-steeped tea. When I finally succeeded in brewing a proper cuppa, I promptly forgot about it, rediscovering it stone cold. I reheated it, only to let it cool down again. I contemplated a second reheating but refrained as I thought It might not be safe. All that effort making cups of tea, and I never got to enjoy even one.

Around my house, I attempt to put on reading glasses until I realise I'm already wearing some. I also frequently misplace my phone. Often, I find it nestled beside my laptop, still presenting notifications I’d read just minutes before. 

Preparing for an upcoming holiday, I impulsively ordered 13 summer dresses online, fearing I had nothing to wear in extreme heat. I opened a box of clothes in the spare room only to find I had loads of gorgeous summer clothes I’d completely forgotten I owned.

Out of everything, I was the most annoyed when I lost my lunch. Yes, I lost my lunch in my own home. I’d had it in my hands only seconds before! I eventually found it on a side table. I must have put it down on my way to doing something super important, which I have now also thoroughly forgotten.

Nowadays, my ADHD symptoms are not usually as extreme as this.

I suspected a recent HRT overdose might be contributing to this heightened state of ADHD-fueled chaos. I wasn’t sure exactly how.

Constantly, I stumble across articles and studies about the intricate interplay between neurodivergence, hormones, menopause, and chronic health conditions. While fascinating, the complexity is overwhelming. I follow a thread, only to have it branch off into five more, leaving me lost in a labyrinth of information. I know understanding these connections is important, but it feels unachievable.

But yesterday, I attended an ADHD & Women Summit in Manchester. I learned *so* many fascinating things, including the powerful effect of estrogen (lack of it) on ADHD symptoms from Dr Anneka Tomlinson, a senior postdoctoral researcher at the University of Oxford. It makes sense now that after reducing my estrogen after overdosing on it, my ADHD symptoms could flare up.

I’d be highly embarrassed if anyone were to find out about my chaotic behaviour while symptoms are high (so why not write about it on Substack!), but what's perhaps interesting for those who don't have ADHD is that through all this chaos, my mood remains surprisingly good. This is because my dopamine levels, despite fluctuating wildly, create a curious sense of equilibrium. My brain thrives on the unpredictability, finding moments of joy and creativity even amidst the mishaps and forgetfulness. 

However, there’s a constant underlying hum of dopamine-seeking behaviour. 

A few months ago, I started following the Glucose Goddess Protocol to combat intense sugar cravings which were making me feel terrible energetically and impacting my self-esteem. Miraculously, the cravings vanished, and I remained sugar-free for a few weeks. 

My ADHD symptoms also lessened significantly. I had read that ADHD symptoms are exacerbated in children via sugar but weirdly hadn’t made the connection that it would probably affect adults too. I thought I had cracked some kind of secret code. 

Then, a period-induced need for a large bag of Maltesers derailed everything, reviving cravings and impulsive tendencies. 

Despite knowing and engaging in healthier dopamine sources like walking and balanced routines, falling into a sugar-induced spiral challenges the discipline I need to escape it.

When I’m in autistic mode there’s no way I would let a shred of sugar pass my lips. I could say my willpower was at its strongest, but that wouldn’t be a good description because willpower doesn’t even come into it. I just decide I will or won’t do something and I am as unmoveable on that as a stone.

I try to stay in autistic mode as much as possible. It gets me where I need to be. I can carefully assess what I currently want to achieve, whether that’s peak wellbeing, losing weight, or creating something meaty (like a memoir!) and then I put a thoroughly researched plan in place to achieve it. I follow it to the letter. 

Until I don’t.

My ADHD brain hates the rigid structure of my ‘safe’ autistic life. I begin to feel so unbelievably bored and like I’m living in a prison. My mind starts screaming to act impulsively—travel, eat sugar, scroll Instagram, buy things, go on dates, get other quick dopamine ‘fixes’.

The way I try and manage these conflicting states is to allow myself small, manageable experiences for my ADHD, sometimes I can manage this, and sometimes I can’t.

Like a continuous game of volleyball where I’m the only player. I sprint to each side of the court while the ball is still in motion hoping not to lose a point. Sometimes I don’t make it in time. It is exhausting and it can be upsetting.

As a young girl autistic Hannah was the quiet geek in the top sets at school. She wore sensible clothing and spent her free time reading and researching obscure topics in the library. 

ADHD Hannah was a rebellious teenager wearing a mini skirt. She was often in detention for swearing at teachers or bunking off to smoke or flirt with older boys. She left school with no GCSEs. 

They were both me.

Nowadays, autistic Hannah is a middle-aged woman who wears only natural fibres, eats only whole foods (at very specific times), walks in nature every day, and goes out socially once a month to a carefully orchestrated dinner party with low lighting and carefully curated guests. She thrives on order, healthy habits, and carefully planned social interaction.

ADHD Hannah is a middle-aged woman who travels the world alone bonding with strangers(!), spends too much money on clothes she’ll only wear once, eats cake and chocolate and processed foods, and can’t seem to keep a room tidy. She’s impulsive, thrill-seeking, and prone to social faux pas.

These two distinct personalities, while seemingly incompatible, coexist within me, creating an internal dynamic that’s admittedly fascinating but also extremely challenging. Like roommates who argue about crumbs on the kitchen worktop forced to share the same apartment - forever.

I started this post by saying that my ADHD has been particularly dominant. This isn’t usually the case anymore. I would say I spent the majority of my 20s and 30s in ADHD and had the life to show for it. Now, generally, I’m more in autistic mode and have the life to show for it.

Until yesterday I didn’t know if my ADHD symptoms are usually less so generally because I’m older. I considered maybe my brain chemistry was different or maybe I was just tired and I didn’t have the same energy to engage in the frivolity of my ADHD mind as much. But this doesn’t align with the research which finds that peri-menopause/menopause can be a time when ADHD symptoms are at their worst.

But at the summit, I also learned from Dr Anneka— I’ve never heard this before— that taking HRT (increased estrogen) can significantly reduce ADHD symptoms in peri-menopausal women. Maybe this is why I have fewer ADHD symptoms generally?

Who knows.

Maybe I’ll never know and maybe that’s ok.

I suppose it’s worth noting that no matter how much trouble my ADHD causes me I am intensely in love with my ADHD brain. It makes my life rich, exciting and wild.

It’s been over two years now since I discovered I was AuDHD. I am still learning more about myself and about the conditions. Things are getting better. Life is becoming more manageable. But it’s a continual quest to balance these two very different aspects of who I am.

I hope you have a gentle week,

Love Hannah xoxo

P.S. This post is also available on my website.

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