[TheatreKid]

I have pretty much failed this term of university. I have a very hard time getting started on tasks. My house is a mess, I never get anything done - even my slacking off isn't focused, I bounce from activity to activity, usually browsing the internet along with whatever I'm doing. I start projects and never finish them - this can be a bipolar symptom, which I have, but it happens when I'm doing fine, too. It's like once the newness has worn off, I'm no longer interested.

But when I AM interested, I hyperfocus, at least for a little while, until it wears off again. I was working on 4 songs at once (I write music) until that hyperfocus ended and none of the songs are done. I'm constantly restless and bored.

I am bad at conversations - I'm a master of the smile and nod. I tune people out, not to be rude, I just do it automatically. It's hard to follow conversation - not because I'm not interested, not because I don't like people, just because other things catch my attention. Noise, other people in the room, my own thoughts. When I'm interested, I'll converse forever. When I'm interested, I'll talk TOO much.

I am quite sure my bipolar diagnosis is accurate, but I've also been diagnosed with Asperger's and pretty much every medical professional since then doesn't believe the diagnosis. I don't even believe the diagnosis, the doctor talked to me for an hour and diagnosed me from that. But I'm the one who asked my psychiatrist to refer me to this professional, so I'm too embarrassed to tell my psychiatrist I don't believe the professional's diagnosis.

Last year, an occupational therapist I was seeing brought up ADHD. She thought I fit many of the signs. She recommended to my psychiatric team that I get tested for it, but my psych nurse never scheduled me for testing, because her reason was "You can't have Asperger's and ADHD." I know this is not true, but I'm not able to fight them on this.

The more personal experiences with adult ADHD that I read, the more I identify with it. Every year of school when I was little, the teachers would be annoyed with my inability to stay on task. Every report card came home with the remark that "TheatreKid is unable to stay on task." But this was the 80's and I wasn't extremely hyperactive, so I guess ADHD never came to mind. They tested my IQ and put me in gifted classes, so I guess they chalked any oddness up to that.

I believe the social difficulties and hyperfocus and the fidgeting I exhibit that may have been indicative of ASD to that one professional, are really ADHD symptoms. Especially the social difficulties. I can be very socially competent, it's the actual organizational aspects of making friends that fails me. I guess they mimic ASD social difficulties in certain situations like that doctor's office, but every doctor has said I'm too socially competent for an ASD diagnosis. I'm going to read more, and if I get the courage I'll tell my psychiatric team that I think the Asperger's diagnosis is a mistake and I'd like to be tested for ADHD.

But really, there's nothing I'd gain other than maybe some self acceptance. I already get accommodations at school due to bipolar. I can't take stimulant medication because of bipolar. I have access to an OT through my psychiatric team to help me with executive functioning, if I can figure out clearly enough what I need help with.

So this is long. Any comments/suggestions?

[nbritton]

You sound a lot like me, and I was diagnosed with ADHD as a kid. Now I'm also diagnosed with schizoaffective disorder. ASD is not often a comorbid condition of bipolar disorder, but ADHD is. Medical literature supports this...

Nord J Psychiatry. 2014 Mar 12.
Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood.
Dalteg A1, Zandelin A, Tuninger E, Levander S.

Abstract
Background: Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. Aims: To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. Method: ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. Results: ADHD and CD were much more common among the patients than in the general population-the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Conclusions: Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.

[TheatreKid]

Thanks. That's interesting. I might mention it to my psychiatrist if I decide to bring up the diagnosis.

[medicalfox]

You can have both ADHD and autism spectrum disorder, I am diagnosed with both. I would get a new psych nurse if possible imo. For ADHD meds you could take Strattera because it's a non stimulant and will not make you manic so there is benefit in getting the diagnosis.

[TheatreKid]

I'm going to try to talk to my psych team in a few months. I've been going through a lot of med changes lately and I'm sure that if I don't wait until I've been stable for a while, my doc will just tell me it's the bipolar disorder.

Apparently the DSM-IV says you can't have both an ASD and ADHD. I don't know what the DSM-V says. But I'm quite sure the ASD diagnosis was a misdiagnosis, every medical professional from nurse to hospital psychiatrist who has seen me since says there's no way. Features of my bipolar disorder (depression, flat affect, lack of eye contact) and possibly ADHD (social problems, inattention) might have interacted to make me seem autistic, my diagnosis came from a 1 hour session with a psychiatrist, not any sort of neuropsych testing. I'm going to ask for testing in a few months.

I recently read all of my old school report cards from kindergarten until grade 7 and every year the teachers say things like "cannot stay on task" and "frequently forgets class materials" and "needs to work on organization and handing work in on time". No mention of social problems or autistic symptoms. I also found a chart from my pediatrician listing developmental milestones and the only ones I missed were turning to react to a sound and something about sitting up. I was 3 months premature, so they were expecting more delay than that.