I wanted to make a post based on a post I saw recently on twitter (or X, or whatever we call it now). It was posted by @ADHDForReal which has easily become one of my favourite pages since being diagnosed with ADHD. They post much more than memes, and I've had genuine 'aha' moments when seeing their tweets. This one, however, made me think a bit more....
Alt text: Image of a tweet posted by @ADHDForReal reading ' start normalizing recognising ADHD as a serious learning disability that includes sensitivities to light & sound, depression, maladaptive daydreaming, not reading social cues, fidgeting & restlessness, not being able to do anything for no apparent reason,'.
I want to pick this apart in a few different ways...
As an initial caveat, intellectual disability is becoming more widely used as a replacement term for learning disability. For the purposes of this post, I will continue to use learning disability as in the UK, this is still the predominantly used term.
What is ADHD?
The NHS defines ADHD (attention deficit hyperactivity disorder) as a 'condition that affects people's behaviour' (incredibly vague, thank you...). They go on to say that it can lead to restlessness, impulsivity, and a lack of concentration, and that is can occur in people with any intellectual ability, but often co-occurrs with learning difficulties (n.b difficulties, not disabilities- this is an important distinction which I'll come back to later) (NHS, 2021). There's an approximate prevalence of 4% in adults in the UK (NHS England, 2024).
Interestingly, there is no reference to ADHD being considered a form of neurodivergence, but this is described by ADHD Aware, who explain that neurodiversity is a term used to describe natural differences between people in the way that their brains function- therefore meaning that ADHD, as a neurodevelopmental condition, is considered as a neurodivergence - neuro= brain, divergence= difference - compared to others, who are described as neurotypical (ADHD Aware, no date). As a personal note, I want to emphasize that neurotypical does not equate to 'normal', therefore making neurodivergence 'abnormal'. Neurotypical is 'typical' because it is the predominant neurotype in the majority of the population. The cis-het of the brain, if you like.
The diagram below gives an overview of the umbrella of neurodivergent conditions:
(Image- Evenbreak, 2023)
Symptoms can be categorised into inattentiveness, hyperactivity/impulsivity, or mixed. Inattentive ADHD was previously referred to as ADD (attention deficit disorder) but this term is not so commonly used anymore, and I'm unsure if it's still listed as a diagnosis in the ICD. Because ADHD is considered a developmental disorder, symptoms are present from childhood, although the condition is not always diagnosed during childhood, particularly in women. Symptoms of hyperactivity may decrease into adulthood, whilst inattentiveness tends to remain.
Symptoms may include (NHS, 2021):
short attention span
easily distracted
making careless mistakes
appearing forgetful
being unable to stick to tasks that are tedious or time-consuming
constantly changing activity or task
being unable to sit still, fidgeting
being unable to concentrate on tasks
being unable to wait their turn
acting without thinking
interrupting conversations
little or no sense of danger
inabiltiy to deal with stress
mood swings and irritability
Co-occurring conditions can include anxiety disorders, depression, learning difficulties such as dyslexia, and other neurodivergent conditions like autism and Tourettes.
Is ADHD a learning disability?
ADHD is well recognised as a distinct neurotype and a neurodevelopmental condition, but is it a learning disability? Going by the UK definition of a learning disability (LD), no, ADHD is NOT a LD.
A learning disability is defined as reduced intillectual ability and difficulty in everyday tasks, which persists through the lifespan (Mencap, no date). A more comprehensive definition is provided by the Department of Health (2001): 'A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning), which started before adulthood'. It's estimated that 1.3 million people in England have a learning disability (Public Health England, 2023)
There are 3 criteria that must be met for a diagnosis of a learning disability (NICE, 2015):
Impaired intellectual ability- generally an IQ under 70.
Significant impairment in social or adaptive functioning
Onset in childhood
And learning disabilities can be categorised, as per ICD-11, dependent on the IQ alongside the level of impairment (NICE, 2023):
Mild- IQ between 50-69. Some difficulties in acquisition and comprehension of complex language and academic skills. Usually able to manage basic self care and practical activities, and can live and work relatively independently with appropriate support.
Moderate- IQ between 35-49. Some basic language and academic skills, some will manage basic self-care and practical activities. Likely to need consistent, considerable support to live and work independently.
Severe- IQ between 20-34. Limited language and academic skills and potentially some motor impairments. May accquire basic self-care skills with intensive support/training, but will typically need daily support in a supervised environment.
Profound and Multiple (PMLD)- IQ under 20. Very limited language skills, may have basic concrete skills. May have motor and sensory impairments, will need daily support in a supervised environment for adequate care.
In the image displayed above, intellectual disability, or learning disability is considered under the umbrella of neurodivergence- and I would agree with this. LD is a difference in how someones brain functions, hence it is divergent from the 'typical'. So, learning disabilities and ADHD are both forms of neurodivergence. However, in comparing the list of signs in the original tweet considering ADHD as an LD, to traits associated with LD, none of these match up.
As stated above, ADHD can occur in people with any intelletual ability (NHS, 2021) but lower IQ is not a diagnostic criterion for ADHD. Childood onset is a criterion for ADHD, and impairments in social or adaptive functioning may be seen in ADHD. So whilst there is some overlap between LD and ADHD, ADHD would not be considered a learning disability. It is possible for LD and ADHD to co-occur, with comordibity rates of LD with ADHD ranging from 0.4% to 19.6%, compared to 2,5% of the general population with ADHD (Royal College of Psychiatrists, 2021).
Learning disability vs learning difficulties
I'm convinced that half the confusion between learning difficulties and learning disabilities is because the names are so similar, so people often don't realise that they're talking about something different. For the remainder of this section, learning disability will be referred to as LD while learning difficulties will be referred to as Specific Learning Difficulties, or SpLD.
SpLDs are neurodevelopmental conditions that affect the way that information is learnt and processed, and are mostly regarded as disabilities under the Equality Act (2010) (The Dyslexia Association, no date).
SpLD include dyslexia- difficulty with reading, estimated UK prevalence of 10% (British Dyslexia Association, no date); dysclaculia- difficulty with numbers, estimated UK prevalence of 6% (British Dyslexia Association, 2024), dysgraphia- difficulty with handwriting, estimated UK prevalence of 10-30%, but this may be over or under reported due to difficulties in diagnosis (Kushki et al., 2011) and dyspraxia, or developmental coordination disorder (DCD)- difficulty with carrying out an action, estimated UK prevalence of 6% (Foundation for People with Learning Disabilities, 2024). Many people with one SpLD will also struggle with another area (NICE, 2023)- 52% of children with dyslexia also show signs of dyspraxia (Kaplan et al., 1998) and 30-47% of people with dysgraphia also have problems associated with dyslexia (Chung, Patel and Nizami, 2020).
The criteria for LD are as above. The difference between LD and SpLD is that SpLD typically will not contribute to a significant impairment in daily functioning, and do not affect general intellect (Mencap, no date; NICE, 2015). However, it is possible to have a learning disability alongside a specific learning difficulty, and ADHD is often comorbid with SpLD, particularly dyslexia and dyspraxia, which are both thought to affect 1 in 2 people with ADHD (ADHD Aware, no date; NHS, 2021). Again, SpLD are also considered a form of neurodivergence, because the individual's brain doesn;t process information in the 'typical' way.
ADHD and Autism
Autism (also known as autism spectrum condition (ASC) or autism spectrum disorder (ASD), but no longer known as Aspergers syndrome- because this name came from a eugenecist nazi who needs 0 airtime) is another neurodevelopmental condition under the neurodivergent umbrella. Typical symptoms can include (NHS, 2022):
avoiding eye contact
not smiling when you smile at them
hyper of hyposensitivity to light, sound, smells, taste or tactile sensations
repetitive movements, such as flapping hands, flicking fingers or rocking back and forth- stimming or self-soothing
not doing as much pretend play as a child
repeating the same phrases- echolalia
not seeming to understand what others are thinking or feeling
liking a strict daily routine and getting very upset if it changes
having a very keen interest in certain subjects or activities- special interests
getting very upset if asked to do something- pathological demand avoidance
finding it hard to make friends or preferring to be on your own
taking things very literally- may not understand phrases like "break a leg" or understand sarcasm
finding it hard to say how you feel or difficulty recognising emotions- alexithymia
not understanding social "rules", such as not talking over people
noticing small details, patterns, smells or sounds that others do not- pattern recognition
liking to plan things carefully before doing them
finding it hard to understand what others are thinking or feeling
getting very anxious about social situations
seeming blunt, rude or not interested in others without meaning to
It's thought that 60% of people with ADHD are multiply neurodivergent with signs of both autism and ADHD, and up to 50% of people with autism also show signs of ADHD (Davis and Kollins, 2012)- this is known as AuDHD, and I think that a lot of the traits that are being described in the post above would fit into this category. Signs like sensory sensitivity and ability to read social cues wouldn't be considered typical for ADHD alone, but do seem to fit into the intersection of autism and ADHD.
Dealing with both can be really difficult, as the symptoms tend to clash. This is demonstrated in the image below from the Autistic Girls Network:
(Image- Autistic Girls Network, no date)
Interestingly, it wasn't possible to be diagnosed with both autism and ADHD until 2013. Prior to the DSM-5, autism was considered as an exclusion criteria for ADHD diagnosis presumably due to the conflicting set of signs (Autistic Girls Network, no date). As someone who is AuDHD, I can't even begin to make sense of what's going on in my head. I'm desparate for routines, but can't follow one to save my life. I want to maintain a singular focus, but find myself being pulled in all directions. I act impulsively, but know I'd be better off if I could make a plan and stick to it. Chaos central in my noggin.
There can be even more overlap with other neurodivergent conditions and mental health conditions, leading to a whole mess of symptoms:
(Image- Sensory Stories by Nicole, 2024)
The long and short is that autism, ADHD, and other neurodevelopmental conditions can and often do co-occur, and can also occur alongside mental health conditions. What seems to be described in the original tweet is AuDHD, alongside some other traits.
A final note on language...
The image below describes the difference between neurodivergence and neurodiversity. It's a real bug bear of mine when people use neurodiverse to describe someone who is neurodivergent, and weirdly this seems to happen a lot from people who work in roles associated with neurodivergence, who should really know better. An individual cannot be neurodiverse. A population is neurodiverse, made up of people who are neurotypical and neurodivergent.
(Image- unknown source)
To sum up...
My thoughts on whether ADHD is a learning disability, and if it's associated with all the traits listed in the tweet that sparked this post:
Sensitivities to light and sound- autism or AuDHD
Maladaptive daydreaming- not technically a sign associated with any specific form of neurodivergence, but is often associated with autism, ADHD, depression, trauma reactions and obsessive-compulsive symptoms.
Depression- often cormorbid with ADHD and autism
Fidgeting and restlessness- ADHD
Not reading social cues- autism or AuDHD
Not being able to do anything for no apparent reason- executive dysfunction seen in ADHD and autism
Learning disability- no, but ADHD may be comorbid with LD or SpLD
I hope this makes some sense, and clarifies my thoughts on whether ADHD is a learnign disability! As always, happy to hear any thoughts or comments on this, and very happy to be challenged if you have a different opinion.
All my love,
Christie x
References:
ADHD Aware (no date) 'Neurodevelopmental conditions'. Available at: https://adhdaware.org.uk/what-is-adhd/neurodiversity-and-other-conditions/ (Accessed 31 May 2024)
Autistic Girls Network (no date) 'AuDHD'. Available at: https://autisticgirlsnetwork.org/audhd/ (Accessed 09 June 2024)
British Dyslexia Association (2024) 'Dyscalculia Awareness Day'. Available at: https://www.bdadyslexia.org.uk/news/dyscalculia-awareness-day#:~:text=It%20is%20estimated%20that%20about,impact%20on%20learning%20and%20life. (Accessed 08 June 2024)
British Dyslexia Association (no date) 'Dyslexia'. Available at: https://www.bdadyslexia.org.uk/dyslexia (Accessed 08 June 2024)
Chung, P., Patel, D., Nizami, I. (2020) 'Disorder of written expression and dysgraphia: definition, diagnosis and management' in Translational Pediatrics. 9(1), pp.46-54.
Davis, N., Kollins, S. (2012) 'Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder' in Neurotherapeutics. 9(3), pp.518-530.
Department of Health (2001) 'Valuing people: A new strategy for learning disability for the 21st century'. Available at: https://assets.publishing.service.gov.uk/media/5a7b854740f0b62826a041b9/5086.pdf (Accessed 09 June 2024)
Evenbreak (2023) 'Recruitment and neurodiversity in the workplace'. Available at: https://blog.evenbreak.co.uk/2019/09/16/neurodiversity-and-the-workplace/ (Accessed 31 May 2024)
Foundation for People with Learning Disabilities (2024) 'Dyspraxia'. Available at: https://www.learningdisabilities.org.uk/learning-disabilities/a-to-z/d/dyspraxia (Accessed 09 June 2024)
Kaplan, B. et al. (1998) 'DCD may not be a discrete disorder' in Human Movement Science. 17(4-5), pp.471-490.
Kushki, A. et al. (2011) 'Changes in kinetics and kinematics of handwriting during a prolonged writing task in children with and without dysgraphia' in Research in Developmental Disorders. 32(3), pp.1058-1064.
Mencap (no date) 'What is a learning disability?' Available at: https://www.mencap.org.uk/learning-disability-explained/what-learning-disability#:~:text=A%20learning%20disability%20is%20to,someone%20for%20their%20whole%20life (Accessed 31 May 2024)
NHS (2021) 'Attention Deficit Hyperactivity Disorder'. Available at: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/ (Accessed 31 May 2024)
NHS (2022) 'Signs of autism in children'. Available at: https://www.nhs.uk/conditions/autism/signs/children/ (Accessed 09 June 2024)
NHS England (2024) 'Attention Deficit Hyperactivity Disorder (ADHD) programme update'. Available at: https://www.england.nhs.uk/long-read/attention-deficit-hyperactivity-disorder-adhd-programme-update/#:~:text=Background,-In%20December%202023&text=d.,at%203%25%20%E2%80%93%204%25. (Accessed 08 June 2024)
NICE (2015) 'Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges'. Available at: https://www.nice.org.uk/guidance/ng11/chapter/Context (Accessed 31 May 2024)
NICE (2023) 'Learning disabilities: What is is?' Available at: https://cks.nice.org.uk/topics/learning-disabilities/background-information/definition/ (Accessed 31 May 2024)
Public Health England (2023) 'Learning disability- applying All Our Health'. Available at: https://www.gov.uk/government/publications/learning-disability-applying-all-our-health/learning-disabilities-applying-all-our-health (Accessed 09 June 2024)
Royal College of Psychiatrists (2021) 'Attention deficit hyperactivity disorder (ADHD) in adults with intellectual disability'. Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr230---attention-deficit-hyperactivity-disorder-(adhd)-in-adults-with-intellectual-disability.pdf (Accessed 08 June 2024)
Sensory Stories by Nicole (2024) 'ADHD, autism, sensory processing disorder (SPD), and generalized anxiety disorder (GAD), very often overlap'. Available at: https://x.com/sensorystories_/status/1757395925243199859 (Accessed 04 June 2024)
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