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Dr. Joanne Paul- MBBS (UWI), FRCPCH (UK), FRCP (Edin)


It is much easier to think of things in binary, either black or white, yes or no. It gives us some sense of absoluteness in the world of unpredictability, lack of control and unanswered universe beginning and end questions. But the majority of things function as part of a spectrum. Height, weight, race, colour, intelligence, just some of the few. This is especially important for persons in the field of medicine to not see one size fits all for a patient’s management but to always try to customize according to the variable patient factors. The spectrum is also even more pertinent with personality, cognitive and psychological disorders. When the person falls into the severe or moderate aspect of the disorder, it is easy to diagnose and to label. When it is mild, this is where the difficulty of the label lies.

The spectrum is very apparent with regards to Autism and ADHD (attention deficit and hyperactivity disorder). For children we have clear methods of testing where we assess in various categories and come to a clear diagnosis. For the ones who are mild though, they often are not picked up at childhood and as adults we have a host of persons with recurrent loops and lifestyle choices and fixed personality traits who actually may be undiagnosed ASD (autistic spectrum disease) or ADHD or even a mixture of both. Supposedly undiagnosed ADHD can be 2% – 5% of the adult population and for Adult ASD, it is approximately 3%

ADHD includes a combination of difficulty paying attention, hyperactivity, and impulsiveness. Well known adults with ADHD are Howie Mandel, Justin Timberlake, Simone Biles, Adam Levine, Solange Knowles. Adult ADHD symptoms may not be as clear as ADHD symptoms in children. Common symptoms include finding it hard to listen to others in conversation, being easily distracted, overlooking details, disorganisation, problems completing tasks, frequent mood swings, problems focussing on a task, low frustration tolerance, poor time management skills, unstable relationships. The person may find it hard to concentrate, follow directions, remember information, and have trouble controlling their anger. They may change jobs often, get speeding tickets and have multiple marriages or multiple serial relationships. In regular society we often perceive these adults as ‘something else yes’



Autism on the other hand encompasses social and behavioural challenges including the need to maintain rigid and sometimes repetitive patterns and rituals, difficulty controlling movement, communication barriers of processing and verbalizing information, differences in perception of people and environments. In the communication section, difficulty reading social cues, body language and facial expression. They find it hard to understand what others are thinking or feeling and hard to express how they feel. There is flat, monotone, or robotic speech, lack of understanding of figures of speech. In the emotional section, seemingly blunt or rude or not interested in others, finding it hard to make friends and preferring to be on their own, getting anxious about social situations, dislike of change of routine or expectation, dislike of people moving your stuff, rigid daily routines. These persons are very smart in a few very specific niche subject areas but not so much with other areas. They are either very sensitive or less sensitive to pain, touch, sound, and smell. They are clumsy and have difficulty with coordination. These adults can be often perceived as eccentric.

With Asperger’s or Asperger syndrome, this is a high functioning type of Autism. Elon Musk, Anthony Hopkins, Steve Jobs, Bill Gates, Courtney Love, Mozart, Steven Spielberg have confirmed they are Asperger’s. It is also suggested that Lionel Messi and Mark Zuckerberg also have this diagnosis. They are often highly intelligent and have above average verbal skills. They also have repetitive behaviours and the same daily routine, do not understand emotional issues, find it hard to see the world from another person’s perspective, have difficulty with empathy, take things literally, and have similar sensitivity to sensory stimuli. They cannot do small talk, have robotic speech, difficulty with eye contact, are clumsy and obsessed with a few topics and prefer one to one relationship without groups.

Both ADHD and ASD tend to run in families and in many cases the genes you inherit from your parents are a significant factor in developing these conditions. The significant point here is to observe your family and observe yourself as an adult. You may have some characteristics above that have been causing you to struggle and remain in a loop from which you feel unable to escape. You may be part of the mild and undiagnosed 5%.

The more significant point here though is, if it is all a spectrum and/or a bell curve, what or who determines the line for what is normal. The spectrum varies according to geography, culture, race, religion, community so the line also varies. It is important to know where you are in the spectrum, but for the ones who are deemed ordinary or normal, it is equally important to appreciate that the line is often not a line at all but a blur, a flexible range, that requires understanding and inclusivity. If you think about it, being normal is just being average. Some biodiversity is a good thing and spectrum mid-range is the new normal.

Dr Joanne F Paul is a Lecturer, a Paediatric Emergency Specialist, and a member of TEL Institute

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