I feel tired all the time! Neurodiversity and me... 10 ways to reduce the feelings of fatigue.

I often hear people who are neurodiverse saying they feel very tired a lot of the time. As a G.P many years ago we used to use an acronym of TATT!

 These feelings are not very surprising in some ways. Coping with an increased mental effort to focus, and sustain a task, having to cope in a specific social situation and try and understand what others want of you, decoding information you can’t quite understanding or carrying out a motor task that has not been automated means greater effort is required for all of these events.

 There is also extensive research describing the increased cognitive demands for people with ADHD, for example, needing to ignore environmental distractors, sustain attention, control impulsive urges, and manage internal restlessness (1).

 If you think we have only so much capacity to manage ourselves per day and using the analogy of having 8 teaspoons of energy per day, we then have to decide how this gets used up. If a lot of the spoons are used by needing to focus, sustain attention, and consciously do tasks such as driving, you can see this leaves little left to feeling energetic.

 When we move from school to the workplace our external demands go up (managing home, relationships and work) and support often goes down.  The scaffolding support we have had from others provided us with the means of being able to cope. Parents often made meals, did washing (and ironing), paid the bills, etc. However, decreased support from parents or from school can result in you having to use up all your spoons of energy. There is a need to decide how to prioritize this limited about of energy and where best to spend this precious resource.

A long commute traveling to and from work on top of a days’ work can take out one of these precious spoons, leaving you on some days with nothing left to manage when you get home. This results in your family or partner getting the exhausted version of you!

I hear some couples complaining that the partner is always tired but seems to be able to manage a night out with work colleagues. Sometimes there is pressure on you to have to go to a ‘works do’ or business meeting, even though you will be paying for it for days after.

 Clinically, over the years, I have seen many people with Developmental Coordination Disorder (DCD) (also known as Dyspraxia), and with ADHD and ASD complaining of chronic fatigue and some people actually being diagnosed with Chronic Fatigue Syndrome (CFS). It can limit their work choices and actually result in them working ‘part-time’. Making life choices can be hard when others don’t understand why you opt-out of after-work activities as you know that going out late AND working maybe just too much to manage.

Anxiety and Depression are commonly co-occurring with Neurodiverse conditions.

Two recent studies with adults with ADHD(2) and DCD(3) (one by a former colleague from The Dyscovery Centre, Dr Marie Thomas) considers the association of Neurodiverse conditions with CFS. Both studies interestingly show significantly lower levels of cognitive difficulties, fatigue, and somatic symptoms compared to adults without ADHD or DCD. They also showed similarities in presentation with people with CFS groups in terms of anxiety, depression, cognitive failures, negative and positive effect, and self-esteem.

The study by Rogers et al, also highlighted the number of people with CFS that had undiagnosed ADHD, which again demonstrates the professional lens people look through may influence the diagnosis you end up getting. A number of other studies have reported daytime tiredness and fatigue in children and adults(4).

What is also complex is the intersection between the effort required, anxiety, depression, and fatigue. Also, poor sleep can also impact your energy levels the next day. For some, the mental health conditions are not just co-occurring with neurodiversity but may be caused in some way by neurodiversity or by the challenges of navigating the world as a neurodiverse person.

People who are neurodiverse have a higher risk of a range of mental health conditions.

?      Attention-Deficit/Hyperactivity Disorder has been associated with anxiety disorders, gender dysphoria, mood disorders, obsessive-compulsive disorder (OCD), personality disorders, schizophrenia and substance misuse disorders

?      Autism Spectrum Disorders have been associated with anxiety disorders, eating disorders, gender dysphoria, mood disorders, OCD, personality disorders, schizophrenia and substance misuse disorders

?      Developmental Coordination Disorder is associated with anxiety disorders and mood disorders

?      Developmental Language Disorder is associated with anxiety disorders, mood disorders, OCD, personality disorders and schizophrenia

?      Dyscalculia is associated with mood disorders and schizophrenia

?      Dyslexia is associated with anxiety disorders, mood disorders, and schizophrenia

?      Tic Disorders are associated with anxiety disorders, mood disorders, OCD and personality disorder

“The Environmental Stress Hypothesis” (5) is one theory to explain why Developmental Coordination Disorder (DCD) (also known as Dyspraxia) is associated with increased risk of anxiety and depression and also fatigue too and demonstrates the intersection between various factors e.g. co-ordination is not so good, you become less fit because you do less exercise, this leads to less stamina, and this leads to increased fatigue!

10 ways to reduce feelings of fatigue.

1.    Pace yourself – if you have a busy week build in some early nights/ and an easier weekend.

2.    Keep fit – this can help with sleep too.

3.    Try and get adequate sleep each night- avoid caffeine, alcohol and working on your computer all evening (or playing video games for hours before bedtime) where possible and try and establish a good sleep routine.

4.    Gain the support you require at work so you can maximize the energy you have for the tasks that really need to be done. You may have to make compromises e.g. choose a job with a shorter commute so that you have some time to relax in your evenings.

5.    Be good to yourself and don’t beat yourself up about the way you feel.

6.    If you are feeling anxious or depressed recognize this and get some support- you don’t have to go-it-alone!

7.    Some people (not everyone) find mindfulness can help; others find being active calms the mind. See what works for you.

8.    Automate tasks you do every day to reduce the effort e.g. put your keys in the same place so you are not spending ages looking for them; use a diary reminder on your phone so you are not having to remember everything too.

9.    Plan meals ahead and make some in batches- if you are making Bolognese then make three times the amount and freeze it for another time.

10. Eat healthily and often so you don’t run out of energy too.

The author, Professor Amanda Kirby is CEO of Do-IT Solutions providing person-centered solutions and tools for helping maximize the talents and skills of neurodiverse people and helping organizations to become more neuro-inclusive.

https://doitprofiler.com/consultancy-and-training/training/?utm_source=LinkedIn

References:

1.    Barkley, R. (2014). Attention-deficit hyperactivity disorder a handbook for diagnosis and treatment (Vol. 4). New York, NY: The Guilford Press.

2.    Rogers, Denise C.; Dittner, Antonia J. ; Rimes, Katharine A. ; Chalder, Trudie (2017).

Fatigue in an adult attention deficit hyperactivity disorder population: A trans‐diagnostic approach.British Journal of Clinical Psychology, March 2017, Vol.56(1), pp.33-52.

3.    Thomas,M and Christopher,G. (2018). Fatigue in developmental coordination disorder: an exploratory study in adults, Fatigue: Biomedicine, Health & Behavior, 6:1, 41-51, DOI: 10.1080/21641846.2018.1419564

4.    Fisher, B. C., Garges, D. M., Yoon, S. Y., Maguire, K., Zipay, D., Gambino, M., & Shapiro, C. M. (2014). Sex differences and the interaction of age and sleep issues in neuropsychological testing performance across the lifespan in an ADD/ADHD sample from the years 1989 to 2009. Psychological Reports, 114, 404–438. doi:10.2466/15.10.PR0.114k23w0.

5.    Mancini VO et al. (2016) The Elaborated Environmental Stress Hypothesis as a framework for understanding the association between motor skills and internalizing problems: A mini-review. Frontiers in Psychology. 7, 239.