Monotropism

Fractal Focus

How could attention deficit hyperactivity disorder (ADHD) and autism both be explained by monotropism despite their apparent differences? An attempt at reconciling and reframing the differences

by Gideon Henner

Introduction

Attention deficit hyperactivity disorder (ADHD) and autism are regarded as different conditions in traditional accounts based on the pathology paradigm, which characterizes neurodivergences such as ADHD by supposed deficits (as is evident from its full name)1. However, community-led research based on the neurodiversity paradigm, which sees neurodivergences as part of the natural diversity of human bodyminds2), has recently identified hyperfocus3 as a feature of ADHD shared with autism. Autistic-led research has in fact proposed explaining autism by what has been termed the monotropism account as primarily based on a ‘difference in the strategies employed in the distribution of scarce attention’4, where monotropism refers to a more narrow focus. The fact that both autism and ADHD have been characterized by what will be referred to in the following as hyperfocus — a trait clearly entailed by monotropism and central to it — suggests that autism and ADHD may be more closely related than traditionally assumed. There is thus a need to either confirm or reject the thesis of a shared monotropic root of autism and ADHD in hyperfocus, and, provided the thesis is confirmed, to reframe/reconcile the apparent differences between autism and ADHD.

To this end, this essay critically considers the evidence for hyperfocus in ADHD from scholarly literature as well as blog posts incorporating lived experience and neurodiversity-informed approaches to reframing and renaming ADHD at the intersection of psychology, neurodiversity and philosophy. Eventually, based on these considerations, this essay proposes ADHD and autism likely constitute two ends of the same spectrum, whose specific embodiment depends on external as well as intrinsic factors, and also suggests a novel intrinsic factor involved in this.

Scholarly literature on hyperfocus in ADHD

A 2018 paper by Hupfeld and others3 using highly validated scales to investigate hyperfocus found that it was more common in ADHD participants than in the control group, and defined hyperfocus as ‘[a] state of heightened, intense focus of any duration, which most likely occurs during activities related to one’s school, hobbies, or “screen time” (i.e., television, computer use, etc.); this state may include the following qualities: timelessness, failure to attend to the world, ignoring personal needs, difficulty stopping and switching tasks, feelings of total engrossment in the task, and feeling “stuck” on small details’5. While a later study by Groen and others did not have the same findings, the authors’ definition for hyperfocus ‘as a period of complete engagement in a task accompanied by failure to notice time and the world’6 made no mention of factors such as difficulties relating to task-switching and stuckness, which they accepted as a potential conceptual reason for the different findings (though they also claim that demographic data might not have been sufficiently controlled for by Hupfeld and others). Moreover, a recent study by Dwyer and others7 that incorporated further measures and adapted the one used by Hupfeld and others also confirmed the presence of elevated hyperfocus (as well as inattention) versus the general population for individuals with both ADHD and autism.

The fact that the definition by Hupfeld and others was devised by a researcher with lived experience, adapted later on and also better reflects monotropism — whose definition includes that ‘moving between attention tunnels can be difficult’8 — suggests it is safe to dismiss the study by Groen and others that did not find hyperfocus in ADHD, and this paper will assume in the following that hyperfocus is a trait of ADHD.

This is further confirmed by other neurodivergent-led accounts of ADHD attempting to reframe ADHD based on the neurodiversity paradigm instead of the pathology paradigm; these papers also make mention of hyperfocus. Firstly, there is a grounded theory study by Champ and others that developed the so-called ADHD Creative Awareness Theory (CAT) based on ‘open-ended but directed, shaped but emergent’ discussions with interviewees with lived experience of ADHD9. CAT is based on individuals with ADHD experiencing states of ‘chaotic attention and hyperfocus’10, once again confirming that frameworks with meaningful involvement of lived experience generally support the presence of hyperfocus and thus supports the plausibility of monotropism as an explanation for ADHD. In addition, Brown and others’ ‘Introduction to Critical ADHD Studies’ mentions (autistic) monotropism as one of the ‘neurodivergent affirmative forms of attention’11. Finally, hyperfocus also finds mention as the term of choice to reframe the pathologizing concept of hyperactivity in a 2023 paper by Bertilsdotter Rosqvist and others, which suggests a general reframing of ADHD as ‘‘intensity’ as well as ‘variable attention or interest-based attention’’12. The following paragraph briefly looks at another such proposal for changing the terminology and narrative coming from a non-scholarly, well-informed autistic-led source, as well as at community sources citing monotropism as an explanation for both autism and ADHD to complement this essay’s argumentation in favour of hyperfocus as an ADHD trait.

Community sources

In an online article13, autistic community researchers Murray and Hallett cite the huge overlap between ADHD and autism: ‘anywhere from 30% to 80% of autistic people seemingly fit the diagnostic criteria for ADHD’. Furthermore, they share their preference for the term kinetic cognitive style (KCS) — coined by Nick Walker14— instead of ADHD, and point to the possibility for an underlying reason for the overlap, such as monotropism. The preference for the term KCS is also supported by community researcher Ryan Boren15, while Patrick Dwyer16 agrees with monotropism being the basis for both ADHD and autism. Based on these sources, the following section summarizes suggested mechanisms and factors involved in the different embodiments, and also proposes a novel intrinsic factor.

Intrinsic differences and external factors

Murray and Hallett’s post mentions distractions, depletion/burnout or past bad experiences — all external factors — as reasons for individuals with a KCS not being able to access the hyperfocus generally characterizing monotropism, which would render ADHD/KCS a sort of ‘monotropism interrupted’. Dwyer differentiates between endogenous (internally motivated, autistic, top-down) and exogenous (bottom-up, distraction-susceptible) hyperfocus, and states that they ‘can coexist with and are probably intertwined with one another in both autism and ADHD’, but that differences may be accounted for by the balance between the two types17.

The present essay agrees with both these arguments. Regarding the two types of hyperfocus differentiated by Dywer, this essay proposes that these form part of a spectrum, the exact distribution of which can result in the different embodiments of monotropism we see in people that are under the current terminology diagnosed with autism or ADHD (or both). As such, this spectrum constitutes one of the two intrinsic factors proposed here impacting how monotropism is embodied.

The factors cited by Murray and Hallett include ‘too many distractions, or too much nervous energy; they might not feel safe enough to lose themselves in the flow; they might have had bad experiences being told off for doing so, or been wrenched out of them too many times’. These could be subsumed under the term of  trauma, the impact of which — especially during childhood, but also continuing in adulthood — is hard to overstate. This is in particular because its continuous strain affects self-awareness and forces the monotropic mind to mask its natural tendencies in order to fall more in line with the neuronormative standard so as to avoid further trauma and punishment18. This can result in interruptions to hyperfocus, fracturing it, but also inhibit impulsive behaviour, including joyful behaviours.

Take the example of a child who loves to read about language(s) and to immediately tell everyone about their new knowledge. Now imagine the child being consistently chastised for reading too much, talking too much about their so-called restricted interest, and also blurting out at inappropriate moments. With time, this trauma will re-educate the child to suppress their hyperfocus as well as showing any joy (this will happen regardless of whether it was the caregivers’ intention or not). They learn they must conform to the norm, or be punished: they consequently mask their traits. This makes it difficult to know whether a person diagnosed as autistic is just masking their impulses/joy (thus not meeting ADHD criteria), or, conversely, whether a person diagnosed with ADHD has simply learned to avoid any hyperfocus as much as possible so as to display more typical attention patterns (resulting, however, in distractible attention).

Since neuronormative society is bound to traumatize autistics19, this makes differentiating between the precise embodiments of monotropism (ADHD and autism) very difficult, and should not be the primary focus either — rather, work should be done on undoing such trauma and changing society such that new trauma and re-traumatization are less likely.

The following section additionally suggests another intrinsic, non-deficit-based factor affecting how a monotropic focus can fracture into apparent distractibility that has not been mentioned in the literature to my knowledge.

Another intrinsic factor: fractal focus

Weak central coherence (WCT) has been suggested by pathology-paradigm-based autism research as an explanation for autistic focus on detail, which in WCT theories is assumed to entail concentrating more on details than the so-called great picture — something autistics are assumed to be unable to comprehend20. While this essay disagrees with this notion, the concept of central coherence is useful in that a focus on detail with concurrent awareness of central coherence could potentially be at the heart of the apparent dichotomy between hyperfocus and chaotic attention.

To illustrate this concept, let us again look at the example of the child enthusiastic about language(s). Even without external interference and in particular when an interest is very strong, one becomes soon aware of how each concept in language can be further divided into sub-units which are not only just as complex, but also interact with one another: e.g. learning something as deceptively simple as vocabulary in a foreign language becomes more complex once one zooms in on just the semantics of a single word, the exact meanings it covers and how it occurs in relation to other words (collocations) — but then again it also interacts with grammatical concepts, each of which alone is just as complex (and can be further subdivided). It has therefore been said that language has fractal complexity21, with each sub-unit being as complex as the super-unit (self-similar).

This is naturally just one example, but it is very conceivable that reality — or our conception of it — has fractal complexity. An awareness of this whilst trying to focus on one aspect of a concept (in line with hyperfocus) may well entail attention that jumps from concept to concept to do justice to all its moving parts (in line with an awareness of the fractal complexity of the central coherence of things). This may also result in a tendency to divide each task into a seemingly infinite number of micro-tasks — which would explain why many organizational techniques (usually based on dividing tasks) are anecdotally less effective in individuals with ADHD22.

This might be termed fractal attention, in contrast to a focus that is broken from the outside, by external factors as described in the section above, which would rather represent fractured attention. It is also worth noting that the term ‘fractal’ originates from chaos theory, and one of the papers cited in the present essay refers to one of the ‘poles’ of ADHD as ‘chaotic attention’23 — certainly without intending this interpretation, but fractal attention is indeed associated with finding order in chaos, whilst not denying the chaotic nature of reality (or at least our thoughts).

Conclusion

While fractal attention — just like the more problematic fractured attention — explains attention-flitting, it can also be distressing for the person if it prevents them from accessing hyperfocus. Neurodiversity-affirming approaches to this are needed, and whilst this falls outside the purview of this brief essay, Creative Awareness Theory might provide a worthwhile avenue to pursue.

Also, OCD may well also be explained in similar terms, and thus be brought closer to autism/ADHD by way of a monotropic explanation including fractal focus (supporting its inclusion under the neurodivergence umbrella).

  1. American Psychiatric Association (APA), Neurodevelopmental Disorders: DSM-5® Selections, American Psychiatric Publishing, 2015. [↩]
  2. Ken Dychtwald, Bodymind (Pantheon, 1986; second edition [↩]
  3. Kathleen E Hupfeld, Tessa R Abagis, Priti Shah, ‘Living “in the zone”: hyperfocus in adult ADHD’, ADHD Attention Deficit and Hyperactivity Disorders, 11 (2019) pp. 191–208, doi:10.1007/s12402-018-0272-y- [↩] [↩]
  4. Dinah Murray and others, ‘Attention, monotropism and the diagnostic criteria for autism’, autism, 9.2 (2005), pp. 139-156 (p. 140), doi:051398 1362-3613(200505)9:2. [↩]
  5. Ibid, p. 196. [↩]
  6. Yvonne Groen and others, ‘Testing the relation between ADHD and hyperfocus experiences’, Research in Developmental Disabilities 107 (2020), p. 103789, doi:10.1016/j.ridd.2020.103789. [↩]
  7. Patrick Dwyer and others, ‘A trans-diagnostic investigation of attention, hyper-focus, and monotropism in autism, attention dysregulation hyperactivity development, and the general population’, Neurodiversity, 2 (2024), pp. 1–27, doi:10.1177/27546330241237883. [↩]
  8. Ryan Boren, ‘Monotropism’, Stimpunks (2022), <https://stimpunks.org/glossary/monotropism/> [accessed 3 December 2024] [↩]
  9. Rebecca E. Champ and others, ‘The Creative Awareness Theory: A Grounded Theory Study of Inherent Self-Regulation in Attention Deficit Hyperactivity Disorder’. Journal of Clinical Medicine, 13.10 (2024), p. 5963, doi:10.3390/jcm13195963. [↩]
  10. Ibid. [↩]
  11. Andrew Ivan Brown and others, ‘An Introduction to Critical ADHD Studies’, in The Palgrave Handbook of Research Methods and Ethics in Neurodiversity Studies, ed. by Hanna Bertilsdotter Rosqvist and David Jackson-Perry (Palgrave Macmillan, 2024), pp. 41-57 (p. 46). [↩]
  12. Hanna Bertilsdotter Rosqvist and others, ‘Intensity and Variable Attention: Counter Narrating ADHD, from ADHD Deficits to ADHD Difference’, British Journal of Social Work 53 (2023), pp. 3647–3664, doi:10.1093/bjsw/bcad138. [↩]
  13. Fergus Murray and Sonny Hallett, ‘ADHD and Monotropism’, Monotropism (2023), <https://monotropism.org/adhd/> [accessed 28 November 2024]. [↩]
  14. Nick Walker, Dora M. Raymaker, ‘Toward a Neuroqueer Future: An Interview with Nick Walker’, Autism Adulthood, 3.1 (2021), pp. 5-10, doi:10.1089/aut.2020.29014.njw [↩]
  15. Ryan Boren, ‘Kinetic Cognitive Style, Stimpunks (2022), <https://stimpunks.org/glossary/kinetic-cognitive-style/> [accessed 28 November 2024] [↩]
  16. Patrick Dwyer, ‘Revisiting Monotropism’, Autistic Scholar (2021), <https://www.autisticscholar.com/monotropism/> [accessed 28 November 2024] [↩]
  17. Ibid. [↩]
  18. Louise Chapman and others, ‘’I want to fit in… but I don’t want to change myself fundamentally’: A qualitative exploration of the relationship between masking and mental health for autistic teenagers’, Research in Autism Spectrum Disorders, 99 (2022), doi:10.1016/j.rasd.2022.102069 [↩]
  19. Nick Walker, Neuroqueer Heresies: Notes on the Neurodiversity Paradigm, Autistic Empowerment, and Postnormal Possibilities (Autonomous Press, 2021), pp. 88-91 [↩]
  20. Elizabeth Pellicano and others, ‘Multiple cognitive capabilities/deficits in children with an autism spectrum disorder: “Weak” central coherence and its relationship to theory of mind and executive control’, Development and Psychopathology, 18 (2006), pp. 77–98, doi: 10.10170S0954579406060056 [↩]
  21. Leonardo Costa Ribeiro, Américo Tristão Bernardes, Heliana Mello, ‘On the fractal patterns of language structures’, PLoS ONE, 2023, doi:10.1371/journal.pone.0285630 [↩]
  22. Andrew Lewis, ‘ADHD trouble with to-do lists’, simply wellbeing, <https://www.simplywellbeing.com/insights/adhd-strategies/adhd-trouble-with-to-do-lists/> [Accessed 4 December 2024] [↩]
  23. Rebecca E. Champ and others, ‘The Creative Awareness Theory: A Grounded Theory Study of Inherent Self-Regulation in Attention Deficit Hyperactivity Disorder’. Journal of Clinical Medicine, 13.10 (2024), p. 5963, doi:10.3390/jcm13195963 [↩]

[languages]