It's not always the loudest who are struggling the most.

One of the biggest misconceptions about children with ADHD and Autism is that they will be loud if they are distressed, or in a situation which they are finding overwhelming or stressed. This is not true.

In my years as a teacher, the children who were the ones that were often missed were quiet and compliant, even in the most triggering of situations. I am very aware of these children, mainly because I was one of them myself. I would use so much energy being present and processing a situation, that I didn't have any excess energy to verbalise or communicate any form of stress.

A friend was recently telling me about a medical appointment she had attended with her autistic son. He was incredibly anxious about the hosptial environment and appointment to the extent that he had become non-verbal. There was another child in the waiting room who was throwing toys and shouting. After a long wait, the other child was called into the consulting room and the receptionist came up to my friend to tell them that because the other child was autistic they would be going in first because they were so stressed. My friend didn't say anything at the time because her focus was on keeping the situation calm and to make her son as comfortable as possible.

Afterwards she complained to PALS about the situation and they agreed that the situation was mishandled.

Having an autisitc or ADHD child that presents in this way when stressed can make advocating even harder. They can appear to others as a child that is in control and coping with the situation, and this in turn can make it harder for their difficulties to be seen and for reasonable adjustments to be made on their behalf. If your child has an appointment and is likely to present in this way then it might be worth mentioning it to the clinic before the appointment so that staff are aware of the situation.