Autism and attention deficit hyperactivity disorder (ADHD) are two distinct neurodevelopmental conditions that are often believed to commonly co-occur together.
Autism is characterized by differences in social communication, social interaction, and behavior, with a wide range of characteristics such as sensory differences, restricted interests, and repetitive behaviors.
ADHD, on the other hand, is characterized by traits such as focus and attentional differences, hyperactivity, and impulsivity, which can make it challenging to complete tasks, follow through on responsibilities, and interact with others.
AuDHD (combining the terms autism and ADHD) is an unofficial but more commonly used term to refer to individuals who are both autistic and have ADHD. Since AuDHD is not an official diagnosis, individuals will have separate diagnoses of autism and ADHD.
“In my experience, having autism and ADHD is like having a wife and a mistress, although I’m not always sure which is which as they can be subject to change, rivalry and the odd spat.
… ADHD gives me a relentless supply of energy, quick thinking and a flurry of ideas. However, this is soon tempered by the autism returning the much-needed order, logic, caution and structure to my thinking and behaviour. They are a bit of an odd couple, really, but they’ve been together for decades and have learned to rub along.”
The Autistic Lawyer, extracted from their book “Smelling the Taste of Sound“
How common is AuDHD?
AuDHD may be more common than was originally believed. It is unclear precisely how common it is, but scientific literature suggests 50-70% of autistic individuals may have co-occurring ADHD.
Dr. Debra Bercovici from Embrace Autism explains that despite high co-occurrence rates, it was believed (prior to 2013) that autism and ADHD could not co-occur as they were viewed as being contradicting conditions. Therefore, research predating this may not account for this overlap, and our understanding of this overlap is limited.
This may mean that there are many autistic individuals who do not realize they also have ADHD and vice versa. It is important to recognize the co-occurrence of autism and ADHD so that individuals can have a better understanding of themselves and to ensure they receive specific support that is tailored to their unique traits.
Overlapping Autism and ADHD Traits
Below are some of the ways in which autism and ADHD can overlap. It is important to recognize that the presentation of autism and ADHD can vary widely among individuals, and not everyone will have the same experiences.
Attentional differences
According to research, both autistic individuals and those with ADHD may experience difficulties with sustaining attention, shifting focus, and disengaging from stimuli.
AuDHDers may:
- Experience hyperfocus, but also hyper-attention depending on the task/activity
- Pay close attention to detail, yet find they are also prone to mistakes
- Struggle to focus on a lecture in class, frequently getting distracted by external stimuli or internal thoughts
- Find it challenging to shift their attention from a topic of intense interest to a less engaging task, such as transitioning from engaging in their hobby to completing a chore
Executive functioning challenges
Autism and ADHD are associated with difficulties in organization, time management, planning, and cognitive flexibility.
AuDHDers may:
- Find their intense interests comforting, but they have a need to switch between interests
- Prefer to have routines but with a need to change tasks spontaneously
- Have a need to plan and organize, but find it difficult to follow through due to feeling overwhelmed
- Have difficulty managing their time effectively, often underestimating how long tasks will take or procrastinating until the last minute
- Crave structure and routine in their daily life but struggle with planning and executing these routines.
Sensory processing differences
Individuals who are autistic and have ADHD may experience hyper- or hypo-reactivity to sensory input as well as racing thoughts, leading to feelings of overwhelm or distress.
AuDHDers may:
- Have sensory sensitivities but also have a need for stimulation
- Have frequent emotional burnouts from being stuck in a cycle of craving stimulation but becoming overstimulated
- Become overwhelmed by the combination of flickering fluorescent lights and the constant buzz of environmental chatter
- Have challenges with filtering out irrelevant information making difficult for them to focus on one person amidst the competing sensory input.
Social difficulties
While the nature of social difficulties may differ, both autistic individuals and those with ADHD can struggle with social interactions, understanding social cues, and adjusting behavior to suit various social contexts.
AuDHDers may:
- Have differences in social-emotional reciprocity & they may mind-wander during conversations
- Have differences in non-verbal communication
- Have difficulty in developing, maintaining, and understanding relationships
- Have trouble following the flow of a conversation, particularly in group settings
- Interrupt others or struggle to understand when it is socially appropriate to respond
- Experience social misunderstandings or social awkwardness.
Emotion regulation differences
Autistic individuals and those with ADHD may experience challenges with emotional regulation, leading to intense or impulsive emotional reactions.
AuDHDers may:
- Have difficulty identifying and expressing their emotions appropriately, leading to misunderstandings or social challenges.
- Become easily overwhelmed in emotionally charged or stressful situations, leading to shutdowns, meltdowns, or avoidance behaviors.
- Experience intense emotional reactions that feel difficult to control
- Have angry outbursts in response to frustration
- Become easily overwhelmed by feelings of anxiety or sadness, leading to impulsive behaviors or difficulty coping with stress.
Neurodivergent masking
Masking (or camouflaging) refers to hiding or suppressing traits of neurodivergence as a way to appear neurotypical and ‘fit in.’ Masking is common in autistic individuals as well as those with ADHD.
An AuDHDer may:
- Attempt to hide their struggles when in social situations to avoid negative judgment and to blend in
- Attempt to hide their struggles at school or work to appear more competent than they feel
- Mimic the social behaviors of others
- Suppress stimming or fidgeting
- Force themselves to make eye contact even if it feels unnatural or uncomfortable
What does it feel like to be both autistic and have ADHD?
For some individuals with AuDHD, the co-occurrence of autism and ADHD can feel like having two opposing forces within oneself.
I spoke to one individual who described her experience with navigating her internal conflicts:
"Describing the experience of being an autistic ADHDer is complicated. The best way I can describe it is that my body is comprised of not one, but two countries. And I’d like to say that they are allies, but really, they are mortal enemies.
Each has its own systems, agendas, and ways of doing things. And they don’t want the same things, or even work together cohesively… yet they are required to coexist.
Parts of me require rigid routines, and have a deeply routed need for autonomy. This part wants quiet, and sameness. She wants to control her environment and predict what comes next.
The other part of me is incredibly spontaneous and impulsive. She likes stimulation and novelty. This part wants to roll with the punches as they come along."
Calypso (@calypsoexplainsitall)
I also spoke to The Autistic Lawyer, who shared an extract from her book: “Smelling the Taste of Sound” to elaborate on this internal dynamic when approaching tasks:
"...if I may need to complete a task, half of my brain is very focused on it and has worked out how I will do it. The autistic half of me is glad that I have an action plan. It feels comforting that I’ve devised a structured timetable and know I’ll have taken care of all the minor details because there’ll be a list and contingency plans.
Meanwhile, the anarchic ADHD half of my brain wants to come in, mess it all up, have a party, hold a riot, facilitate civil unrest and then p*** off. The ADHD side will be quite happy flitting from one subject to the next, looking for distractions, reminding me that I can do it later, suggesting that I can watch television or open a bottle of wine because that’s way more interesting."
For individuals with AuDHD, the demands of parenting and family life can be particularly challenging. The added responsibilities and lack of structure can exacerbate existing difficulties, leading to feelings of overwhelm and frustration.
Calypso (@calypsoexplainsitall) explained to me that she came to realize she is both autistic and an ADHDer after becoming a parent. She shares:
"After my daughter was born in 2016 I started struggling. I couldn't keep my thoughts straight; I lost everything, and it felt like the career I had built was unraveling before my eyes.
When I told this to people who were close to me, they said that this was a normal motherhood experience. But it didn't feel normal.
Several years later in 2020, I was at home with my family every day, and began realizing that just existing with them was becoming difficult. I was quick to anger, frustrated at the lack of routine, and everything just continued to feel harder than it should. I felt like I was failing as a parent.
It was sometime in 2021 when my son got a formal ASD and ADHD diagnosis. This is what changed everything for me. I started noticing the patterns in each of our behaviors and how they mirrored one another."
For some individuals, receiving an AuDHD diagnosis for themselves or their child can be a turning point in understanding their challenges and recognizing patterns within the family.
Individuals with AuDHD may also describe difficulties with impulse control and disorganized thinking associated with ADHD, paired with more rigid, detail-oriented forces from autism.
The Autistic Lawyer explains in her book how this can feel:
"When my ADHD is in full flow and in need of a harness, I feel like a charioteer, battling the reins against the pull of my horses... My brain feels like an internet browser with thirty pages open all at once. I occasionally have little or no ‘thought filter’, and whatever is in my head tends to get propelled from my mouth with the rapidity of a bullet...
When my autism is in the driving seat, I’m tense, intense, detail-obsessed, socially awkward and fraught with anxiety. In short, my ADHD is the accelerator, my autism is the brake and I’m a better motorist for hosting the two.”
So while ADHD provides energy and impulsivity, autism can act as a counterbalance, providing structure and caution. There can, therefore, be value in co-occurring autism and ADHD as they can work together to create a more balanced and effective way of navigating life.
How do I know if I have AuDHD?
If you suspect that you may have AuDHD, it is essential to seek a comprehensive evaluation from a qualified healthcare professional. However, reflecting on your experiences and traits can be a helpful starting point.
Consider the following questions:
- Do you experience difficulty sustaining attention on tasks that do not interest you or hyperfocus on topics of intense interest?
- Do you struggle with organization, time management, planning, and following through on tasks and commitments?
- Do you experience hypersensitivity to certain sensory stimuli, feelings of overwhelm in sensory-rich environments, or a need for sensory stimulation?
- Do you face difficulties with social-emotional reciprocity, nonverbal communication, or developing and maintaining relationships?
- Do you have intense emotional experiences, such as difficulty regulating emotions, impulsive emotional reactions, or a tendency to become easily overwhelmed in emotionally charged situations?
- Do you feel like you have two conflicting internal forces, with one craving structure and routine while the other seeks novelty and spontaneity?
- Do you relate to the experiences shared by other individuals with AuDHD, such as feeling like your mind is constantly pulled in different directions?
If you find yourself answering “yes” to many of these questions and relating to the experiences of others with AuDHD, it may be worth pursuing a formal evaluation.
Remember that self-reflection is a valuable starting point, but a comprehensive assessment by a qualified professional is necessary to receive a proper diagnosis and access appropriate support and accommodations.
References
Carter Leno, V., Chandler, S., White, P. et al. Testing the specificity of executive functioning impairments in adolescents with ADHD, ODD/CD and ASD. Eur Child Adolesc Psychiatry 27, 899–908 (2018). https://doi.org/10.1007/s00787-017-1089-5
Hours, C., Recasens, C., & Baleyte, J. M. (2022). ASD and ADHD comorbidity: What are we talking about?. Frontiers in psychiatry, 13, 837424. https://doi.org/10.3389/fpsyt.2022.837424
Rau, S., Skapek, M. F., Tiplady, K., Seese, S., Burns, A., Armour, A. C., & Kenworthy, L. (2020). Identifying comorbid ADHD in autism: Attending to the inattentive presentation. Research in Autism Spectrum Disorders, 69, 101468. https://doi.org/10.1016/j.rasd.2019.101468
Van Der Meer, J. M., Oerlemans, A. M., Van Steijn, D. J., Lappenschaar, M. G., De Sonneville, L. M., Buitelaar, J. K., & Rommelse, N. N. (2012). Are autism spectrum disorder and attention-deficit/hyperactivity disorder different manifestations of one overarching disorder? Cognitive and symptom evidence from a clinical and population-based sample. Journal of the American Academy of Child & Adolescent Psychiatry, 51(11), 1160-1172. https://doi.org/10.1016/j.jaac.2012.08.024
