Autism and ADHD often overlap. People living with both can feel misunderstood

You may have seen new ways of describing when someone is autistic and also has attention deficit hyperactivity disorder (ADHD). The terms ‘AuDHD’ or sometimes ‘AutiADHD’ are being used on social media, with people describing what they are experiencing or have seen as clinicians.

It may seem surprising that these two conditions can coexist, since some of the traits seem almost opposite. For example, autistic people tend to have set routines and want things to stay the same, while people with ADHD tend to get bored with routines and enjoy spontaneity and novelty.

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But these two conditions often overlap, and the combination of diagnoses can result in unique needs. Here are five important things to know about AuDHD.

1. Ten years ago it was not possible to have both

It was only in the past decade that autism and ADHD could be diagnosed together. Until 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the reference that health professionals around the world use for definitions of psychological diagnoses — did not allow ADHD to be diagnosed in an autistic person.

The fifth edition of the manual was the first to allow both diagnoses in the same person. So people diagnosed and treated before 2013, and much of the research, typically did not consider AuDHD. Instead, children and adults might have been “assigned” to whichever condition seemed most prominent or had the greatest impact on daily life.

2. AuDHD is more common than you might think

About 1 to 4 percent of the population is autistic.
They may have difficulty navigating social situations and relationships, preferring consistent routines, finding change overwhelming and repetition soothing. They may have specific sensory sensitivities.
ADHD affects approximately 5 to 8 percent of children and adolescents and 2 to 6 percent of adults. Symptoms may include difficulty focusing attention flexibly, resulting in procrastination, distractibility, and disorganization. People with ADHD may have high activity levels and impulsiveness.

Studies suggest that about 40 percent of people with ADHD also meet diagnostic criteria for autism, and vice versa. Having concurrent features or traits of one condition (but not meeting full diagnostic criteria) while having the other is even more common, and may be closer to 80 percent. So a substantial portion of people with autism or ADHD who do not meet full criteria for the other condition are likely to have some features.

3. Opposing traits can be stressful

Autistic people generally prefer order, while ADHD people often have trouble keeping things organized. Autistic people tend to prefer to do one thing at a time; people with ADHD often multitask and have many things going on at once. When someone has both conditions, the conflicting traits can result in an internal struggle.
For example, it can be annoying if you want your things organized in a certain way, but ADHD traits make it consistently difficult for you to do so. You may have periods of being organized (when autistic traits are dominant), followed by periods of disorganization (when ADHD traits are dominant) and feelings of stress because you can’t maintain organization.

Eventually, boredom may set in if you continue doing the same routines or activities, but you may also become upset and anxious if you try to switch to something new.

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Autistic special interests (which are often all-consuming, long-lasting, and more important than social contact) may not last as long in Autistic ADHD, or may be more like the interests seen in ADHD (an intense, deep dive into a new interest that can quickly fizzle out).
Autism can result in rapid overstimulation by sensory input from the environment, such as sounds, lights, and smells. ADHD is associated with an understimulated brain, which may require intense pressure, novelty, and excitement to function optimally.
For some people, the conflicting qualities can lead to a balance where people find a middle ground (for example, their house looks tidy, but the closets are a little messy).

Not much research has been done on the personal experience of this ‘trait conflict’ in AuDHD, but there are clinical observations.

4. Mental health problems and other issues are more common

Our research into the mental health of children with autism, ADHD or AuDHD shows that children with AuDHD have more mental health problems than children with autism or ADHD alone.

This is a consistent finding with studies showing higher rates of mental health problems such as depression and anxiety in AuDHD. There are also more problems with daily functioning in AuDHD than in either condition alone.

So there is an additive effect in AuDHD of having the basic executive functioning problems that are common to both autism and ADHD. These problems have to do with how we plan and organize, pay attention, and control impulses. When we struggle with these, it can have a huge impact on daily life.

5. It is important to get the right treatment

ADHD medication treatments are evidence-based and effective. Studies suggest that medication treatment for ADHD in autistic people helps improve ADHD symptoms in a similar way. However, ADHD medication will not reduce autistic traits, and other support may be needed.
Non-pharmacological treatments such as psychological or occupational therapy have been less studied in AuDHD, but are likely to be helpful. Evidence-based treatments include psychoeducation and psychological therapy. This may include understanding a person’s strengths, how their characteristics may affect them, and learning what support and accommodations are needed to help them function optimally. Parents and caregivers also need support.

The combination and sequence of support will likely depend on the person’s current functioning and specific needs.

Do you recognize this?

Studies suggest that people still may not identify with both conditions when they co-exist. A person in this situation may feel misunderstood or feel like they can’t fully identify with others with a single autism and ADHD diagnosis and that there is something else going on with them.
If you have autism or ADHD, it is important that the other person is taken into account so that the right support can be provided.
If only one piece of the puzzle is known, the person will likely have unexplained problems despite treatment. If you have autism or ADHD and are unsure whether you have AUDHD, consider discussing this with your healthcare provider.

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