When you finally receive a neurodevelopmental diagnosis that reflects your strengths and the challenges you face, it can be life-changing .
But for people with both autism and attention-deficit hyperactivity disorder (ADHD) - known colloquially as AuDHD - getting the right diagnosis can be difficult.
People with AuDHD (pronounced awe-D-H-D) often find their traits and experiences don't always neatly fit into either category. Sometimes the two conditions contradict each other and appear to act in opposite ways. Other times they exacerbate or increase a trait or difficulty.
This can delay diagnosis and support.
What are these conditions and how common are they?
Autism is a condition that affects social communication. Autistic people often have significant sensory sensitivities and need certainty and repetition. Around 1-2% of children and adults are autistic.
ADHD impacts either the ability to flexibly focus and sustain attention, or results in hyperactivity and impulsivity - or both. Around 5-8% of children and 3% of adults have ADHD.
Around 30% to 50% of autistic people also have ADHD. But despite them commonly occurring together, autism and ADHD have only been able to be diagnosed together since 2013, when the Diagnostic and Statistical Manual of Mental Disorders received its fifth update in the the DSM-5.
What's usually diagnosed first?
Autism is usually diagnosed at an earlier age than AuDHD and ADHD in childhood.
This may related to autistic traits - social difficulties - often being apparent in preschool, whereas ADHD traits may not become apparent or problematic until school age, when concentration abilities are needed to learn.
But some people can mask their autistic differences through strategies, such as learning explicitly how to socialise, following scripts, copying and mirroring others and hiding autistic traits.
Sometimes, accessing ADHD medication treatment can reveal autistic traits that may not have been obvious and were overshadowed by ADHD. After taking ADHD medications, some people can achieve their preference for being highly structured and organised, when ADHD traits of disorganisation and inconsistency in attention are reduced.
For others, ADHD medication will treat impulsivity that manifests as talkativeness or extroversion, to reveal a deeper introversion and preference for solitary activities.
In recent years, some people who have one existing diagnosis have learned about the other condition on social media and realised they might have AuDHD.
Some difficulties are exacerbated
Maintaining friendships and socialising
For autistic people, maintaining friendships is a core difficulty and can make social interaction draining and overwhelming. Autism makes it difficult to pick up social cues, know what to do or say in social situations, and identify non-verbal signals from others.
ADHD can make it hard to organise social events, stay in touch with friends and respond to texts and calls. When socialising, attention difficulties can make it harder to focus on conversations and remember what was said. Hyperactivity and impulsivity can mean interrupting and talking over others or being overly talkative.
Together, AuDHD can mean a person experiences all these differences in social interactions, resulting in more unintended "social mistakes".
Stims
Repetitive behaviours in autism (stims) are often ways to regulate or express emotions through repeated movements or vocalisations. They could be repetitive noises such as squeaks or humming, or movements such as rocking back and forth or finger flicking.
ADHD hyperactivity often involves fidgeting and not being able to be still or relax.
Together, movement from stims and fidgets can be more obvious and frequent.
Other traits pull people in different directions
Organisation
Autistic traits include the need for order, systems, categorisation and organisation around the house, at work and with hobbies.
ADHD traits of inattention include significant difficulties with organisation.
The result for people with AuDHD is often internal frustration and discomfort: wanting to be organised but not being able to maintain it.
Special interests
Autistic special interests are usually long-standing (over years) and limited to a few subjects.
ADHD involves seeking novelty and quickly becoming bored and moving on to the next interest once something is no longer stimulating. This might mean buying new things for a hobby but never actually using them.
AuDHD tends to follow the pattern of ADHD. So someone may have intense interests but be exhausted by them sooner than they would with autism alone.
Routine
Autism wants certainty, plans and routine. ADHD wants spontaneity and novelty. Together, autism often seems to win.
People with AuDHD may follow routines due to the anxiety uncertainty causes them, but they may feel bored or dissatisfied as their ADHD needs aren't met.
Unique strengths
Many late-diagnosed people with AuDHD are highly intelligent and have developed elaborate compensation strategies for their difficulties. Many have found ways to leverage and maximise their strengths.
Strengths in AuDHD can be related to either condition. This can include common autistic strengths such as being highly focused, having meticulous attention to detail and subject matter expertise.
ADHD strengths can include creativity and the ability to develop novel solutions, strategise, quickly research to a deep level, have a high level of focus, and take quick action in highly stressful situations.
Knowing you have AuDHD can result in self-acceptance and understanding, and replace a lifetime of self-criticism. This can lead to developing a life that is right for each individual person with AuDHD rather than trying to fit in with what might be socially and culturally expected.
It also means you can access treatments and supports to support both autism and ADHD needs. This might include ADHD medication, neuro-affirming education and therapy adjusted for autism and ADHD, occupational therapy , ADHD coaching, as well as workplace and academic accommodations.
Tamara May is a clinical psychologist in private practice.
