Could conflicting ADHD and autism traits be hiding what’s really going on? What AuDHD can look like in adults

Words: Amy Mica Marsden. Images: Shutterstock.

You’ve always felt something was different about you, but you could never put your finger on it. Autism doesn’t fully fit, but neither does ADHD.

Perhaps you read the criteria and shook your head: you don’t need routine, as autism criteria suggest; in fact, you regularly struggle to keep one. Maybe you don’t experience difficulty completing tasks, as stated in the ADHD criteria – in fact, it bugs you to leave things unfinished.

However, there are too many symptoms that do fit to just ignore it. So, what’s going on?

Changes in diagnosis

Until 2013, medical guidance specifically stated that an ADHD diagnosis could be refused if a person was autistic – meaning that, as far as the medical field was concerned, it was not possible to have both disorders.

Now, guidelines present an entirely different picture. Research shows that having both ADHD and autism (often called AuDHD) is not only common but might be the ‘norm’, with some studies suggesting that between 50% and 70% of autistic people may also have ADHD. Similarly, it is estimated that around two-thirds of those with ADHD have at least one other coexisting condition, such as autism.

We now realize that the complex interplay between the two disorders might be the reason they were once thought of as mutually exclusive: it turns out that symptoms may have just been contradicting each other, leading to diagnoses that either came late or were missed entirely.

‘Many late-diagnosed adults share experiences where their underlying neurodivergence has gone unnoticed entirely for years,’ says Saara Kuvaja, certified ADHD and AuDHD coach, and late-diagnosed neurodivergent herself.

‘Women and girls, in particular, are more likely to have been dismissed as “just anxious” or stressed, rather than neurodivergent, due to lack of knowledge and different presentations in comparison to boys and men, on whom the majority of studies on ADHD and autism have been conducted. Luckily, awareness and understanding are increasing.’

AuDHD symptoms and how to spot them

The first thing to know when looking at potential AuDHD symptoms is that the way it presents is different in everyone: there is no ‘one-size-fits-all’ indicator.

‘ADHD and autism, both neurodevelopmental conditions, share some overlapping traits, and unpicking these can be difficult,’ explains Saara. ‘Both conditions shape how we process information and the environment around us, and they are linked to differences in the brain’s executive functioning (the areas and processes responsible for memory, planning, impulsivity, focus, motivation, etc.)…

‘Having a dual diagnosis/presentation of ADHD and autism (AuDHD) doesn’t mean a clean cut in the middle,’ she adds, ‘but is more often a complex interplay between the two that shows up uniquely in each person.’

Saara outlined some common areas in which AuDHD symptoms may become more noticeable below.

Focus style

‘Some may spend a lot of time creating a detailed plan, only to abandon it: the autistic side of the brain may be more rigid and seek structure and organization, and may take pleasure in planning, but the ADHD brain is on the lookout for novelty, and those traits may bring impulsivity and spontaneity into the mix, which can make it harder to follow through with the very structures they’ve set for themselves.’

Social interaction and communication

‘Some may crave social connection and even enjoy being the life and soul at parties, driven by their ADHD side, but then need a lot of recovery time alone afterwards. Others might find the same setting overwhelming from the start.’

Routine

‘Some need routines and simultaneously seek novelty: their routines may start to feel boring, or their novelty-seeking activities create overstimulation or anxiety. It can be hard to plan for things, because how you react to a situation or an environment can look and feel completely different depending on your capacity and energy levels, your mood, and how you feel’

Masked symptoms

If you’ve never felt ‘autistic enough’ or ‘ADHD enough’ for a diagnosis, don’t worry – this is a common experience for late-diagnosed AuDHD adults and those suspecting AuDHD.

‘Sometimes they feel like they don’t qualify for either, and as a result, they may doubt their own experiences,’ says Saara. ‘They may present a set of challenges and strengths that aren’t cleanly fitting into any neat boxes, and that can add to the confusion, alongside the push-and-pull nature of AuDHD that may blend experiences that are opposites, and which often fluctuates, too.’

Saara also notes that many who are ‘late’ to recognize their neurodivergence may have instead developed several coping strategies and ways of compensating for their challenges, working hard to ‘mask’ or hide their differences.

‘It can be helpful to think of this as an iceberg, where only the tip is visible on the surface, but the majority is hidden underneath. These are often the experiences linked to masking and camouflaging, which can be conscious or unconscious, and which often take huge amounts of energy, something that can make a normal workday feel like you’ve come out of a battle.’

What next?

If all of this sounds familiar and you suspect you may have AuDHD, you will likely have to seek separate diagnoses for ADHD and autism, as AuDHD is currently an informal term and not a clinical diagnosis in itself. However, some clinicians will do a combined assessment during which they will assess and potentially diagnose both ADHD and autism within the same appointment.

‘There isn’t one rule for when you should seek a diagnosis, but generally, if you keep struggling, it’s really important that you find support. Getting the right diagnosis and finally finding the understanding of yourself — formal diagnosis or not — can be a relief and very helpful, but it can also trigger a grief cycle, especially if the diagnosis comes later in life.’

At the end of the day, deciding whether to seek diagnoses for ADHD and autism is entirely dependent on your individual experience.

If you want to take that step, you can contact your psychiatrist or primary care physician to schedule an evaluation. You may need to undergo a medical evaluation to rule out any other issues.

In England, you can contact your GP or try Right to Choose.

Before your appointment, take notes about the symptoms you experience that lead you to believe you may have ADHD, autism, or both. You can also take tests online beforehand, such as the Autism Spectrum Quotient test and the Adult ADHD test, though these are not official diagnostic tools and should act as guidance for your doctor.

Advice for managing symptoms

Depending on where you are, the wait time for assessment may be long. In the meantime, Saara outlined some advice on managing symptoms:

– Create environments that work for you. Try to aim for some structure, but leave room for flexibility and change if needed.

– “Capability vs. capacity” — something we often confuse with each other. You can be highly capable, but your capacity fluctuates from one day to the next, depending on factors like hormones (long overlooked, especially in neurodivergent women), age, and life stressors, among others.

– What can be helpful is developing a deeper understanding of how your brain and nervous system work and what you need, and putting new systems into place — this might mean learning about your energy patterns (what gives you energy and what takes it away), or setting and communicating your boundaries — also something we often practice in coaching.

– You are allowed to do things your way, at your own pace. You are probably already doing more than you give yourself credit for — it can help to stop and look for the wins, no matter how small, and try to be as kind to yourself as you are to others. You deserve it too.

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If you’re struggling, help and support are out there. In the US, you can call or text the 988 lifeline or chat at 988lifeline.org. In the UK, call Samaritans on 116 123. Befrienders.org and findahelpline.com can help you worldwide.

Saara Kuvaja is a certified ADHD and AuDHD coach and late-diagnosed neurodivergent herself. She works 1:1 with late-diagnosed professionals, leaders and founders. saarakuvaja.com