AuDHD: When ADHD and Autism Occur Together

A change of plan sets you back. At the same time, sticking to the plan suffocates you. Crowds exhaust you, loneliness bores you. You set up a routine, by the third day you hate that routine, but when it is disrupted your day is ruined too.

When I first read these sentences on a forum I thought "this is me." Then I stopped. Because as someone diagnosed with ADHD I have a tendency to file every oddity I see in myself under a new heading, and I know this is not a healthy reflex.

I do not have an autism diagnosis, and I am not going to give myself one. But what I read about these two headings occurring together taught me something about how the things I had labeled "inconsistent" can be read. That is why I am writing: AuDHD.

What changed in 2013

This is one of the strangest administrative stories in the field.

Before DSM-5 the diagnostic manual did not allow these two headings to be given together in the same person. If there was an autism diagnosis, an ADHD diagnosis could not be given. This was not a scientific finding, it was a classification decision.

DSM-5 lifted the restriction (American Psychiatric Association, 2013), and the picture that emerged was surprising: the co-occurrence turned out to be far from exceptional (Antshel & Russo, 2019).

So for years some people lived without getting their second diagnosis. The diagnosis they had been given was not wrong, it was incomplete. This is a very familiar form of story to me: another kind of late diagnosis.

Where the contradictions come from

The needs of the two conditions pull in different directions in the same person. Underneath what looks like a contradiction there is usually this tug of war.

Predictability. The autism side benefits from an order that is known, repeating and free of surprises. The ADHD side makes that same order invisible as soon as it becomes familiar, and motivation drops. The result: you both defend the system you built and abandon it.

Stimulation. The stimulation seeking common in ADHD and the sensory sensitivity common in autism can exist in the same person. You turn the music on, five minutes later you turn it off; both are real needs.

Sociability. The wish to connect can be strong, and the cost of a social setting can be high. It is possible to want to be with people and to be tired by people at the same time. I described how this running out works in the article on the social battery.

Detail. The autism side leans toward accuracy and completeness, the ADHD side toward finishing and moving on. This is where a task both taking three times as long as it should and being left half done comes from.

Transitions. Jumping from one task to another is hard for both sides, but for different reasons: one gets stuck at starting, the other at stopping. The article on difficulty with transitions deals with this mechanism separately for each.

The two conditions do not cancel each other out. They kick in in turn, and that is why someone looking from outside sees inconsistency.

What it looks like in daily life

Descriptions are no use when they stay abstract, so let me make it concrete. The situations people describing this picture mention often look like this:

• One corner of the house is tidy to the millimeter, the rest is chaos. The need for order is genuine, but it only stretches to one area.
• You can recite the menu from memory, but after three weeks of the same dish you are sick of it. Both the need for repetition and the speed of fullness are there.
• When you make the plan yourself there is no problem; when someone moves it by an hour the day collapses. The problem is not a lack of flexibility; it is that the preparation has been disrupted.
• You sink into a subject for months and become an expert, then one morning the subject dies completely. You cannot tell what is left.
• Sitting at a familiar table in a familiar cafe is restful; when the same cafe fills up you have to leave.

I am writing these not as diagnostic criteria but as a list of where to look in your own life. None of them on its own shows anything.

Why masking blurs the picture

In adulthood this pair is hard to recognize, because over the years a person learns to fit in. Eye contact is memorized, turns in conversation are calculated, restlessness is hidden under the table.

This was the part I found hardest in my own diagnostic process: telling apart "I'm managing well" from "I'm not showing it to anyone." From outside the two look the same, from inside they are not the same at all.

I wrote about this part in detail in the article on masking. What you need to know when you go for an assessment is this: showing the specialist your best self harms you.

What happens in the diagnostic process

Assessing this picture takes expertise, and unfortunately the number of clinicians who see both well is limited. A few things that will help with the process:

• Developmental history is central for both. Childhood information is asked for, and if possible what the family tells too. Old report cards, teacher comments, videos and photographs are more useful than you would think.
• The sensory profile is asked about but does not tell them apart on its own. The study by Bijlenga and colleagues (2017) shows that atypical sensory profiles are not specific to autism and appear markedly in adults with ADHD as well. So the sentence "I'm very sensitive to sounds" does not point in one direction.
• The order can matter. If there is already a diagnosis, the second is often overshadowed; the clinician tends to attribute everything that can be explained by the existing diagnosis to it. This is called diagnostic overshadowing, and it is worth asking about openly.
• A second opinion is legitimate. In complicated pictures it is common and reasonable to get a second opinion. Being unhappy with a diagnosis does not mean being capricious.

What is known on the treatment side

I need to speak carefully here, because this is the doctor's field and the decision is theirs.

The general framework is this: the medications used for ADHD do not treat autism, they are used for ADHD symptoms. It is reported that in people with the co-occurrence the response to medication and the side effect profile can differ (Antshel & Russo, 2019); for this reason the starting and dose adjustment process is carried out more slowly and more carefully.

On the behavioral side the formula that works is to take both needs into account: building systems with a fixed skeleton and a changing inside.

A fixed container, changing contents. Instead of walking at the same time every morning, set it up as "going outside" at the same time every morning. The container stays the same, what you put in it changes. It is one of the rare solutions that handles the side that needs novelty and the side that needs predictability at the same time.

You can apply the same logic to a meal plan, a work routine, the weekend. What needs to change is almost never the time or the place; it is the content.

When to see a specialist

Seeing these contradictions in yourself is not a reason on its own. An assessment becomes meaningful in these situations:

• You already have an ADHD diagnosis but the approaches being applied are not working as expected and nobody can explain why.
• Recovery after social settings lasts for days and this genuinely disrupts your work or relationships.
• There is a very marked and narrow pattern of interest that has run since childhood and it governs your life.
• You get overloaded by sensory input and after that overload the rest of the day becomes unusable. I covered this side in the article on sensory overload.

The most common mistake

Most of the content circulating on the internet on this subject comes as a checklist, and the lists are written so broadly that almost everyone finds themselves in them. Giving yourself two diagnoses and building an identity from that looks easier than getting a diagnosis, and much less risky. The risk comes later: a life built on the wrong framework takes you away from what you actually need.

Also, these two headings are sometimes confused with each other; I described the differences separately in the article on whether ADHD and autism are the same thing.

What this concept does for me

AuDHD does not appear as an official diagnostic name. It is an abbreviation, a community language.

Still, it does something useful: where you see inconsistency in yourself, it makes you think that two separate needs may be on the table at the same time. I do not use that framework to explain my own diagnosis; I use it to stop at the moment I say "I'm inconsistent again" to myself and ask "which need is speaking this time?" Even that question changes something.