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Summary: For people who have autism and ADHD at the same time, AuDHD is a real thing. However, AuDHD is not an official diagnosis listed in standard reference manuals: it describes co-occurring autism (ASD) and attention deficit-hyperactivity disorder (ADHD).

Key Points:

  • Before 2013, the standard reference manual for diagnosing mental and behavioral disorders, the Diagnostic and Statistica Manual of Mental Disorders, Fourth Edition (DSM-4), indicated that autism and ADHD were mutually exclusive, meaning a person could be diagnosed with one or the other, but not both at the same time.
  • Advances in our understanding of both conditions led to changes in the latest edition of the manual, the DSM-5, which removed attentional criteria from ASD diagnosis, revamped ADHD criteria, and allowed for diagnosis of both.
  • Separately, both conditions can create challenges for people with these diagnoses, and when they co-occur, the challenges can take on unique characteristics.
  • Co-occurrence also creates diagnostic and treatment challenges for provider.

AuDHD: When Autism and ADHD Co-Occur

First, let’s cover the basics, and make sure we know what we’re talking about ASD and ADHD.

Here’s a basic definition of autism/autism spectrum disorder from the National Institute of Mental Health (NIMH):

“Autism spectrum disorder is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a developmental disorder because symptoms generally appear in the first two years of life.”

And here’s a basic definition of ADHD, also from the National Institute of Mental Health (NIMH):

“ADHD is a neurodevelopmental disorder characterized by inattention, such as having difficulty paying attention, keeping on task, or staying organized, hyperactivity, such as often moving around (including during inappropriate times), feeling restless, or talking excessively and impulsivity, such as interrupting, intruding on others, or having trouble waiting one’s turn. For some people, inattention symptoms are the strongest, while other people have the most difficulty with hyperactivity and impulsivity. Some people experience symptoms in all three areas.”

Both disorders can cause significant disruption across multiple functional life domains, with the level of disruption directly related to the specific way symptoms appear in each person, the severity of the symptoms in each person, and the duration of the presence of symptoms without treatment or support.

Here’s how Dr. Carrie Huffman, a developmental pediatrician with experience treating people with co-occurring/overlapping ASD and ADHD, describes the term AuDHD in an article published by the Cleveland Clinic:

“They’re separate conditions that can co-occur, and AuDHD is the term used to describe the experience of living in that overlap.”

Studies on co-occurring autism and ADHD published here and here show the following prevalences.

ADHD Diagnosis in People With Autism/ASD: Current and Lifetime/Ever Diagnosed, By Age Group

  • Overall current prevalence: 38.5%
    • Under age 6: 19.1%
    • Age 6-11: 47.8%
    • Ages 12-17: 47.8%
    • Age 18+: 22.4%
  • Overall lifetime prevalence: 40.2%
    • Under age 6: n/a
    • Age 6-11: 39.4%
    • Ages 12-17: 38.8%
    • Age 18+: 44.4%

The data show that co-occurring ASD and ADHD is common, with the highest current prevalence reported among adolescents 12-17, and the highest lifetime prevalence reported among adults 18+. The data show that although the term is informal and descriptive, AuDHD is a real thing.

Next, we’ll discuss how the symptoms of ASD and ADHD overlap and interact.

What Happens When People Have ASD and ADHD, or AuDHD?

For this section of this article, we used information from the following sources:

First, let’s look at the primary symptoms of each disorder.

Autism/ASD Symptoms

Symptoms include, but are not limited to:

  • Differences in social interaction and communication style, such as:
    • Inconsistent eye contact
    • Lack of interest in others/showing little/no interest in others
    • Slow response when addressed by name
    • Slow/no response to social cues
    • Frequent inability/no motivation to engage in typical back-and-forth conversation
  • Preference for/adherence to specific, personal routines:
    • Problems when routine broken/not followed
    • Difficulty with transitions from one activity to another
  • Differences in type and quality of attention and focus:
    • Often display hyperfocus on a limited number of things, restricted to personal range of interests
    • Narrow interest in objects, often mechanical objects with moving parts
  • Repetitive, self-soothing behaviors:
    • Often engage in repetitive physical activity, called stimming or perseveration
    • Often repeat words in a similar manner to stimming/perseveration, called echolalia
  • Sensitivity to external stimuli:
    • Sounds
    • Odors
    • Touch/textures

ADHD Symptoms

Symptoms include, but are not limited to:

  • Inattentive type:
    • Problems with organization
    • Difficulty finishing tasks
    • Problems remembering/following directions
    • Easily distracted
  • Hyperactive/impulsive type:
    • Fidgeting/inability to sit still
    • Frequently blurts out thoughts/ideas/observations
    • Talks and continues to talk at inappropriate times/frequently interrupts others
    • Difficulty waiting in line, waiting for their turn
    • Problems with emotion regulation/managing powerful emotions
  • Combined: both types of symptoms present

Therefore, when a person has co-occurring ASD and ADHD, meaning that for them AuDHD is a real thing, they may experience a combination of the symptoms above. We’ll discuss how these symptoms overlap and intersect, below.

AuDHD: How Co-Occurring Symptoms Can Compound Challenges

When a person has ASD and ADHD at the same time, they may experience a combination of the following symptoms.

Symptom Overlap: AuDHD

  • Social challenges
  • Difficulty with executive function: organization, decision making
  • Hyperactivity/impulsivity
  • Hyperattention/hyperfocus on specific interests
  • Inability to focus/inattention
  • Problems with communication
  • Impulsiveness
  • Narrow/restricted range of interests
  • Problems managing emotions/dysregulation of emotions
  • Heightened/extreme sensitivity to external stimuli

Next, we’ll elaborate and expand on an interesting chart/graphic we found in this article. We’ll use their list as a template and add to it with information from the additional sources we cite above: CDC, NIMH, and others. We’ll list the overlapping areas where ASD and ADHD can cause distinct challenges separately, then describe how those may appear in people with co-occurring ASD and ADHD, or AuDHD.

Social Skills:

  • ADHD: people with ADHD are often very social, but impulsivity and inattention can cause problems like interrupting, not listening, and losing focus on the listener.
  • Autism/ASD: people with ASD may have significant problems communicating with family, peers, and others at home, at school/work, and in the community.
  • Autism + ADHD: people with AuDHD may socialize with apparent ease, but in many cases, social interactions can be difficult and cause distress, depending on the relative severity of both conditions.

Focus:

  • ADHD: people with ADHD – either type – often find it difficult to focus
  • Autism/ASD: people with ASD often display hyperfocus, which is an intense, single-minded quality of attention on a narrow range of personal interests, unique to the individual.
  • Autism + ADHD: people with AuDHD often hyperfocus on their areas of interest, but can also be distracted easily, especially when attempting to focus on things outside their areas of interest.

Routine:

  • ADHD: while many people with ADHD need routine to manage symptoms, they may find it difficult to establish an effective routine themselves.
  • Autism/ASD: people with autism often prefer a set, specific routine, can be rigid and inflexible about their routine, and experience/display significant distress when the routine changes, with response more extreme when change in routine is unannounced and/or unexpected.
  • Autism + ADHD: often loves routine – the ASD component – but has difficulty following it/them – the ADHD component.

Emotions:

  • ADHD: people with the impulsive/hyperactive or combined type of ADHD may have difficulty regulating emotions, and can quickly experience significant frustration.
  • Autism/ASD: people with ASD may have difficulty identifying and communicating their emotions, which can cause frustration and distress.
  • Autism + ADHD: may have strong, overwhelming emotions, and react in ways that my seem disproportionate, or escalate more quickly, than in people with one or the other, or people with neither.

Energy:

  • ADHD: people with all three types of ADHD may appear to have limitless energy and, to others, it often appears as if they never stop moving or talking.
  • Autism/ASD: people with autism/ASD may appear listless and disinterested in the world around them, or appear devoid of energy or missing the motivation to participate in anything outside their range of preferred interests.
  • Autism + ADHD: can vacillate between excess energy for preferred activity and no energy for non-preferred activity.

Interests:

  • ADHD: people with ADHD may be intensely interested in some things and incredibly bored by others, with the variation in level of interest often causing the difficulties with school and work common to people with ADHD.
  • Autism/ASD: people with autism/ASD often have intense, laser-focused interest in some activities or subject areas, but may not appear to be aware – at all – of other activities/topics outside their chosen range of interest.
  • Autism + ADHD: often have intense and specific interests, which may encompass a broader range than people with ASD only.

That list helps to clarify the impact of co-occurring autism/ASD on individuals. What we find instructive about that list is that it’s not difficult to see how AuDHD can not only creates challenges, but can also be seen as creating distinct advantages in certain situations, with adequate awareness and symptom management skills.

How This Information Can Help People with ASD + ADHD

There are three primary groups of people the information in this article can help:

  1. For patients/people with AuDHD. The awareness among patients that a dual diagnosis exists, and that other people share this experience of AuDHD. It sounds cliché, but knowing you’re not alone can make significant difference in personal outlook and hope for the future. Many neurodivergent people report feeling like an alien, not in a delusional way, but in a way that make them think no one else could possibly relate to – or even share – their subjective experience of the world.
  2. For families of people with AuDHD. For families of people with this mix of symptoms, understanding that the symptoms have identifiable – and treatable/supportable – causes or origins can be a relief. They can move from having no idea what to do or how to help to knowing what they can do to help.
  3. For treatment providers. While most providers know, either through experience or training, about co-occurring autism/ASD and ADHD, not all know about the evidence base describing the co-occurrence or how the combined set of symptoms may appear. The more providers who know these facts, the better: that means they can support more people in need.

We’ll add an insight from the publication “Real-World Evaluation of Prevalence, Cohort Characteristics, and Healthcare Utilization and Expenditures Among Adults and Children With Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, or Both.” Here’s how they describe the current state of treatment:

“These findings reinforce the importance of a comprehensive, multidisciplinary approach to treatment that includes medical, behavioral, and support services tailored to the complex needs of the individual. In some instances, common co-occurring conditions among individuals with neurodevelopmental disorders may be amenable to shared interventions, particularly where underlying mechanisms overlap or where one condition exacerbates another.”

The authors indicate that a personalized combination of cognitive behavioral therapy (CBT), medication management, education, and supported lifestyle changes can improve outcomes for people with co-occurring autism/ASD and ADHD. Typical lifestyle changes like improving sleep, diet, exercise/activity and stress management can help, of course. However, in this context, supported lifestyle changes may include focused coaching on challenge areas: time management, personal organization, planning, setting goals, and problem solving.

We’ll close this article with an important reminder for anyone with ASD, ADHD, or both: the sooner a person who needs treatment for a mental or behavioral condition gets evidence-based treatment, the better the outcome.

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.