ADHD and Autism: Exploring a Shared Spectrum

Becki | CBT Therapist | F&B Digital Therapy

Have you ever heard of the term AuDHD? A combination of Autism and ADHD, with research showing a significant overlap between these two conditions. For many adults like me, discovering this connection has been life-changing. However, maybe the diagnostic process needs to catch up.

October 2024 marked ADHD awareness month, with the theme being ‘awareness is key’. Being diagnosed with ADHD myself in adulthood, I understand the impact of misinformation around ADHD. In true ADHD fashion, I missed the month of October to post this! But on reflection, this doesn’t matter; ADHD awareness is important regardless of the month. As I already wrote a blog on ADHD misinformation, I wanted to delve further into something else I’ve been thinking about recently rather than the typical ‘this is what ADHD looks like’ post.

You may or may not have heard the term AuDHD. I’ve only come to know this from viewing TikTok videos myself. Seeing this term a lot, as well as seeing people regularly get diagnosed with both, got me thinking. Hence I decided to answer some common questions around the subject…

Can you have ADHD and Autism?

Yes. It’s very common to see Autism Spectrum Disorder (ASD) and ADHD (Attention Deficit Hyperactivity Disorder) together. Combining research findings, 50-80% of children with Autism meet criteria for ADHD, whilst 20-50% with ADHD meet the criteria for ASD.

This hasn’t always been the case in terms of formal diagnosis. Before 2013, diagnostic criteria stated that you couldn’t have both a diagnosis of ADHD and ASD; an ASD diagnosis would take the place of ADHD or disqualify a future ADHD diagnosis. In the most recent version of the DSM 5 (the manual for diagnosing mental health and developmental conditions), this was changed. However, people with Autism and ADHD haven’t changed.

Do I have ADHD or Autism?

I believe this is a question a lot of people undiagnosed into adulthood are battling with, but there’s no easy answer to this. Hopefully the below will help put this into more perspective.

What is AuDHD?

AuDHD is a term commonly used in the neurodivergent community for those who suspect or have a diagnosis of both ADHD and ASD. AuDHD therefore specifically refers to a combination of symptoms in both ASD and ADHD, with symptoms often appearing contradictory of each other. This has become an easier way to articulate people’s specific experiences and further acknowledges the strong link between the two.

Is AuDHD real?

AuDHD is very real, given how commonly ADHD and ASD co-occur. It’s just preferred terminology for a lot of people to describe their diagnoses. It is not a formal diagnosis recognised by professionals currently and so you can’t be formally diagnosed with ‘AuDHD’. Usually in the UK, the assessment process is separate for each disorder rather than combined.

My AuDHD journey

My AuDHD journey started with uncertainty on whether to go for an ASD or ADHD assessment. Realising I relate to a lot of ASD symptoms often unnoticed both in childhood and throughout my life was a lightbulb moment for me. I’d felt like a weirdo and an outsider for most of my life and this could be an explanation why! I also learned a lot more about ADHD symptoms at the time, again many of which I related to.

At the same time, I was in therapy due to what I thought was depression from burnout. I understand now why it didn’t really help at this point. I was working on the wrong things; I wasn’t depressed, the chronic burnout came from living a life of masking and I just couldn’t cope anymore. I decided to pursue an ASD assessment first, after being told I couldn’t be referred for both at once. In my head I KNEW I had ADHD but ASD was less clear. On reflection I wish I’d gone with ADHD first just to have saved some time.

I waited 3 months for an ASD assessment on the NHS Right to Choose pathway. I was told I didn’t meet the criteria ‘at this time’, but was only slightly under the threshold. This was baffling to me; how could I not have ASD right now but maybe later? I was told ADHD symptoms can mask ASD, and I had very strong and obvious ADHD symptoms. This is why I told to seek diagnosis for this and see if medication would help. This was with the potential of medication amplifying the ASD symptoms once ADHD symptoms were under control.

Fast forward a year and a half later, and I’m now diagnosed with ADHD and trialling which medication dosage works for me in a process called titration. Certain symptoms have improved a lot, but there are still some struggles and things that have been amplified as suggested. I’m still uncertain about whether to pursue another ASD assessment; I know my specific needs now regardless of what exact label they’re given.

So what’s the actual difference between ADHD and Autism?

This diagnostic process of these two seemingly separate conditions so commonly comorbid seems too complicated to me. The more I learned about each condition, the more I started to wonder how they were even different, and people seemed regularly confused between the two. Symptoms can be extremely similar, but extremely different at the same time. Similar symptoms may have different functions depending on the disorder, which could also explain the overlap.

Below is a diagram presenting ways ADHD and ASD symptoms can be both so similar but so contrasting. It demonstrates that whilst they share a lot of similarities, the differences are almost opposite to each other.

(Venn diagram depicting ASD and Autism symptom overlap – Dr. Neff, Neurodivergent Insights)

Is ADHD a form of Autism?

I don’t think that the level of comorbidity between ADHD and ASD is a coincidence.

Right now, the DSM 5 doesn’t take into account things like social difficulties commonly seen in ADHD or the executive dysfunction commonly seen in ASD.

I came up with a basic theory to explain this that made sense to me. To keep it simple, I’ve shown below a scale where one end is ADHD and the other end is ASD. The closer you are to one end of the scale, the more symptoms you may show of that condition. I believe that most people lie somewhere in between this scale, what would be seen as AuDHD. Some people may lean towards more or stronger ADHD symptoms, and others the opposite way. Full ASD with no ADHD symptoms and vice versa would therefore be the exception rather than the norm in this case. The idea here is that this is one scale, one spectrum and one condition ultimately.

This is a very simplisitic idea though. It doesn’t account for the diverse range of symptoms each individual neurodivergent person might have. People are complex; rather than a simple scale, people do fit better on more of a spectrum. This means people have a unique combination of certain strengths and challenges along a range of specific traits and areas. ASD is already understood now as a spectrum, with pie chart and colour wheels commonly used to explain this. I’ve included an example of one I created below.

Seeing ASD as a spectrum recognises the diversity in how it presents. Based on this, I think the possibility of ADHD being a part of that spectrum reasonable and would explain their link.

‘But that’s not what the criteria says?!’

Our understanding of the human mind is constantly changing. As we learn and research more, things we know change, and this has always been the case. Here are some examples:

Aspergers used to be a separate diagnosis to ASD, but now it’s been revised to be included as one disorder.

As mentioned above, you previously couldn’t have both a diagnosis of ADHD and ASD.

Left-handedness wasn’t a known thing a long time ago, whereas we now know it to be quite normal.

Women used to be diagnosed with hysteria and put in inpatient care if they showed any signs of poor mental health

So why couldn’t the same be true for our knowledge on ADHD and ASD? Especially given the executive dysfunction common in both conditions is seen across numerous other neurodevelopmental, mental health and physical health conditions.

Some Current Research

Whilst research hasn’t been extensive, there is a team of researchers in the Netherlands who have been looking into the overlap between ASD and ADHD. They suggest ASD and ADHD are different manifestations of one single condition with multiple subtypes; each individual with this over-arching condition would present with a unique mix of traits, progressing differently over time.

Supporting this idea, genetic and brain structure studies highlight shared causation between ADHD and ASD (brain structures in both conditions are different to the ‘norm’ in areas related to motor control and cognition, and delayed brain maturation). Differences have also been shown in research however, such as those with ASD showing a larger brain volume compared to those with ADHD who had a smaller brain volume. I won’t be critiquing these studies within this blog post, but there are so many factors that can influence the results of research so it’s worth bearing this in mind from both side of the arguments too. Geraldine Dawson, director of the Duke Centre for Autism and Brain Development, notes that our understanding remains incomplete. Larger and more detailed studies are needed to truly unpack the relationship between these conditions.

Maybe these symptoms are normal?

I personally believe ADHD and ASD symptoms are just part of normal, human neurodiversity. A normal variation in how the brain works, similar to normal differences in people’s personality. For example, thriving in social situations (extraversion) ort thriving in solitude environments to recharge (introversion) are both normal ways of interacting with the world. Therefore, ADHD and ASD symptoms could also just be natural variations in how people process information, focus, and engage with their environment. This doesn’t take away from the fact that they do cause disability; society doesn’t cater for this natural difference and this can be debilitating.

This idea is backed by e volutionary psychologists, who argue ADHD/ASD traits had an evolutionary advantage. For example, traits often seen in ADHD, such as quick decision-making and adaptability, might have been beneficial for survival in a hunter-gatherer society. A personal observation from me is that neurodivergent people tend to flock together. If two neurodivergent people have a child together, they are highly likely to also be neurodivergent and then the cycle goes on.

Monotropism as an emerging theory

There is a theory that could help us understand ADHD and ASD links further. Monotropism describes how some people are naturally inclined to focus intensely on one thing at a time, excluding almost everything else. Monotropism suggests our minds are naturally attuned to fewer areas of focus at once, which contrasts with a more typical ‘polytropic’ way of thinking, where attention spreads more widely and evenly.

For those who experience monotropism, this could look like being so absorbed in specific interests or tasks that shifting attention is extremely challenging. Everyday life demands constant switching of tasks however, which could often feel overwhelming.. I certainly see this myself, especially now I’m medicated; interruptions to my hyper-focused periods feel almost painful to me. I’ve had to take a big step back to figure out ways to manage this and avoid burnout.

ADHD typically involves regular novelty seeking and impulsive shifts in focus, whereas ASD presents as more steady, all-consuming interests. Again, this could suggest the two represent different sides of one underlying difficulty with attention. Also, it’s been said the many people with A SD find monotropism to be more in line with their personal experiences than other theories, which is said to be due to the fact it was developed by people who actually have ASD. This is in comparison to other theories being developed by people with no lived experience of the condition.

Other neurodevelopmental conditions

It also needs to be considered how there are many other disorders that often co-occur with ADHD and ASD. For example, Dyspraxia has similar symptoms, including sensory processing issues, but is mainly a disorder of motor functioning. Some suggest around 30-50% of children with symptoms of Dyspraxia may also have many features of ASD.. Also, up to 80% of children diagnosed with ASD show signs of Dyspraxia. This again has potential to be a part of the same spectrum as ADHD and ASD.

Can ADHD/ASD and AuDHD be treated with therapy?

Treated would be the wrong word. As shown above, it’s very complex. There are many symptoms that you can learn to manage, and if worked on from a very young age can be less debilitating. But they’re never really going to go away. This doesn’t mean therapy can’t be helpful in a wide range of ways, but which approach is best depends on each individual person and what they want to address.

At F&B digital therapy, we provide 1-1 CBT (cognitive behavioural therapy) sessions online, through zoom, instant messaging or phone-call. We help neurodivergent individuals transform their self-esteem and drop their masks and have seen this approach help so many people. Within this, you can learn techniques to both manage and accept your symptoms whilst understanding yourself further. The mental health issues that are related to neurodivergence are treatable; We have seen first-hand how changing your perspective on yourself and your neurodivergence can be life changing.

For me personally, CBT has been the most beneficial approach. It was always helpful, but once I realised I was neurodivergent I’ve since been able to apply what I learned so much easier to my life. This has reduced how much i struggle immensely through helping me to:

Give up my need for perfectionism

Acknowledge my worth and what’s this made up of

Stop hiding my opinions and be more comfortable just being myself

Communicate my needs, being more assertive and honest

Work with my symptoms, reducing the pressure on myself and celebrating them as a part of what makes me, me

You can find out more about our approach and how it may help you here.

Does medication help AuDHD?

Stimulants are the most common and effective medications prescribed for ADHD, which increase brain activity in areas controlling attention and behaviour. They generally are known to increase dopamine and norepinephrine in the brain, chemicals which influence executive functioning.They only address specific symptoms and only for a short while. ASD symptoms have been known to actually get worse on this medication, once ADHD symptoms are no longer fighting against them. Therefore, can certainly help you live a more stable lifestyle but isn’t a cure.

There’s mixed results from research. Some have discovered stimulants to be effective in managing ADHD with those with AuDHD. Whereas others say only 49% of those with AuDHD respond positiviely to this medication compared to 79% of those with just ADHD. The ASD symptoms I’ve noticed in myself getting more intense or frequent whilst on medication aren’t currently affecting me negatively and I’m able to accept them. So for me, medication is extremely helpful regardless.

So what do I to do about diagnosis for AuDHD, ADHD or Autism?

Diagnosis is undoubtedly a helpful way to understand yourself and your symptoms better, and can create a clearer pathway when it comes to untangling any issues, especially mental health issues. All we can conclude is to not take it as complete fact, remembering that these categories and labels are man-made and subject to change over time. Unfortunately, the diagnostic process hasn’t caught up to what I’ve discussed above. There’s still lengthy waiting lists (many places this will involve two separate waiting lists and assessments) and AuDHD is not a recognised diagnosis right now.

Many people battle with which assessment to go for first. What I would suggest is a reflection on what symptoms affect you the most. A good option may be to attend therapy first to see what can improve. For me the most logical thing would be to start with an ADHD assessment first, as treatments exist specifically for this category of symptoms. If you feel like you’d then benefit from ASD assessment following this, then go ahead. Either way, it’s important to choose what’s right for you.

None of this is ideal and WILL take time. There are ways to make this process quicker. Some may choose to seek a private diagnosis, but this can get costly. Going through the NHS via Right to Choose at the moment will be a considerably shorter wait that the typical NHS route for both adults and children. You can find out a lot about the NHS right to choose pathway by following this link, including regularly updated waiting times.

Final Thoughts

The bottom line is, our understanding of ADHD, ASD and neurodivergence in general is constantly evolving. I do think the next decade will bring significant changes to what we know of these – maybe a new diagnostic framework, merging symptom categories together or even an entirely new perspective that’s not even being considered yet. Research and diagnosis need to catch up with the lived experiences of neurodivergent people regardless. When they do, increased understanding leads to more effective support, reduced stigma and hopefully over a time a more inclusive society. For now, any understanding you can gain about yourself is valuable. All that matters is doing what feels right for you.

In the meantime, just remember this: you’re not defined by labels, you’re just you. That’s something worth celebrating.

If you would like to get started with F&B Digital Therapy, book an appointment now!