AuDHD

Autism and ADHD

Autism and ADHD very often co-exist. Research suggests that 50 to 70% of autistic people also have ADHD (Hours et al., 2022), though figures vary between studies. Similarly, it is estimated that two-thirds of those with ADHD have at least one co-existing condition such as autism. In other words, autism and ADHD very frequently present together.

Despite this, autism and ADHD could not be diagnosed together until 2013. The fourth edition of Diagnostic and Statistical Manual listed autism as an exclusion criterion for ADHD (Murphy et al., 2016), and only when the fifth edition was released in 2013 were they recognised as co-existing conditions.

It’s not surprising that people used to think Autism and ADHD couldn’t occur together, because a lot of the traits appear to contradict each other. ADHD likes NEW, Autism likes the SAME. ADHD is IMPULSIVE and spontaneous, Autism likes PLANNING. (A massive over-generalisation of course, but you get the picture). Imagine how disorienting it is to have your brain constantly pulled in two opposite directions.

This can feel like a tug of war in an AuDHD-er’s mind, and it can feel impossible trying to balance two completely opposing needs. Because of this, AuDHD can appear like a different presentation altogether. An individual may feel they don’t relate wholly to autism or to ADHD. The two can mask each other, either compensating for each other’s difficulties or making those challenges even harder. For example, the organisation and focus from the autistic brain may compensate for the disorganisation and chaos of the ADHD brain. Or, the mess and chaos from the ADHD may leave the person in a constant state of overwhelm, feeling unable to function because there is no order.

One vital ingredient for any ADHDer is dopamine, the neurotransmitter responsible for feelings of pleasure and the regulation of attention – there’s never enough and we are always craving it. Much of ADHD’s impulsive and risky behaviour can be attributed to the hunt for more dopamine. It can also make ADHDers crave sugar and carbohydrates and this can be hard to fight no matter how much we know and understand about healthy eating. Added to the autistic tendency to restrict food this can add to difficulties around food intake.

Because AuDHD-ers may not present as typically autistic or typically ADHD, they may be less likely to be recognised or diagnosed. It is worthwhile considering what an AuDHD presentation could look like.

Though there are an infinite number of possibilities, here are some common examples:

  • The individual may regularly come up with new routines to try to stick to.
  • They may come up with new ways of doing the same thing or follow a particular process when trying something new. They try to satisfy their craving for new whilst managing their anxiety around change.
  • They may impulsively choose change, then experience anxiety due to the change.
  • They may regularly seek out new things, but only with familiar people and want to complete things in a particular way or following a familiar process.
  • They may regularly burn out from being too busy and overwhelmed socially, but struggle to slow down to recharge.
  • Their environment might become messy and chaotic easily, leading to overwhelm and difficulty functioning.
  • They may be hyper-organised to compensate for their disorganised brain.
  • They may feel anxious every day about running late or not being early.
  • They may have an exceptional long-term memory but a poor working/short-term memory.
  • Their intense/special interests may regularly change theme or topic.

Life as an AuDHD-er is constantly trying to find a balance to satisfy opposing needs. And those needs are changing all the time, depending on the environment, the day and the chapter of life.

AuDHD is exhausting, but also exhilarating. It is intense and chaotic, but vivid and filled with opportunities. Some days feel impossible; other days feel like anything is possible. With the right support and developing strategies to manage, the latter is certainly true.

References

Hours, C., Recasens, C. & Baleyte, J. (2022). ASD and ADHD comorbidity: what are we talking about? Frontiers in Psychiatry, 13, 837424. https://doi.org/10.3389/fpsyt.2022.837424

Murphy et al. (2016). Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatric Disease and Treatment, 7(12), 1669-1686. https://doi.org/10.2147/NDT.S65455.