In recent years, the term AuDHD has emerged as a way to describe individuals who experience the combined traits of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). While ASD and ADHD have been recognised and studied extensively as separate neurodevelopmental conditions, their co-occurrence, often referred to as AuDHD, highlights the unique challenges and strengths of individuals living with both diagnoses.
This article explores the relatively new concept of AuDHD, delving into how it may present across different stages of life, from childhood to adulthood. We will examine whether there is a formal diagnosis for AuDHD or if it requires separate ASD assessments and the process to diagnose ADHD, and how the symptoms of AuDHD differ from those seen in individuals with just one of these conditions.
We’ll also look at the factors that contribute to AuDHD in children, discussing both genetic and environmental influences, and provide insights into how this dual diagnosis can affect behaviours and emotional regulation. For parents, caregivers, and educators, we will offer practical advice on treatment, support, and strategies for fostering positive outcomes.
Lastly, we will address common concerns, including how AuDHD may lead to behaviours of concern and how these can be managed or prevented.
How AuDHD Presents in People of Different Ages
the co-occurrence of Autism spectrum disorder and Attention deficit hyperactivity disorder often results in a unique combination of traits from both conditions. These traits can include difficulties with sensory processing, emotional regulation, and executive functioning, alongside a tendency toward hyperfocus on specific interests, hyperactive and impulsive symptoms, and challenges with social interaction.
The presentation of AuDHD varies widely depending on the individual’s age and developmental stage. While some traits overlap with those seen in individuals with only ASD or ADHD, the interaction of symptoms creates a distinct profile. Below, we explore how AuDHD manifests at various life stages.
0-1 Year (Infants)
In infants, AuDHD may not always be apparent but could present as:
Differences in sensory processing: Overreaction or underreaction to sensory stimuli, such as sounds, textures, or light.
Challenges with routines: Difficulty establishing sleep patterns or feeding routines.
Atypical social responses: Limited eye contact, reduced interest in faces, or inconsistent reactions to social cues.
Motor development: Delays in motor milestones, such as sitting up or crawling, or an unusual style of movement.
These early signs may indicate a pervasive developmental disorder, which includes conditions like autism and ADHD.
1-3 Years (Toddlers)
In toddlers, the combined traits of ASD and ADHD, may become noticeable:
Speech and language development: Delays in speech, echolalia, or highly advanced language skills paired with difficulty using language socially.
Hyperactivity or impulsivity: Constant movement, difficulty staying engaged in one activity, or acting without considering consequences.
Sensory challenges: Intense reactions to clothing, food textures, or environmental noises.
Repetitive behaviours: Hand-flapping, spinning, or a strong preference for routines.
Social difficulties: Struggles to engage in parallel play or form early social bonds.
4-10 Years (Early Childhood)
As children enter school, their AuDHD traits may become more pronounced:
Attention and focus issues: Difficulty staying on task, often shifting between activities quickly, or becoming hyperfocused on a specific interest.
Social struggles: Difficulty understanding social norms, forming friendships, or reading others’ emotions.
Sensory sensitivities: Refusal to wear certain clothing or eat certain foods, or becoming overwhelmed in noisy or chaotic environments.
Masking behaviours: Trying to hide traits of ASD or ADHD to blend in socially, often leading to exhaustion or burnout.
Hyperfocus on interests: Spending excessive time on hobbies or topics of interest, sometimes to the detriment of other activities.
Meltdowns: Intense emotional outbursts triggered by changes in routine or sensory overload.
Executive functioning difficulties: Forgetting homework, losing items, or needing help to organise daily tasks. In some cases, ADHD medication may be prescribed to help manage symptoms, although its effectiveness can vary.
11-18 Years (Adolescence)
During adolescence, hormonal changes and increased social and academic expectations can amplify AuDHD traits making masking across all settings harder:
Self-esteem issues: Feeling “different” or “less capable” than peers, which can lead to anxiety or depression.
Emotional dysregulation: Intense emotional reactions, difficulty calming down, or feelings of being overwhelmed. Adolescents with comorbid ADHD and ASD may experience greater functional impairments and more severe symptoms.
Impulsivity and risk-taking: Acting without thinking, engaging in risky behaviours, or struggling to manage peer pressure.
Social anxiety: Avoidance of social situations due to difficulty navigating complex social interactions.
Academic challenges: Difficulty focusing in class, managing homework, or keeping up with expectations, even in subjects of interest.
Emotional highs and lows: Intense enthusiasm for specific interests followed by frustration or shutdowns when things don’t go as expected.
Increased independence challenges: Struggling with time management, organisation, or planning for future goals, such as exams or career paths.
Adults
In adulthood, many individuals with AuDHD learn coping strategies, but challenges often remain:
Workplace difficulties: Struggling with multitasking, meeting deadlines, or managing sensory environments in offices.
Relationships: Navigating romantic, platonic, or familial relationships can be challenging due to differences in communication styles and emotional needs.
Executive functioning challenges: Managing finances, schedules, or household responsibilities can be overwhelming.
Burnout: A lifelong effort to mask or compensate for traits may lead to periods of exhaustion or mental health struggles.
Strengths in creativity and focus: Many adults with AuDHD excel in areas that align with their passions or interests, often becoming experts in niche fields.
How Can You Tell if Someone Has AuDHD, just Autism or just ADHD?
Distinguishing between autism, ADHD, and AuDHD can be challenging not least because a lot of neurodevelopmental disorders have overlapping traits. For example,
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Difficulty focusing might stem from ADHD, but it could also result from sensory overload due to autism.
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Impulsivity could be related to ADHD, but it might also occur because of challenges with executive function in autism.
Also, individuals with AuDHD often experience shifts where one set of traits (autism or ADHD) may seem more dominant than the other, depending on the situation, environment, or life stage.
Hence, it is important that we get an assessment to confirm the ASD diagnosis and ADHD diagnosis
Below is a description of the symptoms, of each condition and the unique presentation of autism and ADHD together.
First let’s review the symptoms of an Autism Diagnosis:
Autism Spectrum Disorder (ASD) Symptoms
Autistic people are primarily characterised by challenges in social skills, communication, and repetitive behaviours. Autistic children often have difficulty understanding social cues or maintaining eye contact. They have a strong preference for routine and are resistant to change.
Autistic people often have an intense focus on specific interests and have sensory sensitivities such as an aversion to loud noises or certain textures for example.
Autism spectrum disorders are diagnosed when these traits significantly impact daily functioning, particularly in social and sensory environments.
The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) defines Autism Spectrum Disorder (ASD) as a neurodevelopmental disorder characterised by persistent challenges in social communication and interaction and restricted, repetitive behaviours.
Attention deficit hyperactivity disorder (ADHD) Symptoms
Attention-Deficit/Hyperactivity Disorder (ADHD) is defined by trouble paying attention, impulsivity, and hyperactivity.
Behaviours of individuals with ADHD often include a difficulty sitting still or staying focussed on a task, especially those perceived as being boring.
People with ADHD often act without thinking and seek out instant gratification while struggling with activities that give a delayed gratification.
There is a tendency to forget or misplace belongings and people with ADHD symptoms will face challenges with personal organisation. External stimuli are a constant distraction.
The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) defines Attention-Deficit/Hyperactivity Disorder (ADHD) as a neurodevelopmental disorder characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
The diagnostic criteria for ADHD include a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Differentiating Between ASD and ADHD
In summary, individuals with autism often experience persistent difficulties with social skills, making it challenging to form and maintain relationships. They tend to have a strong adherence to routines and show resistance to change, along with consistent sensory sensitivities. Their interests are typically intense and long-lasting, rather than shifting frequently.
In contrast, individuals with ADHD often struggle to start or complete tasks due to trouble paying attention. They may display hyperactivity and impulsive decision-making, but these behaviours are not accompanied by the sensory sensitivities commonly seen in autism. Their interests are usually fleeting, with quick shifts from one activity to another. However, these behaviours often improve significantly in structured environments.
How Does AuDHD Present as a Combination of These Symptoms?
Essentially AuDHD is a blend of traits from both ASD and ADHD. It presents as a mixture of hyperactivity / impulsivity and sensory issues.
Social challenges are present as a result of behaviours triggered by both problems with social communication and impulsivity.
In a somewhat contrary way, it is also common for someone with AuDHD to have intense interests in a specific thing but still be easily distracted from the task in hand while working on that thing.
The intense interest and the reality of sitting down to work on it can be considered two separate things. For an Autistic person, their intense interest in something often manifests as long periods of focus on that subject or hobby. Without the presence of ADHD, the Autistic Person is not so easily distracted.
In someone with ADHD only they are unlikely to have such intense focus on one topic so more likely to be hopping from subject to subject.
The unique presentation of ASD and ADHD at the same time creates the scenario where the individual maintains that intense interest in something but also finds it hard to concentrate on it for long periods.
More Examples of AuDHD Presentation
Here are some more examples of how AuDHD might present in an individual you are supporting at home, in care or at school:
Social Interactions and Communication
Someone with AuDHD might struggle with maintaining a conversation due to impulsively interrupting others (an ADHD trait) while also misinterpreting social cues or becoming overwhelmed by group settings (an ASD trait).
For example, they might hyperfocus on a favourite topic and talk about it at length but struggle to notice when the other person has lost interest.
Routines and Flexibility
They may have a strong preference for routines and predictability (an ASD trait), but their ADHD makes it difficult to follow through or stick to those routines consistently.
For instance, they might plan a rigid morning routine but become distracted mid-task, resulting in incomplete steps or running late.
Task Management and Organisation
AuDHD individuals often want to organise tasks meticulously (an ASD trait) but struggle with the executive functioning required to implement the plan (an ADHD trait).
For example, they might spend hours creating a detailed colour-coded study schedule but find it impossible to adhere to it because they lose focus or forget about the plan entirely.
Sensory Challenges with Movement
Sensory sensitivities (an ASD trait) might clash with ADHD-related hyperactivity. For example, they might feel overwhelmed by loud music in a public space but simultaneously feel the need to move around or fidget, creating an internal conflict.
Emotional Regulation
The impulsivity of ADHD might lead to sudden emotional outbursts, while ASD traits make it difficult to process or understand the emotions of others.
For instance, they might lash out in frustration during a group project and struggle to understand why others are upset by their reaction.
Hyperfocus vs Distractability
While deeply engrossed in an area of interest, they might still lose track of time or forget to complete other essential tasks, like eating or taking breaks.
For example, they might hyperfocus on researching their favourite historical event but leave other assignments incomplete because their ADHD makes it hard to prioritise.
Impulsivity and Overthinking
They might impulsively jump into a new hobby or project (ADHD trait) but overthink every detail to the point of anxiety (ASD trait).
For example, they may decide to start learning a new skill, like painting, and impulsively buy all the supplies, only to feel paralysed by the need to make their first painting "perfect."
Physical Sensations and Hyperactivity
They might feel the urge to move constantly (ADHD trait) but find certain types of clothing or environments unbearable due to sensory sensitivities (ASD trait). For instance, they may refuse to wear jeans because of the texture but constantly fidget in loose, more comfortable clothing.
Group Work and Team Settings
In collaborative environments, they may dominate discussions impulsively (ADHD trait) but then struggle with adapting to group dynamics or understanding their peers’ perspectives (ASD trait).
For example, in a team project, they might propose numerous ideas but find it difficult to compromise or adapt to the group’s direction.
Hobbies and Play
Children with AuDHD might immerse themselves in highly detailed imaginative play (ASD trait) but frequently switch characters, rules, or storylines impulsively (ADHD trait).
For example, they could be engrossed in building a detailed Lego structure but suddenly abandon it to start something else because their ADHD makes them lose focus.
Supporting People with AuDHD: Effective Strategies and Approaches
Supporting individuals with AuDHD requires a blend of approaches that address both Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). The key is to create environments and strategies that acknowledge the unique challenges posed by the combination of traits while leveraging the individual's strengths.
Structured Routines with Flexibility
Individuals with AuDHD benefit from structure (aiding ASD traits) but also need flexibility to accommodate ADHD-related impulsivity and focus shifts.
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Use visual schedules, calendars, or task boards to outline daily activities.
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Build in time for flexibility, such as "free choice" periods, to account for shifts in attention or energy.
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Set alarms or timers to help manage transitions between tasks.
Sensory-Friendly Environments
Sensory sensitivities from ASD traits can cause overwhelm, while ADHD-related hyperactivity may increase restlessness.
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Provide noise-cancelling headphones, fidget tools, or weighted blankets.
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Allow for sensory breaks in quiet, low-stimulation spaces.
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Adjust lighting, temperature, or seating arrangements to minimise sensory discomfort.
Emotional Regulation and Coping Skills
Emotional dysregulation is common due to the interplay of impulsivity and difficulty processing emotions.
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Teach emotional regulation techniques, such as deep breathing or grounding exercises.
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Use social stories or role-play to help navigate challenging situations.
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Encourage journaling or creative outlets to express emotions constructively.
Break Tasks Into Manageable Steps
Executive functioning difficulties can make complex tasks overwhelming.
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Break tasks into smaller, actionable steps with clear instructions.
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Use checklists or "to-do" apps to track progress.
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Provide prompts or reminders to keep tasks on track.
Support for Social Interaction
Social challenges from ASD traits and impulsivity from ADHD traits can complicate relationships.
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Teach social scripts and cues to help navigate conversations.
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Role-play scenarios to build confidence in social settings.
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Encourage participation in structured group activities where social rules are clear.
Foster Intense Interests
Hyperfocus on interests can provide motivation and joy, while also being a valuable learning opportunity.
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Allow time and resources for pursuing their passions.
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Connect their interests to real-world skills or academic goals.
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Use their special interests as a starting point for building relationships and communication.
Encourage Movement and Focus Breaks
Hyperactivity from ADHD traits can make sitting still or sustained focus challenging.
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Incorporate movement breaks or standing desks into daily routines.
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Use activities like yoga, stretching, or sensory-friendly exercises to manage restlessness.
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Provide outlets for physical energy, such as sports or active hobbies.
Tailored Educational Support
School environments can be overwhelming for individuals with AuDHD.
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Work with teachers to implement Individualised Education Plans (IEPs).
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Use assistive technology, such as apps for organisation or speech-to-text tools.
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Provide accommodations like extra time on tests, quiet workspaces, or alternative formats for assignments.
Clear Communication
Miscommunication can arise due to ASD-related social difficulties and ADHD-related impulsivity.
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Use clear, direct language to avoid ambiguity.
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Provide written instructions to supplement verbal communication.
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Check for understanding by asking them to repeat back key points.
Celebrate Strengths
Focusing on strengths builds confidence and self-esteem.
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Recognise and celebrate achievements, no matter how small.
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Help them see their unique traits as assets rather than challenges.
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Encourage activities that showcase their talents and creativity.
Conclusion
Supporting individuals with AuDHD requires a thoughtful blend of strategies that address the unique interplay of autism and ADHD traits. By fostering understanding, creating structured yet flexible environments, and providing tailored tools and resources, we can empower those with AuDHD to navigate their challenges while embracing their strengths.
Whether it’s through personalised educational plans, sensory-friendly spaces, or building emotional regulation skills, the key lies in recognising the individuality of each person and adapting support to suit their needs. When families, educators, and professionals work together, it becomes possible to not only manage the difficulties associated with AuDHD but also help individuals flourish in all areas of life.
Ultimately, the goal is to ensure that those with AuDHD feel supported, valued, and equipped to thrive, highlighting the importance of understanding and acceptance in unlocking their full potential.