Autism & ADHD: Understanding the Combination

Venn Diagram: Autism: Strong interests, unique sensory experiences, literal thinking, routine-driven beheviour, social communication differences. ADHD: Attention differences, hyperactivity, impulsivity, rejection sensitivity, demand avoidance. Union: Emotion dysregulation, anxiety, executive dysfunction, hyper focus, creativity

Autism and attention deficit hyperactivity disorder (ADHD) are commonly co-occurring conditions with significantly elevated prevalence rates. Though they are distinct, people with diagnoses of either autism or ADHD often struggle in similar situations. Also, autism can influence the presentation of ADHD and vice versa; accurate assessment for each is complicated and critical.

While autism and ADHD are life-long experiences, research has focused almost exclusively on children because that is when symptoms first emerge. This emphasis on childhood leaves clinicians to extrapolate interventions and supports for adults. What we do know is that co-occurring autism and ADHD in adults carries unique implications and considerations that don’t exist for either condition on its own.

It is important to note that for many years, doctors were hesitant to diagnose a child with both ADHD and autism. The American Psychiatric Association (APA) stated for years that the two conditions couldn’t be diagnosed in the same person. With the release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, the APA states that the two conditions can co-occur. For that reason, very few medical studies have looked at the impact of the combination of conditions on children and adults.

What is ‘AuDHD’?

You may have seen some new ways to describe when someone is autistic and also has attention-deficit hyperactivity disorder (ADHD). The term “AuDHD” may be used on social media, with people describing what they experience or have seen as clinicians.

It might seem surprising these two conditions can co-occur, as some traits appear to be almost opposite. For example, autistic individuals may have fixed routines and prefer things to stay the same, whereas people with ADHD may get bored with routines and like spontaneity and novelty.

However, these two experiences frequently overlap, and the combination of diagnoses can result in some unique needs.

Is ‘AuDHD’ an official diagnosis?

It is not. AuDHD is a colloquial term, but it does not exist as an official diagnosis in the Diagnostic and Statistical Manual-5 (DSM-5). This means that an individual who has a formal diagnosis will have documents listing both conditions separately; it will likely say that they have ADHD and are autistic.

Can I be assessed for both autism and ADHD at the same time in Ireland?

Typically, assessments for autism and ADHD are done separately and may even be done by separate services or individuals with various areas of expertise. Occasionally, when seeking an assessment for autism, individuals may be screened for ADHD and vice versa, but this is not a uniform experience.

Conflicting Traits

When someone has both conditions, the conflicting traits can result in an internal struggle. For example, it can be upsetting when you need your things organised in a particular way, but ADHD traits result in difficulty consistently doing this. There can be periods of being organised (when autistic traits lead) followed by periods of disorganisation (when ADHD traits dominate) and feelings of distress at not being able to maintain organisation. There can be eventual boredom with the same routines or activities but upset and anxiety when attempting to transition to something new.

For some people the conflicting traits may result in a balance where people can find a middle ground (for example, their house appears tidy, but the cupboards are a little bit messy). For others, finding a middle ground can be a very real challenge resulting in or contributing to mental health challenges.

TCD Supports for ‘AuDHD’

Here in Trinity College Dublin’s Disability Service, we are aware that most research explores autism and ADHD separately, leaving individuals left with no means of describing their unique experiences. We believe the uniqueness of everyone’s experience is vital for us to understand, as it is likely that a student who is both autistic and has ADHD may have different support needs.

At the Disability Service, we strive to offer a wide range of supports for TCD students. These include provision of exam accommodations (in collaboration with Academic Registry), communication with schools regarding individual needs and additional supports such as access to mental health occupational therapy and social work support.

Budding anecdotal evidence is beginning to highlight the importance of recognising that individuals might experience fluctuations in times when their autism or ADHD traits are more dominant than the other. As a result, a support or study technique that worked well for you at one point in your academic journey may not always be a productive strategy for you. This may means that additional supports may need to be put in place or developed in conjunction with Disability Service staff.

If you are a student who identifies as autistic who has ADHD, discussions around the supports you require may need to be additionally nuanced. We recommend, if you are comfortable doing so, to discuss how you experience autism and ADHD with your Disability Officer or Occupational Therapist on an ongoing basis.