For a long time, it was believed that autism and attention deficit hyperactivity disorder (ADHD) were unrelated conditions. The DSM-4 diagnostic manual, which was in use until 2013, did not even allow for a dual diagnosis. The DSM-5 not only brought together all forms of autism under the name autism spectrum disorder (ASD), but it also recognizes the co-occurrence with ADHD. Today, it is estimated that between 30 and 40% of people with autism also have ADHD. We will first take a look at each disorder individually and then examine the combination of the two.

Signs of autism spectrum disorder

When discussing autism, the following characteristics are typically mentioned.

• Lack of social skills (unwritten social cues)
• Rigid thinking and a need for routines
• Distress when faced with change
• Focus on details and difficulty seeing the bigger picture
• Excessive or reduced sensory sensitivity

It is important to note that these are just a few traits that are not necessarily present in every person with autism. Furthermore, this perspective emphasizes “deficits” compared to the majority of people, the so-called “neurotypicals.”

However, there might be some beneficial traits as well, though often overlooked.

• Original thinking
• Extraordinary knowledge in the fields that captivate them
• Above-average performance in a supportive, distraction-free environment
• Integrity, reliability and honesty
• Attention to detail
• Perseverance and precision

Characteristics of ADHD

ADHD, like autism, is a neurodevelopmental disorder. Two key features must be present for a diagnosis: inattention on the one hand, and hyperactivity and/or impulsivity on the other. Moreover, the stereotype of the hyperactive boy who disrupts everyone in class is just one possible facet. ADHD can manifest differently and more subtly, particularly in girls, as well as in adult women and men. This is why it can go unnoticed for a long time, just like autism, which is also often diagnosed later in life or not at all.

The traits of ADHD have a neurological cause, as a deficiency of dopamine and norepinephrine has been observed in the brains of those affected. Listed below are some characteristics of ADHD:

• Difficulty controlling attention
• Easily distracted
• Difficulty starting and finishing tasks
• Difficulty planning and managing time
• Intense internal restlessness (daydreaming) and/or external restlessness (hyperactivity)
• Easily forgetting objects, appointments, and deadlines
• Impatience (e.g. interrupting others)
• Impulsive speech and actions
• Mood swings

You may occasionally notice one or two of these signs in yourself. You’ve certainly put off an unpleasant task at some point. But ADHD affects a person’s life much more deeply. For example, someone with ADHD may even put off things they enjoy. In reality, they aren’t putting them off – they simply lose track of them because their attention has already drifted elsewhere beyond their control. You probably realize just how challenging ADHD can be, as it affects the person in every area of their life and throughout their entire life.

Sadly, positive aspects of ADHD are often overlooked:

• Creative thinking
• Hyperfocus in areas that stimulate them
• Sense of justice
• Open-mindedness
• Ability to improvise

The struggle of people with ADHD

People around them often don’t understand what ADHD is. That’s why those with ADHD often hear comments like: “You just need to try harder.” “You’re doing it on purpose.” “You’re lazy.” ” “You’re stupid.” These remarks are deeply demeaning and harmful. At the same time, people with ADHD are aware that others possess skills they lack. It’s only natural that they begin to doubt their own abilities and that feelings of embarrassment and shame set in.

This leads to the following problems:

• Relationship difficulties
• Anxiety and mental health issues

People with autism share similar experiences, as they, too, are constantly faced with misunderstanding and rejection from those around them. As a result, they doubt their abilities and, naturally, develop very low self-esteem. These factors severely diminish the quality of life for those affected. Moreover, it is not surprising that they face a high risk of burnout, depression, suicide, addiction, and other mental health problems.

Common Challenges

In certain areas, people with autism and those with ADHD exhibit the same traits – but not necessarily for the same reason.

• Missing social cues (autism due to lack of awareness / ADHD due to inattention)
• Hyperfocus (autism on specific interests / ADHD in stimulating areas)
• Interrupting others (autism due to lack of awareness of social norms / ADHD due to impatience)
• Distinctive speech patterns (ASD often monotonous / ADHD rapid speech)
• High sensitivity to sensory stimuli
• Weak executive functions (for planning and organizing)
• Exhaustion and fatigue (due to their sensitivities and the effort to adapt to others’ expectations)

These challenges have a greater impact than they would for someone with only one condition – whether it be autism or ADHD. Furthermore, like those with a single diagnosis, they try to hide their difficulties in order to appear “normal” and avoid being excluded or rejected. This takes a tremendous amount of energy and often leads to periods of intense fatigue.

Contradictory patterns

In some areas, autism and ADHD are associated with opposite patterns. Here are a few examples:

This can be quite confusing for the person in question, who may act one way in one situation and differently in another, without knowing why. Furthermore, those around them may notice this and later accuse them of doing it on purpose when they don’t behave as expected – without realizing that the person is not really able to control their behavior at that moment.

In some situations – based on my personal experience – one condition can serve as a resource and help compensate for weaknesses in the other. For example, ADHD gives me a level of flexibility and openness to change that autism likely would not allow me to have. At the same time, having both conditions can sometimes amplify certain difficulties I face in my daily life.

Are autism and ADHD related?

It is worth noting that some researchers and practitioners believe that autism and ADHD may be two manifestations of the same underlying cause. Research on this topic is currently underway. If this hypothesis proves to be correct, a new term will certainly be established in the future.

Living with AuDHD

I didn’t realize I was autistic until very late in life – when I was over 60, at the beginning of 2022. This realization helped me understand many of the challenges I’d faced throughout my life. Talking with other autistic people was incredibly enriching and helped me better understand how I function and the different aspects of the autism spectrum. At the same time, I continued to have doubts about whether I was truly autistic because some of my experiences didn’t align with what I’d heard from other autistic people or what I’d read on the subject. During my autism assessment, when my psychiatrist told me that an additional session would be necessary to evaluate for possible ADHD, I replied that I didn’t think that would be necessary.

Today, I’m glad he diagnosed me with ADHD in addition to autism. ADHD accounts for many problems in my life that weren’t caused by my autism. In my daily life, it’s important for me to distinguish between these two aspects of myself, which serve as a valuable resource at times and a real inconvenience at others.

Main source: For this article, I relied heavily on the online course “Autism and ADHD” offered by Tony Attwood and Michelle Garnett. This course is no longer available online. It appears to have been replaced by the course Autism, ADHD and Executive Function.

On YouTube, Purple Ella has created a beautiful video in which she discusses the challenges she faces as a person with autism and ADHD: “Having Autism & ADHD (The Paradox)” Having Autism & ADHD (The Paradox) (en anglais)

Book on this topic: In the fall of 2023, a very interesting book related to our topic was published by Ellie Middleton: MIDDLETON, Ellie, 2023. Unmasked: The Ultimate Guide to ADHD, Autism and Neurodivergence. London, UK : Penguin. ISBN 978-0-241-65198-8

A very interesting article on AuDHD published in April 2024 in the British newspaper “The Guardian”: The sudden rise of AuDHD

Two articles by Megan Anna Neff discuss how autism can mask ADHD and vice versa:

• 6 Ways ADHD Hides Autism (And What AuDHD Really Looks Like)
• How Autism Hides ADHD: 6 Ways Autism Hides ADHD

Note: With regard to executive functions, Tony Attwood and Michelle Garnett enthusiastically discuss an ASD and ADHD phenotype—that is, a specific profile associated with this dual diagnosis—based on a study by Craig et al. published in 2016. However, a meta-analysis conducted in 2023 was unable to identify distinct profiles for ASD and ADHD with regard to executive functions. journals.sagepub.com/doi/full/10.1177/10870547231190494

This article was first published in French in January 2024 and has now been translated into English by the author himself.

Author of the article: Beát Edelmann, expert in neurodiversity (autism, ADHD and high IQ) and personality exploration. He is the founder of the Abundana Institute for Self-Management in Geneva, which offers coaching, training, and consulting services in French, English, and German.

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