AuDHD: The Hidden Dynamics of a Dual Diagnosis
The term AuDHD – used within the neurodivergent community to describe individuals diagnosed with both autism and ADHD – highlights a significant yet often overlooked intersection. Autism and ADHD are distinct clinical diagnoses; however, their co-occurrence is well-documented but under-researched [1]. Until the publication of the DSM-V in 2013, a diagnosis of one of the two conditions precluded a diagnosis of the other [2] and the DSM-IV stated that the diagnostic criteria of ADHD, which consisted of inattention, hyperactivity, and impulsivity, were distinct from the criteria of autism, which involves difficulties in social interaction, communication, and stereotyped behavior [3][4].
The argument against the DSM-IV’s statement regarding dual diagnosis is that, clinically speaking, inattentive and hyperactive symptoms are also common in children and adolescents with autism. Since the DSM-V’s release, more research has shown significant similarities and characteristics in the phenotypic and neurobiological features of ADHD and autism [1]. A shared genetic background between autism and ADHD can explain their strong correlation. About 50 to 70% of individuals with autism also present with ADHD [5].
Despite this overlap, autism and ADHD are treated very differently in public discourse, with autism often more stigmatized. So why then, despite dual diagnoses becoming more common, is autism still more stigmatized than ADHD? Here, I present some arguments for this phenomenon, which may elucidate the differences we see in the public’s reaction to these two related diagnoses.
There are high levels of self-diagnosis in ADHD. A national survey commissioned by Ohio State University Wexner Medical Center and College of Medicine found that about 25% of adults suspect they have undiagnosed ADHD [6]. Though one’s awareness of ADHD symptoms can help in seeking a diagnosis, it is not possible to self-diagnose ADHD. ADHD has complex underlying neurological mechanisms, and without formal training, one cannot accurately determine a diagnosis. Additionally, self-diagnosis is comprised of a significantly high risk of bias, with the individual naturally drawing from fears and preconceived notions throughout the process. However, it is important to note that, while self-diagnosis runs the risk of being incorrect, for many people, particularly of minoritized intersections, accessing diagnosis can be hard. It can present a diagnostic barrier in itself. This increased self-diagnosis creates an illusion of ADHD prevalence, leading to broader acceptance of the condition by the public.
The increase in self-diagnosis of ADHD, in part, stems from social media platforms like TikTok, which have increased awareness of ADHD, contributing to the spread of potential overdiagnosis and misinformation. This is not to say that Autism is not represented on social media; however, the behaviors associated with ADHD may seem more familiar, and are attributes that individuals without ADHD will experience from time to time: being distracted, hyper, or impulsive. In contrast, autism traits remain less understood and perceived as less familiar, or even a flaw or disability that must be “cured,” in no part helped by current media discourse on the issue. Behaviors such as sensory overwhelm, atypical eye contact, or difficulty identifying emotions can feel alien to neurotypical individuals and are more likely to be judged than empathized with. While ADHD has been normalized in certain circles, autism remains misunderstood despite the significant overlap between the two conditions.
Due to this stigmatization and experiences of exclusion, it is common for autistic individuals to mask their behaviors and traits to appear more neurotypical. Some individuals feel masking helps them maintain safety and build a sense of resilience [7]. Others mask because they feel it helps them gain social opportunities and more friends. Studies indicate that about 70 to 80% of individuals with autism engage in masking behaviors. This high statistic only emphasizes the illusion that autism is rarer or only looks a specific way. The cost of unmasking can be considered higher for individuals with autism compared to those with ADHD, so individuals with autism may choose to stay silent [7].
To add to the confusion, in individuals with a dual diagnosis, autistic and ADHD traits may conflict with one another. This is especially true for women who are often misdiagnosed due to varying presentations across sexes. Many women grow up masking their symptoms to fit social expectations, making it harder to receive the full scope of support they need. As a result, people with a dual diagnosis may only receive support for one condition (if any), as services and accommodations are usually designed with a singular presentation in mind.
Simultaneously, however, an experience of autism and ADHD can complement one another. The impulsivity associated with ADHD may help individuals with autism step out of their preference for routine, while the structure of autism can also help manage the distractibility of ADHD. In another sense, the emotional urgency associated with ADHD and empathy seen in autism may foster emotional honesty and passionate advocacy for causes or people that matter to an individual. When we only look at the contradictions in a dual diagnosis, society risks seeing the individual as fragmented when, in reality, they are more dynamic and have traits that balance and create unique strengths. Additionally, this complementary perspective encourages individualized and customized support that honors all of the needs of the individual, demonstrating the importance of understanding AuDHD as its own unique experience.
This siloed approach can inevitably leave many people falling through the cracks, forced to choose which aspect of their neurodivergence to disclose or endure, often based on which one is more “socially acceptable.” It underscores the need for more integrated approaches to neurodiversity. Such approaches don’t treat autism and ADHD as isolated conditions but instead recognize the unique ways they interact in real life. While individuals with autism and ADHD each face stigma, an autism diagnosis may be perceived as more “taboo” due to the specific nature of its presentation. A lack of knowledge fuels this perception, and we must use a combined approach of education and awareness to improve the public’s understanding of neurodiversity in all its forms.
Citations
[1] Hours, Camille, et al. “ASD and ADHD Comorbidity: What Are We Talking About?” Frontiers in Psychiatry, vol. 13, no. 837424, 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC8918663/, https://doi.org/10.3389/fpsyt.2022.837424.
[2] Ramtekkar, U. (2017). DSM-5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues. Children, 4(8), 62. https://doi.org/10.3390/children4080062
[3] Substance Abuse and Mental Health Services Administration. (2016). Table 7, DSM-IV to DSM-5 attention-deficit/hyperactivity disorder comparison. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/
[4] DSM IV Criteria For Diagnosing Autistic Disorder*. (n.d.). Www.kennedykrieger.org. https://www.kennedykrieger.org/stories/interactive-autism-network-ian/dsm_iv_criteria
[5] Rong, Y., Yang, C.-J., Jin, Y., & Wang, Y. (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis. Research in Autism Spectrum Disorders, 83, 101759. https://doi.org/10.1016/j.rasd.2021.101759
[6] The Ohio State University Wexner Medical Center. (2024). Osu.edu. https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/survey-finds-25-percent-of-adults-suspect-they-have-undiagnosed-adhd
[7] National Autistic Society. (2025). Masking. Www.autism.org.uk; National Autistic Society. https://www.autism.org.uk/advice-and-guidance/topics/behaviour/masking
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