Do I (Or My Child) Have Autism, ADHD, or Both?

Desmond, an 11-year-old boy living in Birmingham, Alabama, has been struggling to keep friends. He has a hard time knowing when to chime in during conversations, which results in him often interrupting others. Desmond also becomes very excited when talking about his favorite video game, and he tends to “info dump” on other children, not leaving much room for them to respond. During class, he always plays with fidget toys, which he says help him focus. His mother, Jasmine, starts wondering… Is this Attention-Deficit/Hyperactivity Disorder (ADHD), Autism, or both?

Meanwhile, Jasmine starts thinking about some of her own challenges. She has always found eye contact to be incredibly uncomfortable, and she has trouble keeping up with conversations because she is so easily distracted by her own thoughts. When she was growing up, she found herself copying what other people did to “fit in.” Jasmine also realizes that compared to other people at work, she is incredibly disorganized, and if she does not set extensive reminders on her calendar, she forgets to follow through on tasks. She asks herself whether these difficulties are better explained by ADHD or Autism, or if it is possible for her to have both?

You may be surprised to learn that until 2013, both ADHD and Autism could not be diagnosed together – According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a person could only have one or the other. As the field has learned more about neurodevelopmental conditions through research, we now understand that ADHD and Autism can not only co-occur, but that that is actually the norm rather than the exception! In fact, somewhere between 50-70% of autistic people also have ADHD. Colloquially, you may have heard of this as “AuDHD.” Many people who have ADHD display some traits of autism despite not meeting full diagnostic criteria, and vice versa. It can also be tricky to tell the two conditions apart at times due to symptom overlap and how similarly the conditions can present. So how do we tell them apart, and how do we know when someone has both? Let’s dig into these two conditions a bit more.

One hallmark of Autism is social communication and interaction differences; however, difficulties in social situations can be explained by many conditions, including ADHD. If a person struggles with sustaining attention, this may impact their ability to participate in conversations, and impulsive behaviors (e.g., interrupting, intruding on others) can result in people missing social cues or being rejected socially. Additionally, many autistic people and those with ADHD have difficulties with what is referred to as “executive functioning,” which impacts their ability to complete goal-oriented behaviors such as making and executing plans, solving problems, managing emotions and behaviors, and flexibly adapting to situations. 

There’s a concept called “diagnostic overshadowing,” which occurs when a person’s symptoms are attributed to an existing diagnosis when they may actually indicate a co-occurring condition. For example, if a child who already has a diagnosis of Autism is performing poorly in school due to difficulties paying attention to instruction and often being out of their seat, a provider may assume these behaviors are related to their Autism and not consider the possibility of ADHD. While one diagnosis may be part of the picture, failing to recognize the other part of the picture may result in misunderstanding of a person and minimize treatment efficacy.

Many autistic people who also have ADHD can struggle with managing the opposing traits of these conditions. For instance, while autistic people often thrive in routine and struggle with adjusting to change, people with ADHD may have difficulty with organization or become easily bored by doing the same things, making it difficult to adhere to consistent schedules and follow through on plans. This internal conflict can be especially distressing for people with both conditions, who are constantly attempting to balance all their unique needs. 

Importantly, while some therapeutic skills can be relevant to experiences specific to both ADHD and Autism, fully understanding your neurotype can better inform treatment. While medication management is an evidence-based treatment for ADHD, it may not be indicated for difficulties related to Autism. Similarly, social skills training may focus on teaching social “rules” and nuances for an autistic person hoping to improve their ability to navigate relationships, whereas treatment may focus on managing symptoms of inattention and impulsivity that impact social interactions in a person with ADHD. Disentangling these conditions can also help with determining why a person may be having certain challenges and how to best accommodate them at home, school, or work. Overall, interventions and supports should be tailored to each person’s specific strengths and areas of need, and a comprehensive diagnostic evaluation can ensure that nothing is being missed.

At Upward Behavioral Health, we are committed to providing combined ADHD and Autism diagnostic assessment services to children and adults throughout the state of Alabama. Thanks to technology, families living in smaller towns such as Fairhope, Muscle Shoals, Florence, Leeds, Daphne, or Cullman may have increased access to virtual evaluation services offered by our practice. Dr. Ramsey (child psychologist) and Drs. Rathmell and Norton (adult psychologists) happily provide virtual evaluations, and in-person adult evaluations are also available through Drs. Rathmell and Norton for adult clients in the Birmingham area (or who are willing to travel to Birmingham). 

If you are an adult wondering whether you may have ADHD, Autism, or both, check out this ADDitude webinar with Dr. Benjamin Yerys: https://www.youtube.com/watch?v=QE91bFwuhIc