ADHD and Autism: A Paradoxical Experience

Colloquially, individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) have begun to affectionately call this experience “AuDHD”. Since the possible symptoms of both disorders can be contradictory, AuDHD-ers may experience a range of paradoxical or conflicting challenges due to the unique characteristics of their conditions. However, there are also significant overlap of symptoms that can exacerbate dysfunction for some.

The significant overlap between the two disorders is known as comorbidity. When clinically significant symptoms of both are present, it is appropriate to be given both diagnoses. Individuals with ADHD are up to 50% likely to meet criteria for ASD, while up to 80% of those with ASD will likely meet criteria for ADHD (Schachar et al., 2023)

Here are some of the areas where paradoxical experiences might occur:

• Attention and Focus

  ADHD is characterized by difficulties in sustaining attention, task-switching, and disengaging from a state of hyperfocus. Individuals with ASD may display intense focus on specific topic, known as their special interest. Paradoxically, someone with both conditions might struggle with maintaining attention in general but may hyperfocus intensely on specific topics or activities. In addition, the hyperfocus of ADHD and the hyperfixation of ASD can be conflated during diagnostic testing (Lebeña et al., 2023).

• Executive Functioning

  ADHD can lead to difficulties in executive functions such as planning, organization, and time management. ASD is also associated with executive functioning challenges, manifesting in rigid thinking or difficulty adapting to change. The combination may result in a paradoxical struggle with both flexibility and organization. An AuDHD brain might crave novelty to function well, but might also require structure to be able to function (Schachar et al., 2023).

In addition to contradictory symptoms, there are also complementary ones, in the sense that some challenges from one disorder might be amplified by having both.

• Communication

  ASD is often linked with challenges in verbal and nonverbal communication, including difficulties in understanding and using language. ADHD may contribute to impulsivity in communication, leading to challenges in effective expression and comprehension. Someone with both disorders may simultaneously struggle with Auditory Processing to understand the words being said, and also struggle to decode the social implications of what is being conveyed (Khachadourian et al., 2023).

• Social Interactions

  People with ADHD may have challenges in social situations due to impulsivity or inattentiveness. Missed texts, late arrivals, and forgotten occasions all put strain on relationships. Individuals with ASD often face difficulties in understanding social cues and engaging in reciprocal social interactions. Their emotional affect may come across as uncaring, or uninterested, despite wanting to stay connected with a friend. AuDHD-ers may experience a desire a social connection, but find it exceedingly difficult to navigate social nuances effectively (Rau et al., 2020).

• Sensory Sensitivity

  This is an area where the contradictions and amplifications of symptoms may coincide. Many individuals with ASD experience sensory sensitivities, finding certain stimuli overwhelming. ADHD may also contribute to heightened reactions, potentially exacerbating sensory challenges. Both can also lead to understimulation in a particular sense. AuDHD-ers may experience confusing paradoxical responses to sensory stimuli, with heightened sensitivity in some areas and diminished awareness in others (Rau et al., 2020).

It is important to remember that these experiences can vary widely among individuals, and not everyone with coexisting ADHD and ASD will face the same challenges. Additionally, strengths and unique abilities may also emerge from the combination of these conditions. A personalized and multidimensional approach to support is often beneficial for individuals with dual diagnoses. Overall, bringing awareness to the internal dissonance of having AuDHD can help both those with the disorders, as well as family, to better understand and support one another’s needs.

Hanna Knudsen, MS CMHC, PCLC

References

Schachar, R.J., Dupuis, A., Arnold, P.D. et al. Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder: Shared or Unique Neurocognitive Profiles?. Res Child Adolesc Psychopathol 51, 17–31 (2023). https://doi.org/10.1007/s10802-022-00958-6

Khachadourian, V., Mahjani, B., Sandin, S. et al. Comorbidities in autism spectrum disorder and their etiologies. Transl Psychiatry 13, 71 (2023). https://doi.org/10.1038/s41398-023-02374-w

Lebeña, A., Faresjö, Å., Faresjö, T. et al. Clinical implications of ADHD, ASD, and their co-occurrence in early adulthood—the prospective ABIS-study. BMC Psychiatry 23, 851 (2023). https://doi.org/10.1186/s12888-023-05298-3

Rau, S., Skapek, M., Tiplady, K., et al. Identifying comorbid ADHD in autism: Attending to the inattentive presentation. Research in Autism Spectrum Disorders 69, (2020). https://doi.org/10.1016/j.rasd.2019.101468