AuDHD: Autism and ADHD sitting in a tree….
anguage: There is a sordid history of the DSM. I may use direct language from the DSM, this is for educational purposes. The language in the DSM, including the use of the word disorder (D in acronym) is harmful. When this language is used, it is either because I am quoting the DSM, or because there is unfortunately a lack of different terminology out there (i.e. leaving the “d” in OCD or the “D” in ADHD). Because I leave this, does not mean that I agree with the wording.
Educational Purposes: The information presented here is for educational purposes, and not meant to diagnose, treat or cure medical conditions or challenges, including neurodivergence (including mental health challenges), or physical health.
Today’s blog is from our newest therapist, Alex McLaughlin! Alex is working with clients ranging from early childhood to adults in Minnesota, both virtually and in person in Edina, and provides abbreviated Autism assessment! They currently have openings and would love to chat to see if they are a good fit for you!
Picture this! There are kids on a playground, laughing, and giggling gleefully as a group gather around people double dutch jump roping. One of the children holding the ropes, invite two new kids in; “hmmm….” they say, looking around, “I choose Autism and….” continues looking around, “ahh yes, ADHD,” Autism looks around, confused, and asks quietly, “who, me!?” The jump rope holder, and seeming leader says, “yes you!! Go get ADHD, too!” Autism starts blushing, and thinks, I hardly get chosen for these things, oh boy, I feel nervous. Okay, ADHD, gotta find them, I thought I saw them on the monkey bars. Oh now they’re playing four square. Autism walks over, and says, “ADHD, you were chosen to double dutch.” ADHD, mid-toss, drops the ball, and says, “oooh I love double dutch,” grabbing Autism’s hand, and running back over. They ease their way into the rhythm, as the kids start singing in unison “Autism and ADHD sitting in a tree, k-i-s-s-i-n-g….” (1)
Do you remember that song from childhood? If not, you’re not missing out much! So what happens when Autism and ADHD (AuDHD), commingle, so-to-speak? You might wonder, can they be diagnosed together? Or perhaps you think that one could mask the other? You might be asking yourself, “well, what happens if a person has both?”
Hopefully we’ll answer some of these questions for you today in this article.
But first, a fun fact! Fun fact! It’s true that prior to the DSM-V (2), Autism and ADHD could not be diagnosed together!
Luckily, we are currently on the DSM-V-TR, though, that means because they couldn’t be diagnosed together prior to May 2013, there is not a ton of research out there about how they overlap, differ, and ways they may mask each other’s traits.
Thankfully, Neuron and Rose’s founder, Dr. Jessica Hogan, recently began writing a literature review (3) on this very topic! Below is a summary of her summary. We’ve also put together a venn diagram which includes both information from her literature review, and is adapted from Dr. Neff’s misdiagnosis Monday series. (4)
Venn diagram sources (5,6)
According to Antshel & Russo (2019) (7), ADHD and autism have shared genetic heritability.
Krakowski et al (2020) (8) noted that adhd traits can overshadow those of autism, as providers might be more likely to expect to see traits of what is thought of as a “more common” condition. The co-occurrence of Autism and adhd is likely underidentified (Krakowski et al, 2020).
Unfortunately, if someone is both Autistic and an ADHDer, ADHD traits can overshadow those of Autism, can overshadow or mask one another (Krakowski et al., 2020).
Some fun facts:
When Autism and and ADHD co-occur, an Autism diagnosis can be delayed by 5 years (Miodovnik et al, 2015). (9)
Higher levels of autistic traits were found in ADHDers compared to non-ADHDers, at a range of 15-64.3% depending on the study (Zhong & Porter, 2024). (10)
40-70% of autistic people showed clinically significant adhd traits, and 20-60% of ADHDers showed significant social and communication differences often seen in autism (Antshel & Russo, 2019).
When autism is present, ADHD is diagnosed earlier
When ADHD is present, Autism is diagnosed later.
Being female can delay diagnosis even more (Sainsbury, 2023)
One study (Sainsbury et al. 2023(2)) found that AuDHD children showed less atypicaldevelopment than just autistic children (less atypical language and social development). (11, 12, 13)
Because there is so much overlap, there is a debate in the field about whether ADHD and Autism should be considered opposite ends of a spectrum or completely different entities (Deserno et al., 2023). (14)
Some researchers, Waldren et al., (2024) (15), consider attentional control (maintaining attention and shifting it) the most significant overlap. Though, it’s possible that the reason that attentional control exists may be different for Autism and ADHD, one may be sensory and another may happen on a cognitive level, but they present in a similar way.
Remember the series about Autism vs. ADHD vs. OCD? If you didn’t catch that, and you’re interested, take a peak at parts 1, 2 and 3. Well, Kushi et al. (2019) (16) examined brain structures across Autism, ADHD and OCD, and found that because there is so much overlap, neuro-biologically, distinct labels of Autism, OCD, and ADHD are not needed. They suggest these conditions exist along a continuum. There were additional studies that supported these findings, if that tickles your fancy. (17, 18)
From a lived experience standpoint, it can be wild to be an AuDHDer, and it can feel like there is a push-pull between the differing, and sometimes opposing traits. Set a stellar routine, but get bored with it after a few days, and also desperately need the routine? No? Just me…..? Make a plan to have a consistent bed time, but then when the time rolls around, you gawk at the idea, because it’s too “boring?” and also, shout internally to yourself, “You can’t tell me what to do!!!” No? Still just me?.... Well anywhooooooz…..
side note Are you an AuDHDer (suspected or confirmed), if you feel called to, we’d love to hear what your experience is like in the comments! If you’re interested in learning more about what the lived experience is like, you might enjoy checking out this compilation of AuDHD TikToks. If you’d like the next article to be more focused on the AuDHD lived experience, comment, “lived experience!” Or if you’re curious about how to navigate life with both, in a tree, k-i-s-s-i-n-g, comment, the word, “navigate.” Have another topic in mind? Let us know that! end side note
What’s lovely is there are a variety of your neurokin (19) who get it on many levels! So if you live on Wahpekute land (colonized as MN) (20), or Chumash land (colonized as Los Angeles, CA), and want an assessment, a therapist who gets it, or to be a group setting with others who live it too, we got you covered! Reach out to learn more, we offer free consultations for therapy and assessments!
We live and work on the unseated territories of the Wahpekute and Chumash land, we pay respects to their elders past and present. We encourage folks to explore the ancestral lands they live and work on, and to learn about the Native communities that live there, the treaties that have been broken. If folks feel called, we encourage them to consider taking actions to support Native communities, reparations, and land back movements.
Footnotes:
1. NurseryRhymes.org explains this as:“K-I-S-S-I-N-G is a popular schoolyard rhyme / playground song that is used in the USA and in UK. The main purpose with this song, is to make the persons named in the song embarrassed.”
2. The Diagnostic and Statistical Manual of Mental Disorders; it’s the system that we use to diagnose a variety of neurodivergences. We’re currently on the DSM-V-TR.
3. Basically a literature review is a fancy way of saying she looked at all the research about these topics, and summarized them in one spot.
4. Dr. Megan Anna Neff is a fantastic AuDHD psychologist who shares educational content, and more. Here’s her original blog post & venn diagram.
5. Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-
6. Strang, J. F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L. E., Berl, M., Walsh, K., Menvielle, E., Slesaransky-Poe, G., Kim, K. E., Luong-Tran, C., Meagher, H., & Wallace, G. L. (2014). Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Archives of sexual behavior, 43(8), 1525–1533. https://doi.org/10.1007/s10508-014-0285-3
7. Antshel, K. M., & Russo, N. (2019). Autism Spectrum Disorders and ADHD: Overlapping Phenomenology, Diagnostic Issues, and Treatment Considerations. Current psychiatry reports, 21(5), 34. https://doi.org/10.1007/s11920-019-1020-5
8 Krakowski, A.D., Cost, K.T., Anagnostou, E. et al. Inattention and hyperactive/impulsive component scores do not differentiate between autism spectrum disorder and attention-deficit/hyperactivity disorder in a clinical sample. Molecular Autism 11, 28 (2020). https://doi.org/10.1186/s13229-020-00338-1
9. Miodovnik, A., Harstad, E., Sideridis, G., & Huntington, N. (2015). Timing of the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Pediatrics, 136(4), e830–e837. https://doi.org/10.1542/peds.2015-1502
10.Zhong, Q., Porter, M. Autism Spectrum Disorder Symptoms in Individuals with a Primary Diagnosis of Attention-Deficit/Hyperactivity Disorder: A Systematic Review. Rev J Autism Dev Disord (2024). https://doi.org/10.1007/s40489-024-00443-4
11. Sainsbury, W. J., Carrasco, K., Whitehouse, A. J. O., & Waddington, H. (2023). Parent-reported Early Atypical Development and Age of Diagnosis for Children with Co-occurring Autism and ADHD. Journal of autism and developmental disorders, 53(6), 2173–2184. https://doi.org/10.1007/s10803-022-05488-0
13. We know that there are other factors besides sex assigned at birth that can cause non-stereotypical presentations of Autism and can delay a diagnosis.
14. Deserno, M. K., Bathelt, J., Groenman, A. P., & Geurts, H. M. (2023). Probing the overarching continuum theory: data-driven phenotypic clustering of children with ASD or ADHD. European child & adolescent psychiatry, 32(10), 1909–1923. https://doi.org/10.1007/s00787-022-01986-9
15. Waldren, L. H., Leung, F. Y. N., Hargitai, L. D., Burgoyne, A. P., Liceralde, V. R. T., Livingston, L. A., & Shah, P. (2024). Unpacking the overlap between Autism and ADHD in adults: A multi-method approach. Cortex; a journal devoted to the study of the nervous system and behavior, 173, 120–137. https://doi.org/10.1016/j.cortex.2023.12.016
16. Kushki, A., Anagnostou, E., Hammill, C., Duez, P., Brian, J., Iaboni, A., Schachar, R., Crosbie, J., Arnold, P., & Lerch, J. P. (2019). Examining overlap and homogeneity in ASD, ADHD, and OCD: a data-driven, diagnosis-agnostic approach. Translational psychiatry, 9(1), 318. https://doi.org/10.1038/s41398-019-0631-2
17. Bathelt, J., Caan, M., & Geurts, H. (2020, April 16). More similarities than differences between ADHD and ASD in functional brain connectivity. https://doi.org/10.31234/osf.io/4tfmn
18. Vandewouw, M. M., Brian, J., Crosbie, J., Schachar, R. J., Iaboni, A., Georgiades, S., Nicolson, R., Kelley, E., Ayub, M., Jones, J., Taylor, M. J., Lerch, J. P., Anagnostou, E., & Kushki, A. (2023). Identifying Replicable Subgroups in Neurodevelopmental Conditions Using Resting-State Functional Magnetic Resonance Imaging Data. JAMA network open, 6(3), e232066. https://doi.org/10.1001/jamanetworkopen.2023.2066
19. According to Stimpunks Foundation Neurokin is: “a term that refers to the people who share your neurotype: dyspraxia, ADHD, autism, neurotypical.”
20. Native Land Digital
21. Support starts with educating yourself about history, and being willing to sit with uncomfortable truths. It can then include things like: learning about cultural appropriation, and commit to not engaging in and perpetuating cultural appropriation; committing to calling people in to conversations; educating others, honoring Native folks on holidays such as Indigenous People’s Day, considering the implications of celebrating holidays such as Thanksgiving, or the Fourth of July; making land acknowledgements, having conversations with people about what you learn; financial support; uplifting and amplifying Native voices and stories; understanding and supporting Land Back efforts; researching and supporting Native causes, including supporting and advocating Native-led for legislation changes. Some options for financial support of Native communities on Wahpekute land are here, here, here, here, here or here; Chumash land here; National.
