Understanding the Intersection of Autism and ADHD

About the Author

Cornelia Elwood, MA, is a certified autism specialist, therapist, and coach working with neurodivergent individuals and their families in her private practice in Massachusetts. She previously worked at MGH Aspire and AANE, where she currently serves on the Board. Cornelia
co-authored ,Take Charge of Treatment for Your Child with Asperger’s (ASD) and is the mother of an autistic adult.

Cornelia can be contacted at [email protected]

I have had the privilege of partnering with many individuals who navigate the complex intersection of autism and attention deficit hyperactivity disorder (ADHD) and their parents as a clinical mental health counselor, a coach specializing in autism, and as a parent of an Autistic adult. This journey has taught me valuable lessons about understanding the interplay of neurological traits, extending compassion, and celebrating the richness of neurodiversity. 

Recent research indicates that between 50 and 70 percent of individuals diagnosed with autism have a co-occurring diagnosis of ADHD. This discovery suggests the need for tailored approaches that embrace the unique strengths and interests of these individuals while supporting their complex challenges. 

Strengths

Individuals with autism and those with ADHD possess many positive traits. Autistic individuals frequently exhibit qualities such as loyalty, direct communication, and an ability to adhere to protocols and rules. Individuals with ADHD often demonstrate strengths in spontaneity, innovative problem-solving, energy, and enthusiasm. When the traits of autism and ADHD co-occur, informally known as AuDHD, a unique array of abilities emerge. 

The strengths of AuDHDers can enrich their own lives and have a positive impact on those around them. Many have high energy and creativity, along with humor and a willingness to take risks, which brings innovation, dynamic thinking, and vibrancy. Their experiences engaging with people who may not always understand or accommodate their needs often foster deep compassion for others, particularly those who are often misunderstood. Their ability to hyperfocus on areas of interests can lead to remarkable achievements and successful careers. 

Challenges

Amidst these strengths, AuDHDers often have traits that make navigating daily life challenging. While Autistic traits often include differences in social interactions, communication, sensory processing, and cognitive operations, ADHD traits frequently include issues with attention, differences in how they act upon impulse, and executive functioning. The co-occurrence of autism and ADHD can magnify these challenges, resulting in reduced social, daily living, and executive functioning capabilities. When AuDHDers have to navigate daily life without support or accommodations, it can have a profound impact on self-regulation, mental health, sleep, friendships, and academic and professional performance. 

I have a client whose profession aligns with their strong interest. They have deep knowledge and an extraordinary ability to identify patterns and creatively solve problems, making them valuable to their employer. Despite their expertise, they face challenges at work because their communication, attention, organization, anxiety, sensory sensitivity and emotional regulation are not understood. These difficulties have led to strained relationships and resulted in a performance warning. 

Conflicting features of autism and ADHD can spark internal struggles, leading to frustration. For example, a person may have an ADHD trait which seeks new experiences, but their Autistic trait yearns for predictability and consistency. I worked with someone who felt anxious due to their internal tug-of-war between their Autistic strong need for order and their difficulty organizing their life from their ADHD traits. 

Support

While AuDHD challenges can be complex, parents, caregivers, and family members can consider these seven tips to customize support for the  AuDHDer in their lives:

• Celebrate strengths. AuDHDers frequently face criticism, such as being unfairly labeled rude or disrespectful, due to misunderstood challenges and behaviors. This disapproval can lead to diminished self-esteem with long-term consequences. Authentically recognize their strengths to counteract judgment and celebrate their inherent value, empowering them to appreciate themselves without feeling the need to hide or mask their true selves.  Strive to offer significantly more positive feedback, emphasizing encouragement and support over criticism. 
• Build knowledge and extend compassion. Understanding the AuDHDer’s unique set of traits fosters compassion. For example, the behavior, which some might inaccurately label as “disrespectful,” may stem from challenges related to a person’s traits.  Recognizing that such behavior arises from difficulties like misinterpreting social cues or experiencing anxiety, rather than intentional rudeness, can help cultivate empathy and understanding  for the extra effort they have to exert.  In addition to navigating their trait-related challenges, they also have to cope with the accompanying judgment. Increasing knowledge of their traits allows families to provide tailored support, honor their neurodiversity, and promote empathy and understanding from others.
• Embrace interests. Recognize that the AuDHDer’s passions are keys to enjoyment and relaxation and pathways to connection and careers. When individuals immerse themselves in their interests, they can cultivate expertise, which enhances their life and opens doors to opportunities. 
• Cultivate a neurodiversity-informed support team. Collaboration among school staff, family, and professionals is vital for providing compassionate, holistic support. Identify the aspects of the AuDHD traits that impacts the person the most and prioritize support accordingly. For example, determine if it may be appropriate to engage therapists for psychoeducation and coping strategies, coaches for executive functioning and daily living skills, special educators for school challenges, and psychiatrists for medication evaluation. 
• Support executive functioning. AuDHDers benefit from tailored systems and strategies to stay organized and navigate daily activities. Create personalized tools such as visual schedules, checklists and project roadmaps, and use technological solutions such as alerts and organizational apps to provide structure, alleviate anxiety, and enhance productivity. Teach the AuDHDer gradually how to create and use these types of tools independently. 
• Practice and promote self-care. Recognize the impact of AuDHD traits on everyone in the family. Responding when emotions are high can often lead to unsuccessful communication. In addition to professional support, include whatever physical activity, meditation, or mindfulness practices work for those involved to promote emotional well-being and self-regulation abilities for everyone. 
• Foster connections. Encourage connections with other neurodivergent individuals and communities to foster a sense of belonging. Organizations such as AANE and neurodiversity-focused employee resource groups offer invaluable opportunities for support, community, and resource sharing.

Conclusion

Navigating the intersection of autism and ADHD requires compassion, understanding, teamwork, and a commitment to promoting self-acceptance and resilience. Embrace the strengths and interests of AuDHDers, provide them with the support they need, and empower them to navigate life with confidence and grace. Together, we can celebrate the beauty of neurodiversity and continue to create environments where all individuals can thrive.

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Citations

Arthur, S. (2023). Do I have ADHD, Autism, or Both? PsychCentral. https://psychcentral.com/adhd/can-you-have-adhd-and-autism

Attwood, T., Garnett, M. (2023). Autism and ADHD. https://attwoodandgarnettevents.com/lessons/autism-and-adhd-pt-1/

Attwood, T., Garnett, M. (2023). Autism and ADHD. https://attwoodandgarnettevents.com/lessons/autism-and-adhd-pt-2/

Hours et al. (2022). “ASD and ADHD Comorbidity: What Are We Talking About?” Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.837424

Krakowski et al. (2022). “Characterizing the ASD-ADHD phenotype: measurement structure and invariance in a clinical sample.” The Journal of Child Psychology and Psychiatry, 63 (12), 1534 – 1543. https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1111/jcpp.13609

Kutscher et al. (2014). Kids in the Syndrome Mix of ADHD, LD, Autism, Tourette’s, Anxiety, and More! The one-stop guide for parents, teachers, and other professionals. (2nd edition). Jessica Kingsley Publisher.

Neff, M. A., (n.d.). ADHD and Autism: How ADHD and Autism are Related. Neurodivergent Insights. https://neurodivergentinsights.com/adhd-infographics/adhd-and-autism-overlap