Dr Sai Achuthan, Consultant Psychiatrist at ADHD Health Clinic, specialises in autism spectrum disorder and ADHD. He puts the classification issue plainly: “AuDHD is not a recognised formal diagnosis under the DSM-5 and the ICD-11.” In practice, however, many clinicians and neurodivergent communities use the term because it describes a pattern that is increasingly understood and researched: the shared presence of autistic traits and ADHD traits, and the way those traits interact across attention, routine, sensory processing, social experience and emotional regulation.
Why AuDHD can be hard to recognise
Autism and ADHD can look similar at first glance. Both can involve executive function difficulties (planning, organising, starting tasks, completing tasks), attention challenges, emotional dysregulation and social difficulties. Because of this overlap, people are sometimes given one diagnosis while the other is missed. Dr Achuthan describes a common scenario in assessment: “When you go for an ADHD assessment… you will try to present so much more in regards to the ADHD, but forgetting all the other parts of the autism you are actually struggling with.” The same can happen the other way around, when autistic traits are identified but ADHD-related impulsivity, restlessness or time-blindness is framed as anxiety or stress.
This matters because partial recognition can lead to partial support. Someone may receive advice that fits autism but not ADHD, or medication for ADHD without adequate consideration of autistic sensory sensitivities, communication needs, or the impact of routines and rigidity. A more complete understanding helps clinicians tailor interventions and helps individuals make sense of why their experiences have felt contradictory or confusing.
How common is AuDHD?
Co-occurrence is not rare. Research discussed by the clinicians suggests ADHD symptoms appear in around one-third of autistic children. In adults, around three in ten autistic adults also meet criteria for ADHD. Looking from the other direction, estimates suggest that 20% to 50% of adults diagnosed with ADHD may meet criteria for autism or show significant autistic traits, even where those traits fall below strict diagnostic thresholds.
Despite this, identification is still inconsistent. Many people with co-occurring autism and ADHD report only being diagnosed with one condition, often later in life, after years of being told they are “coping”, “anxious”, “too sensitive”, “lazy”, or “not living up to their potential”. A growing public awareness has led to increased demand for assessments, and waiting times can vary significantly across regions. The effect is that people who need clarity and support often face long delays, which can compound distress and burnout.
The “push–pull” experience of AuDHD
One of the most distinctive features of AuDHD is that the traits can pull in opposite directions. Autism often brings a need for predictability, routine, and control over the environment. ADHD often brings novelty-seeking, impulsivity, and difficulty sustaining routines even when they are valued. Dr Achuthan describes this internal conflict from lived experience: “I have planned my routines. I want to do it but I can’t do it.” Many people with AuDHD recognise that pattern: they thrive when structure is in place, yet struggle to initiate, follow through, or remain consistent.
This push–pull can show up in everyday life in subtle ways. A person might create strict systems for organisation, then find themselves unable to stick to them. They might become intensely focused on a new interest, invest time and money in it, and then lose momentum rapidly. They may want social connection yet feel stuck in conversation, unsure what to say, and drained by the unpredictability of social interactions. They may appear outwardly “fine” while feeling internally overloaded.
Masking and why women are often missed
Dr Shyamal Mashru, Consultant Psychiatrist and Founder of ADHD Health Clinic, specialises in adult ADHD, anxiety, depression, OCD and trauma. He highlights how masking can delay or prevent recognition of AuDHD, particularly in women and in high-achieving individuals. Masking involves consciously or unconsciously suppressing neurodivergent traits to fit in. Dr Mashru explains that “individuals with high IQ often develop sophisticated coping strategies that hide neurodivergent traits,” which can make difficulties less visible to others and even to the individual themselves.
In women, the pattern often involves internalising difficulties rather than showing “classic” hyperactivity. Symptoms may present as anxiety, perfectionism, emotional overwhelm, fatigue and low self-esteem. Dr Mashru notes that these compensation strategies can be “temporarily adaptive”, but they come at a cost: “they lead to exhaustion and overlooked difficulties that eventually leads to emotional overwhelm and burnout.” Over time, chronic masking can contribute to depression, relationship strain, and a sense of not knowing who you are without the performance of coping.
Cultural context matters as well. Communication norms, expectations around behaviour, and the meaning of eye contact can differ widely between communities. Distress may be expressed through physical symptoms rather than direct descriptions of attention difficulties or sensory overload. These factors can further obscure AuDHD and make culturally sensitive assessment essential.
Assessment: why experience and depth matter
Because AuDHD involves overlapping traits and frequent masking, assessment should be comprehensive. Questionnaires can help, but they are not sufficient on their own, particularly where someone has learned to camouflage traits or where cultural and gender factors affect how questions are answered. Dr Achuthan emphasises that “spending time with the patient is very, very important.” That time allows exploration of developmental history, education, work, relationships, sensory experiences, coping strategies, and the impact on daily functioning.
A robust evaluation also includes differential diagnosis. Emotional dysregulation can be confused with mood disorders; social fatigue can be labelled as anxiety; longstanding relational patterns may be misread as personality disorder. In AuDHD, it is especially important not to stop at the first plausible explanation. Where possible, collateral history from someone who knew the person in childhood can be helpful, but the aim is not to “prove” a label; it is to understand the person’s lifelong pattern and what support will be most effective now.
Medication and treatment considerations in AuDHD
ADHD medication can be very effective, but AuDHD requires careful prescribing and monitoring. Dr Mashru explains that “stimulant medications… [are] first line of treatment,” but also notes that “stimulants may actually have reduced effectiveness in autism compared to ADHD-only cases.” People with autistic traits can be more sensitive to side effects, making a gradual, closely monitored titration essential. Appetite suppression, sleep disturbance and mood changes are common areas to watch.
Non-stimulant medication options can be useful when stimulants are not tolerated or contraindicated, and they may be particularly helpful where emotional dysregulation is prominent. Another important clinical observation is that when ADHD symptoms reduce, autistic traits can become more noticeable. Dr Mashru describes how “if you’re medicating someone… and you take away the ADHD, the ASD starts looking more prominent.” This can be confusing if it is not explained in advance. It does not mean medication has caused autism; it often means the ADHD traits were masking underlying sensory sensitivities, rigidity, or social fatigue.
Co-occurring anxiety and depression are common in AuDHD and may be treated with psychological approaches, medication, or both. SSRIs can be appropriate for anxiety and depression, but they do not treat core ADHD symptoms, and their benefit for autism-specific repetitive behaviours is limited. As always, treatment should focus on the drivers of distress. If anxiety and low mood are largely rooted in unmet neurodevelopmental needs, interventions that improve functioning, self-understanding, and environmental fit can be just as important as medication.
If you suspect you may have traits of both ADHD and autism, a combined assessment can offer clarity and a joined-up plan. Some people prefer the convenience and privacy of an online appointment, fitting the process around work, family life, or travel. Others feel more comfortable meeting their clinician face-to-face and having that in-room conversation. For that reason, ADHD Health Clinic offers both online and in-person options, so you can choose the setting that feels right for you.
Book an Online Combined Adult ADHD and Autism Assessment.
Book an In-Person Combined Adult ADHD and Autism Assessment
What AuDHD recognition can change
For many people, identifying co-occurring autism and ADHD is not about collecting labels. It is about clarity. It can explain why someone has always felt “too much” and “not enough” at the same time; why structure helps but is hard to maintain; why social connection is desired but exhausting; why burnout seems cyclical; and why previous approaches may have helped only partially.
Looking ahead, clinicians emphasise the need for improved diagnostic tools that better reflect women’s presentations and cultural context, alongside stronger research into co-occurring profiles and outcomes. The aim is practical and humane: earlier recognition, reduced stigma, and tailored support that helps people function well and thrive.
