AUDHD
DESCRIPTION:
AUDHD: Autism and ADHD at the same time – a complex combination. Symptoms, diagnosis and dealing with this particular constellation.
ADHD: When autism and ADHD collide – the silent battle in the mind
In modern psychology, we are experiencing a paradigm shift: it is increasingly recognised that ADHD and autism not only exist separately, but can also occur together. This phenomenon, often referred to as AUDHD by the community, presents unique challenges for those affected.
What it's all about:
· Why this combination is so often overlooked,
· How the conflicting needs manifest themselves in everyday life, and
· Why an accurate diagnosis is key to greater self-acceptance and a higher quality of life.
It's about the complex overlap of these neurobiological characteristics and the path to greater clarity.
What does the term AUDHD mean?
The term AUDHD is not an official medical term from the ICD-10 or DSM-5, but a neologism coined by the neurodiversity community. It describes the simultaneous presence of autism (autism spectrum disorder, ASD) and attention deficit/hyperactivity disorder (ADHD). For a long time, the prevailing opinion in clinical practice was that these two diagnoses could not be made simultaneously. It was only with the updating of diagnostic manuals (such as the DSM-5 in 2013) that it was officially recognised that ADHD and autism can coexist – a condition known as comorbidity.
For those affected by AUDHD, this often means a life full of inner contradictions. While one disorder cries out for novelty and stimulation (ADHD), the other longs for routine, predictability and calm (autism). It is as if the accelerator and brake are being pressed at the same time. This overlap means that the symptoms can mask each other, making it extremely difficult for outsiders and even professionals to recognise neurodivergence.
Why has the combination of ADHD and autism been overlooked for so long?
Historically, diagnosticians tended to focus on the most obvious behaviour. A child who couldn't sit still was diagnosed with ADHD. A child who had difficulties with social interaction was classified as autistic. Outdated diagnostic criteria often ruled out the possibility that both disorders could be present. Many adults who visit the practice today have therefore spent decades in uncertainty.
In addition, the presentation of ADHD is often atypical. The impulsivity of ADHD can mask the social withdrawal of autism, making the person appear more extroverted than a "typical" autistic person. Conversely, the need for structure in autism can partially compensate for the chaos and disorganisation of ADHD. This mutual masking means many neurodivergent individuals fall through the cracks and receive the correct assessment only in adulthood, often after burnout.
Which symptoms of ADHD conflict with autism?
The core characteristic of AUDHD is internal conflict. A classic example is the need for routine. An autistic person often needs fixed routines to feel safe and avoid sensory overload. However, the brain of someone with ADHD quickly becomes bored with repetition and seeks the dopamine rush of novelty. The result is often a painful cycle: plans are made to create structure, but these are broken almost immediately because they feel like a prison.
This conflict is also evident in the area of special interests. Autistic people are known for their deep, long-lasting interests (monotropism). However, when ADHD is added to the mix, their attention span can be shortened. They throw themselves into a new hobby with hyper-focused passion, buy all the equipment, only to lose interest abruptly two weeks later. This shift between intense enthusiasm and sudden distractibility is often frustrating and difficult to explain for those affected.
How do the neurobiological foundations influence each other?
ADHD and ASD are both neurological developmental disorders that are deeply rooted in the way the brain processes information. ADHD often involves a lack of available dopamine in the prefrontal cortex, leading to problems with executive function (planning, impulse control). Autism, on the other hand, is often associated with different brain connectivity, leading to a more intense perception of sensory stimuli and details.
When these two profiles come together, a unique neurobiological dynamic emerges. The executive function impairments of ADHD (such as forgetfulness) can cause enormous anxiety in an autistic person, as mistakes or unpredictability are perceived as threatening. At the same time, the hyperactivity of ADHD can cause the person to constantly put themselves in situations that exceed their sensory limits, leading to chronic exhaustion. It is a constant navigation between under-stimulation (boredom) and over-stimulation (overload).
What role does "masking" play in diagnosis?
Masking (or compensation) is one of the main reasons for late diagnoses. Neurodivergent individuals, especially women and "high-functioning" individuals, learn early on to suppress their symptoms in order not to stand out in a neurotypical world. With AUDHD, masking is particularly complex, as the symptoms sometimes influence and neutralise each other.
For example, a person with ADHD might compensate for their ADHD-related unpunctuality with extreme autistic control and anxiety, making them appear overly punctual. Or they might use their autistic analytical skills to learn social scripts, thereby hiding their social insecurities. However, this constant acting takes enormous cognitive energy. Outwardly, the person appears functional, but inwardly, they are often on the verge of collapse. If diagnosticians only observe behaviour in the consulting room and do not question the inner effort, neurodivergence is frequently overlooked.
Why are misdiagnoses such as depression or borderline personality disorder so common?
Before the correct diagnosis of AUDHD is made, many patients have gone through an odyssey of misdiagnoses. Anxiety disorders or depression are often diagnosed. However, these are usually secondary conditions resulting from the chronic stress of living as a neurodivergent person in an unadapted world. The emotional dysregulation associated with AUDHD – rapid mood swings, outbursts of anger or tears when overwhelmed – is also often misinterpreted as borderline personality disorder or bipolar disorder.
The difference is crucial: in AUDHD, mood swings are usually reactive to the environment (e.g. sensory stress or changes in plans) and are shorter in duration than in affective disorders. Highly sensitive individuals are also often pigeonholed in this way without checking whether they actually have an undiagnosed autism spectrum disorder or ADHD. Treating "depression" with medication or standard therapy alone is often insufficient, as the underlying neurological structure is not taken into account.
What does a differentiated diagnosis look like in adults?
Getting an official diagnosis in adulthood is often a long process. The diagnostic criteria for ADHD and autism are still heavily focused on children. A qualified diagnostician must therefore dig deep and consider not only current symptoms, but the entire life history. When diagnosing ADHD, it is essential to recognise the nuances: What were the problems like in childhood? How were they compensated for?
It is not enough to fill out questionnaires. Clinical interviews are needed that specifically ask about inner experiences. For example: "Are you organised because it comes easily to you, or because you panic when you are not?" This often reveals the difference between neurotypical behaviour and a compensatory mechanism. To do justice to both diagnoses, professionals need to understand that the absence of specific classic symptoms of ASD (such as avoiding eye contact) may be masked by learned behaviour. In contrast, ADHD symptoms may be less physical and more internal restlessness.
What happens if only ADHD or only autism is diagnosed?
If only one of the two conditions is recognised, treatment can paradoxically reveal new problems. A common phenomenon is that patients receive an ADHD diagnosis and are treated with stimulants (such as Medikinet or Elvanse). When the medication takes effect, the inner chaos and "fog" of ADHD subsides. Suddenly, however, the autistic traits become more prominent.
Without the constant drive of ADHD, the patient may suddenly notice how much noise bothers them, how difficult small talk is for them, or how much they hate change. The autistic person inside becomes "visible." This can be confusing ("Is the medication making me more autistic?"). In fact, it is often a case of unmasking: ADHD has previously masked the autism. If these connections are not recognised, it can lead to treatment discontinuation or uncertainty about treatment. It is therefore essential to consider autism and ADHD as a possible package deal.
How can people with AUDHD cope with everyday life?
The key is not to "cure" yourself, but to adapt your life to your own neurodiversity. For people with AUDHD, this means finding strategies that satisfy both sides.
· Flexible routines: Instead of rigid schedules (which ADHD hates), rough structures or "anchor points" in the day (which give autism security) help, leaving room for spontaneity in between.
· Sensory management: Noise-cancelling headphones or sunglasses are not accessories; they are tools for regulating the nervous system to prevent sensory overload.
· Accept stimming: Repetitive movements or noises (stimming) help reduce stress. It is important not to suppress these mechanisms.
· Social batteries: Neurodivergent individuals need to learn to respect their limits. It is okay to leave parties early or cancel meetings if you don't have enough energy.
Is AUDHD a disability or a superpower?
The debate about neurodiversity is often polarised. Is it a disease or a gift? The reality lies somewhere in between. AUDHD undoubtedly presents challenges that are considered diagnostically relevant and limiting in the ICD system. Difficulties in executive function and social interaction can cause real suffering.
But at the same time, people with AUDHD often have extraordinary abilities: creativity, the ability to work with hyperfocus, a strong sense of justice and the gift of recognising complex patterns that neurotypical people miss. The brain works differently, not necessarily worse. With the correct diagnosis and treatment (be it therapy, coaching or medication) and, above all, self-acceptance, those affected can stop fighting against themselves and start using their unique way of being.
The most important points in brief
· AUDHD refers to the co-occurrence of autism and ADHD, which, for a long time, was considered diagnostically impossible.
· The symptoms of ADHD (chaos, curiosity) and autism (structure, routine) often contradict each other and mask each other.
· Classic symptoms of ASD are often less visible in AUDHD, leading to late diagnoses or misdiagnoses.
· Treating only one disorder (e.g. only ADHD) can exacerbate or reveal the symptoms of the other.
· An understanding approach to one's own neurodivergence, adapted to individual needs, is more important than trying to appear "normal".
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