What’s the difference between ASD and AuDHD?

[DooDahFlumps]

Genuine question as I’m getting very confused! And curious as to how anyone is diagnosed with both ASD and ADHD given the overlap that exists between them.

The background to my question is:
When DS was around 3 years old it was clear he was neurodivergent - I thought he had ADHD. He was referred for assessment when he started school after a referral to Early Help made by school due to concerns around his behaviour.

Fast forward to his ADHD assessment and we were told he didn’t have ADHD. The reason cited for this was because there was no evidence of ADHD at school and for diagnosis it needs to be present across more than one setting. This was based on school stating zero issues (which is contradictory to school reports/parents evenings and the original referral made by school).

It was felt that his difficulties were better explained by ASD and so we had an assessment for that and he was given a diagnosis of ASD. We were told that it was noted throughout the assessment that he was impulsive and that this impulsivity wasn’t explained by autism. I then asked for a second opinion on the ADHD given that his impulsiveness is one of the most challenging aspects of his behaviour.

We still haven’t been given a diagnosis of ADHD and I’m basically being told that all his issues are ASD

Excessive movement = sensory seeking behaviour
Not paying attention/getting sidetracked = following his own agenda
Losing stuff/disorganisation = executive function difficulties which are also a feature of ASD
Emotional dysregulation = also a feature of ASD

Even impulsiveness I’m now being told is driven by his ASD whether that be due to sensory seeking/following own agenda/emotional dysregulation.

If every symptom of ADHD is also a symptom of autism how are people getting diagnosed with both?

My DD has AuDHD.

She was diagnosed with adhd first. Then medicated.

A number of issues remained after multiple years of medication and she is now diagnosed ASD also.

I'm wondering this as well. Both of my children have suspected ASD but they both feel like they have adhd. I've googled the subject to death and I'm still none the wiser.

@Octavia64 what issues remained after medication? And is medication helpful or did it just unmask other issues?

This is obviously my main reason for wanting to know whether or not he has ADHD as if there is a medication that could help we want it.

Medication was helpful.

She was diagnosed a lot later.

She'd dropped out of a levels due to severe pain fatigue and anxiety. The pain and fatigue turned out to be due to a serious autoimmune condition. The anxiety plus difficulties with attention led to an adhd assessment and meds for adhd and anxiety (amytriptyline and duloxetine plus the adhd meds).

This helped focus and ability to concentrate and she was titrated to an appropriate dose and now takes long acting in the morning and short acting around 4pm.

There remained quite a lot of anxiety especially around social situations and she didn't go out and interact with people in person much. Interactions in person were... odd.

My understanding - and I’m not saying it’s right. - is that someone who is AuDHD has ADHD and is autistic.

Yes, I understand that someone with AuDHD has autism and ADHD. I asking how they differ in terms of presentation. What additional difficulties does someone with both ADHD and autism experience?

I'm an AuDHD adult, diagnosed in adulthood. In my case I had a battery of diagnostic tests for one, then the other, with the aim of separating out ADHD issues from autism issues. And anecdotally standard-issue ADHD meds wreck havoc on autistic brains, so that's another "helpful" indicator.

More generally - it's complicated. There are lots of overlapping behaviours, with underlying causes, and it's difficult to tease these out esp in children. I would focus on trying different strategies for both, and just keeping what works. It's clearer for adults.

Additional difficulties - without meaning to sound like a special snowflake you never quite know whether you wake up more autistic or ADHD on any given day. Strategies for ADHD sometimes work, sometimes not. Likewise for autism. Medication - as above. Giving stimulants to autistic people is not a fun party! Sometimes the two conditions broadly balance each other out, sometimes the opposite. I forever feel like I'm trying to control a giant unruly dog that pulls me in the direction it wants to go, and I can only follow.

(I work, fwiw. And broadly function. Most people don't know I'm diagnosed with either. But I use many coping mechanisms and definitely am not anywhere near my full potential.)

Which were you diagnosed with first @TheWayTheLightFalls? I’m thinking is someone more likely to diagnosed with both if they were diagnosed with the ADHD first?

None of it makes any sense to me

My 13 yr old was diagnosed with AUDHD at the same time. I suspected autism but since her diagnosis I see more of her adhd ( perhaps that's with her now being a teen).
He adhd makes her impulsive, quick tempered and have high energy. Her autism makes her awkward in social situations, masks heavily, withdraw and burns out quickly.
It so hard for her having both because one condition fights against the other.
Every neurodiverse person is different though and it manifests differently. I believe we are all neurodiverse in some shape or form. We learn to fit into a neuro typical world so have to adapt to Social situations.

How can we all be neuro diverse but trying to fit into a neurotyical world?

@DooDahFlumps it's difficult, in my opinion (parent, not professional in this area) because in order to "diagnose" the type of brain someone has, doctors had to create a list of features and these overlap between ADHD and autism. In real life, it's not as neat. So really it's about working out what might help the unique child in front of you to survive in the neurotypical world.

From your list, not paying attention and movement stands out to me. Especially if the movement seems impulsive. So maybe he has both, or has ADHD features which do not meet the threshold for diagnosis but still affect his ability to behave as school expect etc.

My understanding is that medication is often less helpful for AuDHD anyway, so you may want to look at how to support his executive functioning right now - the "Scattered but Smart" book has lots of ideas on this.

I'm AuDHD. I have contradicting behaviours and difficulties.

I'm an extravert who loves socialising is exhausted and burnt out by socialising.

I am very impulsive and chaotic who hated routines, but without the safety of knowing what to expect, can cause extreme distress.

Just a few examples.

My life has been very difficult and I've only just been diagnosed at age 47

May I ask why specifically you want to make this distinction? I'm asking as DD1 has had a similar journey of school referring for both ASD and ADHD assessment.

An ASD diagnosis was received after 3 years on NHS waiting list and a crash and burn foray into secondary education. DD decided to call it quits and not follow through on the referral for ADHD assessment as she doesn't feel an additional diagnosis will benefit her, especially as she is not interested in medication. I respect her autonomy, and have to accept that this stance means we'll never know whether medication might have enabled her to access education more comprehensively and take some GCSEs ‐she's in no way able to process information and organise her thinking in a way conducive to studying for exams, despite being quite bright.

We feel we've got a good handle on how best to meet her needs irrespective of whether there is an additional ADHD diagnosis, and we've made sure this is reflected in the outcomes and provision outlined in her EHCP.

I think it's a very fine line! I often wonder if one day we'll decide they are one and the same and just present in many different ways.

I was diagnosed with both at the same time.

As I understand it, there is a lot of overlap (executive dysfunction, sensory overload) but also some very distinct differences.

ASD centres around:

-social and communication difficulties
-repetitive/rigid behaviours
-special interests

ADHD is more to do with either attention issues &/or hyperactivity/impulsivity.

The additional difficulties that I face are that the conditions compete against each other so I can crave routine and sameness while also needing dopamine and excitement. My brain also literally never shuts up so I am exhausted. Life is hard.

That's just my opinion from extensive research. I also believe my daughter has Alexithymia which makes it hard for her to explain her emotions and understand others.

We all have expectations of how we should fit in and social norms. We are taught these from born.

Even though autism and adhd have overlapping symptoms, there are also other symptoms which do not over lap. With adhd that would be based around attention span / hyperactivity. If you Google it there are loads of info graphs which show the overlapping and distinctive symptoms. It can also happen that one condition masks the other, this especially happens in girls with both disorders. So the adhd masks the Autism and then when the adhd is treated the autistic traits become more apparent

In my case a psychiatrist suggested that I might have both (I assumed I had ADHD) and referred me to a specialist assessor who assessed for both simultaneously. But that is unusual I think.

DS got an autism diagnosis first, then ADHD. We were told similar at the autism assessment - that the ADHD traits could be explained by the autism diagnosis. However, it was an online assessment during COVID, and they barely interacted with him. We ended up getting him assessed for ADHD too a couple of years later. He clearly has ADHD too (as agreed by assessors, teachers, and everyone we know!)

Given that a large proportion of autistic people also have ADHD, and as assessments have such long waiting lists/are expensive, surely it would make sense to assess for both at the same time...

I find the info graphics very confusing though. They all seem to differ slightly and plenty of the 'only adhd' traits can be explained away by autistic behaviours - e.g. lack of focus = adhd trait but autism can cause lack of focus due to sensory issue, dysregulation, trying to concentrate on something when there are multiple things going on at once. I'm autistic and do not have adhd and I struggled with concentration at school because I found things like the classroom lights and the brightly coloured display boards too distracting (sensory). It is very hard to unpick which traits are autistic and which could be adhd. When you are trying to figure this out with a child who already struggles with communication, it seems like an impossible task.

I have both so I can tell the difference, so it probably is a bit harder with a small child but the professionals should be trained to see the subtle differences. One sign of adhd from my assessment was loosing things frequently I don't think that is on any asd list. Neither Is disorganisation

My dd was first assessed for ADHD as that's what she scored more higher on, on the forms we were given. Though I felt her 'symptoms' were more ASC relatable.

At her ADHD assessment we got told no ADHD and would refer for ASC diagnosis, at ASC assessment she was diagnosed as ASC and ADHD, which shocked us.

All counties do it differently unfortunately as it is based on their practice and the practioneers pov, I think it helped when we got her diagnosis when dd was now 11, (had started the process 4 years earlier) so more history to write about, more observations to note and also dd could give her side. And her AuDHD doesn't impact her daily too much so having a delayed diagnosis wasn't too detrimental.

There is a massive overlap between the 2 and more and more children are being diagnosed as AuDHD. Though my dd adhd is the inattentive side than hyperactive!

The system in general is shocking, I know of adults being messed around getting a combined diagnosis- as they were diagnosed ADHD as kids!

I agree it's really unclear.

At school I struggled to concentrate too. I needed to rock on my chair or doodle at the same time. I have sensory sensitivities and was socially anxious. It wouldn't be obvious from looking at me why I was struggling to concentrate, but I can tell you it was nothing to do with anxiety or sensory stuff.

I was a) bored because the work was too easy, and b) I can only concentrate on verbal info if I can doodle or move around in some way, otherwise it feels unbearable, which I now understand as part of my ADHD. The sensory stuff for me is more things like supermarket lighting/clothing, and the anxiety would only affect me doing group work, at break time, or speaking in front of the class.

If you've got a kid like my DD who is bright and seems articulate, but struggles to recognise or express her feelings, all you might get is "I can't concentrate". With other kids it might just be adults observing that they can't concentrate well. It's such a challenge to unpick it all.

I do know a few people who have been diagnosed with audhd.

There doesn't seem a huge difference in presentation, but I would say they seemed more social and that the adhd seems more noticeable than the autism in these people.

But they thing I have noticed that when they take adhd meds, the autism really shows after. So the communication issues restricted behaviour become more visible.

Thank you for this post. I had no idea that ADHD meds were terrible for autistic brains. DS2 has a diagnosis of autism but has so many ADHD traits that are similar to mine. (I got a late adulthood diagnosis and meds have changed my life.) I was hoping he could start on ADHD meds too but not if they might wreak havoc. Would you mind saying more about how they are incompatible?