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?

They are different but often overlap.

Autism can be:

Social communication Issues
Language issues
Inflexible thinking

Adhd is executive function issues: concentration, focus, procrastination, interrupting etc

Not sure I agree with the 'adhd needs to be in 2 settings'. I have both (Autism isn't diagnosed) and adhd symptoms weren't really present at school, except I would fidget with my legs under the table.

It’s worth getting on to somewhere like reddit and looking up “audhd dexamphetamine” or the equivalent trade name, like Elvanse. People have a wide range of experiences. Broadly my experience mirrored a lot of others’ - the medication heightened my senses, even at a low dose (autistic people can tend to be more sensitive to medication). So all the lights felt brighter, noise felt louder, clothes felt itchier and the dry mouth side effect, which is very common, made my mouth feel like sandpaper. Many autistic people are sensitive to some of the above anyway under normal conditions - having your senses cranked right up is very unwelcome. Lord knows if the medication improved my ability to concentrate - I was too overwhelmed with the above. I also simply felt more autistic - like the ADHD side of me which makes me friendly and able to chat and be a bit spontaneous was severed suddenly, and I was left with just the autistic side.

There are other ADHD medications - second line, third line, subsequent ones which specialist psychiatrists can prescribe. But my experience put me off to the extent that I am not willing to try them.

That is such a helpful post. Thank you so much @TheWayTheLightFalls . I'm amazed never to have heard of this issue before and it would be so relevant to DS. I appreciate your reply a lot.

I haven’t read all. Upwards of 50 percent of autistic individuals also have ADHD there is an overlap but there is also a co-occurrence. 20 years ago you could not diagnose both so there is still an element of over attributing features of ADHD to autism. Autistic people are often more sensitive to meds but there are options that can work and support if that is indicated.

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.

@WomanIsTaken My reason for wanting to make the distinction is because I think ADHD medication may be beneficial. Although after reading all these comments maybe I’m wrong about that.

DS has come to physical harm more than once due to what I see as impulsive/risky behaviour and I fear for his safety. I want to be able to support him in the best way possible and to do that I feel I need to fully understand the reason behind the behaviours.

My 13 year old has been medicated for over 6 mths now and it has made a massive difference tonher levels of aggression, mindfulness and awareness. From a parent whose child was in burnout from bullying at 2 mainstream and could abs not control her outbursts.

So far all the comments on here describing AuDHD are how I would describe DS who is 12 years old now, as this has been going on years!

But I’m being told all his behaviour could be attributed to autism alone.

A few people have mentioned executive dysfunction - losing things, disorganisation etc. DS manages to lose stuff between leaving the house and getting in the car. When I specifically raised this as a potential indicator of ADHD I was told executive functioning is equally part of ASD.

The conflict between the two can be pretty miserable. I was diagnosed with ADHD last year. Currently in the latter stages of ASD review on the recommendation of the psychiatrist I saw for my ADHD assessment.

I can be very impulsive but also have a fear of rule-breaking. When the impulsiveness 'wins' this is followed by huge anxiety and catastrophising about having broken the rules, which then manifests physically in not being able to sleep or settle, upset stomach and so on.

I struggle in busy social situations as I find them overwhelming and very stressful. I am not good at small talk although people say I am friendly and chatty. The effort it takes to try and 'be normal' is huge. I tend to go home early as more than a couple of hours and it becomes too much. But I will impulsively agree to go to things and then regret doing so

I get bored very easily and have the attention span of a goldfish, unless it's something that I feel is worth spending time on, at which point I'll be immersed in it even if the house is burning down. I'm a champion procrastinator, but fear of missing a deadline or not doing something right means I'll leave it to the last minute, and then work all night to get it done.

I have routines that I stick to because they are comforting - re-watching and re-reading things I have already seen because I like the familiarity. I go through food obsessions where I'll eat the same thing for days on end, but there are certain things I can't cope with. I won't touch mashed potato that I haven't made myself or that isn't from a supermarket, because even the tiniest hint of graininess or minute lumps, makes me feel ill. All of my socks are identical because I finally found some seamless ones and that I like, and I have to cut the labels out of clothes because I can't wear them otherwise.

All of the above has become much easier for me to deal with now I know the reason why, and meds have also helped. I feel a lot happier now that I have an explanation, having spent my whole adult life wondering why I feel so unhappy and the odd one out all the time. My work is very structured which helps me feel more organised, and I have similar routines at home which have helped.

My DH is AuDHD. Our DS4 is diagnosed with ASD and I strongly suspect ADHD too, but we've been told we have to wait until he is 6 to explore that because the behaviours are so hard to separate at a young age.

I'm not in my DHs head obviously but my take is always that while he has the rigidity of thought you'd expect in someone with ASD, he's in many ways utterly chaotic and resistant to routine in daily life in ways that aren't usually associated with autism. The idea of things having a place is foreign, he loses everything, he forgets instructions two seconds after they are given, he has no idea how long any task takes, for the longest time he didn't cook a recipe with more than three steps because it just overwhelmed him. I'm making him sound like he barely functions but he's a super successful professional because he hyper focuses on work and expends almost all his executive functioning ability on that.

@SalsaLights "I can be very impulsive but also have a fear of rule-breaking. When the impulsiveness 'wins' this is followed by huge anxiety and catastrophising about having broken the rules, which then manifests physically in not being able to sleep or settle, upset stomach and so on."

This could also very much describe by AuDHD DH, especially in his twenties. He'd drink to excess, do something impulsive and then fret about it for days afterwards. I know the latter isn't uncommon for young men but the anxiety afterwards was horrific.

Yes it really is so awful. Even now, when I know in my head there's a reason for it, I can't stop or control it.

I honestly don't understand how anyone who is autistic isn't ADHD.

How could an assessment possibly distinguish between:

• autistic inertia and being inattentive due to ADD

Or

• hyper focus due to ADHD and special interest due to being autistic

Or

• stimming due to sensory needs due to being autistic and stimming due to hyperactivity in ADHD

Also I believe executive functions difficulties and poor working memory can be due to any Neurodivergent diagnosis.

I don’t want to derail the thread, but oh lord, I relate to your last paragraph so much!!
‘crave routine and sameness while also needing dopamine and excitement’ and the brain that never shuts up!!!

I am newly diagnosed ADHd with autistic traits (I couldn’t face pushing for both at the same time, so thought I would focus on adhd diagnosis first …)

Following with interest.

I suspect we will have the exact same issue with DS1 down the line. Diagnosed autistic, dyspraxic, high IQ and demand avoidant at 4.

In comfortable environments he is hyperactive, impulsive, overtly emotional and has a very low frustration tolerance. Can’t cope with being on his own at all. Needs tons of novelty and stimulation. School only see a tiny fraction of what we do and feel it is all due to sensory issues associated with ASD.

The ASD traits are subtle. His speech is phenomenal and, maybe classically for PDA profile, he is surface level sociable. Stimming is subtle. His need for routine and predictability is subtle, especially given his surface level love of novelty. Family friends were shocked when he was referred and a lot don’t believe it.

I think the difference in home and school will mean we never get referred, which is a shame as I would like a formal assessment.

I think it’s very likely that there is no clear distinction at all between ASD and ADHD. That’s often how things go with diagnoses of mental conditions. A lot of people now believe that schizophrenia and manic depression are the same thing. The way the lines are drawn are very arbitrary and change hugely over time. These are not fixed conditions existing independently of time and place. Barely anyone with an ASD diagnosis would have met the criteria for diagnosis as it was in the 1970s, for example.

I just want to say that ADHD medication has been life changing for my ASD son. He can now enjoy a conversation, tolerate queues, go on holiday and listen in class. I have seen no negatives at all from the medication and my son really notices all the positives.

I can be very impulsive but also have a fear of rule-breaking. When the impulsiveness 'wins' this is followed by huge anxiety and catastrophising about having broken the rules, which then manifests physically in not being able to sleep or settle, upset stomach and so on.

@SalsaLights I recognise this in DS. He will impulsively make poor choices even when he knows the consequences then feel so bad about himself afterwards that he has self harmed. It’s very difficult.

I'm not in my DHs head obviously but my take is always that while he has the rigidity of thought you'd expect in someone with ASD, he's in many ways utterly chaotic and resistant to routine in daily life in ways that aren't usually associated with autism.

@BusMumsHoliday I really relate to this paragraph, I have ASD but I’m chaotic. I think my Mum would agree, she’s always found my resistance to routine confusing. I’ve never considered myself to have ADHD and I’ve always put my disorganisation and forgetfulness down to being dyslexic.

In comfortable environments he is hyperactive, impulsive, overtly emotional and has a very low frustration tolerance. Can’t cope with being on his own at all. Needs tons of novelty and stimulation.

@VivaVivaa This is very much how I would describe DS

I have ASD myself and I also have an another, older DS with ASD. The main difference is I have low support needs and he has high support needs but we are also similar to each other.

Then along came DS3 and he was very different to us - I think this is why I’ve always thought he had ADHD, I didn’t recognise his autism at first because he is like opposite to DS1 and I.

I do wonder if you are right @YellowHeaven and there isn’t a clear distinction between ADHD and autism