For many individuals, the journey to understanding their neurodivergent identity takes unnecessarily long, winding through misdiagnoses and confusion. Or worse still, it doesn’t happen at all, leaving them feeling different, misunderstood, incompetent, or like they’re failing at life.
AuDHD—the co-occurrence of autism and attention deficit hyperactivity disorder—represents a unique neurological intersection that frequently eludes detection by medical professionals. While once treated as entirely separate neurological differences, research increasingly reveals these neurotypes naturally overlap for many people, creating complex presentations that defy traditional diagnostic criteria and often remain hidden beneath layers of learned masking behaviors and societal expectations, particularly in women and girls.
When two neurotypes coexist.
When I was 41, a close family member was diagnosed autistic. After learning about the genetic links of autism, and doing a very deep dive into the literature, I realised I shared a lot of the same traits, such as decades spent struggling with social anxiety, difficulty with change, getting fixated on things, and sensory overwhelm. Yet I’d also experienced lifelong persistent impulsivity and distractibility, that didn’t quite fit the autism profile and was more indicative of ADHD, which I also have a family history of. I felt like with my traits combined, I didn’t fit the strict criteria for autism or ADHD, yet I knew deep down that I wasn’t quite neurotypical either.
Research suggests that this experience isn’t unusual. Current studies indicate that 50-70% of individuals who have a diagnosis of autism will also present with ADHD. And that’s those who actually manage to get a diagnosis. These staggering statistics reveal not a coincidence but a neurobiological relationship that scientists are only beginning to understand.
The co-occurrence happens for concrete neurological reasons. Both autism and ADHD involve differences in executive functioning, sensory processing, and social communication—though these manifest differently depending on whether the autistic or ADHD traits are most predominant and the individual’s unique neurological makeup. Genetic studies have identified overlapping hereditary factors, with certain gene variations appearing in both populations, suggesting shared neurobiological underpinnings that explain why these two neurological differences so frequently appear together.
What makes AuDHD particularly significant isn’t merely the presence of both neurological differences but how they interact within the same person, creating experiences that are more than just the sum of each part.
The masking effect: how AuDHD traits conceal each other.
Deep within diagnostic shadows lurk countless unidentified AuDHD individuals, their dual neurotypes effectively canceling each other’s most obvious presentations.
Hyperactivity from ADHD might obscure the repetitive movements or stereotypical behaviors associated with autism, appearing more as general restlessness than autism-specific stimming. Conversely, autistic tendencies toward routine and order might partially compensate for ADHD disorganization, creating a person who struggles enormously with executive function yet manages to maintain enough structure to fly under the diagnostic radar.
Social difficulties present particularly complex manifestations in AuDHD individuals. The impulsivity and chattiness often seen in ADHD can mask the social challenges associated with autism. Someone might talk excessively but struggle with reading neurotypical social cues—appearing engaged in conversation while missing its subtext. Meanwhile, autistic social caution might temper ADHD impulsivity in certain contexts, creating inconsistent social behaviors that confuse both the individual and outside observers.
The Autistic Girls Network, a charity dedicated to supporting autistic women and girls in a neuroaffirming way describes it as follows:
“This can feel like a tug of war in an AuDHD-er’s mind, and it can feel impossible trying to balance two completely opposing needs. Because of this, AuDHD can appear like a different presentation altogether. An individual may feel they don’t relate wholly to autism or to ADHD. The two can mask each other, either compensating for each other’s difficulties or making those challenges even harder. For example, the organisation and focus from the autistic brain may compensate for the disorganisation and chaos of the ADHD brain. Or, the mess and chaos from the ADHD may leave the person in a constant state of overwhelm, feeling unable to function because there is no order.”
Beyond stereotypes: non-traditional AuDHD presentations.
The situation is even more complicated when we look at non-stereotypical presentations of autism and ADHD.
Internalized traits create silent struggles that evade detection for years. Many AuDHD individuals, particularly those socialized as female, experience their neurodivergence primarily as internal chaos rather than the external behaviors and struggles we are used to seeing portrayed in mainstream media and popular culture.
Rather than visible hyperactivity, a person might experience relentless mental restlessness alongside intense sensory sensitivity. Without obvious external behaviors triggering evaluation, these individuals often receive diagnoses only after seeking help for anxiety or depression—conditions that developed from years of unrecognized neurodevelopmental differences.
The quiet ADHD presentation combines with masked autism to create particularly elusive profiles. Someone might appear thoughtful and reserved rather than hyperactive, struggling privately with both sensory processing issues and executive function challenges while presenting as merely “shy” or “dreamy” to the outside world. This presentation often results in comments like, “You don’t seem autistic” or “Everyone gets distracted sometimes” when they eventually seek evaluation.
Social expectations radically alter how AuDHD manifests across genders. Those socialized as girls often develop elaborate compensation strategies—studying social interactions like academic subjects, developing scripts for conversations, or creating extensive organizational systems that partially offset executive function challenges while generating enormous hidden stress.
Women who are AuDHD often become masters of appearing neurotypical. They’ve spent years observing and mimicking socially “acceptable” behaviors, creating a façade that can fool even experienced clinicians who rely on outdated diagnostic criteria based primarily on male presentation patterns.
It’s now clear from research, that the cost of this masking is significant. It manifests as chronic exhaustion, anxiety, and identity confusion. Many AuDHD-ers report feeling like perpetual impostors, constantly performing a neurotypical role while lacking intuitive understanding of why they struggle with tasks others find simple.
Cultural intersections and diagnostic disparities complicate things further.
Dominant cultural narratives about neurodivergence dramatically influence who receives accurate identification and support. When autism research primarily focuses on white male children, the resulting diagnostic criteria inevitably fail to capture diverse presentations.
Cultural differences in communication styles, emotional expression, and behavioral expectations create additional layers of complexity. In communities where direct eye contact signals disrespect, reduced eye contact—often considered an autism indicator—might represent cultural adherence rather than neurodivergence. Conversely, cultural norms emphasizing respect for authority might suppress the hyperactive or impulsive behaviors that typically trigger ADHD evaluation.
Socioeconomic factors further complicate access to appropriate diagnosis. Comprehensive neurodevelopmental assessments often require substantial financial resources, time off work, transportation, and advocating within complex healthcare systems—barriers that disproportionately affect marginalized communities.
Refugee and immigrant experiences introduce further complexities. Trauma responses can resemble certain aspects of both autism and ADHD, leading to misdiagnosis or missed diagnosis. Meanwhile, cultural differences in understanding neurodivergence may determine whether families seek evaluation at all.
Research confirms these disparities. Studies show Black and Hispanic children receive autism diagnoses significantly later than white peers, even when displaying identical traits. Similar patterns emerge in ADHD diagnosis, with cultural and racial biases often influencing whether behaviors are perceived as neurodevelopmental differences or behavioral problems.
Serious issues with the diagnostic process.
Multiple assessment hurdles create winding paths to accurate identification. Clinical fragmentation represents a primary obstacle—psychiatrists may evaluate for ADHD while remaining unfamiliar with subtle autism presentations, while autism specialists might miss co-occurring ADHD traits.
Diagnostic criteria continue evolving but lag behind current research understanding. The DSM-5 still maintains autism and ADHD as separate, despite mounting evidence of their neurobiological overlap. Clinicians working strictly within these frameworks may hesitate to diagnose both autism and ADHD simultaneously.
Financial barriers compound these difficulties. In the US, insurance coverage often limits assessment scope or requires sequential rather than comprehensive evaluation. In the UK, assessments for autism and ADHD are rarely combined and NHS waiting lists are around 4+ years in some areas. Private assessments are costly. Assessing for one at a time fragments the diagnostic picture, making it harder to recognize how traits interact.
Gender biases persist throughout diagnostic processes. Research demonstrates that clinicians interpret identical behaviors differently, based on perceived gender. Assertiveness might be viewed as typical male behavior but labeled as “problematic” in females, while social difficulties might be attributed to shyness in girls but trigger autism evaluation in boys.
Personal stories I hear every day from the neurodivergent community reveal common experiences despite these varied barriers. Most late diagnosed AuDHD adults report multiple misdiagnoses before accurate identification—typically anxiety, depression, or personality disorders—addressing symptoms rather than underlying neurological differences.
Moving forward: support and understanding for AuDHD individuals.
Self-understanding ultimately provides the foundation for effective support. Many AuDHD adults report that simply learning about their neurological differences offers immense relief and context for lifelong struggles previously attributed to personal failing.
Support communities specifically for dual-diagnosed individuals continue growing, offering spaces where people can discuss unique experiences that might not resonate in spaces focused on either autism or ADHD alone. These communities foster belonging and practical knowledge exchange among people navigating similar neurological terrain.
Professional understanding continues evolving as well, but not fast enough, in my opinion. But some forward-thinking clinicians increasingly recognize the need for comprehensive assessment approaches that capture the full neurodevelopmental picture rather than focusing narrowly on single diagnostic categories.
To navigate life as an AuDHD-er, accurate identification represents not an end point but the beginning of authentic self-understanding—a foundation for developing personalized strategies aligned with your unique neurological makeup rather than exhausting yourself trying to be something you’re not: neurotypical.
