For many years, ADHD and autism were viewed as two completely separate neurological disorders, and very few people had the two conditions at the same time, let alone were diagnosed with both conditions. This is now a very different story. Today, clinicians and researchers have come to understand that ADHD and autism often overlap and a growing number of adults in the neurodivergent community now use a term to encapsulate this overlap – AuDHD.
As you must know, if you’ve felt for years like you don’t fit the profile of either condition – or if you’ve been diagnosed with one and think you may have the other – this guide is for you. As an adult treatment practice, serving New York City and New Jersey, our focus at Dr. John Shershow’s practice is on complex neurodevelopmental evaluation and individualized ADHD treatment that takes into account the entirety of the person.
What Is AuDHD? Understanding the Co-Occurrence of ADHD and Autism
AuDHD is a frequently used informal term for individuals who are diagnosed with both Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). Not a DSM-5 clinical diagnosis, it is becoming more apparent and acknowledged as a neurological reality.
Actually, the DSM-IV would bar clinicians from making two diagnoses at the same time because it assumed the existence of autism explained any ADHD symptoms. This exclusionary criterion was removed from the DSM-5 in 2013, and now thousands of adult patients who had long felt misunderstood by the DSM-5 can get a diagnosis for their ADHD, as well as another psychiatric diagnosis.
What many patients suspected from the start is now proven to be true – ADHD and autism run together at far higher rates than would be expected by chance. Research indicates that 50-70% of autistic children have ADHD symptoms and approximately 20-50% of ADHD children have clinically significant autistic features.
How Are ADHD and Autism Similar – and Different?
But to understand AuDHD, it is important to also understand how these two conditions overlap and differ. This distinction is very important for the proper diagnosis and adequate ADHD treatment planning.
Shared Traits Between ADHD and Autism
Both disorders may include:
- Excessive sensitivity to sounds, lights, textures or overcrowding
- Impulsivity – lack of the ability to delay, respond or act appropriately
- Emotional dysregulation – intense emotional response that is difficult to regulate
- Social difficulties – though for different underlying reasons
- Hyperfocuses or intense interest areas – deep interest in particular topics or activities
- Lack of preparation – reluctance in changing routines or plans
Key Differences Between ADHD and Autism
| Feature | ADHD | Autism |
| Core issue | Lack of attention and/or control of impulses | Social communication and sensory processing differences |
| Social difficulty | Due to inattention, impulsivity or distraction | Due to different social cognition and communication styles |
| Repetitive behaviors | Not a typical characteristic | Stimming and routines are common behaviors |
| Response to novelty | Takes risks for novelty and stimulation | Tends to favor sameness and predictability |
| Medication response | Respond to stimulants on multiple occasions | Stimulants do not treat autism, but they can treat ADHD |
Combined, these characteristics can exacerbate, obscure, and even contradict one another, making accurate diagnosis even more difficult without the aid of a qualified ADHD psychiatrist.
Why Is AuDHD Often Missed in Adults?
Most adults with AuDHD did not receive a diagnosis either in their childhoods or during much of their grown-up life. There are a number of reasons why the diagnosis is late or missed:
1. Masking and Camouflaging
Many adult autistics, especially women and AFAB, develop strategies to mask their autism, attempt to appear normal, try to avoid stimming behaviors, and try to embody a neurotypical personality at a high cost to themselves. Masking can make autism unrecognized by clinicians looking at behavioral presentations.
2. ADHD Symptoms Attributed to Anxiety or Depression
Anxiety, depression or mood instability may result as secondary diagnoses in adults who have never been diagnosed with ADHD and without anyone looking further at the underlying neurodevelopmental condition.
3. Outdated Diagnostic Criteria
The stereotypical image of autism (as a non-speaking child with extreme behavior problems) is not the reality of the majority of autism adults – particularly those with an average or above-average IQ.
4. Gender Bias in Diagnosis
Girls and women have historically been underdiagnosed with ADHD. It’s the same with autism. Some of the children who were referred for evaluation today were “quiet” or “shy” when they were youngsters, and not hyperactive.
5. One Condition Masking the Other
Impulsivity seen in ADHD can cause the rigidity of autism to be overlooked. On the other hand, the structure and repetition of an autistic person’s life can help to compensate for the disorganization of ADHD, which makes neither the autism nor ADD or ADHD noticeable.
That’s why an experienced ADHD doctor, or ADHD psychiatrist in NYC and NJ, is so vital particularly when working with an individual whose brain operates in an unusual and complicated manner.
How Does an ADHD Psychiatrist Diagnose AuDHD in Adults?
No checklist for AuDHD diagnosis. It should be detailed and multi-faceted, based on the history of your development, functioning and symptoms.
Step 1: Comprehensive Clinical Interview
A thorough interview will begin with a qualified ADHD psychiatrist and will consist of:
- Child developmental history – speech, motor, social
- Academic & Occupational Background
- Relationships and social experiences as patterns
- Symptoms in various settings (work, home, social)
- Past mental health and psychiatric/psychopathic history
Step 2: Standardized Rating Scales and Questionnaires
Employing evidence-based tools to measure the severity of the symptoms and patterns:
- For ADHD: Brown ADD Rating Scales, Conners’ Adult ADHD Rating Scales (CAARS), ADHD Self-Report Scale (ASRS)
- For Autism: AQ, Ritvo Autism Asperger Diagnostic Scale (RAADS-R), Social Responsiveness Scale (SRS-2)
Step 3: Collateral Information
Information from family members, partners or others who knew the patient as a child provides important background information, whenever possible. It is often hard to accurately report the early developmental patterns.
Step 4: Differential Diagnosis
Furthermore, a thorough psychiatrist will rule out and/or diagnose other common disorders that can co-occur or be mistaken for AuDHD:
- Generalized Anxiety Disorder
- Major Depressive Disorder
- Bipolar Disorder
- Complex trauma and PTSD
- Processing complex trauma and/or PTSD
- Learning problems including dyslexia, dyscalculia
Step 5: Integrated Clinical Formulation
A detailed assessment does not result in a diagnosis, it results in a story line, a formulation, of how your neurobiology, history and your symptoms interact. This is the beginning of an individualized approach to treatment for ADHD.
ADHD Treatment Options for Adults with AuDHD
After a dual diagnosis of ADHD and autism, treatment focuses on simultaneous treatment of both disorders. While there is a range of methods, each person’s method that works really well for them has its own variations or may not work at all for another person.
Medication Management
Stimulant medications (amphetamine salts, methylphenidate) are the first choice drug therapy for ADHD and can be very effective even in adults with autism. Dosage should be carefully modified, however, because autistic people may be more sensitive to side effects of medication.
Non-stimulant options such as Strattera (atomoxetine), Intuniv (guanfacine), or Wellbutrin (bupropion) may be preferable in some cases.
Psychotherapy and Behavioral Coaching
- CBT (Cognitive Behavioral Therapy) adapted for ADHD addresses executive dysfunction, negative thinking patterns, and emotional regulation
- ADHD coaching supports practical skills like time management, organization, and accountability
- Social skills therapy may benefit the autistic adult learning communication and relationship skills
- Occupational therapy for sensory processing sensory impairments
Environmental and Lifestyle Modifications
- Strategies for routines and supports in the environment
- Noise-canceling headphones, flexible workplace or school schedule
- Accommodation letter for workplace use with formal ADHD diagnosis
Psychoeducation
Knowing your own neurotype can be a game-changer. For many adults with AuDHD, the diagnosis has been a turning point, a language, a context for a lifetime of experiences that they had felt confused or embarrassed by.
Why Choose an ADHD Psychiatrist in NYC or NJ for Your AuDHD Evaluation?
Not all mental health professionals can diagnose and treat a NeDs in an adult. When looking for an evaluation, be sure to find an evaluator that:
- Can diagnose presentations of ADHD and autism in adults
- Uses effective, research-based assessment tools
- Combines the management of multiple conditions in a holistic manner
- Provides personalized treatment for ADHD, rather than a prescription
- Has extensive experience with children, adults (late), and high-masking profiles in women
Dr. John Shershow’s practice in NYC and NJ provides patients with a thorough and thoughtful assessment that is appropriate for complex neurodevelopmental presentations. If you believe you are struggling with ADHD, autism or both, we can assist you to better understand how your brain functions – and how to make the best of it.
Frequently Asked Questions About AuDHD and Adult ADHD Diagnosis
Q1: Can an adult be newly diagnosed with both ADHD and autism?
Yes, absolutely. Some adults are first diagnosed with ADHD (or autism) in their 30s, 40s or beyond. More often than not, people who previously were diagnosed with just one condition later get a second AuDHD diagnosis after a second evaluation.
Q2: Do I need to see a specialist for an AuDHD evaluation, or can my regular doctor diagnose me?
If the ADHD is simple, it can be diagnosed by a primary care physician and treated as such; however, if it is complicated, particularly if there is an autism diagnosis, a psychiatrist or a neuropsychologist with neurodevelopmental expertise is strongly recommended. An experienced ADHD psychiatrist in NYC or NJ will be equipped and trained to distinguish and diagnose them.
Q3: How is ADHD treatment different for someone with AuDHD compared to ADHD alone?
The treatment for an ADHD adult with AuDHD should take both types into consideration. Medications could be significant, although how they are dosed may vary. Therapy approaches should not only target ADHD executive functioning but also strategies for dealing with these autistic elements of the disorder: sensory sensitivities and communication issues. A cookie cutter approach to treating ADHD probably will not suffice.
Q4: What is the difference between an ADHD doctor and an ADHD psychiatrist?
An ADHD Doctor is any doctor, such as a primary care provider or a pediatric physician that treats ADHD. An ADHD psychiatrist is a physician who has trained in psychiatry and is specifically trained in the understanding of mental health and neurodevelopmental illnesses. An ADHD psychiatrist is more likely to provide a comprehensive and in-depth assessment for adult ADHD and AuDHD.
Q5: I’ve been told I have anxiety and depression – could it actually be AuDHD?
One of the most frequent narratives we hear is this one. Undiagnosed ADHD or autism is often the source of anxiety and depression. The secondary symptoms improve greatly when the root neurodevelopmental condition is treated. For those who have already been diagnosed with more than one mental health condition but have not been helped, an evaluation with an ADHD psychiatrist might be the turning point.
Q6: Is ADHD treatment available via telehealth in NYC and NJ?
Yes. At Dr. John Shershow’s practice, patients in New York City and New Jersey can schedule a telehealth appointment for a high-quality ADHD treatment, helping them receive quality care at a more convenient time and location. Secure telehealth platforms can be used for both initial and continuous medication management.
Q7: How long does an AuDHD evaluation take?
A thorough evaluation for both ADHD and autism in adults typically involves multiple sessions – often two to four appointments depending on complexity. Rushing the process risks inaccurate diagnosis, which is why working with a committed ADHD psychiatrist in NYC or NJ who takes the time to understand your full history is so important.
Take the First Step Toward Clarity
Undiagnosed AuDHD can be like constantly paddling upstream – feeling tired, like you don’t fit in with your world, or questioning why things are harder for you than for others. Usually, an accurate diagnosis provides you with a framework, an effective treatment for ADHD, and the recognition that you are not going crazy, you are not second best, and that your experiences are not your own fault, but rather neurological.
If you are an adult in New York City and New Jersey who is ready to learn about your brain and receive the support you deserve, you can visit Dr. John Shershow’s practice today.