AuDHD: When ADHD and Autism Occur Together

AuDHD is a word formed from the first two letters of Autism and the last three letters of ADHD. Bringing the two words together is meant to describe how aspects and traits of both also combine within one and the same person.

Although "AuDHD" is treated as an internet trend -- as ADHD and autism already were before it -- it is in fact anything but. In what follows, I would like to give a brief historical overview of AuDHD and then examine the topic critically -- in the hope that it offers something of value to everyone who engages with it.

The History of AuDHD

In diagnostic thinking, autism and ADHD lived in separate worlds for a long time. Until 1980, autistic traits were mostly filed under "childhood schizophrenia," before the DSM-III (a diagnostic and research manual) recognised autism as a diagnosis in its own right for the first time. That same year also saw the introduction of what we now call ADHD -- back then still termed "attention deficit disorder" (ADD). Yet the DSM-IV contained an exclusion clause within its ADHD criteria, so that until 2013 it was structurally impossible to receive both diagnoses at once. If the symptoms occurred in the context of a "pervasive developmental disorder" -- and autism counted as one -- no ADHD could be diagnosed.1 So if a person was autistic, their restlessness, distractibility, and impulsivity were, by definition, attributed to the autism as well. For almost twenty years, then, AuDHD was an impermissible diagnosis.

The justification for this was the diagnostic hierarchy: a person's symptoms should, wherever possible, be explained by a single, overarching disorder -- and autism was considered the "more pervasive" disorder, one that absorbed all the overlapping symptoms. Disability research calls the consequence of this perspective diagnostic overshadowing: the most dominant label overshadows everything else that is also there.

In everyday practice, clinicians kept encountering people who fell almost equally well into both categories, and studies showed that the two groups could hardly be cleanly separated using the existing DSM-IV criteria. In 2013, the DSM-5 finally drew the conclusion and removed the exclusion.2 As a result, dual diagnoses -- AuDHD, that is -- have been possible since 2013.

The term AuDHD, however, is not a term from psychiatry, psychotherapy, or research. It arose as a self-description within the neurodiversity movement. AuDHD's rapid spread as a self-ascription began around 2022 by way of social media. More and more people shared their stories of knowing both the autism and the ADHD worlds, and of the particular challenge of not knowing which of the two they will have to step into the ring with next.3

Research, too, now confirms what the community had already named: roughly 50 to 70 percent of autistic people also meet the criteria for ADHD4 -- the reverse, incidentally, does not hold; most people with ADHD are not autistic. Twin and family studies also point to substantial shared genetic foundations.5 So AuDHD names something real, for which the official system simply had no box -- and, for almost two decades, not even a permissible thought.

The Problems with the Term AuDHD

The term AuDHD, though, is not entirely unproblematic. Let it be said first of all that this critique is not meant to deny anyone the identity that is bound up with this term. In fact, the biggest problem with AuDHD is not caused by the term, or the idea behind it, at all. Rather, the term actually lays bare the absurdity into which we keep manoeuvring ourselves ever further.

One of the greatest limitations for neurodiversity is that most of the terms underlying it were shaped by deficit-oriented research and language. A great deal was viewed and described through a biological or medical model. This is how terms such as autism and ADHD came about.

The problem with this is that these terms -- even when we wrest them from their originally strict diagnostic corset -- are descriptive. They describe categories of symptoms that a person suffers from.

We do understand, of course, that what hides behind these symptoms is not disorders but merely a difference that is discriminated against. Yet the nervous system behind the symptoms remains hazy.

The biggest problem here is that not every one of these symptom clusters, which we then divide up as autism or ADHD, points one to one to a particular way of being or of experiencing.

That is to say, a highly sensitive nervous system in an unsupportive environment can give rise to autism symptoms, ADHD symptoms, or both (AuDHD symptoms). It can also be autism symptoms for two years and then, rather, ADHD symptoms.

The symptom level is not necessarily stable over time. It is therefore rather like trying to infer a person's uniqueness from the series of illnesses they might come down with. A difficult undertaking.

Behind this, however, lies not arbitrariness but, above all, neuronormativity. For we do not regard neurodiversity -- as diversity in information processing -- as worth investing in per se. Only its appearance as a form of disability, or as strong, clinically conspicuous symptoms, turns it into a financially interesting field of research.

Thanks to researchers such as Prof. Dr. André Frank Zimpel of the University of Hamburg, who heads its Center for Neurodiversity Research; Nick Walker, who coined the distinction between the pathology paradigm and the neurodiversity paradigm; or Robert Chapman of Durham University ("Empire of Normality"), there are increasingly positions, too, that think and frame neurodiversity as "diversity" from the very outset. And with that comes a great deal of hope.

A Functional Perspective on AuDHD

The term AuDHD can be liberating above all for the people who shuttle back and forth between supposedly contradictory worlds of symptoms and who, until now, have never been recognised and seen within them.

For this reason, despite all the points of criticism, I am in favour of accepting the term -- above all so long as such terms are seen as a kind of "initiation"; as an entry point into, or a deconstruction of, neuronormative self-images. Not as final destinations.

It is very important to keep reminding ourselves that descriptive umbrella terms like ADHD and autism do not serve to describe the nervous system of those affected. They serve only to describe the problems that those affected experience when their nervous system repeatedly meets an environment that is not attuned to it. In almost every case it is more important to understand how one's own nervous system works -- so as to navigate the environment better and help shape it -- than to obtain an official diagnosis of which groups of symptoms happen to show up when the nervous system is overtaxed. For the sad reality is that, even with a diagnosis, the environment will make no move to meet the needs of one's nervous system over the long term and in any lasting way.

So although the problem does not lie with the affected person, the responsibility for finding a way forward, unfortunately, often does lie with that person all the same. It is as if you woke up one morning to find that people had broken into your flat during the night, thrown a wild party there, and then quietly vanished again: broken crockery everywhere, stains, confetti, rubbish. And yet you had locked the door and could do nothing about it. Of course you are not to blame for the situation. But no one is going to come and tidy your flat for you regardless. So if you want to live in a clean flat, you have to tidy up yourself -- even though you did not make the mess.

This is the situation in which a great many neurodivergent people with highly sensitive nervous systems find themselves -- especially, too, those who can identify with AuDHD. The sooner they accept this situation, the faster and the better they can drive their personal development forward and improve their satisfaction with life.

The decisive point in personal development and unfolding is still shaped, as ever, by a comprehensive understanding of one's own neuroprofile. This includes metacognition -- above all, knowing how we process information, that is, how we learn; the deconstruction of our internalised neuronormativity, which produces self-rejection and auto-aggression; and creative life design, which calls for actively helping to shape everyday life and can ensure that our nervous system does not merely survive but thrives. One possible way to begin exploring your own neuroprofile is, for instance, our free neurodiversity test.