AuDHD

Living with both autism and ADHD: what the UK expert consensus says about co-occurrence, assessment, medication and support

Reviewed by ADHD Scot,

What is AuDHD?

AuDHD is an informal term for a person who has both autism and ADHD. It is not a separate clinical diagnosis; it describes having both conditions. The UK expert consensus (Young et al., 2020) says that "ADHD and ASD were not formally recognised diagnostically as co-occurring conditions until the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) was published in 2013. Hence, awareness and understanding of both conditions when they co-occur is less established and there is little guidance in the clinical literature."

Autism and ADHD can occur together. The consensus says: "Rates of co-occurrence vary. In children, clinical studies investigating ADHD symptoms in ASD report a co-occurrence ranging between 53 and 78%; whereas in community samples, it is lower at 28–31%. A meta-analysis of the co-occurrence of ASD symptoms in young people from both clinical and community ADHD samples found a comorbid rate of 21%." (Young et al., 2020). These figures are for children and young people.

What the consensus says about overlap

The consensus says: "Although specific distinctions are present between the two conditions, generally both are commonly associated with social difficulties, executive dysfunction and language and cognitive delays." It also says there are "diagnostic challenges for both conditions especially for those with subtle or 'mild' presentations, when difficulties are 'masked' by other comorbid conditions, 'camouflaged' by compensatory strategies, and/or when there is limited information about childhood functioning when making the diagnosis of ADHD or ASD for the first time". Its assessment recommendation 11 says: "Symptoms of both ADHD and ASD may be masked for many reasons, which may cloud clinical judgement".

Recognition and monitoring

The consensus notes that "the average age of diagnosis for the two conditions is discrepant" and recommends that "Young children presenting with an initial diagnosis of ASD should be continually monitored through development for ADHD". It also says "Compared with males, females with ADHD may present with fewer disruptive behavioural problems and those with ASD may have lower intellectual abilities."

Assessment

The consensus (assessment recommendations 1, 5 and 12) says: "Due to the level of complexity involved, assessments should only be offered by healthcare practitioners with appropriate training and skills."; "The assessor should take a parsimonious approach, i.e. they should not 'double count' symptoms present in both ADHD and ASD."; and "There are high rates of comorbidity associated with both ADHD and ASD, and the assessment should identify whether co-existing comorbid disorders are present."

When choosing a private provider, you could ask whether they have experience assessing for both conditions and whether their diagnostic report will address possible co-occurrence.

Our Compare providers tool shows which providers record that they offer combined ADHD and autism assessments.

What it means for medication

The consensus says: "medication is commonly offered to treat ADHD symptoms (usually stimulant and non-stimulant medications) in both people with ADHD and those with co-occurring ADHD and ASD. ADHD medications should not be offered to treat people with ASD (without co-occurring ADHD) as there is no evidence for a positive effect in this population." Its recommendations include: "Close attention should be paid to side effects of any pharmacological treatment due to the increased likelihood of their occurrence in this group" and "A 'low and slow' approach to titration should be adopted as people with both conditions may be more treatment resistant and more sensitive to the effects of medication (especially with respect to side effects)." NICE NG87 (1.7.28) (NICE describes its guidelines as "for health and care in England and Wales"; NAIT 2022 says NHS staff assessing ADHD in Scotland "are expected to follow the standards for assessment and diagnosis set out in NICE Guidelines") also says "dose titration is slower and monitoring more frequent" for people with ADHD and neurodevelopmental disorders such as autism spectrum disorder. If you notice changes after starting medication, talk to your prescriber rather than adjusting anything yourself. See our medications page for prescribing information.

What support looks like

The consensus abstract lists the areas where it reached agreement on support: "non-pharmacological interventions and care management, including psychoeducation, carer interventions/carer training, behavioural/environmental and Cognitive Behavioural Therapy (CBT) approaches; and multi-agency liaison, including educational interventions, career advice, occupational skills and training", and pharmacological treatments. Your own needs will differ, and a prescriber or support service can talk through what applies to you.

Useful organisations

ADHD Scotland, an independent charity registered in Scotland that says it "celebrates, supports, informs, and represents people living with ADHD throughout Scotland, and their families".

Scottish Autism, which describes itself as "Scotland’s leading autism charity".

National Autistic Society Scotland, which says it provides "a range of services and support" and campaigns "at national and local level".

Trusted further reading

ADHD Scot is an independent, non-clinical information project. Nothing here is medical advice. Always speak to a qualified clinician about your own health, assessment, and treatment options.