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Why explore AuDHD and not just ADHD and autism separately?
In the past, we have looked at different aspects of autism and relationships. We recently published an article about autism & relationship compatibility and we have also heard from Gareth & Ruth about how they navigate their relationship.
However, since research shows that anywhere between 50–70% of autistic people also have ADHD,[1]The comorbidity of ADHD in children diagnosed with autism spectrum disorder (Stevens, et al. 2016)[2]Identifying comorbid ADHD in autism: Attending to the inattentive presentation (Rau et al., 2020)[3]Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis (Rong et al., 2021) it’s important to explore how AuDHD (autism + ADHD) impacts relationships differently than autism alone.
There aren’t a lot of studies out there looking at AuDHD. And those that do exist are almost always conducted in children. Therefore, research doesn’t actually know how adult relationships are impacted by co-occurring autism and ADHD. This article is based on a combination of existing research and my own perspectives about AuDHD and relationships. We are always sourcing more community perspectives so if you have thoughts, please let us know in the comments!
Combining ADHD and autistic traits
In a previous article, we talked about how typical autistic and typical ADHD traits get combined together in AuDHD. When these traits combine, they can heighten our experience. For example, as an AuDHDer I often experience more sensory overstimulation than someone who is only autistic. I think this might be because of a combination of being detail-oriented (autistic trait) and having attentional differences (ADHD trait). When they combine together, it can be really difficult for me to ignore every single sensory aspect of my surroundings, leading to sensory overstimulation.
We’ve covered the basics of how AuDHD can look in a previous article:
Autism & ADHD—how do we differentiate similar traits?
How AuDHD characteristics impact relationships
Social interaction differences
Some research (but not all research!) shows that individuals with AuDHD often struggle in social interactions with neurotypicals more than those with autism alone.[4]Impact of ADHD symptoms on autism spectrum disorder symptom severity (Sprenger et al., 2013)[5]Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders (Rao & Landa, 2014)[6]Does the Presence of Anxiety and ADHD Symptoms Add to Social Impairment in Children with Autism Spectrum Disorder? (Factor et al., 2017)[7]The Impact of the Comorbidity of ASD and ADHD on Social Impairment (Harkins et al., 2021) It can be really difficult for us to make friends with neurotypicals or to have long-term relationships with neurotypicals. I think this can be explained by several different reasons:
Peer judgement
Research shows that one reason both ADHD and autistic individuals struggle to maintain friendships with neurotypicals is that we are immediately judged as being “different” (and not in a good way). [8]The acceptance and rejection of peers with ADHD and ASD in general secondary education (Boer & Pijl, 2016)[9]Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments (Sasson et al., 2017) If we think about how AuDHD is a heightening of experiences, this means that we may stand out as “different” even more than usual. It is possible that this causes us to be judged more harshly.
Understanding and abiding by social norms
Another reason that we may struggle in relationships with neurotypicals is that we have a hard time following social norms. In autism, we usually struggle to understand neurotypical social norms.[10]Exploring the Components of Advanced Theory of Mind in Autism Spectrum Disorder (Pedreño et al., 2017) In ADHD, we usually understand neurotypical social norms, but due to our attention differences, we overlook them and we have trouble abiding by them.[11]Social Problems in ADHD: Is it a Skills Acquisition or Performance Problem?(Aduen et al., 2018) For example, a lot of ADHDers struggle with response inhibition and impulsivity.[12]A Causal and Mediation Analysis of the Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) (Sokolova et al., 2017) This means that we have trouble holding back a response once our brain has generated it. When we are in a conversation, even though we know that it is considered rude to interrupt, we may have a hard time waiting for our turn to speak because we’ll otherwise forget what we were going to say.
In addition, because of the attention differences in ADHD, we can miss certain social cues.[13]The co-occurrence of autism and attention deficit hyperactivity disorder in children – what do we know? (Leitner, 2014) Without these social cues, we may not have the information we need to understand how to respond in an “appropriate” way. For example, sometimes when I’m speaking to friends, I get distracted by other thoughts in my head. It has nothing to do with being uninterested; it’s just that my thoughts are distracting. When this happens, I sometimes miss what my friends are saying. One time, my friend was trying to ask me for comfort but since I was distracted by my own thoughts, I missed that piece of information and I accidentally invalidated them because I didn’t know how I was expected to act.
To understand how it feels in AuDHD, we can once again combine these two experiences. AuDHDers often struggle with neurotypical social norms because we don’t understand them (autistic trait) and even when we do, we have trouble due to overlooking them (ADHD trait). This makes it hard to build relationships with neurotypicals who expect us to act in a certain why.
For me, when I make friends with neurotypicals, I don’t usually outwardly struggle too much with social norms because I have become quite proficient at masking and camouflaging. Essentially, I am pretty good at acting neurotypical. But, this comes at a cost. It takes a lot of time and energy for me to “study” and “rehearse” neurotypical social norms. In the end, these relationships are often not as rewarding because I spend so much time concentrating instead of having fun. I’m glad that our society is slowly becoming more neurodivergent-accepting! If I was able to act in more authentic ways without being judged, it would be a lot easier to make and maintain (neurotypical) friendships and other types of relationships.
Neurodivergent versus neurotypical relationships
One thing we do know is that autistic individuals struggle more in relationships with neurotypicals than with other autistics. When we are in a relationship with other autistics, we get to use more similar communication styles and focus less on social norms. This likely applies to AuDHD as well. If autistic individuals seem to be most relationally compatible with other autistic individuals, it’s possible that AuDHD individuals are also more relationally compatible with other AuDHDers. Or, at the very least, AuDHDers are more compatible with other neurodivergent folks who can empathize with our experiences.
Apart from social interaction differences, which usually emerge in relationships with neurotypicals, we can also face barriers to relationships because of our unique support needs. Studies show that on average, AuDHD is associated with more day-to-day support needs than ADHD or autism alone.[14]Brief Report: Adaptive Functioning in Children with ASD, ADHD and ASD + ADHD (Ashwood et al., 2015)[15]Attention-Deficit/Hyperactivity Disorder Symptoms, Adaptive Functioning, and Quality of Life in Children With Autism Spectrum Disorder (Sikora et al., 2012)[16]Physical Functioning, Emotional, and Behavioral Problems in Children With ADHD and Comorbid ASD: A Cross-Sectional Study (Thomas et al., 2015)
This can impact the people who are living with us. For instance, if we have shared responsibilities at home, such as chores and making meals, our typical ADHD struggles with planning and organizing can impact ourselves and the people who depend on us. These struggles can be magnified when they combine with our typical autistic needs for routine and systemizing. For me personally, I find that I struggle to get housework done because I have a hard time doing tasks that are boring (typical ADHD trait). At the same time, I can’t function when the house is not completely organized. My autistic brain just can’t go about my day until things are fully sorted. Therefore, I can get “stuck.” As you can imagine, this isn’t super easy to live with when others depend on you. It often means we end up needing to depend on others. For me, since my partner is also AuDHD, we can even get “stuck” together at the same time!
However, in other ways, living with a family member or partner can also be beneficial. If they understand our AuDHD needs and are able to offer support with organization, routine, planning, etc. it can be extremely helpful! On my end, there is always the risk that my partner and I get “stuck” at the same time, but more often than not, we are able to take turns supporting each other.
Emotional regulation
Another factor impacting AuDHD relationships is emotion regulation. Studies find that AuDHD is associated with more emotional dysregulation than autism or ADHD alone. For example, this could mean that we experience meltdowns more frequently.[17]ADHD severity as it relates to comorbid psychiatric symptomatology in children with Autism Spectrum Disorders (ASD) (Mansour et al., 2017) Because meltdowns are uncontrollable reactions to distressing and stressful situations, if there are aspects of our relationship that are causing stress, we may be highly impacted. If our partner keeps disrupting our morning routine, we may snap at them and experience overwhelm. Or, if our friend keeps canceling plans last minute, we may lash out at them.
It can also be difficult when the person we are in a relationship with doesn’t understand what is causing us to be emotionally dysregulated. For example, it can feel frustrating and embarrassing for us when we have a meltdown in public and the person we are with doesn’t know why or how to help. The hope is that we can debrief after and they can gain an understanding, but because the ways in which we navigate the world are sometimes so different, this doesn’t always happen.
I think it’s important to also remember that when we find ourselves in relationships with other neurodivergent folks, our shared understanding of similar lived experiences can be immensely validating. As an example, having a partner who understands what triggers my meltdowns means that they can help support me more effectively in overwhelming situations. More generally, we can understand and meet each others support needs without judgment. Having that shared understanding is a key aspect of relationship compatibility. We often romanticize the idea that “opposites attract” but in reality, “likes attract!” [18]Similarity in relationships as niche construction: Choice, stability, and influence within dyads in a free choice environment (Bahns et al., 2017)[19]Opposite-sex siblings decrease attraction, but not prosocial attributions, to self-resembling opposite-sex faces (DeBruine et al., 2011)[20]Trust in Me: Trustworthy Others Are Seen as More Physically Similar to the Self (Youyou et al., 2017)
In addition to looking at the research, it can be helpful and validating to learn about how fellow AuDHDers and their partners navigate relationships. In Part II of this series, some of us at Embrace Autism share our AuDHD relationship experiences.
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