Autistic & ADHD traits

So you’ve discovered that you’re autistic. But you relate to many ADHD traits… So perhaps you actually have ADHD? Or maybe both?

If you’re finding yourself spiraling in online discussion boards and on social media trying to figure out if you are autistic, an ADHDer, or both, this article will provide some context for navigating the formal diagnostic criteria of autism compared to ADHD—as well as offer some insight into how these diagnoses may be experienced in combination.

Comparing DSM-5-TR criteria

Research shows that upwards of 50% of autistic people also have ADHD.^[1]The comorbidity of ADHD in children diagnosed with autism spectrum disorder (Stevens, Peng, & Barnard-Brak, 2016)^[2]Identifying comorbid ADHD in autism: Attending to the inattentive presentation (Rau et al., 2020) For AuDHD (autistic + ADHD) individuals like myself, it can be confusing to parse out which of my traits can be attributed to ADHD versus autism, and that’s because internally, it all combines to form one experience. However, clinically, the diagnostic criteria for each are distinct. So let’s break it down:

The DSM-5-TR (diagnostic and statistical manual, 5th edition, text revision) outlines the gold standard criteria for clinicians looking to diagnose autism (listed as ASD in the DSM) and ADHD. According to the DSM, there are no overlapping traits between the two, because autism is diagnosed primarily based on social and communication differences and repetitive patterns of behaviour, whereas ADHD is diagnosed based on attentional differences.

Summary of ADHD criteria

There are two types of ADHD: Inattentive and hyperactive. Here we focus solely on inattentive traits because autistic people with co-occurring ADHD predominantly display the inattentive type.^[3]Identifying comorbid ADHD in autism: Attending to the inattentive presentation (Rau et al., 2020)

Attentional “deficit” traits identified during diagnosis of ADHD:

• Makes careless mistakes/lacks attention to detail
• Difficulty sustaining attention
• Does not seem to listen when spoken to directly
• Fails to follow through on tasks and instructions
• Exhibits poor organization
• Avoids/dislikes tasks requiring sustained mental effort
• Loses things necessary for tasks/activities
• Easily distracted
• Is forgetful in daily activities

Summary of autism criteria

Autistic individuals must display social communication and interaction differences across multiple contexts:

• Differences in social-emotional reciprocity (e.g., reduced back-and-forth conversation compared to allistics [non-autistics])
• Differences in non-verbal communication (e.g., reduced eye contact or body language compared to allistics)
• Differences in developing, maintaining, and understanding relationships (e.g., difficulty adjusting to different social contexts)

The diagnostic criteria for autism also include the presence of distinct patterns of behaviour, interests, and activities. This accounts for our special interests, stimming behaviour, sensory sensitivities, etc.

As you can see, none of the criteria for ADHD refer to social/communication differences, and none of the criteria for autism refer to attention!

Understanding the DSM criteria might make it easier for some of us to distinguish our ADHD and autistic traits based on social interactions versus attentional characteristics. However, for me, this has never felt complete. If the criteria for diagnoses appear to be clearly defined and without any overlap, why then do so many of us neurodivergents struggle to classify our traits (if classifying is something that we want to do)?

My own personal “lightbulb” moment was realizing that diagnostic criteria classify outward, observable traits, but do not reflect internal experiences. What can look like one thing on the outside, does not fully represent the accompanying vast and varied experiences that go on inside our bodies and minds. Since the DSM has distinguished autism from ADHD based on external presentations of traits, the holistic way in which we make sense of and navigate the world does not get factored into the diagnostic criteria, often making it difficult for us to see ourselves fully represented.

To fill this gap, below we discuss some common ADHD cognitive processes and then show how features of ADHD can heighten or contradict our autistic traits.

Unique ADHD traits (not captured by the DSM)

ADHD is an attentional difference, not an attentional deficit

ADHD is experienced as a difference in attentional processing, rather than the deficit it is made out to be in the DSM. Here are a couple of ways in which our cognitive processes differ and how they might be viewed as “deficits” by outside observers:

Divergent thinking

We are more creative than our non-ADHD counterparts.^[4]Abraham, A., Windmann, S., Siefen, R., Daum, I., & Güntürkün, O. (2006). Creative thinking in adolescents with attention deficit hyperactivity disorder (ADHD). Child Neuropsychology, 12(2), 111–123 Our “inattention” can manifest as divergent thinking. “Divergent” or “lateral” thinkers have the ability to start from one concept and expand and make connections across many (often seemingly unrelated) ideas.^[5]Runco, M. A., & Acar, S. (2012). Divergent thinking as an indicator of creative potential. Creativity research journal, 24(1), 66–75 Others may perceive this as an inability to keep on a topic. But, in an environment that nurtures creative thinking, our ability to jump from topic to topic is one way that we are able to think outside the box.^[6]White, H. A. (2020). Thinking “outside the box”: Unconstrained creative generation in adults with attention deficit hyperactivity disorder. The Journal of Creative Behavior, 54(2), 472–483. Studies have shown that because of our unique thinking styles, we make excellent innovators and problem-solvers.^[7]White, H. A., & Shah, P. (2016). Scope of semantic activation and innovative thinking in college students with ADHD. Creativity Research Journal, 28(3), 275–282.

Altered time perception

We do not experience time the same way non-ADHDers do.^[8]Zheng, Q., Wang, X., Chiu, K. Y., & Shum, K. K. M. (2022). Time perception deficits in children and adolescents with ADHD: A meta-analysis. Journal of Attention Disorders, 26(2), 267–281. Studies show that many ADHDers have different subjective experiences of how long an event lasts. We tend to overestimate lengths of time compared to non-ADHDers.^[9]Pollak, Y., Kroyzer, N., Yakir, A., & Friedler, M. (2009). Testing possible mechanisms of deficient supra-second time estimation in adults with attention-deficit/hyperactivity disorder. Neuropsychology, 23(5), 679. One theory to explain this difference is that our “internal clock” may be more susceptible to external influence.^[10]Walg, M., Hapfelmeier, G., El-Wahsch, D., & Prior, H. (2017). WISC-IV profile analyses and time estimation tasks facilitate the distinction between real ADHD and pseudo-ADHD. European Child & Adolescent Psychiatry, 26(10), 1177–1186. Instead of basing time on some abstract internal representation, we may base time on what’s in our environment. For example, if we listen to songs with a certain rhythm, the rhythm of the music may distort our time perception.^[11]Hammerschmidt, D., & Wöllner, C. (2020). Sensorimotor synchronization with higher metrical levels in music shortens perceived time. Music Perception, 37(4), 263–277. A faster tempo song may lead us to perceive that time is moving more quickly than it actually is.

Although not outlined explicitly in the DSM, these differences in cognitive processing shape how many of us struggle with our executive functioning. It may even be the underlying cause for some of the criteria in the DSM such as struggling with sustained attention or organization. For example, if we do not accurately perceive time, how are we supposed to budget our time when making plans? Also, we may become exhausted trying to maintain focus on something we dislike because to us, it may feel like “an eternity” has already passed.

In contrast, while we may struggle with executive functioning, these attentional differences can also be super strengths in certain situations. If we’re engaging in something we love, like a special interest, time “disappears”, and we can persist almost indefinitely. If we are in a work environment that allows us to flow unrestricted from thought-to-thought, our creativity and ability to solve complex problems can flourish.

Co-occurring autism & ADHD

Since the DSM diagnostic criteria for ASD and ADHD are distinct, there is little knowledge within the scientific community about what the AuDHD experience is like (Note: listening to members of the AuDHD community can provide a lot of insight about our experiences which “official research” have yet to capture). In fact, until the DSM-5 was published in 2013, being formally diagnosed with both autism and ADHD was prohibited.^[12]DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (Bell, 1994) As a result, research shows that it is not uncommon for late-diagnosed autistics to have been misdiagnosed with ADHD as a kid, or to have been overlooked completely due to their ADHD diagnosis overshadowing their autistic traits.^[13]Sainsbury, W. J., Carrasco, K., Whitehouse, A. J., McNeil, L., & Waddington, H. (2022). Age of diagnosis for co-occurring autism and attention deficit hyperactivity disorder during childhood and adolescence: A systematic review. Review Journal of Autism and Developmental Disorders, 1–13.^[14]Hosozawa, M., Sacker, A., Mandy, W., Midouhas, E., Flouri, E., & Cable, N. (2020). Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study. Autism, 24(6), 1557–1565.

Seeing as roughly 50% of autistics also have ADHD,^[15]The comorbidity of ADHD in children diagnosed with autism spectrum disorder (Stevens, Peng, & Barnard-Brak, 2016)^[16]Identifying comorbid ADHD in autism: Attending to the inattentive presentation (Rau et al., 2020) it’s important for us to have the resources to understand what these look like in combination. Here are some thoughts:

Heightened experiences

An individual with autism + ADHD often experiences a heightening or an increase in the intensity of certain traits.

For example, one study showed that autistic individuals with ADHD demonstrated higher attention to detail compared to individuals with either ADHD or autism alone.^[17]Co-occurrence of ASD and ADHD traits in an adult population (Panagiotidi, Overton, & Stafford, 2019) Because we have higher attention to detail, this may also lead to heightened sensory sensitivities. Since many autistics are bottom-up processors,^[18]Thinking styles in autistic people (Silvertant. 2021) | Embrace Autism^[19]Local & global processing in autism (Engelbrecht, 2021) | Embrace Autism we already take note of every little detail and sensory aspect of our environment. Add on the attentional differences of ADHD and now we may be completely unable to ignore anything that is going on. This can make the unpleasant sensory stimuli around us even louder and more disruptive.

For me, I sometimes feel like I’m in the movie “Everything Everywhere All at Once”. I feel like I can see across dimensions and experience fragments of many different sensory experiences all at the same time. If I am doing a task that surrounds me with pleasant sensory input, this can feel very stimulating and rewarding. However, the flip side can be frustrating. My ability to see, hear, feel, and think everything all at once makes it harder to concentrate when I need to zone into one single dimension. It is extremely difficult to filter out all the irrelevant stimuli so I can pay attention to only the things that I need to.

My ability to absorb every detail that goes on around me, combined with my inability to ignore certain stimuli, can magnify my sensory overwhelm.

Do you have autistic traits that are “heightened” by your attentional differences?

Contradictions in autism + ADHD

While some autistic and ADHD traits can work in tandem to heighten experiences, they can also oppose each other and create contradictions. Studies report that those with co-occurring autism and ADHD have poorer outcomes than either autism or ADHD alone.^[20]Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment (Reiersen & Todd, 2008)^[21]Attention-deficit/Hyperactivity Disorder in the Context of Autism Spectrum Disorders (Murray, 2010) As a scientist, my theory is that these contradictions are part of what makes it more difficult to manage day-to-day life.

Here are some of the contradictions you may experience as an AuDHD:

• You thrive when there’s a set routine (autistic trait), but you struggle to plan and follow a schedule (ADHD trait)
• You get very distressed when your friend shows up late to your meeting (autistic trait), but you yourself struggle to arrive at events on time (ADHD trait)
• You find engaging in a special interest to be soothing (autistic trait), but you also need to jump between multiple interests to keep you engaged (ADHD trait)
• You are meticulous with your plans (autistic trait), but sometimes you overwhelm yourself by making an impulsive decision (ADHD trait)
• When you infodump, you have a habit of speaking “too fast” (ADHD trait), but when someone asks you an unrelated question, your responses may be delayed, or you may be unable to speak (autistic trait)

Do you at times feel trapped between two opposing worlds because of your contradictory traits? Do you find that these contradictions make it difficult to manage your day?

Summary

Autism and ADHD are common co-occurrences. For neurodivergents seeking to understand more about themselves, it can be confusing to try and differentiate between traits that are considered autistic versus ADHD.

When trying to understand our autistic and ADHD ways of navigating the world, remember that:

• The DSM classifies traits based on outward observable characteristics
  • Autism is a difference in socialization and communication;
  • Whereas ADHD is a difference in attention
• ADHDers often experience differences in cognitive processing. For example:
  • They are divergent thinkers
  • They perceive time differently
• Co-occurring autism and ADHD can be experienced as:
  • Heightening of some autistic traits
  • Navigating contradictions of opposing traits