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Understanding AuDHD

By Emma Hinze, Dr. Michelle Garnett and Professor Tony Attwood

AuDHD, a term describing the co-occurrence of Autism and Attention-Deficit/Hyperactivity Disorder (ADHD), has gained more attention in recent years. This article aims to provide a clear overview of AuDHD, describing both defining features and the evolution of understanding within the community.

Understanding AuDHD

AuDHD is not officially recognised in the diagnostic manuals as a separate condition but is a convenient shorthand used to describe individuals who are autistic and meet diagnostic criteria for ADHD. Both autism and ADHD impacts the way a person thinks, feels, and perceives the world. Autism is characterised by differences in communication and thinking styles and social interaction. It is often accompanied by focused interests and consistent patterns of behaviour that provide structure and enjoyment. On the other hand, ADHD is characterised by a wide-ranging spectrum of attention-regulation challenges, where individuals may have trouble sustaining focus when they are not intrinsically interested in the task, may act without thinking (impulsivity), and often exhibit a high level of physical activity or restlessness (hyperactivity). As a result, the person experiences challenges in planning, prioritising, and initiating daily tasks, organising their time, activities, and belongings, and in regulating social interactions. AuDHD individuals differ in the type and severity of these challenges depending on the levels of stress and support they experience.

Evolution of Diagnostic Perspectives

Until 2013, International diagnostic texts, for e.g. the Diagnostic Statistical Manual for Mental Disorders Fourth Edition (DSM-4, APA, 1994), did not recognise the possibility of co-diagnosis for Autism and ADHD, treating them as distinct and mutually exclusive. However, the DSM-5 released in 2013 acknowledged the co-occurrence and allowed for both diagnoses to be conferred to the person. This change reflects a better understanding of the overlapping and distinct aspects of these conditions, emphasising the need for comprehensive assessment strategies to accurately identify and support Autistic, ADHD and AuDHD individuals.

Characteristics of AuDHD

Attention: Autism and ADHD characteristics intersect in complex ways. While both can involve attention-related challenges, their presentations differ. Autism-related attention issues often focus on intense interests, whereas ADHD involves more general difficulties with sustained attention and impulsivity.

AuDHD individuals navigate the confluence of these traits, which can create internal conflicts and unique challenges. For example, the autistic aspect might crave routine and predictability, finding comfort in established patterns and familiar activities. This individual might meticulously organise their workspace, adhere to a fixed daily schedule, or become intensely absorbed in their special interests. However, the ADHD side may introduce a contrasting impetus for spontaneous decisions, seeking novel experiences or responding to sudden urges without considering the longer-term consequences. This could result in abrupt changes in activities, starting new hobbies on a whim, or an inconsistent approach to tasks, which disrupts their need for routine and predictability.

Time Management Conflicts: Individuals may struggle with punctuality due to ADHD’s influence, which can lead to difficulties in time management and a tendency to be late. However, the autistic side usually experiences significant stress and discomfort due to not being on time, reflecting a deep-seated need for routine and predictability.

Planning and Execution Discrepancies: The impulsivity and forgetfulness associated with ADHD can cause challenges in remembering and following through on planned steps. Meanwhile, the autistic aspect may drive a person toward meticulous planning and a strong desire to execute these plans flawlessly, leading to frustration when plans are not carried out perfectly.

Dietary Preferences and Novelty Seeking: The ADHD trait may present as a desire to explore new and different foods, seeking variety and novelty. In contrast, autism may influence strong preferences for specific tastes and textures, leading to a restrictive dietary pattern. This dichotomy can make mealtime choices particularly challenging.

Craving for Novelty Versus the Need for Sameness: ADHD often brings a need for new experiences and stimulation, while the autistic part of an individual may crave stability, routine, and sameness. Balancing these opposing needs can be a constant struggle, as individuals may feel torn between exploring new activities and the comfort of familiar environments.

Navigating AuDHD

Successfully navigating AuDHD requires a holistic understanding of both neurotypes. It is essential for individuals, families, and professionals to recognise the diverse array of strengths and challenges present in AuDHD. Strategies such as structured flexibility, which combines routine with allowances for spontaneity, can be beneficial. Support may also include multimodal therapy approaches, educational accommodations, and social support networks, all tailored to the individual’s unique profile. Recognising and celebrating the strengths of AuDHD, such as exceptional focus in areas of interest, creative problem-solving, and dynamic thinking, can empower individuals to thrive.

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