A British expert on the subject is spreading the awareness of what was once an unbelievable message: that both autism and ADHD can co-exist in the same person simultaneously, based, in part, on his personal experience and history.
Khurram Sadiq had beaten more than 19 000 applicants for a place at medical school, yet was bunking from his hospital shifts – the then 19-year-old also felt inexplicably anxious around strangers in the wards and was hiding from his own patients.
During lectures he couldn’t focus on what he was being taught, couldn’t motivate himself to revise for exams and instead found himself panic reading textbooks in the final days. He passed his undergraduate pre-medical exams by the skin of his teeth.
That was 30 years ago, reports The Guardian. Since then, Sadiq has qualified as a consultant psychiatrist, been diagnosed with both autism and attention deficit hyperactivity disorder (ADHD), specialised in autism and ADHD psychiatry, and met hundreds of patients with struggles similar to his.
A decade ago, ADHD and autism were considered mutually exclusive, with the Diagnostic and Statistical Manual of Mental Disorders, often referred to as “psychiatry’s bible”, stating that the diagnosis of one precluded the existence of the other.
This wasn’t revised until 2013. “It led to a fork in the road,” said Dr Jessica Eccles, spokesperson for the Royal College of Psychiatrists. “Not only for clinical practice, but also for research and public understanding of these conditions.”
Now some specialists believe the co-existence of both conditions is not just possible, but frequent, that up to half of people diagnosed as autistic also exhibit ADHD symptoms, and that characteristics of autism are present in two-thirds of people with ADHD.
Online, the idea that autism and ADHD can co-exist is so widely accepted that it has spawned its own label – “AuDHD” – and a groundswell of people who say they recognise its oxymoronic nature, perpetual internal war and rollercoaster of needs.
There are tens of thousands of people in AuDHD self-help forums, and millions more watching AuDHD videos.
Some of those videos come from Samantha Stein, a British YouTuber. “The fact that you can have both (autism and ADHD) at the same time is paradoxical in nature,” she admits.
“You think: ‘How can you be extremely rigid and need routines and structure, but also be completely incapable of maintaining a routine and structure?’”
She started making videos on autism after her diagnosis in 2019, then began covering AuDHD after learning she also had ADHD.
“I realised that autistic adults, especially those who are diagnosed late in life, more often than not seem to have ADHD as well,” Stein said.
Her first video on the subject, “5 signs you have ADHD and autism”, has now been viewed more than 2m times.
Some critics like to describe ADHD, and more recently autism, as a “fashionable” diagnosis, a misinformed excuse for life’s struggles.
It’s almost inevitable that the new AuDHD label will cause a similar backlash.
To see just how misguided this is, we must first understand both autism and ADHD.
Both are lifelong neuro-developmental conditions affecting how people think, perceive the world and interact with others, according to Embracing Complexity, an umbrella group of organisations that research neurodiversity.
Autism and ADHD affect people on a spectrum of severity, both are legally recognised as disabilities, and neither is a mental illness to be “cured”, although the knock-on effects can lead to mental illness.
People who experience ways of thinking that diverge from those of most people are described as “neurodivergent”.
Autism spectrum disorder (ASD) is caused by multiple genetic factors that aren’t yet fully understood. Contrary to misconception, autism doesn’t equate to impaired intelligence, and only around half of people with autism also have a co-occurring intellectual disability.
According to the National Autistic Society, autism is characterised by social challenges, repetitive behaviours, over- or under-sensitivity to surroundings and highly focused interests.
“For me, eating in a canteen is like eating in a nightclub for a neurotypical person,” said Jill Corbyn, who is autistic and the director of support organisation Neurodiverse Connection.
“It’s unpleasantly loud, it’s going to distract you from your food, it’s anxiety-inducing.”
Additionally, some autistic people may find social situations exhausting or overwhelming, or feel incompetent when they’re unable to decipher the subtleties of interpersonal communication, 60% of which is non-verbal.
ADHD is also not fully understood. There’s evidence that the condition, involving an imbalance of neurotransmitters – including dopamine, in the brain – has both genetic and environmental causes.
These chemical messengers are responsible for motivation, movement, planning, reward, memory, focus, alertness, impulse control and threat response, among others. People with untreated ADHD, whose reward pathways are therefore more dysregulated, can subsequently experience disordered moods, sleep, eating habits and dysfunction in almost every area of life.
Some people with ADHD are like pinballs of external chaos – of lost keys, missed appointments and cluttered homes. Others may appear inattentive, distracted by balls of chaotic thoughts into which they frequently retreat from the world to untangle.
ADHD affects people to different degrees. But many say their lives are marred by their brain’s misguided attempts to correct its chemical imbalances. They impulsively dopamine-spike with food, sex, drugs, booze, the internet, people, hobbies and novelty of all shades.
What frequently underpins the external and internal chaos, according to experts and many ADHDers alike, is a pervasive sense of deep shame and the quiet realisation that their potential in life is not being met.
When autism meets ADHD, it’s a curious form of alchemy, according to those who have both. Sometimes the conditions are in conflict; at other times they’re symbiotic. There is no such thing as a perfect 50/50 split, said Sadiq, and the brain is often “seesawing” between both conditions.
This makes the presentation of AuDHD a distinctive condition in its own right, “completely different from pure ADHD or pure ASD”, Sadiq added.
Earlier this year, he saw a patient who had been referred to his NHS clinic for an ADHD diagnosis.
He realised 15 minutes into the consultation that the patient was autistic.
“If I had no lived experience of autism and ADHD I would have missed it completely,” he said. “I would have diagnosed either social anxiety or a personality disorder.”
Despite his expertise, Sadiq is not formally qualified to make an autism diagnosis, and instead, he had to refer the patient on to the autism service within the NHS trust.
He believes that psychiatrists specialising in autism should also be trained in ADHD and vice versa, because otherwise “they’re going to miss a lot”.
It’s not just the medical profession that needs more co-ordination. Charities like ADHD UK and the National Autistic Society also work independently from one another.
ADHD UK is one of many advocacy groups calling for the Autism Act, which legally compels the government to support autistic people, to be widened in scope to include other forms of neurodiversity.
Once a correct dual diagnosis is obtained, there are still complications. ADHD can be successfully managed with medication and behavioural coaching, but some autistic people react badly to this medication.
Research indicates that stimulants are overall less tolerable for AuDHDers than they are for people with ADHD, according to the global research platform Embrace Autism, with one report finding that side-effects doubled in those with both conditions.
Another quirk of AuDHD treatment is that in some cases, it’s only after “quietening” someone’s ADHD symptoms that their autism traits come to the fore. This is often when people realise their autistic side for the first time, and it could explain why rates of self-reported autism closely follow those of ADHD.
Medical professionals are emphatic that ADHD medication cannot cause autism. Instead, Eccles says: “It has just changed the balance of symptoms. The balance of masking has changed.”
The prevalence of autism was widely believed to be 1% until last year, when a first of its kind study published in The Lancet found the true rate to be more than double that, with at least 1.2m autistic people in the UK.
The prevalence of ADHD in UK adults is around 4%, according to ADHD UK, and assessment waiting lists for both conditions are increasing year on year, with waits of a decade in some parts of the country for ADHD assessment.
When naysayers argue that we are in the midst of an over-diagnosis epidemic, charities often point them to the statistics on suicide, and the fact that the ripple effects of ADHD and autism often lead to mental ill-health.
Autistic adults without a learning disability are far more likely to die by suicide. In 2022, researchers from Cambridge and Nottingham University, analysing coroners’ inquest records, concluded that a significant number of people who had committed suicide were likely autistic but undiagnosed.
Adults with ADHD, meanwhile, are five times more likely to attempt suicide than their neurotypical peers. Yet AuDHDers have been found to be at even greater risk of suicide than either those with only autism or ADHD, according to an academic study of more than 50 000 people.
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