As I fell into bed after another day of feeling like I’d worked hard but got nothing done, I reflected on why this was.
Was I just disorganised? Lazy? Incapable? Or all of those things, plus another long list of negative qualities I’d convinced myself I had?
I’d heard of ADHD and suspected I might have it, even though every doctor I mentioned it to treated me like I was being ridiculous. I also wondered whether I might be autistic, even though autism looks so different. Which one was it? Or was I just depressed?
As it turns out, you can have both autism and ADHD. People with a dual diagnosis often call it AuDHD. I never realised this was a thing. I didn’t know you were even “allowed” to have both. It didn’t make sense to me because the two conditions seem like polar opposites. But now, after being officially diagnosed: first with autism, then two years later with ADHD. I know exactly what it’s like to live with AuDHD and why it can be so difficult.
Every person with Add is different. Each has a unique profile of autistic and ADHD traits. Some feel their dual diagnosis is balanced, but many experience themselves as sometimes “more ADHD” or “more autistic”. AuDHD people often report internal conflict. Some even describe it as two warring factions inside themselves.
Why do so many people only get one diagnosis?
“Monodiagnosis” is a newer term that refers to people who are AuDHD but have only been diagnosed with one condition. The term was coined to describe what seems to be an increasingly common experience and to help people name it. It can be unsettling to receive a diagnosis that’s meant to explain your experiences, only to later realise you’ve actually got two different conditions.
It’s very rare to be diagnosed with autism and ADHD at the same time, and AuDHD is not formally recognised as a single diagnosis. In fact, it wasn’t until 2013 that the Diagnostic and Statistical Manual of Mental Disorders, often called the psychiatry bible, acknowledged that a person could have both. Before that, autism and ADHD were considered mutually exclusive.
With AuDHD only recently recognised and awareness still limited, it’s no surprise that so many people are only diagnosed with one condition or even none at all.
Why is a dual diagnosis so hard to get?
There are several complicating factors. First, especially for adults, it often requires recognising AuDHD in yourself. Many people aren’t handed a diagnosis. They have to pursue it themselves. That takes self-awareness, knowledge, time, resilience, and often money. Not everyone has these resources, and not everyone is lucky enough to stumble across the concept of AuDHD, which is how many people start their journey.
There’s also the issue of overlapping mental health challenges. Many autistic, ADHD, and AuDHD people also struggle with anxiety, depression, or trauma. These can sometimes be misidentified as the sole cause of someone’s difficulties, particularly among women.
And ADHD and autism can show conflicting traits that seem to cancel each other out. This can make both conditions harder to spot. For example, if someone’s ADHD impulsivity is balanced out by their autistic need for control, they might appear “average” in clinical assessments. And those assessments often fail to account for the coping strategies people use to get by.
The unique challenges of dual neurodivergence
Autism and ADHD aren’t as different as they seem. Some traits overlap, while others can directly conflict.
Take hypointeroception, which is being out of touch with internal bodily signals. It’s commonly associated with autism but also occurs in ADHD. Executive dysfunction is a hallmark of ADHD, but autistic people experience it too. Both groups can struggle to start, stop, or switch tasks. Monotropism, or hyperfocus on a single interest or task, is often linked to autism, but people with ADHD experience it as well.
Where the two conditions diverge, the challenges can be intense. For example, many autistic people crave order and structure, while ADHD is often associated with messiness, disorganisation, and a lack of object permanence. If you’re both autistic and ADHD, you might need order but struggle to create it. That clash can be incredibly frustrating.
Task initiation is another area where the conditions can conflict. The impulsive ADHD part might want to rush ahead and just get started, while the autistic part needs everything to be carefully prepared first. I often think of Eisenhower’s quote: “Plans are worthless, but planning is everything.” It captures the tension between the two mindsets perfectly.
The strengths of neurodivergence
It’s not all challenges, though. There are strengths to having both conditions.
ADHD often sees the big picture. Autism focuses on the details. Having both abilities can be powerful. The two conditions can also temper each other. Autistic inertia can be broken by ADHD drive. And many AuDHD people describe themselves as creative, curious, and deeply engaged with the world when things align just right.
How can we support AuDHD people?
Awareness is a critical first step. Many people still don’t realise that AuDHD is real or that it might apply to them. And mental health issues often complicate the picture.
We also need to ensure that AuDHD individuals get the right support, not just for autism and ADHD, but for any other conditions they might have. Being AuDHD can influence how other issues play out, whether that’s eating disorders, addiction, or trauma. It can also make menopause more difficult and increase sensitivity to life stressors, both good and bad.
But when support is in place, the strengths of AuDHD can be powerful. They can boost confidence, enhance self-understanding, and help manage the very challenges they create.
There’s nothing wrong with having AuDHD. It simply means living with a neurotype that doesn’t fit into a world built for someone else. But with the right tools and understanding, it can also be a meaningful and fulfilling way to live.
Rachel Morgan-Trimmer i
