AuDHD: autism and ADHD together - signs, assessment and support

AuDHD is not a term you will find in diagnostic manuals. It is a shorthand, popular among neurodivergent people and online communities, for being both autistic and having ADHD (attention deficit hyperactivity disorder). Clinicians in the UK diagnose autism and ADHD as two separate conditions, even though they often occur in the same person.

The NHS describes autism as a difference in how your brain develops that affects how you see and experience the world, and says it is often called a type of neurodivergence. It says autistic people are more likely to have some physical and mental health conditions, and that ADHD is also more common in autistic people. NICE guideline NG87 on ADHD says to be aware that people with other neurodevelopmental disorders, for example autism spectrum disorder, may have increased prevalence of ADHD compared with the general population.

The NHS says some people with ADHD call themselves neurodivergent, and that neurodiversity describes the range of different ways brains work.

There is no single AuDHD checklist. The signs are those of autism and of ADHD, which may show up at the same time, in different situations or in ways that seem to pull against each other. The NHS says every autistic person is different, many will not show all the signs, and signs may not always be obvious. Autism may also look different in someone who has other conditions, such as ADHD.

The table sets out the signs the NHS lists for each condition in adults. Having some of these signs does not mean you have either condition: only an assessment can tell.

The NHS explains that some autistic people learn to adapt so that signs are less noticeable, which is called masking, and that masking can make everyday activities and social interactions feel exhausting and stressful. Not all autistic people know they are masking.

The NHS says it can be harder to see signs of autism in women because of masking, and that ADHD is thought to be recognised less often in women than men, probably because women with ADHD more commonly have inattentive symptoms, which can be harder to recognise than hyperactive ones. NICE says ADHD is thought to be under-recognised in girls and women, who may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition.

The NHS adds that it may be difficult to see signs of autism if an adult has other conditions, such as a learning disability, anxiety, depression, an eating disorder or ADHD. That is one reason people are sometimes diagnosed with one condition years before the other is identified.

In practice you may need two assessments, one for autism and one for ADHD, though some teams look at both. The NHS says to speak to a GP to find out how to get an autism assessment in your area. An autism assessment team may ask you to fill in questionnaires, ask about how you behave with others and about your early life, speak to someone who knew you as a child, and read GP reports and school reports. The NHS says the assessment team looks for signs of other conditions that are common in autistic people, such as ADHD or epilepsy, and can refer for additional tests.

For ADHD, the NHS says to make an appointment with a GP if symptoms are affecting your studies, work or relationships. The GP may also want to consider other conditions that could cause your symptoms, such as autism, Tourette's or anxiety, and may refer you for an assessment with a mental health professional specialising in ADHD. The ADHD specialist, such as a psychiatrist, will ask about the history of your symptoms, particularly whether they started in childhood, and how they affected you at school. Symptoms of ADHD usually start before the age of 12.

NICE says that assessment for ADHD should include assessment of any coexisting conditions. If you are not diagnosed, or you do not agree with the result, the NHS says you can ask the GP or assessment team to refer you to another team for a second opinion, or pay for another assessment by a professional outside the NHS.

The NHS says autism is not an illness and there is no treatment or cure, but there are ways of managing it and getting support, from a GP or local autism team, your local council, your school, college or workplace, local support services and national charities. After an autism assessment you may be given a report and, if you are diagnosed, a care plan or information to support you.

For ADHD the NHS says there are many ways to manage it, including lifestyle changes, changes at work and medicines, depending on your symptoms and how much they affect you. ADHD medicines, such as methylphenidate or lisdexamfetamine, must be started and monitored by an ADHD specialist, and not everyone needs or wants to take them. Talking therapies such as CBT or mindfulness may be recommended. Medicine decisions for someone with both conditions are made by the specialist, who will take account of both diagnoses.

You can ask for reasonable adjustments at work, college or university, which the NHS says may include a personalised work space in a quiet area, written instructions as well as spoken ones, and help from another person to plan and structure tasks. The NHS also suggests regular physical activity, regular sleep, a balanced diet and regular mealtimes.

The NHS says signs of autism may be noticed at a very young age or not until later in life, and lists signs such as late speech, not responding to their name, using less eye contact, enjoying repetitive actions, strong interests, upset at changes in routine, and strong reactions to lights, sounds, smells, tastes or textures. For ADHD, it lists being easily distracted, forgetting everyday tasks, high energy levels, fidgeting, restlessness and finding it hard to wait.

The NHS says many children are easily distracted, impulsive and have high energy levels, particularly under 5, and that this does not mean they have ADHD. If you are worried, the NHS suggests talking to one of your child's teachers, who can involve the school's special educational needs co-ordinator (SENCO), and then a GP. For autism, a GP can often refer to a local autism team, or a school or health visitor may make the referral. If you are waiting for an assessment, the child should continue to get support at home and at school.

The NHS says people with ADHD may be more likely to have mental health issues such as anxiety or depression and are also at higher risk of suicide, and that autistic people are more likely to have conditions such as anxiety, eating disorders or depression. Anxiety and depression can make ADHD symptoms worse.

If you feel you want to end your life, or you have seriously harmed yourself, call 999 or go to A&E. For urgent help that is not immediately life-threatening, get help from NHS 111 online or by phone and choose the mental health option, or contact your GP.

On the NHS, your GP is the usual starting point. The NHS says waiting times for ADHD assessments vary, and you may have to wait several months or years. In England the Right to Choose scheme means you can ask for an NHS appointment at any clinic, including a private clinic, that provides ADHD or autism services for the NHS, which may have shorter waiting lists.

You can also pay for a private assessment, and the NHS says you may get a second opinion from a professional outside the NHS. If you go privately, check that the assessor is a suitably qualified specialist, ask whether the assessment covers both autism and ADHD, and check in advance whether your GP or an NHS team will accept the report and take over prescribing, because NHS shared care agreements are needed for GPs to prescribe ADHD medicines.