AuDHD in Focus: Emerging Evidence and Clinical Insights into Dual Neurodivergence in Adults | Pete Crascall, Clinical Director

October 1, 2025
8:00 am

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Public interest in siloed adult neurodivergence has grown, and services are seeing more adults come forward for assessment for either ADHD or Autism Spectrum Disorder. However, it is very possible for autism spectrum condition and ADHD to occur in the same individual; termed ‘AuDHD’. Recognition of this co-occurrence has increased in recent years, particularly in adults^1-3. Just over a decade ago, for example, the two were treated as mutually exclusive in diagnostic manuals, where one precluded the other^1-2. And for many, the idea can still feel “paradoxical” – a concept echoed across many online discussions⁴. Both conditions are neurodevelopmental and multi-dimensional, which is why overlaps commonly appear in attention regulation, executive function, social communication and sensory processing^{1, 5-6}.

AuDHD is a clinical description of co-occurrence, and ought not be seen as a trend in order to allow everyone a diagnosis. One report in The Guardian has noted that some critics have begun calling neurodivergence “fashionable”, warning that AuDHD may therefore attract similar pushback¹.

So, our task must be different: to recognise real patterns that guide care, rather than to medicalise busyness, anxiety or perfectionism. We also need to understand why more adults are seeking referrals and diagnoses for autism and ADHD diagnoses in recent years^{1, 7}. The Nuffield Trust, for example, has reported a substantial rise in demand, with new autism referrals outpacing closed referrals each month and waiting lists ballooning – resulting in patients waiting longer for first appointments⁷. In December 2023, 79% of those waiting over 13 weeks had not had a first appointment recorded, compared with 44% in December 2019⁷.

Likely drivers for such increase in diagnoses include better awareness, lower stigma, clearer pathways to adjustments at work or university, and more people recognising lifelong patterns missed in childhood^7-8. Interestingly, there are other hypotheses that are emerging – such as food-quality concerns⁹ and childhood BPA exposure¹⁰. But these remain unconfirmed and in the early stages of research. Irrespective of this, though, sources have outlined that such a stark rise calls for a rethink of how services are organised – including referral to partners beyond public healthcare service provision¹¹.

What Does the Evidence Say About AuDHD in Adults?

Is AuDHD Clinically Recognised?

Co-diagnosis of autism and ADHD is permitted in DSM-5/DSM-5-TR and ICD-11; but “AuDHD” is a descriptive term for co-occurrence rather than a standalone disorder. Until 2013 though, co-diagnosis was not recognised, reflecting earlier assumptions about contradiction between the two presentations⁴. Because AuDHD is not a separate DSM category, studies can define samples differently – therefore, from a research perspective, clearer specification of co-occurrence might improve comparability and accelerate cumulative evidence.

How Common is AuDHD in Adults, and Is there an Intersection With Mental Health Challenges?

One report suggests that up to half of autistic individuals also show ADHD symptoms, and autism-related characteristics are present in around two-thirds of people with ADHD³. Other sources place co-occurring ADHD in autistic people between 40–70%^{4, 12-13}.

Across studies, the general consensus is that adults with both conditions tend to have higher rates of anxiety and depression, more sleep disturbance, and greater functional impairment than neurotypical counterparts, indicating lower quality of life overall^14-16. In the context of long wait times, service strain, and misdiagnosis^{7, 11, 17-18} – undetected co-occurrence can compound these mental health challenges; something particularly true for women, who are more often misdiagnosed or undiagnosed¹⁸.

Trait-level methods help explain why overlap between the two conditions isn’t rare. ‘Network approaches’ map individual characteristics – such as inattention, working-memory lapses, sensory sensitivity and social reciprocity – and evaluate how strongly they connect within a mixed autism–ADHD sample¹⁹. These studies frequently identify bridges across executive function, attention regulation, sensory processing and social communication. Latent class/profile analyses similarly reveal subgroups that cut across labels … for example, marked executive-function and sensory difficulties, or prominent inattention with relatively intact social reciprocity²⁰. Together, this supports overlapping dimensions alongside condition-specific features^21-22 which, clinically, favours integrated assessment of executive, attentional, sensory and social domains – rather than siloed pathways, and a formulation that targets the domains driving impairment.

Lastly, masking and sex differences remain central to adult detection. Historically, ADHD and autism were framed as male childhood conditions²³. Though diagnoses among women have risen with awareness²⁴, knowledge gaps about gendered presentations persist²⁵. Higher rates of depression and eating disorders in neurodiverse females can complicate recognition²⁶, and there may be a slightly higher threshold for referral and diagnosis in females²⁷. Research and criteria have historically been male-skewed²⁶, where women with autism are frequently under- or misdiagnosed²⁶. This is partly because criteria were developed from male behavioural presentations²⁸. Regardless, late diagnoses in women constitute a public-health concern for care, research and lived experience²⁹. As one example, workplace stigma towards autistic female employees is well-documented^30-31, leaving many to weigh disclosure³²; where masking is maintained, mental-health costs and reduced quality of life are often reported^33-35.

Treatments for AuDHD

When it comes to AuDHD treatment, ADHD pharmacotherapy (e.g., stimulants, atomoxetine, guanfacine) can be effective in autistic adults, however it does require careful monitoring for anxiety, sleep or sensory side-effects^36-37. This is because, in some cases, medication may exacerbate sensory or social overload – warranting such close review and adjustment³⁸. Psychosocial care should complement this with executive-function scaffolding, autism-adapted CBT, sleep, occupational and sensory strategies, with progress monitored against functional outcomes.

Why Is AuDHD Clinically Important in Contemporary Research?

Adults can still be frequently treated for anxiety or depression – or other mental health conditions – while the core autistic or ADHD features go unrecognised. This is where AuDHD exposes the limits of siloed pathways and explains why misdiagnosis and late diagnosis are common – especially for women and other late-presenters^23-29. This is often the result of diagnostic overshadowing (focusing on prominent mood or anxiety symptoms) or incomplete evaluation that seldom screens for both conditions together^{1, 5, 39}.

For many women, the picture is further complicated by camouflaging, social exhaustion, sensory burnout, and cyclical symptoms that can overlap with PMDD – together, these can blur the clinical signal^23-29. So, AuDHD in women may look like high verbal ability with marked post-social fatigue, chronic overwhelm in sensory settings, and longstanding executive-function difficulties that were masked in education or early work. When AuDHD remains unrecognised, what looks like “treatment resistance” to standard anxiety or depression pathways can result in a deep mismatch between needs and approach.

And, service design can exasperate this problem. Many systems still route adults through autism or ADHD or general mental health services. An integrated, staged assessment – including history, collateral, and targeted tools for both conditions – reduces duplication, shortens time to formulation, and improves fit between support and goals. Begin by assuming both may be present, diagnosing AuDHD in adults becomes a matter of ruling in or out, with structured history and appropriate instruments.

Finally, the burden of co-occurrence never ought to be viewed as trivial. While it’s no secret that AuDHD in adults can frequently be misdiagnosed as standalone mental health challenges – such as anxiety, borderline personality disorder, or depression – adults with both conditions do have higher rates of psychiatric comorbidity, sleep problems, and functional impairment^14-16. This underscores the need for early identification and a management plan that addresses both autistic and ADHD dimensions.

AuDHD Treatment: What Looks Promising, What’s Flawed, What’s Emerging?

What works best for AuDHD treatment is an assessment pathway that holds both possibilities in mind from the outset. If we plan for autism and ADHD together then the history, collateral information and tools are chosen once, in a coherent sequence. This reduces mixed messages and shortens the time to interventions that matter. Progress is clearer when we measure what people feel day to day, in the environments where they spend the most time: executive skills at home and work, role functioning, and sleep. Therapeutically, pairing autism-adapted CBT with executive-function coaching (task initiation, planning, time awareness) and small sensory/environmental adjustments tends to be kinder and more sustainable than aiming for wholesale change.

There are cautions, however. Brief screens open the door but should not make the diagnosis; masked presentations – especially in women – can be easy to miss. It’s also worth noting that evidence derived from paediatrics does not automatically translate to adult life. This is because of its competing demands, deep complexity of relationships and hormonal shifts. Medication also needs nuance. Stimulants used for ADHD treatment do not invariably worsen autistic features; some adults benefit, some do not³⁸.

Two areas feel especially promising for future improvements. Firstly; subtle, continuous tracking – sleep regularity, routines, attentional load – can help to guide practical adjustments in real time. A nurse-led, at-home model is well placed for this: a named nurse can notice patterns early, steady the day’s rhythm, and close the loop with the wider clinical team. Secondly, we must better attend to female trajectories and hormones. Falling oestrogen can affect attention, emotion regulation, organisation and memory; during perimenopause, established difficulties may intensify and require tailored treatment⁴⁰. For autistic adults, menopause can amplify neurodivergent features, and neurodivergence can sharpen menopause symptoms⁴¹. So, many reach this stage unprepared without proactive planning⁴¹. Bringing these strands together – integrated assessment, functional measurement, careful pharmacology and real-world support – helps to keeps care both compassionate and effective.

What Should AuDHD Treatment and Referral Pathways Look Like?

What Treatments Help Adults with AuDHD?

Before one even begins to think about treatment and management for AuDHD – we must begin with remembering that it’s about the person, not the label. Medication can help when it’s informed, introduced gently (‘start-low, go-slow’), and reviewed against sleep, anxiety and sensory load. Stimulant or non-stimulant choices should reflect the individual’s pattern and preferences, with regular check-ins.

And then we can begin to pair this with practical skills for everyday life: executive-function coaching (getting started, planning, time awareness) and autism-adapted CBT for worry or rigidity. Once stable, we can then begin to help shape the environment – steadier sleep routines, predictable transitions, and small sensory adjustments at home and work. I also believe that tracking what matters (roles, rest, safety) ensures progress is visible and tweaks are timely.

Families often ask how to support a family member with AuDHD, and my answer is always the same: brief, informed, compassionate and kind psychoeducation reduces friction and builds shared language.

AuDHD Referral and Triage.

It’s important to not over diagnose – that’s key. But, when there is a lifelong pattern of attention and planning difficulties, social “hangovers” after interaction, sensory overwhelm, and later academic or work struggles… we must be confident in thinking ‘AuDHD’ as, for many, diagnosis can genuinely be lifechanging.

AuDHD Assessment Pathway.

Lastly, we must begin to explore autism and ADHD in tandem more often, set expectations about timelines, and be clear about what a diagnosis can (and can’t) do. We must aim for a formulation-led plan that links traits to supports, including simple workplace adjustments; such as clear written instructions, protected focus time, flexible scheduling, quieter spaces and fewer context switches. Regular review keeps the plan compassionate, practical and moving.

Best Practise for an AuDHD Treatment Provider

AuDHD invites us to look beyond categories and focus on function: what helps a person live, work and relate with less distress. That shift matters. It keeps the conversation practical and kind.

Next, we need integrated adult pathways, not silos; neurodiversity-affirming practice that respects identity, and routine measurement of outcomes – sleep, role functioning, safety, and quality of life – rather than symptom totals alone. When we track these, care becomes easier to steer and more transparent for everyone involved.

Research must also catch up. We need adult-centred studies that include female cohorts, account for masking and camouflaging, examine hormonal stages such as perimenopause and menopause, and use culturally sensitive tools that reflect real life.

Clinically, humility serves us well. Avoid over-promising. Stay curious. Co-produce plans with the person – and with family where appropriate – so support aligns with how they live, not how we think their life should look.