The Intersection of ADHD and Autism: Understanding AuDHD and the Need for Better Assessments, Especially for Women
Unique Presentation in Women
Women with ADHD and ASD often mask their symptoms more effectively than men, which leads to delayed diagnoses. This is particularly significant for individuals with AuDHD, as the overlap of ADHD’s impulsivity and autism’s need for routine creates a complex, often contradictory internal experience. For example, women with AuDHD may develop strong coping mechanisms to appear socially adept, despite struggling with internal disorganisation, anxiety, and burnout. Research highlights that women are more likely to internalise their challenges, presenting as “inattentive” or anxious, rather than showing the hyperactive behaviours typically associated with ADHD, which results in their difficulties being overlooked(Autistic Girls Network)(Relational Psych).
In fact, societal expectations often worsen the issue. Girls and women are generally expected to be more socially skilled and emotionally regulated, which pressures them to hide their neurodivergent traits. This "masking" can contribute to mental health issues such as anxiety, depression, and even burnout, as women expend tremendous energy trying to conform to neurotypical norms(Psychology Today).
The Need for Better Diagnostic Tools
Until recently, diagnostic criteria for both ADHD and ASD did not adequately reflect the experiences of those who fall within the overlap of these conditions. In fact, prior to 2013, clinical guidelines prohibited simultaneous diagnoses of ADHD and autism. This historical separation of the two conditions has contributed to a lack of awareness and research into how they interact. Consequently, AuDHD individuals may present in ways that do not align with typical understandings of either condition, resulting in missed or incomplete diagnoses.
Women, in particular, are affected by this diagnostic gap. As researchers advocate for more nuanced diagnostic tools, it is becoming clear that existing frameworks often fail to capture the unique interplay of symptoms in AuDHD, especially in women(Autistic Girls Network)(Relational Psy). For instance, AuDHD can manifest as cycles of high energy followed by burnout, or impulsive decision-making followed by significant anxiety about those decisions. These patterns, along with the often subtle social difficulties women face, make traditional diagnostic assessments insufficient.
Call for a More Inclusive Approach
To address the underdiagnosis of women with AuDHD, healthcare systems in the UK and beyond need to adopt a more holistic and gender-sensitive approach to neurodiversity assessments. This would involve recognising the subtler, internalised expressions of ADHD and ASD in women, and creating assessments that are not biased towards typically male presentations. Additionally, mental health professionals need more training on how these conditions can mask each other, which can complicate diagnosis(Autistic Girls Network)(Relational Psych).
Furthermore, treatment for AuDHD should be tailored to each individual’s specific needs. Many AuDHD individuals benefit from both behavioural and pharmacological interventions that consider the complex ways ADHD and ASD interact. Given the cognitive tug-of-war between the spontaneity-seeking tendencies of ADHD and the routine-driven needs of autism, a more nuanced understanding of how to balance these conflicting impulses is crucial for effective support(Relational Psych).
In conclusion, as our understanding of AuDHD continues to develop, it is vital to push for better diagnostic tools and treatment frameworks that recognise the distinct experiences of those with both ADHD and ASD. Women, in particular, are at risk of falling through the cracks of the current system, making it essential to raise awareness and advocate for neurodiverse-affirming assessments and interventions.
