By Dr. Ryan Sultan, MD
Double Board-Certified Psychiatrist (Adult & Child/Adolescent)
Columbia University Irving Medical Center | Integrative Psych NYC
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📂 Category: ADHD Comorbidities
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ADHD and autism are distinct neurodevelopmental conditions that co-occur in 30-80% of cases. ADHD involves executive dysfunction and hyperactivity, while autism centers on social communication differences and repetitive behaviors. |
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🧩 ADHD vs Autism: More Than Just Confusion "Do I have ADHD, autism, or both?" This is one of the most common questions I hear from patients—and for good reason. ADHD and autism overlap significantly, with 30-80% of autistic people also having ADHD. Both conditions can involve:
But they're fundamentally different conditions that require different approaches to treatment. This guide will help you understand the differences—and what it means if you have both. |
| Aspect | ADHD | Autism |
| Core Issue | Difficulty regulating attention and controlling impulses | Differences in social communication and restricted/repetitive behaviors |
| In One Sentence | "I can't focus on what I should, or I focus too much on what I shouldn't" | "I process social information differently and need predictability/routine" |
| Brain Wiring | Difficulty with executive function (planning, organizing, impulse control) | Different social cognition (theory of mind, reading social cues) + need for sameness |
| Biggest Struggle | Getting and staying organized, focusing on boring tasks, controlling impulsivity | Understanding unwritten social rules, handling social interactions, tolerating change |
The Simplest Way to Think About It:
But here's the complication: 30-80% of people with autism also have ADHD. And 20-50% of people with ADHD have autistic traits. They frequently co-occur, which is why distinguishing them is so challenging.
| ADHD | Autism |
| Social motivation: Wants friends, enjoys socializing (when not distracted) | Social motivation: Variable—may prefer solitude, find socializing exhausting |
| Social skills: Knows social rules but struggles to apply them due to impulsivity or inattention | Social skills: Genuinely doesn't understand unwritten social rules—needs them explicitly taught |
| Eye contact: May forget to make eye contact (distracted) but understands its importance | Eye contact: Finds eye contact uncomfortable or doesn't understand why it matters |
| Conversation: Interrupts, talks too much, derails conversations (impulsivity) | Conversation: Misses social cues, doesn't pick up on hints, takes things literally, struggles with back-and-forth |
| Reading emotions: Can read emotions but may not notice them (inattention) | Reading emotions: Difficulty reading facial expressions, body language, tone of voice |
| Friendships: Has friends but may lose them due to impulsive behavior or forgotten plans | Friendships: Difficulty making friends, prefers solitary activities or one-on-one interaction |
Key Question: Do you struggle with social situations because you're distracted/impulsive (ADHD) or because you don't understand the unwritten rules (autism)?
| ADHD | Autism |
| Attention span: Inconsistent—can't focus on boring tasks, hyperfocuses on interesting ones | Attention span: Can sustain attention, especially on special interests (may seem like hyperfocus) |
| Hyperfocus: On whatever is novel, stimulating, or urgent in the moment | Intense focus: On specific, narrow interests that are consistent over time |
| Distractibility: Easily distracted by external stimuli or internal thoughts | Focus difficulties: May struggle to shift attention away from interests or routines |
| Task switching: Jumps between tasks impulsively, starts many things but finishes few | Task switching: Difficulty transitioning between activities—prefers to finish one thing fully |
Key Question: Is your focus problem "can't sustain attention" (ADHD) or "can't shift attention away from specific interests" (autism)?
| ADHD | Autism |
| Fidgeting: Physical restlessness (bouncing leg, tapping pencil, pacing) to release excess energy | Stimming: Self-soothing repetitive movements (rocking, hand-flapping, finger movements) to regulate emotions or sensory input |
| Repetitive thoughts: Racing thoughts, rumination, mind-wandering | Repetitive interests: Deep, narrow focus on specific topics (trains, weather, numbers, etc.) |
| Routines: Struggles to maintain routines due to forgetfulness and disorganization | Routines: Insists on routines—becomes distressed when routines are disrupted |
| Flexibility: Can be flexible (even if disorganized) | Flexibility: Resists change—prefers sameness and predictability |
Key Question: Are your repetitive behaviors about releasing energy (ADHD) or self-soothing and maintaining sameness (autism)?
| ADHD | Autism |
| Sensory issues: Some people with ADHD have sensory sensitivities (overlap with autism traits) | Sensory issues: Very common—70-95% of autistic people have sensory processing differences |
| Type: More about distractibility from sensory input (background noise making focus harder) | Type: Sensory input can be physically painful or overwhelming (loud noises, certain textures, bright lights) |
| Tolerance: Can usually tolerate sensory input if focused/medicated | Tolerance: Sensory overload can lead to shutdowns or meltdowns |
| ADHD | Autism |
| Language development: Typical—no delays or unusual patterns | Language development: May have delays, advanced vocabulary with poor pragmatics, or echolalia (repeating phrases) |
| Literal thinking: Understands sarcasm, metaphors, idioms | Literal thinking: Often takes things literally—"It's raining cats and dogs" is confusing |
| Tone of voice: Variable volume/pacing due to impulsivity or excitement | Tone of voice: Monotone, unusual prosody, or overly formal speech |
| Nonverbal communication: Uses gestures and facial expressions appropriately | Nonverbal communication: Limited gestures, unusual facial expressions, or difficulty interpreting others' |
Many symptoms appear in both ADHD and autism, which is why they're so commonly confused:
Both conditions involve executive dysfunction—but for different reasons:
Both groups struggle with managing emotions—but the triggers differ:
Both can lead to social challenges—but the underlying cause is different:
This is the most confusing overlap:
Key distinction: ADHD hyperfocus is inconsistent (whatever is stimulating right now). Autism special interests are consistent (same topics over time).
| Domain | ADHD | Autism |
| Core Feature | Inattention, hyperactivity, impulsivity | Social communication differences, restricted/repetitive behaviors |
| Social Motivation | Wants friends, enjoys socializing | May prefer solitude or find socializing exhausting |
| Eye Contact | Forgets due to distraction | Uncomfortable or doesn't understand importance |
| Understanding Social Rules | Knows rules but doesn't follow them (impulsivity) | Doesn't intuitively understand unwritten social rules |
| Attention | Can't regulate—too scattered or hyperfocused | Can sustain attention, especially on interests |
| Hyperfocus | On whatever is novel/stimulating now | On specific, consistent special interests |
| Routines | Struggles to maintain routines | Insists on routines, distressed by changes |
| Flexibility | Can be flexible (if disorganized) | Resists change, prefers sameness |
| Fidgeting/Stimming | Fidgets to release energy | Stims to self-soothe or regulate |
| Sensory Sensitivity | Some (20-40%) | Very common (70-95%) |
| Language Development | Typical | May have delays or unusual patterns |
| Literal Thinking | Understands sarcasm/metaphors | Often takes things literally |
| Emotional Regulation | Impulsive reactions, low frustration tolerance | Meltdowns from overload, alexithymia |
| Executive Function | Poor planning, forgetfulness, time blindness | Difficulty with open-ended tasks, transitions |
| Onset | Symptoms before age 12 (DSM criteria) | Early childhood (before age 3 typically) |
| Prevalence | 8-10% of children, 4-5% of adults | 1-2% of population |
| Gender Ratio | 3:1 male:female (diagnosed) | 4:1 male:female (diagnosed, likely underdiagnosed in females) |
Yes—and it's common.
When someone has both ADHD and autism, they experience:
Example: A child who has intense special interests (autism), insists on sameness (autism), but also can't sit still (ADHD), interrupts constantly (ADHD), and forgets to do homework (ADHD).
Several theories:
Requires 6 or more symptoms from either inattention or hyperactivity-impulsivity lists (5 for adults):
Inattention symptoms:
Hyperactivity-impulsivity symptoms:
Plus:
See our complete ADHD diagnosis guide.
Requires deficits in both categories:
A. Social Communication/Interaction (all 3 required):
B. Restricted/Repetitive Behaviors (at least 2 of 4):
Plus:
For ADHD:
For Autism:
When both are suspected: Comprehensive evaluation addressing both sets of criteria, often requiring multiple sessions with a specialist experienced in neurodevelopmental disorders.
Scenario 1: Jake, 9 - ADHD OnlyPresentation: Jake can't sit still in class. He blurts out answers, interrupts his teacher, and forgets his homework constantly. He has lots of friends but sometimes annoys them by not listening or changing the rules of games impulsively. He understands social cues and feels bad when he hurts someone's feelings—he just acts before thinking. Key Features:
Diagnosis: ADHD, combined type |
Scenario 2: Lily, 11 - Autism OnlyPresentation: Lily is obsessed with trains. She can tell you every fact about locomotives but struggles with back-and-forth conversation. She doesn't make eye contact and doesn't understand when people are annoyed with her train talk. She can focus for hours on drawing trains but melts down when her routine changes. Loud noises hurt her ears. She has one friend who shares her train interest. Key Features:
Diagnosis: Autism spectrum disorder |
Scenario 3: Marcus, 14 - Both ADHD and AutismPresentation: Marcus loves computers and coding (special interest). He can talk about programming for hours but doesn't notice when people are bored. He also can't sit through class—he fidgets constantly and forgets to turn in assignments even though he completed them. He finds eye contact painful, needs his daily routine to be predictable, and has sensory issues with clothing tags. He interrupts constantly (ADHD impulsivity) and doesn't pick up on social cues (autism). Key Features:
Diagnosis: ADHD + Autism spectrum disorder (co-occurring) |
Scenario 4: Emma, 32 - Borderline/UnclearPresentation: Emma works in tech and hyperfocuses on coding projects (ADHD-like). She struggles with eye contact (autism-like) but mostly because she forgets to do it when distracted (ADHD-like). She finds small talk annoying (could be either—ADHD finds it boring, autism finds it confusing). She has sensory issues with certain fabrics (autism-like). She's disorganized (ADHD) but also likes routines (autism-like). Key Features:
Diagnosis: Requires thorough evaluation—could be ADHD with autistic traits, autism with ADHD traits, or both |
The Takeaway: Clear-cut cases are easy to diagnose. Many people fall in the gray area and need comprehensive professional evaluation.
Medications:
Therapy:
Accommodations:
See our complete ADHD treatment guide.
No medications treat autism core symptoms (social communication, repetitive behaviors). Medications may help co-occurring conditions:
Therapies:
Accommodations:
When someone has both ADHD and autism, treatment must address both:
Important: ADHD medication can make autistic people more available for learning (better attention), but it won't change the core autism features.
Why it happens:
Red flags it's actually ADHD:
Why it happens:
Red flags it's actually autism:
If you suspect you have both ADHD and autism:
No. ADHD and autism are separate conditions with different diagnostic criteria. However, they frequently co-occur, and some researchers believe they're part of a broader spectrum of neurodevelopmental differences.
ADHD medication helps with ADHD symptoms (attention, hyperactivity, impulsivity) but does NOT treat autism core features (social communication, sensory issues, need for routine). If someone has both conditions, ADHD medication can make them more able to participate in autism-focused therapies.
Yes. 20-50% of people with ADHD have clinically significant autistic traits. And 30-80% of autistic people also have ADHD. The overlap is substantial.
ADHD: Symptoms often decrease with age (especially hyperactivity), but 60-80% of children with ADHD continue to have symptoms in adulthood.
Autism: A lifelong condition. People can learn skills and develop coping strategies, but the core differences remain.
Professional evaluation is essential. A child psychiatrist, neuropsychologist, or developmental specialist can conduct comprehensive testing to determine whether you have ADHD, autism, both, or neither.
Schedule evaluation with Dr. Sultan in NYC →
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📞 Expert ADHD & Autism Evaluation Dr. Ryan Sultan, MD is a double board-certified psychiatrist (Adult & Child/Adolescent) with expertise in neurodevelopmental disorders including ADHD and autism spectrum disorder. Comprehensive Evaluation Includes:
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