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Is ADHD Autism? Understanding the Overlap

By Ryan S. Sultan, MD
Assistant Professor of Clinical Psychiatry, Columbia University
Board-Certified Child & Adolescent Psychiatrist
February 13, 2026

The Short Answer

ADHD and Autism Spectrum Disorder (ASD) are different conditions:

• ADHD is primarily a disorder of attention, impulse control, and executive function
• Autism is primarily a disorder of social communication and restricted/repetitive behaviors
• They can co-occur — having both ADHD and autism is common
• They share some symptoms — particularly difficulty with focus, social challenges, and sensory sensitivities
• They have different core deficits — but these can overlap in complex ways

Understanding the relationship between ADHD and autism matters because:

1. Misdiagnosis can lead to ineffective treatment
2. Missing a dual diagnosis means addressing only part of someone's challenges
3. Treatment approaches differ for ADHD vs. autism
4. Many people wonder "do I have ADHD, autism, or both?"

ADHD vs Autism: Core Differences

Where ADHD and Autism Overlap

Despite being distinct conditions, ADHD and autism share surprising overlap:

1. Executive Function Deficits

Both conditions involve:

• Difficulty with planning and organization
• Problems with working memory
• Challenges with flexible thinking
• Trouble with time management
• Difficulty inhibiting inappropriate responses

The difference:

• ADHD: Executive dysfunction is THE core problem
• Autism: Executive dysfunction is a common associated feature

2. Attention Difficulties

Both can involve:

• Difficulty sustaining attention
• Appearing not to listen
• Getting lost in thoughts
• Struggling to complete tasks

The difference:

• ADHD attention problems: Difficulty filtering distractions, maintaining focus on non-preferred tasks
• Autism attention patterns: May hyperfocus intensely on interests but struggle to shift attention away; difficulty with divided attention

3. Social Challenges

Both can struggle with:

• Interrupting conversations
• Missing social cues
• Difficulty making/keeping friends
• Saying inappropriate things

The difference:

• ADHD social problems: Usually due to impulsivity (blurting out), inattention (not tracking conversation), or hyperactivity (can't sit still). Understands social rules but can't consistently follow them
• Autism social challenges: Fundamental difficulty understanding unwritten social rules, reading emotions, or interpreting nonverbal communication. Doesn't intuitively understand what others are thinking/feeling

4. Sensory Sensitivities

Both can experience:

• Sensitivity to sounds, lights, textures
• Seeking or avoiding certain sensory input
• Overwhelm in busy environments

The prevalence:

• Autism: 80-90% have sensory processing differences (core feature)
• ADHD: 50-70% have sensory sensitivities (common but not universal)

5. Emotional Regulation

Both can involve:

• Emotional outbursts
• Difficulty calming down once upset
• Intense reactions to seemingly minor events
• Mood swings

The mechanism:

• ADHD: Poor impulse control means emotions expressed immediately without filtering; difficulty regulating intensity
• Autism: Emotional regulation challenges often tied to difficulty understanding/expressing emotions, sensory overwhelm, or rigidity

ADHD and Autism: How Often Do They Co-Occur?

The Statistics

Among autistic individuals:

• 30-80% also meet criteria for ADHD (estimates vary by study)
• ADHD symptoms are extremely common even when formal diagnosis criteria aren't fully met

Among people with ADHD:

• 15-25% also meet criteria for autism
• Autistic traits (even if not full autism diagnosis) are more common than in general population

In the general population:

• ADHD: ~5-7% of children, 4-5% of adults
• Autism: ~2-3% of children (increasing prevalence over time)
• Having both: ~1-2% of population

Why Do They Co-Occur So Frequently?

1. Shared Genetic Risk

Research shows genetic overlap between ADHD and autism:

• Family studies: If one sibling has ADHD, increased risk of autism in another sibling (and vice versa)
• Genetic studies: Some of the same gene variants increase risk for both conditions
• Twin studies: Shared genetic factors contribute to both ADHD and autism traits

2. Overlapping Brain Development

Both involve atypical neurodevelopment affecting:

• Prefrontal cortex development and function
• Dopamine and serotonin systems
• Brain connectivity patterns
• White matter development

3. Common Environmental Risk Factors

• Prematurity
• Low birth weight
• Prenatal complications
• Advanced parental age

Historical Note: DSM Changes

Before 2013 (DSM-IV): You could NOT be diagnosed with both ADHD and autism simultaneously. Autism diagnosis excluded ADHD diagnosis.

After 2013 (DSM-5): Dual diagnosis is now permitted and encouraged when both sets of criteria are met.

Why this matters: Many adults were evaluated under old criteria and told "you can't have ADHD because you have autism" or vice versa. Current understanding recognizes you can have both.

How to Tell Them Apart: Clinical Scenarios

Scenario 1: Primarily ADHD

Michael, age 9: Extremely hyperactive, can't sit still, constantly interrupting class. Has many friends and is socially engaged, but teachers say he "doesn't think before acting." He understand when he's broken social rules and feels bad about it. Loves playing pretend games. No rigid routines. Transitions between activities fine with reminders. Makes good eye contact. Speech and language developed on time.

Diagnosis: ADHD, Combined Presentation

Scenario 2: Primarily Autism

Emma, age 7: Quiet, well-behaved in class. Doesn't initiate play with peers; prefers to line up her toys. Has encyclopedic knowledge of dinosaurs and talks about them constantly, not noticing when others seem disinterested. Becomes very distressed if morning routine changes. Sensitive to clothing tags and loud noises. Speech slightly unusual (overly formal). Makes minimal eye contact. Doesn't understand sarcasm or jokes.

Diagnosis: Autism Spectrum Disorder (without ADHD)

Scenario 3: Both ADHD and Autism

Alex, age 11: Diagnosed with autism at age 4 (speech delay, limited social interest, intense focus on trains). Now in middle school, teachers report Alex is also extremely inattentive, loses materials, can't organize homework, and is impulsive (blurts out train facts at inappropriate times). Even accounting for autism-related social challenges, Alex shows clear ADHD symptoms: forgetfulness, losing things, disorganization, and inability to sustain attention even on preferred activities when tired.

Diagnosis: Autism Spectrum Disorder + ADHD, Combined Presentation

Scenario 4: Borderline/Complex

Sophia, age 14: Significant social difficulties (few friends, doesn't understand social hierarchy), some restricted interests (loves anime, spends hours reading about it), mild sensory sensitivities. Also very inattentive, forgetful, disorganized. Eye contact okay but conversations feel "off." Not sure if social problems are ADHD-impulsivity or autism-social communication deficit.

Possible diagnoses: Could be ADHD with autistic traits, autism with ADHD, or borderline for both. Comprehensive evaluation needed. Regardless of exact labels, treatment addresses both types of symptoms.

Common Misdiagnosis Scenarios

Autism Mistaken for ADHD

Why it happens:

• Inattentive autism can look like ADHD inattentive presentation
• Social difficulties attributed to ADHD impulsivity rather than autism
• Evaluator focuses on attention problems, misses subtler social communication deficits
• Young children with autism often very active (looks like hyperactivity)

Red flags suggesting autism was missed:

• ADHD medication helps attention but not social problems
• Behavioral therapy for ADHD doesn't improve social skills
• Rigid thinking and difficulty with change persist despite treatment
• Sensory issues are prominent

ADHD Mistaken for Autism

Why it happens:

• ADHD-related social problems (interrupting, not listening) misinterpreted as autism
• Hyperfocus on interests mistaken for restricted interests
• Executive dysfunction causing difficulty with changes misread as rigidity
• Sensory sensitivities present in ADHD assumed to indicate autism

Red flags suggesting ADHD was missed:

• Social skills improve dramatically with ADHD medication
• Social problems mainly due to impulsivity/inattention, not misunderstanding social cues
• Transitions fine when given support for attention/organization
• Interests shift frequently rather than staying narrow/intense

Both Present But Only One Diagnosed

Why it happens:

• Clinician focuses on most obvious/impairing symptoms
• One diagnosis made in childhood, second condition emerges or becomes apparent later
• Symptoms of one condition mask or overshadow the other
• Under old DSM-IV rules, dual diagnosis wasn't allowed

Red flags that both are present:

• Treatment for one condition helps partially but significant symptoms remain
• Some symptoms respond to ADHD meds, others don't
• Mix of ADHD-typical and autism-typical behaviors
• Family history of both conditions

Treatment: How ADHD vs Autism Matters

ADHD Treatment

First-line:

• Stimulant medication (methylphenidate, amphetamines) - highly effective for attention, impulsivity, hyperactivity
• Behavioral interventions - parent training, organizational skills training
• Educational accommodations - extended time, reduced distractions

Expected improvements: Attention span, impulse control, task completion, organization

Complete ADHD Treatment Guide →

Autism Treatment

Core interventions:

• Applied Behavior Analysis (ABA) or other behavioral therapies
• Speech/language therapy - social communication, pragmatic language
• Social skills training - explicit teaching of social rules and perspective-taking
• Occupational therapy - sensory integration, daily living skills

Medication: No medication treats core autism symptoms, but medications may help associated problems:

• Irritability/aggression: risperidone, aripiprazole (FDA-approved for autism)
• Anxiety: SSRIs
• ADHD symptoms in autistic individuals: stimulants (with caution)

Treatment When Both Are Present

The challenge: Need to address both ADHD symptoms AND autism-specific needs

Integrated approach:

• ADHD medication - Can help attention and impulsivity in autistic individuals (about 50-70% response rate, somewhat lower than in ADHD alone)
• Social skills training - Addresses autism-related social deficits that medication won't touch
• Executive function support - Organizational systems, visual schedules, timers
• Sensory accommodations - Address sensory sensitivities common in both
• Anxiety treatment - Both conditions have high anxiety comorbidity

Medication considerations in autism + ADHD:

• Stimulants can be effective but may cause more side effects (irritability, appetite suppression)
• Start low, go slow with dose increases
• Non-stimulants (atomoxetine, guanfacine) sometimes better tolerated
• Monitor for mood changes or increased repetitive behaviors

Getting an Accurate Diagnosis

What a Comprehensive Evaluation Should Include

For ADHD Assessment:

• Rating scales (ADHD-RS, Conners, SNAP-IV)
• Developmental history (symptoms present before age 12)
• Functional impairment across settings
• Executive function evaluation
• Rule out other explanations (anxiety, learning disabilities, sleep disorders)

For Autism Assessment:

• Social communication observation and history
• Restricted/repetitive behavior assessment
• Developmental milestones (especially language, play, social)
• Standardized tools (ADOS-2 is gold standard; SCQ, SRS screening)
• Sensory profile

For dual diagnosis evaluation:

• All of the above, plus careful teasing apart which symptoms are ADHD-related vs autism-related
• This requires evaluator experienced with both conditions
• Often benefits from multidisciplinary team (psychiatrist, psychologist, speech therapist)

Questions to Ask Your Evaluator

• "Do you have experience diagnosing both ADHD and autism?"
• "Will you be considering whether both conditions are present?"
• "What assessment tools will you use?"
• "How do you distinguish between ADHD and autism when symptoms overlap?"

Living with ADHD and/or Autism

If You Have ADHD

Strengths to leverage:

• Creativity and out-of-the-box thinking
• Ability to hyperfocus on engaging tasks
• High energy and enthusiasm
• Spontaneity and adaptability

Challenges to address:

• Organization and time management
• Following through on commitments
• Impulse control
• Maintaining attention on boring but necessary tasks

If You Have Autism

Strengths to leverage:

• Intense focus and expertise in areas of interest
• Attention to detail
• Logical, systematic thinking
• Honesty and straightforward communication
• Pattern recognition

Challenges to address:

• Social communication and relationships
• Flexibility with changes to routine
• Sensory sensitivities
• Understanding unwritten social rules

If You Have Both

Unique profile:

• May have social interest (ADHD) but poor social skills (autism)
• Impulsive sharing of special interests
• Difficulty with both attention AND social communication
• Need support in multiple domains

The positive side: ADHD flexibility can sometimes balance autism rigidity; autism focus can sometimes balance ADHD distractibility

Frequently Asked Questions

Is ADHD on the autism spectrum?

No. ADHD and Autism Spectrum Disorder are separate diagnoses with different diagnostic criteria. The term "autism spectrum" refers to the wide range of presentations within autism (from those needing substantial support to those needing minimal support), not a spectrum that includes ADHD.

However, ADHD and autism are both neurodevelopmental conditions, meaning they involve atypical brain development starting early in life.

Can you have ADHD and autism?

Yes, absolutely. Since the DSM-5 (2013), dual diagnosis is recognized. In fact, having both is common—30-80% of autistic individuals also meet criteria for ADHD.

Will my child "grow out of" ADHD or autism?

Both are lifelong conditions, though symptoms and challenges change over time:

• ADHD: Hyperactivity often decreases with age, but inattention and executive function challenges typically persist into adulthood
• Autism: Core social communication differences persist, though many autistic individuals develop compensatory strategies and improved social skills with support

Do autism and ADHD run in families together?

Yes. Research shows:

• If one child has ADHD, siblings have increased risk of both ADHD AND autism
• If one child has autism, siblings have increased risk of both autism AND ADHD
• Parents of children with either condition often have ADHD, autism, or traits of both

I was diagnosed with ADHD as a child but wonder if I'm actually autistic. What should I do?

Consider reassessment if:

• ADHD treatment helps some symptoms but not others (especially social challenges)
• You've always felt "different" in ways beyond ADHD
• You have significant sensory sensitivities
• You have intense, narrow interests that never change
• Social situations feel confusing beyond just attention problems

Many people were diagnosed before increased autism awareness, and evaluators may have missed autism symptoms.

The Bottom Line

ADHD and autism are not the same thing, but they're related:

1. Distinct conditions with different core deficits
2. Frequently co-occur (30-80% of autistic people have ADHD)
3. Share some symptoms especially executive function, attention, and emotional regulation
4. Require different treatments though some interventions help both
5. Both are neurodevelopmental with genetic and neurobiological overlap

If you're wondering whether you or your child has ADHD, autism, or both:

• Seek evaluation from clinician experienced with both conditions
• Don't assume one diagnosis rules out the other
• Focus on which symptoms cause impairment and need support
• Treatment should address all presenting symptoms regardless of diagnostic labels

Further Reading

• Complete ADHD Guide
• ADD vs ADHD: What's the Difference?
• Why 85% of Adults with ADHD Are Undiagnosed
• ADHD Psychiatrist NYC

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