DESCRIPTION:

Autism and ADHD at the same time? The hybrid mode of AuDHS explained: what this not-so-rare combination feels like—research on comorbidity, diagnosis and the brain in both patterns.

Not so rare: the accelerator and brake pressed simultaneously in the brain – more than just symptoms: how ADHD and autism feel at the same time

Welcome to our specialised section on AuDHS. More and more people recognise the feeling of having both autism and ADHD – an inner conflict that is often only recognised at a late stage.

Here you will find well-founded information on neurodiversity, guidance on ADHD diagnosis in adults, and answers to the question of why you often fluctuate between inner restlessness and a need for structure. We shed light on the paradox of sensory overload and boredom and explain the background of autism spectrum disorder and ADHD comorbidity.

🧠 A note about our design (neuro-inclusive reading)

We know that long texts are often exhausting for neurodivergent brains. That's why this blog is designed to be "ADHD-friendly":

– TL;DR (Too Long; Didn't Read): You will find a summary at the beginning of each article.

– Scannability: We use bold type for key terms and lots of bullet points so you can grasp the most important information at a glance.

– Clarity: We avoid walls of text and focus on short, digestible paragraphs.

TL;DR – The most important facts in brief

✓ 50–70% of autistic people also have ADHD – the co-occurrence is anything but rare

✓ The "accelerator-brake phenomenon": autism requires structure and calm, ADHD needs stimulation and variety – both occur simultaneously

✓ Long overlooked: The "symptoms" of ADHD and autism are often similar. Until 2013, both diagnoses could not be made at the same time

✓ Genetic overlap: 50–70% of the genetic factors are identical in ADHD and autism

✓ Practical solutions: "Hybrid strategies" such as flexible routines, controlled stimuli and the "permission framework" help people with ADHD and ASD in their everyday lives.

Do you have an ADHD or autism diagnosis, but some of the descriptions don't quite fit? This is far from rare: studies show that up to 50–70% of autistic people also have ADHD. This dual diagnosis creates a unique neurological profile.

What it's all about:

·         How does it feel to experience both at the same time in everyday life?

·         Why this combination is so often overlooked,

·         findings from current research on autism spectrum disorders,

·         common mechanisms in the brain, and

·         how those affected can deal with conflicting needs.

Comorbidity – how often do ADHD and autism spectrum disorder occur together?

The co-occurrence is by no means rare. For a long time, the prevailing opinion was that the two were mutually exclusive. However, this assumption was incorrect.

Current figures:

·         30–80% of autistic people also meet the criteria for ADHD

·         20–50% of people with ADHD show pronounced autistic traits

·         The prevalence has been underestimated for decades

Why is the co-occurrence so common?

Genetic factors play a key role:

·         Heredity in both cases is around 70–80%

·         Autism occurs more frequently in families with people living with ADHD

·         Approximately 50–70% of genetic variants overlap

·         The brain develops differently in similar areas in both conditions

Particularly affected: regions responsible for attention control, impulse control and social interaction.

The problem of late diagnosis

The gender distribution is noteworthy:

·         Boys are often diagnosed earlier

·         In girls and women, both often remain undiagnosed

·         Many affected individuals receive their diagnosis in adulthood

·         Sometimes, not until the age of four or five, when accompanying psychological problems lead them to seek medical help

Late diagnosis is a particular problem in adults, as compensation strategies mask the symptoms.

Noteworthy: Why was the frequent co-occurrence of the "two disorders" overlooked for so long?

The overlap was systematically underestimated for decades. Researchers had long observed that many affected individuals exhibited both neurological profiles, but the diagnostic system did not allow for this.

The historical diagnostic barrier

Until 2013 (DSM-5):

·         Officially, both diagnoses could not be made simultaneously.

·         A diagnostic rule that contradicted individual reality

·         The fact that ADHD and autism can coexist was ignored

Seemingly different symptom patterns

At first glance, the two seem very different:

ADHD manifests as:

·         Attention problems

·         Impulsivity

·         Hyperactivity

·         Seeking stimulation

Autism manifests itself as:

·         Difficulties in social interactions

·         Repetitive behaviours

·         Rituals and routines

·         Hypersensitivity to stimuli (such as noises)

·         Preference for predictable routines

The hidden similarities

Studies show more similarities than expected:

·         Both ADHD and autism affect executive functions

·         Both show peculiarities in stimulus processing

·         Both have genetic bases with significant overlap

·         The neurological mechanisms in the brain are more similar than assumed

The paradoxical problem: with dual diagnosis, both patterns can occur simultaneously – a condition that is difficult to diagnose.

It's about patterns, not symptoms: what does the internal conflict between ADHD and autism spectrum disorders feel like in everyday life?

The simultaneous presence of both creates a unique experience: those affected often describe it as "stepping on the accelerator and the brake at the same time".

The autistic system demands:

·         Predictability

·         Structure and fixed routines

·         Security through familiar processes

·         Minimisation of stimuli

Any deviation activates the stress system. New situations feel threatening.

The ADHD system simultaneously demands:

·         Dopamine kicks through new experiences

·         Variety and excitement

·         Stimulation

·         Routine seems monotonous and unbearable

The urge for change is physically noticeable.

A concrete example from everyday life

Morning: Detailed daily schedule with fixed times (autistic need for structure)

At lunchtime: Plan completely thrown out the window because something spontaneous comes up (ADHD impulsivity)

Evening: Self-criticism – "Why can't I even stick to my own plan?"

This shame is typical. Those affected often do not understand that their brain is running two contradictory programmes at the same time.

What do current studies on the brain show?

New research from the Child Mind Institute provides groundbreaking insights.

The central study

Design:

·         Over 1,000 children and adolescents

·         Examination of brain activation patterns

·         Functional MRI scans

The remarkable result: it is not the formal diagnosis that determines the brain signature, but the severity of the symptoms.

Common brain patterns identified

The study found common activation patterns:

Particularly affected:

·         Dorsolateral prefrontal cortex (executive functions)

·         Default mode network (self-reflection, social interaction)

·         Networks for attention control

·         Areas for impulse control

The genetic basis

Genetic studies support these findings:

·         50–70% of genetic risk factors overlap

·         This genetic proximity explains the frequent co-occurrence

·         Certain genes influence dopamine and serotonin regulation in both

·         These neurochemical similarities explain overlapping symptoms

How do special interests differ from hyperfocus?

These phenomena are similar in appearance, but they have different neurological bases and characteristics that allow them to be distinguished.

Autistic special interests (monotropism)

Characteristics:

·         Long-lasting (years to decades)

·         Deep engagement with specific topics

·         Encyclopaedic knowledge

·         Serves emotional regulation

·         Providing a "safe haven"

Example: 20 years of studying Roman history, knowledge of every battle, every coin minted.

ADHD hyperfocus

Characteristics

·         Temporary state of intense concentration

·         Occurs during new, stimulating activities

·         Time and space are often forgotten, as observed in ADHD.

·         Ends abruptly when dopamine levels drop

·         Typical: Enthusiastic starts, unfinished projects in people with autism or ADHD.

Example: A week of obsessive engagement with a new hobby, then complete disinterest.

In the case of dual diagnosis, both at the same time

The pattern:

·         Long-term special interests (e.g. psychology) ✓

·         But: Within the topic, the focus constantly shifts

·         This week: trauma therapy

·         Next week: Neurobiology

·         The week after next: Diagnostics

The inner conflict:

·         Autistic part: Wants depth, mastery, expertise

·         ADHD part: Wants something different, new aspects, variety

The result: frustration and the feeling of being "neither truly autistic nor truly ADHD".

Why is stimulus processing so paradoxical?

Sensory processing is particularly contradictory in this dual diagnosis, but it is actually logical.

ADHD: Hyposensitivity

·         The brain actively seeks stimulation

·         Stimuli are needed to activate the dopaminergic system

·         Too little input leads to restlessness

Autism: Hypersensitivity

·         Stimuli are perceived more intensely

·         Hypersensitivity to noise, light, touch

·         Quickly overwhelmed

·         Weak stimulus filter: everything comes through unfiltered

In affected individuals: both simultaneously

In the morning:

·         Intense stimuli required (loud music, movement, multiple screens)

·         The ADHD brain revs up

At lunchtime:

·         Sensory overload

·         Office noises, bright lights, and conversations become unbearable

·         Weak stimulus filter allows everything through unfiltered

The irony: strategies for ADHD (more stimulation) exacerbate hypersensitivity, while stimulus reduction increases under-stimulation.

The constant dilemma: never in the "right" state – either under-stimulated and restless OR over-stimulated and overwhelmed.

How do ADHD and autism affect routines?

Routines and precision are important for autistic people – but torture for people with ADHD.

Why autistic people need routines

Functions of routines:

·         Reduce uncertainty for people with autism and ADHD.

·         Provide predictability

·         Conserve cognitive resources

·         They are a neurological necessity, not a quirk

Typical rituals:

·         Morning routines in a fixed order

·         Always the same route to work

·         Consistent meal times

Reaction to deviations: stress, sometimes meltdowns.

Why people with ADHD hate routines

The problem:

·         Underactive dopaminergic system rebels against monotony

·         The same thing every day = unbearable

·         Attention wanders

·         Steps are "forgotten"

·         Constant 'optimisation' destroys structure

Reality: Compliance requires enormous willpower in ADHD.

The daily dilemma of dual diagnosis

The conflict:

·         Those affected know: they need routines to function

·         At the same time, Part of them rebel against these structures

The result:

·         Constant feelings of guilt: "Why can't I even stick to a simple routine?"

·         Chronic exhaustion due to inner struggle

·         Development of "flexible routines" as a compromise (fixed times, changing content)

What does the dual diagnosis mean for social relationships?

Social interaction is particularly complex, as both neurological profiles present different challenges.

Autistic challenges

Difficulties:

·         Facial expressions and gestures must be consciously "learned"

·         Eye contact is exhausting

·         Small talk seems illogical

·         Implicit social signals are confusing

Consequence: Many develop masking strategies (which are extremely exhausting).

ADHD challenges

Typical patterns:

·         Impulsiveness leads to ill-considered statements

·         Interruptions (otherwise the thought is gone)

·         Sharing personal information too quickly

·         Limited attention span in conversations

The paradoxical pattern in both

The dynamic:

Phase 1: ADHD impulsivity drives social situations

·         "That sounds interesting!"

·         Spontaneous commitments

·         Initial enthusiasm

Phase 2: Autistic component experiences overload

·         During or after the situation

·         Social hangover: days or weeks of exhaustion

The problem: friends do not understand the inconsistency

·         "You were super active last week."

·         "Now you're not getting in touch at all"

The result: "Feast or famine" dynamics lead to misunderstandings and sometimes isolation.

How is emotion regulation affected?

Emotion regulation is affected in both cases; the difficulty is exacerbated in dual diagnosis.

ADHD: Emotional dysregulation

Characteristics:

·         Emotions occur suddenly and intensely

·         Rapid fluctuations

·         Criticism feels existential

·         Enthusiasm is boundless

·         Frustration leads to outbursts of anger

·         Rejection Sensitive Dysphoria (RSD)

Autism: emotional blindness and delayed processing

Characteristics:

·         Difficulty naming emotions felt

·         Delayed emotional processing

·         Event occurs – meaning only becomes clear hours/days later

·         Outwardly calm – inwardly overwhelmed

The combination of both

The pattern:

Immediately: intense emotions (cannot understand why)

After the event: "Emotional hangover" – delayed processing means the full effect only becomes apparent days later.

Example: stressful meeting

·         Immediately: Overwhelmed

·         Question: Was it the content? The volume? Criticism?

·         Three days later: emotional breakdown

The problem: Unpredictable emotional stress severely impairs quality of life.

What are the possible solutions?

Professional coaching requires an integrative approach, including therapy for comorbidities.

Why standard therapies are not enough

The problem with one-sided approaches: ADHD and ASD are not "disorders" or "comorbidities", but patterns.

Focusing only on ADHD:

·         Medication (stimulants such as methylphenidate) can improve attention

·         But: May exacerbate hypersensitivity

Focusing only on autism:

·         Strict routines and stimulus reduction help some

·         But: Exacerbate under-stimulation in others

What studies show

A comprehensive study shows that a multimodal approach is most successful.

The multimodal strategy

Medication:

·         Where necessary, carefully adjusted stimulant therapy

·         Combined with anxiolytic or stabilising medication

·         Important: gradual adjustment

·         People with "both disorders" often react more sensitively

Coaching:

·         Cognitive behavioural therapy methods (clear protocols = structure)

·         Combined with mindfulness-based techniques (flexibility)

·         For emotion regulation

Diagnostics:

·         Both are recorded

·         Many adults are diagnosed with ADHD and ASD at a late stage. Diagnosis

Crucial: Help must be professionally trained and able to empathise with both neurological profiles.

How can those affected cope in everyday life?

The key: Do not suppress one side, but accept both as legitimate parts of the symptoms of ADHD.

The "Permission Framework"

Core idea: Permit yourself to be contradictory.

Examples:

·         Wanting to meet people today AND cancelling all appointments tomorrow ✓

·         Need routines AND sometimes need to break them ✓

·         Seeking stimulation AND needing protection from stimuli ✓

Specific hybrid strategies

Body doubling:

·         Working together without the obligation to interact

·         Provides stimulation without social overload

Controlled stimuli:

·         Noise-cancelling headphones with white noise

·         Blocks environmental stimuli (autistic protection)

·         Provides controlled stimulation (ADHD needs)

Flexible routines:

·         Fixed times + changing content

·         Compromise between the two

Energy management

Preventative breaks and snacks:

·         After stimulating events, plan for recovery time and regular snacks

·         Even if you still feel fine

·         The crash comes later

Externalisation:

·         Visual timers for routines

·         Checklists instead of memory

·         Automation where possible

Communication in relationships

Important: Clear communication

Example wording:

·         "I have phases with different needs."

·         "This is my neurological profile"

·         "Not: rejection or character weakness"

Goal: People who understand can offer genuine support to those affected, significantly improving their quality of life.

Summary: The most critical points

Frequency & genetics

• Co-occurrence is common in people with autism or ADHD: 30–80% of people diagnosed with autism also meet the criteria for ADHD, and ADHD also occurs with autistic traits in 40–50% of cases – this is rarely a coincidence, but has genetic causes.

• Genetic overlap: 50–70% of genetic factors are identical in ADHD and autism

• Long overlooked: Until 2013 (DSM-5), both conditions could not be diagnosed simultaneously in medicine

Neurobiology

• Common brain patterns: Research identifies similar activation in networks for attention control, impulse control and social interaction

• The brain develops similarly: comparable areas are affected in both conditions

Everyday experience

• Accelerator-brake conflict: structural needs meet hunger for stimulation – a permanent internal contradiction

• Special interests + hyperfocus: Long-term deep interests with changing focal points – confuses those affected ("Am I really autistic/have ADHD?")

• Paradoxical stimulus processing: Simultaneous need for stimulation AND tendency to become overwhelmed – never in the "right" state

Challenges

• Routine dilemma: One part needs structure, the other finds it monotonous and challenging to maintain

• "Feast or famine" socially: Impulsivity drives people into social situations, exhaustion follows, leading to misunderstandings

• Double emotional dysregulation: intensity + alexithymia + delayed processing = "emotional hangovers" days after events

Treatment & coping

• Integrated treatment is necessary: Professional approaches must address both equally – a one-sided approach leads to failure

• Hybrid strategies work: flexible routines, controlled stimulation, body doubling

• Permission framework: Recognise conflicting needs as neurologically based – reduces feelings of guilt

• Self-acceptance is key: don't try to 'fix' anything, but accept both parts as legitimate

Future topics:

·         "Am I affected? The challenge of AuDHS diagnostics"

·         Differential diagnosis: Why it is often difficult to recognise both.

·         Masking (compensation): How high intelligence or social adaptation can hide symptoms for years.

·         The diagnostic path: What those affected can expect (interview, questionnaires, third-party medical history).

·         "The overlooked group: AuDHS in women and female-socialised individuals"

·         The "well-behaved" child: Why girls are often diagnosed later (internalisation instead of disruption in class).

·         Emotional dysregulation: risk of confusion with borderline or bipolar disorder.

·         Hormonal influences: How the cycle can affect symptoms.

·         "Order in chaos: coaching approaches and coping strategies"

·         Psychotherapy: behavioural therapy, acceptance and commitment therapy (ACT).

·         Medication: A brief overview of how stimulants can affect an autistic brain (sometimes, autistic traits become more visible when ADHD is treated).

·         Structural aids: visual plans, noise cancelling, energy management (spoon theory).

·         "No deficit: The superpowers of AuDHS"

·         Deep dive: The ability to understand complex systems extremely quickly.

·         Sense of justice: The strong need for fairness and truth.

·         Creativity: out-of-the-box thinking through neurodivergent networking.

Further articles in the AuDHS topic hub:

• AUDHD: Autism and ADHD – A complex combination

• ADHD and autism: Diagnosis within the spectrum of neurodiversity

• AuDHD, Masking & Burnout: Causes and help for those affected by burnout in ADHD and autism