Is it ADHD or Autism? Sometimes, it can be hard to tell
by Dr. Lisandra Mendoza
Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have many overlapping symptoms, such as difficulties with emotional regulation, executive functioning, and impulse control. If you have been diagnosed with ADHD, you may wonder if you’re also autistic and vice versa. As many as 50%-70% of autistic individuals also have ADHD (sometimes referred to as AuDHD). But until relatively recently, the two couldn’t be diagnosed together! It wasn’t until the release of the DSM-V in 2013 that a person could be diagnosed with both neurodevelopmental conditions.
As a psychologist, it’s my job to understand the complexities involved in diagnosing ADHD and autism, especially when it comes to women who may have been ignored or misdiagnosed in the past. Testing for ADHD and autism can help women comprehend their distinct neurodivergent experiences, as well as their strengths and weaknesses. This understanding can empower them to pursue suitable treatment, develop strategies to cope with their symptoms, and thrive in their work, school, and personal relationships.
Let’s go over the core characteristics of each and how they can present in women, specifically.
Core characteristics of ADHD and Autism
ADHD
ADHD is a neurodevelopmental disorder characterized by patterns of inattention, hyperactivity, and impulsivity that are pervasive throughout a person’s life. These symptoms can disrupt daily life and present challenges in social, academic, and occupational settings.
Key ADHD symptoms include:
Inattention: Difficulty focusing, frequent careless mistakes, and easily distracted by sights or sounds.
Hyperactivity: Fidgeting, restlessness, and inability to stay seated when expected (may not apply in adults as much as children).
Impulsivity: Blurt out answers before questions are finished, difficulty waiting their turn, and acting without considering consequences.
There are three subtypes of ADHD:
Predominantly inattentive presentation
Predominantly hyperactive-impulsive presentation
Combined presentation
Women are just as likely as men to have inattentive ADHD but are less likely to have hyperactive or ADHD combined type.
ADHD symptoms in women may present as follows:
Daydreaming
Forgetfulness (i.e., forgetting to do an important task or forgetting where you put something)
Internal restlessness
Struggling to stay organized (i.e., finding it impossible to stay on top of laundry or manage work e-mails)
“Zoning out”
Autism
Autism is also a neurodevelopmental disorder. On the other hand, it is characterized by repetitive behaviors, sensory and communication differences, and difficulty with allistic social relationships.
Key ASD characteristics include:
Social Communication Differences: Difficulty interpreting nonverbal communication and understanding social nuances and allistic cues.
Restricted and Repetitive Behaviors: Intense focus on specific interests, repetitive movements, and a preference for routine.
Sensory Sensitivities: Sensitivity to sensory inputs like sounds, textures, clothing, food, lights, etc.
Autism symptoms in women may present as follows:
Anxiety and/or depression
Being hyper-aware of their behavior in social situations
Crying
Emotional regulation difficulties
Forcing eye contact even though it’s uncomfortable
More sensory symptoms than social difficulties
Outbursts
Restricted interests that are socially “acceptable” for girls or women, such as celebrities, horses or music
Sensitivity to smell, light, touch, sound, or taste
Shyness
Diagnostic challenges and overlapping symptoms
While ADHD and autism are separate conditions, they often co-occur, and they also can present with overlapping symptoms, making differential diagnosis challenging. This is also why it’s so important to work with a provider who understands the unique ways these conditions can present in women when seeking ADHD and autism testing.
Where ADHD and autism symptoms overlap:
Communication differences (info dumping)
Executive functioning difficulties
Difficulty task-switching
Difficulty with emotional regulation and impulse control
Divergent thought patterns
Fidgeting or stimming
Having passionate, intense focus at times
Higher rates of substance abuse, depression, anxiety, suicidality, eating disorders, OCD, bipolar disorder
Increased risk of bullying
Masking
Sensory differences
Struggling with social relationships
How ADHD and autism differ:
While both disorders can involve social difficulties, emotional regulation issues, and executive functioning deficits, the underlying causes of these symptoms differ. In ADHD, social challenges often stem from impulsivity and inattentiveness, whereas in autism, they are rooted in difficulties with allistic social communication and cues.
Difficulty with social relationships
ADHD: Difficulty socializing or making friends tends to be due to impulsivity, interrupting, talking excessively, inattention, not listening or focusing on what’s being said.
Autism: Difficulty socializing or making friends tends to be due to speaking robotically or having difficulty understanding allistic cues and having back-and-forth conversations.
Behavioral nuances
ADHD: Hyperactive behaviors and Hyperfixation.
Autism: Repetitive behaviors may be mistaken for ADHD hyperactivity and special interests may be mistaken for ADHD hyper-fixation.
Novelty or familiarity
ADHD: Combined and hyperactive type will crave new experiences.
Autism: Seeks repetition and routines.
Routines
ADHD: Struggles with routine and monotony.
Autism: Thrives with routines and predictability.
ADHD meltdown vs. autism meltdown in adults
ADHD and autism are both neurodevelopmental disorders that bring unique challenges to those affected. One commonly misunderstood aspect of these conditions is the concept of meltdowns. You may be thinking about your own behavior or witnessing behavior in others, wondering: “ADHD meltdown vs. autism meltdown: What’s the difference?” Though individuals with both ADHD and autism can experience meltdowns, the underlying causes and manifestations of these episodes differ significantly.
Recognizing ADHD meltdowns
An ADHD meltdown usually involves an emotional outburst or heightened emotional reaction lasting from a few minutes to an hour. This can look like explosive anger, yelling, bursting into tears, throwing things, cursing a ton, curling into a ball, stomping around, etc.
People with ADHD might experience more frustration than a neurotypical person because daily life is harder to manage for those with ADHD. Those with ADHD already tend to struggle with emotion regulation, and an ADHD meltdown may come on suddenly and seemingly out of the blue. The feelings expressed can seem disproportionate to the trigger, and emotions can escalate quickly. During an ADHD meltdown, a person may engage in impulsive behavior such as throwing things or shouting.
Various events or factors can trigger an ADHD meltdown. Changes in routine, frustrations related to daily life, home, work and school responsibilities, sensory overload, and executive functioning challenges can all trigger a meltdown.
Recognizing Autism meltdowns
An autism meltdown is usually triggered by an overwhelming sensory experience. Bright lights, uncomfortable clothing, strong smells, loud noises, etc. all can act as triggers for an autistic meltdown.
Autistic individuals may struggle to process sensory information, especially when they become overwhelmed, and turn to stimming as a way to self-regulate. During a meltdown, it becomes difficult for autistic individuals to express their needs and/or their level of discomfort. Having accommodations available to minimize sensory overload is crucial for autistic individuals and can be as simple as noise-canceling headphones or dimming the lights.
Autism meltdowns tend to be longer than ADHD meltdowns and may last for multiple hours.
Support for ADHD meltdown vs. autism meltdown
Knowing the difference between an ADHD meltdown vs. autism meltdown is crucial in ensuring individuals with these neurodevelopmental disorders get the support they need. For ADHD, validating emotions and practicing emotion regulation skills is super valuable, while for autism, reducing sensory overload and allowing time for recovery can be helpful.
Gender differences in diagnosis
ADHD in women
ADHD is often underdiagnosed in women because women’s symptoms may look different than men’s. Women with ADHD are more likely to have inattentive symptoms rather than hyperactive ones, and they may even mask their ADHD symptoms altogether. This can lead to a quieter, less disruptive profile, often mistaken for daydreaming or lack of motivation. Common manifestations of ADHD in women include:
Inattentiveness: Difficulty focusing, frequent forgetfulness, and disorganization.
Emotional dysregulation: Heightened emotional responses, sensitivity to criticism, and mood swings.
Internalizing behaviors: Anxiety, depression, and low self-esteem.
Autism in women
Autism also presents uniquely in women, contributing to diagnostic challenges. Women with autism are often more adept at masking their symptoms, consciously or unconsciously mimicking socially appropriate behaviors to blend in. This camouflaging can delay diagnosis.
Key differences include:
Social mimicry: Efforts to imitate social behaviors, which can be exhausting and lead to anxiety or burnout.
Special interests: Interests may align with socially acceptable hobbies, making them less noticeable.
Sensory sensitivities: Heightened sensory sensitivities that may be expressed through preferences in clothing, food, or routines.
The importance of gender-sensitive diagnosis
Recognizing the gender-specific presentations of ADHD and autism is crucial for accurate diagnosis and effective intervention. Women often receive a diagnosis later in life, which can impact their mental health and quality of life. Understanding these differences allows for a more nuanced approach to ADHD and autism testing, assessment, and support.
Distinguishing between ADHD and autism requires careful consideration and attention. The subtlety and overlap in symptoms necessitate a gender-sensitive diagnostic approach in ADHD and autism testing.
Are you interested in a culturally sensitive Neuropsychological and Psychological Evaluations to gain insight and clarity into your neurodivergent experience?
At Avatar Cognitive and Behavioral Center, we believe in supporting women’s unique experiences. We offer online ADHD and autism testing across Florida, so whether you live in Cape Coral, Fort Myers, Gainesville, Jacksonville, Miami, Orlando, St. Petersburg, Tampa, or West Palm Beach, we can work together
We also offer online Neurodiversity-Affirming Therapy
