Just over a decade ago, autism and ADHD were thought to be mutually exclusive. But in recent years, all that has changed
He had beaten more than 19,000 applicants for a place at medical school, yet Khurram Sadiq was now bunking off his hospital shifts. The 19-year-old felt inexplicably anxious around strangers on the wards and was hiding from his own patients.
During lectures he couldn’t focus on what he was being taught. He deemed himself “a goof, a dunce” in contrast to his peers. Sadiq couldn’t motivate himself to revise for his exams and instead found himself panic reading textbooks in the final days. He passed his undergraduate pre-medical exams by the skin of his teeth.
That was 30 years ago. In the decades since, Dr Sadiq has qualified as a consultant psychiatrist, been diagnosed with both autism and attention deficit hyperactivity disorder (ADHD), specialised in autism and ADHD psychiatry and met hundreds of patients with struggles similar to his. He is now trying to spread what was once an unbelievable message: that both autism and ADHD can coexist in the same person simultaneously.
Just over a decade ago, the two conditions were considered to be mutually exclusive, with the Diagnostic and Statistical Manual of Mental Disorders, often referred to as “psychiatry’s bible”, stating that the diagnosis of one precluded the existence of the other. This wasn’t revised until 2013. “It led to a fork in the road,” says Dr Jessica Eccles, spokesperson for the Royal College of Psychiatrists. “Not only for clinical practice, but also for research and public understanding of these conditions.”
Now some specialists believe that the coexistence of both conditions is not just possible, but frequent. One study by researchers at Duke University found that up to half of people diagnosed as autistic also exhibit ADHD symptoms, and that characteristics of autism are present in two-thirds of people with ADHD. “My clinical experience suggests it’s more than three-quarters in both directions,” adds Dr Eccles.
Online, the idea that autism and ADHD can coexist is so widely accepted that it has spawned its own label – “AuDHD” – and a groundswell of people who say they recognise its oxymoronic nature, perpetual internal war and rollercoaster of needs. There are tens of thousands of people in AuDHD self-help forums, and millions more watching AuDHD videos.
Some of those videos come from Samantha Stein, a British YouTuber. “The fact that you can have both [autism and ADHD] at the same time is kind of paradoxical in nature,” she admits. “You think: ‘How can you be extremely rigid and need routines and structure, but also be completely incapable of maintaining a routine and structure?’”
The 38-year-old started making videos on autism after her diagnosis in 2019, then began covering AuDHD after learning that she also had ADHD. “I realised that autistic adults – especially those who are diagnosed late in life – more often than not seem to have ADHD as well,” says Stein. Her first video on the subject, “5 signs you have ADHD and autism”, has now been viewed more than 2m times.
Some critics like to describe ADHD – and more recently autism – as a “fashionable” diagnosis, a misinformed excuse for life’s struggles. It’s almost inevitable that the new AuDHD label will cause a similar backlash. To see just how misguided this is, we must first understand both autism and ADHD.
Both are lifelong neurodevelopmental conditions that affect how people think, perceive the world and interact with others, according to Embracing Complexity, an umbrella group of organisations that research neurodiversity.
