10 Ways ADHD and Autism Mask Each Other That are Sabotaging Dual Diagnosis

On my endless quest to bring awareness to undiagnosed neurospiciness, I decided it was important to write a post on the ways ADHD and autism mask each other. Somewhere between 30-80% of people with autism also have ADHD. Obviously, 30-80% is quite a big gap, and you may be wondering why that is. Well, it has to do with under-diagnosis rates as well as misdiagnosis rates, which is exactly why I think this post is such an important one to write.

On the surface, ADHD and autism may seem like wildly different types of neurodivergence, but they actually have a lot of similarities. Some of these similarities are:

• Difficulties with executive dysfunction
• Sensory sensitivities
• Challenges with social interactions, including being prone to interrupting
• Issues with emotional regulation
• Tendencies to hyperfocus
• Special interests
• Repetitive behaviors
• Difficulties regulating focus
• Stimming
• Academic and occupational challenges
• Social withdrawal
• Masking to fit into society (especially prevalent in females)

While these similarities are prevalent for both ADHD and autism, their differences can also lead to misdiagnosis and result in an inability of someone who has co-occurring ADHD and autism to access the supports they need. Let’s take a look at ways ADHD and autism mask each other.

5 Ways ADHD Traits Mask Autism Traits

1. The ADHD need for interaction with others masks autistic social exhaustion.

People with ADHD often crave interaction with other people. We seek dopamine through novel interactions that stimulate our brains. People with ADHD tend to impulsively interact with strangers who we may end up on random adventures with. We strike up conversations in grocery store lines, spend time chatting with strangers at bars, and join groups themed around our special interests. Autistic people, on the other hand, often avoid unnecessary social interactions and are easily drained by social interactions that require a heavy use of social skills and reading social cues. So when someone has both ADHD and autism, the ADHD part of them that seeks out those social interactions can easily mask the autistic side’s social exhaustion.

2. ADHD hyperactivity masks autistic communication and social struggles.

ADHD often feels like your impulses are in control of you, rather than you being in control of yourself. Often, our hyperactivity manifests as being talkative in a way that makes us come off more confident in social situations than we actually are. To be completely honest, often this chatty hyperactivity also makes us come off more interested than we truly are. Our dopamine-seeking brain will just start up a random conversation while internally we’re wondering why we did this to ourselves and frantically trying to figure out how we get out of it. This false projection of social confidence is just another one of the ways ADHD and autism mask each other.

For people who have both, the ADHD hyperactivity easily masks the autistic struggle with communication and social struggles, to the point when you disclose you have both ADHD and autism, most people say they never would have suspected it because you’re so chatty.

3. Impulsivity that comes with ADHD masks the autistic need for routine.

One of the other ways ADHD and autism mask each other is due to the ADHD need for novelty and the tendency to be impulsive. People with ADHD often do impulsive things like go out last minute with friends (probably on a night we shouldn’t be) or take last-minute trips. We’re perpetually starting stories with, “So somehow I ended up at this place…” followed by some amusingly random story for our friends. This obviously is in complete contradiction to the autistic need for routine and predictability.

When you have both ADHD and autism, these needs and tendencies are in a constant battle with one another, which often leads to them masking one another. ADHD coping mechanisms such as chattiness, a well-developed sense of humor, or risk-taking often mask underlying social anxiety that comes with both ADHD and autism, as well as the social rigidity that is common with autism.

4. ADHD forgetfulness masks autism’s impressive long-term memory.

If you have ADHD, it’s not news to you that we are a forgetful people. We forget when appointments are, where we put our keys, what assignments are due this week, conversations we had with people, and so many other things. Many of us develop intricate coping mechanisms to help us manage life, like keeping lists, having specific spots for things, using short-lived planners, or other methods that go completely (and rapidly) out the window when we’re not in routine.

People with autism have pretty much the opposite skill set. Many autistic people have photographic memories so remember exactly where they put something, what page they read something on, and even the exact sentence they read in a book eight years ago. When you have both ADHD and autism, the ADHD basically scrambles that autistic long-term memory capability, where it often feels like the only things you remember well are generally pretty useless and completely random.

5. Hyperactivity from ADHD draws more attention than the more subtle struggles of autism.

Hyperactivity caused by ADHD is generally pretty obvious, which is why it’s one of the ways ADHD and autism mask each other. Whether it be from a struggle to complete tasks, constantly interrupting people, perpetual lateness, or forgetting things (including what you were in the middle of saying), the people in your life notice your ADHD, even if they may not know that ADHD is the root cause. Maybe people don’t know enough about ADHD to know what causes you to be that way, but they truly can’t miss any of these things about your ADHD-riddled self. This is one of the other ways ADHD and autism mask each other.

Autism has a lot more subtleties to it, especially for people with low-support needs or who have learned to highly mask. Autistic struggles with social nuance, sarcasm, or sensory sensitivities may not be obvious even to people who know us well. It makes it easy for the ADHD to barge on in and bulldoze its way to pave across the autistic symptoms, further burying them from public perception.

5 Ways Autism Masks ADHD

1. The autistic need for logical decision-making masks ADHD impulsivity and risk-taking.

The same way ADHD impulsivity can mask autism’s need for rigidity, the autistic need to make decisions in a logical and considered way can mask ADHD impulsiveness. It’s basically like being on a perpetual teeter-totter. Some days the ADHD impulsiveness and risk-taking tendencies rule your decision-making. On other days, the autism is clearly in charge. When you have both ADHD and autism, this internal tug of war means both habits may come off more muted to other people. You don’t seem impulsive and like you take risks all the time, because sometimes you seem more logical and considerate. What people don’t see is the internal turmoil and exhaustion from this daily battle of the neurospicies.

2. Autistic pattern seeking and perfectionism mask ADHD struggles with frequent mistakes.

Another one of the ways ADHD and autism mask each other is due to the autistic tendency towards perfectionism and pattern-seeking tendencies. We hate to leave things incomplete and tend to want to do everything perfectly. Our pattern-seeking brains catch mistakes and, for many of us, make school and work assignments easier than they are for others. This often masks the ADHD inability to focus long enough to complete tasks and the tendency to make careless mistakes.

3. Autism’s need to be on time masks ADHD time blindness.

Many autistic people seem to be masters of time. They have an internal clock that allows them to guess with decent accuracy what time of day it is at any given time. We have a set routine, so we know how long each part of it takes to complete. We hate to be late, so we are careful to allow ourselves enough time to get somewhere in order to be almost obnoxiously on time. This is basically the complete opposite of people with ADHD, who struggle to manage time or keep track of time passing. When your autism keeps you on time, it masks right over the ADHD tendency to lose track of time.

4. Autistic masking camouflages ADHD inattentiveness and disorganization in social settings.

Another one of the ways ADHD and autism mask each other is due to masking. People with autism often make intensive efforts to mask their social difficulties. We rely on scripting conversations and suppressing stimming behaviors to be able to fit in better in social settings. These intense efforts often mask symptoms related to ADHD in social settings, such as inattentiveness, disorganization, or impulsivity. Additionally, people with ADHD are also prone to masking to fit into social settings. This masking can make autistic symptoms seem more muted while exhausting the person masking.

5. The autistic need for routine masks ADHD executive dysfunction.

Autism involves a strong need for structure, routine, and detail. Without these things, we often feel dysregulated and struggle with feeling out of control. However, that need for structure, routine, and an eye for detail often masks many ADHD symptoms. Someone who has both ADHD and autism is likely to appear highly organized and controlled despite internally struggling with planning, forgetfulness, and time-blindness. On the other side of the same coin, ADHD can make those autistic needs for routine and structure seem less rigid.

Ways ADHD and Autism Mask Each Other & the Impact on Diagnosis

If you read through this whole list, it’s probably not hard for you to see how the ways ADHD and autism mask each other would cause issues with diagnosis. Many doctors expect someone with ADHD to struggle with everyday life and keeping track of everything it entails. They fail to consider the ways autism’s need for routine and attention to detail can essentially be a coping mechanism for ADHD that masks those more obvious ADHD traits. Similarly, many doctors assume people with autism don’t crave novel social interactions and are never impulsive risk-takers, despite the fact that ADHD can cause you to partake in frequent impulsive and even risky social interactions.

In fact, prior to 2013, people could only be diagnosed with autism or ADHD, but could not be diagnosed as having both. That’s right, only 12 years ago the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) shifted to allow for a dual diagnosis. About 21% of people with ADHD also have autism, but only since 2013 have they been able to have both conditions diagnosed. It’s honestly upsetting to think about because it makes you realize how many people have suffered without a complete diagnosis.

Why It’s Important Doctors Educate Themselves on Ways ADHD and Autism Mask Each Other

It is absolutely crucial that more doctors educate themselves on the overlap between ADHD and autism and the ways they can mask one another. Combined with the gender biases that exist in diagnosing both conditions, too many people are falling through the cracks of diagnosis, and a lack of diagnosis for either has significant risks. People whose autism or ADHD go undiagnosed are more likely to:

• Develop issues with substance abuse
• Struggle with anxiety and/or depression
• Burnout and be incapable of maintaining crucial relationships or holding a job
• Have chronic health issues due to chronic stress
• Suffer from low self-esteem
• Have a higher risk of suicide
• Show poor academic performance
• Face unemployment challenges
• Become socially isolated, resulting in worsened mental health problems
• Be more accident and injury-prone

Why Early Diagnosis and Intervention Matter

Early diagnosis of both ADHD and autism results in improved outcomes in multiple domains. With diagnosis comes access to treatments like therapy, medication, and accommodations. Each of these leads to significantly better life trajectories. Early diagnosis and intervention also reduce the likelihood of accidental abuse, substance abuse and misuse, as well as co-occurring health problems. Additionally, diagnosis is a validating experience that improves self-esteem and helps connect people to supportive communities that can help improve their lives.

What To Do If This Post Resonates With You

If you find yourself identifying with multiple things you’ve read on this page, you’re not alone, and there are steps you can take to get help and improve your life.

1. Seek a full assessment – if you’ve been diagnosed with one or the other but suspect you may have both, request an ADHD or autism screening as well. If you’re worried about the ways ADHD and autism mask each other impacting your appointment, I designed a self-diagnosis worksheet to help. You can find it on my Etsy store.
2. Track your lived experiences – Document patterns you see in mood, attention, social interactions, and health. This will help you significantly in the evaluation process as well as help you better understand yourself and what accommodations you may need.
3. Advocate for yourself – Determine what accommodations you need to be able to succeed and then advocate for yourself in school, work, and healthcare settings. I know self-advocacy can feel daunting at times, but it can truly transform your quality of life and help you feel more empowered.

Seeking a diagnosis may feel overwhelming, and I know the healthcare system doesn’t make it any easier for you, but it truly can make such a difference. Getting a full assessment will give you a better understanding of yourself and what you need to succeed, which can be a gateway to empowerment, enabling you to feel more in control of your life instead of feeling like chaos is controlling you. With a proper and complete diagnosis, you’ll gain access to a better understanding and more resources, which will make daily life safer, more manageable, and emotionally richer. If you need some encouragement pushing through, don’t hesitate to email me, and I’ll be your personal cheerleader through the process.