Is ADHD Camouflaging Autism in Your Child?

Is ADHD camouflaging autism in your child? One can have both ADHD and autism.

The Similarities of ADHD and Autism

It's no secret that ADHD and autism share many similar traits and that some symptoms from each neurodevelopmental disorder overlap. Yet, they are two distinct conditions. Until the fifth edition of the Diagnostic and Statistical Manual of Mental Health (DSM-V) was released recently, clinicians were advised to diagnose ADHD or autism, but never both. Now that the DSM-V tells clinicians that an individual can have both ADHD and autism, this dual diagnosis is on the rise. Now, clinicians must carefully consider if the profile they are seeing is ADHD, autism, or both.

It can certainly still be a challenge to get both diagnoses for one child. My son, Ricochet, is living, breathing proof — I had to push and get multiple opinions for two years before finally finding a psychologist willing to dig deep and keep her mind open to the possibility of both ADHD and autism. A new study released in Pediatrics last month confirms that it's more of a challenge to get an autism diagnosis once a child is diagnosed with ADHD. The study's authors found that it is a three-year delay on average, in fact.



Why does this happen?

In our case, Ricochet's hyperactivity is noticed first by everyone. He also doesn't have any of the overt symptoms of autism, like poor eye contact and repetitive behaviors. On the surface, he's a classic case of pretty significant ADHD, but not a classic case of autism. I never even considered the possibility that autism was part of his alphabet soup of neurodevelopmental disorders until four years after his ADHD diagnosis.

You see, when Ricochet was young, the gap between he and his peers wasn't too large, because all kids are socially awkward and struggle with attention when they are five, six, or seven years old. As Ricochet got older though, the gap seemed to multiple in width each year, instead of follow the same trajectory. As his peers learned more adept and nuanced social skills, he did not. As his peers became good at interpreting pragmatic language, he did not. As his peers learned to be more flexible and control their emotions, he did not.

It wasn't just the Ricochet-to-peers gap that started me thinking about the possibility of autism. Kids with ADHD tend to improve on lagging skills and maturity, with the right support, as they enter adolescence. In areas I expected Ricochet to improve — such as reading nonverbal language, frustration tolerance, and flexibility — he was not improving at all. At the same time, he began down a path of severe school avoidance and refusal. It was as if it was literally painful for him to go to school. When I put all those unanswered questions (clues) together, a picture of high-functioning autism or Asperger's emerged.

I finally saw autism in him at that point (about age ten), but it took me two years of diligent pursuit before I encountered a clinician willing to look past the typical symptoms of autism and see it in Ricochet too. I say “willing,” because the first few clinicians I approached about the possibility of autism refused to look past the absence of typical autism symptoms and dig deeper.



How do you know if your child with ADHD could have autism too?

In my experience, there were still struggles that were atypical of or not explained by ADHD. I felt like there was still a missing piece of the puzzle. Ricochet could not understand intention. He was constantly upset by social interactions. His thinking was still overly literal and he was severely inflexible. He seemed constantly “uncomfortable,” almost pained, in many environments, especially at school. There were so many little things that just weren't explained by ADHD, but fit with autism.

One of the biggest ah-ha's for me was watching a particular episode of  the TV show, Parenthood, where Max decided to go on a overnight field trip with school. He ended up getting bullied and had a meltdown because he didn't understand why the kids would do those things to him. I saw so much of Ricochet in that scene. That felt true to us.

If your child with ADHD has symptoms that seem outside the sphere of ADHD, consider the possibility of co-existing autism. Talk with your doctor about a new evaluation to dig deeper. Listen to your gut and keep pressing forward if you know there are still unexplained pieces of your child's puzzle.

Share your thoughts.

  • I am in the same boat with my son. He is 11 years old now and what you're describing here sounds just like my son. I have tried and failed at getting both diagnosis as well, but I believe it's there. All doctors focus so much on ADHD and ODD, autism is out of their vocabulary. Please give me more advice on this issue.

    • Hi Latrisha!

      Yes, it's a real problem that ADHD is a more overt disorder — it really does camouflage autism for a lot of kids. I wonder if your son's ODD is actually symptoms of autism. Kids with autism can seem defiant and angry because they are often very concrete/black-and-white thinkers (which looks very defiant and inflexible) and then they don't have the emotional regulation skills to manage the frustration that causes.

      The only additional advice I can provide is to keep trying. Keep asking for this evaluation until you find someone who will look very deeply and consider all options. A clinician who will do a brand-new and very thorough evaluation with no prior judgement based on his current diagnoses.

      Keep fighting Momma!

  • Great Article! What would be an ideal treatment for an ADHD plus Autism diagnosis? Is there an advantage to having the Autism diagnosis made in conjunction with ADHD? My boy is on a daily emotional roller coaster with complete inflexibility and defiance. His reactions rarely fit the situation. I love him so much and we are currently in the process of switching Psychiatrists to try to get a second opinion…

    • Autism can open the door to additional therapies. There isn't a medication for autism, so no change there. For us, it helped us understand our son more completely. Helped a great deal with parenting.

  • I guess I was lucky because I was able to get my son diagnosed with ADHD and Autism, however, nobody informed me what these conditions were. I knew what it looked like, my son was very hyper, would bang his head into walls or hit himself in the head and throw himself to the floor crying. I would ask what was wrong he said he did not know and not to touch him. Nobody ever told me what classes we could take or about ABA therapy, they only treated with medication and forgot him. He is now 18 and I have found a doctor who is trying to help us and I am so glad I have found you Penny and the summit. I don't feel so alone any more and have hope for my son. Thank you!

    • I'm glad you found us too. 🙂 And, I'm glad you've found a doctor who is finally hearing you and trying to help.

  • We have ASD diagnosis but struggling to get ADHD and I am confident my child has both

  • My daught has diagnosis off adhd but doctors now saying she also got autism traits and said id she didnt have adhd diagnosis he wound off gave a autism diagnosis

    • The current Diagnostic Manual (DSM-V, US) allows clinicians to now diagnose both conditions in the same patient.

  • My daughter has a dual diagnosis. I do not like how people want to treat your children. Accept your children for who they are of course medication and some therapies can help but for me its about me adapting to my child not the other way round. Do not look at ABA it's not right ask any autistic adult.

  • This could have been written by me. My 13 year old son, diagnosed at 8 with ADHD and then ASD a few months ago. I had to go private as his paed would not explore ASD. But I knew. The gap was widening and senior school and all its grown up expectations just became too much. Its been a very hard journey since primary. A total shock to the system. But its worth the battle.

  • I just came across this article now, mr 12 has ADHD and anxiety and I have been pushing for a ASD diagnosis for years, and they tell me he is too social because he can interact with people when they speak with him, he struggles to initiate any communication with people. Feeling very frustrated.

    • We were told the same at one point. It was because my son learned to respond to peers and how to respond to them but he was also great in conversation with adults, which is who tested him. If you think they're wrong, get another eval somewhere else.

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I'm Penny Williams.

I help stuck and struggling parents (educators, too) make the pivots necessary to unlock success and joy for neurodivergent kids and teens, themselves, and their families. I'm honored to be part of your journey!

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