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There are many reasons why an 
autistic or ADHD person might go

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missed for years. 
If you're an adult who's only 

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recently started making sense of
your own neurodivergence, then 

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you've lived through multiple 
cultural and diagnostic shifts. 

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Changes to the diagnostic 
criteria. 

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A growing emphasis on lived 
experience, more recognition of 

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what autism and ADHD looks like 
in adults, and much deeper 

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awareness of nuanced 
presentations and masking. 

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One of the other things that can
complicate or delay a diagnosis,

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especially an autism diagnosis, 
is when both ADHD and autism are

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present. 
That's what we're looking at 

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today, how the overlap between 
autism and ADHD can lead to 

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misdiagnosis, late diagnosis, 
and a lot of self doubt. 

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Along the way, we'll unpack what
diagnostic overshadowing is, the

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research we do have about a 
delay in diagnosis, and we'll 

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walk through six ways that ADHD 
can over shadow autism. 

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I'm Doctor Megan Ananieff. 
I'm an autistic ADHD clinical 

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psychologist, founder of 
Neurodivergent Insights, the 

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author of self-care for Autistic
People, and the Autistic Burnout

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Workbook. 
I'm currently deep in the 

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research and writing phase of my
next book, Audi HD Unlocked, and

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this video series gives you a 
window into some of what I'm 

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finding and thinking along the 
way. 

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Now, the statistics range quite 
a bit depending on which study 

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you look at, but estimates 
suggest that roughly 30 to 80% 

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of autistic people also meet 
criteria for ADHD, and about 20 

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to 50% of people with ADHD are 
also autistic. 

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Unfortunately, diagnostic 
systems are built on an either 

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or categorical framework, and so
when overlap happens, that can 

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create some unique problems. 
It sets the stage for what's 

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called diagnostic overshadowing.
That's when 1 diagnosis hides 

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another condition that is also 
present. 

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What that means for our lives is
that many of us don't slot 

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neatly into autism or ADHD 
alone. 

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We're often living at that 
complex intersection where it 

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treats blend, blur, and 
sometimes hide each other. 

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Now, the diagnostic tools that 
we have available to us are 

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often built around neat list of 
check boxes or more of that 

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categorical thinking. 
So if you're autistic and ADHD, 

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you might not fit cleanly into 
the autism boxes and you also 

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might not fit cleanly into the 
ADHD boxes either. 

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So you can end up falling 
through the cracks between these

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two categories. 
Now, across multiple studies, a 

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clear pattern has been shown 
that when ADHD is first 

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identified for someone who's 
both autistic and ADHD, it 

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results in a delay in 
identification of the autism. 

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So, for example, one large 
European study found that 

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children who had an ADHD 
diagnosis before the autism 

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diagnosis, on average it took 
1.8 years longer for the autism 

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to be identified. 
Now, when researchers broke this

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down by gender, boys with prior 
ADHD received an autism 

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diagnosis about 1.5 years later,
while girls waited closer to 2.6

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years. 
And then clinical reports and 

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case studies and lived 
experience also echo this 

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pattern. 
Many describe children and teens

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who first carried an ADHD 
diagnosis, and only after years 

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of unmet needs and struggle and 
often mental health challenges 

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did autism finally make it into 
the conversation. 

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And then these numbers, these 
also sit on top of other 

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disparities that we know about. 
For example, we know that black 

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and brown children tend to 
receive both autism and ADHD 

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diagnosis later and after more 
clinical encounters than white 

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children. 
So it's reasonable to assume 

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that when ADHD is picked up 
first in these communities that 

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the delay and recognition of the
autism likely stretches even 

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further for them. 
So then when it comes to an 

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autism recognition, there are at
least 4 overlapping delays that 

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Audi HD ERS may experience. 
First of all, a delay tied to 

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ADHD being recognized 1st and 
then diagnostic overshadowing 

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happens. 
There can also be a delay tied 

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to gendered expectations. 
And then a lot of the tools that

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we have available to us were 
built and designed around the 

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experiences of boys, a delay 
that is tied to racial 

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inequality and unequal access to
assessment and care. 

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And then across the gender 
spectrum, masking adds another 

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layer where a lot of autistic 
and ADHD traits tend to fly just

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under the threshold or under the
radar of what clinicians are 

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looking for. 
So for many Audi HD adults, this

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helps explain why our diagnostic
story feels so fragmented. 

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Perhaps you received a childhood
ADHD diagnosis and then maybe 

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anxiety or depression was added 
in adolescence and only much 

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later does autism enter the 
conversation. 

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And then of course for others, 
both ADHD and autism were 

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completely missed in childhood 
and only entered the 

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conversation in adulthood. 
This is what we often refer to 

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as the lost generation of 
autistic adults or the lost 

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generation of ADHD adults. 
Now, if we look at the 

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diagnostic shadowing when ADHD 
is overshadowing the autism, 

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then here are six ways that ADHD
can hide the autism from the 

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outside. 
ADHD can be pretty loud and 

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colorful, and that can quickly 
drown out the autism. 

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So while this certainly isn't an
exhaustive list, here are six 

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ways that this can happen. 
First, social behavior can look 

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ADHD enough that autism is never
even considered. 

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So, for example, a child might 
be struggling socially. 

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Maybe they interrupt their peers
or talk over others or blurt out

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responses in class, and this is 
often seen as part of a broader 

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pattern of ADHD. 
And so maybe the person is 

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struggling socially or they're 
struggling to connect with their

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peers, but it's interpreted and 
read as impulsive. 

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So on top of the ADHD, they 
might also be missing social 

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cues or context cues and 
struggling to interpret other 

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people's emotions or signals. 
But all of that gets framed as 

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part of ADHD in attention or 
ADHD impulsivity. 

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And then once ADHD seems to fit,
clinicians, parents and teachers

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might stop asking those deeper 
questions. 

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So some of those more subtle 
social communication 

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differences, they're again 
flying under the radar. 

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Or all the social struggles that
that person is having is getting

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attributed to ADHD alone. 
Now a second thing that can 

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happen is where movement and 
sensory seeking often get framed

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as hyperactivity or 
restlessness. 

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So fidgety and pacing or just 
being in constant motion. 

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This can easily be understood as
hyperactivity. 

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And when that happens the 
underlying sensory drivers. 

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So perhaps stimming or needing 
movement to regulate or seeking 

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certain repetitive sensations, 
those go unnoticed. 

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So a child might be spinning or 
cluing or seeking deep 

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proprioceptive pressure, and 
that all might get interpreted 

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as the person being overactive 
rather than as someone who is 

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seeking proprioceptive input. 
Or maybe they have some unmet 

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vestibular sensory needs, which 
is why they're spinning. 

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So all of this which we see in 
autism can be hidden under the 

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framework of hyperactivity and 
ADHD. 

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A third one is when executive 
functioning struggles are 

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attributed solely to ADHD. 
So difficulties with planning, 

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transitioning, or shifting our 
attention all rely on executive 

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functioning. 
And these are classic 

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experiences in the ADHD 
experience, but they can also be

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connected to autism, but often 
for different reasons. 

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For example, autistic people 
tend to be bottom up processors,

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meaning that we absorb a lot of 
details and so we can easily get

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cognitively overwhelmed and 
overloaded, which make a lot of 

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those decisions or shifting of 
attention more difficult, but 

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for slightly different reasons. 
Additionally, when we are 

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sensory overloaded, that's also 
going to impact our executive 

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functioning. 
And so again, that aspect of 

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executive functioning struggle 
or decision fatigue or 

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difficulty with planning might 
get chalked up to ADHD executive

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functioning when actually there 
are autistic drivers in the mix.

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Again, if ADHD is already on the
chart, then those struggles are 

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going to get explained through 
executive functioning and the 

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ways that bottom up processing 
or are sensory processing are 

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contributing to that are going 
to remain unseen. 

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Fourths, the need for security, 
predictability, and routine can 

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get interpreted through an an 
ADHD emotional lens. 

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So for autistic people, it's 
really common to have a lot of 

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distress around sudden change or
unpredictability, things we 

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weren't expecting. 
However, these responses can get

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interpreted as emotional 
reactivity or quote UN quote, 

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poor frustration tolerance. 
These are things that we often 

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see coming along the picture for
ADHD, and so these reactions to 

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routine disruptions or distress 
might get interpreted as simply 

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ADHD emotion regulation 
difficulties. 

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Again, when ADHD is the first 
label, then shutdowns a person 

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might be having during 
transitions or distress they 

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might be showing in response to 
routine disruption or schedule 

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changes. 
All of that can get misread as 

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behavioral issues rather than an
artistic response to uncertainty

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or unexpected change or routine 
disruption. 

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Similarly, sensory distress 
could also be interpreted 

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through that same emotional 
lens. 

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So for example, a child might 
have a meltdown when a parent 

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tries to brush their hair or 
brush their teeth or help them 

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get dressed and they might be 
having a sensory response. 

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However, if that child is known 
to be ADHD, the parent might 

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interpret that as difficult 
behavior in the context of ADHD.

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A fifth way that ADHD can hide 
the autism is when special 

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interests get missed and folded 
into ADHD interest patterns. 

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So deep focused interests is a 
huge part of the autistic 

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experience. 
However, ADHD it's also common 

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to have hyper focus and have 
passions and so special 

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interests can get chalked up to 
hyperfocus and then less 

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attention might get paid to how 
narrow or immersive or 

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regulating those interests are. 
A clinician might write gets 

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very absorbed in preferred 
activities, ADHD hyperfocus. 

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But if they never ask how those 
interests function socially, 

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emotionally, or sensory wise, 
which are key to understanding 

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their role in the autistic 
experience, then that's another 

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part of the person's experience 
that can easily get missed and 

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attributed to the ADHD. 
And finally, masking can hide 

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what's underneath. 
Many Audi HD years become pretty

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skilled at using their ADHD 
traits. 

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So things like humor or 
playfulness or quick speech or 

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storytelling to kind of perform 
sociability, and that can smooth

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over some of the autistic social
anxiety or confusion that we 

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often see in the autistic 
experience. 

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On paper, this can look like the
person's really friendly and 

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talkative and they look like 
talkative ADHD, but the autistic

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person beneath it is often 
carefully scripting or 

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rehearsing or collapsing 
afterward. 

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Now in each of these scenarios, 
the ADHD explanation isn't 

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completely wrong, but it isn't 
complete. 

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And when it becomes the whole 
story, that's when the autism is

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overshadowed. 
And when this happens, that's 

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what we call diagnostic 
overshadowing, where the 

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autistic traits get attributed 
to the ADHD. 

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In audio HD, it is more common 
for the ADHD to over shadow the 

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autism. 
However it can go both ways. 

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So overshadowing between autism 
and ADHD can show up in several 

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different ways. 
Autistic sensory overload can be

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labeled ADHD overwhelmed or 
emotion dysregulation, and the 

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sensory and predictability needs
underneath are never named or 

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going the other way when the 
autism is known but the ADHD is 

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not. 
Forgetfulness and time 

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perception struggles could get 
framed as autistic rigidity or 

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autistic shutdowns or autistic 
cognitive overload, and then the

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ADHD related executive 
functioning differences go 

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unseen. 
And then on top of all of that, 

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global experiences like 
shutdowns or meltdowns or 

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burnout are often explained 
through 1 lens alone. 

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Like that's just the autism or 
that's just the ADHD rather than

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seeing them as a cumulative 
effect of both interacting 

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together. 
So in this kind of diagnostic 

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overshadowing happened, support 
can miss the mark, especially 

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when the underlying neurology 
and the support needs that flow 

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from that are never fully seen 
and supported. 

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Diagnostic overshadowing is one 
of the main reasons that so many

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of us wait so many years before 
we have a full story to actually

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understand ourselves and all of 
our complexity. 

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And so it can delay 
identification. 

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It also tends to delay the 
ability to set up the 

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appropriate accommodations that 
we need. 

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That could make life feel a lot 
more possible and doable. 

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And it can deepen shame as many 
of us repeatedly internalize 

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some form of the message. 
I should be able to do this when

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the truth is the support that we
perhaps have received or built 

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around us was never fully 
designed with all of our 

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neurology in mind. 
In the next video we'll look at 

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how autism can over shadow or 
hide the ADHD. 

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And while that is a less common 
experience, that was actually my

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experience. 
And so I'm excited to talk about

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that in the next video. 
And we'll talk about how 

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understanding our combined 
neurology can bring more clarity

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to our audio HD stories. 
Until then, be gentle with 

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yourself, stay curious, and 
thanks so much for being here. 

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Think I'm supposed to tell you 
to like and subscribe and do all

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the things? 
If you're willing and able to do

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that, that definitely helps us 
be able to make more educational

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videos like this. 
And all of your support is much 

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appreciated.