Ep 4: Understanding AuDHD: Traits, Truths, & Lived Experience

🎙 Episode 4: Understanding AuDHD: Traits, Truths, & Lived Experience 

“When I’m told I’m lazy or unmotivated, I start to believe it — and that belief becomes part of who I think I am.”

In this episode of AuDHD Psych, Aaron and Uma explore what AuDHD can look like beyond stereotypes and diagnostic labels. Aaron shares his lived experience as an AuDHD clinical psychologist, unpacking why ADHD and autism were historically seen as mutually exclusive, how this has shaped diagnostic practices, and why many people have had parts of their neurodivergence misunderstood, minimised, or overlooked. The conversation examines co-occurrence, diagnostic bias, categorical versus dimensional thinking, and the importance of self-understanding — whether through formal diagnosis or self-identification — as a foundation for meaningful, affirming support.

Takeaways:

- ADHD and autism frequently co-occur, even though they were historically excluded from being diagnosed together

- AuDHD presentations can mask or complicate how characteristics are recognised and supported

- Diagnostic systems often miss nuance, particularly when relying on rigid, categorical frameworks

- Understanding both strengths and difficulties leads to more effective and affirming support

- Identity, diagnosis, and self-identification should be guided by individual goals and needs

Keywords:
AuDHD, ADHD and autism, neurodivergence, co-occurring diagnoses, self-identification, diagnostic bias, lived experience, neurodiversity-affirming practice, mental health stigma, clinical psychology, ADHD awareness, Lived Experience

Transcript

SPEAKER_01 0:09

Hello, welcome to the Audi HD Psych Podcast. I'm Aaron Howard, Clinical Psychologist and Me. Thank you to everybody who's checked out our first few episodes. We really appreciate that. And a very cheap thrill for me this week is that we've hit 150 streams, so I really enjoy that. This week we're gonna have a bit of a chat about Audi HD. So we've already spoken a little bit about ADHD and autism. I wanted to have a bit of a chat about what can Aud HD look like. Um it doesn't exist as a diagnosis, so we can have a bit of a chat about that, and just I'll share a bit more of my own experience as somebody who has Aud but might not has like not like I have a cold, uh, who is Audie HD, um, but also might not seem like it from the outside. So I guess I can start with uh Emma, what were we starting with?

SPEAKER_00 1:01

Okay, we can start with contextualizing Aud. And then I guess let's start with maybe talking about the most, the biggest thing, which is like diagnosis and you know, obviously the fact that Audh D is absent from the DSM V.

SPEAKER_01 1:15

Absolutely. So, as Emma was just nice alluding into, uh, autism and ADHD, up until about 2013, with the release of the DSM V, which is an American psychiatric diagnosis type system, um, you couldn't actually diagnose autism and ADHD together. Uh, and this is a gross generalization, but the basic assumption was that autism was the overarching Trump card to other things like ADHD. And what that meant was until 2013, everybody believed that ADHD couldn't exist in somebody who was autistic. Therefore, if you had a diagnosis of autism, ADHD was excluded and wasn't considered. So, why does that matter? Because more and more we're seeing that people often have characteristics of both. And now that we can diagnose both, we are seeing more and more people who were diagnosed with autism before, also have, we use the language clinically significant characteristics of ADHD, which really just means there are difficulties that arise out of those ADHD characteristics. Excuse me. So the other side of that is if I didn't look like I had enough characteristics or enough difficulties from my autistic characteristics to warrant a diagnosis of autism, then I would probably end up with a diagnosis of ADHD, and those other difficulties were kind of sidelined. And I think that's the biggest problem that we probably have is that there are lots of people out there that were diagnosed long ago who actually have characteristics of both ADHD and autism. And while they come with absolutely come with strengths, they also come with difficulties that have not really been seen or have been minimized or sidelined. And that's about uh that's about ADHD, I suppose. What are those characteristics again? So in autism, we're looking at I do beg your pardon. In autism, we're looking at those social, emotional, or communication differences and those repetitive and restricted patterns of behavior, thought, the way we do things, use of objects, and sensory differences. And with ADHD, we're generally looking at difficulties related to impulsivity or impulse control and inattention, my capacity to concentrate, pay attention, and not get distracted. I guess one of the big things that I really see is, and one of the big problems with ADHD not existing in our diagnostic systems is that intuitively ADHD and autism seem to be polar opposites. You know, autism is quite often a stereotype of oh, I'm really rigid and I have to do things exactly the same way and pre-plan. And ADHD is known for novelty seeking and impulsivity and doing things off the calf. And they sound like they can't exist in the same person. And we think that, well, if they can't exist in the same person, then somebody who might be rigid in one setting and really novelty-seeking in another is assumed to not be ADHD or not be autistic. Um, and that's problematic because if there are difficulties coming out of those characteristics, I'm most likely not recognizing them as related to my underpinning characteristics. And people who are trying to help me are probably not recognizing them as things that warrant therapeutic support. And I've had a lovely little monologue there, and I wonder if Emma can bring me back on track.

SPEAKER_00 5:03

No, I think that was a great tangent because I was just a question that sort of popped into my head is like, you touched on it a little bit, but I think why are they sort of not diagnosed together and why are they seen as so different? And that was just exactly what you said because they're very much on the differing ends of that spectrum. But I guess a little question that I would have is probably do you think there'd ever be a moment where Audi HD would be seen as one singular diagnosis? And what are the benefits to that happening for the community and like for people like yourself?

SPEAKER_01 5:32

So I think more and more research is showing that uh I don't want to say Aud is the norm, but we are seeing estimates of 50 to 70 percent of autistic people in some research, and I'm sorry to the authors, I can't remember your names, um, will have clinically significant uh characteristics of ADHD. And from my memory, it was 30 to 50 percent of ADHDers will also have autistic characteristics. So that tells us that, you know, if we assume that we can average that out, that we're seeing about half of people with one diagnosis actually have characteristics of the other. Why does that matter? Please don't do the maths on that, it was really bad maths. Why does that matter? Because again, we're we're diagnosing one thing, the research suggests that the other thing is there with difficulties, but not actually being identified and the difficulties related being treated. I've gone on a segue there and I can't remember what the question was.

SPEAKER_00 6:32

The question was basically why do you think these two are not seen in relation to one another and something that we can diagnose together?

SPEAKER_01 6:40

I think it comes back down to that conversation before around um autism was deemed to be the kind of overarching condition, and it was assumed to explain all other difficulties. Um, and in that case, we kind of exclude other things, but that just leads to a mindset of the two can't co-occur. And not as often as once, but we still do see people with that kind of attitude in professional and clinical settings who still think, oh no, it can't be ADHD if it's autism. How does it impact people like us? Um, I think I've kind of spoken to that already. And I'll bring it back to Uma to ask the next question.

SPEAKER_00 7:20

Yeah, I think why why do you think diagnosis, like specifically getting an ADHD, I know that's not possible in the in the current realm, but like why is that important, do you think, for someone's journey?

SPEAKER_01 7:32

Yeah, I think it's all about self-understanding. So when I do assessments, for example, I you do not need to do a cognitive assessment uh in Australia to diagnose autism or ADHD, but for those people who A, it helps them in their goals in self-understanding, and B, obviously, who can afford it, um, I will roll a cognitive assessment in. Why is that? Because instead of saying to you, you have these characteristics that are likely based in cognitive function, I'm actually doing the best tests that I can on your cognitive function to say to you, this is how your brain appears to work in this nice distraction-free setting. And extending that to diagnosing autism and ADHD, if I can give you more information by telling you exactly how your brain works, just instead of just it works vaguely in this way, being able to tell you exactly what characteristics or differences in characteristics you have that are autistic and or ADHD helps us understand ourselves. That's great in a treatment context, because if I know that you're autistic, but I don't know that you're ADHD, I'm gonna use interventions and you know, I'm gonna plan your treatment based on autism characteristics. But if I know that you're both, or that you have characteristics of both, I can make a better treatment plan. But also, if I'm looking at your characteristics in a diagnostic process, I'm not just looking at perceived weaknesses. I'm not just looking at the mismatch between the characteristics that you or I bring and what the environment demands of me. I'm also going to ask you about when those things are really helpful for you. You know, I was chatting to Uma earlier on. One of my great Audi HD confounds is my love of a detail versus my inattention. I can read an article and love the details, and getting all the details makes me really knowledgeable in an area. But when I get halfway through reading something, if there's a detail I don't understand, my ADHD goes, okay, we'll go and learn that bit, and halfway through that, oh, we'll go and learn that bit. And so my autism wants all the details and it gets lots of details, but my ADHD wants to go off onto this new thing that seems really interesting, and often I'll do five hours work and not finish a whole article that I'm reading. And that's the difficulties we can get when we don't identify both autistic characteristics and ADHD characteristics.

SPEAKER_00 10:00

And I think um one thing that I would love to touch on is potentially because this is something that I think um in the realm of psychology, we are becoming more and more open to the idea of co-occurrence and you know, coexistence, like especially at university, that's taught very much something that, you know, um co-occurrent diagnosis, something that we're always on the lookout for. But I think ultimately, since the toolkits that clinicians are using seem to still go across a categorical sort of approach to diagnosis, um, it can be very checkbox. And I think we were talking a little bit about some biases that might kind of pop up during the diagnostic process. Would you like to chat a little bit about that?

SPEAKER_01 10:35

Yeah, I think and that kind of ties into that old idea that we used to have of um, and you mentioned categorical, the idea that uh if I have autism, I have this cluster of characteristics. If I have ADHD, I have this cluster of characteristics. And I don't know how well everyone can see this little ball here, but it's probably a really good example of our brains. And we might think in current diagnosis that autism is maybe these five balls here, and ADHD is these five balls here. But actually, in reality, those balls aren't discreetly separated like that. There'll be one here for ADHD, ADHD, ADHD, ADHD, and then autism, autism, autism, autism. And your brain actually comes with everything else in between. So if we're going this cluster is autism and giving you that diagnosis, we're actually also missing these other characteristics that you have over here, and that can be really unhelpful. And that's, Uma said, categorical when we assume that they're separate categories of thing that's really unhelpful in psychology. We talk about dimensional approaches, and that's more of everything exists on a spectrum of dimension, low or high, everyone has it. But also, cognitive function isn't just I have a brain that's this part or this part, I have this brain with different levels of each of those characteristics. So diagnosing only one or only another is usually missing part of the story.

SPEAKER_00 12:05

I think for our audio listeners, just to give you a little bit of a heads up, oh yeah. It's what Aaron's got in his hand is actually a stress ball that has multiple little bubbles in them. And it's just like the perfect little metaphor for what we were discussing, and it's so funny because before we started filming, we were actually on the hunt for some good metaphors. And I think this worked out really, really well. And I wonder if we could keep your hand all along.

SPEAKER_01 12:27

I wonder if we could include a picture of that on the little screen thing so that people can see it when they listen.

SPEAKER_00 12:32

Yeah, absolutely. We can um definitely weave that into the artwork for the episode, and I can even put that up as a little reel on Instagram. So if you're watching, please head to our Instagram, have a look, and see what exactly Aaron was talking about.

SPEAKER_01 12:46

Timo.

SPEAKER_00 12:48

Um that wasn't a uh a brand deal, by the way, guys.

SPEAKER_01 12:50

Oh yeah, I'm gonna make it um amazing.

SPEAKER_00 12:54

So just sort of dissecting a little bit more about diagnosis. Um one of the other things that I wanted to talk about is common misconceptions, I guess. Which we have touched a lot on. So maybe some really brief anything that we haven't already talked about. Um, I guess maybe one of the common things that just come off the top of my head is just potentially like if you already sort of go in and you have an a self-identifying, like, oh, I know I have ADHD traits, oh I know I have autistic traits. Why do I need to see them as like something that's together? Like, why can't I see them separately?

SPEAKER_01 13:27

Is that something that you have encountered in your practice or something that you think not so much that I've encountered in my practice, but in terms of how we see ourselves, identity is our own to construct. Uh, you know, I say this to people in the queer community and I say this to neurodivergent people: your identity is yours to construct. Um, however, uh, in you mentioned diagnosis a moment ago, in the diagnostic process, often if people come into me and they think that they might be autistic and they want to get be assessed, one of my first questions is what's the point? And what I mean by that is what is the outcome of the diagnosis? Because certainly in Australia, diagnosis for autism is an expensive process. If it's done by a psychologist, we have ethical obligations, we need to make sure that we're making a correct decision. So there's a lot required to diagnose autism and do it ethically and in a professional manner. So for me to do that, I have to charge you a lot of money. But one of my questions to people about diagnosis if there's no significant resource or support benefit is autism is a social, emotional, communications difference with restricted and repetitive patterns of behavior. So what are your friends like? Because your friends are likely to be the people who have the most similar communication and social style to you. And if you're not having difficulties that will warrant, for example, NDIS funding or funded supports, the benefits don't necessarily outweigh the costs. But if all of your friends are autistic or neurodivergent, that tells me that you communicate in a similar way to them. And so self-identification is fine. And you know, Uma and I were talking earlier about there is a fear of self-identification being seen as invalidating people with higher support needs. But I don't believe for myself that it's helpful to think that somebody who has difficulties that are less than mine don't warrant their difficulties being acknowledged. And that's not invalidating somebody else's greater level of difficulties. It's just highlighting that we're a single community and it's better for us to band together and support one another than it is to exclude other people because they don't have the same experience as us. And that's a lovely little windup that Emma gave me and I ignored for a good minute and a half.

SPEAKER_00 15:58

The hand gestures aren't working anymore, guys. I need more suggestions.

SPEAKER_01 16:02

Oh no, I'm sorry, it was just a couple of important points and left me some noise.

SPEAKER_00 16:06

We definitely had to get to those. I think I want to tangit a bit more into your lived experience, which is ultimately something that's very, very insightful, and viewers have told us that come in. So there's two elements. You are an individual that identifies with Audi HD, and as someone who has Audi HD, and you're also a clinician. So I guess um, let's start with how did you get both your diagnoses?

SPEAKER_01 16:26

Well, so ADHD diagnosis. I was diagnosed by a psychiatrist, uh what am I, 50, nearly 51, so about four years ago. Um, that's how I had that diagnosis. Uh I haven't sought a formal diagnosis for autism. I diagnose myself, I know the characteristics that I have, and I self-identify, and there's a very solid reason for that. Uh many people who are autistic have been assessed and have been told by clinicians who are doing their very best to do a great job, but may not understand how an Audi HD presentation can look, that they're not autistic, and that can be really problematic, and is probably the great hangover problem of an Audi HD presentation is when I tell you that you don't have this set of characteristics, what I'm also kind of telling you if you have difficulties is this is a you thing. You're too rigid, you're not trying hard enough to be free thinking or to be forgiving or whatever the thing is. But actually, what a lot of people call subclinical ADHD or subclinical autism is probably the presentation of those things that is somewhat masked by the presentation of the other. And unfortunately, not everybody has the time to hyperfixate like I have done on neurodivergence. And so that's going to be an ongoing thing. I choose to self-identify without formal diagnosis to say to other autistic people who may or may not be being told what their characteristics are by others that your identity is valid and you're not a bad person, or you know, your difficulties aren't caused by some thing that you're choosing not to do or to do. Having said that, diagnosis is a worthwhile process and it should be a positive process as well, but it should be a process that meets your goals. Um, self-diagnosis or self-identification or diagnosis, that decision needs to be made on what best suits your needs and the supports you require. Um, my story ends there.

SPEAKER_00 18:36

Amazing. Um, I think that you already touched a little bit on that. Just, you know, I wanted to sort of end on the note of what would be the most piece of practic, most practical advice you would give someone who is looking to get their Audi HD diagnosed, or just are on that, on this journey of figuring out their neurodivergence. And I think we've part of the podcast and what we've really talked and emulate in today's session, especially, is to let people know that it's okay if you want to identify with this label and it's okay if you don't want to as well. If you see traits that we discuss on this podcast and it's something that resonates with you and you want to resonate with that, that's beautiful. But if not, that's also perfectly fine and acceptable. But I guess in an Australian setting, just for more of our Australian viewers, what would you give like as the most concrete practical advice in terms of approaching an Audit?

SPEAKER_01 19:28

Well, I think if you wonder if you're an autistic ADHD, what are your friends like? What are your family like? If you have lots of friends that are diagnosed, it might be worth having a bit of a deeper look. If you don't, it might also be that your friends and family just don't have access to the resources and understanding of what those things are. But that's always a good indication. The people that I associate with are often highly telling of what characteristics I have because like attracts like in nature. In terms of the diagnostic process, my strongest recommendation to anyone is seek somebody who is neurodiversity affirming. Because if people are not neurodiversity affirming, it's likely to be a really difficult process for many, many autistic people and ADHD is. But also seek out people who have at least some exposure to lived experience because the nuance of understanding from lived experience informs a really balanced diagnostic decision. It can be a bias, and I think I've spoken about this in the past. I am inherently more biased towards a diagnosis because of the experience of difficulties that I have, and so I actively reflect every week and challenge that. But biases aren't always negative. It also means that I have an intimate understanding of how autism and ADHD can present in a non-textbook setting. So most of the clinicians I know who are neurodivergent out there also engage in that reflective practice and consider the risks and benefits of what they're doing. So again, I would say go to somebody who understands both conditions and the co-occurrence, and if possible, somebody with lived experience, but that doesn't mean that there are not people without lived experience who aren't amazing clinicians as well. Find the person who's the best fit for you.

SPEAKER_00 21:30

I think just to pick your brain a little bit more, Aaron, um, we were touching a little bit about this, just to sort of think about how do we break down Aud and it's, you know, because a lot of the terms that we might be using in the podcast, it come very naturally to us as people that work in the space and we deal with everyone and these words and everything. And I think overall, like just to give you a little scenario right before we wrap up, is let's say I am someone that has no idea and has never worked in a mental health space. So I don't know these words, I don't know what autism is, I don't know what ADHD is. My child has just been, has seen a clinician and has come back and told me that I have ADHD. And I would love to sort of just peek your brain and see what how you would approach that conversation.

SPEAKER_01 22:13

So I guess if if somebody came to me and said that my child's an autistic ADHD art, um a lot of parents that I speak to in those settings often through the diagnostic process start to see those characteristics in themselves. And that's actually how I've I've met a lot of the people that I've worked with is they're like, oh, my child just got diagnosed, and I'm wondering if I'm autistic or if I'm an ADHDer as well. But how I would approach that for somebody who just didn't know what those things were is I would explain them as I always do. It's differences. We're different, we're not less. We are much better at some things than the average person, and we're not as strong as other people as the average person at other things. Autism is a difference of relational styles, a difference of social interactions. We talk about social emotional or communications, um, these are the elements of what we do to interact with other human beings. So it's just differences, and I've used this example in the past, but if you put a classroom full of, you know, ordinary people in a room and one autistic person, the disordered person is the autistic person. But if you put a classroom full of autistic people in a room and then an average or an ordinary person in that room, they're the person who doesn't fit in and doesn't communicate and doesn't interact in the same way. And so I'd say there's nothing wrong with your child. The difference between characteristics doesn't make your child bad, it just makes them different. And the difficulties your child have or you might have with a diagnosis is not inherently a you thing. It's about you in a specific environment where your characteristics might not be the greatest strengths in that environment, but environment, but in another one they will.

SPEAKER_00 24:04

Absolutely. That's such a brilliant um piece of advice, and I think that will be really, really helpful for anyone that might be going through that journey of dealing with someone else in your life, you know, and that's potentially something we could discuss as well. Absolutely. Supporting people in your life, and I guess how do you go about that conversation of telling someone and letting them in and being like, hey, like this is something that I've been recently diagnosed with or something that I think that I might be, you know, exhibiting traits of. Can we have a chat about that? That would be something we could definitely explore in the future.

SPEAKER_01 24:35

Yeah, absolutely. I think that notion of disclosure is such an important question for a lot of neurodivergent people and a lot of queer people as well. So I think it's a lovely chat to have. And if anybody has any questions or queries or would like us to talk about anything particularly, please let us know. Well, I think that's it for us today, guys. Thank you very much for joining us again. It's been an absolute pleasure to talk ad nauseum at you and for Uma to help me stay on track. We will see you in episode five. Thank you.