I wonder if you recognise yourself in this description. Two different parts of you, each needing something the other can’t tolerate, both telling the truth about what they need with no way to satisfy one without failing the other. You might need company and to be entirely alone in the same moment. One part of you might need everything to stay exactly as it is while another part needs something, anything, to change. This is neither ordinary indecision nor a failure to choose between them, because two things that both matter require opposite responses at once.
That’s confusing enough to live with. It becomes even more so when the people around you, sometimes including professionals, expect you to pick one: the sociable version of yourself or the one who needs solitude, the version who thrives on routine or the one who needs to break from it, as if only one of them could be the real you.
From the outside, you may look like you manage all of this easily, perhaps even impressively so. What isn’t visible is the almost constant negotiation happening underneath: meeting one need often means leaving the other unmet, and there’s rarely a version of the day that satisfies both.
Living with two systems that don’t agree
Before any of that has a name, there’s a particular kind of confusion that’s harder to describe than ordinary contradiction. Most people with ADHD brains know contradiction well: you need structure, you can’t sustain it, and the gap between the two is where the frustration lives. I believe that AuDHD is different. You need structure and you need to break from it, both at once. You’re not failing to follow through on what would help you. Two different parts of you need two different things, right now, and both are real.
This is why a diagnosis, even an accurate one, doesn’t always bring the relief people expect. Knowing you’re autistic and ADHD, or that you have ADHD with some autistic traits, or vice versa, tells you something important about yourself. But it doesn’t tell you what to do on a Tuesday morning when a part of you that needs a plan and another part of you needs to abandon it are both awake at the same time. The diagnosis names the pattern. It doesn’t resolve the conflict.
What makes this particularly disorientating is that the things which help you are so often the very things that undo you. Routine can be the difference between coping and not coping, and routine can also be the thing your nervous system rebels against so completely that keeping to it becomes utterly exhausting. Socialising might be exactly what you need and exactly what depletes you past the point of recovery, on the same day, at times in the same conversation. There isn’t a clear way to sort your needs into the ones to keep and the ones to override, because they don’t stay sorted. What steadies you on Monday can be intolerable by Wednesday, for reasons that have nothing to do with how much effort you put in.
Before any of this had language, it may have felt like being permanently ‘wrong’: not quite finding language that fit, and not quite being met by other people’s expectations either.
For some people, ADHD information feels close but not quite right, while autism descriptions feel accurate in places but incomplete. Rather than feeling half-right in each space, it may be more accurate to say each one feels half-wrong. What complicates things further is that outside neurodivergent spaces, autism still often carries more stigma, and internally, the quieter autistic parts can be easily overlooked when the ADHD parts are making all the noise.
Something similar can happen with feelings themselves. Difficulty knowing what you feel until well after the moment has passed has a name – alexithymia – and is often assumed to mean emotional flatness. For someone who is both autistic and ADHD, it rarely feels that way. It’s closer to too much than to too little: everything registering at volume, while the naming and sorting of it lags behind. People around you may read this as calm. It rarely feels calm.
None of this is a contradiction to be resolved. It’s closer to living with two nervous systems that each have a legitimate claim on you, and neither of which is going to stop asking. Research is beginning to address this lived experience. Recent qualitative research with women diagnosed with both autism and ADHD in adulthood describes the two as sometimes contradictory, sometimes complementary, and sometimes so intertwined that separating them becomes impossible (Craddock, 2025). These aren’t scientific descriptions of a distinct AuDHD brain, but they are revealing descriptions of what it can feel like to live with both.
AuDHD is not itself a formal diagnostic category. It’s a term coined within the neurodivergent community to describe the co-occurrence of autism and ADHD, which wasn’t formally recognised as possible until 2013, when diagnostic manuals stopped prohibiting the dual diagnosis. Autism and ADHD are still generally assessed separately, perhaps by entirely different services, and each can mask the other. Clinicians who specialise in one aren’t always trained to recognise the other; and the same is true of the overlap between high sensitivity and autism, where similar confusion can arise. This is part of why so many people arrive at an understanding of their own autism or ADHD, and eventually both together, only after a long detour through something else, such as anxiety or depression, or their own child’s assessment bringing a lifelong pattern into view for the first time.
The labels that came first
For some people, that missing framework has meant years of other explanations: anxiety, depression, perfectionism, emotional instability, even a personality disorder diagnosis. Anxiety and depression can of course be legitimate conditions in their own right, and neurodivergence doesn’t make someone immune from developing them. But it’s also the case that a diagnosis may describe only part of what’ is happening rather than the larger pattern underneath it.
Research into autistic adults’ experiences of psychiatric misdiagnosis is increasingly documenting this problem. In a large 2024 study, personality disorders were the most commonly reported psychiatric misdiagnosis among autistic participants, with autistic women reporting this experience more often than autistic men (Kentrou et al., 2024). Autistic traits, particularly emotional intensity and a fear of abandonment, can resemble the diagnostic criteria for borderline personality disorder, which is part of why the two are so often confused. A separate UK qualitative study explored the experiences of autistic adults who had previously received a diagnosis of borderline or emotionally unstable personality disorder, with participants describing the diagnosis as stigmatising and, in their experience, inaccurate (Tamilson, Eccles and Shaw, 2025).
If you’ve been given a diagnosis that never quite fitted, I’m not suggesting that you merely replace it with AuDHD. There may be several things going on. Some people have neurodevelopmental differences and relational trauma. Some have anxiety or depression as well. Some have a diagnosis that was appropriate at the time but no longer captures the whole picture. What matters is being curious enough to ask whether the explanation actually makes sense of your life, and what might still be unexplained.
Why the wrong label costs more than time
Whatever form the earlier label took, whether anxiety, depression or something more serious, it tends to leave something behind beyond the years spent on the wrong track. It teaches you to distrust yourself. If you’ve been told repeatedly that your difficulties are really about your mood, or your thinking patterns, or your personality, you may have built an entire relationship with yourself around managing a problem that was only ever a partial and actively misleading description of what you were dealing with. That has a cost, separate from and additional to the cost of the original struggle. I’ve written elsewhere about the particular grief that can surface once a late ADHD diagnosis rewrites years you’d already made sense of in a different way. When the earlier label was more serious, or more stigmatising, that grief may well co-exist with a legitimate anger at how long it took, and at what the wrong framework asked of you in the meantime.
Masking two things at once
Much of what I’ve written before about neurodivergent burnout and the exhausting invisible labour of masking applies here too, but AuDHD adds a further layer. The effort involved in masking the autistic parts of yourself in order to seem less rigid, less easily overwhelmed, and more sociable, while simultaneously masking the ADHD parts in order to seem less scattered, less impulsive, and more reliable is huge (van der Putten et al., 2024). It can also lead to performing two different, occasionally contradictory versions of competence, often to different audiences, and rarely getting to be whichever version was true for you in the moment. No wonder if it eventually gave way to burnout.
Whatever shape your particular contradictions take, they were very likely present long before anyone had language for them, showing up as the child who was called wilful in one setting and painfully shy in another, or the one who could focus with total absorption on precisely the things adults hadn’t asked for. I’ve written more generally about how early relational experience shapes the adult patterns we bring into adulthood. For AuDHD adults, that shaping happens against a nervous system that was already processing the world differently from the people around them, which tends to make both the adaptation and its later cost more pronounced.
What relational integrative therapy offers here
Finding a framework that makes sense of your experience can be enormously relieving, but it doesn’t necessarily resolve the difficulties that brought you to that point. In some ways, it can initially make you more aware of them. Once you understand how much effort has gone into appearing capable, you may start to notice the cost of that effort more clearly. You may question routines, relationships or expectations that you had previously accepted without thinking about them, and begin to wonder which parts of your life actually work for you and which have just been organised around what you thought you ought to be able to manage.
There can be a difficult period here too. Understanding that something is genuinely difficult for you doesn’t mean that every difficulty needs to be accommodated, any more than recognising a neurodevelopmental difference means that you should simply push yourself through it. Part of the work can be learning to distinguish between the things you need to respect about yourself and the things you might want to approach differently. That distinction is rarely as straightforward as it sounds, particularly if you have spent much of your life being told that your needs were unreasonable or that you simply weren’t trying hard enough.
For people for whom AuDHD seems to make sense, I think it’s important to work with a therapist who really understands this territory. In my clinical experience, being understood can make a difference in itself. If you’ve spent years explaining why something that looks simple from the outside is actually difficult for you, there can be enormous relief in not having to explain or defend it yet again. You don’t necessarily have to convince me that the difficulty is real, demonstrate that you’re trying hard enough, or present the most organised, coherent version of yourself in order to be taken seriously. Therapy can otherwise become another place where you have to mask.
Sometimes the work is practical: understanding the conditions under which you function best and thinking about how your life could accommodate those conditions more realistically. At others, it’s about shame, separating what you genuinely find difficult from what you’ve learned to judge yourself for finding difficult. It might also at times be about grief, particularly if late recognition has changed the way you understand your childhood, relationships, education or career. And sometimes it’s about relational trauma: a neurodivergent child whose needs were repeatedly misunderstood may have learned very early to suppress those needs, monitor other people closely, become exceptionally capable, or make themselves smaller in order to remain connected. I don’t see neurodevelopmental differences and relational history as competing explanations. Someone may have been born with an AuDHD neurotype and then spent years developing shame, hypervigilance, perfectionism or people-pleasing because of how that neurotype was received by other people. The work isn’t to decide which one is ‘really responsible’, but to understand how they’ve interacted: which of your strategies are still supportive and which have become exhausting, what happens in your relationships when you need connection and solitude at the same time, and what happens inside you when you cannot do something you know perfectly well how to do.
Who is this for
This type of psychotherapy tends to suit people who are ready to hold more than one explanation at once, rather than searching for the single, tidy answer as quickly as possible. It’s a good fit if you’re willing to be curious about the parts of your experience that don’t yet make full sense.
You may have a formal diagnosis of one condition and wonder whether the other explains the rest, or you may simply have come across the term AuDHD and felt a startling sense of recognition. We don’t need to decide whether autism, ADHD, AuDHD, anxiety, trauma, attachment, or something else is the ‘real’ explanation. If you want to seek psychiatric assessment further down the line, or if you’ve already done so, that’s fine, and we can discuss that as part of the work. What matters to me is understanding you and all your parts in their own terms: your temperament, your neurodevelopmental characteristics, your history, your relationships, the adaptations you’ve made, and the person you have become through all of those things interacting over time.
You may have spent a long time believing that the contradictions in you were evidence that something was wrong. Perhaps they are better understood as information: information about what you need, what overwhelms you, and the conditions in which you flourish. And perhaps, eventually, that understanding allows you to stop fighting yourself quite so hard.
I offer a free 20 to 30-minute initial conversation so you can get a sense of whether this way of working might suit you, with no obligation to proceed beyond that.
Garthine Walker is a UKCP-registered psychotherapist based in Cardiff, offering online therapy across the UK. She specialises in trauma, attachment wounds, neurodivergence, burnout and maladaptive daydreaming.
REFERENCES
Emma Craddock (2025). ‘Navigating residual diagnostic categories: The lived experiences of women diagnosed with autism and ADHD in adulthood’, Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 30:2. DOI: 10.1177/13634593251336163.
Vasiliki Kentrou, Lucy A. Livingston, Rachel Grove, Rosa A. Hoekstra and Sander Begeer (2024). ‘Perceived Misdiagnosis of Psychiatric Conditions in Autistic Adults’, EClinicalMedicine, 71, 102586. DOI: 10.1016/j.eclinm.2024.102586.
Bruce Tamilson, Jessica A. Eccles and Sebastian C. K. Shaw (2025). ‘The Experiences of Autistic Adults Who Were Previously Diagnosed with Borderline or Emotionally Unstable Personality Disorder: A Phenomenological Study’, Autism: The International Journal of Research and Practice, 29:2, 504–517. DOI: 10.1177/13623613241276073.
W.J. van der Putten et al. (2024). ‘Is Camouflaging Unique for Autism? A Comparison of Camouflaging Between Adults with Autism and ADHD’. Autism Research, 17:4, 812–823. DOI: 10.1002/aur.3099.