Introduction
You have probably been told, more than once, that you are a contradiction.
You need routine, and you are the one who wrecks it. You are desperate for something new, and a change of plan can ruin your whole day. You will talk for two hours about the thing you love, then leave a two-line message unanswered for eleven days. You are the most organised person in the room about one particular subject, and you cannot find your keys.
If you have looked into ADHD, some of it fitted and some of it did not. If you have looked into autism, exactly the same thing happened. So you came away thinking you must be inventing it, because nothing lined up cleanly, and people who are really struggling presumably line up cleanly.
Or you are reading this about your child. Bright, funny, full of information about one enormous subject, and completely undone by the school shoes, the birthday party, and the fact that swimming has moved to a Thursday.
That in-between place has a name in the neurodivergent community. AuDHD.
This is a long piece, because it is a large subject and because most people arriving at it have already read twenty short ones that did not quite answer the question. Take it in sections if that is easier.
What AuDHD Actually Means
AuDHD is not an official clinical diagnosis. It is shorthand, used widely in the neurodivergent community, for having both ADHD and autism. It is not a third condition. It describes what happens when two well-documented ones occur in the same person, which turns out to be far more common than anyone assumed for most of the last century.
A 2021 meta-analysis found that roughly 40% of autistic people also meet the criteria for ADHD. A 2025 longitudinal study found that nearly 45% of adults with ADHD show significant autistic traits.
Those are not small numbers. If you know a fair amount about one of these conditions, there is a reasonable chance you have been looking at half a picture.
Why Nobody Was Allowed to Say Both
There is a specific reason so many people were left with only part of an explanation.
Until 2013, clinicians were not permitted to diagnose both conditions in the same person. If you presented with features of each, somebody had to choose. Usually they chose whichever was more visible, which in practice meant whichever was more inconvenient to the adults around you.
So a generation was handed one label, given strategies designed for that label, and left wondering why the strategies only ever half worked. If you were assessed as a child in the 1990s or early 2000s and something about the outcome never sat right, this may be why. The assessment was not necessarily wrong. It was working within a rule that no longer exists.
The Tug of War
The thing that makes AuDHD distinctive is not having twice as many traits. It is that two sets of needs pull against each other, constantly, inside one person.
It tends to look like this:
- A brain that needs predictability, and a brain that is bored senseless by it
- Sensory seeking and sensory avoiding at once. Loud music through headphones, to block out a noise you cannot bear
- Wanting people badly, then needing three days on your own to recover from having seen them
- Firm rules about how something must be done, and no ability whatsoever to start doing it
- Deep, absorbing interests that give you real joy, alongside an inability to make yourself do anything you have not personally chosen
- A strong need for fairness, and impulsive decisions that create unfairness you then have to live with
This is why people describe feeling as though they are fighting themselves. In a sense you are, and no strategy built for one half will hold, because the other half will object to it.
It also explains something that comes up constantly in my room. You will find a system that works beautifully, for about three weeks, and then it collapses and you conclude you are lazy. You are not. The system met one set of needs and starved the other.
AuDHD in Adults
Adults who come to see me about this tend to recognise a particular cluster of things.
Tiredness that never quite clears, because ordinary life costs you more than it appears to cost other people. Scripts prepared in advance for phone calls. A career built entirely around your interests, or one you have quietly under-performed in for twenty years while working twice as hard as anybody realised. Friendships that were intense and then faded without you being sure what happened. Overwhelm that arrives with no warning at the end of a perfectly ordinary day.
There is usually a history of other explanations. Anxiety. Depression. Being told you are sensitive, or difficult, or that you have so much potential. Anxiety and depression may well be present, and they are worth treating. Very often they are what decades of managing an unrecognised difference produces, rather than the whole explanation for it.
It shows up at home too. The misreadings that build up between two people over years, where distraction gets read as not caring and a need for routine gets read as control, are much easier to untangle once both of you understand what is actually happening.
AuDHD in Women and Girls
This deserves its own section, because it is where the diagnostic system has historically performed worst.
Both ADHD and autism were described, researched and diagnosed for decades largely on the basis of how they present in boys. Girls who were inattentive rather than disruptive, and girls who were socially anxious rather than socially absent, did not look like the picture in the textbook. A great many of them were not referred at all.
What often happens instead is a lifetime of very effective compensation. Watching how other girls do it and copying carefully. Rehearsing conversations. Being the quiet, conscientious one who is fine at school and unravels at home. Being described as shy, or dreamy, or a bit intense.
It is common for women to arrive at this question in their thirties or forties, frequently after their own child is assessed and they recognise themselves in the report. If that is how you got here, you are in very ordinary company.
AuDHD in Children
In children, AuDHD often looks like a child nobody can quite place.
The school says one thing and you see another at home. There are sensory differences, social differences, big feelings that take hours to settle. And then there is the puzzling opposite of an attention problem: four uninterrupted hours on the thing they love, which is usually what convinces everybody it cannot possibly be ADHD.
Alongside that, you may notice:
- Rigidity about routines that they themselves are the first to break
- Transitions between activities that cost far more than they appear to
- A need for fairness so strong that it causes conflict at school
- Enormous distress at a change of plan, from a child who is otherwise impulsive and disorganised
- Coping all day at school and coming apart entirely at the front door
That last one causes more misunderstanding than anything else on the list. A child who is fine for the teacher and impossible for you is not manipulating you. They have held it together all day, and home is the only place safe enough to stop.
AuDHD in Teenagers
Adolescence is very often when a child who has been coping stops coping, and parents cannot understand what has changed.
Usually nothing has changed about the child. What has changed is the load. Secondary school means more subjects, more teachers, more classrooms, more transitions, more social complexity and far less structure, and the demands go up every single year. Compensation that worked comfortably at nine stops working at fourteen.
Exam season is particularly hard, because it removes routine and adds pressure at the same time, which is precisely the combination this brain handles worst.
What you may see is a teenager who is exhausted, irritable, refusing school, or retreating to their room for longer and longer. It is easy to read that as laziness or defiance. More often it is a young person running out of capacity.
Masking, and What It Costs
Masking is the effort of appearing like everybody else, and it is one of the most important ideas in this whole subject.
It looks like eye contact you are consciously maintaining while losing track of what is being said. Copied mannerisms. Suppressing the movement that would actually help you concentrate. Laughing a beat after everyone else because you worked out it was a joke.
It works, in that other people do not notice. It costs enormously, in that you are running a second process all day on top of the actual task.
The bill arrives as burnout: a flattening exhaustion, loss of skills you previously had, less tolerance for noise and light than usual, and a strong pull to withdraw completely. In adults it is regularly mistaken for depression. In teenagers it is regularly mistaken for attitude.
Why It Gets Missed
There are predictable reasons people reach adulthood without anybody raising it.
- Each one hides the other. Impulsivity can disguise rigidity, and a need for routine can look like an ADHD brain simply trying to compensate.
- Masking, particularly in girls and women, and particularly in anyone who learned early that difference was not welcome.
- Academic success. If the marks are fine, concerns get dismissed, even where the child is drowning socially.
- Giftedness sits inside neurodiversity too, and high ability can cover a great deal until the demands outgrow it.
- The quiet presentation. Children who drift rather than disrupt do not generate the attention that leads to referral.
What This Is Not
A few things worth saying plainly, because they come up in nearly every first session.
This is not a fashion. The rise in people asking the question reflects a rule change in 2013, better recognition of how women present, and a great deal of catching up on people who were missed. It does not mean everybody suddenly has it.
This is not caused by parenting. Neurodevelopmental differences are not produced by screens, sugar, working mothers, or being too soft. Parents arrive carrying an extraordinary amount of guilt about this, and it is misplaced.
And it is not the same as everyone being “a bit like that”. Most people are disorganised sometimes and dislike loud restaurants. The question is never whether a trait exists. It is whether the pattern is getting in the way of a life.
Where to Start
If you are recognising yourself or your child here, some practical steps.
- Write it down. Specific examples, with dates. What happened, what came before it, how long recovery took. This is far more useful to any professional than a general impression, and it will show you patterns you had not noticed.
- Talk to the school. Teachers see your child in a setting you never observe, and their view is valuable even when it is uncomfortable to hear.
- Start with your GP or paediatrician. They can rule out other explanations, such as hearing difficulties, and begin the referral.
- Know who does what. Educational psychologists carry out learning and cognitive assessments. Clinical psychologists, psychiatrists, paediatricians and neurologists diagnose ADHD and autism. Occupational therapists assess sensory processing.
- Be realistic about the wait. It is long here, and that reflects a system under strain rather than anything you have done wrong. International health guidance still supports starting the process early.
- Get support for yourself in the meantime. SADAG offers free telephonic counselling nationally.
The waiting period does not have to be dead time. A great deal of useful support does not require a diagnosis first, and finding somebody who understands this properly matters more than the letters after their name.
How Therapy Helps
A word on my own role first. As a registered specialist wellness counsellor I do not diagnose ADHD or autism, and I do not prescribe medication. What I do is work with the person in front of me, before, during or after the formal process.
In practice that looks like:
- Making sense of the contradiction, which for many adults is the single most relieving part of the whole thing
- Working out which of your needs are non-negotiable, and which are preferences you have spent years apologising for
- Building systems that feed both halves, instead of one that collapses in three weeks
- Managing masking, and recovering from the burnout that follows it
- Practical structures at home, and specific help with mornings, homework and getting out of the door
- Self-esteem work, which matters enormously for anyone who has spent years being told to try harder
- Parent guidance, so that you are not managing this on instinct alone
- Preparing you or your child for assessment, so that it feels like being understood rather than tested
What Changes When You Know
People sometimes ask what the point is, particularly adults who have already built a life and are not going to be medicated at fifty.
What changes is the story you tell about yourself. Thirty years of evidence that you are lazy, difficult and inconsistent turns out to describe something quite different, and that reframe is not cosmetic. It changes what you ask of yourself, what you stop apologising for, and how much of your energy goes on pretending.
For children it changes what the adults do. Demands get pitched properly. The right things get supported instead of punished. And a child grows up understanding how they work, rather than concluding that they are the problem.
Conclusion
The people who come to see me about this are usually braced for me to tell them they are imagining it. Very often they have carried the suspicion for years without saying it out loud to anybody at all.
You are not imagining it. Whatever the formal process eventually concludes, the contradiction you have been living with is real, it has a shape, and it becomes far easier to work with once you can see it.
Noticing now, at whatever age you or your child are, is not late. It is the point at which things start getting easier, because you can finally work with how a brain is built instead of against it.
About Me
I am Paula Marais, a registered specialist wellness counsellor based in Claremont, Cape Town. I hold an Honours in Psychology (Unisa) and a Master’s in Creative Writing (UCT), and I am registered with the Association for Supportive Counsellors and Holistic Practitioners (ASCHP).
I see adults, teenagers and children, in person in Claremont and online across South Africa. Online sessions are equally as effective as in-person sessions.
There is no pressure and no judgment. You can reach me at info@paulamaraistherapy.com or on WhatsApp at 072 633 7661.
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