In recent years we have begun to understand how conditions like autism and ADHD present differently in women and girls than they do in men and boys, and the subtle symptoms that go unnoticed. For all genders, it is possible to have a diagnosis of both autism and ADHD (sometimes referred to as AuDHD) but how might this manifest differently in women? 

Here, we are exploring how both autism and ADHD show up in women and girls, the symptoms both might present, what combination of symptoms may suggest AuDHD, the benefits of early recognition and management of these comorbid conditions, how to get a diagnosis of AuDHD, and the treatment and support options available. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about AuDHD in women and girls, we can help. 

What is autism?  

Autism is a neurodevelopmental condition affecting how people interact with others and the world around them. It also impacts how they understand and respond to sensory information, so people with autism can experience common sensory issues, leading to certain negative reactions when exposed to particular triggers. Each autistic person will experience their own unique symptoms and traits, but some of the main symptoms of autism in adults include things like: 

• Having trouble reading social cues or participating in conversations
• Having trouble reading body language or facial expressions 
• Using a robotic or monotone speaking pattern that does not convey true emotions 
• Avoiding eye contact during conversations
• Carrying out restrictive and repetitive behaviours often 
• Having difficulty with changes to routine, especially if they are last-minute
• Having a fixation on one or two favourite subjects, either that they care deeply about or are extremely skilled in 
• Experiencing sensitivity to sensory input like pain, sound or touch 

Some of the signs of autism in children may include: 

• Lining up toys or objects, and becoming upset when the order is changed
• Repeating words or phrases over and over 
• Playing with toys in the same way each time
• Focusing on parts of an object, such as the wheels on a toy car 
• Getting upset by small changes to the norm 
• Obsessively following certain routines or interests 
• Movements such as flapping hands, rocking, or spinning in circles
• Unusual reactions to certain sounds, smells, tastes, or how things look or feel 

How is autism different for women and girls?

In recent years, researchers have begun to understand that women and girls tend to present with less noticeable symptoms of autism than men and boys, and may have a completely different experience of living with autism.

"We tend to see women are better at masking autism features. It is not completely understood why that is, however they seem to be have a better ability when it comes to meeting the societal expectations around social communication and interaction." - Dr Shakeel Islam, Consultant Psychiatrist

Some of the key areas in which autism manifests differently in women and girls include:  

• Repetitive behaviours and obsessions – Autistic women/girls may develop highly-focused and obsessive interests, talk excessively about their interests, or carry out personalised rituals that provide comfort to them. 
• Sensory sensitivities – Like in autistic men and boys, women and girls may also experience their own unique sensory sensitivities such as becoming easily overwhelmed by bright lights, harsh sounds or displeasing textures. 
• Masking behaviours – Masking is a coping mechanism sometimes used by autistic people, but studies suggest this could be more common in autistic women. Whether done consciously or unconsciously, masking allows them to conceal symptoms in an attempt to blend in with neurotypical peers. While masking may seem helpful, research shows these behaviours are associated with conditions like depression, anxiety and higher levels of suicidal thoughts, so this is not a helpful solution. 
• Social challenges – These can be less noticeable in women/girls, as they may be able to mask social challenges more effectively than men/boys. Internally, they may experience difficulties understanding social cues, communicating, or maintaining friendships, but they may also have more motivation to seek friendships and ‘fit in’ with their wider social groups, which can make autism difficult to spot in women.
• Issues with executive function – Autistic adults may struggle with everyday challenges like self-regulation, organisation and executive function. This could include things like cognitive flexibility or impulse control. While all genders can experience these challenges, studies find that autistic women are often high functioning, and may also have additional societal expectations placed upon them, making issues with executive function more difficult to identify. 
• Mental health challenges – Studies suggest autistic women tend to experience more mental health challenges than autistic men, possibly due to their tendency to mask symptoms. As an example, autistic women are thought to have higher rates of anxiety and suicidal thoughts. 
• Workplace struggles – Due to symptoms like having a limited ability to adapt to change, autistic women may experience difficulties in the workplace. Studies suggest that autistic women are less likely to retain their position at work than autistic men.
• Later diagnosis – Research shows autistic women are often diagnosed later than men. A 2021 study found 75.4% of autistic women received their diagnosis on average 8 years after having their initial evaluation.
• Comorbid conditions – Autistic women are thought to be more likely to have co-occurring conditions such as eating disorders (research suggests 4-23% of people with an eating disorder are also autistic), obsessive compulsive disorder (studies suggest links between OCD and autism), borderline personality disorder (studies find autistic women are more likely to have co-occurring BPD and autism in a possible 36.4% of cases), and more.
• Physical health challenges – Studies suggest autistic women may experience higher rates of physical health issues than both non-autistic women and autistic men, with one study finding them more likely to have poor general health.

"Women with autism can fly under the radar. They are able to get further without causing too much impact on their day to day lives. In autism diagnostic services we see autism is often picked up later in life for women.” - Dr Shakeel Islam, Consultant Psychiatrist

What is ADHD?

ADHD stands for attention-deficit/hyperactivity disorder. This is a type of neurodivergence that means a person’s brain is hard-wired differently to neurotypical individuals. In adults, this might cause symptoms such as trouble focusing, impulsive behaviours, and difficulties paying attention, all of which can make everyday life more challenging. 

ADHD can impact areas such as learning, studying, working, organising, managing time, and getting tasks done, and this condition is known to present differently in women and girls than in men, such as featuring less hyperactivity symptoms and more inattentive symptoms. 

However, each person will experience their own unique combination of symptoms. Some common signs of ADHD include things like:

• Regularly making what appear to be careless mistakes
• Trouble paying close attention to details and maintaining attention during long tasks
• Trouble organising tasks and activities, and managing time
• Frequently losing important items like keys or phones
• Forgetting things like paying household bills or attending appointments
• Difficulty waiting, such as in a line or for their turn to speak
• Restlessness, difficulty sitting still, fidgeting or squirming a lot
• Excessive talking, interrupting, or answering questions before they are finished
• Being easily distracted by unrelated thoughts or external stimuli 

How is ADHD different for women and girls?

"ADHD women are often the more inattentive type rather than hyperactive. Because hyperactivity is a clear manifestation and is very observable, the rates of misdiagnoses for women in the past were higher." - Dr Kapil Bakshi, Consultant Psychiatrist

According to the Centers for Disease Control and Prevention (CDC), boys are three times more likely to be diagnosed with ADHD than girls. This could be because ADHD symptoms in boys are typically more external (such as fidgeting) than symptoms in girls, which are thought to be more internal (such as anxiety). Many ADHD studies have identified more cases of ADHD in boys than in girls, with only 4.2% of women thought to receive an ADHD diagnosis in their lifetime, compared to 13% of men.

Some of the key areas in which ADHD shows up differently in women and girls include:  

• More inattentive symptoms – Research finds women and girls with ADHD tend to experience more inattentive symptoms that may be missed by people around them, such as teachers or parents/guardians. This could be symptoms like difficulty staying organised or completing tasks, frequently losing important items, struggling to pay attention to details, fast-paced thinking, difficulty following conversations, becoming distracted by external stimuli, being interested in many subjects at once, and more.  
• Coping strategies – Research on ADHD has found women may develop more coping mechanisms than men, such as masking symptoms. Many symptoms in women/girls could be missed due to something called the ADHD Iceberg, which is when people with ADHD present as neurotypical but experience many inattentive ADHD symptoms internally that are not easily noticed by others. For example, women with ADHD might experience less hyperactive symptoms like fidgeting or loudness, and more inattentive symptoms like difficulty staying organised. You can read more in our article: What Is The ADHD Iceberg & Why Is It Important? 
• Mental health difficulties – Studies have suggested women with ADHD commonly experience symptoms such as low mood, mood swings and anxiety, which can lead to an ADHD diagnosis being overlooked in favour of diagnosing and treating these individual symptoms. 
• Menstrual cycle symptoms – It is now understood that the menstrual cycle can influence symptoms of ADHD, making it challenging for medical professionals to diagnose the correct condition. Hormones like oestrogen and progesterone fluctuate around a woman’s period, ovulation, pregnancy, breastfeeding or menopause, resulting in either positive or negative impacts on their typical ADHD symptoms. 

With a lack of understanding around how ADHD manifests differently in women and girls, many women who struggle with some of the above symptoms may not recognise the condition in themselves, and studies suggest women often lack the awareness needed to identify ADHD in their own life and seek a diagnosis. 

What is AuDHD?

Historically, research favoured separating ADHD and autism into two distinct conditions with a separate diagnosis for each, rather than one singular condition. Autism and ADHD were not diagnosed together until 2013 when the fifth edition of the DSM recognised this comorbidity, leading to a comorbidity rate of 45% at the time. 

It is now understood that both can exist together, however there are differing opinions within the medical community about how commonly this comorbidity occurs. An estimated 50-70% of autistic individuals also present with ADHD, and in children, studies have found 22-83% of autistic children also have symptoms that align with the criteria for ADHD, while 30-65% of children with ADHD have symptoms that satisfy the criteria for autism. 

There is no official term to describe an individual with both autism and ADHD, but the term ‘AuDHD’ has become more common recently in order to bridge the gap between the two conditions, and bring awareness to the possibility of both existing simultaneously. 

There remains a lack of research on how these conditions overlap, but one notable study examined three groups – autism-only, ADHD-only, and autism with ADHD – and found men had a higher chance of having all three diagnostic categories than women. With a lack of research on the problems facing both autistic women and women with ADHD, this finding presents further challenges for those who may be experiencing symptoms of both. 

Some of the overlapping symptoms of autism and ADHD might include:

• Impulsivity – ADHD impulsivity can result in symptoms like jumping up at inappropriate times or speaking out of turn in conversations. These are similar to typical autism symptoms that may arise when someone is unable to read social cues. 
• Hyperactivity – While this tends to be a more common symptom in men/boys with ADHD, anyone with both ADHD and autism might experience symptoms such as fidgeting or stimming behaviours. 
• Attention issues – Studies have found similar symptoms of inattention in children with autism and children with ADHD. Often attention issues are more associated with ADHD, however research suggests attention could be more of a challenge for autistic children of any severity than for those with inattentive or combined type ADHD. 
• Social difficulties – It is known that both autistic individuals and those with ADHD may experience difficulties with social interaction, whether that means difficulty with social cues (as is common in those with autism) or a tendency to interrupt others (as may be the case for those with ADHD). 

Studies have found the strongest links in the co-occurrence between autism and ADHD to be social difficulties, attention issues, and impulsivity. You may find more useful information on this dual diagnosis in our article: AuDHD: Dual Diagnosis of Autism & ADHD.

How does AuDHD present differently in women/girls than in men/boys?

Just as both autism and ADHD tend to present differently in women and girls, AuDHD presents differently, too. Some of the overlapping symptoms might include:

• Masking behaviours – As described above, both autistic women and those with ADHD may mask their symptoms in an attempt to hide them from peers or in social situations where they wish to appear as neurotypical. This can result in missed diagnoses of both conditions. 
• Distractibility – Attention issues are much more associated with ADHD, however both ADHD and autism may lead to similar symptoms of distractibility. 
• Hyperfocus – Both autism and ADHD can cause intense focus on specific subjects, whether that means topics the individual is skilled in, or simply ones that bring them enjoyment. Focus issues are common in women with ADHD, but hyperfocus is also known to occur, and may look similar to the intense interests and obsessions experienced by autistic individuals. 
• Emotional regulation challenges – Both autistic women and women with ADHD could experience difficulties regulating their emotions, resulting in things like heightened anxiety or mood swings. As an example, both conditions may be more susceptible to rejection sensitivity dysphoria, which causes individuals to become very sensitive to any perceived criticism or rejection. 
• Hormonal challenges – One study suggested female hormone difficulties could be a catalyst for menopausal women seeking a diagnosis after many years of struggling with AuDHD. 

Unfortunately there remains little research on the experiences of women with suspected AuDHD, and just as gender stereotypes continue to negatively impact both ADHD diagnoses and autism diagnoses in women, the same appears to be true for women with suspected AuDHD.  

Why is it important to recognise and manage AuDHD in women and girls?

Understanding a comorbidity of more than one condition is extremely important across the board. Only treating one issue rather than multiple can lead to further problems, such as certain treatments potentially exacerbating a secondary issue while attempting to improve symptoms of the first. 

A 2024 research paper states “Being an undiagnosed AuDHD woman is a confusing and traumatising experience with profound and enduring repercussions”, which appears to be the experience shared by other women with overlapping autism and ADHD symptoms. 

Early recognition and proper management of AuDHD can ensure no further mental health implications arise as a result of either ADHD or autism being left untreated, such as depression or low self-esteem. This is undoubtedly challenging when a person’s symptoms do not fit the criteria for either condition exactly, and they also face long waiting lists and a lack of support in the meantime. 

Similarly, for parents of young children showing signs of either condition, it is important to understand where these might overlap in order to avoid misdiagnosis and seek the appropriate support.

How can women and girls get an AuDHD diagnosis, treatment and further support? 

AuDHD is a colloquial term, so although both ADHD and autism may be recognised as comorbid conditions, a person will not be diagnosed as being or having AuDHD. When looking at both conditions separately, it is important to remember that neither can be cured, and treatment will be primarily about managing symptoms and learning coping strategies. 

One of the main difficulties people with AuDHD might come across is the potential need for ADHD medication to manage symptoms, without negatively impacting autism symptoms – striking the right balance here is key, and a professional with experience treating both conditions will be the best way to achieve this. 

To date, the diagnostic criteria have been criticised for having a narrow focus on deficits, more of a focus on male symptoms, and a limited understanding of the areas neurodivergent individuals struggle with. For this reason, finding a specialist with experience in diagnosing and treating both conditions in women and girls could lead to more positive results.

Some of the challenges in diagnosing AuDHD and seeking treatment include: 

• Age issues – Diagnosing comorbid autism and ADHD can be difficult as autistic children are able to be identified before they reach 3 years old, while children with ADHD are often diagnosed later in life. 
• Lack of specialised training – Many medical professionals lack the specialised training needed to fully understand the unique combination of ADHD and autism symptoms being experienced by someone with AuDHD. Often, GPs can miss or overlook certain signs, and may even misdiagnose patients based on accompanying symptoms like anxiety or depression. 
• Contradictory symptoms – Comorbid ADHD and autism may result in overlapping and contradictory symptoms. As an example, an autistic individual may wish to stick to a rigid routine, while someone with ADHD may struggle with organisation, therefore struggling to stick to a routine. In cases where one symptom counteracts another, secondary conditions could be missed. 
• Isolated testing – Autism and ADHD are treated separately, with assessments and treatments usually conducted in isolation. This can make comorbid ADHD and autism difficult to identify. Seeking a specialist who can combine knowledge of both conditions may be the most effective way of getting the appropriate diagnosis.  
• Stigma – There remains a certain amount of stigma attached to both autism and ADHD separately, meaning a diagnosis of both could lead to further stigma, and as a result, barriers to achieving a diagnosis and accessing treatment. 
• Long waiting lists – In recent years, the NHS has experienced a significant increase in those with suspected autism seeking a diagnosis, leading to long waiting lists and delays in people reaching a diagnosis. While this can cause barriers, it is still incredibly important for women to seek support for either issue. Private assessments via organisations like Augmentive could provide a timely alternative by pairing individuals with therapists with experience of both autism and ADHD. 

If you recognise some of these AuDHD symptoms in yourself or a loved one, it may be best to seek a professional who specialises in helping those with both ADHD and autism, and with experience treating women and girls. If you are already working with an autism specialist or an ADHD specialist, talk to them about how you can also seek advice on this potential comorbidity. They may be able to help you themselves, or put you in touch with someone with the experience you need for an effective diagnosis. 

When it comes to treatment, not enough research exists on the complexities of treating comorbid ADHD and autism, which is why it is so important to seek a professional with experience supporting those with both ADHD and autism so they can help by figuring out the appropriate combination of treatment options based on your overlapping symptoms. This might mean psychoeducation, therapies like cognitive behavioural therapy (CBT), ADHD medication to manage ADHD symptoms, or something else. 

You can find out more about available support for ADHD and what is involved in a private ADHD assessment, or you may be interested in learning more about what to expect from an adult autism assessment. 

At Augmentive, we believe advice and support for anyone with AuDHD should be bespoke and tailored to the individual to help with their specific symptoms, so if you believe you might be experiencing this particular comorbidity, or you would like to discuss diagnosis, treatment, and the coping techniques that might work best for you, we can match you with a psychiatrist or therapist who has the experience you need. 

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private AuDHD assessments to helping you get a private psychiatric assessment for support on your journey.

If you have a question about mental health, like what the signs of autism are in adult women, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.