Emotional dysregulation is an invisible string linking sensory processing, anxiety, and ADHD in children, according to new research that explores the relationship between sensory processing subtypes and self-regulation in children with neurodevelopmental disorders. Researchers found that, while some sensory subtypes were associated with elevated anxiety and others with elevated ADHD symptomatology, all sensory processing subtypes were associated with higher emotional dysregulation compared with sensory-typical children.

The study, published in Nature, enrolled 117 participants from a community-based specialty clinic; all participants were children aged 8 to 12 years old with various neurodevelopmental diagnoses, including autism and ADHD.¹ The researchers uncovered five distinct sensory processing profiles in this group:

• Typical Sensory Processing (30% of the sample)
• Sensory Under-Responsive (20%): Child often does not respond to verbal information or what is around them
• Sensory Over-Responsive (19%): Child is bothered by wearing certain garments or by loud sounds
• Sensory Seeking (19%): Child has a persistent desire for fast movement and often cannot stop touching things or people
• Mixed Sensory Processing (11%): A combination of the above, depending on context or the stimuli

The study highlights the “wide range of heterogeneity in sensory experiences among populations with neurodevelopmental concerns,” say the study’s authors.

Elevated Emotional Dysregulation, Anxiety, ADHD

The researchers investigated the prevalence of behavioral and emotional regulation challenges in the group as a whole and in different sensory subtypes. They also considered the following comorbidities:

• 62% of the group exhibited ADHD symptoms
• 39% exhibited emotion dysregulation
• 19% exhibited anxiety

They also studied patterns associated with specific sensory subtypes:

• Children in the sensory over-responsive subtype reported significantly elevated anxiety levels.
• Children in the sensory seeking and sensory under-responsive subtypes reported the highest levels of ADHD behaviors.
• All subtypes, apart from typical sensory processing, reported elevated levels of emotion dysregulation.

These findings offer insights into the complicated relationship between sensory processing and self-regulation challenges, which researchers hope will help clinicians better serve neurodivergent children through targeted interventions that address overlapping symptomology.

“Not many people realize that the sensory systems are foundational to development, functioning and wellbeing. Differences in sensory processing may undermine the acquisition of skills of a higher order – from behavior to learning,” explains Candace Peterson MS, OTRL, in her ADDitude article. “What Is Your Child’s Sensory Profile?” “This is why sensory challenges in kids often manifest in school, show up as behavior problems, and make daily living difficult.”

An ADDitude reader who struggles with sensory over-responsiveness explains: “Sounds seem to overstimulate me the most frequently and easily. It feels like the sounds are physically pushing me into a corner and squishing me.” Another reader with sensory over-responsiveness says clothing tags and seams are her “mortal enemies.” “On good days, they’re a slight annoyance,” she says. “On bad days, it feels like they’ve come alive with tiny needles for fingers, incessantly poking at me, causing repeated stings.”

Sources

¹Brandes-Aitken, A., Powers, R., Wren, J. et al. Sensory processing subtypes relate to distinct emotional and behavioral phenotypes in a mixed neurodevelopmental cohort. Sci Rep 14, 29326 (2024). https://doi.org/10.1038/s41598-024-78573-2

Autism in Girls: Key Takeaways

• Autism in girls is overlooked because symptoms manifest differently across genders, and because of persistent gender bias in clinical and research settings.
• Compared to boys, autistic girls are more socially motivated, which may make their social challenges less apparent and thus more likely to be missed by clinicians.
• Autistic girls seldom demonstrate repetitive movements, and their special interests are more likely to be seen as typical.
• In-depth evaluations are often necessary to identify or rule out autism in girls. Other supports — from therapy to emotional regulation skill-building — can significantly help.

Autism in Girls Looks Different

About one in 36 children in the U.S. is autistic, a diagnosis that is four times more common in boys than in girls.¹ What explains this gender gap?

Science is working to determine factors that may explain autism’s diagnostic prevalence in males, but many clinicians who specialize in autism in girls and individuals assigned female at birth clearly see that gender bias — in referrals, diagnostic criteria, and tests — plays a role in diagnostic outcomes.

Autism is more readily identified in boys than in girls because, historically, the clinical and research focus has been on boys almost exclusively. Many clinicians who are trained in diagnosing autism are unaware how its traits can uniquely manifest in girls. Failing to realize that girls and women don’t always demonstrate the more stereotypical signs of autism, many clinicians end up overlooking behaviors that are indicative of autism. This is part of why girls and women are often diagnosed as autistic later in life than boys.

Signs of Autism in Girls

Social Motivation

Autism is characterized, in part, by difficulties and differences with social communication and interaction. Some autistic children may have trouble initiating or engaging in social interactions, which can result in them feeling left out or different. Some children, meanwhile, may prefer solitary activities.

Some children may struggle to understand when and how to join a conversation. An autistic child may follow up to a peer’s question with a brief response or with nothing at all, bringing the interaction to an end. Sometimes, conversations and interactions can become one-sided; an autistic child, for example, may not realize that others want to play differently and will continue to insist that everyone play a game according to very fixed rules. Autistic children may also show differences in use of eye contact, gestures, and facial expressions or misinterpret these cues from others.

[Take This Free Screening Test: Autism in Girls]

Autistic girls may experience all of the above. However, many demonstrate more social motivation — the drive to understand, connect, and enter relationships with others — than do autistic boys, which may make their social challenges less apparent and thus more likely to be overlooked.

• Autistic girls are more likely to want to fit in. As such, they are more likely to mask (i.e., hide or compensate for autistic traits) and mimic neurotypical behaviors.
• Autistic girls are more socially observant, which helps them pick up on details that allow them to better fit in and mask. It’s common for autistic girls to painstakingly study patterns in how people interact to reverse engineer “normal” behavior.
• Autistic girls are often perfectionists. The urge to fit in and flawlessly mask drives
  perfectionistic tendencies. Sensitivity to rejection is also common; when autistic girls stumble and experience social exclusion — despite their best efforts and desires to make and maintain
  friendships — the pain of rejection is profound.

Autism in Girls: The Consequences of Masking

We can’t talk about autism in girls without talking about masking. While masking often emerges as a coping strategy for socializing, especially for autistic girls without intellectual development disorder or who may not have observable behavioral or academic needs, it can create lots of issues, too.

• Masking is mentally taxing. Constantly trying to figure out others, understand unspoken
  social rules, and fit in with changing circumstances is highly exhausting.
• Masking interferes with self-understanding. Autistic girls often have trouble tuning into their own needs and emotions because masking has long forced them to suppress their authentic selves. Identity and self-esteem issues are common; some girls don’t even realize when they are masking. Masking can also interfere with friendships, as girls are unable to bring their full selves to these relationships or know what they want in a friend.
• Masking can impact clinical evaluations. Autistic girls who have become accustomed to hiding their traits may struggle to express and make sense of their behaviors and experiences, which can interfere with autism evaluations and lead to underdiagnosis or misdiagnosis. (This compounds the gender bias that causes girls’ autistic behaviors to be downplayed.)
• Masking can cause health issues. Constantly worrying about blending in with societal norms can turn into anxiety and other internalizing and physical issues. Many autistic girls tend to suppress their feelings, which causes more mental health challenges.

[Read: What Does Autism Spectrum Disorder Look Like in Children?]

Differences in Restricted and Repetitive Behaviors

Autism is characterized by restrictive, repetitive patterns of behavior, interests, or activities as demonstrated by the following signs:

• hand flapping, finger flicking, rocking, and other stereotyped behaviors (or “stims”)
• lining up, stacking, spinning, sorting and/or categorizing toys and objects
• echolalia and other forms of repetitive speech
• a strong preference for routine; resistance to change
• rigid, perseverative thinking; insistence on adherence to rules
• highly restricted, fixated interests (i.e., special interests)
• hyper- or hyporeactivity to sensory input

While autistic girls can show the above signs, these behaviors may manifest differently.

• Autistic girls are less likely to demonstrate repetitive movements. When they do, they are more likely to demonstrate different types of repetitive movements than boys, like tapping their fingers or twirling their hair, which can be easily overlooked.
• Autistic girls’ special interests are more likely to center on animals, celebrities, or fictional characters, which can seem more socially acceptable and thus less likely to be flagged as a sign of autism.

Autism in Girls: How to Support Neurodivergent Youth

Know the Signs — and Myths

Early detection is key for autistic girls to receive the support they need so they can develop self-
understanding without shame. Parents, educators, and clinicians should be aware of the above signs of
autism in girls and these common autism myths:

Clinicians: Peel Back the Layers

Clinicians overlook autism in girls, especially in those without intellectual or language disorders, because these girls can be adept at camouflaging. Their symptoms tend to be more internalizing, and they may have trouble verbalizing their experiences and what they need. Even when girls do show signs of autism, to the untrained eye, these girls can appear “not autistic enough.”

• Dig deep. Ask about relationships when evaluating girls for autism. How does your patient experience friendships and connecting with others? How does your patient feel about their ability to make friends and maintain them? How does this experience connect to her self-esteem? What is the toll of social interactions on your patient? Watch for cues that your patient finds social interactions exhausting and effortful. You may need to carry out longer assessments and observe your female patients over time so you can dive deep into their experiences. If they do not show signs of or report impairment across settings, watch for signs of subjective distress.
• Screen for comorbid conditions. Autism and ADHD co-occur at high rates, and the symptom overlap cannot be overstated. Anxiety and specific learning disorders are also common.
• Actively educate yourself on autism in girls. Seek out training and review the latest literature. Listen and learn from patients with lived experience.

More Ways to Support Autistic Girls

• Seek interventions and supports. From speech, physical, and occupational therapy to IEPs or 504 plans, secure the services that support your child’s individual needs. Medications are available to help support mood and reactivity. Talk to an autism specialist about the best interventions for your child and seek a second opinion if your provider makes you feel disrespected or unheard.
• Provide structure and routine. Stability and predictability reduce anxiety, stress, and overwhelm in autistic children, who often struggle with rigidity, inflexibility, and stress during transitions.
• Support executive functions. The cognitive skills that allow us to plan, prioritize, organize, manage time, start tasks, and self-regulate are often impaired in autistic individuals and can significantly impact daily functioning. Scaffolding in the classroom and at home can help.
• Teach healthy coping skills. Emotional dysregulation is very much a part of autism. What’s more, girls are socialized to suppress their emotions, which can accumulate and lead to intense emotional outbursts. Autistic girls must be taught emotional awareness, including how to monitor, label, and understand their emotions. Breathing exercises, mindfulness, muscle relaxation techniques, and other strategies can help improve emotional regulation.
• Talk about autism from a neurodiversity-affirming standpoint. Viewing autism from a strengths-based perspective can help young girls accept themselves, refrain from masking, and gain the confidence to advocate for themselves throughout their lives.

Autism in Girls: Next Steps

• Get This Free Download: The ADHD-Autism Link in Children
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: 4 Autism Myths — Dispelled
  

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD” [Video Replay & Podcast #511] with Karen Saporito, Ph.D., which was broadcast on June 27, 2024.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., Ladd-Acosta, C. M., McArthur, D., Pas, E. T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A., Hall-Lande, J., Nguyen, R. H. N., … Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2020. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 72(2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1

Art is Hayley Wall’s love language. Since Wall was a young child, she has found her footing as a communicator through drawing. Wall struggled academically as a child due to dyslexia and undiagnosed ADHD and autism, but she says, “What I did have was this gift where I could create images and I could tell stories.”

When Wall graduated from university and considered where to take her art, she was drawn to the topic of disability. “I was exploring the things I felt were important, the things that needed to be spoken about,” Wall explains. “My mom is disabled, so that’s been around me for a long, long time and it’s felt like people with disabilities are always the last to be thought of.”

Wall was asked to illustrate an article on chronic illness for the cover of Sick magazine, and then another on the same topic for It’s Nice That. These illustrations caught the attention of The New York Times, which commissioned Wall to illustrate a package celebrating the anniversary of The Americans with Disabilities Act. Her work became known for her signature bodies — large, gender-fluid forms, typically without faces, that exude strength, joy, and confidence.

As Wall’s art career gained momentum, so too did her personal journey to understand her own neurodivergence. Though Wall struggled with mental health challenges all her life, it wasn’t until she was 34 that she received a diagnosis of ADHD and autism.

Below, Wall shares her creative process, the challenges and joys of being a neurodivergent artist, and her commitment to a future that celebrates different minds and bodies.

[Read: “Happily Neurodivergent — at Last”]

Q: How did your diagnoses come about?

I’ve always wondered, ‘What’s wrong with me?’ and always struggled with my mental health. It was a feeling of being too much — too emotional, too sensitive, I always carried this feeling of, I just don’t fit in.

When I was 30, I sat down with my partner at the time, and was like, ‘I found this article about adults that have been diagnosed with ADHD and I’ve just done multiple quizzes. Can you do the quiz as well, please?’ They did, and they scored really low. I was like, ‘So you don’t do that? And that?’ It made me think, ‘OK, I think something’s going on.’ I approached my general practitioner, and from there, it took four years to get a diagnosis.

When I was 36, a year ago, I got diagnosed with autism and a mental health condition. I’m coming to terms with all these diagnoses and trying to understand how to navigate them. To me, what’s more important is not the label but just working out what I need.

Credit: Hayley Wall, illustrator

[Self-Test: Autism Test for Adults – Signs of ASD]

Q: When did your love of art begin?

I was a kid who bounced off the walls, I had so much energy. I wouldn’t shut up, and I would cry and scream. To calm me down, my parents would give me pens and paper and I would draw. It was the one time I was calm and focused.

Q: How does your ADHD inform your work?

After graduating, it took me 8 to 10 years to establish myself. I’ve done so many random jobs. I’ve worked as a nanny, in factories, in cafes. But running parallel to that was my hyperfocus, which kept me on track to pursue art. My hyperfocus is the reason I’ve been able to turn art into a career.

My work is all about bodies, usually gender ambiguous bodies. They are these big bodies that take up space — maybe because I’ve always felt really small and inferior. The bodies in my work are powerful. I can live through them.

The whole ‘taking up space’ idea is a big f&*k you to society for being like, ‘You have to be like this, or like that.’ It’s, ‘No, we can be whomever we want to be.’

Q: Can you tell us about your creative process?

A commission will come through and it’s like jumping on a roller coaster. There’s a voice that goes, ‘Here we go.’

I center myself and breathe to remove any negative voices and let the process take me.

As I read the commission, the visuals start coming, and my brain is joining dot-to-dots. I have a background in dance, and the dancing lives in my work now. Sometimes I’ll get myself or my friends into different positions and I’ll draw from that. I create loose, playful hand-rendered drawings and textures, and then I bring it onto my computer to work with.

Once I’ve got my concept down, I enter the most playful part of the process. I can enjoy coming to the end of the roller coaster nice and slowly.

Q: What’s the hardest part of your job?

The first bit of the process, mind-mapping concepts, is hard because I’ve got so many ideas, and I need to hone in. It’s the organization of thoughts that’s hard.

What crushes mind-mapping is impostor syndrome, a feeling I’ve carried of being inferior. I wish I was able to remove that saboteur voice that creeps in to say, ‘You’re not good enough,’ so I could just let my brain run free.

Q: What ADHD supports have you found helpful?

Freelance work is definitely hard because you don’t have HR, you don’t have colleagues to turn to. You are your absolute everything, and it’s really tough.
I was doing it for a long time all by myself, and I reached burnout. My mental health crashed.

In the UK, we are very lucky in terms of the benefits we get from the government. The ‘Access to Work’ program offers a sort of grant or reimbursement scheme to cover the cost of a support worker. It has been very helpful to me, and I’ve used that to have somebody support me through the admin tasks.
I never want to go back to a point where I’m trying to manage it all alone.

Q: Any advice for other artists with ADHD?

If you can tune into your voice and communicate your story, that’s when you’re going to create something nobody’s ever seen before.

Q: Where are you now on your journey of understanding your neurodivergence?

With the community I’ve found, I have a feeling of being able to unmask, to be my true self, to be able to be too much, weird, overly emotional, and sensitive.

Recently, I did a commission for a London museum and library called The Wellcome Collection. They asked me to respond to an article written by a person who was diagnosed with autism as an adult, and because this piece was so personal to my experience, I really wanted to place myself in the work. It was a three-part series: before, during and after diagnosis.

For the final image, I Photoshopped my face in quite a warped way onto the figure. I’ve hid behind my work for years, so to put my own face on this figure felt quite important. It was like, ‘I’m unmasking now. I’m showing myself. I’m allowing myself to actually come through. This is me.’

ADHD, Art, and Mental Health: Next Steps

• Read: Stifled Creativity and Its Damaging Impact on the ADHD Brain
• Read: Why ADHD Masking Is a Form of Self-Sabotage
• Read: “I’m Not Hiding My ADHD Anymore”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

At the same time, the medical community has its work cut out for it. We’ve barely begun to scratch the surface on ADHD and autism — conditions with strikingly similar traits and challenges that also happen to co-occur at significant rates. We primarily understand these conditions in white males, and we have a long way to go to ensure that women, people of color, and gender-diverse individuals are represented in research and published findings.

As our understanding of ADHD, autism, and neurodivergence evolves, I share my insights on where we are and where the field should be headed.

1. Most Providers Are Not Trained in ADHD or Autism

My first introduction to diagnosing and supporting ADHD and autism wasn’t until my pre-doctoral internship, after I had already spent four years in graduate school. A lot of what I have learned since then about ADHD and autism has been through clinical experience with patients and ongoing self-education.

Until 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) did not even allow for co-diagnosis of both ADHD and autism. With the publication of DSM-5 that year came significant changes to the diagnostic criteria for both conditions.

[Get This Free eBook: The Truth About Autism in Adults]

• Autism spectrum disorder was once divided into several distinct disorders, including autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). The DSM-5 consolidated these categories into a single diagnosis: autism spectrum disorder.
• With the DSM-5, the age by which ADHD symptoms must be present to qualify for a diagnosis changed from age 7 to age 12. Additionally, the DSM-5 said adults need to show five symptoms of inattention and/or hyperactivity/impulsivity, compared to the six required by children for diagnosis. These and other changes have helped to capture more girls and women in the diagnostic process.

That ADHD and autism were kept separated for so long invariably affected clinical work and research, which we are still working to rectify. Neurodevelopmental conditions are not a standard part of medical training in the first place, and many medical providers, especially those who have not sought training in these conditions, remain unaware of how the diagnostic categories have evolved and how to diagnose and support these conditions.

2. The ADHD-Autism Overlap Is Significant — and Seriously Under-recognized

Autism and ADHD are highly comorbid and share a staggering number of traits and symptoms, many of which are not reflected in diagnostic criteria for either condition.

Autism and ADHD: Shared Symptoms, Traits, and Challenges

• inattention to non-preferred tasks; hyperfocus on interests
• hyperactivity and restlessness
• impulsivity
• executive dysfunction (manifested by issues with organization, time management, planning, etc.)
• hypo or hypersensitivity to sensory input
• social and communication issues, including fear of rejection
• inflexibility; difficulty with change and transitions
• emotional dysregulation; meltdowns
• sleep problems
• self-esteem issues
• anxiety
• masking
• perfectionistic tendencies
• dichotomous, all-or-nothing thinking

[Read: “A Living Contradiction” — the AuDHD Experience]

While distinct, multidimensional, and complex conditions, ADHD and autism overlap so much that I sometimes view them along the same spectrum. This does not mean that I think everyone who has ADHD is also autistic, or the inverse. It’s just that, when we look closely, we see that a vast number of people with ADHD frequently exhibit autistic traits, and vice versa.

As clinicians, we need to educate ourselves beyond the basic mechanics of diagnosis for either condition, seek experience and supervision when necessary, and include clinical judgment in our decision-making matrices. We cannot rely only on test or scores. We need to learn about behaviors and traits that we know clinically exist in both ADHD and autism but may not be currently reflected in diagnostic criteria.

3. ADHD and Autism Are Routinely Overlooked in Girls and Women

Boys are more likely than girls to be diagnosed with ADHD and autism. Girls and women, who often display more subtle, internalizing symptoms, tend to be overlooked because clinicians and researchers largely continue to view these conditions from a male-centric view. Female manifestations of either condition are often misdiagnosed, misinterpreted, and normalized. Gender and societal norms also mean that girls and women are more likely to overcompensate and mask their symptoms and challenges of ADHD and/or autism.

To understand female presentations and potential signs of neurodivergence (e.g., emotional dysregulation, low self-esteem, overwhelm, perfectionism, social anxiety) clinicians must take a different, nuanced approach when evaluating girls and women for ADHD and/or autism. It can be helpful to see patients across multiple sessions during the diagnostic process and ask about functioning in different settings.

4. How We Talk About Autism and Neurodiversity Matters Greatly

• Be the paradigm shift. Changes are underway in how we collectively understand autism, ADHD, learning differences, and other neurodevelopmental conditions. We see this in the growing use of the term “neurodivergence” — language that aims to normalize and de-stigmatize, not pathologize, differences in thinking and functioning. While we must pay attention to medicalized and pathologized language, we must also retain the idea that neurodivergent individuals may need specific kinds of support, especially if their symptoms and traits interfere with functioning and cause distress.
• Identity-first vs. person-first language. Individuals can label themselves however they want to. But many autistic individuals — viewing autism as a fundamental part of their identity that shapes all aspects of life — prefer identity-first language over person-first language. That is, most of the time, people want to be referred to as “autistic,” not as “having autism.” With ADHD, however, person-first language appears to dominate. Patients may feel more respected when they hear medical professionals use these terms.
• The medical community must listen to patients. Understanding — not undermining — the lived experiences of those who live with ADHD and/or autism is critical. The experiences, traits, symptoms, and challenges of our patients do not always align with textbook definitions and available research findings, and firsthand accounts can offer a more accurate and comprehensive understanding of these conditions. Listening to patients helps us appreciate the nuances and variations in symptoms and offer personalized treatment plans. When patients feel heard and respected, they are more likely to engage in their care and advocate for themselves, leading to better outcomes.

5. Those Who Don’t Diagnose Still Play a Role

Licensed and trained medical and mental health providers who specialize in neurodevelopmental conditions can properly and comprehensively evaluate, diagnose, and treat ADHD and/or autism. It also bears repeating that those outside of healthcare— a patient’s family members, friends, teachers, and so on — absolutely cannot diagnose or treat these conditions.

And yet, non-specialists and those outside of healthcare still hold tremendous influence over a patient’s outcomes. Pediatricians and primary care providers, regardless of specialization in ADHD or autism, should be able to notice signs of these conditions, perform preliminary screenings, and refer patients to specialists. At the same time, family, friends, and teachers are often first to notice if someone is exhibiting signs that would warrant speaking to a medical professional. These individuals are often part of the clinical evaluation process.

While important people in a patients’ lives can serve as catalysts for diagnosis and support, they can also derail the process, especially when they are uninformed or misinformed about ADHD and autism. Family, friends, teachers, and even medical providers may miss the signs. Even worse, they can deny them, which can cause harm by derailing the path to evaluation and diagnosis on a child, adolescent, or adult’s health journey. Without a label or diagnosis, neurodivergent individuals are at greater risk of mental health issues, lack of appropriate and needed supports, and co-occurring issues like depression, anxiety, and self-harm.

My suggestion to all non-specialists and those outside of medicine: Don’t put individuals in a position where they begin to doubt themselves and their health providers. Instead, be curious. Educate yourself and ask how you can be supportive. Listen and be respectful of peoples’ experiences.

6. We Need to Pay Close Attention to Gender-Diverse Populations

Research is beginning to uncover what many clinicians and patients have observed: That gender diversity is present more frequently in autistic individuals and in those with ADHD.^{1 2} To be clear, research is limited in this area.

Nonetheless, his is an important connection because gender-diverse populations are already vulnerable to mental health issues — from depression and anxiety to self-harm and loneliness — due to stigma, discrimination, and social rejection. Living with ADHD or autism can compound these challenges.

The association between gender diversity and neurodivergence shines a light on the importance of inclusive, affirming care among ADHD and autism specialists. This includes asking patients for their pronouns, updating intake forms to include more gender options, self-monitoring for gender bias, and committing to ongoing education, among other approaches. Clinicians must also be careful about diagnostic overshadowing, whereby a patient’s emotional and behavioral issues are attributed to their experiences related to gender identity as opposed to other co-occurring conditions. As all of available studies on ADHD and autism are based on binary gender, researchers should include gender diverse options in studies and testing.

7. Social Media Can Open the Door to Understanding

There is a lot of misinformation on social media, and we should always view what’s online through a critical lens.

That being said, there is also lots of excellent, valid, and vital discussion online around the neurodivergent experience. On social media, individuals speak openly about their lived experiences with ADHD and/or autism — conversations that create transformative communities of understanding, friendship, support, and belonging while helping the undiagnosed begin to put a name to their experiences. (It’s my view that conversations in these spaces have and will continue to inform research on ADHD, autism, and neurodivergence.) From a health equity perspective, these online spaces offer support when access to evaluations, treatments, and health insurance is difficult.

As medical providers, we should refrain from making blanket statements about the “harms” of social media when it is a tool that has helped many. At the same time, patients should remember that people online are sharing their own unique experiences that may not apply to others. All-or-nothing statements about ADHD and autism should raise an eyebrow or two, as should anything that is offered as a “cure” for neurodivergence.

The ADHD-Autism Overlap: Next Steps

• Take This Self-Test: Female Autism Test — “Am I Autistic?”
• Autism in Kids Self-Test: Early Signs of ASD
• Free Download: Autism Evaluation Checklist
• Read: Stop Fighting Your Child’s Neurodiversity

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD” [Video Replay & Podcast #511] with Karen Saporito, Ph.D., which was broadcast on June 27, 2024.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-1

² Kahn, N. F., Sequeira, G. M., Garrison, M. M., Orlich, F., Christakis, D. A., Aye, T., Conard, L. A. E., Dowshen, N., Kazak, A. E., Nahata, L., Nokoff, N. J., Voss, R. V., & Richardson, L. P. (2023). Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents. Pediatrics, 152(2), e2023061363. https://doi.org/10.1542/peds.2023-061363

To study this emerging issue, our team at the Simons Foundation analyzed 25 datasets collected across 18 studies that involved 600 children with autism. We created and ran an algorithm to identify differences between kids with autism and their neurotypical counterparts. We then correlated the microbiome against so-called cytokines, which are immune markers, to see how the gut microbiome is linked to individuals’ immunity and inflammation. ¹

This is important because many chronic disorders, such as inflammatory bowel disease and diabetes, demonstrate components of immune dysfunction. Identifying the immune-microbe link in autism not only creates new opportunities for managing autism symptoms, but it also introduces ideas regarding how the microbiome could be manipulated to regulate immune response.

Gut Microbiota May Signal Autism

When we looked at the microbes predicted to be associated with autism and compared them with microbiota likely associated with neurotypical controls, we observed a strong difference between the two groups. Further investigation suggested that we could distinguish accurately between individuals with autism and neurotypical controls just by using their measured gut microbiota. This means that future research might unlock autism diagnoses through gut microbiome analysis, potentially guiding symptom management and therapeutic developments.

[10 Foods (and Supplements and Vitamins!) to Boost Your ADHD Brain]

When we compared the gut-brain axis — the gut microbiota and human brain pathways, or the enzymes responsible for the breakdown of products in the brain — we observed a strong overlap between pathways detected in the gut and those detected in the brain. This suggests that diet affects gut diversity and brain function, from thinking to mood.

GI and Sleep Problems

Many children with autism have gastrointestinal (GI) and sleep problems. In one study, researchers found that the chances for behavioral problems substantially increase when children have GI and sleep problems. ²

Parents should track foods eaten, bowel movements, and sleep patterns to establish connections between these factors and their child’s symptoms. Preventing or treating GI symptoms may provide children with some relief and help them sleep through the night.

Research into the gut-brain axis, and what this correlation can tell us about certain conditions like autism and depression, is still new. In the near future, it is possible that knowledge of gut bacteria will help determine predictive biomarkers of disease, with implications for new therapeutics. What we know about the gut-brain axis will look very different 5 to 10 years from now.

Autism and Gastrointestinal Issues: Next Steps

• Download: Autism Evaluation Checklist
• Read: The ADHD Diet Plan — Healthy Foods and Supplements for Kids & Adults 
• Read: Autism vs. ADHD — A Parent’s Guide to Tricky Diagnoses

Jamie Morton, Ph.D., is an independent consultant who has previously worked for the National Institute of Child Health and Human Development.

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Sources

¹ Morton, James T., Dong-Min Jin, Robert H. Mills, Yan Shao, Gibraan Rahman, Daniel McDonald, Qiyun Zhu, et al. (2023). Multi-Level Analysis of the Gut–Brain Axis Shows Autism Spectrum Disorder-Associated Molecular and Microbial Profiles. Nature Neuroscience 26 (7): 1208–17. 10.1177/1087054718816169

² Leader, G., Barrett, A., Ferrari, C., Casburn, M., Maher, L., Naughton, K., Arndt, S., Mannion, A. (2021). Quality of Life, Gastrointestinal Symptoms, Sleep Problems, Social Support, and Social Functioning in Adults with Autism Spectrum Disorder. Res Dev Disabil.;112:103915. 10.1016/j.ridd.2021.103915

While autistic girls and boys can present similarly, autism in girls generally looks different. The social difficulties that are part and parcel of autism, for example, manifest differently in girls, who tend to be more socially motivated. They may, for example, mask their traits and suppress their challenges to fit in. Girls are also not as likely to demonstrate repetitive or externalizing behaviors. Some autistic traits — like having special interests — are more likely to be regarded as typical in girls. For undiagnosed girls without intellectual or language disability and with low support needs, an autism diagnosis may be difficult to come by.

Think your child may be showing signs of autism? Answer the questions in this self-test and share the results with a medical provider who specializes in autism in girls.

Time's up

Can’t see the self-test questions above? Click here to open this test in a new window.

The questions in this autism in girls test are informed, in part, by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), research literature and screeners on autism in girls and women^{1 2 3}, and from the ADDitude ADHD Experts webinar titled, “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD” with Karen Saporito, Ph.D. This autism in girls is designed to screen for the possibility of autistic traits and symptoms in girls, especially girls without intellectual or language disability and with low support needs, and it is intended for personal use only. This autism in girls test is not intended as a diagnostic tool.

Signs of Autism in Girls Test: Next Steps

• Take this Test: ADHD Symptoms in Women and Girls
• Take this Test: Is My Child Autistic? Early Signs of Autism Spectrum Disorder
• Subscribe to ADDitude magazine
• Free Download: The ADHD-Autism Link in Children
• Watch: Why Autism Is So Difficult to Diagnose in Women and Girls with ADHD
• Read: What Does Autism Spectrum Disorder Look Like in Children
• Find: Specialists or Clinics Near You

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¹ Brown, C. M., Attwood, T., Garnett, M., & Stokes, M. A. (2020). Am I autistic? utility of the girls questionnaire for autism spectrum condition as an autism assessment in adult women. Autism in Adulthood : Challenges and Management, 2(3), 216–226. https://doi.org/10.1089/aut.2019.0054

² Bargiela, S., Steward, R., & Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of autism and developmental disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8

³ Autistic Girls Network (2022.) Autism, girls, & keeping it all inside. https://autisticgirlsnetwork.org/wp-content/uploads/2022/11/Keeping-it-all-inside.pdf

Autistic women with strong coping skills, low support needs, and who do not have an intellectual or language disability are more likely to be overlooked. (Some individuals call this “high-functioning autism,” though autism advocates urge against the use of functioning labels. “Functioning labels aren’t a good way to think about autism,” reads part of a statement by the Autistic Self Advocacy Network. “We all have things we are good at and things we need help with. Using functioning labels makes it harder for us to get the help we need, and for us to make the choices we want. Instead, we should talk about people as individuals.”)

Answer the questions in this self-test and share the results with a licensed mental health professional who specializes in autism in women.

Time's up

Can’t see the self-test questions above? Click here to open this test in a new window.

The questions in this female autism test are informed, in part, by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), research literature and screeners on autism in women^{2 3 4}, and from the ADDitude ADHD Experts webinar titled, “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD” with Karen Saporito, Ph.D. This female autism test is designed to screen for the possibility of autistic traits and symptoms in women, especially women without intellectual or language disability and with low support needs, and it is intended for personal use only. This female autism test is not intended as a diagnostic tool.

Female Autism Test: Next Steps

• Take this Test: ADHD Symptoms in Women and Girls
• Free Download: Autism Evaluation Checklist
• Free eBook: The Truth About Autism in Adults
• Read: “Could I Be Autistic, Too?” Signs of Autism in Women with ADHD
• Read: “A Living Contradiction” The AuDHD Experience
• Find: Specialists or Clinics Near You

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

¹ Milner, V., Colvert, E., Hull, L., Cook, J., Ali, D., Mandy, W., & Happé, F. (2024). Does camouflaging predict age at autism diagnosis? A comparison of autistic men and women. Autism Research : Official Journal of the International Society for Autism Research, 17(3), 626–636. https://doi.org/10.1002/aur.3059

² Brown, C. M., Attwood, T., Garnett, M., & Stokes, M. A. (2020). Am I autistic? utility of the girls questionnaire for autism spectrum condition as an autism assessment in adult women. Autism in Adulthood : Challenges and Management, 2(3), 216–226. https://doi.org/10.1089/aut.2019.0054

³ Bargiela, S., Steward, R., & Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of autism and developmental disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8

³ Autistic Girls Network (2022.) Autism, girls, & keeping it all inside. https://autisticgirlsnetwork.org/wp-content/uploads/2022/11/Keeping-it-all-inside.pdf

But just like other families, we crave a “third place” where we can relax. So when we discovered Wheated, a gourmet pizza restaurant in our Brooklyn neighborhood, it filled a huge hole in our lives.

Our Third Place: A Neurodiversity-Affirming Pizzeria

I won’t soon forget the tang of the first sip of Umbria or the texture of the pizza’s sourdough crust. But what will stay with me forever is how the restaurant staff made us feel.

After a few visits, my son was on a first-name basis with the owner, who was also a huge soccer fan. He’d chat with my son about soccer as if he had all the time in the world, while the restaurant bustled around us. No matter what drama happened during the week, we had our Sunday night ritual to look forward to and to savor. The servers knew our complicated order and didn’t blink at all the substitutions.

[Take This Self-Test: Signs of Autism in Children]

We would arrive most Sundays just as they opened for dinner. We reserved the same table in the back corner every time. There was loud music, and at times our kid was overstimulated; at other times, I was overstimulated. Waiting for the food was hard. Sometimes, our son moved around in ways that were not the safest for the wait staff and the other diners.

But the staff was gracious to us, always, even when patience ran out on both ends. Even when my son had a meltdown during one of our first visits. Thankfully, it happened to be Super Bowl Sunday, and we were one of the only families there, but the moment was hard nonetheless.

Even as my son screamed and cried and jumped, we were treated respectfully and kindly. The staff set the tone for the other diners. We never had the feeling of hairy eyeballs on us that was so common in other places.

A Friendly and Inclusive Space

The more we visited, the easier the dining experience became. I brought art supplies and noise-canceling headphones. We danced in our seats near the open kitchen, where our son could watch the chefs twirling dough in the air. There were some swift exits and half-eaten meals—but through these experiences, my son developed new skills, and we enjoyed ourselves together.

[Read: “A Love Letter to My Son’s Special Interests”]

We became loyal customers. Eventually, over years, our son got used to the many noises of a busy restaurant. He learned dining etiquette, how to order his own dinner, and where he could safely stim while keeping the aisle clear for servers. We took our family and friends to the restaurant, and were able to have lovely, relaxed celebrations because our kid was known and accepted for who he was there.

I will forever be grateful to that restaurant for helping my son gain social skills and confidence while accepting him unconditionally. The sense of belonging to a “third place” will stay with him as he grows up and branches out to other restaurants and public spaces.

I’d like to think that our family had a positive influence on the restaurant as well. (At the very least, we tipped well!)

If you’re looking for that “third place” for your own family, don’t give up. Inclusive places are out there, and they are delicious.

Autism Acceptance: Next Steps

• Free Download: The ADHD-Autism Link in Children
• Read: 4 Autism Myths — Dispelled
• Read: How to Process and Accept Your Child’s Neurodiversity

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What’s behind this? And what else can AuDHD individuals expect when taking ADHD medication?”

Certainly, stimulant medication can lower the volume on ADHD symptoms that might have once overshadowed autistic traits and behaviors, thus appearing to “unmask” autism. Enhanced focus brought on by stimulant medication can also increase awareness of one’s autistic traits, which may have gone mostly unnoticed before.

But stimulant medication may impact the expression of autistic traits in other ways. A common side effect of ADHD medication, for one, is anxiety. In the context of autism, this side effect can enforce autistic traits like a need for control, rigid thinking, and perseverative thoughts — traits rooted in anxiety that are present in almost all people on the spectrum.

In addition, while stimulant medications increase focus, this can go one of two ways. Ideally, the stimulant will help individuals focus on what they need to and want to focus on. Sometimes it can go the other direction, where stimulants can lead to hyperfocusing on distractions and getting stuck on mental processes. While this can happen to anyone who takes a stimulant, it’s not an uncommon side effect among autistic individuals who are already prone to rigid thinking and perseveration.

[Take This Self-Test: Signs of Autism Spectrum Disorder]

Stimulant medications also can increase heart rate and blood pressure. People on the spectrum may notice even small changes in heart rate and blood pressure, given heightened sensory sensitivities.

Are AuDHD Individuals More Sensitive to Stimulants?

In general, many autistic individuals tend to be more sensitive to medications and have a difficult time tolerating them. Between the two classes of stimulant medications and other non-stimulant medications, many treatment options exist for those with ADHD and autism. I have found that patients who are sensitive to medications do better on small doses of different medications rather than the traditional route of increasing each medication as far as can be tolerated. For all cases, we try to use the minimal amount needed.

Alpha agonists (such as guanfacine or clonidine) are a class of medication used to treat hyperactivity and impulsivity in ADHD in both children and adults. These medications tend to work well for many of my patients with ADHD and autism with a lower risk of side effects compared to stimulant medications. For example, I often prescribe guanfacine to help with restlessness and racing thoughts rooted in ADHD, as the alpha agonists may be less likely to increase rigidity and related traits rooted in autism. For some patients with the common trifecta of ADHD, autism, and anxiety disorder, using an alpha agonist or SSRI to reduce anxiety puts them in a better position to tolerate a stimulant for ADHD symptom control.

All patients, but especially those with ADHD and autism, should know what to expect when they start a medication. Patients should feel empowered to ask specifically what side effects to expect with these medications and how long the side effects may last, along with information about when to ask for help and/or stop the medication. In some cases, it’s a matter of tolerating side effects for a few weeks until the individual adjusts to the medication. Without this information, individuals who experience side effects may immediately assume that medication isn’t for them, when medication may be the key to improving quality of life with some patience.

[Get This Free Special Report: Scorecard of ADHD Treatments]

Beyond medication, other supports are available for managing co-occurring ADHD and autism, from therapy to skills-training. Additionally, many of my AuDHD patients say executive function coaching has made day-to-day living much smoother. Ultimately, treating AuDHD patients requires a multifaceted approach that needs to be individualized to each person and their other co-occurring diagnoses.

Autism and ADHD: Next Steps

• Free Download: Autism Evaluation Checklist
• Read: Medication Effectively Treats ADHD Symptoms in Adults with Comorbid Autism
• Read: “A Living Contradiction” Stories of the AuDHD Experience

Veena Ahuja, M.D., is a psychiatrist and the owner of Balanced Innovative Care located in Columbus, Ohio.

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Sam was held in the general prison population. Clearly, he did not belong there. After calls to the district attorney’s office from his grandmother, Sam was released. He was nonverbal for six days. His grandmother and I filed a complaint with the San Antonio Police Department.

We wanted change. I prepared a list of recent court cases in which sheriff’s offices were sued for injury and/or murder of people with autism. Subsequent meetings followed, and other disability group advocates joined us, along with officers and the lead trainer of cadets from the Crisis Intervention Team, which supports first responders in encounters with people with disabilities.

[Download: Free Autism Evaluation Checklist]

Police Training to Better Recognize Neurodivergent People

Among our requests: We wanted police to provide more training to police officers, lessen their sensory footprint (using sirens or flashing lights only when necessary), and place fidgets and cards with visual representations of commands in their squad cars for interactions with impaired individuals. We also wanted to forge a connection between local police precincts and families with children who have ADHD and autism. If your child is nonverbal or experiences a mental health disorder, the local police officers should know who they are.

My organization, Family ADDventures, is now working with two nonprofits, Any Baby Can and Autism Community Network, to revamp training about autism and mental health conditions for all local police cadets. Family ADDventures is also working with a police training company to develop a national training program on neurodivergence for police and emergency responders.

My advice to advocates looking to make changes in their local police departments: Start by offering support. Our officers deserve to know their work is valued. Family ADDventures created a program wherein local bakeries and businesses share treats and information with officers before they start their night shift. It’s a small step toward building bridges.

Another word of advice for advocates: Understand your city’s complaint procedure and file when appropriate. If there is no movement on your complaint, read it as testimony at your county council meeting. Know how your city operates so you can show up and make noise. Timing and persistence matter.

[Download: The Truth About Autism Spectrum Disorder in Adults]

Visit FamilyADDventures.com to learn more about neurodiversity training for your organization

Police Training & the Neurodivergent Community: Next Steps

• Download: The ADHD-Autism Link
• Read: Prepare Your ADHD Driver for Traffic Stops
• Read: What Are Signs of Autism Spectrum Disorder in Adults

*Sam is not his real name.

Nicole Santiago, M.ED., is a disability advocate with ADHD. She is the founder of Family ADDventures.

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“My autism is extremely invisible,” Lehmann says. “Society has more tolerance for a child having a meltdown but when an adult male who doesn’t look disabled does it, it comes across as very threatening.”

Recently on a work trip, Lehmann’s flight was delayed, causing his “Jenga tower of functioning” to come tumbling down. He kicked a trash can in frustration, attracting the attention of a heavily-armed police officer. Lehmann’s mother stepped in, explaining, “My son has autism. I’ve got this.” The officer took a step back, ready but waiting, as Lehmann calmed down.

Lehmann has had enough negative encounters with law enforcement — cornering him, cursing at him, shaming him — to know this was a best-case scenario. He’s terrified about what could have happened if he hadn’t had a traveling companion, or if the officer was more forceful. He wonders what the outcome might have been if he’d been Black.

The duty of law enforcement is to protect and serve, but when they encounter people with disabilities, too often the result is harm instead of help. Adults and teens with autism, ADHD, and other neurodevelopmental disorders appear to be at a heightened risk for negative outcomes every step of the way in the criminal justice system, from first police contact to questioning and detainment, to jail, trial, and beyond. Mishandled interactions can result in everything from distress and humiliation to jail time, or even death.

[Read: What the Americans with Disabilities Act Means For You]

While no comprehensive data exists on the collective outcomes when people with disabilities encounter police, we do know that neurodivergent individuals are over-represented in the carceral system. Rates of ADHD are six times higher among inmates than in the general public,¹  and rates of intellectual and developmental disabilities (including autism) are four times higher.²

Law Enforcement and the Neurodivergent: Unique Risks

Neurodivergent people face challenges with law enforcement as victims, witnesses, and especially as suspects. For individuals with autism, common behaviors like stimming, avoiding contact, or meltdowns arouse suspicion, which can lead officers to shout commands or make physical contact. This, in turn, intensifies sensory overwhelm and anxiety, making compliance less likely, not more.

Similarly, people with ADHD may have trouble following commands, because of impulsivity or distractibility, and this behavior can be viewed by police as uncooperative or disrespectful. An individual’s hyperactivity and restlessness, exacerbated by confinement to a chair in a small room, might be perceived as a sign of guilt. Working memory problems, time blindness, and memory distrust syndrome may cause a person with ADHD to have difficulty accurately answering questions or to reply, “I don’t know” to even simple questions such as: “Is this the road you live on?” Police may misinterpret this as evasiveness, another possible sign of guilt.

[Read About the Mom Spearheading Police Training on Autism]

In all these cases, what might have begun as a harmless situation can escalate quickly. “Officers that can’t identify the signs of disability may over-utilize force, may make an arrest for a situation that doesn’t call for one,” explains Texas Police Sergeant James Turner, who spent nearly a decade heading the Crisis Intervention Team (CIT) training in Austin, Texas.

Heightened Threats for People of Color

For neurodivergent people of color, the perils of an interaction with police are even greater. Black Americans are killed by police at twice the rate of White Americans, according to the Fatal Force Database, which has been tracking deadly police shootings since 2015.

Stephon Watts, a Black 15-year-old with autism in Illinois, was one of these victims. Watts’ parents called 911 to help respond to their son’s meltdown, but the arrival of the police only escalated Watts’ distress. Police fired two shots, killing Watts in his own home. In 2021, Illinois passed the Stephon Watts Act, also called the Community Emergency Services and Support Act (CESSA), which requires emergency responders to send mental health professionals to respond to mental or behavioral health calls.

Devastating stories like these keep Evelyn Polk Green, M.S., Ed., up at night. Past president of ADDA (Attention Deficit Disorder Association) and CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), Green says that as a mother to Black sons with ADHD, she worries about all the things that any mother of a person with ADHD worries about in a police encounter. “It’s just multiplied exponentially by all the other things that we already have to worry about on top of it,” she explains. “Unfortunately, so often law enforcement is ready to jump to the absolute worst conclusion and with Black and brown kids, it’s even worse, because they often automatically assume they’re up to something.”

Disability Awareness Training on De-escalation Techniques

Experts agree: training is the essential first step in ensuring better outcomes. “Most people call 911 when they don’t know what to do. We have to be properly equipped in that moment to handle that crisis,” says Sergeant Turner. “We are problem solvers but we have to have the tools.”

Those tools are exactly what David Whalen, project director for Niagara University First Responder Disability Awareness Training (DAT), aims to provide. The DAT is an eight-hour comprehensive training that covers victimization, Americans with Disabilities Act (ADA) compliance, interface with CIT, interaction skills, proper language and specific information on identifying and understanding a dozen disabilities including ADHD, autism, Tourette’s syndrome, dementia, and epilepsy.

Sergeant Turner’s disability awareness training was received during a 40-hour CIT training, required for all cadets in Texas. CIT training addresses how to support people experiencing a mental health crisis, and Turner hastens to clarify: “People with disabilities are not mentally ill, though they can have that issue as well.” Because some of the techniques (including de-escalation) overlap, disability awareness is often folded into CIT training.

Key topics include:

• Recognition of Disability: Officers learn common signs and symptoms of disabilities. Not all individuals can self-identify, and some choose not to. Proper identification of disability prevents officers from jumping to erroneous conclusions, including that the person is intoxicated, and allows for ADA accommodations.
• De-escalation Techniques, including:
  • Giving the individual space and time to respond. Many encounters with disabled individuals take a tragic turn simply because of the speed at which they unfold, creating unmanageable (and often unnecessary) distress. “You don’t always need to rush up on them,” says Turner. “You need to ask yourself, what are the risks vs. benefits of delaying action?”
  • Appropriate communication is essential. If someone with autism is distressed or experiencing sensory overwhelm, for example, a loud, commanding voice may cause further overwhelm. Adjusting tone and pace of speech, or using a pad and pen or hand signals, might be appropriate. Sometimes, Turner says, the key might be to call a family member to ask for specific guidance about support.
  • When force is unavoidable, using less lethal tools like tasers and pepper spray can save lives.
• Connect with Community Resources: Often, Whalen says, it is invaluable for officers to help individuals pursue longer-term support. Turner agrees: “We are not the experts. We just need to know who the experts are.”

“Fighting for Crumbs of Funding”

It’s clear that training works to improve outcomes. Yet there’s enormous variability in how much, if any, disability awareness training police officers receive, since it’s largely determined on a local level.  Too often, Whalen says, training only happens as a term of a settlement after a person with disability, or their family, sues the police for wrongdoing.

This was the case in Maryland; the bill that now requires disability awareness training for all police officers — through the Ethan Saylor Alliance — was created only after a 26-year-old man with Down Syndrome was killed when sheriff deputies tried to forcibly eject him from a movie theater where he neglected to buy a ticket.

“It would be beneficial to have something mandated at the national level but you have got to have the funding to support implementation,” says Leigh Anne McKingsley, senior director of Criminal Justice Initiatives at The Arc. “This issue of disability justice has been bumped down the priority list, and we’re fighting for crumbs of funding to bring about the exposure and education we need.”

Beyond Training: Community Resources

Training is crucial, but McKingsley says: “You can’t just expect training to take care of everything,” This is why, as part of its training, The Arc’s Pathway to Justice program assembles Disability Response Teams (DRT). These are multidisciplinary planning teams that bring together law enforcement, people with disabilities, attorneys, victim advocates, and disability advocates to collaborate in an open dialogue.

“The mandate is, on the day of training, the DRT starts making a plan of action moving forward,” McKingsley says. That includes brainstorming how to address the most glaring gaps in support and services both short and long term, and figuring out how to expand disability training in the community.

Sergeant Turner, who served on a DRT in 2019, agrees that bringing together police officers and people with disabilities leads to better policing. “Anytime someone calls 911, well, it’s probably not the best day of that person’s life,” Turner says. “Showing what a person with a disability looks like when they’re not in crisis is important.” Lehmann agrees: “Get-togethers with fun activities allow police officers to see the human side of disability, and they give that context.”

On the flip side, Lehmann points out, these community events help people with disabilities familiarize themselves with police officers in a calm environment, alleviating anxiety and setting the stage for better outcomes.

To truly tackle the problem though, McKingsley says, we have to understand its contours more fully, and this requires research, which is currently scarce. “Data would help us better evaluate the training, to know what strategies work and why,” he says. “The more we can show how often these encounters are happening, the more we can bolster our ability to go to local and state entities for action.”

Detained by Police? Keep This in Mind

If law enforcement stops you with questions, remember these three key pieces of advice from Rosemary Hollinger, J.D., founder of Partner Up, LLC:

1. First, pause. It’s important to not say the first thought that goes through your mind.
2. Tell the officer you have ADHD. Under the ADA, you’re entitled to reasonable accommodations, including modified questioning, fidgets, frequent breaks, and access to your medication.
3. Before you answer questions, make sure to have someone you trust, such as a lawyer or family member, with you to figure out exactly what happened. You must be truthful and accurate with police, so if you are forgetful and have time blindness, it’s essential to have a lawyer or trusted person with you to support you.

ADHD and the Risk of False Confession

Susan Young, Ph.D., a clinical psychologist in London, has conducted extensive research about people with ADHD in the criminal justice system. One study in which she was involved found that people with ADHD were at an increased risk of making a false confession, and the more severe the person’s ADHD, the greater the risk.³

If police don’t recognize that an individual’s difficulty following commands, sitting still, and answering questions is a result of ADHD, they may misinterpret these behaviors as evasive and guilty, explains Young. This may cause police to detain the person for even longer, which in turn exacerbates symptoms — particularly if the person’s ADHD medication has worn off. It’s a vicious, dangerous cycle which creates desperation.

“There’s all this anxiety; they want to get out,” says Young, who adds that sometimes, people with ADHD will choose to proceed without an attorney present, because they can’t bear to extend the process at all.

“They just want to leave,” Young concludes. “And they’ll say anything.”

The study concluded that safeguards for people with ADHD must be “put in place to prevent miscarriages of justice.”

Law Enforcement and Neurodivergent Justice: Next Steps

• Read: Crime, Punishment, and Redemption for My Son with ADHD
• Q&A: Recently Diagnosed, ADA Information
• Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children
• Upcoming Webinar: AuDHD Guidance – Why Autism Is So Difficult to Diagnose in Women and Girls with ADHD

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Young S, Moss D, Sedgwick O, Fridman M, Hodgkins P. A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med. 2015 Jan;45(2):247–58. https://doi.org/10.1017/S0033291714000762

²   Bureau of Justice Statistics, Disabilities Among Prison and Jail Inmates, 2011-2012 (U.S. Department of Justice, 2015), tables 4 and 5, http://www.bjs.gov/content/pub/pdf/dpji1112.pdf.

³ Gudjonsson, G. H., Gonzalez, R. A., & Young, S. (2021). The Risk of Making False Confessions: The Role of Developmental Disorders, Conduct Disorder, Psychiatric Symptoms, and Compliance. Journal of Attention Disorders, 25(5), 715-723. https://doi.org/10.1177/1087054719833169

Officer Yancey offers her perspective, as a mother and a police officer, on ensuring the safety of community members with autism and other invisible disabilities.

Q: What worries you most when you think about your son with autism, or others with disabilities or mental health concerns, encountering the police?

Nationwide, many people, particularly African Americans, have been injured or killed by police officers because of misunderstandings about autism, mental illness, or other conditions. Officers are too quick to get physical, from giving a command to drawing a gun. Where is the in-between?

When my son hears sirens or loud noises, he shuts down and grabs his ears. Sometimes he’s in so much pain, he says that he can’t even hear you speaking. What if an officer is talking to him and he shuts them out, and they misconstrue that as being rude or non-compliant? What if he starts flapping his arms, and they think he is violent?

[Self-Test: Signs of Autism Spectrum Disorder in Children]

Q: How have you benefited from disability awareness training?

I received training to learn how to understand and respond to people with autism. They gave us a lot of insight: statistics, what to look for, and better ways to approach someone when we’re called to a scene.

I learned that people with autism tend to gravitate toward bodies of water, and this can lead to drownings. In Sleepy Hollow, we’re on the Hudson River, so that opened my eyes.

Q: Tell us about the H.E.A.R.T.S. registry you developed.

H.E.A.R.T.S. is a voluntary registration program for people in the community with autism, dementia, and other conditions. You register your loved one by filling out a questionnaire, giving us (first responders) information, so we can make things better when we respond to a call. The questionnaire asks for the person’s address, school, emergency contact, and about fears, favorite things or places, and actions or words to avoid. A parent might write, “My son has an infatuation with trains.”

[Download: The ADHD-Autism Link in Children]

Q: How does a registry help first responders support people with autism?

When we get a call from a mom who says that her son is a little out-of-control, we can check to see if they’re on the registry. If so, the desk officer can tell the dispatched officer, “No lights, no sirens,” so we know not to spook the kid. The responding officer can call the desk and get more information.

If a person is missing, it helps us locate them. A little girl who had autism and was nonverbal was signed up. One day, someone called in and said they saw a child in pajamas in the middle of winter on a busy roadway. Because her picture was in the registry, the officer identified her right away and reunited her with her family.

Autism Awareness: Next Steps

• Upcoming Webinar: AuDHD Guidance: Why Autism Is So Difficult to Diagnose in Women and Girls with ADHD
• Free Download: Free Autism Evaluation Checklist
• Read: ADHD, Anxiety, and Autism — Your AAA Guidebook
• Read: Autism vs. ADHD — A Parent’s Guide to Tricky Diagnoses

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ADHD and autism share many symptoms. Yet the Diagnostic and Statistical Manual of Mental Disorders (DSM) allowed for ADHD and autism to be diagnosed in the same person only 11 years ago. Before 2013, the DSM did not recognize or allow for a dual diagnosis. Since then, research and clinical understanding of AuDHD have evolved.

However, we still don’t have an evidence-based, standardized approach to diagnosing and supporting adults, women, and gender-diverse individuals with AuDHD. Clinical consensus, stakeholder perspective, and increasing empirical research suggest that ADHD and autism are spectrum conditions that present differently across development and genders, making accurate diagnoses and treatment both challenging and vital.

This presentation will explain the ways in which ADHD and autism overlap and how they can present differently in children and adults — and across genders. In this webinar, you will also learn:

• About how AuDHD is diagnosed in children and adults
• How autism can look different from childhood to adulthood and across genders
• About the association between autism and gender diversity
• Why autism is so easily missed and misdiagnosed, especially in girls and women, and the consequences of that
• About the myths and misinformation about autism in adults and girls and women
• About what your medical and mental health providers need to know and how you can help them make an accurate diagnosis
• Future directions in diagnosis and treatment

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app:Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO; YouTube 

ADHD & Autism: More Resources

• Sign Up: The Clinicians’ Guide to Differential Diagnosis of ADHD
• Self-Test Video: What Does Autism Look Like in Adults?
• Read: Signs of Autism in Women with ADHD
• Read: An Open Conversation with Temple Grandin, Autism Advocate

Obtain a Certificate of Attendance

If you attended the live webinar on June 27, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Dr. Karen Saporito is a licensed clinical psychologist who has been in private practice for over 20 years. She provides care to a wide range of clients with varying issues, but has a particular interest and specialty in diagnosing and supporting children and adults with ADHD and autism spectrum disorder. She is passionate about educating medical and mental health providers, as well as clients, about the different presentation of girls and women with neurodevelopmental disorders. Karen has been a member of APSARD for several years and serves on the APSARD Adult ADHD Guidelines Committee and the Diversity Committee.

Listener Testimonials

“I’m so glad I was able to listen in to this webinar. It was one of my absolute favorites so far. It was so refreshing to hear an expert talk honestly about gender, self-diagnosis, social media, etc.”

“Excellent program! Although I’ve worked with ADHD adults for 20+ years and attended numerous ADHD-specific trainings/webinars along the way, this is the first one in a long time that provided new information and resulted in a lengthy list of topics for me to consider moving forward. Thank you!”

“Thanks for the lens of gender diversity and the intersectionality with neurodiversity. That was impactful for me as a practitioner as well as a person who is trans and ND.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Google Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

Earning my doctoral degree was no easy feat. From navigating social interactions and managing sensory sensitivities to coping with a learning disability, every step felt like a battle against the odds. I came face-to-face many times with imposter syndrome, intrusive thoughts, and task paralysis.

But with unwavering support from mentors and peers – along with my own inner strength and a desire to make a change – this journey ultimately become one of triumph, resilience, and unrelenting advocacy.

[Read: “Could I Be Autistic, Too?” Signs of Autism in Women with ADHD]

A Novel Tool to Improve Workplace Inclusivity

During my Ph.D. research, I became acutely aware of the lack of understanding and support for individuals with invisible disabilities in the workplace and its consequences. Too often, stigma and stereotypes prevent talented individuals from reaching their full potential, leaving them feeling marginalized and misunderstood instead.

Determined to address this issue, I developed a tool for employers called the Workplace Invisible Disability Experience (WIDE) survey. This survey aims to assess the experiences of employees with invisible disabilities in the workplace by shedding light on the challenges they face and identifying areas for improvement. By collecting data and raising awareness, the WIDE survey empowers organizations to recognize and address the barriers that prevent a thriving and inclusive environment.

Advocacy’s Many Forms

Advocacy is not just about raising awareness; it’s also about action. That’s why I took the initiative to establish a disability ERG (Employee Resource Group) in my workplace. This group serves as a platform for disabled employees to come together, share their experiences, and advocate for positive change. Through awareness campaigns, training sessions, and policy initiatives, our ERG works to create more inclusive and accommodating workplaces for all.

Education is another crucial aspect of advocacy, which is why I am committed to continuing to educate and inform others about invisible disabilities. Through speaking engagements, workshops, and training sessions, I aim to dispel myths, challenge stereotypes, and promote a culture of acceptance and understanding.

[Read: How I’m Improving the Workplace for Adults with Autism]

I am most excited to be a speaker at AutisticaPalooza, a multi-day conference that delves into a diverse range of topics by and for autistic women. By sharing my own experiences and insights, I hope to inspire others to embrace neurodiversity and work toward a more inclusive future.

A Transformative Journey

Completing my Ph.D. was just the beginning of my transformative journey of self-discovery, resilience, and empowerment. As I continue to advocate for change, I am driven by a vision of a world where individuals with invisible disabilities are valued, respected, and empowered to reach their full potential. I am confident that together, we can create a more inclusive and equitable world for all.

Autism Advocacy: Next Steps

• Free eBook: The Guide to Autism in Adults
• Read: An Open Conversation with Temple Grandin
• Read: ADHD and Adult Autism – Symptoms, Diagnosis & Interventions for Both
• Read: “A Living Contradiction” Stories of the AuDHD Experience

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

In 2014, I experienced a heartbreaking loss when my dear friend, Erin, essentially a sister to me, tragically took her own life at age 17. Erin was a remarkable individual filled with spunk, love, and empathy. Despite her supportive family, try-anything attitude, and impressive musical and culinary talents (her pasta dishes were truly legendary!), Erin struggled with social challenges and making friends. She was often excluded from weekend plans and parties, and she lacked a peer confidante to share her joys and passions. The complexities of social interaction, so effortless to neurotypical individuals, were often a puzzle for Erin — a reality she lived daily and felt deeply.

Making Friends with Autism Spectrum Disorder

Out of the tragedy of her death emerged Erin’s Hope for Friends, a non-profit organization dedicated to fostering friendships among individuals with ASD. At Erin’s Hope for Friends, we believe in the profound impact of genuine connections. True friends accept you for who you are, quirks and all, providing a sanctuary free from judgment. Finding friends who embrace each individual’s differences can be transformative, instilling a sense of belonging and confidence.

[Self-Test: Is My Child Autistic?]

Erin’s Hope for Friends offers dynamic social programs known as e’s Clubs virtually and in Atlanta, Georgia, and Lexington, Kentucky. These clubs provide a welcoming, safe space for autistic teens and young adults (ages 12 to 24) to connect and engage in various activities tailored to their interests. From Foosball to karaoke to crafts to video games, e’s Clubs offer diverse activities to foster interaction and camaraderie. If you visit a club, it only takes a very short period to witness the joy they create. Currently serving more than 500 members annually, our clubs continue to grow and thrive.

The potential for Erin’s Hope for Friends and e’s Clubs — and other groups like it —  is limitless. By expanding our reach nationwide, we aim to significantly impact the autistic community by challenging stereotypes, promoting neurodiversity acceptance, and ultimately creating a space for our members to make life-changing connections.

If you’re passionate about supporting individuals with autism in their quest for friendship and acceptance, I encourage you to check out Erin’s Hope for Friends or another similar organization. Together, we can celebrate abilities, challenge societal norms, and empower individuals to navigate the landscape of friendship with confidence and joy. After all, it just takes one good friend to change the course of a life.

Autism in the Workplace: Next Steps

• Download: Free Resource: Autism Evaluation Checklist
• Watch:  An Open Conversation with Temple Grandin – Autism Expert, Author, and Scientist
• Read: Autism and ADHD: The Complete Playbook for Social Challenges
• Blog: “I Grew Up Gifted and Autistic — and Suffered the Burnout of Twice Exceptionality”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.