ADHD vs Autism in Adults: Signs, Overlap, and Screening vs Diagnosis
If you’ve ever thought, “Is this ADHD or autism… or both?” you’re not overthinking it. In adults, ADHD and autism can overlap in real ways, and many people (especially high-masking adults, women, and marginalized folks) don’t get clarity until later in life.
This post is designed to help you:
understand how ADHD and autism can look similar on the surface
spot the differences that matter clinically
know what a screening can (and cannot) tell you compared with a formal diagnosis
choose the next step that fits your goals, budget, and level of need
Quick answer
ADHD is primarily characterized by patterns of inattention and/or hyperactivity-impulsivity that impact daily functioning.
Autism is defined by persistent differences in social communication/interaction plus restricted or repetitive patterns of behavior/interests (and often sensory differences).
Overlap is common, and co-occurrence happens often enough that it can be hard to tell what you’re seeing without a careful clinical conversation.
A screening offers informed clarity and next-step guidance. A diagnosis requires a comprehensive evaluation process.
Why ADHD and autism are so often confused in adults
A lot of adults don’t present with the “classic” childhood stereotypes. Instead, they show up with:
chronic overwhelm and burnout
anxiety or depression from years of coping
relationship stress (miscommunications, mismatched needs)
shame about “why things feel harder for me than other people”
years of masking (appearing “fine” while struggling internally)
On top of that, both ADHD and autism can involve:
executive dysfunction (starting tasks, switching tasks, prioritizing)
emotional dysregulation
sensory differences
sleep problems
rejection sensitivity and social fatigue
These overlapping features are widely recognized in research and clinical discussion.
ADHD vs Autism: the differences that tend to matter most
Below are patterns that often help people tell the difference when the overlap is high. This is not a checklist for self-diagnosis. It’s a way to organize what you’re noticing.
1) Attention and focus
More ADHD-leaning patterns
attention varies based on interest and stimulation
difficulty sustaining attention on low-interest tasks
novelty-seeking and impulsive switching (tab-hopping, idea-hopping)
More autism-leaning patterns
deep, sustained focus that can look like “tunnel attention”
strong pull toward specific interests (sometimes intense and long-term)
focus is often less about novelty and more about depth, mastery, and predictability
A common shorthand used in clinical education is: ADHD often seeks novelty and stimulation; autism often seeks predictability and lower overwhelm.
2) Social communication
More ADHD-leaning patterns
impulsive interruptions or “talking too much”
missing social cues due to distractibility
social missteps that improve significantly when attention is supported
More autism-leaning patterns
lifelong differences in social communication (not just situational)
difficulty reading implicit social rules, tone, subtext, or indirect communication
feeling like socializing is “manual,” effortful, or performative, especially with masking
Autism diagnostic frameworks emphasize persistent differences in social communication and interaction, not just “awkwardness.”
3) Routine, change, and sensory load
More ADHD-leaning patterns
difficulty maintaining routines even when they are desired
boredom intolerance and restlessness
inconsistent organization (systems work briefly, then fall apart)
More autism-leaning patterns
strong preference for routine and predictability (because it reduces overwhelm)
distress with unexpected change
sensory sensitivities can drive avoidance, shutdown, or irritability (noise, lights, textures, crowds)
This “novelty vs structure” distinction is commonly noted in clinical summaries of ADHD and autism.
4) Repetitive patterns and interests
Autism diagnostic criteria include restricted or repetitive patterns of behavior/interests (for example, repetitive movements, strong attachment to routines, intense special interests).
ADHD can include intense interests too, but the “shape” of it is often different (more novelty-driven and shifting over time).
What about “both”?
It’s possible to meet criteria for both ADHD and autism, and co-occurrence is well documented in research and professional discussion.
When both are present, adults often describe a push-pull:
part of them craves structure and predictability (autism)
part of them resists routine or needs stimulation (ADHD)
This can create chronic frustration, especially if you’ve spent years thinking you were “just bad at life” instead of recognizing competing nervous system needs.
Why trauma, anxiety, and burnout can “look like” ADHD or autism
This is one of the biggest reasons people seek clarity. Executive dysfunction and sensory overwhelm can also be driven by:
chronic stress and trauma responses
anxiety (especially rumination and hypervigilance)
depression (low energy, slowed processing)
sleep deprivation or sleep disorders
medical issues that impact attention and mood
That’s why high-quality evaluations (and good screenings) focus on patterns across time, context, development, and functional impact, not just a list of symptoms.
Screening vs Diagnosis: what’s the real difference?
What a screening is
A screening is an informed, structured way to explore whether your experiences align with ADHD and/or autism traits, and whether a full diagnostic assessment is likely to be worth your time and money.
Screening tools and questionnaires can be helpful for organizing symptoms, but they are meant to be interpreted alongside clinical context, not treated as definitive on their own. For example, the Adult ADHD Self-Report Scale (ASRS v1.1) is commonly used as a screening instrument.
What a diagnosis is
A diagnosis is a comprehensive clinical determination using established criteria (typically DSM-5 or ICD frameworks) and a fuller evaluation process.
For ADHD, diagnostic guidance emphasizes meeting DSM criteria and using clinical evaluation rather than questionnaires alone.
For autism, adult diagnostic processes are typically multi-step and may involve multiple appointments, interviews, developmental history, and standardized tools used by trained clinicians.
Why this matters: if you need formal accommodations, school/work documentation, or medication decisions, you usually need a formal diagnostic assessment. If your goal is clarity and next-step guidance, a screening may be enough.
When a screening can be the best first step
A screening is often a smart first step if:
you want informed clarity before investing in a full assessment
you suspect masking or late-identified neurodivergence and want to talk it through with someone who gets it
you want help separating neurodivergence traits from anxiety, trauma, or burnout
you’re not sure what support would help (therapy strategies, workplace accommodations, formal testing, etc.)
What our neurodivergence screening includes
At R&R Integrative Counseling, the Neurodivergence Screening is not a diagnosis. It’s a collaborative, structured exploration to help you understand whether your experiences align with ADHD or autism traits and whether formal assessment is recommended.
What the screening includes (90 minutes):
A guided conversation about lived experience, traits, and history related to ADHD and autism
Structured questions informed by DSM-5 criteria
You’ll receive:
Immediate verbal feedback on whether full diagnostic testing is recommended
A brief written summary report typically within 24 hours
Referrals for comprehensive assessment if desired
Investment: $225 (not eligible for insurance reimbursement).
Screenings are available virtually across **North Carolina and in person in **Raleigh.
How to decide what you need next
Here’s a simple way to choose:
Choose a screening if you want:
clarity, validation, and direction
a grounded answer to “is it worth pursuing diagnosis?”
practical next steps for support
Choose a full diagnostic assessment if you need:
formal accommodations documentation
medication evaluation decisions (often requires formal diagnosis by appropriate prescriber/clinician)
official diagnostic confirmation for school/work systems
If you’re unsure, a short consultation is usually the fastest path to figuring out what fits your situation.
