ADHD vs. Autism in Girls: Spotting the Differences

Understanding Autism and ADHD 

ADHD and ASD are neurodevelopmental disorders, which means that they start early in childhood and affect how our brains grow and function.

ADHD is a neurodevelopmental disorder characterised by inattention, hyperactivity, or impulsivity. In girls, these symptoms may present differently than in boys, often leading to internalisation and masking of behaviours.   

Autism Spectrum Disorder (ASD) is another neurodevelopmental condition that affects communication, social interaction, and behaviour. Individuals with autism may exhibit repetitive behaviors, sensory sensitivities, and challenges with understanding social cues.

Overlapping Symptoms 

The National Institute for Health and Care Excellence estimates the global prevalence of ADHD in children to be around 5%, and in adults in the UK at 3% – 4%. ASD is one of the most common childhood-onset neurodevelopmental disorders. In the UK, the estimated prevalence in adults is about 1.1%

According to research completed in 2023, ADHD presents in 30-80% of people we with ASD, while ASD presents in 20-50% of people with ADHD. Which suggests ADHD symptoms are more likely to be fund in people with ASD than vice-versa. Twin and family studies show a genetic overlap between ADHD and Autism of 50-72%. So, it is worth bearing in mind that while we are trying to isolate the distinction between ASD and ADHD in girls, the reality is - it could well be both. Or neither. 

While ADHD and autism are distinct conditions, they can share some overlapping symptoms, making it challenging to differentiate between the two. For example, both conditions can involve difficulty focusing, social challenges, and sensory sensitivities. As there is such a lot of overlap between ASD and ADHD, this information is not exhaustive.

• Difficulty picking up on social cues
• Self stimulation or 'stimming'
• Fidgeting
• Emotional Dysregulation
• Barriers to task initiation
• Time perception 
• Interoception

ADHD and ASD often share symptoms, but their underlying causes differ. While both can involve social difficulties and attention issues, ASD is characterised by challenges in social interaction, communication, and a tendency to regulate emotions through repetitive behaviours or routines. ADHD, on the other hand, is primarily marked by difficulties with attention, hyperactivity, and impulsivity

Our understanding of overlapping of ADHD and ASD is pretty new. Until the DSM-5 was released in 2013, if someone presented with with both conditions , the healthcare professional would have had to choose the diagnosis of best-fit. Thankfully - both conditions can now be diagnosed in the same person. 

Looks similar but isn't the same.

Although the presentation may often look similar, often the distinction is in the reasons behind the symptom.

For example, girls with ADHD or ASD can have trouble picking up on social cues,  but the reasons for this are different. A girl with ADHD might miss social cues because they zoned out or didn't catch the whole conversation, or they might interrupt the conversation. However, a person with ASD may not have understood body language signals or may have interpreted parts of the conversation, literally. 

Anyone can use self-stimulation or 'stimming' to reduce anxiety, but often it's used more consistently in girls with ASD. A girl with ASD might be seen to be  bouncing or shaking her leg underneath her desk which may be her way of communicating that something is making her uncomfortable  in the room, and she is using this movement to calm herself. Whereas, a girl with ADHD may fidget to keep herself focused and present, which may be calming and reassuring. The fidgeting could well be with anything at hand clicking a pen, picking at fingers whereas there may be consistent 'go to' behaviour in girls with ASD.There tends to be more intense repetition in ASD.

A girl may doodle in a her book, with her pencil, in her chair because shes comforted by familiarity and routine. A girl with ADHD might do this for a little while but then her brain may look to find something new because the routine is boring. Hyper-fixation and hyper-focus, around passions and key interests, are common amongst girls with ASD and ADHD. Hyperfocus, as seen in the context of ADHD, can look a lot like hyper-fixation. 

While ADHD and ASD can share some overlapping symptoms, there are distinct differences, particularly in girls. 

Possible Ways to View the Overlapping Symptoms 

Internalisation 

One of the most significant differences between ADHD and ASD in girls is the tendency for girls with ADHD to internalise their symptoms. While both conditions can lead to social challenges, girls with ADHD often mask their struggles, leading to feelings of anxiety, depression, or low self-esteem.

This can make it more difficult to diagnose ADHD in girls compared to boys, who may exhibit more externalised behaviours like hyperactivity or impulsivity.

Social Challenges

Social challenges are common in both ADHD and ASD.  In ADHD, social difficulties often stem from impulsivity, inattention, or difficulty controlling emotions. Girls with ADHD may struggle with friendships, peer relationships, or understanding social cues.

In ASD, social challenges are more closely related to difficulties with communication, understanding social cues, and engaging in reciprocal interactions. Individuals with ASD may have trouble initiating or maintaining conversations, understanding nonverbal communication, or empathising with others.

Routines

Individuals with ASD often have a strong need for routines and predictability. Changes to their daily schedule can cause significant distress or anxiety. Routines provide a sense of structure and help them feel more comfortable and in control.

While girls with ADHD may also benefit from routines, they often find them boring or restrictive. Routines can be difficult to maintain due to impulsivity or inattention. Flexibility and adaptability are often more important for girls with ADHD.

Sensory 

Sensory sensitivities in ADHD can be variable, fluctuating depending on individual factors.

In ASD these sensitivities are often more intense and predictable, affecting specific senses like sound, touch, or light.

Seeking a Diagnosis 

It's important to consult with a healthcare professional for a proper diagnosis as only they are qualified to diagnose.

Early diagnosis can lead to earlier intervention and support, which can significantly improve quality of life.

Questions to Ask Regarding ASD or ADHD Behaviours 

• Is the behaviour repetitive and does it seem to help her calm down and focus?
• Is the behaviour spontaneous, appear uncontrolled? Is it like a burst of energy?
• Are there specific, sometimes predictable response to certain things, such as new environments or a type of noise?
• Does she crave predicability and routine?
• Does she have interest interests and passions that are relatively short-lived?

References