When it's not only ADHD
ADHD rarely shows up on its own. How it overlaps with autism, dyslexia, dyspraxia, anxiety and more, and why seeing the whole picture helps.
One brain, more than one difference
Most people with ADHD have at least one other difference or condition alongside it. That isn't unusual or unlucky. It's the norm.
But it can make things confusing. You get an answer for one thing, put the support in place, and some of what you're seeing still doesn't make sense. Or the thing everyone focuses on isn't the thing that's causing the most trouble at home.
This page explains the most common overlaps, why they're so easy to miss, and what you can do. It isn't a checklist, and it can't tell you what your child has. If something rings a bell, it's a reason to ask, not a conclusion.
What neurodivergent means
Neurodivergent is an umbrella word. It covers the natural variations in how brains work, and those variations can show up in any of these areas, often in more than one.
Thinking
How we understand and make sense of things
Learning
How we take in, process and hold on to information
Attention
Focus, impulse control and staying with a task
Senses
How we notice, filter and react to sound, touch, light and taste
Communication
Language, expression and understanding others
Feelings
Managing emotions, stress and the size of reactions
Movement
Coordination, motor skills and balance
Social
Reading social cues, connection and friendships
Processing
Speed, memory, sequencing and problem solving
Different, not less.
The most common overlaps with ADHD
What each one is, in plain words, and how it can look when it sits alongside ADHD.
Autism
Differences in social communication, sensory experience, and a strong need for routine and predictability.
Being autistic and ADHD is common enough to have its own name: AuDHD. The two can pull against each other, with one part craving routine and the other part bored by it. Until 2013, the main diagnostic manual didn't allow both to be diagnosed together, which is why so many adults are only finding out now.
Dyslexia
Differences in how the brain handles reading, spelling and the sounds in words.
Reading takes more effort, and ADHD makes that effort harder to sustain. It can be hard to tell whether a child is avoiding reading because of their attention or because reading itself is hard. Often it's both.
Dyspraxia (DCD)
Differences in coordination and in planning movements, from handwriting and shoelaces to sport.
Dyspraxia also affects planning and organising, so it overlaps with the executive function side of ADHD. The child who is always late, loses things and finds getting dressed a battle may be dealing with both.
Dyscalculia and dysgraphia
Dyscalculia affects numbers, maths and often telling the time. Dysgraphia affects handwriting and getting thoughts down on paper.
Both can look like carelessness or not trying, especially next to ADHD. A child who understands the idea but can't get it onto the page is not being lazy.
Tics and Tourette's
Movements or sounds that aren't chosen, like blinking, sniffing, throat clearing or words.
Tics are more common in children with ADHD, and they often get worse with stress, tiredness or excitement. Telling a child to stop usually makes them worse.
Sensory differences
Being over or under sensitive to sound, touch, light, smell, taste or movement.
Many people with ADHD have sensory differences, whether or not they're autistic. Labels in clothes, noisy classrooms or a need to keep moving can be behind a lot of what looks like behaviour.
Anxiety and low mood
Worry, fear or sadness that sticks around and gets in the way of everyday life.
Anxiety is one of the most common things to sit alongside ADHD. Very often it grows out of years of struggling in systems that weren't built for their brain, and of being told off for things they couldn't help. Treating the anxiety without seeing the ADHD underneath it rarely gets to the root.
Sleep
Trouble switching off, falling asleep, staying asleep or waking up.
Sleep problems are very common with ADHD, and tiredness makes attention, mood and emotional control harder. It's worth mentioning to your GP rather than just putting up with it.
Giftedness (2e)
Being exceptionally able in some areas while also being neurodivergent. This is called twice-exceptional, or 2e.
Ability can hide the difficulties, and the difficulties can hide the ability. A bright child may cope until the work gets harder, often at secondary school, and then seem to fall apart for no obvious reason.
Many people are multiply neurodivergent
These are just a few of the combinations. Many more are possible, and each person's mix is their own.
Why overlaps get missed
One difference can hide another. A child whose anxiety is obvious may get help for the anxiety, while the ADHD driving much of it goes unseen. Or ADHD is identified, everyone relaxes, and nobody looks for the dyslexia or the sensory differences that are still making school hard.
They can cancel each other out. An autistic need for routine can mask ADHD disorganisation. High ability can cover difficulties for years. The picture looks milder, or just confusing, when really there's more going on.
Traits overlap.Difficulty with attention, big emotional reactions and trouble with friendships can come from several different places. That's why working it out is a job for someone qualified to assess, and why your observations at home are such an important part of it.
Assessments look for one thing at a time. At the moment, each condition has its own separate assessment, often with its own waiting list. Each one is looking for its own piece of the picture, which is one of the main reasons signs of something else get overlooked or missed.
Neither half of the picture on its own serves your child. The aim is to see all of them.
My hope for the future
I hope that before too long we'll have neurodiversity assessments that look at the whole person. Instead of a set of separate names or labels, everyone would get their own individual neurodiversity profile, showing how their unique brain works and what it's brilliant at.
Whatever the labels, these are common
Different neurodivergent children often share the same everyday experiences, whichever combination they have:
- Sensory overwhelm
- Burnout and exhaustion
- Masking, or holding it together until home
- Executive function difficulties: planning, starting, organising
- Feelings that arrive fast and big
- Deep interests and hyperfocus
- Communicating in their own way
- Struggling in rigid systems, like school
What you can do
Describe the whole child, not just the ADHD.
If you're filling in forms or talking to school, include the things that don't fit the ADHD picture too: the reading that's still hard, the clothes they won't wear, the worry that keeps them awake. Assessors can only see what they're told about.
If something doesn't fit, it's worth asking about.
If support for one thing isn't helping as much as you'd hoped, ask whether something else might be going on as well. Your GP, the school SENCo or the person assessing your child are the right people to ask.
Support the need, not the label.
You don't have to wait for every label to help. If noise is hard, reduce the noise. If writing is slow, find another way to get the ideas down. What helps usually matters more than what it's called.
Watch what drains them and what fills them up.
Patterns tell you a lot. Which days end in tears? What happens before a good afternoon? Those clues often point to the parts of the picture that are easy to miss.
Keep strengths in view.
Every one of these differences comes with strengths as well as challenges. A child who is mostly hearing about what's hard needs to hear, often, about what they're good at.
Wondering where to start with ADHD itself? Read Might my child have ADHD? or When school doesn't see what you see.
Making sense of the whole picture
I work with young people and support parents who are trying to make sense of how their child's brain works, whatever combination of differences they have. I'm a coach, not a clinician, so I can't diagnose. What I can do is help you understand what you're seeing and what might help at home.
If you're worried about your child's safety, wellbeing or mental health, please speak to your GP.
Abby Parkes ADHD Coaching & Support · adhdcoachingandsupport.co.uk