'Not Autistic enough?' How underdiagnosis of ADHD and autism is impacting women
When I first told my therapist I might be autistic, she laughed. I was told that I couldn’t be, as I was nothing like the autistic children she knew.
During my autism assessment four years later, I was sent a test for masking - concealing neurodivergent traits to appear ‘normal’. I scored almost full marks.
It was like putting on glasses for the first time, showing me how every experience I’d ever had was shaped by both autism and ADHD. My whole life, every move I made was carefully strategised, requiring immense energy to camouflage myself as ‘normal’.
I’d masked to myself as much as others. For years, I beat myself up for being ‘weird’, ‘lazy’, and ‘stupid’, unable to understand why no one seemed to accept me - least of all, myself.
Until 2013, Autism and ADHD couldn’t be diagnosed in the same person. Today, research shows a 50-70% crossover between these neurodevelopmental conditions, known as ‘AuDHD’.
Two-thirds of people are discovering that they’re autistic after being treated for ADHD. This is associated with a 30% developmental delay in executive functioning skills like decision-making, impulsivity, and emotional regulation.
I was diagnosed at 25, after almost taking my own life. Sadly, this is not uncommon - one in four women with ADHD have attempted suicide, and it’s linked to a five times higher suicide risk.
Six years later, I became suicidal again and finally accepted I needed help for autism. My ADHD symptoms had become more manageable, allowing me to live in one place for more than a year for the first time in a decade, but I was struggling to leave it at all.
After a significant change to my routine, I started experiencing daily panic attacks. I now know these were autistic meltdowns, caused by years of masking and the stress of change.
To cope, I forced myself to go on holidays with friends for a ‘break’. However, being around people left me obsessing over every word I said, carefully curating how to appear ‘normal’ during the unstructured days.
After one trip, I had a screaming meltdown in the airport because I got lost, nearly setting off the fire alarm to evacuate the building.
Until that point, I had avoided an autism assessment for many reasons.
Firstly, I wasn’t sure if I was just making it up, ‘jumping on a trend’. I’d heard of many invalidating experiences of people not being diagnosed because they ‘could make eye contact’ or appeared social. I could make eye contact, and appeared highly social externally - I just hated every second.
Besides, NHS waiting lists were years long, which seemed like an eternity. Private assessments costed thousands, and I was afraid of how traumatic these could be after the one I’d had with ADHD.
The under-diagnosis of ADHD and autism in women isn’t a coincidence - it’s a systemic problem rooted in outdated diagnostic criteria. These conditions were studied primarily in young boys, whose symptoms present more outwardly, making them easier to spot.
Women tend to mask their symptoms, blending in and meeting societal expectations, leading to years of undetected struggles and severe mental health challenges. Autistic women are twice as likely to attempt suicide as autistic men, and autistic individuals are nine times more likely to die by suicide than the general population.
When combined with ADHD, things get even more complicated. ADHD says an energetic yes to everything, whilst autism screams no. The impulsivity and creativity of ADHD responds with complex solutions, like my starting social interactions with tequila shots wherever possible. Autism makes rules, and ADHD breaks them, often leading to self-sabotage.
After my diagnosis was confirmed, these ‘creative adjustments’ I’d developed throughout my life became glaringly obvious. From creating scripts for every conversation I had, to finding myself in situations I didn’t want to be in, I realised that I had no idea who I actually was. All I could see was a shape-shifting character, constantly adapting to my environment.
I found support through a neuro-affirmative, in-depth assessment with Autistic Girls. It was deeply validating to finally understand my brain, as if I was meeting myself for the first time.
If my experiences resonate with you, here’s some steps to consider:
Educate yourself: learn about how AuDHD presents in women and see if it aligns with your experiences.
Trust your instincts: if you’ve been masking your symptoms, allow yourself to explore the possibility of being neurodivergent.
Seek assessment: a diagnosis can provide clarity and validation, but find assessors who understand women’s experiences.
Find community: connecting with others who share your journey can be incredibly affirming. Remember, no matter how isolated you may feel, you are not alone.
AuDHD can feel like living in a bubble that nobody else can see. It’s exhausting, but you are not the problem. Your brain is simply wired differently. By accepting that, you can start to appreciate your immense strength in navigating a world that wasn’t built for you.
Leanne Maskell is the founder and director of ADHD coaching company ADHD Works, and the author of ADHD Works at Work and ADHD an A-Z.
More health news...
Laura Whitmore talks setting boundaries ahead of her 40th birthday
'I'm an autistic ADHD-er, these are my tips for better emotional regulation'
Cut through the noise and get practical, expert advice, home workouts, easy nutrition and more direct to your inbox. Sign up to the WOMEN'S HEALTH NEWSLETTER
You Might Also Like
