How do we know where ASD ends and comorbids begin?

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Being so everyone with autism are so different and almost everyone with autism has at least one co-morbid and that most co-morbids seem to have similar symptoms to autism anyway, how do we know these are actually comorbids and not just part of the autism?

For example I've watched a YouTube video of an autistic 3-year-old with OCD. How do they know the OCD behaviours aren't just part of his autism?

Also with ADHD, it seems most, if not all the symptoms of ADHD are symptoms or at least traits of autism, although somehow not so much vice versa. Is hyperactivity also a symptom of autism, or is it less common in autistics without ADHD? Even though I have been diagnosed with ADHD now, what if all my ADHD symptoms are just Asperger's symptoms? Or what if my Asperger's symptoms are all just ADHD symptoms? My Asperger's has always been so complex, contradictory and atypical, that if you think about it it could be anything but Asperger's with me.

I am always snookered by this.

Disclaimer: I'm not invalidating anyone's autism or their co-morbids. It's just a question.

Also two more questions:

1. Can Asperger's be a co-morbid of ADHD? In other words, can one have ADHD as a dominant diagnosis but have Asperger's/autism traits, as a co-morbid? I only seem to have two autism traits (which are well outweighed by my ADHD traits), which are sensory issues with certain sounds and pain, and being crap at making friends even though I can be passable as NT without even needing to mask who I am much.

2. Generally speaking, what is a child with autism but without ADHD like, Vs a child with both, Vs a child with ADHD but without autism? I can't find information on this properly on Google.

I don't know how to answer. Comorbids are co-occurring conditions so I don't think there's one "primary" diagnosis and the comorbids are secondary. Afaik they can be equally strong and happening at the same time. If there's overlap it would be like a Venn diagram where many symptoms are written twice in the same circle, but the edges of the circles have their own unique traits which aren't shared.

I sense however that if ASD and ADHD were diagnosed at the same time ASD would probably be listed first, since it's neurodevelopmental. Then again I think ADHD is also neurodevelopmental, but somehow autism is usually considered to have come first. Maybe ASD starts at the moment of conception or when the brain is built, and ADHD starts later in gestation? (irdk - just guessing).

Another thought is that ADHD can be somewhat controlled by drugs so maybe they assume it's not as intractable as ASD.

Are you able to contact your ADHD doctors to ask these questions? Maybe if you were to try ADHD meds and see how they affect your mood and behaviour, you'll notice all or most of the "ASD stuff" seems to go away? That might be a good way to check how prominent your ADHD really is. I'm loving this new med Intuniv. It's helping me a lot with ADHD but I can still note my ASD alive and kicking underneath.

One of the reasons I like the term AuDHD is that it helps express the idea that when those two are comorbids that it's impossible to detangle them fully given the overlapping symptom profile.

Three possibilities;
-Only the person would truly know. There's a strong introceptive and metacognitive prerequisite when it came to it.
-An experienced, competent professional outside observer may able to discern.
-No one can.

I can untangle my own.

I based symptoms on origin; if it's there passively/actively and independently, if it exists due to a set of condition/triggers, if it happens before/after an incident or during a state, if it's a habit/learned with hows and whys of how it came to be, etc.

I also able to chart how much ASD is involved, how direct or indirectly it is involved.

Am I getting worse because I'm aging, am I actually sick, or was it because I'm doing something wrong?

Is it ASD related aging?
Is it ASD vulnerability?
Is it ASD processing involved as to why I get worse/not coping?
Is it due to my ASD mind that I went to a certain conclusion and ended up with a bad habit?
Is it ASD relevant why I'm doing a certain habit?
Is it ASD why I cannot stop the habit?
Is the habit itself gives me feelings internally (I want/don't want it) or externally (someone else want/don't want it)?
Do I want someone else to feel something?
Do I have a conscious motivation for this?

Etc.
So many self inquiry processes.


1. Is possible.

2. AS only -- routines and obsessions, hyperlexic or has a language and speech learning issues, has a more notable cognitive strengths and weaknesses. Notable receptive and expressive language issues, may be nonverbal. Higher incidence of physical and movement related issues.
Repetitive behaviors, reacts when one cuts off/interupts. Sensory seeking/aversions are triggered. The alexithymia factors.
Growing up -- likely won't graduate from OT, poor EF means requires a network to be independent instead.
Not very treatable.

ADHD only -- higher incidence of learning disabilities, likely no speech and language issues, not a lot of social awkwardness involved.
There's no speech issues here, at least not permanently. Attention regulation issues came from within, novelty seeking. There's no real incidence of alexithymia unless trauma is involved.
Growing up -- can graduate from OT, can eventually find a system that can protect them.
Is very treatable.

AS+ADHD -- depends which influences more than the other.
These are just simplified answers.


I can pass for someone who may have ADD/ADHD due to my own EF issues.
Except; I don't have that in childhood.
Most of my EF issues are crappy habits.

And is too incidental, too circumstantial (whenever I have brain fog, whenever I'm too emotional, etc.) to be 'inherent' in my being.

My 'energy' is more like temperament than something developmental, something neurological. It is warped by mental health issues.
And that dwindling is either hormonal, emotional, mental... Than 'becoming ADD'.

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Regarding question 2 I found this article: https://link.springer.com/article/10.10 ... 018-1165-5

If you scroll down to the bit just before the conclusion, there's a section which lists how co-morbid ASD and ADHD can present, as well as separately. It's a shame that this info put together like this seems a bit difficult to find. It's an interesting question.

I don't know how they figure out whether problems with attention are down to ASD or ADHD. I wish I knew of a really good way of self-testing that. I wouldn't want to go to a health professional to find out, because I don't much trust them to get it right and if they said it was ADHD then I wouldn't want pressure to take medications for it. I don't much trust the medications either, especially if the client can't choose which one they want to try. But if I could find out for myself whether I had ADHD then I could just keep it to myself, and maybe if there wasn't a doctor pushing pills at me from the start, I might feel more motivated to ask them what they thought.

As a gut reaction I'd say I don't have ADHD, or if I do it's not severe enough to warrant messing with chemical interventions. I can focus on more or less anything that I'm convinced I have to pay attention to, I just procrastinate a lot especially if I'm not confident of achieving whatever the desired result behind the attention is without ending up in some kind of trouble - also I just dislike failing, and if I'm worried that I'll get drawn into a long, inefficient, perfectionist can of worms at the expense of better things, I tend to be afraid to make a start. I have trouble paying attention to information that goes too quickly for me (because I'm a slow, careful thinker), to TV shows with too many characters (because I have trouble thinking about complex interactions between lots of people), and to information that's not expressed very clearly or raises more questions than it answers (because I get hung up on the errors, the lack of methodical consistency, and the sloppy language). Yet it's surprising what I can figure out from poor-quality information if it's written and I'm allowed to take my time over it. And although I have trouble giving my attention to stuff I'm not naturally interested in, I'm fairly good at it. I just find it painful and tedious.

As for hyperactive, I can certainly move quickly when I think I know what I'm doing, but overall I'm not physically very active and I don't end up burning tons of calories per day. I'm not markedly thinner than my diet would suggest I ought to be, i.e. there's no unusually high calorie burning going on.

Anyway, maybe somebody could say whether or not the grasp of ADHD implied by my remarks is anything like accurate. I guess I've kind of assumed that ADHD is characterised by physical hyperactivity and inability to pay attention, i.e. it is what its name suggests it is, but names aren't always very well-chosen.

The psychologist who diagnosed me with ASD didn't specifically look for anything else, but when I asked she said that she'd listened to me for a few hours and would probably have noticed if I'd had anything other than ASD going on.

I don't like the pressure of medication either, and when I was first diagnosed I got medication suggested to me, but they don't force you to take it if you don't want to. I said I didn't want to, and they said that's fine and left it at that.

Despite being hyperactive I am pretty lazy too. But my hyperactivity involves wanting to talk excessively about anything, surges of excitement, easily amused, feeling impatient like wanting time to go fast, walking fast, rushing to get things done like I'm on a deadline even if I'm not, easily annoyed at certain sensory stimuli, restlessness, overemotional, trouble sitting still, and chattering thoughts that "bully" me and can make me paranoid (but not in a schizophrenic way).

Splitting where it start and ends only matters in the individual level -- if one or the other is relevantly treatable/preventable/manageable/can be improved by knowing which is which.

Regardless, ignoring one over the favor of the other is more impractical, blended or not.

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Copypasting what I wrote on another thread:

Thank you Recidivist, that was an interesting article.

I also read that autism is basically all about anxiety or is a neurodevelopmental anxiety disorder. I'm not sure how true this is. I've always been anxious, but my NT mum had an anxiety disorder too and could get just as anxious as I get.

How do we tell the difference between anxiety disorder and autism?

If we look at two facts we see the logical answer:-

1. There is no such thing as a single condition called autism rather autism is an umbrella term for different brain conditions that seem to overlap in places.

Different autistic people have different autism genes impacted and some have no genes that have been identified yet, maybe the causes of their symptoms are not genetic maybe more auto immune reaction who knows

2. If one in 3 autistic people are intellectually disabled or suffer from epilepsy it’s not mere coincidence. This figure is by many orders of magnitude greater than the NT population.

Other more minor conditions such as anxiety and depression are more complicated to really discuss.

So the logical explanation is these are not co-morbids at all rather symptoms of that particular autism.

The reason why they are separated are two reasons, first brain science still hasn’t separated the relevant different autisms despite knowing this and secondly is it’s easier to treat as a separate condition, for example those with epilepsy, ADHD or anxiety can be given specific drugs to target those things.

science is doing a lot of study on this subject right now. Many believe ASD and ADHD/ADD are different ends of the same stick, and probably closely related on the neurological development ladder of diagnoses. There are certain differences, which professionals can discern. Comorbid diagnosis is common. There are loads of studies and articles that discuss differences and well as similarities and there seem to be a lot of overlapping traits. I don't suppose it matters, when you have both, which side of the diagnosis the struggles or behaviors come from as much as it does finding a way to work around those which trouble you.