Is It ADHD, Autism, Anxiety… or All Three? Why It Isn’t Always Obvious
Updated: Sep 14
ADHD, autism, anxiety and trauma can sometimes look surprisingly similar from the outside, and they can also coexist. We explore why understanding what sits beneath a difficulty matters more than simply matching experiences to a checklist.
Sometimes people arrive at neurodevelopmental assessment with a very clear question.
“I think I have ADHD.”
Others arrive with something more like:
“I have absolutely no idea what is going on anymore.”
Perhaps you've always felt anxious.
You overthink conversations.
You find social situations exhausting.
You procrastinate.
You become overwhelmed easily.
You need things to be predictable.
You struggle to concentrate.
You're sensitive to noise.
You replay things in your head.
You can function brilliantly for a while and then suddenly seem to hit a wall.
Maybe you've previously been told it's anxiety.
Or depression.
Or trauma.
Then you start learning about ADHD.
That seems to fit.
Until you read about autism.
And that seems to fit too.
Three hours and approximately 47 browser tabs later, you're now wondering whether you have ADHD, autism, anxiety, trauma, all of them, or whether you've simply spent too much time on the internet.
Welcome to one of the complicated things about human psychology:
Different experiences can look surprisingly similar from the outside.
Concentration difficulties don't automatically mean ADHD
Let's start with attention.
Difficulty concentrating is obviously associated with ADHD.
But it's not exclusive to ADHD.
If you're highly anxious, part of your attention may be occupied by threat.
Did I get that wrong?
What if this happens?
Why did they say that?
What if I can't cope?
It is quite difficult to concentrate on an Excel spreadsheet while your brain is simultaneously conducting an extensive risk assessment of you just existing.
Trauma can also affect concentration.
So can depression.
Poor sleep.
Chronic stress.
Autistic overwhelm.
Physical health difficulties.
Hormonal changes.
And many other things.
So during an ADHD assessment, the question isn't simply:
“Do you struggle to concentrate?”
We need to understand the pattern.
When did it begin?
What was it like during childhood?
When is attention easier?
When is it harder?
What happens when something is interesting?
Does it occur even when anxiety is relatively low?
What else is happening alongside it?
Context matters.
Social anxiety and autism can sometimes look similar
Imagine two people standing at a party not knowing what to say.
From across the room, they might look exactly the same.
But internally, their experiences could be very different.
One person might understand the social situation intuitively but be thinking:
“I know what I want to say, but what if they think I'm stupid?”
Another might be thinking:
“I genuinely don't know what I'm supposed to say next.”
And another:
“I know what I'm supposed to say because I've learnt how these conversations work, but I'm exhausted from monitoring all of this.”
All three may appear anxious.
But the processes underneath that anxiety aren't necessarily the same.
Of course, autistic people can also have social anxiety.
In fact, if you've spent years misunderstanding social situations, being excluded, getting things “wrong” or feeling different, developing anxiety around social interaction would be entirely understandable.
Which is why sometimes the answer isn't:
Autism or anxiety?
It's:
Autism and anxiety, and how are they interacting?
Predictability is another interesting one
A strong preference for predictability can be associated with autism.
But anxiety can also make uncertainty incredibly uncomfortable.
Trauma can increase someone's need to feel safe and in control.
ADHD can create its own relationship with predictability because external structure may help compensate for executive-functioning difficulties.
So someone saying:
“I hate plans changing”
is useful information.
But it doesn't tell us why.
We need to understand what happens when the plan changes.
Is it difficult to mentally shift from the expected sequence?
Does uncertainty create anxiety?
Were you relying on that structure to organise yourself?
Does the change create sensory or social demands you hadn't prepared for?
Does unpredictability feel unsafe?
Or is it several of those things at once?
Psychology rarely gives us the satisfaction of one symptom equalling one explanation.
Emotional dysregulation can have multiple explanations too
Feeling emotions intensely isn't exclusive to any one diagnosis.
ADHD can involve difficulties regulating emotional responses and inhibiting immediate reactions.
Autistic people may become dysregulated when overwhelmed by sensory, social, cognitive or emotional demands.
Anxiety can create a nervous system that is already highly activated.
Trauma can influence how readily we perceive threat and how our bodies respond to it.
Then add:
Sleep.
Stress.
Hormones.
Work.
Parenting.
Relationships.
And the fact that someone has moved your favourite mug.
Human behaviour starts looking considerably more complicated than a diagnostic checklist.
And then there is masking
Masking can complicate the picture further.
Someone may have spent decades consciously or unconsciously compensating for neurodevelopmental differences.
They may rehearse conversations.
Overprepare.
Become perfectionistic.
Rely heavily on routines.
Use anxiety to ensure they don't forget things.
Monitor their behaviour around other people.
Force themselves through sensory discomfort.
Create elaborate organisational systems.
From the outside, we see someone functioning.
Internally, they may be using an enormous amount of cognitive and emotional energy to maintain that functioning.
Sometimes the coping strategy itself eventually becomes the thing somebody seeks help for.
For example, anxiety may have developed partly because being anxious helps you remember things.
If you're terrified of being late, you might always arrive early.
If you're terrified of making a mistake, you might check your work repeatedly.
If you're terrified of forgetting an appointment, you might check your calendar ten times.
The underlying executive-functioning difficulty hasn't necessarily disappeared.
It's being compensated for.
“I was diagnosed with anxiety, but it never explained everything”
I hear versions of this relatively often.
And importantly, it doesn't necessarily mean the previous diagnosis was wrong.
You may genuinely have experienced anxiety.
The question is whether anxiety explains the whole picture.
Perhaps therapy helped enormously with certain worries, but you still struggled with organisation, working memory and time.
Perhaps your mood improved but social interaction remained exhausting.
Perhaps you became much more confident but still needed significant recovery after being around people.
Perhaps you learnt excellent anxiety-management strategies but remained intensely sensitive to sensory environments.
Sometimes a previous formulation was accurate but incomplete.
Human beings are allowed to have more than one thing happening.
Trauma deserves particularly careful consideration
This is an area where I think nuance really matters.
Trauma and neurodivergence can overlap in presentation.
Both can affect emotional regulation.
Attention.
Relationships.
Sense of safety.
Sensory experiences.
Behaviour.
Executive functioning.
And responses to uncertainty.
But we shouldn't assume that neurodivergent traits are “just trauma”.
Equally, we shouldn't reinterpret every trauma response as autism or ADHD simply because neurodivergence is being explored.
Sometimes trauma is central.
Sometimes neurodivergence is central.
Sometimes a neurodivergent person has also experienced trauma.
And sometimes their neurodivergence has influenced the way they experienced and processed those events.
Ultimately, during assessment, the most important this is to understand the individual.
Developmental history is incredibly important
This is one reason comprehensive neurodevelopmental assessment looks backwards as well as at what is happening now.
Autism and ADHD are neurodevelopmental conditions.
We're therefore interested in patterns that began during development, even if nobody recognised them at the time.
What were you like as a child?
How did you play?
How did you manage friendships?
Were you forgetful?
Dreamy?
Constantly moving?
Very rule-focused?
Intensely interested in particular things?
Did you struggle with transitions?
Were there sensory differences?
How did you cope with school?
What did teachers notice?
What did your family notice?
And importantly:
What strategies had you already developed?
Sometimes childhood differences were obvious.
Sometimes they only become obvious in retrospect.
This is why assessment shouldn't be about proving a diagnosis
I don't think a good assessment should begin with:
“Let's find evidence that this person has ADHD.”
It should begin with:
“Let's understand what is happening for this person.”
That means being open to different explanations.
It means considering strengths as well as difficulties.
It means taking masking seriously without assuming everything is masking.
It means recognising that autism and ADHD commonly coexist with other psychological difficulties.
And it means being willing to say when something doesn't fit.
A diagnosis can be incredibly validating when it accurately explains someone's experiences.
But the aim shouldn't be diagnosis at any cost.
The aim is understanding.
Sometimes the answer genuinely is “more than one thing”
Psychological difficulties don't politely organise themselves into separate boxes.
Someone can be autistic and have ADHD.
They can also experience anxiety.
They can have a history of trauma.
They can become depressed.
They can experience burnout.
One doesn't automatically invalidate another.
In fact, understanding how different aspects of someone's experience interact can be far more useful than trying to identify one diagnosis that explains absolutely everything.
Perhaps ADHD helps us understand why daily organisation has always required so much effort.
Autism helps us understand longstanding sensory and social differences.
Anxiety helps us understand the constant anticipation of things going wrong.
And life experiences help us understand why particular situations now feel unsafe.
That's a much richer picture than:
“Which one is it?”
Personally and professionally, I'm much more interested in the whole picture
As a Clinical Psychologist, my background is broader than neurodevelopmental assessment alone.
I've spent many years working with mental health, trauma and psychological difficulties alongside my work in autism and ADHD.
I also have ADHD myself.
Both perspectives have reinforced something important for me:
People are far more than their diagnosis.
Sometimes discovering ADHD or autism makes decades of experience suddenly make sense.
Sometimes it explains one important part of the picture but not all of it.
And that's okay.
You don't need every experience you've ever had to fit neatly underneath one label.
The most useful question is often not:
“Which diagnosis am I?”
It's:
“What helps me understand myself?”
What has been present throughout my life?
What developed later?
What makes things harder?
What helps?
What am I compensating for?
What environments allow me to function well?
What support do I actually need?
Those are the questions that can lead to meaningful change.
You don't need to work it out before asking for help
If you've spent months going backwards and forwards between:
Maybe it's ADHD.
Actually, maybe it's autism.
Maybe I'm just anxious.
Maybe I'm imagining all of it.
You don't need to arrive at an assessment having solved the puzzle yourself.
Instead,
Bring the uncertainty.
Bring the contradictions.
Bring the things that don't seem to fit.
A thoughtful assessment should make space for all of them.
Because ultimately, the goal isn't to collect diagnoses.
It's to develop an understanding of yourself that feels accurate, compassionate and genuinely useful.
Not Sure What Might Be Going On?
Autism, ADHD, anxiety, trauma and other psychological experiences can overlap in complex ways. Recognising yourself in individual traits doesn't necessarily tell you what is driving them.
At I.N. Therapy Berkshire, neurodevelopmental assessment considers developmental history, current functioning, strengths, difficulties, masking and compensatory strategies alongside other possible explanations for someone's experiences.
If you're wondering about autism or ADHD but aren't sure whether a full assessment is the right next step, a Neurodevelopmental Consultation can provide space to talk through what you've noticed and consider the available options.
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