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ADHD Chatter Podcast

3 Signs You Might Have AuDHD

Dr Mark Rackley has over 20 years experience as a psychologist, specialising in ADHD & Autism. He’s an expert in helping people understand their brains, and live a happier life.

Dr. Mark RackleyguestAlex Partridgehost

May 26, 202543mWatch on YouTube

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CHAPTERS

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Chapter summaries

Trailer and Welcome Back
A trailer previews the episode's themes of anxiety, RSD and the internal tug of war in AuDHD. Alex then thanks listeners and welcomes Dr. Mark Rackley back for his third solo episode.
- •Having both ADHD and autism raises the likelihood of anxiety and depression compared with having just one
- •Trailer previews the pull between competing directions and holding back one's authentic self
- •Alex asks listeners to follow or subscribe to help book more guests
- •Mark returns for his third solo episode, fourth appearance
Mark's Mission: Removing Ignorance
Mark explains his 20+ years working with autistic and ADHD patients and why he wants to advocate for the community. He cites a quote that ignorance, not autism, is the tragedy.
- •Over 20 years of professional work with autism and ADHD
- •Feels a responsibility to advocate after hearing patients' stories
- •Quote by Kim Stagliano: "Autism is not a tragedy. Ignorance is a tragedy."
- •When you know better, you can do better
Common Traits of ADHD and Autism
Mark outlines the typical traits of ADHD and the two main features of autism. Alex asks how shared characteristics show up together, and they discuss overlaps like sensory sensitivity, stimming and emotion regulation.
- •ADHD: executive functioning difficulties, emotional dysregulation/RSD, impulsivity, dopamine chasing, hyperactivity
- •Autism: social interaction challenges and rigidity of thought or behavior
- •Autism presentation varies with where a person sits on the spectrum
- •Sensory sensitivities and emotion regulation overlap, with stimming as a regulation tool
- •Alex describes using a thumb stone to manage hyperactivity
Opposing Traits and the Internal Tug of War
Alex raises the contradictions in AuDHD, and Mark describes how opposing traits pull a person in different directions. They cover impulsivity versus resistance to change, social craving versus misreading cues, and emotional regulation differences.
- •Impulsivity of ADHD clashes with autistic difficulty with change
- •Craving social stimulation versus struggling with small talk and reading the room
- •Outbursts in ADHD versus confusion about feelings in autism
- •Being pulled in multiple directions while trying to maintain stability causes stress
Social Battery, Masking and Selective Mutism
Alex describes the shift from an energized start at a party to a drained social battery. Mark links this to masking, which he calls exhausting, and to selective mutism and the shame that can follow, and Alex shares his own experience of going non-verbal in group settings.
- •Patients learn social behavior from TV characters or change their accents
- •Masking is exhausting and leaves people thrown if the mask drops
- •Selective mutism can be a way of feeling safe when the nervous system is overwhelmed
- •It can compound a sense of "What's wrong with me?" and trigger shame
- •Alex goes non-verbal in groups with too many signals to mirror
How ADHD Masks Autism and Rising AuDHD Presentations
Mark explains that ADHD tends to be obvious while autism can be subtle and missed in people who have masked for years. Difficulty with change can be a clue. He also describes seeing more mixed presentations in recent years and cites research that 80% of autistic patients have ADHD.
- •ADHD can "scream" at you, while masked autism is subtle
- •Heavy distress around change may point toward autism
- •People with ADHD can manage change without getting as stuck
- •Mixed ADHD and autism presentations have increased over roughly the last 10 years
- •Some research suggests 80% of patients with autism have ADHD
Brain Regions Behind Autism and ADHD
Mark explains that the prefrontal cortex and cerebellum are involved in both conditions. He describes how each region relates to ADHD and autism traits.
- •Prefrontal cortex in ADHD develops slower, roughly a three-year delay, affecting planning and organization
- •In autism the prefrontal cortex relates to social cognition and managing social situations
- •Cerebellum in ADHD relates to motor functioning, clumsiness and time blindness
- •Autism's two main symptoms are social difficulties and repetitive behaviors or interests
Why Dual Diagnosis Took So Long and Whether AuDHD Will Be Official
Mark traces the history through the DSM, where DSM-4 in 1994 did not allow both diagnoses and DSM-5 in 2013 allowed both assessments. He doubts an official AuDHD diagnosis will come soon, comparing it to burnout, and says some doctors stay in their lane.
- •DSM-4 treated autism as developmental and ADHD as behavioral, and did not allow dual diagnosis
- •DSM-5 in 2013 introduced autism spectrum disorder and allowed both assessments side by side
- •AuDHD is not yet an official diagnosis
- •New diagnoses require professional consensus and research, as burnout shows
- •Some doctors may not raise a second condition unless it is glaringly obvious
The Dr. Jekyll and Mr. Hyde Narrative and Finding Your True Self
Alex asks how common the Jekyll and Hyde internal narrative is, and Mark says very. He explains how constant adapting and holding back keeps people from an authentic life, and how hard it is when the thing that excites you also causes anxiety.
- •Patients are physically present but stuck in their heads, staying a step ahead
- •People hold back deep dives and obsessive interests to avoid negative attention
- •Constant adapting to fit in comes at a high price in anxiety
- •Finding a true self requires allowing yourself to do what feeds your soul
- •Risky excitement needs boundaries and a check on whether it brings pleasure or distress
Anxiety, Depression and Rumination After Social Events
Using the example of oversharing at a work event and replaying it at home, Mark explains why AuDHD is linked to greater anxiety and depression. The spiral can trigger shame and RSD, which can be dangerous.
- •Research suggests more anxiety and depression with both conditions than with one
- •Anxiety starts before the event because of worry about small talk and reading the room
- •Overthinking afterward creates a spiral
- •Shame and RSD can escalate quickly and be very dangerous
The AuDHD Experience of RSD
Alex asks whether RSD is different in AuDHD. Mark explains that people with ADHD often read the room well and pick up small cues, whereas the autistic side can make it hard to notice a line was crossed until the response arrives, which is confusing.
- •RSD involves sensitivity to possible rejection and noticing small cues
- •ADHD alone can read the room very well
- •Autism can make reading the room hard
- •Someone with AuDHD may only realize they crossed a line after the reaction
Addiction Risk and Health Anxiety in AuDHD
Mark says people with ADHD are two to three times more likely to have addiction problems, including behavioral ones, thanks to dopamine chasing and risk-taking. Autism is less associated with the chase. Alex asks about health anxiety after a binge, and Mark describes catastrophic, rigid thinking the next day.
- •Addiction includes behaviors like gambling, not only substances
- •ADHD carries two to three times the likelihood of addiction problems
- •Instant gratification and dopamine chasing drive the ADHD risk
- •Autistic rigid thinking can turn a hangover into fears like a brain tumor or psychosis
- •Reassurance can help in these spirals
ADHD Agony Aunt: Friends Who Think It's Just a Label
In the "washing machine of woes" segment, a listener with ADHD who suspects autism asks how to get friends to understand it isn't about wanting another label. Mark says the real issue is helping friends understand the struggle, and suggests an open conversation with friends who are on your team.
- •Labels give context but don't explain lived experience
- •The underlying problem is getting friends to understand the struggle
- •A label may help the person explain why they struggle
- •Explaining why it matters that friends understand can help
- •Understanding oneself with both conditions is hard, and good friends should be supportive

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