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ADHD Chatter Podcast

The AuDHD Expert: 3 Alarming Risks of Undiagnosed Female AuDHD | Dr Samantha Hiew, PhD

AuDHD (The dual diagnosis of ADHD + Autism) is on the rise, but how can we spot AuDHD in ourselves, or in those close to us. How can we spot it early in children and what are the risks of staying undiagnosed.

Dr. Samantha HiewguestAlex Partridgehost

Mar 25, 202551mWatch on YouTube

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CHAPTERS

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Chapter summaries

AuDHD Overlap Statistics and Why It Was Recognized Late
Alex opens by asking for the latest figures on the overlap between ADHD and autism. Dr Hiew says estimates range from 20% to 70-80% depending on study design, and that both could not be formally diagnosed together until 2013. She links wider recognition to the diagnoses that followed the pandemic.
- •Overlap estimates range from 20% to as high as 70-80%, depending on how the study is set up
- •Underdiagnosis means the true figure is probably higher
- •Autism and ADHD could not be diagnosed together until 2013
- •Post-pandemic late diagnoses showed that people who flew under the radar may have more going on
- •Dr Hiew says AuDHD is a different animal rather than simply autism plus ADHD
Brain Networks, Neurotransmitter Flux and the Jekyll and Hyde Personality
Dr Hiew explains that AuDHD involves shifting regulation across many neurotransmitters and the same brain networks affected in autism and ADHD. She describes how this can make personality swing between structured and chaotic, and shares her own experience of this. Alex relates it to being told he had mood swings and to descriptions from other guests.
- •AuDHD involves flux across dopamine, norepinephrine, serotonin, glutamate and GABA
- •The frontoparietal control, default mode and salience networks are affected
- •Higher regulation can bring autistic traits such as rigidity and need for routine, while lower levels let ADHD traits emerge
- •Dr Hiew describes her own Jekyll and Hyde shift after moving to the UK
- •Alex cites other guests' images of order and anarchy and of two warring siblings
Which Diagnosis Comes First and Why
Asked what struggles the contradictory traits create, Dr Hiew points to mental health difficulties during life transitions. She then explains why ADHD traits are often noticed first in children, while autistic traits like sensory sensitivities are internalized and masked, especially in girls.
- •Transitions remove structure and coping strategies, creating internal chaos
- •Sensory sensitivities often appear early, including food textures and taste
- •Autistic traits can be internalized, especially in girls and women
- •Perfectionist and people-pleaser personas can develop, with meltdowns and shutdowns in private
- •Children may seek neurotransmitter top-ups, making ADHD traits more visible
Being Missed for Both Diagnoses and Female Special Interests
Alex asks whether someone can be missed for both conditions because their internal experience matches neither stereotype list. Dr Hiew says that was her story, and that autism assessments were outdated and built around male presentation. She notes that women often have more socially acceptable special interests.
- •Neither checklist fully matched her experience, so she was missed for both
- •The ADHD label alone did not explain her challenges
- •Autism assessments were not catered for female presentation
- •Women's special interests, such as psychotherapy or nutrition, are less recognized as autistic interests
- •Special interests change over time and are things that light you up
Early Special Interests and How AuDHD Develops Through School and Adolescence
After the sponsor read, Alex asks how early special interests show up. Dr Hiew describes little professors, rich inner lives, and how school brings executive function demands, anxiety and later reward-seeking in the teenage years. She stresses the importance of healthy regulating activities.
- •Special interests can be visible very early, such as her daughter's cat facts
- •Special interests are regulating and bring flow
- •School exposes executive function and variable attention challenges
- •The stress and anxiety system comes online before the prefrontal cortex matures
- •Teenage reward-seeking can lead to self-medication without guidance
Masking and the Risk of a Half-Told Diagnosis
Alex links school to the start of masking and asks how ADHD and autistic traits mask each other. Dr Hiew says girls are told early that masking is the better way and are neurobiologically less overtly hyperactive. They discuss how a single ADHD label can leave someone feeling more misunderstood, and she says the key is understanding yourself first.
- •Masking often begins when a child leaves the home environment for school
- •Girls are better at masking and internalizing
- •ADHD presentation is widely misunderstood
- •A half-accurate diagnosis can feel like an entirely different being from the full story
- •Understand yourself before expecting others to understand you
Dopamine Pursuit, Hormones and Metabolism in AuDHD
Dr Hiew explains that dopamine in AuDHD is in flux and shaped by factors like time of day and hormones across the menstrual cycle. She also suggests some people may struggle to clear dopamine and stress molecules fast enough, causing highs and crashes.
- •Dopamine is not always low, so some AuDHDers appear well organized at times
- •Testosterone and estrogen affect dopamine across the day and month
- •Estrogen peaks around ovulation bring social seeking, and the dip before menstruation lowers dopamine
- •Dopamine and norepinephrine metabolism may be part of the challenge
- •High levels can bring stress, anxiety and anger
AuDHD, Bipolar and Schizophrenia
Alex asks whether AuDHD is tied to bipolar or confused with conditions like schizophrenia. Dr Hiew says they are different but share gene variants, and that additional genetic and environmental factors are needed. She notes ADHD emotional reactions usually have a trigger, whereas bipolar swings can come without one.
- •Autism and ADHD share gene variants, many also found in bipolar and schizophrenia
- •Additional gene variants and environmental triggers are needed for those conditions
- •ADHD emotional regulation problems tend to have a trigger
- •Bipolar swings can occur without a trigger
How AuDHD Can Look to Partners and Others
Alex asks what AuDHD swings look like to a friend, new partner or boss. Dr Hiew says people can find the Jekyll and Hyde shifts unpredictable, and that the person themselves may not know the cause. She adds that biology and trauma imprints shape reactions.
- •Others may be confused when a liked personality suddenly changes
- •The person may not know where the shift comes from either
- •Family history of bipolar or schizophrenia may add to the picture
- •Triggers carry traumatic imprints that shape emotional reactions
Introverted Extroverts, Energy Management and Relationships
Alex asks whether AuDHD links to being an introverted extrovert. Dr Hiew describes layered explanations, a fast-filling energy tank from heightened sensory input, and push-pull relationship dynamics that may be energy management rather than attachment style. She highlights sleep, morning light and nutrition.
- •Autistic and ADHD traits may be tied to different personas such as the professor and the life of the party
- •Feeling, hearing and seeing more fills the energy tank quickly
- •Needing space to recharge can create push-pull relationships
- •Some anxious-avoidant attachment patterns may be simpler energy management
- •Sleep, morning light and eating well support brain energy
Message of Hope: Radical Acceptance and Owning the Mask
Alex asks for a message of hope for undiagnosed women. Dr Hiew recommends radical acceptance and feeling safe within yourself. They discuss whether the mask is also part of you, and how the dislike of change can be channeled into anchoring routines.
- •A tug-of-war indicates a dysregulated system, so balance matters
- •Radical acceptance starts with waking up to who you are beyond one label
- •The mask may be an adaptation that is also you
- •Owning the darkness can become a source of power
- •The need for routine can anchor you, but the default mode loop can trap you
Latest AuDHD Research Findings and Women's Underrepresentation
Asked what has shocked her most, Dr Hiew says the research is in its infancy but cites a study on AuDHD brain dynamics showing both chaos and order. She notes that the study had few girls and that AuDHD women tend to present differently and may carry more trauma. She also mentions a bright side to menopause.
- •AuDHD research is in its infancy
- •A study on brain dynamics showed both chaos and order, depending on the situation
- •The study had few female participants
- •AuDHD women may be hyper-empathetic and seek connection
- •Difficulty reading intentions may lead to higher trauma
- •Her reading suggests theory of mind matures in menopause so you care less about others' opinions
AuDHD Agony Aunt: A Child Who Rejects an Autism Diagnosis
In the Washing Machine of Woes segment, a listener asks about a child with an ADHD diagnosis who shows autistic behaviors but refuses an autism assessment. Dr Hiew says social acceptance matters most at that age and autism carries more stigma. She says understanding is enough and parents can still offer support.
- •Social rejection is felt as real pain, especially in adolescence
- •Autism is still more stigmatized than ADHD
- •Young people often do not announce diagnoses
- •Knowing is enough, and lifestyle strategies and social scaffolding can still help
Debunking Autism Myths and Closing Segments
Dr Hiew says autistic traits in AuDHD can look milder because they are internalized, and credits her autistic side for her achievements. The episode closes with a letter of three rules from the previous guest and her AuDHD items, a crystal ball and a parachute.
- •Autistic traits can appear mild externally but are internalized
- •She credits her special interests and structure to her autistic side
- •Her inner dynamic is like a mother inside the brain reeling in the child
- •The previous guest's rules include embracing your inner child, staying weird and embracing your mask
- •Her items are a crystal ball for certainty and a parachute for safe risk-taking

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