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Our understanding of and diagnostic criteria for autism, a lifelong condition, have evolved considerably over the last 50 to 60 years. One fall-on effect of this awareness: Many autistic adults overlooked or misdiagnosed in childhood are finally pursuing an evaluation. This population is sometimes called “the lost generation.”

Today, there remains a significant lack of information and understanding about the unique needs, supports, and challenges of autistic people in midlife and at older ages. This webinar will highlight autism and aging as a rapidly advancing and important area of research, and it will provide approaches to help autistic adults live full and happy lives.

In this webinar, you will learn:

• About the historic changes to diagnostic criteria that resulted in some 90 percent of autistic people receiving diagnoses at and after age 50 worldwide
• How complementary conceptual approaches can be used to examine aging in autism (i.e., dimensional trait-based approaches and categorical diagnosis-based approaches)
• What recent empirical research findings tell us about aging as an autistic person, covering a range of studies related to cognition, health, wellbeing, and life experiences
• How the information gained from these studies can be pieced together to create a broad picture of where support can be provided to improve the quality of life and outcomes of older autistic adults to ensure they live long and happy lives

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Autism in Adults: Resources

• • • Free Download: The Truth About Autism in Adults
    • Read: AuDHD: ADHD and Adult Autism Symptoms, Diagnosis & Interventions for Both
    • Read: Q: How Can I Get Evaluated for Autism as an Adult?
    • Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus

Meet the Expert Speaker

Gavin Stewart, Ph.D., is a senior postdoctoral research fellow at King’s College in London. He is an expert in autism and aging, and his research takes a multifaceted approach to explore the life experiences of autistic people across adulthood and as they age.

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

Closed captions available.

I used to think autism meant headbanging or stimming in obvious ways. I didn’t see myself in the stereotypes, and I definitely didn’t think it explained my chaos. But then came TikTok.

It started innocently enough. Like many people, I downloaded the app during the pandemic to see what the fuss was about. The algorithm didn’t take long. Almost instantly, my For You page was filled with chaotic, rainbow-haired women my age talking about ADHD and autism. Women who looked like me. Women who were me.

I didn’t even have to search. They just appeared — video after video of people with the same explosive personality traits, the same sensory issues, the same thought patterns. The same trauma responses. The same jokes. The same blue hair.

At first, it was comforting. “That’s me!” I’d laugh. “Oh my God — that’s so me!” But then the laughter started to sting.

[Read: “I’m ‘The ADHD Doctor’ on TikTok. Here’s How the App Has Changed Me.”]

One video hit particularly hard. A woman — split-dyed blue and black hair, like mine — left her house to grab blueberries. The timestamp showed it had been over an hour when she came back through the door with five full shopping bags, arms overflowing. Her husband called out, “Did you get the blueberries?” And her face froze in horror. She hadn’t. She’d forgotten the one thing she went out for. I laughed out loud… then felt punched in the gut. Because I had done that exact thing — only with orange juice.

Once the algorithm clocked my reaction, it doubled down. Every time I opened the app, I saw someone like me: brushing their teeth and suddenly realizing the toilet roll needed changed… which led to changing the bin… which led to discovering their toothbrush in the kitchen beside the bin they forgot to empty. These bizarre, tangled thought spirals I thought were unique to me were suddenly just… everywhere.

As my friends discovered the app, my inbox started to fill with more versions of myself — daily scenarios acted out by strangers who looked like me, always with the same message: “This is so you.” People even said it in person: “You know that girl — the one who’s basically you on the Internet,” when they were talking about an AuDHD video.

And that’s when it hit me. I wasn’t special. I was one of thousands. Millions, even.

Weirdness as Identity, Stolen by TikTok

All my life, I’d felt weird, different. I had clung to that as a form of identity. Even when it hurt, even when I felt alone, I had accepted my quirks as mine. But TikTok held up a mirror I hadn’t requested — and in that mirror, I saw not one reflection, but hundreds. Thousands. My traits, once mine alone, were playing out on screens all over the world. It felt like I’d been cloned and scattered across the Internet.

That realization spiraled into a strange grief. I was relieved to have answers for my lifelong struggles, yes. But at the same time, I was grieving the person I thought I was. I had worn my difference like armor — if I couldn’t blend in, I’d be the loudest, weirdest one in the room. I didn’t realize how much of my identity hinged on feeling like the only one.

Seeing “me” reflected back so often, in so many strangers, made me feel exposed. Invisible, even. Was I just ADHD sprinkled with some autism — another neurodivergent stereotype of blue hair and mandalas? Had anything about me ever been unique?

I Don’t Need to Be One-of-a-Kind

For weeks, I found myself torn. I kept scrolling through these videos that made me laugh, cry, and feel understood. But they also made me feel hollow. Like my sense of self had dissolved. I started snapping the app shut, unable to face the steady stream of doppelgängers.

And then one night, I looked at my son — this messy, brilliant little boy who shares many of my quirks — and something shifted.

If I can see myself everywhere… maybe that means I was never alone.

Maybe there’s comfort in that.

Maybe I’m not a diluted version of a stereotype, but a real, whole person who happens to be neurodivergent — like so many others. And maybe that’s not a bad thing. Maybe it’s a blessing. Maybe I can see the humor in this — the light in myself by seeing it in others like me.

Because if I can find myself in all of these strangers, then maybe he will, too.

Maybe he’ll grow up seeing himself everywhere and never feel the kind of loneliness I felt as a child.

Maybe the weird won’t feel weird at all. That’s all I can hope for.

These days, I still fall into the TikTok rabbit holes. I still see my reflection in strangers. But now I feel a little more grounded. A little more grateful. I’m learning to let go of the need to be “one of a kind,” and embracing the strange, beautiful truth that we are never as alone as we think.

I may not be the only blue crayon in the box — but I’m still here, coloring outside the lines.

AuDHD in Women: Next Steps

• Read: TikTok Is My Therapist — The Dangers and Promise of Viral #MentalHealth Videos
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: “5 Unique Features of AuDHD in Women”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

To complement ADDitude magazine’s Spring 2026 cover story on autism, we invited readers to share artwork that captures the diversity and depth of life on the spectrum for them. Here, we spotlight seven artists whose artwork is as varied as the autistic community itself.

“My art is as detailed as my cluttered brain folds, and the detailed artworks that conceal things in the nooks and crannies are most representative of how this autistic person sees the world.”

Kimberly Gerry-Tucker
Connecticut

“I painted this piece to understand myself better, to feel free and renewed. This piece represents strength and humility talking with each other in my inner universe.”

Marcele Silvina Rodrigues White
Epsom, United Kingdom

“I originally painted this piece to explore colors and textures and to capture the magic I see in nature. As a neurodivergent person, this painting is me: bright, bold, beautiful, and sometimes, a little chaotic, just like Mother Nature.”

Casey-Lee Flood
Hai’kū, Hawaii

“I drew this image because, my whole life, I felt like an alien who didn’t belong. Today, this alien stands proud in a sea of other neurodivergent folks. I finally feel seen and accepted for who I am.”

Cat Contillo
Newburgh, New York

“Many people are under the false understanding that individuals with autism are restricted by their diagnosis and act according to their prescribed identity. The sky here is visible and asks for attention, just as autism is still characterizing and relevant but isn’t the most important thing on the canvas.”

Lilly Corradetti
Ontario, Canada

“There is beauty and vibrance in embracing neurodivergence. I have learned to move with the dance of darkness, light, and color, in the emergence of self, and integrating who I am.”

Angela Taylor
Winnipeg, Manitoba, Canada

“I wanted to portray the complexities of what it is like for neurodivergent people to mask, and how much of ourselves we lose in the process. It is my first piece of work, and, because of that, I found it cathartic to finally put my experiences of masking down on canvas. As chaotic as it looks, it’s very real.”

Lilya Taylor
Portsmouth, United Kingdom

Understanding Autism: Next Steps

• Free eBook: The Truth About Autism in Adults
• Read: “My Art Style is Expressive, Bold, and Moving — Like Me.”
• Read: “A Big Part of Unmasking Is Honoring Your Limits”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Today, Vittert is a NewsNation TV anchor and author of a book with Don Yaeger. Born Lucky: A Dedicated Father, A Grateful Son, and My Journey with Autism (#CommissionsEarned) illuminates the ferocity of parental love and support in the face of adversity. Here, he speaks with ADDitude.

Q: Why did you write this book with your dad, and why now?

LV: We wrote this to give parents the hope that my parents didn’t have when I was diagnosed. I had behavioral issues and sensory issues. My parents were told by an expert that it was difficult to know what was going on in my mind and that they couldn’t do much for me.

Born Lucky is a love letter to my dad, who encouraged me to reach my full potential. It follows the arc of my development from not being able to understand human interaction to being able to get along and function in the real world. We want parents to know that they have enormous agency and power to affect the outcomes of their kids’ lives.

Q: Can you talk more about the challenges of growing up autistic and how, as you say in the book, it led you to become resilient?

[Is My Child on the Autism Spectrum? Take This Test To Learn More]

LV: I was in and out of four schools by fifth grade. Two weeks into seventh grade, the principal told my parents, “Everyone in this school thinks Lucky is weird and, frankly, I do too.”

I had lots of meltdowns. If a kid touched me in line, I’d turn around and hit them because touch felt very threatening to me. If kids were being serious, I’d tell a joke. I didn’t understand how to interact, and the rejection was so persistent and stinging that I cried myself to sleep every night.

My dad was my best and only friend. He gave me an immense amount of love and care, and he always made me go to school the next day. My parents were very clear that I could not expect the world to change for me. This made me resilient. I always say the best training for the Washington newsroom was middle school!

In 2021, I had just been asked to leave by my employer, Fox News, had broken up with my longtime girlfriend, and was living in my parents’ guest bedroom. My dad and I were talking one night, and I was feeling sorry for myself. He said, “If you could get up and go to school day after day as you did in eighth grade, you can get through this.”

[Get This Free Download: What Are Your Teen’s Weakest Executive Functions?]

Q: How did you build the social skills you felt you needed to interact with people? 

LV: I still struggle every day with the things my dad and I worked on for 15 years: how to listen, how to understand where someone else is coming from emotionally, how to match that emotion.

My dad used to take me to lunch with his friends, and, when I was talking too much, rather than say, “Be quiet,” he’d tap his watch as a cue for me to stop. Later, we’d talk about it. He’d say, “When you interrupted Mary to talk about something else, why did you think that’s what she wanted to talk about?” I’d say, “Well, that’s what I wanted to talk about.” Then we’d role-play. He was teaching me how to interact with others. Social dynamics are innate for other people. For me, they’re a learned skill.

Q: What qualities do you credit for your success as a TV anchor and now author?

LV: I was taught that you can control just two things in life: your character and your hard work. I was taught to work like hell. When I started in journalism, my quest was to outwork everybody. It’s hard to beat a man who won’t quit.

Parental Love: Next Steps

• Free Download: Help Your Child Develop Positive Self-Talk
• Read: Your Positive Parenting Toolkit Has Arrived
• Read: Autism and ADHD: The Complete Playbook for Social Challenges
• Read: A Dad’s Role in Modeling Social Skills

Leland Vittert is the anchor of On Balance with Leland Vittert at NewsNation.

Carole Fleck is Editor-in-Chief at ADDitude magazine.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Chronic stress, high rates of co-occurring conditions, and unhelpful school and clinical interventions are common among individuals living with pathological demand avoidance (PDA), according to the first-ever comprehensive survey exploring the lived experience of PDA.¹ The survey found that failure to meet the needs of children and adults with PDA results in difficulties at school, at work, and in relationships, often leading to family breakdown and estrangement, school refusal, underemployment, and mental health struggles.

The 2,000 survey respondents comprised three groups: caregivers of children and teens with PDA; caregivers of adults with PDA; and adults with PDA themselves. Though the ripple effects of PDA on education, work, and family life varied across these groups, the core characteristic of PDA remained strikingly stable, with the “resistance to being told what to do” emerging as the most commonly reported trait across all groups.

For children, school was one of the realms most dramatically impacted by PDA; 88% of children with PDA experienced school avoidance or refusal at some point, and 40% struggled to attend school most days. While 70% of children with PDA had IEPs/ 504 Plans, only 17% of caregivers found these to be “very helpful.”

For adults with PDA, family life and mental health were major areas of struggle, with almost a quarter of adults with PDA, and/or their caregivers, reporting family estrangement. Nearly 60% of adults with PDA reported experiencing thoughts of suicide.

Understanding PDA

In a recent ADDitude webinar, “Don’t Tell Me What to Do: Pathological Demand Avoidance in Neurodivergent Kids,” Diane Gould, LCSW, founder and executive director of PDA North America, discussed the degree to which PDA is misunderstood. She explained that core features for children include:

• Resisting and avoiding ordinary demands of life
• Difficulty complying with the requests or rules of others
• Difficulty making themselves do the things they want to do
• A fundamental need for control

Because of this difficulty with compliance, Gould said: “PDA individuals are so often undiagnosed or misdiagnosed. Adults and teens are often misdiagnosed as having bipolar or borderline personality disorder. Children are misdiagnosed with oppositional defiant disorder or conduct disorder.”

As the report’s authors write: “PDA is not about ‘refusing to cooperate,’ but about the need for autonomy, safety and survival.”

A Dearth of Effective Interventions

This lack of awareness about PDA has resulted in a notable dearth of effective interventions.

“Across surveys, no single intervention was consistently rated as helpful, highlighting the need for better tailored approaches for PDA individuals,” write the report’s authors. Moreover, the report found that encounters with affirming, informed providers were rare, and that caregivers and adults with PDA infrequently received helpful, validating guidance. According to survey results:

• The most helpful interventions were medication management and occupational therapy
• The least helpful interventions were Applied Behavior Analysis (ABA) and emergency room visit
• 94% of caregivers reported that punishment can worsen behaviors

“Probably the hardest thing for parents to talk about was how hard they tried to follow all the advice that they were given from therapists, psychiatrists, pediatricians, teachers, and even parenting books,” Gould said. “But those strategies didn’t work, and often made things worse.”

The report’s authors explain that PDA-informed care involves “respecting autonomy at any age, reducing pressure and unnecessary demands, planning for sensory needs, and using relationship-based, responsive approaches.”

Common Co-Occurring Conditions

PDA commonly co-occurs with neuropsychiatric conditions, most frequently autism, ADHD, or both.

The Impact of PDA on Education

Chronic, severe difficulty attending school is the norm for children and teens with PDA. The survey revealed the following:

As Reported by Caregivers of Kids

• 88% of children with PDA experienced school avoidance or refusal at some point
• 4 in 10 children struggled to attend school most days
• 1 in 5 reported suspensions
• 1 in 10 was not currently accessing any education
• 70% had an IEP or 504 Plan
• Just 1 in 6 found their IEP/ 504 Plan to be “very or extremely helpful”

Despite these consistent difficulties, adults with PDA overwhelmingly report having received a high school diploma, with the majority also earning a four-year college degree.

As Reported by Adults

• 96% completed an education equivalent to a high school diploma
• 83% had a four-year college degree<

The Impact of PDA on Work

While adults with PDA struggle to attend work regularly, and experience episodes of under- or unemployment, the vast majority are employed. A high percentage of PDA adults are self-employed, which helps alleviate work-based challenges:

As Reported by Caregivers of Adults

• Two-thirds reported employment at some point
• More than half reported periods of unemployment or underemployment

As Reported by Adults

• 97% of adults reported employment at some point
• Among these, 55% had a history of self-employment
• 80% reported challenges with workplace attendance
• Two-thirds reported periods of unemployment or underemployment

The Impact of PDA on Family

Family life is strained for those with PDA, whether adults or children. This finding is vividly illustrated by Lisa McKay’s experience, as described in the ADDitude article, A Parent’s Guide to Navigating Pathological Demand Avoidance.

“During his early years, Max would frequently refuse to do what was asked of him and insist everything be done his way,” McKay writes. “He would inexplicably melt down or erupt in anger over seemingly minor issues.”

The survey measured the extent to which these areas of life are affected by PDA:

As families navigate these turbulent, murky waters, validation and accurate information about what works for PDA — and what doesn’t — is key.

“Commonly suggested behavioral strategies for neurodivergent children — from setting clear rules to using checklists, visual timers, and liberally doling out praise — didn’t help.” McKay says. “In fact, all they seemed to do was set up further power struggles where everyone lost.”

McKay’s experience is echoed over and over again by the findings of the survey. “This report makes clear that the challenges families face are not due to a lack of effort or care, but to systems that are not designed with PDA in mind,” said Ruth Hevelone, PDA North America’s director of Strategic Growth & Marketing. “When supports are aligned with how PDA is actually experienced, outcomes can change dramatically.”

Research Team Lead for the PDA report, Michele Kleinmann, added: “We hope this data helps shift conversations away from ‘fixing behavior’ and toward building environments where PDA individuals can feel safe, understood, and supported.”

Sources

¹McKenzie, M., Kleinmann, M., Hevelone, R., & Gould, D. (2026). The PDA Experience Report. PDA North America. https://learn.pdanorthamerica.org/products/digital_downloads/key-findingsPDA-Experience-Report

Many autistic people hear this as they get to know their true selves better and intentionally begin to unmask. This observation is often followed by the equally unhelpful, “You used to be able to do it; why can’t you do it now?”

In the process of unmasking, some neurodivergent people experience “skill regression.” This is the term many clinicians use when a person with autism and/or ADHD suddenly has trouble with routine tasks like self-care, attending events they once seemed to enjoy, or managing executive functions like time management. The term skill regression, however, is quite pathologizing and a bit misleading.

[Take This Self-Test: Signs of Autism in Women]

Why ‘Skill Regression’ Is a Misleading Term

When I was in college, I went for a hike in the woods by myself and fell, rolling my ankle. It stung but held my weight, so I walked the rest of the way back. As soon as I got home and sat down, I couldn’t get up again. It’s not that the pain suddenly hit at home, but that I pushed myself past my limits, ignoring the pain until it was safe to acknowledge it.

When someone is high-masking, they exert a lot of energy presenting as neurotypical. Masking your authentic self involves disregarding your own needs, sensory sensitivities, and communication style to meet society’s expectations. A big part of unmasking is getting back in touch with these needs and recognizing the unhealthy or even unsafe ways you have overextended yourself.

In other words, it is misleading to call this a skill regression. I prefer to say that the individual has recognized their limits and begun to honor them. If you are in the process of unmasking, you may notice that some previously palatable situations and tasks now seem exhausting or even impossible. In my case, I realized how overwhelming I found my in-person office setting. Spending 40 hours in that setting was suddenly unsustainable. Learning what is sustainable has helped me discover hidden strengths and capabilities.

If someone you love seems to be experiencing skill regression, please be patient with them. Know that they are not trying to give you a hard time; rather, they are getting to know themselves better. If they trust you enough to show you how they are struggling, recognize that this is an honor. They feel safe telling you about their needs and newly identified limitations. Support them and encourage them to be honest and open about all of it.

Unmasking in Autism and ADHD: Next Steps

• Free Download: The Guide to Autism in Adults
  
• Read: 10 Steps to Unmasking Your ADHD
• Read: “I Thought I Sucked at Life. But I Was High-Masking Autism All Along.”
• Watch: “Understanding AuDHD Burnout: How Neurodivergent Masking Sparks Stress, Exhaustion”

Amy Marschall, Psy.D., is a licensed psychologist, author, and speaker.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

During this time, I was diagnosed with autism and ADHD. I wasn’t expected to show up to work or social gatherings due to the pandemic, and that left more space to focus on drawing — something I did for up to 10 hours a day. I made my own schedule, added physical therapy to reduce my chronic pain, adapted my clothing and home to better suit my needs, and engaged in my special interest full time, all of which deepened my relationship with myself.

[Read: ADHD & the Interest-Based Nervous System]

“The illustration I created for the cover of this issue was inspired by movement and repetitive movement, something that autistic people do as a form or regulation and communication. To me, the illustration shows a person spinning in their own world, and I wanted to illustrate the feeling of vestibular movement.”

I started to draw on the computer and eventually moved to an iPad, which allowed me to create works at the speed of my thoughts and impulses. As I began to truly understand my autism, I was able to find a path to the art of illustration.

A friend recommended that I try illustrating articles in magazines and newspapers, and that really sparked my interest. It felt like a perfect way to combine my love for drawing scenes and for creatively telling a story.

[Read: On the Awesomeness of ADHD Creativity]

I also began posting my works online. Viewers’ reactions to my work gave me the confidence to approach retail stores and pitch my designs for greeting cards and prints, and to create more art around storytelling. An art director saw my work at a bookstore and hired me for my first editorial assignment.

All the hours I spent on my special interest helped to develop my skills and allowed me to fully dedicate myself to illustration – and get paid for it. My style is expressive, bold, and moving – a lot like me.

Emcie Turineck, an artist in Montreal, Canada, created the artwork that appears on this issue’s cover.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Autistic and ADHD burnout can build gradually and vary in intensity. Signs include:

• persistent fatigue
• chronic pain
• headaches
• difficulty focusing, worsening executive dysfunction
• social withdrawal
• depression, anxiety, and other emotional shifts
• heightened sensory sensitivities

If ignored or unaddressed, these signs of stress can erode day-to-day functioning and weaken coping mechanisms. Some people are so paralyzed by burnout that they pause their careers and relationships, and may need a year or longer to reset.

If you recognize the signs of burnout, explore which situations might be causing you the most harm. Ask yourself:

• What drains or energizes me?
• When do I function best or worst?
• How do I judge productivity?
• Which environments support me?

💡Free Self-Test: Am I Burnt Out?

To halt the downward spiral into burnout, you will need to make changes that prioritize your health over others’ needs or wants. These can include:

• Establishing reasonable goals. Learn to ask for help. Drop non-essential tasks from daily life. If your job is overwhelming, consider pivoting to a less stressful job or career path if you can.
• Practice unmasking. It takes time and thoughtful practice to know your authentic self. Experiment with approaches that have helped others unmask — for example, stimming at home.
• Finding the right provider. A neurodivergent-affirming healthcare professional can help you unmask and stop the burnout cycle. Ask potential providers these questions:
  • Have you provided care to someone like me?
  • What does providing neurodiversity-affirming care mean to you? (Their answer should reflect that neurodivergence is not a problem to be solved nor something shameful.)
  • What is your experience assessing and helping someone who is high-masking?

Treatment can include:

• cognitive behavioral therapy for coping skills and improved self-awareness
• support groups that help neurodivergent individuals find validation by connecting with others who face similar situations
• self-care, such as eating healthy foods, getting adequate sleep, and exercising regularly

Amy Marschall, Psy.D., is an autistic psychologist diagnosed with ADHD. She is the author of Neurodiversity-Affirming Therapy.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Chronic pain — twice as common in neurodivergent youth — is as real as it is invisible and misunderstood. (Veterinarians receive more education about the neurobiology of pain than do human doctors!) As awareness grows, so has our understanding of why autism and ADHD place children at higher risk for chronic pain, and of the supports that help their unique nervous systems feel safe and heal.

The Neurobiology of Pain

Chronic pain, which is defined as pain that lasts for more than three months, is often the result of a nervous system imbalance rather than ongoing tissue damage.

The brain and nervous system work to keep us safe by shifting between two branches: the sympathetic system, which activates the fight-or-flight response to mobilize the body during challenges, and the parasympathetic system, which calms and regulates us.

Chronic pain occurs when the fight-or-flight system stays activated, amplifying pain signals, intensifying danger perception, disrupting sleep and mood, and further dysregulating the body – creating a cycle of overactivation.

But what triggers overactivation?

The Chronic Pain-Neurodivergence Overlap

Pain is influenced by biological, psychological, and social factors, as described by the fear-avoidance model of pain.¹ This framework also illustrates how neurodivergence can make children more susceptible to sympathetic activation and chronic pain.

Neurodivergence and Pain

• Sensory sensitivity amplifies pain and discomfort in response to everyday sensory input.
• Differences in interoception heighten awareness of bodily sensations.
• Emotional dysregulation intensifies worry, distress, and overwhelm caused by pain.
• Hyperfocus, cognitive inflexibility, and perseveration lock attention on pain.
• Uncertainty intolerance undermines coping beliefs and fuels hypervigilance.
• Social challenges increase stress and trigger the fight-or-flight response.
• Co-occurring conditions — sleep disturbances, anxiety and depression, developmental conditions, migraines, autonomic dysregulation and more — predict and contribute to chronic pain.^{2 3 4 5 6}

About 16 percent of autistic children experience frequent or chronic pain — nearly twice the rate seen in neurotypical peers — and the rate rises to 20 percent among those with developmental conditions.⁵ In our study, we found:⁶

• About 30 percent of pediatric pain clinic patients are autistic.
• More than half report widespread rather than localized pain.
• About 60 percent are girls, reflecting the higher chronic pain rates found in women likely due to factors like hormones, co-occurring conditions, stress, and medical bias.

About one-quarter of youth with chronic pain have ADHD, while 65 percent of children with ADHD report chronic pain.⁷ Women diagnosed with ADHD in childhood show higher chronic pain rates in adulthood.

Signs of Chronic Pain

Expressions of pain may include:

• Guarding a body part or favoring one side
• Avoiding movement or reduced range of motion
• Tenderness to light touch
• Increased sensory sensitivity
• Sudden or increased irritability or meltdowns
• Sudden or increased anxiety, clinginess, or fear of being alone
• Needing help with tasks previously done independently
• Frequent nurse visits, requests to go home, or school refusal
• New or worsened sleep problems
• Fatigue, low stamina, need for frequent breaks
• Reduced engagement with special interests and enjoyable activities

Pain Management: Regulating the Nervous System

Managing chronic pain requires coordinated approaches that calm a dysregulated nervous system over time and restore function. Treatment must be tailored to each child’s needs, abilities, and context.

Pain Management Programs

Chronic pain programs include pediatric anesthesiologists, pain psychologists, occupational and physical therapists, and other specialists. Many programs are housed in pediatric hospitals with specialists who have experience with neurodevelopmental differences.

These programs focus on function beyond pain reduction, helping kids return to daily activities. Most are outpatient, but inpatient or day treatment options exist for severe cases.

For neurodivergent children, treatment plans should address:

• Sensory regulation
• Executive function challenges
• Activities of daily living (e.g., bathing, dressing, eating)
• School-based behavioral and social supports

School Advocacy

Educators will benefit from understanding chronic pain and how the school environment influences it. A pain psychologist can explain the chronic pain and school connection, provide documentation of your child’s needs, and advocate for accommodations supporting gradual school participation, including:

• Quiet space for short breaks
• Sensory-regulating tools (noise-reducing headphones, sunglasses)
• Reminders to use pain-management strategies (deep breathing, muscle relaxation)
• Alternative seating options
• Excused absences, tardies, and extra transition time between classes
• Note-taking accommodations (access to notes, speech-to-text, typing)
• Adapted physical education with low-impact options

What Caregivers Can Do

1. Validate your child’s pain.
Most of us equate pain with acute, nociceptive forms — broken bones, cuts, burns. But that is just one type of pain. Nociplastic pain, common with chronic pain, can occur without tissue or nerve damage. Believing your child helps to calm their nervous system. Remember that neurodivergence alters pain processing. Avoid viewing your child as noncompliant or attention-seeking, as this leads to power struggles that can increase stress and dysregulation.

2. Start low and go slow.
Begin with tiny steps to help your child heal and regain function. Increase demands only when manageable. If walking to the driveway is challenging, start with a few steps, gradually increasing. Use fitness trackers and rewards for motivation.

3. Redirect.
Shifting focus from pain can reduce its intensity. Say, “It makes sense that you’re experiencing pain and that hyperfocus makes it hard to think of anything else. Let’s try taking a smaller step this time.” Psychologists can also help shift your child’s thinking patterns related to pain and come up with replacement behaviors.

Other ways to redirect your child:

• Ask for help with a task (e.g., deliver a message to a family member, think of grocery list items, brush the family pet)
• Count objects by color
• Name things they can see, touch, hear, smell, and taste

4. Create a comfort toolbox with calming activities:

• Breathing exercises
• Music, coloring, puzzling
• Guided imagery and meditation
• Special interests

5. Provide visual cues to remind your child of preferred coping strategies.

6. Maintain routines to establish predictability and reduce anxiety.

7. Prioritize quality sleep.

Quality sleep reduces pain and supports self-regulation. Ensure your child is screened for sleep disorders and receives adequate treatment. Support healthy sleep habits, too:

• Dim lights and turn off screens one hour before bed
• Follow a short bedtime routine with a visual schedule
  (e.g., bath, brush teeth, put on pajamas, bedtime story or relaxation exercise)
• Use timers to indicate transitions
• Choose comfortable pajamas and bedding (remove scratchy tags)
• Keep the bedroom dark, cool, and quiet
• Maintain consistent sleep-wake times, even on weekends
• Reserve the bed for sleep only

8. Educate others.
Help family and friends understand how chronic pain is different. This explanation works well for children: My body is like a pot of water. Sometimes, the water boils and overflows, which hurts. I’m getting help to keep water from overflowing!

9. Keep calm.
Chronic pain is highly treatable. You did not cause your child’s pain — we all have different nervous systems and are shaped differently by life’s experiences. However, your calm presence can significantly influence how they respond to pain over time.

Gradual exposure to uncomfortable activities is part of healing — it’s how fear subsides and pain fades. A pain psychologist can help you understand how to best support and encourage your child in breaking the fear-avoidance cycle and regaining their life.

Gloria T. Han, Ph.D., is a pediatric pain psychologist at Vanderbilt Children’s Hospital in Tennessee and an assistant professor at Vanderbilt University Medical Center.

Anna C. Wilson, Ph.D., is a pediatric pain psychologist at Oregon Health & Science University Doernbecher Children’s Hospital and a professor at OHSU.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

^{1 Asmundson, G. J., Noel, M., Petter, M., & Parkerson, H. A. (2012). Pediatric fear-avoidance model of chronic pain: foundation, application and future directions. Pain Research & Management, 17(6), 397–405. https://doi.org/10.1155/2012/908061}

^{2 Jain, S. V., Panjeton, G. D., & Martins, Y. C. (2024). Relationship between sleep disturbances and chronic pain: A Narrative Review. Clinics and Practice, 14(6), 2650–2660. https://doi.org/10.3390/clinpract14060209}

^{3 Velly, A. M., & Mohit, S. (2018). Epidemiology of pain and relation to psychiatric disorders. Progress in Neuro-psychopharmacology & Biological Psychiatry, 87(Pt B), 159–167. https://doi.org/10.1016/j.pnpbp.2017.05.012}

^{4 Groenewald, C. B., Murray, C. B., & Palermo, T. M. (2020). Adverse childhood experiences and chronic pain among children and adolescents in the United States. Pain Reports, 5(5), e839. https://doi.org/10.1097/PR9.0000000000000839}

^{5 Whitney, D. G., & Shapiro, D. N. (2019). National prevalence of pain among children and adolescents with autism spectrum disorders. JAMA Pediatrics, 173(12), 1203–1205. https://doi.org/10.1001/jamapediatrics.2019.3826}

^{6 Han, G. T., Heavner, H. S., Rains, T. R., Hoang, A. H., & Stone, A. L. (2024). Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team. Children (Basel, Switzerland), 11(3), 312. https://doi.org/10.3390/children11030312}

^{7 Battison, E. A. J., Brown, P. C. M., Holley, A. L., & Wilson, A. C. (2023). Associations between Chronic Pain and Attention-Deficit Hyperactivity Disorder (ADHD) in Youth: A Scoping Review. Children (Basel, Switzerland), 10(1), 142. https://doi.org/10.3390/children10010142}

New research has identified distinct genetic profiles linked to different behavioral and developmental patterns in autistic individuals, reinforcing the understanding that autism is highly complex and not driven by a single cause or influence.

In one study, researchers at the University of Cambridge discovered that individuals who were diagnosed with autism in early childhood, usually before age six, appeared to have a different genetic makeup and lower risk of developing co-occurring mental health conditions than did those who were diagnosed in late childhood and beyond.

Children with an early autism diagnosis were more likely to demonstrate challenges with social interactions from infancy to early childhood, the study showed. Children with a later diagnosis were more likely to experience social and behavioral struggles in adolescence, plus higher rates of comorbid ADHD, depression, PTSD, and self-harm. The study was published in October 2025 in the journal Nature.¹

“Understanding how the features of autism emerge not just in early childhood but later in childhood and adolescence could help us recognize, diagnose, and support autistic people of all ages,” senior study author Varun Warrier, Ph.D., assistant professor of neurodevelopmental research at Cambridge University’s Department of Psychiatry, said.

In a separate study from Princeton University and the Simons Foundation, researchers identified four clinically distinct subtypes of autism, setting the stage and establishing the potential for specialized care. They used data from more than 5,000 children to analyze combinations of traits, looking at social interactions, repetitive behaviors, and developmental milestones, rather than studying genetic links to single traits. The study was published in July 2025 in Nature Genetics.²

The four autism subtypes defined in the Princeton/Simons Foundation study included:

1. Social and Behavioral Challenges

Children in this group face more difficulties with social communication, attention, and repetitive and disruptive behaviors than do participants in other subtypes. This group also has the highest genetic predisposition for ADHD, anxiety, obsessive-compulsive disorder, and depression. Its members do not experience significant developmental delays.

2. Moderate Challenges

In this subtype, children exhibit traits that manifest as social challenges or stimming, but they usually reach developmental milestones at ages similar to their neurotypical peers. They generally do not experience co-occurring psychiatric conditions.

3. Mixed ASD and Developmental Delays

Gene variations identified in this subtype lead to early developmental challenges, as with walking and talking, in many, but not all, children. Members in this group tend to receive an autism diagnosis at an early age, and usually do not show signs of anxiety, depression, or disruptive behaviors.

4. Broadly Affected

Children in this subtype present with the most severe and wide-ranging difficulties, including ADHD, anxiety, depression, and mood dysregulation. The researchers observed impulsivity, hyperactivity, and aggressive behaviors only in this subtype.

Diagnosing Autism and Comorbid Conditions

In the University of Cambridge study, researchers analyzed genetic data from more than 45,000 autistic individuals in the U.S. and Europe, and behavioral data across childhood and adolescence from the U.K. and Australia. The team then linked the genetic data to the age at diagnosis, and found that the genetic profiles differed between those diagnosed with autism earlier vs. later in life, with only a modest overlap.

They also found that the average genetic profile of autism diagnosed later in life was closer to that of ADHD, and co-occurring disorders like depression and PTSD, than it was to autism diagnosed in early childhood. A lack of support in early childhood, however, may potentially increase the risk for mental health issues in the later-diagnosed group, the researchers pointed out.

“The presence of clear behavioral signs helps to facilitate diagnoses in younger children, but the umbrella of core features — social-communication differences and restricted interests and repetitive behaviors — can be more subtle and look different by age, sex, and sociocultural context,” says Gloria T. Han, Ph.D., assistant professor in the Department of Anesthesiology, Division of Pain Medicine, at Vanderbilt University Medical Center.

She says the Cambridge University study helps explain why some individuals, including females, children without language delays, and those who are highly verbal, are often identified later — sometimes after ADHD, anxiety, or other mood concerns are diagnosed. She says autism can be missed or overshadowed when differences in attention, executive functioning, or social difficulties are attributed only to ADHD or social anxiety.

Cambridge University’s Warrier summed up his research: “For the first time, we have found that earlier- and later-diagnosed autism have different underlying biological and developmental profiles. An important next step will be to understand the complex interaction between genetics and social factors that lead to poorer mental health outcomes among later-diagnosed autistic individuals.”

Carole Fleck is Editor-in-Chief at ADDitude magazine.

Sources

¹Zhang, X., Grove, J., Gu, Y., Buus, C. K., Nielsen, L. K., Neufeld, S. A., Koko, M., Malawsky, D. S., Wade, E. M., Verhoef, E., Gui, A., Hegemann, L., Geschwind, D. H., Wray, N. R., Havdahl, A., Ronald, A., St Pourcain, B., Robinson, E. B., Bourgeron, T., Warrier, V. (2025). Polygenic and developmental profiles of autism differ by age at diagnosis. Nature. https://doi.org/10.1038/s41586-025-09542-6

²Litman, A., Sauerwald, N., Green Snyder, L. et al. Decomposition of phenotypic heterogeneity in autism reveals underlying genetic programs. Nat Genet 57, 1611–1619 (2025). https://doi.org/10.1038/s41588-025-02224-z

Among autistic and ADHD children, the risk of developing comorbid depression or anxiety in adulthood is driven largely by emotional exposures in childhood and how intensely they are experienced, suggests a new study published in the Journal of Child Psychology and Psychiatry.¹ In other words, it’s not the ADHD and autistic traits alone that increase the risk for comorbidities, but the emotional load and regulation problems that often come with trauma.

The study found that emotional burden (EB) and emotional regulation difficulty (ERD) independently predicted higher rates of depression or anxiety in autistic youth with and without ADHD, as well as among teens with ADHD alone. Adolescents within these groups also experienced greater frequency and intensity of common upsetting events (CUEs) and substantially higher overall EB, especially during unstructured or socially complex situations at school, compared to their neurotypical peers. The frequency and intensity of CUEs, and higher EB, were uniquely associated with depression or anxiety.

The researchers identified distinctive sets of CUEs with discriminating burden among the ADHD, autistic, and ADHD-autistic groups.

ADHD-Autistic Group: Burdensome CUEs

• last-minute change of plans
• not allowed self-regulation strategies
• being rushed to move on from task to task

ADHD Group: Burdensome CUEs

• teachers don’t listen
• boring lessons or tasks
• stopped from doing something enjoyable
• losing and forgetting things
• being told to try harder
• being unfairly accused of something

Autistic Group: Burdensome CUEs

• peer gossip
• unexpected wait in a queue
• sensory discomfort
• being rushed to complete work
• not understanding others

Lowering stressors and emotional triggers, the researchers suggest, may be just as important as learning emotion regulation skills.

“The concept of induced EB has the potential to expand, or even to shift, the focus of emotion-related interventions from attempts to reduce ERD within an individual through emotion regulation training alone to ones that incorporate EB reduction — by decreasing CUEs and/or improving ways such provocations might be managed to ameliorate the intensity of emotional reactions they induce,” the researchers wrote.

How Autistic and ADHD Traits Relate to Emotional Burden

The study also revealed that autistic adolescents with ADHD appeared to experience only the same level of burden as those with ADHD or autism alone, rather than the conditions acting additively. “This was a surprising finding, which needs to be replicated in future studies,” the researchers wrote.

One possibility is that there exists a ‘ceiling’ in emotional burden experienced by neurodivergent individuals. “Another possibility,” the researchers wrote, “is that the co-occurrence of ADHD and autism leads to the former cancelling out the latter effect and vice-versa, leading to each contributing to a smaller proportion of emotional burden than each condition alone.”

More longitudinal studies are needed to explore how EB and ERD relate to depression and anxiety in ADHD and/or autistic individuals.

“EB could add significant power to explain the emergence of mental health problems in adolescents with ADHD and/or autism, over and above more traditional measures of emotion dysregulation,” the researchers wrote.

By adulthood, about half of autistic people and 30% of those with ADHD will have a clinical depression and/or anxiety diagnosis. ², ³

“Understanding — not undermining — the lived experiences of those who live with ADHD and/or autism is critical,” explained Karen Saporito, Ph.D., in the ADDitude webinar “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD.” “The experiences, traits, symptoms, and challenges of our patients do not always align with textbook definitions and available research findings, and firsthand accounts can offer a more accurate and comprehensive understanding of these conditions… When patients feel heard and respected, they are more likely to engage in their care and advocate for themselves, leading to better outcomes.”

Sources

¹Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Wyatt, A., Funnell, E., Pavlopoulou, G., Baker, S., Stahl, D., & Sonuga-Barke, E. Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co-produced self-report measure. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.70003

²Dow, D., Morgan, L., Hooker, J.L., Michaels, M.S., Joiner, T.E., Woods, J., & Wetherby, A.M. (2021). Anxiety, depression, and the interpersonal theory of suicide in a community sample of adults with autism spectrum disorder. Archives of Suicide Research.

³Wilens, T., Nierenberg, A.A., Rostain, A., & Spencer, T.J. (2008). Adult attention-deficit hyperactivity disorder and the role of depression. CNS Spectrums.

November 24, 2025

U.S. Health and Human Services Secretary Robert F. Kennedy, Jr., has never attended medical school. He has no prior experience in formulating public health policy and no training in neurodevelopmental disorders. His opinions on the causes of autism have no basis in science and have drawn widespread criticism from medical and public health experts for their inaccuracies.

And Kennedy was wrong last week to order the U.S. Centers for Disease Control and Prevention (CDC) to change its website guidance on autism and vaccines. It now claims, without credible evidence, that “scientific studies have not ruled out the possibility that infant vaccines contribute to the development of autism,” an alarming reversal of the CDC’s longstanding position based on decades of research.

The American Academy of Pediatrics, along with 40 other medical, health, and patient advocate groups, responded immediately with a letter chastising the CDC for “promoting the outdated, disproven idea that vaccines cause autism.” For the last 25 years, dozens of rigorous, large-scale studies have found no evidence of an association between childhood vaccines and autism.^{1, 2, 3} These include a large-scale Danish study, published in the New England Journal of Medicine, which involved more than 537,000 participants (all the children born in Denmark over a seven-year period)⁴ as well as a meta-analysis involving cohort and case-control studies and more than 1.2 million children.⁵

[News: Anti-Vaccine Activist David Geier (Not a Doctor) Heads HHS Study on Vaccines and Autism Despite Past Censure]

“There is no link between autism and vaccines,” wrote the Autism Science Foundation on its website last Thursday. “This is consistent across multiple studies, repeated in different countries around the world, with different individuals, at different ages including infancy, and using different model systems. In addition, we know that some biological features of autism can be found prenatally, before any vaccines are administered.”

We know that autism is a highly heritable neurodevelopmental disorder. More than 100 genes have been associated with the condition, but experts agree that genetics and environmental factors likely both contribute. Controlling for a host of potentially confounding factors — including a high comorbidity rate with ADHD^{6, 7} — is critical in uncovering causes of autism, and it is difficult to accomplish.

Meanwhile, untrained and unqualified individuals continue to mistake association with causality when reviewing research studies on autism. For example, President Donald Trump recently claimed that a mother’s Tylenol use in pregnancy causes autism in her offspring, citing a study, co-authored by a Harvard epidemiologist, that found a small association between use of acetaminophen during pregnancy and risk of autism in children. This association, however, was not shown to be causal, a fact explicitly stated by the lead author of the review, Diddier Prada, M.D., Ph.D., assistant professor at the Icahn School of Medicine at Mount Sinai.

“We show that acetaminophen is associated with a higher risk, but not causing it. Those are very different things,” Prada said in an interview with The Washington Post.

[Tylenol and Autism Are Not Causally Linked, Researchers Confirm]

These false claims about autism, published on the CDC website and broadcast at White House press conferences, have an immediate and profoundly negative impact on autistic people and their loved ones. The damage being done is not theoretical. It is real, it is measurable, and our readers are telling us about it right now. Here are some of their stories.

“Both my kids, 14 and 16, are autistic. My daughter came home from school crying shortly after the absurd proclamation. She was insistent that I have all references to autism and ADHD stricken from her school and medical records. The more she cried and talked, the clearer the picture became. She was worried that the Trump administration was creating a list of kids with autism, like her and her brother, so they could be rounded up and put into concentration camps. It took a couple of normalizing hours of conversation for her to calm down. As a parent, when you need to hold your 16-year-old until they stop quaking because of something said by the leader of our country, I get closer to the decision that our family needs to leave the U.S. While I consoled my daughter, I went through the gamut of emotions with anger and fear the predominant ones.”

“We live in Ireland, and even here my autistic child was affected. He asked me, as his mother, ‘Did you do this to me? Did you take a drug that caused my autism?’ He was emotionally dysregulated for days, and very angry toward me as everyone in school was discussing it.”

“My 8-year-old autistic son was watching a news story about the Tylenol-autism claims. He looked at me and said, ‘Wait, I’m autistic. Do I have a disease?’ I affirmed him the same way I always do when he struggles with one of his diagnoses, telling him he is a gift from God to us.”

“My son did have questions, as he is 14, and we didn’t get the diagnosis until he was 13. I felt relieved that I didn’t take Tylenol with his pregnancy, and I did with my other two pregnancies. The other two children are not diagnosed with ASD. I don’t think that the statements made by Kennedy and Trump are sound, but that speaks to the fact that mother shaming still exists when children have disabilities. I am a school counselor and I know better, and it is disheartening to think this still goes on. My son was happy I didn’t take Tylenol, however, he was open to me explaining how studies and research works.”

“Our child is a voracious consumer of science and political videos, plus the autistic kids at her school have a loosely connected network for mutual support. They are smart kids. They just laughed at the stupidity of the pronouncement.”

“This is my AuDHD daughter’s course of study, so she understands the flawed conflation of causation and correlation. It has been more difficult to speak with relatives about it, especially those who are taking this information at face value. Mostly, I have given up trying to change their minds, but am more vocal with the younger relatives who may become pregnant or have a significant other who may become pregnant on the importance of treating high fever during pregnancy.”

“We’ve had very animated conversations about this. We are both outraged by this and find it difficult to fathom how someone running a country can say such wildly inaccurate things without any evidence.”

Anni Layne Rodgers is General Manager at ADDitude.

Sources

¹Uchiyama T, Kurosawa M, Inaba Y. MMR-vaccine and regression in autism spectrum disorders: negative results presente from Japan. J Autism Dev Disord 2007;37:210-217.

²Jain A, Marshall J, Buikema A, et al. Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA 2015;313(15):1534-1540.

³Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism. Ann Int Med 2019

⁴Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med 2002;347(19):1477-1482.

⁵Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine 2014;32:3623-3629.

⁶Hours C, Recasens C, Baleyte JM. ASD and ADHD Comorbidity: What Are We Talking About? Front Psychiatry. 2022 Feb 28;13:837424. doi: 10.3389/fpsyt.2022.837424. PMID: 35295773; PMCID: PMC8918663.

⁷Ying Rong, Chang-Jiang Yang, Ye Jin, Yue Wang, Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis. Research in Autism Spectrum Disorders. 2021 May 83: 101759. ISSN 1750-9467, https://doi.org/10.1016/j.rasd.2021.101759

When ADHD exists alongside autism, obsessive compulsive disorder (OCD), or other conditions, opposing symptoms often wrestle for dominance.

One of my autistic clients with ADHD described it as a battle inside his brain. His ADHD craves novelty to stay engaged, but his autism needs routine and structure to think clearly. Another client said her ADHD causes messes and impulsivity, while her OCD scrambles to clean them up. Both conditions invite intrusive thoughts and relentless analysis.

To help clients respond to these internal conflicts, I help them develop metaphors to describe the warring parts of themselves. This begins by imagining internal characters that represent the different drives or voices within their minds.

[Get Answers: Try ADDitude’s Comprehensive Symptom Checker]

One client imagines his mind as a spacecraft. At the controls is The Professor, representing his autism traits. This logical, emotionally neutral figure thrives on systems and predictability. Also on board is Captain Jack, modeled after the Pirates of the Caribbean character, representing ADHD – impulsive, fun-loving, distractible, and prone to chaos.

The Professor likes order. Captain Jack wants freedom. Their constant conflict once felt unbearable; now, the client sees it as a negotiation. By giving inner experiences distinct named personalities, clients externalize their struggles and reduce feelings of shame. Instead of being overwhelmed by contradictory thoughts and emotions, they begin to identify a cast of characters – each with its own point of view, clear motive, and pressing need. Thinking in metaphors offers enough distance to observe with compassion, curiosity, and even humor.

A client with OCD named her intrusive thought pattern The Spy, a stealthy infiltrator who sows doubt and anxiety. “What if you’re wrong or missed something?” By characterizing her OCD as a saboteur, she could begin to separate its voice from her own and respond with a strategy.

Not all parts of ourselves deserve equal airtime. ADHD and autism traits often need support and boundaries, but they also bring strengths – creativity, depth, and passion. The facets of our identity benefit from understanding, not erasure. OCD, by contrast, thrives on fear and distortion. It must be called out and silenced, not engaged in negotiation.

[[Self Test: Autism Tests for Adults]

Sometimes, a new character emerges: The Mediator. This figure might be modeled after a therapist, coach, teacher, or an idealized version of the client. The Mediator helps The Professor feel heard, helps Captain Jack stay grounded, and reminds everyone that The Spy is not trustworthy. The Mediator becomes the captain of the ship.

And that’s the goal of this metaphor method: to help individuals hear all the voices, but choose which ones to follow and which to send packing.

ADHD with Autism, Neurodivergent Traits: Next Steps

• Read: AuDHD Signs, Diagnosis & Interventions
• Q&A:Treating Comorbid Considerations Alongside ADHD
• Free Resource: 9 Conditions Linked to ADHD

Tamar Rosier, Ph.D., is the founder of the ADHD Center of West Michigan.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Autism diagnosed in early childhood is genetically distinct from autism diagnosed after age 10, according to a new study that identified two unique genetic profiles in early- and later-diagnosed autistic individuals. The study, published in Nature, found that later-diagnosed autism had a more significant genetic correlation to ADHD, as well as mental health conditions including depression and post-traumatic stress disorder (PTSD). This research challenges the assumption that autism is one single condition and highlights the heterogeneity of its causes, comorbidities, and manifestations.¹

The international study, led by a team of researchers from the University of Cambridge, reveals that the average genetic profile of an autistic individual diagnosed later in life is closer to that of someone with ADHD than it is to an autistic person diagnosed in early childhood.

The research found that children diagnosed with autism before age 6 were more likely to present with behavioral difficulties, such as problems with social interactions, that stabilized over time. However, individuals diagnosed with autism after age 10 experience worsening social and behavioral difficulties during adolescence, and they are more likely to merit an ADHD diagnosis as well.

“The term ‘autism’ likely describes multiple conditions,” said senior author Varun Warrier, Ph.D., an associate professor of psychiatry and psychology at the University of Cambridge. “For the first time, we have found that earlier and later diagnosed autism have different underlying biological and developmental profiles.”

“Some of the genetic influences predispose people to show easily identified autism traits from a very young age, leading to an earlier diagnosis,” Warrier continued. “For others, genetic influences may alter which autism features emerge and when. Some of these children may have features that parents or caregivers do not pick up until they cause significant distress in late childhood or adolescence.”

Higher genetic correlations between later-diagnosed autism and other mental-health conditions may contribute to the misdiagnosis or diagnostic overshadowing (where a co-occurring mental-health condition delays an autism diagnosis) in adolescents and adults.

For the study, researchers analyzed behavioral data from the United Kingdom and Australia, and genetic data from more than 45,000 autistic individuals across several large cohorts in Europe and the United States. They based the two different genetic profiles and trajectories on common heritable polygenic factors, which are sets of thousands of genetic variants that can collectively shape particular traits. These polygenic factors explain around 11% of the variation in age at autism diagnosis.

“Understanding how the features of autism emerge not just in early childhood but later in childhood and adolescence could help us recognize, diagnose, and support autistic people of all ages,” the researchers wrote.

The researchers underscore that diagnosing autism is immensely complex, with access to health care, stigma, gender bias, and other factors affecting when and who receives a diagnosis.

“An important next step will be to understand the complex interaction between genetics and social factors that lead to poorer mental health outcomes among later-diagnosed autistic individuals,” Warrier says.

Autism Misinformation

In April 2025, Health and Human Services Secretary Robert F. Kennedy, Jr., said, “By September, we will know what has caused the autism epidemic and we’ll be able to eliminate those exposures.” Though his division of Health and Human Services conducted no new research on autism and consulted few, if any, experts on the condition in 2025, Kennedy and President Trump announced that the use of acetaminophen — the active ingredient in Tylenol and many cold and flu medications — during pregnancy increases the risk of autism, despite evidence to the contrary.²

“There is no scientific evidence supporting a causal link between prenatal acetaminophen use and autism,” said Gloria Han, Ph.D., assistant professor at Vanderbilt University Medical Center. “Observational studies have reported correlations, but larger sibling-comparison studies suggest these associations are likely confounded by genetic or familial factors rather than a direct effect of acetaminophen.”

Sources

¹Zhang, X., Grove, J., Gu, Y., Buus, C. K., Nielsen, L. K., Neufeld, S. A., Koko, M., Malawsky, D. S., Wade, E. M., Verhoef, E., Gui, A., Hegemann, L., Geschwind, D. H., Wray, N. R., Havdahl, A., Ronald, A., St Pourcain, B., Robinson, E. B., Bourgeron, T., Warrier, V. (2025). Polygenic and developmental profiles of autism differ by age at diagnosis. Nature. https://doi.org/10.1038/s41586-025-09542-6

²Ahlqvist, V.H., Sjöqvist, H., Dalman, C., et al. (2024) Acetaminophen use during pregnancy and children’s risk of autism, ADHD, and intellectual disability. JAMA. https://doi.org/10.1001/jama.2024.3172

Yesterday, President Donald Trump carelessly advised that pregnant people should avoid Tylenol (acetaminophen), suggesting it causes autism. As an autistic, ADHD parent and social scientist, I can say plainly: this isn’t science; it’s fear-mongering. It revives mother-blaming myths, weaponizes uncertainty, and treats autistic existence as something to prevent rather than accept.

What the Evidence Actually Shows

The scientific record does not support a causal link between prenatal acetaminophen use and autism. Some observational studies report small associations — slightly higher rates of autism or ADHD in children whose mothers used acetaminophen during pregnancy — while others find no link. Associations aren’t causation, and these studies are limited by confounding and measurement problems that Trump and others in his administration didn’t mention in their press conference, which has been widely criticized.

A stronger test comes from sibling-comparison research. In a large 2024 Swedish study¹, researchers compared brothers and sisters born to the same mother when she used acetaminophen in one pregnancy and not another. If acetaminophen truly caused autism, the exposed children should show higher autism rates than their unexposed siblings. They didn’t. Once you hold family factors constant — shared genetics, home environment, maternal health — the supposed link disappears. That tells us that the small associations in simpler studies are likely explained by family-level factors (like genetics, infections, or maternal conditions) rather than acetaminophen itself. Claims that Tylenol “causes” autism ignore this stronger evidence.

[Research: Tylenol Use Is Safe During Pregnancy]

The Old Pattern of Blaming Mothers

Blaming pregnant people for autism continues a well-documented pattern of pinning differences on maternal failings. Mid-20th-century theories accused “refrigerator mothers” of causing autism and “schizophrenogenic mothers” of causing mental disorders in children. Those ideas did real harm — and they were wrong. The Tylenol scare repeats the pattern with new props.

This narrative loads families with guilt and second-guessing, fuels anxiety and depression, and can worsen perinatal mood disorders. It also discourages care: Some parents may avoid needed pain relief for their children, and some pregnant people may forgo safe, indicated treatment because they fear being blamed for lifelong outcomes. Maternal blame doesn’t support health; it undermines it.

Autism Is Human Diversity, Not a Defect

Efforts to hunt for single preventable causes — and to attempt to police pregnant people’s behavior — assume autism is a problem to eliminate. It isn’t. Autism is a heritable, lifelong form of human variation. Treating it as pathology invites stigma, casts autistic people as mistakes to be avoided, and revives eugenic thinking. It also distorts policy priorities: funds and attention shift from access, supports, and accommodations toward “prevention” or pressuring autistic people to mask or pass.

The practical alternative is clear: respect autistic ways of being; invest in communication and sensory supports; expand inclusive schooling and healthcare; and measure success by quality of life, not by reducing the number of autistic people.

[Read: “Rising ADHD and Autism Rates Reflect Education — Not a Crisis”]

What Responsible Communication Looks Like

This administration owes the public both accuracy and humility. Responsible communication distinguishes association from causation; explains uncertainty; avoids single-factor stories about complex traits; and centers the people most affected — in this case, autistic people and pregnant people. It resists the urge to make sweeping behavioral edicts based on contested findings. And it keeps the focus on what helps: access to prenatal care, evidence-based guidance from clinicians, and robust supports for autistic children and adults across the lifespan.

The Cost of Moving the Goalposts

But by asserting that acetaminophen use in pregnancy causes autism, the President shifts public focus toward prevention and surveillance of pregnant people rather than acceptance and support for autistic people. That move has a price. It diverts attention and resources to unhelpful causes and spreads avoidable fear — fear that lands hardest on those with the least margin for error, the least access to care, and the most to lose from stigma.

Autism is human diversity, not a defect. Policymakers should focus on what matters: not finding the “answer” to a complex neurotype like autism, not blaming mothers, but making autistic lives easier, safer, and freer.

Autism and Neurodiversity: Next Steps

• Read: “RFK, Jr., Is Spreading a Dangerous, Ignorant Myth About Autism”
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: MAHA Commission Draws Swift Criticism, Condemnation

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Sources

¹Ahlqvist, V. H., Sjöqvist, H., Dalman, C., Karlsson, H., Stephansson, O., Johansson, S., Magnusson, C., Gardner, R. M., & Lee, B. K. (2024). Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. JAMA, 331(14), 1205–1214. https://doi.org/10.1001/jama.2024.3172