Embracing the Tapestry

A Comprehensive Guide to Understanding and Supporting Girls with AuDHD

1. Introduction: A New Paradigm for Understanding Your Child's Brain

The conventional approach to neurological differences, often referred to as the medical model, has long viewed conditions such as autism and Attention-Deficit/Hyperactivity Disorder (ADHD) as disorders to be corrected or cured. This perspective frames an individual's neurotype as a deficit or pathology, focusing primarily on what is "wrong" and how to remediate it.

This report is predicated on an alternative, evidence-based framework known as the neurodiversity paradigm. This paradigm does not deny that neurodivergence can present significant challenges, but it reframes these differences as a natural and valuable form of human variation, similar to other forms of human diversity like ethnicity or culture [1]. From this vantage point, the goal shifts from making a person "normal" or "indistinguishable from their peers" to creating an environment where they can thrive as their authentic self [2].

The neurodiversity paradigm is a framework and a sociopolitical movement that originated from the disability rights movement [1]. Its core tenet is that neurological differences are not inherently pathological. Instead, it posits that disability often arises from a mismatch between an individual's neurotype and their environment [3]. This is often referred to as the social model of disability, which directly contrasts with the medical model by arguing that societal barriers, not an individual's neurobiology, are the primary cause of a person's challenges [1]. For instance, a child's struggles may not stem from their neurobiology but rather from a social and educational system built exclusively for neurotypical people.

Embracing this perspective means acknowledging that all brains are unique and that the neurodivergent community—which includes those with autism, ADHD, dyslexia, and Tourette's, among others—is a legitimate and valuable minority group [2]. The mindset behind the language used is crucial; this approach encourages professionals and families to be mindful of neurodiversity-affirming language and to prioritise approaches that honour an individual's identity, rather than trying to "fix" them [1]. The term "neuronormativity" is often used to describe the societal bias that assumes a single "normal" way of thinking and functioning, which is a primary driver of the pressure to conform and mask natural behaviours [4].

Another crucial element of this paradigm is understanding the "Double Empathy Problem," a theory coined by autistic researcher Damian Milton that challenges the long-held belief that autistic individuals lack empathy. Instead, the theory posits that communication difficulties are a two-way street, a "disjuncture in reciprocity" that occurs between people with different neurotypes [5]. The breakdown in communication is not a deficit in the autistic person, but a mutual misunderstanding that stems from differing cognitive and communication styles [6]. For example, autistic people may use a more direct and literal communication style, while non-autistic people rely on social nuances, metaphor, and body language [5]. This reciprocal gap in understanding means that non-autistic individuals often struggle to interpret autistic communication, and vice versa [6]. Research suggests that when autistic people communicate with other autistic people, they do so as effectively as neurotypical people communicating with each other [5]. This reframing of the problem is fundamental to neuro-affirming support, as it shifts the responsibility from "fixing" the neurodivergent individual to bridging a shared gap [6].

term AuDHD refers to the co-occurrence of both autism and ADHD, a combination previously disallowed under the Diagnostic and Statistical Manual of Mental Disorders (DSM) but now formally recognised in the DSM-5. This co-occurrence is increasingly recognised as common, with recent large-scale studies showing significant overlap between autism and ADHD traits in both children and adults [7,8]. Research indicates that this combination presents unique challenges and strengths, particularly for girls and women who may experience different presentations than their male counterparts [9].

2. Understanding AuDHD: The Intersection of Autism and ADHD

The Science Behind AuDHD

The co-occurrence of autism and ADHD has been the subject of extensive research in recent years. Large-scale empirical studies have revealed substantial overlap in traits and characteristics between the two conditions [7]. Population-based research indicates that the prevalence of this co-occurrence is higher than previously thought, with significant implications for diagnosis and support [8].

The neurobiological underpinnings of AuDHD are complex and multifaceted. Research suggests that individuals with both conditions may experience unique cognitive profiles that differ from those with either autism or ADHD alone [15]. This intersection creates a distinct neurodivergent profile that requires specialised understanding and support approaches.

Gender Differences in AuDHD Presentation

Recent research has highlighted significant gender differences in how AuDHD presents, particularly in girls and women [9,16]. Traditional diagnostic criteria were developed primarily based on observations of boys and men, leading to systematic underdiagnosis of girls and women with these conditions [2].

Girls with AuDHD often present with:

• More internalised symptoms and emotional regulation difficulties

• Better developed social mimicry skills that mask underlying challenges

• Different patterns of special interests that may appear more socially acceptable

• Higher rates of anxiety, depression, and eating disorders as secondary conditions [9,16]

The lived experiences of women diagnosed with AuDHD in adulthood reveal the profound impact of late diagnosis and the challenges of navigating systems not designed for their needs [17]. These experiences highlight the importance of developing more inclusive diagnostic practices and support systems.

3. The Hidden Struggles: Masking and Camouflaging

Understanding Masking behaviours

One of the most significant factors contributing to the underdiagnosis of autism and ADHD in girls is the phenomenon of masking or camouflaging. This refers to the conscious or unconscious strategies used to hide neurodivergent traits to fit in with neurotypical expectations [10,11]. Research has consistently shown that girls and women are more likely to engage in camouflaging behaviours than boys and men [12,13].

Systematic reviews have identified the "camouflage hypothesis" as a key factor in explaining why autism spectrum disorder is often missed in girls [12]. The female autism phenotype, characterised by different presentations and coping strategies, has been extensively documented in the literature [11].

Components of Camouflaging

Research has identified several key components of camouflaging behaviours [10]:

Masking: Actively suppressing or hiding autistic behaviours and traits in social situations 

Compensation: Developing alternative strategies to manage social and communication challenges

Assimilation: Actively trying to fit in by copying others' behaviours and social scripts

These behaviours can include:

• Mimicking social behaviours observed in others

• Suppressing stimming behaviours in public

• Creating scripts for social interactions

• Forcing eye contact despite discomfort

• Masking special interests or discussing only socially acceptable topics [10,11]

The Cost of Masking

While masking may help girls navigate social situations in the short term, research indicates it can lead to significant mental health consequences, including increased anxiety, depression, and autistic burnout [12]. The energy required to maintain this facade can be exhausting and unsustainable [13]. 

Validation studies comparing different measures of camouflaging have confirmed these patterns and their associated costs [13].

4. Strengths-Based Approaches: Celebrating Neurodivergent Abilities

Moving Beyond Deficit Models

Contemporary research emphasises the importance of strengths-based approaches when working with neurodivergent individuals [1,2]. This perspective recognises that autism and ADHD come with inherent strengths and abilities that should be celebrated and nurtured rather than suppressed.

Research on intersectionality in neurodevelopmental disorders highlights the importance of considering multiple identities and strengths when developing therapeutic approaches and interventions [15]. This holistic view acknowledges that individuals with AuDHD bring unique perspectives and capabilities to their communities.

Autism-Associated Strengths

Research has identified numerous strengths commonly associated with autism:

• Enhanced attention to detail and pattern recognition

• Systematic and logical thinking approaches

• Honesty and direct communication styles

• Deep expertise in areas of special interest

• Strong sense of justice and fairness

• Innovative problem-solving abilities [15]

ADHD-Associated Strengths

Similarly, research has documented positive characteristics associated with ADHD:

• Enhanced creativity and divergent thinking

• High energy and enthusiasm for preferred activities

• Ability to hyperfocus on engaging tasks

• Resilience and adaptability in changing situations

• Strong crisis management and problem-solving skills

• Entrepreneurial thinking and risk-taking abilities [15]

The AuDHD Advantage

For individuals with AuDHD, these strengths can combine in unique and powerful ways, creating individuals who are both detail-oriented and creative, systematic yet adaptable [7,8]. 

Research suggests that understanding and leveraging these combined strengths is crucial for developing effective support strategies.

5. Creating Neurodiversity-Affirming Environments

Principles of Neurodiversity-Affirming Practice

Creating truly inclusive environments requires a fundamental shift in how we conceptualise and respond to neurological differences [2]. 

Neurodiversity-affirming practice is grounded in several key principles:

Presuming Competence: Assuming that all individuals have inherent worth and capability

Honoring Autonomy: Respecting individuals' right to make choices about their own lives

Celebrating Difference: Viewing neurological diversity as natural and valuable

Addressing Barriers: Focusing on environmental and systemic changes rather than trying to "fix" individuals

Centering Lived Experience: Prioritising the voices and experiences of neurodivergent individuals themselves [1,2]

Educational Environments

Research supports the implementation of neurodiversity-affirming practices in educational settings [2]. This includes:

Flexible Learning Approaches: Accommodating different learning styles and processing speeds 

Sensory-Friendly Environments: Creating spaces that consider sensory needs and preferences

Strengths-Based Planning: Developing educational plans that build on individual interests and abilities 

Neurodiversity Education: Teaching all students about neurological diversity to promote understanding and acceptance 

Collaborative Support: Working with families and neurodivergent individuals to develop appropriate accommodations [2]

Family Environments

Creating neurodiversity-affirming family environments involves several key elements:

Language Choices: Using respectful, person-first or identity-first language based on individual preferences 

Celebration of Differences: Recognising and celebrating neurodivergent traits as part of family identity 

Emotional Support: Providing validation and understanding for the unique challenges faced 

Community Connection: Linking with other neurodivergent families and supportive communities 

Advocacy Skills: Developing skills to advocate for appropriate supports and accommodations [17]

Healthcare and Professional Settings

Healthcare providers and other professionals play a crucial role in creating affirming environments [2]. 

This requires:

Training in Neurodiversity: Understanding neurodiversity paradigms and their implications for practice 

Collaborative Assessment: Involving individuals and families as partners in assessment and planning processes 

Strengths-Based Interventions: Focusing on building skills and supports rather than eliminating differences 

Trauma-Informed Care: Recognising the potential impact of previous negative experiences with services 

Cultural Competence: Understanding how neurodiversity intersects with other aspects of identity [2]

6. Diagnostic Considerations and Gender Equity

Moving Toward Equitable Diagnosis

Research has highlighted significant disparities in autism and ADHD diagnosis across genders, with girls and women historically underdiagnosed or misdiagnosed [2]. 

Contemporary approaches emphasise the need for more equitable diagnostic practices that account for gender differences in presentation.

Key considerations for equitable diagnosis include:

Updated Diagnostic Criteria: Ensuring that criteria reflect the full range of presentations across genders

Clinician Training: Educating professionals about gender differences in autism and ADHD presentation

Cultural Considerations: Understanding how cultural factors may influence symptom expression and help-seeking 

Intersectional Approaches: Considering how multiple identities (gender, race, class, sexuality) may impact presentation and access to services [2]

The Importance of Lived Experience Research

Recent qualitative research examining the lived experiences of women with AuDHD has provided crucial insights into the diagnostic process and its impact [9,16,17]. These studies highlight:

• The relief and validation that comes with accurate diagnosis

• The challenges of navigating systems not designed for their needs

• The importance of peer support and community connection

• The ongoing need for advocacy and systemic change

This research emphasises that the voices and experiences of neurodivergent individuals themselves must be centered in efforts to improve diagnostic and support practices.

7. Supporting Girls with AuDHD: Practical Strategies

Early Identification and Support

Research supports the importance of early identification and intervention for girls with AuDHD [2]. However, this must be balanced with neurodiversity-affirming approaches that focus on support rather than normalisation.

Key strategies include:

Strength-Based Assessment: Identifying and building on individual strengths and interests 

Sensory Considerations: Understanding and accommodating sensory needs and preferences 

Social Support: Providing opportunities for connection with neurodivergent peers 

Family Education: Supporting families in understanding and advocating for their children

School Collaboration: Working with educational teams to develop appropriate accommodations [2]

Adolescent and Transition Support

The adolescent years can be particularly challenging for girls with AuDHD, as social demands increase and masking behaviours may intensify [10,11]. 

Support during this period should focus on:

Identity Development: Supporting positive neurodivergent identity formation 

Masking Awareness: Helping individuals understand the costs and benefits of masking behaviours 

Mental Health Support: Addressing anxiety, depression, and other co-occurring conditions 

Transition Planning: Preparing for adult life with appropriate supports and accommodations 

Self-Advocacy Skills: Developing skills to communicate needs and preferences effectively [12,13]

Adult Support Needs

Research on adult women with AuDHD reveals ongoing support needs that extend well beyond childhood [17]. 

These include:

Workplace Accommodations: Understanding and requesting appropriate workplace supports 

Relationship Support: Navigating romantic, family, and friendship relationships 

Healthcare Navigation: Advocating for appropriate healthcare that understands neurodivergent needs

Parenting Support: For those who choose to have children, understanding how neurodivergence may impact parenting 

Community Connection: Maintaining connections with supportive neurodivergent communities [9,16,17]

8. The Role of Research and Advocacy

Participatory Research Approaches

Contemporary neurodiversity research increasingly emphasises participatory approaches that center the voices and experiences of neurodivergent individuals themselves [1]. This shift recognises that research "about us, without us" has historically perpetuated harmful stereotypes and missed crucial aspects of the neurodivergent experience.

Key principles of neurodiversity-affirming research include:

Community Partnership: Involving neurodivergent individuals as research partners, not just subjects

Strength-Based Focus: Investigating abilities, strengths, and positive outcomes rather than only deficits 

Practical Relevance: Ensuring research addresses questions that matter to the neurodivergent community 

Ethical Considerations: Prioritising the wellbeing and autonomy of research participants 

Accessible Dissemination: Sharing research findings in formats accessible to the broader community [1]

The Importance of Advocacy

Advocacy efforts by and for neurodivergent individuals have been crucial in advancing understanding and improving supports [1]. Key areas of advocacy include:

Educational Policy: Working to ensure schools provide appropriate accommodations and inclusive environments 

Healthcare Access: Advocating for healthcare providers who understand neurodivergent needs 

Employment Rights: Promoting workplace inclusion and reasonable accommodations 

Research Funding: Ensuring research priorities reflect community needs and interests 

Public Awareness: Challenging stereotypes and promoting accurate understanding of neurodivergence [1,2]

9. Future Directions and Recommendations

Research Priorities

Based on current evidence and community needs, several research priorities emerge:

Longitudinal Studies: Following girls with AuDHD over time to understand developmental trajectories and support needs

Intervention Research: Developing and testing neurodiversity-affirming interventions and supports

Intersectional Research: Understanding how neurodivergence intersects with other aspects of identity

Healthcare Research: Improving diagnostic practices and healthcare delivery for neurodivergent individuals

Workplace Research: Developing evidence-based approaches to workplace inclusion and accommodation [2,15]

Policy Recommendations

Several policy changes could significantly improve outcomes for girls and women with AuDHD:

Educational Policy: Mandate training for educators on neurodiversity and gender differences in presentation 

Healthcare Policy: Improve access to knowledgeable healthcare providers and reduce diagnostic disparities 

Employment Policy: Strengthen disability rights protections and promote inclusive hiring practices 

Research Policy: Prioritise funding for participatory, community-engaged research 

Social Policy: Address broader social determinants of health that impact neurodivergent individuals [1,2]

Building Inclusive Communities

Creating truly inclusive communities requires effort at multiple levels:

Individual Level: Developing personal understanding and advocacy skills 

Family Level: Creating supportive family environments that celebrate neurodivergence 

Community Level: Building inclusive schools, workplaces, and social spaces 

Societal Level: Challenging ableism and promoting neurodiversity acceptance [1]

10. Conclusion: Embracing the Full Spectrum

Understanding and supporting girls with AuDHD requires a fundamental shift from deficit-based medical models to neurodiversity-affirming approaches that celebrate difference and focus on creating inclusive environments. The research consistently shows that when neurodivergent individuals are supported in environments that understand and accommodate their needs, they can achieve remarkable outcomes and contribute their unique perspectives and abilities to society [1,2].

The journey toward true inclusion requires ongoing commitment from individuals, families, communities, and society as a whole. It demands that we question long-held assumptions about what is "normal" and instead embrace the beautiful tapestry of human neurological diversity.

For girls with AuDHD, this means:

• Recognising their unique strengths and challenges

• Understanding the impact of masking and providing support for authentic self-expression

• Creating educational, family, and community environments that celebrate their differences

• Ensuring access to knowledgeable healthcare providers and appropriate supports

• Centering their voices and experiences in research and advocacy efforts

The research evidence is clear: neurodiversity is a natural and valuable form of human variation. Girls with AuDHD are not broken or in need of fixing. They are unique individuals with their own strengths, challenges, and contributions to make. Our role is not to make them "normal," but to create a world where they can thrive as their authentic selves.

By embracing the neurodiversity paradigm and implementing strengths-based, affirming approaches, we can help ensure that all girls with AuDHD have the opportunity to reach their full potential and contribute their unique gifts to our communities. The tapestry of human diversity is richer and more beautiful when it includes all voices, including those of our neurodivergent daughters, sisters, and friends.

References

1. Craine, M. (2020). Changing paradigms: The emergence of the autism/neurodiversity manifesto. In Neurodiversity in Higher Education (pp. 295-308). Springer. https://doi.org/10.1007/978-981-13-8437-0_19

2. Lai, M. C., Lin, H. Y., & Ameis, S. H. (2022). Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders. Current Opinion in Psychiatry, 35(2), 90-100. https://doi.org/10.1097/yco.0000000000000770

3. Tewes, C. (2024). Reconsidering the double empathy problem: A source of exclusion and stigmatisation of autistic persons. Phenomenology and Mind, 26, 178-189. https://doi.org/10.17454/pam-2710

4. Goodman, J. W. (2025). Neurodivergence and marginalised gender - A thematic analysis of women's and gender-diverse peoples' experiences of ASD and ADHD. PsyArXiv. https://doi.org/10.31234/osf.io/wh2ns

5. Milton, D., Gurbuz, E., & Lopez, B. (2022). The 'double empathy problem': Ten years on. Autism, 26(8), 1901-1903. https://doi.org/10.1177/13623613221129123

6. Ekdahl, D. (2023). The double empathy problem and the problem of empathy: Neurodiversifying phenomenology. Disability & Society, 38(9), 1473-1493. https://doi.org/10.1080/09687599.2023.2220180

7. Waldren, L. H., Leung, F. Y., Hargitai, L. D., et al. (2024). Unpacking the overlap between autism and ADHD in adults: A multi-method approach. Cortex, 172, 120-137. https://doi.org/10.1016/j.cortex.2023.12.016

8. Canals, J., Morales‐Hidalgo, P., Voltas, N., & Hernández‐Martínez, C. (2024). Prevalence of comorbidity of autism and ADHD and associated characteristics in school population: EPINED study. Autism Research, 17(5), 943-956. https://doi.org/10.1002/aur.3146

9. Craddock, E. (2024). Raising the voices of AuDHD women and girls: Exploring the co‑occurring conditions of autism and ADHD. Disability & Society, 39(3), 456-478. https://doi.org/10.1080/09687599.2023.2299342

10. Jorgenson, C., Lewis, T. J., Rose, C. A., & Kanne, S. M. (2020). Social camouflaging in autistic and neurotypical adolescents in the general population. Journal of Autism and Developmental Disorders, 50(12), 4290-4306. https://doi.org/10.1007/s10803-020-04491-7

11. Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7(4), 306-317. https://doi.org/10.1007/s40489-020-00197-9

12. Allely, C. S. (2019). Understanding and recognising the female phenotype of autism spectrum disorder and the "camouflage" hypothesis: A systematic PRISMA review. Advances in Autism, 5(1), 24-37. https://doi.org/10.1108/AIA-09-2018-0036

13. Milner, V. L., Colvert, E., Mandy, W., & Happé, F. (2022). A comparison of self‐report and discrepancy measures of camouflaging. Autism Research, 15(12), 2294-2308. https://doi.org/10.1002/aur.2873

14. Wodka, E. L., Parish-Morris, J., et al. (2021). Co-occurring attention-deficit/hyperactivity disorder and anxiety disorders differentially affect males and females with autism. The Clinical Neuropsychologist, 36(4), 750-770. https://doi.org/10.1080/13854046.2021.1942554

15. Baladaniya, M., & Baldania, S. (2024). Intersectionality in neurodevelopmental disorders: A literature review on co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder – Examining therapeutic approaches and interventions. International Journal of Health Sciences, 18(2), 45-62. https://doi.org/10.47941/ijhs.1728

16. , E. (2024). Being a woman is 100% significant to my experiences of attention deficit hyperactivity disorder and autism: Exploring the gendered implications of an adulthood combined autism and attention deficit hyperactivity disorder diagnosis. Qualitative Health Research, 34(10), 1234-1248. https://doi.org/10.1177/10497323241253412

17. Craddock, E. (2025). Navigating residual diagnostic categories: The lived experiences of women diagnosed with autism and ADHD in adulthood. Health, 29(3), 287-305. https://doi.org/10.1177/13634593251336163