Moderate Evidence

Differential Patterns

How to distinguish between conditions with similar presentations. Understanding the underlying mechanisms helps guide support.

Why understanding differences matters

Different conditions may need different interventions
Medication that helps one condition may not help another
Understanding root causes leads to better support
Reduces trial-and-error in finding what works
Helps explain experiences to the child

Important: These comparisons are guides, not diagnostic tools. Many children have multiple conditions. Behaviours can have multiple causes. Professional assessment is needed for accurate diagnosis.

Autism vs ADHD

These conditions frequently co-occur, but distinguishing their contributions helps target support.

Difficulty with social cues

In autism

Doesn't naturally read or understand social cues; may not recognise facial expressions or tone

In ADHD

Understands social cues but may miss them due to inattention or act impulsively despite knowing better

Question to ask: Does your child understand the rule but break it, or not understand the rule at all?

Talking excessively

In autism

Monologuing about special interests; may not notice listener disengagement

In ADHD

Tangential speech; jumps topics; interrupts; difficulty waiting turn to speak

Question to ask: Is the excessive talking topic-driven (interest) or impulse-driven (can't stop)?

Difficulty with transitions

In autism

Distress at unexpected change; needs predictability; difficulty shifting mental sets

In ADHD

Hyperfocus makes stopping hard; poor time awareness; absorbed in current activity

Question to ask: Is the difficulty about unpredictability/change, or about being interrupted mid-activity?

Sensory seeking/avoiding

In autism

Consistent sensory preferences; systematic; part of regulation

In ADHD

Seeks stimulation when under-aroused; fidgeting for alertness

Question to ask: Are sensory preferences consistent, or variable depending on arousal level?

Meltdowns

In autism

Often triggered by sensory overload, unexpected change, or demands exceeding capacity

In ADHD

Often triggered by frustration, being told no, emotional overwhelm, or rejection

Question to ask: What typically triggers the meltdown? What precedes it?

Play patterns

In autism

May prefer parallel play; content alone; play may be systematic or repetitive

In ADHD

Wants to play with others but may struggle to follow rules or take turns

Question to ask: Does your child want to play with others but struggle, or prefer playing alone?

Autism vs Anxiety

Many autistic traits can look like anxiety, and vice versa. They also commonly co-occur.

Social avoidance

In autism

May not desire social interaction; content alone; social situations confusing or exhausting

In anxiety

Desires social connection but fears judgment, embarrassment, or rejection

Question to ask: Does your child avoid social situations because they're not interested, or because they're afraid?

Rigidity/routines

In autism

Routines provide predictability and comfort; intrinsic preference for sameness

In anxiety

Routines as safety behaviours; reassurance-seeking; avoidance of feared situations

Question to ask: Are routines about preference for predictability, or about avoiding feared outcomes?

Repetitive questions

In autism

May be about understanding, clarification, or enjoying the response pattern

In anxiety

Reassurance-seeking; checking; fear-driven; temporarily reduces anxiety

Question to ask: Do the questions feel like seeking information/patterns, or seeking reassurance?

Selective mutism

In autism

May not see point of social chat; communication is effortful; situational

In anxiety

Wants to speak but physically can't; freezes; fear-based

Question to ask: Does your child seem unable to speak (anxiety), or choosing not to (autism)?

School refusal

In autism

Overwhelm, sensory overload, social exhaustion, lack of understanding of implicit rules

In anxiety

Fear of separation, performance, or specific feared situations

Question to ask: What specifically does your child say or show about why school is difficult?

ADHD vs Anxiety

Both can cause restlessness, concentration difficulties, and avoidance. Understanding why helps target treatment.

Restlessness

In ADHD

Constant motor activity; fidgeting; driven by internal motor; feels good

In anxiety

Restlessness accompanies worry; muscle tension; feels uncomfortable

Question to ask: Does the restlessness feel driven (ADHD) or uncomfortable (anxiety)?

Difficulty concentrating

In ADHD

Mind wanders to other interesting things; distractible by external stimuli

In anxiety

Mind preoccupied with worries; difficulty concentrating due to rumination

Question to ask: Where does the mind go? To random things, or to worries and fears?

Sleep problems

In ADHD

Racing mind, not tired, delayed sleep phase; body not ready for sleep

In anxiety

Can't sleep due to worry; nightmares; waking with anxious thoughts

Question to ask: What keeps your child awake? Energy/ideas, or worries/fears?

Avoidance of tasks

In ADHD

Avoids boring, unstimulating tasks; seeks more interesting activities

In anxiety

Avoids tasks due to fear of failure, judgment, or getting it wrong

Question to ask: Is the avoidance about boredom/disinterest, or about fear of outcomes?

Irritability

In ADHD

Frustration with demands, interruptions, or not getting needs met

In anxiety

Irritability as anxiety symptom; feeling on edge; easily startled

Question to ask: Is irritability triggered by demands/frustration, or present more generally?

Both (or all) can be true

Conditions commonly co-occur. You don't always have to choose.

Autism + Anxiety

Anxiety is extremely common in autism (up to 40-50%). Navigating a confusing world creates genuine anxiety. Both may need addressing.

ADHD + Anxiety

Anxiety is common in ADHD (about 25-50%). Years of criticism, failure, and unpredictability can create genuine anxiety.

Autism + ADHD

50-70% of autistic people also have ADHD. They're distinct conditions that frequently co-occur.

All three

Some children have autism, ADHD, AND anxiety. Each needs to be understood and addressed.

Helpful questions to consider

Social differences

Do they understand social rules but break them, or not understand them?
Do they want friends but struggle, or prefer being alone?
Are social difficulties consistent or situational?

Attention and focus

Can they focus well on preferred activities?
Is the difficulty with starting, maintaining, or switching focus?
Does their attention improve in high-stimulation settings?

Rigidity and routines

Are routines about preference or about avoiding feared outcomes?
How does your child respond to pleasant surprises vs unpleasant ones?
Is flexibility difficult in all areas or specific ones?

Emotional regulation

What typically triggers emotional overwhelm?
How does your child express anxiety vs frustration vs overwhelm?
What helps them regulate?

Developmental history

Were there differences in early development (speech, play, motor)?
When did concerns first emerge?
Have difficulties been consistent or emerged at a specific point?

Red flags to consider

Presentation changed suddenly

Consider: Trauma, medical issue, environmental change, or masked condition emerging

Only shows difficulties at school

Consider: School-specific factors, masking at home, or school-specific demands

Only shows difficulties at home

Consider: Masking at school, different demands, or home-specific factors

Doesn't fit any category neatly

Consider: Co-occurring conditions, atypical presentation, or need for specialist assessment

The key insight

The same behaviour can have different causes. Understanding why a child shows a particular difficulty - not just that they show it - is essential for effective support. A child who avoids tasks due to boredom needs different help than one who avoids tasks due to fear of failure. Both might look like "avoidance" but require different interventions.

Continue learning

Autism + ADHD Lookalikes Diagnosis Pathways