April is National Autism Awareness Month, a time to highlight not only awareness but also understanding and compassion for the lived experiences of those on the autism spectrum. One area of increasing focus is the significant overlap between Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). While each of these conditions is distinct, they often coexist in ways that shape how children experience the world, interact with others, and navigate daily life.
At Palo Alto Therapy, we recognize how overwhelming it can be to parent a child whose traits span across multiple neurodevelopmental profiles. It can also be extremely rewarding and joyful in surprising ways. We want to share a little bit about intersection of ASD and ADHD as it relates to therapy so that families can feel more equipped, less isolated, and better supported.
Our Palo Alto, Menlo Park and San Jose therapists can help.
Contact us today for an appointment.
Understanding Autism Spectrum Disorder (ASD)
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how individuals perceive, interact with, and respond to the world around them. While it is often associated with challenges in social communication, restricted interests, and sensory sensitivities, autism is also a reflection of neurodiversity, meaning that it is a comprehensive way of thinking and processing rather than a singular diagnosis that fits neatly into a box.
A Brief History of Autism Diagnosis
The term “autism” was first introduced in the early 20th century, though it originally referred to a symptom of schizophrenia rather than a separate condition. In the 1940s, researchers such as Leo Kanner in the United States and Hans Asperger in Austria began identifying children with distinct developmental patterns that differed from those with intellectual disabilities or psychosis. Over time, the field began to recognize autism as its own category, distinct from other mental health or developmental conditions.
In the decades that followed, our understanding of autism expanded significantly. Earlier views focused on severe cases involving nonverbal communication and intellectual disability. More recently, however, researchers and clinicians have come to appreciate the wide range of abilities and presentations within the autism spectrum. This shift helped lead to the adoption of the term “Autism Spectrum Disorder” in 2013 under the DSM-5, which replaced earlier subcategories like Asperger’s Syndrome and Pervasive Developmental Disorder.
How Autism Presents Differently in Each Person
ASD is called a “spectrum” because it includes a diverse range of traits, abilities, and support needs. No two individuals with autism are the same. One child might speak early but find back-and-forth conversations difficult. Another might communicate nonverbally and thrive with visual supports. Some may need extensive daily support, while others live independently and excel in academic or professional environments. This is why we discuss it not only as a spectrum but also using the language of neurodiversity.
Autism can influence many areas of life, including:
- Social communication: Children with autism may have difficulty interpreting facial expressions, body language, or the unwritten rules of social interaction. Some prefer parallel play rather than group play, while others may initiate conversations but be unable to maintain them.
- Behavior and interests: Some children may develop strong, focused interests (often called “special interests”) and want to talk about them frequently. Others may engage in repetitive movements, routines, or rituals that provide comfort or predictability.
- Sensory experiences: Sensory processing differences are very common. For some children, bright lights, loud noises, or even certain clothing textures can feel overwhelming. Others may seek out certain sensations, such as spinning or deep pressure.
- Emotional regulation: Transitions, unexpected changes, or unstructured environments can be especially difficult. Meltdowns or shutdowns may occur when a child feels overwhelmed, not out of defiance but as a response to sensory or emotional overload.
Gender and Diagnostic Gaps
It is important to note that ASD may be underdiagnosed or misdiagnosed in girls and those assigned female at birth. Many diagnostic criteria were originally based on male presentations of autism. Girls are more likely to mask or camouflage their symptoms by mimicking peers or developing compensatory strategies. As a result, their experiences related to ASD may be overlooked or attributed to anxiety or other conditions instead.
This diagnostic gap is gradually closing as awareness grows and clinicians become more attuned to the full range of autism expressions across gender and culture. Still, it remains an important factor when considering evaluation or treatment. Palo Alto therapists are aware of these differences and consider your whole child when working with you around ASD.
A Strengths-Based Perspective
People often frame autism in terms of what a child finds difficult. But individuals on the spectrum also demonstrate remarkable strengths, including:
- Creativity and original thinking
- Deep focus and attention to detail
- Logical or systematic reasoning
- Honest communication
- A unique and refreshing perspective on the world
By focusing on both strengths and support needs, we can help children with autism thrive in environments that value who they are and how they learn.
A Brief Look at ADHD
ADHD is another neurodevelopmental condition, but it differs from ASD in several key ways. While ASD often centers around differences in social communication, sensory processing, and rigid routines or interests, ADHD is primarily characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Children with ADHD may find it difficult to stay focused, sit still, or follow through on tasks, but their social understanding or communication style may be typically-developing.
You can learn more about ADHD in these related posts:
- Not All ADHD Is the Same: Recognizing the Diversity of Its Three Types
- ADHD Symptoms in Kids at Different Ages
- Navigating ADHD Through the Teenage and Young Adult Years
That said, the two conditions can overlap in ways that complicate both diagnosis and daily life. It is not uncommon for a child to have both ADHD and ASD, which can amplify emotional regulation difficulties, executive functioning challenges, and sensitivities to environmental stimuli.
Because of this frequent co-occurrence, understanding how ADHD and ASD interact is essential to providing the right kind of support, which is exactly why we are exploring them together in this article.
Where ASD and ADHD Intersect
It is increasingly recognized that ASD and ADHD can, and often do, occur together. In fact, current estimates suggest that as many as 50%-70% of children with ASD also meet criteria for ADHD. However, this co-occurrence was not always officially acknowledged. It has only been in the last decade or so that we have really come to understand the overlap.
Children with both ASD and ADHD may show overlapping symptoms such as:
- Challenges with executive functioning, including difficulty starting tasks, staying organized, or following through
- Difficulty with emotional regulation
- Sensory sensitivities that affect attention and behavior
- Impulsivity that may be misinterpreted as intentional or defiant behavior
- Difficulty transitioning between tasks or environments
The presence of both conditions can also intensify certain behaviors. For example, a child might have the social processing differences associated with ASD alongside the distractibility and restlessness associated with ADHD. This combination can make it more difficult to manage classroom expectations, form friendships, or adapt to changes in routine. It also complicates the diagnostic process, as symptoms can mask, overlap with, or mimic one another.
When both conditions are present, individualized care becomes especially important. A therapy plan that may be effective for one diagnosis often needs to be adjusted significantly to address the other. That is why our therapists take time to get to know your child, not just in terms of diagnosis but also in understanding how their unique mind works.
When to Consider Therapy and What Kind of Therapy Helps
If you are parenting a child with both ASD and ADHD, therapy can help your child better understand their strengths and challenges while also offering families concrete tools and emotional support. Two therapeutic approaches we often use in our clinic are Cognitive Behavioral Therapy (CBT) and Play Therapy. We are also closely following the evolving use of SPACE Therapy (Supportive Parenting for Anxious Childhood Emotions) for children on the spectrum.
Cognitive Behavioral Therapy (CBT) for ASD/ADHD
CBT is a structured, skills-based therapy that helps children learn to identify unhelpful thought patterns, manage strong emotions, and make thoughtful choices when faced with stress or frustration. For children with both ASD and ADHD, traditional CBT is often adapted to be more visual, concrete, and experiential, which helps align with how these children process information and engage with the world.
Therapists may use tools such as storyboards, color-coded visual schedules, or social scripts to help children understand patterns of behavior, cause and effect, or expected steps in a social interaction. These visual aids are especially helpful for children who experience difficulty with abstract thinking or verbal processing.
CBT sessions typically involve hands-on, real-world practice. For example:
Learning to manage sensory overload
A child who regularly shuts down during noisy lunch periods at school might work with their therapist to identify the first signs of overwhelm (clenching fists, covering ears, or pacing), practice coping strategies like using noise-canceling headphones or taking five deep breaths, and rehearse how to ask a teacher for a quiet break spot using a visual cue card.
Reframing rigid or negative thinking
A child with both ASD and ADHD might become distressed after making a small mistake on a class project, convinced it “ruins everything.” A therapist might walk them through a visual “thought ladder” to identify the original thought (“I messed up”), evaluate the emotional response, and then explore alternative thoughts (“It’s okay to make mistakes – everyone does”) while practicing calming strategies like drawing or stretching.
Improving social understanding and flexibility
For a child who often interrupts during group play, CBT might involve role-playing conversations, practicing turn-taking with games, and using visual rules of conversation (such as “wait, listen, respond”). The therapist may also introduce self-monitoring tools, like a “talk meter,” to help the child notice and manage impulsivity during social interactions.
Building independence and emotional regulation
A child who resists transitioning between preferred and non-preferred activities might work on a visual transition chart that includes reward-based motivation and a “feelings thermometer” to help identify rising frustration levels before they escalate. Over time, the child learns to tolerate discomfort while developing a sense of agency and predictability.
In all of these scenarios, CBT is not about telling a child to “calm down” or “think differently.” Instead, it’s about helping them build emotional awareness and flexible thinking through consistent, scaffolded learning experiences that feel manageable and empowering.
These foundational skills don’t just support behavior in the classroom – they also promote confidence, problem-solving, and emotional resilience in daily life.
Play Therapy for ASD/ADHD
Play therapy is particularly effective for younger children or those who have difficulty expressing themselves verbally. While CBT focuses more on structured skill-building and cognitive awareness, play therapy uses the natural language of children (play!) as a way to support emotional expression, relationship-building, and behavioral growth. It is less directive than CBT and often feels more intuitive and spontaneous for the child, which makes it a valuable tool for children who may resist traditional talk-based approaches.
For children with ASD and ADHD, play therapy creates a safe, low-pressure space to explore emotions, practice social interaction, and build self-regulation skills. Sessions may include imaginative play, art, games, or storytelling. The therapist closely observes how the child engages with toys or responds to specific scenarios, then uses those moments as gentle opportunities to introduce new coping tools or model more adaptive behaviors.
For example:
- A child who experiences frustration tolerance during competitive games might practice taking turns during a simple board game. The therapist may coach them through big feelings when they lose a round and help them find words to express disappointment.
- A child who prefers parallel play might be encouraged to engage in shared imaginative play with the therapist, slowly expanding their ability to collaborate, share space, and notice social cues.
- For a child who becomes overwhelmed in transitions, the therapist might play through a scenario like “getting ready for school,” using figurines or stuffed animals to show steps and offer calming strategies—such as counting, breathing, or packing a familiar comfort item.
Because play therapy is child-led, it honors the child’s pace and interests, which is especially important for children on the autism spectrum who may feel anxious in more structured or adult-centered environments. While CBT often focuses on building cognitive insight and structured strategies, play therapy focuses on connection, emotional processing, and developmental readiness, which are all essential foundations for learning to navigate the world with confidence.
SPACE Therapy for ASD/ADHD
SPACE Therapy was originally developed to help parents reduce the accommodations that unintentionally reinforce anxiety in children. It focuses on empowering caregivers to support their child while setting healthy boundaries and reducing anxiety-driven avoidance behaviors.
Recent research is now exploring the use of SPACE with autistic children. A 2023 pilot study published in Child Psychiatry & Human Development found that SPACE was both feasible and well-received by parents of children on the spectrum. The study demonstrated a significant reduction in both anxiety symptoms and family accommodation behaviors, with improvements maintained at follow-up .
At Palo Alto Therapy, we are watching these developments with enthusiasm. While SPACE is not yet widely established as a treatment for ASD, its early promise as a parent-based intervention for managing anxiety in autistic children represents an exciting new possibility.
Supporting the Whole Child and the Whole Family
When a child experiences both ASD and ADHD, their world may feel more intense, unpredictable, or even overwhelming. At the same time, these children often bring creativity, curiosity, and unique problem-solving skills to everything they do. With the right support, their differences can become their strengths.
If you are wondering whether therapy could help your child or your family, we are here to answer your questions. Our team provides compassionate, evidence-informed care that honors the full picture of your child’s development and well-being.