AuDHD and Bipolar Disorder: Comorbidity and Misdiagnosis

By Dr. Patty Gently on September 28, 2025

duality

Bright Insight Support Network founder and president Dr. Patricia Gently supports gifted and twice-exceptional adults in their own autopsychotherapy through identity exploration, structured reflection, and alignment with inner values. A writer, educator, and 2e adult, Dr. Patty centers depth, integrity, and complexity in all aspects of her work.

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***The terms “bipolar disorder" and “bipolarity" are used in this article, along with the phrase: “those with bipolarity." I would like to acknowledge, however, that is known and respected that some individuals prefer identity-first labels, which name an individual with bipolarity as simply “bipolar" or “a bipolar person," for example. This is a nuanced and dynamic discussion, and I appreciate that different people have different beliefs and preferences. I wish to honor all of them.***

AuDHD and Bipolar Disorder: Comorbidity and Misdiagnosis

The meeting point of autism, ADHD, and bipolarity (bipolar disorder, per the DSM) often seems messy, and it is certainly misunderstood. For those who live with both autism and a dynamic attentiveness, what we sometimes call AuDHD, life can feel both brilliantly dynamic and frustratingly misread. Clinicians and researchers are still learning to see the full picture, which means that individuals often face misdiagnosis and confusion before recognition. Rather than simply a mix of autism and ADHD characteristics (aka symptoms per the medical model), AuDHD represents a distinct neurotype and way of moving through the world, with overlapping intensities that bring creativity, complexity, and resilience alongside real challenges.

And I know many people personally and through my work who were misdiagnosed and medicated for bipolar disorder, only to experience painful side effects, the weight of stigma, a whole lot of confusion, and the frustration of not being understood. Later, with an eventual AuDHD diagnosis, their stories reframed these strengths and struggles as differences in neurotype rather than evidence of a supposed pathology that is regularly medicated as a best practice approach to treatment. This lived reality reminds us that misdiagnosis is not only theoretical, though. It can deeply impact lives.

One way to frame this phenomenon is through an understanding of hyperneuroplasticity: the heightened neural adaptability that allows rapid shifts in attention, energy, and sensory processing. This underlying orientation helps explain why AuDHDers can reconfigure quickly in response to environment and context, a process that can be both a gift and a challenge. With overlapping intensities that bring creativity, complexity, and resilience alongside real challenges, hyperneuroplasticity offers a lens for understanding AuDHD not as instability but as dynamic responsiveness. **You can read more about the concept of hyperneuroplasticity here.

How AuDHD Presents in Daily Life

AuDHD is not just the sum of autism and ADHD traits. It has its own unique presentation that reflects the interplay between the two, presenting in a third space or way of being. Individuals often describe experiencing contradictory pulls: craving novelty while simultaneously needing sameness and predictability. This can create cycles of hyperfocus followed by distraction, or bursts of energy followed by a need for rest and recalibration. And many of my clients and AuDHD loved ones report feeling like they are pushing on the brakes and the accelerator at the same time, while remaining frustratingly stuck. 

Socially, AuDHD may look like a paradox. A person might be deeply motivated to connect yet navigate challenges in reciprocity, often oscillating between intense engagement and sudden withdrawal. Communication styles can also be distinct, and sometimes tangential, rapid, and dynamically ADHD-like, and at other times scripted, literal, and more seemingly autistic in nature. This variability can be confusing to others who would like to understand or diagnose the AuDHDer, yet it also brings authenticity and creativity in expression.

And executive function differences seem central to the AuDHD experience. Many AuDHD individuals report difficulty initiating tasks, organizing, or maintaining routines. At the same time, they may also demonstrate exceptional problem-solving or creativity when working within areas of interest. This seemingly uneven (in relation to the neuromajority) profile, with unique strengths in one domain alongside challenges in another, contributes both to distinctive abilities and to areas where support may be needed.

Sensory experiences also play a large role in the AuDHD experience. Some individuals fluctuate between seeking stimulation and avoiding it, depending on internal state or external stressors. These shifting sensory needs can fuel innovation and adaptability, while also requiring intentional strategies for regulation.

Importantly, also, AuDHD is often masked. Many people learn to camouflage traits to fit social or academic expectations, which may delay recognition and increase the risk of exhaustion, burnout, or misdiagnosis. This masking can also obscure the difference between AuDHD’s trait-like variability and the episodic shifts seen in bipolarity.

Symptom Overlap and Diagnostic Confusion

Emotional intensity, impulsivity, and variable energy levels are common in both ADHD and autism (and gifted/galvanic neurodivergence), and when combined in AuDHD, these traits can resemble the fluctuating patterns seen with bipolarity. For example, rapid shifts in mood or energy due to sensory overload, rejection sensitivity, or executive function challenges may be misinterpreted as hypomanic or manic episodes (Skirrow & Asherson, 2013). Similarly, cycles of hyperfocus and recalibration can look like bipolar mood swings (Joshi et al., 2010).

What makes this especially complicated is how these traits are expressed in everyday life. For many AuDHDers, variability is not an exception but a constant rhythm of being. Mood and energy can change quickly in response to environment or stress, yet these changes are grounded in a lifelong neurobiological and neurodevelopmental pattern rather than a separate episodic illness. This is why an AuDHD individual may have vivid highs of focus or creativity one day, followed by exhaustion or withdrawal the next, without this representing mania or depression. And this is not a question of whether variability exists. Rather, we are asking as clinicians whether it follows a consistent, trait-like course (Antshel & Russo, 2019) or an episodic, cyclical course (Birmaher et al., 2006).

Understanding this distinction is essential. Without it, clinicians may overpathologize natural AuDHD rhythms as bipolar disorder, leading to diagnostic and pharmacological errors and overlooking the affirming reality that variability is part of hyperneuroplastic neurodiversity and how AuDHD minds navigate and adapt.

Comorbidity Rates

According to the research, individuals with ADHD have a significantly higher risk of developing bipolar disorder compared to the general population, with comorbidity rates estimated between 10–20% (Masi & Millepiedi, 2001; Rydén et al., 2013). Autism has also been linked to an elevated risk of bipolar disorder, although the estimates vary widely due to methodological differences (Antshel & Russo, 2019). The overlap of both ADHD and autism in AuDHD presentations suggests that these individuals may face an even greater vulnerability, though targeted research remains limited. Family studies further suggest how bipolar disorder has strong familial clustering (Duffy et al., 2007), while ADHD and autism also show high heritability (Kessler et al., 2006). When these genetic predispositions intersect, the diagnostic picture becomes more complex.

It is also important, however, to recognize that misdiagnosis can distort research findings. For many years, AuDHDers may have been misidentified as having bipolar disorder, meaning that studies of bipolar populations could actually be describing this experience (Hull et al., 2020; Antshel & Russo, 2019; Rydén et al., 2013). This raises critical questions about how much of the literature reflects autistic and dynamically attentive lived realities rather than distinct mood disorder trajectories. And while both misdiagnosis and dual identification are possible, neither reduces the validity of AuDHD experience. It is important to honor this reality with compassion and affirm the diverse, self-defined ways AuDHDers experience and describe their lives. 

Distinguishing Features

While AuDHD and bipolarity share surface similarities, there are also meaningful differences that honor AuDHD as a distinct way of being. Understanding these distinctions is less about separating people into categories and more about recognizing that AuDHD variability is consistent and lived, while bipolar shifts appear episodic and cyclical. This distinction affirms that our rhythms of attention, energy, and reciprocity are valid expressions of neurodivergent life, while also informing proper diagnostics.

In practice, AuDHD mood and energy changes tend to be short-lived, situational, and rooted in sensory or social context, whereas bipolar patterns persist for days or weeks and follow a different clinical course (Duffy et al., 2007; Skirrow & Asherson, 2013). Sleep in AuDHD often follows irregular or inconsistent cycles that may leave a person exhausted, while in bipolar mania, the decreased need for sleep is paired with a sense of energy and rest (Kessler et al., 2006; Van Meter et al., 2011). Socially, reciprocity differences and dynamic attentiveness are present across the lifespan, whereas bipolar social changes fluctuate with mood states (Antshel & Russo, 2019; Masi & Millepiedi, 2001). And while AuDHD executive functioning reflects a lifelong pattern of difference, bipolar cognitive shifts are more often tied to discrete occurrences, with functioning returning to baseline between them (Joshi et al., 2010; Rydén et al., 2013).

Framing the differences this way emphasizes that AuDHD is not a disorder to be contrasted but a neurotype with its own integrity, while bipolar disorder follows its own unique course. Holding both truths affirms neurodivergent identity and encourages a more accurate, compassionate understanding.

Clinical Challenges and Conclusion

Misdiagnosis is common, and it can have a lasting impact on how AuDHDers are understood and supported. AuDHD traits are often mistaken for rapid-cycling bipolarity, leading to treatment strategies that do not match lived realities. For instance, prescribing stimulants for ADHD/dynamic attentiveness in someone with undiagnosed bipolar disorder can trigger mania (Rydén et al., 2013). Conversely, treating AuDHD presentations solely with mood stabilizers risks compounding difficulty while leaving attentional, sensory, and social differences unsupported and unacknowledged (Antshel & Russo, 2019).

Masking and camouflaging further complicate the picture. Many autistic and dynamically attentive adults, especially women and gender-divergent persons, report having been misdiagnosed with bipolar disorder or borderline personality disorder before their AuDHD traits were recognized (Antshel & Russo, 2019). This diagnostic overshadowing not only delays affirming recognition but can also increase the risk of exhaustion, burnout, and self-doubt. Expanding awareness of AuDHD helps reduce these harms and allows individuals to be understood in the fullness of their neurodivergent identities.

The overlap of AuDHD and bipolarity highlights the importance of nuanced, longitudinal assessment. While AuDHD shares surface similarities with bipolar disorder, the persistent, trait-like nature of attentional, social, and regulatory differences distinguishes it from the episodic course of bipolarity. Recognizing these differences reduces misdiagnosis and helps tailor interventions that respect both strengths and challenges, and it also affirms AuDHD as a distinct neurotype. By centering lived realities, we can avoid unnecessary misdiagnosis, support dual identification without stigma, and foster environments where AuDHDers and those with bipolarity thrive on their own terms. This perspective encourages clinicians, researchers, and communities alike to approach AuDHD with nuance, compassion, and respect.

References

Antshel, K. M., & Russo, N. (2019). Autism spectrum disorders and ADHD/dynamic attentiveness: Overlapping phenomenology, diagnostic issues, and treatment considerations. Current Psychiatry Reports, 21(5), 34. https://doi.org/10.1007/s11920-019-1020-5

Birmaher, B., Axelson, D., Strober, M., Gill, M. K., Valeri, S., Chiappetta, L., … Keller, M. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63(2), 175–183. https://doi.org/10.1001/archpsyc.63.2.175

Duffy, A., Alda, M., Crawford, L., Milin, R., & Grof, P. (2007). The early manifestations of bipolar disorder: A longitudinal prospective study of the offspring of bipolar parents. Bipolar Disorders, 9(8), 828–838. https://doi.org/10.1111/j.1399-5618.2007.00421x

Hull, L., Mandy, W., & Petrides, K. V. (2020). Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 24(6), 1611–1624. https://doi.org/10.1177/1362361320909176

Joshi, G., Faraone, S. V., Wozniak, J., Petty, C., Fried, R., Galdo, M., … Biederman, J. (2010). Symptom profile of ADHD/dynamic attentiveness in youth with high-functioning autism spectrum disorder: A comparative study. Journal of Attention Disorders, 13(5), 455–463. https://doi.org/10.1177/1087054709332447

Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Faraone, S. V., … Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD/dynamic attentiveness in the United States. American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716

Masi, G., & Millepiedi, S. (2001). Comorbidity of bipolar disorder in children and adolescents with ADHD/dynamic attentiveness. Journal of Child and Adolescent Psychopharmacology, 11(4), 485–494. https://doi.org/10.1089/104454601317261546

Rydén, E., Thase, M. E., & Stråht, E. (2013). Bipolar disorder with comorbid ADHD. Journal of Affective Disorders, 146(1), 1–13. https://doi.org/10.1016/j.jad.2012.07.010

Skirrow, C., & Asherson, P. (2013). Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of Affective Disorders, 147(1–3), 80–86. https://doi.org/10.1016/j.jad.2012.10.011

Van Meter, A., Moreira, A. L. R., & Youngstrom, E. (2011). Meta-analysis of epidemiologic studies of pediatric bipolar disorder. Journal of Clinical Psychiatry, 72(9), 1250–1256. https://doi.org/10.4088/JCP.10m06290