21/01/2026
Dear DSM-6 Decision-Makers,
Hi there.
It’s me, Max, a member of the Autistic community.
I’m one of the people whose brains you metaphorically dig into every time you decide to change the list of things that make a person Autistic.
It must be so odd for you to have a representative of one of your official diagnoses weigh in on your decisions.
You tell clinicians how to identify us, but frankly, your track record is not so good.
With that in mind, I want to talk to you about autism and ADHD, called AuDHD in my community.
For years, you told us autism and ADHD could not co-exist. Mutually exclusive, like oil and water. War or peace. We could have one of these identities or the other, but not both.
You also told us Autistic people couldn’t experience co-occurring selective mutism (what we call situational mutism).
Funny thing, though.
Many speaking-Autistic people, myself included, experience environments or interactions that trigger a loss of our ability to communicate with spoken words.
Imagine my surprise when your “science” finally caught up with my lived experience. After the 2013 edit of the Diagnostic and Statistical Manual, what had always been true was suddenly allowed to be named: I could be Autistic and ADHD, and experience situational mutism. Woo hoo!
Since those DSM-5 edits, research has continued to validate what Autistic people already knew.
A 2017 Swedish population study of nearly 1.9 million people found that ADHD is not just slightly more common, but dramatically more prevalent in Autistic people than in the general population.
Sit down for this one. It’s not a little more likely in our community, or something that happens sometimes.
ADHD is 22 times more common in Autistic people.
Twenty-two times.
At what point does “co-occurring” stop meaning exception and start meaning the majority experience for Autistic people?
From where we sit, AuDHD is not rare.
It is common and it is expected.
Autistic people without ADHD are starting to look like they are in the minority, especially among those without an intellectual disability. (I suspect that latter may be due to diagnostic overshadowing.)
The diagnostic manual has changed dramatically in just 13 years. Criteria have been rewritten, categories have merged, and assumptions have been overturned.
It is time to formally recognize the prevalence of ADHD for Autistic people, develop more relevant supports for our particular blend of neurodivergence, and recognize the AuDHD identity.
There is no date set for the next revision of the DSM, but there is every reason for your team to get to work on it.
When ADHD is ignored in Autistic people, the result is unmet needs.
To be precise: more unmet needs — something Autistic people already have more than enough of.
