Autism Spectrum Disorder

Q: “Can ADHD Meds Unmask Autism?”

What AuDHD individuals need to know about taking ADHD medication.

By Veena Ahuja, M.D., Updated on May 9, 2025
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Q: “Many autistic individuals who also have ADHD report experiencing a curious phenomenon when taking ADHD medications: magnified, pronounced, or seemingly unmasked autistic traits. As one ADDitude reader told us, ‘When I started Ritalin, it was magic for my ADHD symptoms. But what I didn’t see (but my psychiatrist and those around me did) was that my autism came out in full force.’

What’s behind this? And what else can AuDHD individuals expect when taking ADHD medication?”

Certainly, stimulant medication can lower the volume on ADHD symptoms that might have once overshadowed autistic traits and behaviors, thus appearing to “unmask” autism. Enhanced focus brought on by stimulant medication can also increase awareness of one’s autistic traits, which may have gone mostly unnoticed before.

But stimulant medication may impact the expression of autistic traits in other ways. A common side effect of ADHD medication, for one, is anxiety. In the context of autism, this side effect can enforce autistic traits like a need for control, rigid thinking, and perseverative thoughts — traits rooted in anxiety that are present in almost all people on the spectrum.

In addition, while stimulant medications increase focus, this can go one of two ways. Ideally, the stimulant will help individuals focus on what they need to and want to focus on. Sometimes it can go the other direction, where stimulants can lead to hyperfocusing on distractions and getting stuck on mental processes. While this can happen to anyone who takes a stimulant, it’s not an uncommon side effect among autistic individuals who are already prone to rigid thinking and perseveration.

[Take This Self-Test: Signs of Autism Spectrum Disorder]

Stimulant medications also can increase heart rate and blood pressure. People on the spectrum may notice even small changes in heart rate and blood pressure, given heightened sensory sensitivities.

Are AuDHD Individuals More Sensitive to Stimulants?

In general, many autistic individuals tend to be more sensitive to medications and have a difficult time tolerating them. Between the two classes of stimulant medications and other non-stimulant medications, many treatment options exist for those with ADHD and autism. I have found that patients who are sensitive to medications do better on small doses of different medications rather than the traditional route of increasing each medication as far as can be tolerated. For all cases, we try to use the minimal amount needed.

Alpha agonists (such as guanfacine or clonidine) are a class of medication used to treat hyperactivity and impulsivity in ADHD in both children and adults. These medications tend to work well for many of my patients with ADHD and autism with a lower risk of side effects compared to stimulant medications. For example, I often prescribe guanfacine to help with restlessness and racing thoughts rooted in ADHD, as the alpha agonists may be less likely to increase rigidity and related traits rooted in autism. For some patients with the common trifecta of ADHD, autism, and anxiety disorder, using an alpha agonist or SSRI to reduce anxiety puts them in a better position to tolerate a stimulant for ADHD symptom control.

All patients, but especially those with ADHD and autism, should know what to expect when they start a medication. Patients should feel empowered to ask specifically what side effects to expect with these medications and how long the side effects may last, along with information about when to ask for help and/or stop the medication. In some cases, it’s a matter of tolerating side effects for a few weeks until the individual adjusts to the medication. Without this information, individuals who experience side effects may immediately assume that medication isn’t for them, when medication may be the key to improving quality of life with some patience.

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Beyond medication, other supports are available for managing co-occurring ADHD and autism, from therapy to skills-training. Additionally, many of my AuDHD patients say executive function coaching has made day-to-day living much smoother. Ultimately, treating AuDHD patients requires a multifaceted approach that needs to be individualized to each person and their other co-occurring diagnoses.

Autism and ADHD: Next Steps

Veena Ahuja, M.D., is a psychiatrist and the owner of Balanced Innovative Care located in Columbus, Ohio.

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