A child who will not sit for circle time, does not answer when called, melts down at transitions and seems to live in their own world could be autistic, could have ADHD, could have both, or could be dealing with something else entirely. The two conditions share a lot on the surface, and they can occur together. This page sets out the signs side by side, explains how they overlap, and shows why the diagnosis matters so much in Florida: it usually decides whether insurance will pay for ABA.
How are autism and ADHD different?
Both are neurodevelopmental conditions that start in childhood, but they are defined by different core features.
Autism is defined by two areas: persistent differences in social communication and social interaction across settings, and restricted, repetitive patterns of behavior, interests or activities (including sensory differences). Signs must be present in early development, though they may not be obvious until social demands increase.
ADHD is defined by a pattern of inattention and/or hyperactivity and impulsivity. According to the American Psychiatric Association's DSM-5 fact sheet, children must have at least six symptoms from the inattention group, the hyperactivity-impulsivity group, or both (five for people over 17), present in more than one setting such as home and school, and several symptoms must have been present before age 12.
What signs might I notice in a young child?
| Area | More typical of autism | More typical of ADHD |
|---|---|---|
| Response to name and attention | May not respond to name by 9 months; may seem not to notice people | Trouble paying attention to people, tasks or instructions; easily distracted |
| Shared attention | May not point to show you something by 18 months, or share interests with you | Not part of the ADHD criteria |
| Play | Lines up toys, plays the same way each time, focuses on parts (like wheels); pretend play may be limited | Play differences are not part of the ADHD criteria; trouble staying seated or settled may show up during play |
| Social interest | May not join other children in play by age 3, or may want friends but struggle with the back-and-forth | Not a core ADHD feature, though impulsive behavior can make play with others harder |
| Routines and change | Gets very upset by small changes; must follow certain routines | Difficulty organizing tasks and activities; distress over change is not part of the ADHD criteria |
| Repetitive behavior and speech | Hand-flapping, rocking, spinning; repeating words or phrases (echolalia); intense, narrow interests | Fidgeting, unable to stay seated when expected, talking excessively |
| Sensory | Unusual reactions to sounds, smells, tastes, textures or lights | Not part of the ADHD criteria |
| Focus | Can focus intensely on preferred interests; hard to shift away | Failure to pay close attention to details; hard to keep attention on tasks |
The autism signs above come from the CDC's list of signs and symptoms; the ADHD signs are examples from the American Psychiatric Association's DSM-5 fact sheet and the CDC's definitions. No single sign means a child has either condition, and many children without either show some of them. This table is a starting point for a conversation with your child's doctor, not a way to diagnose.
Can a child have both autism and ADHD?
Yes. Before 2013 the diagnostic manual did not allow both diagnoses at once. The DSM-5 changed that. The APA's fact sheet says the DSM-5 "includes no exclusion criteria for people with autism spectrum disorder, since symptoms of both disorders co-occur." The CDC lists "hyperactive, impulsive, and/or inattentive behavior" among characteristics often seen in autistic people, and the American Academy of Pediatrics' 2020 clinical report names ADHD among co-occurring conditions that affect autistic children's function and quality of life. Research estimates of how often the two occur together vary widely from study to study, so we do not quote a single number here.
Overlap also comes from other directions. The CDC notes that sleep disorders, anxiety, depression and some learning disabilities can have symptoms similar to ADHD. Hearing problems, language disorders and stress can also look like either condition. That is why a careful evaluation looks at the whole child.
Who can tell the difference, and how?
A diagnosis should come from a qualified clinician, such as a developmental-behavioral pediatrician, child psychologist, child psychiatrist or pediatric neurologist. For ADHD, the CDC notes that the American Academy of Pediatrics recommends gathering information about the child's behavior in different settings from parents, teachers and other caregivers. For autism, the AAP recommends autism-specific screening at the 18 and 24 month well-child visits, followed by a full evaluation if screening raises concerns. Our page on who can diagnose autism in Florida lists the professionals who can make the diagnosis.
Before the appointment, write down specific examples, ask your child's teacher or daycare for notes, and record short videos of the behaviors that worry you. Ask the evaluator directly: "Have you looked at both autism and ADHD? Could it be both?"
Why does the diagnosis matter for ABA coverage in Florida?
This is where the label has real financial weight.
- Florida's autism insurance mandate (Fla. Stat. 627.6686) requires certain group plans to cover ABA for autism spectrum disorder and Down syndrome. ADHD is not on the list.
- Aetna requires a DSM-5 autism diagnosis (ICD-10 F84.0, or F84.3 to F84.9) for ABA, and its policy calls ABA "experimental, investigational, or unproven" for "all other non-ASD indications."
- Cigna (Evernorth) considers ABA "not medically necessary for all non-autism spectrum disorders (ASD) indications."
So in most commercial plans, ADHD alone does not open the door to insurance-funded ABA, while autism (with or without ADHD) can. That does not make a diagnosis something to aim for: an accurate diagnosis is what gets your child the right treatment. For ADHD, the CDC says the AAP recommends parent training in behavior management as the first treatment for children under 6, before medication is tried, and combining medication with behavior therapy for children 6 and older. For details on payment options, see ABA coverage for ADHD.
Decision checklist: what to do next
- My child shows several signs from either column in more than one setting: talk to the pediatrician and ask for screening and a referral for evaluation.
- My child already has an ADHD diagnosis, but social communication differences, intense routines or sensory reactions do not fit: ask whether an autism evaluation makes sense.
- My child has an autism diagnosis and attention or impulsivity is a big problem: ask the doctor about evaluating for ADHD too, since treatment may differ.
- I want behavior support now while waiting: ask about parent training and whether self-pay services are available.
- I am not sure what my plan covers: get a benefits check before starting any service.
How Hope Center can help
Hope Center offers diagnostic evaluations through our clinical director with a supervising licensed psychologist. Our BCBAs do not diagnose. We provide ABA for autistic children and ABA-based behavior support for ADHD and ODD; because insurance coverage for ABA usually depends on an autism diagnosis, we check your plan first. Self-pay with a sliding scale is available for all services, and a diagnosis is not required to self-pay. We also offer weekly parent training, and mental health therapy for adults, couples and families.
Contact us or call 561-337-8865 for a free consultation and benefits check. We speak English, Spanish, Haitian Creole, Bengali and Russian.