Two wirings, one brain
Autism and ADHD get written about as separate things, and I spent a long time reading about them separately and feeling like each description was about seventy percent right. They aren't separate in me. They argue with each other constantly, and most of what's difficult happens in that argument, not in either one on its own.
The plain version. I'm autistic and I have ADHD, diagnosed as a combined neurotype and not two conditions sharing a skull. On top of that there's a longer list, including anxiety disorders, chronic illness, and a dissociative condition that's still being worked out with a specialist. This page is what all of that's like from the inside. It isn't advice and it isn't a diagnostic guide.
What the combination actually does
The clearest way I can put it: autism wants the same thing every time, and ADHD can't make itself do the same thing twice. One half of me builds a system. The other half loses interest in the system approximately four days later, which the first half experiences as a personal betrayal.
So I need routine to function, and I'm incapable of maintaining routine unaided. That's not a contradiction I get to resolve. It's the actual operating condition, and every piece of scaffolding I've built for myself exists because of it.
I need structure I didn't have to remember to build. That sentence is the reason there's a Discord bot with my dog's name on it.
If you want the long version of that, it's on the ADHD & Hazel Care page, because it turned into a build story instead of a health one. The short version is that the thing which finally worked was external, automated, and slightly bossy, and it worked because none of it depends on me remembering.
Autism, specifically
I was assessed as Level 1. That's the label that replaced the one people used to use, and I only mention it because the older words still turn up and saying this saves the confusion. It doesn't mean mild. It means the support I need isn't the kind that's obvious from outside.
Three things that are true about it for me, none of which I understood before someone put a name on the whole:
The empathy runs hot, not cold. The stereotype has autistic people feeling less. I feel considerably more than I let on, to the point where I learned to turn it down deliberately because the volume wasn't survivable. When people describe autistic flatness they're often describing the turned-down version, which is a coping strategy, not a personality.
Masking is work, and the bill arrives later. I can do a whole day of being normal at people. What I can't do is a whole day of that and then an evening of anything at all. The cost doesn't show up during, it shows up after, and for years I read that as being lazy in the evenings. What was really happening is that I'd spent everything by four in the afternoon.
A burnout specialist asked me something this year that I haven't been able to put down. If you're always managing the mask, who's the person underneath it? I didn't have an answer. I had thirty years of practice at the mask and almost none at the thing it was covering. Finding out what's under there turns out to be its own piece of work. It doesn't just happen on its own the moment you stop.
There's a trap on the other side of that, too. Part of the work is noticing what you feel and writing it down as it happens, and I'm very good at that, because analysing myself is the thing I've always done instead of feeling. At some point I realised I was pausing a children's film to journal about my reaction to the film. Watching yourself have an experience isn't the same as having one. I'm still working out where the line is.
Sameness isn't preference. Same food, same route, same order of operations. It looks fussy from outside. From inside it's the difference between having some processing capacity left over for the actual day and not having any.
One thing nobody warned me about
My ADHD got noticeably worse after I started HRT.
Is that hormonal, or is it that transitioning meant I finally stopped spending every waking moment managing a performance, which freed up enough attention to notice what my brain was doing underneath? I have no idea. Both explanations are plausible and I'm not qualified to pick. What I can say is that the difference was large enough that I ended up medicated for something I had managed unmedicated for thirty years.
I mention it because I couldn't find anyone talking about it at the time, and I went looking. If you're a trans person who feels like your attention fell apart somewhere in the first two years of transition, you aren't imagining it and you aren't the only one. Take it to whoever is managing your care, not to a forum. Mine included.
The rest of the list
Putting this here as a list, plainly, because the alternative is mentioning things one at a time across nine pages and letting people assemble it themselves. The caveat goes in the same breath: several of these overlap, some of them probably cause each other, and a few are still being argued about by people more qualified than me.
The dissociative one is deliberately the only entry without a firm name on it, and that's not modesty. There are multiple test results, more than one professional opinion, and an ongoing process with a specialist, and the specific label at the end of that's not mine to announce before it exists. I wrote a whole page about why I won't guess at it.
Two anxieties, which aren't the same anxiety
Worth separating, because I spent years assuming they were one thing and treating them as one thing, badly.
Social anxiety is specific and situational. It has an object. It's the phone call, the door, the group where I don't know who I'm going to be talking to. It responds to preparation, and it lies to me in a very consistent way, which after enough repetitions becomes almost useful: if the prediction is that everyone will find me unbearable, that prediction has been wrong every previous time, and I can hold onto that in a way I can't hold onto general reassurance.
Generalized anxiety has no object. It's just on. It attaches itself to whatever is nearest, which means arguing with the content is pointless, because the content isn't the point. The content is a costume the feeling is wearing.
The reason this distinction matters practically: the things that help with one do very little for the other. Preparing for the phone call helps the phone call. It does nothing for waking up already braced at six in the morning about nothing.
What actually helps
Not a listicle, just the things that have moved the needle for me.
External structure that doesn't need me. The bot, the alarms, the automated nudges. Anything that depends on me remembering to use it will be abandoned inside a week, and that isn't a character flaw to fix, it's a design constraint to build around. Software defaults work the same way: if the good behaviour is opt-in, almost nobody opts in, including me.
Actual professionals, more than one. There's a regular psychotherapist, a trauma specialist, a group program, and a psychiatrist in the queue. That's a lot of appointments and a genuinely stupid amount of money even with benefits, and it's the only thing on this list that has produced change and not just management. The therapy page is about why finding someone you click with matters more than credentials alone.
Medication, once I stopped treating it as a defeat. Vyvanse for the ADHD. I put that off for a long time out of something I'd have called principle and would now call stubbornness.
Being able to say the actual thing. Not being brave about it. Just not spending the energy on the performance, with the specific people where that's possible.
Why put all this on the internet
Two reasons, and one of them is a bit selfish.
The selfish one: this is a list I've had to recite out loud, in order, to a lot of strangers this year. Doctors, intake coordinators, insurance people, HR. Writing it down once, properly, means I get to point at it instead of assembling it from memory while already tired.
The other one is that the version of this I needed at twenty-five didn't exist anywhere I could find it. What existed was clinical descriptions written for clinicians, and inspirational content written for people who wanted a tidy arc. I wanted somebody to just say the boring specifics without either flinching or making it a triumph. So that's what this is.
None of it is resolved. I'm on medical leave while I work through the trauma end of it, some of these labels will probably shift, and a couple of them I'm actively hoping turn out to be describing something else. I've been saying some version of "the diagnosis is a tool, not an identity" for a while now, and I think I'm about halfway to believing it.