How can co-occurring conditions be considered when addressing play in autism? 

Many autistic children experience more than one diagnosis. According to NHS data, up to 70% of autistic children have an additional condition such as ADHD, anxiety, epilepsy, dyspraxia, or sensory processing disorder. These co-occurring conditions don’t just affect medical care, they shape how children play, communicate, and engage with the world. 

Recent systematic reviews and NICE guidance highlight that understanding these overlaps is essential for effective play-based intervention and emotional development.  

Why co-occurring conditions matter in play 

Play is a key part of social and emotional learning, but its form and quality can change when multiple conditions overlap. For instance, research led by Cheung et al. (2025) found that autistic children with both ADHD and anxiety showed more fragmented, less flexible play, and higher emotional dysregulation compared to children with autism alone. 

Similarly, co-occurring dyspraxia (developmental coordination disorder) can make physical play challenging, while epilepsy or sensory sensitivities may limit a child’s comfort with certain types of activities. As NICE notes, these differences must be recognised in every child’s support plan (NICE CG170). 

How co-occurring conditions shape play behaviour 

Conditions such as ADHD, anxiety, or sensory challenges can influence how children with autism play. These factors affect their focus, interaction, and enjoyment during play: 

ADHD 

When ADHD occurs alongside autism, it often increases impulsivity and inattention during play. Children may interrupt, switch activities quickly, or struggle with turn-taking. The Royal College of Speech and Language Therapists (2025) recommends structured, visually supported play sessions to help maintain focus and predictability. 

Anxiety 

Anxiety is one of the most common co-occurring conditions in autism. It can heighten repetitive or ritualistic play, as children use sameness and control to manage stress. Experimental research (Cheung et al., 2025) shows that anxious children display more rigid, rule-based play and less peer engagement. 

Dyspraxia (Developmental Coordination Disorder) 

Motor planning challenges may make climbing, running, or building activities frustrating. Occupational therapy targeting fine and gross motor coordination can improve confidence and play participation (NCBI, 2023). 

Epilepsy 

Children with autism and epilepsy often need extra support for safety and fatigue management. Research in Frontiers in Psychology (2023) found that seizure activity and anti-seizure medication can reduce attention and energy levels, influencing play engagement. 

Sensory Processing Disorder 

Sensory sensitivities frequently underlie both feeding and play difficulties. Over- or under-responsiveness to touch, sound, or movement can result in solitary or sensory-seeking play (Autism.org.uk). 

The UK shift toward integrated care 

The NHS National Framework for Autism Assessments (2023) and NICE guidance now advocate integrated neurodevelopmental pathways, meaning co-occurring diagnoses are assessed and supported under one multidisciplinary team. 

This move replaces “single-condition” models with holistic approaches that recognise how ADHD, anxiety, or epilepsy may influence play, learning, and family life. 
Play interventions should therefore be mechanism-targeted, addressing underlying emotional regulation, executive function, and motor challenges rather than diagnostic labels alone. 

Evidence-based interventions for children with multiple conditions 

Children with autism and additional conditions benefit from tailored, research-backed approaches. These interventions address overlapping needs, supporting both social development and emotional well-being.  

Occupational Therapy (OT) 

OT remains a first-line intervention for addressing sensory, motor, and adaptive play needs. Current best practice encourages OTs to consider ADHD-related distractibility, DCD-related motor issues, and anxiety-driven rigidity within play-based plans (NCBI, 2023). 

Play and Behavioural Therapy 

Structured play therapy, Positive Behavioural Support (PBS), and child-centred models can help children explore flexibility and cooperation safely. Programmes are most effective when tailored to co-occurring conditions, for example, planning low-arousal sessions for anxiety, or using movement breaks for ADHD (Mazza et al., 2025). 

Parent-Mediated and Group Interventions 

Parent-led approaches that focus on emotional co-regulation and attention scaffolding have proven success. These methods help parents manage both sensory and emotional needs while promoting inclusive, peer-based play (RCSLT, 2025). 

NICE and NHS guidance at a glance 

• NICE CG170: All autism interventions should consider co-occurring mental and physical health conditions; play and therapy must be individualised. 

• NICE NG87: ADHD management in autism should integrate behavioural and environmental adjustments. 

• NICE CG142: Recognises emotional dysregulation and social participation as part of holistic autism support. 

• NHS Framework, 2023: Advocates a single neurodevelopmental pathway for children with multiple diagnoses. 

When to seek extra support 

If your child’s play is limited by anxiety, impulsivity, sensory sensitivities, or medical issues, a multidisciplinary assessment can clarify what’s driving these patterns. 
You can explore private, NICE-aligned autism assessments through Autism Detect, a UK provider rated “Good” by the CQC. Their aftercare services offer tailored guidance and therapy referrals for families managing co-occurring conditions like ADHD, anxiety, or epilepsy. 

Takeaway 

For autistic children, play provides both joy and a vital learning space, but co-occurring conditions can shape how it unfolds. Whether it’s impulsivity from ADHD, sensory overload from anxiety, or fatigue from epilepsy, understanding these influences allows professionals and families to adapt play in meaningful ways. 

Following NICE and NHS integrated care pathways, early identification and collaborative, flexible interventions can help every child engage confidently and creatively in play, no matter how complex their neurodevelopmental profile.