How therapists can create a neurodivergence-inclusive practice
In the realm of therapy and personal development, growth and evolution are constants. As we come to terms with so many ways that historical biases have influenced our perceptions and approaches, neurodivergence is another area that deserves consideration.
For far too long, research and treatment of ADHD and autism were confined within a narrow framework, one that centered around privileged narratives—mainly those of rich, white, male children. These limited perspectives not only overshadowed the true diversity of neurotypes but have left many neurodivergent folks out to fend for themselves without the supports that would help them thrive.
With that, as we expand our curiosity about neurodivergence as it intersects with other marginalized identities (gender identity, race, and sexual orientation, age, other disabilities), we need to educate ourselves and open our eyes to how these genetically-based neurodevelopment differences show up for these folks. Someone can have ADHD and/or autism without actively “stimming” or talking a mile a minute.
I want to call on helping professionals to grow a more nuanced understanding of neurodivergence. It’s extra important to create healing spaces where every individual's unique way of processing and responding to their world is acknowledged, valued, and understood. Otherwise, we’re offering just another barrier in a series of systemic barriers that a neurodivergent person must burden and will often personalize, until someone else notices that neurodivergence may be or is a factor in their suffering.
Mary came to me seven years ago with a history of familial and religious trauma, a familiar narrative of self-criticism and perceived "laziness," and an incredibly strong drive to get things right. In the past two years, however, guided by my growing understanding of neurodiversity and my clients’ discovery of her own sister being autistic, a new lens emerged—one that shed light on her challenges through the prism of sensory and processing differences. We discovered—together—that Mary's aversion to certain experiences wasn't just about the past trauma; it was intricately intertwined with her autistic traits of finding certain sensory experiences unbearably aversive to almost be painful. Now, when we integrate traumatic experiences, we include understanding the particular ways her upbringing was ill-fitted to her needs as a neurodivergent person. We also are deep in a process of building understanding about her sensory system, slowly building tools to support her in her life as she attunes to what her sensory system needs to avoid becoming overloaded.
Here is a list of ways we can all work toward the aim of better meeting our neurodivergent clients. Some examples are no-brainers—I’ll be honest—but I just couldn’t leave any of it out. After the (exhaustive? tedious?) list, I’ve added some personal and professional reflection questions as well, for those who want to delve more deeply into this inquiry.
Educate Ourselves: The first step toward becoming effective allies for neurodivergent individuals is to educate ourselves. Attend workshops, read literature, and engage in conversations that center around neurodiversity. As I’m sure you know already, DO NOT LEAN ON TIK TOK FOR INFO UNLESS IT’S A TRAINED SPECIALIST. If you would like a place to start, here is a list of resources I regularly add to.
Recognize the Overlap: Neurodivergent traits can sometimes overlap with trauma-related symptoms, leading to misdiagnoses or incomplete treatment plans. By familiarizing ourselves with the unique characteristics of various neurodivergent conditions, we can accurately assess our clients and provide tailored interventions that address both their trauma and their neurotype, and how they intersect and inform one another.
Create Inclusive Environments: Our therapeutic spaces should be inclusive and welcoming to all individuals. By recognizing and validating the experiences of neurodivergent clients, we create an environment where they can comfortably discuss their challenges and successes without the fear of judgment, rather than reinforcing impossible standards and expectations that they’ve likely experienced throughout their lifetime prior to entering our offices (virtual or not).
Advocate for Assessment: Encourage thorough assessments for neurodivergent conditions, especially in cases where trauma-related symptoms are present. Collaborate with professionals who specialize in ADHD and autism to ensure accurate diagnoses, enabling clients to access appropriate interventions and support. This can only be done once we’re familiar with the markers.
Tailor Treatment Approaches: Understanding the neurodiversity framework allows us to refine our therapeutic approaches. Incorporate strategies that cater to neurodivergent strengths and challenges, acknowledging that techniques effective for neurotypical clients might need adjustment for those with ADHD or autism.
Normalize Medication Conversations: For individuals with ADHD, the inclusion of medication can be transformative. Foster open conversations about medication options, addressing concerns and potentially providing accurate information to help clients make informed decisions about their well-being. Clients need support in sussing out whether a med works, how it’s working for them, and when it’s time to reach out for further exploration with their medication management team.
Cultivate Empathy and Understanding: Embrace a mindset of curiosity and humility when working with neurodivergent clients. Approach each individual with a willingness to learn about their unique experiences and challenges, while offering empathy for the ways their neurotype shapes their perception of the world. Sayings abound in ND (neurodivergent) circles that basically if you know 5 people with autism or ADHD, you know 5 different ways it can show up.
Embrace the Sensory and Processing Lens: As we endeavor to provide comprehensive care for our clients, let's remember that the human experience is profoundly influenced by sensory and processing differences. Just as Mary's discomfort with the sensation of wet skin against air was not solely a matter of "laziness" or even solely trauma-related, our clients may have unique sensory experiences that play a crucial role in their well-being.
Ask About Sensory Experiences: Incorporate questions about sensory preferences and aversions into your discussions with clients. By delving into their sensory world, you may uncover factors that contribute to their challenges or behaviors. This approach not only widens your understanding but also empowers clients to recognize and communicate their sensory needs.
Collaborate on Sensory Strategies: Work with your clients to develop sensory strategies that can help them navigate their everyday experiences. These strategies could range from identifying calming sensory stimuli to developing routines that accommodate their sensory needs.
Cultivate a Multi-Layered Approach: As therapists, our expertise lies in understanding the intricate interplay of various factors in our clients' lives. While trauma may certainly be a part of their story, it's essential to recognize that sensory and processing differences have contributed to how these traumas get coded. By adopting a multi-layered approach that integrates both trauma-informed care and sensory-aware interventions, we offer a more accurate and compassionate framework for healing and growth.
Challenge Assumptions: Break away from the tendency to attribute everything to a single cause, be it trauma or any other factor. Embrace a mindset that encourages curiosity and exploration, allowing room for the complexities of human experiences. By challenging assumptions, we create space for clients to reveal their authentic selves, free from the constraints of predefined labels.
Evolve and Learn: The field of mental health is dynamic and ever-evolving. Let's commit to continuous learning and evolution. Stay updated on the latest research, engage in peer discussions, and remain open to new insights that can enrich your practice and benefit your clients.
Refer Out: Once you can assess for traits of ADHD and autism, you have the knowledge base that will allow you to refer out if this is not in your wheelhouse. That is a completely valid and ethically sound thing to do. Of course this means you have to first recognize traits in the first place!
By including a neurodivergence in the way we formulate cases, we become more versatile, empathetic, and effective therapists and coaches. In doing so, we honor the complexity of the human mind and its interactions with the world, and we create a therapeutic space that celebrates individuality and embraces the vast spectrum of human neurodiversity.
Consider the following questions as guideposts for your journey:
Am I Assuming or Inquiring?: Do I find myself assuming that certain behaviors or challenges are solely rooted in trauma, or am I consistently inquiring into the potential influence of neurodivergence, recognizing the coexistence of these factors?
Do I Normalize Neurodiversity Conversations?: Have I created an environment where clients feel comfortable discussing their neurodivergent traits without fear of judgment? Do I actively normalize conversations about ADHD and autism?
Am I Equipped for Accurate Assessment?: Do I possess the knowledge and resources to accurately assess the presence of neurodivergent traits in my clients? Am I prepared to collaborate with specialists for comprehensive assessments when needed?
Is My Approach Inclusive and Adaptive?: Have I adapted my therapeutic techniques to accommodate the needs of neurodivergent clients? Am I tailoring my strategies to celebrate their strengths and address their challenges effectively?
Am I Creating Space for Multi-Layered Understanding?: Am I allowing room for multiple perspectives and factors to coexist in my therapeutic framework? Have I moved beyond the inclination to label experiences solely as trauma or neurodivergence?
Am I Committed to Learning?: Do I actively engage in ongoing learning about neurodiversity, staying informed about the latest research and insights? Am I open to evolving my approach based on new understandings?
By answering these questions with honesty and self-awareness, we take steps towards enriching our practice and better serving the diverse individuals who entrust us with their journeys. I invite each of us to advocate for neurodivergent voices and to create a therapeutic space where healing is holistic, compassionate, and truly inclusive.
