What do Psychologists need to consider about neurodivergence and mental health?

Families seek diagnosis as they are desperate for support, they already know their child so do not need the label, yet diagnosis has no supportive follow-up. In fact, mental health services actively use diagnosis to close down support, stating that there is no need for their service as it is 'just autism'. It is counterintuitive to extrapolate that an ND diagnosis somehow excludes children from also struggling with their mental health particularly when considering the lack of services, social support or community understanding open to them.

Jacy Thomas
Director of BRAINS Wellbeing CiC

In the treatment of Eating Disorders, identification of traits and autism can be critical to formulation and tailoring care; specifically, as it helps clinicians to better understand individual presentation and needs. This understanding can be critical in distinguishing between eating disorder symptomology and autism, allowing more effective and appropriate challenge of illness, rather than inappropriate and unhelpful challenge of neurodivergence. Importantly, identification of neurodivergence also allows for collaborative treatment adaptions. This promotes a better experience of care and also better longer-term outcomes for the individual and their families.

Dr Linnie Telford
Lead Clinical Psychologist, Hampshire CAMHS Eating Disorder Team

Never make assumptions. Curiosity is key. A verbally astute individual may still need processing time to disclose. Don't blame mental health symptomology on neurodivergence: the two can co-exist.

Dr Pip Wood, She/They
Autistic Clinical Psychologist with C-PTSD

Research informs us that neurodivergent populations may be more vulnerable to psychiatric comorbidities, including anxiety and depression, thus highlighting the importance of improving a patient's quality of life through person-centred, early intervention strategies. Without the careful consideration of a neurodivergent client's emotional needs, psychologists risk perpetuating their rates of unemployment, loneliness, and physical illness- just three factors that are frequently overlooked when implementing therapeutic support.

Emily Hustwick
Autism and mental health consultant, Instagram: life.behind.a.mask

Psychologists often do not consider neurodiversity at all... in my experience (lived and working with homeless, sex workers, offenders, drug and alcohol misusers and parents whose children have been removed) psychologists are very quick to give a diagnosis of personality disorder, and don't look beneath the surface. Also, recognise that anyone growing up with an ND is likely to have experienced trauma as a child, just from trying to fit into a world that doesn't make much sense to them!

Kerry
Pause Practitioner, Autism, ADHD, Dyspraxia, GAD and depression (both in remission since learning I was neurodivergent and understanding my needs)

Psychologists should have an open mind and not believe everything they have been taught. Knowledge is emerging all the time now that we are actually being consulted, it's not one size fits all!

Anthony
(Autism, ADHD, PDA – retired medically) 

Psychologists should consider that neurodivergent people have different ways of communicating their feelings, and that our language can often misrepresent what we are actually feeling or wanting to say. Psychologists should consider that when communicating with a neurodivergent person, they ask the same question in a different way to get a true representation of that person's thoughts or beliefs.

Bethany George
Support Worker by profession, studying a BSc in Psychology

Traditional systems of evaluating mental health against the Edinburgh scale, GAD 7 and PHQ 9 need to be carefully worked through with neurodivergent clients, because the person might struggle to comprehend the information despite being able to read, they might not understand the intent of the question. People who are autistic or ADHD might experience Alexithymia too, which means talking about their emotions full stop might be extremely distressing. Finally, bear in mind that an autist that is articulate doesn't always mean they are able to articulate feelings, and often they need a lot of help to understand their internal worlds.

Anna Day
AuADHD Mum, Lived Experience Strategy Consultant for Samaritans

Neurodivergence may affect every aspect of a person's mental health, and without suitable accommodation being made for a person's neurodiversity, they might experience discrimination, exclusion and be at risk for poor mental health outcomes. On the other hand, I want to draw attention to the many positives that neurodivergent people bring to all aspects of life, including staff teams and the psychological professions.

Dr Jen Mance
Clinical Psychologist and Lecturer

To be less afraid of neurodivergence and, ideally, to consider it in initial assessment for mental health problems. I was put off a diagnosis for a long time by well meaning psychologists who couldn't imagine that I was neurodivergent. I think that says more about the stigma and judgment that still exists about what neurodivergence is – and the implicit understanding that we would rather be neurotypical. It doesn't consider the often incredible relief with understanding yourself better and having multiple questions answered.

Dr Emma Svanberg
Autistic Clinical Psychologist and author of 'Parenting for Humans'?

A few years ago when discussing a case (an autistic child with a learning disability), I was encouraged to reflect on the difference between anxiety and uncertainty. The process was pivotal in influencing my work. Everyone is stressed by uncertainty and this can lead to challenging or concerning behaviour, however uncertainty can be removed by providing some certainty about events. To do this we need to understand the communication needs of an individual. Most professionals overestimate the understanding of individuals with learning disability.

Dr Vicky Slonims
Consultant Speech and Language Therapist and Researcher, Newcomen Neurodevelopmental Service, Evelina London

I felt this was my only way to, to get heard, to get support was to try and get my psychiatrist to see actually that my presentation was more autistic and less emotionally unstable personality disorder. I wasn't having emotional ups and downs randomly. It was all- there was all very good, valid reasons to be having.. umm... upsets. And actually, in essence, meltdowns. So it's really invalidating when she was saying things like autistic people wouldn't know they're autistic.

Anonymous autistic adult 

Neurodivergent transgender and non-binary individuals often come up against huge assumptions and a lack of understanding in healthcare settings, which can negatively impact on mental health outcomes. Promoting acceptance, respecting individual experiences, providing appropriate resources and adjustments in addition to challenging societal stigma is crucial for creating inclusive and supportive environments, and are all important steps towards supporting the mental health needs of neurodivergent individuals who also happen to be gender diverse.

Dr Laura Charlton
Consultant Clinical Psychologist and Clinical Lead, Leeds Gender Identity Service

Neurodiversity has led me to reflect seriously about what our societally accepted notions of 'neurotypical' are and how we arrived at those. As practitioners, parents and researchers we need to maintain a critical sense about what we deem to be typical and divergent, and how the contexts we are in might shape those definitions. Normalising neurodiversity would help us build more effective mental health services, schools, and communities and nurture a sense of belonging for a lot more people.

Suparna Choudhury
MFA, PhD. Developmental Cognitive Neuroscientist and Writer, Montreal, Quebec, suparnachoudhury.com

Depression in people with ADHD is common and often more severe than in neurotypical people, but it can be difficult to spot and diagnose. Clinicians should assess people with ADHD carefully, with an awareness that some features of ADHD overlap with signs of depression (e.g., restlessness, poor concentration), and that depression may sometimes 'look' different in ADHD (e.g., greater irritability and self-harm).

Dr Lucy Livingston
Lecturer in Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London

Please don't send children back onto a waiting list for mental health intervention because they are awaiting assessment of neurodivergence. I have seen it time and time again that neurodivergent children wait longer for CAMHS interventions than neurotypical children and by the time they are seen by diagnostic services, they are in severe autistic burnout. There is a national crisis within diagnostic services and children are often waiting for many years for their diagnostic assessments. We cannot continue to doubly disadvantage neurodivergent children by awaiting these assessment outcomes before starting therapies. Embrace neurodiversity – put the whole child at the centre of your formulation, get creative and remember the impact of a strong therapeutic relationship.

Dr Rebecca Hunt
Clinical Psychologist, privatechildautismassessment.co.uk

It doesn't matter whether you get a triple PhD or whatever the highest thing you can get, you've just got to understand every day you will learn something new, and it doesn't ever mean you know everything. That's all I'd ever ask of anybody. Trying to understand the next person that comes along in your life could learn so much. Just open your mind to that.

Anonymous autistic adult

It is really important for clinicians to understand neurodiversity when working within the field of PTSD/CPTSD. Being able to consider a person's neurodivergence when formulating is essential, and adapting evidence-based interventions to ensure that the person can meaningfully engage with the therapy is so important. Otherwise, someone who could have benefited will likely miss out and worse still, be blamed for 'failing to engage'.

Dr Helen Penny
Consultant Clinical Psychologist, Clinical and Strategic Lead for Aneurin Bevan University Health Board

Two main points that can embrace diversity and empower conversations. One is the use of 'space' in relation to sensory stimuli; client-led design is needed for each individual to be active and empowered from simply moving a chair or changing lighting to mapping the whole space. The other is the use of creative writing within each session (or in assessment). I would especially underline word mapping, writing words/feelings/episodes and positioning them on a page to then connect during a further stage of reflection. I believe maintaining a line of processing that is safe and client led, and can build up an understanding of triggers to emotional instability and mental health struggles.

Luca M. Damiani
Autistic/ND University Fellow in Arts and Neuroscience

Firstly, it is vital that Psychologists keep in mind the differences in cognitive, sensory and emotional processing experienced by neurodivergent individuals. Psychologists should always try to reflect on the ableist assumptions embedded within the status quo, and should be proactive in inviting meaningful conversations with clients (and, when relevant, carers) about their needs and reasonable adjustments.

Secondly, it is incumbent on all mental health professionals to engage with appropriate Continued Professional Development (CPD) to provide quality care and support to neurodivergent clients in any setting. You don't always need to be an expert; you need to be open to learning, and curious towards understanding many different ways to be human.

Finally, take a strengths-based approach, helping clients recognise and leverage areas of unique strength and talent! Remember, in the words of Chloe Hayden we are 'Different Not Less'.

Dr Holly Kahya
CPsychol, FHEA, Lecturer, Supervisor & Personal Tutor, Professional, Doctorate in Counselling Psychology, City, University of London

Read a longer version of Dr Kahya's answer.