Neurodiversity: Autism, ADHD, PDA and mental health

29 Sep

What is Neurodiversity?

Neurodiversity refers to the full range of brain types which exist. Neurotypical brains make up the majority, while neurodivergent brains include Autistic, ADHD (Attention Deficit Hyperactivity Disorder), Specific Learning Disorders (commonly termed dyslexia, dysgraphia, dyscalculia and dyspraxia) and more.

As we move away from a medicalised model, we understand that ‘curing’ neurodivergence is not possible or desirable. For example, Autistic traits such as hyperfocus and hyper-empathy, and ADHD traits including exploration and curiosity are highly desired in many contexts including research, medicine, creative arts and business (Sedgwick et al., 2019).

How does therapy support individuals with neurodivergent brains?

Current psychological practice aims to help individuals to understand their wants and needs, their significant and different strengths and their relative challenges. Psychologists work with individuals to help them to self-advocate and adapt their environment to be more supportive of their needs. This could mean using headphones to quiet a busy environment, replacing bright fluorescent lighting or planning downtime during the day to recover after intensive stimulation such as team meetings.

What is Autism?

Our understanding of Autism continues to develop. The original diagnostic criteria was based on young, male experiences and ‘symptoms’ in USA. In Germany, research with a different sample of young boys led to the development of a separate diagnostic category of Aspergers. From 2013, the diagnosis of Aspergers has been covered by Autism (American Psychological Association, 2022).

Recently, research has focused on less typical experiences of Autism, initially thought to be ‘female’ experiences (Bargiela et al., 2016; Hull et al., 2020). These are now more accurately called ‘atypical’ or ‘internalised’ experiences or symptoms, which occur across the gender spectrum.

Internalised experiences of Autism include masking (e.g., forcing eye contact despite this being uncomfortable, and denying urges to ‘stim’ or fidget) and camouflaging (e.g., learning and copying neurotypical social interactions and speech tones). Masking and camouflaging are extremely effortful, as they suppress innate needs, and can lead to meltdowns and shutdowns (Hull et al., 2021). These are very distressing for individuals affected as well as their loved ones. Chronic mental health concerns such as anxiety and depression may also occur when the environment is not supportive of Autistic people’s differences.

What is ADHD?

ADHD is another neurodevelopmental difference. When most people think of ADHDers, the image is of hyperactivity, impulsivity and loud fidgeting, typically in young males. However, the most common experiences of ADHD include inattentive presentations, which encompass difficulties with sustained attention and concentration, and may look more like daydreaming, being late for appointments and losing important items. The inattentive type of ADHD is associated with more masking, anxiety and difficulties with friendships (Quinn & Madhoo, 2014).

Can Autism and ADHD co-occur?

Autism and ADHD co-occur in approximately 40-70% of people (Rong et al., 2021), which can exacerbate difficulties experienced. PDA (Pathological Demand Avoidance aka Pervasive Drive for Autonomy) is considered to be a subtype of Autism (PDA Society, 1997-2023) which occurs most commonly in AuDHDers. PDA is believed to be an extreme form of anxiety which occurs in response to demands. It can look like an inability to fulfil basic and desired functions such as personal hygiene needs and can be extremely debilitating.

Exceptional intellectual ability and intellectual disability are likely no more common in Autistic or ADHDer folk than in other folk, despite the stereotypes of Rainman and Sheldon.

How can a psychologist help?

Understanding your (and your children’s) brain type and associated strengths and challenges can be really important for mental wellbeing. With the support of a neurodivergent-affirming (NDA) psychologist, you can learn more about yourself and your personal needs and preferences, and develop your self-advocacy skills to improve your environment.

* Note that our knowledge regarding these topics is evolving quickly as much-needed resources are now being made available to explore them; the information and terminology used in this blog is based on current thinking, and is likely to change as we learn more.