This was a specialization that found me. I have been working with adults with eating disorders and OCD for a long time, and over a few years, I noticed that many of my clients were Autistic or ADHDers. I began to tune into more subtle, hidden (or masked) expressions of Autism and ADHD. These clients and I would develop a deep understanding – we just got each other. Eventually, I realized that I too was neurodivergent, and this was the foundation of our connection. We shared similar experiences and a way of communicating that fitted so well together.

This was a big thing to understand about myself, and I spent over six months contemplating what this meant for me as a clinical psychologist and reading more to understand myself better. I waited a while before seeking a formal assessment. I was confirmed to be Autistic at 48 years old, and an ADHDer six months later. I have no regrets – understanding my own neurodivergence has created so many opportunities for self-compassion.

Many neurodivergent people experience a kind of burnout that is quite different from the burnout associated with work. Autistic burnout has been studied recently however ADHDers also experience burnout, and it’s an experience that affects every aspect of your life.

This kind of burnout can be acute, such as the feeling of complete overwhelm at the end of a long day speaking to customers, and it can also become chronic when it is caused by ongoing stressors in your life that don’t change.

The symptoms of neurodivergent burnout include feeling chronically overwhelmed, being exhausted no matter how much sleep you get, increased sensory sensitivities, being unable to get things done, increased self-criticism and constantly feeling like you are failing. Habits such as skin-picking and hair-pulling may increase, and it may also affect the person’s health, worsening headaches, stomachaches, digestive issues, autoimmune disorders, and chronic pain. 

Neurodivergent burnout keeps the person stuck in daily problems, makes it hard to move towards goals, and can exacerbate mental health problems. Burnout can be mistaken for depression and anxiety, and while a person may also have these problems, the source of the problems includes exposure to distressing sensory experiences, social stressors and relationship problems, and executive functioning overload.

The usual treatment for depression involves helping the person get back to their interests and connecting with others, however, when you are in burnout, you do not have the capacity to do more. Only attempting to treat the observable symptoms risks failing to address the underlying cause of the problems, and the neurodivergent person doesn’t get better. Instead, it’s essential to take a step back and do less. And, to prevent burnout in the future, it’s crucial to address the causes and make life more manageable and enjoyable.

Until recently, the medical model has been the primary way that people have understood neurodivergence. The medical model views Autism and ADHD as disorders and highlights dysfunctions and problems that need to be solved. Unfortunately, this approach has perpetuated negative stereotypes and strengthened the powerful negative stigma associated with these neurotypes. The application of the medical model in Autism and ADHD research has resulted in research focused on measuring deficits, searching for genetic markers and brain scan studies, and very little focus on identifying how to improve the quality of life for Autistic people and ADHDers.

The social model of disability views a person’s disability as socially constructed, emerging entirely from how our society responds to an individual’s characteristics and differences. A person is disabled when society favors the able-bodied majority (able-ism) causing greater difficulties for the minority and does not accommodate or make adjustments for this. Within the social model of disability, neurodiversity is viewed as a social justice issue.

The neurodiversity-affirming framework views disability as something that emerges from the interaction between an individual’s characteristics and their environment including the person’s physical environment, the attitudes and expectations of others, and social, academic, and employment opportunities. Disability occurs when there is a mismatch between the person’s characteristics and their environment. The neurodiversity-affirming framework focuses on both support for the individual and change within our society and physical environment.

Autism and ADHD are highly genetic, with many different genes involved. This leads to a wide range of differences that vary in every person and makes it difficult to identify clear neurological markers. Autistic people and ADHDers have a range of neurobiological differences in information processing that influence how they experience and respond to the world around them. These differences tend to include:

• Being strongly oriented towards interests so that something is either very interesting or not at all interesting, and finding enjoyment in exploring these interests deeply

• Hyper- and hypo-sensitivity to sensory experiences such that uncomfortable sensory experiences cause intense distress and result in sensory avoidance and sensory-seeking behaviors

• Differences in emotion processing, either experiencing intense emotions or more muted emotional sensations in their body and often having difficulty identifying these emotions

• A style of communication that prioritizes language semantics (the literal meaning of words) over language pragmatics including body language, inferences, hints, sarcasm, and other non-verbal cues

• Social expectations that people will be consistent, honest, fair, and follow rules that are fair and make sense

• Executive functioning difficulties in initiating tasks, planning, organizing, prioritizing and decision-making, maintaining attention, working memory, monitoring the impact of their behavior, controlling impulses, a different experience of time, and emotion regulation

• Self-regulation through all the senses including through repetitive sensory behavior called “stimming”
  

Being genetic, these neurobiological differences are within every cell in the body, and you can find differences in all nervous systems including the central nervous system (brain and spinal cord), peripheral nervous system which senses the world around us and inside our bodies, and the autonomic nervous system, which regulates the automatic processes in the body such as heart rate, breathing, digestion, and blood pressure.

Put simply, using a functional contextual approach with neurodivergent clients involves looking at the function (or purpose) of the person’s behavior in its context. Understanding context for neurodivergent people, however, involves many additional factors that are not always considered in therapeutic practice.

For neurodivergent people, context includes their broader social context such as experiences of discrimination, rejection, and social exclusion, and other intersectional differences the person has from others such as their sexuality, gender, ethnicity, mental health, and other disabilities and differences.

It also includes the person’s social relationships, whether they are supportive or hostile, their experiences at work or while studying, and the level of support they receive from others. Moreover, it includes the neurobiological differences that are part of their neurodivergence.

It's essential to understand how each neurodivergent person’s unique experience of the world emerges from these differences. How well the person’s environment fits and accommodates these differences will determine their experience of life.

The behaviors you observe in that person serve specific functions in that context. For example, a person who has experienced many instances of rejection and exclusion will be sensitized to the potential for further painful rejections. They are likely to develop people-pleasing and masking behaviors that function to keep themselves safe in social situations.

Neurodiversity-affirming therapists amplify neurodivergent perspectives within their practice, and actively address the communication difficulties that can occur between neurodivergent and non-neurodivergent people, known as the ‘double-empathy theory’.

The principles of neurodiversity-affirming practice include:

• The therapeutic approach is informed by neurodivergent-led research and practice

• Neurodivergent people are actively consulted in the formulation of policy and practice principles, with lived experience respected

• Non-neurodivergent input is from the position of ally and does not speak over neurodivergent experiences

• Implicit bias is openly questioned and explored

• Therapy is strengths-based rather than deficit-focused, and encourages self-acceptance

• Neurodivergent communication styles are respected with the responsibility for effective communication shared equally by neurodivergent and non-neurodivergent people

• The physical environment is adapted to meet the client's sensory needs (such as noise, lighting, and textures)

• Difficulties with executive functioning are supported (for example, reminders, lists, and homework prompts)

• Practitioners use respectful and affirming language in speech and all written documents

Effective therapy with neurodivergent adults is built on a foundation of understanding your client’s differences and how this influences their experiences in life. Neither a deficit focus nor an emphasis solely on strengths will help your client; instead, take a pragmatic approach that explores both strengths and difficulties across several domains.

Most, if not all, of your clients will come to therapy with Autistic/ADHD burnout that may have lasted for years. This is much more than anxiety and depression—its origins come from sensory, social, and executive functioning burnout, and chronic stress from trying to live up to societal expectations. Get to know your client and build your relationship before leaping into solutions. Explore the origins of burnout and identify ways they can alleviate it now and prevent it in the future. Many of these clients have had experiences with health professionals where they haven’t felt heard or understood. Share your formulation of their difficulties with them and ask for feedback. Look for signs that your client feels unsure and be willing to adapt your perspective.

Always work within a trauma-informed framework. Most neurodivergent adults experience interpersonal trauma including violence and abuse, and have experiences that don’t meet the DSM criteria for PTSD such as bullying and rejection. These have nevertheless had a powerful and lasting impact on them, and you will need to build trust.

The specific therapeutic tools you use should be founded on a strong relationship but may vary according to your therapeutic approach. Avoid narrowing to a single focus such as trauma and be willing to help your client with everyday problems in relationships, with work or study, advocating for themselves in the workplace or study, and with other health professionals. Help them unwind their internalized stigma. Help the client develop a range of tools to self-regulate through their interests and all of their senses, and adapt their environment to better meet their needs.

Therapy with neurodivergent adults can take longer and it may feel like you aren’t making progress at times. Your client may have difficulty implementing new strategies if they are in burnout, however, avoid applying pressure or discharging the client on this basis. This can amplify trauma symptoms and severely rupture the relationship.

Language choices have changed dramatically in the broader Autistic and ADHDer community in the past five years, while those of health professionals have lagged. Person-first language (“person with Autism” or “person with ADHD”) is still being taught in many professional training programs due to the perception that this is more respectful and acknowledges the person as more than their neurotype.

However, the majority of Autistic and ADHDer adolescents and adults prefer to use what is called “identity-first” language (“Autistic person” or “ADHDer”). This language reflects a deliberate choice to communicate pride in and acceptance of their neurodivergence. It also acknowledges that a person’s neurotype is woven into their identity and physiology, and is relevant in all aspects of mental and physical healthcare.

Labels like “high functioning” or “low functioning” have also been abandoned. These are problematic terms that summarize a person’s entire functioning in just one when functioning is something that varies according to context. The label “high functioning” may be intended to acknowledge that a person has high intelligence, but implying that there is somehow a better or more mild form of Autism reflects an ableist perspective.

Both Autism and ADHD can be considered a disability because when an environment doesn’t accommodate your needs, you are “dis-abled” by it.

You can continue to use whatever terms feel most comfortable to you. At first, changing your language can feel awkward, and you might not be ready for that right now. So, my aim is to show you how you can talk about yourself in a way that reflects your acceptance and pride in your neurodivergent identity.