Autism spectrum disorder and neurodiverse people

Throughout my career I have worked extensively with neurodiverse people, and in my personal life I have several close friends who are neurodiverse, including people with autism and others with ADHD and other neurodevelopmental differences. 

I am often amazed by the many different presentations of neurodiversity, especially how certain characteristics present typically in boys and men as opposed to girls and women. Unfortunately this has led to many young girls, teenagers, and adult women being diagnosed with a variety of mental health conditions ranging from psychotic disorders, emotional and anxiety disorders, and various forms of personality disorders. I am very pleased to note the progression of our knowledge and psychological science in relation to the presentation of neurodiversity in girls and women although I am mindful that many people are still misdiagnosed, misunderstood, labelled as either ‘stubborn people’, ‘loners that don’t fit in with others’ or even worse diagnosed with some unworkable personality disorder. 

There are specific guidelines for how a thorough, multi-sourced, and developmentally assessment should be conducted. In my own practice I do not conduct formalised ASD assessments, however I will refer people to other psychologists and medical specialists who I trust to follow proper assessment guidelines. I will also inform the person of my diagnostic impression and provide as much education as possible if this is of interest. Formal assessments and diagnosis may be helpful to the person if the person needs assistance with living, work and study, socialising, or to improve their life more broadly (i.e. NDIS application for support). 

In my experience, neurodiversity is just that – diversity, meaning a difference in neurodevelopment (note: based on statistics! After all, the diagnostic manual we use in mental health is the Diagnostic and Statistical Manual of Mental Disorders - DSM 5 TR in short). 

In my opinion, the main hallmarks of autism present differences in rigidity and inflexibility of thinking, a variation in the way the person communicates, difficulties with relationships with people of their own age – making new friends, maintaining friendships, etc., expressing emotions and understanding their own and other people’s emotions, and often experiencing sensory insensitivities and/ or sensory hyper sensitivities. 

People who are neurodiverse are often misunderstood by other people, and they may describe difficulties in fitting in well with others. As much as autism and ADHD are considered differences in neurodevelopment, inferring that symptoms are static and the person “will always be autistic”, I find a vast fluctuation of symptoms and impact in the person’s life. 

In my opinion, a person’s disorder (cringe term!) or disability is not based on biology alone (this is the old-fashioned medical model) but rather based on the interplay between the person’s biology and abilities AND the task and environment. For example, in a learning or working environment a neurodiverse person may be sensitive to bright lights and loud noises (hypersensitivity) and finds it difficult to follow complex verbal directions or instructions. However, if there are dim lights, carpets on the floor to reduce echoing sounds, and visual presentation of material as well as verbal instructions the person’s “disorder or impairment” (double cringe terms!) disappears all together or is greatly reduced. 

In my experience neurodiverse people often report having emotional difficulties and very high levels of anxiety. They can also have been conditioned over time to think there is something wrong with them, that they are not good people, that their way is the wrong way, and that lots of things that go wrong in life is their own fault. Remember the note about rigidity and inflexibility mentioned before? Well, it can be hard for them to see another person’s perspective, even when there is little to no real evidence to support their own conclusions. 

My work with autism is about normalising and validating the way they think, feel, behave, and relate to others. I offer help to make sense of themselves and the world, acknowledging their skills and abilities, assisting with finding the right accommodations or strategies that may help with particular problems, and to modify the traditional therapeutic approaches to be effective to reduce anxiety and other emotional problems.