Many people diagnosed with Autism Spectrum Disorder (ASD) or ADHD or who are questioning their neurodivergence during adulthood will seek help from mental health professionals. Research tells us that seventy percent of people with an Autism diagnosis will also be diagnosed with depression or anxiety. How many will receive treatment from providers who are knowledgeable about the differences in how neurodivergent brains experience, sense, perceive, process information, feel and communicate emotions? Do we, as health and mental health care providers, even know what neurodivergent mental health is when neurotypical brains and nervous systems are the baseline of research and practice?
These are questions my Associates and I often discuss at Scattergram Counselling and Consulting, an interdisciplinary, virtual group practice for neurodivergent youth and adults located in Toronto, Ontario. I founded this practice with a focus on neurodivergence just as my daughter was turning eighteen, three years after an ASD (Autism Spectrum Disorder) diagnosis. While I did not find any Autism services that fit my daughter’s needs as a teenager, there were agencies and services to try out. When I looked around for services for adults on the spectrum after she turned eighteen, I found…nothing. Neurodivergent adults must turn to services designed by and for neurotypical brains and nervous systems.
There is a term for what happens when service providers unintentionally do harm to the people seeking their help: sanctuary trauma. Dr. Steven Silver coined the term to describe the experiences of veterans who sought help, expecting to find a supportive and safe environment, and instead experienced further trauma.
There are many ways in which traditional neurotypical therapeutic responses to Autistic and ADHD distress can cause moral injury. They can:
- Reinforce stigmatizing messaging that Autism and ADHD are disorders
- Invalidate legitimate experiences of trauma that don’t match neurotypical definitions or expectations
- Invalidate neurodivergence by mistaking it for trauma or mental illness
- Invalidate any perceptions and sensations that diverge from the neurotypical norm
- Mistakenly assess and treat sensory distress as emotional distress
- Promote social skills and behaviours that encourage masking and lead to Autistic and ADHD burnout
- Provide advice and exercises to encourage clients to change aspects of their thoughts, feelings, or behaviour that are hard-wired and unchangeable
- Fail to modify the therapeutic environment to reduce sensory demands
If you are a mental health care provider and don’t want to cause sanctuary trauma, you can begin by practicing from a neurodiversity-affirming perspective, where there is no disorder in an Autism Spectrum or ADHD diagnosis, only difference. A different brain and nervous system creates differences in perception, how thought is processed, how physical, sensory, and emotional pain are experienced, and what types of experiences cause trauma. Some differences may require support of varying degrees over the lifespan, especially when our social environment is geared toward brains that fit the statistical norm aka neurotypical brains. Those of us in helping positions work directly with our clients’ thought processes, emotional processes, and nervous systems. These are the things that by definition, in the Autistic and ADHD population, diverge. With these differences, how is it possible that the same medical and therapeutic treatments will be effective?
Neurodiversity-affirming therapy supports neurodivergent clients with the knowledge to make realistic choices about what to accept and what to change in their lives and environment. For some, a radical career change may be needed to eliminate sensory or social distress. For others, friendships with people who continually invalidate their perceptions and experiences may need to be let go or reprioritized. For most, becoming more attuned to their sensory and emotional responses can help them to avoid or manage triggers. Self-knowledge underpins self-advocacy and the capacity for authentic relationships across neurotypes. The first step is often the process of unpacking the negative messaging you have received over your lifetime from well-meaning family members, friends, teachers, and mental health and healthcare professionals.
If you are an Autistic or ADHD adult or young person transitioning to adulthood, you are entitled to mental health services based on the evolving knowledge of your brains and nervous systems by providers who understand how to modify their practice to use the right tools to help you achieve your life goals. To find a neurodiversity-affirming therapist or healthcare provider, you may want to start with questions like these:
Do you work with neurodivergent clients?
If the therapist doesn’t know, they don’t recognize the signs or aren’t even looking for them. These providers are at high risk for perpetuating sanctuary trauma.
What do you know about ADHD, Autism, the ADHD or Autistic brain, or the ADHD or Autistic nervous system?
Pay attention to deficit-based language (different and disordered) or language that minimizes differences (not different) from neurotypical brains. Does the therapist acknowledge social, emotional, cognitive, sensory, and physical differences and recognize Autism as a spectrum of traits, not a continuum from low to high functioning?
Do you use different therapeutic modalities or approaches for neurodivergent clients?
There are no ‘bad’ therapeutic modalities, only misuse of a modality to try to change what is unchangeable. CBT, for example, can be useful to challenge stigmatizing beliefs about one’s Autism but can’t be used to eliminate rumination which comes with a hyper-focused, detail-oriented, hyper-systemizing brain. Obsessive rumination may co-occur, but should not be mistaken for OCD. Is the provider’s knowledge enough to know the difference?
What do you know about meltdowns or shutdowns? Autistic or ADHD burnout?
Therapists who have not heard of these terms probably won’t understand the Autistic of ADHD nervous system and may confuse sensory overwhelm with emotional dysregulation resulting from trauma. They will not know what causes Autistic or ADHD burnout, how to recover from it, and how to avoid it in the future.
Have you ever heard of sensory dysregulation?
When sensory distress is treated as emotional distress, the therapist will support internal change when what is needed is external environmental modification. Exposure therapy to try to desensitize the neurodivergent clients’ nervous system (habituated to an unpleasant sensory stimuli such as sound, light, or smell) is ineffective and cruel.
All neurotypes have the right to competent, knowledgeable health and mental healthcare. In the decade to come, I hope that neurodiversity-affirming care becomes competent, mainstream, effective care. In the meantime, seek out providers who are ahead of the curve, such as the Psychotherapists and Occupational Therapists at Scattergram, where neurodivergence is normal.
Heather Davis. (2021), Autism and Depression. Retrieved from: Autism and Depression | Adult Autism Center
Steve Rose. (2014). What is Sanctuary Trauma? Retrieved from: What is Sanctuary Trauma?
Sanctuary Trauma: When Helpers Unintentionally Cause Harm to Neurodivergent Adults
Sanctuary trauma occurs when service providers unintentionally do harm to the people seeking their help. Providers can learn how to provide neurodiversity-affirming care and neurodivergent people can learn to recognize these providers to put an end to retraumatization.
To recognize neurodiversity-affirming providers, ask questions:
Do you work with neurodivergent clients?
What do you know about _________(ASD, ADHD)?
What do you know about sensory dysregulation, meltdowns or shutdowns?
How do you modify your practice for neurodivergent brains and nervous systems?