Neurodivergent individuals are often labeled as treatment resistant when, oftentimes, treatment has been resistant to them. What if there were a world in which we took neurodivergent individuals out of the box and created care that is affirming and unique to them? Neurodivergence encompasses a range of conditions that society has determined skew from “the norm”. Autism, Attention Deficient Hyperactivity Disorder (ADHD), AuDHD (Autism and ADHD), dyslexia, etc. Historically, the stigma and harm have been rooted in misunderstanding, spreading misinformation, and forcing neurodivergent individuals to conform to neurotypical standards. Instead of pushing a self-serving agenda, we can adopt true client-centered care where the neurodivergent community feels that treatment is informed, affirming, and ethically delivered.
Neurodiversity identifies differences in the human brain that are not disordered but are becoming more widely normalized and valued. We are moving away from dated viewpoints that conceptualize this umbrella term as a deficit and instead learning about its unique strengths. The brain functions, perceives, conceptualizes, learns, and emotionally processes differently than the “majority”. Social interactions and sensory experiences are not typical for them as internal or external experiences, though their problem-solving skills, creativity, and special perspectives are significant contributions. Neurodivergent individuals have not always been uplifted for their differences, leading them to develop systems to blend into society through pattern recognition, scripting, and masking. While these serve as their means of self-preservation, they offer further insight into the reality of neurodiversity being viewed as “othered” rather than accepted. Amongst their adaptive coping strategies to blend into society has unfortunately resulted in high rates of trauma and chronic stress in this population. And while standard therapy addresses these hardships, it needs to have the neurodiverse considerations to be thoughtful and effective. Without affirming care, we as clinicians are falling short and, in the worst-case scenario, can cause additional unintended harm.
A major component of therapy processes includes emotional development. Understanding how emotions are stored, processed, and expressed for each individual is a way to become attuned to neurodivergent clients. Due to the differences in how emotions are stored, therapists need to be mindful of chronic validation, misattunement, and system barriers to their healing in this setting. Neurodivergence is curious in its etiology, sometimes stemming from birth or acquired from traumatic incidents (such as brain injuries or other adverse events). There are disruptions to development resulting in changes to the nervous system. These changes result in different lived experiences and interpretations of the world around us.
For example, two individuals, one neurodivergent and one neurotypical, are attending the same concert and enjoying the music in similar sections. They both wear sunglasses and earplugs to limit the overstimulation from light and sound at the event. The neurodivergent individual feels the music physically and intensely, which may feel disorienting and painful due to challenging stimuli. The nervous system is overwhelmed and working to regulate, resulting in increased fatigue. The neurotypical individual registers the music as loud and exciting, leading to more arousal and increased energy; their fatigue may be delayed post-concert. An individual begins crowd surfing, and while a neurotypical person immediately jumps into the festivities and lifts the person in the crowd, the neurodivergent individual may feel confused by the social rules around crowd surfing, unsure whether or when to participate. There may be more concern about engaging in a “wrong” manner or about interpreting crowd proximity as invasive rather than communal. Nonetheless, experiences differ internally, leading to externally influenced behaviors. The way we just explored this neutral event, now imagine the differences in a traumatic event and the way the brain will internally process differently and behaviorally adjust as a result.
The neurodivergent community not only may conceptualize experiences and information differently, but they also may verbally process differently, leading traditional psychodynamic therapy to be a less effective model when processing trauma. Eye Movement Desensitization and Reprocessing (EMDR) focuses less on external verbal processing and more on internal systems. Bilateral Stimulation (BLS) is a primary tool in EMDR, activating both sides of the brain through sensory input while cueing the distressing event. Lateral eye movements, tapping, and auditory tones are techniques used during EMDR treatment that help clients neutralize adverse events. Neurodiverse-affirming care is imperative throughout the stages of EMDR, including history-taking, treatment planning, assessment, desensitization, installation, body scans, closure, and re-evaluation. The structure of EMDR addresses gaps that may exist in conventional psychotherapy practices.
Similarly, Ketamine Assisted Psychotherapy (KAP) is an additional tool that reduces negative mental health symptoms and promotes neuroplasticity, encouraging new and restructured neural pathways. The process for a psychedelic like ketamine to alleviate depressive symptoms and rewire the brain accelerates relief. The benefits are profound, including reduced rigidity, decreased negative narratives, increased flexibility in cognitive thinking patterns, and relief from sensory/trauma-related emotional fatigue. There are strong considerations to review before recommending KAP to an individual with neurodivergence, like their processes around sound, light, and physical sensations, as ketamine produces a dissociative effect when used in low doses. The dissociative effect can feel foreign and, for many, exciting, although potentially new and uncomfortable for others. Thorough screening and assessment are needed with your provider to determine the appropriate dose, curating the setting, and exploring the most effective integration style.
Both EMDR and KAP are proven and effective treatment tools, and when tailored to be attuned care, can greatly positively impact the quality of one’s life. The appropriateness of each treatment should be considered based on a person’s nervous system, communication styles, perceptions, and cognition. The most important distinction is the structure of each treatment — EMDR being a formal, structured, bottom-up trauma-processing model that emphasizes dual attention stimulation and rapid associative processing. KAP is a hybrid model primarily used to access trauma that is deeply stored, blocked, and difficult to access due to rigid defense structures. EMDR could be better for neurodivergent individuals who have identified a specific trauma they’d like to address, prefer more structured approaches, can manage sensory stimulation, and can identify bodily reactions. KAP would be more appropriate for a neurodivergent individual whose trauma is developmental, relational, or preverbal, has high rigidity or fixation, and has a more intellectual method of processing that ketamine helps to soften. For either approach, there should be a strong emphasis on neurodivergent affirming care and a trauma-informed focus.
As a clinician focused on trauma-informed care, the focus on expanding treatment to be more nuanced for increased accessibility is a key part of ensuring more people can feel relief. Our mission is to ensure we adapt modalities to support clients with different capacities. While it can be a challenge to find a clinician who is trauma-centered AND attuned to neurodivergent spectrums, it is possible. At GTS, we promote an inclusive environment that embodies hope for all individuals seeking high-quality and compassionate care.
