Spotlight: Therapy for Neurodivergent Adults

Therapy for Neurodivergent Adults: Neurodiversity-Affirming Skills Training for Adults with ADHD and Autism in Alabama

“I feel like I’m constantly in a fog. It’s hard to focus, and sometimes I forget what I was doing mid-task.”

“I want to connect with people, but social situations often feel like a minefield. I never know if I’m saying the right thing.”

“Everyone else seems to fit. Things seem so much easier for everyone else. I always say the wrong thing or do the wrong thing.”

“People don’t understand how exhausting it is to mask my true self every day. It’s like I’m performing a role that isn’t me.”

“I have these interests that I’m super passionate about, but I struggle to explain them to others without feeling overwhelmed.”

“Sometimes I wonder if I’ll ever feel like I belong. I just want to be accepted for who I am.”

Autistic adults, adults with Attention-Deficit Hyperactivity Disorder (ADHD), and adults with both conditions (“AuDHD”) often report that life can feel confusing, exhausting, invalidating, emotionally overwhelming, and isolating. Understanding the traits that characterize these conditions is critical to offering effective therapeutic support. Providing comprehensive, neurodiversity-affirming evaluation and therapy for autistic adults, adults with ADHD, and adults with AuDHD is one of Upward Behavioral Health’s areas of expertise.

Neurodiversity-Affirming Therapy

Neurodiversity is the concept that celebrates and values the diverse ways in which human brains function. It emphasizes that neurological differences, such as those found in autism and ADHD, are not deficits; rather, they are variations of human experience. Neurodiversity-affirming therapy focuses on embracing these differences and generating strategies for success rather than simply attempting to modify behaviors to fit societal norms.

At Upward Behavioral Health, our providers are passionate about promoting neurodiversity. We believe in fostering authenticity and helping individuals understand and appreciate their unique perspectives and strengths. Our approach is rooted in compassion, validation, science, and a commitment to empowering neurodivergent individuals.

Research has demonstrated a number of crucial truths that must be recognized in neurodiversity-affirming therapies:

· Simply providing standard (i.e., non-affirming) therapeutic approaches without tailoring them for neurodivergent adults has been shown to yield shown poorer outcomes for these neurodivergent adults.

· Neurodivergent care that is not used in tandem with measurement-based care has been shown to be less-effective for neurodivergent people.

· Flexibility through collaborative, individualized treatment plans which incorporate evidence-based therapy protocols as well as holistic and complementary treatment considerations yields the best outcomes for neurodivergent people.

Understanding Different Neurotypes

An insightful analogy presented by Hartman et al. in The Adult Autism Assessment Handbook compares neurotypes to different dog breeds. Just as each dog breed has distinct traits, strengths, and needs, every human neurotype—including those of autistic people, people with ADHD, and people with AuDHD—requires individualized understanding and support. For instance, a border collie thrives on mental stimulation and physical activity, while a bulldog may be more laid-back and require less exercise. Similarly, adults with Level 1 Autism or ADHD may excel in environments that recognize their unique strengths, such as analytical thinking or creativity, while struggling in settings that demand conformity to neurotypical behaviors. This analogy underscores the importance of valuing neurodiversity and creating supportive environments tailored to individual needs.

Taking the analogy further, Dr. Rathmell is fond of saying the following: “it’s as though for generations, we collectively agreed that “normal” dogs are Golden Retrievers simply because historically, that was the most-common breed in America. And so we built everything around the Golden Retriever-type dog. Imagine we decided that dog food bowls should be manufactured on a two-foot stand because that is the most comfortable for a Golden Retriever to use, and then we labeled that type of dog food bowl as “normal”. Imagine that when pugs, terriers, and collies couldn’t reach it, we decided that they were “weird”. It’s a clearly-ridiculous analogy because obviously all dogs are just dogs—there are no “normal” and “weird” dogs. We don’t look at a Dalmatian and comment that it is weird because it doesn’t behave like a Golden Retriever. We all understand that this is simply a different type of dog.”

Neurodivergent people deserve the same consideration. One neurotype is not superior to others, even though we have built the world around the most-common neurotype. The answer is not for all other types to conform. The answer is that we celebrate and accommodate all types as equally valuable.

There are lots of different ways to be neurodivergent. As renowned professor and autism advocate Stephen Shore said, “if you’ve met one person with autism, you’ve met one person with autism.” Neurodiverse people are wonderfully diverse in their experiences of strengths and challenges.

At Upward, we focus on ADHD, AuDHD, and autistic neurotypes in our neurodiversity-affirming evaluations and therapies. Let’s take a closer look at these neurotypes.

Autism

Autism is characterized by challenges in social communication and restricted interests or repetitive behaviors that may not be immediately apparent. Autistic adults often possess above-average intelligence and may have unique talents or skills. However, they may struggle with social interactions, understanding social cues, and managing anxiety. Recognizing these traits is essential for creating a supportive environment that fosters growth and acceptance.

Common Traits of Autism

Autistic adults may exhibit the following characteristics:

Social Communication Challenges: They may find it difficult to initiate or maintain conversations, interpret nonverbal cues, or understand social norms. For example, they might not recognize when someone is losing interest in a conversation or may misinterpret a friendly gesture as an invitation to engage further. This is particularly challenging as autistic people often have areas of intense interest, such as anime or collectible items, and once they begin discussing these interest areas they have a hard time seeing when their conversation partner has lost interest. Autistic people also tend to experience discomfort with direct eye contact. Interpreting others’ facial expressions and managing their own facial expressions can also be challenging. Finally, autistic people do not always understand social cues and norms, and may say the “wrong” thing, which can lead to embarrassment and social ostracizing.
Restricted Interests: As mentioned above, many autistic people have an intense focus on specific topics or activities about which they are passionate, such as gaming. These interests can be a source of joy and expertise. However, autistic individuals may struggle to engage in conversations outside of that interest.
Difficulty with Change: Transitions and changes to routine can be particularly challenging. An individual might become anxious or upset when plans change unexpectedly, leading to a sense of instability or discomfort.
Sensory Sensitivity: Many autistic people have heightened sensitivity to sensory input, such as sounds, lights, or textures. This sensitivity can lead to sensory overload in busy or chaotic environments.

Best Therapies: Evidence-based interventions include protocols to address social anxiety, emotional dysregulation, social skills training, and mindfulness practice.

ADHD

ADHD is a neurodevelopmental condition that manifests in various ways. It is characterized by patterns of inattention, hyperactivity, and impulsivity that can significantly impact daily functioning, relationships, and overall quality of life.

Common Traits of ADHD

Individuals with ADHD may exhibit a range of traits, which can vary widely from person to person. Some of the most common traits include:

Inattention: Difficulty sustaining attention, organizing tasks, and following through on projects. Individuals may frequently lose items necessary for tasks or forget appointments, deadlines, and obligations.
Hyperactivity: While hyperactivity may be more pronounced in children, adults with ADHD can still experience restlessness or a sense of being "on the go." They may fidget, tap their feet, or feel compelled to move around in situations where being still is expected.
Impulsivity: Individuals with ADHD may struggle with impulse control, leading to hasty decisions without considering the consequences. They may interrupt others during conversations, speak out of turn, or struggle to wait patiently for their turn in group settings.
Emotional Dysregulation: Many adults with ADHD experience intense emotions, leading to feelings of frustration, anger, or sadness that can be difficult to manage. This may result in challenges when navigating social situations or coping with everyday stressors.
Difficulty with Time Management: Individuals with ADHD often struggle with estimating how long tasks will take, leading to procrastination or missed deadlines. They may also have trouble prioritizing tasks effectively.
Challenges with Organization: Maintaining an organized environment—both physically and mentally—can be difficult for individuals with ADHD. They may find it challenging to keep track of schedules, plans, and projects.

Best therapies: Evidence-based interventions include protocols to address impulsivity, improve focus, improve organization and problem-solving skills, regulate emotional responses, and manage stress.

AuDHD

AuDHD refers to the co-occurrence of autism and ADHD in an individual. Between 50-70% of autistic adults also have ADHD. This dual diagnosis can present a unique set of challenges and strengths, as individuals may experience traits and behaviors from both conditions. Understanding these traits is essential for providing effective support.

Common Traits of AuDHD

Individuals with AuDHD may exhibit a combination of traits from both ADHD and autism, including:

Difficulty with Social Interactions: Individuals may struggle to understand social cues and engage in conversations, while also experiencing impulsivity or hyperactivity that disrupts social dynamics.
Intense Focus and Interests: Individuals may have hyperfocus on specific interests, similar to restricted interests seen in autism, while also experiencing the distractibility typical of ADHD.
Sensory Sensitivities: Heightened sensory sensitivities can be present, which may lead to sensory overload in certain environments, making it difficult to concentrate.
Emotional Dysregulation: Individuals may experience intense emotional responses, which can be compounded by the challenges of managing both autism and ADHD traits.
Challenges with Organization and Time Management: Difficulties in executive functioning can be pronounced, as individuals may struggle to keep track of tasks and deadlines while managing their time effectively.

Best Therapies: Evidence-based interventions include protocols to manage impulsivity and emotional responses, enhance social skills, improve focus, improve self-advocacy, improve goal-setting and organizational skills, and mindfulness practice.

Rejection Sensitive Dysphoria

Rejection Sensitive Dysphoria (RSD) is a common emotional response among neurodivergent individuals, particularly those with ADHD and autism. RSD refers to the intense emotional pain that can occur in response to perceived rejection or criticism. This experience can lead to heightened anxiety, self-doubt, and avoidance of social situations.

For individuals with RSD, even minor comments or feedback can trigger overwhelming feelings of shame or inadequacy. For example, Jordan, a 30-year-old marketing professional in Huntsville, Alabama, might feel devastated after receiving constructive feedback on a project, interpreting it as a personal failure rather than a chance for growth. Similarly, Maya, a 25-year-old artist in Vestavia, Alabama, may find herself avoiding art shows and networking events because she fears negative criticism of her work.

Consider Lisa, a 34-year-old woman in Montgomery, Alabama who experiences RSD in her relationship. When her partner casually mentions that the house isn't clean, even without any accusatory tone, Lisa feels an intense wave of shame and self-loathing. She interprets the comment as a reflection of her inadequacies and worries that her partner is disappointed in her. This reaction may lead her to withdraw emotionally, feeling overwhelmed by the fear of not living up to expectations. Acknowledging the impact of such comments on her emotional state is crucial for her healing and growth.

Understanding RSD is crucial for developing coping strategies and fostering emotional resilience in therapy. By addressing the impact of RSD in therapy, individuals can learn to manage their emotional responses and develop healthier ways of coping with perceived rejection. This focus can lead to improved self-esteem and more fulfilling social interactions.

The Importance of Evidence-Based Skills Modules

Using evidence-based skills modules can effectively address the diverse combination of symptoms presented by different clients. These modules are designed to target specific challenges associated with ADHD and autism, allowing therapists to customize treatment plans according to individual needs.

Tailored Skills Modules

Executive Functioning Skills: For clients struggling with organization and time management, skills modules focusing on executive functioning can be particularly beneficial. These modules may include techniques for prioritizing tasks, creating structured schedules, and breaking larger projects into manageable steps.
Social Skills Training: Social skills modules help individuals understand social cues, improve conversation skills, and build confidence in social situations. Role-playing and real-life practice can enhance these skills, allowing clients to navigate social interactions more effectively.
Emotional Regulation: Emotional regulation modules teach clients strategies to manage intense emotions and reduce anxiety. Techniques may include mindfulness practices, deep breathing exercises, and cognitive restructuring to challenge negative thought patterns.
Self-Advocacy and Communication: Empowering clients to express their needs and advocate for themselves is vital. Self-advocacy modules may focus on teaching clients how to communicate their preferences, set boundaries, and navigate challenging conversations.
Coping Strategies for Sensory Sensitivities: For individuals with sensory sensitivities, skills modules can provide strategies for managing overwhelming sensory input. This may include techniques for creating sensory-friendly environments and developing personal coping mechanisms.

Therapists must be well-versed in the spectrum of autism and ADHD, understanding that one size does not fit all. Effective therapy requires a deep understanding of each client’s unique profile, including their strengths, challenges, and personal goals. This individualized approach is essential for fostering growth and empowerment.

Limitations of Traditional Evidence-Based Therapies

While traditional evidence-based therapies like Cognitive Behavioral Therapy (CBT) have proven effective for many individuals, they may be less effective for neurodivergent clients. Traditional CBT focuses on identifying and modifying negative thought patterns, which can be beneficial for many individuals. However, neurodivergent individuals may require adaptations to these protocols to address their unique needs.

Challenges with Traditional Approaches

Social Communication Differences: Autistic people may struggle to articulate their thoughts and feelings in the same way that traditional CBT expects. This can lead to frustration and disengagement from the therapeutic process.
Cognitive Styles: Neurodivergent individuals may have different cognitive styles, affecting how they process information and learn new skills. Traditional CBT may not align with their learning preferences, making it challenging to implement strategies effectively.
Focus on Conformity: Traditional therapies often emphasize conforming to neurotypical standards, which is invalidating for neurodivergent individuals. Approaches that unwittingly encourage masking or assimilation and are not neurodiversity-affirming have been linked to poor mental health outcomes for neurodivergent people. This focus on modification rather than acceptance can hinder the therapeutic relationship.
Emotional Responses: The emotional responses of neurodivergent individuals (i.e., “meltdowns”) may differ from those of neurotypical clients, affecting how they engage with therapy. Traditional CBT approaches may not adequately address these unique emotional experiences.

Given these challenges, it is essential for therapists to be experts in evaluating and providing therapy to neurodivergent individuals. This expertise allows them to adapt traditional approaches and incorporate evidence-based practices that resonate with their clients. Furthermore, the therapies themselves must be tailored to the neurodivergent brain to ensure that they are effective and supportive.

The Role of the Therapist

Therapists who specialize in working with neurodivergent individuals must possess a deep understanding of the autism spectrum and ADHD. They should be skilled in assessing individual needs and tailoring therapy accordingly. This involves building rapport, fostering trust, and using cutting-edge, science-backed techniques to help clients maximize their therapeutic benefits.

Neurodiversity-affirming therapists should procure and be trained to use therapy protocols that have specifically developed for neurodivergent people. These protocols should be backed by research that has been conducted on neurodivergent people. Neurodiversity-affirming therapists should also be committed to continuous learning and consultation with other professionals to ensure that their skills remain sharp and current.

Holistic and Complementary Approaches to Treatment

In addition to traditional therapeutic interventions, holistic and complementary approaches can play a crucial role in supporting the well-being of neurodivergent people, Focusing on proven lifestyle factors such as exercise, sleep, and nutrition can enhance overall mental health, resolve underlying deficiencies (such as iron and magnesium), and complement therapeutic efforts. Upward’s providers offer evidence-based modules addressing each of these factors, and interested clients frequently keep food diaries, sleep records, and regular exercise routines with the support of their Upward provider.

Concern About a National Autism Registry

Recent news headlines have raised concerns about the establishment of a national autism registry, igniting discussions around privacy and the potential misuse of personal information. We understand and validate these concerns, as many individuals worry about how their sensitive data may be stored and utilized. At Upward Behavioral Health, we want to assure our clients that we take privacy very seriously. Since we do not accept insurance, we are not required to report any diagnoses to external entities, ensuring that your information remains confidential and secure. We encourage you to read our blog post on this topic for a deeper exploration of the implications of such registries and the measures we take to protect your privacy.

Conclusion

At Upward Behavioral Health, we recognize that neurodiversity is not just a concept but a vital part of the human experience. Our commitment to providing neurodiversity-affirming therapy stems from a deep understanding of the unique strengths and challenges faced by individuals with ADHD, autism, and AuDHD. Our providers are not only highly trained in evidence-based practices but also deeply passionate about fostering an inclusive and supportive environment for our neurodivergent clients. We believe that each individual's experience with neurodivergence is distinct, and we tailor our approaches to meet their specific needs and goals.

Our expertise in neurodiversity-affirming practices enables us to create personalized treatment plans that empower our clients to thrive. We take pride in continuously expanding our knowledge through ongoing education, research, and collaborative discussions. This commitment is reflected in our participation in conferences and workshops, where we actively share insights and engage with other professionals in the field. We believe that by disseminating our knowledge about neurodiversity and effective therapeutic practices, we can contribute to a broader understanding and acceptance of neurodivergent individuals in society.

We understand that the intersection of science and lived experience is crucial in delivering the best care possible. Our evidence-based interventions are informed by the latest research, ensuring that our clients receive the most effective and relevant support. This combination of scientific rigor and real-world application allows us to not only address the symptoms our clients face but also to celebrate their unique identities and strengths.

If you are considering therapy to address autism, ADHD, or AuDHD, we encourage you to click here to schedule a free consultation call with us.

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