Anxiety and Neurodivergent Clients
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Angela Kelly
A link between anxiety and neurodivergence is widely observed and commented upon by mental health professionals – yet often narrowly understood. To mark the start of Mental Health Awareness Week 2023, neurodivergent therapist Angela Kelly asks us to centre an appreciation of the lived experience of being an individual who learns, thinks or processes differently in a world designed for the neuromajority, including the impact of invalidation trauma.
“Autism and anxiety go hand in hand,” I was told recently, by a professional who worked with autistic individuals. Intrigued, I asked what they meant by this statement. Their answer, sadly, did not surprise me. They thought that anxiety was a feature of autism and that it was unavoidable and untreatable and impossible to be unaffected.
Whilst there are many autistic and other neurodivergent* (ND) individuals who experience anxiety to very high levels, it is equally important to highlight that anxiety is not in the diagnostic criteria for neurodivergence.
So why do professionals think that? The likelihood is that they’re either taught this (in the very little teaching that they are given on neurodiversity and neurodivergence) or that it is one of those myths that never gets challenged.
Confirmation bias plays a part – most neurodivergent folk have anxiety or have been highly anxious, therefore it must be present as a direct result of being neurodivergent and have nothing to do with their lived experience in a world designed for the neuromajority.
Of course, experiencing some anxiety is natural. Anxiety is and has been essential for our survival. However, for neurodivergent individuals this feeling is often a profound and daily experience, which is debilitating and can limit everyday experiences and interactions.
When you live in a world that is an inherently unpredictable place, it is no wonder. As well as people not saying what they mean, or meaning what they say, there are unwritten social rules including, for example, making eye contact, not interrupting conversations, not messaging too often or sending long messages, not having smart phones at the table – doing or not doing all these things, plus many more, can be construed as rude.
Get these things wrong at your peril. The risks include being labelled as anti-social, blunt, or withdrawn. Coping strategies might cause you to avoid people and situations, creating a sense of aloneness. Other coping strategies include self-harm, substance use and suicidal thoughts and ideation.
Sensory processing differences can also have a huge impact on a neurodivergent person’s lived experience and are something to explore when anxiety is a presenting symptom in therapy. It is often a significant factor in the visceral and somatic experience of anxiety. Imagine a world where you are bombarded by sensory input, the feel of your clothes, the sounds and smells when visiting a restaurant, the hustle and bustle of a shopping centre. The feeling of feelings and the often very real struggle to identify or name them!
Again, the negative reactions of others can compound the issue. If neurodivergent individuals try to communicate these sensory experiences, they may be told that they are ‘too sensitive’ or ‘self absorbed’ or something else equally unpleasant. Imagine the impact this is likely to have on the capacity to trust yourself and others.
When you begin to doubt your own lived experience of your senses, the very idea of trusting someone else or yourself can become traumatising. Invalidation trauma is often a common experience for people who are neurodivergent.
It is OK to learn about our client’s individual experience from them, however it is not our client’s responsibility to teach us about neurodiversity. There are numerous sources of information and tools available, many of which are free to access online.
I have listed some places to start looking below. I have deliberately chosen those that are authored by neurodivergent individuals because who better to learn from than NDs themselves!
* Neurodivergence includes but is not limited to Autism (including Pathological Demand Avoidance), ADHD, specific learning difficulties, sometimes referred to as SpLd (Dyslexia, Dyspraxia, Dyscalculia), Tourette’s Syndrome, Sensory Processing Disorder, Hyperlexia and Synaethesia.