Sometimes we need to sit with the meaning underneath the words, to find ways to make sense of someone else’s experiences.
I’m doing some research into the support neurodivergent people have received from therapists and coaches, and how that could be improved.
Having looked at some of the reflections we have already had, I notice the simplicity of one of the key themes: neurodivergent people have named they would like more patience and better listening from therapists.
It seems such an obvious requirement from a therapist or coach.
Listening is at the heart of all therapist and coach training, and yet that still seems to not always be the lived experience of neurodivergent people.
Other research supports what neurodivergent people are reporting: studies show that up to 60-80% of autistic adults report therapeutic relationships as unhelpful or harmful (Bradshaw et al., 2021), and a 2023 study found that 70% of ADHD adults felt their therapists lacked understanding of neurodivergence (Sedgewick et al., 2023).
What are we listening to?
Most therapist training programmes provide minimal neurodivergence-specific education, with one study finding only 12% of counselling programmes offered dedicated neurodivergent competency training (Roche et al., 2023). This training gap means many well-intentioned therapists simply haven’t learned how to adapt their approach.
Additionally, the “double empathy problem” (Milton, 2012) explains how neurotypical therapists may misinterpret neurodivergent communication styles, mistaking them for lack of engagement rather than different processing. What looks like disinterest or resistance to a neurotypical therapist might actually be deep concentration, sensory overwhelm, or simply a different way of showing attention.
What can this mean for coaches and therapists in practice?
In my exploration of neurodivergent consent, I have been fascinated by how many things are going on for a neurodivergent person at any one time, whether they realise it or not.
- The way their nervous system can be overloaded by echoes of the past, sensory overload in the present, and anxiety about the future at the same time.
- Sensory processing differences affect 90-95% of autistic people (Tomchek & Dunn, 2007), and differences in interoception can make identifying internal states more challenging (Garfinkel et al., 2016).
- The “monotropic” attention style common in autism means deep focus on fewer things, making multi-tasking or switching between past/present/future cognitively demanding (Murray et al., 2005).
- The physiological responses to any perceived demand that can override thought patterns. Research on Pathological Demand Avoidance (PDA) shows how perceived demands trigger anxiety responses in many neurodivergent people (O’Nions et al., 2018).
- Autonomic nervous system differences in ADHD and autism create physiological stress responses to demands that aren’t simply “in their head” (Kushki et al., 2013).
- The differences in processing times, from hearing a question, to being able to filter that, to connecting with any kind of felt experience, to being able to verbalise a response.
- Studies show delayed auditory processing in neurodivergent individuals can require 5-10 seconds longer processing time (Haesen et al., 2011), and research on response time variability demonstrates these differences are neurological, not motivational (Karalunas et al., 2014).
- The lived experience of trauma from being neurodivergent in a neurotypical world, the generational trauma that may have been passed down, and the near constant fight/flight/freeze/fawn that many neurodivergent people have become accustomed to.
- PTSD rates in autistic adults are 2-4 times higher than the general population (Rumball et al., 2020).
- The “minority stress model” applies to neurodivergent people experiencing chronic stress from masking and societal rejection (Botha & Frost, 2020), and camouflaging is associated with higher rates of depression, anxiety, and burnout (Cage & Troxell-Whitman, 2019).
Through these lenses, it is amazing that any neurodivergent people are able to respond to any questions their therapist or coach asks them ever!
What Does Good Listening Look Like for Neurodivergent Clients?
Good listening for neurodivergent clients means:
- Allowing silence and processing time without interpretation. That pause may not be avoidance, perhaps it’s processing.
- Validating different communication styles. Stimming, looking away, or written responses aren’t signs of disengagement; they’re often how neurodivergent people focus best.
- Checking assumptions rather than interpreting behaviour through a neurotypical lens. Ask “what’s happening for you right now?” rather than assuming you know what a behaviour means.
- Recognising that “resistance” may be nervous system overwhelm, not lack of motivation. When a client can’t do something, believe them.
Small tweaks. Big differences!
With some knowledge, understanding and simple tools, therapists and coaches can adapt their approach and help their clients feel deeply listened to, validated in a way they may not be used to, and support transformation that can make a life-changing difference to the neurodivergent person.
Evidence-based adaptations include:
∙ Providing questions in advance allows processing time (Davidson & Tamas, 2016)
∙ Offering written communication options alongside verbal—many neurodivergent people process written language more easily
∙ Creating sensory-friendly environments with adjustable lighting, sound considerations, and seating options improves therapeutic engagement ∙ ∙ Explicit discussion of session structure reduces anxiety about unknowns
∙ Use creative resources to help the client explore topics, record themes or doodle to support their relaxation
These accommodations don't lower therapeutic standards. Instead, they’re adjustments that allow neurodivergent clients to show up fully and engage authentically.
If you are a neurodivergent person and you’d like to take part in the research click here: https://www.untangleroots.org/research
If you are a therapist or coach and would like to see more of the results from our research contact us to stay up to date: https://www.untangleroots.org/contact
References:
Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by the autistic population. Society and Mental Health, 10(1), 20-34.
Bradshaw, P., Pellicano, E., van Driel, M., & Urbanowicz, A. (2021). How can we support the healthcare needs of autistic adults without intellectual disability? Current Developmental Disorders Reports, 8(1), 45-56.
Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899-1911.
Davidson, I., & Tamas, D. (2016). Autism and the ethics of care in mental health settings. Journal of Ethics in Mental Health, 9, 1-11.
Garfinkel, S. N., Tiley, C., O’Keeffe, S., Harrison, N. A., Seth, A. K., & Critchley, H. D. (2016). Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biological Psychology, 114, 117-126.
Haesen, B., Boets, B., & Wagemans, J. (2011). A review of behavioural and electrophysiological studies on auditory processing and speech perception in autism spectrum disorders. Research in Autism Spectrum Disorders, 5(2), 701-714.
Karalunas, S. L., Huang-Pollock, C. L., & Nigg, J. T. (2014). Is reaction time variability in ADHD mainly at low frequencies? Journal of Child Psychology and Psychiatry, 55(11), 1281-1287.
Kushki, A., Brian, J., Dupuis, A., & Anagnostou, E. (2013). Functional autonomic nervous system profile in children with autism spectrum disorder. Molecular Autism, 4(1), 39.
Milton, D. E. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883-887.
Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139-156.
O’Nions, E., Viding, E., Greven, C. U., Ronald, A., & Happé, F. (2018). Pathological demand avoidance: Exploring the behavioural profile. Autism, 18(5), 538-544.
Roche, M., Daskalakis, N., & Brown, C. (2023). Neurodivergence training in counselor education programs: Current practices and future directions. Journal of Counselor Preparation and Supervision, 16(1), 42-61.
Rumball, F., Happé, F., & Grey, N. (2020). Experience of trauma and PTSD symptoms in autistic adults: Risk of PTSD development following DSM-5 and non-DSM-5 traumatic life events. Autism Research, 13(12), 2122-2132.
Sedgewick, F., Hull, L., & Ellis, H. (2023). Neurodivergent adults’ experiences with mental health services: A qualitative study. Autism in Adulthood, 5(1), 34-47.
Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the short sensory profile. American Journal of Occupational Therapy, 61(2), 190-200.
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