Neurodiversity: A Professional Opinion
With the academic year commencing, it is important to remember that people with difference face challenges when returning to school or commencing university. We wondered how neurodiversity, a condition that has received an increase in conversation in recent months, affects students returning to school? And how can occupational therapy can help those with neurodiversity?
We proposed this question to our associate Lisa, an OT who first worked with neurodiversity in 1990 and university students with the condition in 2017. Lisa has been Head and Clinical Specialist OT, the Team Leader for a Learning Disability Team, and a Care Co-ordinator for a specialist autism team. She has crafted and presented a range of training packages to and at OT conferences nationwide. Lisa has embraced the opportunity to work privately, and she now shares her expertise in the article below.
##Neurodiversity: An Introduction
Neurodiversity is a young term. Until more recently the conditions now included in the term – autism, AD(H)D, dyspraxia, dyscalculia and Tourette’s Syndrome – were not described as neurodiversity. It didn’t develop significantly until the 1960s, originally being linked to schizophrenia. Today, neurodiversity is a term that denotes and embraces a collection of similar individualised needs of those people who experience the world in a way that is different from ‘normal’. Neurodiversity has become topical recently because of a change in trends. Society accepts disability more, and people are now familiar with conditions such as autism and ADHD. This social rising of people with neurodiversity has created a voice and positively impacted the politics of disablement. In this article, I will focus on my university students who have neurodiversity while, using the specific example of autism. I will begin with explaining the challenges neurodiversity can bring then, I will discuss the effect of occupational therapy intervention.
Autism Spectrum Condition has evolved greatly since the term’s conception. Now, it is a term embracing those with and without learning disabilities. Previously, Asperger’s Syndrome identified those without a learning disability, however, in 2013 this was removed from the Classifications of Diagnoses (DSM-5). Autism and Learning Disabilities are now two separate diagnoses – autism having a more complex diagnostic pathway. In my experience, diagnosing autism generally requires a focused approach by a team using specialist diagnostic tools, observation and interviewing techniques. Diagnosis can be at any age and in my experience, the older the person, the more likely that post-diagnostic support will be required. This is generally to support the individual to context and consider their life pre and post diagnosis.
I consider it important to note that a significant part of the evolution of our understanding of autism is linked to gender. Throughout my career, autism was previously known to be primarily a diagnosis of men, however, research has demonstrated that girls and women can have autism, although they present differently. Therefore, women require a different type of diagnostic approach to boys and men. An example of differences between the genders is how girls and women may present as ‘normal’ or ‘ordinary’ in their socialisation. However, as Attwood (2019) documents, it is now understood that many girls and women copy or mimic others in their social approach, to the extent that they may actively practice these skills when by themselves. Masking is a regularly used term by women regarding their experience of autism.
From my standpoint, those with autism experience an assortment of aspects which are understood through a variety of routes. For example, someone with autism may: find it hard to communicate and interact with people, and to understand how others think or feel; they may take longer to understand information, become anxious or upset in unfamiliar situations or social events; or they may find bright lights or loud noises overwhelming and stressful. When training and educating others about autism, I have found it helpful to draw together symptoms into 3 areas. These offer a succinct method of understanding the nuances of autism which inform the therapy strategies. The three aspects are: Theory of Mind, Executive Functioning and Central Coherence.
I estimate that everybody has these three aspects, however, someone with autism has them to varying degrees. To start, I will outline Theory of Mind which is crucial to the understanding of one’s own and other people's behaviour. Neurodivergent individuals may find naming and understanding their emotions difficult. They may know how the emotions happy, sad and angry feel, but the more ‘subtle’ emotions of, say jealousy or envy, may elude them. In short, if someone is uncertain about their own emotions then understanding those of others; how to read and interpret them; is difficult and this can be disabling, creating high, fluctuating levels of anxiety. For example, I work with a student who is studying occupational therapy and therefore requires an understanding of the emotions of others to build the relationships required to help her clients. Therefore, she requires guidance through occupational therapy herself, to help her understand the nuances of her condition when working with others. Moving on, Executive Functioning (EF) is not, in my view, exclusive to those with autism – but, it represents fundamental aspects of challenge (primarily taking longer to understand information). In summary, the issue embraces planning and organisation difficulties. For example, understanding the passing, management and planning of time, or transferring skills and knowledge from one environmental setting to another (this is known as working memory). Furthermore, Central Coherence are skills related to processing large information. In my view, these skills can be particularly relevant for OTs due to sensory processing elements including ‘holding’ information to process and how environments are key to learning and engagement. This links to how lights or noises can be overwhelming and how anxiety can arise from the unfamiliar experiences of life. In all, our understanding of autism has evolved significantly.
The way in which, then, people experience autism varies, and there is no one size fits all diagnosis. Occupational therapy support can be vital nonetheless. I will now share some methods of how I help the university students that I work with.
Occupational therapy is a profession best suited to helping those with neurodiversity. Because the occupational therapy process is person-centred – looking at, among other things, a client’s environment, responsibilities, self-esteem, confidence, habits, routines and skills – we are able to best understand a neurodivergent client’s needs. For instance, in our role as occupational therapists, we listen to what is and is not being said, and we observe the individual’s actions. Actively listening offers me an understanding of what style of communication to choose, and how to pace the sessions accordingly. I regularly receive feedback from my students that this is a new and welcomed experience for them.
My first point of intervention is to consider a client’s Executive Functioning and Central Coherence skills and therefore where they are experiencing difficulties. Often this is in relation to their daily living tasks, and we work together to create a structure in their week, subsequently introducing study skills time to meet their academic targets. In other words, to manage domestic tasks we work on routine (for example, going shopping every Wednesday). Although, I find the term rhythm is better received by those who struggle to fit into routines. Also, I support students to reflect and understand why certain situations or environments suit them, and how this is an empowering way of increasing their self-awareness. I have found that this helps reduce anxiety by helping clients to feel more in control of their life patterns. Linked with this, in terms of how students are processing new situations, is their central coherence. It’s important for them to begin to build their self-awareness and confidence within themselves in the choices they make and why they are making them. In essence, by considering the three aspects I outlined above, occupational therapy becomes particularly effective.
Aside from academic goals, socialisation is also a key expectation of a university student. As mentioned above, I have found socialisation to be linked to Theory of Mind. Internal Theory of Mind allows a person to socialise effectively because they are aware of their own emotions. However, external Theory of Mind means socialisation proves difficult. Someone with neurodiversity, or in this case autism, may be considered by others as awkward in their style of socialisation, not knowing what to say or when to say it for example. Often my work includes discussing their experience of situations to help them learn about their own emotions by naming and engaging with how each emotion feels, the etiquette of social skills and the reality of the boundaries in relationships with others. This is essential because society, however unforgivingly, expects people to fit in and pitch themselves correctly, and when this is missed people can respond in ostracising ways. Because we require human connection, when the social expectations of someone with neurodiversity are not met their mental health is negatively impacted. Every neurodivergent client I have worked with has had at least some experience with loneliness, anxiety and depression. For my students, occupational therapy has been an instrumental and holistic drawing together of solutions.
I hope this article has helped bring ideas to your planning and organisation when working with those amazing individuals who have neurodiversity. So that we can begin to understand how those with autism experience the world differently and how occupational therapists may help in their role, I have found it helpful to create practical methods that explain autism to help others understand. It is broken down into what is not generally part of a client’s everyday life, what is not part of their repertoire of responses to the world around them, and the habits or actions they might choose.
Attwood, T. (2019). Autism and Girls. Future Horizons Incorporated.
Colley, M. (2006). Appendix 6. Living with Dyspraxia. London: Jessica Kingsley Publishers. p 161.
(2022). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 5th ed. Washington: American Statistical Association.
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