5 Ways to Support Neurodivergent Clients as a Therapist

In my time as a neurodivergent person/therapist, I’ve learned that we respond well to the basic tenets of empathy, genuineness, and unconditional positive regard that form the basis of many therapists’ work. However, if you really want to up your game and get in good with the “neurospicy” folk, I have some super awesome tips for you.

First, what does “neurodivergent” really mean?

The most basic and, frankly, vague definition of neurodivergent is having a brain that processes things in a way that is not typical of most individuals. It is most often used to describe folks who are autistic, have attention-deficit hyperactivity disorder (ADHD), and/or learning disabilities. However, some people also include obsessive compulsive disorder (OCD), anxiety disorders, and other mental health experiences as part of neurodivergence. It is estimated that about 15-20% of people are neurodivergent in some way. Boy Howdy, are there a lot of us if that’s the case!

The definitional opposite of neurodivergent is neurotypical. A neurotypical person tends to think, perceive, and act in ways that are considered “normative” for their culture. Clearly, normalcy is a nebulous concept that virtually nobody can fully define, but you get the idea.

Being neurodivergent can be framed as having a different version of a normal human experience. In other words, the term is not meant to shame people for being different, but rather to embrace difference. For those of us who grew up feeling totally out of the loop as to why we were so “weird,” this is a welcome sentiment.

For more information of neurodivergence and neurodiversity, please check out this Medium article or one of my favorite organizations, the Autistic Self-Advocacy Network (ASAN).

Note: For the purposes of this blog post, I’ll be focusing on peeps who are more commonly seen as neurodivergent, such as those who are autistic and/or have ADHD. Otherwise, this post would be a novel! That said, if you ever want to see my thoughts on working with other types of clients who may also be considered neurodivergent, I’m all ears. Just pop a comment down below.

Okay, now for the good stuff. How do I help my neurodivergent clients?

I’m so glad you asked! Here’s what I recommend for working with us ND folk.

1) Create a positive sensory environment

Many neurodivergent people experience heightened sensitivity to sounds, smells, textures, and the like. While it’s impossible to predict an individual’s sensory needs, it’s a good idea to have an office that is set up in a way that is as neutral and comfortable as possible. Some ideas for physical offices include:

• Soft, warm lighting from lamps, rather than overhead fluorescents

• Limited scents from candles, air fresheners, essential oils, and perfumes (or better yet, have a scent-free office)

• Ample soft things to touch such as blankets, pillows, stuffies, etc.

• Gentle noise makers that can be turned on or off depending on a person’s preferences

• A collection of sensory objects such as fidget toys, stress balls, spiky rings, etc.

(All of the above apply to both children and adults, by the way! Sensory needs have no age.)

If a client informs you before or during their intake that they are neurodivergent, it’s a good idea to ask them about their own specific preferences for comfort in the therapy room. While you don’t necessarily have to accommodate their every wish, simply asking and making an effort is meaningful.

2) Don’t automatically frame neurodivergence as a struggle

Avoid using phrases such as “struggling with autism” or “your ADHD problem.” Rather, try to talk about symptoms such as social challenges, executive function, or sensory overwhelm. And even then, don’t lean in too hard to the idea of neurodivergence as something that is 100% problematic. As clinicians, it’s important for us to help our clients recognize the unique strengths and gifts of having a different brain, and that neurodivergence cannot be “cured.”

3) Understand the limitations of diagnosis and the Diagnostic and Statistical Manual (DSM), especially with autism spectrum disorder (ASD)

If someone comes to you and lets you know that they have X neurodivergent diagnosis, and you feel hesitant because they “don’t fit the standard criteria,” remember that diagnosis is far more complicated than whatever we learned in grad school. Unfortunately, the DSM has always been a bit off in each of its iterations—remember when gay people were considered “mentally ill” just for being gay?—so we need to take the DSM with a grain of salt.

Professionals who study neurodiversity beyond the strict confines of the DSM 5 diagnosis understand that ND diagnoses need to be guided by expanded criteria that accounts for different backgrounds. For example, young girls and women are especially likely to be misdiagnosed as non-autistic when they actually do fit into our contemporary understanding of ASD. Other research suggests that Black children with mild-to-moderate ASD may also be under-identified as autistic in the testing process. Not every autistic person presents as Sheldon from The Big Bang Theory and we sorely need to update our references when it comes to assessing our clients.

Conversely, you are likely to run into folks who have self-diagnosed as neurodivergent, especially as autistic. While the general consensus among therapists is that self-diagnosis is dicey, it’s important to keep in mind that an autism diagnosis can be a costly and exhausting venture, especially for adults. Specialists who focus on adult autism, especially autism in AFAB people, are few and far between. Autism testing for adults can be extremely expensive as well; I’ve seen evaluations that run between $1,000 and $6,000 in my home state of California. YIKES!

This is not to say that you as a therapist have no right to inquire about the diagnosis or even respectfully question it. Rather, it’s important to understand that if a person presents with a significant number of autistic traits, but cannot or will not obtain a formal diagnosis, they probably have a good reason.

4) Inquire about special interests

Many people with autism and ADHD have special interests that consume a large portion of their time, energy, and brainspace. It can be challenging for an ND person to find someone who can really hold space for them as they discuss their interests, especially if members of their support system don’t share their passion. Discussing special interests is also extremely regulating, especially when more intense therapy topics feel overwhelming to discuss during a particular session. Let’s not forget about earning those sweet, sweet rapport points when you happen to know about or even share their special interest!

So therapists, don’t be shy about sharing your affinity for D&D, secular witchcraft, or xeriscape landscaping if you think it can help your client feel comfortable and regulated. You are helping them more than you know.

5) Don’t take certain things too personally

Now, listen. The idea that all autistic people are blunt and lack empathy or that all ADHD people are horribly disorganized are stereotypes that are harmful to apply to all of us. We come in all stripes and it’s important for us to be considered as whole people in the therapy room.

That being said, for ND folks who do present in these fashions, it’s important to bear in mind that their idiosyncrasies may be a result of their brain differences, rather than meant as deliberate or careless offenses.

For example, let’s say that you’re reflecting the feelings of an autistic client, and they correct you a bit harshly (e.g., “No, why would I be sad? I’m angry.”) Yes, an autistic person who is frequently seen as quite direct by most of the general population is going to come off as rude at times, especially to neurotypical folk. However, in the autistic person’s mind, they mean no harm—they are simply trying to point the listener towards their truth.

As another example, if a person with ADHD frequently misses appointments or needs to be called a few minutes into most sessions because they’re not logging into the telehealth platform, it generally does not mean that this person doesn’t respect their therapist’s time. Rather, this person may just need a leg up through extra auto-reminders, changing of their appointment time, or other workarounds.

Overall, neurodivergent people need the same thing every client needs: respect and understanding.

Yes, we’re different, and we’ve often been made to feel different by society. And yes, it may take a little extra effort to understand our inner worlds. But the things that bring us to the therapy room are not all that different from what brings neurotypical people, like the desire to heal our past trauma, break harmful cycles, or increase our sense of self-esteem.

I truly hope this article was helpful to any therapist reading this, whether new or experienced. I also want to acknowledge that due to the brevity of this article, it is a mere snippet of thought regarding the state of mental healthcare for neurodivergent folks. Thus, I will direct you to this reading list and the sources linked throughout this article for further information-gathering purposes.

Finally, if you’re a therapist who got to the end of this article, strong work. Please know that your hard work and dedication to your clients will not go unnoticed.

…especially by neurodivergent people, because we tend to be a pretty detail-oriented bunch. :)

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About the author: Haley O’Bryan (she/they) is a queer, neurodivergent, animal-obsessed therapist who is just starting to love writing again. She is passionate about working with queer, polyam, and neurodivergent folks, and is also becoming increasingly involved in immigrant rights work. She is the proud mother of one cat daughter and five plant children and will have you know that the plant children stress her out way more. She lives and loves in Long Beach, CA.