IS THIS THERAPIST ACTUALLY ADHD/AUTISM AFFIRMING?

What questions to ask a potential therapist to see if they are actually ADHD/Autism affirming.

As an AuDHD therapist, I’ve been on both sides of things when it comes to therapy. I’m a big believer that we as therapists need to continue doing our own work, so always promote therapists going to a therapist (but that can be a topic for another day).

I was 37 when I finally got a diagnosis of ADHD (I am privileged in this respect and so fully acknowledge that self-diagnosis is valid based on systemic barriers). I had always struggled, especially in school when I was younger, but my ADHD never became apparent until I hit early perimenopause due to my autoimmune condition. I was wondering what an earth was going on! Later, I was to discover how much hormones play a role in ADHD symptoms in cis women and those assigned female at birth (AFAB). 

At the time, I was also assessed and diagnosed with being Autistic, which, to be honest, surprised and confused me at first. We don’t get any training on this in school as clinicians, and all I had to go on was the DSM-5 criteria based on cis white boys and stereotypical things I’d heard in the past or seen on TV…think Sheldon Cooper from Big Bang Theory. How could I be Autistic when I’m empathic to the point of being able to feel others' pain, I can do things like give eye contact, and I’m able to work, etc?

So, obviously, now knowing in true AuDHD style, having a long-term special interest in psychology and understanding how minds and interrelated things work, I began doing a deep dive into the lived experiences of others in similar situations and reading the research. It was like a lightbulb coming on, and yet I was shocked at how misunderstood and misrepresented so much information and support for ADHDers and Autistic people has been and continues to be in the mental health field.

From research, none of the traditional methods of therapy, e.g. CBT, DBT, etc., have been researched on us ADHDers and Autistics, let alone them considering other intersectionally marginalized groups. These modalities were also written and developed based on neurotypical standards and ways of being, and so for those of us wired differently, these haven’t been affirming or effective and often have left us with the pathologizing messages that we are non-compliant, treatment-resistant, too complex, and have been provided with interventions that will further push us towards burnout because they teach us that we need to mask and comply to fit in. 

The issue is, is that we are different, not something to be fixed. Being Autistic and ADHD is developmental, not a disease. We have stories and lived experiences that need to be included and understood in a nuanced way within research and support given to us, and to be honest, I’m not really seeing it right now in practice. I’m just seeing a lot of buzzwords being thrown around combined with the same old DSM-5 criteria and problematic, strict models being used. Of course, some strategies can be helpful from each, and for some people, they might work, but when evidence-based models seem to boast of being, on average, 50% effective, I think that it isn’t really something to be proud of. I would hazard an informed guess that many of us ADHDers and Autistic folx, along with those in other marginalized communities, make up most of the 50% of people who don’t find these therapies effective or validating, and this can and does cause harm.

Additionally, while the myth, pathologizing, and unnuanced screening criteria for ADHD and Autism still exist, which never included lived experience in them, continue to be done by clinicians trained in these same ways, many people will continue to go undiagnosed and misdiagnosed. Sadly, this is something I’ve experienced myself and hear from people on a weekly basis.

So, what are some things that I think are important to ask when meeting with a new mental health provider regarding ADHD and Autism:

1. What are their views on the limitations of the DSM criteria for ADHD and Autism? Can they identify why it is often not nuanced and can be over-pathologizing?

2. Have they taken training based on lived experience and qualitative research, or do they focus on just the old ‘evidence-based’ treatments that use words like ‘non-compliant’ in them?

3. Do they acknowledge the nuances of what ADHD and Autism can present as for groups other than cis white boys/men (and even within this group)? For example, do they hold beliefs about people not being ADHD/Autistic because they can give eye contact, talk on the phone, hold down a job, and for some, that they got good grades at school, etc?

4. Are they able to identify the complexities of often co-occurring health conditions associated with ADHD/Autism, such as hormonal conditions and higher likelihood of having challenges with menopause, autoimmune issues, connective tissue disorders/hypermobility, POTS, etc., and how misunderstood these also are?

5. Do they recognize the links and nuances between ADHD/Autism and substance use and eating differences/eating disorders? Can they illustrate how these things might not be due to just diet culture and can be sensory in nature, combined with trying to cope with being in a world where we don’t often understand our differences and which isn’t made for us? Do they get the difference between an ‘eating disorder behaviour’ and sensory needs being met in terms of stimming, sensory differences with eating different foods, and how our eating is also linked to often co-occurring health issue symptoms?

6. Do they acknowledge that many of the issues we face as ADHDers and Autistic people are down to systemic problems and norms that don’t include or celebrate diversity and difference? Have they checked their own biases around ableism?

I hope that this gives you some food for thought and some direction in terms of how to find both mental health and physical health providers who are validating and affirming. Sadly, for many of us ADHDers/Autistics, this often feels pretty impossible within the public system and not always much easier to navigate within the private systems either. Still, there are affirming and educated helpers out there, so please don’t give up!