Transcript for
A neurodivergent-affirming approach to children’s mental health

Tammie Sinclair (00:00): 

If the child can embrace who they are from day one, that’s going to reduce the likelihood of them developing mental health conditions down the track because they’re not going to grow up feeling as though they’re broken, there’s something wrong with them, if a child is continually told the message, “You need to do better, you need to do this, you need to do that,” you’re thinking, I can never get it right. Why can’t I get this right? And you just feel like you don’t fit in. 

Narrator (00:26): 

Welcome to the Emerging Minds Podcast. 

Jacquie Lee (00:34): 

Hi everyone. My name is Jacquie Lee, and this is the first episode in a two-part series on practises for supporting the mental health of autistic and ADHDer children. Before we begin, I’d like to acknowledge the traditional custodians of the lands on which this podcast is being recorded, the Kaurna people of the Adelaide Plains and the Gadigal people of the Eora Nation and pay my respects to all Aboriginal and Torres Strait Islander peoples, their ancestors, and elders past, present, and emerging. This always was and always will be Aboriginal land. It’s estimated around 3.4% of Australian children are autistic, while approximately 5% are ADHDers. Many of these children also face mental health challenges such as anxiety and depression, often because they’re trying to navigate a world built for neuro typical people, a world that doesn’t always understand or support the unique ways of thinking, being, and doing. 

(01:34): 

Therapeutic approaches that encourage autistic and ADHDer children to behave in neuro typical ways can lead to shame, anxiety, depression, and reduce self-worth. In contrast, approaches which equip children and their families with skills, tools, strategies, and accommodations to meet their needs have been found to increase self-esteem and confidence, strengthen family and social relationships, improve learning and academic outcomes, and reduce anxiety and stress. These approaches are commonly referred to as neuro divergent affirming practise. Neuro divergent affirming practise stems from the neuro diversity affirming paradigm, which views differences in the ways we think of process information as a natural and necessary form of human diversity. 

(02:23): 

The idea that there is only one normal or healthy way for a brain to work is seen as a culturally constructed fiction that is no more true or helpful than the idea that there’s only one normal or correct gender, ethnicity, sexual orientation, or culture. In this episode, I’m joined by psychologists Jason Tran and Esther Fidock, speech therapists Kate Mulheron, and Tammie Sinclair and Jasmine Deakin from Sunny Spectrum Supports, along with Bec and Jaisen, two of our emerging minds family partners with autistic and ADHDer children. Through these conversations, I sought to gain a better understanding of what neuro divergent affirming practise involves and just how it can benefit children’s mental health. To begin, I asked Tammie, Jason, Kate, and Jasmine to share what neuro divergent affirming practise means to them. 

Tammie Sinclair (03:17): 

If I had to put it simply in one sentence, it would be acknowledging that brains think differently and neither way is right or wrong. I don’t think we have to put people in diagnostic boxes to acknowledge that. 

Jason Tran (03:31): 

So to me, neuro diversity affirming practise is about acknowledging and celebrating, I guess, each individual’s unique way of thinking, learning, and the way they process information as well. And what we know about neuro diversity practise is that we’re actually moving away from more of a medical model of disabilities and more about disorders, using word disorders, thinking more of a deficit-based model. And we’re moving that away from more a social model with disabilities, so acknowledging about how we can make accommodations in our environments or how to really celebrate individual strengths, more of a strengths-based approach. 

Kate Mulheron (04:07): 

It’s one of those things where neuro divergent affirming practise is based on principles that are kind to everybody. So I do ask the same questions to people that we think are neuro typical because sometimes you get told they’re neuro typical and they turn out not to be, but it doesn’t matter to me. I would still be trying to get their perspective in whatever way they communicate it. 

Jasmine Deakin (04:31): 

I mean, I don’t really find it any different to engaging with any other person in the fact that, whether they were neuro typical or neuro divergent, you want to be included in the conversation and you want to be part of particularly decisions made about you or things about you that we just have to consider that like everyone else. 

Kate Mulheron (04:54): 

It’s not what you say or it’s not the information that you have. It’s not how much do you know about neuro divergence, but it’s do you like them and do you have a vibe of I want you to be yourself? Because they will pick up on that and then you can learn the neuro divergent stuff later. 

Jasmine Deakin (05:13): 

And I guess the fact that working with a neuro divergent person, if you reference that based on another neuro divergent person you’ve met, whether that’s a family member, anyone in your life, you’ve only met that one neuro divergent person. So it isn’t a one size fits all scenario. Neuro affirming practise isn’t something that has a really strict set of guidelines. Really, it is about seeing a person for who they are rather than a one size fits all of, yep, that will work for Bob, so it’s going to work for Sally kind of thing. 

Jacquie Lee (05:53): 

As a neuro divergent practitioner herself, I was interested to hear Kate’s perspective on how a neuro affirming approach can benefit children’s mental health. 

Kate Mulheron (06:02): 

Neuro divergent people are always picking up information wherever they go about what they should do and how people are responding to them, and they are internalising that information, adding it to their data that they use to make choices about what they do. And then, so what’s really important about neuro divergent affirming practise is making sure that the messaging is quite on point because of the power that adults and figures of authority have to shape these mental narratives that the neuro divergent people are making for themselves. So we need to be really careful about what we accidentally are reinforcing in them. 

(06:48): 

Sometimes it could be that you’ve accidentally reinforced that someone made themselves uncomfortable and then you praised them and what accidentally you’ve just taught them is that making yourself uncomfortable is good. You should do that to be likeable. So it’s those kinds of little moments where mental health is really on the line because if you believe that other people’s wants or other people’s comforts are more important than yours, you’re going to act in a way that puts other people’s comfort on top of yours. And then the longer that goes on for the harder it gets to come back from that and realise that you also deserve to be comfortable. And then it all spirals from it. And a lot of neuro divergent people will be people pleasers, they don’t like admitting anything’s wrong. They’re often perfectionists. 

(07:42): 

There’s a high correlation with depression and anxiety. And the thing that’s really important in neuro divergent affirming practise is separating that out. What is inherently a neuro divergent trait, for example, an autistic or ADHD trait, and what is a learned behaviour and a defensive response that you’ve created? And then, so by having that in mind as a health professional, you can help them to honour what needs to be honoured and unlearn what can be unlearned and make sure the kid knows the difference between those two things. 

Jacquie Lee (08:17): 

Tammie is an AuDHDer and the mother of two neuro divergent children. She shared how early interventions can have a significant impact on a child’s mental health and wellbeing. 

Tammie Sinclair (08:28): 

Yeah, so my experience of this is growing up feeling like I wasn’t good enough. No matter what I did, it wasn’t right. And that ultimately led to me feeling like I was broken and I was disordered. They call autism a disorder, but it isn’t really. It’s just a different way of thinking. We all know those shape sorters that we have when we’re children, babies, those Tupperware things. If you try and put that square shape in that round hole and bang it in there, however many times you bang, it’s going to chip away bits of that square to fit in the circle. So we can make our square pegged children fit into the circle, but it’s going to chip away bits of their identity, bits of their spirit almost, and they’re going to end up a pretty funny shape. 

(09:12): 

So if we can remove those pressures of performing a particular way that doesn’t come naturally, they’re going to feel more connected to who they are as a person and feel happy within themselves. And if the child can embrace who they are from day one, that’s going to reduce the likelihood of them developing mental health conditions down the track because they’re not going to grow up feeling as though they’re broken. There’s something wrong with them. If a child is continually told the message, you need to do better, you need to do this, you need to do that. You’re thinking, I can never get it right. Why can’t I get this right? And you just feel like you don’t fit in. 

Jacquie Lee (09:53): 

I asked Esther how an understanding of the child’s autistic or ADHD experience can help in identifying any coexisting mental health concerns. 

Esther Fidock (10:02): 

Yeah, I think this is a really important question actually, because what can happen is autistic, ADHDer kids can have anxiety, they can have depression, they can have OCD, all of these co-occurring things can happen for them. But what can happen if we don’t know that a child is autistic is, if we’re trying to treat anxiety and we’re coming at it from a typical anxiety reduction approach, which is we’ll just keep doing it and you’ll realise that it’s not so scary, and then you’ll feel better. But if this person is autistic and the anxiety inducing thing they’re doing is actually sensory overload and you’re saying to them, “Just keep doing it and it’ll feel better and you realise that it’s not so scary,” then actually that’s not only not helpful, but it’s actively harming that child. It’s making things worse for them. 

(10:52): 

So I think it’s incredibly important that we properly identify if we’ve got children coming to us with anxiety, depression, OCD, separation anxiety, any of the mental health concerns we might see, it’s so important that we screen if we see any flags around autism or ADHD, because how we treat that anxiety is going to look a lot different. 

Jacquie Lee (11:14): 

So what does a neuro divergent affirming approach look like in practise? I asked Jason and Kate to share how these principles show up in their work with children and their families. 

Jason Tran (11:25): 

I would say that neuro diversity affirming practise starts throughout the whole course of when I’m interacting with that young person or the young adult anywhere from the initial stages, like initial assessment to assessment phase, all the way down to intervention and also where we are interpreting services as well. So you can think of this way that when a client comes to see me, let’s say, the very first initial session, usually I consider maybe their sensory sensitivities. So usually I will even ask, “Oh, how are you finding the lights in my room today? How are you finding the smells of the environment that we are?” And even starting from the first get-go, “How can I make this space more comfortable for you as well?” And sometimes when I have ADHDers coming in, I’m saying, “You’re more than welcome to move. You don’t have to sit down this long time. I can give you fidgets if you like, just to make it easy to process information.” 

(12:11): 

And sometimes when I do intakes, they’re quite a lengthy process, so I try to ask them, “How would you like me to structure today? Would you like me just to ask you questions or would you prefer more of a venting, ranting style where you just tell whatever you like and I just go with what your flow is?” So I guess really going with the individual from the get-go about their unique way of communication, their unique communication styles or maybe their sensory sensitivities and just how to make it a more comfortable, non-judgemental and respectable space for them as well. 

Kate Mulheron (12:40): 

It’s about giving them a space to experiment where they can try not doing the things they feel they should do or where they feel like they are safe to try out things that would make them more comfortable because they know they’re not going to be judged and they know that you are going to help them with feeding back, how did that feel for you? Was that something that calmed your body? That’s awesome. You’re listening to your body, you can show them because a lot of the time they already know, but they’re suppressing. So if you open up a space where they don’t have to be small or they don’t have to feel worried about your response, they will start the process of unmasking and then you can guide them in that and go, “How is this feeling for you? I noticed last session you weren’t moving around, but this session you are moving around. What’s the difference for you?” 

(13:41): 

With a lot of neuro divergent people, they already know subconsciously a lot of the things that they are not able to reconcile logically. So they don’t have the information to contextualise what’s happening and make sense of it. So they have this knowledge, but it’s irreconcilable. And then so as a health professional, we can start to reconcile it for them by giving them information about the neuro divergent community or by giving them information about what you’ve observed in them. “I noticed that when I asked you to do this thing, you started moving around quite a lot. Is this a tricky thing? Is that connected?” And then they’ll go, “Yeah, it is tricky,” if it is tricky. And then you can go, “Oh, okay, yeah, that’s really good that you showed me in the way, by moving your body. Now, we can make it easier.” You can start to honour them so that they can start to honour themselves. 

(14:43): 

And then from a clinician perspective, what it really is, is making sure that everything you do supports this idea of knowing yourself is good, honouring yourself is a good thing, and it’s not like they’re getting the message that they should honour themselves, even though it’ll bother people or honouring yourself is okay, or making sure that you are comfortable is fine just as long as it doesn’t bother people. There’s so much unspoken nonverbal cues and neuro divergent people, especially ones who are later to be picked up, they can very much tell the difference between people that tolerate them and people that like them. So for me, neuro divergent affirming practise is about making sure that the people know that they’re likeable and that you like them and that when you want to help them with things that are challenging for them, it is coming from a place of love and not from a place of, this is what you have to do in order to be loved. 

(15:46): 

It’s about making sure that the kid’s perspective is always heard and getting their input on their own plans because they need to have buy-in if they’re ever going to do it without grownups guiding them. And they’re going to, like all people, are going to make decisions for themselves based on the information that they have. So as long as you’re giving them empathetic and a full amount of information, they’ll be able to make whatever a good choice looks like to them for themselves without our guidance eventually. 

Jacquie Lee (16:21): 

Esther described how a trauma-informed approach can compliment neuro divergent affirming practise. 

Esther Fidock (16:27): 

If we think about children who are neuro divergent, there’s a chance that they probably have experienced some type of trauma in their background, not from anything necessarily happening, but just from finding themselves in environments where their voices weren’t heard or they were incredibly dysregulated and went into shutdown or meltdown or had those experiences that can feel very traumatising. I think a trauma-informed approach is really holistic as well, is that you look at the entirety of the person as a whole human being. You think about what it is that has happened to them and how that has impacted their experience and how they move through the world. And I think that applies really well to working with autistic ADHDers is, what’s going on for you? What’s your experience? How’s that impacting the way you move through the world? And how can we figure that out together? It’s just having that slightly different lens, I think. 

Jacquie Lee (17:17): 

Kate also shared how the language you use can make a big difference to an autistic or ADHDer child’s experience. 

Kate Mulheron (17:24): 

I do use little language choices a lot to make sure that the overall vibe of what I’m saying is very warm, very welcoming. So if someone has done something, I’ll never say, “Why did you do that?” I’ll always say, “What made you do that?” Because people who are rejection-sensitive will take, why did you do that as that’s a weird thing to do. Why did you do a weird thing? Whereas what you actually meant was, I assume you had a reason for doing that. Could you tell me what that reason was? So it’s within your question, you’re building this trust that you trust them to know what they’re doing, and then they trust you to see them as they’ve probably been told they’re doing random things for no reason by other people. And you can be like, “You’re not doing random things for no reason. You’re doing specific things for a reason.Let’s figure out what that reason is.” 

(18:17): 

And then the other thing, the language choice that I always make, these kids are already feeling like everyone knows something that they don’t know, and they’re always struggling to keep up and they’re scrambling and they’re being versatile and being on their toes trying to figure out what is happening. So if I ever introduce something new, I’m never going to say it as, “Here’s a thing that everyone knows. Oh, that might be masking.” And then they go, “What’s masking?” Because in their heads, they’re probably going, should I know what masking is? Has someone told me masking before? What’s masking? What am I supposed to say? Whereas if you say it as, “Have you heard of a thing called masking?” Then they get to say “No,” because the question implies here is a new thing, you might know it, but if you don’t know it, that’s fair. And then they get to go, “Oh, I don’t know it, but I’m not supposed to, so I’m okay right now.” They don’t have to worry and then feel better. They didn’t worry in the first place. So little language choices are really important. 

Jacquie Lee (19:18): 

Bec has been through the autism diagnostic process twice now. The first time following the traditional medical model, and the second time with a neuro divergent affirming approach. She shared the difference this made for not just her children, but for herself as a parent. 

Bec (19:34): 

We’ve had two really vastly different experiences of that process where we were less informed and empowered about what pathway we would take, and we were just doing what we were told. When we went through the first diagnosis, we just saw a paediatrician and a speech pathologist, and the whole thing was really deficit focused, and it was just us regurgitating all the things that our child was really struggling with. And it left me feeling absolutely horrible about having to do that, I guess, and it didn’t make us feel good initially then hearing the assessment because it was so negative, I guess. It was focused on his negative traits and behaviours. But when have learned more over the years, we sought out a multidisciplinary team that advertise themselves as being neuro affirming. 

(20:45): 

For us, the key things were a lot of the practitioners were neuro divergent themselves and or parents of neuro divergent children as well as they use the tools that they need to use, but the way that they inquire about what’s going on for your child is looking at their strengths as well, and also celebrating the differences, not necessarily viewing them as something that they’re not achieving or that they’re not meeting a milestone. So we found it a really positive experience, and it was something that I’m really pleased that we sought out in going through that. I think the conversations that we were able to have around what was going on for our child helped empower us to know how to advocate for them at school, socially, what accommodations they would need and what supports could be put in place, and helped us explore that in just a really lovely way, I think. 

(22:00): 

So, yeah, I really appreciate the concept of practitioners that are neuro affirming rather than just doing a diagnosis or an assessment and following a tool and asking all those questions that pick apart what might be going wrong for your kid. 

Jacquie Lee (22:25): 

Jaisen has four children, three of whom are neuro divergent. He talked about the importance of practitioners acknowledging and valuing his insights as a parent. 

Jaisen (22:34): 

I think the hard thing was we had practitioners who wouldn’t listen or had their own ideas around what they thought, and they were very dismissive, and they blocked us a lot on a lot of things. So I think it’s really important that practitioners listen to what we’ve got to say as parents, because we spend 24 hours a day, seven days a week with our kids. We see things and we hear things, and we know things are different for our children, and that might not present to a practitioner at the time that they’re seeing the child, but we have seen those behaviours or those mood changes and things like that. So it’s really important that a practitioner is prepared to listen and put their own biases aside and really think about what those parents are saying to them in relation to their children. 

(23:31): 

So a good example of when a practitioner has helped us understand our children is when we first went to see our child health nurse, because they check on our growth and milestones and things like that. Our child health nurse, we raised the subject with her that we thought something wasn’t quite right. We explained to her that our son was rocking and self-soothing and that our daughter needed really tight swaddling and lots of bottom pats to get her to sleep, and it would take four or five hours of walking the floor with her. So her child health nurse actually looked into it a little bit and confirmed our suspicions that our children had ASD. So she was really instrumental in helping us navigate that pathway when they were babies, and that was really important because you need to get those diagnoses early. 

Jacquie Lee (24:27): 

I asked Jason Tran and Tammie why they believe it’s important for practitioners to work in neuro divergent affirming ways. 

Jason Tran (24:35): 

In an age where autism assessments or ADHD assessments are being more refined. There’s a lot more research about it, which was leading, I guess, to more increased and more awareness as well and less stigma around neuro divergence that’s leading to more diagnosis being made. But I can understand for many practitioners and clinicians that it’s a very uncomfortable space to be working with. But I would also say that it always will come back to a person-centred approach. It’s just about really understanding their unique needs, neuro divergence or neuro diversity in general was an ever-changing field as well. So I guess it’s very important, but there’s CVDs. There’s continuing professional development that we always up skill our knowledge as well. 

(25:12): 

And I think what I find really, really important is hearing I guess from neuro divergent voices as well. I find that incredibly valuable, especially neuro divergent clinicians or practitioners I find they’re crucially very valuable as well. Because they offer maybe different insights that me, being I guess, a neuro typical person, could be helpful to be aware of as well, and make better informed choices with our critical judgement when it comes to treatment or therapy as well. 

Tammie Sinclair (25:40): 

Any person out there could be neuro divergent and they don’t need that label to be able to align with the experience and to embrace who they are as a person. I think a lot of the time, embracing yourself is the biggest key to happiness, and that’s what we all want at the end of the day. We want to be happy. We want to live a life that’s meaningful to us. We don’t need a diagnosis and therapy to do that all of the time. There’s obviously points where input from a professional is probably required. If your receptive language skills aren’t quite there, and you want to build on those so that you can express what you need, understand what you need, those sorts of things, but that diagnosis doesn’t automatically mean that you need therapy to be fixed of something. So I think we need to be looking at it as, oh, cool, I’ve been identified as autistic. Okay, all right, let’s learn about that and how does that affect me in my experiences and things like that. It is just about embracing who you are. 

Jacquie Lee (26:43): 

Finally, I asked our guests whether they had any advice for practitioners who maybe feel a bit unsure about working with autistic and ADHDer children. 

Jason Tran (26:52): 

Hearing from neuro divergent voices, particularly neuro divergent psychologists or practitioners, their own unique experiences to better inform our practise as well. For example, I remember very early on in my career, I might use the phrase, “Oh, I’m working with neuro diverse clients,” and what I actually mean is working with neuro divergent clients because neuro diverse is a term that includes neuro typical people in that term. And now I’m noticing for myself as a practitioner when someone says, “Oh, I’m with a neuro diverse populations,” but I’m like, “Oh, actually what you mean is neuro divergent populations.” I think that’s just from working in this field for a long period of time, hearing from neuro divergent voices. There’s a lot of big voices out there that better inform us as practitioners about maybe the language that we use, identity first language, but just really be willing to hear from different voices as well to better inform my practise. 

Tammie Sinclair (27:44): 

Yeah, I guess the advice would be to look at those reputable sources of information. There’s lots of them out there. I understand it’s probably hard to pick apart which ones are the credible ones and which ones aren’t. So for example, there’s ReFraming Autism. It’s a very, very good not-for-profit website that has evidence-based research on there with examples and tips and lots of support for parents. So if they take the time to do some learning from something credible and research-based. 

Jason Tran (28:19): 

And I guess be willing that we might make mistakes. Of course, we want the best for our clients as well, but sometimes during that process we may make mistakes. We might, I guess, engage with things that might not be person-centred perhaps. Or again, we might maybe not be aware that we are actually going ahead with neuro-normative norms, neuro-typical norms, and it’s just checking and reflecting back and going, oh, am I actually pushing a certain agenda or an expectation when maybe the young person doesn’t want? 

Kate Mulheron (28:50): 

I’m not going to separate it for them, but I am going to provide common neuro divergent experiences. A lot of people say this and it makes sense, doesn’t it? So you can provide some information from that. You can reflect back some observations in a kind way to say, “Oh, I noticed that whenever I bring up this topic, it seems to make you uncomfortable. Is that right for you? Does that sound right?” And they know. They will tell you, “No.” And then I’ll be like, “Oh, okay, cool.” As long as you bring it up humbly and you keep your sense of, I say all the time, “I’m going to say something and let me know if I’m completely wrong because I might be,” but some people find this a little bit of a relief to know. 

(29:41): 

And then you say the observation, and then they know that they’re allowed to go, “Nope, you’re wrong.” And then if they are, then that’s great and you move on. And if you are a little bit right, but they weren’t ready to think about it, they’ll noodle on it later. And if you were completely wrong, you won’t talk about it again. 

Esther Fidock (29:59): 

I’d really like people to know that it’s not scary to work with autistic ADHDers. I think sometimes people assume that you need an entirely different skill set, and you need this really unique approach, and you have to have quite specific niche skills to work with autistic ADHDs. But I think if you are the type of therapist that is very warm, authentic, engaging, you have that holistic, unconditional positive regard and if you are trauma informed in your practise, then you are most of the way there in doing neuro diversity affirming practise. 

(30:34): 

So I think I just want to say, don’t be scared to work with autistic ADHDers and their families. Connect with other clinicians who are in the neuro diversity affirming space. Join Facebook groups. Find peer supervision. People who are in this space love talking about it. So find people who can help you out. And yeah, I think it’s just such a beautiful space to work in. So yeah, don’t be scared to work with this cohort. 

Bec (30:59): 

I think all practitioners, if they just recognise that it’s not a one size fits all, that each kid’s going to present differently, behave differently, need different levels of care, and show that in the way that they work with kids and their families, I think that’s the most you can hope for. And For some of us, I think a lot of the time we do just feel like we’re surviving and we’re just getting through and acknowledging that it is really tricky. And for us, we wouldn’t have it any other way, though. We really value all of our family members as they are, but it is still really hard. And I guess the goal for us is to feel like hopefully that we are not always just surviving. The kids are thriving and our family’s thriving. So yeah, I think we need all the help we can get from all those practitioners out there. 

Jacquie Lee (32:21): 

Thanks again to Jason Tran, Esther Fidock, Kate Mulheron, Jasmine Deakin, Tammie Sinclair, Bec, and Jaisen for sharing their time and wisdom with us. If you’d like to learn more about working with neuro divergent children, check out the links in our show notes and join us next time for part two of our conversation. Also, keep an eye out for our new online courses launching soon. In the meantime, thank you for listening and I hope you’ll join us again soon. Take care. 

Narrator (32:51): 

Visit our website at emergingminds.com.au to access a range of resources to assist your practise, brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The Centre is funded by the Australian Government Department of Health and Aged Care under the National Support for Child and Youth Mental Health Program.