Choosing Therapy

Sep 01, 2022

As parents, we often get the message that because we are raising a neurodivergent child, they must engage in therapy. Our society currently has a deficit-based model where neurodivergence is a disability, and therapy is designed to address our child’s deficits. I agree that being neurodivergent (ND) is a disability because society does not meet our needs for sensory and relational safety. We can not develop or thrive in mainstream systems because they are not designed for our bodied or brains to cope. Parents, teachers and therapists have good intentions, but until our children get support from a neurodivergent affirming lens, unintentional harm will continue. 

Neurodivergence in itself is a valuable and valid way to be in this world, and it is just not understood or catered for. Many deficits are caused by children not having their basic needs met, and complex behaviours develop to manage their overwhelming feelings. Even those seen as ‘successful’ have often been through significant trials and trauma but found a way to manage despite the way society does not meet the needs of ND people. The cost is often paid for in long-term health and well-being, such as burnout or secondary mental health issues. 

We are all learning how to be ND-affirming, and even ND people struggle with internalised ableism as we have all been raised in a society that puts a lot of pressure on young children to be productive and judges or criticises them when they can not cope. We can not meet the Neurotypical (NT) productivity standards in NT environments and stay healthy. The pressure is too much because we develop on a different trajectory as children, and we need more space, time and support during childhood. This very act of pushing ND children before they are ready causes many of the challenging behaviours and deficits labelled as “autism” or “ADHD”, but in fact, it is stressed-based behaviours as we do not understand the neurology and needs of ND children, and this causes them damage.

I support some families that have created an ND-affirming lifestyle for their family, and their child is still dysregulated, unhappy and has stressed-based behaviours. This is when you look at the child's internal world, as the ND population has high rates of co-occurring conditions such as digestion issues, autoimmune disorders or cardiovascular issues. There could be something inside your child’s body that makes them feel uncomfortable, in pain or scared. Pain often is expressed as sleep, eating, toileting or behaviour issues. Always address co-occurring issues; otherwise, it could impact development and regulation. 

Therapy is necessary when our child is struggling and not coping with everyday life. The underlying issues must be addressed as nobody can learn or grow while in pain or feeling overwhelmed. Therapy does use a lot of resources. It is expensive, takes children away from play, education and downtime, and puts pressure on parents' work and household schedules. It can be exhausting for both parents and children, but most importantly, if it is not neurodivergent affirming therapy, it can be harmful, but often, our child does need some therapy. So it is important to make sure you are choosing the right therapy for your child. 

There are two areas that we always need to seek professional help with, which are health needs and safety-related needs. We need to seek medical professionals if our child has any issues with pain, movement, breathing, sleeping, drinking, eating or digestion. We need to get support from allied health professionals if our child struggles to keep themselves safe and are at risk of hurting themselves or others.

As neurodivergent people, we often have co-occurring health conditions that need to be diagnosed and addressed separately from our primary diagnosis. Do not dismiss and leave health conditions untreated. I went to numerous professionals with my daughter and was told “gut problems are just part of being autistic”, but just because they are common, it doesn’t mean they should go untreated. I persisted and found someone who listened. My daughter did not sleep through the night at the age of 7, and within ten days of treating her gut issues, she started sleeping through the night, learned to read, and could concentrate and regulate better. Treating all underlying health issues is essential as they are a common cause of behavioural challenges.  

Find an amazing GP that can do a thorough health check and listens to you. Neurodivergent people process pain differently than neurotypical people, and all research and training are done on neurotypical bodies. I have heard too many stories of neurodivergent people not getting proper medical treatment as they didn’t present like they were in enough pain. I did a webinar on Autistic Pain Differences that discusses that it was not until I ended up in ICU that I realised that I process pain differently. 

You know your child, and if they have a very high pain threshold, you need to have a doctor who listens to you when you say they need urgent medical care. Find a GP who trusts you, and you trust them. A good GP can also refer your child to any relevant specialists to further investigate any health concerns. 

If your child struggles to keep themselves safe and is at risk of hurting themselves or others, they may be offered a Positive Behaviour Support Plan which is a plan that helps everyone who supports your child to know what their triggers are and what to do when unsafe situations occur. It is a set of guidelines and recommendations that can keep you informed of what to do to avoid and manage unsafe situations. It is even more essential to engage with a neurodivergent-affirming clinician when developing this plan. I find positive behaviour clinicians that also have an occupational therapy background develop plans that are responsive to the child's regulation needs. 

Safety also refers to feeling secure in their body and feeling emotionally secure. Many of our kids feel unsafe in their bodies due to pain, coordination, spatial awareness (knowing where you are in space and in relation to others) or strength issues. Our kids can feel unsafe as they can’t always rely on their bodies. A physiotherapist, exercise physiologist or occupational therapist (OT) can help with strength and low muscle tone. An OT can assist with spatial awareness and coordination, as well as sensory modulations, which can help them to get sensory needs met, so they feel calmer in their bodies. 

In the next article, we will cover social and communication therapies, which is a complex area to navigate as we are moving towards validating our child’s neurodivergent culture while also understanding how to navigate neurotypical culture instead of teaching kids to mask and look more neurotypical. There are significant well-being issues for neurodivergent people who mask their true identity, especially if they begin masking from a young age. We want to support wellness in our neurodivergent children and find responsive therapy that supports them in understanding themselves and how to get their needs met in a neurotypical world. 

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