Examples of neurodivergence:

*Please note that "disorder" refers to the current medical terminology used to describe a divergence, or variance, in relation to societal "norms" for functioning, learning, and behavior. We do not believe neurodivergence is something that needs to be "fixed". It is a state of being related to neurological functions that one learns to navigate with.

Autism - variance in how one interacts, socializes, and communicates with others and the world around them due to connectivity differences in brain structures and pathways. This presents with repetitive interests and behaviors, sensory processing challenges, and variances in learning pathways and abilities.

Sensory Processing Disorder - variance in pathways for brain connectivity that affects one's processing speed and ability of processing stimuli (or sensory input), usually described as being under-reactive or over-reactive according to what is considered to be the baseline for reaction to stimuli. Stimuli is anything we perceive through our senses and respond to through our nervous system.

ADHD - variance in certain brain structures, the neurotransmitter system for dopamine, and circuitry connections that causes a divergence in the degree and length of sustained attention, elevated activity levels, and acting without foresight.

Dyslexia - variance in the maturation of the cerebral cortex related to brain asymmetries that cause an impairment of the brain’s ability to handle brief, rapidly occurring stimuli. This shows up as a divergence in reading and language processing as it relates to identifying the relationship between speech sounds and written words.

Dyspraxia - variance in the coordination of movement. Neural messages are transmitted in a way that causes information to be processed in an uncoordinated or out of sync manner.

Dyscalculia - variance in the specific regions of the brain, such as the parietal lobe and the intraparietal sulcus, that inhibits one's ability to understand and manipulate numbers.

Tourette's - variance in the brain neurotransmitter system that causes motor and/or verbal functions characterized by the presence of repetitive tics and unintentional sounds, both of which are sudden and difficult to control or completely uncontrollable. Tics can be in the form of thoughts, words, or bodily movements.

PTSD (or cPTSD) - a form of acquired neurodivergence characterized by neurological variance brought on by one's nervous system being exposed to either severe acute trauma or a chronic series of less acute trauma or severe distress.

Dissociative Disorders such as D.I.D. and O.S.D.D. - variance in brain activation patterns in neurological networks linked to cognition, self-awareness, memory, self-regulation, and emotional processing.

OCD - variance in patterns of brain activity and communication in regions of the brain that are involved in pathways such as judgement, motivation, and reward. These variants often result in behaviors to help alleviate persistent thoughts, fears, sensations, and/or urges through ritualistic actions and/or behaviors.

Pathological Demand Avoidance - variance in the nervous system's ability to process and respond to demands within the context of a need for autonomy as a pathway to perceived safety.

Oppositional Defiance Disorder - variance in the relationship between three interconnected brain pathways that play a role in mentally processing undesirable vs desirable outcomes and in intentionally selecting thoughts, emotions, and behaviors based of social context and task demands.

Anxiety or Panic Disorders - variance in the interconnected brain circuitry involved in the instinctive or learned responses to present or perceived danger, the management of thoughts and actions by adjusting to surroundings, and the involuntary recollections and impressions of a distressing or traumatic event.

Depressive Disorders - variance in neurotransmitter systems and/or in the structure and function of certain brain regions such as the amygdala. This produces a variety of symptoms including a lack of energy, profound feelings of sadness and hopelessness, and a range of somatic symptoms.

Bipolar Disorder - variance in the regulation of neurotransmitters in the brain, hormone-based mood regulation in the neuroendocrine axis in the brain, and intracellular signaling pathways, producing extreme mood swings.

Prevalence

Neurodivergence is more common in the LGBTQIA+ community, especially in the transgender and gender non-conforming community. This is thought to occur because neurodivergent individuals are much less likely to understand and/or follow societal "norms". A study in 2018 showed a strong link between autistic neurodivergence and non-heterosexual orientations. The links between neurodiversity and the LGBTQIA+ community are still being studied.

Impact

The impact of being neurodivergent varies from individual to individual. Impact can mean the barriers and stressors that neurodivergent people face from simply having to navigate a society that is not set up for their neurological differences. There are many misconceptions and stigmas around neurodivergent people. Even those neurodivergent people who are within the LGBTQIA+ community itself face bullying and being treated as outcasts. These impacts follow neurodivergent people into mental health and recovery spaces due to lack of knowledge, insight, and understanding.

We seek to shine a light on these issues and to help foster more equitable spaces at this intersection of our community.

We focus on a strengths-based approach to neurodivergence by acknowledging the challenges and barriers neurodivergent people face, while purposefully highlighting and utilizing the strengths that someone naturally has by having a neurodivergent mind and nervous system.

The following are positive traits of neurodivergent people and vary person to person and by type of neurodivergence.

• Strong observation skills

• Extraordinary pattern recognition

• Impressive information processing speed

• Creative problem-solving capabilities

• Ability to find innovative solutions

• Ability to stay laser focused on an activity for long periods of time

• A strong and inherent sense of justice

• Unique and interesting points of view

• Highly proficient in identifying and utilizing available supports and resources

• Elevated visual processing abilities

• Exceptional memory and information recall

• Strong boundary setting skills

• Remarkable attention to detail

• Aptitude in a particular area such as numbers and logic or the arts

• Special interests that produce subject matter expertise

• Dynamic abstract or non-linear thinking capacity

• Vivid and detailed imagination with potent visual recall abilities

• Realistic viewpoints and plans of action based on knowledge of limitations or abilities

• Adaptive abilities to function and navigate a world that was not built with them in mind

• A macro view on issues and problems that can take all information and patterns into account

• Propensity to notice things that no one else notices

• Openness to understanding and trying new things driven by curiosity

• A vigorous awareness of others that yields compassion

• Enhanced levels of energy and enthusiasm

• Ability to be extremely honest

• High degree of self-awareness

Neurodivergent people have to operate in a world that is catered more towards neurotypical people. There are daily challenges and systemic challenges that require high amounts of energy and time to either adapt to or work around. This leads to high levels of mental health and substance usage concerns within the neurodivergent community.

We define these challenges within the context of having a high level of difficulty with something based on social "norms" and expectations.

These challenges occur due to variances in one's nervous system functions, including brain signals that cause differences in thoughts, emotions, and behaviors that do not fit into the current mold, or accepted standards, of society.

Challenges and barriers include:

• All types of neurodivergence:

  • A lack of access to, or major gaps in, proper resources and care

  • Chronic exhaustion for trying to mask their differences

  • Co-occurring mental health concerns due to excess anxiety and depression

  • Not fully being able to express themselves aka "masking"

  • Difficulty navigating their environment

  • Struggling in neurotypical-based education and/or employment settings

  • Trouble finding and maintaining meaningful employment

  • Social bias and rejection leading to isolation

  • Religious or other ideological-based discrimination against them

  • Difficulty connecting with others and maintaining relationships

  • Overwhelming sensory challenges

  • Drugs and/or alcohol usage to lessen sensory issues or to self-medicate emotional dysregulation

  • Co-occurring health conditions which are often nervous system based, such as sleep, digestive, and movement disorders

  • Being chronically misinterpreted and misunderstood

  • Having low self-esteem due their neurodivergence being trivialized and shunned.

  • Chronic feelings of hopelessness and frustration leading to self-harm, being withdrawn, and having suicidal ideations.

• Autism Specific

  • Being perceived as being restless and fidgety (from stimming) or uninterested and stand-offish

  • Difficulty straying from a set routine or dealing with sudden changes

  • Inability to pick up on or participate in "social cues" or interpreting implied meaning

  • Trusting people at face value and being taken advantage of

  • Becoming easily overstimulated, or unable to process sensory, emotion, and cognitive information

• ADHD Specific

  • Difficulty maintaining attention and staying on task

  • Difficulty following a set routine

  • Trouble finding a balance between being over and under stimulated

  • Executive dysfunction, or the impairment of one's cognitive ability to plan, focus, organize, and control their thoughts, emotions, and behavior.

  • Tendency to engage in high-risk or impulsive behaviors.

  • Distrust of one's own self and abilities due to difficulty with focus and memory

Neurodivergent people are more likely to engage in drug and alcohol usage in risky ways that ultimately have a negative impact on their ability to function.

Here are some observations on how neurodivergence interacts with recovery spaces:

There is a tendency to self-medicate.

In an effort to alleviate unwanted, intrusive, and/or repetitive thoughts, emotions, and behaviors, neurodivergent people sometimes try to mix recovery with drugs and/or alcohol usage. This might work for some people some of the time, but the majority are unable to maintain this at safe levels long term.

There can be distrust of professional providers.

Neurodivergent people often go undiagnosed and are therefore not taken seriously when interacting with medical, mental health, recovery, or peer providers. Even those with a diagnosis are at times treated in a dismissive manner. It is crucial that providers actively listen to the people who know themselves the best - the patient or client.

Navigating treatment and IOP (Intensive Outpatient Programming) settings can be exhausting.

Treatment and IOP settings first focus on the drug and/or alcohol related issues and symptoms. While many treatments and IOPs now understand and address co-occurring mental health conditions, neurodivergence is still not being fully considered and accommodated appropriately. This causes numerous neurodivergent people to drop out of these settings because they become too overwhelming to navigate. A newly sober person does not have the capacity to stop and advocate for themself while educating those who should be fully supporting them.

Recovery housing can cause severe sensory overload.

Recovery houses are less sensory friendly than a lot of spaces. There are usually several individuals in a house and each person usually lives in a room with a roommate. For neurodivergent people trying to say sober, this can become overwhelming as they have no completely private space to decompress and self-regulate other than the bathroom. With several other people in the house, noise, movement, and lighting levels are automatically louder, more frequent, and brighter.

Groups and meetings can cause sensory overload.

Recovery groups and meetings can be vigorously over-stimulating with overhead bright lighting, loud conversations and other noises, and numerous people within close proximity to one another. Seating can feel hard or awkward and nearly impossible to settle into for someone with sensory concerns. Some neurodivergent people have physical challenges that make driving or traveling to meetings or groups more difficult. Some neurodivergent people need to move around a lot and/or having trouble paying attention and need to be able to do something with their hands or body. Some meetings or groups want everyone to participate, and that can feel too sudden, unknown, and overly stressful to neurodivergent people - especially those in early recovery.

Sponsorship feels inaccessible.

The majority of recovery mentors or 12-step sponsors are not sufficiently informed about neurodivergence and how it interacts with recovery. This causes a massive disconnect in a neurodivergent person's ability to connect with, trust, and learn from a mentor or sponsor. Mentors and sponsors lead with their own experiences. Unless they have direct experience with someone's particular form of neurodivergence, they will not understand the differences in daily functioning and behaviors. Sometimes a perceived "behavior" is just a normal function of someone's neurodivergence. An example of this is when a mentor or sponsor is working with someone who has ADHD and who is chronically late to meetings. This is not a behavioral issue, but rather a time blindness facet of the ADHD. While there are ways to better manage time blindness, it is not some sort of "moral failing" or innately bad behavior that a mentor or sponsor needs to "correct".

Recovery literature language lacks inclusion.

The majority of neurodivergent people do not follow "traditional" models of gender and sexuality expression, family dynamics, and other "norms" that are most often expressed in recovery related literature. This lack of inclusion in recovery literature filters out into recovery programming, including 12 step models, which essentially ostracizes those who do not more closely follow its societal patterns.

Social rejection, intentional or not, happens at meetings.

Some neurodivergent people, such as people who are autistic, might seem standoffish, uninterested, or disengaged at meetings while in reality they are just overstimulated and unsure about how to approach social interactions. Some neurodivergent people might look extra fidgety, seem restless, or have neurological tics, which can be perceived as being "on something". Neurodivergent people have different experiences and communication styles, which can come off as "odd" when sharing in meetings. Neurodivergence has many physical and behavioral manifestations that are often misinterpreted. Misinterpreting or misunderstanding what someone has going on leads to not engaging with or including them directly.

Limitations are often perceived as a moral failing.

Depending on the form of neurodivergence someone has, functioning with and navigating through a set type of recovery programming might not work for them. They might need to seek a different type of programming or utilize a mixture of different types of programming. If they exit out of a program that isn't working for them, they might be viewed as having "failed" in their recovery. This is not true. Neurodivergent people come to know themselves well and understand what their boundaries and needs are. These will often not align with set recovery programming and there is nothing wrong with that. Furthermore, some recovery-based concepts, suggestions, or ways of doing things might not make any sense or not register at all with a neurodivergent person. This could be due to factors such as having a strong sense of justice, a short or shifting attention span, sensory concerns, hyperfixations, differences in social abilities, and strong pattern recognition. These are not "moral failings," but rather a variance in the way someone approaches their sobriety.

High levels of "masking" make open and honest recovery nearly impossible.

Some neurodivergent people use substances try to mask their neurodivergence. When becoming sober, their neurodivergence can become glaring to them, causing them to want to "mask", or hide or change their traits to fit into a neurotypical society, including in recovery spaces. They might not share aspects of themselves with other in recovery and therefore not gain the same type of insight and experience sharing that others enjoy. This can lead to feelings of isolation and being "stuck".

Taking off the "mask" is exhausting and scary.

Many neurodivergent people "mask," or try to cover up their neurodivergence, in order to fit in socially. Once in recovery, some people figure out for the first time that they are neurodivergent and begin the process of unmasking themselves in order to live more authentically. Others might come into recovery already understanding that they are neurodivergent but also seek to live life more freely and openly. Remember - a lot of neurodivergent people turn to substances to try to alleviate their neurodivergent behaviors or co-occurring conditions.

This process of unmasking is exhausting. Unmasking once in recovery takes an additional level of courage and determination above and beyond what it takes to recover. Each person's process of unmasking will look different. Each person will go at their own pace as they learn to be themself. Masking produces safety at times, and someone might go back and forth between masking and unmasking. Some people might need extra alone time to figure out what they are truly like without have to be "on" for other people. For neurodivergent people, this goes beyond most people's need for some alone time into a safe zone of being able to learn what their baseline "being" is, how they shift behaviors when around others, and overall, what their unmasked self looks like.

Unmasking is an extensive process of discovery, letting go, and moving forward. We have found that when someone suddenly finds a sense of safety, such as in recovery housing that was set up to accommodate them, they are able to take a deep breath and being this process. The exhaustion from having held on so tightly such a long time sets in, and they might need extra support for a while as they get their bearings. Sleep, nutrition, therapy, medication management for co-occurring concerns, primary care check ins, flexibility in recovery meetings, and routine alone time are crucial at this time in their journey.

As they begin to unmask, they will encounter some socially challenging situations, as highlighted in some above sections. Learning to navigate through this is best supported through an experienced therapist and other peers in recovery who have already been through the process of unmasking while navigating recovery.

Neurodivergence is often viewed as being primarily a mental health issue, or even a moral failing, and is not properly recognized for the physical variances happening in the nervous system. This is sometimes misinterpreted as a psychological issue that needs to be "fixed", instead of a pattern of functioning that one needs support in learning to navigate with.

Neurodivergence often comes with co-occurring mental health concerns. In this context, co-occurring means that someone is both neurodivergent and has a diagnosed mental health condition or mental health related symptoms.

It is important to note that some neurodivergence is also considered to be a mental health condition. In the "Scope of Neurodivergence" section, we identify the physical divergence within the nervous system. In this section, we will focus on the actual thoughts, emotions, and behaviors that are a result of the divergence, or variance.

These co-occurring mental health conditions or symptoms need to be addressed in order for one to be able to learn to navigate and thrive with their neurodivergence.

Here are some examples of mental health symptoms that often co-occur with neurodivergence and are either brought on by difficulty navigating with neurodivergence or are part of a separate mental health condition:

• Depressive episodes

• Anxiety or panic attacks

• Dissociation

• Suicidal ideations

• Mood instability

• Mania

• Paranoia

• Excessive guilt or fear

• Obsessions

• Compulsions

• Intrusive thoughts

• Sleep disturbances

• Confused thinking

• Trouble concentrating

• Withdrawing from people and activities

• Dysregulated eating habits

• Excessive anger and hostility

• Episodes of rage

• Smaller "Window of Tolerance"

These co-occurring symptoms that prompt people to seek guidance in mental health spaces are often interpreted only within the context of a mental health condition and without the recognition of any underlying or co-occurring neurodivergence. This results in insufficient mental health care that is not individualized enough to provide the proper level and types of support.

Additionally, many mental health spaces are not sensory friendly and do not take underlying neurodivergence into consideration in their forms, communication methods, waiting area, therapy offices, types of therapy offered, etc.

We have identified some key gaps in resources and programming that have been directly observed while working with LGBTQIA+ neurodivergent people in recovery housing, particularly with trans and gender non-conforming individuals. All of these gaps can be addressed by working together to educate people around them and pooling knowledge and resources. We have already taken a first big step in opening a recovery house specifically for queer autistic people.

Current known gaps:

Roadblocks with access to testing and diagnosis -

Many adults have difficulty getting approval from doctors and insurance to have testing done due to having masked and found ways to move through life for a long period of time without any interventions. Finding a quality provider who does comprehensive psychological evaluations that can narrow down one's particular type of neurodivergence can be strenuous. Quality providers are not numerous and often have long wait lists.

Lack of sensory friendly recovery or other housing -

We operate a sensory friendly sober living house for autistic people in Richmond, Virginia. "Sensory friendly" is an approach that minimizes sensory input that might overwhelm someone who has sensory sensitivities.

To establish a sensory friendly house:

• Minimize overall lighting and use softer lighting

• Cover or remove blinking lights

• Reduce overall noise level including music, TVs, conversations, doors closing, and overall loud movement through the house

• Intentionally leave more space between furniture for movement

• Have earbuds available for those who need background noise

• Have earplugs available for those who need to reduce background noise

• Have lighter and heavier bedding options

• Have a weighted blanket available

• Have temperature regulation items such as cooling blankets and heating pads

• Have footstools and railing available to help with balance

• Have fidget items available

• Have bins and baskets available to help keep items organized

• Make sure curtains can sufficiently block out excess sunlight

• Have an air purifier to reduce overstimulating scents

• Set up one dry erase board per person/bed for keeping track of appointments and tasks

• Have plenty of non-busy but colorful visual cues and reminders

• Have stuffed animals available

• Have one resident per room whenever possible or room people together who have similar sensory sensitivities

• Use a minimalist and organized approach to household items to reduce clutter and promote ease of use

• Use neutral or soothing colors, such as grays or beiges and softer blues, greens, and teals
  

Lack of mental health co-occurring supports -

Neurodivergent people often face a lack of acceptance, even from mental health professionals who might view these divergences as "abnormalities" rather than a normal part of the human condition. This can exacerbate anxiety and depression. It is important for neurodivergent people to seek guidance from experienced therapists who specialize in their area of neurodivergence and its co-occurring conditions. Experienced therapists, though currently few, can individualize their approach with neurodivergent clients. Some current therapy models work for the symptoms of the co-occurring mental health conditions but do not always address the other supports needed to navigate more smoothly with the neurodivergence. This lack of co-occurring support also shows up in mental health crisis stabilization and treatment settings, causing many people to get released without proper support or a workable plan.

Lack of proper support in taking next steps -

Some individuals we have worked with get "stuck" in their current space because they either do not know how to or cannot access the next step in the available system of support, such as housing support. Housing support for people who are neurodivergent and have a recognized "disability" due to their form of neurodivergence and its co-occurring conditions can be difficult to navigate. They tend to have strict guidelines for access and a long waiting period.

In addition to housing support, neurodivergent people often need support with securing meaningful and accommodating employment and/or academic support and guidance. Neurodivergent people are very capable, as we highlighted in the "Strengths" section, but need to be able to function and navigate in a way that their brain and nervous system was naturally built to do. The chronic lack of understanding and accommodations can make taking next steps towards goals and growth very intimidating.

The amount of people who need this support is growing as more people become properly recognized as being neurodivergent and have properly diagnosed co-occurring conditions.

Complications when trying to get into specialized programming -

Some individuals may have been tested and diagnosed as children but have no access to those records as an adult - or not tested at all. Certain key programming requires diagnosis documentation, along with other criteria that not everyone fits into. Not fitting into narrow criteria often disqualifies someone from programming or support that would greatly help them stabilize and take some next steps.

Becoming overactivated and frustrated when trying to navigate resources -

Trying to locate and connect with resources can be challenging based on someone's form of neurodivergence. For example, autistic people can get overstimulated while trying to navigate phone calls and speak with strangers about unknown variables and details. On the other hand, people with ADHD can have severe executive dysfunction that result in "thought loops" or forget altogether what they were attempting to navigate.

Some resources require a form of communication that the neurodivergent person may struggle with. Some resources and supports might have forms to fill out that a neurodivergent person might have an internal battle or acute response over because of the way the questions are worded or the nature of the questions being asked.

Proper medication management -

We have observed in our residents that some neurodivergent people are either undermedicated due fear around seeing a prescriber or overmedicated due to a lack of acknowledgement and understanding of their neurodivergence and its co-occurring conditions. Prescribers sometimes keep medicating the symptoms without addressing the root causes of the symptoms. It is crucial for prescribers to understand the difference between neurodivergence and mental health conditions, as well as how they overlap or interact.