Beyond the Label: Rethinking Therapy for ADHD and Autism

At Neurodivergence by Design, we start from a radical premise:

1. You were never broken.

2. You were never meant to fit.

3. You were designed to remember.

ADHD and autism are frequently approached as conditions requiring intervention or ongoing management. However, there is value in considering therapeutic methods that respect and accommodate neurodiversity, rather than attempting to conform individuals to neurotypical standards. Traditional therapeutic approaches often focus on integrating neurodivergent individuals into models intended for neurotypical experiences, which can lead to a lack of recognition, insufficient support, and increased frustration among those seeking assistance.

The Limits of the “Gold Standard”

Cognitive Behavioral Therapy (CBT) is frequently considered the standard approach in ADHD treatment, focusing on identifying and modifying thought patterns to influence behavior. However, CBT may not always address the specific needs associated with ADHD, as it assumes cognitive flexibility and self-monitoring skills that some individuals with ADHD may find challenging. Research indicates that ADHD-specific psychotherapy is often reported by patients to be more effective than general therapy, particularly when combined with psychoeducation and opportunities for peer support (Philipsen et al., 2015).

In the context of autism support, research highlights a gap in provider training. A large-scale study found that most psychotherapists do not receive formal education regarding autism in adults, may hold outdated views, and sometimes decline to treat autistic clients (Lipinski et al., 2022). Without familiarity with sensory preferences, communication differences, and experiences such as autistic burnout, therapeutic goals risk being perceived as less relevant or potentially unhelpful by clients.

Therapy that Fits

Tailored interventions have demonstrated effectiveness in certain contexts. In a randomized controlled trial involving women with ADHD, a 7-week occupation-based program that emphasized routine-building, organization, sensory regulation, and stress management resulted in measurable improvements in symptoms, stress levels, and satisfaction with daily roles (Gutman et al., 2021). The intervention was delivered in participants’ actual environments, such as their homes and workplaces, addressing real-life challenges rather than hypothetical situations.

The Cost of Masking

For autistic individuals, masking or camouflaging autistic traits to appear more neurotypical has various consequences. Research indicates that while such efforts may reduce instances of bullying or exclusion, they are associated with emotional challenges (Bradley et al., 2021). Masking can involve suppressing natural communication styles, experiencing sensory discomfort, and continuously monitoring one's actions, which may lead to issues such as fatigue, anxiety, depression, and changes in self-perception. Many participants in the study reported a desire to belong without altering their identity. Therapeutic approaches that recognize these factors aim to promote environments where authenticity is supported. Strategies might include lowering sensory input during sessions, providing direct communication, or respecting individual choices regarding social participation.

When “Good” Therapy Goes Wrong

In clinical training, "person-centered" therapy is frequently taught as a standard approach that emphasizes focusing on the individual, establishing rapport, and allowing their goals to guide intervention. However, for clients with ADHD or autism, a person-centered method lacking neurodiversity-informed understanding may unintentionally obscure important aspects of their experience.

Without appropriate identification, practitioners might attribute all symptoms to trauma or mood and anxiety disorders. Although trauma is genuine and commonly co-occurs with neurodivergence, it does not fully account for the complexities present. A treatment plan focused exclusively on trauma, regardless of its implementation quality, will not address challenges such as time management for individuals with ADHD or assist autistic clients in managing sensory overload within workplace environments.

Certain interventions may also pose risks. For instance, Eye Movement Desensitization and Reprocessing (EMDR) is an established therapy for trauma. Yet, for those experiencing sensory processing difficulties, the bilateral stimulation utilized, whether via eye movement, tapping, or sounds can exacerbate shutdowns, migraines, or heightened anxiety levels.

This issue does not arise from a lack of therapeutic proficiency but rather from the absence of a neurodivergent perspective. When ADHD or autism remains unrecognized, therapy risks becoming uniform and insufficiently tailored, potentially causing clients to perceive themselves as unsuccessful in treatment, when in fact, the applied model did not meet their specific needs.

Five Principles for Change

Incorporating insights from both direct experience and scholarly research, we can identify five core principles that underpin effective neurodiversity-affirming therapy.

1. Identify: Accurately discerning an individual’s neurotype is essential to effective intervention. Errors in diagnosis, including misdiagnosis or underdiagnosis, may lead to therapeutic strategies that are incongruent with the client’s neurological profile, potentially resulting in diminished therapy outcomes and feelings of inadequacy. Studies indicate that clinicians' readiness to support autistic clients improves markedly with comprehensive training (Lipinski et al., 2022).

2. Anchor: It is important to establish psychological safety at the outset of therapy. Affirming a client’s strengths and identity prior to introducing changes fosters engagement, particularly for neurodivergent individuals who may have previously experienced misunderstanding or criticism.

3. Suggest: Rather than prescribing new narratives, practitioners should introduce possibilities and encourage exploration. Evidence from the COMPAS ADHD psychotherapy trial demonstrates that combining psychoeducation with guided self-reflection enables clients to identify adaptive strategies without evoking defensiveness (Philipsen et al., 2015).

4. Redirect: Support clients in transforming frustration, overwhelm, or emotional intensity into productive channels such as creative pursuits, advocacy, or problem-solving. This respects the heightened emotional experiences common in neurodivergence, promoting agency instead of burnout.

5. Infect: Convey impactful and relatable accounts of neurodivergent success. Research on social camouflaging (Bradley et al., 2021) highlights the influence of narrative on identity formation; providing authentic, positive examples helps clients envision themselves as part of a constructive future.

These principles are intended to help important truths remain memorable, supporting increased personal agency and deeper self-awareness.

Beyond the Label, Toward the Blueprint

If we’re serious about improving therapy for ADHD and autism, we must move past “one-size-fits-all” and into “built-for-your-mind.”

Initiative	Description
Therapist training	Expanding therapist training in adult autism and ADHD
Interventions	Funding and scaling tailored, environment-based interventions
Values	Valuing authenticity over assimilation

Beyond diagnostic labels exists a framework aimed not at remedying individuals, but at restructuring the systems that have neglected their essential role. At Neurodivergence by Design, we regard this as more than reforming therapeutic practice; it is an act of cultural restoration, recognizing the evolutionary significance of diversity and consciously creating environments where it can prosper once more.

References

1. Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2021). “I want to be myself, but I don’t know who I am”: Social camouflaging and identity in autistic adults. Autism in Adulthood, 3(2), 134–143. https://doi.org/10.1089/aut.2020.0024

2. Gutman, S. A., Wesson, J., & Dayan, E. (2021). Effectiveness of a tailored intervention for women with attention deficit hyperactivity disorder (ADHD) and ADHD symptoms: A randomized controlled study. Journal of Attention Disorders, 25(14), 1991–2002. https://doi.org/10.1177/1087054719875786

3. Lipinski, S., Boegl, K., Blanke, E. S., Suenkel, U., & Dziobek, I. (2022). A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. Autism, 26(6), 1509–1521. https://doi.org/10.1177/13623613211057973

4. Philipsen, A., Jans, T., Graf, E., Matthies, S., Borel, P., Colla, M., ... & Huss, M. (2015). Effects of group psychotherapy, individual counseling, and pharmacotherapy in adults with attention-deficit/hyperactivity disorder (ADHD): A randomized clinical trial. JAMA Psychiatry, 72(12), 1199–1210. https://doi.org/10.1001/jamapsychiatry.2015.2146