5.2b Initial appointment and exploring neurodivergence

KEY ISSUES

Initial appointments can be a source of anxiety due to unfamiliarity of setting, people and processes. Part of the assessment process will involve exploration of neurodivergence. It is important that clients feel comfortable, understood and accepted so that they can engage with the assessment process. This is an opportunity to learn about the client’s needs and begin to build a trusting working relationship. 

PRACTICAL TIPS

Before exploring neurodivergence

• Make sure to consult and implement specific adaptations and preferences identified during the initial contact (e.g., sensory, communication tools).
• Ascertain seating preference (if safe to do so).
• Give permissions for people to move their bodies how they choose, including moving around the room.
• Tell client ‘it is ok to be you’ (e.g., reassure the client that you are aware that we all think, experience and interact with the world differently).

Intersectionality

Being Neurodivergent is only one aspect of a person’s identity, which they may or may not choose to identify with. It is also important to remember that people’s identities consist of multiple, intersecting parts. The theory of intersectionality (Crenshaw, 1989) draws attention to the different privileges and relative levels of discrimination that people face. As practitioners, it is important to recognise that neurodivergence intersects with other identities (e.g., gender, sexuality, ethnicity). This means: 

• Diagnostic tools typically privilege externally observable behaviours rather than what it feels like to be a Neurodivergent individual.  
• Ethnically minoritised people and women are less likely to receive a diagnosis. 
• Men may be less likely to disclose/explore due to societal expectations (e.g., disability equated with weakness, not seen as ‘masculine’).
• Social class impacts access to assessment, diagnosis and support.  

Questions for exploring neurodivergence 

These questions should be explored sensitively and supplemented with exploratory and needs-based questions (see section 5.2C)

• Have you considered the possibility that you may be Neurodivergent? (client may ask what Neurodivergent is so it is important to be able to explain this using the prompts below)
• Rather than ask ‘are you Autistic/ ADHD’, you could say, ‘there’s some things you are explaining to me that:
  • ‘fits with what people who have a diagnosis of..[ADHD]……..say’ 
  • ‘are similar to some of the struggles people who identify as……[Autistic]…….have’
• Do you ever feel like the world isn’t really designed for how you process things? Can you give me some examples so I can understand?
• Have you noticed patterns in how you experience focus, energy, or social interactions? Can you explain them?
• Are there certain environments where you feel more like yourself than others? What are they?
• Have you found any labels or identities that help you better understand yourself? What are they?
• Have you explored any neurodiversity-related content that resonates with your experience? What was it?
• What kinds of challenges do you face that others seem not to?
• What helps you feel more regulated day to day?
• Some people find that learning about ADHD or Autism helps explain a lot about how they experience the world, have you ever looked into any of that?

Practitioner self-disclosure can be helpful too as a way of reducing stigma.