Dual diagnosis: the uniqueness and challenges of double and multiple neurodivergence

Silja is a neurodiversity coach working with neurodivergent adults at Acorn to Oak Education. Silja has a special interest in supporting neurodivergent adults to succeed in ways that are authentic to them and is also interested in the interactions between neurodivergence, mental health and intersectionality.

Many resources about neurodivergence and neurominority groups focus, understandably, on one type of neurodivergence at a time (such as dyslexia, adhd or autism) and may not address the impact of other aspects of a person’s identity that may be key such as a person’s gender, sexual or ethnic identity or another type of neurodivergence.

In terms of neurodivergence, these books and resources tend to focus on the characteristics observed with suggestions of ways in which support can be obtained and the kinds of strategies that can be useful. Typically, there may be a mention of the fellow travellers with that condition eg if you are an ADHDer there could be an increased likelihood that you could also be autistic. This can then lead to another rabbit hole of researching online and potentially further diagnostic processes.

Many of my clients as a neurodiversity coach have more than one neurodivergence diagnosis. They tend to report that despite a great deal of reading and researching they do not see themselves in the literature as materials focussing on one condition at a time do not capture the unique mixture of traits and experiences they face as a person who is a neurodivergent hybrid.

For example, the way that clients see their neurodivergent identity and which element feels dominant, if this is the case, can immediately reveal some of the subtleties. I know of ADHDers who describe themselves as also autistic and autistics who are also adhders. I also know ADHDers who describe themselves as also dyslexic. But do not describe themselves as a dyslexic ADHDer.

In addition, the need for organisation as a way of managing anxiety and reducing uncertainty can be helpful for autistic clients and yet the demands of an organisational structure, even if self designed, can prompt procrastination from the client’s ADHD perspective as the organisation and structure also feel boring and reduce interest and the ability to be spontaneous. I myself can produce complex Gantt charts for work projects mapping out tasks months ahead while knowing that I am unlikely to be able to follow them as ADHD means I will resent the idea of following a rigid framework.

Clients have also reported to me feelings of exclusion even within the neurodivergence world as there is little material about managing potentially conflicting traits and the “regular ” strategies for one type of neurodivergence may not apply. Needless to say, outside of neurodiversity allies this can feel even more excluding with even greater feelings of invisibility.

Don’t forget mental health

Another element that may be present is the mental health aspect of being poorly understood, potentially feeling invisible, and having a brain that does not function in the way that society, the workplace and the world of education assume that it does. This can involve further diagnoses for neurodivergent people although clients have reported that due to being neurodivergent their mental health needs are not always taken as seriously as they would like.

In my work, it can be hard to identify neurodivergent clients that have not experienced trauma, discrimination, and othering in various ways. This can contribute to mental health challenges such as anxiety and depression. Anxiety can appear to be seen as an inherent part of ADHD or autism, for example, and while this may be the case, it also needs to be addressed appropriately as a critical strand in the support system for the individual.

Intersectionality

The experience of those who have other identity elements that can cause them to experience difficulties from discrimination can add another critical layer. For example, black and minority ethnic groups can feel even more invisible in the neurodivergence literature with or without a dual diagnosis and, especially if experienced by others as neurotypical, may find it is even easier for others to decline to offer support or dismiss their needs.

Anecdotal evidence from the significantly greater difficulties experienced by our black clients in accessing support for neurodivergence compared to white clients has clearly been exceptionally challenging for the individuals involved. It has been infuriating and distressing for us a team to see the injustice and the irony of the need for black professional clients to need input from (white) advocates in order to receive passable treatment.

Adams and Liang (2020) have written about the heart breaking experiences of trans-autistics with the medical, psychiatric and therapeutic professions. Needless to say, this book is not a testimony of an abundance of understanding, support, validation and inclusion being experienced by this group.

These aspects are also vital as I have seen from my clients that any experience of attack, misunderstanding or prejudice regarding any element of their identity can be difficult to manage on top of everything else.

What is the answer?

What appears to have worked best in terms of neurodivergence for my clients is to look inwards and reflect. This means going beyond any diagnosis or self-identification and noticing what preferences, traits, habits, feelings, experiences and behaviours there are and going through a process of figuring out and trying out for themselves ways to acknowledge and work around the inner and outer obstacles faced.

This process can be supported by neurodiversity coaching and / or the right therapeutic input with a neurodivergent therapist or neurodivergence ally. Resources can be useful although each person really is a unique mixture of characteristics, experiences and emotions that all need to be understood, accepted and cared for.

This is, however, not the whole picture. My clients, as do we all, still need better understanding and fairness in society as a whole so that othering and discrimination due to any aspect of a person’s identity whether due to race, sexual preference, gender identity, ability or neurodivergence are properly addressed with equity of opportunity for all.

If you would like to explore neurodiversity coaching we can help and you can book a free initial session to discuss how it could help you.

Read more

Adams, N. and Liang, B. (2020), Trans and Autistic: Stories from Life at the Intersection, Jessica Kingsley, London

Nancy Doyle talks with Tumi Sotire, also known as the Black Dyspraxic: https://www.forbes.com/sites/drnancydoyle/2020/08/07/the-intersection-of-race-and-neurodivergence-the-black-dyspraxic-shares-on-overcoming-barriers/?sh=e0b1caa54c06