World Autism Month: Understanding the mental health needs of neurodiverse adolescents

There isn't a singular ‘right' way of thinking, behaving, and learning. "Diverse minds are just as much a part of humanity as other types of diversity, such as gender and sexuality. The concept of neurodiversity includes all of these variations - including ASD (autism spectrum disorder), ADHD (attention deficit hyperactivity disorder), dyslexia, or Tourette's syndrome - framing none of them as better or worse than the other," explains Dr Jalpa Bhuta, consultant psychiatrist at Global Hospital. "These conditions should not be viewed as ‘deficits'."

April is designated as World Autism Month to spread awareness about the developmental condition that impacts over 1 percent of the global population as per WHO estimates. Although it varies from person to person, autism spectrum disorder (ASD) is associated with differences in learning, communication, and behaviour. The term ‘neurodiversity' has been used by advocates to reinforce the idea that individuals experience and interact with society in different ways.

Several initiatives have sprung up to increase the understanding about and acceptance of neurodiverse individuals among the neurotypicals. Interesting among them is India's first comic depicting a neurodiverse character interacting with neurotypical children, published by Not that Different (NTD), an ally movement led by kids to embrace neurodiversity and promote inclusivity. NTD offers children a one-of-a-kind platform to write their own stories, and express their ideas. Founders Mugdha Kalra, Archana Mohan, and Nidhi Mishra are mothers of neurodiverse and neurotypical children who found stress and mental health issues to be common among both. By launching the country's first live podcast by teenagers, the initiative also focuses on spreading awareness about adolescent mental health by placing children at the centre and building a community safe space where conversations and mindfulness are encouraged.

According to Dr. Bhuta, the prevalence of mental health conditions among neurodiverse adolescents is likely to be higher than neurotypicals owing to limitations in communication and social skills. She says, "Young adults have several needs, i.e. friendship, companionship, sexual urges, need for peer acceptance, educational progress, wanting to be accomplished with degrees and getting jobs in the future. However, because of their limitation in social and communication skills and or their intelligence, it can be very frustrating for them in regard to most of the above. This may lead to acting out or challenging behaviour. So, if someone has Tourette's disorder, they may also have comorbid OCD, or anxiety disorders, etc. Two or more mental health disorders may co-exist in both neurotypicals and in neurodivergent people, though the prevalence may be more common in neurodivergents."

Co-founder of NTD and autism activist Mugdha Kalra's preteen son Madhav has sensory processing disorder (falling under the autism spectrum) and ADHD which informs her experiences of living with neurodiversity. "The premise of the social communication disorder is anxiety stemming out from the pressure of communicating - finding it difficult to communicate. There is a high precedence of mental health issues among neurodiverse individuals. Many mental health conditions come as co-morbidities, for example, if one's neurodiversity goes undetected, and if you've been masking all your life, anxiety can mount up because one is trying to be someone they are not," shares Kalra.

When asked how challenging it can be for parents to identify signs of mental health distress, she explained, "For parents of neurodiverse children it is very easy to figure out if our child is stressed. Self-stimulating behaviour, known as stimming, is found to be very common among people on the spectrum. When the child is indulging in stimming - we can figure out that they are trying to soothe themselves. Even though the child may be semi or non-verbal, such behaviour is indicative of distress. Parents can spot signs of mental wellbeing by observing children retreating into shells, or body ache. When they are younger, they have meltdowns - which parents observe and learn from. It is a sure shot way of figuring out whether your child is experiencing anxiety. As a parent of a child on the spectrum who is in tune with his behaviours, I am certain when he is experiencing anxiety."

Considering mental health issues among the neurodivergent are more common, in terms of mental health support, how do their needs differ from neurotypicals? "The needs of both can be similar and can be different. Similar in a way that all of them need to be understood, parents need to keep a tab on the mental health of their children by looking out for non-verbal cues and catching signs of anxiety early. Intervention is perhaps different. In neurodiverse kids you may also look at medication, whereas in neuro-typicals, one goes for counselling, and talk therapy. Art and movement therapy is effectively used in case of both, and the most important role of parents is to pay attention and look for non-verbal cues," shares Kalra.

Spotting these non-verbal cues is among the biggest challenges of caregiving for a neurodiverse child as per Kalra, "My child - who is semi-verbal - is on the spectrum. He can barely tell me verbally when he's experiencing anxiety, so how do I spot that he's in distress. I notice when he's stimming or visibly anxious. If there is a change in behaviour, there are physical symptoms - there can be meltdowns or unprovoked seizures. In my case, I noticed my son didn't like online school. When made to sit for an online class, he would stim a lot, and get anxious. Caregiving becomes challenging because of repetitive behaviour, and intolerance, and the fact that your child isn't typically communicating. We need to be more adept at reading non-verbal cues."

Kalra also stresses upon the importance of social interaction beyond one's immediate circle of family and caregivers. "It is only then when acceptance comes about. It is the only way for your child to get accustomed to the outside world, and the outside world gets used to your child. It really takes a village to raise a child. People in the community have to be accountable, have to be responsible, and accepting of a child of any need. Only when my child steps out in the world and is understood, can he achieve his full potential. There is nothing missing in the child, he is simply misunderstood, and that's the reason why we need to have more stakeholders - more people in the community that one interacts with on a daily basis - who understand that there are people with varying needs who exist among us."

To help neurodiverse individuals cope with daily stressors, Dr. Bhuta shares some effective tools and strategies that can help, "People who are neurodivergent can be very different from one another, which makes it difficult to provide a single list of accommodations. However, there are some accommodations that can support both children and adults with or without specific neurodivergent diagnoses."

Some of the most effective accommodations are:

• Awareness of neurodivergence and willingness to be flexible at school or in the workplace when specific, reasonable requests are made: These may range from wearing noise-blocking headphones in school corridors to a preference to work from home or communicate via text versus videoconference.
• Positive responses to sensory challenges that may cause physical discomfort: These may include replacing fluorescent light bulbs with less-harsh incandescent or LED lights, reducing ambient noise, eliminating perfumes, providing noise-blocking headphones, and providing natural light.
• Technological support for managing time and schedules: These can include smartphone alarms, calendars, and other time-management software.
• Options for different ways of taking in and communicating information: These may include oral vs. written reports, videos vs. lectures, typed responses vs. in-person meetings.
• Sensitivity to social differences: Examples include taking it in stride rather than reacting negatively if someone speaks loudly, has tics, stammers, or finds it difficult to socialise in a typical manner, as well as repeating words or speaking more slowly to improve comprehension.
• Opportunities to learn or communicate in preferred ways.

In addition to accommodating coping strategies, it's also important to recognise and build on differences when they are helpful. Ways this is accomplished include:

• Carving out a job that makes the most of an individual's strengths without unduly challenging weaknesses.
• Assigning a particular job or activity based on an individual's strengths and preferences.
• Asking neurodivergent students or employees for their advice and input when designing office spaces, teams, and project management systems.

Also Read: Families of kids with autism face mental, social burdens, says Study