S1E18 – Trauma and Neurodivergence, with Amanda Marples

W: Hi everyone, before we begin today’s show I want to give you some content notes about what to expect. We will be discussing the close relationship and interplay between trauma and neurodivergence, including for autistic people and those with ADHD. There will be brief references to sexual assault and bullying. We will also discuss the impact of early childhood trauma on brain development and how having a higher sensitivity to sensory experiences can impact traumatic memories. There are a lot of references to research in this conversation, so you’ll find a whole stack of links in the show notes that will take you to where you can read more if you are interested.

Take care whilst listening and if anything comes up that you need help with right away you’ll find sign posting on our website anyamedia.net/LivelyMinds

E: Hello my name is Ellie

W: and my name is Will.

E: You are listening to Lively Minds, the podcast about mental health challenges that go beyond the ebb and flow of the everyday.

W: The podcast that is less about how we deal with our mental health and more about how we understand it in the first place.

E: So in today’s episode we are chatting again to Amanda Marples who is a writer, social worker and mentor with over 20 years experience in community mental health.

W: She has written for numerous magazines, is the author of The Healing Workbook and operates a mentoring service for neo-divergent writers called Reconcile Creative.

E: The last time we chatted to Amanda was in episode 14 when she spoke to us about trauma.

W: If you haven’t heard that episode then we recommend you go back and have a listen. In today’s episode we’re going to be talking specifically about the relationship between neurodiversity and trauma.

E: Thank you for joining us today Amanda.

A: Hello, no, it’s really lovely to be back.

E: We’re very happy to have you back.

A: Oh yeah it’s great.

E: So to begin with for those who haven’t heard the last episode we did with you could, could we just recap on what your definition of trauma is?

A: We can yes, so trauma I guess, this is my, I suppose this is my definition, I would say that trauma is any difficult or painful experience where the person experiencing that is left feeling helpless, frightened, trapped or threatened in some way. So I think that’s quite a broad definition but yeah that is what I would say.

E: It would also be helpful to define what we mean by neurodiversity.

A: Yeah of course, I think it’s really confusing and I think it, I get confused by it myself really so.
Neurodiversity, you can’t really talk about neurodiversity without talking about neurodivergence, which I think we’re going to talk about as well, aren’t we?

E: But I guess the two get confused, don’t they? So I guess it’s good to just sort of explain the different words.

A: Yeah, and I guess there is, obviously there’s overlap and obviously, and some people do use them interchangeably and I think that’s okay, because I think generally we know what people know we are talking about roughly when we’re talking about that. But I suppose neurodiversity encompasses all brains, that’s what I think of when I think about neurodiversity. It’s the same as we would think about, it’s the whole gamut of the, the way that brains can be and are, the whole spectrum of human brains, I guess, is what we mean when we’re talking about neurodiversity. Does that make sense?

E: Yes, that does.

A: Yes, good.

E: So if someone said, “I am neurodivergent,” what would that mean?

A: So if somebody said I am neurodivergent, and I identify as neurodivergent, I have a diagnosis of ADHD and also threat syndrome. So when I say that, for example, what I mean is my brain is structured differently and therefore processes things differently than would be considered typical. ‘Cause we have the other phrase neurotypical as well. So I guess neurotypicality is how brains are typically structured. So neurodivergent and neurodivergence is where that diverges away from what’s typical.

E: Perfect. That was a very succinct explanation.

A: You think? Ah I am really pleased

E: Well done!

A: Thank God!

W: So it’s quite common, isn’t it, for people who are autistic, people who have ADHD, to identify as neurodivergent, it does not guarantee that they will, of course, but that is quite often the case as well, would you say?

A: It is. And actually, through, through looking at social media, I’ve heard quite recently as well, all kinds of people with all kinds of different conditions also now starting to talk about themselves as neurodivergent. So people, for example, with bipolar disorder or chronic depression, for example, would say I’m neurodivergent in the sense that it’s not just that I have this illness that my brain is just different to other people’s, you know, to what would be considered typical. And I think that’s totally valid.

E: Yeah. And I think especially if people might use that word, especially if they’re sort of don’t quite feel comfortable, don’t necessarily identify themselves as disabled, but do want to highlight that, yeah, there is sort of a, yeah, a divergency from what they expect other people to expect of sort of a neurotypical behaviour I guess.

A: Although I often wonder about neurotypicality and what that actually means and what that actually look like because I don’t know many people that are what I would consider you know typical but I also know that neurodivergent people do tend to be quite tribal so the people that we have in our lives tend to be quite similar to us. Although, and I am going a bit of a tangent here. There was some research recently that showed that neuro, brains that would be considered neurotypical, which makes sense really, it’s kind of what it says on the tin, are more like each other than neurodivergent brains are, which is really interesting if you think that, for example, autism and also ADHD as well, I’ve got these really kind of, almost like these narrow, finite buncher traits that would almost indicate that we’re kind of all the same but actually neurodiverse brains, neurodivergent people’s brains are more different from each other and much more unique in the way that they’re structured than neurotypical brains are.

E: Wow, that’s amazing.

A: I know, it’s very interesting.

W: That’s really interesting. If you can dig out that article or that research you saw, it would be great to put it in the show notes. I’m sure many of our listeners will be really interested in that.

A: I will have a look, definitely, I will see if I can find it.

W: So what do you see as the relationship between neurodiversity and trauma?

A: I guess it’s a relationship that, it’s an inseparable relationship. That’s what seems to be in the research. That’s my personal experience and my professional experience as well, as they are things that do seem to go hand in hand. It’s difficult to know where to start really, to even start unpicking it, so complicated. But some of the statistics, I guess, we’ll start there. ADHD, for example, it’s like a bi-directional relationship as well, ’cause ADHD is diagnosed twice as often in traumatised children, for example.

E: Wow.

A: Which is

E: That’s really significant.

A: It’s hugely significant, yeah, like twice as often. But also, the other way around is ADHD kids, and autistic kids are much more likely to experience, in fact it’s not even just children, scrap that’s not even just children, it’s all neurodivergent people particularly autistic and ADHD people are far more likely to experience trauma than their neurotypical counterparts are.

E: And when we say experience trauma, I think, correct me if I’m wrong in this, I think it’s important to clarify we mean being more susceptible to experiencing events as traumatic, rather than it being the case that being neurodivergent means you’re inherently more likely to have like trauma inflicted upon you.

A: It’s actually both.

E: Wow.

A: It is both. So if you think about school experiences for example, so neurodivergent children are more likely to be bullied because of differences in behaviour, they’re more likely to be socially isolated. They can be targets for bullying.

E: Yeah

A: Kids can tell when a child is ‘different’ in inverted commas, and that can leave them wide open to being picked on, called names, teased, that sort of thing. So there’s that side of it. Also people with, on the autistic spectrum for example, might have difficulties in interpreting behaviour and other people’s intentions which makes them more vulnerable to being exploited, abused, assaulted. It’s quite a shocking, statistic really. I can’t remember where I saw it but it’s something like three times as common for autistic women in particular to be sexually assaulted.

E: Gosh

A: Than neurotypical women which is dreadful but it’s yeah it’s part of that picture.

E: Does neurodivergency also mean being more susceptible to experiencing certain things as traumatic where someone neurotypical might not?

A: Yes definitely and here is where it gets kind of messy and complicated. Going back to the definitions in the ICD-11 and the DSM-5 where one requires that that experience be life threatening and the other one the ICD-11 doesn’t require it just requires it to be a threatening situation. So we know that neurodivergent people are more just more sensitive and their brains are more vulnerable to experiencing something as traumatic and again I know I keep using this as an example there are other examples but going back to childhood experiences for example ADHD children and autistic children are more likely to not cope in a school environment because of being in a noisy environment or being forced to interact with peers which could feel frightening or overwhelming and that can become a trauma. And it’s a bit of a double bind as well because what we know is that ADHD kids and autistic kids can be difficult for the, or can be experienced as difficult for the adults around them to manage. So if you have a child for example who is being forced to be in a situation that feels unbearable, say noisy, bright lights, lots of other people around, they are going to be prone to rages, meltdowns, shutdowns, needing to go away and do stimming or anything like that and if the adults around them are not adequately trained or have got difficulties of their own, not forgetting that you know ADHD kids, autistic kids are much, are likely to have, their parents are likely to have those conditions as well. That often that means that they are managed in a way that will involve being shouted at,
being punished, sometimes physically punished, which then leads to further trauma. So it’s a real, it is a real double bind, I think.

W: You wrote an article about the relationship between neurodiversity and trauma and,

A: Yes.

W: that again we can put the link to that article in the show notes, and in that article you ask whether trauma can cause neurodivergence.

A: Yes.

W: Can you expand a little bit more on that?

A: Early trauma or any kind of trauma is not going to cause kind of pervasive changes in, you know, people’s brain structure or traits that might manifest out of that. Certainly not single
events are going to do that. But what we know about early, early childhood trauma is that, that
particularly that condition, can be a consequence of early adverse experiences because we know that it has an impact, a real observable impact on brain development, particularly if a child is in an environment where trauma is ongoing. So if they are in a neglectful environment or an
abusive environment or are witnessing violence on a regular basis or something like that, what happens is, the threat systems in that developing brain get overdeveloped. So in particular the amygdala, which is a part of the brain that’s really implicated in your fight or flight response. That particular brain area becomes enlarged. So that overdevelopment comes at the expense of other areas of the brain developing, such as the executive functions, and it’s the executive functions that are often impaired or appear to be impaired in people that have ADHD. So that’s being able to organise yourself, being able to plan ahead, being able to manage your emotional responses. All of those executive functions are, are not, don’t get the same attention, if you like, in a child’s developing brain if all of the attention is going to, making the threat system big enough, I guess, to cope with ongoing trauma. Does that that makes sense?

W: Yeah, yeah, it does.

A: It does.Yeah.

E: Yeah.

A: Good. It’s quite hard, I think it’s quite hard to get your head around. So it’s basically, it’s like the system is trying so hard to keep that person alive and keep that person safe, that it forgets to deal with all the other stuff. So the other stuff just doesn’t develop properly.

W: Hmm.

A: And I think Gabor Maté talks about this quite extensively in his book. And I know he’s a bit of a controversial character, I think, in some ways. I know some people don’t like what he says at all, but he’s somebody that talks about that in his book, ‘Scattered Minds’ that ADHD is often a consequence of early adverse childhood experiences.

W: Yeah.

A: It makes sense to me.

W: Yeah, again, we can put a link to that book in the show notes as well.

A: It’s a great book, actually. When I first read that, I found it deeply comforting. I know not everybody reads it that way, but I certainly did.

W: Shall we go to a quick break?

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E: We’ve spoken a bit about this just now, but why do you think there is this relationship and how aware of are, I suppose, practitioners and people about this relationship?

A: I think one of the issues is that trauma frequently gets missed amongst people, you know, in divergent people. PTSD definitely gets missed, we’ve not talked much about PTSD, but we can do it if we’ve got time. If you look at the symptoms and the traits of autistic spectrum and the traits of ADHD and other conditions as well, and the symptoms of trauma, they quite often overlap and they can mask each other. So the best example I can think of is, if you imagine when a person is dissociating because they’ve been triggered, so they’ve kind of dropped out, they might have gone mute, they might be just not, not in the room sort of thing, that can look like being inattentive and being forgetful and being disorganised, which is, which are typical ADHD traits. So quite often when somebody is, might be in a prolonged dissociative state and if they’re in that state then they are going to forget things, they are going to be prone to accident and be clumsy and things like that. So it can look like, very much look like PTSD, so the underlying trauma might get missed. And that’s very common according to the, according to the research. So I guess one of the things that some of the researchers are suggesting is that any clinician working with somebody neurodivergence should routinely screen for trauma even if that is not what they are presenting with. Other questions should be asked, has anything happened to you that has been distressing or has left you feeling frightened, threatened, helpless so that we can kind of get to that underlying stuff because there is a lot that can be done.

W: And before we move on to the sort of more detail about the treatment options you mentioned about PTSD specifically, proposed traumatic stress disorder.

A: Yeah.

W: Yeah, could you expand on that a little as in the links between that and neurodivergence.

A: Yeah, definitely. So PTSD is like a clinically diagnosable, it’s clinically diagnosable and it’s different I guess from just trauma, can be kind of low-level trauma, it can be trauma with a small t, you know, I guess trauma is something that most people experience at some point in their life, it may not necessarily develop into post-traumatic stress disorder. Usually for the most part trauma will just resolve itself of its own accord so if you’ve been through a difficult experience that was upsetting in some way, it, you might have a few sleepless nights, you might be jumpy for a while but usually those things will just settle down of their own accord without any need for intervention. PTSD is when those things persist and is also when, we’ve also got things like flashbacks and reliving experiences, that’s like the key thing. And again going back to the diagnostic criteria, PTSD in the DSM is only diagnosed where the event was life-threatening. But as we’ve been talking about people that are autistic or have ADHD or any of those other kind of neurodivergent group of conditions can be traumatised quite easily by things that would be considered ordinary for a neurotypical person. And sensory things is a really… I’ve got a quote actually that I’d like to read to you that I really love that I found recently. I don’t know if you… Do you are you familiar with Temple Grandin?

E/W: No.

A: So she’s an academic, an American academic who identifies as autistic and she’s pretty amazing and she’s done a lot. A lot of her academic writing is actually about animal rights and environmental rights but she’s also written. She wrote an amazing memoir about being autistic and she were one of the first people I think, because she’s quite old now, I think she’s almost in her 80s so she were writing about this stuff long before it became as talked about as it is now. So she says
“my earliest most powerful memories are sensory, of things feeling chaotic, of being terrified of loud noises, of being terrified of a lot of foods, of not being listened to in those experiences and then being deemed to to be problematic for fighting for my right not to be traumatised.”
And I think that’s really, really a common experience. And I work with a lot of students who report really similar things of being traumatised just by being at school, just by being in a noisy area or a dog barking or a train going past or things like that can very easily traumatise an autistic person or an ADHD person and the key thing here is that those things can absolutely develop into PTSD. Regardless of it being life threatening or not, it can develop into that and people can have flashbacks and can have reliving experiences and can dissociate. It doesn’t mean it’s not PTSD just because the neurotypical opinion would be, well that weren’t a traumatic experience, that were just something that were a bit noisy. Those symptoms can develop and should be treated as PTSD and treated in the same way.

W: Can you expand a little bit more on what you said in your article about, for neurodivergent people one of the other big factors here is that those experiences that keep replaying in their minds have that sensory richness

A: Yeah

W: That neurotypical people may not have and to the same degree.

A: Yes and this is really the most interesting thing that I found when I were researching this article actually, that part of the reason why we think that those experiences can develop into PTSD is because of differences in the way that neurodivergent brains process memories and retrieve memories as well. So and it, it almost, the way that memory is stored almost paves the way for PTSD to develop because what we find is that sensor, it’s the sensory detail of the event that is remembered and stored. So often a neurodivergent person experiencing a trauma will not remember so much of the context or the kind of global picture of what happened. They will remember the detail. So they will remember what they could smell. They will remember what colour, let’s say it was an assault, they will remember the colour of the jumper. They will remember what the fabric felt like. They will remember what music was playing at the time on the radio, they will remember the weather at the time. And that’s what gets stored rather than that kind of global picture of what happened. So what that means is that they have this bank of really rich sensory-laden detail that produces intrusive memories that are highly susceptible to being triggered in the environment in here and now because, you now, red jumpers are everywhere and it’s quite often a sunny day and you know that song might be really popular at the moment and so it’s really, it means that those reliving experiences are much more likely to occur because of the way that they have stored the memory of the event, which I did not know until I started looking into this bit more carefully and it explains so much.

W: So what kind of treatment options can people think about?

A: So I guess the first line treatment, well I mean the way that PTSD would normally be treated and managed certainly in this part of the world would be through cognitive behavioural psychotherapy so that can be about, and there’s various different protocols that a clinician might use and I do talk about some of this actually in the book, but it would be CBT but what, what researchers are saying is that CBT protocols, things like, I don’t know, let me think of an example, so behavioural experiments for example, or exposure work for example, all of those protocols have been developed and designed largely for neurotypical populations. So there needs to be some flexibility and adjustments made for people that are not neurotypical. And I, and I don’t think that that is something that we have got our heads around yet about what that needs to look like. But what we do know is that, and I guess this is about the person seeking support as well, I would say it’s just really, really important to ask for what you need and be clear about what is not going to work for you. So an example that I often use is if you are a person who can’t cope with really strong smells for example, it is absolutely valid and okay to ask the clinician or anybody that’s treating you not to wear perfume on that day for example. Or it might be that you need the curtains or the blinds closed and not have the light on or it might be that you need more regular breaks to get out of the room, it might be that you need space to be able to stim or do other kind of self-regulating activities because the work of coping and dealing with, ith trauma for anybody, you know, never mind somebody that’s neurodivergent, it’s really hard work, it’s exhausting work and it’s… do you know what I mean? So I think it’s so important to ask for what is going to be helpful and also learn some skills of self-regulation. That work is really critical I would say and I think that, thats needs to be the first thing that anybody needs to do is learn how to emotionally regulate themselves.

E: I guess it does come back to some of the activities in your work or even just the principle of having a workbook because it is difficult especially in a situation where you’re with a therapist talking about trauma or you’re about to talk about the traumatic experience, but for people to kind of, people could kind of make a list before embarking on a treatment plan of the sorts of sensitivities that they know they have.

A: Definitely.

E: And you can kind of come back to it like, yeah, don’t think that will work. Because it’s important to also sort of feel empowered to be able to say kind of what you need and what is and isn’t working.

A: Definitely. And I think it’s really important to do that because I think that there is a risk for neurodivergent people have been doubly traumatised by being, you know, pushed into something too quickly or by, again, it’s kind of replicating what happens for a lot of people in childhood, being forced to endure situations that they cannot cope with, whether that’s about the physical environment or whether it’s about, yeah, like I said, the pace or things like that. So I think it’s really important to try and self advocate. And if that feels too hard, to get an actual advocate, and I think it’s okay to ask if somebody can come with you, especially if it’s a first appointment or you know if you feel like you cannot ask for what you need, you know try and enlist somebody that can help you have that conversation with a therapist. And I would also say as well, I know this is not always possible for everyone, but if you are in a position to be able to be selective about who you see I would absolutely encourage people to shop around for a therapist that feels like, like they’re working in a neurodivergent friendly way and have got that awareness. I think it’s okay to ask that question. Are you familiar with working with people on the spectrum? You know, What’s your experience? How can you make accommodations for me? I think it’s all right to ask those questions and I would encourage people to do that.

E: That’s brilliant advice. Thank you so much.

A: No, No problem.

W: Thank you so much, Amanda. Another really fascinating conversation, thank you so much. The Healing Workbook by Amanda Marples is out now, published by Summersdale, and available from all the usual bookstores.

E: Thank you so much everyone for listening, and please do tune in again in two weeks for another episode of Lively Minds the Mental Health Podcast.

W: Please note that this show does not constitute medical advice, and is not a replacement for seeking professional help. You can find signposting to support on our website, anyamedia.net/LivelyMinds

E: Make sure you keep up to date with our shows by subscribing wherever you get your podcasts

W: Take care and bye for now

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