Do You Evaluate For Neurodiversity?

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In short, yes. And no.

Prior to 2022, no one had ever asked me that question. Terms like neurodivergent and neurodiversity have become increasingly popular in public conversations around individuality, differentness, disability, and ability over the last several years in particular. 

They have certainly been new to me and they have been used by potential clients and referral sources in a variety of ways. They most commonly refer to characteristics of Autism Spectrum Disorder (ASD), although individuals seeking ADHD diagnoses have used them with me as well. 

 

What does “neurodiversity” mean anyway?

Ironically, the concept of neurodivergence has origins in perspectives eschewing traditional psychotherapeutic labeling and assignment of causes and blame. 

I had already completed my doctoral and post-doctoral training when Australian sociologist Judith Singer first used the term neurodiversity in her honors thesis in 1988. It was further popularized by a 1998 article in the Atlantic (link below) that stated that “Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general.” Singer’s perspective was largely impacted by her own personal experiences with ASD (Asperger’s at the time). Singer also wrote that “Neurodiversity is really just a new word for a really old idea” – that we are all unique, with unique strengths, weaknesses, skills, perspectives, and experiences.

 

Neurodiversity and neuropsychology

I like that statement. And so, in that regard, Singer’s comment is highly consistent with my perspective as a neuropsychologist. My diagnostic evaluations start with referral questions and concerns: what does the referral source hope to learn from the evaluation? What are the functional impairments – challenges – for which problem-solving is needed? And, what are the innate strengths that we can nurture and highlight concomitantly?

In my work, I presume that each person and their brain is unique. Two people might demonstrate the same behaviors for very different reasons, just as two people exposed to the same environment or circumstances may react very differently. Textbook descriptions of neuropsychology highlight “brain-behavior relationships.” The Oxford Dictionary defines neuropsychology as “the study of the relationships between behavior, emotion, and cognition on the one hand, and brain function on the other.” Brains and people don’t exist in vacuums, either, and so evaluation of an individual’s context cross settings, and contextual demands, are also important considerations. 

 

The realities of healthcare systems

Yet, our current medical and mental health systems are label-based, ostensibly representing underlying causes. This labeling system presumes in many cases a deficit model, implying that presence of the diagnostic characteristics is “bad” vs. “differently abled.” Good diagnosticians take context and other factors into account, because weaknesses in some settings and under some circumstances can become assets in others. Does that mean there is a “true” deficit, warranting said labels? Good question!

I believe that our culture as a whole is quick to diagnose and label. Have a problem? Here’s a new diagnosis, and sometimes irrespective of cause. Oh, and take a pill! I believe that skyrocketing rates of diagnosis of ADHD are a great example of this trend. As a neuroscientist I believe strongly in neurobiology and medications when they are warranted, but not always or necessarily as the first option. And again, people can demonstrate the same behaviors for a variety of reasons, and it is my job to tease all of that apart. 

 

So, do I evaluate for neurodiversity?

Do I personally use neurodiversity and neurodivergent in my daily vernacular? No, not really. Do those concepts permeate and characterize all aspects of my work? Absolutely. 

I was the creative artist in a family of bankers and accountants – the square peg in the round hole of my family. I was fortunate to have a mom who recognized and nurtured the artist in me. That creative side, the outside-the-box thinking that was a poor fit for my family’s business are my biggest assets as a neuropsychologist. It is because every person, and every brain is different that I enjoy my work as much as I do. 

 

Some references… 

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