Neurodiversity: What is It?

As well-known child and adolescent psychiatrist and psychoanalyst Dr. Susan Donner describes: "For autism, most people use autism spectrum disorder (ASD). I am now being more inclusive with neurodiversity since it includes patients with milder spectrum symptomatology but other elements that impact perception, processing, and mental representations that directly impact the clinical presentation and, even more importantly, have to be addressed for effective clinical intervention."

What does this mean? Many kids have some components of brain development that are different than that of the majority of kids. That is, some pathways of brain development "diverged" from normal development. Often these include brain areas that are involved in perception (what one notices and pays attention to), social assessment (e.g., how to "read" facial expressions on others), and figuring out reciprocal interaction behavior (e.g., engaging in a mutually enjoyable conversation and knowing when to stop).

Some kids easily get overloaded with too many stimuli and thus exhibit behaviors that are seen by others as "inappropriate." Such behaviors may become the focus of teasing, bullying, or social exclusion in school, all of which creates a stressful school environment. Some neurodivergent kids may have trouble recognizing and labeling their own emotions, so it may be difficult for them to recognize when they are anxious or depressed. Frustration may get acted out with disruptive behavior in school or at home.

Neurodiversity and Chronic Pain

In our pain clinic, we see many kids who have been evaluated by numerous sub-specialists and have had many, many tests performed on them without "answers" for their pain. Even when doctors label pains such as "irritable bowel syndrome,” “complex regional pain syndrome,” “fibromyalgia," the descriptions of and reasons for these pain types are often not clear or satisfying. Treatments provided may have worked in other kids, but not on your child. Why?

Most sub-specialists do not have the training, knowledge, or time to inquire about your child's sensory developmental history. Questions such as early and current sensitivities to fabrics, textures of foods, sounds, smells, and need for enough personal space (dislike of crowds) can be helpful in understanding a child's developmental neurobiology.

Asking questions like a history of bullying or exclusion in elementary and middle school, difficulty with early parental separation (e.g., kindergarten), the need to keep arguing a point until you give up – any combination of these characteristics can be components of a developmentally neurodiverse brain.

Kids who have difficulty with sensory filters may be labeled as having ADD or ADHD and have difficulty focusing in school because there are too many competing stimuli. They may start resisting school attendance or refocus their time at home on computer games at the expense of doing homework. The more behind they get in school, the more frustrated they become until their pain becomes the focus of their attention and the reason why they can't attend school.

There can be a chain reaction development of other symptoms, like inability to sleep at night, which is replaced by daytime sleeping. They may start limiting food intake because their stomach hurts until they become malnourished. They may isolate in their rooms, staying in bed all day and saying that they are just too tired to engage in family or peer activities, too fatigued to do any physical activity, and may begin to withdraw and appear depressed and irritable.

“Dandelions” and “Orchids”

As I have mentioned in a prior blog, Dr. Tom Boyce published a book that described 80% of kids as "dandelions" who can grow anywhere. He described the other 20% as "orchids." They need recognition that they are more sensitive, need special soil, light, watering, etc. "Orchid" kids may be difficult to parent, and many may be neurodiverse. However, as Dr. Boyce noted, with correct recognition and parenting, many of these "orchids" grow up to become adults who outshine most dandelions. Many doctors, scientists, writers, musicians, artists, etc., were "orchids" as kids and have "pieces of neurodiversity."

To best help your teen who has developed chronic pain, it is important to understand his/her/their development and figure out if your teen is a "dandelion" or "orchid" and learn how to parent them accordingly for optimal outcome. Remember that while some neurodiverse teens may be difficult to parent, they have the potential to become highly successful adults.

CHYP's inaugural webinar for January 2024 will be on the neurodiverse teen, especially those who might be in need of psychological help. Follow CHYP on social to learn the date of this important webinar so that you can identify if your child has some "orchid" characteristics, and how to best help your teen succeed and be happy.