Neurodiversity celebration week

by Rosi Sexton
We're supporting Neurodiversity Celebration Week. March 18-24 2024

As this week is neurodiversity celebration week, I wanted to write a blog about what neurodiversity is, and how this affects what we do in our clinic.

Simply put, “neurodiversity” refers to the wide range of different ways people experience and interact with the world around them. We say that someone is “neurodivergent” if their brain works in a way that’s different from the majority. This is often used to refer to conditions such as autism, ADHD, dyslexia, dyspraxia and certain mental health conditions which may cause people to have challenges in certain aspects of their day to day life. These challenges can vary hugely from one person to another.

One of the wonderful things about the neurodiversity paradigm is that it doesn’t just apply to particular conditions or diagnoses. Lots of our patients will identify with one or more of the factors we’ve highlighted below, and by customising each person’s treatment to take into account those individual differences we can get the best results for everyone, whether they identify as neurodivergent or not. There are lots of different approaches to treatment that will work; the important question is which of those is best suited to the person in front of me. This is the essence of patient centred care.

I’ve talked before about my own experience of having a “limited edition” brain. That’s influenced how I work as an osteopath. I’m really proud to be able to say that our clinic has a large number of neurodivergent patients. It’s important to me that we can create a space that feels safe and accepting of differences, especially given the difficult experiences many neurodivergent people have had with medical care in general.

In this blog I want to talk about some of the ways that neurodivergence can affect treatment, and the kinds of adjustments that we make.

Differences in sensory perception

One of the first differences we come across is how people actually perceive the world around them. We all have different levels of sensitivity to certain sensory stimuli, and for someone who is particularly sensitive it may often feel as though they are being bombarded by input. The world can be too noisy, too bright, too smelly, too hot or cold… in a way that can become quite overwhelming and make it impossible to relax.

When someone is already a bit nervous about going for treatment, this barrage of sensory input can be an additional barrier. While every good osteopath will try to create a treatment environment that they feel is relaxing, the reality is that what is relaxing to you may be different from what is relaxing to me. From the temperature to the lighting, to the smells and background sounds there may be specific things that you prefer and others that really bother you. I’m always more than happy to have a chat about how we can adjust things to suit you better!

Differences in touch and pain sensitivity

Touch and pain are particular kinds of sensory input, but since they’re such a big factor in osteopathic treatment they deserve their own mention. There’s sometimes a belief that someone’s pain tolerance is down to “toughness” or mental resilience, but the reality is that the way a particular stimulus is experienced can vary massively from one person to another, and at different times and in different contexts. What is excruciatingly painful to one person may not even register for someone else.

Different kinds of touch also affect people differently. Some of our patients love deep massage for example; others find this can make them feel quite unwell. I have patients who prefer gentle touch, and even one or two who don’t like being touched at all. One of the wonderful things about osteopathy is that we have such a wide range of different treatment techniques and strategies that we can use, so we can almost always find something that works well for each individual.

Differences in communication

Pain is a tricky thing to talk about, since our experience of it varies so much from one person to another. Finding the words to describe your symptoms isn’t always easy. Sometimes healthcare professionals rely on patients to describe things in the “correct” way so as to fit the criteria for a particular diagnosis. For neurodivergent people there’s often the fear that if you don’t get it right then your concerns may be dismissed or belittled (sadly, this is an experience many of us have had). To make matters worse, neurodivergent folk who are in pain don’t always look or behave in the same way as neurotypical people, adding to the likelihood that we might be perceived as “overreacting”.

When someone’s having a hard time explaining how they feel, I always reassure them that this isn’t unusual. I quite often hear things like “I don’t know how to explain this, but my shoulder just doesn’t feel right”.

By treating it as something that we need to explore together, instead of expecting the patient to be able to clearly articulate what they’re experiencing as soon as they walk in, it can help to take the pressure off. Sometimes rephrasing my questions in a different way, or giving some suggested descriptions can help. At other times it’s useful to compare how the pain feels in different positions or with different movements. I tell people that it’s ok to take their time if they need to figure out how to answer, or to say “I don’t know” if they aren’t sure. Most of all, I make sure I allow plenty of time to listen.

Differences in movement, and your relationship to physical activity and exercise

The patients I see have a wide range of different experiences with exercise and movement. Some find coordination particularly challenging (those with a diagnosis of dyspraxia, for example), and may find it hard to do particular movements. Some don’t like exercise, perhaps because of sensory challenges or bad experiences they might have had with it in the past. Others have a particular sport or physical activity that forms an important part of their routine, and they find not being able to do their normal activities a real struggle.

This is why I never use standardised one-size-fits-all exercise and rehabilitation plans. I always start by asking the person to tell me what activities they enjoy doing and what they want to be able to do, and we work from there. During the treatment we might try out certain exercises, and I’ll adjust them to suit the patient. Sometimes I’ll need to change how I explain an exercise, use different cues, or to break it down into simpler parts. It’s important that we allow plenty of time and don’t try to rush through it. I also make sure that the advice I’m giving is appropriate for what the person wants to be able to do.

Differences in attention, organisation and daily routines

A treatment plan has to fit into a person’s life. This is particularly true for my neurodivergent patients many of whom find it harder to change their habits and routines, or who might need to think more about how to set up and structure those changes.

When I was starting out as an osteopath, I’d often give people advice and exercises and then when they came back for their next appointment would find that they hadn’t got round to doing them. Too often health professionals in this situation tend to blame the patient, and to label them as “non-compliant” or criticise them for not being motivated or organised enough. When I thought about it a bit more I realised that there were often hidden barriers getting in the way.

Nowadays, I talk to people about what they normally do at work, at home, and any hobbies they have. We’ll think about what kinds of routines and habits work well for them and what doesn’t, and what they might be able to adjust. Some people prefer very fixed routines and any changes can prove tricky; other people struggle with organisation and fitting one more thing into an already overflowing brain can seem like too much. Some struggle to remember how the exercises once they get out of the clinic, and others just forget to do them. Some people want a list of very specific instructions; other people do best if we focus on just one or two ideas that are most important. By recognising that even small changes can sometimes be challenging, we’re much more likely to come up with a plan that works.

Differences in anxiety

For me, this last one is perhaps the most significant. There’s often a lot of anxiety that goes along with having a neurodivergent brain, particularly when it comes to healthcare. There’s the anxiety about our health and our symptoms, the anxiety of having to communicate that to someone, the prospect of not being understood or having our pain dismissed, the worry of having to deal with an unfamiliar environment with unpredictable sensory stimuli, and the sinking feeling of being judged for finding things difficult that other people can do easily.

This is not a complete list. There’s more to neurodiversity than I can fit in a single blog, and I’m sure that there are things that, even with the best of intentions, I sometimes miss. If there’s anything I haven’t covered here, let me know in the comments – and if there are adjustments that would make a difference for you or a family member, please get in touch to discuss how we can accommodate these!

One of the reasons why I do this job is because it allows me the opportunity to do things differently. I hope that our clinic is an environment where people feel they can be themselves.