Mental Health and Neurodevelopmental Disabilities
Mental Health and Neurodevelopmental Disabilities
Two of the most common concerns I deal with as a Family Nurse Practitioner are depression and anxiety. At some point, almost everyone seems to deal with symptoms of one or both of these mental health issues. Symptoms of fatigue, lack of interest in previously enjoyed activities, excessive sleepiness or insomnia, and feeling down, depressed or hopeless are all too common in my general practice. Even though I see this almost daily, I didn’t know that depression, anxiety, and other mental illnesses are even more common in people with neurodevelopmental disabilities.
Studies have shown that 3 in 10 people with ADHD have also been diagnosed with an anxiety disorder. Autistic people have more significant risks for anxiety, depression, eating disorders, mood disorder, and substance misuse disorder. These conditions have long been treated separately, which has led to ineffective treatment for many. As a healthcare provider, this made sense to me, but this just scratches the surface of the complexity of mental illness and mental illness in Neurodivergent patients.
Neurodivergence and Mental Health
There are many theories about why anxiety, depression, and other mental illnesses are more common in the Neurodivergent population. Some feel there is a genetic component. ADHD has been found to have a genetic link with a heritability of 71-90% and many of the genes linked to ADHD are also linked to dopamine transporter dysfunction. Anxiety and depression can be linked to dopamine dysfunction as well. Dopamine imbalance has been seen in Autism, Tourette’s syndrome and dyspraxia as well.
Another factor to consider is “Masking”, which is attempting to hide a disability, medical diagnosis, or mental health condition. A poll by JobSage revealed that 64% of people are afraid of showing their true selves when around their co-workers. The unfortunate stigma that continues to accompany mental health and neurodivergence makes it difficult for those with ADHD, Autism, or other Neurodivergent disabilities to be forthcoming about an accompanying mental health issue like anxiety. Fear of losing their job or being ostracized by co-workers leads to Masking, which causes increased anxiety and depression. Any time we’re not allowed to be who we genuinely are will bring stress and fear.
Timing of diagnosis can also play a role in the development of mental illness. For many Neurodivergent individuals, there have been long periods when they have been unable to meet expectations of social and academic environments due to a lack of appropriate support. If an individual was diagnosed later in life, they are unlikely to have received necessary accommodations to help them succeed. Late diagnosis can lead to low self-esteem as well as increased anxiety and depression. Imagine living your life knowing something is wrong, but not knowing what. Not knowing why you are struggling when everyone else seems to be doing fine. It’s no surprise that anxiety and depression would follow.
Mental Health Care
There is a mental health care crisis in the U.S. The statistics speak for themselves. In 2020, 21% of American adults experienced a mental illness. More than half of them did not receive professional care for their mental illness. Reluctance to come forward is due to stigma, lack of support, and lack of access to mental health care.
Lack of access to proper mental health care is even more of an issue for those who are neurodivergent. The techniques used to treat mental illness in Neurotypical patients do not work as well, if at all, for those who are Neurodivergent. Neurodivergent individuals often do not respond well to traditional Cognitive Behavioral Therapy. The conventional system of specialization in professional training creates a separation of treatment. For example, a psychiatrist well trained in treating anxiety and depression may have little to no experience working with a Neurodivergent patient. Therefore, they may treat a Neurodivergent patient the same way they would treat a Neurotypical patient, only to see little to no improvement in the patient.
In a Psychology Today blog post, Amanda Kirby, MBBS, MRCGP, Ph.D., explains that the current system of attempting to categorize and narrow diagnostic criteria has led to inadequate treatment and poor outcomes. She encourages moving away from specialization and towards an individualized approach to improve outcomes. As a general practice healthcare provider, I agree with her approach. A narrow vision approach can cause important patient information to be missed and limits the quality of care. While specialists are definitely important, it can be more beneficial to an individual to work with one provider that is knowledgeable about all aspects of their healthcare needs. While I don’t foresee the healthcare system changing quickly to a newer, more progressive model, I do hope that more mental health providers and primary care providers will develop a broader approach to taking care of their patients.
Where Do We Go From Here?
Until we can erase the stigmas surrounding both Neurodivergence and mental illness, we will continue to hit roadblocks in providing appropriate support for those who need it. Improving training and education in the workplace is one way that has allowed for some improvement in this area. Making mental health a common topic of discussion can help to minimize stigma and stereotyping. Diversity, equity, and inclusion (DEI) training is also becoming more common. Having proper DEI practices in place ensures better quality of support for all.
While anxiety and depression are more common in the Neurodivergent population, it is essential to note that Neurodivergence and mental illness are different. Being neurodivergent does not necessarily mean that person also has a mental health condition. Everyone’s brain is unique and we have to remember that people are not statistics.
More recently, there has been talk around the subject of developing “Wrap Around Care” or “Wrap Around Services.” This involves a team of professionals often including a physician, psychologist, and service coordinator working together to ensure all of a patient’s needs are met. This type of care would be so beneficial for so many families. Luckily, fundraising and continued research are in progress hoping to make this all-encompassing healthcare model more accessible to those who need it.
There is an urgent need for increased access to mental health care for everyone. Finding a mental health practitioner for my patients who need it is becoming increasingly difficult. Finding care for patients with multiple care needs is even more difficult. With continued research and funding through grants and other fundraising, we can close the gap and have better programs and quality care for everyone.
Resources
The current state of Mental Health in America in 2022. PlanStreet. (2022, April 8). Retrieved November 9, 2022, from https://www.planstreetinc.com/the-current-state-of-mental-health-in-america/
Hawthorne, L. (2022, September 15). The connection between neurodiversity and mental health in the Workplace. Uptimize. Retrieved November 8, 2022, from https://uptimize.com/mental-health-dei
Melore, C. (2022, May 11). Workplace identity crisis: 3 in 5 are hiding something from their employer. Study Finds. Retrieved November 9, 2022, from https://studyfinds.org/hiding-something-from-employer/
Mental health by the numbers. NAMI. (n.d.). Retrieved November 9, 2022, from https://www.nami.org/mhstats
Neurodiversity and mental health in the Workplace. LDT. (n.d.). Retrieved November 8, 2022, from https://www.learningdisabilitytoday.co.uk/neurodiversity-and-mental-health-in-the-workplace
Sussex Publishers. (n.d.). Is there a link between neurodiversity and mental health? Psychology Today. Retrieved November 9, 2022, from https://www.psychologytoday.com/us/blog/pathways-progress/202108/is-there-link-between-neurodiversity-and-mental-health
University of Surrey News. University of Surrey news | University of Surrey. (n.d.). Retrieved November 8, 2022, from https://www.surrey.ac.uk/news
Amy Burden
About the Author
Amy Burden is a Family Nurse Practitioner, Health Content Writer, and an ally to the neurodivergent community. She has a passion for helping people and enjoys volunteering her time to advocate for education, accessibility, and kindness.