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Do Helping Professionals and Educationalists (including parents) understand the prevalence of undiagnosed ADHD, ASPERGERS, ASD and its link wit

h mental health issues?

In my work as a systemic psychotherapist and therapeutic supervisor in Dublin I have noticed a pattern regarding clients. It is my experience that at least one in every three/four adolescent and adult clients who present with severe anxiety, depression, chronic low self-esteem and addiction appear to be neuro different, are struggling and are unaware why they might find integrating with people, managing tasks or performing in certain academic subjects or tasks difficult if not impossible.

This difference can be confusing because it remains unnamed for most of their young and adult lives, this is a huge loss to them. Often this can lead to emotionally traumatic experiences in social, educational and work environments. Not understanding or naming their neuro-difference can leave them vulnerable to much struggle and eventually medical and mental health issues. When eventually named the difference can take the form of Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD), Asperger (high functioning autism) and Autism Spectrum Disorder (ASD). Because their presentation is so obvious and measurable those high on the spectrum are afforded an earlier diagnosis and supports whereas those lower on the spectrum can fall under the radar leaving the person to struggle alone and confused without support.

Many experts say that the origin of ADHD and ASD can be genetic or biological, others say it can come from trauma either before birth or after birth. This is not a debate I wish to get into in this article. But perhaps we can for the purposes of this article name the difference that the experts believe came from trauma as the ‘first trauma’ if it is not indeed genetic or biological. To support this article and the snippets within it – it might then be helpful to call the neuro-different person’s needs not being understood or met by our social system and our educational system as a ‘second trauma’. The purpose of this article is to bring attention to this ‘second trauma’. THIS IS SOMETHING WE CAN AND MUST DO SOMETHING ABOUT.

Neuro-different people are highly intelligent yet because of their difference they frequently find themselves on a traumatic life journey of being excluded, bullied, and in a social and educational system that does not understand or meet their needs. This experience has led to confusion, hurt, low trust, anger, panic, chronic low self-esteem, and an unjustifiable feeling of low capability for most of their lives. Which in turn has led to serious emotional pain. All too often to escape the pain, the individual can also turn to addiction to cope.

In my experience, I have found that a lack of diagnosis and a clear understanding of what they are struggling with has left many people alone and confused with their hyperactive, distracted or rigid brains that the individual can become so distressed that it has lead in very serious cases, to suicide plans or attempted suicide. One would wonder if it does have a part to play in our high suicide rate in Ireland.

It has been my experience that looking at the client simultaneously from both an emotional and a neurological perspective to be essential in understanding the person seeking support and in their understanding of themselves. This has afforded me the opportunity to identify the supports they need to move forward. I would like to share some of my client experience with you and the useful information I have gathered in the form of snippets which will address different issues which I have encountered on this important subject.

The purpose of writing these snippets are

  • Firstly to help those with ADHD, Aspergers, and ASD to consider the beauty of their brain and how it functions thereby perhaps giving themselves more understanding about how to manage their needs on a day to day basis thus helping them to achieve their potential.

  • Secondly, to help the client identify the interests, career and studies that suit their neurological make up thereby giving them hope and vision moving forward.

  • Thirdly to ask helping professionals (clinicians, therapists, social workers, teachers, educational system and parents etc.) to consider the possible presence of these creative differences in the person, so that their needs are met and that they no longer slip under the radar re support. If required, this will allow the client to be sent for a diagnosis without any unnecessary delay.

  • Finally so that consideration and provision is made for the ‘Neurological’ and ‘creative differences’ of this population by our schools, colleges and workplaces – in the hope that we might stop measuring peoples intelligence via points in our educational system and put a value on a skills based system where continuous assessment courses and trades are encouraged and considered an achievement. This would suit many neuro-different people and they would then rightly feel as successful as those who do well in the points system.

Perhaps everyone would then have a chance to succeed in their own unique way. It is our ignorance of it, not the neurological difference that is the problem. At the end of this article I have included some of the testimonials from clients I have worked with past and present.

In the following seven thought snippets on this subject I will discuss:

Snippet 1 Neuro-difference – Facts and personal observations about ADHD/ASD

ADHD/ ASD (Autism Spectrum Disorder) and their similarities

Autism spectrum disorder is a neurological developmental disorder that begins early in childhood and lasts throughout a person’s life. It affects how a person acts and interacts with others, communicates, learns, food and clothing sensitivities can also have an impact on some. For the purposes of this snippet I will describe some fact and traits of the Asperger and the ADHD (attention deficit hyperactivity disorder) neuro-diverse person to assist identification of this difference in ourselves or in others.

Symptoms often begin by ages 6 – 12.

ADHD affects 1 – 7% of people aged 18 and over.

67 % carry ADHD into adulthood. Symptoms of hyperactivity recede or tend to disappear with age and inner restlessness can take its place in adolescents and adults.

Girls can often hide their difference, if struggling they mimic therefore hiding their distress causing professional to not identify their real struggle.

Between 2 – 5 % of adults are estimated to have ADHD. Most remain untreated therefore in my experience leading to family issues, work issues, mental health issues for the person.

So, it is no surprise that these adults present for help in the form of therapy at some stage. Research indicates that in the UK approximately 1 million people are on the autism spectrum and present at some stage with anxiety and depression.

Asperger presentation is 5 times more common in males than in females. ADD and ASD can present similarly. It is only in recent years that psychiatrists have recognised that ASD and ADD/ADHD can co-occur together – half to one fifth of those diagnosed with ADHD have ASD. It is my experience that ADHD can mask the Asperger side of the client.

ADHD and Asperger traits that can be found in the neuro-different person

Asperger traits - female:

In my work I have found it a little more difficult to spot the neuro-different female who has ADHD or Asperger traits that is causing emotional or social problems for them. In his article ‘Misdiagnosis is All Too Common for Women with Autism’ Robert T Muller describes how women can camouflage their neuro-difference when with professionals or in social environments because they learn to mimic social skills. This can lead to emotional suffering and to misdiagnosis. He also refers to the fact that clinicians can tend to look for only for content such as interest in trains, dinosaurs and trucks and that girls repetitive behaviours are missed. He goes on to say that girls might only be diagnosed if there are intellectual difficulties or behavioural issues. He says that Australia is the first country to form new national guidelines to increase women with autism. Considerations of social camouflaging, anxiety, sensory overload and depression are being included in their new guidelines.

Further facts re: the Asperger female

  • 34-36 % suffer from mood disorders in the form of depression and anxiety – the underlying cause is not generally picked up by GPS or psychotherapists or treatment centres

  • Some studies show an overlap between autism and eating disorder

  • Dr Shana Nichols indicates this female can often be misdiagnosed with borderline personality disorders, avoidant personality disorder or schizoid personality disorder

  • Might imitate to hide social confusion – become co-dependent and look for external validation for sense of self to an unhealthy degree

  • Overwhelmed by external stimulus but hides it

  • Silent and isolates in the class room or social situations but different at home

  • Is exhausted hiding her difference and deciphering social rules

  • Anxious in social settings or when asked to perform without notice – yet sometimes comfortable when in a definable role ie acting or dancing

  • Likely to have passionate interests focus on specific interests play in solitude

  • Difficulties re: relationships don’t understand nuanced emotional and social exchanges

  • Some are verse to what is feminine/fashionable

  • Appear naïve immature and out of sync with trends

  • Likely to have been bullied and traumatised, vulnerable to narcissistic people

  • The Asperger female will often need support with parenting as her children get older.

  • When their children start to socialise they can become their primary focus. This behaviour can be damaging for the child. They can become critical and controlling of the child and develop narcissistic behaviours. They can also find it difficult to relate to the parents of the child’s friends.

Asperger traits - male

  • Concentrate too much and avoid over stimulation - Can be robotic in speech

  • Talk about self most of time, poor in the art of two-way conversation

  • Don’t know how to respond if someone talks to them

  • Intense on a single subject like football statistics etc.

  • Repeats self on subject of interest - Repetitive movements - Dislike change

  • Lack of social awareness -depends on routines - speech not relevant to the discussion

  • Lack of interest in socializing - Poor eye contact

  • Difficult making and keeping friends - misunderstand social cues and body language

  • Difficult to infer thoughts feelings or emotions to others

  • Failure to respect interpersonal boundaries

  • Loud rapid or slow tone - can be sensitive to odours, noise, fabrics and food

  • Angry and unreasonable - Tunnel vision

ADHD Traits - Male and Female

  • Lack focus and seek constant stimulation – Seek attention

  • Need routine yet hate routine - Have trouble waiting their turn

  • Talk too much blurt out interrupt say something irrelevant poor listeners

  • Forgetful – hate being managed yet need to be - Difficulty following through on tasks

  • Easily distracted yet focused if interested - Difficulty taking and giving traffic directions

  • Fidgeting and squirming - Adults can suddenly behave like children to get attention

  • Feeling trapped - Need choice and freedom(therefore dislike confinement i.e. school office)

  • Can get physically hurt a lot

  • Trouble controlling their emotions, can get angry easily therefore causing social problems

  • Trouble making and keeping friends, resulting in low self-esteem and depression

  • Can struggle in secondary school keeping up where workload is more intense

  • They struggle with relationships and may not fare well in the dating world

  • Poor planners - Poor time managers - Lose possessions - Difficulty being on time

  • They know outcome they are aiming for – but can break down steps to get there

  • Difficulty setting deadlines and completing work or getting along with co-workers

  • Difficulty accepting criticism calmly

  • Problems holding down intimate relationships - Emotional and reactive

  • Can appear co-dependent or narcissistic when inside they are lost fearful and are hurting

  • Poor listeners, statistics show that people with ADHD have a higher rate of divorce.

  • Likely to be mentally exhausted as focusing does not come naturally to them

  • They tend to go into jobs that put a structure on them but gives them a bit of space too

i.e.. Navy, Army, police force, trades,

  • Due to their creativity can be great entrepreneurs – this gives choice and freedom

  • Likely to have trouble driving -penalty points, road rage, accidents, court appearances or jail

  • They could be exposed to dangerous addiction behaviours: alcoholism, smoking, drug use, risky sexual choices, gambling, internet/social media addiction, workaholism, etc.

Note: You may find upon exploration paternal, maternal or sibling neurological patterns are similar

Working with a creative, self-employed 26-year-old ADHD client who presented with severe anxiety, frustration and disconnection from people. She felt people were unsafe. She felt very stuck in her life because her self-administration ability was poor. In the time we worked, she decided to change her medication to one that might suit her neurological make up, within three weeks her focus had improved to the point, ‘that she had earned in two days what had previously taken her one month to earn’ and she had started reconnecting – she also felt that understanding her brain had helped. After 6 weeks I asked her to score herself re: personal satisfaction compared with when she first came – she scored herself 2/10 for when she first came. When I asked what score she would give herself in this the 6th session she scored 8/10. I asked her to outline the factors that she felt made the difference, she outlined the following:

  1. Understanding my brain for the first time

  2. Working on the trauma re: imposition of school, having no choice and college norms

  3. Getting rid of the guilt - if I didn’t get something done I would just do it the next day

  4. Learning to value my artistic abilities and not put myself down because of my ‘difference’

  5. Putting a strict daily structure in place via time management and planning (because I now understand it’s not something my brain does naturally)

  6. She now sees her time as valuable and uses it wisely and efficiently.

  7. She doesn’t become frozen when she has a task to do, she just set a time for it and does it. (This freeze is something I have found in a number of ADHD clients)

Finally my client drew a picture of her brain – she said she previously felt trapped in the back of her brain and disassociated from the front of her brain and was watching the world go by. Now that her medication has been changed she feels connected to the front of her brain – everything feels less hazy and clearer. I found this description very interesting and similar to what others have described.

Neuro-difference is unique in a positive way, but not so if the person is struggling and their needs are not accommodated or they are not given support with learning social skills or self-administration skills. I wonder if our educational system and treatment centres take the statistics discussed in this snippet into account when devising curriculum or treatment plans. This must change if the neuro-different person’s needs are to be met and they are to achieve their full potential. People’s brains work differently, yet many are made to feel bad or shamed about their difference because they feel like failures in systems that do not provide for them.

Snippet 2 My experience of the presenting patterns of the ADHD/Asperger/ASD Person

In our initial sessions we establish how the client has been functioning from a neurological/self-administrative perspective while at the same time supporting them through the emotional trauma they have experienced throughout life. If undiagnosed ADHD, ADD, or Aspergers is suspected, depending on the age and the seriousness of the situation we discuss whether a visit to a specialist is necessary. Some young people might need it if they have suspected dyslexia or other presentations. To date, all those who have chosen to attend this service have been diagnosed with what was suspected and they and their families were relieved. Some will choose to go on medication, others do not. Either way, major positive change can happen for them.

Those who decide not to go for a formal diagnosis frequently say that they do not need a ‘piece of paper’ to tell them what they already now know deep down. They are just happy to have some clarity. Surprisingly, most people are not resistant to knowing how their brain functions and why it might make them feel ‘different’ in ways. In fact, in all cases I’ve encountered clients are relieved to finally have found a lost piece of the jigsaw particularly where this difference has caused problems for them socially or intellectually through how they learn, how they manage themselves in life and how they fitted in socially. They finally understand why they have had a struggle and what to do about it to move forward.

This difference can manifest in early years and in primary school. However, in my work I have found that by the age of 12/14 years, upon entry to secondary school; life starts to fall apart for the undiagnosed ADHD or Asperger Child. As the helpful structure provided by primary school and parents is no longer available to the same degree, the child cannot manage as they did before. They are now expected to put a structure in place for themselves. This causes serious problems for these children because they do not have the self-administration skills or for some the social skills required to function and these skills can deteriorate as they get older – they become unconsciously stressed and depressed.

Working recently with a bright 21 year old ADHD client today who was absolutely frozen with fear regarding the prospect of applying for his driving theory test – upon exploring this fear we uncovered bullying by a teacher who would call him derogatory names because of his focus issues. I have other similar stories experienced by many ‘different’ young people. One highly intelligent young man of 32 years who presented displaying some mild Asperger traits told me this week that most of his class in secondary school and many in the village stopped speaking to him and he didn’t know why. He became severely depressed and is now visibly traumatised. It is my experience that the Asperger different person is very vulnerable to bullying because their difference can be somewhat visible to others.

As the school years progress and the ADHD/Asperger child is expected to produce academic results, the adolescent deteriorates intellectually and emotionally. Their brain gets exhausted/burnt out trying to focus on subjects that don’t suit their brain. Or their brain that will not stay on the same station – it seems it’s like remote control on the television that someone is forever changing on them. To survive this difficulty they must find the tools that will support them. They get distracted and get caught up in their own interests. With the ADHD person when they are interested they can be very focused but when they are not you can forget about it. So parents and our educational system must find what these interests are.

I had the recent experience of talking to the mother of my intelligent 12-year-old ADD diagnosed nephew who is attending school in America. He told his principal last week that their maths curriculum ‘sucks’, instead of the principal hearing out his ideas – he was told not to criticise the school and given detention. Is this the correct way to meet his needs? I wonder if something similar is happening in schools in Ireland? If a child behaves outside the norm are they are in trouble? – I wonder what affect this could have on them and others like them? Perhaps confusion, anger, low self-esteem, disillusionment, loss of self and for many a high dropout rate.

The perfectionistic ADHD person who has used all their energy on focusing a brain that won’t stay focused will eventually become exhausted and burnt out. The child therefore loses interest becomes disheartened, upset, low in confidence, anxious, ashamed, impatient, bored, angry, disruptive and drawn to distractions. These highly intelligent young people end up with intellectual and emotional low self-esteem because they are measured and are measuring themselves against a curriculum that does not meet their neurological needs. They are then at risk of dropping out or of suffering from anxiety or depression.

The resulting low self-esteem they can experience causes susceptibility either to social withdrawal or to needing people’s approval and the child can become the class clown to fit in. One Adult ADHD 50 year old told me he would steal from his parents to buy sweets for the other school children to fit in, because he couldn’t focus he felt inadequate. Yet at a very young age this client had the intelligence, skill and ability to take motor cycles apart and put them back together. Another 43 year old ADHD client recently diagnosed told me he couldn’t go into a pub without buying drinks for everyone to fit in because of his feelings of shame about himself. He also shared he brought sweets into school too to fit in. He is very relieved to finally know what he has been struggling with all these years.

Statistics show that half the children and adolescents with ADHD experience social rejection by peers compared to 10-15% of children with no ADHD. So some will put mechanisms in place to avoid this from happening. Other self-protective mechanisms might come in the form of becoming defensive, bullying to protect themselves to avoid further feelings of vulnerability or to deflect from the fact they are not doing well academically. The child also can isolate completely and become a loner because they can’t make sense of social interactions. This is likely to be the Asperger child who finds it difficult to communicate or understand social cues. All behaviours come from a place of fear of further rejection or failure. Unfortunately, many of these fears and behaviours follow them into adulthood. People with these devastating experiences can eventually present to therapy for help. We clinicians, helping professionals need to understand what has happened and why.

Snippet 3 ADHD/ASD - Medication its role

I have found that it is helpful for the ADHD, Asperger and ASD person to understand their brain and how it works, clients are relieved to finally understand this. It encourages them to befriend the beauty of their individuality as that is their way forward. They do not always need medication. However, in serious cases, the emotional trauma of feeling socially alone for years or the difficulty of not being able to focus or communicate or understand social cues or blurting out inappropriately or not being able to handle academics and not understand and feeling like a failure can eventually bring about severe anxiety and depression. This presentation might require the support of medication in the form of suitable anti-depressants for some, or stimulants to help with focus for others.

In America, they see medication as a first line of action for those with ADHD or ADD. Ritalin is prescribed in many cases as it is said to increase performance of the young persons’ focus in 80% of cases. In the last few weeks a 43 year old adult client has presented emotionally and physically exhausted saying I cannot go on. He was yesterday diagnosed with ADHD after 40 years of struggling. He has been prescribed Adderall. My client is so grateful to finally understand his brain – he now feels hopeful for the first time in years, we are working on regaining ‘the lost self’ if he ever had it because it’s seems his family have similar presentation, which can often be the case.

It is my experience that many anti-depressants prescribed by the GP do not always suit because they may not understand that their patient may have undiagnosed ADHD, Asperger, or ASD. This is a loss to the person seeking help and in fact it has been my experience that the wrong anti-depressant can make the person feel worse.

Research indicates that medication/antidepressants that get the neurotransmitters bringing serotonin, dopamine and norepinephrine to the frontal lobes seems to work most effectively. Interestingly norepinephrine is also an ingredient in Strattera another non stimulant medication given to those with focus issues. Perhaps this is why this anti-depressant is a helpful match, if an anti-depressant is required. Research shows that people with ADHD have a low level of the neuro transmitter dopamine, a chemical released by nerve cells in the brain. This makes the ADHD person more chemically wired to seek out more dopamine perhaps this is why they engage in what a neuro-typical person might describe as risky behaviour. As John Ratey, Professor at Harvard Medical School; mentions, ‘Eating carbohydrates triggers a rush of dopamine in the brain. So, it’s recommended if you regulate your brain’s dopamine levels you might be able to regulate compulsive eating’. This begs the question whether this issue is being considered when people are being treated for food addiction in treatment centres. Could there be a requirement for dual diagnosis and does it take place? Also, it is possible that if there is an excessive need for people and people approval which gives a rush of dopamine might this put the ADHD person at risk of people addiction too?

Often by the time the ADHD/ASD client presents to therapy they are already suffering with trauma, general/social anxiety, depression, chronic low self-esteem, a general sense of low achievement, and fear of rejection due to having experienced unsafe relationships inside and outside the family because of a lack of understanding by others of their difference.

In many casesdue to the visibility of their ‘difference’ and their lack of confidence they are then vulnerable to bullies in the class, village, or their organisation leaving them feeling further alone and traumatised. To cope with this trauma the ADHD, ASD, Asperger person can seek addiction coping strategies from a very young age i.e. eating disorders, people pleasing/co-dependency, social media dependency, drugs, gambling, alcohol addictions to name but a few.

Snippet 4 ADHD/ASD - Addiction - Treatment

My career has led me down a variety of paths, one of which led me to facilitate some courses in Addiction Treatment Centres and to Addiction Counsellors attending my open courses. Frustration was openly expressed by addiction course leaders that they had found it difficult when they have restless, interruptive people in the group. These leaders had felt that it was possible they unknowingly had undiagnosed ADHD/ASD patients in the room. Often they don’t come with a dual diagnosis, so they are seen as disruptive. However, as we have seen, so many ADHD people suffer with addiction it is likely many of these people were dual diagnosis, but it hadn’t been identified. Perhaps we need to design programs that meet the needs of the ADHD/Asperger person and perhaps use treatment programmes as an opportunity to have them finally diagnosed. The most important thing is not to re-enact their childhood in school and groups and re-traumatise them when in treatment.

It is also my concern that the pleaser type ADHD/Asperger person might just mimic what is expected in treatment only to fail when they leave the programme (I sadly heard of one case two years ago where a very well behaved and pleasing patient in treatment took his life within three weeks of leaving treatment). Was he dual diagnosis? Was it possible he had people addiction (co-dependency) and it was not recognised?

There is also a risk that the energetic ADHD person who finds it hard to stay easy might become angry and reactive at being made sit in an environment that feels controlling and unsafe/unfree of choice, similar to that of school. This might cause them to yet again ‘drop out’ thus causing a feeling of failure. Even if they do stay in treatment are they at high risk of relapse eventually due to a lack of diagnosis of their ADHD or Aspergers?

A Swedish study confirmed that the risk for those who have ADHD and are in the below average IQ range increased the risk of addiction fourfold. Those with ADHD within above average IQ range increased the risk of addiction by eightfold. People with autism show signs of both impulsivity and compulsivity they act quickly without thinking. This leads to obsessive compulsive disorder and compulsive behaviour type addiction such as on line shopping, gaming, gambling, internet addiction.

Espen Arnevik’ - Norweigian psychologist found 18 studies that overlap autism and addiction. Therefore with such a high link between Addiction, ADHD and ASD is it not a lost opportunity to diagnose the undiagnosed ADHD, Asperger and ASD person and help them to understand its link with their addiction while in treatment?

Research shows that 25 - 40% of people in prison have ADHD – I wonder how many have gone through a treatment centre at some point? Do some people who have completed treatment need to be given a dual diagnosis and the support or the medication they have required all their life? Might this make their treatment in the centre become more helpful? But I wonder if some psychiatrists and caring professionals are not open to this possibility. While speaking to a psychiatrist some months ago I explained my theory and asked him if it makes sense. He mentioned that it does make sense, however he works from the medical model and will continue to.

Snippet 5

The role of Psychoeducation in recovery from ADHD/Asperger Social and Educational Trauma

It is vital that the neuro-different person works through the ‘trauma’ of not having been understood by society or the educational system. We as therapists must not miss what other professionals have missed all the traumatised person’s life. Last year a 40-year-old man presented desperately looking for help. He recently had a breakdown and was just out of a psychiatric hospital and was diagnosed with behavioural disorder. He was in the throes of addiction but from the moment we met I could see ADHD screaming at me. We discussed this possibility and he said this was the first time a person ever discussed this with him. He mentioned that he’d known ‘it' forever but never could put a name on ‘it’. He said after the session he went out and cried for an hour with relief, and then called his wife and father, who both agreed with the probability. I referred him for diagnosis with a psychiatrist specialising in this area and it was verified. He did require the relevant medication. When I last worked with him he had returned to the family home, given up alcohol and has been promoted in work. Understanding this allows compassion, understanding and the correct supports.

I have heard therapists say ‘I don’t work with addiction’. That is their prerogative (although I do wonder about this because I believe addiction comes into the room in one form or other with almost every client). However, it is our responsibility as therapists to identify the specialist help the client requires and to refer them on if we do not provide it. To the client I would say if you do not feel understood do not stay with the professional.

If the professional does decide to work with the client, they must help the client to understand their ‘neurological difference’ and how it has been impacting on their life and help them work through the trauma and effect of this. In my experience psychoeducation is especially needed when a client comes from a family of origin where parents or siblings also had ADHD, Aspergers or ASD. We need to help the client to understand how to set healthy boundaries. Coming from Asperger/ADHD family background these clients would not have learned healthy communication or conflict resolution skills. In many cases they are not aware that they have a right to choice or boundaries or how to identify their feelings and to communicate them. Those with Aspergers will need extra support with how to build relationships and understand the etiquette of social skills i.e. how to start and continue a conversation - to enable them to function in a ‘neuro-typical’ society. The helping professional must support the learning of these skills.

The ADHD person who struggles with poor self-administration skills with also need support with learning how to self-administrate, plan and manage time. They must learn that their diary can replace where their frontal lobe may not function like the neurotypical person. We must help them to identify their strengths and specialist skill areas so that they might choose a course or career that will play to their strengths. We must help them value their skills set and to see that they are part of the 2% who have solved problems where others couldn’t and that they have brought many great things to society.

However, it has been my experience that for this to be fully achieved it is essential that the therapist understands the neurological and emotional construction of the person that they are working with. I would also encourage with client’s agreement that systemic therapy be considered at some stage in the treatment particularly with people living in the family home. It gives an opportunity for the family to grow together particularly if the client is an adolescent or for a couple in a relationship. I remember a 15-year-old wise young client saying to me once ‘yes I would like my mum and Dad present because I want them to grow with me’.

In my experience the best treatment is to help the individual to understand how ADHD, ASPERGERS or ASD has affected their life and process the trauma. Then help them connect with their emotional and intellectual self and their environment. Research has proven that as the quality of the interaction and the understanding with their therapist improves the severity of their ADHD/ASD decreases. As mentioned in a previous snippet that is possible the therapist will find addictions present which the client has used to help them survive the emotional pain of feeling ‘different’.

Snippet 6 The Next Generation

Understanding our neuro-difference - benefits to your neuro-diverse child- their career direction

Understanding our neuro-difference increases our awareness and will help the next generation. I find my clients are very encouraged to know that their newfound awareness with help them understand their children, in particular that ‘different’ child in the family that they felt so frustrated with and didn’t know why. They will now know how to give them loving and practical social and educational support moving forward so that they can avoid the social, educational, and career trauma they experienced. These children will not have to endure the lonely struggle of pain and educational shame suffered by their parents and family members of past generations. If you do feel your child, adolescent or adult child requires diagnoses for emotional, social or educational or career purposes do choose a professional whose diagnosis will be recognised by the state so that the supports or exemptions are provided educationally for your child.

In the case of the mild Asperger neuro-different child they can require encouragement and skills to engage with the family. I have found systemic therapy essential here so the young person and their family can be supported to name and communicate their feelings. Having family members present in a therapy session allows them to name and articulate their feelings to maybe for the first time in their lives. Engaging in this way also allows them to practice communicating with others and prepares them and the family to engage differently inside and outside the family home. Generally this can help the person to become less anxious socially and to perform better academically.

Understanding your child with ADHD Traits - Career

I have found that in the case of the ADHD type personality their tendency to get impatient easily and their need to be active draws them unconsciously to subjects that give timely logical results that yield clear satisfying answers i.e. mathematics, physics, chemistry, geography, business studies etc. In my experience they tend to avoid foreign languages particularly Irish, though as mentioned earlier every presentation is different. Others are drawn to subjects that yield visible skills and results i.e. baking, woodworking, mechanics, technical graphics, engineering, knitting, butchering, dressmaking, financial trading etc. Parents must ensure their children’s needs are met and that they are offered subjects that suit them neurologically or they are at risk of losing interest focus , confidence and could drop out of school or college.

My experience is that as some ADHD person get older they tend to gravitate (or need) careers that provide them with the structure that they can’t provide for themselves i.e. army, police force, teaching, technical graphics, organisations with structure etc. Others reject a structure being imposed on them – and often elect to be self-employed because they need freedom, choice and their own space to be creative. The ADHD person is very creative and has vision can be entrepreneurial and talented at getting a business off the ground but can struggle with the discipline of managing themselves within the business, they can be reactive and shoot off in too many directions. It is essential that they are helped to understand how their brain works and use planning and time management systems diligently. Support must be provided to help them develop these vital skills so that they can achieve their full potential emotionally, socially and professionally.

Understanding your child with Asperger traits - Career

Due to the high retention ability and extreme focus of many people with Asperger traits, they can do well in our educational system. However some struggle because they cannot handle the stress or pressure of our educational system, parents must watch out for this. There are different types of Asperger presentations that must be supported and understood to prepare them for their future. Some will be visual thinkers while others will be non-visual or others drawn to repetition type tasks. These careers could include still photography, videographer, working vocationally with others who have Aspergers, animal trainer, (interestingly the neuro-diverse person with Asperger traits can often find it difficult to bond with people yet they can bond easily with animals), taking care of others pets, handicrafts i.e. making jewellery or pottery, painter or artist, acting (what they can’t express in words can be expressed in art).

Others careers that suit the high functioning Asperger person are accounting, actuary, engineering, computer animation, computer troubleshooting and repair, video game design, web page design, maths, statistics etc. However it is important they do not choose a pressurised job that depends on short term memory, they also need independence and low stress. Again this group often elect to work freelance so that they may work at their own convenience. It is helpful for our educational system and parents to be aware of individual needs when educating and when helping with career choice. Indeed it is vital for the individual to understand their needs too so that they can ensure their needs are met in throughout their adolescent and adult lives.

I would like to restate an important point I made earlier in this article, that experts are now realising that a large number of people have a mix of Aspergers and ADHD which in my experience is complimentary when understood. However all individuals needs and differences must be understood by parents and our educational system to enable them to meet their potential personally and professionally and most importantly to afford them mental health contentment.

Again as mentioned at the beginning of this article everyone would then have a chance to succeed in their own unique way. It is our ignorance of it, not the neurological difference that is the problem.

Snippet 7 Testimonial Samples (2019/2018)

Gusy 43 year old ADHD client (clinically diagnosed)

“These are my feelings and understanding on being advised of ADHD - I have long had difficulties with self-esteem and have always been my own worst critic but I feel much kinder to myself now that there is an explanation for the way I think, operate and feel. This makes me hopeful for the first time in so long. I feel like a weight has been lifted and that things can and will get easier. It has been a long frustrating journey but it all feels worth it now I have had my eyes opened to this condition. I only wish I had the opportunity to understand this a decade ago”.

Jate 20 year old ADHD/Asperger client (clinically diagnosed)

“Working with Margaret has helped me understand my condition and to not hate myself. I now know why I behave in a certain manner. It has helped to recognise patterns in myself and mitigate the difficulties that I am currently facing”.

Mother of Gracey 17 year old Dyslexia (booked with clinician for diagnosis)

“Since attending Margaret, Gracey seems happier to know that it’s not her fault that she can’t concentrate and stay focused. She has gained more confidence and this has been noticed by all the family”.

Ann-Marie, 52, ADHD client (clinically diagnosed)

I was diagnosed with ADHD at 51 years of age. Finally an explanation for the unexplained void conflicted feelings and behaviours I’ve experienced since childhood. Two years on I live the same life but in a much happier way. I’ve learned to understand how my brain works and how to manage the secondary life numbing symptoms ADHD presented for me, low self-esteem, the self-blame, depression and anxiety. I now find that I can cope with the life I so struggled to navigate in the past. I have developed a much happier healthier relationship with myself, which in return has enriched my relationship with my husband, three children and with life itself. I no longer just exist in life, I can now live it’.

Stephen, 56, ADHD Client

When I came to Margaret first I was lost, confused and depressed. I scored myself 1/10. I am able to cope so much better now that I had therapy that helped me understand my ADHD which I feel I have struggled with all my life. This lead to severe bullying inside and outside school. I left school at a young age. I would look at a photo of my-self of when I was younger and would see a failure. I hated myself. I can now accept myself because I now know it wasn’t my fault. I am now on medication and am able to live my life without feeling confused, overwhelmed and am able to deal with issues. My last check in score with was 9/10. I am now at the age of 56 going to college for the first time in my life.”

Dave, 65, Client

For more than 50 years I have tried to put a name on a collective set of behaviours that have affected my life and relationships. For example difficultly recalling a story I have just been told, say whatever first comes into my mind, poor focus with verbal detail yet meticulous with figures, pretend to listen attentively, but am distracted and bored with conversation, I get confused taking road directions, and with right and left directions, am a recovering alcoholic, sometimes suffer with eating disorders. I get obsessive with hobbies and activities. I am a nice person but some would say I am a people pleaser. I am working with Margaret to work on these behaviours and find it amazing and helpful that I only found out about ADHD since I met with her for counselling’.

Johnny, 26, Male, ADHD

Being diagnosed with ADHD at 26 was bittersweet, all those years I spend thinking the reason I wasn’t getting on in school was because I wasn’t smart enough – which wasn’t the case. I could have been capable of achieving academically I just had to take a different approach. This feeling of me not being smart enough led me to drop out of school and have negative effects on my mental health. The few tools that I have learned recently to help me with ADHD have had a great impact on my life. I just wish I had learned them sooner’.

Siobhan, 32, ADHD Client

Understanding my brain and the fact that I had ADHD has helped me understand my actions and behaviour. I guess the hurt of not understanding my self has made me act out has made me look for an escape that has not always been the right choice. Being able now to understand my brain and what triggers affect me it is something I can use going forward in life. Since I have changed my medication my attention to detail and focus has improved dramatically’.

Lorna - Partner of Neurodiverse Client

I have been mystified for years. My partner is so poor with soft skills, not listening, interrupting stumbling over words, poor focus, poor spelling, misinterprets messages, trouble with directions, yet could put his hand to any task, jigsaw crossword puzzle and is precise at DIY. Everything is making sense having had sessions with Margaret and participating on her course. I now understand my partner. I can cut him some slack on the basis that he may not be able to process information as a clear and critical thinker. Since the concept has been suggested by Margaret that he may have ADD I have come to understand many of the behavioural issues. I am really grateful to Margaret for highlighting this to me and wish that when he was in rehabilitation for alcoholism that this was addressed as part of the problem/diagnosis’.

Gillian, 32, ADHD Client (clinically diagnosed)

I always struggled with feeling stupid, misunderstood and lost in life – especially academically in school. This turned into anxiety and depression and brought me into counselling with Margaret. Here I discovered this might be ADD and went for specialist diagnosis and was diagnosed with ADHD. I have learned to understand my brain and manage myself differently using tools like planning, time management and meditation to slow my brain down. I have learned to make an effort to stay focused on the task in hand and to do one thing at a time. I now understand and have compassion for myself. My confidence has grown, and I no longer feel stupid’.

Leona, 30, ADD Client

When you don’t realise you have it, it can sabotage your life. You feel shame, stupid and dumbed down due to an inability to focus. I was so hard on myself and felt so confused and such a failure in school and in work. I am now on medication to help me with focus and I feel relieved, like my brain is unclogged. Understanding my brain helps me take control of it and not be so hard on myself. Also understanding my ADD helps me understand both my parents. I now believe my Mother also has ADD and my Father has ADHD. I now have less anger regarding my Mothers hyper-talking and her constant loud interruptions. I feel sad that they never got the opportunity to understand themselves in the way that I got to understand myself”’.

Mother of a 21 year old ADHD Male who attended the sessions with her son

Margaret without your help over the past few weeks I don’t know what I would have done. I feel professionals do not see the whole story. If young people who had ADHD understood it they would not feel worthless, stupid, panicked, leading to anxiety and horrible thoughts of self -harm’

Mother of a 17 year old ADHD/Asperger male who attended the sessions with the Father and Mother (clinically diagnosed)

Margaret with your help and guidance we now understand Tom’s behaviour and personality a lot better. Tom has an understanding of himself and is a lot more open and in tune with himself’.

Carol, Supervisee Re: her client

I found your insight helpful. It brought new awareness to me as a therapist. It helped in identifying that my client had ADHD which allowed me to alter how I worked with him. To slow the work down, to not get frustrated and to help him understand himself. I am more aware of the signs and indeed how prevalent and undiagnosed these conditions are’.

Eric, Adult client

Margaret helped me to open my eyes. Helped me to slow down my brain to a speed where I could interact with it. Helped me to see my true worth within myself. Helped me to lay the foundations of a new road for my life to take, this time empowered and directed by me – thank you’.

John, 45, Asperger /ADHD client (clinically diagnosed)

For years what I thought what held me back were personality traits and couldn’t be helped. Margaret helped me understand how my mind works which enabled me to confront my issues and take steps to progress. I would never have changed my views without being helped to see how my brain is wired up’.

Samantha Doyle, Supervisee re: client work

Through Margaret’s guidance I have gained a huge amount of knowledge that has helped me to identify clients that have anxiety and depression on the surface but have been suffering all their lives with undetected with ADHD , Asperger’s and other neurological issues. Which in turn led to the clients being officially diagnosed with such disorders and receive proper care, having Margaret as a supervisor has greatly helped me to grow as a therapist’.

Mother of 24 year old daughter - ADHD/Aspergers

Margaret I can’t thank you enough for your input. Since counselling and change in medication my daughter’s life has changed. She is focusing better and connecting with people more. She has learned to understand herself and her thoughts better and to accept her ‘difference’. She feels justified in giving herself what she needs when she’s around people. She has also become more connected, more caring and understanding of family members – in particular a family member who was also recently diagnosed with ADHD. She is able to support and share the tools that she has learned with him’.

Brein, 45yrs, ADHD/Asperger Client (clinically diagnosed)

I now understand that my brain works differently from others and why. Anything task based was not a problem but when it came to emotions i.e. being a parent, partner, or son I had to pretend to as that [emotional] side does not come naturally. I now understand why I have to put effort into working this side of my brain. I realise the way I was and the way I was is nothing to be ashamed about. I still get frustrated when people don’t see what I see and I have to learn to accept their difference more. Now I understand why’.

Linda, Supervisee re: ADHD, ASPERGERS, ASD

Through my training as a therapist and counsellor/psychotherapist I have had many supervisors. It wasn’t until I commenced supervision with Margaret I gained a wealth of knowledge around the impact undiagnosed and diagnosed ADHD Asperger and ASD had on clients when not addressed appropriately. Through supervision and research I found that it had a profound effect on feelings emotion and behaviour on the self and towards others. I found that exploring this with the client lead to self-acceptance and growth’.

Cathy, Supervisee Re: Client (clinically diagnosed)

Cathy received the following feedback from her 37 year old client who had been bullied in school and work and who she recently encouraged to go for diagnosis and who been diagnosed by a specialist with ADHD. This client then told his boss the diagnosis and they are now putting a structure in place to support this client. Cathy feels this young man has a very different view of himself now that he understands how his brain works. He accepts himself more. He has stopped drinking, he is walking the dog, is reflective and now understands at 37 why he was suicidal in the past.

Client: ‘I had always thought there was something wrong with me – you brought the pieces of the jigsaw together – thank you’.

Helpful support sites:

HADD Ireland

For more information about the subjects covered in this blog, contact Margaret Parkes - phone: 086 832 0422 email:

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