Updates on Neurodiversity in Couples

Navigating relationships in which neurodiversity is present.

Reviewed by Jessica Schrader

Key points

• Neurodiversity is an umbrella term, serving to normalize previously marginalized experiences.
• Neurodiversity encompasses autistic-spectrum conditions, ADHD, sensory and learning differences, and more.
• Couples in which at least one individual is neurodiverse may face challenges and enjoy unique rewards.

The concept of neurodivergence has taken the internet by storm, serving as an important and much-needed movement to provide a safe space for people who have suffered from marginalization and misunderstanding. Harvard Health¹ defines neurodiversity as:

"[T]he idea that people experience and interact with the world around them in many different ways; there is no one 'right' way of thinking, learning, and behaving, and differences are not viewed as deficits."

As a non-diagnostic term, neurodiversity serves as an umbrella concept covering autistic-spectrum disorders, ADHD, sensory processing differences, learning disabilities, giftedness, Tourette's, and a host of other conditions, asserting that these differences in thinking, learning and emotion are part of the normal range of human experience. Up to 15% to 20% of people are thought to be neurodiverse, with higher numbers in STEM (science, technology, engineering and math) fields². As such, neurodivergence transcends diagnosis and has become a much-needed powerful political and cultural identity for advocacy and change.

Dr. Natasha Liu-Thwaites is a neurodiversity expert and author of the neurodiversity chapter in a recently co-edited volume on couples therapy³. I recently spoke with Dr. Liu-Thwaites.

GHB: How did you become interested in studying neurodiversity?

NLT: I trained as a psychiatrist, later specialising in Medical Psychotherapy, with my main modality of therapy being in cognitive behavioural therapy (CBT). However, throughout my training I took on some special interest sessions in neurodevelopmental conditions, being familiar with features in several people close to me. I initially started doing some CBT with people with attention deficit hyperactivity disorder (ADHD), and then expanded this to working with autistic people. As time went on, I found I really enjoyed working with this group of very individual people, often so interesting, and so likeable, and I didn't want to give it up! I continued with my special interest sessions, and also trained in the diagnostic assessment of both ADHD and autism, and I have continued working in this field, now being a consultant psychiatrist in the National Adult ADHD and Autism Service at the Maudsley Hospital. I am also accredited with the British Association of Behavioural and Cognitive Psychotherapies (BABCP) as a cognitive behavioural therapist.

GHB: How do you define neurodiversity? Is it a clinical definition? If not, what does it cover and do you think a new diagnostic category is needed?

NLT: This is an interesting question, as when I first started working in this field, the "neurodiversity" movement was in its earlier stages. Since my time as a consultant, this has grown to a great extent. I would currently see neurodiversity as an umbrella term, which I would use to describe the many different ways in which people's brains can work and process information, and which can encompass a wide range of neurodevelopmental and neurological differences. Therefore, rather than being a clinical definition as such, neurodiversity could include anything from dyslexia, dyscalculia and dyspraxia, to ADHD and autism. However, "neurodivergence" is also a term being used to encompass some of these ideas too, although it tends to be applied more to conditions such as ADHD and autism. More recently, people have been talking about having "AuDHD," when they have combined diagnoses of ADHD and autism. It seems that concepts and language around this are ever-changing, so I would say, "Watch this space!"

GHB: What are the main differences when working with couples in which one or more partners are neurodiverse?

NLT: In some ways, I don't think working with neurodiverse conditions in couple relationships is completely different to working with couples who are neurotypical. The same conflicts can arise in all couple relationships. However, due to the differences and difficulties with relating to others that neurodivergence can present, it makes sense that relationship difficulties are not uncommon. When it comes to relationships, there are a number of common themes and issues that can occur in autistic people and those with ADHD, but it is also important to consider the many strengths that neurodivergence can bring to relationships too.

GHB: What are some common issues which come up in neurodiverse couples?

NLT: Some ADHD difficulties that can affect relationships can include: organisation and executive function difficulties, distractibility and not listening, restlessness, being a "chatterbox," impulsive behaviours, and getting bored easily. Some autism difficulties that can affect relationships can include: difficulties with socialising and communication, intense special interests getting in the way, cognitive rigidity around things needing to be done in certain ways, having autistic "meltdowns," alexithymia and perceived empathy issues, and sensory differences. Self-esteem issues can be a problem if an individual has had difficult lifetime experiences related to their neurodivergence, such as being told they were lazy from childhood, or being rejected by others because they were perceived as being annoying or "weird" [GHB rates of bullying are higher among people on the autistic-spectrum³].

Some describe experiencing "rejection sensitive dysphoria," which can be characterised as having intense emotional experiences related to being inordinately sensitive to rejection. Although this has not been fully researched or understood, it may develop as a result of a combination of emotional dysregulation issues, and having a number of difficult life experiences, particularly around relationships with others. Individuals who experience this are more likely to experience stress at work and at home.

GHB: Given these considerations, how should we approach neurodiversity in couples work?

NLT: I would always advise that developing a shared formulation of any difficulties in the relationship is essential when approaching neurodivergence in couple relationships. One or both of the partners may need to engage in individual therapy before working on couple problems. Being familiar with neurodiverse conditions is helpful, and I would recommend liaising with specialists in neurodevelopmental conditions if needed. Psychoeducation about the condition(s) may need to be considered as part of the therapy itself, and a focus on neurodivergent strengths and positives can be really useful. Interventions such as communicating emotions, and activity scheduling, may look slightly different when adapted for those with autism and/or ADHD, due to specific difficulties, for example, issues with alexithymia, issues with making eye contact, and individuals finding certain activities challenging rather than enjoyable.

GHB: Do you have any advice for neurodiverse individuals who are dating and trying to meet people?

NLT: This is a very hard question! No, not really! Dating can probably be a minefield for everyone.