Neurodivergent Women: Autism, ADHD, Adjustments and Women's Counselling

Why do I have so many neurodivergent clients?

It occurred to me recently that around half of the people I work with are neurodivergent, generally autistic, have ADHD, or both.

I’ve been reflecting on why that might be.

It certainly isn't because every neurodivergent person knows that I am neurodivergent myself, or that I have under taken specific training and courses around neurodiversity. Many people simply come to me because they need support during a difficult time in their lives.

But I do think there is another reason.

I work as a perinatal counsellor and trauma therapist, as well as working as a doula and antenatal educator. I support people through pregnancy, birth, the postnatal period and parenthood, and I also work with women through perimenopause and menopause.

These are all significant transitions.

And for many neurodivergent people, significant transitions can be particularly difficult.

Neurodivergence isn't something that needs fixing

One of the things I most want neurodivergent people to know is this:

You are not broken.

Neurodivergence describes differences in the way a person's brain processes information, communication, sensory experiences, emotions and the world around them. Autism and ADHD are not personal failures, and needing things to be done differently doesn't mean that you are less capable.

But we do live in a world that is largely designed around neurotypical ways of communicating, processing information and functioning.

That can create disability.

If the environment, systems and people around us understood and accommodated different ways of thinking, communicating and processing the world, many of the barriers experienced by neurodivergent people could be reduced.

This is one reason I describe myself as neuro-affirming.

I'm not interested in teaching somebody how to become better at pretending to be neurotypical.

I'm interested in understanding what you need.

Sometimes that means therapy. Sometimes it means understanding your own neurodivergence for the first time. Sometimes it means learning to recognise the impact of years of masking. And sometimes it means helping you find the confidence to say, "Actually, this is what I need."

Why can life feel so much harder?

I hear versions of the same things from many of my clients:

"Why can't I cope with this?"

"Why does everyone else seem to manage?"

"Why am I so overwhelmed?"

"Why can't anyone seem to understand what I'm trying to say?"

"I've spent my whole life trying to fit in."

Living in a world that doesn't always accommodate you can be exhausting.

Constantly masking, adapting, second guessing yourself, managing sensory overwhelm, trying to understand unspoken social expectations and feeling that you have to behave in a particular way can take a considerable emotional toll.

For some people, there can also be a history of being misunderstood, bullied, dismissed, excluded or told that they are "too sensitive", "difficult" or simply not trying hard enough.

These experiences matter.

They can affect how we see ourselves, how safe we feel with other people and how we respond when life becomes difficult.

This is one reason I see so many neurodivergent clients in my work as a counsellor and trauma therapist.

It isn't that neurodivergent people are inherently mentally unwell.

It is that living in a world that isn't always designed with neurodivergent people in mind can create additional stress, barriers and difficult experiences, and those experiences can affect mental health.

Why can pregnancy, birth and menopause feel particularly difficult?

Major life transitions can magnify things that were already difficult.

Pregnancy, preparing for birth, becoming a parent, the postnatal period, pregnancy or baby loss, perimenopause and menopause can all involve enormous physical, emotional, hormonal and practical changes.

For some neurodivergent women and birthing people, this can feel like the volume has suddenly been turned up on everything.

Sensory sensitivities may change.

Executive functioning can feel harder.

Decision making can become more difficult.

Sleep disruption can make existing difficulties harder to manage.

There can be a huge amount of information to process, often from multiple healthcare professionals, sometimes while you're exhausted, anxious or physically uncomfortable.

And then there are the expectations.

You may be expected to make decisions quickly, communicate clearly when you are overwhelmed, tolerate unfamiliar environments and sensory experiences, advocate for yourself, remember lots of information and cope with constant change.

That is a lot for anybody.

For somebody who already has to use considerable energy to navigate a neurotypical world, it can be overwhelming.

There is also increasing research looking at the experience of autistic people and people with ADHD during hormonal transitions. Research into menopause and autism, for example, suggests that menopause symptoms can have significant effects on daily life and mental health, while healthcare barriers can make it harder to access appropriate support. (PubMed)

Research into ADHD and sex hormones is still developing, but there is evidence suggesting that hormonal changes may be associated with changes in ADHD symptoms. (PubMed)

This is an area where we still need much more research.

But we also need to listen to the women who are telling us what their experiences are.

You are allowed to ask for what you need

This is something I feel particularly strongly about.

You are allowed to ask for what you need.

You don't have to wait until you're completely overwhelmed.

You don't have to prove that you are struggling enough.

And asking for an adjustment isn't asking for special treatment.

It is asking for care to be provided in a way that allows you to participate in it.

The Equality Act 2010 places duties on service providers to make reasonable adjustments for disabled people where necessary to avoid substantial disadvantage. NHS England's Accessible Information Standard also requires relevant NHS organisations to consider people's communication and information needs. (NHS England)

NICE guidance also recognises the importance of adapting communication and making reasonable adjustments within maternity care. This can include things such as allowing additional time, supporting effective communication and using appropriate information formats. (NICE)

Reasonable adjustments will be different for different people.

They might include:

• having information provided in writing as well as verbally

• being given additional processing time before making a decision

• having information explained clearly and without unnecessary jargon

• being told what is going to happen before something happens

• reducing unnecessary noise, bright lights or other sensory triggers where possible

• having longer appointments where needed

• having a support person or advocate involved

• being given time to ask questions

• having important information repeated or summarised

• agreeing how healthcare professionals should communicate with you when you become overwhelmed

• having your communication preferences documented in your notes.

  
  

You can tell people what you need.

And you don't need to apologise for it.

Think beyond the birth plan

If you are pregnant and neurodivergent, I would encourage you to think about more than simply writing a birth plan.

You could consider creating a reasonable adjustments document alongside your birth preferences.

You might also find it helpful to create a trauma or triggers document, particularly if you have previous birth trauma, medical trauma, sexual trauma or other experiences that may affect how you feel during pregnancy, birth or examinations.

These documents could include things such as:

Communication

• How do I communicate when I'm calm?

• What happens to my communication when I'm overwhelmed?

• Do I need extra processing time?

• Is written information helpful?

• Do I need things explained one step at a time?

  
  

Sensory needs

• Are there particular sounds, lights, smells or types of touch that are difficult for me?

• Is there anything that can be done to reduce sensory overload?

  
  

Decision making

• Do I need information repeated?

• Do I need time to think before answering?

• Who can support me to process information?

  
  

Trauma

• Are there particular examinations, procedures, words or situations that may be triggering?

• What helps me feel more in control?

• What should healthcare professionals know if I become overwhelmed?

  
  

Support

• Who do I want involved?

• How can my birth partner, doula or other support person help me communicate?

  
  

I would recommend discussing these needs with your maternity team early and ensuring they are documented rather than simply arriving at the birth with a piece of paper that nobody has seen.

Your 36 week appointment can be a useful opportunity to review your birth preferences and make sure your maternity team understands your communication, sensory, trauma and reasonable adjustment needs.

NICE guidance already emphasises that women should be listened to, involved in decisions and supported to make informed choices during labour and birth. It also specifically recognises adapting communication for autistic people. (NICE)

I wish I'd known this when I gave birth

There is a personal reason why this matters so much to me.

When I had my own birth, I didn't know that I was neurodivergent.

I didn't understand what was happening to me when I became overwhelmed and lost the ability to communicate in full sentences.

I didn't understand my need for additional processing time.

And I didn't know that I could ask for reasonable adjustments.

Looking back, there were decisions I made during pregnancy, labour and birth that I might have approached differently if I had understood how my brain was responding to the situation and had been given more time, information and support.

I couldn't advocate for needs that I didn't understand myself.

That experience has stayed with me.

Because now, when I work with neurodivergent clients, I understand just how important it can be to plan for the possibility that communication may become harder when somebody is frightened, overwhelmed, exhausted or in pain.

Sometimes the person who normally communicates perfectly well may suddenly find that the words just aren't there.

That doesn't mean they don't understand.

It doesn't mean they don't have capacity.

And it doesn't mean that their wishes don't matter.

It may mean that they need a different way of communicating in that moment.

This is where my different areas of work come together

I think this is one of the reasons I have so many neurodivergent clients.

I'm not only a counsellor.

I'm a perinatal counsellor and trauma therapist, but I'm also a doula, antenatal educator, birth rights activist, mindfulness teacher, pregnancy and postnatal yoga teacher, trauma yoga teacher and breathwork practitioner.

These different areas of my work overlap.

For one client, counselling might involve talking therapy.

For another, we might spend time understanding neurodivergence and what it has meant to spend years masking.

Another person might need psychoeducation, practical coping strategies and help understanding why pregnancy or the postnatal period has become so overwhelming.

Someone going through perimenopause or menopause may be processing a late diagnosis and looking back over their life with a completely different understanding of themselves.

And for somebody with previous trauma, we may need to work gently with what has happened to them and how those experiences continue to affect them now.

There isn't one correct way to do therapy.

You may benefit from a mixture of all of the above, and even have some yoga tips thrown in, some coaching, some birth prep and some relaxation scripts could be sent your way.

I tailor my sessions to the person sitting in front of me.

That might mean online sessions, face-to-face sessions, walk-and-talk therapy, or a mixture depending on what works for you.

You don't need to become better at coping with an unsuitable world

Sometimes the answer isn't that you need to try harder.

Sometimes you need more support.

Sometimes you need information.

Sometimes you need an adjustment.

Sometimes you need someone to help you understand why something that seems straightforward to everyone else feels completely overwhelming to you.

And sometimes you need therapy to work through what has happened to you because of years of masking, misunderstanding, trauma or feeling that you weren't allowed to be yourself.

I want neurodivergent people to know that they deserve to have their needs heard and understood.

The goal isn't to teach you how to fit more successfully into a neurotypical world.

Sometimes the work is about understanding yourself, finding ways to work with your brain rather than against it, and becoming more confident about asking the people and systems around you to adapt too. I work a lot with confidence and self-advocacy, particularly with pregnant people, heading into the maternity system.

That is all particularly important during pregnancy, birth, the postnatal period, perimenopause and menopause, times when life can already feel like a lot.

If you recognise yourself in any of this, you don't have to work it all out on your own.

I offer a free 20 minute discovery call for people who are considering counselling or would like to find out whether working together might be a good fit.

You can explore the counselling side of my work, as well as my pregnancy and birth services, through The Essex Birth Company.

I'd be very happy to talk things through with you.

Common Questions

Why do autistic and ADHD women sometimes struggle more during pregnancy or menopause?

Hormonal, physical, emotional and environmental changes can increase the demands already being placed on a neurodivergent person's nervous system and coping strategies. Research into autism and menopause suggests that some autistic people experience significant difficulties during the menopausal transition, including impacts on mental health and daily functioning. (PubMed)

Can I ask for reasonable adjustments during pregnancy and maternity care?

Yes. Disabled people (that includes neurodivergent people) have legal protections around reasonable adjustments under the Equality Act 2010 in Great Britain, and NHS guidance recognises the need to adapt information and communication to people's individual needs. What is reasonable will depend on the individual and the service involved. (NHS England)

What reasonable adjustments might help an autistic or ADHD person during maternity care?

This depends on the individual, but could include additional processing time, clearer written information, reduced sensory demands, longer appointments, communication preferences being documented, and support with understanding and making decisions. NICE specifically recommends adapting communication where necessary in maternity care. (NICE)

If you’re reading this and would like a free copy of my triggers and reasonable adjustments document please send me an email. I will send you a copy with no obligation to book anything, kirstie@theessexbirth.com

Could I be neurodivergent if I've only started struggling during perimenopause?

It is possible for difficulties associated with autism or ADHD to become much more noticeable during periods of significant change, including hormonal transitions. This doesn't mean that everyone who struggles during perimenopause is neurodivergent, but for some women the changes can make previously successful coping strategies much harder to maintain. (PubMed)

Do I need a diagnosis before asking for support?

Not at all. You can tell healthcare professionals about the difficulties you experience and ask what support or adjustments may be possible. If you're concerned that you may be neurodivergent, that can also be something you explore with an appropriately qualified professional if you choose to.

A final thought

If you have spent years believing that you are too sensitive, too emotional, too disorganised, too difficult or simply not coping as well as everyone else, I hope you can pause before accepting that story as fact.

Perhaps you don't need to become better at being somebody else.

Perhaps you need to understand yourself better and to have the people and systems around you understand you too.