MENTAL HEALTH MATTERS: Delving further into neurodivergence and mental well-being

In my last column, I shared a general overview of neurodivergence, sensory processing disorders and mental health. Today, I want to look at how these conditions can lead to the classification of a disability, as well as what are considered best treatment practices in each case.

A tiny review of the first installment!  There are differences between conditions that we come wired for during gestation and those that develop later. Some of those conditions include autism, ADHD, misophonia and chromesthesia.  Some of them are seen as on the continuum of ‘typical” brain activity, and others are seen as an aberration, or a condition that one develops after all that wiring has taken place. Regarding the question of qualifying as a disability, the short and unsatisfying answer is…it depends! I will not leave you hanging with that, so here goes with the more detailed answers.

Understanding disability services

To understand how a condition becomes a disability, here’s just a quick review of the Americans with Disabilities Act of 1990. George H.W. Bush was president, and this act was an historic “first” in American history and in the world. The ADA was the first comprehensive civil rights declaration for people with disabilities and was modeled after the Civil Rights Act of 1964.

Like other civil rights movements, the original ADA provided the benefit of legal protections. There are five major pillars of the original act. The first pillar prohibited employer discrimination in hiring and required employers to provide reasonable accommodations for workers who qualified. Second, it demanded that all state and local public programs be fully accessible. For instance, public schools, county courthouses and public transit, to name just a few, were mandated to be fully accessible.

The third pillar involved required public accommodation for private businesses such as restaurants, hotels and stores. It required those businesses to remove any architectural barriers to provide access, such as wheelchair ramps and turnstiles big enough for assistive technology to fit through or alternative access points for those who qualified.  The fourth pillar involved telecommunications. Particularly designed for those with speech and hearing impairments, it required that there be nationwide 24/7 relay services made available. Finally, the fifth pillar included what was referred to as “miscellaneous” provisions. This included connections between the ADA and other laws that explicitly protect individuals from retaliation for exercising their rights.

Mental health conditions like major depression, schizophrenia, bipolar depression and severe post-traumatic stress disorder are covered under the ADA as well. They qualify as disabilities because at their worst, they make it very hard if not impossible to maintain a job, go to school or keep personal relationships. These are also medical conditions that can shorten a person’s life. Research tells us that conditions such as bipolar disorder or schizophrenia can shorten a person’s lifespan by 10-20 years. These illnesses also carry a high risk of self-harm or suicide if left untreated.  Take note that the ADA Act provided protections of rights. It did not provide funds or resources for those protections.

Neurodivergence and sensory processing conditions

While I covered a few sensory processing disorders in my last column, I want to be clear that the field of study and treatment is far more sophisticated and nuanced than my mention of it indicated. Those details deserve their own column.  As a standalone condition, misophonia is not explicitly recognized as a disabling disorder under the ADA, but it often occurs alongside conditions such as ADHD.  In that regard, those who live with significant sensory processing disorders may still qualify for legal protections. As mentioned above, this too rests on meeting the three criteria to qualify as a protected disability.

Just like the conditions mentioned so far, the ADA does protect conditions such as autism, ADHD and dyslexia, as long as they meet the same three criteria I’ve mentioned so far. The condition must substantially limit a person’s major life activities such as working, learning and communicating. Several years after the ADA was enacted, it was expanded to include conditions that are episodic in nature such as cancer and epilepsy, where a condition can go into remission.

Treatments and providers of care

Let’s look at the world of treatment for conditions of neurodivergence and sensory processing! Because these conditions cannot be treated to cure, we focus on processes of adjustment and acceptance. Treatment focuses on personalized support, skill-building and emotional safety. These can include neurodiversity-affirming therapies that work on building psychological flexibility and self-acceptance. You may hear terms such as “acceptance and commitment therapy” and “cognitive behavioral therapy.”

The goal with these approaches is to help the client work on accepting and embracing the condition itself rather than masking it in order to fit in. Masking takes an enormous amount of energy.  We do much better to love who we are rather than change ourselves for every context we find ourselves in.

Who provides the treatment these conditions require? Mental health providers such as licensed professional counselors, clinical social workers and psychologists are potential providers. Any one of these needs to be licensed by the state to be considered a provider. It is always a good idea to read up on individual practitioners to see who identifies these conditions as within their scope of practice. You can often find out by looking at their practice websites. Psychology Today has a site where you can search for a qualified provider in your area. The proof will be in the experience. Your criteria should include feeling seen, heard and understood by whichever practitioner you choose to interview. And yes, it is always a good idea to “interview” any practitioner before we commit to working with them.

Occupational and speech therapy can be very helpful as well. These practitioners will help you to navigate sensory processing differences, daily motor tasks and authentic communication needs. You will want to look for practitioners who are licensed as occupational therapists and/or speech therapists.  

Medication can be a useful tool alongside behavioral treatment approaches. Best practices indicate that this tool be used in conjunction with other therapies. It can be helpful for conditions such as ADHD and can help regulate emotions, support focus and improve daily functioning.

Finally, family and parent training can help equip caregivers with specific strategies. The goal here is to help the caregiver to build and create environments at home and school that create accommodations for those who carry these diagnoses. As with the other treatment approaches, these accommodations are provided by a range of professionals, specialized organizations and community programs. Look for clinical practitioners such as licensed professional counselors, clinical social workers and psychologists. It will again depend on the specialization of the practitioner.

Treatment of mental health conditions

So how does mental health intersect with disabilities?  What are considered best-practice treatments for these conditions?  Let’s start with the question of disability.  To be considered a legal disability, it must cause a significant, ongoing limitation in a person's ability to perform major life activities or participate in everyday life.

Mental health conditions can be lifelong, short-term or episodic. There are some folks who experience a depressive episode, are able to benefit from the appropriate treatment and never experience another episode again. Others have lifelong struggles with mental health and require ongoing care of some kind. Mental health care can be found at various levels of intensity and duration. Therapies are offered through outpatient, partial day and inpatient programs, determined by the type and severity of specific symptoms and needs of the client.

Treatment for mental health conditions usually involves a combination of psychotherapy, medication and supportive services tailored to the specific condition. What is psychotherapy? Provided by a trained professional, it helps you explore your thoughts, feelings and behaviors in order to build coping skills. Common treatment approaches include cognitive behavioral therapy, or CBT, and dialectical behavioral therapy, or DBT. These approaches give us the tools by working on how we think about things and the feelings and behaviors those thoughts lead to.

Who provides these treatments? We want to look for licensed professional counselors, clinical social workers and psychologists who promote themselves as specifically treating mental health conditions. If their promotional materials such as websites or community outreach literature mention treatment for mental health conditions, you can put them on your list of people to interview!

Medication management is a very helpful counterpart to psychotherapies. Not everyone who experiences a mental health condition needs or wants to use medication. However, research on best practices indicates the combination of the two leads to the most significant improvements. Medication management is provided by licensed medical doctors. Family practitioners often fill this role, largely because we have a significant shortage of psychiatrists in our country. To be fair, a good general practitioner who listens to you and with whom you feel comfortable can provide care that far outweighs that of a psychiatrist you do not have a good connection with.

Where one is available, a psychiatrist can be most helpful because mental health is their specialized area of practice. Just like going to a cardiologist for specialized cardiac care, the same is true for mental health. My mantra is that you need a really good chemist as your provider, because this area of practice requires a great deal of specialized knowledge about brain functioning, as well as effective interpretation of symptoms in diagnosing conditions and choosing appropriate pharmaceutical options. Adjustments may need to be made around which medication and the dosage that research shows to be most effective for your specific symptoms and condition.

Another more recently developed mental health treatment option is brain stimulation. The oldest and most well-known of these approaches is electroconvulsive treatment. A more recent brain stimulation option is that of transcranial stimulation. These therapies are often used when someone does not experience effective responses from other treatment options. They can sometimes be known as treatment-resistant forms of a disorder.

And finally, a helpful treatment approach to mental health is known as supportive services. There are a number of ways this can be provided. Just know that support is one of the biggest factors in recovering from any condition, be it mental or physical health. Services that fall under this approach include but are not limited to non-clinical, community-based services that can help with coping with emotional distress and mental health recovery. You can find these types of programs through your local community mental health clinic.

Crisis hotlines, peer support groups, community support teams and educational and vocational programs fall into this type of treatment modality. Advocacy groups are also very helpful. NAMI, the National Alliance on Mental Illness, is the largest grassroots patient and family-driven approach to mental health education and advocacy. Supportive services do not replace some of those mentioned earlier, but they are surely helpful as adjunctive therapies.

Our understanding of the brain has come a long way in the last 50 years, with far more to be discovered. It is fascinating. It is the command center for our complex and intricately made beings. It will be interesting to see where this area of scientific investigation and practice brings us in another 50 years!