Psychological Problems in Neurodiversity

Any person who has atypical neurological development will likely have atypical psychological development as well. This means when everybody else (the neurotypicals) have the same development (psychosocial, emotional, and cognitive), the neurodiverse definitely has a different developmental pattern.

Now, before explaining psychological problems in neurodiversity, let me share what is the normal (or neurotypical) psychological development (that is, a person without learning disabilities, developmental disorders, and emotional disorders).

Image courtesy of natural-passages.com. Psychosocial development by Erik Erikson.

Image courtesy of Muskingum University. Jean Piaget’s Cognitive Developmental Stages.

Okay. I’ll end the list here. The first table regards to the psychosocial development in humans developed by Erik Erikson. At each stage of human development, there is a specific crisis each must face. For example, the infant’s trust vs mistrust crisis. Here, the infant must learn to trust her surroundings, her parents (particularly mother), caregivers, and environment. If these needs are not met, the infant will fail to learn trust and instead will learn mistrust and will be afraid of everything around her. If crises are managed well, the psychosocial development of a person will flow chronologically. However, any negative response to a crisis will suspend a person’s psychosocial development and that is detrimental to the person’s being.

Now, move to the second table. It is Jean Piaget’s theory of cognitive development. This theory is about the nature and development of human intelligence.[1] According to Piaget (who is a gifted person in psychology, see my article on giftedness), cognitive development was a progressive reorganization of mental processes resulting from biological maturation and environmental experience. He believed that children construct an understanding of the world around them, experience discrepancies between what they already know and what they discover in their environment, then adjust their ideas accordingly.[1][2] He regarded the child as a philosopher who perceives the world only as he has experienced it. Therefore, most of Piaget’s inspiration in cognitive and intellectual development came from observations of children.[3] The theory of cognitive development focuses on mental processes such as perceiving, remembering, believing, and reasoning. Reasoning is the essence of intelligence, and reasoning is what Piaget studied in order to discover “how we come to know.”[4]  Piaget believed that cognitive development is cumulative; that is, understanding a new experience grows out of a previous learning experience.[3]  Accordingly, there are four stages of cognitive development[3]:

• Sensory-Motor (Ages Birth Through Two)
• Preoperational (Ages Two Through Seven)
• Concrete Operations (Ages Seven Through Eleven)
• Formal Operations (Ages Eleven Through Sixteen)

Here, these four stages have different modes of learning. At the beginning of life, a baby uses her reflexes to navigate the world (sensorimotor). Then, from toddler to preschool years, she uses only her point of view (egocentrism) to navigate the world (preoperational). Her language matures, but their thinking is based on intuition and still not completely logical. They cannot yet grasp more complex concepts such as cause and effect, time, and comparison.[5] Following the elementary years, the child now demonstrate logical, concrete reasoning (concrete operational). Children’s thinking becomes less egocentric and they are increasingly aware of external events. They begin to realize that one’s own thoughts and feelings are unique and may not be shared by others or may not even be part of reality. During this stage, however, most children still can’t think abstractly or hypothetically.[5] As they move into adolescence, are able to logically use symbols related to abstract concepts, such as algebra and science. They can think about multiple variables in systematic ways, formulate hypotheses, and consider possibilities. They also can ponder abstract relationships and concepts such as justice.[5] Take note that Piaget acknowledged that some children may pass through the stages at different ages than the averages noted above and that some children may show characteristics of more than one stage at a given time. But he insisted that cognitive development always follows this sequence, that stages cannot be skipped, and that each stage is marked by new intellectual abilities and a more complex understanding of the world.[5]

The summary of  both Piaget’s sensorimotor development and Erikson’s early psychosocial developments are found here at this picture:

Image courtesy of buzzle.com. An illustrated normal development from infancy to toddlerhood. Piaget’s sensorimotor cognitive development and Erikson’s trust vs mistrust, autonomy vs shame, and initiative vs guilt, all summed up here.

There are more theories regarding psychological development in humans like Freud’s psychosexual development and Sullivan’s interpersonal development, Kohlberg’s stages of moral development, and so forth. These theories explain the normal development of the human mind, personality, and the whole personhood itself. Any delay or obstruction can cause significant halt in the person’s total development and may lead to various psychological and mental and even personality problems that may cause distress to the person.

But what about psychological development for people in neurodiversity?

Image courtesy of Middlebury College.

For neurodiverse people, psychological and cognitive development may be different from the rest of us neurotypicals. This has something to do with atypical brain development (as in the case of autism) or atypical learning styles (in case of learning disabilities) or cognitive abilities (giftedness, intellectual disability). This difference in psychological development causes various psychological problems for people in neurodiversity ranging from depression to anxiety to substance abuse and suicide.

Let’s cite autism as an example of neurodiversity with different psychological development (excerpt from Psychology Today):

Children with autism do not follow the typical patterns of child development. In some, signs of future problems may be apparent from birth. Other children develop typically at first, but between the ages of 18 and 36 months, their development stagnates. Parents may notice that they begin to reject social contact, act strangely, and even lose language and social skills that they have already acquired. In other cases, there is a plateau or leveling of progress, and the difference between the child with autism and other children the same age becomes more noticeable.[6]

Here, the autistic child clearly develops differently and more delayed than the neurotypical children. The autistic child may not reach a particular milestone (let’s say she cannot move from preoperational to concrete operational cognitive development) because of her different mental and psychological development.

Another example of neurodiversity with different psychological development is ADHD. Because ADHD is characterized by short attention span, hyperactivity, and impulsivity, many kids with ADHD tend to suffer from school difficulties and social rejection. Here, I can say that the ADHD child may have halt in Erikson’s industry vs inferiority where he, because of his ADHD, may perceive himself as inferior to his peers in relation to task mastery (studying). The same goes with other learning disabilities where people having it have a sense of inadequacy.

The more difficulty neurodiverse people develop is in the social domain. Because they are different from most humans, they tend to be socially isolated (usually failing Erikson’s intimacy vs isolation where they become isolated) and can either become depressed or harbor anger to other people, become needy, and may become suicidal.

People in neurodiversity experience lots of psychological struggles more than neurotypical individuals thus experience more psychological illnesses and disorders. Why? Because their atypical neurological development also means atypical psychological development.

Image courtesy of Huffington Post. People in neurodiversity do experience psychological problems more than neurotypicals.

What are some of the common psychiatric disorders experienced by people in neurodiversity?

Anxiety – people in neurodiversity are more anxious than neurotypicals because neurodivergents have different ways of dealing with the world, which can be weird or unacceptable to the majority (neurotypicals). Because of this, neurodivergents experience anxiety.

Depression – when a neurodivergent experiences more and more failures and social isolation, that’s a perfect recipe for depression. This is true especially when a neurodivergent gives up trying new things (learned helplessness) and begins to be aggressive turned inside (depression); hence, depression develops.

Phobia – a phobia is excessive and irrational fear of a real or perceived object or occurrence. Neurodivergent people, because of traumas they experience in life, may develop phobias of specific objects (i.e., sports equipment for a person with dyspraxia) or social events (in case of autism and language disorders). They develop phobias in order to protect themselves from further humiliation, which I’ll bring another psychological problem in neurodiversity.

Obsessive-compulsive disorder (OCD) – having a neurodiverse condition can also have repeated failures in motor skills (dyspraxia) or failures in understanding mathematical concepts (dyscalculia), which may cause obsessions in failures, which could turn into compulsions of excessive perfectionism (obsessive-compulsive disorder) in order to compensate the disabilities in neurodiversity. Not a good compensation, as OCD is one extreme form of anxiety. If disabilities are not properly addressed, the end result will be more anxiety, depression, and procrastination (not really doing anything to solve a problem, just obsessing with how a particular problem is solved without action), which could also lead to underachievement in life areas.

Post-traumatic stress disorder (PTSD) –  when repeated failures and rejections are experienced by the neurodivergent (i.e., bullying, always failing at school, social rejection), he or she may develop post-traumatic stress disorder, is an anxiety disorder that can develop after a person is exposed to one or more traumatic events[7] such as bullying. Symptoms include disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, which does continue for more than a month after the occurrence of a traumatic event.[7][8] A neurodivergent can experience PTSD after years of rejection and failures.

Eating disorders – neurodivergents who are always rejected by peers would become obsessed with their looks (weight included), which can lead them to have various eating disorders (very abnormal eating habits) like anorexia nervosa (eating little to nothing to decrease weight even if already underweight), bulimia (binge eating followed by induced vomiting/excretion), binge-eating disorders (eating excessively even if it causes a person to be obese), and so forth. This is common for people with autism spectrum disorders (click this link for more details) because of their obsession with details and are longing to be part of a group, hence forcing their bodies to become “perfect” just to be accepted by a group.

Suicide/suicidal tendencies – because the neurodivergent feels she’s different and it seems that no one could understand her (these occur in undiagnosed neurodivergents), she will resort to self-harm or self-destruction, which is ultimately a tragedy for any neurodivergent.

It’s very disheartening for neurodivergent people to experience these psychological problems. What to do to avoid these problems in neurodiversity?

Proper assessment of the neurodiverse condition is a must in order to truly identify the key problems of a neurodivergent person. By properly identifying either a learning disability, developmental disorder, or emotional/behavior disorder, the neurodivergent person will finally identify who he really is, will have an introspection of himself (though it will take months to years before acceptance just like what I did), then he will develop healthy coping strategies (i.e., individualized education plan, shift to a job that truly suits his strength, social skills training, etc.) in order to reach his full potential.

Image courtesy of lifehacker.com. Self-awareness of the neurodiverse condition is a key to alleviating psychological problems in neurodiversity.

Self-awareness and self-acceptance of the neurodiverse condition is also a must for the neurodivergent in order to alleviate his psychological problems. Yes, someone can be aware of his condition, but if he cannot accept it as part of his personhood, then nothing happens. There is no introspection. Without it, the neurodivergent still encounter problems because of his failure to accept himself as who he is. This is hard at first, because being different from majority (neurotypicals) would mean struggle in self-acceptance, lest acceptance by the group. But when a neurodivergent finally becomes aware of his condition and accepts it, then change will occur because he can learn to navigate the world with his “real” self without compensating to psychological problems.

Love and support from family and friends is also a must. And it’s not conditional. Families and friends of neurodivergent people should be educated and/or be aware of the neurodivergent’s condition and unconditional love and support is ever needed in order for the neurodivergent to feel accepted and loved. Neurodivergents usually have a hard tie when it comes to acceptance because of his hard-wired difference. Nevertheless, when he is valued and accepted, he will have the courage to go on in this world and he will feel that he “belongs” alongside all people, whether be neurodivergent or neurotypical.

Final words: Being a person in neurodiversity whether having learning disabilities or developmental disorders doesn’t exempt him or her from having various psychological problems whether brought by neurodiversity or other life trials. This means a neurodivergent is similar to the neurotypical; in short, he is human too but with different brain makeup.

References:

1. https://en.wikipedia.org/wiki/Piaget%27s_theory_of_cognitive_development
2. McLeod, S. A. “Piaget | Cognitive Theory”. Simply Psychology. Retrieved 18 September 2012.
3. http://www.icels-educators-for-learning.ca/index.php?option=com_content&view=article&id=46&Itemid=61
4. Singer, D.G. & Revenson, T.A. (1997). A Piaget Primer: How a Child Thinks (Revised Edition). Madison, Connecticut: International Universities Press Inc.
5. http://www.webmd.com/children/piaget-stages-of-development
6. https://www.psychologytoday.com/conditions/autism
7. https://en.wikipedia.org/wiki/Posttraumatic_stress_disorder
8. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–280.ISBN 978-0-89042-555-8.

ADHD As A Social Construct

Disclaimer: the following blog contains my own opinion as well as some opinions from my researches.

Recently, I read an article about the comparison of the United States and France in dealing with ADHD.[1] For the Americans, more children are diagnosed and quickly medicated to control the symptoms. In France, on the other hand, don’t medicate kids with ADHD (or hyperkinetic syndrome). Instead, they use only psychotherapies and special education. They don’t attribute ADHD to neurotransmitter (brain chemical) imbalances. Instead, French psychologists propose psychosocial causes of ADHD.

Really?

I began to think whether ADHD is a social construct or a psychological condition.

How that can be? ADHD is a brain condition, right?

Yes, ADHD is not really a disease. I wrote about ADHD’s occurrence in evolution (click my article on ADHD and evolution here) and thought that condition is suited to the nomadic prehistoric world. Since we now live in an information-technology age relying on prolonged sitting type of education and employment, ADHD characteristics are considered burdensome or not suited to the classroom or the workplace; hence, people with ADHD are automatically given medications in order to control the symptoms.

Image courtesy of acautiousdisplay.wordpress.com. Medications to control symptoms are given to kids with ADHD.

Unfortunately, too much medication has its side effects, particularly stimulants (Ritalin, Concerta), and these are not good for children. They can be drug dependent later on in their lives. Remember that stimulants make the brain awake (like when you’re drinking coffee, it can awake you). Common side effects of ADHD meds (I just shortcut medications to meds for short) include low appetite, stomach pain, or sleep problems[2], and more serious but not so common side effects are heart problems, such as chest pain, liver problems, or suicidal thoughts.[2]

Not so good. Controlling ADHD symptoms can be good for teachers and employers (I’m totally can relate to this, though…) but not for the person with ADHD. Yes, his symptoms controlled, but his liver and brain jeopardized.

Now, I am thinking maybe ADHD is a constructed psychological disorder not accepted in 21st century environments.

There is a theory about ADHD as a social construct[3] and was “invented and not discovered”[3][4][5] said by Thomas Szasz, the proponent of ADHD social construct theory.

How?

A common argument against the medical model of ADHD asserts that while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional. However, by definition, in order to diagnose with a mental disorder, symptoms must be interpreted as causing a person distress / especially maladaptive.[3] According to DSM, the diagnosis of ADHD is made when  “there must be clear evidence of significant impairment in social, school, or work functioning.”[3][6] In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as ‘problems’. Medically defining their behaviour (by giving labels such as ADHD and ADD) serves the purpose of removing blame from those ‘causing the problem’.[3]

This means ADHD is “invented” to lessen the stigma of people/children who cannot follow the “passivity and order” norm. They are instead given such diagnosis.

Hmmm…

In the ADHD Social Construct Theory the idea is that ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are generally speaking, not biological or psychiatric disorders, but can be better explained by environmental causes or even the personality type of the person. For example an ADD person can be introvert, while the hyperactive person is an extrovert.[7]

Accordingly, the observed behaviors are not abnormal, but normal behavior for a part of the human race. However the extreme overreactions are caused by environmental factors. Factors include cramped living conditions with inadequate play space[7], whole day classroom setup with the increased educational burden being expected from children (i.e. being able to be intelligent in all subjects while sitting for 5 hours or more, multiple intelligences, etc). Here, if a child isn’t interested to learn and becomes disruptive, he will be diagnosed right away with ADHD and will be put on medication.

Here’s an example on how ADHD Social Construct Theory is illustrated[7]:

As an example: a young child sitting quiet and still for three quarters of an hour at a time, listening to something they are told to learn, but which they do not find interesting, is an unnatural behavior. This a new phenomenon in human history.

 I see. Any person uninterested in a particular topic will be bored to death and will find ways to distract himself from it. But that’s school.

Image courtesy of ellabastone.wordpress.com. Does lack of interest and disruption are automatically diagnosed as ADHD?

But there’s more.

According to the blog Social Deviance 360, “ADHD seems to have become the catch all phrase for disruptive children.”[8] Accordingly, any very active (and disruptive) child is automatically diagnosed with ADHD. Also, like the previous explanation above, the classroom setting is a “landmine” where ADHD symptoms are apparent. Let’s quote from Social Deviance 360 blog[8]:

The school system is in itself a social construction, one that was “designed, conceived and structured for a different age” during “the intellectual culture of the enlightenment and in the economic circumstances of the industrial revolution (Robinson).” The context of this unnecessary emphasis on adherence to strict behavioral conformity, concepts of behavioral conformity which are created by us, make these behaviors deviant. These inattentive, hyperactive behaviors are mostly noticed in the classroom, during an era that is the most stimulating in history (Robinson). There are constant pulls for attention from video games, computers, movies, sports, and advertising, while academia is a largely unexciting endeavor for most children. Outside of school, the majority of the “symptoms” of ADHD are barely visible. There is no biological requirement for how children should behave. Age is a convenient frame of reference but it is a social construction, which creates problems when society attaches real value to it. The assumptions about how children should act, based on their age, are too narrowly defined by society to account for variations in child development, and children’s personalities, as is made apparent by the current ADHD “epidemic.”

Yes. The author has a point.

The workplace (specifically office setup) has also the same features as the classroom. Long sitting hours, listening to many, long tasks required by superiors, and conformity also. But what if the employee becomes bored also? Then the employer will require him to be diagnosed with ADHD and drugged. Some critics of the ADHD diagnosis will be mad over that decision, as it will only “control” the person’s boredom just to comply with his employer. Lucky if he continues to work. But in some cases like mine where I was forced to leave or resign, that’s totally unfair.

On the other hand, I also find the ADHD diagnosis valid too. That’s because I believe that ADHD is a neurological variation, not a psychiatric/neurological disorder or social construct whatsoever. The problem here is that the modern world is unfriendly to the ADHD brain, but ADHD brain is here as a catalyst for evolution as with the rest of neurodiversity.

Maybe the French are right. We really don’t need medicating brains too much to control the symptoms. Yet, the ADHD diagnosis is right too. What we need to do is find the right education and employment choices and strategies for all ADHD folks in all walks of life and not just forcing them to follow rules against their will.

But to think ADHD is a social construct, I don’t think so. But I really don’t know if it is.

Reference:

1. http://thespiritscience.net/2015/07/10/adhd-does-not-exist-why-french-children-dont-have-adhd/
2. http://www.webmd.com/add-adhd/childhood-adhd/features/reduce-side-effects-adhd-medications
3. https://en.wikipedia.org/wiki/Social_construct_theory_of_ADHD
4. Chriss, James J. (2007). Social control: an introduction. Cambridge, UK: Polity. p. 230. ISBN 0-7456-3858-9.
5. Szasz, Thomas Stephen (2001). Pharmacracy: medicine and politics in America. New York: Praeger. p. 212. ISBN 0-275-97196-1.
6. http://www.psychiatryonline.com/content.aspx?aID=7721
7. http://www.adhd-health.com/philosophy/adhd-social-construct-theory.php
8. http://socialdeviance360.blogspot.com/2012/04/adhd-story-of-social-construction.html