Neurodivergent is an inclusive term that celebrates the attributes and positive impact of individuals with different ways of interacting and understanding the world while recognising the challenges, stigma and bias they face.
The first blog post in this series reviewed factors that commonly influence flexibility training in neurodivergent people. Read the blog here.
Part two suggested strategies and accommodations that support inclusive, safe and meaningful flexibility training for neurodivergent people. Read the blog here.
This post is a guide to fostering productive training alliances with neurodivergent people and is primarily directed towards coaches. Client-centred approaches to coaching are beneficial to everyone (coaches included) but are essential for overcoming systemic barriers that limit the inclusion of neurodivergent people.
NB: Language is power
Most neurodivergent people prefer identity-first language to reflect their diagnosis or self-identification. For example, 'Autistic' rather than 'a person with autism'. This reflects neurodivergent as a valid and valuable way of looking at the world, inseparable from identity, rather than a deficit (Colombo-Dougovito, 2020)(Kapp, 2020). Deficit-based language can further marginalise neurodivergents, so it's important to be aware of this distinction even if you never have to use the terms. If you do, always ask an individual their preference.
Productive training alliance
A productive training alliance is the positive social connection fostered between an individual and coach that leads to better outcomes for all. It's based on mutual respect and collaboration. In addition, self-efficacy, i.e. confidence in success, becomes a key motivator of both coach and client.
Why is it important to adapt coaching to support neurodivergent people?
Approximately 17% of the global population has a diagnosis that is considered neurodivergent, and many more people self-identify (Colombo-Dougovito, 2020). I suggest that neurodivergent people have an even greater representation among those who train flexibility due to cross-over with performance arts and the prevalence of joint hypermobility in this population (Csecs, 2021). Not only does flexibility training encourage positive expression of favourable attributes, but it can also be a way for neurodivergent individuals to foster self-efficacy. Conversely, failure to adequately support differences and accommodate preferences erodes self-efficacy and perpetuates power imbalance.
Flexibility training. A basic human need?
OK. So we don't NEED flexibility training, but according to Self-determination Theory (Deci & Ryan, 1985; Ryan & Deci, 2000), we are motivated by a need for autonomy, relatedness and competence. The theory states that fulfilment of these results in enhanced performance and well-being, making it a good framework for modelling effective flexibility coaching.
%20(1).png)
1. Autonomy (Choice and ownership over the training)
Historically, neurodivergents have been excluded from decision-making, and their preferences have been ignored (Colombo-Dougovito, 2020).
Neurodivergents need to be made aware that participation is voluntary and there is always a choice, without judgment, punishment or need for explanation. It's always appropriate to ask for consent. Explicitly asking for consent highlights choice and empowers (Van Rens, 2022). Coaches need to be aware that neurodivergents may say 'yes' so as not to disappoint. Efforts must be made to ensure individuals feel safe to say 'no'.
Consider consent an ongoing conversation:
-Ask for preferences
-Offer choices
-Allow time to process and consider options
-Accept that people often change their minds and adapt accordingly
-Encourage clients to make decisions
-Listen with an open and curious mind
-Practice active listening: Ask open questions, summarise what you understood and encourage correction
-Educate and explain the implications of choices
-Always respect decisions
-Encourage feedback
-Be open to constructive criticism
-Present information in multiple ways i.e. verbal, communication boards, demonstrations, illustrations, props, text, multimedia, facilitation...
Beyond consent, coaches should provide ongoing opportunities for neurodivergent clients to develop preferences and make choices that direct their training. This may include offering a choice between exercises and encouraging clients to make drills more meaningful/valuable to them.
2. Relatedness (Belonging)
Usual ways of teaching can make processing more challenging for neurodivergents and lead to exclusion. Neurodivergents may have difficulties with focus and attention (hypo/hyper-focus), strongly prefer one presentation style over others, and find it difficult to engage if too much information is provided at a time.
To communicate more effectively when coaching, try:
-one instruction, cue or focus at a time
-Allow time to process and absorb
-Present information in multiple ways ie describe, demonstrate, copy…
-Breakdown complex drills into component parts
-Limit the amount of new material in a class or session
-Provide feedback in multiple ways i.e. tactile (not just hands on), pictures, videos and using subjective/objective measures.
-Ask for feedback. Note: Neurodivergents may prefer communicating outside training sessions after they have had time to reflect. They may also find it challenging to communicate constructive feedback face-to-face. Allowing conversation via text or email can be helpful.
We all need to feel that we can express our authentic-selves without judgment to belong. Neurodivergents should be encouraged to stim, and not 'mask', if they feel comfortable. Stimming or Self-stimulatory behaviour is the repetition of familiar sounds, movements, words or behaviours. Stimming increases confidence, sense of safety, and relieves overwhelming emotions and sensory stimulation (Kapp, 2019). Masking describes efforts to conceal differences in behaviour and communication. Masking is fatiguing and correlates with worse biopsychosocial outcomes (Crompton, 2020).
True inclusion is not possible without consideration of sensory preferences. Neurodivergents may experience: 1) Hyposensitivity, so require more feedback or load to feel the impact of an exercise, 2) Hypersensitivity, so are more sensitive to sensory inputs and prone to sensory overload, or 3) A mix of both. It's common for neurodivergents to 'under-feel' stretches but be sensitive to environmental stimuli. 'Sensory overload' can lead to meltdowns, shutdowns and contribute to burnout (Casinova, 2020)(Murray, 2022), so it's essential to accommodate sensory preferences and discuss with neurodivergents how they can best be supported in the event they are over-stimulated.
3. Competence (Participation and achievement)
Coaches need to foster inclusive, not just accessible, training environments to allow neurodivergents the opportunity to succeed and excel.
Typical neurodivergent traits that are beneficial to flexibility training include (IMHO):
-Creative thinking and out of the box problem solving
-Being goal and task-driven
-Hyperfocus on areas of special interest
-Developed strategies to tolerate sensory and pain sensitivity
-Practice regulating emotions
-A desire for stong tactile sensory input ie stretching
-Stimming to down-regulate the sympathetic nervous system
-A desire for consistency, routine and repetition
Flexibility coaches are responsible for setting clients up for success by establishing client-centred goals and facilitating effective goal-based training considering clients' preferences, strengths and weaknesses. It's critical to provide positive feedback and constructive recommendations related to areas within a client's control.
End note:
Many thanks go to the gracious neurodivergents that have been supportive and provided guidance and feedback to help me put this series together.
References:
Colombo-Dougovito, A.M., Dillon, S.R., Mpofu, E. (2020). The Wellbeing of People with Neurodiverse Conditions. In: Mpofu, E. (eds) Sustainable Community Health. Palgrave Macmillan, Cham.
Crompton, C. J., Hallett, S., Ropar, D., Flynn, E., & Fletcher-Watson, S. (2020). ‘I never realised everybody felt as happy as I do when I am around autistic people’: A thematic analysis of autistic adults’ relationships with autistic and neurotypical friends and family. Autism, 24(6), 1438–1448.
Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, Savage GK, Dowell NG, Prowse F, Themelis K, Mathias CJ, Critchley HD, Eccles JA.(2022) Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Front Psychiatry. 2;12:786916. doi: 10.3389/fpsyt.2021.786916. PMID: 35185636; PMCID: PMC8847158.
Doyle, N. (2020). Neurodiversity at work: a biopsychosocial model and the impact on working adults. British Medical Bulletin, 135(1), 108-125.
Failla MD, Moana-Filho EJ, Essick GK, Baranek GT, Rogers BP, Cascio CJ. Initially intact neural responses to pain in autism are diminished during sustained pain. Autism. 2018 Aug;22(6):669-683. doi: 10.1177/1362361317696043. Epub 2017 May 17. PMID: 28513186; PMCID: PMC6352721.
Gentili, C., Rickardsson, J., Zetterqvist, V., Simons, L. E., Lekander, M., & Wicksell, R. K. (2019). Psychological Flexibility as a Resilience Factor in Individuals With Chronic Pain. Frontiers in Psychology.
Kapp SK, Steward R, Crane L, Elliott D, Elphick C, Pellicano E, Russell G.(2019) 'People should be allowed to do what they like': Autistic adults' views and experiences of stimming. Autism. doi: 10.1177/1362361319829628. Epub 2019 Feb 28. PMID: 30818970; PMCID: PMC6728747.
Kapp, S. K. (Ed.). (2020). Autistic community and the neurodiversity movement: Stories from the Frontline. London, UK: Palgrave Macmillan.
Kindgren E, Quiñones Perez A, Knez R. (2021) Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study. Neuropsychiatr Dis Treat. 2021 Feb 10;17:379-388. doi: 10.2147/NDT.S290494. PMID: 33603376; PMCID: PMC7882457.
Murray D, Milton D, Green J, Bervoets J. The Human Spectrum: A Phenomenological Enquiry within Neurodiversity. Psychopathology. 2022 Sep 30:1-11. doi: 10.1159/000526213. Epub ahead of print. PMID: 36183692.
Owens, A. P., Mathias, C. J., & Iodice, V. (2021). Autonomic Dysfunction in Autism Spectrum Disorder. Frontiers in Integrative Neuroscience.
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68-78.
Van Rens, F. (2022). Circus Psychology: An Applied Guide to Thriving Under the Big Top (1st ed.). Routledge.
