Psychiatrist Indraja Veličkienė discusses neurodiversity: “Our different ways of seeing and experiencing the world contributes to our civilisations and inventions”

“Our values, our ability to accept those around us as the same or different, are very important. Openness, curiosity and tolerance are also the key values that help us understand neurodiversity, neurotypical people and ourselves,” Dr Indraja Veličkienė, a psychiatrist from the Faculty of Medicine at Vilnius University, said. I talked with the doctor during the World Mental Health Day on neurodiversity, a topic that has received a lot of attention recently. What is neurodiversity? Why do some people fall within the non-neurotypical spectrum, and how are they getting on in our society? I discussed these and other important issues with her.

What is neurodiversity? Can you explain the concept? What kind of people are considered neurotypical?

Neurodiversity is the term for the natural variations in the functions and behaviour of the human brain. We often use the term neurodiversity in connection with Autism Spectrum Disorders (ASDs), Attention-Deficit/Hyperactivity Disorder (ADHD) and dyslexia, to emphasise that it is not a disease, but a different way of thinking, feeling and understanding the world.

It’s getting harder to describe a neurotypical person. It’s perhaps time to move away from generalised terms in today's society that is increasingly oriented towards individuality and uniqueness.

Aren’t Autism Spectrum Disorder, Asperger's Syndrome, ADHD and other diagnoses used in the field of neurodiversity rather personal matters? How do they differ from the definition of a personality disorder? I have read, for example, that ADHD is actually PTSD (Post-Traumatic Stress Disorder), and in some publications PTSD is often compared to borderline personality disorder but what is it really like?

The most accurate definition would be that it falls under ASDs – these cover the different levels of functioning in autism, including Asperger's Syndrome. Although the term Asperger's Syndrome is included in the ICD (International Classification of Diseases), it should no longer be used, for ethical reasons.

ADHD is different from ASD, a personality disorder or PTSD

With ASD, symptoms develop at a very early age and have a genetic component. Symptoms of autism include difficulties with social functioning, and unplanned changes, the need for predictability, defined habits and sensory sensitivity.

Personality disorders can also be diagnosed in the context of autism spectrum disorder. The symptoms transpire in the context of interpersonal relationships and the dysregulation of emotions. By contrast, in ASD, people may be more sensitive to social situations, sound, and excess stimuli. One of my patients has noted that when he is too tired, he will wait for his wife to leave the room. Although he loves her very much, she “generates information” even with her silent presence, which is even more tiring for him. The desire to be away and silent and the love for his wife coexist and do not contradict each other.

In the case of personality disorders, interpersonal relationships, being close to someone or being alone, are much more important than usual. Attachment Theory and the strategies that continue to emerge, are particularly important, influencing self-awareness and emotion regulation, and these difficulties are most often observed in close interpersonal relationships. In terms of PTSD, we are discussing overlap. To what extent traumatic experiences are more frequent for those on the spectrum or those with ADHD, and to what extent the experience of trauma disrupts a person's growth and their ability to recognise and regulate their own emotions and to understand relationships.

Is there a difference between ADHD and Attention Deficit Disorder (ADD)? Can a person have ADD but not have the hyperactivity element of ADHD?

According to the DSM V (Diagnostic and Statistical Manual of Mental Disorders) and the ICD-11, ADHD has several types: inattention (ADD), hyperactivity, and a combination of the two. In order to diagnose any of them, adults must exhibit five symptoms and children six symptoms from various symptom groups, for example, inattention and hyperactivity. With 10 or 12 symptoms, a combined disorder is diagnosed.

Can you tell us more about autism spectrum disorders?

The first thought that comes to my mind is the book Autizmas – dalis manęs (Autism – A Part of Me), by Barbara Suisse and Jurgita Žalgirytė-Skrudenienė. I really don't think I can explain it better. The fifteen stories collected in the book are about the most sensitive experiences and self-awareness. Many people come to me who have read this book and want to be assessed as to whether they have symptoms on the autistic spectrum, or sometimes just to talk about their family members. Parents send their children to talk to me and children send their parents. Often, by talking, by hearing each other out, they can better understand past misunderstandings or perhaps the fact that it is possible to feel and think very differently.

How to avoid confusing autism spectrum disorders with ADD?

They are so different. Although, on second thought, inattention and hyperactivity (ADD) can sometimes be confused with ASDs. Say, a person finds it hard to maintain friendships. What does it look like in both cases? In the case of ASD, meeting friends occurs only in a specific context and time, the person may need to make an effort to stay at social gatherings and is likely to avoid contact in general. However, with ADHD, they might forget to reply to a letter, find it difficult to organise themselves, to issue invitations, or plan a meeting.

How do non-neurotypical people get on in science, at work, or with their families? What difficulties do they face? What kind of societal attitudes do such people have to deal with?

It probably, varies. I meet patients who have ASD or ADHD who have studied at Cambridge University. They tell me that school was really easy, they didn't have to study, they did their homework in class, and they don't recall having to re-visit the information in order to remember it. But they did have to start seriously studying at university. A lot of people with these conditions have a high IQ. It would seem to be their strength, which helps them adapt. Professionals call it “masking”. However, masking can also be unhelpful, because you get more tired, lose yourself, adopting roles that you “should”, rather than who you really are. Long episodes of depression follow, and patients ask me why they keep getting depressed. For others, learning and working can be very difficult. They may find it difficult to understand explanations, to ask for clarification, or they may solve tasks in their own way. Teachers may not be willing to take the time to explain or to listen to a long detailed answer, and may even assume that the student simply does not know.

How are these disorders treated?

Treatment is as different as the disorders themselves or the need to treat them. There is no specific treatment for ASDs. Many people would say “what is there to treat?” For me, as a psychiatrist, what matters is the extent to which the symptoms interfere with or affect the functioning of my patients and how they feel. Often co-morbid disorders such as anxiety, mood, and addictions are treated. It is important not only to choose the correct medication and psychotherapy, but also to remember that this is a neuro-diversity, i.e. whether a certain unpleasant sound may be more important than interpersonal misunderstandings at work, and that a change in the sensory environment might make the symptom diminish or disappear. Psychotherapy and building self-awareness are useful for everyone, but it is important to remember that therapies can vary slightly in the accuracy of explanations and insights, with a variety of modules applied to different symptom groups.

The treatment of ADHD is slightly different, with a clearer biological basis and effective medication. Stimulants, and other medications are often prescribed. I would like to emphasise that not only stimulants are used to treat ADHD, although they are usually the first choice of medication. They help you to concentrate and procrastinate less, to finish the tasks you have started. When ADHD is correctly diagnosed and treatment is started, there is a very marked change in the condition. It is important that medication alone is not sufficient, other strategies, like sports, or cognitive training, are also required. Some people choose strategies rather than medication, and it is really encouraging to see positive changes.

Tell us more about how psychotherapy can help with ASDs or ADHD

I would like to explain that therapy can be very useful in the case of co-occurring disorders. Trauma is quite common in ASD or ADHD, so therapy is particularly important in these situations. Sadly, and unfairly, literature shows that people who are prone to violence can notice and take advantage of the vulnerability of those with ASD or ADHD.

People on the spectrum or with ADHD feel different from others and feel they don’t fit in, so in the case of a trauma there is a risk of falling into a vicious cycle of self-deprecation and self-blame, which particularly exacerbates the effects of trauma. After traumatic experiences and thinking how unworthy they feel, getting a diagnosis can bring relief. It is as if it reduces their perceived responsibility for failure and gives a different perspective on the situation. I remember a case where a patient refused to take medication for ADHD and therapy. To the patient, rapid thoughts, changing hobbies and activities provided an escape from a severe traumatic experience as a teenager. Starting therapy made the patient remain with intense emotions longer, which they were not ready for.

How are non-neurotypical people different? Are there any advantages to having a non-neurotypical brain?

Each of us has something interesting, important and necessary. Our different ways of seeing and experiencing the world contributes to our civilisations and inventions.