Psychological Therapies
When neurodivergent children struggle with anxiety, mood, sleep, or other psychological difficulties, therapy can help - but approaches often need adapting.
Psychological therapy is for treating mental health difficulties that co-occur with neurodivergence - like anxiety or depression - not for treating autism or ADHD themselves.
Standard therapeutic approaches often need adaptation for neurodivergent individuals. A therapist experienced with this population is important.
Types of psychological therapy
Used for: Anxiety, depression, OCD, specific phobias
Strong evidence in general; adaptations needed for neurodivergent children.Adaptations for neurodivergent children:
- More visual and concrete approaches
- Longer to build rapport and trust
- Account for literal thinking
- Include sensory and executive function factors
- May need more parent involvement
- Interoception support (recognising body signals)
Traditional CBT may not suit all autistic or ADHD individuals. Modifications are essential.
Used for: Anxiety, emotional flexibility, values-based living
Growing evidence for neurodivergent populations.Adaptations for neurodivergent children:
- Mindfulness adapted for sensory differences
- Values exploration may suit autistic thinking
- Less focus on changing thoughts
- Concrete, visual exercises
May suit some neurodivergent individuals better than traditional CBT.
Used for: Younger children, trauma, attachment, emotional expression
Moderate evidence; developmental approach.Adaptations for neurodivergent children:
- May need to follow child's interests more
- Sensory play often helpful
- Non-directive approaches may suit some
- Structured play may suit others
Good option when verbal therapy isn't appropriate.
Used for: Family conflict, communication, adjustment to diagnosis
Moderate evidence for family-level outcomes.Adaptations for neurodivergent children:
- Include understanding of neurodivergence
- Validate all family members' experiences
- Address sibling needs
- Communication accommodations
Can help families adjust and reduce conflict.
May present differently
Anxiety may look like avoidance, meltdowns, rigidity, or physical symptoms rather than expressed worry.
Different triggers
Sensory overload, uncertainty, social confusion, and change can all drive anxiety.
Interoception challenges
May not recognise anxiety building in their body until it's overwhelming.
Overlap with core features
Hard to separate anxiety from autism/ADHD features. Need careful formulation.
Helpful approaches:
- Modified CBT with visual, concrete approaches
- Gradual exposure with high levels of support
- Environmental modifications to reduce triggers
- Predictability and preparation strategies
- Interoception training
- Parent involvement in supporting exposure
Sleep interventions
50-80% of neurodivergent children have sleep difficulties.
Consistent bedtime, dark room, screen limits, calming routine.
Foundation - necessary but often not sufficient alone.
Gradual withdrawal, sleep restriction (older children), addressing bedtime resistance.
Strong evidence in general; adaptations needed.
Weighted blankets, white noise, specific bedding, temperature regulation.
Individual; trial and error needed.
Can help with sleep onset. Should be discussed with healthcare provider.
Good evidence for neurodivergent children. Discuss with clinician.
Addressing thoughts and behaviours around sleep.
Strong evidence in general; may need adaptation.
When to seek psychological help
- Anxiety significantly affecting daily life or school attendance
- Persistent low mood, hopelessness, or withdrawal
- Self-harm or suicidal thoughts (seek immediate help)
- Severe sleep problems not responding to behavioural approaches
- OCD symptoms (intrusive thoughts, compulsions)
- Trauma symptoms following distressing experiences
- Eating difficulties beyond typical selective eating
- Family conflict that isn't resolving
Finding the right therapist
Neurodivergent-affirming
Understands autism and ADHD as differences, not deficits. Respects autistic identity.
Experience with population
Has worked with neurodivergent children. Knows how to adapt approaches.
Flexible approach
Adapts to your child rather than applying one-size-fits-all.
Involves parents appropriately
Works with you, shares strategies, maintains appropriate boundaries.
Registered and qualified
Registered with appropriate body (HCPC, BACP, BABCP). Check registration.
What to expect from therapy
Assessment
Understanding the difficulties, history, and goals. May involve questionnaires.
Formulation
Developing an understanding of what's maintaining difficulties.
Treatment plan
Agreeing goals and approach. You should understand and agree with the plan.
Therapy sessions
Regular sessions (often weekly). May be with child, parent, or both.
Between-session work
Practice and activities between sessions. Often crucial to progress.
Review and ending
Regular review of progress. Clear ending with relapse prevention.
Therapy needs to fit the person. Standard therapeutic approaches often need significant adaptation for neurodivergent children. A therapist who understands this and adapts their approach is essential.
If therapy isn't working, it might not be the right fit. It's okay to try a different approach or therapist.