What does “Neurotypical” actually mean?
Neurodivergence is a collective term used for people who have a condition like ADHD, Autism, Tourette’s Syndrome, Dyslexia, Dyspraxia, Dyscalculia, Dysgraphia and other similar conditions. Neurotypical is someone who’s not neurodivergent. They’re.. I guess typical? It’s in the name. So we know they’re not neurodivergent. But what does that actually mean?
Firstly, this blog today is based on a YouTube video I put out. If you would prefer to watch instead of read, you can find the video here:
I was someone who was very aware of the world of neurodivergence before my own diagnosis (yet I didn’t spot it in myself for a long time) and the language used around it has always felt a bit odd to me. “Neurotypical”. “Typical”. Is this just another way to say we’re not normal?
It’s a term defined by what it’s not. When asked what neurotypical means, we say it’s someone who is not neurodivergent, and in order to do that we have to define what neurodivergent is.
We seem to know that one in a lot more detail. If you’re neurodivergent, it’s because you have or are something, depending on the language you prefer to use. You are autistic. You are dyslexic. You have ADHD or Tourette’s syndrome.
I don’t really want to get into the person-first (I have autism) vs identity-first (I am autistic) debate here because that’s a whole different topic not completely relevant to this conversation. But that the language we use matters, and the language of describing “neurotypical” as “not-neurodivergent” is itself very relevant.
Neurodivergent, in contrast is very clearly defined. We have a rich collection of sub-types, each with their own definition that seem to partition the neurodivergent space, with this set of traits indicating an autism diagnosis, another set indicating dyslexia. There are criteria that clearly lay out what it takes to be classified as each of these neurotypes and they define who is in the in-group and who is out of it.
Each form of neurodivergence has a set of rules and criteria that defines who “has” or “is" this neurodivergence.
And in fact, as I discussed in my two previous posts, it’s not just shared traits. There’s actually a large correlation between neurodivergence and personality, with one study even going as far as being able to predict autistic people with 70% accuracy based on their personality traits (Schriber et al., 2014). So we can put people into “groups of people who are like this” and we piece together these groups to build our definition of neurodivergence.
What if we didn’t stop there? If we know that personality is highly correlated with different sub-groups of neurodivergence, what if we did the same with neurotypicals? Are there collections of people with low neuroticism, low extraversion and high openness to experience that share the same behaviours and we could write out a whole diagnostic criteria for them like that of the DSM-5. What makes this group different from how we look at, say, the ADHD group?
There are a number of interesting questions that this brings up. For starters, what are the implications of being able to split up our entire human population into groups based on personality? That question is a bit outside of my realm of expertise, but I can question whether this whole premise is really that straightforward.
Because as I’ve spent more and more time in this world, I’ve realised something that I don’t see discussed much in the academic literature, healthcare systems or indeed enough in the various communities I’m part of and that’s the fact that there is a massive overlap between all of these forms of neurodivergence.
Studies have shown that between 30% and 80% of autistic children also meet the diagnostic criteria for ADHD (Rommelse et al, 2010). Even if we take the lower end of this scale, this means that 30% of autistic children also meet the diagnostic criteria for ADHD. These neurodivergences aren’t something that we grow out of, which means a huge segment of the autistic population also have ADHD.
It works the other way around too. The percentages are not quite as high but the same study found that between 20 to 50% of children with ADHD also meet the diagnostic criteria for autism (Rommelse et al, 2010). The overlap between these two neurodivergences are huge.
What’s even more surprising about this is that the DSM didn’t allow you to be diagnosed with both ADHD and autism at the same time up until 2013. It’s only in the last decade that we’ve acknowledged that these two do co-occur and aren’t completely separate things!
You might be thinking that this means that maybe we need to combine ADHD and Autism into one category, or have a third separate category, which we call AuDHD, in amongst the neurodivergences. This is a fair attempt at a solution, but actually the overlaps don’t stop here.
About 50% of children diagnosed with ADHD have a comorbid tic disorder and conversely 35-90% of people with Tourette’s Syndrome have been reported to have ADHD-like symptoms, and actually often present with the ADHD symptoms first (Oluwabusi, 2016). So there’s also a massive overlap between Tourette’s Syndrome and ADHD.
Knowing what we know of the ADHD and Autism overlap, it’s probably not surprising to hear that between 2.6 and 11 percent of autistics also have Tourette’s Syndrome, and between 3% and 20% of people with Tourette’s also have autism (Cravedi, 2017). So we’d need to include the categories of ADHD and Tourettes, Autism and Tourettes and all three as well.
Between 25-40% of people with dyslexia also have ADHD and vice versa (McGrath & Stoodley, 2019), which suggests an extra sub category, but also means we have to create more sub-categories with our existing overlaps. I could continue, but I think you get the idea.
The more and more overlaps we add the more and more complex this picture becomes…
In reality, it’s far more complex than assigning people into particular sub-groups. And while that doesn’t mean that diagnoses aren’t helpful, it’s been so helpful for my own self-understanding to receive my ADHD diagnosis and to get support to help with those challenges, even though I likely have autism as well.
It also doesn’t mean we shouldn’t treat the challenging symptoms of our neurodivergence, rather that we should take a more individual approach and like I always say, try things that often work for people like us, and if they don’t, that’s okay, try something else instead!
I think this is also a good point to talk about increased diagnoses in recent years because this has been caused by an increased recognition of what these neurodivergences actually are.
Historically, it was thought that the autistic population was overwhelmingly male and it was rare for women to get diagnosed but recent years have seen more and more women get diagnosed as our understanding of the diagnostic criteria and what it might look like in women has evolved.
This means there are many people like me who grew up believing we were neurotypical later finding out that we are actually neurodivergent. The line between neurodivergent and neurotypical isn’t clear cut and it’s moving as learning and definitions change. So how can we define neurotypical in this context?
Taking this to the natural conclusion, leads to the concept of neurodiversity. That we all think different, and much like biodiversity, neurodiversity is a natural part of life.
We accept the value of biodiversity in this world, why not neurodiversity as well?
I read a really interesting paper called “Neurodiversity studies: mapping out possibilities of a new critical paradigm” by Stenning & Bertilsdotter-Rosqvist published in 2021 that talks about this topic.
It looks at reframing our understanding of neurodiversity, instead of being something related to the clinical categories of autism, ADHD, Tourettes and the like, it poses the question that there are other forms of difference yet to be defined, and that neurodiversity is a collective property of our brains.
They acknowledge that neurodiversity tends to be used with the assumption that “what is natural is always beneficial” and that this contradicts clinical research which suggests it to be suffering that we need to alleviate.
But they also acknowledge that the definition of neurodiversity is a “moving target” that responds to culture and society and potentially infinite neurological differences between humans and that we currently consider to be significant differences between brains might be something to reconsider.
Another interesting point of discussion raised is that historically, research has been done “on” other people, eg research has been done on dyslexics or people with ADHD, rather than with us. This leads to people drawing conclusions and making statements about those of us who are spicy brained without taking into account our lived experiences.
This has led to papers asking patronising questions like: “Are autistics self aware enough to know their own personalities?” which is a genuine question from a study I found when researching last week’s post. The answer was unsurprisingly yes, by the way (Schriber et al., 2014).
It also means that the criteria and understanding of what makes up a certain form of neurodivergence is set in a way that is exclusionary if someone doesn’t fit that exact mould.
For example, autistics who have excessive interests in machinery and other technical areas are much more widely accepted in society since technology has revolutionised our lives and the autistics building their careers and finding their space in the technology industry are more palatable and more “useful” to our society.
Guess who is one of those “useful” techy autistics… yep, I fit the stereotype…
This can lead to the perception that these people aren’t actually autistic because they “function so well” in society and thus can exclude them from the communities and support that they should be able to receive as an autistic individual.
It’s something that affects me personally with ADHD. I recently watched a Webinar hosted by ADDitude by Dr William Dodson talking about emotional dysregulation and rejection sensitivity. He talks about how the diagnostic criteria for ADHD is not made for actually diagnosing, but for categorising people for research.
This means that the diagnostic criteria is built around describing behaviours, how people behave, how they’re sleeping and things like that. It doesn’t include any of the things that are internal to us.
I personally am someone whose ADHD presents very internally and my biggest struggle with my ADHD is the emotional dysregulation. But emotional dysregulation isn’t on the diagnostic criteria so my report doesn’t recommend putting me on medication, despite, as Dr Dodson describes, medication being the best treatment for ADHD emotional dysregulation. I am currently fighting to get the treatment I need because the diagnostic criteria is exclusionary towards me.
Stenning and Bertilsdotter-Rosqvist’s response to this is that we neurodivergents are reclaiming the pathologizing aspects of our diagnoses and reframing it as a position from which we can claim resources, representation and recognition. That we should be working with neurodivergent individuals to learn what neurodiveristy actually looks like, remove the stigma and thus understand what it actually means to be neurodivergent, neurotypical or just a neurodiverse group of humans.
Now this is a natural place for me to conclude but I think there’s something I’ve been missing from the conversation so far, and that is that if neurodivergence is just a natural difference, part of neurodiversity, then why do some people find it so much harder than others? Why is some people’s dyslexia very disabling while others can use it as an advantage?
In order to answer these questions we need to delve into the topics of models of disability to be able to understand the complicated relationship between neurodivergence, neurodiversity and disability. While the paper I read doesn’t cover this explicitly, a book featuring the same authors does. So next week we will dive into this concept a little further.
References:
Personality and Self-Insight in Individuals with Autism Spectrum Disorder, (Schriber et al., 2014)
Tourette syndrome and other neurodevelopmental disorders: a comprehensive overview (Cravedi, 2017)
If this resonates with you and feel you would be interested in talking to an adhd and autism-friendly coach, feel free to get in touch. If you’re looking for more blog posts, you can find them here.
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