Por que no los dos? - Why not both?

Putting a taco advertisement in a Neurodiversity blog post may seem a little unorthodox. I’m hoping that most Australians still remember this campaign that ran in the late ‘00s (sorry to Gen Zs or Alphas who probably have no idea what I’m talking about!). A feuding family who can’t decide whether to have hard or soft tacos are suddenly brought to reason by the wisdom of a 6-year-old girl who simply says “Por que no los dos?” (Why not both?). Thus, the family conflict is resolved, and everyone lived happily ever after with both their hard and soft tacos. A heart-warming tale if ever there was one!

What do tacos have to Neurodiversity you may ask? Fair question! Allow me to explain…

I began my career as a young, wide-eyed, and very “green” support worker in the foster care system. I’d finished my undergraduate in psychology and was excited to start working. Needless to say, working in foster care settings threw me straight into the deep end! The work was hard, and often involved responding to serious crises, but I loved my role and thrived in the high-paced environments it put me in.

The more I worked with these children and young people, the more I realised that I needed to learn so much more about trauma. My clients’ case files were full of details about horrific physical, sexual, and emotional abuse and/or neglect they had experienced since early childhood. It was widely discussed in care team meetings that these traumatic events were the likely cause of the challenging behaviours that we needed to manage as carers and support workers. However, we were rarely provided with information or strategies about how to support these children to heal from these events.

At 23, I read a book that had been recommended to me by a colleague in the industry. Little did I know that a new special interest was about to emerge that would change the course of my career. The book was called “The Body Keeps the Score” and I’ve often heard it referred to as the “Bible” for understanding trauma. Those who work in the helping profession will likely be aware of this book and the author’s (Bessel van der Kolk) subsequent work. For those who aren’t familiar, The Body Keeps the Score summarises approximately 30-40 years of research regarding the significant impact that traumatic events have on the brain and body.

Suddenly, I had an explanation for what I was seeing every day at work. Thus began my spiral down the research rabbit hole of trauma-informed practise. I devoured book after book and probably bored my colleagues half to death about all the things I was learning! Unsurprisingly, my reading led me to hearing about this different kind of therapy called Eye Movement Desensitisation and Reprocessing (EMDR), which is widely recognised for efficacy in the treatment of PTSD symptoms. A new special interest area quickly emerged, and I became immersed in the Australian EMDR community as a result.

A couple of years later, I moved interstate to Tasmania (the little island at the bottom of Australia – which is often left off the map!) and was warmly welcomed into a private practise as a psychologist. My new colleagues had a passion for an area of psychology called “Neurodiversity”, something I’d never really heard of before. I began to research and research Neurodiversity and began to integrate these principles into my therapeutic work with my clients. I was amazed at the ways Neurodiversity affirming models of therapy positively impacted my clients’ self-esteem and became even more passionate about learning all I could in the area.

I was also still really immersed in the Australian EMDR community and was excited to share my positive experiences of using EMDR with Autistic/ADHD clients. However, to my surprise, many of my EMDR peers (who I have huge respect for) almost rolled their eyes at my mention of “ADHD”. I became confused. These were the warmest therapists I knew and whom I had usually agreed with on most things. Thinking back to my days as a social worker, I remembered all the lengthy (and heated) office chats about over-medication of traumatised children. We were SO frustrated about health professionals not seeming to recognise the impact of trauma on our clients, and were really concerned about potential over-diagnosis of ADHD. I realised that when I was fully immersed in the world of traumatology, I too believed that ADHD was almost a myth in comparison to the impact of trauma on the nervous system! It was only because I now worked at a Neurodiversity affirming clinic that I had even learnt all these new things. Therefore, I understood that my brilliant EMDR colleagues held the same beliefs that I used to.

I went through a period trying to put all this conflicting information together. I still believed in the impact of trauma on the brain, nervous system, and overall wellbeing of my clients. However, I also now had all this information about Neurodivergence and how this also explained so much of what I was seeing clinically. As I looked more into the literature the answer was clear:

IT IS BOTH!

Research has consistently shown that Autistic/ADHD people are at significantly higher risk of having repeated traumatic experiences across their life. Poorer executive functioning, impulse control, and hyperactivity lead to increased likelihood of ADHD people engaging in risk-taking behaviour, including substance use, and criminal offending. Autistic people are more likely to experience abuse because of challenges understanding social cues and high risk of social isolation.

I started to wonder why more EMDR therapists weren’t talking about this issue. I understood that many clinicians dismissing ADHD as misdiagnosed trauma were doing so with the best of intentions. They were hoping to decrease the stigma associated with diagnostic labels and ensure that their client’s experiences of trauma were validated and appropriately treated. However, it suddenly seemed really strange to me that we were having this debate at all. Instead of arguing about whether ADHD is real or misdiagnosed trauma, I often felt like screaming in meetings “WHY NOT BOTH THOUGH?!” It. Just. Makes. Sense. Why not allow both things to be true and treat both the client’s experiences of trauma and provide support for remaining symptoms attributable to having a different type of brain?

My experience as a therapist who is passionate about both EMDR therapy and Neurodiversity-Affirming practise is that putting the two together can be so beneficial for Neurodivergent clients. So, for those who have followed this story along to the conclusion of this blog I ask you, why not have both Neurodiversity-Affirming practise and EMDR therapy a part of the way you work with Neurodivergent clients? Following the eternal wisdom of our dear taco fiesta friend has certainly served me well so far! I hope her famous phrase may also help you on your journey in putting these two essential methods for working with clients together too!