By Adam D. Blum, Founder and Director, Gay Therapy Center
Have you been noticing more people getting diagnosed with autism and/or ADHD? Especially those in the LGBTQ+ community? If so, you’re not alone. There is an increasing awareness and understanding that autism and ADHD often overlap with each other — and with LGBTQ+ identities.
Dr. Brandon Guin, a licensed psychotherapist and gay man, and a Gay Therapy Center therapist, is an expert at navigating those intersections. He found a passion for working with autistic people while studying psychology in undergrad. But it was in the early 2000s, when there was a limited understanding of neurodivergence.
He attended grad school to learn more and interned at a family foster agency, supporting people diagnosed with autism. He noticed the treatment protocols for autistic people at the time mostly focused on behavior or speech, neglecting their mental health and nervous systems. Determined to find a better, more holistic way to help neurodiverse people thrive, he attended another graduate program with an emphasis on neurology and physiology. Through this work, he developed his own whole-person approach.
For a time, his career progressed and he did less hands-on work and more supervising other therapists. But his magic touch remained in demand, especially as people he referred out reported back that other therapists “didn’t get it” or know how to communicate with them.
So he went into private practice, focusing on mental health for neurodiverse patients, especially in the LGBTQ+ community. He sees more people coming in the door with autism and/or ADHD diagnoses, but it’s not because it’s trendy, he says. It’s because society is finally gaining a better understanding of how neurodivergence shows up differently for people, and social media has helped many better understand themselves and prompt them to get support.
Gay Therapy Center interviewed Dr. Guin to learn more about why ADHD and autism so often overlap, why neurodiverse people are frequently also LGBTQ+, and why therapy can be so beneficial for those at this intersection.
Why is this topic so important right now?
There’s an overlap in the double layers of stress for being LGBTQIA and neurodivergent. Current discourse about topics such as the cause of autism, whether neurodivergent individuals need to go to a rehabilitation camp, and conversion therapy is increasing stress for many of the individuals I work with. There’s an increased need for everyone, especially therapists, to understand and support both people who are LGBTQIA and people who are neurodivergent.
People who are neurodivergent, particularly those with autism or ADHD, are more likely to identify as LGBTQ+ than neurotypical people. There’s more research with autism, and the correlation with being LGBTQ+ is even higher than ADHD.
What might be some of the reasons for this?
Both groups — neurodivergent and LGBTQ+ — are marginalized. I think sometimes when you already find yourself in a marginalized group, you experience life differently, you question things more. You are open to seeing things from different lenses, so I think that probably contributes to the overlap.
How interesting. Putting the LGBTQ+ identity aside, why are so many people diagnosed with both ADHD and autism?
ADHD and autism are like a venn diagram, with unique experiences but shared similarities. Both are neurodevelopmental conditions that share genetic origins. Compared to neurotypical individuals, autism and ADHD share differences in executive functioning, attention, and emotional regulation.
There are also some similarities in the way they experience the world; both groups tend to have sensory sensitivities and differences in the way the brain and the body perceive their environment. Whether you’re diagnosed with autism or with ADHD, certain environments can be over- or under-stimulating in certain ways, including from sights, smells, or textures. People usually associate that with autism, but it’s very common among people with ADHD too.
They aren’t the same, though; for example, with autism, there can be social and communication differences, along with preferences for sameness and predictability, which you don’t typically see with ADHD.
How frequently do ADHD and autism overlap?
People may not realize that before 2013, you could not be diagnosed with autism and ADHD at the same time. I was in the field at the time and thought it was an odd diagnostic exclusion.
Then there was a big shift in 2013 when the Diagnostic and Statistical Manual of Mental Disorders was updated to allow it. ADHD symptoms occur in autistic people much more than in the general population. Percentages vary based on which research you’re looking at; however, there is a large number of individuals who are both autistic and have ADHD.
Are there any unique issues you’ve seen with LGBTQ neurodivergent clients compared to straight and cis neurodiverse folks?
Yes, and I think there are unique issues even in how it shows up within the LGBTQ population.
If you’re straight and cis and you’re neurodivergent, you have to deal with being in a marginalized group. If you’re LGBTQ+ and you’re neurodivergent, you experience double marginalization.
Both groups, whether LGBTQ or neurodivergent, have higher rates of depression and suicidal ideation. When looking at someone in both communities, it comes up more. I don’t want to create stigma; it’s not because of anything innate, but because of all of these things happening underneath. There are higher rates of bullying and discrimination. There’s a lack of accommodation across settings. And masking to try to fit in occurs both within neurodivergence and masking occurs within the LGBTQ+ community.
Yes, it’s so important to acknowledge that being LGBTQ+ and/or neurodivergent doesn’t give you mental health problems — it’s the external stressors.
Yes! Being neurodivergent and LGBTQ results in multiple pressures to mask to try to fit in. And people may not feel fully accepted within either group.
Each group has its own expectations. Say for example you’re an autistic gay man. There are expectations and understanding of what behavior might be like within an autistic circle, and then there are expectations about what behavior should be like within gay men. If you’re autistic and it’s harder for you to initiate conversations or be really social and outgoing, you might face challenges since the social expectation might be that gay men are social and outgoing. If that’s not who you naturally are, you might struggle to feel accepted. It may be more challenging to connect with and find groups that fully accept and embrace both of your identities.
How else does neurodivergence show up differently within LGBTQ+ identities?
It can impact those within the LGBTQ+ community very differently, especially when it comes to gender and sex since that affects how people are perceived and what they experience.
If you look at research and history, lesbians are more likely to feel invisible within LGBTQ culture. Then with ADHD and autism, the attention and focus has been on men, especially white. There are gender stereotypes that boys are hyperactive and girls are not, so women have a greater likelihood for later diagnosis for neurodivergence.
For gay men, as I mentioned, there’s a pressure to conform socially. Even if you’re not naturally socially engaged and going out and about, there may be a higher pressure to mask.
I think for people who identify as bisexual or pansexual, there can be additional frustrations as many dismiss your experience and identity. I think if you overlap that bisexuality with neurodivergence, there’s a lot of overlap with being told “you’re confused” or maybe “you don’t really know, everyone’s a little autistic, right?” Or “you just haven’t had enough experience.” There may be multiple layers of feeling dismissed and wanting to just live life your way.
What’s really interesting is that individuals who are transgender or non-binary have the highest level of overlap with neurodivergence. And as someone who specializes in this area, lots of my clients are trans and or nonbinary and also autistic or ADHD.
Why do you think that is?
Transgender, nonbinary or gender-diverse individuals and neurodiverse individuals both share experiences of social difference and atypical cognition. They frequently share characteristics such as introspection and identity questioning. They both might also face frustrating expectations and ideas from other people about what’s right for their bodies. As a result, they may be more likely to seek out support from a therapist.
Do we know what causes neurodivergence in the first place and why we see more diagnoses now?
There’s no singular cause, but science consistently shows high genetic underpinnings. If you’re autistic or you have ADHD, it’s very, very likely that someone else in your family does too.
I don’t think incidents of these are increasing; I think more individuals are being diagnosed with ADHD and autism because we have better understanding of these neurotypes, reduced stigma, and better access to services.
Also, as I said, in 2013, the definition and category of autism completely changed and was broadened. You no longer have to be an extremely wealthy family to get a diagnosis now; that’s how it used to be, but now insurance companies cover diagnosis, and even receiving a diagnosis makes a big difference. Though there is still some stigma, and it can vary based on where someone is located and if they’re in a state that offers support and resources.
I know part of your work focuses on providing psychotherapy to neurodivergent people, and you’ve noted this is often neglected. What types of issues do these folks come to you seeking support for?
There are a few common reasons. Sometimes people come to me for a diagnosis because they’re curious or have a suspicion. Maybe they’ve gotten feedback from friends, or seen themselves in an autistic person on TikTok. They want to better understand themselves.
If they’re already diagnosed, I often see neurodiverse people for anxiety and depression. A lot of people also have trauma. Sometimes it’s a specific incident, like an assault. But there’s a lot of developmental trauma, like consistently over time experiencing bullying, not fitting in and difficulty making friends or maintaining relationships. They might have communication differences that make relationships challenging with friends, family, and romantic partners. Sometimes people that we have relationships with don’t fully understand what it means to be autistic or to have ADHD, so there can be misunderstandings.
Other people come to me with work and employment issues. For example, they might say that they’ve been written up twice and are at risk of losing their job and need help.
I have worked with autistic individuals and observed how if someone isn’t well understood or supported, it can be difficult for everyone involved.
Autistic people sometimes struggle with flexibility and prefer predictability, so there can be misunderstandings and frustrations in the workplace. I often work with clients on addressing their employment challenges and helping them understand what’s really going on.
Some of these groups’ traits are misunderstood as negative but can be really positive, like how autistic people have a strong sense of justice. Historically, there’s been a big misconception that they don’t have empathy. In fact, there’s deep empathy in many cases, which can make it really challenging to navigate a world that doesn’t value that.
There is also a big misunderstanding that people with ADHD can’t focus. That’s not true; if you give someone with ADHD a task they’re really interested in, they can go into a state of hyperfocus. They might be so focused, they don’t get up to go to the bathroom or eat or participate in small talk with coworkers. I think it’s a superpower, but in the workplace, it can show up as problematic.
Deep focus and hyperfocus can come with a level of expertise. Or someone who’s autistic can really easily become experts in specific fields if it’s aligned with what they’re interested in. People with autism also have strong pattern recognition.
There are some differences between the two; with autism, there can be a preference for predictability and sameness. With ADHD, there’s often more spontaneity and adaptability, more able to go with the flow, and sometimes a lot of creativity, innovation, and charisma.
So both autism and ADHD come with huge positives even if not everyone recognizes them that way. Sometimes workplace issues can be resolved as simply as making a request for an accommodation. I actually consult with a few companies that specifically work to help maintain employment for neurodiverse people. It’s wonderful, because workplace issues are common given that the way the world, our offices, and our communication are not set up to be inclusive. Neurodiverse people do best when they’re allowed to take care of themselves and do what’s best for their bodies.
Speaking of bodies, I know you’ve said that what goes on in neurodiverse peoples’ physical bodies is often ignored; why is it so important to consider this aspect?
Many neurodivergent individuals experience varying levels of arousal in their nervous system. That can include being really hyper-aroused, where their brains and bodies are on high alert for threats, like a hypervigilance.
This is also common for LGBTQIA+ individuals. The brain is constantly scanning the environment for things like: Where am I OK? Where can I just be me? Am I walking wrong? Am I saying the wrong thing? Did I not talk enough? Did I not give enough eye contact?
Anxiety is more heavily associated with hyperarousal, where the nervous system is more on alert. I work with these patients and remind them our brains are doing this for a reason; they are trying to keep us safe and alive. We look at what’s happening in their world that might be showing up as a threat and explore how we can decrease those threats. If we can’t, how do we help balance their nervous system so they’re not constantly hypervigilant when they’re safe and there is no threat, like when they’re home watching TV with their partner?
The opposite end of that is more closely associated with depression or being numb and kind of shut down. The nervous system can only take so much, and for some people, it goes from fight or flight into more of like a freeze response. Sometimes that can create problems within relationships because people will think that you’re shut down or you’re ignoring them.
My work with clients can be unique in that we do a nervous system check. If you’re in either extreme, hyper or hypo aroused, even with all the skills and practice in the world, it’s going to be really hard to connect with people in the way that you want. We all have a unique window of tolerance based on our genetics, environment, history, and more. My goal is to help people expand and find that sweet spot, where they aren’t over or under aroused, so they’re better able to be flexible and tolerate changes in their environment.
What are some of the other ways therapy can help neurodivergent and LGBTQ+ people
Many of the people who work with me were diagnosed as an adult. They’ve gone through their whole life experiencing things differently from others and not understanding what the heck’s going on.
They might have blamed themselves. “They tell me I’m supposed to sit still, I should be able to.” Or “I’m supposed to be able to focus on this” or “I need to eat this food but I don’t want to.” All of these pressures, without them really knowing it’s because their brain is different — not wrong.
Many individuals come to me looking for an initial diagnosis, or they weren’t diagnosed until adulthood. In addition to the somatic, or physical and nervous system work, a big part of my therapy with those diagnosed in adulthood is educational. Let’s talk about what’s actually happening here. I think that that brings validation and it supports an acceptance of self.
If someone has spent a whole lifetime feeling like they should be doing something a specific way and they just can’t, they can realize this is just how their brain works. They can better accept themselves. I work with people on learning how to optimize their brain and their experience, versus trying to make it fit in with what other people say their experience is supposed to be. I want to help them find a sweet spot for their own brain.
I also see all the time that my clients have experienced years of shame and misunderstanding of who they are, because other people told them who they are. This can happen when you’re both neurodiverse and LGBTQIA+; years of shame and misunderstanding that can create trauma and double minority stress.
Therapy is a space to release that, better understand themselves, and develop new skills to navigate a world designed for neurotypical people. Therapy should be a safe space for them to explore their identity, get support navigating relationships and improving communication, develop coping strategies that support their nervous system and optimize their brain function, and get help addressing trauma.
In my experience, neurodivergent individuals are the most beautiful, loving and caring people I’ve ever met. I think that’s because they bring a perspective to the human experience that only they can bring. They are important and belong just the way they are, and their experience isn’t something that needs to be cured.
There are many amazing therapists out there, including those who are LGBTQIA and/or neurodivergent. If you don’t find someone who’s a good fit right away, keep trying. You will find someone who understands and wants to help you get in touch with and show up as exactly who you are.
