In a discussion on the topic of giftedness, Noks Nauta clearly opposed the use of the term neurodiversity. Instead of giving a detailed explanation, she referred to her blog post on this topic. It is written in Dutch, I have made a rough translation for my understanding with the help of DeepL.
Even though I personally hold Noks in high esteem and recognise her expertise, I was determined at the time to take a detailed counter-position here. I then looked into the subject in more detail.
Eric Papagelidis has added a very thoughtful text to the discussion and has allowed me to publish it here.
Among other things, I asked two child and adolescent psychiatrists I know for their opinion. Their unanimous response was that the term ‘neurodiversity’ plays no role in a professional context. However, clients and their parents bring the term into the diagnostic-therapeutic environment with different intentions. More on this later.
In my perception, neurodiversity originally referred to conditions such as autism or ADHD, which manifest themselves on a spectrum ranging from characteristic personality traits on the one hand to severe disability with the need for special support on the other.
Then there are conditions such as dyslexia or dyscalculia, which are usually only described as deficits. In the past, the term partial disability was used for this.
Tourette's or bipolar disorder can also have considerable consequences for a person's social integration and are generally regarded as illnesses worthy of treatment.
In addition, there are high sensitivity or synaesthesia, which describe a special experience of people, but whose effects are rather limited to the internal psychological processes of those affected.
And finally, giftedness, which has an almost exclusively positive connotation in society.
Seen in this light, neurodiversity is a collection of the most diverse mental states that are actually only connected by their deviation from the norm. This makes the term largely worthless for scientific or diagnostic use. However, it can still have an impact in social discussions. I will go into this in more detail below. I will primarily refer to ADHD and autism as forms of neurodiversity.
ADHD and autism are spectrum disorders, which means that they exist in very different forms, from mild cases that just fulfil the diagnostic criteria to severely affected people who cannot cope in society without appropriate help. There are also many people who only partially fulfil the description of the disorder, who do not have a diagnosable disorder, but who nevertheless benefit from dealing with these issues in their lives.
Although autism and ADHD were initially found to be medical terms for people in need of treatment, they are increasingly being used to describe milder, subclinical conditions. For those caring for those with severe disabilities, this may seem like a misleading dilution of the terms. On the other hand, it gives those who use it as a personality description a framework of understanding for their self-perceived otherness. Also, coping strategies for people with a proven ADHD or autism disorder can also be useful for people who do not fulfil these diagnostic criteria in the strict sense.
The accusation of trivialising disease concepts is understandable. The problems of the colleague who needs a quiet workplace and a structured task in order to be able to work properly are categorised in the same way as the stress of parents of a severely autistic child. The term autism or ADHD is used regardless of whether we are talking about a disability with disease value or a subjectively perceived speciality. But we also know this from other deviations from the norm. The conflicts of a person whose body shape exceeds the usual norms have nothing to do with the serious health problems associated with morbid obesity. And yet both fall under the heading of obesity.
This broad spectrum of manifestations also raises very different questions and problems for people who fall under the headings of autism or ADHD. But all of these issues are dealt with under the heading of autism or ADHD or neurodiversity. This is a source of misunderstanding and also different perspectives on the discussion.
Nevertheless, I see value in the description of these neurodiversities as traits below the borderline of pathology as drawn by the DSM. They are like pigeonholes or typologies that we can use to describe ourselves and our fellow human beings. They characterise a set of strengths and difficulties that often occur in combination. They allow people to understand themselves, find kindred spirits and share experiences and strategies. Teachers can categorise the children's abnormalities into pigeonholes, which then contain the appropriate help and interventions based on experience. One child needs a low-stimulus room, while another benefits from being allowed to run around the school playground in between. And the third needs more challenging, more interesting tasks.
Self-description in terms of neurodiversity can also create identity, as suggested by the attribution ‘I am autistic’. This can give rise to self-confidence, but it may also involve a narrowing of the view - after all, the person is not only autistic but also, for example, a musician, manager or neighbour. Neurodiversity then becomes an interpretative framework for the whole personality.
I learnt about ADHD when we were trying to understand the difficulties of a child in my environment. And the more I read about it, the more I came to understand the difficulties in my own childhood. Even though neither of us would probably fulfil the diagnostic criteria for ADHD as an illness, I found the knowledge of this personality structure very helpful. Traits or difficulties that I had previously perceived as my own inadequacies or lack of character were described here as typical of ADHD. It is a great relief for self-esteem that life problems can be seen as the result of a neurological peculiarity rather than a personal fault. Self-help groups for various problems may have a similar effect; knowing the stories of other sufferers gives a different perspective on one's own experience.
Lay people often claim that these neurodivergences can also be particular strengths. People with ADHD or autism have special abilities for certain professions or activities. This may be true, but it is difficult to separate it from the usual concept of specific, personal focal points of talent. For me, for example, my ADHD tendency may be a reason why intensive care and emergency medicine is a coherent field that is easily accessible to me. However, the fact that I have become a good intensive care doctor is not due to ADHD but to talent, interest and commitment. I might have been good at other subjects too, but I would have been much less satisfied.
The healthcare sector comes into contact with all forms of these spectrum disorders. In pathological cases, the role of the healthcare system is to provide therapy or to compensate for a disability. However, people who do not perceive themselves as manifestly ill due to their neurodivergence also seek a diagnosis. One motivation may be to obtain compensation for a disadvantage at school, university or work, or to improve performance with medication. The measures that are otherwise used to treat disorders become a tool for optimising life. However, the downside of a medical diagnosis can be that it restricts suitability for some professions (e.g. police service) and can therefore become a boomerang.
Perhaps, however, the pursuit of a medical diagnosis is also about confirming that subjectively perceived deficiencies are not a personal failure but the result of an objectifiable diagnosis. This corresponds with the demand on society to accept divergent forms of emotional and social experience as ‘normal’.
The concept of neurodiversity oscillates here between the expectation of recognising neurological peculiarity as an equivalent variant of normality and the demand for compensation for the social restrictions that this condition entails.
‘Everyone is an individual’ is worthless as an insight. Of course, everyone has their own individuality, but some are more successful than others, some have it easier than others, some swim along in society and others fall out. Everyone should be accepted and supported in their particular form of individuality.
But the type descriptions discussed here provide a framework for understanding the special characteristics of individual people. Without such mental schemata, it becomes too much of a challenge to recognise and do justice to everyone's specific characteristics.
Does giftedness belong within the conceptual horizon of neurodiversity? There are certainly parallels that suggest this: the subjective experience of being different, ‘not fitting’ into the structures of the education system and working life, the relief when those affected meet their peers and hear about similar experiences and life stories.
However, giftedness is not a uniform phenomenon. It relates to very different dimensions of intelligence (linguistic, analytical, mathematical, etc.) and overlaps with giftedness in areas such as music or social skills, which are not usually mapped in intelligence tests.
What fundamentally distinguishes giftedness from the phenomena of neurodiversity described above is that there is no pathological form of it and that it never requires therapy. It can lead to adaptation disorders to the environment, but is itself never a condition that is regarded as faulty or worthy of treatment. Its essence is that a socially desirable characteristic is particularly pronounced.
The connotation of illness that the term neurodiversity (with all the problems described) conveys makes it understandable why it is considered highly inappropriate in the context of giftedness by experts in the field.