Listening for Intersections of Neurodivergent Experience and Perinatal Mental Health

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By Chelsea Blackwell, CPM, PMH-C

As a midwife and perinatal psychological well being knowledgeable, I’ve listened to hundreds of latest dad and mom specific and navigate their psychological well being wants. These intimate conversations give me a novel lens into emergent themes in perinatal psychological well being.¹ As I’ve discovered extra about neurodivergent (ND) psychological well being, particularly the experiences of women and girls, I’ve begun to note the methods this intersects with and impacts perinatal seasons. I’ve began to listen to undertones of neurodivergent expertise in most of the perinatal individuals I work with, and it’s changing into clear how lack of help for neurodivergent ladies units the stage for Perinatal Psychological Well being Issues (PMHDs). Merriam-Webster defines Neurodivergent as:

“having or regarding a dysfunction or situation (akin to autism spectrum dysfunction, consideration deficit hyperactivity dysfunction, dyslexia, or obsessive-compulsive dysfunction) that impacts the way in which the mind processes info: exhibiting or attribute of variations in typical neurological growth”

In his e book, Neurotribes, Steve Silberman provides this strengths-based definition:

“…circumstances like autism, dyslexia, and attention-deficit/hyperactivity dysfunction (ADHD) needs to be thought to be naturally occurring cognitive variations with distinctive strengths which have contributed to the evolution of know-how and tradition somewhat than mere checklists of deficits and dysfunctions.”

In the US, consciousness of how ND expertise impacts perinatal psychological well being is rising, however we’re nonetheless within the nascent phases of offering help that’s tailor-made to the distinctive nervous techniques, wants, and experiences of neurodivergent ladies within the perinatal interval. The most important barrier to offering this help is that the majority neurodivergent ladies are undiagnosed. ^2,3

The “naturally occurring cognitive variations” in neurodivergent nervous techniques contain how environmental, social, and emotional stimuli are processed. ND brains and our bodies attune to and take in extra stimuli and reply to it in a number of areas of the mind. It has been discovered that neurodivergent individuals have much less circulating hormones and neurotransmitters that help temper and government operate. These variations make transitional life phases, akin to parenting and perinatal seasons, extraordinarily difficult and may mark a psychological well being breaking level for undiagnosed grownup ladies. This breaking level nearly at all times meets diagnostic standards for PMHDs and whereas many widespread therapies could be useful to neurodivergent moms, key features of their psychological well being stay invisible.

Neurodivergent perinatal ladies deserve an method that’s tailor-made to their distinctive nervous techniques. They want psychoeducation that helps them perceive why the perinatal interval is so intense, and therapeutic help in rewiring detrimental internalized messages. They may thrive with validation that highlights their strengths and coping that helps them artfully handle challenges and understand their potential.

Addressing the Wants of Neurodivergent Girls within the Perinatal Interval

How do perinatal suppliers and professionals start to deal with the wants of neurodivergent ladies who’re unaware of the foundation reason for their continual psychological well being challenges, are already navigating the sequelae of an untreated situation, and (as if that isn’t already sufficient?!) are derailed by the change and chaos of the perinatal season?

We begin by rising consciousness inside our discipline and in our work with perinatal individuals. Marginalization and gender-bias present necessary context for understanding the psychological well being image of an undiagnosed pregnant or postpartum lady. Though grownup women and men are equally doubtless to have ADHD, boys are 15% extra prone to be identified throughout childhood, and in line with UCLA Well being, “practically 80% of Autistic females are undiagnosed as of 18.” This lack of attunement to the experiences of neurodivergent ladies renders their items and struggles invisible- not solely to adults round them but additionally to themselves.

Perinatal ladies presenting with neurodivergent “variations” discovered to cover (masks) and handle their signs to operate comparatively properly regardless of this vacuum of help. Adaptability is certainly a energy, however hiding variations and difficulties whereas receiving no help requires huge quantities of bodily and emotional power. This continual power drain is one layer of the unconscious adaptive load⁴ that undiagnosed ND ladies carry all through their growth.

Internalized trauma and detrimental self-concept are two extra layers that develop each inside the limitations of that power drain and from being chronically unseen and misunderstood of their households, communities, studying environments, and social techniques that heart completely different skills. Arline Geronimous⁵ coined the time period “weathering” to explain “how inhabitants teams who expertise systemic cultural oppression, long-term materials hardship, exploitation, stigma and political marginalization endure organic getting older lengthy earlier than they’re chronologically outdated.” Neurodivergent women and girls with marginalized identities akin to BIPOC, LGBTQIA+, first-generation and new Individuals, in a different way abled people and people with continual medical circumstances expertise psychological & bodily weathering that intersects and overlaps with neurodivergent weathering.

Carrying this unconscious adaptive load and different sources of weathering funnels important power away from growing the self consciousness and coping expertise neurodivergent ladies have to thrive, and is a barrier to accessing help that may reduce impacts of studying variations. This is the reason so many unsupported ND ladies have low self-worth and underrealized potential. This is the reason neurodivergent younger ladies ceaselessly develop comorbid circumstances like anxiousness, melancholy, and substance use issues.⁶

Understanding the accrued psychological well being sequelae of neurodivergent moms informs how we maintain them throughout pregnant, birthing and postpartum experiences. As birthworkers, doulas, nurses, midwives, medical doctors, and psychological well being suppliers we have now a possibility to develop our responsiveness to those moms in methods that may profoundly enhance their wellbeing- not simply throughout the perinatal season however for the remainder of their lives.

Placing Psychoeducation and Validation Abilities to Work

You don’t should overstep your position to make this distinction. Nicely-crafted psychoeducation and compassionate validation supply quick aid to a struggling mother and plant highly effective seeds of long run change. Whereas evaluation and analysis are important to medical therapy & lodging, they aren’t obligatory to assist neurodivergent perinatal individuals start to deal with points impacting them. If we glance somewhat deeper, pay attention fastidiously and develop our psychoeducation and validation expertise, we will help these ladies to combine their neurodivergent wants with their perinatal and parenting journeys.

Encouraging self assessments and bibliotherapy are useful preliminary steps to share. ADDitude and Autism Speaks web sites are dependable favorites that embody self evaluation instruments and referrals. Discussing formal analysis and the potential entry obstacles akin to inherent bias, price, restricted availability of suppliers skilled with excessive functioning grownup females, and particular person priorities, can help subsequent steps. Widespread therapies are remedy, teaching and medicines that enhance signs. Suppliers are inspired to hunt further coaching in neurodivergent psychological well being (assets offered beneath).

Cultural Norms and the Neurodivergent Expertise

It’s necessary to needless to say familial, group and cultural norms and expectations inform how psychological well being wants are internalized and expressed. Neurodivergent perinatal expertise isn’t any extra a monolith than our rainbow nation with the distinctive people and various communities we’re blessed to be in group with. For those who maintain social identities which can be systemically privileged remember that, with out intending hurt, our gaze usually facilities and standardizes our expertise and neurodiversity in perinatal psychological well being requires a multicultural lens.

Increasing consciousness and offering normal info, inclusive assets and referrals are foundational steps to supporting the wants of neurodivergent perinatal ladies. And, we will achieve this rather more by studying to pay attention for the intersections of neurodivergent expertise in perinatal narratives. Attuning to the underlayer of neurodivergent expertise throughout the perinatal season is nuanced as a result of it mirrors and overlaps with PMHD symptomology. In my work, I’ve observed the next key themes:

detrimental self idea/guilt/disgrace
government operate (EF) challenges
emotional & sensory overwhelm

Searching for Cues in Neurodivergent Perinatal Girls

All perinatal individuals expertise guilt, disruption to routine and overwhelm. PMHDs enhance frequency and depth and influence day by day functioning in these areas. As a result of neurodivergent ladies enter the perinatal season with an power deficit and their nervous techniques are naturally extra triggered by the calls for of the fourth trimester, their capability to manage is commonly extraordinarily low. If we all know what to pay attention for and set up belief and rapport, ND ladies are prone to share necessary cues pointing to neurodivergent expertise. These cues could be direct or oblique. Direct cues are when somebody shares their very own struggles as in; “I don’t know what’s fallacious with me…” or within the case of somatic expression, “I’ve fixed head aches…” Oblique cues convey necessary details about psychological well being by an individual’s projections, decisions, relationships, or different psychological well being circumstances. One neurodivergent perinatal lady could talk her detrimental self idea by saying: “I really feel like such a failure…” One other could not discuss herself in any respect however her expertise of detrimental self idea is mirrored in her main criticism of a poisonous relationship. A brand new mom experiencing a substance use dysfunction (SUD) deserves our consciousness that SUD’s typically supply from unresolved neurodivergent trauma that shatters self value.

Are all perinatal ladies experiencing an SUD or a poisonous relationship neurodivergent? Do all perinatal complications supply from the unmet want for decrease stim environments? Bleep no! Is it necessary to acknowledge the vary of expression throughout people, communities, and cultures? Completely. Oblique cues are legitimate methods of expressing psychological well being wants, and since they will level to a number of wants, they have to be understood inside the wider context inside which they’re shared.

Whether or not straight or not directly, neurodivergent perinatal ladies are expressing their struggles, and we will enhance how we pay attention and reply. Sharing could be therapeutic in and of itself, however we will additionally hear it for the invitation it’s. Whether or not acutely aware of it or not, ND mothers are searching for individuals and environments that help their well-being and validate their value. This searching for is woven into their narratives. If we’re listening fastidiously for a way these themes emerge in dialogue, we will settle for their invitation for help. So what precisely are we listening for, and the way can we differentiate from typical PMHD signs?

Depth, Complexity, and Different Elements

Typically, neurodivergent ladies will current with a better degree of depth and/or cognitive complexity. Not solely the depth of expertise, however they current as intense. This may be outwardly expressed with a loud voice, extremely animated, and frequent use of hyperbole. Depth and complexity can be expressed with an inward have an effect on that will sound flat and distant, contain restricted verbal expression/sharing, and be extraordinarily direct by neurotypical requirements. You would possibly hear her say (loudly) “I’m shedding my shit on a regular basis!” or (very softly) “I didn’t need to be a mother or father…typically I simply need to disappear…” Projecting on others and/or inserting all blame and duty on others is one other manner this may be expressed: “Nobody is there for me; nobody helps me; nobody cares…” “My mother does X; my accomplice says Y…”

Cognitive complexity can sound loads like anxiousness, and whereas they do overlap, neurodivergent brains are inherently extremely lively. Pay attention for fast speech, frequent subject shifting, intensive and layered connections of ideas and concepts.

One other key distinction is that detrimental self-concept, EF challenges, and emotional and sensory overwhelm have been lifetime challenges for ND ladies that the surge of perinatal stressors exacerbates and intensifies. Her detrimental self-concept is not going to be restricted to the perinatal interval, however is deeper and wider. Pay attention for long-term detrimental self-concept and a historical past of psychological well being diagnoses. The desk beneath provides a spectrum of direct and oblique listening cues, and scripting that weaves psychoeducation and validation into our conversations with perinatal ladies who current with neurodivergent traits.

These easy scripts might help a neurodivergent lady who has felt invisible and incapable her whole life really feel seen and supported. The phrases we share have the ability to plant seeds of reassurance, hope, and alter. She will be able to hear in them that she will not be inherently flawed in spite of everything, that her variations can be strengths. We will present her that she just isn’t alone, she is to not blame, and with assist that honors and helps her whole-complex-neurodivergent-being, she might be properly.

Assets:

ADDitude.com
Edge Foundation: A Hug for the ADHD Moms
Autismspeaks.org

For Suppliers:

Project Teach NY: Free webinar on the treatment of ADHD in perinatal people
Perinatal Collaborative Care Collective
ADDitude: Moms with ADHD
PESI: Neurodiversity in Women: Therapeutic Strategies for Empowering Women with Autism or ADHD

References:

¹ LGBTQIA+ of us create and nourish households and deserve sturdy helps and elevated illustration in perinatal psychological well being discussions. A (small) 2025 examine cited beneath, explores well being fairness for LGBTQIA+ and ND of us from the lens of a midwifery schooling program.
² https://www.uclahealth.org/news/article/understanding-undiagnosed-autism-adult-female
³ https://pmc.ncbi.nlm.nih.gov/articles/PMC10173330
⁴ This can be a phrase I coined – Chelsea Blackwell 2025
⁵ https://psc.isr.umich.edu/news/a-monumental-new-book-weathering-arline-geronimuss-lifes-work
⁶ Rogers We Demand Consideration on Understanding Why Comorbid Situations Like Nervousness and Despair Uniquely Affect Girls with ADHD

In regards to the Writer

Chelsea Blackwell, CPM, PMH-C

Chelsea Blackwell, CPM, PMH-C, is a midwife and perinatal psychological well being knowledgeable who sees magnificence all over the place. In her 17 years serving perinatal individuals, she is regularly impressed by the moms of this world and their shimmering capability for love and resilience. She is satisfied that centering the wants of perinatal individuals can heal households, communities, societies, and perhaps even the entire, hurting, lovely human world. Visit her website.