“ADHD Coaching can be an important part of a comprehensive program for individuals with ADHD. Coaching intervention can make a real difference in how people with ADHD negotiate their own particular deficits and cope with life on a daily basis.”
– Attention Deficit Disorder Association (ADDA)

Hey there, incredible healthcare providers at QueerCME.org. In this feature, I’m going to ambitiously try to describe both why coaching is an important and effective addition to Queer Neurodivergent care, as well as elucidate some of the Neuro-Queer specific health concerns that the medical and coaching community are realizing. I’m going to try to write this both for support providers, as well as for those of us who may need support ourselves. The explosion of identifying ADHD & ASD in the general population has included increased awareness that many medical professionals have ADHD and/or ASD and may also reasonably need support accessing care for themselves.  

It’s well known that health outcomes & quality of life for LGBTQ and neurodivergent folx are reduced. Thus it is essential to understand and explore the contributing challenges. However, little research has been done about the way these identities combine to create additional obstacles & negative impact. One area we can create meaningful improvement is by preventing anxiety, depression, isolation, and the inability to access adequate healthcare. We can begin through collaborations between individuals, healthcare providers, and coaches.

The High Frequency of ADHD and Autism in the LGBTQ Community

“Being assigned female at birth while having a boy brain led to 25+ years of my ADHD symptoms presenting more like a typical boy’s. However, because I am female, I was just thought to be a tomboy or rebel and, as a result, nobody ever noticed my struggles trying to keep up with everybody else. I only got diagnosed when I went to grad school in the U.S. and my higher-than-average IQ couldn’t manage school, a part-time job, and taking care of myself.” — An ADDitude Reader

First, let's talk about frequency. People diagnosed with ADHD or Autism are far more likely to be LGBTQ. This overlap is not just a coincidence but a reflection of the complex interplay between neurodivergence and gender/sexual identity. To date, we aren’t sure if this correlation is entirely causal in a genetic sense, or if it’s also a result of neurodivergent culture, (e.i. A common hypothesis is when one diverges in one way, accepting other divergences in identity is easier; implying ND rates of LGBTQ are more accurate than those seen in the general population due to cis/het masking.).  Unfortunately, outdated research and pervasive stigma have often pathologized and patronized both groups, leading to a lack of proper care and understanding.Modern research, however, is attempting to shed light on these issues. 

How Coaching Complements Other Health Services

“Coaching is wonderful for those with ADHD because it gets to all the nitty, gritty stuff that medication does not address. Medication can reduce the symptoms of ADHD and help you concentrate, but it doesn’t teach you how to get organized or get that better job.”
— Patricia O. Quinn, M.D.

Coaching can be an invaluable supplement to traditional health services. It partners with clients right at the point of performance, where executive dysfunction often prevents theory from turning into action. Without partnering with the individual to establish their baseline of accessibility, directive strategies only create more stress and less functionality. Similarly, leaving things as theoretical, or colliding with Pathological Demand Avoidance, or Rejection Sensitive Dysphoria, can all perpetuate internalized ableism. Coaches pragmatically partner with individuals to assist with implementing interventions. Without specialized training in neurodivergence it’s easy to miss how dopamine, executive functions, and sensory overwhelm undermine willpower and the ability to manifest intentions toward goal achievement. 

Examples of Coaching in Action:

• Appointments: Coaches can help clients develop scripts  for making phone calls, reminders, anticipating an uncomfortable social interaction, regulating anxiety or fear of an appointment, turning a daunting task into a manageable one.
• Communicating with Care Providers: Coaches can help clients improve interoception, articulate symptoms, track changes & responses, advocate for tests or care, and communicate more effectively with their health team. 
• Medication: Establishing visual reminders and habit-stacking techniques can ensure that medications are taken consistently. Advocacy in asking questions about restrictive medication requirements. 
• Healthy Routines: Coaches support clients in setting realistic goals, establishing intentional routines, creating peer support and providing the encouragement needed to maintain these routines.

Overlapping Health Issues in ADHD, Autism, and LGBTQ Identities

As mentioned earlier, the intersection of ADHD, Autism, and LGBTQ identities often results in overlapping health concerns, including diminished life expectancy due to anxiety, depression, and isolation. This is called the Double Minority Effect, or the experience of having two culturally devalued identities combine to create a negative experience greater than the sum of the independent impacts of each identity, and it has been linked to higher mental distress, poorer well being, and increased risk of physical health issues.

  We also see significant comorbid conditions with ADHD & ASD, meaning these health conditions are also likely more common in the LGBTQ community. Unfortunately, as of yet, few professional associations have promoted following a diagnosis of Autism or ADHD with a complete health evaluation beyond a questionnaire. Screening for common comorbid conditions, such as musculoskeletal and nervous system issues, gastrointestinal (GI) problems, and the impact of hormone treatments, is crucial. The managing various health concerns often comes up in coaching, for example: 

• Mental Health: Anxiety, depression, isolation, OCD, Bipolar, 
• Comorbid Conditions: Neurodivergent individuals frequently experience conditions affecting musculoskeletal, nervous systems, & G.I. systems, including: COPD, Apnea, Epilepsy, PMDD, Migraines, POTS, Chronic Pain, Ehlers-Danlos, ARFID.  
• Hormone Treatments: For transgender individuals (as well as cisgender people with a menstrual cycle, menopause, or hormone replacement therapy), hormone treatments can interact with ADHD and Autistic symptoms, necessitating careful monitoring and adjustments in care plans. 

What we don’t entirely know yet is: How do these three categories interact? How might hormone fluctuations cause exacerbated ADHD symptoms which then reduce an individuals’ ability to adhere to a care plan? Anxiety about phone calls, sensory issues in the office, just as anxiety about transphobia or medication stigma, could reduce an individual’s ability to bring this concern to their medical providers? 

The Need for Culturally Competent, Customized and Contextualized Strategies

To be effective in our mutual goals of providing care for queer and neurodivergent individuals, coaches and medical providers must cultivate both queer and neurodivergent competence.This involves being curious, while understanding and respecting diverse genders and sexual orientations, and providing care that is inclusive and affirming. Providers should be knowledgeable about the specific challenges associated with ADHD and Autism, and tailor their approaches to meet these needs. Standardized, cookie-cutter approaches often fail for neurodivergent LGBTQ individuals. Strategies must be customized and contextualized to address the unique needs of each person.  Both queer and neurodivergent populations frequently engage in masking—adopting behaviors to fit societal norms, which can lead to stress and burnout, and misdiagnosis. 

• Masking and Dysmorphia: Masking behaviors, akin to performing "neurotypical drag," can exacerbate anxiety and depression. Masking may look like overperforming, minimizing symptoms, or giving anticipatorily ameliorative responses. Similarly, dysmorphia (whether physical or "neuro-dysmorphia") affects self-perception and mental health. Customized coaching can help clients develop authentic coping strategies and reduce the need for masking.
• Trauma-Informed Care: Recognizing the high prevalence of trauma in these populations is essential. It’s also a great way to approach people generally!  The core principles can help overcome cultural and communication challenges. Core Principles: Safety, Trust/Transparency, Peer Support, Collaboration, Empowerment/Voice/Choice, Cultural Awareness. 
• Awareness of Multiple Levels of Oppression: Coaches must be attuned to the various forms of oppression—such as ableism, homophobia, and transphobia—that impact their clients. This awareness helps address barriers to financial access, power, and agency. For example: Recent legislation in some areas has sought to prevent neurodivergent individuals from accessing transgender care, citing lack of capacity. An individual may not seek care for fear of their autonomy being taken away. 

Neurodivergent coaching offers a powerful tool for enhancing the health and wellbeing of neurodivergent LGBTQ individuals.Medical providers who understand the unique challenges and needs of this population can collaborate with coaches to offer comprehensive, empathetic, and effective care. Through trauma-informed practices and a commitment to queer and neurodivergent competence, providers can help ensure that neurodivergent LGBTQ individuals receive the support they need to thrive. We are in a historical moment of increased awareness and understanding. If you or someone you know needs support, please reach out. 

In this journey, let’s build a compassionate, inclusive, and effective support system that not only acknowledges the struggles but also celebrates the resilience and strength of neurodivergent LGBTQ individuals. Together, we can create a community where everyone feels understood, supported, and empowered to lead healthier, more fulfilling lives.

Dylan Alter, JD, AACC, CACP

www.AlternativeADHD.com  for 1:1 and group coaching. 

www.Neuroqueer.org: for peer support and empowerment, co-regulation, body doubling, workshops, access to various coaches and community at monthly membership of $25/month, less than a single 1:1 coaching or therapy session.