Neurodivergent burnout and rising youth anxiety - No Such Thing as Normal

The body can shut down down when autistic, ADHD or AuDHD young people spend years trying to meet the demands of systems that do not work for them. Photo / 123RF

Youth anxiety rates have risen sharply in Aotearoa over the past decade. So toohave prescriptions for medications such as Selective Serotonin Reuptake Inhibitors (SSRIs). More children and teenagers are struggling with chronic stress, low mood and school refusal. And for those who are neurodivergent, these struggles are not just more common, they are also more complex.

So what exactly are we dealing with? And what helps? That’s the focus of the latest episode of No Such Thing As Normal, which looks at the nuances of distress in young people - particularly those with neurodivergent profiles - and at the roles of psychoeducation, therapy and SSRI medication treatments.

Child and adolescent psychiatrist Dr Darryl-Lee Prince has spent 25 years working with young people and says she is seeing more complex presentations in her clinic than ever before; combinations of ADHD, autism, anxiety and sometimes trauma, for example. The result can be significant functional impairment: withdrawal, shutdown and what she describes as “avoidance loops”.

But Prince says there’s another layer to this. “I don’t think it’s just more anxiety,” she says. “I think young people are finding it harder to regulate. Their nervous systems are chronically overstimulated.”

Child and adolescent psychiatrist Dr. Darryl-Lee Prince has spent 25 years working with young people and says she is seeing more complex presentations in her clinic than ever before. Photo / supplied.

In some cases, she says, young people with anxiety or low mood may be experiencing system overload. “We’re seeing a lot more neurodivergent burnout. People aren’t looking for it because it’s not formally recognised in the DSM [Diagnostic and Statistical Manual of Mental Disorders].”

Prince describes this type of burnout as the body shutting down when autistic, ADHD or AuDHD young people spend years trying to meet the demands of systems that do not work for them.

“They’re trying desperately to fit in, to be normal, and then … they just can’t anymore.”

This is a point host Sonia Gray returns to throughout the podcast series: neurodivergent profiles - like ADHD and autism - are not the root cause of the distress.

“The struggle comes from a misalignment with the environment,” Gray says, “from trying to function in a system that continually tells these brains they should go left, when they want to go right.”

Burnout in autistic and ADHD children can be difficult for parents to spot. Many children are skilled at masking, using enormous effort to appear calm, capable or “fine”. When they can no longer keep the mask up, the collapse can feel sudden, but it has often been years in the making.

Prince says recognising burnout is important because the response may need to be different. “The system’s overloaded,” she says. “We need to unload the system.”

That means reducing distress, supporting regulation, easing sensory overload, and putting the right accommodations in place.

But for some young people, reducing pressure and making accommodations is only part of the answer. Professor Dave Coghill says the most effective first-line treatment for anxiety is psychoeducation: helping young people and their families understand exactly what is going on in their brains.

Coghill, a child and adolescent psychiatrist based in Melbourne, co-authored the world’s first evidence-based guidelines for treating anxiety in children and young people.

The next step is evidence-based psychological therapy “but it has to include exposure”, Coghill says. That means helping a young person face anxiety safely, rather than simply avoiding it.

Medication, including SSRIs, may be added when anxiety or depression is moderate to severe, or when a young person is too overwhelmed to properly engage in therapy. They can be helpful, even life-changing, but Coghill and Prince are clear: medication needs to be part of a larger treatment plan.

“They’re not a solution to isolation. They’re not a solution to dysregulation.”

Listen to the full episode for more on:

• The safety of SSRI use in young people
• The effectiveness of alternative therapies for ADHD
• The surprising science around sugar and artificial food colouring.

No Such Thing as Normal is an NZ Herald podcast, hosted by Sonia Gray, with new episodes available every Saturday.

Made with the support of NZ on Air.

You can listen to it on iHeartRadio, Apple Podcasts, Spotify or wherever you get your podcasts.