Motivational Interviewing for Neurodivergent Minds

Chapter 1: Different Brains, Different Conversations Neurological considerations Sarah sits across from her therapist, fidgeting with a small rubber cube in her hands. The therapist leans forward with what she hopes is an encouraging smile and asks, "What would you like to be different in your life?" Sarah's eyes dart to the window, then to her hands, anywhere but the therapist's face. After a long pause, she responds with laser precision: "Different how? Different from what baseline? Are we talking about behavioral changes, environmental modifications, or internal state alterations?" The therapist blinks. She wasn't expecting a request for clarification of her open-ended question. This is motivational interviewing 101-start broad, let the client guide the conversation. But Sarah's brain doesn't work the way the textbooks assume brains work. Welcome to the reality of motivational interviewing with neurodivergent minds. Understanding neurodivergent brain differences Traditional motivational interviewing assumes certain things about how brains process information, handle social interaction, and respond to emotional appeals. These assumptions work beautifully for neurotypical individuals. For neurodivergent people-those with autism, ADHD, and other neurological differences-these same assumptions can create barriers instead of bridges to change. Neurodivergent brains aren't broken versions of typical brains. They're different operating systems running on different hardware. When we try to run neurotypical software on neurodivergent hardware, things get glitchy fast. The autism spectrum brings us minds that process information with remarkable precision but struggle with ambiguity. An autistic person might interpret "How are you feeling about this?" as genuinely requesting a detailed physiological and emotional status report rather than recognizing it as a conversation opener. Their brains excel at pattern recognition and systematic thinking but may miss the subtle social cues that guide typical therapeutic conversations. ADHD brains operate on a different reward system entirely. The neurotypical assumption that people can sustain attention on important-but-boring topics falls apart when dopamine doesn't fire for "should" activities. An ADHD brain might fully engage with passionate intensity about topics that capture their interest while appearing distracted or resistant when discussing changes they intellectually know they need to make. These aren't character flaws or deficits in willpower. They're neurological realities that require us to adapt our approach. Dr. Ari Ne'eman, a prominent autism self-advocate, explains that autistic people often process social and emotional information differently, not deficiently (Ne'eman, 2010). When we understand these differences as variations rather than impairments, we can work with the brain's natural patterns instead of against them. Research in neurodiversity reveals that executive function differences in ADHD aren't about lacking motivation-they're about having a brain that requires different kinds of scaffolding to support planning, attention, and follow-through (Barkley, 2018). The dopamine dysregulation that characterizes ADHD means that traditional motivational approaches that rely on delayed gratification or "should" motivation often fail to engage the brain's reward circuits. Traditional MI assumptions vs. neurodivergent realities Classic motivational interviewing rests on several foundational assumptions that don't always match neurodivergent cognitive patterns. Let's examine where these assumptions break down and why. Assumption 1: Open-ended questions promote exploration Traditional MI trains us to ask broad, exploratory questions like "Tell me about your concerns" or "What brings you here today?" The theory suggests that open-ended questions give people space to share what's most important to them. Neurodivergent reality: Many autistic individuals find open-ended questions overwhelming or confusing. Without clear parameters, they may not know where to start or what level of detail is expected. An autistic person might respond to "Tell me about your concerns" with either a overwhelmed silence or an exhaustively detailed forty-minute monologue covering every possible interpretation of the word "concerns." Better approach: Start with more structured questions that still honor the person's autonomy. "I'm curious about three specific areas of your life-work, relationships, and daily routines. Which of these would you like to talk about first?" This provides structure while preserving choice. Assumption 2: Reflective listening builds rapport Standard MI emphasizes reflecting back what you hear, often with slight emotional amplification: "It sounds like you're really frustrated with how things are going at work." Neurodivergent reality: Some autistic individuals interpret reflective statements as the listener not paying attention or not understanding correctly. If they just explained their situation, why is the person repeating it back differently? This can feel condescending or confusing rather than validating. ADHD individuals might find reflective listening slow and repetitive, causing their attention to drift just when you're trying to build connection. Better approach: Use more direct acknowledgments combined with clarifying questions. "I heard you say work is frustrating. Help me understand specifically which parts feel most challenging right now." Assumption 3: Ambivalence is normal and workable Traditional MI expects ambivalence about change and treats it as a natural part of the process to explore and resolve. Neurodivergent reality: Autistic individuals often experience less ambivalence and more clarity about what they want, but they may struggle with the social expectations or sensory demands of change rather than mixed feelings about the change itself. Their resistance might be practical rather than emotional. ADHD individuals might feel certain about wanting change in the moment but struggle with the sustained attention and executive function demands required to implement changes over time. Their "ambivalence" might actually be realistic assessment of their brain's capabilities. Better approach: Distinguish between emotional ambivalence and practical barriers. Ask directly about obstacles rather than assuming mixed feelings. Assumption 4: People can identify and articulate their intrinsic motivations MI assumes people can recognize and express what matters most to them when given the right conversational space. Neurodivergent reality: Alexithymia-difficulty identifying and describing emotions-occurs in up to 50% of autistic individuals (Kinnaird et al., 2019). Asking someone who struggles with emotional awareness to identify their deepest motivations can be frustrating and unproductive. ADHD individuals might have very clear motivations in the moment but struggle to access those same motivations when they're in a different emotional or energy state. Better approach: Use concrete examples and behavioral observations to help people identify patterns in their motivations over time. The neurodiversity-affirming approach to change conversations A neurodiversity-affirming approach starts with a fundamental shift in perspective: neurodivergent traits aren't pathological symptoms to eliminate but natural variations that bring both strengths and challenges. This changes everything about how we approach change conversations. Instead of: "How can we help you overcome your ADHD symptoms that interfere with your goals?" Try: "How can we work with your ADHD brain to create systems that support your goals?" This isn't just semantic politeness. The language reflects a deeper philosophical shift from a deficit model to a difference model. When we pathologize neurodivergent traits, we often end up fighting against the person's natural neurology. When we work with neurological differences, we can harness their strengths while providing support for genuine challenges. Take stimming-repetitive movements that many autistic people engage in. Traditional approaches might view stimming as a behavior to reduce or eliminate. A neurodiversity-affirming approach recognizes stimming as a valuable self-regulation strategy and asks how to accommodate it rather than suppress it. Marcus, a 28-year-old software developer with autism, rocks gently in his chair during therapy sessions. Instead of asking him to sit still, his therapist provides a rocking chair and notices that Marcus is most articulate and engaged when he can move rhythmically. The stimming isn't interfering with the conversation-it's supporting it. Neurodiversity-affirming practice means adapting goals and settings to the person's natural communication and sensory patterns-rather than forcing "typical" behaviours like sustained eye contact or a single style of social reciprocity. Communication difficulties are often bi-directional between autistic and non-autistic people (the "double empathy problem"), and autistic-to-autistic communication can be highly effective; current consensus guidance describes what affirming practice should...