Is the current demand on school counsellors manageable when AuDHD - A reflexive piece.

© Jade Rita Taylor

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The reflections of a AuDHD counsellor working in a second school. I wanted to publish this as a literature review, but because time is not on my side, and research moves on quickly, I felt this is the best option.

I hope this proves insightful and interesting.

An Autistic and ADHD (AuADHD) Counsellor working in a Secondary School. The clash.

Introduction

Traditionally both autism and ADHD are associated with specific behaviours and traits (American Psychiatric Association, 2013).  It is historical fact that boys have a higher ratio of diagnoses than girls (First and Tasman, 2011). However, recent advancements in information and research show how Autism and ADHD present differently in those born females (Hull, Petrides and Mandy, 2020) and so the ratio gap is declining (Loomes, Hull and Mandy, 2017). While society catches up on such differences, there continues to be a stigma and assumptions around being Autistic or an ADHDer that cause difficulties with judgements and inclusion (Gates, 2019). It is argued that due to Autism being linked to foetal testosterone, regardless of the advancements in diagnoses, there will always be a male predisposition (Szalavitz, 2016), leaving females with struggles that go unsupported and importantly, unrecognised and understood in a social (in this case, work) environment (Bargiela, Steward and Mandy, 2016).

I am an AuADHD practitioner working in private practice with adults, children, and families. Being my organic self with clients does not ever pose a problem that can’t be managed. In fact, I would say who I am is celebrated in the inclusive environment I create. A local secondary school hires my business twice a week, and this is where the many agendas and my neurological needs can collide. I not only battle my conflicting neurological and neurobiological demands but also manage the agenda of the school. I campaign for the needs of the students against the restrictive resources of the school while navigating the social interactions with the staff and their individual agendas. Questioning the balance between positive rewards and nuisances.

Counselling in schools is crucial, especially for vulnerable children (Public Health England, 2021). I chose to work in a school, knowing that I could provide critically needed support to some young people who would be unable to afford my service. I run my business to a high standard, working with all young people and all concerns. Due to a much higher ratio of born females coming into my counselling room, I see autism and ADHD being brought at a substantial rate. Due to self-acceptance and growth being stunted without awareness of neurological differences (Zener, 2019), I identify traits in children that it is yet unrecognised. I am aware this is my expert view and I champion recognition of neurodiversity when difficulties are affecting the child’s mental health and quality of life. However, this is one area where my expertise and awareness clash with resources and educational expectations of high-achieving young people with mental health difficulties. 

I am a predominately person-centred practitioner, hired as the only counsellor in a secondary school and due to the significant waiting time for a diagnosis via the government’s child mental health service (CAMHS), schools are reluctant to refer students for Autism and/ or ADHD tests if it will disrupt educational achievements. This clashes with my knowledge of life-long difficulties of unrecognised ADHD and autism, especially in females (Rynkiewicz, Janas-Kozik and Słopień, 2019; Van Ameringen et al., 2010). This knowledge causes psychological distress to my own autistic brain, wanting to ensure I work ethically to the needs of the client, which in this case, there is no black-and-white answer. With multiple agendas and a lack of answers, the school environment can leave me dysregulated and overthinking. Questioning whether even with strict boundaries and honesty of my needs and modality, the lack of united insight would ever match a workable environment. This is especially true with my rigid and fixed nature, in an ever-changing school environment.

As an autistic working in a school, I am highly structured, organised, honest and professional, yet struggle with surface communication and meant intent. I find it difficult when my routine is changed, or I am asked to deliver a service without substantial notification. The school environment requires a counsellor to be fluid, progressive and adaptable (Good, 2008). Even though I am openly AuADHD and I do not feel an outwardly expressed sigma towards me, there can, however, certainly be mind-blindness, meaning a lack of understanding of my needs (Edey et al., 2016). Without the school having a working knowledge of my role and appreciation of my need for consistency, my routines and plans are challenged and altered, creating overwhelm and resulting in abrupt interactions. Even though I am confident in what I do and know the work I do with the children is unquestionable, the innate difference between school expectations and counselling can be quite divided, then mix in an AuADHD mind and it has felt unbearable at times.

As an ADHDer working in a school, the conflicting demands and clash of ideologies can trigger neurological overwhelm, overthinking and irrational thoughts, causing emotional dysregulation and accelerated burnout. Especially true when I feel my role is questioned or my boundaries are not respected, and I need to again assert myself and my role. I went into the school wanting to be part of a team, but as I have had to put up my boundaries, implement procedures and explain my practice, this team-working has become isolation and working alone. Continuous questioning and a difference in demands can cause internal uncertainty and autistic burnout. 

Essay Scope

Within this essay, I plan to examine autistic and ADHD differences in thinking and behaviour and how this is experienced within the counselling setting, giving specific focus to the difficulties then experienced in the school system. Reviewing the needs of an AuADHD counsellor and whether they can be united with school demands.

I intend to look at differences between the school requirements and the school counsellors’ capabilities, giving focus on how this then further impacts AuADHD processing. These sections are:

•           Autism versus the school system: This section will analyse the literature on Autism and compare its presentations against the requirements of a secondary school setting. Providing my own lived experiences and insight.

•           ADHD versus the school system: This section will analyse the literature on ADHD and compare its presentations against the requirements of a secondary school setting. Providing my own lived experiences and insight.

•           Is the need too great for my neurological capabilities: This section will explore the literature on the current demand for mental health support in schools and how this impacts the school counsellor. I will relate this to my professional modality and how this impacts my AuADHD needs.

•           The clash of referral needs: Within this section, I will analyse the literature on the current diagnosis and referral demands. Exploring the dangers and positives of recognising Autism and ADHD in the counselling room and how a difference in organisational constraints and ethos can affect my processing.  

These sections will provide a critical review with the intent to answer the essay question in two parts:

-           What are the difficulties an AuADHD counsellor will face in a school

-           How to keep the negatives from outweighing the positives.

I intend to critically reflect using Honey and Mumford’s learning style theory. Summarising that individuals learn in four distinct ways. I intend to apply this to my experiences within the school while also giving focus to my autistic and ADHD cognitive and behavioural differences.

Ethics

Due to my experiences being at a specific school, I will not disclose the name or location. Any information relating to students will be holistically disclosed as one experience and not individual incidents.

Due to the sensitive nature of some of my neurological and neurobehavioral presentations, I shall only discuss my reactions to the school environment.

All concerns and practice considerations have been discussed and reflected upon in supervision and with the school in question prior to writing this assignment. Because let me be honest. I was not going to be able to stifle them.

Literature Review

This section will explore the difficulties that arise in being an AuADHD counsellor working in the school system. Exploring the wider context and expectations of mental health support needs for young people and the ethical considerations of when opposing values collide.

-           Autism versus the school system

Within this section, I intend to reflect on some Autistic and ADHD traits and how they may present in the school context. Evaluating against the needs of a school system and how these may impact the AuADHD practitioner.

The Autistic brain likes routine and predictability, finding change hard to navigate (Sinha et al., 2014). ‘Routine is more important than food to many autistic people. It gives me the stamina I need to succeed in daily life. Routine Is a sequence of things I have been told, taught, and shown to do, and I do them sometimes obsessively because succeeding on the wrong planet is an addictive, proud feeling. Without a daily, weekly, and monthly routine I do not have the self-confidence or flexibility of mind to function in the world. I do not feel safe’ (Murphy, 2020, p. 107). It is well documented and researched that a change in routine and structure can cause emotional overwhelm for autistic individuals, leading to difficulties in communication, behaviour, and assertiveness (Barahona Corrêa and Van Der Gaag, 2017; Bauminger-Zviely, 2013; Dennler, Quick and Wilson, 2022; Nason, 2020; National Autistic Society, 2020). Meaning, I look outwardly annoyed, I do not have the patience to be socially acceptable when interacting, and I have to instantaneously adapt, requiring emotional regulation before seeing students to ensure my overwhelm does not affect the sessions. However, the school system is not fixed and requires fluidity and adaptation.

Schools require counsellors to be adaptable to the school environment and the needs of the students (Edwards and Amanda, 2022; Sandifer, Gibson and Brant-Rajahn, 2022). There is little published UK qualitative research on the difficulties school counsellors face from the counsellor’s perspective. Arguably this may be due to mental health support in schools being a more recent development, especially in England (BACPb, 2022). There is more in-depth research, both traditionally and currently, conducted around the world. (Kovač et al., 2016; Pereira and Rekha, 2017; Zuković and Slijepčević, 2020), all identifying difficulties such as a school system’s lack of awareness of counselling, inefficient supervision, and counsellor burnout. Most international research focuses on student difficulties instead of practitioner experiences (Dogan and Aras, 2022; Falzon and Camilleri, 2010; Ozcan and Uzunboylu, 2020). However, one Australian study concluded that the main difficulty school counsellors face is advocating for themselves and their role (Bettman and Digiacomo, 2021; Robles, 2016). There is also extensive research indicating difficulties a school counsellor could face from the perceptions of other professionals, students, and literature. These include internal challenges such as client willingness, teachers’ personal perceptions, and a clash of school and counsellor ideals and ethics: external factors, such as family and culture, and personal challenges faced by the counsellor (Low, 2009). The research complements my working experience, suffered together with my autistic mind and a difference in communication style, such experiences can be unmanageable. 

-           ADHD versus the school system

Being overwhelmed leads to ADHD overthinking and emotional regulation difficulties. The literature states that ADHD individuals have differences in behavioural inhibition, information processing, emotional regulation and have (poor) social skills (Plessen et al., 2006 ; Shapiro, 2019; Stern and Alosco, 2019; Van Dessel et al., 2019). In my search, I found no published qualitative research on the experiences of ADHD counsellors/therapists, in the UK or around the world. True, it has to be recognised that the rate of ADHD diagnosis has soared around the world over the last 10 years (Chung et al., 2019; Giacobini et al., 2014; Grimmsmann and Himmel, 2020; Xu et al., 2018), especially regarding females (London and Landes, 2019). If we consider the higher rate of female counsellors (Brown, 2017), hopefully, the literature will catch up to those who experience ADHD as practitioners. There is a more recent recognition of ADHD and Autistic counsellors and their experiences, but it is agreed they are written as in-house university papers rather than researched and included in the literature. We can only determine experiences based on the presentations of ADHD and how this may impact being a counsellor. In my experience, when my practice is questioned, or my schedule is changed, this can trigger an intense emotional response. I need to rectify the problem as a matter of urgency, or it will continue onto overthinking and bleed into the sessions. By doing this my temperament for social niceties with school professionals becomes limited and my interactions are direct, honest and solution-focused. Due to ADHD assertiveness often being seen as aggressive (Nadeau, 2015) firm interactions can then cause emotional dysregulation after the event and initiate the fight-or-flight response during retrospection (Carroccia, 2019). As a team, the school promote multi-disciplinary working, open communication, and togetherness.  Attributes as a hired-in AuADHD practitioner do not come either professionally or naturally to me.

Schools as standard have an interwoven communication system, that reports, signposts and promotes the development of friendly relationships (Barwick, 2000). A review of 607 secondary schools in England and Wales, paying particular attention to the conflict between The Children act 2004 and the counsellor’s role within schools, established the discrepancy between relationship needs and confidentiality limits and a school’s desire for the sharing of information (Jenkins and Polat, 2006). My autistic determination to ensure professional correctness and a degree of relational distance (Torres and Donnellan, 2015), and my ADHD-driven anxiety and overthinking when having to interact or enforce professional boundaries (Kelly and Ramundo, 2006), conclude that the needs of the school and what I will deliver can be very much opposed.

This section has summarised the challenges school counsellors face and the potential consequences, including burnout and difficulty in the advocation of self and role. I have explored what impact this could have on an autistic and ADHD mind, and how communication, structure and adaption are standard requirements of an organisation such as a school, concluding in further struggles to be managed.  

-           Is the need too great for my neurological capabilities

Within this section, I intend to evaluate the school’s corporate needs against my modality and ability to process arising difficulties.

Due to the high demand in some schools, including my own, they request 30-minute sessions instead of the full therapeutic hour. Studies suggest that 30-minute counselling sessions are enough to provide positive therapeutic results. These include focused strategy-based interventions such as cognitive behaviour therapy (CBT), brief therapy or solution-focused (Lusk and Melnyk, 2011; Murphy, 2015; Turner et al., 1996), or play therapy with younger children needing shorter sessions (Blanco and Ray, 2011; Post et al., 2019; Trice-Black, Lynn Bailey and Kiper Riechel, 2013; Wilson and Ray, 2018). However, as a primarily person-centred counsellor, I find that 30-minute sessions produce an overall longer therapeutic time. In my experience creating a relationship, allowing therapeutic exploration, and delivering an appropriate ending with students can be challenging within 30-minute sessions. Because of the lack of outside provisions, young people are presenting more complex needs such as suicidal intent, sexual abuse, eating disorders and unrecognised autism and or ADHD (Hayes, 2022). Students themselves have told me that 30-minute sessions are not long enough, and just as they are warming up to talk about difficulties, the session is having to end. It is acknowledged that to gain the same results, where CBT can deliver focused 30-minute sessions, person-centred requires a full therapeutic hour (Freire et al., 2015). The drive to be ethical and ensure my practice is the best I can deliver, the awareness that the time constraints and demands are counterproductive to how my brain wishes my practice to be.

The need for mental health support for children and young people is currently deemed critical (Department for Education, 2018), with a particular emphasis on school support (Department for Education, 2022; Health and Social Care Committee, 2021). With research indicating the positive results from school counselling (Cooper et al., 2021), the need for counsellors in every school is quickly becoming established and implemented (Scottish Government, 2020). However, with the current needs so high and NHS provisions such as CAMHS strained, turning away 25% of all referrals and having to determine the severity of presentation (Crenna-Jennings and Hutchinson, 2020), the strain has been referred to the school counsellors. With GPs now ringing the school, I work in asking for pupils to be put on my waiting list. So, with the need so high and the difficulties more severe, there is increasing pressure from the school for me to quickly work through students. Due to high levels of stress, it is well-documented around the world, but less in the UK, that school counsellors frequently emotionally burnout (Earle, 2017; Ender et al., 2018; King, Subotic-Kerry and O’Dea, 2018; Kounenou et al., 2018; McCarthy et al., 2010; Mullen and Gutierrez, 2016). Include the increased demand due to CAMHS denials, the stress on school counsellors is ever-increasing.

Due to historical research being conducted on autistic individuals instead of with them (Jones, 2021) autistic and ADHD burnout is not yet explained in literature other than in association or by autistic individuals themselves through expressions of lived-experience (Mary et al., 2020). Autistic burnout is explained as extreme exhaustion, increased anxiety, more intense emotional reactions and increased autistic traits (Raymaker, 2022), luckily it is starting to be recognised as a very real and debilitating condition that limits functioning (Higgins et al., 2021). Merged with the well-researched burnout experienced by school counsellors, there’s no denying I can get additionally affected due to being an AuADHDer. Interestingly burnout syndrome specifically has some relation to ADHD along with other neurological difficulties, but the research on ADHD burnout primarily focuses on the burnout of caregivers of ADHD individuals, rather than the ADHDers themselves (Arafa and Lamlom, 2020; Gokcen, Coskun and Kutuk, 2018; Karlsdóttir, 2019). It is argued that the key to managing autistic burnout is awareness and acceptance (Mantzalas et al., 2021), arguably difficult if there is a social stigma or organisational discrimination.

This section has weighed the evidence for school counsellor burnout and determined the ever-increasing demand and presentation complexity for school counsellors. I have analysed the impact on my autistic and ADHD needs and the difficulty it creates in regulation and meeting demands.

-           The clash of the referral needs

Within this section, I intend to look at the difference in the views between the school and the health system regarding diagnoses and how this can impact, not only professional integrity but also highlight neurological and behavioural differences when working within the school system.

My professional urge to support individuals to recognise and embrace potential autism and ADHD, clashes with the school’s desire for academic accomplishments.  Pressure on academic achievements and financial pressures can take precedence over disability support (Heller and Parker Harris, 2011). Only recognising a need for referral when the behaviour is unmanageable (Department for Education, 2018). An extensive study involving over 7000 students in England, found a lack of access to specialist support for additional needs, highlighting an increased demand for support since the Covid-19 pandemic. However, even as far back as 2010, there was a campaign highlighting the failure of CAMHS for autistic children and their families, with referrals for a diagnosis stretching years (Read and Schofield, 2010; The National Autistic Society, 2020). In my private practice if a young person is showing significant traits of autism and or ADHD, which is significantly impacting their quality of life and personal safety, I contract that I will disclose such identifications to the child and if age appropriate and consented to, the parents. Within the school, my parent leaflet is sent out stating I will share such observations with the child and the school if understood and consented to by the young person. These are consequences due to previous experiences that the school will disregard my referral if it could impact the student’s educational achievements, regardless of if there is a suicide risk or long-term implications. Having such contrasting ethical stances can cause processing-overwhelm for me when I have defined guidelines and ethics that I struggle to deviate from.

For success in treating comorbid difficulties, autism and or ADHD needs to be recognised and treated alongside (Ford and Connor, 2009; Reale et al., 2017). The research has shown that autism and especially ADHD have high rates of internalising comorbid mental health and behavioural struggles such as sleep disorders, anxiety, depression, substance misuse, criminality, low self-esteem, obsessive compulsive disorder (OCD), borderline personality disorder and oppositional defiance disorder (Alzaben et al., 2018; Banaschewski, Coghill and Alessandro Zuddas, 2018; Essa and Qoronfleh, 2020; Gillberg, 2021; Gnanavel et al., 2019; Katzman et al., 2017; May et al., 2021; Sadek, 2019; Thomas et al., 2015). The research on ADHD and treating comorbid difficulties suggest that they need to be treated together in order to have long-term therapeutic effects (DuPaul, Gormley and Laracy, 2012; Kooij et al., 2012; Shapero et al., 2018; Testa et al., 2020). Undeniably the majority of research is conducted on adults with ADHD due to the later-in-life onset of most comorbid difficulties, with the extensive literature on each comorbid difficulty and the link with ADHD, rather than the treatment of ADHD and subsequently the comorbid difficulties. It is argued that identifying ADHD and Autism earlier could reduce morbidity and mortality (Daviss, 2018). However, as previously contended this can come up against resistance from the school system and national resources. And without recognition of potential autism and or ADHD, the success of treating comorbid difficulties gets more difficult. Knowing this and my predisposition to ensure I am doing the best job possible, the organisational and national restrictions can cause significant retroactive reflection and overthinking, adding to the potential of stress-induced autistic burnout. 

It is debated whether diagnoses are accurate with the frequency they are given. It is noted that due to the widening parameters of diagnostic traits diagnoses are significantly on the rise and some argue that both diagnoses are currently over diagnosed and misdiagnosed (Rowland, 2020; Paris, 2020; Paris, Bhat and Thombs, 2015). Believed to be a result of new information, studies have argued that some children were later found not to be autistic after previously receiving an autism diagnosis (Blumberg et al., 2016; Fein et al., 2013). Questioning ADHD symptoms against what would be seen as normal difficulties experienced by the pandemic, it is well discussed that the increase in diagnoses is excessive since Covid-19, and social media influence especially has come under scrutiny, (Korducki, 2022; Mohler-Kuo et al., 2021). However, many females argue that social media has awakened them to a diagnosis that ‘saved their life’ (ADDitude, 2016; Kennefick, 2022). This is evidenced in my counselling room, where the majority of my students are female and self-identifying as having ADHD, but then finding that the school, the NHS, and their families are not accepting.

Regardless of the ongoing discussion, the majority of literature and research take a stance that the diagnoses are not over-diagnosed in women, and awareness is just more suitably acute (Abdelnour, Jansen and Gold, 2022; Bachmann, Philipsen and Hoffmann, 2017; Belcher, 2020; Happé and Frith, 2020; Hinshaw et al., 2021; Kentrou et al., 2021; Piterman, 2022; Sibley, 2021). With the debates in mind, being accurate in the identification of traits is essential. The potential rejection of the school, parents, coupled with an extensive waiting time for a diagnosis that potentially doesn’t exist, could cause significant psychological damage (BACP, 2022a). Argued that the recognition of autism and ADHD is essential, and that psychotherapists and other professionals lack the insight and up-to-date knowledge to identify them (Lipinski et al., 2021; Young et al., 2020). These concepts add an additional complication to my overthinking and perfection-driven mind, aware that I am an expert in this field but without the ability to diagnose, I come against organisational and personal psychological barriers of faultlessness.

This section has concluded that the school’s precedence to achieve academic success and the government’s limited resources, conflict with my knowledge of how a late diagnosis can impact mental health and the need for adjoined treatment when working with comorbid presentations.  I have evaluated the mismatch between practitioner knowledge and the need for professional accuracy, against the requirements of the school, which could trigger autistic and ADHD overthinking burnout, and emotional dysfunction.

Methods

‘Reflection is a practice of reviewing an experience of practice in order to describe, analyse, evaluate, and so inform learning about practice’ (Reid, 1993, p. 305)

In this section, I intend to examine three reflective models, analysing how they relate to counselling and psychotherapy and inform practice

in 1910 American Philosopher John Dewey defined reflection as ‘active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends’ (Dewey, 1933, p. 118). Denoting that a practitioner takes an inquisitive approach, inspecting how and why things are, and questioning how they could be. Counselling as a practice requires the practitioner to be conscious of their own reactions, their belief system and how this could impact future therapeutic development (Bond, 2015). Argued that past experiences can tighten reflective practices, however, it is not challenged that this can also lead to complacency and a conditioned supposition that as practitioners we are being reflective when we are not (Stedmon and Rudi Dallos, 2009). Arguing that it is the reflection after an event which allows us to learn rather than the event itself, Dewey argued that reflection gives us awareness of how we behave and feel, enabling an ability to consciously choose how we shall act (Dewey, 1933). Based on a foundation that students learn from experience and observation, it has been well criticised that under Dewey’s theoretical rule, demolishing moral law and natural order, not only would teacher authority dissolve, but students would also not gain basic skills or academic knowledge (Featherstone, 2017; Meredith Corporation, 2020; Parks, 2021). With respect to this assignment brief, I argue that instead of a school system dominated by authority and the memorisation of information, a theory which promotes ‘learning by doing, relating material to the interests of the child, and doing projects’ (Spring, 2018, p. 287) would be more suited to the ADHD and autistic mind. Minds that naturally interact with authority differently (Raskin, 2019), are reactive to social conformity (Bertelli et al., 2022) and have attention and memory variances (Benson and Haith, 2010; Wachs and Sheehan, 2013).

In 1983 Donald A. Schön developed Dewey’s concept, stating that reflection has two separate characteristics (Schön, 1983). Examining professionals, Schön identified two types of reflection: reflection-in-action and reflection-on-action (Jasper, 2013). Generating surprise when operating in a situation where previous actions are not effective, reflection-in-action describes how practitioners will review their practice in-the-moment. More commonly known as ‘thinking on our feet’ we unconsciously react and consciously adapt, and change based on our knowledge and internal belief system (Kleinberg, 2015, p. 234). In relation to counselling and psychotherapy, the practitioner goes through extensive personal therapy and group introspection to become aware of their internal responses to specific stimuli, enabling conscious deliberation of a course of action (Koocher, Norcross and Greene, 2013). Argued to be action-based, Schon’s reflective model has been effective in practice when acting in an unexpected situation (Jarvis, 2013).

Reflection-on-action is defined as retrospective reflection, inspecting actions after the event, in order to learn, adapt and implement change to improve their practice and attend to their client’s needs (Darvill, Stephens and Leigh, 2021). Within counselling and psychotherapy, there are various modalities in order to reflect retrospectively, including reflective journalling, personal therapy, supervision, and client review sessions (Bager-Charleson, 2010).

One critique of Schön’s theory was the lack of acknowledgement of ethical and organisational influence. Paying closer attention to individual experiences, it can lose focus on the conflict between ethics and personal values (Tan, 2020). One example of this counsellor’s face is the internal requisite to protect the relationship and maintain a safe therapeutic space and the instantaneous awareness of a reportable safeguarding concern. Leading to an action based not only on personal wishes but ethical demands. Another criticism is the lack of awareness of an individual’s need to self-protect and divert from uncomfortableness in evaluating their own practice, leading to unconscious defensive behaviour (Baldwin and Gould, 2016). Concluding that Dewey and Schön paved the way in defining reflective practice in relation to exploring experiences, both instantaneously and retrospectively to develop best practices. It is also evidenced they do not consider organisational, individual differently abled needs and practitioners’ ability to reflect.

In 1984 David A. Kolb introduced the theory of experiential learning, describing a systematic way of reflecting on experiences through four stages (Kolb, 1984).

‘Learning is the process whereby knowledge is created through the transformation of experience’ (Kolb, 1984, p. 38). After experiencing a new experience through new insights, three additional stages of reflection are then entered into until a new experience is felt and the process starts again. The four stages are Concrete Experience (feeling), Reflective Observation (watching), Abstract Conceptualisation (thinking), and Active Experimentation (doing) (Kolb, 2015). Known as the first stage, the initial reaction initiates reasoning into the analysis of practices to develop learning and skills. The second stage is described as the link between experience and doing, where the practitioner reflects on the difference between the experience and their existing knowledge. The third stage is where reflection creates a new idea or a change in a pre-existing concept. Finally leading to the fourth stage where the new insight and knowledge are transferred into action and experimentation of what may materialise (Johnson, Mckay-Jackson and Grumbach, 2018). Kolb explained that a practitioner can enter the model at any time, however, all four stages must be completed to ensure learning. No one stage is effective on its own (Kolb, 2015). This is researched and concurred with when evaluating counsellors’ reflective practice in relation to Kolb’s model (Abbey, Hunt and Weiser, 1985), but contended as inaccurate, describing the four models as fundamentally intertwined and not separate at all (Webb, 2004). Nevertheless, it is well respected that Kolb’s model was vital as a concept and model to help students process and learn from events (Miedany, 2019).

Figure 1: Kolb's Cycle of Experiential Learning (Source: (Kurt, 2020)

Claimed as one of the best-known and cited educational theories (Hafler, 2011), Kolb’s original four-stage experiential learning model has come under criticism since its first development. Argued there is a lack of definition of what constituted a concrete experience, causing confusion on what is to be reflected upon, proposing a revision of the model to include ‘critically rich concrete experiences’ (Morris, 2019). The model as a whole was also criticised due to the lack of exploration of how humans learn and how they have come to gain the knowledge they have and the lack of acknowledgement of individual learning styles, differences, and intentions (Rogers and Horrocks, 2010). Concluding that due to the extensive needs of diverse learners, one directive approach is not suitable for all students (Ryan, Cooper and Tauer, 2012). Unlike Dewey, Kolb focuses on cognitive processing and the separation between thinking and doing, rather than exploring experiences and emotional connections (Illeris, 2009). The concept that Kolb’s model does not consider emotional responses and learner differences, fits with my experiences as a neurological and neurobehaviourally differently-abled practitioner. Who at times can have experiences solely based on social difficulties, overthinking and burnout creating emotional reactions which are not based on evidence or fact.

Developing from his original works Kolb went on to explore the different ways people learn, noting that some learners prefer one stage over the others, explaining this preference as ‘learning styles’ (Kolb, 2015, p. 135).

Figure 2: Kolb's Cycle of Experiential Learning (Source: (Kurt, 2020)

Developing from Kolb’s four-stage reflection cycle, in 1986 Peter Homey and Alan Mumford coined the theory of their own four learning styles (Gallagher, 2013). Influenced by Kolb’s personality style theory but identifying low validity for some groups of individuals, they developed a questionnaire, and so instead of asking the learner to consciously analyse their own learning style, they devise a way to identify it (Mir, 2012). The four styles identified were, Activists, Theorists, Pragmatists and Reflectors. Activists are explained as individuals who learn by doing, especially repeatedly. Immersing themselves in new encounters with enthusiasm. They enjoy brainstorming with others, roleplaying, and new hands-on experiences. Theorists Like to understand the theory behind experiences, needing facts, figures, and logic to gain new insights.  They like to ask questions and have a defined theoretical explanation and purpose. Pragmatists learn by seeing how the theory is put into real-world experience. They require a process of experimentation to ensure new ideas are applicable and workable in their present reality. Reflectors like to watch how something is done, taking time to process and digest what they have seen. They like to take multiple perspectives and reflect before committing to an outcome. Reflectors work best without rushed deadlines and they have time to consider before acting (Honey and Mumford, 1986). Honey and Mumford’s model has been well respected as one of the leading theories to support students to better understand themselves and their needs (Simpson, 2013).

Since the development of Honey and Mumford’s theory, there have been observed disadvantages in the learning styles concept. Some argued that rather than a learning style theory, Honey and Mumford rather defined personality (King and Lawley, 2019).  One significant criticism of learning style theories is that there is no scientific evidence of validity in the theory (Cuevas, 2015; Husmann and O’Loughlin, 2018; Newton, 2015; Pashler et al., 2008; Weinstein, Madan and Sumeracki, 2018). Another criticism, which I questioned myself, was that learning styles do not consider neurological differences and how the brain processes information (Aslaksen and Lorås, 2019; Lethaby and Harries, 2015; Sadler‐Smith, 1996). Sadler-Smith was central to a lot of research that followed on cognitive ability contradictions of learning style theory. With learning styles currently remaining widely used (Hernandez et al., 2020), there is a risk of inflicting inaccurate learning methods and impacting self-esteem (Dandy and Bendersky, 2014; Wininger et al., 2019). Honey and Mumford’s theory has undoubtedly enabled teachers and learners to evaluate their learning styles and adapt learning to suit specific styles. However, it is argued that as a theory it does not consider differences, including neurodiversity, cognitive and behavioural variances, and social and environmental factors.

When reviewing reflective practice in relation to the essay scope, one criticism is that it does not apply to every situation (Bassot, 2015). I believe this is especially true for autistic and or ADHD individuals who will have different reactions and different needs. There is extensive research on reflective practice working with autistic and ADHD individuals (Iannuzzi et al., 2018; Robinson, Galbraith and Carrick, 2020; Kucharczyk, Sreckovic and Schultz, 2019; Milton and Ryan, 2022; Orsino and Ng, 2019), but qualitative research with AuADHD practitioners is non-existent. Even when speaking to fellow autistic, ADHD and or AuADHD therapists, counsellors, and psychotherapists around the world we found no published works. So, we can only explore the neurological and neurobehavioral differences and assume their application to being a reflective practitioner. The question definitely alters when we ponder how being reflective will be experienced in practitioners who are unaware, they are either autistic or have ADHD.

Critical Analysis and Reflection

Within this section, I intend to reflect on the difficulties explained in my introduction and literature review. These Are:

-          Autism versus the school system

-          ADHD versus the school system

-          Need too great for my neurological capabilities

-          The clash of the referral needs

I intend to reflect with particular reference to Honey and Mumford’s learning style so I can analyse their learning styles against autistic and ADHD needs and behaviour.

At the start of this section, I completed their 80-question learning style questionnaire. Within a few questions, I am hearing my autism and ADHD represented in very distinct questions and often opposing. Upon completion of the questionnaire, I identified 18 questions that could be dually answered with no definitive answer between both an autistic and ADHD drive. I assert that the answers will depend on which presentation has more prevalence on the day, how am functioning overall and if either has been triggered by a situation. I argue that I would have different answers based on whether I was at work or in my day-to-day life, where my ADHD is more prevalent than my autism. For reference, I scored 15 for Activist, with a possible ten questions that could be the opposite answer. 13 for Reflector, where eight questions could be the opposite answer and I had two scored as very distinct representations of myself. 18 for Theorist with one possible opposing answer and three strong representations. And finally, 13 for Pragmatist with one possible opposing answer and two strong representations. By describing these results, I argue that the results are inconclusive and if I was being taught based on a particular style without consideration of my neurological and neurobiological needs, environmental factors, social factors, current processing ability and emotional regulation, then I would be taught wrong.

-          Autism versus the school system

I devise my schedule. It is structured, based on the needs of the young people, the school, and my practice. I communicate with the young people, arranging their sessions in unison with them and their study needs. I require this, and I advocate so do my students. As a reflector, it would be argued that I need time to process and to ensure that I have considered all of the information before making the correct decision (Rutter and Brown, 2015). I find this especially true with a need for an undisrupted schedule, highlighting the Theorist in me (Honey and Mumford, 2000). I know what I have agreed with the students, and I am aware of how vital my service is for them. Due to the school not being aware, or considerate of what goes on in my counselling room, their need to change my schedule to suit the organisational requirements can take precedence, and the potential damage to the student is not considered. They think nothing of moving a student to another day and swapping with a student I saw two days ago and asking me to adapt at that moment, while I try and process the harm it could cause while also trying to be socially acceptable. Being socially acceptable and considerate of people’s feelings is something a Pragmatist is argued to struggle with (Vivelo, 2013). I agree that if someone has upset my routine, taken away my ability to reflect and pushed me to be an Activist when I wasn’t ready to be, the Pragmatist will become dominant. Or as I like to say, my autism. A change in my schedule or questions regarding my practice through mind-blindness causes my autism to malfunction, or arguably the Theorist, and the Pragmatist and Activist in me to ignite. The Theorist knows the reasoning behind any potential harm that could be caused, and considers ethical considerations, while also processing the fact I now have to regulate. However, the Activist helps to assert my position at that moment, while the Theorist desperately tries to navigate this unforeseen incident and ensure my scheduling continues as planned. The reflector in me is screaming that I need time. I need to retreat. I need to be left alone to think over everything and come to an appropriate conclusion (Allan, 2013). I argue the reflector in me takes charge, triggering a sense of paralysis by emotion and an inability to reflect-in-action, as described by Schön. This triggers an emotional response, triggering ADHD dysregulation and anxiety while also weakening my ability to be socially polite. Requiring any conversation to be to the point and be very direct, just like a Theorist (Honey, 2006), or rather an autistic person who no longer has the energy reserves for social niceties.

-          ADHD versus the school system

I would argue that my ADHD is shown mainly as intense emotional reactions and retrospective overthinking to a disturbance of my autistic needs. Such as social interaction, routine changes, questioning, social interactions and being put into situations which causes flight-or-flight response (American Psychiatric Association, 2013; Hens, 2021). True in my personal life I am spontaneous, a, it’ll-be-ok-we’ll-figure-it-out-in-the-moment kind of person. Arguably according to Honey and Mumford, an Activist. But at work, because there are specific procedures, students’ welfare needs, and ethical and lawful considerations, things I would argue are based on fact and theory, then my Theorist style is more dominant at work (Mangal, 2019). Due to needing to reflect on emotionally triggering situations, I have advocated that I need time to process I have been able to state that if asked a question I need time to think before giving an answer, arguing that the Theorist and Reflector needs are most prevalent when I am emotionally triggered (in fight-or-flight) (Gray, 2004). I do contend however that the learning styles do not explain such intense emotional responses or completely define the irrational overthinking that ADHD brings. It could be argued that the ADHD immediate emotional reaction and retrospection reflection (Ramsay and Rostain, 2014) could be reflective-in-action and reflection-on-action. Or that the experience was created due to my learning styles being challenged and not catered for. But when it is irrational thoughts such as, ‘now they hate me because I was not polite enough’ which then cause complete psychological shutdown and a need to regulate such thoughts for days. Or the utter rage because someone has changed my routine and so forced me into interactions am not comfortable in, then based on my lived experience, it is my opinion that my cognitive processing, and social and emotional needs are not rationalised or fully explained by Honey and Mumford’s theory.

-          Need too great for my neurological capabilities

Even though I have been a practising counsellor for over 15 years, this was my first position working in a school. When I went to my interview, I was very candid that this position must work for me and I wanted to be part of a team and offer counselling to children in need (O’Neil and Guzzo, 2019). It was explained then that they wanted 30-minute sessions. The Theorist in me had all the knowledge and skills to know the limitations 30-minute sessions would bring but the Activist just wanted to try and make it work. The reflector was screaming at me to think about it. Luckily, I know my reflector well and said I would need to think (Rosewell, 2005). The overall potential positive outcome and the fact they said there were no restrictions on the duration of counselling, I felt the positives outweigh the immediate concerns. Three years later and the needs have changed. There is pressure to obtain results within the shortest time period. I have explained that as a person-centred counsellor with CBT training, the children do not want CBT, they want a safe place to talk. 12 sessions is six therapeutic hours, hours of which are not going as in-depth as a full session. To be working with suicidal, sexually abused and mainly ADHD and autistic children, their demand is impossible. I am grateful that I am talented at what I do. I do not get refusers and once the children meet me, they want to stay. But the change in demand is starting to overshadow. My Theorist is fundamentally always active, advocating my knowledge of the children’s therapeutic needs and ethical and lawful requirements. it would be argued that the Pragmatist, knowing when things won’t work in practice, pushes me to assert myself. I argue that it is neither my ADHD nor autistic that asserts myself, however, it is also both. My autistic self will know I am right based on knowledge and experience and emotionally react with annoyance (Schopler, Mesibov and Kunce, 2012), my ADHD self will pick up that feeling, run with it, react, overthink, and turn that annoyance into anxiety and remain with it for potential days. Turning into a reflect-on-action hell. In that situation alone, we could explain this as my Theorist initially reacting, my Pragmatist and Activist taking over and eventually turning into my Reflector that is crying over the fact it was out-ruled when it was screaming to be heard. However, I argue that if learning styles are to help us learn, how do we account for all four-interchanging based on any given situation, surely this makes them void. It could be argued that after all the learning styles at play, I then engaged in reflection-on-action. However, when these thoughts are irrational and my neurological and neurobehavioral responses cannot be changed, then it could be argued that no matter the reflection the situation will happen again. Arguing that the theories do not account for neurological differences and automatic responses, however, they could aid acceptance that it will happen. Even though my Activist and Reflector are interchangeable depending on the situation and my Theorist is always strong, I argue that it is my Pragmatist that both attempts to keep the AuADHD burnout at bay, but also demonstrates my burnout. By asserting myself, holding strict boundaries and allowing myself to be heard above the expectation of social niceties (Puff and Seghers, 2014).

-          The clash of the referral needs

This is one of the most difficult areas I manage at the school. If I’m honest the main difficulty is between my knowledge and my assuredness. Argued to be a conflict between all learning styles. On one hand, I am more of an expert on autism and ADHD than most. However, knowing the potential damage that can be caused by being inaccurate in observations, the waiting times for diagnosis and family and social stigma, my Theorist battles between all the conflicting knowledge I have. In these situations, I feel my Activist is silenced by the uncertainty of what is the right thing to do. In my private practice, this situation is very different, I contract whether parents and young people (dependent on age) would like to know if I notice autistic and or ADHD, explaining my inability to diagnose. My engagement with the school forever changed after one incident of speaking to them about suicidal young people whom I suspected had ADHD and being told they would not follow this up and requested I not say anything to the young people in case it disrupts their learning. After my Pragmatist came out fighting along with my Theorist, I reflected on the incident and ultimately changed my relationship with the school. I devised a leaflet to send to parents explaining my role but also informing them that if I identify traits of autism or and ADHD in their child and they have contracted they wish to know, I will explore this with them. As an AuADHDer working with AuADHD adult clients, attempting to undo all the damage done from their difference not being recognised and celebrated, this interaction with the school altered our whole relationship. No longer part of a team, my Pragmatist and Theorist are always on defence. Argued that my autistic socialisation tendencies are less camouflaged and my ADHD overthinking over any strained interactions is less intense. Meaning my boundaries are high, my socialisation techniques are low, and my annoyance is obvious.

Within this section, I have explored some of the most prevalent difficulties I experience working within a school environment. I have related those difficulties specifically to Honey and Mumford’s learning style theory, highlighting that my learning style can change depending on the situation and emotional responses. So rather than fixed, they are linear and quickly changing. And so, rather than my autism and ADHD, they can be explained by specific learning styles, questioning whether they are learning styles or just who I am, and more importantly just how my brain works. My argument would be they are too fixed and simplistic, and anyone relying on them as an explanation for how they learn could dangerously ignore their neurological and neurobehavioral needs and ever-changing reactions.

Conclusion

Essay aims

-           What are the difficulties an AuADHD counsellor will face in a school

-           How to keep the negatives from outweighing the positives.

Within this essay difficulties have been highlighted which have included a clash in ideals between the school system and the school counsellor, including session duration, timetabling, academic and psychological needs, and adaptation requirements (Bettman and Digiacomo, 2021; Edwards and Amanda, 2022; Sandifer, Gibson and Brant-Rajahn, 2022). It has been concluded that these cause a need for advocating for my role, the children’s needs as well as my own, leading to professional burnout (Earle, 2017; Ender et al., 2018; King, Subotic-Kerry and O’Dea, 2018; Kounenou et al., 2018; McCarthy et al., 2010; Mullen and Gutierrez, 2016). It has been established that both autistic and ADHD individuals can be wrongly judged when being assertive (Bauminger-Zviely, 2013; Nadeau, 2015), and this can cause ADHD retrospective overthinking and emotional dysregulation after the event (Carroccia, 2019). The need for structure, control, and perfection while balancing both the introverted and extroverted traits are factors which create burnout (Murray, 2018). Add a continuous clash of ideals between the school and counsellor and the difficulties experienced by an AuADHD individual the evidence states there will be accelerated burnout (Mary et al., 2020).

The literature explored the positives of school counsellors and how the need for support in schools is essential (Department for Education, 2022) and how I experience huge rewards when working with the students. Including enthusiastic engagement in sessions, a lack of refusers and positive outcomes. However, it has been explored that this has come at a cost. This assignment has gone a long way to identifying the needs of an autistic and ADHD practitioner working in the school and the continued pressure from the wider systems. It has been explored that to be able to manage difficulties requires a strong knowledge base, and an ability to reflect and assert such knowledge. It was established that the need to assert oneself is great and for some people who may find this difficult, the school system may not be compatible (Robles, 2016).  I explained that I went to the school wanting to be part of a system. However, through the need for continuous assertiveness, fuelled by autistic frustration (Schopler, Mesibov and Kunce, 2012), the incapacity to regard others’ feelings (Vivelo, 2013) has caused a divide, one that I reflect is needed to maintain an appropriate professional distance and protect myself from familiarity and an assumption that my work can be challenged without merit (Marshak, 2010).

And so, with the great need for my service and the overall positive impact on the children that come to see me. Along with my continuously revised policies and my ability to implement them. I accept the sacrifice of a team relationship as a necessary loss to protect my own AuADHD needs and remain at the school.

-          Critical Analysis

I have reflected upon my experiences using Honey and Mumford’s learning style theory, that my reactions in situations are based on one of their four learning styles (Honey and Mumford, 1986). However, it was also determined that all four could be utilised within one situation and determined by my reaction or emotional response. Determining that in this case there is no particular learning style that is absolute while also recognising my neurological and neurobehavioral differences (Aslaksen and Lorås, 2019; Lethaby and Harries, 2015; Sadler‐Smith, 1996). Concluding that all four learning styles have a place in learning about our personalities, but not to be taken as central, because based on my own experience they do not adapt to different needs or situations.

There is a huge gap in published qualitative research into the experiences of autistic and, or ADHD practitioners, including those in a school. It is recognised by myself and fellow neurodiverse practitioners around the world that there is an increase in academic papers being written by students on the experience of AuADHD individuals, as well as blog posts from neurodiverse counsellors, however, the literature is yet to catch up. As ADHD and autism become more widely accepted and embraced, I hope this will start to bridge the gap of research being conducted into autistic and ADHD clinicians and their experiences, highlighting how this can help increase the accuracy of referrals and also the government health care provider and school support packages.

With this gained knowledge I intend to utilise the Honey and Mumford learning style theory to help me reflect and theorise in difficult moments, allowing myself a Theorist perspective when my Pragmatist wishes to react.

For others, I hope this assignment has given an insight into the difficulties a neurodiverse therapist may face and provided some comfort to the other neurodiverse practitioners. It has highlighted that it is important to reflect, be aware of burnout and create a professional distance to help strengthen the boundary defences.

Word Count 8797

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