Listening for Intersections of Neurodivergent Experience and Perinatal Mental Health

By Chelsea Blackwell, CPM, PMH-C

As a midwife and perinatal mental health expert, I have listened to thousands of new parents express and navigate their mental health needs. These intimate conversations give me a unique lens into emergent themes in perinatal mental health.¹ As I’ve learned more about neurodivergent (ND) mental health, specifically the experiences of girls and women, I’ve begun to notice the ways this intersects with and impacts perinatal seasons. I’ve started to hear undertones of neurodivergent experience in many of the perinatal people I work with, and it’s becoming clear how lack of support for neurodivergent girls sets the stage for Perinatal Mental Health Disorders (PMHDs). Merriam-Webster defines Neurodivergent as: 

“having or relating to a disorder or condition (such as autism spectrum disorder, attention deficit hyperactivity disorder, dyslexia, or obsessive-compulsive disorder) that impacts the way the brain processes information: exhibiting or characteristic of variations in typical neurological development”

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

“…conditions like autism, dyslexia, and attention-deficit/hyperactivity disorder (ADHD) should be regarded as naturally occurring cognitive variations with distinctive strengths that have contributed to the evolution of technology and culture rather than mere checklists of deficits and dysfunctions.”

In the United States, awareness of how ND experience impacts perinatal mental health is growing, but we are still in the nascent phases of providing support that is tailored to the unique nervous systems, needs, and experiences of neurodivergent women in the perinatal period. The biggest barrier to providing this support is that most neurodivergent women are undiagnosed. ^2,3

The “naturally occurring cognitive variations” in neurodivergent nervous systems involve how environmental, social, and emotional stimuli are processed. ND brains and bodies attune to and absorb more stimuli and respond to it in multiple areas of the brain. It has been found that neurodivergent people have less circulating hormones and neurotransmitters that support mood and executive function. These differences make transitional life phases, such as parenting and perinatal seasons, extremely challenging and can mark a mental health breaking point for undiagnosed adult women. This breaking point almost always meets diagnostic criteria for PMHDs and while many common treatments can be helpful to neurodivergent mothers, key aspects of their mental health remain invisible. 

Neurodivergent perinatal women deserve an approach that is tailored to their unique nervous systems. They need psychoeducation that helps them understand why the perinatal period is so intense, and therapeutic support in rewiring negative internalized messages. They will thrive with validation that highlights their strengths and coping that helps them artfully manage challenges and realize their potential. 

Addressing the Needs of Neurodivergent Women in the Perinatal Period

How do perinatal providers and professionals begin to address the needs of neurodivergent women who are unaware of the root cause of their chronic mental health challenges, are already navigating the sequelae of an untreated condition, and (as if that isn’t already enough?!) are derailed by the change and chaos of the perinatal season? 

We start by increasing awareness within our field and in our work with perinatal people. Marginalization and gender-bias provide important context for understanding the mental health picture of an undiagnosed pregnant or postpartum woman. Even though adult men and women are equally likely to have ADHD, boys are 15% more likely to be diagnosed during childhood, and according to UCLA Health, “nearly 80% of Autistic females are undiagnosed as of 18.” This lack of attunement to the experiences of neurodivergent girls renders their gifts and struggles invisible- not only to adults around them but also to themselves. 

Perinatal women presenting with neurodivergent “variations” learned to hide (mask) and manage their symptoms to function relatively well despite this vacuum of support. Adaptability is definitely a strength, but hiding differences and difficulties while receiving no support requires massive amounts of physical and emotional energy. This chronic energy drain is one layer of the subconscious adaptive load⁴ that undiagnosed ND girls carry throughout their development. 

Internalized trauma and negative self-concept are two more layers that develop both within the limitations of that energy drain and from being chronically unseen and misunderstood in their families, communities, learning environments, and social systems that center different abilities. Arline Geronimous⁵ coined the term “weathering” to describe “how population groups who experience systemic cultural oppression, long-term material hardship, exploitation, stigma and political marginalization suffer biological aging long before they are chronologically old.” Neurodivergent girls and women with marginalized identities such as BIPOC, LGBTQIA+, first-generation and new Americans, differently abled individuals and folks with chronic medical conditions experience psychological & physical weathering that intersects and overlaps with neurodivergent weathering.

Carrying this subconscious adaptive load and other sources of weathering funnels vital energy away from developing the self awareness and coping skills neurodivergent girls need to thrive, and is a barrier to accessing support that can minimize impacts of learning differences. This is why so many unsupported ND girls have low self esteem and underrealized potential. This is why neurodivergent young women frequently develop comorbid conditions like anxiety, depression, and substance use disorders.⁶

Understanding the accrued mental health sequelae of neurodivergent mothers informs how we hold them during pregnant, birthing and postpartum experiences. As birthworkers, doulas, nurses, midwives, doctors, and mental health providers we have an opportunity to expand our responsiveness to these mothers in ways that can profoundly improve their wellbeing- not just during the perinatal season but for the rest of their lives. 

Putting Psychoeducation and Validation Skills to Work

You don’t have to overstep your role to make this difference. Well-crafted psychoeducation and compassionate validation offer immediate relief to a suffering mom and plant powerful seeds of long term change. While assessment and diagnosis are essential to medical treatment & accommodations, they are not necessary to help neurodivergent perinatal people begin to address issues impacting them. If we look a little deeper, listen carefully and expand our psychoeducation and validation skills, we can support these women to integrate their neurodivergent needs with their perinatal and parenting journeys.  

Encouraging self assessments and bibliotherapy are helpful initial steps to share. ADDitude and Autism Speaks websites are reliable favorites that include self assessment tools and referrals. Discussing formal diagnosis and the potential access barriers such as inherent bias, cost, limited availability of providers experienced with high functioning adult females, and individual priorities, can support next steps. Common treatments are therapy, coaching and medicines that improve symptoms. Providers are encouraged to seek additional training in neurodivergent mental health (resources provided below). 

Cultural Norms and the Neurodivergent Experience

It’s important to keep in mind that familial, community and cultural norms and expectations inform how mental health needs are internalized and expressed. Neurodivergent perinatal experience is no more a monolith than our rainbow nation with the unique individuals and diverse communities we are blessed to be in community with. If you hold social identities that are systemically privileged be aware that, without intending harm, our gaze often centers and standardizes our experience and neurodiversity in perinatal mental health requires a multicultural lens. 

Expanding awareness and providing general information, inclusive resources and referrals are foundational steps to supporting the needs of neurodivergent perinatal women. And, we can do so much more by learning to listen for the intersections of neurodivergent experience in perinatal narratives. Attuning to the underlayer of neurodivergent experience during the perinatal season is nuanced because it mirrors and overlaps with PMHD symptomology. In my work, I have noticed the following key themes:

• negative self concept/guilt/shame 
• executive function (EF) challenges
• emotional & sensory overwhelm

Looking for Cues in Neurodivergent Perinatal Women

All perinatal people experience guilt, disruption to routine and overwhelm. PMHDs increase frequency and intensity and impact daily functioning in these areas. Because neurodivergent women enter the perinatal season with an energy deficit and their nervous systems are naturally more triggered by the demands of the fourth trimester, their capacity to cope is often extremely low. If we know what to listen for and establish trust and rapport, ND women are likely to share important cues pointing to neurodivergent experience. These cues can be direct or indirect. Direct cues are when someone shares their own struggles as in; “I don’t know what is wrong with me…” or in the case of somatic expression, “I have constant head aches…” Indirect cues convey important information about mental health through a person’s projections, choices, relationships, or other mental health conditions. One neurodivergent perinatal woman may communicate her negative self concept by saying: “I feel like such a failure…” Another may not talk about herself at all but her experience of negative self concept is reflected in her primary complaint of a toxic relationship. A new mother experiencing a substance use disorder (SUD) deserves our awareness that SUD’s sometimes source from unresolved neurodivergent trauma that shatters self worth.

Are all perinatal women experiencing an SUD or a toxic relationship neurodivergent? Do all perinatal headaches source from the unmet need for lower stim environments? Bleep no! Is it important to recognize the range of expression across individuals, communities, and cultures? Absolutely. Indirect cues are valid ways of expressing mental health needs, and because they can point to multiple needs, they must be understood within the wider context within which they are shared. 

Whether directly or indirectly, neurodivergent perinatal women are expressing their struggles, and we can improve how we listen and respond. Sharing can be therapeutic in and of itself, but we can also hear it for the invitation it is. Whether conscious of it or not, ND moms are seeking people and environments that support their well-being and validate their worth. This seeking is woven into their narratives. If we are listening carefully for how these themes emerge in dialogue, we can accept their invitation for support. So what exactly are we listening for, and how do we differentiate from typical PMHD symptoms? 

Intensity, Complexity, and Other Factors

Generally, neurodivergent women will present with a higher level of intensity and/or cognitive complexity. Not only the intensity of experience, but they present as intense. This can be outwardly expressed with a loud voice, highly animated, and frequent use of hyperbole. Intensity and complexity can also be expressed with an inward affect that may sound flat and distant, involve limited verbal expression/sharing, and be extremely direct by neurotypical standards. You might hear her say (loudly)  “I’m losing my shit all the time!” or (very softly) “I didn’t want to be a parent…sometimes I just want to disappear…” Projecting on others and/or placing all blame and responsibility on others is another way this can be expressed: “No one is there for me; no one helps me; no one cares…” “My mom does X; my partner says Y…” 

Cognitive complexity can sound a lot like anxiety, and while they do overlap, neurodivergent brains are inherently highly active. Listen for rapid speech, frequent topic shifting, extensive and layered connections of thoughts and ideas. 

Another key difference is that negative self-concept, EF challenges, and emotional and sensory overwhelm have been lifetime challenges for ND women that the surge of perinatal stressors exacerbates and intensifies. Her negative self-concept will not be limited to the perinatal period, but is deeper and wider. Listen for long-term negative self-concept and a history of mental health diagnoses. The table below offers a spectrum of direct and indirect listening cues, and scripting that weaves psychoeducation and validation into our conversations with perinatal women who present with neurodivergent traits. 

These simple scripts can help a neurodivergent woman who has felt invisible and incapable her entire life feel seen and supported. The words we share have the power to plant seeds of reassurance, hope, and change. She can hear in them that she may not be inherently flawed after all, that her differences can also be strengths. We can show her that she is not alone, she is not to blame, and with help that honors and supports her whole-complex-neurodivergent-being, she will be well.   

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Resources:

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

For Providers:

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

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References:

¹ LGBTQIA+ folks create and nourish families and deserve strong supports and increased representation in perinatal mental health discussions. A (small) 2025 study cited below, explores health equity for LGBTQIA+ and ND folks from the lens of a midwifery education program.
² https://www.uclahealth.org/news/article/understanding-undiagnosed-autism-adult-female
³ https://pmc.ncbi.nlm.nih.gov/articles/PMC10173330
⁴ This is 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 Attention on Understanding Why Comorbid Conditions Like Anxiety and Depression Uniquely Impact Women with ADHD

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Explore More PSI Resources: 

Specialized Support Services for Parents with ADHD
Specialized Support for Neurodivergent Parents
Perinatal Mental Health Discussion Tools
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