Many therapists enter this field with the best of intentions—we want to help, support, and empower our clients. We follow evidence-based practices, rely on clinical training, and implement strategies that have been proven to be effective.
However, when we don’t take a neurodivergent-affirming approach, even our best efforts can unintentionally harm the very people we’re trying to help. If you're a therapist, I want you to take a moment to think about your go-to intervention for a client who is in the midst of a depressive episode. I'm willing to bet that you were taught to use some form of behavioral activation.
For those who are not familiar, behavioral activation (BA) is a well-established intervention for depression that encourages individuals to engage in meaningful activities, even when motivation is low. The idea is that action precedes motivation—by getting up and doing things, people experience positive reinforcement, which can help lift them out of a depressive cycle.
And for some people, it works beautifully.
But for Autistic or ADHD clients experiencing neurodivergent burnout, it can actually make things much worse.
Burnout Is Not Depression
Autistic and ADHD burnout can present in the same ways that depression does. Both are characterized by persistent sadness, lack of interest, exhaustion/fatigue, a shift in the ability to engage in self-care, and isolation.
Depression stems from biological, psychological, social, and environmental factors. Neurodivergent burnout stems from chronic exhaustion due to masking, sensory overwhelm, and a long-term mismatch between a person’s environment and their needs.
For a neurodivergent person experiencing burnout, the nervous system is depleted. Their brain and body are in a prolonged state of stress and demand a deep, restorative reset—not just more activity.
Why Behavioral Activation Can Be Harmful in Burnout
When someone is in autistic or ADHD burnout, the “just push through it” approach of behavioral activation can be devastating. Here's why:
The Root Cause Isn’t Apathy—It’s Overwhelm. Many neurodivergent clients experiencing burnout are not struggling with motivation in the same way someone with depression might be. Instead, they are physically and mentally exhausted from prolonged effort to function in a world not built for them. Forcing activity doesn’t replenish their depleted energy—it drains them further.
Masking and Compliance Can Lead to Further Burnout. Neurodivergent individuals, especially those who have spent their lives masking their traits, often excel at doing what’s expected of them—even to their own detriment. A client might comply with behavioral activation exercises, but instead of feeling better, they may push themselves into deeper burnout, leading to shutdowns, increased sensory sensitivity, or even physical symptoms like migraines, chronic pain, or digestive issues.
Activity Does Not Equal Restoration. For someone in depression, reintroducing enjoyable activities can be a path to rediscovering meaning and connection. But for someone in burnout, what they actually need is deep rest, reduced demands, and a reassessment of the conditions that led them to burnout in the first place. Encouraging more doing instead of allowing for being can delay their healing.
Trust Can Be Lost. When a therapist becomes yet another person who suggests that a neurodivergent client "just push through" it can cause a rupture in the therapeutic relationship that cannot be repaired. It can also contribute to long-term feelings of shame over therapy not "working for" the client.
A Neurodivergent-Affirming Approach to Burnout
Instead of defaulting to behavioral activation, therapists working with neurodivergent clients need to take a different approach. We cannot assume that all of our clients are neurotypical. We have to do our work to assess if a client is neurodivergent so that we can understand how to differentiate between depression and burnout. We can also:
Assess Energy, Not Just Mood. Ask about sensory overload, exhaustion, and masking—not just feelings of sadness or loss of motivation.
Prioritize Rest First. Before encouraging clients to “engage more,” help them remove energy drains. This might include sensory accommodations, reducing social demands, or encouraging quiet, restorative time.
Encourage Self-Compassion Over Productivity. Many neurodivergent people feel guilt when they’re not “doing enough.” Helping them unlearn that productivity equals worth is a powerful intervention.
Modify Traditional Interventions. If movement is helpful, frame it as sensory regulation rather than a task to complete. If engagement is needed, focus on low-demand, low-stimulation activities instead of structured social outings.
The Cost of Not Understanding
When therapists don’t take a neurodivergent-affirming approach, we risk misdiagnosing, retraumatizing, or invalidating our clients. We may unintentionally reinforce harmful narratives—telling a burned-out Autistic client they just need to “try harder” or an ADHD client in shutdown that they’re just “avoiding responsibility.”
The truth is, traditional interventions aren’t one-size-fits-all. Neurodivergent people often need different strategies, not just more effort.
As therapists, our role is to see the full picture of our clients’ experiences—not just what fits within our training. When we honor the nuances of neurodivergent burnout, we can offer care that truly heals rather than unintentionally harms.
Final Thoughts
If you’re a therapist working with neurodivergent clients, ask yourself: Am I treating the symptoms, or am I addressing the root cause? Am I making space for rest, regulation, and self-acceptance—or am I expecting my client to fit into a neurotypical model of healing?
Because when we recognize the difference, we don’t just prevent harm—we provide the kind of care that actually helps neurodivergent clients thrive.
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