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Neurodivergent clients and psychedelics: what competent support actually requires
Neurodivergent people are already in psychedelic spaces. Diagnosed or not, disclosed or not – they are already showing up to ceremonies, clinical trials, and coaching sessions. The question is whether the space is ready for them.
Guest contributions from Dr. WaiFung Tsang and Nadia Violet Erlam
Foreword
By Dr. WaiFung Tsang
Neurodiversity should not be treated as a specialist consideration at the edge of psychedelic practice. Neurodivergent people are already entering therapeutic, clinical and ceremonial spaces, whether or not they have a diagnosis or choose to disclose it. The real question is whether those spaces are prepared to meet them: whether the system is inclusive enough to fit the person, rather than only the other way round.
Many psychedelic settings, particularly clinical ones, have been designed around assumptions about a typical nervous system: how a person communicates, processes sensory information, participates in a group and responds under pressure. These assumptions can unconsciously exclude people from a systemic starting point, even when everyone involved has good intentions.
The more I work in neurodivergent fields, exploring adaptations for conditions such as autism and ADHD, the more I realise these adaptations are simply good practice for all. Placing neurodiversity at the centre of practice benefits everybody. It asks practitioners to become clearer, more flexible and more accountable, to consider things proactively as well as reactively. Most importantly, it allows clients to arrive as they are, rather than having to perform acceptability before they can receive support: a space where you are free to be more you.
By Nadia Violet Erlam
Neurodiversity belongs at the centre of psychedelic practice for many reasons. The people most in need of the healing benefits of psychedelics are often vulnerable people, and that frequently includes neurodivergent people. The psychedelic experience itself is arguably an expression of neurodivergence. Yet if spaces are not built with diversity at the centre, problems are inevitable, including the potential retraumatising of individuals. It has been reported many times how often psychedelic spaces and communities repeat the inequalities of the wider world.
When psychedelic practice comes well informed about neurodiversity, ideally run by neurodivergent people for neurodivergent people, there are exciting potential benefits for everyone. When you make spaces more inclusive for undervalued groups, it helps everyone involved. Many people might not even know they are autistic before attending a psychedelic ceremony.
1. Start with understanding, set diagnosis aside
The question of competent support opens with relationship rather than with assessment. A diagnostic label, present or absent, tells a practitioner remarkably little about the person in front of them: their sensory world, their processing style, what communication feels safe to them, what they have had to hide to get through the week. Many neurodivergent clients arrive having spent years feeling alone and different with their experience, often without language to express or share it. In certain cases, some will discover that language through their work with psychedelics.
In a 2024 survey of 233 autistic adults published in Psychopharmacology, the majority attributed reductions in psychological distress (82%) and social anxiety (78%), and increases in social engagement (70%), to a single impactful psychedelic experience. The same survey found that a minority, around one in five (20%), reported undesirable effects, with some describing the experience as among the most negatively impactful of their lives. Importantly, neurodivergent people are already in these spaces; the potential is real, and so is the cost of incompetent holding. Both groups in that study argue for the same thing: prepared, informed and specialised practitioners are a necessity.
The practitioner’s first preparatory task is to create a therapeutic space where the client’s unique way of functioning can be discussed without becoming a problem that needs to be fixed. Frequently, this is more than a matter of tone. Nadia is direct about the stakes:
“When people like me, autistic folks, are met as a problem to fix, this comes from a culture saturated in eugenics, ableism and oppression. Most of our problems as autistic people come from an ableist world. The main things we need help with are recovering from the harm this world has done to us, self-acceptance, and being treated as people who have value. Being seen as a problem increases the likelihood of abuse and harm, and it ignores how many others in the room may be autistic or ADHD themselves, including the practitioners.”
– Nadia Violet Erlam
Nadia’s alternative is the social model of disability: society, rather than the person, is understood as the disabling force. A practitioner who works from that model asks what in the environment needs to change? Interestingly, the answers turn out to be concrete, trainable and largely inexpensive. The rest of this article explores those interventions.
2. The foundation: what neurodivergence means in an altered-state context
Neurodivergence covers differences in cognitive functioning including ADHD, autism, dyslexia and dyspraxia. These differences are present in many clients, disclosed or not. Psychedelic-assisted work raises the stakes on all of them: sensory processing is amplified, interoception shifts, and the capacity for spontaneous communication under high arousal drops sharply. A setting that was merely uncomfortable in ordinary consciousness can become overwhelming in an altered state.
“In both clinical work and psychedelic work, neurodivergent inclusion cannot be reduced to a list of accommodations added at the end. It affects how we prepare people, communicate expectations, construct the physical environment and respond when someone’s needs change. The most helpful thing is to remain curious and person-centred about the individual in front of us, not overgeneralising based on a diagnostic label.”
– Dr. WaiFung Tsang
It is also worth remembering that the deficit framing of neurodivergence is culturally specific rather than universal. Nadia points to traditions that have held these minds as carrying particular value: the Hmong, an East Asian ethnic group in China and Southeast Asia, have viewed epilepsy and autism as indications of spiritual and healing power. Sakha shamans in Siberia, or vegetalistas/onayas in Peru, with physical disabilities are frequently considered healers. Conversely, the Itako in Japan hold the belief that those with visual impairments can see into different and informing realities, consequently, gaining access to a form of esoteric knowledge. The Dagara in Burkina Faso may read an episode of mental distress as a sign that the person is called to become a healer, and the community responds by placing them with a skilled spiritual practitioner who accompanies them through training and supervision. As Nadia affirms, the point is to show the intrinsic value these individual minds have carried across cultures, as a challenge to the dominant narrative, without romanticising the experiences themselves.
AuDHD: more common than most practitioners assume
One pattern deserves particular attention because it is both prevalent and routinely missed. The co-occurrence of autism and ADHD, often called AuDHD, is far more common than intuition suggests. A meta-analysis of 63 studies by Rong and colleagues found a lifetime ADHD prevalence of around 40% among autistic people, with other studies estimating between 20-50% of adults with ADHD show clinically significant autistic traits. It is also systematically underdiagnosed: a dual diagnosis has only been formally possible since DSM-5 in 2013, and while recent research suggests nearly half of adults with ADHD show significant autistic traits, large claims analyses find only a small fraction carrying concomitant diagnoses. Therefore, many AuDHD clients arrive with half a diagnosis, or sometimes even none.
The therapeutic significance lies in the internal contradiction. The two profiles pull in opposite directions: the ADHD side seeks novelty, stimulation and spontaneity, while the autistic side needs routine, predictability and sensory regulation. Living with both often means chronic internal conflict and deep confusion about one’s own needs. Dominance of either disposition can also shift over time. One profile may lead overall, or take over in certain states and contexts. Under stress, in groups, or in an altered state, the balance can flip: a client who prepared from their ADHD side may meet their autistic needs mid-session, or the reverse. The practical consequence for practitioners is simple to state: never assume one label describes the whole nervous system in front of you. Prepare for both directions, and check which side is leading on the day rather than relying on what was true at intake.
3. Masking: the central concept for this work
Masking is the continuous, effortful performance of neurotypical behaviour: suppressing stims (repeating physical movements, sounds, or words to help regulate the nervous system), forcing eye contact, scripting conversation or overriding sensory distress. For many clients it is so practised that they barely register doing it. The research picture matches the lived one. In the study that first mapped camouflaging systematically, Hull and colleagues interviewed 92 autistic adults and found its consequences included exhaustion and threats to self-perception: the very attempt to connect with others through masking leaves people disconnected from themselves. Nadia describes the same territory from the inside:
“Masking can cost people a lot, from increasing mental health issues to identity erosion and worse. It is a highly complex area. I do not really know if I am able to unmask; it is so cemented into who I am at this stage. Many of us are in a situation where we feel we cannot be ourselves, at a cost to us, but also we do not know who we are, and do not know how to stop. Masking is also important in certain situations, like at work or in places we feel unsafe. It can protect us at times, so it is never a question of needing to unmask all the time.”
– Nadia Violet Erlam
Nadia’s point concerning protection deserves emphasis, because it reframes the practitioner’s task. The goal is never to strip a client’s mask off. Instead, the goal is to set conditions in which unmasking becomes safely possible, and to respect that it may only happen partially, or later, or with other neurodivergent people rather than in the session at all. Nadia notes that autistic people often communicate most effectively with each other, and that spaces run by and explicitly for neurodivergent people make unmasking most likely. Nadia also recommends a concrete and simple routine procedure: talk about masking explicitly before a ceremony or retreat, name that people are allowed to be themselves and will be welcomed as themselves. Even then, some participants will not unmask, and that has to be acceptable too.
For AuDHD clients masking is often double-layered: masking autistic traits and ADHD traits at once, sometimes using one profile to camouflage the other, which makes both harder to see and exhausting to sustain.
Interestingly, non-altered states, including psychedelics, can dissolve masking capacity. A client may unmask involuntarily, mid-session, in front of a practitioner and a group who have only ever met that individual while they are masking. Handled without understanding, and the correct skillset/toolkit, that moment can compound years of shame. Handled well, the medicine space may be the first place in a client’s adult life where their masking behaviour switches off and nothing bad happens. The outcome depends entirely on the practitioner, which is why the following three sections deal with preparation, the journeying space itself, and integration.
4. Preparation through a masking lens
Initially, preparation is where masking is either gently alleviated or reinforced. It is also where a widespread assumption in psychedelic culture needs challenging: the loose, “flowy”, emergent format many retreats and sessions default to, in which participants are told to “trust the process” and “let it unfold”, is itself a systemic barrier for certain individuals. For clients whose baseline safety depends on predictability, vagueness reads as threat. Consequently, for certain neurodiverse individuals more structure should be the standard, with flexibility negotiated from there.
The relational container comes first
Before any protocol, there is the relationship. Research on psilocybin-assisted therapy by Murphy and colleagues found that the strength of the therapeutic alliance predicted clinical outcomes: a stronger relational bond before the session predicted an acute experience with greater emotional breakthroughs and mystical-type experiences, and stronger subsequent response. There is no reason to expect this phenomenon to be less apparent for neurodivergent clients, and every reason to expect it to may even matter more. For example, a client who has spent decades masking is, by definition, practised at appearing normal in front of professionals. The working alliance cannot be assumed from a pleasant intake call; it has to be built to the point where the client can tell the practitioner something true and inconvenient, such as that a proposed element of the ceremony frightens them, or that they did not understand an instruction, or that they need a specific process changed. That level of honesty is the real readiness marker, and it typically takes longer to reach with clients whose default is compliance, as opposed to an unfiltered expression of needs.
Pacing as a safety practice
This is why pacing (an energy-management strategy used to prevent sensory overload and burnout) belongs in the preparation standard, and never in the category of a luxury protocol. A single preparation session, still common in retreat formats, is rarely enough for a neurodivergent client to move from performing readiness to actually being ready. Several shorter contact sessions spaced over weeks serve better than one longer intake: each meeting, virtual or in-person, lowers the novelty load of the next, giving the client time to process between conversations rather than respond on the spot, allowing sensory requirements and communication agreements be revisited once the client has had time to notice what they actually need. Practical markers of adequate pacing include the client having asked at least one question that adapts a standard protocol to their bespoke needs, agreements being revisited and potentially revised rather than signed off in a single pass, and the practitioner being able to name, before the session, how this particular client signals distress through verbal or non-verbal means. If none of these have happened, preparation is not yet finished, whatever the calendar says.
“Preparation works best when clients have a clear sense of what to expect and feel comfortable sharing what may help them, lessening the anxiety of uncertainty. Reasonable adjustments such as a simple written outline, a point of call, clear language and a conversation about sensory preferences can make the process feel more accessible. It can also help to agree on different ways of communicating, including non-verbal signals or taking time in silence. Particularly for someone with autism, ADHD or AuDHD, a balance of structure and flexibility may be especially useful. Manage expectations and welcome all experiences: they can all be different, and it does not need to involve visions, strong emotions or a major breakthrough to be meaningful.”
– Dr. WaiFung Tsang
In practice this translates into a short set of concrete moves. A written overview of what happens before, during and after, with times, locations, and who is present in what role. Clear, literal language, dropping abstract metaphors and esoteric phrasing unless the client welcomes them. Explicit sensory mapping across light, sound, smell, touch and temperature, leading to a short sensory plan covering earplugs, weighted blankets and comfort items. Co-created communication agreements for high-arousal moments: non-verbal signals, yes and no questions, permission for silence. For AuDHD clients, prepare both directions: structure the container firmly enough to support the autistic requirements while leaving room for the ADHD requirements, and agree in advance what happens if the leading profile shifts mid-process. Finally, honest expectation-setting throughout, in exactly the spirit of WaiFung’s closing line above: feeling nothing is also a valid session.
5. Setting the space: overstimulation is the first design question
Group settings are dense with stimulation before any medicine enters the body: unfamiliar people, shared sleeping and eating, music, incense, chanting or close physical proximity. For many neurodivergent clients this baseline load is already near capacity, which means the design question proceeds facilitation considerations. Arrival may need to look different: some clients need regulation before connection, whether through time alone, a quiet arrival window, or a low-demand orientation before the group forms. A designated low-sensory decompression space, communicated in advance, turns leaving the room into a planned option rather than a visible rupture. Alternative participation is legitimate participation: eyes open, observing, moving, opting out of group rituals without explanation. A named point of contact who understands neurodivergent needs, and intervenes only by prior agreement, giving the client a single stable thread through the experience. Additionally, transitions out of the altered-state should be slow: extra time to reorient to space, sound and speech, with presence and support available but no pressure to talk.
Nadia adds a dimension that design checklists miss: the character of the people holding the space.
“Tackling any glaring inequalities, such as leaders of psychedelic spaces who have power or ego issues, is really important, and one reason among many is that autistic people are sensitive to injustice and power imbalances. These should be addressed before the ceremony, and the people leading it being kind, calm and supportive is a must.”
– Nadia Violet Erlam
This observation should not be read as a soft preference. A client whose nervous system registers interpersonal dominance as threat cannot be regulated by a sensory plan alone. Who holds the space is part of the space.
6. Integration: unmasking as the material, at the client’s pace
What surfaces when masking behaviour drops is often the most significant content of the session, and integration determines whether this material will manifest as positive insights or entrenched shame. The structural principle carries through from preparation: concrete prompts, scheduled check-ins and clear options serve better than an open invitation to reach out if anything comes up. Consciously enable autistic pacing and personal meaning-making, while resisting over-interpretation. Offer structured and optional tools: journaling prompts, visual and symbolic expression for clients with limited emotional vocabulary, and solo reflection as a full alternative to group sharing rather than an inferior or irregular option. Plan decompression for the return to daily life: rest, low stimulation, repetitive movement, nature-immersion and low-demand social connection.
“I have felt quite alone in the integration period, which was difficult, especially when I was confused by my experience. The more practitioners can make sure open channels are available for issues that come up in integration, the better. Having mentors who are themselves autistic available to talk with afterwards matters. If people are working, taking time off or having a quieter period during integration helps, though I am aware that is not always possible.”
– Nadia Violet Erlam
Nadia’s experience points to the structural gap: integration support is often the thinnest part of the container, precisely where a neurodivergent client is most likely to be processing an identity-level reframing. The longer arc matters here. Integration may include the client renegotiating how much masking they want to carry back into their life. That is deep selfhood work, and it deserves adequate support, peer connection with other neurodivergent people where possible, and honest referrals where the work exceeds the practitioner’s scope.
7. What this means for practitioner standards
Everything in this article is trainable and verifiable. Preparation protocols, relational pacing, sensory planning, communication agreements and integration options are concrete practices, and their absence is visible across the field. Perfection is the wrong bar; transparency is the right one. Practitioners name what they can and cannot accommodate, and communicate it warmly. The connection to verification is direct: clients deserve a way to know whether a practitioner has done this work before they are in an altered state and unable to advocate for themselves.
Nadia offers a checklist of essential checks, and it maps closely onto what a verification framework can hold:
“It is important to check a practitioner’s credentials: whether they have experience with neurodivergent participants or have practitioners who are autistic themselves, whether they believe in a social model of disability, and whether there is disability-specific support and consideration before the ceremony. And whether they are open to constructive feedback, reflexivity and accountability, and seem like people who could hear feedback if things did not go as planned. Accountability is a fantastic way to redesign spaces and rethink practices.”
– Nadia Violet Erlam
That final point arrives where this piece keeps landing. Competence with neurodivergent clients is a matter of specific, learnable practices held inside an accountable bi-directional relationship. Neither element substitutes for the other, and clients should be able to check for both.
About the contributors
Dr. WaiFung Tsang is a clinical psychologist and co-founder of Onaya Science, where his work spans NHS clinical practice and psychedelic research, with a particular focus on adapting therapeutic and ceremonial practice for neurodivergent clients. Their published work on preparation and support for neurodivergent participants informs several of the practices described in this article.
Nadia Violet Erlam is a neurodiversity activist and educator whose work sits at the intersection of inequality, disability and psychedelic practice. They studied gender policy and inequality at the LSE and have worked in inequalities fields for over a decade. They write and teach from lived experience as an autistic person with ADHD, including on Onaya’s accredited psychedelic mentorship training, which they have also completed.
References
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on My Best Normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534.
Murphy, R., Kettner, H., Zeifman, R., et al. (2022). Therapeutic alliance and rapport modulate responses to psilocybin assisted therapy for depression. Frontiers in Pharmacology, 12, 788155.
Rong, Y., et al. (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis. Research in Autism Spectrum Disorders, 83, 101759.
Stewart, C., et al. (2024). Perceived changes in mental health and social engagement attributed to a single psychedelic experience in autistic adults: Results from an online survey. Psychopharmacology. [Author list to confirm at review]
