Neurodevelopmental vs. Mental Health Conditions: What You Need to Know
Why this matters:
Current classification creates barriers to appropriate mental health care for neurodivergent individuals
The pathologizing language perpetuates stigma while missing genuine mental health needs
Neurodivergent individuals experience dramatically higher rates of depression and anxiety that often go unrecognized
What we'll cover:
The fundamental difference between neurodevelopmental and mental health conditions
Why current diagnostic categories create systematic gaps in care
A proposed framework that respects neurodiversity while addressing mental health needs
What this means for clinical practice, education, and workplace settings
Adults diagnosed with ADHD or Autism later in life often gain a framework and a translation problem at the same time. The diagnosis finally brings coherence to patterns that never quite fit. Yet the clinical language required for documentation often obscures what is actually being described. It classifies enduring neurodevelopmental differences as mental disorders rather than natural variation.
We, as providers, often find ourselves navigating a pragmatic gap. In our current healthcare landscape, diagnostic labels are the necessary keys that unlock support, insurance coverage, and workplace accommodations. But while these labels serve a functional purpose for access, they often fail to capture the reality of the lived human experience.
For many neurodivergent individuals, the diagnosis isn't a description of an illness to be cured. It is a description of their cognitive architecture: how they process information, how they perceive time, and often, a fundamental part of who they are.
Recent research published in the Journal of Psychopathology and Clinical Science seeks to address this tension. The authors propose a fundamental restructuring of how we classify these conditions (Morris et al., 2025). The core argument is that we are confusing stable architecture with accumulated distress. Neurodevelopmental conditions are stable variations in how the brain functions, which is fundamentally different from the treatable states of distress (the mental health conditions) that need clinical intervention.
The Core Distinction: Architecture vs. State
To understand why this reclassification matters, we need to recognize that we're dealing with two fundamentally different types of human experience.
1. Neurodevelopmental Conditions (The Architecture)
These are early-arising, stable differences in how the brain processes information. They affect cognition, motor function, sensation, perception, and communication. Examples include autism, ADHD, dyslexia, and intellectual disabilities.
The key characteristic: People typically experience these as inseparable from their identity. When neurodivergent individuals say "I am autistic" rather than "I have autism," they're making a meaningful distinction; the difference isn't something they carry, it's how their brain works.
Think of it as the brain's operating system. Just as a Mac and a PC process information differently but both function as intended, neurodevelopmental differences represent alternative but equally valid ways of experiencing the world.
2) Mental Health Conditions (The State)
These involve distress, impairment, or patterns of behavior that individuals experience as separate from their core sense of self. Depression, anxiety, substance use disorders, and trauma-related conditions fall into this category.
The key characteristic: People can usually identify themselves as existing before, during, and hopefully after these states. Someone experiencing depression might say, "This isn't who I really am" or "I want to get back to feeling like myself."
Here's where the distinction becomes clinically important: while ADHD affects the brain's architecture (how time feels, how effort registers, how attention distributes), the friction this creates in a neurotypical world often generates genuine mental health conditions. We need a diagnostic model that both respects and properly accounts for the architecture without ignoring the distress that friction creates.
The Hidden Crisis: What We Miss When We Pathologize Neurodivergence
The current classification system creates a troubling paradox. By grouping neurodevelopmental conditions under "mental disorders," we focus treatment on managing "symptoms" of neurodivergence; that is, the very traits that are often integral to identity—while overlooking co-occurring mental health conditions that cause and/or contribute to suffering.
There is ample data to support that neurodivergent individuals experience depression, anxiety, and substance use disorders at significantly higher rates than the general population (Khachadourian et al., 2023). These aren't necessarily inherent to neurodivergence; rather, they often develop from chronic experiences of:
Stigma and discrimination (resulting in accumulated shame)
Inadequate environmental supports (contributing to burnout from masking and compensation)
Social exclusion and victimization (compounding innate social differences)
The exhausting cognitive load of constant adaptation to environments not designed for them (deepening a sense of “other-ness”)
When a child is diagnosed with ADHD at age seven, the assessment focuses on attention, hyperactivity, and impulsivity. By age seventeen, when depression or anxiety has developed from years of being told they're "not trying hard enough," the mental health condition often goes unrecognized or gets attributed to "the ADHD" rather than treated as a separate concern requiring its own intervention. While this is an oversimplified example, painting with a broad brush, it illustrates the underlying issue:
a fundamental misunderstanding of what neurodivergent individuals actually need from mental health care.
The Proposed Solution: Restructuring Diagnostic Categories
Researchers propose a straightforward but profound change: restructure the diagnostic manual into the "Diagnostic and Statistical Manual of Neurodevelopmental and Mental Disorders." This places the two categories alongside each other rather than subsuming neurodevelopmental conditions under mental disorders.
This is more than semantic games; it’s a paradigm shift that would:
Acknowledge that neurodevelopmental conditions represent natural variation in human neurology
Maintain recognition that individuals may need substantial supports to function in current environments
Create explicit space for assessing and treating co-occurring mental health conditions
Reduce stigma by moving away from deficit-based language
Think of it like reorganizing a library. Currently, we shelve books about different cultures under "Problems and Abnormalities." The new system would create separate sections: "Human Neurological Diversity" and "Mental Health Conditions." Both would receive equal resources and attention, but the classification would reflect their true nature, which would both serve clinicians and clients. Clincians would have a better diagnostic map for understanding presenting issues and developing treatment plans, and clients would have a greater understanding of themselves by being able to differentiate between that which is stable and central to their identity and that which is transient and more episodic.
Moving Toward Dimensional Models
The solution also involves adopting what researchers call "transdiagnostic dimensional models." Instead of rigid categories—you either have ADHD or you don't—this approach recognizes that traits exist on continuums.
Rather than asking "Does this person have ADHD?" we might ask "Where does this person fall along dimensions of attention regulation, time perception, and effort-cost processing?" This dimensional thinking better captures reality:
Neurodevelopmental conditions commonly co-occur (autism + ADHD + dyslexia)
Neurodevelopmental and mental health conditions frequently overlap
Traits don't exist as all-or-nothing categories
Shared patterns cut across traditional diagnostic boundaries
When we classify ADHD purely as a "disorder to be fixed," we treat differences in time perception as defects requiring correction rather than architectural differences requiring accommodation. The dimensional approach allows us to recognize where someone falls on relevant dimensions and what specific supports would help them function effectively, without pathologizing the underlying architecture.
What This Means for Clinical Practice
In practical terms, this reconceptualization changes how we approach assessment and treatment.
Assessment shifts from:
"What symptoms does this person have?"
To:
"How does this person's brain process time, effort, sensation, and social information? And what mental health conditions have developed in response to the friction between their neurology and their environment?"
Treatment shifts from:
Trying to normalize neurodivergent traits
To:
Creating environmental accommodations while addressing genuine mental health concerns with evidence-based interventions that respect neurodivergent processing styles
This matters because current approaches often fail neurodivergent individuals in both directions. We either:
Focus exclusively on "fixing" the neurodivergence while ignoring depression and anxiety, or
Assume all distress stems from societal barriers and miss genuine mental health conditions requiring treatment
The dimensional framework allows us to hold both truths: neurodivergence is natural variation that deserves recognition and accommodation AND neurodivergent individuals often develop mental health conditions requiring treatment.
Implications Beyond the Clinic
In Educational Settings:
Recognition of neurodivergent learning profiles as differences rather than deficits, with accommodations that support diverse cognitive styles while attending to mental health needs that may develop under academic pressure.In Workplace Contexts:
Inclusive practices that enable neurodivergent employees to contribute effectively while ensuring access to mental health resources that understand neurodivergent presentations.In Policy and Legal Frameworks:
Protections that recognize neurodevelopmental variation as natural diversity while maintaining access to supports and accommodations without requiring pathologizing labels.
Moving Forward
The movement toward recognizing neurodiversity as human diversity rather than pathology represents more than diagnostic reclassification; it's a fundamental shift in how we understand human variation.
For clinicians, this means developing frameworks that:
Distinguish stable neurodevelopmental differences from transient/episodic mental health conditions
Address the actual priorities neurodivergent individuals identify (often co-occurring depression and anxiety)
Provide evidence-based mental health treatment that accommodates rather than tries to override or “fix” neurodivergent traits
Advocate for environmental changes alongside individual support
The goal isn't to deny that neurodivergent individuals may face significant challenges or need substantial support. It's to accurately represent the nature of those challenges and respond appropriately to the diverse needs within neurodivergent communities.
When we stop pathologizing natural neurological variation, we create space to address the genuine mental health concerns that develop when individuals don't receive appropriate support. That shift—from trying to fix people to creating environments where different minds can thrive—is what this reconceptualization ultimately makes possible.
References
Morris, I., Michelini, G., & Wilson, S. (in press). Moving Toward Transdiagnostic Dimensional Models of Neurodiversity and Mental Health (and Away From Models of Psychopathology). Journal of Psychopathology and Clinical Science. https://doi.org/10.1037/abn0001007
Khachadourian, V., Mahjani, B., Sandin, S., Kolevzon, A., Buxbaum, J. D., Reichenberg, A., & Janecka, M. (2023). Comorbidities in autism spectrum disorder and their etiologies. Translational Psychiatry, 13(1), Article 71. https://doi.org/10.1038/s41398-023-02374-w
