Autism, ADHD, and Trauma: Using EMDR Therapy in Ways That Support Neurodivergent Processing
EMDR for Autism and ADHD: How to Adapt Trauma Therapy for Neurodivergent Minds
Trauma is a common thread in the lives of many neurodivergent people. Autistic, ADHD, AuDHD, and other neurodivergent individuals are more likely to experience trauma; not only because of an increased risk of abuse, bullying, or victimization, but also due to a lifetime of being misunderstood, marginalized, or pressured to conform to environments and expectations that never truly fit. These experiences can leave lasting imprints on the nervous system, even if they aren't always recognized as “trauma” in traditional terms.
What is the Best Trauma Therapy for Autism, ADHD, and Other Neurodivergence?
Eye Movement Desensitization and Reprocessing (EMDR) is a well-researched therapy that offers hope for many people navigating trauma and distress. Yet for neurodivergent clients, EMDR can sometimes feel confusing, inaccessible, or misaligned with how their brains naturally process information.This doesn’t mean EMDR is ineffective for neurodivergent people. It means the process must be adapted to honor different cognitive, sensory, and emotional needs.
This blog explores how standard EMDR protocols may fall short for some neurodivergent clients, and how thoughtful adaptations can open the door to deeper safety, self-understanding, and post-traumatic healing.
Does EMDR Work if You’re Autistic?: Understanding EMDR’s Core Components
EMDR is an 8-phase therapy model developed to help people process distressing or traumatic experiences in a structured way to support healing and reduce psychological and physiological distress. A key feature of EMDR is bilateral stimulation (BLS); typically eye movements, tapping, or auditory tones applied alternatingly to the right and left sides of the body. Bilateral stimulation is used to activate the left and right hemispheres of the brain to help the brain reprocess trauma in a more complete and more adaptive way.
Traditionally, EMDR relies on:
Mental imagery (e.g., visualizing a memory or safe place),
Verbal tracking (describing what you’re noticing after each BLS set),
Emotional and body awareness,
And linear memory processing.
But for many neurodivergent people, some or all of these expectations may clash with how their nervous system and cognition actually function.
Rather than being a reason to avoid EMDR altogether, these challenges are an opportunity for therapists to adapt the therapy in a way that affirms and accommodates neurodivergent needs so that the benefits of EMDR are accessible to autistic, ADHD, and other neurodivergent clients..
Adapting EMDR for ADHD, Autism, and Other Neurodivergence: Practical Strategies
Visual Processing and Eye Movement Challenges
For many autistic or ADHD individuals, visual tracking can be difficult due to conditions like convergence insufficiency (a common co-occurring condition) or differences in visual-motor coordination. Visually tracking a quickly moving object side to side repeatedly may cause eye strain, headaches, or disorientation.
Others may simply find the traditional method of following a therapist’s fingers or light bar too fast, too demanding, or visually overwhelming.
Adaptations:
Use alternative forms of BLS such as tactile input (e.g., self-tapping on knees or shoulders), auditory tones through headphones, or even passing a soft object hand-to-hand.
Offer client choice and control in selecting the form of BLS that feels most comfortable and effective.
Aphantasia and Imagination Blocks
Not everyone can "picture" things in their mind. Neurodivergent individuals are more likely than non-neurodivergent people to experience aphantasia; an inability or reduced ability to conjure up clear mental images.
When EMDR asks clients to visualize aspects related to a traumatic experience, an image of themselves as strong and resilient, or a calming “secure place,” those with aphantasia may feel confused, may struggle, or may worry that they aren’t “doing EMDR” well enough.
Adaptations:
Focus on physical sensations, e.g., “What do you notice in your body as you think about that memory?” or emotions e.g., “What feeling comes up?” rather than visual images.
Use sensory cues like sounds, textures, or smells to access memory or safety.
Invite individuals to select objects, photos, or artwork that symbolize their experiences or calming resources.
Normalize that mental images are not required for EMDR to work.
Sensory Overwhelm or Sensory Avoidance
Neurodivergent people often experience heightened sensory sensitivity. For some, the EMDR environment, which can include bright lights, beeping sounds, or buzzing tappers among other tools, can be overstimulating or dysregulating.
When sensory input overwhelms the nervous system, it can be nearly impossible to stay grounded enough for trauma processing.
Adaptations:
Create a sensory-safe therapy space with dimmable lighting, quiet surroundings, and calming textures.
Support grounding with sensory tools such as weighted blankets or pillows; cold packs to hold or a grounding scent to smell in between sets of bilateral stimulation.
Allow clients to opt out of certain tools (like headphones or vibrating paddles) in favor of gentler or client-initiated BLS.
Respect sensory preferences, including the need for breaks, fidget tools, movement, or silence.
Prioritize co-regulation and safety before jumping into processing.
Emotional Awareness, Alexithymia, and Interoception Challenges
Not all neurodivergent people are easily able to identify, describe, or track emotions in the body. Alexithymia (difficulty recognizing and naming emotions) and interoception challenges (difficulty sensing internal body states) are common experiences for autistic, ADHD, and other neurodivergent individuals.
Traditional EMDR may ask clients to name emotions or body sensations during processing, but that’s not always accessible or even possible in the moment.
Adaptations:
Use external tools like emotion wheels, body maps, or visual cards to support emotional awareness.
Encourage metaphor or symbol-based language (“It feels like a tight rope” instead of “anxiety”).
Normalize not having the words, and support curiosity without pressure.
Allow more pacing and scaffolding when discussing internal experience.
Nonlinear Thinking, Perseveration, and Memory Access
Many ND clients don’t recall memories in neat chronological order. Memories may emerge associatively (e.g., via smell, color, or body feeling), not logically. Neurodivergent people may also be more prone to getting stuck on a thought or aspect of an experience being processed and struggle to move past this thought loop. These tendencies can clash with EMDR’s structured approach to identifying and targeting specific memories for reprocessing, or in moving through the reprocessing experience.
Adaptations:
Use a theme-based rather than timeline-based approach to memory targeting.
Let clients start with the emotion or sensation and work outward.
Allow for “target hopping” when it serves the healing process; trauma is rarely linear.
Incorporate adjunctive approaches such as ego state work, parts work, or Internal Family Systems (IFS) to help clients access and process stuck points in a more relational and less analytical way. These methods can externalize looping thoughts as distinct “parts” with their own needs or perspectives, making it easier for the client to address them and move forward.
Trust the client’s inner logic and create flexible protocols that support their unique pathways through memory and meaning.
Verbal Communication Demands
Verbal expression is one of the most under-recognized barriers in trauma therapy for neurodivergent people.
Many ND clients struggle to put their internal experiences into words, especially when emotionally activated, overstimulated, or dysregulated. Speech and language access can become limited during shutdown, overload, or even periods of high stress. For some, this is a consistent part of how their brain works; for others, it fluctuates depending on sensory, cognitive, or emotional demands.
Because traditional EMDR includes frequent verbal check-ins (e.g., “What do you notice?” after each bilateral stimulation set), clients may feel stuck, ashamed, or pressured to speak, even when speech is inaccessible or doesn’t accurately capture their experience.
Adaptations:
Normalize silence during or after sets. Clients should never feel obligated to “perform” insight. Insights can arise later; sometimes hours or days after a session.
Offer alternative communication modes such as:
Drawing or writing,
Typing responses on a device,
Pointing to visual symbols or emotion cards.
Indicating changes in distress levels with a thumbs up, down, or to the side
Use sentence stems or scaffolding to support expressive language, such as:
“What I’m noticing is…”
“This reminds me of…”
“If this feeling had a color, it would be…”
Allow extended processing time. Some clients need several seconds, or even minutes, before they can access words or meaning. Hold space without rushing. Silence is not a void; it’s part of the process.
Clarify that sharing is optional. Clients don’t need to verbalize everything they experience for EMDR to be effective. I often tell clients: “You’re the one doing the healing work. I'm here to support and guide, but your system already knows what to do. If you're noticing shifts, even silently, that matters more than whether you put them into words.”
Reframe silence or minimal speech as nervous system communication. Reduced speech, selective mutism, or verbal shutdown is not resistance. It’s a valid neurobiological response to stress and should be honored, not pathologized.
Why Adapting EMDR Therapy for ADHD, Autism, and Other Neurodivergence Matters
Adaptation doesn’t water down EMDR. It unlocks it.
Neurodivergent clients don’t need to force themselves to “fit” a protocol designed for neurotypical brains. Instead, EMDR should be flexible enough to meet clients where they are; in their sensory needs, cognitive styles, emotional rhythms, and communication capacities.
In fact, the adaptability of EMDR is one of its greatest strengths. The core model is robust enough to allow for creative, collaborative approaches that preserve its healing potential while making space for neurodivergent ways of being.
Finding EMDR Therapy That Works for Your Neurodivergence
If EMDR hasn’t worked for you in the past, or if you’ve felt frustrated, ashamed, or unseen in trauma therapy, that does not mean that EMDR therapy and other trauma therapies cannot help you. There is nothing wrong with how your brain processes or communicates experience. The problem is a lack of fit between your needs and the structure of the therapy you were offered.
But that can change.
When practiced with neurodivergent clients in mind, EMDR can become a powerful, affirming, and regulating tool for trauma recovery. You don’t need to force yourself into a neurotypical mold to heal. Your brain deserves healing that meets you where you are, on your own terms. An experienced and skillful EMDR therapist who understands neurodivergence and how to use EMDR to support your nervous system’s healing process can make all the differnce. You deserve trauma therapy that works with your brain, not against it.
If you’re looking for a neurodiversity-affirming therapist trained in adapted EMDR, contact me for a free 15-minute consultation to get your questions answered. I am a certified EMDR therapist who specializes in neurodiversity-affirming trauma therapy. I offer in-office therapy support at the quiet and cozy Shore Therapy office in Evanston, Illinois, just adjacent to Chicago. I also provide EMDR therapy online via telehealth with PSYPACT in over 40 states across the U.S. if being in your own home environment helps therapy feel more comfortable for you.
