EMDR Therapy Quarterly

Introduction 
‘Neurodivergence’ refers to variations in human brain structure and cognitive functioning that diverge from what is typically considered ‘neurotypical.’ This includes differences in learning, attention, mood, sensory processing and social interaction. Common examples include Autism, ADHD, dyslexia, dyspraxia, dyscalculia and Tourette syndrome. These differences are not deficits to be ‘fixed’ but variations to be recognised and accommodated (Singer, 1999; Armstrong, 2015). 

While EMDR has been shown to be effective for treating trauma, most research has focused on neurotypical populations. Yet many clients in clinical practice are neurodivergent. These clients may present with overlapping neurodevelopmental conditions, such as the high rates of ADHD in individuals with Autism (Antshel et al., 2013; Hours et al., 2022) and may also experience increased rates of mental health difficulties, including anxiety and depression (Brook et al., 2013; Georgiou et al., 2024; McKinney et al., 2024). 

Neurodivergence and trauma frequently intersect. Adverse childhood experiences are more common among neurodivergent individuals (Wilson et al., 2024), and trauma responses can mimic or amplify neurodivergent presentations (McDonald & Ejesi, 2021). For example, the emotional dysregulation characteristics of Autism can intensify PTSD symptom severity following trauma (Cai et al., 2018; Quinton et al., 2024). Similarly, undiagnosed dyslexia can lead to shame and trauma responses rooted in negative educational experiences (Alexander-Passe, 2015). 

Despite these intersections, there remains a paucity of research on EMDR with neurodivergent populations. Existing evidence consists primarily of case studies and small trials, often focused on Autism and ADHD (Buuren et al., 2019; Firat et al., 2023; Guidetti et al., 2023; Leuning et al., 2023). The literature provides promising indications but little systematic guidance for clinicians. This article therefore integrates the available research with clinical insights to outline adaptations and considerations across the EMDR protocol to support neurodivergent clients in accessing EMDR effectively. 

Evidence base for EMDR with neurodivergent clients 
The current evidence base for EMDR with neurodivergent populations is limited but growing. Most studies focus on individuals with Autism and, to a lesser extent, ADHD. 

Several case studies and small trials have shown EMDR to be effective in reducing trauma and stress symptoms in autistic children and adults. For example, Firat et al. (2023) reported successful treatment of specific phobias in two children with Autism using only two 90-minute EMDR sessions. Leuning et al. (2023) conducted a study with 21 autistic adolescents and found significant reductions in daily stress and improved global functioning, though EMDR did not reduce core Autism symptoms. Similarly, Buuren et al. (2019) compared EMDR with treatment-as-usual for 21 autistic adults and found EMDR significantly reduced PTSD symptoms, psychological distress, and some autistic features, with gains maintained at follow-up. 

There is less research on ADHD, but two case studies demonstrate EMDR’s potential. Guidetti et al. (2023) treated a 12-year-old with ADHD and PTSD using EMDR, reporting improved executive functioning and reduced emotional dysregulation at a nine-month follow-up. Gokcen et al. (2022) described a 9-year-old boy with ADHD and a history of sexual abuse whose PTSD and oppositional defiant symptoms improved after five EMDR sessions. 

Currently, no studies have examined EMDR adaptations for clients with dyslexia, dyscalculia or dyspraxia. Much of the adaptation guidance therefore comes from clinical experience and neurodiversity-affirming therapeutic approaches rather than formal research. 

Adapting EMDR across the eight phases 

Phase 1: History taking 
Attention to the therapeutic environment is essential. Lighting, sounds, room temperature and textures should be comfortable and predictable. Clinicians should observe how clients engage with forms and assessments, offering support as needed. Questions may need to be phrased more concretely; for example, “How are you feeling right now?” may be more effective than “How are you?” 

Exploring how clients organise their memories can guide treatment planning. Some may generalise their experiences (e.g., merging multiple bullying incidents), while others describe each event separately. Adjusting pacing is crucial: some clients prefer shorter sessions to avoid overload, while others may need longer to feel fully heard. Direct language should be used when assessing risk (e.g., “Do you have suicidal thoughts?” rather than euphemisms such as “dark thoughts”). 

Phase 2: Preparation 
Bilateral stimulation (BLS) should be tailored. Clients with ADHD may find slow BLS frustrating, whereas some clients with Autism struggle with eye movements and prefer tactile or auditory methods. Clients with dyslexia or dyspraxia often find tapping easier but may worry they are ‘doing it wrong.’ Normalising this is important. 

Calm or safe places should be adapted to individual sensory preferences. Some may prefer movement-based or textured imagery, while others prefer minimal sensory input. Photographs, music, scents or tactile objects can support affective engagement if visualisation is difficult. For clients with tics or Tourette syndrome, noticing calm sensations during resource installation can reduce tic frequency, especially when incorporating movement. 

Phase 3: Assessment 
Clarifying questions collaboratively ensures understanding before memory activation. Reviewing the worksheet together can reduce confusion. Some neurodivergent clients compartmentalise experiences, recounting events without emotional engagement; therapists may need to help them connect memory and affect. 

Scales may need adaptation. Clients may describe validity of cognition or subjective units of distress (SUD) qualitatively (e.g., ‘low,’ ‘medium,’ ‘high’) rather than numerically. Emotional expression may be physical rather than verbal; using tools such as an emotions wheel can support identification. Therapists should observe body language as well as verbal responses. 

Phase 4: Desensitisation and reprocessing 
Set length and speed should be flexible. Clients with ADHD may benefit from shorter, faster sets; clients with slower processing speeds may need longer. Some neurodivergent clients talk extensively during processing – this may reflect avoidance or their neurocognitive style. Therapists can allow brief sharing during BLS, then return the focus to the task. 

Movement-based techniques can help regulate arousal. Some clients may pace or march on the spot during BLS, which can keep them within their window of tolerance. Emotional intensity should be validated, particularly for clients who have been told they are ‘too much.’ Adapt SUD measurement flexibly, as some clients may simply indicate their distress is gone without a number. 

Phase 5: Installation 
Positive cognitions should use the client’s own language. Some clients with Autism may resist formulaic ‘I’ statements, and ecological cognitions, such as “it’s in the past,” may be more congruent. If clients express boredom or frustration during installation, therapists should not take this personally but adapt accordingly. 

Phase 6: Body scan 
Some clients prefer not to close their eyes or need explicit guidance to notice body sensations. Language should be clear and concrete, focusing on observable tension or relaxation rather than abstract internal states. 

Phase 7: Closure 
Praise should be genuine and non-patronising; some neurodivergent clients may be suspicious of praise due to negative educational experiences. Post-session processing should be explained concretely (e.g., “Your brain is like a computer running a background program”). Note-taking expectations should be managed carefully to avoid triggering shame or perfectionism. 

Phase 8: Re-evaluation 
Therapists should check that previous targets remain resolved and adapt questioning as needed. Some clients may move quickly to new material; others may benefit from re-completing parts of the protocol to notice changes. 

Additional considerations 

Environmental sensitivity: Changes in the therapy room or schedule can be distressing. Therapists should communicate changes clearly and be prepared to repair ruptures if clients perceive them as intentional. 

On-the-spot method: Originally developed for clients with dementia (Amano & Toichi, 2014), this method involves applying adapted EMDR procedures in real time when distress arises. For neurodivergent clients, similar in-the-moment desensitisation can be helpful when sudden environmental changes trigger intense reactions. 

Timeliness: Punctuality and clear communication about delays are crucial, as unexpected lateness can provoke significant anxiety. 

Conclusion 
Neurodivergent clients bring unique strengths and challenges to EMDR therapy. While formal research on EMDR adaptations for neurodivergent populations is limited, existing studies and clinical experience suggest that thoughtful, individualised modifications can make EMDR more accessible and effective. By attending to sensory preferences, communication styles, processing speeds and environmental sensitivities, clinicians can deliver EMDR in a way that is both neuro-affirming and faithful to the standard protocol.