Systematic review synthesises eleven studies on neurodivergent perinatal experience
A systematic review published in Women and Birth in late 2024 examined eleven studies on the perinatal experiences of autistic and ADHD individuals. The review, led by researchers at Edith Cowan University in Australia, synthesised qualitative evidence from 1,563 participants — 893 neurodivergent and 670 neurotypical — to identify what is known about pregnancy, birth, and early parenting for this population.
The answer: not much, and what exists is heavily skewed toward autism. Of the eleven included studies, only one focused specifically on ADHD. The remainder examined autistic perinatal experience, with some including comparison groups. This imbalance reflects a broader pattern in neurodivergent research: autism has received sustained attention while ADHD — particularly ADHD in women — remains under-studied across the lifespan, including the perinatal period.
The review identified three central themes across the literature: failures in care provider support, elevated perinatal mental health risk, and under-recognised strengths that neurodivergent individuals bring to pregnancy and parenting. Together, these themes characterise a pregnancy and birth system that does not understand, accommodate, or learn from neurodivergent perinatal experience.
Perinatal care providers fail neurodivergent people through dismissal and sensory ignorance
Across all eleven studies, neurodivergent participants described inadequate care from perinatal health professionals. The failures clustered around three areas: dismissal of concerns, ignorance of sensory needs, and inflexible communication.
Participants reported that their expressions of pain or discomfort were not taken seriously. One described feeling that staff “did not believe me about how I was feeling, but I couldn’t express it in any other way.” Another recounted being laughed at by labour nurses when she said the baby was coming: “They didn’t listen to me. I tend to be aware of my body.”
The adjustments (not “accommodations”!) that would address these needs are not complex — nor are these adjustments just preferences; they are, to the neurodivergent, essential.
Sensory needs emerged as a consistent challenge that care providers failed to address. Neurodivergent individuals process environmental stimuli differently — fluorescent lighting, background noise, unfamiliar textures can trigger overwhelm in ways that neurotypical people do not experience. During labour, one participant described “the bright lights and the cacophony of sounds” as feeling “like an assault.” Another reported becoming nonverbal due to sensory overload, unable to communicate her needs at the moment she most required support.
Communication barriers compounded the problem. Neurodivergent individuals may communicate pain, distress, or need differently — masking symptoms (of course, without realising it), struggling with the binary language of health screening questions, or appearing calm while experiencing significant internal distress. One participant described appearing “fairly calm on the surface in an attempt to remain focused” while in significant pain, leading staff to dismiss her concerns. The mismatch between neurodivergent communication styles and neurotypical expectations left participants feeling unheard, dismissed, and unsafe.
Neurodivergent perinatal mental health risk is elevated — but screening tools miss ADHD and autistic presentations
The review found consistent evidence that neurodivergent individuals face heightened risk of perinatal mental health difficulties. One included study reported that autistic individuals were significantly more likely to experience depressive episodes during pregnancy (40% versus 25%) and postpartum (60% versus 45%) compared to non-autistic counterparts. Another found that 19% of neurodivergent participants were diagnosed with postnatal depression, compared to 7% of neurotypical participants.
The single ADHD-focused study in the review highlighted how hormonal changes, sleep disturbances, and the demands of early parenting interact with ADHD symptoms to elevate depression risk. This finding points to a significant gap: ADHD research has historically focused on prepubescent boys, leaving clinicians poorly informed about how ADHD manifests across the female lifespan — including during the perinatal period when hormonal shifts may intensify symptoms.
Current mental health screening tools compound the problem. The Edinburgh Postnatal Depression Scale and GAD-7 questionnaire are standard in perinatal care but were developed using neurotypical populations and criteria. They may miss neurodivergent individuals who express distress differently, mask symptoms, or struggle with the binary or simplistic language these assessments use.
The review suggested that tools like the Autism-Spectrum Quotient and Sensory Perception Quotient — which account for sensory processing differences, alexithymia, and non-typical communication styles — may better capture distress in this population. But these tools are not standard in perinatal mental health screening. The result is a system that simultaneously places neurodivergent individuals at elevated risk and fails to detect when that risk actually manifests.
Continuity of care emerged as a protective factor. Participants who saw the same providers throughout their perinatal journey described building trust, feeling understood, and being able to communicate honestly without fear of negative consequences. One noted that with a new caregiver, “I felt that I had to kind of strategize, if I said something too concerning, I didn’t know how she’d react, so I felt that I had to be super OK and fake it a bit.” Continuity reduces the cognitive load of constant re-explanation and allows providers to learn individual needs over time.
Neurodivergent strengths in pregnancy and parenting remain unspoken, under-researched and under-resourced
The deficit framing that dominates neurodivergent research extends into perinatal care. But the review identified a counter-narrative: neurodivergent individuals described strengths that positively influenced their experience of pregnancy, birth, and early parenting.
Sensory sensitivity — typically framed as a vulnerability — enabled some participants to read their newborn’s cues with unusual accuracy. One autistic mother described how her sensory alignment with her baby made it easier to anticipate his needs: “Babies are very sensory-oriented, which I fully understand. In some sense it makes it easier for me to anticipate his needs.”
Hyperfocus, a trait associated with both autism and ADHD, appeared as an asset in breastfeeding and parenting. Participants described making breastfeeding a “special interest,” researching extensively, and persisting through difficulties that might have led others to stop. This deep engagement extended beyond feeding to other aspects of parenting, fostering profound connection and understanding.
Self-advocacy developed through the perinatal journey. Participants who had previous childbirth experience were more assertive in requesting accommodations. Some chose specific birth settings — midwifery-led units with controllable lighting and limited staff traffic — based on their sensory needs. Others used stimming behaviours during labour to manage stress and pain, finding that self-soothing strategies they used in other contexts applied effectively to childbirth.
The review authors framed these findings within a neurodiversity-affirming perspective: neurological differences are natural variations, not deficits to be corrected. The strengths neurodivergent individuals bring to parenting — sensory attunement, focused engagement, self-knowledge — benefit both parent and child. A healthcare system that understood this would design care around these capabilities rather than treating neurodivergence solely as a risk factor to be managed.
Citations
Elliott, J. K., Buchanan, K., & Bayes, S. (2024) — The neurodivergent perinatal experience — A systematic literature review on autism and attention deficit hyperactivity disorder
