Neurodiversity in Sport, Part 1: Understanding Neurodivergence in Athletes and Sports Systems

Earlier this year I had the privilege of co-presenting a webinar series on neuroaffirming interventions in sport with Dr. Samantha McLeod from The SAM Centre, delivered through Sports Medicine Australia and College of Sport & Exercise Psychologists. The conversations that followed, with practitioners, coaches, and athletes, made one thing clear: most of us working in sport have had little to no formal training on neurodiversity, and our systems still expect neurodivergent athletes to fit into structures designed for neurotypical norms.

This blog is the first of two summarising what we covered.

Part 1 is about understanding neurodivergence: what it is, how it shows up, what the prevalence actually looks like in sport, and the dimensions of presentation that practitioners and coaches need to be alert to. Part 2 will turn to neuroaffirming interventions, what we can actually do, which will come later in the year.

Getting the Language Right

Before we go any further, the language matters.

• Neurodivergence refers to a neurodevelopmental difference in neurological function from what is considered "typical". Neurodiversity describes the broader reality that any group of people contains both typical and atypical brains. Neurodivergent refers to the individual whose brain processes differently. And neuroaffirming is the orientation we are trying to embed: a shift from framing difference as deficit to framing it as difference, with associated strengths and challenges.

• A neuroaffirming approach is not just about being patient or kind with neurodivergent athletes. It is not about treating neurodivergence as a problem to fix, and it is not about making neurodivergent athletes appear more neurotypical so they fit into the team. It is about working with someone's neurotype rather than against it.

• There is also a choice between identity-first language ("Autistic person", "ADHDer") and person-first language ("a person with Autism", "a person with ADHD"). Best practice is to ask the athlete what they prefer. Many neurodivergent people use identity-first language about themselves but may not be comfortable with others using it about them.

Prevalence in Athletes: What the Research Actually Shows

One of the questions we hear most often is whether neurodivergence is more common in athletes than in the general population. The short answer, based on the evidence available, is yes, particularly for ADHD.

A 2023 systematic scoping review of neurodiversity in elite sport (Hoare et al., 2023) found that ADHD is more common in elite athletes than in the general population, with rates varying by sport but consistently elevated. As Dr. George Pujalte at the Mayo Clinic has noted, "ADHD can have positive effects on sports performance, and we need to study that more. Sports that require reactive decision-making and quick movements could benefit."

The bulk of existing research focuses on ADHD, concussion risk, and anti-doping considerations. Far less of it has examined athlete wellbeing, performance, or quality of care for neurodivergent athletes more broadly. Autism in elite sport is even less studied (Grosprêtre et al., 2024), and the lived experience research is only just beginning to catch up (Wood et al., 2026).

What this means in practice is that there are likely many more neurodivergent athletes in our sporting systems than current systems are recognising, and that the framework we build our coaching and support practices around has been shaped by very narrow research.

The Neurodivergence Umbrella

When we talk about neurodivergence, we are talking about a wide range of conditions that often co-occur. Comorbidity is the norm, not the exception. ADHD and ASD frequently co-present. Mood disorders, anxiety disorders, sleep disorders, intellectual and learning differences, and burnout often sit alongside.

There are particular risks to be aware of. ADHD has been identified as a risk factor for concussion and impaired post-concussive recovery, and for substance abuse, particularly when ADHD medication is involved. As one athlete with ADHD

described it: "I gave up on wanting to participate. I protected myself and withdrew. I became really anxious and suicidal." The cost of going unidentified or unsupported can be very high.

A particular group that often gets missed are the twice exceptional athletes, those who are gifted (high IQ, high verbal ability) and also have a learning challenge such as dyslexia, ADHD, or ASD. Their giftedness can mask the learning challenge, and the learning challenge can mask the giftedness. Twice exceptional athletes can often present in sport as either underachieving or as confusing to coaches who cannot reconcile the obvious capability with the inconsistent application.

Female Neurodivergent Athletes Are Often Missed

One of the patterns we see clinically and in the research is that female neurodivergent athletes are often missed entirely, or identified much later than their male peers.

The reasons are a mix of biological presentation differences, social conditioning, and masking. Female athletes are often more practiced at camouflaging neurodivergence to fit in with peers, which makes the underlying neurotype harder to spot. Often, neurodivergent female athletes, are more likely to be labelled as anxious or perfectionistic than as ADHD or autistic. And the assessment tools we use have historically been validated on male presentations.

For young female athletes especially, this often means a long period of being told they are simply struggling, lazy, oversensitive, or not coping, when what is actually happening is that they are working extremely hard to mask, with a significant invisible cost.

Celebrated neurodivergent athletes breaking barriers in sports: Elise Muller, Britney Griner, Alysa Liu, Simone Biles, Michelle Carter, Molly Seidel, and Jessica Jane-Applegate.

Assessment: Who, What, Where, When, and How

Assessment of neurodivergence is not a linear process, and there is no single gold-standard diagnostic pathway.

Who gets assessed often starts with the athlete themselves, raising concerns or questions, sometimes through a sport psychologist, sometimes through their GP, sometimes through a multidisciplinary team.

What the assessment looks like depends on what is being explored: a formal diagnosis is not always the goal. For some athletes, the more useful question is not "do I meet criteria" but "what is going on, how does it affect me, and what would help." A range of tools exist for both ADHD and ASD assessment, the AQ, ASSQ, CAT-Q, RAADS-R, ASRS, CAARS-2, ESQ, and others. None of these are stand-alone diagnostic instruments, and a clinical assessment integrates multiple sources of information.

Where assessment matters is across functional domains, not just behaviours. Athletes can seem fine on the surface while experiencing significant challenges in psychological wellbeing (self-esteem, sense of belonging), social functioning (masking, peer relationships), academic or occupational life (executive function, time management), and daily living.

When it matters is across the lifespan, demands change with transitions, and many athletes "fly under the radar" until the demands of their level outpace their skills or capacity. The myth that people "grow out of ADHD" continues to result in late diagnosis well into adulthood.

The clinical goal, in our view, is to help athletes and their families understand themselves, advocate for what they need, and put strategies in place to achieve what they want.

How Neurodivergence Shows Up in Sport

There are a handful of dimensions that come up consistently when we work with neurodivergent athletes. Knowing these dimensions helps coaches, support staff, and athletes themselves understand what is going on under the surface.

Executive function is the brain's management system: planning, organising, time-management, working memory, and self-monitoring. Difficulties can show up when demand exceeds skill or capacity, learning new strategic information in long meetings, sticking to routines, navigating logistics around training and competition.

Emotional regulation and rejection sensitivity dysphoria (RSD) are common experiences, particularly in ADHD. Emotional volume gets stuck on high. Feedback from coaches, comments from teammates, mistakes, and losses can trigger intense emotional responses, sometimes explosive, sometimes internalised. Recovery from these episodes can take longer than peers, and applying regulation strategies in the moment can be harder when the system is already escalated.

Sensory processing varies significantly. Some athletes are sensory-seeking, others sensory-avoidant. The sensory profile of an athlete can have practical consequences across the whole high-performance environment, from dining halls to physio rooms to crowd noise during competition. A sensory profile assessment can be a really useful tool here, both for the athlete and for the multidisciplinary team supporting them.

Interoception, the ability to detect internal body cues like hunger, thirst, fatigue, temperature, and emotional states, is can be different in neurodivergent athletes. Signals may be absent, delayed, amplified, or misread. This has obvious implications in elite sport for fuelling, recovery, injury prevention, and emotional regulation.

Masking and camouflaging is the survival strategy many neurodivergent athletes use to appear neurotypical and stay in the environment. It has three components: masking (hiding traits), compensation (covering up difficulties with effort and strategy), and assimilation (working hard to fit in). The invisible effort involved is real, and practitioners need to account for it. An athlete who appears to be coping well may be paying a significant hidden cost.

Strengths and Challenges, Not One or the Other

The neuroaffirming framing is not "challenges are real but let's focus on strengths." It is that strengths and challenges co-exist, and the sport environment can amplify either.

Common strengths we can see in ADHD athletes include processing quickly, fast reaction times, hyperfocus on high interests, high energy and creativity, and thrive in fast, action-rich sports. Difficulties that include distractibility, executive function demands, following long verbal instructions, and sticking to routines. Coaching learning styles can affect motivation, coachability, and connecting when mismatched.

Common strengths in Autistic athletes can include deep focus, pattern recognition, commitment to mastery, attention to detail, and consistency. Difficulties can include social communication, restricted and repetitive behaviours and interests, sensory processing in busy environments, navigating team dynamics, and figurative language ("pull your socks up", "run like the wind" can be confusing for someone who interprets language literally). Different communication styles can be misread by coaches and teammates as arrogance or rudeness.

Elite sport environments built for neurotypical norms tend to amplify both the strengths and difficulties. The same setting that lets a neurodivergent athlete's strengths shine can leave them excluded, exhausted, or burnt out if the environment is not adapted.

What This Means for Practice

Even before we get to specific neuroaffirming interventions (which Part 2 will cover), there are some things that follow from what we have outlined here.

Recognising neurodivergence in sport requires looking past surface behaviours to the underlying executive function, sensory, regulatory, and interoceptive picture. It requires understanding that masking is invisible work. It requires being aware that female and twice exceptional athletes are particularly likely to be missed. And it requires the humility to ask, rather than assume, what each athlete needs.

The athletes we work with are telling us this is not optional. The systems we operate in still have a long way to go. Part 2 will look at what neuroaffirming sport actually looks like in practice, the strategies athletes can use, the changes that sports systems can make, and how multidisciplinary teams can apply these principles together.

This blog draws on the Part 1 webinar "Neuroaffirming Interventions in Sport and Exercise" co-presented with Dr. Samantha McLeod (The SAM Centre) for SMA and COSEP, March 2026.

References

• Grosprêtre, S., Ruffino, C., Derguy, C., & Gueugneau, N. (2024). Sport and Autism: What Do We Know so Far? A Review. Sports Medicine, Open, 10(1), 107.

• Hassmén, P., & Hindman, E. (2025). Emotion Control Strategies for Peak Performance in Neurodivergent Brains: Wired to Thrive. Springer Nature Switzerland.

• Hoare, E., Reyes, J., Olive, L., et al. (2023). Neurodiversity in elite sport: a systematic scoping review. BMJ Open Sport & Exercise Medicine, 9, e001575.

• Hyun Han, D., McDuff, D., Thompson, D., Hitchcock, M. E., Reardon, C. L., & Hainline, B. (2019). Attention-deficit/hyperactivity disorder in elite athletes: a narrative review. British Journal of Sports Medicine.

• Inga, C., & Mills, J. P. (2017). 'Hey, look at me': An {auto} ethnographic account of experiencing ADHD symptoms within sport. Qualitative Research in Sport, Exercise and Health.

• Wood, S., Marshall, B., Kaiseler, M., & Wood, G. (2026). Navigating neurodiversity in elite sport: lived experiences of neurodivergent athletes. Qualitative Research in Sport, Exercise and Health, 18(2), 123–137.