A qualitative coproduced study on school drivers of low mood in neurodivergent adolescents: Structural inflexibility, emotional burden, burnout and masking.

<p>BackgroundADHD and autistic adolescents experience elevated rates of anxiety, depression, burnout and school distress. Emerging evidence suggests that mainstream school environments can create an “emotional burden” for neurodivergent students, through sensory overwhelm, social exclusion, and pressures to conform to neurotypical expectations, potentially contributing to poor mental health. However, little is known about how neurodivergent young people themselves who face low mood, understand these experiences.ObjectiveTo qualitatively explore the experiences of autistic and ADHD adolescents with low mood, depression and burnout and how school environments may contribute to them.MethodsOnline semi-structured interviews were conducted with 22 ADHD and/or autistic adolescents aged 11-16 years (Mage= 13.82, SD=1.44) attending or previously attending mainstream secondary schools in the United Kingdom (UK). Interviews explored experiences of school, low mood, depression, anxiety, emotional burden and wellbeing, and were analysed using reflexive thematic analysis. Using a deep participatory model of qualitative research, interviews were co-designed, co-delivered and co-analysed with neurodivergent youth co-researchers.FindingsFive themes were generated: (1) School culture prioritises discipline over wellbeing; (2) Lack of neurodivergence-informed practice; (3) No choice but hiding self to survive; (4) Chronic exhaustion, hypervigilance, and burnout; and (5) Depression and low mood. Participants described school environments characterised by academic pressure, punitive systems, sensory and social overwhelm and limited psychological safety, contributing to mental health problems. Masking and self-suppression were commonly described as necessary for survival and linked to chronic exhaustion, burnout, cognitive shutdown, withdrawal, anxiety, and low mood. Participants’ accounts suggested that distress was closely associated with ongoing environmental mismatch and pressures to adapt to neurotypical expectations.ConclusionsSchool environments characterised by repeated demands for adaptation can create chronic emotional burden. Hypervigilance and masking become adaptive responses. These responses accumulate into exhaustion and burnout, alongside which low mood and depression develop.Clinical implicationsThese findings highlight the need for more neurodivergent-informed, context-adaptive and preventative approaches within educational and mental health settings to help reduce the risk of low mood and prevent the escalation of these experiences. Neurodivergent students’ perspectives should be at the forefront of these mental health approaches.</p>