Why prematurity and… neurodiversity?

Or, before we get to that question, perhaps a better question is: what is neurodiversity?

Neurodiversity is the idea that there’s a variation in how people’s minds function, and in how their minds influence their behavior. It’s a mashup of two words: neurology and diversity. Initially, it sounds pretty basic, an undisputed fact: people’s minds do work in different ways, and do have different strengths and weaknesses.

Given that, neurodiversity isn’t something that someone “has.” Groups of people are diverse, minds are diverse, cultures are diverse; individuals themselves aren’t “diverse.” The term “neurodivergent” represents the individual who feels that she or he varies from the norm of neurological functioning, that is, “neurotypical.”

Origin of the Idea of Neurodiversity

The words related to neurodiversity originated with the autism self-advocacy community, specifically, as a way to lessen the pathology associated with autistic ways of being in the world. (At least, that’s how I understand it).  Now, the term is often used to denote other forms of mental functioning difference beyond autism, like ADHD, learning differences, bipolar disorder, depression, or anxiety. Sometimes people use the idea of neurodivergence to suggest that their differences aren’t disordered, but are in fact part of the normal variations found in the human species, variations which can be beneficial to the progress of the species. (Here is a very clear overview about neurodiversity, neurodivergence, and neurotypicality).

Neurodiversity and Prematurity: A Personal Perspective

On this blog, though, I’m going to jump to thinking about what neurodivergence might have to do with prematurity.

Specifically, it gets kind of messy whenever people talk about attempts to change or cure or otherwise alter someone’s way of thinking or feeling that’s intrinsic to a person’s fundamental experience of the world.

And this is pretty much how I feel about being premature: that had I not been born 12 weeks early, I wouldn’t be the same person I am today. You can’t take away the prematurity without taking away something essential to my experience of the world.

I have a gut-level feeling that if I’d stayed in the womb until full-term (or, at least, average full-term for twins), I would not be the same person.  Who I am is intrinsically bound up with being born early, and I suspect this means that there’s some neurodivergence going on. Call it a “not otherwise specified,” a little bit of this, a little bit of that, which over time has put me in the therapist’s chair or the care of other health professionals more than once.

What catches my attention are the statistics. Put simply, rates of learning differences (particularly on the visual/spatial/mathematical/nonverbal side), as well as ADHD, autism, mental disorders, and other neuropsychological outcomes are much higher among those born preterm than those born at full-term.

Take this note from the website BabyCenter, to put things in perspective:

The lower a baby’s birth weight and gestational age, the more likely he is to have some learning differences as he gets older. About half of preemies weighing less than 3 1/2 pounds at birth develop learning disabilities or behavioral issues, says Cathy Boatman, a child development specialist at the Children’s Medical Center of Dallas.

It sounds alarming at first: about half of the very early preemies will develop learning disabilities or behavioral issues! Oh no!

But take a step back: half will not develop those kinds of issues, and if your baby was born larger than 3.5 lbs, or at a later gestational age, well, her chances of not having learning or behavioral issues increases dramatically! Every week matters, every little bit of weight gain matters, the research tells us.

Neurodiversity and a Preterm Baby’s Brain Development

A baby’s brain triples in weight during the final trimester, but when a baby is born premature, the protection of the womb is gone. The mother’s womb had regulated temperature, sound, and light, but in the NICU, the preemie is exposed to noise, light, and fluctuations in temperature. I’ve read numerous studies showing that this cannot help but have an effect on the brain as it’s growing, developing, and laying down neural connections outside the womb in those final weeks or months.

Contemporary NICU procedures that promote bonding (like supporting skin-to-skin contact through “kangaroo care,” or encouraging breastfeeding when at all possible) can help to reverse the adverse environment of the NICU, as can the usual parental love, care, play, and engagement after the NICU, along with all the wonderful things parents do with their babies as they grow and develop.

Nothing is a foregone conclusion: most preemies, as I noted in my “Dear Parents in the NICU” article at “The Mighty,” have normal, happy, typically functioning lifetimes. But prematurity — with its different brain development that (for varying lengths of time) takes place outside of the womb — there seems to be a close, complicated relationship with neurodivergence. And the idea of neurodivergence, which gets beyond diagnostic labels and emphasizes simply the uniqueness of each person’s neurological functioning, is one thing I hope to explore further at Acorn in the Oak.

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