'The Unique Privilege of Working with an Athlete with Diagnosed or Suspected Autism Spectrum Condition'

1 Jan

Written by Caz Nahman. Subheadings added by the Neurodiverse Sport team to support readability.

An introduction to Dr Caz Nahman

👋 "Hi, my name is Caz Nahman. I'm a child and adolescent psychiatrist with interests in Autism, eating disorders, compulsive exercise and athlete mental health. I have a small athlete clinic, but work mainly within a community adolescent eating disorders team, where up to 1/3 of my patients do competitive sport, and up to 1/2 of my patients present with Autism traits. I am the teaching lead for child and adolescent psychiatry, for undergraduate medical students at Oxford University.”

Caz: "The following story is based on real life scenarios from my work with several athletes with autism but does not refer to one particular athlete and any resemblance to a known athlete is co-incidental."

Katie – an anecdotal story

A new environment

Katie is a 19-year-old swimmer competing at a national level. She recently transitioned to university and changed coaches after ten years. Her new coach, Andy, is finding it difficult to understand her behaviour.

Miscommunication and misunderstanding

Andy didn't realise Katie had a bruised tendon. Katie believes she told him, but Andy doesn’t recall any conversation. Katie doesn’t show pain outwardly, so Andy can’t visually assess her condition. During her first week, Katie suffered a head injury and reacted emotionally when taken out of training. Andy misread her distress as childish behaviour and decided she was 'badly behaved.'

Different ways of processing

Katie frequently asks “why” when asked to do things. Andy suspects she doesn't trust him and feels he has gone out of his way to help her without much appreciation. She works hard but doesn't smile much or engage in team banter. To Andy, this seems ungrateful or standoffish.

Psychological context

Katie is working with a psychologist for anxiety. With Katie’s permission, the psychologist requested a meeting with Andy. He was surprised by this, feeling she was performing reasonably well as an athlete despite being difficult to coach. The psychologist explained that Katie had been diagnosed with Autism at 14. She is highly anxious and desperate to get things right—but often doesn't know the rules or whether she's doing things wrong.

Katie loves her sport. It’s her main interest and central to her life. She enjoys understanding the biomechanics behind training and prefers detailed, specific corrections. To her, not being corrected means the coach isn’t interested. She thrives on structure and clarity.

Overexertion from mixed messaging

The head injury occurred after a team pep talk in which Andy told the squad, “nobody is trying.” Katie took this literally and pushed herself to the point of dizziness. Andy was surprised—everyone knows Katie works hard. He didn’t realise his words would be internalised that way.

Current challenges

Katie is struggling with sleep, university demands, and managing nutrition around her academic schedule and training. The psychologist shared that Katie becomes distressed if she has to miss training sessions—this can feel overwhelming for her. When told of her diagnosis, Andy's first thought was, "she doesn’t look Autistic." He saw her as quiet, dedicated, and intelligent—“normal” in many ways.

What is Autism?

Key characteristics

Autism is a lifelong neurodevelopmental condition. It involves differences in social communication, emotional regulation, and often includes intense and restricted interests. Autistic individuals can be very different from one another. Some may be profoundly learning disabled; others may be academically gifted.

Diverse presentation

The phrase "if you've met one person with Autism, you've met one person with Autism" is particularly important. Autism can present subtly, especially in females, who may be underdiagnosed because they often work hard to mask their differences. Co-occurring conditions like Dyslexia, Dyspraxia, and ADHD are common.

Autism & athletes – the overlap

Strengths that align with sport

Athletic traits like perseverance, commitment, and attention to detail are common Autistic strengths. Autistic individuals often have intense interests and can persist through highly repetitive training without boredom.

Gaps in research

There is little research on Autism in sport, particularly in non-disabled contexts. Existing studies tend to focus on motor skill difficulties. However, anecdotal evidence shows that Autistic athletes can master predictable and repetitive movements to a high standard.

Observations from practice

Practitioners working with elite athletes often see overlaps. One study by Grant (2008) found higher-than-expected athletic achievement in students with Dyslexia and Dyspraxia. Individual sports were often preferred, but not exclusively.

Katie's relationship with her coach

Navigating multiple transitions

Katie has entered several unfamiliar environments at once: a new team, university life, and shared accommodation. It takes her time to learn the unspoken social rules. Unless she knows someone well, she may struggle to read body language, facial expressions, or tone.

Impact of communication style

When Andy told the squad, “nobody is trying,” Katie took this literally and felt she was doing something wrong. She didn’t say anything but pushed herself harder. Generalised or shouted instructions can cause confusion and distress.

Visible vs invisible signs

Katie doesn’t display obvious signs of anxiety or pain until a situation becomes overwhelming. When she does react, it can seem sudden or disproportionate—but these reactions often stem from prolonged internal stress.

What would help?

1. Building mutual understanding

Katie and Andy need to build rapport. Many Autistic strengths—focus, persistence, problem solving—can be misinterpreted. Questioning isn’t defiance; it’s curiosity and a need for clarity. Andy should be aware of his own emotional responses, too.

2. Clear communication

Andy can support Katie by:

Making implicit rules and expectations explicit
Helping her interpret tone and intention
Clarifying when feedback is general versus personal

3. Avoiding generalisations

Sweeping statements like “nobody is trying” may demotivate or confuse Autistic athletes. Even well-meaning criticism can be internalised deeply. Clear, direct communication is more effective.

4. Structured feedback

Katie needs:

Clarity on the purpose of each session
Explicit explanations that “trying” doesn’t always mean maximum effort
Assurance that correction means the coach is engaged

5. Managing perfectionism

Katie’s perfectionism should be supported, not punished. Unrealistic self-expectations can lead to burnout. Andy can help by:

Setting flexible, achievable goals
Communicating regularly about expectations
Encouraging recovery and self-care as part of training

Other considerations…

Physical and sensory differences

Hypermobility is more common in Autistic individuals and may increase injury risk.
Sensory differences may lead to high pain thresholds, so injuries may not be noticed right away.

Interoception and self-care

Katie may not recognise when she's hungry, tired, or dehydrated.
Tools like heart rate monitors can help bridge the gap between feelings and physical states.
Data-driven feedback can help her make informed decisions about rest and effort.

Written by Dr Caz Nahman