Autistic athletes face unique challenges in elite sport, but could have a competitive edge

In 2021, Caragh McMurtry was selected for the British rowing team, representing her country at the Tokyo Olympics. This was a testament to her illustrious career, during which she won multiple medals at the World Cup and World Championships.

However, what was less known was that Caragh had been battling a series of interpersonal issues behind the scenes, which led to a disconnect between her and her teammates and coaching staff. Caragh admitted that she was very honest and straightforward, sometimes even too blunt.

"I think people find me difficult because I need to break everything down... to understand 'why'," Caragh explained. "I can't take anything for granted, and that annoys coaches, who think I'm questioning them or joking." Caragh was troubled by the "lack of transparency" in the decision-making process, believing that some athletes were favored for being good at "self-promotion" rather than based on objective criteria.

"I have a strong sense of justice," Caragh said. "It doesn't even necessarily have to do with me; if I see something unfair, I care a lot. This shouldn't be a problem if everything is fair... but unfortunately, in elite sports, the system is hierarchical." In addition, Caragh also faced sensory challenges. In the gym—which she called a "hellscape"—the music was deafening, and the floor was shaking. And the only place she could seek refuge—the cafe or "crew room"—was too bright and filled with strong smells. "I wanted to leave to recharge, but that would be considered antisocial," she said.

In retrospect, Caragh realized that these challenges were typical characteristics of autism. It wasn't until later in her athletic career, after being misdiagnosed with bipolar disorder, that she was finally diagnosed with autism. This led to a five-year period of severe confusion, during which Caragh took various medications, including the mood stabilizer lithium, which hindered her performance and well-being. During this time, she failed to win any races until she won a silver medal in the women's four at the 2021 Rowing World Cup after stopping medication. Subsequently, she participated in the women's eight at the Tokyo Olympics, where the British team was eliminated in the repechage. Now retired, Caragh, as the founder of the non-profit organization Neurodiverse Sport, is transforming her passion for justice into a mission to ensure that other neurodiverse athletes not only survive in elite sports but also "thrive."

Caragh didn't always readily accept her autism diagnosis: "It made sense, but I was thinking, 'What are people going to think about this? This is another thing that makes me different. I went from bipolar to autistic, great.'" However, over time, she realized that autism "is defined by non-autistic people." Caragh said, "I grew up with all the information and stereotypes about autism, just like everyone else. But when I read articles about autism from the perspective of autistic people, I felt much better." Looking back on her athletic career, Caragh now understands that autism was essential to her success as an elite athlete. Qualities like her "obsession, high focus, attention to detail, and pattern recognition" all benefited her. "To be an elite athlete, you need a sharp profile, you need to be extreme in some way," Caragh said.

Erin Hoare, a psychologist and neurodiversity researcher, believes that people with ADHD and autism may have advantages in elite sports. Dr. Hoare said, "Examples we often talk about are a preference for repetitive routines, the ability to highly focus on goals, and quick reactions to stimuli—for example, when decision-making time is extremely short. Their strengths may ultimately provide a competitive advantage." Dr. Hoare stated that there is "[some epidemiological evidence to suggest that neurodiverse individuals are overrepresented in elite sport, although more research is needed.](https://bmjopensem.bmj.com/content/9/2/e001575)" This is partly because the understanding of autism is rapidly evolving, and autism remains underdiagnosed, especially in women and girls. Dr. Hoare attributes this to broader gender biases in medicine and science. "Historically, science has focused on a very specific population, which has often excluded women, their experiences, insights, and contributions," she said. Specifically for ADHD and autism, diagnostic criteria are primarily based on male experiences. "Then we have diagnostic tools based on male experiences... this creates a view that ADHD and autism are more common in men."

She said that women are also good at "masking" or "camouflaging" their neurodiversity, which means using "compensatory behaviors" to meet social expectations. "If they don't meet those expectations, the social consequences are also more severe. This, in turn, leads to a risk of being undiagnosed or misdiagnosed." Caragh was initially misdiagnosed with bipolar disorder, and she believes that what superficially looked like mood swings was actually a cycle of burnout and regrouping. Autistic burnout is often understood as a state of mental and/or physical exhaustion caused by trying to adapt to an environment that is incompatible with someone's needs. "I just kept going because I thought, [rowing] is my life: it's my obsession, it's everything, I need to find a way to make it work," Caragh said. She also believes that gender stereotypes played a role in how she was judged for her behavioral patterns: "I don't think my traits [as a man] would have been a problem. Some of the advice I got was, if you were on the men's team, your honesty and straightforwardness might be seen as passion. But you're on the women's team, so you need to learn to sugarcoat it." Caragh also felt that she had fewer opportunities to utilize her sensory preferences, such as wearing noise-canceling headphones. "I think it's more acceptable for men to do what they need to do to take care of themselves," she said. "But for women, we face a pressure to be completely compliant."

Caragh now spends a lot of time educating sports organizations on how to make their environments more inclusive. The first thing to explain is that not all neurodiverse people are the same, and relying on diagnoses or labels is not particularly helpful. "Many people are undiagnosed, don't want to be diagnosed, or have comorbidities," she explained. Instead, she guides organizations to adopt a "trait-based" approach to support their athletes. This means recognizing that everyone—not just autistic people—has different ways of thinking and learning, as well as sensory preferences. "There are a lot of things you can do to help people, it's just about being flexible, innovative, and meeting them where they are. It's also about challenging your own assumptions and not putting people in boxes." Dr. Hoare, who is also a former elite netball and Australian rules football player, agrees with this approach. "The starting point is to talk directly to autistic athletes, work more closely with them, understand their experiences, and be curious about their worldview," she said. She said that this "inside knowledge" is essential for "developing an environment that explores and accommodates communication and sensory preferences." "Neurodiverse people possess incredible strengths and differences that are potentially untapped resources."