Mackenzie Carson is an unintentional pioneer. The first rugby player to represent England having been capped by another nation – Canada – she is now among the most successful openly neurodivergent athletes in the country.
Infectiously joyous, Carson can talk for both her original and adopted homes, and you get the sense she’s always going somewhere. Last Sunday, she won her third Premiership Women’s Rugby title – a second with Gloucester-Hartpury after one with Saracens – and has joined England’s Six Nations squad to add to her 21 caps.
Having spent three years on NHS waiting lists, the Canadian-born prop was formally diagnosed with ADHD six months ago, able to go private after being centrally contracted by the Red Roses.
ADHD is one of a range of conditions covered by the umbrella term of neurodivergence, a difference in brain function from the wider population, estimated to affect around 15 per cent of people. Other neurodivergent conditions include autism, OCD, dyslexia and Tourette’s.
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Across the Women’s Premiership alone, The i Paper is aware of at least 15 openly neurodivergent current players. One top-flight club employs at least six senior ADHD players – but given studies estimate around 15 to 20 per cent of people are neurodivergent, this should not be abnormal from a near 50-strong squad.
This is despite lower rates of ADHD diagnosis in women than men, the product of long-standing stereotypes of a condition for misbehaving young boys and a lack of research around neurodivergence in women more generally.
For Carson, keeping time has always been an issue, whether at school, on the university course she never finished at one of Canada’s leading colleges, or in double-booking our first call. Time blindness is a common ADHD symptom – an inability to sense how much time has passed or how long something will take. It is one of the leading triggers for the stereotype those with ADHD are rude, disruptive or disrespectful.
“I once had a coach pull me aside for a serious chat and say, ‘You’re a great player, but you’re always the last person out and you just don’t give a shit’,” Carson explains. “’It seems like you’re rocking up and you think you’re better than everybody.’” A deeply anxious person who loves rugby, this just wasn’t true.
Carson won the 2023-24 PWR with Gloucester-Hartpury (Photo: Getty)The double empathy problem helps explain why neurodivergent athletes so often struggle to fit in. It theorises that when people experience the world in fundamentally different ways, they struggle to empathise with each other.
Studies have shown neurotypical people struggle to read autistic people’s emotions, and tend to form negative first impressions of them. There are suggestions this expands to most neurodivergent people, who often feel most comfortable around those whose brains function like theirs.
“Even with England, there’s still a lot of work to do, but people just assume it’s the best,” she admits. “When you have a coach that has a lot of empathy towards people, you tend to excel. Things aren’t always so black and white, and people don’t always just present the way that they are. My emotional regulation isn’t always good.”
Struggles with controlling emotional response are a common problem across neurodivergent athletes, more prone to lashing out or withdrawing completely.
One PWR player with ADHD told the story of an international age-group camp where she felt she had underperformed due to anxiety and her usual routine being broken.
She then contacted the head coach to apologise and explain, revealing her diagnosis for the first time and discussing how it impacted her. After receiving a short reply from the coach, she received no further help or safeguarding, before being told a few days later she had been dropped. She has since not been selected internationally at any level.
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A different character to Carson, Mathilda Ryall is a 21-year-old scrum-half with ADHD who plays for Bristol Bears while studying at Hartpury University.
Many of her difficulties come on the social side of the game – while Carson is one of Gloucester-Hartpury’s social secretaries, Ryall is quieter, more reserved. She doesn’t drink and actively avoids events where she could be singled out or forced to do something.
The pair are as clear an example as possible of why a blanket approach to coaching neurodivergent players is infeasible, but they still have a lot of shared experiences.
“I get worried that people think I’m rude or not paying attention,” Ryall says. “But it’s almost that I’m paying so much attention that I don’t have enough left in me to be able to talk, because everything else is like going at a million miles an hour, and something has to give.
“At the start of the year, you have meetings on concussion and menstrual cycles and wellbeing, but not so much on within the team on any differences between individuals. They just kind of assume we’re all the same – deep down they know we’re not, but do they actually understand that?”
This is a more pronounced difference between coaches, executives and players, rather than from player-to-player. But the men’s game could still learn a lot about building a neuroinclusive culture from their female counterparts.
“In the women’s game, we’re more open in terms of our sexuality and things like that,” Carson explains. “It’s probably more an inclusive space than any other sport.
“Rugby is almost a game for misfits. In a lot of sports, there’s a very strict mould of what you look like and what you are and who you are. We completely flip that on its head, and you don’t actually have to look a certain way at all. You can just be who you are.”
Meet UK sport’s first neurodiversity coach
Women’s rugby is not perfect on the diversity front – it remains overwhelmingly white – but it is gradually becoming a petri dish for advancements in neurodiversity provision.
A significant proportion of this is thanks to Jacob Kelly, better known as @adhdfatheruk on social media, a mental health worker with the NHS and ADHD advocate having been diagnosed aged 14.
Kelly is the first neurodiversity coach in British sport, starting with third-tier women’s side Dings Crusaders Mavericks before expanding to work with Saracens, alongside a number of individual players around Bristol and the South West.
Saracens are the first professional club to launch such a role, and Kelly’s work alongside women’s sports psychology lead Tiggy Teare is already widely praised by players he’s worked with. Former Exeter Chiefs and Bristol lock Aly Muldowney has recently started a similar position at his local club Stoke-on-Trent RUFC.
Now 37, Kelly’s calming, charming energy lends itself to working with marginalised people of all backgrounds.
Kelly is a pioneer in neurodiversity provision in rugby (Photo: Alistair Durden)Training on a quarter of the Shaftesbury Park pitch, a bus ride out of Bristol and about 200 yards into Gloucestershire, Dings is something of a neurodiverse Eden.
Not long after he started, Kelly added two questions to a standard wellness survey, asking how many players identify as neurodivergent, or were questioning if they were. Seventeen of the 49 women replied that they were neurodivergent – 35 per cent of the first-team set-up.
This had developed organically, with the club gaining a reputation for taking in players who struggled to find homes elsewhere.
“We find people’s strengths and work with them, that’s what’s massively different here,” manager and player Rebecca Bird says.
“There’s no one way to teach anyone the same thing. It’s a lot of different understandings, different learning styles, clear communication, it’s a lot of people getting very overwhelmed very easily and it’s about knowing every single player within the team. We do a lot of debriefing.”
Kelly acts as something of an emotional translator, helping players and coaches understand both each other and themselves.
“My role can include working on the pitch, finding strategies around self-esteem, confidence, dealing with impulsive thoughts or mannerisms, negative symptoms of neurodivergence.
“Another big part is educating the coaches, about how ADHD and autism present in girls and women and then offering support off the field. Each of their needs are unique, so it’s a bespoke bit of work with each of them.”
He also helps players pursuing diagnosis and medication, as well as work benefits and educational resources. Head coach Tom Lindsay, the former Wasps and Bristol hooker, has a complex job, but his openness and willingness to learn should set an example. Kelly suggests methods to get the best out of some of the neurodivergent players, including increased levels of praise.
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“Some coaches will say, ‘Why should I have to do that?’,” he says. “Well, if you’re getting 20 per cent more effort, more passion, more concentration by saying, ‘Well done, that was great’.”
Neurodiversity coaching will appear an alien, perhaps redundant, concept to most, but you only have to watch Kelly work at Dings to realise there are the seeds of something vastly scalable and valuable here. His current dream is to work with the Red Roses and given their prevalence of neurodivergent players, this makes sense.
“The most basic thing you can do is ask your players. That’s an hour’s work. Then you can look at what resources are available. There’s loads of free webinars, loads of free training, every city in England has a charity that’s offering free training. I can guarantee that if 40 per cent of the club had hearing issues, there would be stuff put in place.”
Somewhere within all this is the crucial point that catering for neurodivergent players, aside from being morally and legally necessary, can be hugely beneficial to both them and their clubs.
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“When I play rugby, it’s the one time my brain goes quiet,” Dings player Anya Steel explains. “I’m just able to be completely immersed in something that’s a full body stimulating experience, which is weird to say unless you have ADHD.
“Neurodivergent players can bring something really special but you have to take the time with everyone to get the best out of them.”
Teammate Amy Coggins, who is both ADHD and autistic, outlines similar benefits: “I love that I can do rugby without feeling bored. I really struggle to focus, so exercise generally can be quite hard if it’s not a sport. Anyone fits in here.
“[Kelly] is very patient, and that goes a very, very long way for someone like me. I’m already kicking myself because I’m not understanding something. I know you’ve told me three times, but I don’t get it. If I could, I would. He’s very good at helping with emotion regulation.”
This is the start of a long and complex journey. Most people inside and outside the game probably still do not recognise neurodivergence as something which needs catering for, or something they can benefit from catering for. A silent crisis is simmering beneath rugby’s surface.
“I’ve been contacted by a few parents whose children are neurodivergent, and they left their clubs because they weren’t given enough support,” Kelly explains.
“I think that happens in every club in England. They don’t see it as an issue or something they’re willing to change on. We’ve noticed more families wanting to join here because they know I work here because they know there’s a bit more education around neurodivergence.
“There are a huge number of unbelievable neurodivergent players, so if you become the club that supports neurodivergent players, that’s a massive selling point. Imagine if we added some support everywhere – how much better could we be?”
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