General Attitudes of Mental Health Professionals Towards Neurodiversity in Luxembourg

Introduction

The neurodiversity movement represents a paradigm shift in mental health, moving away from a traditional medical model that views neurological differences as defects to be "cured". Instead, the neurodiversity framework pioneered by Judy Singer emphasizes these differences as natural individual variations to be appreciated and celebrated. Despite the growing advocacy for neurodiverse affirming care, many neurodivergent individuals continue to face significant barriers when seeking mental health services and support. This includes diagnostic overshadowing as well as implicit bias from practitioners, and research continues to report individual experiences of feeling misunderstood or receiving support from frameworks that aren’t effective for them. These barriers have dire consequences. Studies show that neurodivergent individuals, particularly youth, experience disproportionately higher rates of mental health distress and co-occuring psychiatric disorders such as anxiety and depression, as well as higher rates of suicidal ideation compared to their neurotypical peers. When mental health professionals lack informed understanding, they risk inadvertently contributing to the stigma that prevents this vulnerable population from benefiting from life-saving therapeutic strategies. While theoretical models are slowly beginning to emerge globally, there is a stark lack of empirical data regarding the attitudes and comprehension of the concept of neurodiversity from the perspective of practitioners in specific European contexts. In Luxembourg, while community-led neurodiversity initiatives are flourishing, scholarly research on professional perspectives remains limited. This study seeks to bridge that gap by utilizing the newly developed Neurodiversity Attitudes Questionnaire (NDAQ) by post-doctoral scholar Rachel K. Schuck to assess the current landscape of practitioner attitudes in Luxembourg. By understanding how the local scope of mental health professionals perceive neurodivergence, we can better identify the training needs and systemic changes required as informed by identified gaps in individualized beliefs. That way, mental health services can work towards targeted areas of improvement for neurodiverse individuals seeking out mental health services to receive the best-fit inclusive and effective care in particularly identified geographic populations.

Literature Review

In the United States, mental health professionals help individuals, clients, and patients to achieve their recovery goals in terms of psychological and emotional well-being, and practitioners have a variety of different specialties from one another, as well as expertise and amount or kind of training received in education. Mental health professionals may work in inpatient hospital or psychiatric unit settings, or outpatient community settings, schools, or their own private practice (NAMI). The National Alliance on Mental Illness lists categories by professional ability based on training: Assessment and Therapy related professions (Psychologists, Counselors, Clinicians, Therapists), and Prescribed and Monitor Medication related (Psychiatrists, Psychiatric Or Mental Health Nurse Practitioners, Primary Care Physicians, Family Nurse Practitioners, Psychiatric Pharmacists) and Other Professionals (Certified Peer Specialists, Social Workers, Pastoral Counselors), and proceed to list job descriptions, degree requirements, and licensure and certification requirements. It should be noted that these professions are not the only qualified titles in the United States even though no more were listed on this particular NAMI page. There is no one-size-fits-all model for what makes up a mental health practitioner. Otherwise, we would be excluding certified guidance or education-based professionals such as a Special Education Professional, or Registered Behavior Technicians, as well as just as qualified therapists in mental health as any other who choose to identify and practice more holistically and use less traditional methods such as Hypnotherapy, even with the same amount of training as other professionals. In fact, the National Alliance on Mental Illness even says that the titles and specialties of mental health professionals may vary by state, and the provided list is meant to give the general population an overview of credentials to look out for. 

Clearly, we get the idea that the term ‘mental health professional’ is a broad term encompassing a range of practice, ability, and training, and we must be aware that when using such a term especially in research, that we are consistent with our definitions and going off of more substance than pure subjectivity. If credentials and ability may differ among state lines in the United States, we can make the inference that such measures are going to vary even more drastically across global lines. In fact, professions we may have certifications for in the United States may not even exist in other parts of the world. For example, the United States has a Behavior Analyst Certification Board, however in Luxembourg, and most of Europe, behavior analysis is not a formally regulated or recognized independent profession (Keenan et al., 2023). Additionally, even if we synthesized credentials across different countries, what about practitioners who may have completed their education in one country, and moved to one where requirements changed what they can and can’t do, or how they can practice? We can never assume. For example, in Luxembourg, while 25% of employees residing in the country are foreign nationals, an even larger portion, 47%, comprises cross-border workers, predominantly from neighbouring France, Belgium and Germany. “In 2024, Luxembourg counted 489,000 salaried workers, with almost half of them being cross-border workers, especially from France, which alone accounts for 126,000,” the report says. 

Because the United States classifies mental health professions by going into depth about particular job descriptions while keeping the only generalization as ‘achieving recovery goals through various levels of expertise and in a variety of settings,’ researchers must be sensitive any description that is similar when reviewing or conducting global research in order to make comparative inferences to professions in the United States. It is also imperative to note the effects that cultural differences as well as languages and translation will can have on comprehensive, accurate, and sensitive interpretation. The simplest way to acknowledge this is by referring to credible profession descriptions and credentials and drawing similarities between profession descriptions and credentials to your location of study (the United States), and when collecting qualitative data from more than one geographic/global population, trusting materials that allow a participant to self-identify a mental health related profession as long as it is determined the individual is over 18 years of age, has at least some level of higher education, and is currently working in said profession with the overarching goal to use strategies and approaches to either assess, treat, or prevent emotional and psychological distress, or improve individualized well-being surrounding experience of disability. 

What is Neurodiversity

The term neurodiversity was popularized by Judy Singer’s honor thesis in 1998 in shifting the focus away from the medical model and pathologizing brain differences, especially when it comes to ‘treatments’ and ‘cures,’ to instead recognizing and normalizing them as natural variations that came to light in the context of hoping to spark an advocacy movement. Under traditional measures, neurodiversity encompasses an umbrella term for individuals with sensory processing issues, Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, Intellectual Developmental Disabilities, Obsessive Compulsive Disorder, and learning disorders such as Dyslexia, Dyscalculia, and Dyspraxia or developmental coordination disorder. 

Unfortunately, a wide variety of stereotypes and biases exist around conditions that classify individuals as neurodivergent. Prejudice against, or support for neurodivergent individuals can have real-life daily impact, affecting both interpersonal social relationships and interactions in the form of whether someone feels as if they belong. Experiencing microaggressions or direct scrutiny from peers may lead to perceived burdensomeness and is connected to minority stress when individuals expect this kind of treatment towards their identity group (Baams et al., 2018). Stereotypes and biases also directly impact how services are tailored to neurodivergent individuals in both a mental and physical health service setting, and whether the approach is aligned to truly support, validate, and accommodate needs. A major example of implicit disability and neurodivergence bias in healthcare is the concept of diagnostic overshadowing. Diagnostic overshadowing is a biased tendency to group signs of mental distress such as psychological and behavioral symptoms as an inherent part of their disability rather than a problem of a possible mental health condition. This indicates not only a lack of knowledge on mental health presentation and disability, but a call to bias of healthcare providers that needs to be held accountable. Among disabled U.S adults who indicated a perceived need for mental health services, a seeming contradiction of a lower likelihood in use of these services was significantly associated with an anticipated disability bias from providers (Manning et al., 2023). This same qualitative study by Manning et al., identified six overarching themes that characterizes participants’ experiences of ableism while seeking care in mental health services. 1) Misplaced assumptions (Diagnostic overshadowing, or, an opposite situation in which the role of disability was ignored or minimized in their mental healthcare experience). 2) Medical trauma and gaslighting (Disbelieved or invalidated experience and knowledge about one's own needs. This can also look like providers not believing they have the actual disability the individual is attesting to experiencing). 3) Interpersonal ableism (Microaggressions, infantilization, asexualization). 4) General lack of disability knowledge. 5) Accessibility challenges, and lastly, 6) Systemic ableism and the policies the healthcare system was built upon. The findings from this particular study uses the framework of overarching disability and its definition. However, for the current review, we can infer that a high percentage of the participants from this study and others would be classified under the neurodivergent umbrella, assuming disabilities affecting cognitive functioning take up a major aspect of the samples. 

The amount of distrust in how relevant, understanding, and supportive mental health services can be for neurodivergent individuals and how much this perceived ableism and inadequacy of care influences lower likelihoods of actually utilizing supports is a major concern. Especially knowing that neurodivergent people, especially neurodivergent youth face incredibly disproportionate levels of psychological distress in comparison to their neurotypical peers. These are findings that have not only been discovered in U.S samples, but additionally a study sample of 11-19 year olds in Northern Ireland also found that neurodivergent youth were “nearly four times more likely to screen positive for anxiety or depression, three times more likely to report suicidal ideation, and twice as likely to engage in self-harm compared to neurotypical peers” (McNulty, 2026), pointing inference to the possible universality of this crisis and the need to assess it across even more populations around the globe. If results are consistent in finding the severity of mental health distress that neurodivergent individuals including youth experience, and yet research additionally shows either an avoidance of or unsuccessful attempts of treatment, we need to start being concerned as a field about adapting the particular approaches or strategies mental health professionals may be taking with their clients who identify as or have a diagnosed neurodiverse experience or we may as well turn our attention to suicide prevention stemming from untreated and unsupported psychological distress.

How Neurodiversity Intersects with Mental Health

One way that has been proposed in recent literature and the neurodiversity movement has been for mental health practitioners to take a neurodiversity affirming approach to integrate into their current therapeutic model of care. Many older models of services catered to neurodivergent individuals, most researched in those with autism spectrum disorder, took a perspective from the medical model, which sees disability and neurodivergence as something that needs to be ‘cured’ or ‘treated,’ instead of working around and accepting how it changes the individuals life perspective and how it interacts differently with their co-occuring mental health distress or psychiatric disorders compared to their neurotypical peers recieving mental health services. In fact, neurodiversity advocates claim that treatment and support from professionals that is geared towards changing the behavior of autistic individuals to match neurotypical norms compels masking behaviors and suppresses individuality, inviting internalized shame about how they respond to the world (Mantzalas et al., 2022). The neurodiversity movement as a whole alongside the concept of neurodiversity affirming practices being framed in a social model of disability in contrast to the medical model means promoting acceptance, support, and improving inclusivity and accessibility within societies to improve person-environment-fit rather than focusing on changing the person. 

Such evidence has inspired researchers in Australia to define what principles of a neurodiversity affirming approach would look like for psychologists in order to take the next step forward and actually identify what such a framework would look like in practice. 104 Statements from both psychologists and autistic adults who have seen a psychologist were collected in this study to generate a model outlining seven principles of neurodiversity-affirming psychology practice for Autistic clients (although this does not encompass other experiences on the neurodivergent spectrum). They are as follows: “(1) a commitment to continued learning about autism, (2) providing safety to be one’s Autistic self, (3) finding a way to communicate, (4) authenticity and humility in practice, (5) validation of Autistic experiences, (6) Autistic informed person-centered support, and (7) genuine acceptance and appreciation of autism” (Flower et. al, 2025). We have at least some support in literature of what neurodiversity affirming frameworks may look like in practice. Now, future considerations must be focused on not only refining and polishing such models, but also where both geographically and what professions need their implementation most, and to what extent.

One way to answer this question is to focus research upon current practices of mental health professionals, and subsequently, we can make inferences on these approaches and their quality based on assessing the comprehension of mental health professionals on neurodiversity. The idea is that educated and approving professionals on the subject would hopefully be taking neurodiverse affirmation into consideration in their treatment plans, while the latter would highlight where implementation and improvements need to be going towards. 

Post-doctoral scholar Rachel K. Schuck from Stanford University developed what is called The Neurodiversity Attitudes Questionnaire, and in 2024 published a work on the process of it’s development and initial validation, calling action to some of the same issues highlighted here such as the impact of attitudes of the general population towards neurodivergent people and the need to ensure professionals provide services that are truly supportive as opposed to inadvertently contributing to stigma and prejudice, pushing clients away from seeking treatment at all (Schuck et al., 2024). It is the first instrument designed to specifically assess attitudes towards the neurodiversity perspective and was found to have reliable construct validity, although further validation work is still needed. When developing the measures, they wanted to gear the items towards helping professionals, but later decided to adapt more general concepts so that the instrument could go on to be validated in other populations. In its pilot testing, both undergraduates interested in working in the helping profession (although in the study was coded as medicine/mental health, education, professor, and other) and online participants who were as well or did currently work in the profession made up the recruitment. Data analysis was focused on determining the actual factor structure of the instrument, and future research needs to be done to continue assessing validity. However, in addition to this, more populations need to be assessed, both geographically and in terms of participants–corresponding with even more specific focusing on the mental health professional population–if we want to tackle the expansion of improved therapeutic approaches and the betterment of mental health services provided to neurodivergent clients experiencing psychological distress.

Neurodiversity in Luxembourg

Currently, one geographical area with limited research on neurodiversity perspectives is the country of Luxembourg. Studies have been conducted on the mediating role of ADHD Symptoms and emotion regulation in the association between executive functions and internalizing symptoms in the Luxembourg population and greater German region (Battistutta et al., 2021), the role of depressive symptomatology, alexithymia, and antidepressants on suicidal behaviors in adults with Autism Spectrum Disorder in Luxembourg (Costa et al., 2020), and the impact of the time of diagnosis on the perceived competence of adolescents with dyslexia (Battistutta et al., 2018), getting us only a bit closer to perception and attitudes, but not quite specific to neurodiversity. These studies only confirm to us that research is being conducted in Luxembourg involving different interactions of variables and overall experiences in diagnoses that would classify under the umbrella term of neurodiversity. 

Results look to be more positive when searching outside of scholarly literature and peer-reviewed journals/articles and instead onto search engines and press. Taking this approach, a variety of resources for neurodiversity can be found in Luxembourg, such as Autisme Luxembourg Asb, Fondation Autisme Luxembourg, a Neurodiversity Group within the CIGALE Centre for people on the neurodiversity spectrum and LGBTQ+ identity spectrum, the celebration of Neurodiversity Pride Day, a Neurominority programme developed by neurodivergent women to educate on self-advocacy and rights awareness, and more. From a research perspective, this may look like a call to action and need for change that the people and citizens of Luxembourg may be progressing to come to the realization of, but a need for such approaches to actually be implemented into scholarly research and actually practiced in mental health service settings. 

The current survey aims to to understand the perspectives on neurodiversity held by licensed professionals in Luxembourg, using The Neurodiversity Attitudes Questionnaire (NDAQ), to broaden the populations that the NDAQ has assessed so far in the literature– which so far is not very many. The goal is to infer how self-identified (because of cultural sensitivity, competence, and need for generalized definitions) mental health professionals in Luxembourg are currently approaching the concept of neurodiversity, possibly giving us indications of the types of support neurodiverse people living in Luxembourg may be receiving and under what framework.

Methods

In 2024, post-doctoral scholar Rachel K Schuck from Stanford University and colleagues developed and conducted an initial validation study of what they called the Neurodiversity Attitudes Questionnaire, using revision and input from neurodivergent individuals and experts to write 28 items on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Examples of items include “I believe that neurodivergent people’s brains work differently because they have inherent defects in their brains*” (Question 6), “Many of the challenges neurodivergent people face are due to society not being accommodating to them” (Question 13), and “Neurodivergence (brain differences such as autism, ADHD, intellectual disability, etc.) contributes to diversity just as do race and gender” (Question 4).

Recruitment materials for this portion of the Schuck’s study did not use the word “neurodiversity”; they instead referenced learning about disability and/or neurological differences, therefore the present survey adapted this as well for reliability. Data from the original study were collected from two sources: (1) the UCSB Communication department undergraduate research pool and (2) online via listservs/social media. The study also asked participants if they either were currently in the helping profession or wanted to be, as the majority of participants were undergraduates, as they deemed this population to be the target for the NDAQ, inspiring the present survey to narrow down the population to mental health practitioners (which did not include students or professions such as teachers). Those who were not undergraduate students in Schuck’s pilot analysis took the questionnaire online, and online participant countries represented included Germany, Canada, South Africa, and Portugal. 

The present questionnaire, focusing on the country of Luxembourg, provided the consent form, questionnaire, and debriefing page all in three languages most common in the country; English, French, and Luxembourgish– Luxembourg’s native language slowly being transitioned out, with German possibly being more commonly used now. Translation assistance credits go to Dr. Aurélien Bellucci (French) and Professor Anouk Friederici (Luxembourgish). Due to the nature of “mental health professional” being a broad category, alongside requiring participants to be at least 18 years of age and fluent in one of the three languages available, it was required to “Identify” as a mental health professional practicing in the country of Luxembourg. It was included that “A Mental Health Professional is classified by self-identifying as having one of but not limited to the following occupations: Psychiatrist, Psychologist, Clinical social worker, Family Therapist, Licensed Professional Counselor, Licensed Mental Health Counselor, Addiction Counselor, Psychiatric-mental health nurse practitioner, Psychotherapist, Social Worker, Therapist, Psychotherapist, Behavioral Analyst, School Counselor, Special Education Professional, Primary care physician, Psychologist, Nurse Practitioner, Physician assistant, Psychiatric nurse, or Psychiatric pharmacist.” 

After the consent form was completed, participants were brought to three initial questions different from the initial development and validation study in order to identify and validate participants role as a mental health professional. The questions included: “What is the specific title of your profession? (Example: Behavior Analyst, Special Education Professional, etc.)”, “What is your highest level of completed education?”, and “Approximately how many years have you been working as a mental health professional?” Additionally, there were two questions included to assess familiarity with neurodivergence. In Schuck’s development and initial validation study of the Neurodevelopmental Attitudes Questionnaire, participants were assessed on familiarity with neurodiversity on a scale from 1 to 4 (not at all, slightly, moderately, or extremely). However, the current questionnaire simply asked, “Have you heard of the concept of neurodiversity?” (Yes/No), followed by, “If indicated yes, what do you understand by the term “neurodiversity”?” allowing for short-form free responses. After this, participants were shown all 28 items of the NDAQ to respond to. 

Participants

Participants were found using search methods categorizing by profession through the application software Doctena.lu, where individuals can search for healthcare practitioners across their country and book appointments. Categories of profession were chosen based on if the role had any relevance to treating or counseling mental health, psychology, or were focused on improving a person's well-being. Doctena categories of professions searched in included “Clinical Psychologist,” “Child Psychiatrist,” “CBT Therapist,” “Family Coach,” “High Potential ADHD Assessment,” “Holistic Therapist,” “Hypnotherapy,” “Neurologist,” “Neuropsychologist,” “Pediatric Psychologist,” “Personal Coach,” “Psychiatrist,” “Psychologist,” “Psychometrist,” “Psychotherapist,” and “Therapist.” Individuals were not contacted if their practitioner page did not include an email address or website to contact from, and phone-number only contacts were excluded from inquiry. Individuals were excluded from inquiry if their spoken languages for practice did not include English, French, or Luxembourgish, as these three languages were the only translations available for the materials of the present study. Based on initial inference and elimination, 160 emails were sent to practitioners or mental health, counseling, or psychology-related organizations across the country, and were contacted through an inquiry script. 87 were sent the invitation in French, 51 were sent the invitation in English, and 22 were sent the invitation in Luxembourgish. 

Only 17 responses were collected. Two participants’ responses had lost information and had to be excluded entirely. Identified gender demographics alongside what language participants actually took the survey in were additionally recorded. 2 participants were men (one french and one english) and 13 were women (8 french, 5 english). Multilingual proficiency can otherwise be assumed as one participant who selected English materials responded to free-response prompts in German. Although all study materials were translated to Luxembourgish as one of three options and 22 individuals were outreached using Luxembourgish inquiries, none of the final participants identified it as their primary language or took the survey under Luxembourgish translation. 13 out of 15 participants clearly identified having completed at least a master’s degree level of education. Participants were also asked to identify approximately how many years they have been working as a mental health professional. Responses ranged from 2 to 15 years, in addition to an outlier of 50 years. A mean was calculated, excluding the 50-year respondent: 8.29 years. Participants were asked to self-identify their profession title, and responses were very well-rounded for a small sample size. Six identified under psychologists (with focuses ranging from neuropsychology to child psychology), four under differently focused psychotherapists, two holistic therapists, two focuses in psychiatry identified, with others individually self-reporting backgrounds in sexology and hypnotherapy or simply a coach title. 

Only 15 participant responses were valid for one correlation and 14 were valid for another, where participant 5’s (French) response could not be counted due to not providing a response to the final question, “Overall, my experiences with neurodivergent individuals have been positive,” which served as a correlation variable. Interestingly, participant 5 was the only individual in this survey who responded “No” to the question “Have you heard of the concept of neurodiversity?” A few more outliers have to be reported due to a lack of participant response to questions, and it should be considered that depending on the response, these participants total NDAQ scores from a sum perspective may vary from 1 to 12 points, and additionally impact the total NDAQ scores from a mean perspective. P5 additionally did not respond to NDAQ19 (I would be embarrassed to admit if I had a learning disability, such as dyslexia*), P2 (French)- did not answer NDAQ1 (Neurodivergent people should learn social skills in order to fit in with their peers*), P10 (French)- did not answer NDAQ1 (Neurodivergent people should learn social skills in order to fit in with their peers*) or NDAQ2 (It is important for non-neurodivergent people (“neurotypical” people) to learn to better interact with neurodivergent people).

Limitations

As do all studies, the present study has several identified caveats within itself that should be taken into consideration when interpreting results and analysis. First, the results may have low reliability. The weak correlations found may be due to the low sample size of 15, rather than results indicating true nonsignificance. Although low sample size was attempted to be accounted for due to the chosen Kendall’s Tau-b correlation measure, replication of the study with a larger sample size will be the true determinant of the results, and the researcher's initial ideal sample size of at least one hundred has the high potential to be much more sufficient in drawing such conclusions. Secondly, the initial validation and development study done by Dr. Schuck included a correlation between NDAQ total scores and a self-report measure of familiarity with neurodiversity ranging from 1 (not at all) to 4 (extremely) that was asked at the beginning of the questionnaire before any of the NDAQ items to test validity. While the present study asked whether participants were familiar with the concept in a yes/no format and then asked individuals to write their own response describing their understanding, because it was not measured in the same format, a replicable and reliable validity correlation was not able to be completed in the same fashion. Especially because of two new translated versions of the NDAQ in French & Luxembourgish, this validity correlation would have been incredibly important to measure, given that meaning and terminology can conceptually present themselves differently across languages. 

On the topic of translation, when it came to discussion with the assisted credited translators, Dr. Aurélien Bellucci (French) and Professor Anouk Friederici (Luxembourgish), a topic of contention was that names of professions cross-language are variable, and especially when it came to translating occupation title examples from English to Luxembourgish or French, not all names are directly translatable, familiar, or exist in the same connotation. Dr. Bellucci in a French context expressed concern that a preference in word choice of ‘disabilité’ by the researchers over ‘personnes handicapées’ could cause struggles with comprehension, as the language of French has not fully moved away from the integration of what we in English now consider more inclusive terminology. However, ‘disabilité’ was ultimately the chosen word in the end to make efforts towards its integration. Due to time constraints, it should initially be noted that Luxembourgish materials have Google-translated aspects mixed in with peer-reviewed aspects, and this can affect true readability and comprehension. It must be considered that all translated materials, regardless, always have the possibility to impact perception and response towards specific questions, interpretations and analysis of results, and affect even future initiatives.

Future Directions

Additionally, one of the primary goals of this research is that by assessing both the understanding of and attitudes towards neurodiversity that mental health professionals in Luxembourg hold, inferences can be made to the adequacy of support in services that potential neurodivergent clients may be receiving under a neurodiverse affirming, or less affirming, approach. This can highlight future directions of therapeutic strategy implementation and improvements. Conducting the same study and questionnaire with a comparative sample from a different population, such as mental health professionals in the United States, in addition to a replication of the present study with a larger sample, would show more explicit comparative correlations with a higher impact. This future research would then be able to assess where improvements in neurodiverse attitudes are needed in comparison to an appropriate group, rather than having no comparison group. In attempts to draw some kind of measure, Dr. Rachel K. Schuck was contacted about summary descriptive statistics for the NDAQ questionnaire total from participants in her initial validation study. Each person’s mean subscale (1-6) and total NDAQ questionnaire score was calculated, the average of those scores was found to obtain the overall NDAQ score mean. M(SD) for the present study = 4.59(0.563) while M(SD) for the initial validation and development study done by Rachel K. Schuck = 4.44(0.586). Just for curiosity, Welch’s t-test (used for unequal variances due to sample size, Schuck’s study having a population of N = 351 from not only the U.S but several countries) was run between the two datasets. A correlation was not significant, at 0.327. Yet, the thought experiment serves as a look into how we might approach a future study from a comparative analysis lens in order to acquire significant results and make inferences of different populations.

To increase interest in participation to achieve a higher sample size, attempts to replicate the research with the same intended population members should consider a different approach in email inquiry, or consider providing an incentive in the form of a more direct benefit for the participants. Future research should additionally address the reformatting of particular questions and further addition of instruction that the initial validation study provided mentioned in the limitations section for smoother and more reliable replicated methodology and results. 

Overall, mental health professionals in Luxembourg and across the globe should work towards opening up their therapeutic strategies to be informed by the social model of disability rather than the medical model of disability. Incorporating a neurodiverse affirming approach into mental health services ensures that neurodivergent individuals feel fully supported and understood in their life experiences, reducing fear and anticipated provider bias when seeking out support, ultimately impacting the benefits that they receive through adequate care, their well-being, and quality of life.

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Approved as IRB Protocol #05222e, October 2025.