Neurodiversity-Affirming Practice 

It is amazing how easy it is to fundamentally shift someone’s frame of mind by switching out the term “red flags” for “characteristics”. This kind of negative language is completely unnecessary and will only create more barriers for Neurodivergent people and their families. Other language may not be intrinsically negative but may be disliked by some Neurodivergent individuals due to negative associations. 

There are many excellent articles written by Neurodivergent and disabled people that describe how language can be empowering or detrimental (I recommend Maddy’s blog!). The rule of thumb is to always use positive or neutral language and when in doubt, ask your client about their preferences.

Dr. Penner, Maddy, and Dr. Binns all agree: masking (i.e. hiding one’s true personality or behaviours to fit in socially) is causing significant long-term mental health damage to Autistic individuals and should not be taught by therapy. 

But how do we support Neurodivergent clients in connecting meaningfully with others without teaching them to adopt Neurotypical behaviours? I found out that one important way is by doing all that you can to address the roots of behaviours that interfere with participation. Another is to frame therapy as providing behavioural tools that can be useful in specific contexts. (These will be elaborated on below). This way, neurodivergent people are not taught that the way they are is a problem, but are empowered to use solutions that work for them when they encounter challenges.

Maddy emphasizes the particular need to accommodate Autistic children instead of requiring them to simply put up with the anxiety and overwhelm of uncomfortable situations or excluding them from activities. Maddy explained that by providing Autistic children with the accommodations and stable environment they need to participate with their Neurotypical peers, it allows Autistic children to build resilience and executive function that they can use as they get older to self-regulate and adapt to uncontrolled environments. While providing “tools for their toolbelt” so that they can plan for such situations once they are old enough to do so, accommodating Autistic children teaches them that they are valued and accepted as they are, and that they are capable of and entitled to participation in all areas of life, thereby reducing mental health problems later along the road and promoting self-advocacy. In Maddy’s experience, therapists may not always be able to correctly identify and address the antecedents of behaviours, but if you are trying your best to do so, the client will appreciate that you are trying to support them. 

Dr. Penner believes in using what is best from the medical and social models of disability by selecting the most fitting solution for the context. Before choosing a solution, it is important to look beyond the behaviour and consider everything that is going on in the patient’s life, including environmental factors that may be causing or influencing the behaviour. This aligns with the World Health Organization’s International Classification of Functioning, Disability, and Health – approaching a client’s challenge by examining all factors contributing to it and treating the root of this challenge appropriately (whether by modifying the environment, how the client is required to participate, or altering a biological process by using medications such as anti-anxiety medications). 

When it comes to particular SLP concerns, Dr. Penner explained that she views most behaviours as communication, and stressed that it is important to understand the context of behaviour in order to try to understand what it communicates. She also noted that for all people, communication abilities vary from one moment to the next, and that clients may need different forms of communication when in distress than in other circumstances – so getting to know your client’s abilities and communication preferences in a variety of contexts is important.

Maddy described an Autistic teenager who had been supported in their childhood as described above and was taught how to recognize signs of sensory dysregulation and identify personal helpful strategies. Now, this young person enters new and uncomfortable situations with confidence, having planned and written on their phone up to four strategies to deal with possible triggers or seek help if they should need to. Maddy made it clear that these strategies are tools to assist the person in certain situations, but do not change the individual or make them “less Autistic”. 

Dr. Binns echoed this sentiment, adding that evaluating social skills programs and their intentions is very important. She asserted that clinicians could unintentionally promote masking if the underlying message they communicate to their client is that certain Neurotypical ways of interacting are the right way to act (e.g., “This is how you should do X”). By contrast, if clinicians show their clients helpful skills to use in certain circumstances, such as in a workplace, and very clearly tie them to the context, they are empowering the client and imparting the message that there is nothing wrong with how they naturally are.

Maddy, as an Autistic person and parent of four children, multiple of whom are Autistic as well, has a wealth of first-hand patient experience with the health and social services provided to Autistic individuals. Their advocacy work has involved engaging with, presenting to, and advising health professionals in numerous roles, including as an Autistic Advocate and Parent Advisor with Autism Services’ ECHO program at Holland Bloorview Kids Rehabilitation Hospital. Maddy is of the opinion that “if you engage Autistics often [in conversations pertaining to them], both groups will be enriched”. They recommend that any team working with Autistic children or parent-support groups seek the perspective of Autistic adults in generating possible strategies or therapies, especially Autistic parents with Autistic children who have experienced both perspectives of therapy. 

Maddy is also a strong advocate of multi-disciplinary collaboration so that professionals are able to focus their expertise to the needs they can best address and learn from each other, rather than attempting to work outside of their scope of practice. Dr. Binns and Dr. Penner are examples of researchers who work very hard to center client voices in research, and Maddy recommends looking for evidence of this in programs and research. They caution that the quality of research in the area of Neurodiversity varies, and that SLPs should use careful critical evaluation of methods and sources rather than relying solely on descriptors like “Evidence-based”.

Dr. Penner focuses on grounding her practice in Humanistic principles, and says that Neurodiversity-affirming practices are similar. In recognising that there are neurologically-based differences in the way that humans are, you get to know clients as individuals, understand their preferences, strengths, and challenges, and validate their experiences even if they differ from your own experience. When developing goals with a client, Dr. Penner recommends asking yourself how you would want your own abilities respected, and stresses that therapists should choose meaningful goals that help the client thrive and participate in what they want to participate in. 

Dr. Binns’ approach to affirming Neurodiversity has many similarities to Dr. Penner’s humanistic stance. As a clinician, she focuses on creating a space that is welcoming and inclusive to all her clients. When working with Neurodivergent clients, Dr. Binns feels that the most important way to support them is to center the voice of the client and their family, making sure that all goals and work align with the families’ and clients’ values rather than simply ticking a box on a developmental chart. When families’ goals may not be achievable yet, she takes the time to look at the heart of the goals to identify underlying shared values that they can build a program on together. 

Next Steps