By Dr. Michelle Garnett, Professor Tony Attwood and Emma Hinze
In recent years, there has been a significant shift in how autism and other forms of neurodivergence – such as ADHD, dyslexia, dyscalculia, dyspraxia, and Tourette’s syndrome – are understood and approached. Traditionally, the medical model dominated, framing these conditions as primarily disorders requiring treatment. However, the rise of the neurodiversity-affirming perspective, rooted in the social model and the disability model has led to a rethinking of these views.
The Neurodiversity-Affirming Movement
The neurodiversity-affirming movement, which began in the 1990s through the advocacy of autistic individuals, challenges the notion of neurodivergence as inherently pathological. This movement posits that neurological differences, including autism, should be understood as variations of human experience rather than deficits or disorders requiring correction. For example, while certain neurodivergent characteristics, such as acute auditory sensitivity or difficulties with working memory, can impede everyday functioning, the neurodiversity-affirming approach emphasises understanding and support rather than treatment or cure. Expecting individuals to perform at the same level as those without these challenges can be seen as discriminatory or ableist (Bottema-Beutel et al 2020).
The social model of understanding autism highlights that many challenges faced by neurodivergent individuals arise from living in a world designed for neurotypical people. For instance, the extent to which communities accommodate neurodivergence in workplaces, schools, and social settings can significantly impact the experiences of neurodivergent individuals. In contrast, the medical model focuses on deficits within autism and ADHD, viewing these conditions as intrinsic problems that require treatment.
What is Neurodiversity Affirming Practice?
Personal preference in terms for autism.
One key aspect of neurodiversity-affirming practice is the language used to describe neurodivergent individuals. For some, this may involve using identity-first language, such as “autistic person,” which emphasises autism as an integral part of their identity. Others may prefer person-first language, such as “person with autism,” which prioritises the individual over the condition. The choice between these language preferences is deeply personal and needs to be respected. Whether an individual prefers identity-first, person-first, or another form of self-identification, the core of neurodiversity-affirming practice is to support and empower them in a way that aligns with their self-conception and lived experience.
A positive identity.
Embracing autism as a positive identity is often chosen by autistic people to de-stigmatise autism and celebrates the strengths inherent in being autistic. Research has shown better mental health outcomes for identity-affirming mental health treatment for autistic (Davies et al 2024) and neurodivergent individuals (Kroll et al, 2024). Identity-affirming practice is not based around the goal of making a person ‘normal’ or ‘not autistic’ but instead the focus is on addressing any underlying mental health concerns such as depression or anxiety in addition to being client-led in creating goals for treatment. Identity-affirming mental health treatment for neurodivergent individuals does not require a medical diagnosis, self-diagnosis is enough. This is based on emerging research that shows no meaningful difference between formally diagnosed and self-diagnosed autistic people on important indices such as autism identity scores, internal stigma, quality of life, and self-esteem (McDonald, 2020).
A Strengths-focus.
A neurodiversity-affirming practice affirms the strengths and abilities in a person’s profile. If you know and/or live with an autistic person, you will know their strengths. These often include personality characteristics such as being honest, compassionate, kind, fair-minded, and loyal. Cognitive strengths often include specialist interests, long-term memory for facts, and ability to hyperfocus on topics of interest. The person often has hyper-developed verbal, visual and sensory talents.
Autistic person as expert.
The medical model views the professional as the expert whilst the neurodiversity-affirming movement acknowledges and actively welcomes the autistic person as being the expert. They draw on standpoint epistemology which views our knowledge as being influenced by our social experience and situation. In the context of the neurodiversity-affirming paradigm, this means that the autistic person, being marginalised in our society has much greater access to knowledge and understanding about their own experience of marginalisation than an expert who is often in a more privileged position of not being marginalised (Chapman & Botha, 2022). There has been some research to support this view that showed that autistic people tended to have a less stigmatizing and more scientifically grounded understanding of autism than non-autistic people (Gillespie-Lynch et al, 2017). Neurodiversity-affirming includes autistic people as collaborators in both research and clinical work about and for autistic people.
Understanding disability and support needs at the individual level:
The neurodiversity-affirming model understands that the strengths and positive identity of autism co-exist with disability because of the context of living in a community that does not understand, accept, or accommodate autism. For example, an autistic individual may be outgoing, friendly, artistic, energetic and a good problem-solver, but still struggle to read people’s intentions and motivations, leading the person to be vulnerable to ‘predators’ in social situations. There is much research now to show that an autistic person is more vulnerable to experiencing all forms of abuse (Berg et al, 2016, Hibbard & Desch, 2007, Kildahl & Helverschou, 2024). This person would benefit from specific social skill interventions to learn how to read people using nonverbal and contextual cues, in addition to asking for help may facilitate keeping that person safe. Considerations for support needs, intervention and therapy need to be individually tailored.
Including the Perspectives of Profoundly Autistic Individuals
While the neurodiversity-affirming movement has been largely shaped by speaking autistic individuals, there is growing recognition of the need to include the perspectives of those with profound autism. The term “profound autism,” introduced in a recent report by the Lancet Commission (Lord et al., 2022), seeks to acknowledge and address the distinct experiences and support needs of individuals whose autism characteristics require significant levels of care and support. Profound autism typically includes those who:
- Are at least 8 years old
- Require 24-hour access to an adult caregiver
- Have a cognitive ability measured by an IQ of less than 50 and/or are non-speaking or have minimal verbal ability
The Lancet Commission emphasised that the DSM-5’s broad categorisation under a single autism spectrum disorder diagnosis may not adequately address the needs of those with significant levels of care and support. While the DSM-5 includes specifiers for intellectual disability and language impairment, these are often underutilised and may not fully represent the diverse needs of autistic individuals. The Commission suggests that this framework may be insufficient for addressing the complexities and varying levels of support required (Lord et al., 2022; Wachtel et al., 2024).
Importantly, it is necessary to challenge the assumption that non-speaking autistic individuals automatically have an intellectual disability. Many non-speaking individuals have average or above-average intelligence and can understand far more than they can express. Their perspectives can be best captured through alternative communication methods, such as visual aids, music, art, and body movements (Lord et al., 2022; Wachtel et al., 2024).
The Impact of the Neurodiversity-Affirming Movement
The neurodiversity-affirming movement has already brought significant changes to how autism is understood, discussed, and researched. Autism-first language is now widely used by authors, clinicians, and researchers. The principle of, “Nothing about me without me” championed by Dr Wenn Lawson ( https://autism.org/autism-research-nothing-about-me-without-me/) has been embraced by the research community worldwide where increasingly journals will only accept papers about research that include autistic people as collaborators and/or co-authors.
Autistic people are being recognised as being experts on autism through lived experience, and there is a move to include self-diagnosed autistic people as participants in research on autism, where before only formally diagnosed people would be included.
The ‘internal presentation’ of autism, previously known as ‘the female autism phenotype’, is being embraced and researched. Since it is hidden, being well masked and camouflaged, the internal presentation of autism can only be truly understood by listening to and believing the person’s lived experience.
Psychologists to Embrace Neurodiversity – New Competency Guidelines Introduced
As the neurodiversity-affirming movement continues to influence practices and policies, it is crucial to ensure that all voices within the autistic community, including those with profound autism, are heard and respected. The Psychology Board of the Australian Health Practitioners Association (AHPRA) announced recently new guidelines about how to meet the professional competencies associated with working with diverse groups of people as a psychologist which will take effect in December 2025. These guidelines emphasise the importance of understanding and supporting the unique needs of all individuals, regardless of where they fall on the autism spectrum (AHPRA, Competency 7.9, 2024).
By embracing neurodiversity and fostering inclusive environments, we can create a society that values and supports the diverse experiences and strengths of all its members.
Where To from Here?
We have created a two-day Masterclass: Diagnosis, Support and Therapy for Autistic Teenagers for professionals and those interested in increasing their understanding of autism and ADHD within the framework of the neurodiversity-affirming model. We will be presenting our course live -in the-room and live webcast in London on 16th and 17th January, 2025.
References
AHPRA, (2024) Competency 7.9, retrieved from Fact Sheet Competency 7; https://www.psychologyboard.gov.au/Standards-and-Guidelines/Professional-practice-standards/Professional-competencies-for-psychology.aspx.
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Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., and Hand, B. N. (2020). Avoiding ableist language: suggestions for autism researchers. Autism Adulthood 3, 18–29. doi: 10.1089/aut.2020.0014
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Kroll, E., Lederman, M., Kohlmeier, J., Kumar, K., Ballard, J., Zant, I., & Fenkel, C. (2024). The positive impact of identity-affirming mental health treatment for neurodivergent individuals, Frontiers in Psychology, 15, DOI – 10.3389/fpsyg.2024.1403129.
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