A Shift Towards Neurodiversity-Affirming Care
Before correcting a difference, ask what you’re trying to change, and why.
"Imagine visiting a doctor for leg pain, only to have the doctor notice that you’re left-handed and recommend services to help you become right-handed.”
104658 A New Lens: An Introduction to Neurodiversity Affirming Care
As understanding of the concept of neurodiversity continues to grow, mental health professionals are increasingly being called to examine how traditional clinical approaches, models, language, and assumptions influence the care they provide. This introductory training offers a foundational overview of neurodiversity affirming care, exploring the paradigm shift from a pathologizing lens toward recognizing and supporting natural variations in the ways...
You may have seen terms like neurodiversity or neurodiversity-affirming care popping up more frequently and found yourself asking, “What does that actually mean?” or “What makes it different from traditional approaches?”
Let’s explore some answers to those questions.
Before we can dive into neurodiversity-affirming care, we need to define neurodiversity. It can be defined as the naturally occurring variation of human minds. People differ in how they think, learn, communicate, and experience the world, and these differences are a natural part of human diversity. I recommend checking out the work of Dr. Nick Walker for further neurodiversity related definitions.
Neurodiversity-affirming care describes a philosophical approach to clinical work that recognizes and respects differences in neurocognitive functioning as natural variations of human diversity rather than inherently problematic deficits. It challenges the assumption that there is one ideal way for people to think, learn, communicate, or behave. Instead, it emphasizes self-acceptance, accommodations, and strengths-based support to help individuals navigate challenges in their daily environments.
What Makes That Different from Traditional Approaches?
To answer that, we need to consider the frameworks that influence Western medical and mental health systems. Many of these approaches draw on a pathology paradigm, or the medical model, which emphasizes identifying and treating conditions or characteristics understood to be abnormal or problematic.
There are times when this approach is helpful. Identifying and treating a medical condition causing significant distress or disruption can be essential to someone's well-being. However, when we apply a similar framework to neurocognitive differences, we risk assuming that anything outside the norm needs to be fixed, cured, or prevented.
Imagine visiting a doctor for leg pain, only to have the doctor notice that you're left-handed and recommend services to help you become right-handed. Your left-handedness might make navigating certain environments more difficult because those environments were designed with right-handed people in mind. But this treatment isn't being recommended because your left-handedness bothers you. It's being recommended because the doctor is viewing it as something “abnormal” and the underlying assumption is that it needs to be corrected.
This illustrates an important shift in neurodiversity-affirming care. Rather than assuming a difference is a problem that needs to be fixed, we let the client lead the goal-setting process and collaboratively determine what concerns are worth addressing.
For example, someone might want to become more comfortable making eye contact or engaging in small talk with cashiers. A neurodiversity-affirming provider might explore whether these interactions cause genuine distress or whether the person feels they should be able to do them because of social expectations. Depending on the individual's experience and preferences, support might involve developing communication strategies, examining internalized expectations, or finding accommodations that make the interaction more comfortable.
The important question is not simply what we are trying to change, but why. Are we changing the person, their environment, or their response to their environment?
Recognizing Neuronormativity
One important part of this shift involves recognizing neuronormativity. Neuronormativity refers to the social norms and expectations that privilege particular ways of thinking, behaving, communicating, and processing information. These expectations are often so deeply embedded in our culture that we may not even recognize them as expectations. They might just seem like the way things are “supposed to be.”
In the cashier example, the expectation might be that people should exchange pleasant small talk while checking out. Another neuronormative expectation is that people will take turns in conversation and naturally recognize when someone else has finished speaking before jumping in.
These expectations are shaped by the systems and cultures surrounding us. In some cultures, interrupting may be a normal part of an engaged conversation. In others, initiating conversation with a cashier might be considered intrusive rather than polite.
When we fail to recognize neuronormativity, we risk interpreting differences as evidence of a personal failing. We may label someone as unmotivated, disrespectful, rude, disorganized, or resistant when their behavior reflects differences in how they naturally think, communicate, or engage with the world. Their experience may be much more complex than these labels suggest.
As helping professionals, we need to examine the beliefs and assumptions we bring into our work. Neuronormative expectations can influence our clinical training, the interventions we select, the goals we establish, the language we use, and the ways we measure progress. Even when our intentions are to help, we can unintentionally reinforce the idea that a person needs to change their natural ways of thinking or behaving to be acceptable. We may also contribute to increased shame when someone struggles to “just do” the things we've suggested in session.
Recognizing these influences allows us to approach familiar clinical situations with fresh curiosity. Instead of assuming a difference needs to be corrected, we can explore the individual's experience, the expectations they are navigating, and the supports that might help.
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Exploring Misconceptions
Some misconceptions about neurodiversity-affirming care are that it means accepting everything as it is, avoiding goals that build skills, or focusing only on strengths while ignoring challenges.
Neurodivergent* people experience genuine challenges in their daily lives. They may struggle with relationships, emotional regulation, executive functioning, sensory overwhelm, or environments that were not designed with their needs in mind. They may want to develop new skills, change certain behaviors, or find ways to participate more comfortably in situations that matter to them.
*The term neurodivergent was coined by Kassiane Asasamasu and means a brain that diverges from neuronormativity. The term was intended to be inclusive rather than exclusive and is sociopolitical rather than diagnostic in nature. Per the definition the entire DSM is a book of ways that individuals may diverge from neuronormativity.
Affirming care does not require us to dismiss these experiences or respond to every difficulty by telling someone to simply accept themselves. Instead, it asks us to zoom out and consider the individual, their environment, and the expectations influencing their experience.
Someone might come to therapy feeling overwhelmed by their daily responsibilities. Our first instinct might be to help them organize their tasks and manage their time better. But what might we discover if we first slow down and explore what they find most difficult? The conversation might still lead to organizational strategies, or it might reveal a need for accommodations, adjustments to expectations, or a different understanding of what a manageable day looks like.
The point is not that one approach is always right and another is always wrong. When we pause before making assumptions about the desired outcome, we have more options available and are more likely to find solutions that actually address the individual's needs.
What Does This Mean for Our Work?
Shifting towards neurodiversity-affirming care requires more than changing the language we use. It involves a fundamental shift in how we understand problems, identify solutions, and approach our work. This includes valuing lived experience alongside professional research, particularly when research has been conducted primarily by neurotypical researchers using neuronormative definitions of “success” without direct input from the people receiving the interventions.
An analogy I like to use is shifting from the traditional view of the therapist being in the driver's seat to the client being in the driver's seat, with the clinician serving as a co-pilot.
The client chooses the destination. The clinician can suggest possible routes and point out potholes in the road that might be worth avoiding, but the client ultimately chooses the route and can change the route or destination at any point. We can also support the journey by helping accommodate the client's needs, whether that means adjusting the temperature or changing the music.
Becoming more neurodiversity-affirming is an ongoing process rather than a destination. It starts with a willingness to question what we have been taught, consider perspectives that may be unfamiliar, and remain curious about what meaningful support looks like for each individual.
Changing our lens can expand the possibilities we offer the people we support. But what does this shift look like in practice, and how can we begin integrating these perspectives into our work?
These are some of the questions we'll explore in New Lens: An Introduction to Neurodiversity-Affirming Care. This training offers helping professionals an opportunity to explore foundational terminology, examine the differences between deficit-based and neurodiversity-affirming approaches, and consider how these principles can inform clinical practice and therapeutic relationships.
Sometimes, supporting meaningful change begins with changing how we see the person in front of us. ◼
104658 A New Lens: An Introduction to Neurodiversity Affirming Care
As understanding of the concept of neurodiversity continues to grow, mental health professionals are increasingly being called to examine how traditional clinical approaches, models, language, and assumptions influence the care they provide. This introductory training offers a foundational overview of neurodiversity affirming care, exploring the paradigm shift from a pathologizing lens toward recognizing and supporting natural variations in the ways...
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Opinions and viewpoints expressed in this article are the author's, and do not necessarily reflect those of CE Learning Systems.
