Neurodiversity-Affirming Practice Facts & Terms

1. Neurodiversity means that neurological diversity exists as a natural part of human variation, and there is no such thing as a “normal” brain. Variation in neurology is natural, and there is no singular right way. Practitioners monitor and regulate their own responses and biases, particularly when neurodivergent expressions challenge neurotypical expectations.

2. Neurodivergent clients (autistic, sensory differences, ADHD, learning differences, HSP, PDA, gifted, etc.) are NOT in therapy simply because they are neurodivergent. They are in therapy because they have needs such as anxiety, regulation challenges, trauma issues, social needs, marital/parent/child relationship issues, or other mental health needs. Neurodivergence is understood as part of a client’s identity and requires different therapeutic approaches to align with the client’s neurotype. This understanding should inform how the client’s neurotype is described and supported in the therapeutic plan.

3. Client’s therapy, special interests, and play preferences should be honored. All neurodivergent clients interact in a multitude of valid ways to engage in the therapeutic process. Each client’s preferred therapeutic approach should be respected, and neurodivergent clients should not be forced to conform to a specific approach. Therapeutic services may include digital environments, abstract systems, or object-focused routines and should be recognized as meaningful, valid, and therapeutic.

4. Client’s voices are encouraged, heard, and valued in identifying their needs, setting goals, and shaping the therapeutic process. Clients should have a say in what needs they want to address and be granted freedom and flexibility to navigate therapy at their own pace, with support in place that fosters autonomy.

5. Play approaches and interventions should not promote masking and camouflaging (the act of hiding or suppressing one’s authentic self to appear more “typical”). Instead, focus should be on strengths: helping the client value their authentic selves, recognizing what they already do well, and communicating value. Strengths can serve as entry points for therapeutic growth, resilience-building, and achieving identified therapy goals.

6. Neurodivergent clients may experience compounded marginalization based on other aspects of identity, and affirming care should be culturally responsive and take into consideration intersectionality needs. Additionally, procedures should be in place to understand language use and respect the client’s choices, such as identity-first language.

7. Body autonomy (consent to participate, sensory needs, touch boundaries) is respected. All client’s should be treated as capable and worthy of making choices about their bodies and participation. Professionals should not insist on or push a client to participate in an intervention or theory protocol that ignores their neurodivergent differences and disregards their body autonomy.

8. Competence is presumed. Each client is capable of understanding, communicating, and engaging meaningfully, even if they do so differently.

9. Communication differences are valid expressions, not deficits. Verbal communication is not the only form of communication. The use of AAC devices, movement, scripting, echolalia, gestures, play, and other forms of communication should be recognized and accommodated.

10. Different ways of navigating are recognized as valid. Differences are not bad, wrong, or problematic. Differences in thinking, feeling, and behaving are supported rather than pathologized. The goal is to support each client in navigating the world in ways that align with their authentic selves, not to change a client to “appear” neuro-normative.

11. Relationship development is a core process in the client’s therapy process. Establishing a therapeutic relationship is key to working with neurodivergent clients and their families. The relationship begins at first contact and is intentionally maintained throughout the therapeutic journey, fostering trust, safety, and connection. 

12. Play is the natural language of children (and sometimes adults!) The therapeutic powers of being person-centered are the grounding principle in therapeutic work. Play is a change agent, not a tool used to manipulate a “change agent”. Play is never withheld or used as a reward to gain compliance.

13. Supporting neurodivergent clients in any form of therapy will likely require advocating for inclusion, accommodations, accessibility, and support needs.

14. Neurodiversity affirming care includes understanding neurodivergent related concepts such as:

* Social Model of Disability. Disability created by societal barriers, not the individual.

* Double Empathy Problem (Theory): Mutual misunderstandings occur when individuals with different life experiences or neurotypes find it difficult to empathize with each other due to fundamentally different perspectives on the world and social interactions. 

* Alexithymia: A personality trait characterized by the inability to identify and describe one’s emotions with traditional emotional expression.* Masking: The act of hiding neurodivergent features and/or characteristics. Also, hiding one’s identity as being neurodivergent in response to neurotypical expectations to act a certain way.

* Stimming: Self-regulatory repetitive thoughts, words, or body movements/actions such as hand flapping.

* Rejection Sensitive Dysphoria: A form of emotional dysregulation commonly observed in ADHD and other neurodivergence. Individuals may feel distress and pain as a result of perceived or actual rejection, teasing, or criticism.

* Monotropism: A processing style, or way of thinking, marked by a strong focus on a limited number of items, often excluding input outside of the person’s focus.

* PDA Presentation (Pathological Demand Avoidance or Persistent Desire for Autonomy): Displaying a strong need for autonomy and control, requiring unique supports, and being socially oriented.

15. The client and the therapy process will likely require a prescriptive or integrative therapy approach. The therapy approach and process should be individualized to each client’s unique neurotype, recognizing their neurodivergent spectrum of presentation.

16. Sensory systems and regulation needs are supported. Each client’s sensory experiences are recognized by proactively creating sensory-safe environments and offering regulation support, such as movement breaks, sensory tools, and environmental adjustments, without judgment.

17. Caregivers and families are considered partners in the client’s therapy process. Collaboration should occur with families and caregivers to support neurodiversity-affirming practices across environments, helping families better understand and support the client’s needs. Psychoeducation or neurodiversity affirming family therapy with caregivers can help them to support and not “other” the client or emphasize masking in an unintentional attempt to match them to neuronormative standards. Caregivers can give neurodivergent clients a boost in regulatory resilience at home, rather than the ongoing onslaught of demands from external systems such as educational settings.

18. Practitioners support caregivers in recognizing that developmental stages for neurodivergent clients may not overlap with neuronormative expectations. Neurodiversity affirming therapy does not treat neurodivergent clients to imitate the neurotypical expectations for their age, which could be another form of masking. Instead, the emphasis is on engaging with the neurodivergent client at their current stage and supporting them where they are, while simultaneously educating family members about developmental vs. chronological stages. Neurodivergent clients navigating at their own pace is important to avoid gaps in attachment connections, shame in identity, and feelings of being wrong based on ableist standards of development that are not inclusive of more neurodivergent trajectories.

19. Practitioners support caregivers and family members to identify sources of connection attempts from the client and help to normalize neurodivergent expressions of communication and connection. Care is given to support loved ones in identifying those attempts to connect, as they may or may not reflect neuronormative examples of engagement, i.e. a neurodivergent individual may request reading to them the same book on repeat, speak to them about the same topic for hours, respond to them without words, ask them to turn on and off a light switch for them/with them, avoid eye contact, not reference them on cue, and become dysregulated if they are not joining in the client’s attention.

20. Every neurodivergent individual experiences trauma differently, especially children: Trauma in neurodivergent clients is often rooted in chronic invalidation, social exclusion, pressure to mask, misattuned caregivers, and systemic ableism. These experiences may not always be recognized as “trauma” by traditional models, but they impact regulation, attachment, identity development, and safety. Practitioners should affirm that trauma can arise not only from acute events but also from ongoing relational and environmental harm.

21. Neurodivergent clients may be struggling with a variety of mental health needs that are addressed through a therapy plan. Therapy goals should always be rooted in reducing neurodivergent distress and promoting positive neurodivergent mental health. (affirming identity awareness, self-worth, self-advocacy, and autonomy).

22. Any therapy theories and protocols utilized should conform to the neurodivergent client’s spectrum of presentation. Theories and protocols should be adapted to meet the needs of the neurodivergent client. The client should not be forced into a theory or protocol that disregards their neurodivergent self or way of being.