Editor's note: This text-based course is a transcript of the webinar, How To Start Your Neurodiversity Affirming Journey - Neurodiversity Affirming Practice, Part 2, presented by Virginia Spielmann, PhD, OTR/L.
*Please also use the handout with this text course to supplement the material.
Learning Outcomes
- As a result of this course, participants will be able to identify the principles of neurodiversity affirming goal setting and goal setting as an act of advocacy.
- As a result of this course, participants will be able to recognize the importance of critical self-reflection in creating inclusive environments for neurodiverse individuals.
- As a result of this course, participants will be able to list ways in which power differentials manifest within occupational therapy practice and recognize strategies to identify and neutralize these imbalances.
Starting the Neurodiversity Affirming Journey
Hello everyone, and thank you for joining today’s course on neurodiversity affirming practices. I’m Dr. Virginia Spielmann, an occupational therapist and Executive Director at the STAR Institute for Sensory Processing in Denver, Colorado. Today, we’ll focus on how to start your neurodiversity-affirming journey, following on from Part One of this series. If you missed it, don't worry; each part can stand independently, but you can always return to Part One later.
As we begin, I’ll briefly share my disclosures, and then we will dive into our learning outcomes. By the end of this course, participants will be able to identify the principles of neurodiversity-affirming goal-setting as an act of advocacy, recognize the importance of critical self-reflection, understand power differentials within occupational therapy practice, and explore strategies to identify and neutralize those imbalances.
Defining Neurodiversity
To start, it’s crucial to recognize that we are all neurodiverse. Neurodiversity refers to the infinite variation in neurocognitive functioning within humanity. It’s a concept akin to biodiversity. When we adopt a neurodiversity-affirming approach, we embrace and celebrate these differences, understanding that brain differences are normal and that we benefit from diversity in cognitive processing. This makes our community richer, fuller, and more vibrant.
While there is a long list of neurotypes included under the umbrella of neurodivergence, the most commonly discussed are autism, ADHD, dyslexia, and dyspraxia. These variations are natural, and the goal is to support individuals in overcoming the barriers to participation and engagement in meaningful occupations—not to change who they are.
Reframing Success and Therapy Goals
When we shift to a neurodiversity-affirming model, we must reconsider how we measure success. Success should be defined by the individual’s quality of life, autonomy, and self-determination rather than fitting into neuronormative standards. Therapy should not aim to “fix” a neurodivergent person but to support their flourishing in their own unique way.
For instance, consider traditional models that focus on extinguishing autistic traits. These models, while well-intentioned, often resulted in autistic individuals suppressing who they were to meet societal expectations, sometimes leading to poor mental health outcomes in adulthood. The goal should never be to make someone "less autistic" but rather to help them lead a fulfilling life as they are.
Rethinking Independence and Interdependence
One key aspect of neurodiversity-affirming practices is rethinking independence. Much of traditional goal-setting in occupational therapy centers around increasing independence, particularly in self-care and academic settings. However, this approach neglects the importance of interdependence. Interdependence—the ability to accept and offer help, connect meaningfully with others, and build reciprocal relationships—is vital for all humans, particularly those needing fluctuating support levels.
For example, some autistic clients may have days where they need more assistance due to sensory overload or other factors. Therapy goals that only emphasize independence may fail to recognize these needs and create unnecessary stress. Instead, we should design goals that allow flexibility, adapting to the client’s needs on any given day.
Addressing Power Differentials in Practice
Another critical topic is the power differentials embedded in healthcare. Often, the traditional hierarchy places the medical professional in a position of power over the client, which can inadvertently undermine the client’s autonomy. In neurodiversity-affirming practices, we aim to shift this power dynamic. Rather than imposing our goals on clients, we work collaboratively, respecting their unique strengths and perspectives.
This collaborative approach can significantly change how clients perceive themselves. When they see that we, as therapists, value their input and respect their autonomy, it can empower them and enhance their dignity.
Advocacy Through Goal Setting
One of the most powerful ways we can advocate for our neurodivergent clients is through goal-setting. When we work with individuals to set goals that are meaningful to them rather than goals that align with neurotypical standards, we affirm their identity and support their autonomy. This is where the concept of advocacy in occupational therapy comes to life. It’s not just about helping a client meet a functional milestone; it’s about supporting their journey to self-acceptance, helping them identify and achieve goals that foster their well-being.
For example, a common goal for autistic children in traditional therapy might be to make eye contact more consistently. But when viewed through a neurodiversity-affirming lens, we realize that eye contact may not be a priority for the individual, nor is it necessary for successful communication. Instead, the goal may shift to ensuring the client feels confident and comfortable in social interactions, whether or not that includes eye contact.
This shift in perspective can be quite freeing. It allows us to honor the individual’s preferences and experiences rather than imposing expectations based on what society deems typical.
Critical Self-Reflection in Practice
Engaging in critical self-reflection is an essential component of neurodiversity-affirming practices. As therapists, we must continually examine our biases and beliefs, recognizing when they may influence our clinical decisions. This includes reflecting on the power dynamics that exist between therapist and client. Who is setting the goals? Whose values are being prioritized?
I encourage all practitioners to think deeply about how power is distributed in the therapeutic relationship. Are we inadvertently steering the client toward goals that we think are best? Are we making assumptions about what success looks like for them? These are important questions to consider as we strive to create a therapeutic environment where clients feel heard, respected, and supported in their unique journey.
Self-reflection also involves knowing how our cultural background and training may influence our expectations for the client. In occupational therapy, we are taught to prioritize certain outcomes, but we must remain open to the fact that these outcomes may not align with the goals of the neurodivergent individuals we serve.
Shifting Toward a Client-Centered Approach
A client-centered approach is at the heart of neurodiversity-affirming therapy. This means the client—not the therapist—is the expert on their own life. Our role is to listen and offer guidance as they navigate their personal goals, not to impose our expectations of what those goals should be.
For instance, I once worked with a young man who was neurodivergent and struggled with executive functioning. The initial plan was to help him improve his organizational skills at school, as that was what his teachers and parents prioritized. But during our sessions, it became clear that what mattered most to him was improving his social skills and feeling more connected to his peers. By shifting our focus to his social goals, we created a meaningful plan for him, resulting in greater engagement and success.
When we embrace a client-centered approach, we honor the individual’s preferences and goals, which leads to better outcomes. Therapy becomes a partnership rather than a directive process, allowing for more meaningful and impactful interventions.
Addressing Neurotypical Biases in Therapy
A significant part of embracing neurodiversity-affirming practices is addressing our own neurotypical biases. Neurotypicality is often considered the default in society, and as therapists, we may unconsciously prioritize goals that align with neurotypical standards. However, this can be harmful to neurodivergent individuals, as it places undue pressure on them to conform to societal norms that may not be aligned with their own well-being.
For example, a neurotypical bias might lead a therapist to emphasize punctuality or structured routines for a client with ADHD without considering that the client may function better with more flexible, adaptive strategies. Acknowledging and addressing these biases can create more inclusive and supportive therapy plans that respect the neurodivergent experience.
One way to reduce neurotypical bias is to continuously educate ourselves on neurodivergent perspectives. This includes listening to the voices of neurodivergent individuals themselves—whether through books, blogs, or direct conversations—so we can better understand their lived experiences and incorporate that understanding into our practice.
Navigating Change in OT Practice
As occupational therapy practitioners, many of us were trained under models that focused heavily on “fixing” deficits. But as we shift towards a neurodiversity-affirming approach, we are learning to navigate this change by embracing a model that values differences and supports individuals as they are, rather than attempting to mold them into a neurotypical framework.
This change doesn’t mean abandoning our clinical skills or therapeutic interventions. It means applying them in ways that honor the individual’s neurotype and unique strengths. For instance, instead of aiming to reduce stimming behaviors in an autistic client, we might explore ways to ensure that stimming can be a safe and supportive coping mechanism within their daily routine.
This shift may feel challenging, particularly for those trained in more traditional models, but it opens up a more compassionate and effective approach to care. We are not just helping our clients meet developmental milestones or functional goals; we are advocating for their right to exist as authentic selves.
Conclusion: Moving Forward Together
In conclusion, I want to emphasize that the journey to becoming a neurodiversity-affirming practitioner is ongoing. It requires us to constantly reflect on our practices, educate ourselves, and remain open to the perspectives and experiences of neurodivergent individuals. By doing so, we become better therapists and stronger advocates for inclusion and diversity within our communities.
I hope today’s discussion has given you some new insights and tools to return to your practice. Together, we can move towards a model of care that respects and uplifts neurodivergent individuals, helping them thrive in a world that too often seeks to change them.
Thank you for your time today, and I look forward to continuing this important conversation.
Exam Poll
1)Play in neuroaffirmative therapy involves...
You all answered all of the above. Well done.
2)Neurodiversity affirming goals should include ALL EXCEPT:
Correct. The answer is limited free play.
3)When writing neurodiversity affirming goals, it is important to...
The answer is c. You should use language that reflects the neurodiversity paradigm.
4)What is an autistic strength?
The answer is D, all of the above.
5)What is a flexible communication method that OTPs can incorporate in practice?
The answer is C. We want to adapt communication styles to meet the preferences and needs of neurodivergent clients.
I appreciate your time and attention today. I hope this information is helpful to you and your practice.
References
Biklen, D., & Kliewer, C. (2006). Constructing competence: Autism, voice and the ‘disordered’ body. International Journal of Inclusive Education, 10(02-03), 169-188.
Cope, R., & Remington, A. (2022). The strengths and abilities of autistic people in the workplace. Autism Adulthood, 4(1), 22-31. doi:10.1089/aut.2021.0037
Craine, M. (2020). Changing paradigms: The emergence of the autism/neurodiversity manifesto. In S.K. Kapp (Ed.), Autistic community and the neurodiversity movement: Stories from the frontline (1st ed., pp. 41-49). Springer Nature. https://doi.org/10.1007/978-981-13-8437-0
Dallman, A. R., Williams, K. L., & Villa, L. (2022). Neurodiversity-affirming practices are a moral imperative for occupational therapy. The Open Journal of Occupational Therapy, 10(2), 1-9. https://doi.org/10.15453/2168-6408.1937
Fletcher-Watson, S., Brook, K., Hallett, S., Murray, F., & Crompton, C. J. (2021). Inclusive practices for neurodevelopmental research. Current Developmental Disorders Reports, 8(2), 88-97. https://doi.org/10.1007/s40474-021-00227-z
Hartman, D., O’Donnell-Killen, T., Doyle, J. K., Kavanagh, M., Day, A., & Azevedo, J. (2022). The adult autism assessment handbook: A neurodiversity affirmative approach.
Rogers, K., Dziobek, I., Hassenstab, J., Wolf, O., & Convit, A. (2007). Who cares? Revisiting empathy in Asperger syndrome. Journal of Autism and Developmental Disorders, 37(4), 709-715. https://doi.org/10.1007/s10803-006-0194-1
Milton, D. (2012). On the ontological status of autism: The “double empathy problem.” Disability & Society, 27(6), 883-887. https://doi.org/10.1080/09687599.2012.710008
Mahoney, W. J., & Kiraly-Alvarez, A. F. (2019). Challenging the status quo: Infusing non-Western ideas into occupational therapy education and practice. The Open Journal of Occupational Therapy, 7(3), 1-10.
Missiuna, C., & Pollock, N. (1991). Play deprivation in children with physical disabilities: The role of the occupational therapist in preventing secondary disability. The American Journal of Occupational Therapy, 45(10), 882-888.
Wildham, Vernon, K., & Wise, S. J. (2022). Are you actually neurodivergent affirming? An interview with Sonny Jane Wise. Retrieved from https://therapyreimagined.com/modern-therapist-podcast/are-you-actually-neurodivergent-affirming-an-interview-with-sonny-jane-wise/#Episode-transcript
Citation
Spielmann, V. (2024). How to start your neurodiversity affirming journey - Neurodiversity affirming practice, part 2. OccupationalTherapy.com, Article 5735. Retrieved from https://OccupationalTherapy.com
