Neurodiversity-Affirming Therapy Approaches

There are 2 main viewpoints from which we can approach the idea of supporting autistic people:

1.The Pathology Paradigm and the Medical Model of Disability

2.The Neurodiversity Paradigm and the Social Model of Disability

What type of support should we be providing?

When we look at the idea of support, we have to ask what our overall goal is and what we want for the child. 

Under the ideology of the pathology paradigm, we would want to “fix” the autistic child.  We would want them to improve as quickly as possible to be able to fit into and function within society.  We would want them to be more neurotypical.  And this approach can appear to work – autistic children can memorize skills and be trained to act in particular ways…but at what cost? One cannot change a child’s neurology.  By using this approach, you are teaching the child that they have to change to be accepted. 

Conversely, working from the neurodiversity paradigm, we want the child to feel inherently accepted.  We want to teach them skills to help make their life easier, help them foster a positive self-identity, and help them to feel happy. 

Pathologizing approaches focus on developing a child that the outside world accepts, whereas Neurodiversity-affirming approaches focus on developing a child that accepts themselves. 

Any parent would agree that they want their child to be happy and accept themselves, but they may never have been told that the popular pathologizing models of “autism treatment” won’t get them there.  Neurodiversity-affirming therapy will accomplish this goal.

Neurodiversity-affirming therapy and education will have goals that focus on improving a child’s quality of life and prepare them to live well as an autistic person.  Though they try to help improve their life, neurodiversity-affirming therapy will not try to fix the child and will not try to make them more “normal”. 

Neurodiversity-affirming therapists or educators will also avoid certain techniques and approaches that are commonly used to “treat” autism.

Choosing a Good Therapist

If you decide to pursue some kind of therapy for your autistic child, how do you find a neurodiversity-affirming therapist for them?  Here are some things to look for, as well as some red flags:

Neurodiversity-Affirming:

• Does not use any ABA-based techniques

• Presumes Competence

• Teaches Self-Advocacy Skills

• Uses strength-based child-led therapy

• Honors Sensory Needs

• Accepts All Forms of Communication

• Listens to Autistic Voices

Ableist:

• Uses ABA and other compliance based methods

• Claims to “treat” autism

• Trains Neurotypical Communication or Social Skills

• Violates Bodily Autonomy

• Requires Whole Body Listening

• Uses Puzzle Piece Logos, Functioning Labels, and Person-First Language

• Speaks over Autistic Voices

Remember, being neurodiversity-affirming is the bare minimum for being a decent therapist.  It’s important to talk to any potential therapists for you child before beginning therapy, so as to not expose your child to any practices that may be abusive or traumatic.

Therapy Goals

It’s important for your child to work on neurodiversity-affirming goal if they are receiving therapy.  Examples of appropriate goal targets are:

•Self-advocacy

•Building functional communication (in any/multiple modalities)

•AAC Implementation

•Perspective taking

•Problem Solving

•Developing functional motor skills

•Self-regulation

•Interoceptive Awareness

Other goals can be related to changing factors in the environment (including people in your child’s environment), such as:

•Educating neurotypicals about autistic communication styles and social skills (Perspective taking)

•Using modeling, aided language stimulation, and other strategies for teaching AAC

•Making changes to the sensory input in the environment

•Advocating for inclusion and self-determination for your child

•Using more visuals

Speech/Language Therapy

There’s a good chance that speech/language therapy has been recommended for your child at one point or another.  Speech/language therapy can be helpful to support your child in developing functional communication skills. 

Along with the neurodiversity-aligned concepts, therapist guidelines, and goals already mentioned, there are a few other ideas that neurodiversity-aligned speech/language pathologists (SLPs) should use or consider within their practice:

• Total Communication Approach - This approach involves finding and using the right combination of communication modalities for each autistic individual. This approach supports the individual in forming connections and having successful interactions. 

• Respecting the Autistic Individual’s Preferred Mode of Communication - This involves not trying to force an autistic child to speak or use another assigned communication modality, but rather letting the child use the communication methods that work best for them.

• Neurodiversity-Affirming Social Skills - SLPs are often responsible for social skills instruction in schools, but a neurodiversity-affirming SLP will teach perspective taking and self-advocacy skills rather than train neurotypical social skills

• Not writing goals just because a student is autistic - Being autistic doesn’t automatically mean having a communication disorder. Goals should be individualized but the same as with any other student, regardless of whether they are autistic or not.

• Providing Unrestricted Access to Robust AAC

Augmentative & Alternative Communication

AAC is all of the ways people share ideas and feelings without speaking.  It can include writing, gestures, sign language, using an iPad or other speech-generating device, or pointing, just as some examples.  For some autistic people, they may not have access to speech or some of these other methodologies, or they may not have reliable access to them.  These individuals should choose what their preferred method(s) of communication are and these choices should be respected.

As I already mentioned, students should be given unrestricted access to robust AAC.  What does this mean?

Unrestricted access

•This means that the AAC system of choice should be provided and available at all times and without requiring the individual to show prerequisite skills

Robust AAC

•Robust AAC systems are those that include a large number of core words, a wide variety of types of words, the ability to use grammatical functions, and the ability to type or spell. Basically, they allow the individual to say whatever they want.

Occupational Therapy & Physical Therapy

Many autistic people experiences sensory and movement differences.  Occupational and/or physical therapy can help support individuals who need help in these areas. 

Occupational Therapy:

Occupational therapists can help with skills such as emotional and sensory regulation, executive functioning skills, and fine motor skills including handwriting and activities of daily living such as tying shoes or buttoning a shirt.  These are important to increase the autistic person’s independence and quality of life.

They can also work on activities to increase an individual’s interoception, which involves understanding signals one’s body is sending, such as hunger, thirst, or pain.

Physical Therapy:

Physical therapists can help with some of the more gross motor aspects of autistic movement differences, such as such as balance, coordinating movements, and muscle strength. Again, these can be important to help increase the autistic person’s ability to do certain tasks they may want to do.

They can also work on activities to increase an individual’s proprioception, which involves understanding where one’s body is in space and relative to other things.

Respecting Bodily Autonomy

Respecting bodily autonomy is particularly important in an occupational therapy or physical therapy setting! Although these therapists work on a lot of motor movements with students, it is important that they get the student’s permission or consent before touching or moving their body in any way.

Trauma-Informed Therapy & Mental Health

Due to the nature of living in a world that wasn’t designed for them, most autistic people carry some amount of trauma.  Additionally, events that may not seem traumatic to a neurotypical person could be highly traumatizing to an autistic person.  This can greatly impact the individual’s mental health and well-being, both now and in the future.

Whether there is a documented traumatic event for an autistic person or not, trauma-informed approaches can benefit everyone.  For many students, trauma-informed practices should be used along with neurodiversity-aligned practices. 

Trauma informed practices involve:

• Making sure the child feels safe

• Providing consistency and structure

• Being intention and specific about building relationships

• Empowering the student and giving them choice

• Discontinuing the use of exclusionary practices or punishment

• Helping the child to co-regulate when needed

• Letting the child know you are trustworthy

• Collaborating with the student and working together

Additionally, dealing with “problem behavior” in an appropriate way is especially important in regards to autistic children, because they are already highly at risk for trauma and mental health concerns.

Respectful & Empathetic Behavior Techniques

The therapeutic and educational approaches we have discussed thus far have focused on areas such as communication, sensory, and movement differences.  However, one area that you may be concerned about as a parent is your child’s behavior.  When dealing with this area, it is important to remember the feeling differences associated with autism. There are a few concepts to keep in mind, as well as a few specific programs that are widely accepted within the autistic community.

Accepting behavior as communication

One thing that leads to “problem behaviors” is that your child either cannot communicate what they need you to know, or they are communicating it but they aren’t being heard. Not every behavior is necessarily a form of communication, but it is very important to pay attention and determine if it may be.

If a child is displaying behavior concerns, the environment is what needs to change, not the student

Your child may be in an intolerable sensory environment, undergoing emotional turmoil, or having another similar problem. If a child’s learning environment, including how they are taught and interacted with, is suitable to their needs, there is no reason they would be showing ‘problem behaviors’. In the words of Dr. Ross Greene, children do well when they can.

Specific Programs:

• Ross Greene’s Collaborative & Proactive Solutions

• Alfie Kohn’s theories

• Circle of Security framework

Education & Academic Instruction

We have discussed all sorts of specialized supports, approaches, and therapies.  These are often very important, and sometimes necessary before a child will be able to participate in school.  However, what about the main reason students go to school? – to learn academics! 

Based on the principle of presuming competence, we can presume that all children are capable of learning academic skills, such as math and reading.  However, because schools were designed with neurotypical students in mind, in order to access the general education curriculum, many autistic students may require some accommodations, modifications, and other types of extra support to be able to do this.  This is where an IEP really comes into play. 

Individualized Education Plans (IEPs)

Your child’s Individualized Education Plan (IEP) is what dictates the education and services your child will receive at school.  They are legal documents, and the school is required to do what they say, or risk being taken to due process.  The IEP will include everything, such as goals for your child, the specially designed instruction they will receive, and their related services.  All of this is decided upon by your child’s IEP team, of which you are a major part.

Getting your child’s IEP team all on the same page regarding what you want for your student is what will be most beneficial and easiest for everyone.  However, as was mentioned earlier, many schools and educational professionals align their practices to the pathology-paradigm.  They may not presume competence and they may not use neurodiversity-affirming practices with your child.  In these situations, you may need to advocate for your child to get the instruction, supports, and accommodations they should have.

Supports, Accommodations, & Modifications

In order to succeed in an inclusive general education environment, your student may need some support.  Each child is unique and will need different types of support, but here are some ideas to get you started:

•Using assistive technology

•Not being required to sit in a chair at a desk

•Being allowed to type instead of handwrite

•Having peers and teachers be educated about autism and neurodiversity

•Being allowed to stim how and when they need to

•Incorporating the student’s special interest(s) whenever possible

•Allowing the student to take breaks when they need to

•Being accompanied by someone (trained specifically to work with your child and use neurodiversity-aligned techniques) to help with attention and classroom activities

•Providing additional visual aids, such as visual schedules and timers, checklists, and written instructions.

•Giving advanced warning before transitions or when there is a change in the regular schedule

•Allowing extra processing time

•Using closed-captioning when watching a video

•Assisting with organizational and planning skills

•Giving clear and concise directions

•Assigning tasks that play to the student’s strengths

•Allowing access to a quiet and distraction-free work environment when needed

•And most importantly, listening to your child about what would help them the most.

Advocating for Your Child at School

Many schools and educational professionals align their practices to the pathology-paradigm.  Trying to educate them and getting them to use neurodiversity-aligned practices can be very challenging.  Often they may not agree with your perspective, so in these situations, you may need to advocate for your child to get the instruction, supports, and accommodations they should have.

What do you need to do to advocate for your child?

•Learn all you can about autism and the neurodiversity paradigm.

•Ask lots of questions and listen to the answers.

•Remain focused on your child’s needs and goals.

•Understand your rights as a parent and your child’s rights.

•Trust your own understanding of your child; you know them best.

•Don’t be passive - ask for the things your child needs.

•Come prepared to meetings – be proactive rather that reactive.

•Advocate that your child be in the least restrictive environment, receive academic instruction, and have neurodiversity-aligned supports.

Hopefully as the neurodiversity-paradigm becomes more dominant and more people learn about it, you won’t need to do as much convincing and advocating won’t be so hard.  We all need to work towards a society where everyone is accepted and accommodated. 

Special Education Laws & Parental Rights

Parents of children who receive special education services have specific rights under a law called the Individuals with Disabilities Education Act (IDEA). The full law cannot be discussed within the scope of this handout, but you should receive a Procedural Safeguards Notice when your child enters special education; this document will outline all of your parental rights. 

However, here are some of the highlights of your rights as a parent:

•You have the right to participate in all decision making meetings regarding your child.

•You have the right to consent or to revoke your consent to assessments, special education services, and related services.

•You have the right to disagree with the recommendations made by the IEP team.

•You have the right to access your student’s educational records.

•You have a right to decline changing your child’s placement until you come to a mutually acceptable solution with the school.

•You have the right to request documentation be kept of everything said during IEP team meetings.

•You have a right to seek third party mediation. This includes bringing an advocate with you to IEP team meetings.

•You have the right to request legal action to settle disputes between you and the school district.

Make sure to use all your rights as you advocate for your child at school.