English is my 2nd language, autism is my first.

- Dani Bowman

Changing minds. The overarching mission of the neurodiversity movement has been to create a cultural shift in focus away from disease and pathology and toward acceptance, respect, and inclusion. In many ways this transformation has begun. Younger generations are becoming more aware and accepting, there are more spaces online, on campuses, and in communities that provide avenues of connection, and employers are offering more accommodations for diverse sensory needs. However, progress remains an uphill battle, with many wrong assumptions still baked into existing structures and institutions, like schools, medical associations, diagnostic manuals, and treatment procedures. For example, the misconception that autistics lack empathy or emotional depth still persists. As an autism activist using the pseudonym Muskie, aptly wrote, "As someone with considerably greater expertise in my emotions than the 'experts,' I can state unequivocally that my emotions are not 'flat.' They are different, yes, but they are most certainly not 'flat.'" We now understand that autistics experience and express emotions differently and in ways that are much more easily understood by fellow autistics. British sociologist Dr. Damien Milton referred to this observation as the "double empathy problem;" empathy flows most easily among people of similar neurotypes. An important message here is that empathy "deficits" are also commonly found in neurotypical folks who struggle to understand the experience of neurodivergent people.

Neurotypical syndrome is a neurobiological disorder characterized by preoccupation with social concerns, delusions of superiority, and obsession with conformity.

- Muskie, coiner of this fictitious syndrome, and creator of the satirical website, Institute for the Study of the Neurologically Typical (ISNT)

Biases persist. Cultural biases about communication styles cause significant distress for neurodivergent people, who often feel pressure to mask their differences in order to fit in. Also, school systems are fraught with biases that disadvantage some neurodiverse folks. For example, K-12 curricula tend to heavily prioritize verbal skills such as textual analysis and writing over other forms of analysis and expression. As such, many neurodiverse students who shine in other areas may be overlooked and undervalued. Someone who is destined to become an literature professor who can’t read a map or draw can sail easily through school with lots of As and an intact self esteem, but someone who is destined to become a graphic designer who struggles with reading and writing would likely carry a dyslexia diagnosis and have faced many years of academic struggles and negative feedback.

The lens I bring. So what does all of this mean about my practice as a psychologist? Generally, it means my thoughts, words, and actions are imbued with an element of social justice, as I seek to address the inequities that may have gone previously unnamed. I've had the privilege of working with many neurodiverse individuals over the years, and have learned to adapt my approach in several important ways. Here's a sampling:

I won't judge or shame squirming, stimming, or eye contact preference differences.
Clients' unique strengths and interests are always highlighted and applied to therapeutic goals.
Educating about neurodiversity and improving communication between clients and their loved ones is often part of the work.
We'll revisit the question of which behaviors are "symptoms" to work on, and which are valued expressions of self to celebrate.
Therapeutic goals often include increasing self-advocacy and healing internalized shame.
I help clients learn ways to manage sensory overload and recognize warning signs of autistic burnout.
When needed, I switch to using more concrete language. I also invite clients to use alternative modes of expression when words fail, and to correct me when my phrasing or approach needs adjusting.
Behavioral goals are approached in ways that honor individual motivational systems, which are often interest-based for neurodivergent folks. Typical behavioral reward systems often won't work and can yield unexpected and counterproductive results.
Demand avoidance is de-shamed and approached by addressing underlying causes.
Therapeutic methods that rely on one's ability to focus inward and talk about felt experience are modified for individuals with alexithymia. In such cases, learning to name feelings and attune to internal body experiences ("interoception") may become therapeutic goals.
Therapeutic methods that rely on one's ability to use visualization, such as with EMDR, for example, are modified for individuals with aphantasia.

Most importantly, I promise to stay curious, creative, and nonjudgmental, and open to learning from you about the best ways to support you!

If you are a professional interested in learning more about incorporating neuroaffirming approaches in your organization, school, or therapy practice please reach out! I offer professional consultation and always appreciate the chance to chat with colleagues.