Neurodiverse affirming Occupational Therapy
Hey there!
Get comfortable, grab your favourite sensory tool and settle into this fortnight’s blog post.
Neurodiversity and autism
First, I want to acknowledge the disability rights movement and advocates who have held this space for so long. As researchers and clinicians recognise and catch on, the neurodiverse-affirming movement has gained a whole heap of traction. I’m enthusiastic about seeing the shifts that are happening in the therapeutic space!
Neurodiversity is a term that covers neurological differences, such as autism, learning difficulties, and attention deficit disorders (and more). The neurodiversity movement advocates that differences in an individual’s thinking and processing are an integral part of their identity and who they are as a person.
Autism involves unique ways of thinking, processing sensory input, moving through space, communicating, and socialising. Autistic advocates state these differences contribute to their sense of identity, and shape how they live fulfilling lives. These advocates continue their discussion, describing how being autistic in a world built for neurotypical individuals can lead to difficulties. Managing sensory overload and masking autistic traits to ‘fit in’ to neurotypical norms can result in struggles.
Now, historically, medical and health communities have pathologized autistic behaviours, with therapeutic interventions often having a goal of minimising ‘typical’ autistic behaviours in favour of appearing more neurotypical. Examples of this include interventions around developing eye contact, whole-body listening, or reducing stimming.
If we are thinking critically, why are neurotypical behaviours considered the standard? An affirming approach recognises that autism is a core way of being, and that trying to change a brain to be more neurotypical is not helpful and can actually be harmful. An affirming approach looks to provide support in a way that respects a person’s neurotype, not with a desire to change it, but to provide support so an individual can work towards a life they identify as fulfilling.
Affirming occupational therapy
When considering what an affirming occupational therapy approach would look like, the following is essential:
Goals and interventions do not seek to reduce, alter, or replace behaviours simply because they are considered ‘autistic’.
An autistic person’s well-being and personhood are protected, without the use of ‘cure/fix’ language.
Occupational therapists work with the individual and their support system to understand and make meaning of what is meaningful to the individual, how they may be experiencing the world, and how they participate in it.
All communication forms are accepted and used, with broader use of augmentative, alternative communication.
Sensory preferences are a core part of being, with these being embraced (not changed/desensitised).
Bodily autonomy is respected, with individuals having the right to move their body as they see fit, without being directed into activities with hand-over-hand input.
Supports include building skills in self-advocacy and acceptance.
Neurodivergent individuals are supported to socially engage in ways that are comfortable with them, and masking is not taught as a skill.
*(Dallman et al., 2022)
Acknowledging history and moving forward
I firmly believe that no health professional goes out to deliberately cause harm, however, historical occupational therapy practice hasn’t typically been affirming. The autistic community has stated this has caused harm. As a profession, there is a moral imperative to move forward and adopt an affirming approach. If neurodivergent social media is anything to go by, there is an upswing in occupational therapists who are keen and enthusiastic about embracing an affirming approach. But, if we think about the systems that shape professionals, there is a definite lag (and this isn’t limited to occupational therapists).
Many universities continue to hold onto the medical, pathologizing approach to supporting autistic individuals – new graduates are coming out knowing very little about neurodivergency, let alone affirming interventions. Once graduates leave university, there is no compulsory training on what best practice is in terms of affirming interventions. I could go on… but basically, how can we make sure occupational therapists are doing their best, most ethical work?
I believe that by listening to autistic voices and developing interdisciplinary communities of practice where we reflect on our work, we can ensure we are providing the best, most ethical support. As an autistic occupational therapist, I’m invested in this journey and would love to share it with you. If you are interested in joining the #connectedcommunity, subscribe to the newsletter below.
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