Neurodiversity: A Changing Paradigm

The neurodiversity paradigm is a unique perspective that challenges healthcare practitioners to view individuals with neurocognitive differences such as autism through a changing lens that defies the status quo.

The common biomedical model considers autism a disorder and, as is true with the mandate of medical practice, aims to find a ‘cure’ for what ails the client. This approach is evolving to recognize the distinct strengths and challenges of autistic people and their capacity to succeed, provided that they have access to appropriate support and accommodations.¹

This shift in thought regards autism as a neurologically based variation that requires acceptance, respect, and accommodation, rather than seeking treatments that will make autistic people appear neurotypical or aim to rid them of their autism.

Understanding Important Neurodiversity Terminology

Neurodiversity is the infinite variety of neurodevelopmental functioning within our species. Neurodiversity is a trait assumed by a group, not an individual.

Neurodevelopmental conditions that fall within the spectrum of neurodiversity include (but are not limited to):²

• Attention-deficit hyperactivity disorder (ADHD)
• Intellectual differences such as: Down’s Syndrome, Fragile X Syndrome, Developmental Delay
• Mental health differences such as: Bipolar Disorder, Obsessive-Compulsive Disorder, Schizophrenia
• Autism
• Dyspraxia
• Dyslexia

The term neurodivergent refers to an individual who diverges from a so-called societal “norm.” Neurotypical is a style of neurodevelopmental functioning that is within the typical range of expected human capacity—i.e., it meets the dominant societal criteria of “typical.” Neurotypical is the opposite of neurodivergent. It is not the opposite of “autistic.”³

The neurodiversity movement, which emerged in the late 1990s, is a social justice movement seeking civil rights, equality, respect, and full societal inclusion for those who are neurodivergent.

What Is the Neurodiversity Paradigm?

The neurodiversity paradigm embraces the importance of having different perspectives on topics, problem-solving strategies, and ways of understanding and perceiving the world.

The foundational principles of the neurodiversity paradigm include:

• Neurodiversity is a natural and valuable form of human diversity.
• The notion that there is one “normal” or “healthy” type of brain, or one “right” style of neurocognitive functioning, is invalid and culturally constructed.
• The social dynamics regarding neurodiversity are similar to other forms of human diversity such as ethnicity, gender, or culture, which encompass social power inequalities. Thus, embracing diversity acts as a source of creative potential.

Identity-First Language

Language plays a role in shaping and changing societal attitudes. For example, using identity-first language such as “an autistic person” conveys that autism is an inherent aspect of an individual’s identity, rather than “a person with autism” or person-first language. Identity-first language conveys a positive, valuable, and inseparable part of an individual. Autism is a meaningful aspect of a person’s identity.⁴

Many advocates in the autism community prefer the use of identity-first language in a similar way one uses identity-first language when referring to African-American, Jewish, Lesbian/Gay/Bisexual/Non-Binary/Transgender/Queer, or gifted individuals.

Conversely, many parents and professionals prefer person-first language because autism is not an aspect of the individual’s identity. Some parents do not want their children identified as “autistic.” Autism carries a stigma, discrimination, and a barrier to opportunities.⁵

For many autistic adults, however, person-first language belongs to the disease paradigm reinforcing the assumption that autism is a defect, an illness, or something that requires curative treatments. Patients with cancer are referred to as “people with cancer” or “a person who has cancer.”

Unlike cancer, a disease that is may be terminal, autism is a neurological, developmental condition. It is lifelong and challenging in many ways. However, autism is not a life-threatening disease like cancer. Autism defines how an individual experiences, processes, understands, and perceives the world. It is all-pervasive.

Given the individuality of human preference, it is important to address any person in a manner that they desire, so it is critical to ask a person what their preference is and honor their preference while not assuming what it might be. When addressing groups, it is important to acknowledge that there are different preferences and that you will utilize identity-first as well as person-first language to honor all options. These ideas are being strongly advocated from within the neurodiverse community.

High-/Low-Functioning Labels

Function labels can be misleading and do not provide accurate information about the level of support that a person may need. One positive change made in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a “level of support” model that includes the need for either support, substantial support, or very substantial support. 

For example, a “high functioning” college student performs well academically, has a substantial vocabulary, and does not require support for self-care skills. However, he is lonely and depressed and finds the demands of the neurotypical world overwhelming to navigate. How well is this person functioning?⁶

What about the child with minimal verbalization, who exhibits self-stimulating behavior (or stimming) and attends an autism class, but is quite content? She needs substantial support with skills of daily living, yet is cooperative. Should she be considered “low functioning”? 

Labels can distort the needs of autistic persons and lead to the denial of services.

Using a Strengths-Based Approach

Occupational therapists and speech-language pathologists are competent at identifying deficits and maladaptive behaviors, and remediating weaknesses to justify the need for services. However, they are also skilled at identifying strengths and a clear path forward that honors and harnesses these strengths. Further, they are also skilled at listening to their clients and ensuring that goals and approaches are aligned with the individual they are serving. Thus, therapists can be a part of a cultural shift in addressing intervention through a strengths-based lens. This is critical, as we rarely build our lives on remediated weaknesses. We build our lives on our strengths and interests.⁷

Nevertheless, autistic children spend much of their time in a variety of interventions, including therapy and school working on challenges rather than cultivating their strengths. Rewards, schedules, and token economies become a means to elicit compliance while engaging in interests and competencies are withheld. Many of the demands made on autistic children become exhausting and devalue their self-worth.⁸

An Example of Strength-Based Therapy Compared to Traditional Intervention

Allen refuses to eat the school cafeteria lunches.

Traditional Intervention:

The multidisciplinary team develops a behavioral plan to clarify the expected behavior and provide rewards for eating the cafeteria lunches. Allen watches a video of a child eating school lunch to reinforce the behaviors expected of him.

Deficits to be remediated:

• Allen does not like the cafeteria lunches.
• Allen is distracted in the cafeteria.
• Allen demonstrates difficulty relating to his neurotypical peers.

Strengths-Based Intervention:

Allen can bring a lunch from home with his preferred foods that he prepares with his mother. He can eat in a quiet corner of the cafeteria with an autistic classmate who is a friend. Allens’ team supports his goals and strengths and works inter-disciplinarily to ensure success. 

Strengths:

• Allen can prepare his lunch with assistance from his mother.
• Allen easily relates to his autistic peers.
• Allen can eat his lunch in a quieter environment.

The neurodiversity movement challenges the traditional biomedical model focusing on deficits and obtaining compliance versus cultivating strengths and honoring interests. Cultivating the strengths and interests of neurodivergent individuals better equips them to participate and succeed in life.

We must listen to the voices in the autism community calling for greater empowerment and rights through a neurodiversity framework. 

One framework for providing support is the SCERTS® Model, which is a comprehensive, multidisciplinary approach to enhancing the communication and socioemotional abilities of young autistic children. In their 7-part series of MedBridge courses, MedBridge instructors Amy Laurent, Barry Prizant, and Emily Rubin introduce the core values and guiding principles of the SCERTS® Model, delve into each of the three model domains—Social Communication (SC), Emotional Regulation (ER), and Transactional Support (TS)—and provide guidance for using the SCERTS® Model for assessment and planning with family and educational partners.