Neurodivergent people represent a significant proportion of people who may seek Occupational Therapy involvement with assistance animals.

An AAOT may work with people who are (or have):

• autistic;
• ADHD;
• dyslexic;
• dyspraxic;
• Tourettic;
• otherwise neurodivergent;
• multiply neurodivergent (e.g.AuDHD); or
• neurodivergent alongside physical, sensory, intellectual or psychosocial disability.

Some people will have a formal diagnosis. Others may be awaiting assessment, self-identify as neurodivergent, or simply know that they process, communicate or experience the world differently.

Assistance animals may be considered for many reasons, including support with:

• routines;
• sensory regulation;
• transitions;
• community participation;
• interrupting or responding to particular behaviours;
• functional prompting;
• retrieving items;
• creating physical space;
• responding to distress;
• supporting occupational participation; or
• combinations of disability-related needs.

However, neurodivergent people have also historically been subjected to interventions focused heavily upon making them appear more neurotypical, sometimes without sufficient consideration of autonomy, distress, sensory needs or the person’s own goals.

For this reason, AAOT asks participants to develop an understanding of neurodivergent-affirming practice before considering its application to assistance animals.

The central question should not be:

How can we make this person behave more normally?

It should be closer to:

How does this person experience the world, what matters to them, what barriers are affecting their occupations, and what supports would genuinely improve their life?

What Do We Mean by Neurodiversity?

Neurodiversity describes the natural variation that exists in human brains, minds and nervous systems.

People differ in areas such as:

• attention;
• sensory processing;
• communication;
• learning;
• movement;
• executive functioning;
• emotional regulation;
• social interaction;
• information processing; and
• patterns of interest and cognition.

The neurodiversity paradigm challenges the assumption that there is one correct way for a human brain to function and that deviation from this norm should automatically be corrected.

This does not require practitioners to deny disability.

A neurodivergent person may experience substantial disability, distress or support needs.

Affirming practice should not turn into:

“Autism/ADHD is just a difference, so you don’t need support.”

For some people, neurodivergence is profoundly disabling.

A person can simultaneously:

• value their neurodivergent identity;
• reject attempts to make them appear neurotypical; and
• require substantial disability support.

These positions are not contradictory.

What Is Neurodivergent-Affirming Practice?

Neurodivergent-affirming practice broadly seeks to recognise neurological differences without automatically treating those differences themselves as defects requiring correction.

In practice, this may mean:

• listening to neurodivergent people;
• respecting different communication styles;
• identifying strengths as well as support needs;
• recognising sensory differences;
• providing accessible environments;
• supporting autonomy;
• respecting meaningful self-regulation;
• understanding behaviour within context;
• reducing unnecessary demands;
• adapting environments;
• supporting authentic participation;
• avoiding unnecessary normalisation goals; and
• working toward outcomes that matter to the person.

This aligns strongly with the Human Rights Model of Disability introduced earlier in AAOT.

Instead of asking only:

What is wrong with the person?

we also ask:

What is happening between this person and their environment?

Affirming Practice Does Not Mean Ignoring Difficulties

This distinction is important.

Neurodivergent-affirming practice does not require an OT to pretend that every characteristic associated with neurodivergence is positive.

A person may experience significant difficulty with:

• executive functioning;
• sensory overload;
• communication;
• interoception;
• sleep;
• transitions;
• planning;
• attention;
• emotional regulation;
• daily living;
• education;
• employment;
• community participation; or
• maintaining routines.

The goal is not to minimise those difficulties.

It is to address them without unnecessarily framing the person’s way of being as the problem.

For example, instead of:

“How do we stop this person needing a predictable routine?”

consider:

“How can we make necessary routines more predictable while developing strategies for unavoidable change?”

The latter recognises the need rather than treating the need itself as a behavioural defect.

Person First or Identity First?

You will encounter different terminology.

Some people prefer:

autistic person

Others prefer:

person with autism

Others may use:

neurodivergent person

or another description entirely.

Professional conventions have historically favoured person-first language, but many autistic people and neurodiversity advocates prefer identity-first language.

There is no need for an AAOT to impose a universal terminology rule upon every client.

Where possible:

Ask the person what language they prefer and use it.

Do not correct someone else’s description of their own identity because it does not match terminology you were taught.

Communication Is More Than Speech

A person may communicate effectively without communicating in the way a practitioner expects.

Communication may involve:

• speech;
• writing;
• AAC;
• typing;
• sign;
• gesture;
• images;
• visual systems;
• communication partners; or
• combinations of approaches.

Some people may communicate very differently depending upon:

• sensory load;
• fatigue;
• familiarity;
• stress;
• environment;
• processing demands; or
• emotional state.

A highly verbal person may sometimes be unable to communicate verbally.

A person who makes limited eye contact may still be listening closely.

A person who requires substantial processing time may understand the question perfectly well.

An AAOT should therefore avoid interpreting different communication as absent understanding.

This connects directly with the supported decision-making material you have already completed.

Do Not Measure Engagement by Eye Contact

Eye contact is a particularly useful example.

Some neurodivergent people find eye contact:

• uncomfortable;
• distracting;
• painful;
• cognitively demanding; or
• unnecessary for communication.

Someone may listen better while looking elsewhere.

An OT should not automatically record:

“Poor eye contact indicates poor engagement.”

unless there is genuinely relevant evidence supporting that interpretation.

Ask instead:

How does this particular person show me that they are engaged?

The same principle applies to body movement, posture, tone of voice and other neurotypical social expectations.

Stimming and Self-Regulation

Stimming or self-stimulatory behaviour can include repetitive movement, sounds, sensory activities or interaction with objects.

Examples might include:

• rocking;
• pacing;
• hand movements;
• repeating sounds;
• using fidget objects;
• touching particular textures; or
• repetitive movement.

These behaviours may serve important functions such as:

• regulation;
• sensory input;
• emotional expression;
• concentration;
• enjoyment; or
• managing distress.

An affirming practitioner does not automatically ask:

How do we stop the stimming?

Instead ask:

What function does this behaviour have?

If a behaviour is safe and useful to the person, there may be no therapeutic reason to eliminate it.

Where a behaviour causes injury or creates substantial functional difficulty, intervention may be appropriate—but the aim should include understanding the underlying need and finding safe ways of meeting it.

Masking

Some neurodivergent people learn to suppress natural behaviours or deliberately imitate neurotypical behaviour.

This is often described as masking or camouflaging.

It may involve:

• forcing eye contact;
• suppressing stimming;
• rehearsing conversations;
• copying other people’s expressions;
• hiding sensory distress;
• pretending to understand;
• suppressing communication needs; or
• enduring environments that are overwhelming.

A practitioner may therefore meet somebody who appears:

“fine in the appointment.”

That does not necessarily mean the environment is easy for them.

An AAOT should be cautious about equating visible composure with absence of disability or distress.

Behaviour Is Information

When a person is distressed, professionals may focus upon the observable behaviour.

An affirming approach asks what the behaviour may be communicating.

For example:

Why won’t they enter the shopping centre?

might become:

What happens to them in that environment?

Possible factors could include:

• noise;
• lighting;
• crowds;
• unpredictability;
• smells;
• communication demands;
• previous experiences;
• anxiety;
• difficulty navigating;
• cognitive load; or
• combinations of factors.

This distinction becomes particularly important when considering an assistance animal.

Do Not Train the Animal to Make the Person Look Neurotypical

Assistance-animal tasks should have a meaningful disability-related functional purpose.

An assistance animal should not be used simply to suppress harmless neurodivergent behaviour because other people find it unusual.

For example, an AAOT should critically examine proposed tasks intended to:

• stop harmless stimming;
• force eye contact;
• prevent harmless repetitive movement;
• make someone appear calmer for other people’s comfort; or
• interrupt behaviour simply because it looks “autistic”.

Ask:

Who benefits from this task?

What occupational problem does it address?

Does the person want this intervention?

Is the behaviour actually harmful or simply different?

Are we supporting regulation—or training conformity?

That distinction is fundamental to affirming assistance-animal practice.

Assistance Animals and Regulation

An assistance animal may nevertheless play an important role in regulation for some people.

For example, appropriately trained interaction with an animal might form part of a broader strategy supporting:

• transitions;
• routines;
• grounding;
• responding to escalating distress;
• accessing particular environments;
• prompting functional actions; or
• participation in occupations.

However, the OT should avoid vague reasoning such as:

“Dogs are calming for autistic people.”

That is not an adequate individualised assessment.

Instead ask:

• What happens for this person?
• What is the functional problem?
• What specifically does the animal do?
• Can that action be reliably trained or facilitated?
• What outcome does it produce?
• Is the person able to use the strategy?
• What other strategies exist?
• Is the animal actually comfortable performing the role?
• Does the intervention increase meaningful participation?

Sensory Needs Affect the Animal Decision Too

An assistance animal is itself a substantial sensory presence.

Dogs, for example:

• smell;
• shed;
• pant;
• lick;
• bark;
• move unpredictably;
• require touch;
• create noise;
• require grooming;
• bring dirt inside;
• require toileting; and
• alter household routines.

For some neurodivergent people, these characteristics may be regulating or enjoyable.

For others, they may be extremely difficult.

A person may love dogs but find:

• barking intolerable;
• wet fur overwhelming;
• licking distressing;
• particular smells difficult; or
• unpredictable physical contact dysregulating.

Therefore:

“The person loves animals”

does not automatically mean:

“Living and working with an assistance animal will be suitable.”

This needs individual assessment.

Executive Function and Animal Care

Assistance animals require consistent daily care.

A person who experiences executive-function difficulties may have difficulty with:

• remembering feeding;
• medication;
• grooming;
• scheduling veterinary appointments;
• purchasing food;
• maintaining training;
• organising equipment;
• exercise routines; or
• noticing when supplies are running low.

This does not automatically mean they cannot have an assistance animal.

An affirming OT asks:

What support would make this achievable?

Possible strategies might include:

• visual routines;
• reminders;
• automatic ordering;
• shared-care plans;
• support-worker assistance;
• automated feeders where appropriate;
• calendars;
• checklists;
• environmental prompts; or
• family support.

The relevant question is not simply whether the person can perform every aspect of care independently.

It is whether a safe and sustainable care arrangement can exist.

Interoception

Some neurodivergent people experience differences in interoception—the perception and interpretation of internal bodily signals.

This may affect awareness of things such as:

• hunger;
• thirst;
• temperature;
• fatigue;
• pain;
• toileting needs;
• emotional states; or
• physiological arousal.

This can have significant occupational implications.

An assistance-animal task might sometimes be proposed in relation to a functional consequence of these difficulties.

Again, avoid assuming:

diagnosis → standard task

The practitioner should identify the person’s actual experience and determine whether the proposed animal behaviour has a meaningful, reliable and appropriate functional role.

Avoid Assuming Every Neurodivergent Person Wants an Assistance Animal

There is substantial discussion of assistance animals within neurodivergent communities, particularly in relation to autism.

That does not make an assistance animal universally appropriate.

Some people may prefer:

• assistive technology;
• environmental modification;
• sensory equipment;
• human support;
• communication supports;
• routines;
• psychological strategies;
• occupational adaptations; or
• combinations of approaches.

Some may simply not want the responsibility of an animal.

As discussed earlier in AAOT:

Choosing not to have an assistance animal can be an entirely successful outcome.

Neurodivergent Children and Assistance Animals

Children require particular care.

Parents may understandably approach an assistance animal hoping it will help their child with multiple areas of life.

However, the child should not disappear from the assessment.

Consider:

• Does the child like animals?
• Does the child want interaction with the animal?
• How does the child communicate preferences?
• What sensory responses occur around animals?
• What happens when the animal approaches unexpectedly?
• What tasks are actually proposed?
• Who will be the handler?
• Who will provide daily care?
• What does the child understand about the animal?
• How will the relationship change as the child develops?

An assistance animal should not simply become something done to the child because adults believe it will be therapeutic.

This connects directly with the supported decision-making principles explored earlier.

Behavioural Safety Still Matters

Affirming practice does not require practitioners to ignore safety.

There may be situations involving:

• impulsive behaviour;
• aggression;
• elopement;
• unsafe interaction with animals;
• difficulty recognising animal signals;
• unpredictable physical contact; or
• other risks.

The appropriate response is not:

“Neurodivergent-affirming practice means we cannot discuss this.”

Nor should it automatically be:

“This person cannot have an assistance animal.”

Instead ask:

• What is actually occurring?
• Why might it be occurring?
• How likely is harm?
• What supports could reduce risk?
• What does the person understand?
• What environmental changes are possible?
• What does the animal need?
• Is specialist behavioural input required?
• Is the proposed arrangement realistically safe?

Both the person’s rights and the animal’s welfare matter.

Be Careful With “Independence”

Neurodivergent people may rely upon routines, people, technology, animals and environmental supports.

That does not necessarily make them less autonomous.

An assistance animal may enable someone to exercise greater control over how support is received, even where other supports remain necessary.

As discussed earlier in AAOT:

Independence does not have to mean doing everything alone.

A more useful goal may sometimes be:

• autonomy;
• participation;
• predictability;
• reduced support burden;
• occupational engagement;
• access;
• self-determination; or
• quality of life.

Ask the person what outcome matters to them rather than assuming “independence” is everyone’s ultimate goal.

Reasonable Adjustments to the AAOT Assessment Process

Neurodivergent-affirming practice also affects how the AAOT conducts assessment.

Reasonable adjustments might include:

• providing questions beforehand;
• allowing written responses;
• communicating by email where appropriate;
• providing predictable appointment structures;
• explaining what will happen next;
• reducing sensory demands;
• allowing movement;
• allowing fidgets;
• permitting support people;
• using AAC;
• avoiding unnecessary eye-contact expectations;
• offering breaks;
• allowing additional processing time;
• dividing a long assessment into shorter appointments; or
• allowing the person to provide additional information after the appointment.

These adjustments do not reduce assessment standards.

They may make it possible for the practitioner to obtain better-quality information.

Neurodivergent People Are the Experts on Their Own Experience

A practitioner may understand diagnostic criteria, occupational performance and clinical evidence.

The neurodivergent person understands what it is like to live their life.

Both forms of knowledge matter.

Avoid statements such as:

“Autistic people don’t…”

or:

“People with ADHD always…”

Population-level information cannot tell you exactly how an individual experiences their neurodivergence.

Ask.

Listen.

Observe.

Collaborate.

And be willing to revise your initial assumptions.

Neurodivergent-Affirming Does Not Mean Uncritical

Like every developing area of professional practice, terminology and evidence around neurodiversity and affirming practice continue to evolve.

AAOT participants should not treat social-media statements, professional trends or even this credential as substitutes for critical appraisal.

Consider:

• What evidence supports this claim?
• Who conducted the research?
• Were neurodivergent people involved?
• What population was studied?
• Whose outcomes were measured?
• Who decided what counted as “success”?
• Was the aim improved quality of life or greater neurotypical appearance?
• Does the evidence apply to this particular person?

Affirming practice should remain evidence-informed, reflective and professionally accountable.

Language, Evidence and Practice Will Continue to Change

Terminology in this area has changed substantially and will continue to evolve.

Words considered appropriate today may change.

Evidence may challenge current practice.

Neurodivergent communities may identify problems with approaches currently considered acceptable.

Professional practice should therefore involve continuing:

• learning;
• listening;
• critical reflection;
• engagement with lived-experience scholarship;
• evidence appraisal; and
• willingness to change.

The goal is not to memorise the current “correct vocabulary”.

It is to develop a professional approach capable of adapting when better knowledge becomes available.

What This Means for an AAOT

When working with a neurodivergent person, ask:

What does this person identify as the actual problem?

What matters to them?

What strengths do they already have?

What environmental barriers exist?

Are sensory needs being considered?

Is my assessment accessible?

Am I interpreting communication differences as lack of understanding?

Am I expecting neurotypical behaviour unnecessarily?

Who benefits from the intervention I am recommending?

Does the proposed assistance-animal task address a genuine functional need, or merely suppress difference?

Does the person actually want the animal?

Can the animal’s care requirements be sustainably supported?

What alternatives exist?

What reasonable adjustments could improve participation?

What are the animal-welfare implications?

Am I listening to lived experience as well as professional evidence?

These are not questions that can be answered from a diagnosis alone.

Connecting This Topic to the Rest of AAOT

Neurodivergent-affirming practice brings together many concepts already introduced in the credential.

The Human Rights Model of Disability asks us to examine barriers rather than locating every problem within the individual.

Supported Decision-Making asks us to support communication, will and preferences rather than assuming difficulty communicating means inability to decide.

NDIS participant rights reinforce dignity, autonomy, safeguarding and choice and control.

Culturally responsive practice reminds us to examine our own assumptions rather than treating our professional worldview as universal.

Neurodivergent-affirming practice adds another important question:

Are we helping this person participate in the life they want—or helping everybody else feel more comfortable because the person appears less neurodivergent?

That distinction can profoundly change professional reasoning.

Continue This Topic in Your Reflective Workbook

You have now completed the foundation material for:

Topic 7 — Neurodivergent-Affirming Practice

Please complete the recommended neurodivergent-affirming learning identified in your AAOT Foundation Learning requirements, and then refer to the corresponding section of your AAOT Foundation Learning Reflective Workbook.

The workbook will ask you to apply these principles to assistance-animal situations involving:

• autistic and other neurodivergent communication;
• sensory processing;
• stimming;
• masking;
• regulation;
• executive functioning;
• interoception;
• reasonable adjustments;
• neurodivergent children;
• family expectations;
• assistance-animal task selection;
• environmental barriers;
• autonomy;
• safety;
• animal welfare; and
• the difference between supporting function and attempting to normalise harmless neurodivergent behaviour.

The purpose is not to test whether you can memorise terminology.

We want you to consider how your assessment process, professional reasoning and assistance-animal recommendations may need to change when practice is genuinely neurodivergent-affirming.

You may return to your responses throughout AAOT as your understanding develops. Questions arising from this topic may also contribute to your Capstone Portfolio and Capstone projects, particularly around accessible assessment, sensory environments, assistance-animal task design, communication, reasonable adjustment and inclusive professional practice.

Once you have completed or commenced the corresponding workbook activities, continue to Topic 8 — Rights of Refugees.