Topic 1.7 Neurodiversity-Affirming Practice

Neurodiversity recognises that differences in how people think, learn, communicate, process information and experience the world are a natural and valuable part of human diversity. Rather than viewing all neurological differences solely through a deficit-based medical model, neurodiversity acknowledges that human brains develop and function in many different ways. These differences create both strengths and challenges, and neither should be overlooked.

Within assistance animal services, neurodivergent individuals comprise a significant proportion of handlers, family members, volunteers and professionals. Autism, Attention Deficit Hyperactivity Disorder (ADHD), dyslexia, dyspraxia, Tourette syndrome and other neurodevelopmental differences are frequently encountered in occupational therapy practice. Many individuals also experience more than one form of neurodivergence, alongside physical disabilities, chronic health conditions or mental health conditions, further emphasising the importance of an intersectional approach.

Occupational therapists have an important responsibility to provide services that are both evidence-informed and neurodiversity-affirming. This means recognising neurological differences as part of normal human variation while also acknowledging that many neurodivergent individuals experience genuine disability, require significant supports and face barriers created by environments that are designed primarily for neurotypical people.

Neurodiversity-affirming practice does not mean ignoring disability or suggesting that support is unnecessary. Rather, it focuses on understanding the individual, reducing unnecessary barriers, building upon strengths and supporting meaningful occupational participation. The goal is not to make neurodivergent individuals appear neurotypical, but to enable them to live safely, independently and authentically while achieving their own occupational goals.

Understanding Neurodiversity

Neurodiversity is an umbrella term describing the natural variation that exists in human neurological functioning.

Several related terms are commonly used.

Neurodiversity refers to the diversity of all human brains.

Neurodivergent refers to individuals whose neurological functioning differs from what society considers typical.

Neurotypical refers to individuals whose neurological development aligns more closely with societal expectations.

Neurodivergence includes, but is not limited to:

• Autism Spectrum Disorder (ASD)
• Attention Deficit Hyperactivity Disorder (ADHD)
• Dyslexia
• Dysgraphia
• Dyscalculia
• Developmental Coordination Disorder (Dyspraxia)
• Tourette syndrome
• Intellectual disability
• Giftedness and twice-exceptionality
• Foetal Alcohol Spectrum Disorder (FASD)
• Acquired neurological differences where relevant to occupational participation.

Many individuals identify with multiple neurodivergent conditions, and every neurodivergent person has unique strengths, support needs and life experiences.

Diagnosis alone provides only limited information about an individual’s occupational performance.

Neurodiversity and Occupational Therapy

Neurodiversity aligns closely with the philosophical foundations of occupational therapy.

Occupational therapy focuses on enabling participation in meaningful occupations rather than attempting to eliminate human differences. Practitioners seek to understand the interaction between the individual, their occupations and the environment.

This perspective reflects the principles of the Person–Environment–Occupation (PEO) model and contemporary disability frameworks, recognising that disability often arises through the interaction between individual characteristics and environmental barriers rather than from the individual alone.

Rather than asking:

“How can this person become more neurotypical?”

Occupational therapists ask:

• How can participation be improved?
• What barriers exist?
• What strengths can be built upon?
• What supports are required?
• How can the environment be modified?
• What occupations are meaningful to this individual?

This strengths-based, person-centred approach forms the foundation of neurodiversity-affirming practice.

Moving Beyond the Deficit Model

Historically, neurodevelopmental conditions were primarily described in terms of deficits, impairments and abnormal behaviours.

While understanding functional impacts remains important, a purely deficit-focused approach may unintentionally:

• overlook strengths;
• reduce autonomy;
• encourage masking;
• reinforce stigma;
• underestimate potential;
• focus on compliance rather than participation.

Neurodiversity-affirming practice seeks a more balanced understanding.

It acknowledges genuine disability while also recognising strengths such as:

• creativity;
• honesty;
• attention to detail;
• persistence;
• innovation;
• pattern recognition;
• specialist knowledge;
• problem-solving abilities;
• loyalty;
• unique perspectives.

Recognising strengths does not minimise disability. Rather, it enables practitioners to develop interventions that support both capability and wellbeing.

Every Neurodivergent Person Is Different

No two neurodivergent individuals are identical.

Even individuals sharing the same diagnosis may differ substantially in:

• communication styles;
• learning preferences;
• sensory processing;
• executive functioning;
• emotional regulation;
• occupational goals;
• support needs;
• family circumstances;
• coping strategies;
• personal interests.

Practitioners should therefore avoid making assumptions based solely upon diagnosis.

Individual assessment remains essential.

The guiding principle should always be:

“If you’ve met one autistic person, you’ve met one autistic person.”

The same principle applies to every form of neurodivergence.

Neurodiversity in Assistance Animal Practice

Neurodivergent individuals may seek assistance animals for many different occupational goals.

Examples include:

• increasing independence;
• supporting emotional regulation;
• interrupting harmful behaviours;
• improving community participation;
• enhancing safety;
• reducing anxiety;
• supporting routines;
• facilitating education or employment;
• increasing confidence during public access;
• supporting executive functioning.

The role of the assistance animal should always relate to functional occupational outcomes rather than diagnosis alone.

Recommendations should remain person-centred, evidence-informed and individually justified.

Sensory Processing Differences

Many neurodivergent individuals experience differences in sensory processing.

Sensory experiences may involve:

• hearing;
• vision;
• touch;
• taste;
• smell;
• movement;
• body awareness;
• pain perception;
• temperature regulation;
• interoception.

Some individuals actively seek sensory input, while others experience sensory overload from everyday environments.

Examples relevant to assistance animal services include:

• busy shopping centres;
• loud training environments;
• multiple barking dogs;
• fluorescent lighting;
• crowded waiting rooms;
• strong smells;
• physical contact.

Occupational therapists should assess sensory needs and consider environmental modifications such as:

• quieter appointment times;
• sensory-friendly training areas;
• reduced background noise;
• scheduled breaks;
• flexible environments;
• alternative communication methods.

Supporting sensory regulation often improves participation, learning and wellbeing.

Executive Functioning

Executive functioning describes the cognitive processes involved in organising, planning, initiating and regulating behaviour.

Some neurodivergent individuals may experience difficulties with:

• planning;
• organisation;
• working memory;
• task initiation;
• prioritisation;
• time management;
• flexible thinking;
• sustaining attention;
• self-monitoring.

These differences should not be interpreted as laziness, lack of motivation or unwillingness to participate.

Instead, occupational therapists can support executive functioning through:

• visual schedules;
• checklists;
• calendars;
• digital reminders;
• breaking tasks into smaller steps;
• routines;
• environmental cues;
• habit formation strategies.

Supporting executive functioning enables greater independence without reducing expectations.

Communication Differences

Neurodivergent people may communicate differently from neurotypical individuals.

Examples include:

• direct communication;
• literal interpretation of language;
• reduced eye contact;
• delayed responses;
• use of Augmentative and Alternative Communication (AAC);
• different facial expressions;
• different body language;
• varying conversational styles.

These differences should not be interpreted as disinterest, disrespect or reduced understanding.

Occupational therapists should adapt communication to suit the individual rather than expecting neurodivergent people to communicate in neurotypical ways.

Clear, predictable and respectful communication supports participation far more effectively than expecting conformity.

Masking and Camouflaging

Many neurodivergent individuals consciously or unconsciously suppress natural behaviours to fit social expectations.

This process is often referred to as masking or camouflaging.

Examples include:

• forcing eye contact;
• suppressing stimming behaviours;
• rehearsing conversations;
• copying social behaviours;
• hiding sensory distress;
• mimicking neurotypical communication.

While masking may appear socially successful, it often requires considerable mental effort and has been associated with:

• fatigue;
• anxiety;
• depression;
• autistic burnout;
• reduced wellbeing;
• delayed diagnosis.

Practitioners should avoid encouraging masking simply to make someone appear more socially typical.

Instead, intervention should focus on meaningful participation, self-advocacy and environmental adaptation.

Identity, Language and Respect

Language preferences differ considerably among neurodivergent communities.

Some individuals prefer identity-first language, such as:

• autistic person;
• disabled person.

Others prefer person-first language, such as:

• person with autism;
• person with a disability.

There is no universally correct approach.

The most respectful practice is to ask individuals how they wish to be described and to respect those preferences.

Similarly, practitioners should avoid deficit-based language such as:

• suffers from;
• afflicted with;
• high functioning;
• low functioning;
• normal.

Instead, describe support needs, strengths and functional impacts using respectful, objective language.

Supporting Neurodivergent Handlers

Neurodiversity-affirming occupational therapists seek to create environments where neurodivergent handlers can succeed.

Examples include:

• adapting communication;
• allowing additional processing time;
• providing written information;
• using visual supports;
• respecting sensory needs;
• encouraging self-advocacy;
• collaborating with support networks;
• recognising strengths;
• reducing unnecessary environmental barriers;
• maintaining flexibility while upholding professional standards.

Reasonable adjustments should facilitate equitable participation without compromising animal welfare, public safety or competency requirements.

The Occupational Therapist’s Role

Occupational therapists have an important leadership role in promoting neurodiversity-inclusive assistance animal services.

This includes:

• educating multidisciplinary teams;
• advocating for reasonable adjustments;
• promoting strengths-based practice;
• challenging ableism;
• supporting occupational participation;
• facilitating informed decision-making;
• recognising intersectionality;
• promoting accessible environments;
• ensuring services remain person-centred and evidence-informed.

Neurodiversity-affirming practice benefits not only neurodivergent individuals but also organisations by creating more flexible, inclusive and responsive services for everyone.

Key Message

Neurodiversity is an important aspect of human diversity that should be recognised, respected and valued within assistance animal organisations. Effective occupational therapy does not seek to eliminate neurological differences but rather to understand how they influence occupational participation and how services can be adapted to maximise inclusion, independence and wellbeing.

By adopting neurodiversity-affirming approaches, occupational therapists move beyond deficit-focused models towards practice that is collaborative, strengths-based and genuinely person-centred. This creates assistance animal services where neurodivergent individuals are not expected to fit rigid systems; instead, systems are thoughtfully designed to support the diverse ways in which people think, learn, communicate and participate in everyday life.