The Transition to Neurodiversity-Affirming Practice

Apr 22, 2023

Transitioning to neurodiversity-affirming practice

It’s been a while since my last blog post and I (finally!) seem to have the spoons to write again. Yesterday I was inspired to write about the journey into practicing as a neurodiversity-affirming Speech and Language Therapist due to so many amazing discussions with likeminded professionals.


First up, what do I mean by Neurodiversity-Affirming (NDA) Practice?

It’s in short, the acceptance of neurodiversity – the idea that all brains are different and that diversity of our neurotypes is natural variation within the human race. It means seeing disabled people as equals, discarding ableism and listening to neurodivergent voices to guide our practice. We do not attempt to change the person and don’t believe there is anything to be ‘fixed’ for the autistic brain for example.

To work as a NDA Practitioner, we have to deviate from the norm of Speech and Language Therapy practice and a large proportion of what we were taught during our training. It’s not any easy process but it’s necessary and so I wanted to share my journey into this with you all.


Support (intervention) never felt right

Side note: I do not use the term “intervention” within my practice. The word suggests that something is broken and is in need of fixing. Instead, I prefer to use “support”.

I’ve always enjoyed the assessment aspects of Speech and Language Therapy, analysing, observing and processing my conclusions down on paper. It’s systematic and structured and requires little masking energy on my part. But support given after the assessment was something I just couldn’t get a handle on. I felt like I was never seeing any outcomes and making much of a difference. I felt deflated, like I was no good at being a Speech and Language Therapist (SLT). I knew that social skills training didn’t work but no one seemed to listen and kept asking me to do some work on social communication. Whenever I did, something about it felt wrong.

But, then I found the Neurodiversity MovementNeurodiversity Movement and learnt about NDA practice and I understood for the first time why I hated providing support so much – it was ableist and didn’t actually benefit my clients. Realising that the gut feelings I had about “intervention” approaches feeling wrong were all totally valid I begin to think I wasn’t such a rubbish SLT after all…



My world was flipped upside down

I received my own autism diagnosis my own autism diagnosis at a very similar time to learning about the Neurodiversity Movement. It was a time of great reflection, processing and understanding the world around me and it was extremely overwhelming. I recall attending training of NDA practice and having a meltdown afterwards feeling like everything I had done to date was wrong and I didn’t even know where to start with being an SLT anymore. I felt completely lost, which continued for a good two weeks after my realisation.

Alas! It was not forever. After the first few weeks of processing what my new role as an SLT would now look like I threw myself head first into NDA practice. I would like to say that I took small steps to begin with but in true ADHD-Hat style I did everything at once. I signed up for conferences and training and wrote my presentations until 3am. I changed my entire assessment process overnight. Within the first few weeks of work I had written the basis for a post-diagnostic group for ADHD and autistic children. I was tired but I felt I had finally found my feet in the SLT world.


No one talks about the guilt

At an interview recently, I shared that I was SO thankful that I didn’t go straight into autism assessments immediately because I had such an ableist view of autism (from my training) and would have misdiagnosed so many people. I will forever be thankful that my path was different from what I had first planned. However, that doesn’t mean I don’t have immense guilt about the ableist approaches I have used in the past.

It still keeps me awake at night that I didn’t recognise Gestalt Language Processors and that I saw echolalia as meaningless speech (still crying about that one). I still think about autistic children I supported who experienced periods of mutism (like me) and I didn’t support them to use AAC (Alternative and Augmentative Communication). The times I sat neurodivergent children down to do long, standardised assessment (the CELF – yikes) and wrote pathologising reports that were all deficit-based. I’m ashamed that I was that practitioner but I have to remind myself that I only did was I knew, what I was taught by my superiors.

To feel guilt that you, as a practitioner, have had a hand in encouraging a child to mask, to hide who they are and the trauma that goes with that is hard to acknowledge. I truly believe this is one of the main barriers people have to becoming NDA practitioners, because you have to really reflect not only on your practice but your ethical and moral compass. That’s not easy, but it’s essential.



Writing strengths-based reports

It’s funny that now I wouldn’t have a clue how to start writing reports from a deficit-based approach. My strengths-based lens is so well engrained that I would struggle to revert back to writing in the way universities have trained us, even for some training I need to deliver. Despite that, at first it was a real headache! Reports that had taken me an hour before were now taking three hours because I was constantly evaluating how I was phrasing everything. Pathologising terminology had to be replaced by new vocabulary, so Google became my best friend for a while.

I can’t state the importance of writing strengths-based reports. I look back now and want to cry about the reports I’ve written in previous jobs and how my clients may read them in the future and think so negatively about themselves as a result. If I could, I would go back and rewrite them all in my own time.

If you want to read more about NDA report writing then I’ve written a blog previously here.


Unmasking has saved me from more burnout

Face to face sessions have always tired me out. I’d come away from my university placements shattered, unable to use or process language afterwards and need some serious alone time. I can’t explain the extent of that exhaustion  and how it feels, it’s debilitating. I was constantly evaluating what I was doing, how I was communicating then processing everything that the other practitioner in the room was thinking about what I was doing and my communication. And of course, on top of that I was constantly evaluating and observing what the child was doing, how they were communicating, what they were playing with and how etc etc.

Then, I learn about my autistic identity and I started my unmasking journey. First, it started with unmasking at home and then in the safety of supportive and accepting colleagues in the office and then I started to unmask with my clients. It has never been easier to be myself than when I am around my neurodivergent clients, it’s natural. They play with autistic play styles, which is easier and more natural for me to join in with, rather than trying to adapt it into a neurotypical version. We cut straight to the chase at the beginning of a session without any meaningless and annoying small talk. We infodump about our interests, most when they are shared. We also share openly about our experiences of being autistic and having ADHD and can laugh together about the confusion of the neurotypical world. It’s honestly magical.


Final thoughts…

Transitioning to neurodiversity-affirming practice is not just about making adjustments to the way you delivery therapy and assessments. It’s about changing the infrastructure of your entire belief system. It’s confronting and challenging your own internalised ableism. It’s having the courage to be honest about your previous mistakes in practice and correcting them. It’s processing the guilt for children you have previously aided in masking and meeting society’s needs rather than their own. It’s about having respect for the disabled community and seeing us as equals in a world that often doesn’t.

By unmasking, respecting my clients for exactly who they are and changing the way I talk about and support neurodivergent children I finally feel like I am a good SLT. My communication differences do not hold me back, they make me better at what I do and build more meaningful and trusting relationships with my clients and their families. Finding the Neurodiversity Movement has been the best thing that has and will ever happen to me as a professional and the clients I support.

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