Each month at Ability Partners, our hard-working Occupational Therapists gather to present, analyse and discuss different journal articles. This month, the group discussed neurodiversity-affirming practices and why they are a moral imperative for Occupational Therapy. 

They recently covered the following journal: 

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

In summary, from their discussion, our OTs found that this article:

• Opens the discussion on neurodiversity affirming practices from three neurodivergent individuals, and
• Considers past and current practice trends in light of various ethical mandates for occupational therapy that align with the neurodiversity framework.

Introduction & Objectives of Journal Article

 

Neurodiversity-Affirming Practices

Neurodiversity-affirming occupational therapists must critically question whether their goals are targeting, reducing or changing diverse behaviours that are central to their client’s personhood and important for their well-being.

What is this journal article’s relevance to occupational therapy?

• Encourages occupational therapists to move away from deficit-based models and instead focus on strengths-based, individualised interventions that empower neurodivergent clients.
• Critiques outdated OT interventions with experiences and opinions from the authors’
• Providing a ‘How?’ for occupational therapists on how to deliver best practice and be neuro-affirming of neurodivergent clients

Objectives

• Understanding past and current practices working with neurodivergent communities
• The way moving forward working with neurodivergent clients in practice

Background & Rationale

 

Key Terms:

Neurodiversity –

• The term neurodiversity was first coined in 1988 (Singer, 1988)
• Definition: Neurodiversity refers to the natural variations in neurological processes and how everybody may be experiencing information differently.
• The neurodiversity movement advocates for respecting different ways of thinking and processing rather than viewing these as deficits.
• Neurodivergent Individuals: Experience and process information differently from their neurotypical peers.

Neurodivergent Individuals –

• Individuals living with diagnoses such as ASD or ADHD have unique ways of thinking, moving, communicating and socialising.
• Neurodivergent individuals can experience challenges with sensory overload, burnout, alienation and the burden of masking natural ways of being, such as using natural forms of self-regulation.

Neuro-affirming Practice –

• Designing therapeutic intervention aligned to individual’s goals
• Honouring differences in meaningful participation and engagement in everyday occupations
• Collaborating with clients to understand the goals that are meaningful for them
• Critically reflecting and questioning whether goals are targeting, reducing or changing diverse behaviours that are central to the neurodiverse client’s personhood.

Why is this topic important for occupational therapists and other HCP?

• Occupational therapists are well-suited to support neurodiverse to participate in everyday life and in their meaningful occupations.
• Continuing the conversation with moving away from “normalising” neurodivergent behaviours and instead affirming neurodivergent ways of being.

Ethical and Professional Responsibilities as an Occupational Therapist

• Occupational Therapists are ethically obligated to respect and affirm neurodivergent individuals’ ways of being to promote their autonomy.
• The article also critiques traditional approaches such as Applied Behaviour Analysis (ABA) which traditionally prioritises normalising behaviours over agency, autonomy and well-being.

History of Occupational Therapy Practice

 

Historical Approaches to Neurodivergence in Occupational Therapy

Focus on Normalisation

• Therapeutic practices were based on neurotypical assumptions about proper functioning and that autistic behaviours “should not exist”.
• Aim was to reduce or change autistic ways of moving and interacting with the environment without considering their function for self-regulation, emotional expression, or enjoyment

Applied Behavioural Analysis (ABA)

• ABA first developed in 1960s → Applied Behavioural Analysis Interventions (ABAIs)
• ABAIs have been used to address neuro-normative goals e.g. eye contact, stimming, functional play skills, keeping the body still at a desk and ADLs in the same way neurotypical people would.

Limitations

• Prioritising compliance and normalisation over meaningful participation and well-being
• Fail to align promoting individual autonomy, well-being and meaningful participation
• ABA emphasises conformity to societal norms at the expense of respecting neurodivergent ways of being.

Current Shift towards Neuro-Affirming Practices

 

Strength-Based Neuro-Affirming Practices

Strength-based

• Nurturing a client’s strengths rather than focusing on perceived
• Assists client’s improve skills for daily occupations and achieve goals meaningful to them.

Respecting & Acknowledging Neurodivergent Identities

• Recognising the different traits of neurodivergent individuals as not deficits but as completely valid ways of thinking, processing and behaving that may be different to the norm.
• Always practicing reflexivity

Holistic, collaborative and client-centred

• Goals are co-created with clients, aligning with their values, strengths, and sensory preferences.

Examples