Neuroaffirming Approaches for Discussing Disability

Disability Models, The Neurodiversity Movement, and Neurodivergence

When discussing disability, it can first be important to know that there are different models for understanding and/or conceptualizing what disability means. While many people may have encountered the medical model of disability, which can often be at the forefront of medical and mental health practice, an alternative model that has been steadily gaining traction is the social model of disability (Human, 2017). In comparison to the medical model of disability, which views disability as the result of abnormalities in the body and/or brain, the social model of disability views disability as primarily caused by environmental physical, attitudinal, communication, and social barriers (Human, 2017). In other words, the social model of disability asserts that people are disabled by their environments rather than inherent deficits. 

The social model of disability is also a critical component of the neurodiversity movement and many neuroaffirming approaches. In short, the neurodiversity movement has been defined as a “social justice movement that seeks civil rights, equality, respect, and full societal inclusion for the neurodivergent”. Neurodivergent individuals who may particularly benefit from the neurodiversity movement and neuroaffirming approaches include autistic individuals; individuals experiencing other forms of neurodivergence, such as ADHD, epilepsy, and dyslexia; and individuals that are multiply neurodivergent (some who has more than one form of neurodivergence) and have neurocognitive functioning that diverges from dominant societal norms in multiple ways. 

Neuroaffirmative Disability Discussions

Recent research has suggested that discussing disability in a way that affirms neurodivergent individuals’ experiences can be particularly important. One of the first steps to engaging in neuoraffirming discussions is to be aware of the language used. For example, in a research article published by Bottema Beutel and colleagues in 2021, several recommendations for replacing potentially ableist terms and discourse with more neuroaffirming alternatives are suggested. Some of their recommendations include avoiding medicalized or deficit-based language such as:

• “High or low functioning”
• “At risk for ASD”
• “Burden of/suffering from” and
• “Treatments”

And instead describing specific strengths and level of support needs across different domains, such as:

• “Increased likelihood/chance of autism”
• “Impact/effect” and
• “Supports, services, or educational strategies”

Of course, as with any language, it’s also ultimately important to respect a given individual’s preference and recognize that preferences may vary across individuals. Having a conversation about preferred language can be an important first step to engaging in neuroaffirming discussions.

These language considerations and knowledge about neurodivergence can also be particularly important when caregivers choose to disclose autism or other disability diagnoses to their children. For example, caregivers can help their children with positive identity development by taking a strengths-based, neuroaffirming approach to describing diagnoses. As an example, instead of describing autism as low functioning to high functioning or less autistic to more autistic on a linear scale, conversation may benefit from describing the many different components of autism that vary across individuals and even throughout the day depending on the specific interaction with the environment (Enright, 2021). Indeed, some recent research indicates that adolescents whose parents voluntarily disclosed their autism diagnoses to them in this manner described autism and themselves more positively than adolescents who did not experience the same voluntary disclosure (Riccio et al., 2020). 

Neuroaffirming Clinical Practice

In addition to caregivers and loved ones engaging in neuroaffirming discussions of disability, it can also be important for clinical providers to engage in neuroaffirming practice. Signs that your provider is engaging in neuroaffirming practice include the following (Izuno-Garcia, 2023; Nicolaidis, 2012): 

• The provider does not assume that verbal communication is the only form of functional communication.
• The provider recognizes the social context of disability, and acknowledges that living in a society designed for neurotypical people can exacerbate challenges experienced by disabled individuals. 
• The provider does not separate the person from their disability and recognizes that disability can be part of a person’s identity. 
• The provider learns from and listens to disabled individuals to avoid misalignment between practice and what community members identify as priorities and needs.
• The provider engages in discussion with clients and families to integrate their input and work toward goals identified as meaningful.

Conclusion and Resources

In sum, discussing disability in a neuroaffirming manner at home and within clinical services can have important and positive implications for disabled individuals. Additional resources for learning more about the neuroaffirming approaches are listed below. 

• Autistic Self Advocacy Network: 
  • The Autistic Self Advocacy Network is a nonprofit organization run by and for autistic people that has great resources about neurodivergence and autism from the perspectives of autistic people themselves. (https://autisticadvocacy.org/about-asan/) 
• Raising Children’s Neurodiversity and Neurodivergence: A Guide for Families
  • This resource is created by the Australian government and includes information about neurodiversity in children, and how to embrace neurodiversity at home and school (https://raisingchildren.net.au/guides/a-z-health-reference/neurodiversity-neurodivergence-guide-for-families)
• Center for Connection: 
  • The Center for Connection is an organization that provides lists of books, social media groups, podcasts, and websites for learning more about neurodiversity (https://www.thecenterforconnection.org/ot-resources) 

References

Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood.

Enright, J. (2021). Why I Prefer Identity-First Language. Medium.com. 

Human, E.  (2017). Disability 101: Medical  vs Social Model. EisforErin.com. 

Izuno-Garcia, A. K., McNeel, M. M., & Fein, R. H. (2023). Neurodiversity in promoting the well-being of children on the autism spectrum. Child Care in Practice, 29(1), 54-67. https://doi.org/10.1080/13575279.2022.2126436

Nicolaidis, C. (2012). What can physicians learn from the neurodiversity movement?. AMA Journal of Ethics, 14(6), 503-510.

Riccio, A., Kapp, S. K., Jordan, A., Dorelien, A. M., & Gillespie-Lynch, K. (2021). How is autistic identity in adolescence influenced by parental disclosure decisions and perceptions of autism? Autism, 25(2), 374-388.

Walker, N. (2014). Neurodiversity: Some Basic Terms & Definitions.