Embracing Neuro-Affirming Approaches to ADHD and Autism: Transforming Perspectives on Diverse Minds

In recent years, the understanding of neurodiversity has shifted significantly, leading to a fresh perspective on many mental health diagnoses, but perhaps most strongly with ADHD and autism. Neuro-affirming approaches aim to recognize and celebrate differences in brain functioning rather than framing them solely in a pathologized/disordered/medical context. This shift encourages a more inclusive view of individuals with these conditions, showing us that they enrich the fabric of human experience.

In this discussion, we will explore the principles of neuro-affirming practices. We will also look at the important distinction between viewing brain differences as 'different' rather than 'disordered,' along with the implications of these ideas on diagnosis and treatment methods.

A little history: How psychology became so "clinical"

First, I'll start with a tiny bit of history. Long ago, in its origins, psychology was just a way to describe how different people work. In the late 1800s and very early 1900s, the goal of most professional psychologists was just to understand people. We did not treat disorders; we just wanted to better understand the human mind. Even the first official psychological clinic, founded by Lightner Witmer at the University of Pennsylvania in 1896, was focused on assessment, not treatment, and primarily focused on identifying learning differences in children. However, over time, the field of pyschology grew increasingly "medically oriented," due to the prominent influences of several MDs (physicians/neurologists/pscyhiatrists) who developed an interest in the field, and in applying the lessons from the field toward their patients. As this happened, clinical psychology became more, well, clinical, and the goals transformed away from understanding people but toward classifying human behavioral and mental pathology.

This transition was transformative for the field in a lot of positive ways, because it legitimized our work and showed that the work we did could make very real differences in improving people's lives. But, along with the transformation also came some negative outcomes - namely, as we started classifying pathology, it suddenly became "a bad thing," to have a mental health diagnosis. In fact, the idea of a "diagnosis" itself suggested that labels used to describe human behavior can be inherently pathological, because "diagnosis" and "pathology" are one and the same.

What is "disorder"?

Making diagnoses and classifying pathology is the way clinical psychology has been working now for nearly a century. The modern clinical psychologist is trained, specifically, to diagnose and treat mental disorders. We (mostly) use the DSM-5 to do so - the Diagnostic and Statistical Manual of Mental Disorders. It's there in the name - if something is included in the DSM-5, it is a disorder.

But we've made mistakes in the past. One of the most famous was that in early versions of the DSM, homosexuality was (wrongly) included as a diagnosis - a disorder. But there are other examples of mistakes too. The point I'm trying to make, though, is that the DSM-5 is not infallible, and our field sometimes underestimates the stigma created when we include descriptive terms in a manual of disorders. Now, I am certainly NOT arguing that we completely overhaul our system for classifying behavioral and mental disorders. There are good (practical) reasons to continue calling many human experiences "disorders." First of all, we function in a world where there is a need to classify and justify reasons to offer someone a clinical intervention. Though I don't personally feel such a system is always necessary, the real truth is that the system is so large and powerful that overhauling it is impractical. So, we have to learn to function within that system, and functioning within the current system means that we must agree to call something a disorder, so that we can then "treat" it. So, there is a benefit to you those who are patients, in calling something a disorder, in that the very act of calling it a disorder opens them up to access to interventions, treatments, and accommodations they would not otherwise get. Second, the word "disorder" does not have to imply a permanent condition, as many people believe. There are many medical conditions which are transient. The common cold is a good example. Practically everyone will get the common cold at some point in their lives - which results from infection from a virus. Now, the presence of that virus in the body certainly causes a certain amount of "disorder," and our immune system then works to restore order. While that virus is present, then, we technically "have a disorder." And once the virus is gone, we are heatlhy again (relatively). In mental health, a person with major depressive disorder can be effectively cured of it, for extensive periods of time - the rest of their lives even. Just because that had a major depressive episode (and major depressive disorder at some point) doesn't mean they'll have it forever. So, it's important to remember that the word "disorder" doesn't have to mean something one has forever. It simply describes a state that is (undesirably) different from the usual. This, of course, calls into question of "what is the usual state." The usual state can be 2 things: a) different from your own typical baseline, and b) different from everyone else's typical baseline. I think (A) is the easier one for us to agree one. When our body or mind functions one way for most of our lives, then starts to malfunction, it is a disorder. (B) may be a little harder to agree on. Just because something in one person's body/mind functions differently than everyone else's does NOT mean it is malfunctioning, right? However, definition (b) is exactly how the DSM defines a LOT of mental illnesses - by the amount of aberration from the norm. The neurodevelopmental disorders, as they are often classified in the DSM, are perfect examples of this. These "disorders" are NOT defined by change in baseline, but, rather, are defined by a course of development that veers away from the "expected" trajectory. But this then calls into question what is the "expected" trajectory. How do we know what is "normal?" Well, most scientists would tell you we base "normal" off of research and study of thousands and thousands of people. When we see enough people, we get a good idea of typical trends, and we thus know what is atypical. And this is certainly true to an extent. We can absolutely identify, through research, "typical" trends, and "atypical" trends. But, where scientists may have erred in the past is when we've called some "atypical" trends "disorders." Autism is a great example of this. Autism has always been defined within clinical fields as a maladpative variant of human social behavior - it is a problem that needs to be corrected in order for the child to function in society.

But what if that definition of autism is just wrong. What if autism is an example of "atypical" but not "malfunctioning?" This is the core argument of the neuroaffirmative stance to autism. A neuro-affirming practioner does not, then, diagnose autism with the purpose of correcting a malfunction. Rather, we diagnose autism in order to give patients and parents a descriptive term to understand how their (or their child's) brain works - that is, autism is an atypical variant of human social behavior. In the neuroaffirming approch, we may recommend certain interventions - like ABA or social skills training - but these interventions should not be considered to be ways to change your child to make them "better' or to "cure" them of something that is wrong with them. Rather, the goals of such programs - if therapists are being neuro-affirming - is simply to give an autistic person an opportuntiy to learn how the neurotypical world works, so they can get through it better. I often use the analogy of cross-cultural training. If I (a nuerotypical person) were going to spend a significant time in another culture - let's say I were taking a trip to the Middle East, or something - I would want to take some time to learn about Middle Eastern culture - how they relate to each other, how they greet each other, what actions are considered offensive vs which are considered polite, and I would want to shape my own behaviors to better match the expectations of the culture, whenever I'm immersed in it. This would make my life easier because I wouldn't be accidentally offending people without knowing what I'm doing wrong, but it would also show that I am trying to respect the larger culture around me, that I care enough about people to adapt myself to their culture, when and where I can. Of course, this goes two ways. I would also want my Middle Eastern hosts to understand that I'm not going to be perfect in my assumptions of their culture, and I would hope they'd offer me clemency and understanding if and when I do something that doesn't fit their expectations. So, when I (or any other neuror-affirming provider) talk to an autistic person and their family about social skills training or ABA or things like that, I try to explain that the goal is to give them an opportunity to learn how the neurotypical culture works, so they can adapt accordingly, and make their lives easier. I also say, though, that neurotypical people can do the same. Neurotypical family members, for example, can learn to adjust their expectations and their own behaviors to suit the autistic brain/culture. They can learn about the "atypical" brain and shift their own ideas accordingly. The adaptations and accommodations go both ways! So, that is a long-winded way of saying that many practitioners in the modern world are making efforts to amend the history of clinical pscyhology by moving away from this idea that atypical development is a disorder or malfunction that needs to be corrected. Rather, we are trying, instead, to move toward understanding atypical development simply as a normal (though less common) variant of human behavior; something that adds beauty and wonder to the world, and makes it a richer place.

Different Brains vs. Disordered Brains: Neurodiversity

So, to sum everything up, what we are really trying to do is move away from "neurodevelomental disorders" and instead toward "neurodevelopmental differences."

The Implications of Viewing Differences

1. Shifting the Role of Diagnosis: As I've noted above, diagnostic labels do not always need to be used for naming "disorders." Rather, we can use them instead to simply "describe" people, and then make recommendations for what people who fit those descriptions might need to thrive best. In other words, certain diagnoses, particularly ADHD and Autism, should not always represent "disorders." Rather, we as professionals can play a role in shifting the framework toward using descriptive labels to describe a person's tendencies and general needs, without also implying that these tendencies and needs are things that need to be treated, "fixed," or "normalized." By leading the charge with this mindset, professionals can be a big part of moving away from "diagnoses as problems," but, rather, "diagnoses as descriptors."

   
   

2. Challenging Stigmas: By shifting conceptualizations, stigmas about various diagnoses can be decreased dramatically. Of course, this will take time, effort, and some cultural shifts, but with enough lead from those in power to do so, we can start to shift away from stigmatized diagnoses and instead toward affirming ideas.

   
   

3. Individualizing needs based on diagnosis: Even as we move away from pathologizing neurodevelopmetnal differences, we can still hold onto the idea that neurodevelopmental atypicalities can benefit from specific services. People with ADHD may still benefit from medicine, if they want, to help them better succeed in their schools, jobs, and lives. People within the autism spectrum may benefit from social skills groups and the like. The act of receiving services does not have to mean that we are trying to correct something that is wrong. Rather, it only means that we are offering something based on individual needs. This is another important part of the transition toward neuro-affirming approaches then, is categorizing services as ways to be responsive to individual needs, rather than ways to treat disorders.

   
   

4. Promoting Inclusivity: Lastly, another key task of neuro-affirming approaches is to promote unique tasks that fit an individual's natural skills and personality, whatever they may be. There is no reason, then, to ask neurodivergents to "conform" to our norms. Rather, we can just include them in our everyday world and allow them to thrive in the tasks they are naturally skilled at. This is no different than part of the reasons I became a psychologist. That is, becoming a psychologist suited my natural personality and natural skills. Being a law enforcement officer, for example, probably wouldn't have suited my personal skills (I probably wouldn't be very good at arresting and interrogating people that break the law). This doesn't make me "lesser," because I'm not naturally drawn to being a cop; it's just a truth of who I am as a person.

   
   

   What we tend to do as a society is we tend to blame neurodevelopmental differences for limiting people. We tend to say, "John shouldn't be a surgeon because he has ADHD" or "Jane has autism. Should she really be at the customer service desk?" But these ideas miss the point entirely. What we should be asking, instead, is "Does John have any of the natural skills and personality traits that make a good surgeon?" or "What would Jane be like if she were our main customer service representative?" We do not NEED to include diagnoses in these discussions, we just need to know what their natural personality is like, and whether that natural personality suits the skill. Now, let's say that John dreams of being a surgeon, even if he doesn't have the natural skills. Well, we might let him know that the path to being a surgeon is going to, perhaps, even more of an uphill climb for him than it is for other people, but if he decides he still wants to pursue it, we can try to shape his training a surgeon to give him what he needs to overcome any natural limitations he has. I'll use myself and my psychology training as another good example. Though I think I have many natural qualities that fit my field well, I am not naturally confrontational. I am actually quite the opposite. I am someone who just "goes with the flow," most of the time. However, psychologists do have to confront patients a lot of the time. We have to be able to let someone know when something they're doing isn't healthy, and we have to be open to challenging people when necessary. So, I had to to develop this particular skill in my training more so than some of my colleagues, who may have been more naturally able to confront their patients. I did develop this skill eventually, but I just needed to work harder at it. The same is true for any field, really. Almost no one is 100% perfectly suited for a job/task. We all have to push ourselves, eventaully, outside our comfort zone and build specific skills. We can use diagostic labels like ADHD and Autism to better understand a person's specific skills and tendencies, but these diagnoses themselves don't have to always be seen as "limits." Rather, they can be seen as acknowledgement that a person may need to work harder at certain things to meet their goals.

   
   

Closing

In closing, neuo-affirmative approaches are, I think, the future of our field. Across the entire spectrum, all professionals, parents, and patients can move toward neuro-affirming practices and this will only help us better serve people.