Neurodiversity-Affirming Practice: A Starting Point For SLPs

For years, autistic people have described a gap between what happens in clinical practice and what they experience in their own lives.¹ Their accounts of intervention and daily support often look very different from what research and the clinic have claimed. Closing that gap means giving up the "clinician-as-expert" model in favor of full partnership with the autistic community.

Autistic people are experts on autism. One study comparing autistic and non-autistic adults found that autistic participants held more accurate knowledge about autism and less stigmatizing attitudes toward autistic people.²

The mantra "nothing about us without us" belongs at the center of this work. No goal should be set for an autistic client without their partnership, and no research agenda should be built without autistic representation. Participatory research, where community members join as equal partners rather than as an advisory afterthought, gives clinicians a clearer understanding of autistic lived experience.¹

How disability models shape your practice

Neurodiversity-affirming practice begins with recognizing ableism, the beliefs and systems that favor an "ideal non-disabled standard" and cast disability as a diminished way of being human.³ It shows up in prejudice toward individuals, in how policy is built, and in professional attitudes, which is why the work starts with reflection.

A model of disability is a set of assumptions about what disability is and where it comes from. Models are shaped by culture and time, and no single model captures any one person. The model you carry, often without naming it, influences how you assess and how you partner with clients.

The medical model is the most pervasive. It locates disability in individual factors (neurological, physiological, psychological) and treats them as the primary cause, so the aim becomes curing or fixing the disability, and professionals are positioned as the experts who repair what is wrong.

The social model locates disability elsewhere. It treats human variation as naturally occurring and points to society's role in building the physical, systemic, and attitudinal barriers that create a disabling experience.

The biopsychosocial model, sometimes called the hybrid social model, draws on both. It acknowledges that a person's challenges can be significant while holding that barriers created by community, environment, and attitudes remain the larger problem. This is where many clinicians find affinity. Our training lets us support an individual's challenges through intervention, while also supporting environmental changes and accommodations, and coaching behavior change in the people around a client so the responsibility for successful communication does not rest on the autistic person alone.

If you were trained only in the medical model, this can feel unsettling. There is still a substantial role for you. Our skills in supporting individuals remain valuable, and we can add to them by recognizing society's role and amplifying the autistic community's efforts to change it.

Language matters in the clinic and on the page

Getting the terms right

Neurodiversity has been defined as "the diversity of human minds, the infinite variation in neurocognitive functioning within our species," and it is a biological fact rather than a perspective or paradigm.⁴ Neurodivergent describes a mind that functions in ways that diverge significantly from dominant societal standards of "normal."⁴ Neurodiverse describes a group that includes both neurodivergent and neurotypical people.

Say the word "disability." Whispering it or reaching for euphemisms such as "special needs" reinforces stigma and treats disability as something shameful. The disability community rejects that framing and claims disability as identity and culture.⁵

Identity-first and person-first language

One influential critique of person-first language argues that autism is not a suitcase to be picked up or put down, and that separating "person" from "autism" implies autism is a minor or negative attachment rather than part of who someone is.⁶ Many autistic people prefer identity-first language, and the aim is to avoid labeling anyone against their own preference.

Some communities, such as many people with Down syndrome, prefer person-first language. Defer to the individual first, then to the community. Major style guidance and academic journals have moved away from a strict person-first default, which makes room for that responsiveness. When a clinician argues that person-first should stay the default whenever preferences are unknown, the question worth asking is why either one should be the default at all.

Functioning labels and support needs

Classification deserves the same scrutiny. Functioning labels create a double bind: a "high functioning" label often leads to denied supports, and a "low functioning" label often leads to denied rights.

Autistic people tend to have a spiky skills profile, and context shapes access to skills, so a single static level describes no one well. Support needs offer a clearer alternative when they are specific. "Needs help with daily living tasks after a long social encounter in a noisy environment" tells you far more than a numbered level.

Consider a common case report:

Alex, a 57-year-old man with low-functioning autism spectrum disorder, presents with significant expressive language and social communication deficits, as well as co-occurring mental health concerns, including reported fatigue and depression. He demonstrates limited functional verbal language and requires maximum support for ADLs.

Now look at the same information from a strengths-based lens:

Alex, a 57-year-old autistic man, demonstrates use of gestures and spoken sounds with his sibling (legal guardian) to express a variety of wants and needs. An augmentative and alternative communication (AAC) evaluation is warranted to further investigate alternative communication modalities. According to sibling report, Alex demonstrates co-occurring challenges with fatigue and depression.

A strengths-based approach does not erase challenges. It documents what a person can do, asks whether they have had real opportunities to show it, and questions whether something labeled a deficit is closer to a difference.

The first version says little about how Alex engages with his sibling or what he enjoys, and it asserts depression and fatigue without explaining how they were established for someone with limited communication access and no AAC. The phrase "verbal language" is worth retiring too, since it can imply a person lacks language altogether, while "spoken language" or "speech" leaves room for language expressed through other modalities.¹

Communication myths and the double empathy problem

Rethinking assumptions about speech

The belief that speech is the superior mode of communication is common and grounded in ableism. Speech serves most people most of the time, particularly non-disabled people, yet a significant share of autistic people do not speak at all, and many who do speak still do not reach full communication through that channel.⁷

Autistic accounts describe four internal states that shape speech:⁷

• Intermittent speech: being able to speak sometimes and not others.

• Unreliable speech: when what comes out does not match the intended message.

• Insufficient speech: when the words fit but do not meet the full communicative need.

• Expensive speech: when speech is reliable and sufficient but drains an enormous amount of cognitive resources.

Affirming practice supports communication in a variety of forms so a person can participate in their own care, give or refuse consent, and build rapport with providers, whether or not they are speaking.

The double empathy problem

The concept of the double empathy problem reframed decades of clinical assumptions.⁸

Autistic people tend to communicate well with other autistic people, and non-autistic people tend to communicate well with other non-autistic people. The breakdowns tend to happen across these groups. That reframing replaced the idea of a one-sided autistic deficit with cross-community supports.

Rather than teaching autistic clients a single "correct" way to interact, we can offer strategies to non-autistic people about autistic communication and to autistic people about non-autistic communication and treat both as skills a person can choose to use.

Presuming competence

Presuming competence supports all of this. It is the assumption that every person brings capability and strengths to a task, and it matters most for people who use limited or no speech, about whom society readily makes assumptions.⁹

A few practices help:

• Communicate using age-appropriate language.

• Speak directly to the person and ask consent before sharing their information.

• Avoid speaking about someone in front of them.

• Treat so-called challenging behavior as possible communication or a sensory or motor response before interpreting it.

• Look for signs of comprehension before assuming its absence.⁹

Meet clients where they are. You can partner well with someone who holds a medical model of disability without trying to talk them out of it, and still model a strengths-based approach through the language you use and the way you document your work. Every person you work with is a full human being, and your documentation can reflect that in each note you write.

Continue the conversation

If you want to take these ideas into your intervention planning, learn more in our Medbridge course, Foundations of Neurodiversity-Affirming Practice. It goes further into strengths-based goals that prioritize self-advocacy and quality of life, and into respecting bodily autonomy and privacy, including the ethical handling of harmless stimming and sensitive clinical information. Case-based activities and self-reflection help you apply each one.

References

1. Donaldson, A. L., Corbin, E., & McCoy, J. (2021). Everyone deserves AAC: Preliminary study of the experiences of speaking autistic adults who use augmentative and alternative communication. Perspectives of the ASHA Special Interest Groups, 6(2), 315–326. https://pubs.asha.org/doi/10.1044/2021_PERSP-20-00220

2. Gillespie-Lynch, K., Kapp, S. K., Brooks, P. J., Pickens, J., & Schwartzman, B. (2017). Whose expertise is it? Evidence for autistic adults as critical autism experts. Frontiers in Psychology, 8, Article 438. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.00438/full

3. Campbell, F. K. (2001). Inciting legal fictions: “Disability’s” date with ontology and the ableist body of law. Griffith Law Review. https://research-repository.griffith.edu.au/bitstreams/bdf45182-e5b6-59f6-8285-2c44ad749a65/download

4. Walker, N. (2014). Neurodiversity: Some basic terms and definitions. Neuroqueer: The Writings of Dr. Nick Walker. https://neuroqueer.com/neurodiversity-terms-and-definitions/

5. Andrews, E. E., Forber-Pratt, A. J., Mona, L. R., Lund, E. M., Pilarski, C. R., & Balter, R. (2019). #SaytheWord: A disability culture commentary on the erasure of “disability.” Rehabilitation Psychology, 64(2), 111–118. https://psycnet.apa.org/record/2019-07468-001

6. Sinclair, J. (1999). Why I dislike "person first" language. Autonomy, the Critical Journal of Interdisciplinary Autism Studies, 1. https://scispace.com/pdf/why-i-dislike-person-first-language-d7jw4gccdm.pdf

7. corbin, e. (2025). Speech is exhausting. Augmentative and Alternative Communication, 41(3), 245–247.  https://pubmed.ncbi.nlm.nih.gov/40509739/

8. Milton, D. E. M. (2012). On the ontological status of autism: The “double empathy problem.” Disability & Society, 27(6), 883–887. https://psycnet.apa.org/record/2012-26140-011

9. Donaldson, A. L., Krejcha, K., & McMillin, A. (2017). A strengths-based approach to autism: Neurodiversity and partnering with the autism community. Perspectives of the ASHA Special Interest Groups, 2(1), 56–68. https://pubs.asha.org/doi/abs/10.1044/persp2.SIG1.56