Neuroaffirmation—A Therapist’s ConcernsI worry about the unintended consequences of the neurodiversity movement, particularly when their demands are promulgated religiously and without nuance.
Rita Range
29 Jul 2023
As an occupational therapist of almost 30 years, I have watched many aspects of my profession (and of healthcare in general) change over time. As new discoveries are made, evidence bases evolve, and our practices (hopefully) shift to accommodate these new developments. Such is the ethical code we adopt as healthcare professionals to act in an evidence-based manner for the good of our clients.
I am wary, however, of the neurodiversity-affirming movement and the zeal of some of its advocates, especially younger therapists. A perusal of their webpages reveals that many describe themselves as neurodivergent, or if that shoe doesn’t fit, as “neurodivergent allies.” Tried and tested therapeutic models are critiqued and repackaged to make them more “neurodiversity affirming,” or they are avoided altogether. In theory, this all sounds fine, but I worry about the unintended consequences of this movement, particularly when their demands are promulgated religiously and without nuance.
The term “neurodiversity” was coined in the 1990s by Judy Singer, a sociologist on the Autism Spectrum, and adopted to describe the idea that the brains of people with autism work differently. It now also encompasses those with presentations such as ADHD, OCD, and dyslexia. Rather than focusing on the deficits of such people, we are advised to take a strengths-based perspective to ensure acceptance and even celebration of their uniqueness. A recent article by Ariane Resnick on verywellmind.com states: “Neurodiversity embraces differences in brain function and behaviour as a natural manifestation of humanity’s variety, rather than viewing them as wrong or problematic.”
The neurodiversity affirming movement has produced many benefits. A focus on the unique qualities of those with disabilities reflects their inherent dignity and worth and should be a part of the practice of anyone working in the therapeutic professions. A push towards acceptance of those with differences in their physical, cognitive, and/or neurological make-up is similarly imperative if we are to work towards the wellbeing of those with disabilities. So, what could possibly go wrong?
In her excellent article “The Cognitive Distortions that Feed Neurodiversity Radicalism,” Lucy Kross Wallace, a person on the Autism Spectrum, describes her journey out of the neurodiversity advocacy movement and back to a more balanced point of view: “The path towards neurodiversity radicalism,” she writes, “begins with the adoption of autism as an identity and the perception that being autistic grants a person authority over all autism-related matters.” Problems have arisen, however, as the diagnosis of autism has changed over time.
* * *
Take play-based therapy, for example. Play is considered “the work of childhood” and provides children with a framework within which to explore their world and develop the foundations of language, problem solving, social skills, symbolic thinking, and motor skills. Highly regarded professionals have noticed strong differences in the play profiles of children with autism, who will struggle with collaborative and imaginary play and will instead show a preference for solitary, cause-and-effect-type play, sorting and lining up items etc. These same professionals have developed interventions to gently shift children’s play skills and tolerance for different types of play, so that they engage in more symbolic and imaginary play and are more tolerant and inclusive of their peers in the process. When this is done well, it can result in significant gains in the child’s ability across a range of developmental areas.
However, the “neuroaffirming community” is now adamant that we should allow all children to play as they choose, and that we should not have play skills goals for children because, by its nature, play should be freely chosen. In their words, “All play is good play.” This new approach is informed by the voices of some of those with autism who have reached a seemingly successful adulthood and now recount that approaches that “forced” them to play in a neurotypical way were very stressful.
I will concede that any approach, when used clumsily and without regard for the client’s level of comfort and tolerance, can be counterproductive and even harmful. In the hands of a surgeon, a scalpel works well; in the hands of a carpenter, it doesn’t. But monochromatic thinking appears to be characteristic of the neurodiversity affirming movement, which makes bold declarations with great confidence and authority about what is helpful or harmful, and passes stern judgement on dissenters.
* * *
Source:
https://quillette.com/2023/07/29/neuraffirmation-a-therapists-concerns/
