What does neurodiversity-affirming speech therapy actually mean?

What does neurodiversity-affirming mean?

In speech therapy it means the therapist works with the way your child communicates, sets goals with you and your child, and looks at what the environment and the adults can change, instead of trying to make an autistic child seem less autistic. The RCSLT, the professional body for speech and language therapists in the UK, has committed the profession to developing neurodiversity-affirming practice and says an autistic person's own needs and preferences should be at the centre of therapy.¹

The phrase gets used a lot, sometimes loosely, and I'd rather tell you what it means in a room than leave it as a label. My about page sets out what I commit to. This guide is about the thinking behind it, and what you can ask any therapist.

What does it commit a therapist to in a session?

Quite practical things. The RCSLT says neurodiversity-informed support should build on a person's strengths and interests, affirm their neurodivergent identity, be personalised to that person at that time, and be agreed with the autistic person or their parent or carer.¹ In a session, that looks like this:

• Every way of communicating counts: speech, signs, gesture, pictures, a device, a favourite phrase from a film.
• Your child can say no, take a break or leave the room, and that's treated as communication.
• Stimming is allowed, and eye contact and sitting still aren't goals.
• The adults and the setting change too, because communication has two sides.
• Goals are agreed with you, and with your child where possible, before anything starts.

Does it mean no therapy and no goals?

No. Some people hear the phrase that way, but the RCSLT says speech and language therapists will teach specific skills where that improves a person's quality of life and reduces risks to them.¹ Being able to tell someone that you're in pain, to say no, to ask for a drink, or to join a game with a sibling are all worth working on.

What changes is who decides the goals and what they're for. Leadbitter and colleagues argue that practitioners and researchers need to move away from a normative agenda and towards targets that autistic people themselves prioritise, with more emphasis on autonomy, coping strategies and wellbeing.² Their paper is an argument about how early intervention research should work, not a trial showing which approach is best, but I find it a useful standard for my own work.

What is the double empathy problem?

It's the idea that when an autistic and a non-autistic person misunderstand each other, the difficulty belongs to both of them. The term comes from Milton's 2012 paper, which questions describing autism as a deficit in understanding other minds and treats it as a matter of reciprocity and mutuality instead.³ That paper is a theoretical argument, not an experiment.

Some experimental evidence points the same way. In one study, 72 people took part in groups of eight, passing a story from person to person. Autistic groups shared information as well as non-autistic groups did. In mixed groups, much less information was shared, and people reported lower rapport with the person they were talking to.⁴ It's a single, small study, so I wouldn't lean on it too hard. For therapy, the practical point is that the work is rarely only about the child: the pace, the noise, and the way adults talk can all need to change.

What about masking?

Masking, also called camouflaging, means hiding signs of being autistic to fit in. The NHS describes it as learning to adapt so that signs of autism are less noticeable, and says it can make everyday activities exhausting and stressful.⁵ A 2021 systematic review of 29 studies found that higher self-reported camouflaging was associated with worse mental health outcomes. The same review says the research base is limited and its conclusions can't be applied to the autistic community as a whole.⁶

That's why I don't set targets like eye contact or sitting still. A child can learn to look like they're listening and be working very hard to do it. I don't want my therapy to teach that. This is my reasoning from the evidence rather than a finding in itself.

Does the language we use matter?

It matters to many families. In a survey of 3,470 people in the UK autism community, "autistic" was endorsed by a large percentage of autistic adults, family members and parents, but by considerably fewer professionals. The study concluded that no single term is universally preferred.⁷ I say "an autistic child" in my own writing, and if you or your child prefer something else, tell me and I'll use your words.

What questions can I ask a therapist?

You can ask these of any therapist, including me.

• Who sets the goals, and how will my child's views be included?
• What happens if my child doesn't want to take part, wants a break, or says no?
• Do you work on eye contact or sitting still? Why, or why not?
• How do you treat stimming, and repeated phrases or scripts?
• Do you use rewards, and if so, for what?
• What will you ask the adults around my child to change?
• What evidence is your approach built on, and where is it thin?
• How will we know if it's helping, and what happens if it isn't?

When should I ask for help?

If you're worried about how your child communicates, your GP or health visitor is the first free route, and the special educational needs coordinator (SENCo) at nursery or school is another. You don't need a diagnosis to ask any of them.

What happens if I get in touch?

On the free 15-minute call you can put any of these questions to me. No GP referral is needed to see me, and it doesn't take your child off an NHS waiting list. The first step is an assessment (£270), mostly play, and the fees page has the rest. How I work with autistic children is on the autism and social communication page.