Neurodiversity in the Clinic

Some autistic people have long criticized the “medical model” of disability, which treats atypical development as a pathology and seeks to “cure” it, or at least help patients become as close as possible to typically developing peers. An alternative lens popularized in the 1990s by autism rights activist Judy Singer is “neurodiversity.” Autism researcher Patrick Dwyer looks at what this framework could offer professionals working with autistic people and others with differences in neurodevelopment.

Dwyer advocates for a view of neurodiversity that has room for both social factors and individual impairments that may be addressed with treatment, as well as for the idea that neurodivergences can come with strengths. This allows for responses that involve changing the environment and/or helping an individual adapt to their surroundings. For example, responses to ADHD may include offering stimulant medications to help with focus and also removing distractions.

Parents who view their autistic children through a deficit lens may be more likely to pursue ineffective and dangerous pseudoscientific treatments.

Dwyer argues that it’s crucial for neurodivergent people themselves to be the ones deciding which approach to take, to the extent possible. He also distinguishes between interventions to promote well-being and those that aim purely at making people behave more neurotypically, such as trying to suppress harmless autistic “stims” like arm-flapping.

One controversy around the neurodiversity approach involves its application to people with what’s sometimes (controversially) referred to as “severe” or “low-functioning” autism. Parents and caregivers of intellectually disabled or non-speaking autistic people sometimes argue that neurodivergent self-advocates with low support needs can’t speak for those with disabilities that affect their daily lives in more profound ways.

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But Dwyer suggests that, in practice, the medical model is often simply inapplicable to people with high support needs. For example, there is no pill to help people gain language abilities. Instead, the best-proven interventions are environmental supports like communication tablets and assistance with daily tasks.

Dwyer also argues that a strength-based approach among clinicians, parents, and autistic people themselves can help people with high support needs find the approaches that make most sense for them. Parents who view their autistic children through a deficit lens may be more likely to pursue ineffective and dangerous pseudoscientific treatments.

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Meanwhile, for researchers, Dwyer’s neurodiversity approach includes focusing more on environmental factors, which have often been neglected in favor of biological ones, and considering how strengths related to atypical development may help in areas like employment. It also involves looking to autistic self-advocates and conversations within autistic communities for guidance on research directions to pursue. This might include more focus on autistic experiences of sensory overload and meltdowns, as well as the value and pleasure to be found in hyperfocus and intense interest in particular topics.

One stark example here is that, historically, researchers often incorrectly painted autistic people as lacking empathy or even the ability to love. Criticism by autistic individuals led to further research that has found neurotypical researchers may simply fail to see how autistic empathy manifests itself—ironically due to their own lack of empathy for autistic perspectives.

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