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Embracing Neurodiversity-Affirming Practice With Autistic Clients _ AOTA

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As a school-based OT, you've probably heard an increasing buzz around the neurodiversity-affirming movement in the past few years. Put simply, the neurodiversity movement means respecting and celebrating neurodivergent individuals, and recognizing neurodiversity as a unique culture of its own instead of something to be "fixed" or remediated. Obviously, this is a huge shift from what most of us were taught in OT school as well as the framework of our current education system. All the same, this is an important shift in practice to make. If you're wondering how you can be more neurodiversity-affirming as a school-based OT, read on.

Listen to Neurodivergent Individuals

The core of this type of practice involves listening to the actual people our therapy affects. Previously, medical professionals were considered to be the "experts" on autism and ADHD. The neurodiversity movement shifts that tenet and highlights the expertise that neurodivergent individuals themselves carry about their neurotype.

So, as a non-autistic/ADHD therapist, the biggest piece of advice I can give you is to seek out the opinions of neurodivergent individuals when making therapy decisions. Obviously, this means listening to the students you have in front of you first and foremost as the experts on their bodies, needs, and goals. But it also means you should listen to other autistic/ADHD individuals. This can be incredibly illuminating. You'll learn to appreciate the real perspectives of people who have gone through OT, and what they found helpful or harmful. You'll also hear the internal feelings, thoughts, and experiences of the neurodivergent experience in ways that you probably haven't considered if you're neurotypical.

One of my favorite places to get autistic perspectives is the group Autism Inclusivity on Facebook. It is full of autistic adults who want to help all caregivers of autistic children do a better job supporting them. If you do decide to join this group, keep in mind that this is a space that highlights autistic opinions. If you are not autistic, I recommend reading more than commenting, and taking some initial time in the group to understand the rules and just listen.

Stop Using Hand-Over-Hand

At this point, I have completely removed hand-over-hand from my practice and I suggest you do the same. The most important reason to stop doing this immediately is that it violates an individual's bodily autonomy. By moving someone else's body without permission, you are teaching them that they do not have a right to their own body. They learn that other adults can do as they please to their body. Kids and adults with disabilities are already a vulnerable population when it comes to sexual assault, and this kind of teaching can put them in an even riskier position. And neurodivergent individuals often have trouble communicating, so they are even more at risk of having their bodies violated without the proper tools to speak up about it.

If that alone doesn't convince you, it should also be stated that hand-over-hand isn't even really that effective at teaching new skills. It often instead teaches students to be dependent on adults. I've worked with many older autistic students who literally wouldn't even attempt tasks without grabbing for an adult's hands to guide them. Is this really teaching students the independence that we so highly value as OTs?

If you're wondering what to do instead, try modeling, visual cues, verbal cues, and tactile cues. And above all else, make sure you're asking students to do tasks that are meaningful and interesting to them.

If you must continue using hand-over-hand, make sure you have explicit consent from your student, even if they are non-speaking and this may be difficult to obtain. We can always try another therapy activity that day - but we can't necessarily undo the damage that hand-over-hand can cause.

Use a Strengths-Based Lens

One of the best changes we can make in our school-based OT practice is to shift from a deficits-model to a more strength-based lens. And really, this is true for all of our students, not just the neurodivergent ones. Be sure that when you're evaluating, you're not just piling on all the things the student isn't great at. Can you imagine someone writing a report about you at work with that focus? If it sounds incredibly demoralizing, it's because it is. Instead, take time to get to know your student, find out their strengths, and use them to guide goals, interventions, and educational curriculum.

If you're looking for more guidance on how to shift to a strengths-based approach, I can't recommend The Learn Play Thrive Approach to Autism enough. I took this course a couple of years ago, and it completely shifted the way I approach working with autistic students, especially in regard to visual schedules, behavioral strategies, and intervention design. I truly believe it should be required training for any OT working with autistic students. Plus, you can get 15% off the course with coupon code DEVON15!

Allow Stimming

You may have been taught that self-stimulatory behavior, or "stimming," was harmful and something that needed to be redirected. But in actuality, there's not good evidence for this. In fact, we now know stimming serves important functions for neurodivergent individuals and should not be "managed" just for the sake of it. Stimming should never be attempted to be stopped or redirected just to make a student appear more neurotypical. If you or an IEP team member is considering whether you should attempt to stop a stim, ask the following questions:

Is this stim harming the student or others around them?

Does the student want to stop the stim?

Is the stim interfering with a task that is important to the student?

Unless the answer to at least one of these questions is "yes," then the stim should probably not be redirected. And if the answer is yes, work collaboratively with the student as much as possible to explore other ways to stim that might still meet their needs.

Push for AAC Devices

Neurodivergent individuals often have communication differences. Many autistic individuals don't speak at all, or may have extreme difficulty doing so. For these students, AAC devices are a lifesaver. There are few interventions I've consistently seen make a bigger difference for my autistic students than implementing an AAC device. Unfortunately, there is still a lot of misinformation around AAC devices, and the IEP team - including the SLP - may be hesitant to recommend them because of persistent myths. If you've ever heard that AAC inhibits verbal speech, or that a student is too young for AAC, or that there are certain prerequisites that a student needs to meet before trialing a high-tech AAC option, know that none of these are supported by evidence. Please recommend AAC evaluations to your IEP teams for any students that don't have consistent methods to communicate - especially students who may be exhibiting behavioral difficulties.

If you're looking to learn more about using AAC with autistic students, Learn Play Thrive also has a course on Authentic AAC that is a great place to get started! My coupon code (DEVON15) will work to take 15% off this course as well.

Be Willing to Speak Up

Over the past couple of years, I've also been shifting my approach to be more neurodiversity-affirming. This hasn't been an overnight change, and I still have a long way to go. I've had to unlearn a lot of things (things I was taught as gospel in grad school) and I've had my own cognitive flexibility tested.

Some of these shifts have been easy. I've never been a fan of hand-over-hand, so that's been simple enough to remove from my own practice. But some of them have been much harder. As much as I am the type of person to speak up, it is STILL hard to make recommendations that are neurodiversity-affirming when you're working with teams who are not familiar with this approach. I've been to hundreds and hundreds of IEP meetings at this point, and I still get a nervous pit at the bottom of my stomach when I think about telling a team that what they thought was "best practice" for autistic students is anything but.

But someone was willing to do this for me. And so I need to be willing to be that person for someone else. And now, you should be that person, too. After all, our teams want to do right by their students. They might just need us to help point them in that direction.

If you're looking to make your school-based OT practice more neurodiversity-affirming, implementing these changes will help. And if you're committed to taking this even deeper, The Learn Play Thrive Approach to Autism is the perfect next step. It's one of the best CEU courses I've taken in general, and I can't imagine a better, more evidence-based primer for working with autistic students. When you're ready to sign up, feel free to use my coupon code (DEVON15) to save 15%. Cheers to making your school-based OT practice more neurodiversity-affirming!

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How To Make Your School-Based OT Practice More Neurodiversity-Affirming - Devon Breithart

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Have you heard about the neurodiversity-affirming movement but don't know how to apply it to school-based OT practice? Here's how to start.