Transforming allied health: The ‘how’ of neurodiversity-affirming services

Written by Liz Baird

When I graduated my speech pathology degree six years ago, I had no clear idea about what area I wanted to work in. Luckily enough, I fell into roles working with and supporting Autistic children, youth, adults and their families again and again – Autism chose me. And each opportunity has led me to my passion – delivering neurodiversity-affirming services. This professional journey has also been a personal one – helping me to recognise my own neurodivergence and finally understand the intuition I had begun to rely on.

My university study and even work within the current disability sector promotes the teaching of “social skills” – e.g., the utilisation of neurotypical communication and interaction in place of neurodivergent norms. This never felt right! I began to earnestly seek to understand the perspectives of my clients, and ask questions about “how” neurodivergent ways of processing, perceiving and interacting with the world were different.

Responses did not match with my training – what I was taught about Autism often significantly differed from the shared lived experience. My journey began with the question, “How did health professionals get this so wrong?”

Through the privilege of working with Autistic youth and adults, I was able to create a more holistic view of what Autism actually is – and break down my preconceived ideas built through years of study and employment, and cultural views of Autism stereotypes. A neurodiversity-affirming approach validated me personally, and provided a way forward professionally. As I learned and reflected, I have relished opportunities to share with others – colleagues, clients, friends and family. Overall the response has been very positive – a neurodiversity-affirming approach just makes sense.

A very common referral I receive is for Autistic teenagers to receive support with “social skills” – to help them succeed at school, make friends, and transition to employment. What I have learned is that while each client is filled with individualised complexities, some narratives are very familiar. Over time, many teens reflect on how past rejections, constant social anxiety, and an ongoing sense of failure have led them to withdraw. Sensory overwhelm, difficulties with understanding neurotypical conversations, and lack of acceptance by peers causes barriers – often too high to overcome on their own. Supporting each individual to identify their desired outcomes – and the struggles they face – has helped me to validate and connect. 

I was surprised at how many individuals shared experiences of feeling alone in their journey – despite often having stories similar to thousands of other Autistic Australians. A key missing piece was Autistic connection. With my confidence and understanding building, I started a new social group and invited a small group of isolated Autistic young adults.

Traditionally, I would have attempted to teach neurotypical social behaviours and encourage clients to practise these on each other. Instead, I created a safe space, where all could be themselves and where neurodivergent social skills were accepted. Positive feedback from participants has led me to continue running the group for over 18 months. 

Our social group is a chance to engage in a range of Autistic interaction norms, and I actively “unmask” – consciously disengage in neurotypical communication methods and model authentic connection. I feel so much more relaxed when my body is moving and my eyes are looking away, and I encourage all participants to create a comfortable space.

I join in as a fellow Autistic rather than a health professional, and invite everyone to equally plan and contribute to group sessions, and sessions frequently run without my direct instruction over each step. Tabletop games (e.g., Monopoly, Jenga, Uno) are a favourite of all participants, which provide a fun way to take the pressure off social engagement.  

My goal is to encourage confidence in interactions and this is achieved every time – in ways that are meaningful for each individual client.

There are no set expectations of how interaction “should” look, no pre-determined “goals” and no “skills” for my clients to progress through and tick off. Participants are supported and validated whether they are chatty, naturally lead the group, are quiet, or prefer to “go with the flow”.

Some participants play to challenge themselves and engage in strategy, some prefer just to be part of the fun. However, the outcomes of the group speak for themselves. Enjoyment of the group is high – increased perceived success, acceptance by peers, and expansion of confidence within social interactions are paramount. Traditional objectives are also observed, e.g., initiation of conversations, asking questions, asking for help/clarity, and flexibility within teamwork. These skills were not directly taught or requested, and may not present exactly as neurotypical, but are expressed as a result of feeling safe and comfortable. 

Often Autistic people, myself included, spend so much energy and focus on trying to present ourselves as socially engaged in the right and accepted ways.

When we feel safe to be ourselves, we are free to relax and enjoy socialisation. What better space to do this than with others who are similarly neurodivergent! We are not alone; we are not abnormal. Chances to learn about Autistic identity, explore our neurology, and chat to others show us that our way of “normal” is just that – a different normal.  

I believe all speech pathology (and wider allied health) services should focus on building self-awareness and embracing Autistic identity, and supporting problem-solving based on the outcomes that each individual wants. Emphasis should go into understanding and validating the different ways that we think and feel, how we relate and communicate, and how we dream and develop – truly embracing neurodiversity. 

Liz Baird is a speech pathologist from Perth, Australia. You can follow her neurodiversity-affirming practice on Instagram.

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