The neurodiversityparadigm is a framework for understanding human brain function that considers the diversity within sensory processing, motor abilities, social comfort, cognition, and focus as neurobiological differences. This diversity falls on a spectrum of neurocognitive differences.[1] The neurodiversity paradigm argues that diversity in neurocognition is part of humanity and that some neurodivergences generally classified as disorders, such as autism, are differences with strengths and weaknesses as well as disabilities that are not necessarily pathological. Neurotypical individuals are those who fall within the average range of functioning and thinking.
The neurodiversity movement started in the late 1980s and early 1990s with the start of Autism Network International. Much of the correspondence that led to the formation of the movement happened over autism conferences, namely the autistic-led autreat, penpal lists, and Usenet. The framework grew out of the disability rights movement and builds on the social model of disability, arguing that disability partly arises from societal barriers and person-environment mismatch, rather than attributing disability purely to inherent deficits.[2][3] It instead situates human cognitive variation in the context of biodiversity and the politics of minority groups.[4][5][6] Some neurodiversity advocates and researchers including Judy Singer and Patrick Dwyer argue that the neurodiversity paradigm is the middle ground between a strong medical model and a strong social model.[7][8][9]
Neurodivergent individuals face unique challenges in education and the workplace. The efficacy of accessibility and support programs in career development and higher education depends on the individual.[10][11] Social media has introduced a platform where neurodiversity awareness and support has emerged, further promoting the neurodiversity movement.
The neurodiversity paradigm has been controversial among disability advocates, especially proponents of the medical model of autism, with opponents arguing it risks downplaying the challenges associated with some disabilities (e.g., in those requiring little support becoming representative of the challenges caused by the disability, thereby making it more difficult to seek desired treatment[12]), and that it calls for the acceptance of things some wish to be treated for.[12][13][14][15][16] In recent years, to address these concerns, some neurodiversity advocates and researchers have attempted to reconcile what they consider different seemingly contradictory but arguably partially compatible perspectives, and some researchers have advocated for mixed or integrative approaches that involve both neurodiversity approaches and biomedical interventions or advancements, for example teaching functional communication (whether it be spoken or not) and treating self-injurious behaviors or co-occurring conditions like anxiety.[17][18][19][20][21][22][23][24]
History
The word neurodiversity first appeared in publication in 1998, in an article by American journalist Harvey Blume,[25] as a portmanteau of the words neurological diversity, which had been used as early as 1996 in online spaces such as InLv to describe the growing concept of a natural diversity in humanity's neurological expression.[3] The same year, it was published in Judy Singer's sociology honors thesis,[26][27] drawing on discussions on the independent living mailing list that included Blume.[28] Singer has described herself as "likely somewhere on the autistic spectrum".[26]
Blume was an early advocate who predicted the role the Internet would play in fostering the international neurodiversity movement.[29] In a New York Times piece on June 30, 1997, Blume described the foundation of neurodiversity using the term neurological pluralism.[30] Some authors[31][32][33] also credit the earlier work of autistic advocate Jim Sinclair in laying the foundation for the movement. Sinclair's 1993 speech "Don't Mourn For Us" emphasized autism as a way of being, claiming "it is not possible to separate the person from the autism."[34]
The Neurodiversity Movement grew largely from online interaction. The internet's design lent well to the needs of many autistic people.[35] People socialized over listservs and IRCs. Some of the websites used for organizing in the Neurodiversity Movement's early days include sites like Autistics.Org[36][37] and Autistic People Against Neuroleptic Abuse.[38][39] Core principles were developed from there. Principles such as advocating for the rights and autonomy of all people with brain disabilities with a focus on autism. The main conflicts from the beginning were about who the real experts on autism are, what causes autism, what interventions are appropriate, and who gets to call themselves autistic.[40] During the 2000s, people started blogs such as Mel Baggs' Ballastexistenz[41] and Kevin Leitch's Left Brain Right Brain.[42] Eventually, Autistic Self Advocacy Network (ASAN) was started by Ari Ne'eman and Scott Robertson to further align the Neurodiversity Movement with the greater disability rights movement. ASAN led the Ransom Notes Campaign[43][44] to successfully remove stigmatizing disability ads posted by the NYU Child Study Center. This was a massive turning point for the Neurodiversity Movement.[45]
From there, the Neurodiversity Movement continued to grow with the formation of more organizations in the early 2010s such as Autistic Women & Nonbinary Network[46] and The Thinking Person's Guide to Autism.[47] More autistic people were appointed to federal advisory boards like Interagency Autism Coordinating Committee and National Council on Disability. There were various campaigns like the ongoing #StopTheShock related to the use of aversive treatment at Judge Rotenberg Center and various protests against Autism Speaks. Various flashblogs[48][49] popped up during the 2010s to support campaigns. Annual traditions were formed such as Disability Day of Mourning[50] and Autistics Speaking Day.[51]
Damian Milton notes that, in 2014, Nick Walker attempted to define neurodiversity, the neurodiversity movement, and the neurodiversity paradigm. Walker tied neurodiversity to the idea that "all brains are to a degree unique". She also defined the movement as a rights movement, and the paradigm as a broader discussion of diversity, cultural constructions and social dynamics.[52][53]
In recent years, the concept of neurodiversity and many related findings have gained traction among many members of the scientific community,[54][55] who have argued that autism researchers have sometimes been too ready to interpret differences as deficits.[55][56][57] It has also been suggested that there are both ethical issues and practical risks in attempting to reduce or suppress some autistic traits (e.g. some stimming behaviors that do not cause harm to self or others, focused interests) that can sometimes be adaptive or instilling neurotypical behaviors (e.g. eye contact, body language) through interventions.[58][59] Researchers and advocates are concerned about such issues and risks as most recent studies and multiple systematic reviews have indicated that higher levels of masking, passing as neurotypical, or camouflaging are generally associated with poorer mental health outcomes including depression, clinical anxiety, and suicidality among autistic people (including children, adolescents, and adults) and across various regions or cultures.[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] In addition, two reviews published in 2024 indicated some forms of repetitive behaviors can be adaptive for sensory regulation and emotional regulation of some autistic people, and masking or suppressing some autistic repetitive behaviors that can be adaptive may risk worsening mental health and well-being.[75][76] One multiple-year longitudinal study found that autistic children who showed decrease in repetitive behaviors experienced more severe and worsening in mental health symptoms, whereas autistic children who showed increase in repetitive behaviors experienced less severe mental health symptoms.[77] Relatedly, qualitative studies have shown some forms of behavioral interventions increase camouflaging or masking of autistic traits (e.g. stimming) for some autistic people, with negative effects on mental health.[78][71][79]
Moreover, researchers have found that psychoeducation based on the medical model is associated with higher stigma.[80] Another study found that endorsements of normalization and curative goals (goals of some medical models) are associated with heightened stigma.[81] Similarly, some researchers and advocates also argue that a medicalizing approach can contribute to stigma and ableism,[82][83] and that the persistent focus on biological research in autism based on deficit-based medical model is at odds with the priorities of those in the autism community.[55][84][85][86][87]
Autistic self-advocate and researcher Ari Ne'eman has suggested a trait-based approach, where elements of the medical (or pathology) model can be applied in treating certain traits, behaviors, or conditions that are intrinsically harmful (e.g. self-injury behaviors, epilepsy, or other co-occurring health conditions), while neurodiversity approaches can be applied to non-harmful or sometimes adaptive autistic traits (e.g. some stimming behaviors that do not result in self-injury, intense interests) of the same individual.[88][89] Relatedly, some neurodiversity researchers, as well as autistic people, advocates and researchers, have advocated for application and sometimes integration or combination of both neurodiversity approaches and biomedical research plus practice.[18][19][20][90][21][22][91]
In recent years, researchers and neurodivergent people have advocated for more neurodiversity-affirming interventions, with both new intervention strategies being developed and advancements or reforms of existing intervention strategies informed by experiences, strengths, interests, preferences, and feedback of autistic people as well as neurodiversity approaches, with some emerging evidence.[92][93][94][95][96][97][98][99][100][70][101][102][103][104][105] In addition, some researchers and advocates have called for more neurodiversity-affirming psychoeducation and stigma reduction methods.[106][107][108][109][110]
Neurodivergent
A hypothetical radar plot of spikey cognitive profile. Similar details can be found in Doyle, Nancy. "Neurodiversity at work: a biopsychosocial model and the impact on working adults." British medical bulletin 135, no. 1 (2020): 108-125.[111]
Following the rise of the autism rights movement in the 1990s, many autistic advocates, including Kassiane Asasumasu, recognized that a wide variety of people experienced the world in ways similar to autistic people, despite not being autistic. As a result, Asasumasu coined the related terms neurodivergent and neurodivergence circa 2000.[53][112]
According to Asasumasu, neurodivergent/neurodivergence refers to those "whose neurocognitive functioning diverges from dominant societal norms in multiple ways".[53] She intended for these terms to apply to a broad variety of people,[53][113][114] not just people with neurodevelopmental differences, such as autism, attention-deficit hyperactivity disorder, and dyslexia. She further emphasized that it should not be used to exclude people but rather to include them.[115] This term provided activists a way to advocate increased rights and accessibility for non-autistic people who do not have typical neurocognitive functioning.[116]
Neurodivergent has been used in multiple ways since Asasumasu's conception, especially to refer specifically to individuals diagnosed with neurodevelopmental differences.[53] It is also used as an umbrella term to describe people with atypical mental and behavioral traits, such as mood,[117]personality,[118] and eating disorders.[119] Under the neurodiversity framework, these conditions are often referred to as "neurodivergencies", in an effort to move away from the medical model of disability (sometimes referred to in the neurodiversity community as the "pathology paradigm"[120]).
Alternative terms used for neurodiversity
Advocates within the neurodiversity movements have also coined other alternative neologisms that people use to refer to themselves with the goal to remove the stigma of the medicalized view of neurodiversity. These terms, such as neurospicy are often used instead of neurodivergent by people when referring to themself.[121][122][better source needed]
Neurotypical (an abbreviation of neurologically typical, sometimes NT) is a neologism widely used in the neurodiversity movement as a label for anyone who has a neurotype that fits into the norm of thinking patterns. Thus, the term "neurotypical" includes anyone who is not autistic, and does not have ADHD, dyslexia, anxiety, or any other condition that would be considered neurodivergent.[123][124][125] The term has been adopted by both the neurodiversity movement and some members of the scientific community.[126][127]
In contrast to some of the shortcomings of terms like 'neurotypical' (such as its underlying assumption that neurodivergent experiences are an anomaly, i.e. not typical), a growing group of advocates in the neurodivergent movement prefer other terms such as "neuroconforming".[128] The term "allistic" is also used, meaning "not autistic".[129]
Modern neuroscientists such as writer Mo Costandi view terms like "neurotypical" as not being of use in neuroscience[130] and Ginny Russell mentions that there is no clear bimodal distribution separating autistic and non-autistic people because many people non-autistic people have some autistic traits.[131] Another criticism, that "neurotypical" was a dubious construct, because there is nobody who could be considered truly neurotypical[131], has been said by Nick Walker to reflect a misunderstanding of the term.[132]
Early definitions described neurotypicals as individuals who do not have autism and do not meet the criteria to be diagnosed with autism.[133][134] Early uses of NT were often satirical, as in the Institute for the Study of the Neurologically Typical,[135][136] but it has been adopted by the neurodiversity movement too, and is now used in a serious manner.[137]
People with any form of neurocognitive or mental disorder or difference, whether congenital or acquired, have also sometimes been excluded from the neurotypical label, particularly in academic studies for specific disorders or differences that use neurotypical control groups.[138] In this sense, the term is now contrasted to neurodivergent.
Both autistic and non-autistic people can find it difficult to empathize with each other. The fact that both people in the interaction have trouble with understanding and empathy is why the theory is called the "double empathy problem".[139]
The theory of the double empathy problem argues that autistic people do not inherently lack empathy as often supposed by people who see autism as pathological, but most autistic people may struggle in understanding and empathizing for non-autistic people whereas most non-autistic people also lack understanding and empathy for autistic people. It was originally conceived in 2012 by autistic scholar Damian Milton.[140] The theory argues that characteristics and experiences of autistic and non-autistic people are so different that it is hard for one to understand how the other thinks and empathize with each other; for example, non-autistic people may not understand when an autistic person is overwhelmed.[141]
An increasing number of studies in the 2010s and 2020s found support for double empathy theory and related concepts such as bidirectional social interaction.[142][143][144] One study comparing the conversations and socialization of autistic groups, non-autistic groups, and mixed groups found that autistic people were more able to build rapport with other autistic people than with non-autistic people, and at a level similar to the purely non-autistic group.[145] A systematic review published in 2024 found that most autistic people have good interpersonal relations and social-communication experiences with most autistic people, and interactions between autistic people are associated with better quality of life across multiple domains, including mental health and emotional well-being.[143]
The double empathy problem theory implies there is no simple fix that can help each group better empathize with each other, but it is worthwhile to bridge the double empathy gap through more equal contact and enhancing public understanding and empathy about autistic people based on neurodiversity-affirming approaches.[146] The advantage of the theory is reducing pathologization of autistic people by identifying that everyone struggles to empathize with different neurotypes. It can also help neurotypical individuals to better understand how neurodivergent people think and empathize and to recognize their own limitations in empathizing with autistic people.[147]Jaswal and Akhtar (2019) highlight the difference between being socially uninterested and appearing socially uninterested, and challenge preconceived notions of a lack of social motivation. For example, testimonies from autistic individuals report that avoiding eye contact serves an important function of helping them to concentrate during conversation, and should not be interpreted as expressing social disinterest.[148]
Proponents of neurodiversity strive to reconceptualize autism and related conditions in society by acknowledging that neurodiversity does not require a "cure", changing the language from the current "condition, disease, disorder, or illness"-based nomenclature, "broadening the understanding of healthy or independent living", acknowledging new types of autonomy, and giving neurodivergent individuals more control over their interventions, including the type, timing, and whether there should be interventions at all.[33][9]
A 2009 study[161] separated 27 students with conditions including autism, dyslexia, developmental coordination disorder, ADHD, and having suffered a stroke into two categories of self-view: "A 'difference' view—where neurodiversity was seen as a difference incorporating a set of strengths and weaknesses, or a 'medical/deficit' view—where neurodiversity was seen as a disadvantageous medical condition". They found that, although all of the students reported uniformly difficult schooling careers involving exclusion, abuse, and bullying, those who viewed themselves from the "difference" view (41% of the study cohort) "indicated higher academic self-esteem and confidence in their abilities and many (73%) expressed considerable career ambitions with positive and clear goals".[161] Many of these students reported gaining this view of themselves through contact with neurodiversity advocates in online support groups.[161]
A 2013 online survey which aimed to assess conceptions of autism and neurodiversity suggested that conception of autism as a difference, and not a deficit, is developmentally beneficial and "transcend[s] a false dichotomy between celebrating differences and ameliorating deficit".[162]
Neurodiversity advocate John Elder Robison argues that the disabilities and strengths conferred by neurological differences may be mutually inseparable. "When 99 neurologically identical people fail to solve a problem, it's often the 1% fellow who's different who holds the key. Yet that person may be disabled or disadvantaged most or all of the time. To neurodiversity proponents, people are disabled because they are at the edges of the bell curve, not because they are sick or broken."[163]
Higher education
There are several models that are used to understand disability within the spectrum of neurodiversity. There is the medical model of disability that views people as needing to be treated or "cured".[164] Another model is the social model of disability, which puts emphasis on the way that society treats people with disabilities.[164] Through the social model of disability, the experiences of neurodivergent students in higher education is partially influenced by the reactions and attitudes of other students and the institution itself.[10]
Experiences of neurodivergent students
The emotional experiences of neurodivergent students in higher education depend on a combination of factors, including the type of disability, the level of support needs, and the student's access to resources and accommodations.[10] A common difficulty for neurodivergent students is maintaining social relationships, which can give rise to loneliness, anxiety, and depression.[10] There is also the added stress and difficulty of transitioning into higher education, as well as the responsibilities and task management required in college.[10] Many neurodivergent students may find that they need added support.[10] As for academics, neurodivergent students may experience difficulties in learning, executive function, managing peer relationships in the classroom or in group work, and other difficulties that can affect academic performance and success in higher education.[10] However, neurodivergent students may find that their differences are a strength and an integral part of their new social roles as adults.[10]
Higher education institutions
The typical curriculum and format of higher education may pose as a challenge for neurodivergent students, and a lack of support and flexibility from staff may further complicate the university experience.[10] Thus, reasonable adjustments are available to students who disclose their disabilities.[10] However, these adjustments or accommodations may put an emphasis on academics, and less on the various challenges of higher education on neurodivergent students.[10] For instance, neurodivergent students in higher education also report a need for non-academic supports, such as social mentorships and resources for strength-based interventions in order to further assist neurodivergent students in the social aspects of college life.[10] Similarly, career preparation that is specifically targeted for neurodivergent students is lacking. There are several programs, such as supported employment, that exist to help assist neurodivergent individuals in finding and obtaining a job. However, many of these programs do not exist in schools. This can make it difficult for neurodivergent students to find a career path that they feel is attainable for them.[164] Another consideration is the implementation of a universal design approach (UDL) when building learning spaces or communal areas that considers the needs of neurodivergent students. A UDL design incorporates a design that accommodates the needs of all students, including the neurodivergent population.[11]
According to an article published in 2023, universities and post-secondary establishments would show more tolerance towards neurodivergent people. A tolerant environment can increase autonomy, leading to kindness and understanding among students.[165] Higher education institutions offer counseling and support services to students. However, neurodivergent students face particular challenges that impair their ability to receive consistent support and care. Additionally, counseling and support services face a lack of funding, personnel, and specialists that can adequately support neurodivergent students. Overall, these services work for some students and not for others.[10]
Nachman and colleagues reviewed several articles published by two-year community colleges and found some discrepancies in the way that they perceived and categorized "disabled" students and "non-disabled" students. They found that all of the articles were attempting to normalize disability. Many of them put distinct separation between typical and atypical learners as well as their potential academic achievement. Nachman also found that many of the articles showed a lack of autonomy for neurodivergent students. They had little power in regard to academic choices and classroom management.[166]
In the workplace
Neurodivergent individuals are subjected to bias when applying and interviewing for job positions.[167] Specifically, neurodivergent individuals can have their social engagement style compared to neurotypical individuals, which can affect their ability to obtain a job position.[167] Stigmas against neurodivergence (especially against autistic individuals) and cognition challenges in social situations can hinder an individual's ability to perform well in a traditional job interview.[168] Organizations such as Specialisterne aim to use neurodivergent employees' particular skills – such as pattern recognition, detection of deviations, attention to detail, analytical thinking, and extended focus – in the workforce, as well as educate companies on supporting neurodivergent employees.[169][170][171]
In a systematic review that considered developmental dyslexia as "an expression of neurodiversity", it was suggested that neurodiversity is not yet an established concept in the workplace, and therefore, support from social relationships and work accommodations is minimal.[172] Furthermore, another systematic review that focused on pharmacological and combined pharmacological/psychosocial interventions for adults with attention deficit hyperactivity disorder found that there were few workplace-based intervention studies, and suggested that additional research needs to be conducted to figure out how to best support neurodivergent employees in the workplace.[173]
A study conducted during the COVID-19 pandemic suggested that neurodivergent individuals would benefit from remote work as it allowed them to engage in their interests, but that social engagement is still necessary for productivity and performance.[174] Another study supported these findings and stressed the need for redesigned work and social conditions to be more inclusive for autistic individuals.[175]
The increase of representation of the neurodiversity movement in the media came about with changes in the technology of the media platforms themselves.[100] The recent addition of text-based options on various social media sites allow disabled users to communicate, enjoy, and share at a more accessible rate.[100]Social media has a two-fold benefit to the neurodivergent community: it can help spread awareness and pioneer the neurodiversity movement, and it can also allow members of the communities themselves to connect.[176][177]
Social media as a platform
Media platforms allow the connection of individuals of similar backgrounds to find a community of support with one another.[176] Online networking and connections allows for the user to decide their level of comfort with interactions, and allow them to retain control of a relationship with another user. For the neurodivergent community, the use of social media to create relationships has proven a useful tool for those with difficulty in social situations.[178] By connecting neurodivergent users, media platforms provide "safe spaces" that are helpful in forming relationships.[178] Some media developers have created platforms such as Blossom, which are designed specifically to connect neurodivergent users and families.[179]
Social media as a driving force
Social media also allows users to spread awareness about the neurodiversity movement.[180] Increasing awareness about mental conditions has been shown to increase the amount of factual information spread.[180] The spread of information through social media exposure can assist the neurodiversity movement in educating the public about understanding disabilities such as autism and sifting out misinformation.[177] By sharing neurodivergent experiences from a first hand perspective, social media can educate the public and destigmatize certain conditions, but negative portrayals of neurodivergence can have an obstructive impact on members of the community.[180][181]
Challenges within media
Although representation of the neurodivergent community has grown with the help of social media platforms, those users are often criticized and misunderstood.[182] Social media has not entirely removed the social barriers that restrict inclusion of neurodivergent people. Some have reported needing to conform to the mainstream view of their disability to be seen as "authentic" users.[182] Doing so has indirectly made it more difficult for neurodivergent users to grow platforms.[182][183] Non-disabled users evaluating the authenticity of neurodivergent users based on stereotypes shows that the neurodiversity movement has not reached its goal of inclusion.[182]
Clinical setting
Medicine and healthcare
Medical and healthcare professionals have begun to acknowledge neurodivergence among employees.[184][185] Specifically, more groups are being created that are centered around advocacy and peer support among medical and healthcare professionals who associate themselves with neurodiversity, such as the Autistic Doctors International created by Dr. Mary Doherty.[184] Another approach is the implementation of a 5-minute video summary (5MVS) for medical learners and physicians who have attention deficit hyperactivity disorder (ADHD).[185] It consists of a 5-minute recorded video summary in which an engaging speaker presents the relevant information from a scientific article about ADHD using a brief PowerPoint presentation shared using videoconferencing technology. The researchers state that providing this educational tool for helping medical learners and physicians with ADHD acquire relevant information from scientific articles could help in addressing their inattention, impulsivity or hyperactivity, and improve their development of critical appraisal skills when working in healthcare.[185]
Similarly, healthcare systems may benefit from hiring neurodivergent individuals to gain a unique perspective when caring for patients.[186] Some healthcare staff agree that inviting neurodivergent individuals to join patient advisory groups or hiring them as staff are essential steps to acceptance and integration in the workforce. Neurodivergent people's unique strengths can be vital to health system innovation and improvement efforts.[186] One example of the push toward this is the Stanford Neurodiversity Project, in which one of their goals is to discover the strengths of neurodivergent individuals and make use of their talents to increase innovation and productivity of their society, such as working in the field of healthcare and medicine.[187]
Neurodiversity has also recently been investigated as a new way of working within neurodevelopmental clinics in the UK.[188] A team of researchers in Portsmouth, England, have created an approach in aiding neurodivergent individuals known as PANDA, or the Portsmouth Alliance Neurodiversity Approach. This approach may help medical and healthcare professionals facilitate understanding, communication and early support for children who may identify as being neurodivergent.[188]
Therapy
Neurodiversity and the role it plays in therapeutic settings has been a central focal point in recent years. Many therapists and mental health professionals have pushed for more inclusive psychotherapeutic frameworks appropriate for neurodivergent individuals.[189][190] One example is neurodivergence-informed therapy, which reframes dysfunction as interconnectedness among society rather than strictly individual, advocating for acceptance and pride in the neurodiversity community, and the push for therapists to pursue humility regarding the knowledge and education associated with individuals who identify as neurodivergent.[189] Similarly, neurodiversity affirming therapy supports neurodivergent differences, rather than viewing them as something that should be "cured", and to offer ways to support the individual with difficult areas, while still appreciating their needs and strengths.[190]
Therapeutic programs and interventions are also being investigated for the neurodivergent community.[191][192]Self-determination programs to help neurodivergent individuals achieve goals in their life have been found to be successful, with neurodivergent participants finding it to be "appropriate, acceptable, and feasible".[191] Various approaches (e.g., eye-tracking, longitudinal data, computational modeling) in understanding perceptual decision-making in neurodivergent individuals are also being studied and the implications it may have in the therapeutic environment in working with the neurodivergent population.[192]
Another form of therapeutic intervention in that has been investigated in neurodivergent individuals is the use of Naturalistic Developmental Behavioral Interventions (NDBIs).[70] NDBIs have been shown to have positive effects on language and social-communication while, at the same time, respecting individuals’ needs and autonomy. One of the key goals in this type of intervention is putting the focus of therapy on the neurodivergent individual themselves in the creation of intervention goals, procedures, and outcomes. In doing so, they are likely to be seen as more acceptable, useful, and effective to that individual.[70]
In addition to support from neurodiversity advocates for affirming therapies, concerns have been raised about the role of certain approaches such as applied behavior analysis. Neurodivergent individuals and activists tend to emphasize that these interventions aim to enforce conformity with expectations of society rather than addressing the needs of the person receiving the intervention.[193] While a large body of research on the role of ABA seems to support its efficacy in cognitive and behavioral outcomes, a meta-analysis by Sandbank et al. challenges the evidence.[194] Additionally, there are concerns regarding long-term mental health impacts and with the measures used in determining social validity by those who have raised these concerns. In addition to advocates from within the neurodivergent community, some behavioral analysts have begun to reconsider the role of these therapies with the context of a neurodiversity framework.[195][193]
The neurodiversity paradigm is controversial in autism advocacy. The dominant paradigm, the medical model of disability holds that neurodivergent individuals have medical conditions which should be treated. The neurodiversity paradigm, under the understanding that differences in neural function are natural variations in function, suggests that not all conditions that would be classified as neurodivergent need medical intervention. A prevalent criticism about application of the neurodiversity paradigm to autism comes from the understanding that – even with a framework of natural variance that neurodiversity includes – individuals with functional difficulties would continue to have challenges. Some critics of the neurodiversity paradigm, such as family members that are responsible for the care of an autistic individual, consider it detached from the needs of individuals that would continue to be functionally disabled through the frame of natural variation.[196]
A common criticism is that the neurodiversity paradigm is too widely encompassing and that its conception should exclude those whose functioning is more severely impaired. In response, autistic advocate Nick Walker suggested that neurodiversity refers specifically to "pervasive neurocognitive differences [...] intimately related to the formation and constitution of the self", in contrast to medical conditions such as epilepsy.
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