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Neurodiversity

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For the movement, see Neurodiversity movement.

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Neurodiversity is a framework for understanding human brain function and mental illness. It argues that diversity in human cognition is normal and that some conditions classified as mental disorders are differences and disabilities that are not necessarily pathological.

The framework grew out of the autism rights movement and builds on the social model of disability, arguing that disability partly arises from societal barriers, rather than attributing disability purely to inherent deficits. It instead situates human cognitive variation in the context of biodiversity and the politics of minority groups.[1][2][3] Some neurodiversity advocates and researchers argue that the neurodiversity paradigm is the middle ground between strong medical model and strong social model.[4][5][6]

The neurodiversity paradigm has been controversial among disability advocates, with opponents arguing it risks downplaying the suffering associated with some disabilities, and that it calls for the acceptance of things some would wish to be treated.[7][8][9][10][11]

History

The word neurodiversity was popularized by Judy Singer, a social scientist who has described herself as "likely somewhere on the autistic spectrum."[12] She used the term in her sociology honours thesis published in 1999,[13][12] drawing on discussions on the InLv mailing list that included American journalist Harvey Blume,[14] whose September 30, 1998, article in The Atlantic was the first to use the term in print.[15] Blume was an early advocate who predicted the role the Internet would play in fostering the international neurodiversity movement.[16] In a New York Times piece on June 30, 1997, Blume described the foundation of neurodiversity using the term "neurological pluralism".[17] Some authors[18][19] 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."[20]

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". He also defined the movement as a rights movement, and the paradigm as a broader discussion of diversity, cultural constructions and social dynamics.[21][22]

In recent years the concept of neurodiversity has gained traction among members of the scientific community,[23][24] who have argued that autism researchers have sometimes been too ready to interpret differences as deficits.[25][26] It has also been suggested that there are both ethical and practical risks in attempting to reduce or suppress autistic traits through interventions, as some recent studies have indicated that higher levels of masking are generally associated with poorer mental health outcomes among autistic people, and perhaps even suicidality.[27][28][29][30][31] Researchers have found that psychoeducation based on medical model is associated with higher stigma.[32] Similarly, some researchers and advocates also argue that a medicalizing approach can contribute to stigma[33] and that the persistent focus on biological research in autism is at odds with the priorities of those in the autism community.[34][35][36]

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 adaptive autistic traits (e.g. stimming, intense interests) of the same individual.[37][38] In recent years, both new intervention strategies and neurodiversity-based reforms of existing intervention strategies have been developed.[39][27]

Neurotypical

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 typical neurotype and fits into the norm of thinking patterns. Thus, neurotypicals are anyone who is not autistic, diagnosed with ADHD, dyslexia, anxiety, or any other condition that would be considered neurodivergent.[40][41][42] The term has been adopted by both the neurodiversity movement and some members of the scientific community.[43][44]

Term

Early definitions described neurotypicals as individuals who do not have autism and do not meet the criteria to be diagnosed with autism.[45][46] Early uses of "NT" were often satirical, as in the Institute for the Study of the Neurologically Typical,[47][48] but it has been adopted by the neurodiversity movement, too, and is now used unironically.[49]

People with any form of neurocognitive or mental disorder, whether congenital or acquired, have also sometimes been excluded from the neurotypical label, particularly in academic studies for specific disorders that use neurotypical control groups.[50] In this sense, the term is now contrasted to neuroatypical, an umbrella term used to describe people with atypical mental and behavioral traits, such as mood,[51] anxiety, dissociative, psychotic, personality,[52] and eating disorders.[53] 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"[54]).

Some people prefer the term allistic,[55] which unambiguously means "not autistic".[56]

The National Autistic Society of the United Kingdom describes the word as "mainly used by autistic people so may not be applicable in, for example, the popular press."[57]

Reception

"Critiques of the Neurodiversity Movement", a 2020 review, raised two concerns regarding the term:

  • Many people who do not have an autism diagnosis have autistic traits (known by researchers as the "broad autism phenotype"), so there is no clear bimodal distribution separating people with and without autism. In reality there are not two distinct populations, one "neurotypical" and one "neurodivergent".[58]: 288 
  • "Neurotypical" was a dubious construct, because there is nobody who could be considered truly neurotypical, and there is no such standard for the human brain.[58]: 290 

Double empathy problem theory

Main article: Double empathy problem
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".[59]

The theory of the double empathy problem argues that autistic people do not lack empathy, but rather that the experiences of autistic and non-autistic people are so different that it is hard for one to understand how the other thinks; for example, non-autistic people may not understand when an autistic person is overwhelmed.[60]

It was originally conceived in 2012 by autistic scholar Damian Milton.[61] 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.[62]

The problem with the double empathy problem theory is that there is no simple fix for it. Attempting to "treat" the person with autism could generate other mental health issues and feelings of inferiority and self-blame. However, neurotypical individuals can adapt this theory to better understand how neurodivergent people think and empathize.[63]

Within disability rights movements

Further information: Autism rights movement
Neurodiversity paradigm
Philosophy
Organizations
Events
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People
Films
Criticism

The neurodiversity paradigm was developed and embraced first by autistic people,[64][65] but has been applied to other conditions such as attention deficit hyperactivity disorder (ADHD), developmental speech disorders, dyslexia, dysgraphia, dyspraxia,[66] dyscalculia, dysnomia, intellectual disability, Tourette syndrome,[67] and sometimes mental illnesses such as schizophrenia,[6][68] bipolar disorder,[69] schizoaffective disorder, and, somewhat more controversially, personality disorders such as antisocial personality disorder.[70] Neurodiversity advocates[which?] who support those with autism, ADHD, dyslexia, and other neurodevelopmental disorders do not agree in framing medical interventions as a way to "cure" or "fix" these individuals. Rather, they promote support systems such as inclusion-focused services, accommodations, communication and assistive technologies, occupational training, and independent living support.[39][71][72][73] The intention is for individuals to receive support that honors human diversity and feel that they are able to freely express themselves. Other forms of treatment may cause them to feel as though they are being coerced or forced to adapt to social norms, or to conform to a behavioral standard or clinical ideal.[74][75]

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 treatment, including the type, timing, and whether there should be treatment at all.[19][6]

Activists such as Jennifer White-Johnson have helped bring attention to the neurodiversity movement, by creating symbols of protest and recognition, including a combination of the black power fist and infinity symbol.[76]

A 2009 study[77] 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."[77] Many of these students reported gaining this view of themselves through contact with neurodiversity advocates in online support groups.[77]

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."[78]

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."[79]

Neurodiversity and education

Diversity in the education system is not always observed from a neurodiverse perspective. There are several models that are used to understand disability. One is the medical model of disability that views people with disabilities as needing to be treated or cured.[80] Another is the social model of disability putting emphasis on the way that society treats people with disabilities.[80] The social model argues that people with disabilities experience more difficulties from society than the disability alone.[80]

Nachman and colleagues reviewed several articles published by 2-year community colleges and found some discrepancies in the way that they perceived and categorized "disabled" students and "non-disabled" students.[81] They found that all of the articles were attempting to normalize disability.[81] Many of them put distinct separation between typical and atypical learners as well as their potential academic achievement.[81] Nachman also found that many of the articles showed a lack of autonomy for neurodivergent students.[81] They had little power in regard to academic choices and classroom management.[81]

Another study explored minority stress through the lens of transgender and gender diverse students who were neurodivergent.[82] The researchers found that these students were likely to experience multiple forms of oppression rather than just one.[82] Some of those types include gender related oppression and oppression related to their neurodivergence.[82] The students who had a higher level of minority stress due to stigma awareness were expected to have lower academic performance and higher risk of psychological distress.[82]

Career preparation that is specifically targeted for neurodivergent students is lacking.[80] There are several programs that exist to help assist neurodivergent individuals in finding and obtaining a job but not many of those programs exist within schools.[80] This can make it difficult for neurodivergent students to find a career path that they feel is attainable for them.

Neurodiversity and the workplace

Neurodivergent individuals are subjected to bias when applying and interviewing for job positions.[83] Specifically, neurodivergent individuals can have their social engagement style compared to neurotypical individuals, which can affect their ability to obtain a job position.[83] 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.[84]

In a systematic review that considered developmental dyslexia (DD) 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.[85] 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.[86]

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.[87] Another study supported these findings and stressed the need for redesigned work and social conditions to be more inclusive for individuals with autism.[88]

Controversy

Further information: Controversies in autism § Advocacy initiatives

The neurodiversity paradigm is controversial in autism advocacy.[64] The dominant paradigm, the medical model of disability holds that neurodivergent individuals have medical conditions which should be treated.[89]

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.[64][90] 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.[6] [undue weight? – discuss]

In social media

The increase of representation of the neurodiversity movement in the media came about with changes in the technology of the media platforms themselves.[39] 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.[39] 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.[91][92]

Social media as a platform

Media platforms allow the connection of individuals of similar backgrounds to find a community of support with one another.[91] 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.[93] By connecting neurodivergent users, media platforms provide 'safe spaces' that are helpful in forming relationships.[93] Some media developers have created platforms such as Blossom, which are designed specifically to connect neurodivergent users and families.[94]

Social media as a driving force

Social media also allows users to spread awareness about the neurodiversity movement.[95] Increasing awareness about disorders has been shown to increase the amount of factual information spread.[95] 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.[92] By sharing neurodivergent experiences from a first hand perspective, social media can educate the public and destigmatize certain disorders, but negative portrayals of neurodivergence can have an obstructive impact on members of the community.[95][96]

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.[97] Social media has not entirely removed the social barriers that restrict inclusion of neurodivergent peoples. Some have reported needing to conform to the mainstream view of their disability to be seen as "authentic" users.[97] Doing so has indirectly made it more difficult for neurodivergent users to grow platforms.[97][98] Non-disabled users evaluating the authenticity of neurodivergent users based on stereotypes shows that the neurodiversity movement has not reached its goal of inclusion.[97]

Clinical setting

Medicine and Healthcare

Medical and healthcare professionals have begun to acknowledge neurodivergence among its employees.[99][100] 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.[99] Another approach is the implementation of a 5-minute video summary (5MVS) for medical learners and physicians who have attention-deficit/hyperactivity disorder (ADHD).[100] 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 and/or hyperactivity, and improve their development of critical appraisal skills when working in healthcare.[100]

Similarly, healthcare systems may benefit from hiring neurodiverse individuals to gain a unique perspective when caring for patients.[101] Some healthcare staff agree that inviting neurodiverse individuals to join patient advisory groups and/or hire them as staff are essential steps to acceptance and integration in the workforce. Neurodiverse people’s unique strengths can be vital to health system innovation and improvement efforts.[101] One example of the push toward this is the Stanford Neurodiversity Project, in which one of their goals is to discover the strengths of neurodiverse 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.[102]

Neurodiversity has also recently been investigated as a new way of working within neurodevelopmental clinics in the UK.[103] A team of researchers in Portsmouth, England have created an approach in aiding neurodiverse 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 neurodiverse.[103]

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.[104][105] 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.[104] 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.[105]

Therapeutic programs and interventions are also being investigated for the neurodivergent community.[106][107] Self-determination programs to help neurodivergent individuals achieve goals in their life has been founded to be successful, with neurodivergent participants finding it to be "appropriate, acceptable, and feasible."[106] 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.[107]

Another form of therapeutic intervention in that has been investigated in neurodivergent individuals is the use of Naturalistic Developmental Behavioral Interventions (NDBIs).[108] 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.[108]

See also

References

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Further reading

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