Defining Neurodiversity Affirming Psychology Practice for Autistic Adults: A Delphi Study Integrating Psychologist and Client Perspectives

Abstract

Background: The term “neurodiversity affirming” has been used to describe an inclusive and strengths-based approach to mental health care, aligned with the neurodiversity paradigm and social model of disability. However, there is no known consensus on what neurodiversity affirming practice entails.

Methods: We aimed to define neurodiversity affirming support in the context of Australian psychologists working with Autistic adult clients (what we have termed “neurodiversity affirming psychology practice”). Using a classical Delphi design with three rounds, we recruited expert panel members, including Autistic adults who had seen a psychologist, and psychologists (Autistic and non-autistic) who described their approach as neurodiversity affirming. The final panel consisted of 28 experts, aged 24–76 years (M = 37.29, SD = 11.74). In Round 1, we gathered the panel members’ opinions on essential aspects of neurodiversity affirming support using a series of open-ended questions. In Round 2, the panel members rated key statements for importance, and in Round 3, items that had not met consensus criteria in Round 2 were re-rated.

Results: In total, 104 statements reached consensus. We generated a model from the statements, which outlines a set of seven principles characterizing neurodiversity affirming psychology practice for Autistic clients. These principles are as follows: (1) a commitment to continued learning about autism, (2) providing safety to be one’s Autistic self, (3) finding a way to communicate, (4) authenticity and humility in practice, (5) validation of Autistic experiences, (6) Autistic informed person-centered support, and (7) genuine acceptance and appreciation of autism.

Conclusion: Our results suggest that neurodiversity affirming support goes beyond a psychologist having knowledge of autism and taking a strengths-based approach. Rather, there are interconnected principles spanning from clear actions to more nuanced and subtle adjustments to the psychologists’ way of working that form the foundation of neurodiversity affirming psychology practice for Autistic adult clients.

Community Brief

Why is this an important issue?

Many Autistic adults seek mental health support from psychologists, but traditional approaches to therapy might not always be a good fit for them. Professionals such as psychologists have started using the term “neurodiversity affirming” to describe their work, and multiple Australian guidelines say that healthcare professionals should provide neurodiversity affirming care to Autistic people. However, there is no clear agreement on what neurodiversity affirming psychology practice involves. This is an important issue because Autistic adults deserve therapy that works for them, does not cause harm, and respects and supports their unique needs and strengths.

What was the purpose of this study?

We wanted to define what it means for psychologists in Australia to offer “neurodiversity affirming” support to Autistic adults.

What did the researchers do?

We used the Delphi technique, which involves gathering knowledge from people with relevant expertise (“expert panel members”) and asking questions over a series of “rounds” to reach agreement. The 28 experts who took part in this study were Autistic adults who had seen a psychologist, and Autistic and non-autistic psychologists who believed their work was neurodiversity affirming. In Round 1, we gathered the panel members’ opinions on essential aspects of neurodiversity affirming support using open-ended questions. In Round 2, panel members rated statements for importance, and in Round 3, they re-rated items that they had not agreed on in Round 2.

What were the results and conclusions of the study?

The expert panel members agreed on 104 statements that were an important part of neurodiversity affirming psychology practice. We used reflexive thematic analysis to create a model with seven principles that describe neurodiversity affirming psychology practice for Autistic adults. These principles are about psychologists having a commitment to ongoing learning about autism, creating a safe space for Autistic people to be themselves, finding ways to communicate with each individual, being authentic and humble in their work, validating Autistic experiences, providing support centered on the person, and genuinely accepting and appreciating autism as a valuable way of being.

What is new or controversial about these findings?

While Autistic advocates and psychologists have been sharing information about neurodiversity affirming psychology practice for some time, before this study, there was no research-based evidence to guide professionals wishing to adopt a neurodiversity affirming approach in their work with Autistic clients.

What are potential weaknesses of the study?

We focused on psychology practice in Australia, and don’t know whether the model might apply to people in other countries. The model we developed may be missing aspects of care that might suit males, as none of the experts in this study was male.

How will these findings help autistic adults now or in the future? 

Our findings provide a guide for what Autistic adults can expect from a psychologist who claims to offer neurodiversity affirming support. This can empower Autistic adults to find this kind of support, or advocate for the kind of support that respects and values their unique way of being.