Diverse Brains,Shared Humanity: Neurodiversity and Neurodevelopmental Disorders

Neurodiversity is a concept that recognizes and celebrates the natural variation in human brain function and cognition. It emphasizes that the differences in how people think, learn, and process information are normal aspects of human diversity. Rather than viewing these differences as deficits or disorders that need a “fix,” neurodiversity promotes acceptance and inclusion, focusing on the strengths and unique perspectives individuals bring to society. This approach challenges the traditional medical model, which views neurological differences as deficits or disorders that need to be cured. Instead, neurodiversity embraces these differences as unique strengths and perspectives. It promotes a more inclusive and accepting society that values diverse ways of thinking, learning, and interacting with the world and emphasizes the notion that neurological differences, such as that seen in neurodevelopmental disorders (autism, intellectual disability, Attention Deficit Hyperactivity Disorder [ADHD], dyslexia), are not actually, but unique ways of processing the world.

Over the years, it has been seen that the medical model limits the understanding of people to view disability from the lens of deficits or impairment in an otherwise able person and the focus on “cure and normalization” and transforming into typical/neurotypical individuals. The critics of the medical model^1-3 mostly belonging to the “disability communities” have heavily criticized this, emphasizing the divide it creates and leads to a binary world leading to the continuing debate between “them” and “us.” The traditional medical model, which pathologizes disability and focuses on individual limitations, fails to recognize the social and environmental barriers faced by people with disabilities. It is therefore unrealistic to expect “disabled” individuals to strive for “able-bodiedness.” This experience of attempting to identify with abled individuals because of the demands posed by society and medical communities can be frustrating and unfair to disabled individuals.

For example, recent research is exploring the social pressures that lead “people with autism” (PWA) to camouflage or mask their problems in social interactions^4-6 leading to experiences of burnout caused by excessive environmental, social, and sensory demands that may be easy for neurotypicals to meet, but which many PWA find exhausting. ⁷ Hence, there is a compelling need for a paradigm shift and to accept a more inclusive social model that considers the lived experiences of these disabled communities. It gives a more compassionate view of the unique and diverse experiences of every neurodivergent individual. As Singer (2016) suggested, the optimal neurodiversity approach should take a middle ground between the social and medical models. ⁸

Neurodiversity is a state of nature to be respected, an analytical tool for examining social issues, conservation of arguments, and human diversity facilitation. It is not a synonym for a neurological disorder. ⁹ The concept of neurodiversity emerged in the late 20th century, primarily within the autism rights movement. Activists and scholars began to question the pathologization of autism and other neurodevelopmental conditions. They argued that these conditions are not impairment but rather different ways of being, often associated with unique talents and abilities. It was considered a natural variation. One middle-ground understanding of neurodiversity could draw on social-relational models of disability. These models, which are substantively quite different from the original strong social model, suggest that “disability” arising from society coexists with restrictions arising directly from individual “impairment”/reduced function.^10,11 This neurodiversity approach would consider disability as emerging from an interaction of individual and context, and it would allow interventions to either change individuals in limited ways (e.g., teaching skills, using medication to manage difficulties) or to change environments and societies. Therefore, this neurodiversity approach would not permit interventions aiming to normalize or cure disabled individuals.

It is not difficult to think of cases wherein characteristics of both the individual and their environment contribute toward disability. In this interactionist neurodiversity framework, intervention could operate either at the individual level (e.g., stimulant medications for ADHD individuals), or by changing the environment (e.g., removing environmental distractors), or by changing both the environment and the individual. The decision between these alternatives should not be based on whether the individual or environment is perceived to be the ultimate cause of the disability but based on which intervention would best enhance the quality of life. Neurodivergent individuals will likely have crucial insights regarding which approach would be most helpful for them, and their preferences should be respected to the extent that the person can communicate with them. The neurodiversity approach as defined here could be quite accurately described as a type of biopsychosocial approach. ¹² It simply comes laden with additional normative claims regarding the appropriate way that atypically developing individuals should be treated in society.

Whereas proponents of the neurodiversity approach view neurological variations as normal and valuable and highlight strengths, creativity, and diverse perspectives, neurodevelopmental disorders are classified based on diagnostic criteria, focusing on challenges, areas of difficulty, and impairment in daily functioning. However, challenges to the categorization of neurodevelopmental disorders are also present. For example, we all know that behaviors that are understood as symptoms of ADHD and autism are not categorical; rather there are no well-defined boundaries differentiating individuals with and without these diagnoses. Also, research is plentiful in emphasizing the significant phenotypic and genetic overlap in different neurodevelopmental disorders on one hand and also being highly heterogeneous in the neurocognitive profiles despite having similar clinical presentations. ¹³ Thus, it makes a case for understanding neurodevelopmental disorders in the context of neurodiversity.

The key aspects of the intersection between neurodiversity and neurodevelopmental disorders are: (a) Shifting perspective from improving functioning in individuals with neurodevelopmental disorders by treatment/cure to accepting these conditions as natural variations in human cognition, advocating for accommodations and acceptance of these individuals; (b) Focusing on strengths such as creativity, hyperfocus, and extraordinary memory that often accompany these conditions rather than looking at the limitations with social interaction, communication, or attention. The neurodiversity movement seeks to dismantle stigma and create environments where individuals with neurodevelopmental disorders are fully included and supported. While some may still require interventions and treatment to address challenges, this essentially does not negate their inherent value or unique contributions. (c) And not to forget individual experiences wherein not all individuals identify with or feel included in this movement. While some may prioritize medical support to manage their challenges, others embrace neurodivergence as a core part of their identity.

The balance in the approach can be achieved by supporting the difficulties neurodevelopmental disorders may cause (e.g., through therapies, medications, or environmental modifications) with due recognition of the unique perspectives and talents individuals bring. It underscores the importance of societal change to create systems that empower neurodiverse individuals to succeed on their own terms. By embracing the viewpoints from all approaches, we must move forward keeping in view the diversity, quality, and inclusion of all individuals for better outcomes and improving the lives of the neurodiverse individuals.

Disclaimer

This editorial expresses the opinion exclusively of the authors, and not necessarily of the Journal.