Moving to a neurodiversity-affirming paradigm in the support system: Autistic professionals As paradigm change

Abstract

The purpose of support provided to autistic people in the United States has been to normalize their behavior and communication. Due to serious risks of normalization, support professionals have begun to question normalization as the best approach. The Neurodiversity Movement has initiated a paradigm shift in clinical support, mental health therapy, and special education away from normalization and toward affirmation of neurocognitive diversities as natural for human beings. Self-advocates want supports that eschew normalization. However, normalization still dominates the support system. Paradigm change remains incomplete. Eleven autistic professionals were interviewed utilizing emancipatory methodology to elicit their suggestions for movement to a neurodiversity-affirming paradigm in the support system. One suggestion was to ensure that autistic individuals have regular access to autistic professionals. If we follow this advice and develop society-wide, visible, and powerful cohorts of autistic professionals across support settings and contexts, the paradigm will change.

Lay abstract

The purpose of support provided to autistic people has been to teach autistic people to mimic non-autistic people. Normalization is still common; however, normalization can be harmful. Autistic self-advocates have asked professionals to stop normalization practices in schools, clinics, and agencies. They believe that we can support autistic people in new neurodiversity-affirming ways that respect human differences. In this study, 11 autistic professionals were interviewed to hear their suggestions for changing to a neurodiversity-affirming model. They said autistic people need access to autistic teachers, clinicians, and therapists. When autistic professionals are widely available, normalization will stop completely.

The United States has followed the medical model of disability for two centuries (Hogan, 2019; Marks, 1997). Under this model, disabled people, including autistic people, were and sometimes continue to be subjected to normalization protocols to rid them of their alleged abnormality (Altman, 2001; Hayes & Hannold, 2007). Disabled people, including autistic people, were frequently placed in wretched institutions precisely because they were viewed as abnormal (Irving, 2015; Trent, 2016). They were even subjected to eugenic practices such as forced sterilization to prevent reproduction because their assumed abnormality made them “defective” human beings (Castles, 2002; Rafter, 2004; Stern, 2007; Stubblefield, 2007). The idea that autistic people are inherently “abnormal” was further cemented when autism was defined as a lack of the “social instincts” unique to our species (Kanner, 1943, 1949, 1951; Wing, 2005, p. 201). Normalization practices were and sometimes still are the main nexus of harm and oppression experienced by autistic people (Zaks, 2023).

Largely due to the efforts of autistic self-advocates, cultural constructs regarding autism are changing. Normalization is being challenged (Botha et al., 2024). Neurocognitive diversity has been positioned as a biological fact, not a tragic aberration (Cutler, 2019; Walker, 2021). The assumption that autistic people lack human attributes such as empathy and desire for companionship is being contested (De Jaegher, 2023; Jaswal & Akhtar, 2019). In demonstrating that autistic people differ “as a matter of degree, not kind,” the justification for normalization has been greatly weakened (Winzer, 1993, p. 380).

In addition to lacking justification, normalization protocols are often ineffective (Davis et al., 2022; Mottron, 2017). Subjection to normalization “treatments” can cause autistic people stress (Dawson & Fletcher-Watson, 2021; Sandoval-Norton & Shkedy, 2019; Sweetapple, 2020). Autistic people may internalize a sense of shame, threatening their mental health (Cumming et al., 2020; Field et al., 2024). Masking and camouflaging—strategies used by autistic people to appear more normal—have been correlated to suicide, depression, and autistic burnout (Cage & Troxell-Whitman, 2019; Cassidy et al., 2020; Hull et al., 2021; Raymaker et al., 2020).

Ending normalization has potential to increase effectiveness of support and to reduce harm (Jaffee, 2022). However, what will professionals do instead? Consensus on neurodiversity-affirming support is emerging (Izuno-Garcia et al., 2023; Leadbitter et al., 2021; Lerner et al., 2023; Schuck et al., 2022). Autistic professionals are training colleagues in neurodiversity-affirming protocols (Endow, 2022; Randall, 2021). Mental health professionals, some autistic, are demonstrating ways to provide neurodiversity-affirming mental health therapy (Chapman & Botha, 2023; Pantazakos & Vanaken, 2023). Speech-language pathologists are promoting neurodiversity-affirming practices (DeThorne & Gerlach-Houck, 2023; Gaddy & Crow, 2023; Santhanam, 2023). Occupational therapists have called switching to neurodiversity-affirming practices a “moral imperative” (Dallman et al., 2022; Sterman et al., 2022; Taylor, 2023). Education professionals are striving for paradigm change in K-12 schools and colleges (Acevedo & Nusbaum, 2020; Armstrong, 2017; Broderick & Lalvani, 2017; Goodall & Ward-Sinclair, 2022; Jackson & Sibbald, 2024; Keefe, 2022).

Yet, clinical work, therapy, special education, and adult support may replicate past harms until we remedy the current gap in autistic wisdom necessary for strong consensus on what neurodiversity-affirming support entails (Kudlick, 2018). Autistic people need to be leaders in defining a new purpose for support (Chown et al., 2017; Fletcher-Watson et al., 2019; Milton, 2014; Pukki et al., 2022). All autistic people can lend their expertise and experiences, even those with intellectual disability or significant communication challenges (Nicolaidis, 2019; Pellicano et al., 2014). This study contributed to closing the knowledge gap by asking professionals in various support fields who have experience as both autistic adults and as autistic professionals for their suggestions because as a distinct group, they hold unique wisdom (Wittgenstein, 1953/1973).

Autism-related investigations do not automatically result in less discrimination (Ellis et al., 2018; Erevelles, 2002; Linton, 1998). For example, studies calling for full inclusion in schools still refer to disabled children as abnormal, never interrogating the harmful consequences of sorting humans into abnormal/normal groups (Gindis, 1999; Rodina, 2006). Therefore, this study utilized emancipatory methodology which seeks to answer questions expressly to liberate autistic people from injurious practices and inequitable features of society (Oliver, 1992, 1997). A critical disability theory framework that interrogates stigmatizing cultural constructs also guided data analysis (Burghardt, 2011; Garland-Thomson, 2002; Nasir & Hussain, 2018). Three main themes emerged: (1) consensus on features of normalization protocols to avoid, (2) attributes of neurodiversity-affirming professionals and practices, and (3) access to autistic professionals as crucial to autistic well-being.

Methodology

Sampling

A purposeful sample of autistic professionals equipped with the necessary experience to provide “information rich” data were interviewed (Patton, 2002, p. 230; Rai & Thapa, 2015). Autistic and non-autistic colleagues made referrals to 23 autistic professionals they believed could contribute to articulating a new purpose of support that will move the support system away from normalization (Bakkalbasioglu, 2020). Of these, nine did not respond, one did not identify as autistic, and one responded after interviews had been conducted. The remaining 12 were interviewed. One interview was not recorded successfully, resulting in 11 transcripts for analysis.

Participants

Interviewees had to identify as autistic; to be known as autistic to some clients or students; to have at least 1 year of experience supporting autistic individuals; to make decisions and set goals in collaboration with autistic clients and students; to hold professional responsibility; to utilize neurodiversity-affirming practices; and to work in the United States.

The geographic restriction controlled for the fact that support, health, and education systems and disability attitudes vary widely across the globe. Autistic identity and disclosure allowed for exploration of the role of autistic identity in support contexts. However, participants were not required to publicly identify as autistic in all aspects of professional life due to ongoing ableism. Participants were also not required to hold a professional license or a specific academic degree to prevent exclusion of participants unable to acquire these privileges. Instead, features of professional work were utilized as markers for inclusion. However, all interviewees did hold licensure in their respective fields.

Because autistic people belong to many identity groups, suggestions for ending normalization in the support system must come from a diverse group. Of the 11 interviewees, four disclosed privately that they identify as queer, gay, lesbian, or gender divergent; four disclosed privately that they identify as Black, Asian, Indigenous, or multiracial; two disclosed privately that they grew up in working-class families; and some experienced significant developmental delays in childhood. Drawing correlations between viewpoints and demographics would have been valuable; however, demographic data was not recorded to protect participants from discrimination.

Emancipatory methodology

Qualitative methodology is often the best option for capturing perspectives (Abberley, 1992). Emancipatory methodology seeks to produce disability knowledge that does not bypass the people under study, that is inclusive and accessible, that solves problems of importance to the disabled community, and that empowers participants as part of the process (Barnes, 1992, 2002; Oliver, 1992). Disability oppression must be reduced by altering research dynamics and relationships (Lather, 1988; Oliver, 1992; Zarb, 1992). Criteria for emancipatory methodology research projects continue to be elucidated (Chown et al., 2017; Humphries et al., 2020). Generally, emancipatory research projects must:

reduce ableism and oppression

be led by disabled people

position study participants as co-experts and co-producers of wisdom

empower all involved

hold potential to improve disabled people's lives, according to disabled people

situate disability as heavily socially produced and as relational, with reduction of discrimination requiring participation of non-disabled people

allow disabled people to vet all aspects of the research project

ensure accessibility at all phases of the study including participation and dissemination

This study met these requirements. Investigating how to end normalization is de facto seeking a way to reduce ableism. Ending normalization is expected to improve quality of life (Armstrong, 2017; Davis et al., 2022; Jaffee, 2022). Figuring out how to change paradigms is an autistic priority (Gillespie-Lynch et al., 2017; Pellicano & den Houting, 2022; Pukki et al., 2022). Regarding accessibility, interviewees were provided with accommodations that ranged from additional time to answer a question to providing questions in a written format.

This study also altered traditional research relationships. My identity as an autistic researcher was viewed as increasing trust, facilitating effective knowledge production, and ensuring accurate results (Goode, 1992; Marshall & Rossman, 2016). Study participants were co-experts, providing feedback throughout the project and checking study results for accuracy and relevance (Creswell & Miller, 2000; Kornbluh, 2015). A semi-structured interview format was rejected to avoid constraining what participants shared (Brinkmann, 2014; McGrath et al., 2019). These steps maximized participant autonomy (Pellicano et al., 2014).

Emancipatory methodology also prioritizes new ways of knowing. Autistic researchers appear capable of both generating knowledge in unique ways and producing unique knowledge (Chown, 2013, 2014; Griswold, 2024; Milton, 2014; Woods & Waltz, 2019). Producing and prioritizing autistic knowledge has the potential to disrupt traditional power dynamics, challenge misconceptions, and reconceptualize autism in new non-oppressive ways that might more effectively help autistic people solve their problems.

Data collection and interpretation

Participants were interviewed virtually over Zoom for an hour after answering affirmatively to all inclusion criteria. Several interviewees asked me to type questions into the chat box. Some requested time to reflect before answering and a few asked for breaks. These accommodations served to validate autistic ways of communicating and interacting. Raw Zoom transcripts were edited for accuracy, personally identifying information was removed, and names were replaced with pseudonyms.

Transcripts were analyzed in random order using an inductive process that allows viewpoints to emerge from the data (Charmaz, 2006; Marshall & Rossman, 2016). Emancipatory methodology does not see subjectivity as a barrier to discovery (Tufford & Newman, 2012). In fact, emancipatory methodology sees relational, emotional, and experiential proximity as crucial aspects of projects aiming to liberate disabled people, including autistic people, from harmful practices (Burghardt, 2011; Garland-Thomson, 2002; Nasir & Hussain, 2018).

Still, I bracketed my reactions as I looked for clues in the data (Creswell & Miller, 2000; Gearing, 2004). The importance of bracketing increases when a researcher's connection to the phenomena under study is strong (Fischer, 2009; Hofmann & Barker, 2017). My proximity facilitated trust, rapport, and collaboration at crucial points in the research endeavor while bracketing created space for participant views to arise and become known during analysis and interpretation (Ashworth, 1996, 1999; Giorgi, 1998; Ladkin, 2005).

A colleague who served as the external reader on my dissertation committee independently analyzed the first three transcripts. We derived four nearly identical codes based on keywords and phrases and reached consensus on two additional codes. Selection of data and placement of data into a code was guided by the need for autistic professional viewpoints on what support professionals should do instead of normalization (Linneberg & Korsgaard, 2019; Saldaña, 2014). Inclusion was wide to prevent exclusion of data that had potential to become relevant as meaning solidified (Miles & Huberman, 1984). Categories stood out within codes across transcripts (Grodal et al., 2021). These patterns strengthened into three themes: consensus on the features of normalization, attributes of neurodiversity-affirming professionals and practices, and access to autistic professionals as crucial to autistic well-being (Bradley, 1993; Williams & Moser, 2019).

Community involvement

This study centered community involvement by having autistic people produce knowledge that autistic people want.

Results

Theme 1: Consensus on features of normalization

Interviewees spoke strongly against normalization. Interviewees identified six features of normalization to avoid, described below.

Violation of bodily autonomy

Study participants viewed disrespecting bodily autonomy as a violation of human rights. They said that any procedure that restricts movement, withholds basic needs, or inflicts unwanted body sensations is unacceptable. Ian, an autistic social worker, noted that professionals sometimes rub an unpleasant texture on an autistic child's skin to increase sensory tolerance for “normal” clothing; however, he said professionals can say, “Well, it's not a disorder that he doesn’t like unpleasant textures. Let's just dress him in clothes that feel good on his skin and call it a day.”

Removal of choice

Removal of choice was identified as a hallmark of normalization. They blamed removal of choice on the ableist assumption that autistic people are incapable of self-determination. They expressed concern that when professionals and parents choose goals based on this flawed assumption, autistic needs and wants are ignored. Interviewees said parents frequently clamor professionals to make their child normal, pushing aside other options. Dara, an autistic counselor, urged parents and professionals to pay attention to “situational pressures” that contribute to emphasis on normalization and removal of choice at the expense of helpful, self-determined non-normalization skills and goals.

Emphasis on finding and fixing deficits

Interviewees lamented that professionals are required to identify and document deficits to comply with insurance, school, and agency regulations. Kim, an autistic clinical psychologist, said she worries this focus causes autistic individuals to internalize shame. Anna, an autistic psychoanalyst, warned that by focusing on deficits, a professional “might not ask about the person's feelings or ask about their imaginary world, which ends up a huge loss.” Caleb, an autistic speech-language pathologist, added that a deficit focus can thwart growth. He said echolalia, a common autistic trait usually framed as a linguistic abnormality to extinguish, is actually a unique attempt at communication and an important aspect of language development for neurodivergent people (Cohn et al., 2022; Pruccoli et al., 2021).

Enforcement

Enforcement was identified as a feature of normalization. Judy, an autistic social worker who works with autistic adults at a service agency, complained that enforcement is often required of professionals with no critical questioning of the usefulness of the skill being enforced. The act of enforcement itself can be harmful (Kupferstein, 2018). For example, Caleb decried the practice of sensory desensitization which can involve rubbing substances such as “sandpaper on [an] autistic kid's skin” in the name of increasing the child's tolerance when “it's not a disorder that he doesn’t like unpleasant textures.” Several interviewees expressed concern that enforcement behaviors on the part of the professional can convey the message that being autistic is so inferior that denying individual needs and concerns is worthwhile, damaging an autistic person's ability to trust themselves and others.

Unrealistic expectations

Interviewees said protocols promising attainment of normalcy can instill a deep sense of failure because expectations are frequently unrealistic. Interviewees were not suggesting assuming incompetence. Rather, Jessica, an autistic occupational therapist, explained that clients and students can usually sustain normalcy expectations only with heavy masking. Furthermore, promising inclusion in society if normalcy is achieved loses meaning if that society sustains an autistic person's marginalized status (Sweetapple, 2020).

Interviewees also noted that the normalcy autistic people are pushed to achieve is often predicated on White, cisgender, heteronormative, Western standards of “normal,” denying varying experiences of autism by race, ethnicity, sexuality, gender expression, and other factors. They said assuming autistic people should and can become “normal” denies the relational nature of disability, recusing non-disabled people from the job of creating a non-ableist society and leaving autistic people and other disabled people to bear full responsibility for their predicaments.

Emphasis on outward appearance

Interviewees said normalization prioritizes the outward appearance of an autistic person and the comfort of the neuromajority. Interviewees worried that autistic clients and students may mask when the focus is on normalization to avoid disappointing parents and professionals. Masking has been shown to negatively impact mental health and exacerbate vulnerability to abuse (Dell’Osso et al., 2021; Sandoval-Norton & Shkedy, 2019). Ian, the autistic social worker, said teaching autistic people to appear as “normal” as possible is tantamount to teaching autistic people “to hide our pain.”

Theme 2: Attributes of neurodiversity-affirming professionals and practices

Interviewees shared strong consensus on the features of neurodiversity-affirming support and described features across two domains: attitudes and actions. Each domain is detailed below.

Attitudes

Curious

Interviewees said neurodiversity-affirming professionals are curious. Dara said they “ask the client why they’re doing that…” Professionals remain open to novel priorities and solutions. Kim said, “Who am I to say they shouldn’t do it?” Syd, an autistic social worker, said that if a client feels lonely, they ask “how [does the client] want to be social?” instead of presuming.

• Collaborative

Interviewees stressed the importance of a collaborative mindset. Dara explained, “I’m very aware that if I’m working with BIPOC or LGBTQ clients … their experiences might be different than mine.” She said they may have unique understandings of what a particular skill looks like or may identify goals that a White, privileged professional would not automatically consider. Jessica agreed and cautioned that many skills and goals are “centered in White supremacy.” She said that by working collaboratively with diverse autistic individuals, a neurodiversity-affirming professional can avoid replicating past harms.

• Impartial

Interviewees said neurodiversity-affirming professionals are non-judgmental. Experiencing challenges simply reflects human complexity and imperfection. Learning and interdependence should be destigmatized. Judy noted, “Nobody is entirely independent.” Kim said she conveys to her clients, “We all have things we could work on.” Caleb declared, “All kids need to develop … that's not limited to autistic people.”

Furthermore, they said impartiality allows a professional to refrain from making assumptions about someone's capacities. Matthew, an autistic special educator, said he has seen professionals resort to “a dumb baby voice” with augmentative and alternative communication (AAC) users. “I just refuse to do that. I will talk to the autistic person like a person even [if they] might not be able to directly respond to me … it's important to acknowledge them … as an individual that … deserves to be talked to.” Judy added that an autistic person “should never be shamed for needing more support than others” and that “regardless of … what kind of support needs they have … everybody is worthy of acceptance and inclusion.”

Valuing diversity

Interviewees said neurodiversity-affirming professionals view neurocognitive diversity as natural and as beneficial. Morgan said neurodiversity-affirming professionals “really embrace the recognition that we’re not all the same.” Ian agreed “that people have different brains [and] that's not a bad thing.” Syd explained that valuing diversity is necessary for “making sure that folks with all types of neurocognition can … actually feel included.”

Actions

Teach how to code-switch

Study participants said neurodiversity-affirming professionals teach autistic people how to code-switch, which they defined as going back and forth between autistic and non-autistic ways of behaving and communicating. Caleb, the autistic SLP, framed autistic ways as a unique culture, noting that while “autistic people don’t have a geographic culture or a dialect … autistic communication just really seems to closely resemble [a] cultural variation.” He said neurodiversity-affirming professionals can teach “non-autistic culture” to the degree doing so is useful. Dara, the autistic psychologist, also compared teaching code-switching to “teaching another language.” Kim, the other autistic psychologist, agreed with Dara and Caleb and said teaching “non-autistic culture” resembles preparations she made before spending a year in France, when she found it “helpful … to know a little bit of French, even though I find it incredibly difficult.”

Interviewees differentiated code switching from masking, a stressful survival tactic that involves hiding who you are. Morgan, a third autistic therapist, conceded it can be difficult to distinguish between the two and that she herself felt she had to mask to succeed in her career. Caleb said code switching is different than harmful masking because clients choose to gather information on non-autistic culture and choose whether to use it. Dara agreed, saying she presents code-switching as a tool for “times when you decide for whatever reason consistent with your goals that you want to communicate with a neurotypical person in their preferred method of communication.” However, she always lets clients know “there's nothing wrong with the way you communicate” and that an autistic person has the right to be themselves.

Foster self-determination

Study participants agreed that neurodiversity-affirming professionals encourage self-determination. Morgan spoke about “letting the client take the lead … instead of me … telling them, ‘Hey, this is what you have to do to be a functioning adult.’” Matthew, the autistic special educator, said the focus should always be on helping an autistic person “find a strategy that works for them” and never assuming what a client or student needs. Judy said lack of self-determination “interferes with the autistic person's quality of life.” Caleb concurred, stating that choice “enables that individual to live the life that they want to live.”

Interviewees acknowledged that sometimes, adults need to make choices for children. However, they cautioned that parents and/or professionals always choosing goals and making decisions hampers a child from learning to recognize their needs and advocate for themselves. Jessica, the autistic OT, said children miss an opportunity to learn how to negotiate and compromise and as a result, may not experience “equitable access” to getting their needs met. Even in situations requiring compliance for safety reasons, such as wearing a seatbelt, Jessica pointed out that professionals and parents can provide choices and meet autistic-identified needs—perhaps by changing the feel of the seatbelt using a neck protector or by using other types of approved car restraint options.

Judy decried parents continuing to make choices for an autistic person in adulthood. She said that taking away choices “shows that you’re not trusting of them. It shows that you’re not willing to take a chance and let them practice… You know, natural consequences happen… That's … using those opportunities to teach those kinds of things rather than just controlling a person's life.” While conceding that self-determination can be “terrifying if you’re not … ready” Jessica agreed with Judy and added that a person should receive support to identify needs and make choices, not have choices taken away.

Support development of a positive autistic identity

Study participants identified development of a positive autistic identity as a key aspect of neurodiversity-affirming support (Cooper et al., 2017). Ian said professionals can support a client to form “an identity … around your brain differences that isn’t … a negative thing.” Kim and Dara discussed helping clients accept their autistic differences. Dara said she feels that the most important skill an autistic person can learn is figuring out “how your brain works and accepting it.” Both Kim and Syd said they show clients how they match DSM-5 criteria in positive ways.

Connecting to the autism community was described as a component of developing a positive autistic identity. When Taylor, another autistic SLP, worked at a school for autistic students, she observed first-hand the importance of community “and how much they cared for each other.” Ian said neurodiversity-affirming professionals can help clients and students find “people who have had similar experiences. And [find] healing through that.” Annie also helps clients connect to the autistic community so clients can avoid “beating up on yourself and just feeling lonely.”

Several autistic professionals emphasized development of a positive autistic identity based on their own experiences. Judy described adults telling her in high school that she was overcoming her disability because she longer needed an IEP and said this was “unhelpful… I’ve come to embrace who I am openly as an autistic person.” Matthew shared that learning he was autistic gave him language for his experiences and that as he got older, he “started to incorporate it into my identity like some people incorporate, for example, their masculinity. Or their Asian-ness or Black-ness….” He said he wants clients and students to feel proud of who they are, too, just as he does.

Solve problems utilizing traits common among autistic people

Interviewees said neurodiversity-affirming professionals utilize an autistic person's traits to solve problems. Jessica mentioned working with an autistic child who interrupted others; rather than wasting time learning how to avoid interrupting, he “wanted strategies for … interrupting better.” The autistic SLPs spoke about their clients requesting support to “infodump” effectively. The shift to a neurodiversity-affirming paradigm requires rethinking traits of an autistic person as features that are not going away—and that do not need to go away.

Teach non-autistic people to be tolerant

Study participants said neurodiversity-affirming professionals teach non-autistic people to be tolerant (Davis & Crompton, 2021; Kim & Bottema-Beutel, 2019; Sasson et al., 2017). Dara underscored, “autistic people should not have to change their autistic nature to be more accepted in this world. Society needs to be more accepting.” Taylor said that especially at school, teaching tolerance places “less onus on the autistic kids.” Annie, the autistic psychoanalyst, said teaching non-autistic people to be tolerant must involve non-autistic people taking accountability for their role in misunderstandings, noting that it is “always a two-way problem. It's not just the autistic person that's to blame.”

Theme 3: Access to autistic professionals as crucial to autistic well-being

The third theme that emerged from the data was resounding agreement among interviewees that autistic individuals need access to autistic professionals. Interviewees did not disparage non-autistic professionals and acknowledged their contributions. However, lack of access to autistic professionals was identified as a dire problem for the following three reasons: autistic professionals can serve as role models; they can draw upon shared experiences for more effective support; and they can empathize with autistic individuals more readily.

Role models

Interviewees said they demonstrate successful ways to have a happy, meaningful autistic life. Jessica said she can describe to autistic clients “what it was like when I realized I was masking, and what does unmasking look like?” Syd said, “Autistic clinicians can really show, ‘here's what has worked for me.’” Logically, a non-autistic professional cannot show an autistic client or student what an autistic adult looks like, or what an autistic life can be. Dara said that in essence, the autistic people she works with are “seeing their future.”

Shared experiences

By sharing common experiences in the world and common ways of processing the world, interviewees said that autistic professionals can provide autistic students and clients more effective support than non-autistic professionals. They often referred to the experiences of other identity groups to support this claim. Caleb pointed out, “There is hard data, solid, quantitative, statistical data, that shows that Black children learn better from Black teachers… The same thing probably holds true that autistic students … learn better from autistic teachers or service providers,” (Bristol & Martin-Fernandez, 2019; Egalite et al., 2015; Lindsay & Hart, 2017; Redding, 2019). Ian mirrored Caleb, stating that “when you don’t know what life is like for other groups of people who are dealing with different things, the solutions you’re going to come up with might work for White folks, but they may not work with for Black kids, or Arab kids. It's the same with non-autistic practitioners working with autistic” people.

Matthew noted that “Neurotypical [professionals] … have the most kindest … intentions, but they can only perceive the world through their own neurotypical lens.” Agreeing with Matthew, Taylor felt that as a result of shared life experiences and shared processing styles, the connection between a professional and the client or student is strengthened and trust deepened. Annie added that because autistic professionals and the autistic people they work with frequently share experiences of oppression, autistic professionals can recognize “…grief from ableism, from having certain assumptions or projections placed on you” and thus “bring awareness of things like minority stress … and … ableism … and how they can impact the person,” something non-autistic therapists simply cannot provide.

Empathy

Interviewees said autistic professionals could also provide empathy, defined as reciprocal understanding, more effectively to autistic people than non-autistic professionals. Caleb referenced double empathy as justification, stating “It turns out that … autistic people understand autistic people…” (Crompton et al., 2020; Milton, 2014). Syd described intuitively providing a multiplicity of options for their clients. Judy also said she can make recommendations in her agency's community living program intuitively. Taylor agreed with Caleb, Syd, and Judy and said autistic professionals “just get it. The autistic person isn’t using up all of their spoons—energy—to educate the clinician.” Dara said this intuitive understanding allows autistic clients and students to receive “validation from somebody … and internal[ize] that.”

Interviewees said autistic professionals also solve problems more effectively out of mutual empathy. Ian said non-autistic clinicians miss “a lot of nuances and dilemmas” which makes it difficult for them to be “focusing on the specific things that will actually help us.” Caleb said neurotypical professionals often do not understand why an autistic person is deregulated, but that he can walk in the room and immediately see that the “air conditioner … is super annoying” and “recognize … ‘Oh, that's an awful noise stimuli!’” Taylor concurred, noting that non-autistic professionals and parents see “so-called behaviors that their kid is doing, but … [they don’t have much] understanding … about the internal experience that goes with that” behavior. By ensuring access to autistic professionals, non-autistic professionals and families could benefit from the unique autistic intuition and empathy of autistic professionals.

Discussion

The support system has not pivoted away from normalization completely. Interviewees provided consensus on features of normalization to avoid and features of neurodiversity-affirming practice to promulgate. They also urgently and repeatedly called for autistic people to have unfettered access to autistic professionals. As action steps, all three can contribute to paradigm change. However, the third suggestion—unrestricted and ubiquitous access to autistic clinicians, teachers, and therapists—is the heftiest catalyst for sparking total paradigm change.

Limits of reforming the normalization paradigm system

The autistic professionals interviewed in this study provided a roadmap away from normalization. Avoiding features of normalization and adopting neurodiversity-affirming practices and attitudes can restore agency to autistic individuals and can disrupt imbalances of power. Helping autistic people develop a positive autistic identity challenges the notion that being autistic is inferior. Curiosity makes room for new ways of communicating, loving, working, and being together. Yet, with mandated programs, rules on what supports healthcare will cover, school policies, and deficit-based diagnostics, normalization is vociferously sustained by our current system. For example, Kim, the autistic psychologist, noted, “Assessment psychologists feel like they have to follow the DSM criteria” which frame autism as an abnormality.

Mostly non-disabled people are setting priorities at agencies, schools, and organizations, despite increasing solicitation of autistic advice. Hearing what autistic people have to say about clinical and educational matters and following autistic consensus reduces harm and begins to call the abnormal/normal binary into question, but these actions do not adequately dismantle fundamental societal constructs and are insufficient for destabilizing an entire paradigm. An autistic student may wear noise cancellation earphones or stretch and pace at the back of an affirming classroom without ending societal notions of the student's “abnormality.” A clinician may dim the lights for an autistic person with sensory sensitivities or let an autistic person choose from a menu of therapeutic activities, but autistic people still largely occupy an overall inferior status outside the therapy room. As autism activist and scholar Robert Chapman explains, we can try to “reform the world one piece at a time,” but relationships, social structures, and embedded attitudes maintaining the normalization paradigm are primarily left intact (2024).

Systems theory: Autistic professionals As paradigm change

A system does not change until the fundamental beliefs that support the old system are altered (Meadows, 1997, 2008). Currently, an abnormal/normal binary presumption about humans shapes protocols and practices in clinics and classrooms, no matter how neurodiversity-affirming we wish to be. For paradigm change to occur, the conceptualization of autism as an abnormality must be revoked (Kuhn, 1962). Society is beginning to view autism and autistic people differently. However, notions that autistic people are not fully human, are deficient or damaged, and need to be rescued from their alleged abnormality still thoroughly pervade scientific and social assumptions (Botha & Cage, 2022; Pellicano & den Houting, 2022; Walker, 2012).

Switching to a neurodiversity-affirming paradigm requires new implicit and explicit beliefs about human beings (McVey et al., 2023). What conditions of society would allow new beliefs strong enough to buttress a new paradigm to bloom? Regular and consistent access to autistic professionals would. A large and authoritative cohort of autistic professionals would entirely upend traditional notions of expertise. If we assumed society-wide that an autistic professional can and should determine what is best for an autistic client, the idea that autistic people are incapable or unempathetic would be utterly refuted.

By allowing autistic professionals to solve the problems of autistic people, non-autistic people would be signaling willingness to accept autistic verdicts, priorities, and values (Sprague & Hayes, 2000). These acts of deferment and trust would further disrupt and contest autistic incapacity and inferiority. A consistent consensus that autistic people need access to autistic professionals is such a challenge to traditional constructs and relationships that at last, sticky cultural constructs fueling normalization would disintegrate.

Furthermore, acknowledging the empathy of autistic professionals would restore autistic people to their full humanity. That autistic people can understand one another, can help each other out of mutual shared experiences, and can do this for one another better than non-autistic people demonstrates that autistic people do not lack the human traits of compassion, connection, and concern. This runs directly contrary to the foundational beliefs of the normalization paradigm and provides a steep enough challenge to those beliefs to budge the normalization paradigm.

Admitting across society that autistic professionals should be the primary agents of support for autistic people and then rearranging society for this to transpire can destabilize normalization. A robust cohort of autistic professionals would quickly dispute autistic incompetence and incapacity; refute autistic abnormality; destigmatize autistic priorities and ways of being; and rectify imbalances of power in decision-making. Unfortunately, creating such a cohort may be difficult in today's climate because disclosure often risks discrimination (Fetter, 2020; Guthrie, 2023; Oates & Bean, 2023; StEvens, 2022). Thus, paradigm change hinges on the willingness of neuromajority professionals to actively refute stigma, contest ableist workplace cultures, and share equitably the struggle to reduce ableism (Dahunsi et al., 2024; Hamraie, 2016; Volpone et al., 2022). If non-autistic allies avail themselves of the opportunity to play a role in bolstering safe disclosure, the reality of public-facing networks of autistic professions could flourish, contesting the valorization of a certain kind of person, upending the disenchantment with those who do not match that ideal, and unwinding the vilification of the interdependence and diversity that is a natural part of human existence. In sum, we need many more autistic professionals whose very presence and authority, as the fresh raison d’être of support, will at last refract the paradigm in the support system away from normalization and toward affirmation.

Recommendations

Findings are based on the experiences of a small group of neurodiversity-affirming autistic professionals. Additional studies of autistic professionals are needed to continue building consensus on features of neurodiversity-affirming support. Correlating autistic professional viewpoints with demographic characteristics is also recommended to allow consideration of paradigm change in relationship to marginalization along multiple axes of identity.

Another limitation is practicality. The ability to grow a sizable network of autistic professionals is thwarted by ableism (Sherman, 2023). We need to ensure that autistic people enter support professions and stay there. One step is for non-autistic colleagues to become passionately committed to disrupting ableism. Countering ableism is difficult; however, persistence is the only option. It may be paradoxical, but we need to live the neurodiversity paradigm through our transition to it.