ASD Child

07/05/2025

The concept of interception is important to understand some of the difficulties in autism.

07/05/2025

Stimming as an important behaviour for self regulation.

07/05/2025

An important contribution for our understanding of repetive behaviour in autism.

20/11/2024

This is an important topic. The discussion gives some important insights to depression in autistic adolescents.

Understanding Depression in Autistic Children and Adolescents

Depression is a significant mental health concern affecting many individuals worldwide. In autistic children and adolescents, it presents unique challenges. This blog explores the challenges of depression within this population, exploring its prevalence, presentations, underlying causes, and support ideas for depression.

◾️ Prevalence of Depression in Autistic Youth

Depression is notably prevalent among autistic individuals, with approximately one in three adolescents experiencing at least one episode of depression (Hollocks et al., 2019). This rate is alarmingly higher compared to their neurotypical peers, emphasising the need for timely and targeted mental health support and intervention, including accurate diagnosis and the prompt provision of appropriate support services.

◾️ What is Depression?

Major Depressive Disorder (MDD) is characterised by a persistent feeling of sadness or loss of interest in previously enjoyed activities, impairing daily functioning. According to the DSM-5-TR (APA, 2022), a diagnosis requires the presence of at least five symptoms over a two-week period, including changes in appetite, sleep disturbances, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death or su***de.

◾️ Challenges in Diagnosing Depression in Autistic Youth

Recognising depression in autistic children and adolescents is challenging due to the overlapping of autism characteristics and depression symptoms. Characteristics such as social withdrawal, sleep disturbances, and changes in appetite can be attributed to either condition, leading to potential misdiagnosis or underdiagnosis. This phenomenon, known as diagnostic overshadowing, often results in depressive symptoms being mistaken for autistic behaviour (Oakley et al., 2021).

◾️ Presentations of Depression in Autistic Youth

While many depressive symptoms are similar across different populations, autistic children and adolescents may express and experience these symptoms differently. In addition to the DSM-5-TR symptoms for depression, other presentations may be experienced:

🔹Changes from Personal Baseline: Any changes from an individual's usual behaviour or baseline should not be solely attributed to the dynamic nature of autism; they might signal underlying mental health issues.

🔹Irritability and Frustration: Increased irritability or frustration, especially when finding it difficult to articulate their feelings or when overwhelmed.

🔹Loss of Interest in Special Interests: Changes in the frequency or topic of special interests are common, including reduced engagement and motivation or shifts to new, often more negative topics. Some may maintain or increase special interests out of a sense of obligation or routine, despite a loss of genuine enjoyment.

🔹Changes in Autistic Characteristics: Increased self-soothing behaviours such as stimming during periods of stress or depression. Additionally, there is often a heightened need for routine and structure to cope.

🔹Social Withdrawal and Camouflaging: Some individuals may feel an increased need to mask both autistic characteristics and signs of depression to fit in or to lessen the perceived burden on others. This can lead to significant mental and physical exhaustion, necessitating withdrawal from social interactions to cope and reduce sensory input. For many, the ability to mask diminishes during depressive episodes, which can further exacerbate depressive symptoms due to increased vulnerability and exposure of their authentic selves without the usual protective barriers of masking.

🔹Physical Symptoms: Emotional distress can often present as physical complaints, including headaches, body pains, and stomach aches.

🔹Emotional Dyskinesia: A reduced range of emotional expression in the face and body language, which can result in their feelings being overlooked. This lack of recognition can lead to feelings of alienation and increased depression.

🔹Externalised Agitated Depression: Depression can present as agitation and blame directed towards others. This may appear as aggressive behaviour but often stems from low self-worth and underlying depression.

🔹Suppression of Emotions: Suppressing painful emotions can hide depressive symptoms, leading to a lack of recognition and support. This suppression can intensify depressive episodes and create intermittent 'depression attacks.' The effort to mask true emotions can lead to chronic feelings of alienation and personal defectiveness, significantly contributing to depression.

🔹Functional Use of Anger: Using anger functionally to achieve solitude.

🔹Depression Attacks: Intense episodes where suicidal ideation rapidly intensifies, marked by a deep, out-of-control feeling and a dangerous urgency to act on impulses. These attacks can be overwhelming and require immediate attention and support.

◾️ Underlying Causes of Depression in Autistic Youth

Several factors contribute to the heightened risk of depression among autistic children and adolescents:

🔹Social Isolation and Loneliness: Difficulties in social interaction often led to feelings of isolation, unheard, and loneliness, significantly impacting mental health.

🔹Peer Rejection and Bullying: Repeated negative social experiences can erode self-esteem and lead to a persistent sense of worthlessness.

🔹Mental Exhaustion: The continuous effort to analyse and navigate social interactions can be mentally draining, leading to depression.

🔹Internalising Criticism: Frequent bullying and negative feedback can result in internalised negative beliefs about oneself, perpetuating depressive feelings.

🔹Cognitive Patterns: Autistic individuals may tend to focus on errors and potential problems, contributing to a negative self-image and hopelessness about the future.

🔹Family History: A higher incidence of mood disorders in the families of autistic individuals suggests a genetic predisposition to depression.

🔹Autistic Burnout: Many autistic individuals experience autistic burnout, characterised by extreme mental, physical, and emotional exhaustion, often due to prolonged periods of stress and masking autistic characteristics. If left untreated, autistic burnout can lead to the development of depression.

🔹Hyperarousal of Emotional Empathy: Intense affective empathy can lead to self-imposed social isolation to protect one's mental health.

🔹Alexithymia: Many autistic individuals also experience alexithymia, a condition characterised by difficulty in identifying and describing emotions. Alexithymia can mask depressive symptoms, making it harder for individuals to recognise and communicate their distress. This can lead to underreporting of symptoms and delays in receiving appropriate treatment, thereby increasing the risk and severity of depression.


◾️Interventions and Support Strategies

Effective interventions require a multi-faceted approach tailored to the unique needs of autistic children and adolescents. Each intervention should be individually tailored and person-centered, considering the person's sensory profile, cognitive needs, history, and other personal characteristics. It's important to recognise that not all programs will be suitable for every individual, and flexibility in approach is crucial to provide effective support:

🔹Early Recognition and Diagnosis: Improving awareness and training among healthcare professionals to accurately recognise and diagnose depression in autistic youth.

🔹Therapeutic Interventions:

Cognitive-Behavioural Therapy (CBT): Adapted for autistic individuals, CBT can help address depressive symptoms and improve coping strategies by focusing on changing negative thought patterns and behaviours.

Dialectical Behaviour Therapy (DBT): This therapy can be beneficial for managing intense emotions and improving interpersonal effectiveness and distress tolerance.

Acceptance and Commitment Therapy (ACT): ACT focuses on helping individuals accept their thoughts and feelings rather than fighting them, encouraging them to commit to personal values and take action towards a meaningful life.

🔹Behavioural Activation: This strategy involves encouraging engagement in enjoyable or meaningful activities to counteract the withdrawal and inactivity common in depression. However, this might not be suitable during periods of autistic burnout due to the additional mental and physical exhaustion.

🔹Mindfulness and Relaxation Techniques: can help manage stress and improve emotional regulation. Techniques include mindfulness meditation, deep breathing exercises, and progressive muscle relaxation.

🔹Social Skills Training: Programs designed to enhance social interaction skills can reduce feelings of isolation and improve self-esteem. These can be particularly effective when tailored to the specific needs of autistic individuals.

🔹Parental and Caregiver Support: Providing resources and support to caregivers can help them better understand and support their child's mental health needs. This includes psychoeducation, support groups, and respite care to alleviate caregiver stress.

🔹Creating Inclusive Environments: Schools and communities should foster inclusive environments that promote acceptance and understanding of autistic individuals. Reducing the risk of social isolation and bullying can significantly improve mental health outcomes.

🔹Monitoring and Addressing Autistic Burnout: Recognising the signs of autistic burnout and implementing strategies to manage it, such as reducing demands, increasing downtime, and providing supportive environments, can prevent the progression to depression.



💡Where to From Here?

We have created a brand new event to assist clinicians who see adolescents to increase their knowledge and skill in recognising autism and distinguishing autism from other conditions, such as ADHD and depression, and in the provision of support and therapy for autistic teenagers who are often suffering with mental health issues. Our event comprises two days, Masterclass Day 1: Diagnosis for Autistic Teenagers and Masterclass Day 2: Support and Therapy for Autistic Teenagers. The events will be help live in London, and can be attended live via webcast and watched later for 60 days after the event.

https://attwoodandgarnettevents.com/product/webcast-event-and-live-in-london-day1-diagnosis-for-autistic-teenagers-16-january-2025/

https://attwoodandgarnettevents.com/product/webcast-event-and-live-in-london-masterclass-day-2-support-and-therapy-for-autistic-teenagers-17-january-2025/

📚References

American Psychiatric Association [APA]. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Cassidy, Sarah, Au-Yeung, Sheena, Robertson, Ashley, Cogger-Ward, Heather, Richards, Gareth, Allison, Carrie, Bradley, Louise, Kenny, Rebecca, O'Connor, Rory, & Mosse, David. (2022). Autism and autistic traits in those who died by su***de in England. The British Journal of Psychiatry, 221(5), 683-691. https://doi.org/https://doi.org/10.1192/bjp.2022.21

Cassidy, S. A., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J. (2018). Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism Research, 11(5), 738-754.

Chandrasekhar, T., & Sikich, L. (2015). Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan. Dialogues in clinical neuroscience, 17(2), 219-227.
Hedley, D., Uljarević, M., Wilmot, M., Richdale, A., & Dissanayake, C. (2017). Brief report: Social support, depression and suicidal ideation in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47, 3669-3677

Hedley, D., Uljarević, M., Foley, K. R., Richdale, A., & Trollor, J. (2018). Risk and protective factors underlying depression and suicidal ideation in Autism Spectrum Disorder. Depress Anxiety, 35(7), 648-657. https://doi.org/10.1002/da.22759

Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological Medicine, 49(4), 559-572. https://doi.org/10.1017/s0033291718002283

Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80–89.

Oakley, B., Loth, E., & Murphy, D. G. (2021). Autism and mood disorders. Int Rev Psychiatry, 33(3), 280–299. https://doi.org/10.1080/09540261.2021.1872506

Rhodes, S. M., Eaton, C. B., Oldridge, J., Rodgers, J., Chan, S., Skouta, E., McKechanie, A. G., Mackie, L., & Stewart, T. M. (2023). Lived experiences of depression in autistic children and adolescents: A qualitative study on child and parent perspectives. Res Dev Disabil, 138, 104516. https://doi.org/10.1016/j.ridd.2023.104516

20/11/2024

See a podcast from Prof Atwood.

04/11/2024

Some thoughts about camouflaging

Camouflaging can help autistic adolescents blend in, but it's important to remember that survival doesn't always mean thriving. True support means recognising the cost behind the mask. - Dr Michelle Garnett, AuDHDer and Clinical Psychologist


When I talk about camouflaging, I think about the effort autistic adolescents put into blending in with their peers. It's a survival mechanism—a way to avoid bullying, rejection, and misunderstandings. But while camouflaging can offer temporary safety, it often comes with significant emotional and cognitive costs. It's exhausting, and over time, it can erode one's sense of identity and well-being. As a psychologist, I believe our role isn't about helping these young people fit in but to help them thrive—to understand the toll that camouflaging takes and to create environments where they can be their authentic selves without fear.

Learn more about supporting autistic teens:
On Friday, January 17th, 2025, Tony and I will present Day 2 of our Masterclass on Autistic Teenagers. The course equips professionals with neurodiversity-affirming strategies and therapeutic techniques to support autistic adolescents, focusing on best practices for addressing depression, anxiety, social connections, and self-identity through adaptations informed by current research and clinical expertise. The full day will be webcast live from London, so the timing will suit people in the Northern Hemisphere best, but participants will have 60 days to access the event.

https://attwoodandgarnettevents.com/product/webcast-event-and-live-in-london-masterclass-day-2-support-and-therapy-for-autistic-teenagers-17-january-2025/

02/11/2024

Autism and challenges in families

02/11/2024

Autism and Parenting

Autism, Custody and Access Issues

There is a popular belief that having an Autistic child causes so much parental stress and discord that the divorce rate is at least 80%. However, this is a myth, as research on over 900 families who have an Autistic child has found no evidence to suggest a greater risk of divorce (Freedman et al. 2012). The study found that 64% of Autistic children had married parents, compared to 65% of non-autistic children. If divorce occurred, the level of support needed was not a factor. Instead, results showed that divorce was more likely when the Autistic child was young. In the first few years after diagnosis, there can be stress associated with acceptance of the diagnosis and the effects on the relationship of intensive early intervention. Over time, many families adapt, and stress levels stabilise. Research shows that parents of Autistic children experience higher rates of depression, anxiety, stress and burnout than parents of nonautistic children (Chen et al., 2024). The rates of depression are often higher in mothers than in fathers, likely due to mothers often taking on a more prominent caregiving role. Each of these factors can impact marital satisfaction (Freedman et al. 2012).

When divorce occurs, there can be legal issues regarding custody and access, and the Autistic child’s specific needs are often a specific consideration. Here are some common issues that may arise:

- Best Interests of the Child
Courts will prioritise the child’s best interests when making custody and access decisions. For an Autistic child, their best interests often require particular attention to their developmental and emotional needs.
Judges may ask for expert evaluations (e.g., from psychologists or developmental specialists) to better understand the child’s specific needs to make decisions regarding custody and access.

- Parenting Ability and Capacity
The ability of each parent to understand and accommodate the needs of the autistic child is a critical factor in custody decisions. This may include:
* Acceptance of the diagnosis of autism.
* Ability to provide emotional and practical support.
* Knowledge of the child’s therapeutic and educational requirements.
* Capacity to manage the child’s routines and behaviours effectively.
* Willingness to cooperate with professionals involved in the child’s care.
Parents might have different levels of ability or understanding regarding how to meet the child’s unique needs and be effective advocates with relevant agencies.

- Consistency and Structure
Many Autistic children thrive on routine, consistency and structure. A disruption in their daily routine (e.g., due to changing homes frequently between parents) can be particularly distressing for them.
Courts may prefer arrangements that maintain consistency for an Autistic child, such as having a primary residence with one parent and specific, structured visitation with the other.

- Therapeutic and Support Needs
Autistic children often have specialised therapeutic and support needs (e.g., speech therapy, occupational therapy, and behavioural interventions), which are time-consuming. Parents will be expected to engage and liaise with and coordinate support and therapy services.
The court may consider how much each parent educates themselves in the various therapy and support services.
Both parents may be required to ensure that the child has access to necessary support and therapy. Custody arrangements may be influenced if one parent fails to follow therapeutic and support plans.
Decisions on therapy, treatment options and support to ensure consistency might require mediation or court intervention, especially in high-conflict divorce proceedings.

- Educational Requirements
Autistic children may require specific school placements, which can vary between geographical locations. The parent/s with custody may have significant input in selecting schools or managing Individualized Education Programs (IEPs).
Frequent school changes can be detrimental, so stability in educational placement is often prioritised.

- Communication and Collaboration Between Parents
Co-parenting an autistic child often requires a high level of cooperation and communication. Parents must coordinate appointments, therapy sessions, and schooling and remain consistent in behaviour management approaches.
Courts may recommend joint parenting plans, but one parent may be given more decision-making authority if communication is poor.
The prevention by one parent of another’s meaningful involvement in therapy will impede positive outcomes for an Autistic child. The court would perceive it as contrary to the child’s best interests.

- Sensory Sensitivities and Environment
Autistic children can have specific sensory sensitivities that need to be considered in custody decisions. The child’s environment in each parent’s home must be accommodating, calm, and suited to their needs.
A home that is overly stimulating or lacks accommodations for autism may not be appropriate for the child.

- Sibling Relationships
The relationship between the autistic child and their siblings can be important in custody arrangements. Courts might consider whether a separation of siblings could negatively affect the Autistic child, especially if they rely on their siblings for emotional support or routines.

- Access Schedules
Traditional access schedules (e.g., alternating weekends or overnight visits) may need to be adjusted for an Autistic child. The schedule must be tailored to the child’s unique behavioural and developmental abilities.
Some Autistic children may struggle with transitions between homes, so minimising the frequency of transitions could be beneficial to their well-being.

- Child Advocate
A court may appoint a child advocate to represent the best interests of the Autistic child during the custody proceedings. The advocate’s role is to make recommendations based on the child’s needs and ensure the court recognises their preferences.

- Financial Considerations
There may be additional financial responsibilities (e.g., therapy, resources, or medical expenses). Parents may need to negotiate how these costs will be shared in a custody arrangement.
Child support payments might be adjusted to account for the child’s long-term needs, especially if they are likely to continue needing support beyond the age of majority.

- Impact on Long-Term Care
Some Autistic children may require care and support beyond the age of 18. This could impact long-term custody and financial arrangements, including who will be responsible for decisions regarding the child’s future care, education and support, and living arrangements.

- Practical Steps for Parents:
* Obtain expert evaluations: Consider getting professional assessments to outline the child’s specific needs.
* Build an ‘umbrella’ over the Autistic child: Regardless of the level of tension or acrimony in the relationship, as much as it is possible to do so, protect your child from these feelings.
* Develop a comprehensive parenting plan: The plan should address all aspects of the child’s care, including schooling, therapy, support and medical needs, and transitions between homes.
* Be flexible: Understand that the child’s needs may change over time, so the custody arrangement may need to evolve.
* Consider mediation or counselling: These can help parents resolve disputes and improve communication, ensuring that the child’s needs remain the priority.
* Be aware that the characteristics of Autism may be different in each household.
* Being present during conflict and acrimony between parents will be distressing for an Autistic child, who is likely to be very sensitive to either parent’s distress. A court may make an order regarding avoiding arguments in the presence of the Autistic child or third-party supervision during times associated with expressed agitation.
* An Autistic child will need to be adequately prepared before access visits and supported when those visits end.


Where to from here?
Tony and Michelle will present a webinar, Autism in the Family, on the 15th of November, 2024. The webinar will help participants understand the effects of Autism on family dynamics and appropriate ways of accommodating Autism within the family.

WEBCAST EVENT: Autism in the Family – 15 November 2024

https://attwoodandgarnettevents.com/product/webcast-event-autism-in-the-family-15-november-2024/

References
Chen et al. (2024) Factors predicting depressive symptoms in parents of children with autism spectrum disorder in eastern China. BMC Public Health. 2024 Jan 18;24(1):226. doi: 10.1186/s12889-024-17731-7.

Freedman, B. H., Kalb, L. G., Zablotsky, B., & Stuart, E. A. (2012). Relationship status among parents of children with autism spectrum disorders: A population-based study. Journal of Autism and Developmental Disorders, 42, 539-548.

02/11/2024

19/10/2024

This is an important topic which has received limited attention.

10/09/2024

This is an important topic that has received limited attention. Autistic individuals are highly vulnerable in experiencing certain situations as potentially traumatic.

Autistic individuals experience a lifetime rate of probable PTSD as high as 60%, with over 40% showing probable PTSD within the last month.
- Rumball et al., 2020

Autistic Individuals may be more vulnerable to developing PTSD due to their unique perception of trauma, with a wider range of life events triggering PTSD symptoms compared to the non-autistic population. This includes non-DSM-5 traumas, which are not always recognised by traditional diagnostic criteria, yet still have significant psychological impacts. As a result, autistic individuals may be at risk of underdiagnosis and inadequate treatment for PTSD, highlighting the need for broader assessments and tailored interventions in this population.

Where to From Here?
To further understand the association of autism with trauma we have developed two brand new events: Trauma and Autistic Children and Teens and Trauma and Autistic Adults.

Children and Teens: https://attwoodandgarnettevents.com/product/webcast-event-trauma-and-autistic-children-and-teens-25-october-2024/

Adults: https://attwoodandgarnettevents.com/product/webcast-event-trauma-and-autistic-adults-25-october-2024/

Reference: Rumball F, Happé F, Grey N. Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events. Autism Res. 2020 Dec;13(12):2122-2132. doi: 10.1002/aur.2306. Epub 2020 Apr 22. PMID: 32319731.

01/09/2024

This is an important contemporary topic that brings many challenges including social, psychological, medical and paedagogical. It is a true that autistic people become (mentally and physically) unwell (also) in their contact with the specificl framework of a neurotypically designed world (e.g. a prime example is how schools are designed). The question about autism is thetefore fundamentally a question about ourselves and our world irrespective of our neurolodevelopmental make up.

What is the Neurodiversity-Affirming Movement?

In recent years, there has been a significant shift in how autism and other forms of neurodivergence – such as ADHD, dyslexia, dyscalculia, dyspraxia, and Tourette’s syndrome – are understood and approached. Traditionally, the medical model dominated, framing these conditions as primarily disorders requiring treatment. However, the rise of the neurodiversity-affirming perspective, rooted in the social model and the disability model has led to a rethinking of these views.

The Neurodiversity-Affirming Movement
The neurodiversity-affirming movement, which began in the 1990s through the advocacy of autistic individuals, challenges the notion of neurodivergence as inherently pathological. This movement posits that neurological differences, including autism, should be understood as variations of human experience rather than deficits or disorders requiring correction. For example, while certain neurodivergent characteristics, such as acute auditory sensitivity or difficulties with working memory, can impede everyday functioning, the neurodiversity-affirming approach emphasises understanding and support rather than treatment or cure. Expecting individuals to perform at the same level as those without these challenges can be seen as discriminatory or ableist (Bottema-Beutel et al 2020).

The social model of understanding autism highlights that many challenges faced by neurodivergent individuals arise from living in a world designed for neurotypical people. For instance, the extent to which communities accommodate neurodivergence in workplaces, schools, and social settings can significantly impact the experiences of neurodivergent individuals. In contrast, the medical model focuses on deficits within autism and ADHD, viewing these conditions as intrinsic problems that require treatment.

What is Neurodiversity Affirming Practice?
Personal preference in terms of autism.
One key aspect of neurodiversity-affirming practice is the language used to describe neurodivergent individuals. For some, this may involve using identity-first language, such as “autistic person,” which emphasises autism as an integral part of their identity. Others may prefer person-first language, such as “person with autism,” which prioritises the individual over the condition. The choice between these language preferences is deeply personal and needs to be respected. Whether an individual prefers identity-first, person-first, or another form of self-identification, the core of neurodiversity-affirming practice is to support and empower them in a way that aligns with their self-conception and lived experience.

A positive identity.
Embracing autism as a positive identity is often chosen by autistic people to de-stigmatise autism and celebrates the strengths inherent in being autistic. Research has shown better mental health outcomes for identity-affirming mental health treatment for autistic (Davies et al 2024) and neurodivergent individuals (Kroll et al, 2024). Identity-affirming practice is not based around the goal of making a person ‘normal’ or ‘not autistic’ but instead the focus is on addressing any underlying mental health concerns such as depression or anxiety in addition to being client-led in creating goals for treatment. Identity-affirming mental health treatment for neurodivergent individuals does not require a medical diagnosis, self-diagnosis is enough. This is based on emerging research that shows no meaningful difference between formally diagnosed and self-diagnosed autistic people on important indices such as autism identity scores, internal stigma, quality of life, and self-esteem (McDonald, 2020).


A Strengths-focus.
A neurodiversity-affirming practice affirms the strengths and abilities in a person’s profile. If you know and/or live with an autistic person, you will know their strengths. These often include personality characteristics such as being honest, compassionate, kind, fair-minded, and loyal. Cognitive strengths often include specialist interests, long-term memory for facts, and ability to hyperfocus on topics of interest. The person often has hyper-developed verbal, visual and sensory talents.

Autistic person as expert.
The medical model views the professional as the expert whilst the neurodiversity-affirming movement acknowledges and actively welcomes the autistic person as being the expert. They draw on standpoint epistemology which views our knowledge as being influenced by our social experience and situation. In the context of the neurodiversity-affirming paradigm, this means that the autistic person, being marginalised in our society has much greater access to knowledge and understanding about their own experience of marginalisation than an expert who is often in a more privileged position of not being marginalised (Chapman & Botha, 2022). There has been some research to support this view that showed that autistic people tended to have a less stigmatizing and more scientifically grounded understanding of autism than non-autistic people (Gillespie-Lynch et al, 2017). Neurodiversity-affirming includes autistic people as collaborators in both research and clinical work about and for autistic people.

Understanding disability and support needs at the individual level:
The neurodiversity-affirming model understands that the strengths and positive identity of autism co-exist with disability because of the context of living in a community that does not understand, accept, or accommodate autism. For example, an autistic individual may be outgoing, friendly, artistic, energetic and a good problem-solver, but still struggle to read people’s intentions and motivations, leading the person to be vulnerable to ‘predators’ in social situations. There is much research now to show that an autistic person is more vulnerable to experiencing all forms of abuse (Berg et al, 2016, Hibbard & Desch, 2007, Kildahl & Helverschou, 2024). This person would benefit from specific social skill interventions to learn how to read people using nonverbal and contextual cues, in addition to asking for help may facilitate keeping that person safe. Considerations for support needs, intervention and therapy need to be individually tailored.

Including the Perspectives of Profoundly Autistic Individuals
While the neurodiversity-affirming movement has been largely shaped by speaking autistic individuals, there is growing recognition of the need to include the perspectives of those with profound autism. The term “profound autism,” introduced in a recent report by the Lancet Commission (Lord et al., 2022), seeks to acknowledge and address the distinct experiences and support needs of individuals whose autism characteristics require significant levels of care and support. Profound autism typically includes those who:
- Are at least 8 years old
- Require 24-hour access to an adult caregiver
- Have a cognitive ability measured by an IQ of less than 50 and/or are non-speaking or have minimal verbal ability

The Lancet Commission emphasised that the DSM-5’s broad categorisation under a single autism spectrum disorder diagnosis may not adequately address the needs of those with significant levels of care and support. While the DSM-5 includes specifiers for intellectual disability and language impairment, these are often underutilised and may not fully represent the diverse needs of autistic individuals. The Commission suggests that this framework may be insufficient for addressing the complexities and varying levels of support required (Lord et al., 2022; Wachtel et al., 2024).

Importantly, it is necessary to challenge the assumption that non-speaking autistic individuals automatically have an intellectual disability. Many non-speaking individuals have average or above-average intelligence and can understand far more than they can express. Their perspectives can be best captured through alternative communication methods, such as visual aids, music, art, and body movements (Lord et al., 2022; Wachtel et al., 2024).


The Impact of the Neurodiversity-Affirming Movement:
The neurodiversity-affirming movement has already brought significant changes to how autism is understood, discussed, and researched. Autism-first language is now widely used by authors, clinicians, and researchers. The principle of, “Nothing about me without me” championed by Dr Wenn Lawson ( https://autism.org/autism-research-nothing-about-me-without-me/) has been embraced by the research community worldwide where increasingly journals will only accept papers about research that include autistic people as collaborators and/or co-authors.

Autistic people are being recognised as being experts on autism through lived experience, and there is a move to include self-diagnosed autistic people as participants in research on autism, where before only formally diagnosed people would be included.

The ‘internal presentation’ of autism, previously known as ‘the female autism phenotype’, is being embraced and researched. Since it is hidden, being well masked and camouflaged, the internal presentation of autism can only be truly understood by listening to and believing the person’s lived experience.

Psychologists to Embrace Neurodiversity – New Competency Guidelines Introduced:
As the neurodiversity-affirming movement continues to influence practices and policies, it is crucial to ensure that all voices within the autistic community, including those with profound autism, are heard and respected. The Psychology Board of the Australian Health Practitioners Association (AHPRA) announced recently new guidelines about how to meet the professional competencies associated with working with diverse groups of people as a psychologist which will take effect in December 2025. These guidelines emphasise the importance of understanding and supporting the unique needs of all individuals, regardless of where they fall on the autism spectrum (AHPRA, Competency 7.9, 2024).

By embracing neurodiversity and fostering inclusive environments, we can create a society that values and supports the diverse experiences and strengths of all its members.


Where To From Here?
We have created a two-day Masterclass: Diagnosis, Support and Therapy for Autistic Teenagers for professionals and those interested in increasing their understanding of autism and ADHD within the framework of the neurodiversity-affirming model. The course, co-designed and presented by Michelle, an AuDHD clinical psychologist with over 30 years of experience specialising in autism, will be offered live-in-the-room and via live webcast in London on 16th and 17th January, 2025.

https://attwoodandgarnettevents.com/product/webcast-event-and-live-in-london-day1-diagnosis-for-autistic-teenagers-16-january-2025/

https://attwoodandgarnettevents.com/product/webcast-event-and-live-in-london-masterclass-day-2-support-and-therapy-for-autistic-teenagers-17-january-2025/

References
AHPRA, (2024) Competency 7.9, retrieved from Fact Sheet Competency 7; https://www.psychologyboard.gov.au/Standards-and-Guidelines/Professional-practice-standards/Professional-competencies-for-psychology.aspx.

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