A neuro-affirming approach does not mean ignoring disability or support needs. It means understanding the whole person, recognising individual strengths and differences, respecting identity and autonomy, and considering how environments and expectations can either support or create barriers to participation.

The descriptions below provide accessible, clinically informed explanations of neurodevelopmental conditions and associated experiences. They are informed by current diagnostic frameworks and clinical guidance, while recognising that a diagnosis never describes the whole person.

Autism

Autism is a lifelong neurodevelopmental difference that can influence how a person experiences and understands the world, communicates and connects with others, and responds to their environment.

Autistic people may experience social communication, interaction, predictability, attention and sensory information differently from non-autistic people. This can include deep and focused interests, a preference for routine and predictability, distinctive ways of communicating, repetitive or regulating movements, and heightened or reduced sensory experiences.

Autism is a spectrum, but this does not mean a simple scale from “mild” to “severe”. Every autistic person is different, with their own combination of strengths, needs, interests, communication styles, experiences, and ways of interacting with the world.

Some autistic people may need substantial support in particular areas of their lives, while others may need less support or may have developed strategies that help them navigate environments that work well for them. Support needs can also vary depending on the person, their environment, and the situation.

A neuro-affirming approach recognises that autistic people may communicate, connect and experience the world differently. These differences are respected as part of who a person is, with support focused on helping them feel understood, valued and able to thrive in ways that work for them.

This means taking the time to understand each person as an individual, recognising their strengths, preferences and support needs, and creating environments where they can feel comfortable, understood and included. Neuro-affirming support respects autonomy and individuality, while recognising that the right support and reasonable adjustments can make a meaningful difference to a person’s everyday life.

Current clinical frameworks describe the characteristic features of autism, while NICE also emphasises individualised care, autonomy, strengths, preferences and the interaction between the person and their social and physical environment.

ADHD - Attention Deficit Hyperactivity Disorder

ADHD is a neurodevelopmental condition associated with differences in the regulation of attention, activity and impulses.

People with ADHD may experience differences in sustaining or shifting attention, working memory, planning, organisation, time perception, task initiation, task completion, activity levels and impulse regulation. Emotional regulation can also be an important part of the lived experience of ADHD.

Attention in ADHD is often better understood as attention regulation rather than simply a lack of attention. A person may experience periods of intense and sustained focus when something is interesting, meaningful, novel, rewarding or urgent, while finding less stimulating or highly structured tasks much harder to engage with.

ADHD is highly individual. People may bring energy, curiosity, spontaneity, creativity, enthusiasm, problem-solving approaches and a different perspective to situations, alongside areas where their environment or expectations may create barriers.

A neuro-affirming approach focuses on understanding the person's individual profile and identifying ways of working with their brain rather than expecting them to continually compensate for differences.

NICE recommends considering individual strengths, goals, resilience, environmental modifications and the person's wider occupational, social and educational context when planning support for ADHD.

Rejection sensitivity and Rejection Sensitive Dysphoria

Rejection sensitivity refers to a tendency to anxiously expect, readily perceive or strongly respond to possible rejection, criticism or social evaluation. It is not specific to ADHD and can occur in many different contexts.

Rejection Sensitive Dysphoria (RSD) is a term used particularly within ADHD communities to describe an intense emotional response to perceived or actual rejection, criticism or failure.

RSD is not currently a recognised standalone diagnosis and is not a diagnostic criterion for ADHD. It is therefore important to distinguish the lived experience described by the term from formal diagnostic terminology.

For some people, perceived rejection can produce a very rapid and intense emotional response, including hurt, shame, anxiety, anger or withdrawal. Understanding this experience can help people develop greater self-understanding and identify strategies that support emotional regulation, relationships and participation.

A neuro-affirming approach takes these experiences seriously without labelling the person's emotional response as a character flaw or assuming that their interpretation is simply “overreacting”.

Dyslexia

Dyslexia is a developmental learning difference involving persistent differences in acquiring and using reading and spelling skills.

It particularly relates to the development of accurate and fluent word reading and spelling and may involve differences in phonological and language processing. Dyslexia is heterogeneous, meaning that it presents differently from person to person.

Some people may find decoding, reading fluency or spelling particularly effortful, while others may have developed highly effective strategies for working with written information.

Dyslexia is recognised within current diagnostic frameworks as a developmental learning disorder affecting reading. The 2025 Delphi consensus work on dyslexia also emphasises the importance of recognising its heterogeneity rather than assuming a single presentation.

A neuro-affirming approach recognises different ways of learning and processing information and considers how education, employment and everyday environments can be made more accessible.

Developmental Coordination Disorder (DCD / Dyspraxia)

Developmental Coordination Disorder (DCD) is a neurodevelopmental condition affecting the development and performance of coordinated motor skills.

People with DCD may experience differences in motor planning, coordination, balance, sequencing and the learning or performance of everyday motor activities. This can influence activities such as handwriting, typing, dressing, cooking, using tools, driving, sport or other occupations.

The impact of DCD is highly individual. People often develop their own strategies, adaptations and ways of approaching activities.

Dyspraxia is a widely used term in the UK, while Developmental Coordination Disorder (DCD) is the recognised clinical term.

A neuro-affirming occupational therapy approach builds on the person's existing strategies and strengths while considering whether changes to tasks, equipment or environments could make participation easier.

Dyscalculia

Dyscalculia describes persistent differences in acquiring and using mathematical and numerical skills.

These may involve understanding quantities and numerical relationships, learning arithmetic facts, calculation, mathematical reasoning or working efficiently with numerical information.

Within current diagnostic frameworks, dyscalculia is understood within developmental learning disorder with impairment in mathematics / Specific Learning Disorder with impairment in mathematics.

For some people, these differences may affect formal education, while for others they may become particularly noticeable in everyday activities involving money, time, measurements, budgeting, schedules or numerical information.

A neuro-affirming approach recognises individual ways of understanding and working with numbers and looks for practical strategies and adaptations that support autonomy and participation.

Sensory processing differences

Sensory processing describes how we receive, organise and respond to information from our senses and from within our bodies.

Sensory experiences are individual. A person may experience some sensory information very intensely, may notice certain sensations less readily, or may actively seek particular types of sensory input.

This can involve sound, light, touch, movement, smell, taste, temperature, visual information, proprioception, vestibular information or internal bodily sensations.

Sensory differences can also be regulating and meaningful. Movement, repetition, pressure, texture, sound or other sensory experiences may help a person to concentrate, communicate, regulate arousal or feel comfortable.

Sensory processing is particularly relevant to occupational therapy because the sensory environment can influence how people participate in everyday activities.

The term Sensory Processing Disorder (SPD) is sometimes used, but it is not currently recognised as a standalone diagnosis in ICD-11 or DSM-5-TR. I therefore generally use sensory processing differences and consider these within the person's wider developmental, health and occupational profile.

Tourette syndrome

Tourette syndrome is a neurodevelopmental tic condition involving multiple motor tics and at least one vocal (phonic) tic, with onset during the developmental period and persistence for at least one year.

Tics can involve movements, sounds or vocalisations and may change considerably over time. Some people experience a premonitory urge before a tic and may be able to suppress a tic temporarily, although this can require significant effort.

Tics can wax and wane and may be influenced by factors such as excitement, stress, fatigue and the environment.

Tourette syndrome is much broader than the stereotypes sometimes portrayed in popular culture. Coprolalia, the involuntary production of socially inappropriate words or phrases, is not required for diagnosis and is relatively uncommon.

People with Tourette syndrome have individual personalities, interests, strengths and ways of communicating, just like everyone else. A neuro-affirming approach considers whether the environment is creating unnecessary pressure to suppress natural movement or vocalisation and focuses on what helps the individual participate comfortably and authentically.

Mental health and neurodivergence

Mental health conditions and neurodevelopmental differences can overlap and co-occur, but they are not interchangeable.

Experiences such as anxiety, depression and OCD may occur alongside autism, ADHD and other neurodevelopmental conditions, while also occurring independently.

A person's mental health can be influenced by many factors, including life experiences, relationships, environment, discrimination, sensory demands, social expectations and access to appropriate support.

A neuro-affirming approach considers the whole context rather than assuming that distress is an inherent part of being neurodivergent.

Co-occurring and associated conditions

Neurodivergent people may also experience a range of physical health conditions, mental health conditions and other health or learning differences.

These conditions are not all forms of neurodivergence, but they can interact with a person's neurodevelopmental profile and influence energy, sensory experiences, cognition, emotional wellbeing and participation.

Every person's combination of experiences is different. Understanding these interactions can help identify what supports wellbeing, autonomy and meaningful participation.

ME/CFS - Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

ME/CFS is a complex, long-term condition involving a characteristic combination of symptoms including post-exertional malaise (PEM), fatigue, unrefreshing sleep and cognitive difficulties.

PEM is a worsening of symptoms following activity and may occur after physical, cognitive, emotional or social exertion. It can be delayed and may result in a prolonged recovery period.

ME/CFS is highly individual and can fluctuate over time. People often develop detailed knowledge of their own energy, patterns, environments and limits.

NICE describes energy management as a personalised, flexible approach led by the person, recognising that each person's energy limit can fluctuate. It is not an exercise programme and should not involve automatically increasing activity.

Long Covid / Post-COVID-19 condition

Post-COVID-19 condition, commonly known as Long Covid, describes longer-term health effects following COVID-19 infection.

Symptoms vary widely and may include fatigue, post-exertional symptom exacerbation, breathlessness, cognitive changes, pain, sleep disturbance and other physical or autonomic symptoms.

WHO's clinical definition recognises that symptoms may fluctuate or relapse and may affect everyday functioning. Long Covid can affect people regardless of the severity of their initial infection.

People living with Long Covid often develop considerable awareness of their own energy, symptoms and environmental needs. A person-centred approach supports them to understand their individual patterns and find sustainable ways of engaging in meaningful activities.

Anxiety

Anxiety is a normal human response to uncertainty, threat or perceived danger. Anxiety disorders occur when anxiety or fear becomes persistent or excessive and significantly affects a person's wellbeing or everyday life.

Anxiety can influence concentration, sleep, decision-making, sensory tolerance and participation.

A neuro-affirming approach explores the person's experience with curiosity and compassion and considers how their environment, sensory needs, communication, previous experiences and current circumstances may contribute to anxiety.

Depression

Depression is a mental health condition involving persistent changes in mood and associated emotional, cognitive, physical and behavioural experiences.

It can affect interest, motivation, energy, sleep, appetite, concentration and participation in everyday activities.

People experiencing depression remain individuals with their own identity, interests, relationships, strengths and aspirations. Support can recognise these alongside the impact depression may currently be having on their lives.

Obsessive-Compulsive Disorder (OCD)

OCD is characterised by obsessions, compulsions or both.

Obsessions are recurrent and intrusive thoughts, images or urges, while compulsions are repetitive behaviours or mental acts that a person feels driven to perform.

OCD is a distinct clinical condition and can co-occur with autism, ADHD and Tourette syndrome.

A neuro-affirming approach recognises the difference between someone's identity, personality and values and the experiences associated with OCD, while respecting the person's autonomy and individual understanding of their experience.

Eating differences, eating difficulties and eating disorders

Eating is a complex occupation influenced by sensory processing, interoception, appetite, gastrointestinal health, anxiety, executive functioning, medication, culture, previous experiences and many other factors.

Neurodivergent people may experience individual sensory preferences around taste, texture, smell, temperature, appearance or the environment in which food is eaten.

Some people experience an eating disorder that meets recognised diagnostic criteria, while others experience significant eating difficulties without meeting criteria for an eating disorder.

A neuro-affirming approach avoids shame and judgement and seeks to understand the person's individual relationship with food, their body, sensory experiences and environment.

Learning disability / intellectual disability

Learning disability and specific learning difficulties are not interchangeable terms.

In UK practice, learning disability generally refers to intellectual disability: a lifelong difference involving intellectual functioning and adaptive functioning that begins during the developmental period.

Specific learning difficulties, such as dyslexia and dyscalculia, affect particular areas of learning and are distinct from intellectual disability.

People with intellectual disability have individual communication styles, interests, abilities, personalities and support needs. A person-centred approach prioritises autonomy, choice, accessible communication, meaningful participation and the person's right to direct their own life.

Autoimmune, chronic and other health conditions

Neurodivergent people may also live with autoimmune conditions, chronic pain, migraine, gastrointestinal conditions, epilepsy, sleep conditions and other long-term health conditions.

These experiences can interact with energy, sensory processing, cognition, emotional wellbeing and everyday occupations.

A holistic occupational therapy approach recognises the person's existing knowledge, adaptations, resilience and expertise in their own experience and works collaboratively to identify what enables them to participate in the things that matter to them.

A neuro-affirming Occupational Therapy approach

Neuro-affirming Occupational Therapy is grounded in respect for neurodivergent identity, autonomy, individual ways of being and the right to participate on one's own terms.

I take time to understand the person beyond any diagnostic label: their interests, values, relationships, communication, sensory world, ways of thinking, physical and emotional wellbeing, strengths, aspirations and the occupations that bring meaning to their life.

Occupational therapy looks at the relationship between the person, their occupations and their environment. This means that support is not simply about asking a person to adapt themselves to existing expectations. It can also involve changing the task, environment, systems or expectations around them.

Support may include adapting environments and tasks, developing sustainable strategies, exploring sensory and regulation needs, supporting executive functioning, using assistive technology, reducing unnecessary barriers or finding different ways of approaching everyday occupations.

The focus is on agency, participation, wellbeing and quality of life: enabling people to understand themselves, use their strengths, make informed choices and create environments and routines in which they can flourish.

I work with people who have a formal diagnosis as well as people who self-identify as neurodivergent.

The aim is to work collaboratively with each person to identify what helps them thrive, what matters to them and what enables them to participate in life in ways that are authentic, meaningful and sustainable.