Neurodiversity Affirming Care in Child and Play Therapy
Over the past few decades, the neurodiversity paradigm and movement have emerged as a call to shift outdated and often harmful ableist narratives about neurodivergent individuals and produce more affirming support and therapy. For practitioners, this shift involves understanding and implementing neurodiversity affirming care. Dr. Megan Anna Neff (Neurodivergent Insights) describes neurodivergent-affirming care as a therapeutic approach that creates an environment and therapy plan rooted in a deep understanding of neurodivergence. It emphasizes supporting individuals through their challenges and making accommodations for their needs. This approach views neurodivergence not as a flaw that needs correction but as a distinct neurotype or brain style that is an integral part of an individual’s identity. The goal is to empower neurodivergent individuals to recognize and leverage their strengths, navigate their challenges, and make adjustments tailored to their personal requirements.
When practitioners respect and value neurodiversity, it’s good for neurodivergent children’s mental health, self-worth, and identity. Neurodivergent people bring many strengths to society. These include strengths related to innovation, analytical thinking, creativity, and expertise in areas of special interest. Providing neurodiversity affirming care is about accepting, including, celebrating, and supporting neurodivergent children and understanding that their differences are part of natural variation.
Unfortunately, there is a considerable history of lack of support, invalidating, and misunderstanding neurodivergent children. It has taken neurodivergent adults through the neurodiversity movement to begin important changes needed to better help neurodivergent clients. It is important for practitioners to realize the harm and possible trauma that previous therapeutic approaches have caused neurodivergent individuals. Understanding neurodiversity affirming care and how theories and approaches align with affirming practices can ensure progression from past therapy failures to a new paradigm focused therapy that helps, promotes growth, empowers, and produces positive mental health care for neurodivergent children.
Any efforts toward working with neurodivergent children (including mental health therapy) must begin with an understanding of a person’s own ableist ideas and conditioning. Practitioners should commit to an ongoing cultural humility process regarding neurodiversity (“I don’t know what I don’t know”) and continue to learn and stay open to better understanding. The following is a list of important neurodiversity affirming practices for child and play therapy work. It is not intended to be a complete list. It is provided to help practitioners better understand neurodiversity affirming care application.
1. Neurodiversity means that neurological diversity exists as a natural part of human variation, and there is no such thing as a “normal” brain. Variation in neurology is natural, and there is no singular right way. Practitioners monitor and regulate their own responses and biases, particularly when neurodivergent expressions challenge neurotypical expectations.
2. Neurodivergent children (autistic, sensory differences, ADHD, learning differences, HSP, PDA, gifted, etc.) are not in play therapy simply because they are neurodivergent. They are in therapy because they have needs such as anxiety, regulation challenges, trauma issues, social needs, parent/child relationship issues, or other mental health needs. Neurodivergence is understood as part of a child’s identity, requiring different methods of implementing child and play therapy to align with the child’s neurotype. This understanding should inform how the child’s neurotype is described and supported in the therapeutic plan.
3. Children’s play preferences and special interests should be honored. All neurodivergent children play and there are multiple valid ways to engage in play. Each child’s preferred type of play should be respected, and neurodivergent children should not be forced to play in a specific way. Play may include digital environments, abstract systems, or object-focused routines and should be recognized as meaningful, valid, and therapeutic.
4. Children’s voices are encouraged, heard, and valued in identifying their needs, setting goals, and shaping the therapeutic process. Children should have a say in what needs they want to address and be granted freedom and flexibility to navigate therapy at their own pace with support in place that fosters autonomy.
5. Play approaches and interventions should not promote masking and camouflaging (the act of hiding or suppressing one’s authentic self to appear more “typical”). Instead, focus should be on strengths: helping children value their authentic selves, recognizing what they already do well, and communicating value. Strengths can be used as entry points for therapeutic growth, resilience-building, and achieving identified therapy goals.
6. Neurodivergent children may experience compounded marginalization based on other aspects of identity, and affirming care should be culturally responsive and take into consideration intersectionality needs. Additionally, procedures should be in place to understand language use and respect client choices such as identity first language.
7. Body autonomy (consent to participate, sensory needs, touch boundaries) is respected. All children should be treated as capable and worthy of making choices about their bodies and participation. Professionals should not insist on or push a child to participate in an intervention or theory protocol that ignores their neurodivergent differences and disregards their body autonomy.
8. Competence is presumed. Each child is capable of understanding, communicating, and engaging meaningfully, even if they do so differently.
9. Communication differences are valid expressions, not deficits. Verbal communication is not the only form of communication. The use of AAC devices, movement, scripting, echolalia, gestures, play, and other forms of communication should be recognized and accommodated.
10. Different ways of navigating are recognized as valid. Differences are not bad, wrong, or problematic. Differences in thinking, feeling, and behaving are supported, not pathologized. The goal is to support each child in navigating the world in a way that is aligned with their authentic self, not to change a child to “appear” neuronormative.
11. Relationship development is a core process in child and play therapy. Establishing a therapeutic relationship is key to working with neurodivergent children and their families. The relationship begins at first contact and is intentionally maintained throughout the therapeutic journey, fostering trust, safety, and connection.
12. Play is the natural language of children. The therapeutic powers of play are a grounding principle in play therapy work. Play is a change agent, not a tool used as a manipulator to create a “change agent”. Play is never withheld or used as a reward to gain compliance.
13. Supporting neurodivergent children in child and play therapy will likely require advocating for inclusion, accommodations, accessibility, and support needs.
14. Neurodiversity affirming care includes understanding neurodivergent related concepts such as:
* Social Model of Disability. Disability created by societal barriers, not the individual.
* Double Empathy Problem (Theory): Mutual misunderstandings occur when individuals with different life experiences or neurotypes find it difficult to empathize with each other due to fundamentally different perspectives on the world and social interactions.
* Alexithymia: A personality trait characterized by the inability to identify and describe one’s emotions with traditional emotional expression.* Masking: The act of hiding neurodivergent features and/or characteristics. Also, hiding one’s identity as being neurodivergent in response to neurotypical expectations to act a certain way.
* Stimming: Self-regulatory repetitive thoughts, words, or body movements/actions such as hand flapping.
* Rejection Sensitive Dysphoria: A form of emotional dysregulation commonly observed in ADHD and other neurodivergence. Individuals may feel distress and pain as a result of perceived or actual rejection, teasing, or criticism.
* Monotropism: A processing style, or way of thinking marked by a strong focus on a limited number of items, often excluding input outside of the person’s focus.
* PDA Presentation (Pathological Demand Avoidance or Persistent Desire for Autonomy): Displaying a strong need for autonomy and control, requiring unique supports, and being socially oriented.
15. The child and play therapy process will likely require a prescriptive or integrative therapy approach. The therapy approach and process should be individualized to the unique neurotype of each child, understanding their neurodivergent spectrum of presentation.
16. Sensory systems and regulation needs are supported. Each child’s sensory experiences are recognized by proactively creating sensory-safe environments and offering regulation support such as movement breaks, sensory tools, and environment adjustments without judgement.
17. Caregivers and families are considered partners in the child and play therapy process. Collaboration should occur with families and caregivers to support neurodiversity-affirming practices across environments, helping families better understand and support their child’s needs. Psycho education or neurodiversity affirming family play therapy with parents can help them to support and not “other” their children or emphasize masking in an unintentional attempt to match them to neuronormative standards. Caregivers can give neurodivergent children a boost of regulatory resilience from home, versus the continuing onslaught of demand from outside systems such as an educational setting.
18. Practitioners support caregivers in recognizing that developmental stages for neurodivergent children may not overlap neuronormative expectations. Neurodiversity affirming therapy does not treat neurodivergent children to imitate the neurotypical expectations for their age, which could be another form of masking. Instead, emphasis is placed on engaging with the neurodivergent child at their current stage and supporting them where they are, while simultaneously educating caregivers on developmental vs chronological stages. Neurodivergent children navigating at their own pace is important to avoid gaps in attachment connections, shame in identity, and feelings of being wrong based on ableist standards of development that are not inclusive of more neurodivergent trajectories.
19. Practitioners support caregivers to identify sources of connection attempts from their children and help to normalize neurodivergent expressions of communication and connection. Care is given to support parents in identifying those attempts to connect, as they may or may not reflect neuronormative examples of engagement, i.e. a neurodivergent child may request reading to them the same book on repeat, speak to them about the same topic for hours, respond to them without words, ask them to turn on and off a light switch for them/with them, avoid eye contact, not reference them on cue, and become dysregulated if they are not joining in their child’s attention.
20. Neurodivergent children may experience trauma differently: Trauma in neurodivergent children is often rooted in chronic invalidation, social exclusion, pressure to mask, misattuned caregivers, and systemic ableism. These experiences may not always be recognized as “trauma” by traditional models, but they impact regulation, attachment, identity development, and safety. Practitioners should affirm that trauma can arise not only from acute events but also from ongoing relational and environmental harm.
21. Neurodivergent children may be struggling with a variety of mental health needs that are addressed through a therapy plan. Therapy goals should always be rooted in reducing neurodivergent distress and promoting positive neurodivergent mental health. (affirming identity awareness, self-worth, self-advocacy, and autonomy).
22. Child and play therapy theories and protocols should conform to the neurodivergent child’s spectrum of presentation. Theories and protocols should be adapted to fit the neurodivergent child. The child should not be forced into a theory or protocol which disregards their neurodivergent self or way of being.
Practitioners can also complete the AutPlay® Therapy Neurodiversity Affirming Care –
Practitioner Self-Assessment Checklist located on the AutPlay Therapy website (www.autplaytherapy.com). This self assessment tool can help practitioners better conceptualize the application of the 22 constructs and explore their own bias and areas for further growth.
Citation: Grant, R. J. (In collaboration with the AutPlay Therapy Advisory Board) (2025, July 2nd). Neurodiversity affirming care in child and play therapy. AutPlay Therapy.
