TL;DR

• The problem: Most therapy for autistic and neurodivergent people was designed by and for neurotypical brains, and research now shows it frequently causes harm rather than healing.

• The shift: Neuroaffirming therapy starts from a fundamentally different premise, that neurodivergence is not a deficit to be corrected but a way of being to be understood and supported.
• What it looks like: Client-led, strength-based, identity-affirming practice that treats the whole person, not a checklist of symptoms.
• An unexpected fit: Adlerian Individual Psychology, a framework from the early 20th century, aligns more naturally with neuroaffirming principles than most approaches developed in the last 50 years.
• How I work: My practice draws on neuroaffirming principles and Adlerian theory to offer therapy that starts from the assumption that you are not broken.

When my son was young, the advice was consistent: redirect the perseveration, broaden the focus, discourage the fixation on airplanes.

We didn’t follow it.

He became a pilot. He found his people, a community of others who speak the same language of flight, who share the same intensity of interest, who understand exactly what it means to know something that deeply. What looked like a problem to manage turned out to be the path to his vocation, his identity, and his belonging.

That experience has shaped how I think about neurodivergence in the therapy room more than almost anything I’ve read in the research literature. And I’ve read a lot of the research literature.

The Problem with “Standard” Therapy

Here is what the research actually says about mental health care for autistic and neurodivergent adults; it is failing them. Significantly and consistently.

Between 75% and 80% of autistic adults experience at least one co-occurring mental health condition, most commonly anxiety, with rates as high as 84%, and depression at approximately 57% (Micai et al., 2023; Wichers et al., 2023). These are not rare exceptions. They are the norm. And yet autistic adults consistently report unmet mental health needs and widespread dissatisfaction with the services available to them (Khudiakova et al., 2026).

So why are so many neurodivergent people still falling through the cracks?

Part of the answer is access. But a larger part of the answer is fit. The therapeutic frameworks most widely used with neurodivergent populations, applied behavior analysis (ABA), social skills training (SST), and cognitive behavioral therapy (CBT), were designed primarily by and for neurotypical people. They tend to measure therapeutic success by how closely a neurodivergent person can approximate neurotypical behaviour.

That orientation is a problem. Recent scholarship puts it plainly; standard approaches frequently exacerbate rather than alleviate psychological distress, in large part because they target core autistic traits rather than co-occurring symptoms, reinforcing camouflaging and undermining autistic identity (Graf-Kurtulus & Gelo, 2025; Wichers et al.. 2023).

Camouflaging, or masking, the sustained, cognitively exhausting effort to mask neurodivergent characteristics in order to appear neurotypical, is not a therapeutic goal. It is a trauma response. And yet many of the frameworks’ clinicians are trained to inadvertently encourage it. The research on what camouflaging costs is unambiguous; it is directly associated with anxiety, depression, autistic burnout, identity disruption, and suicidality (Alaghband-rad et al., 2023; Hull et al., 2017).

The cumulative effect of sustained masking produces what Arnold et al. (2023) describe as autistic burnout: a state of profound physical and mental exhaustion, reduced executive function, and decreased social tolerance that can be debilitating and long-lasting. When therapy asks a neurodivergent person to become better at hiding who they are, it is not helping. It is causing harm.

What Neuroaffirming Therapy Actually Means

Neuroaffirming therapy is not a single modality or a specific set of techniques. It is a fundamental reorientation in how we understand the purpose of therapy itself.

At its core, neuroaffirming practice starts from a different premise; that neurodivergence (autism, ADHD, dyslexia, sensory processing differences, and related profiles) is not a deficit to be corrected. It is a neurological difference to be understood, accommodated, and affirmed.

In practice, this means several things.

It is client-led. The neurodivergent person drives their own therapeutic journey. When working with parents, it means supporting a child-led approach rather than imposing a compliance-based framework. The person in the room, regardless of whether they are verbal, nonspeaking, a child, or an adult, is the expert on their own experience.

It is strength-based without being naive. Neuroaffirming therapy does not pretend that being neurodivergent is easy or that challenges don’t exist. It acknowledges strengths within the context of real difficulties. My son’s intense focus on aviation was not a problem to be managed away, but that doesn’t mean his path was without struggle. Both things were true. Neuroaffirming practice holds both.

It does not try to fix people. Therapy is a process of empowerment and growth, not remediation. The question is never “how do we make this person more neurotypical?” It is “what does this person need in order to live a life that feels meaningful, connected, and sustainable for their particular brain?”

It takes intersectionality seriously. Being autistic and Black, or autistic and transgender, or autistic and a recent immigrant shapes a person’s experience in ways that cannot be separated out. Research documents that Black, Indigenous, and People of Colour (BIPOC) autistic individuals face a compound adverse impact, a convergence of racial marginalization and neurodivergent stigma that operates simultaneously across clinical, educational, and occupational contexts (Doyle et al., 2022). Neuroaffirming practice recognizes that therapy must account for the whole person, not just the diagnosis.

It insists on autonomy. Historically, neurodivergent individuals have been excluded from the planning and design of their own treatment. Their voices have been minimized. Their reported experiences have been discounted. Neuroaffirming practice treats autonomy as non-negotiable, including for individuals who communicate differently or who need support to express their preferences.

An Unexpected Framework That Gets This Right

Here is something that surprised me when I began looking seriously at the research on neuroaffirming practice; one of the frameworks most naturally aligned with these principles was developed over a hundred years ago.

Alfred Adler, the Austrian psychiatrist who founded Individual Psychology in the early 20th century, built a therapeutic framework around a set of ideas that feel remarkably relevant when read through a neuroaffirming lens (Rasmussen, 2024).

Social interest, what Adler called Gemeinschaftsgefühl, is the human need for genuine belonging and contribution to community. Not conformity to the community. Not performance of belonging. Genuine connection, on one’s own terms. Social interest has been empirically linked to improved psychological health outcomes and functions as both a therapeutic goal and a mechanism of change (Kato, 2024; Koç & Uzun, 2024). For neurodivergent people who have spent years being told that their natural ways of relating are wrong, the distinction between truly belonging and merely fitting in is not semantic. It is the difference between healing and harm.

Authentic belonging is the natural extension of this. Adlerian therapy is interested in whether a person feels genuinely connected to the people and communities that matter to them, not whether they can pass as someone who belongs. This maps directly onto what the research identifies as a core need for autistic adults, many of whom describe a lifetime of social exclusion not because they lack the desire for connection but because the environments around them were not built to include them (Khudiakova et al., 2026).

Encouragement, not praise, not reward, but genuine recognition of a person’s strengths, efforts, and capacity, is central to Adlerian practice. For neurodivergent individuals who have often received a lifetime of correction and deficit-focused feedback, the therapeutic use of encouragement is not a soft add-on. It is clinically significant (Kato, 2024).

Lifestyle assessment, understanding the whole person through their unique patterns of meaning-making, their early experiences, their private logic about how the world works and what they must do to survive in it, is how Adlerian therapy individualizes care. There is no generic treatment plan. There is this person, this history, this set of beliefs about self and others and the world.

Teleological behavior, the Adlerian principle that behaviour is purposeful and goal directed rather than simply reactive, changes everything about how we understand neurodivergent presentations. The child who is labeled defiant. The adult who is labeled difficult. The teenager who is labeled unmotivated. Adlerian therapy asks: what is the goal of this behavior? What is this person trying to achieve, protect, or communicate? That question, applied to neurodivergent experience, aligns closely with what Milton et al. (2023) describe as the double empathy problem, the recognition that social difficulties arise not from deficits within the autistic person but from a bidirectional mismatch between neurodivergent and neurotypical communication styles. When we understand behaviour as purposeful and contextually meaningful, we stop pathologizing differences and start trying to understand it.

Where most standard approaches ask what needs to change about this person, Adlerian therapy asks what does this person need in order to belong, contribute, and thrive as they are. That is fundamentally different, and I would argue fundamentally more ethical, place to begin.

Why This Matters Beyond the Therapy Room

I want to be honest about something; this is not an abstract clinical question for me.

As a neurodivergent person, I know what it feels like to navigate systems that were not designed with your brain in mind. I know what it costs to perform neurotypicality in spaces that demand it. And I know how rare, and how genuinely healing, it is to encounter a framework that begins from the assumption that you are not broken.

I also know, from watching my son find his path, that the things that look like problems from the outside are often the things that matter most. The intensity. The specificity. The refusal to be interested in things that don’t genuinely interest you. These are not deficits. They are, in the right context, extraordinary. Neuroaffirming therapy is not a niche specialty. It is what ethical, evidence-informed care for neurodivergent people looks like. And as the research continues to make clear, the cost of getting this wrong, of asking neurodivergent people to mask, conform, and shrink in the name of treatment, is not theoretical. It shows up in the anxiety rates, the depression rates, the burnout, and the suicidality (Alaghband-rad et al., 2023; Micai et al., 2023).

We can do better. The frameworks exist. The research supports the shift. What’s needed now is clinicians willing to practice from a different premise, and neurodivergent individuals who know they deserve care that actually sees them.

References

Alaghband-rad, J., Hajikarim-Hamedani, A., & Motamed, M. (2023). Camouflage and masking behavior in adult autism. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1108110

Arnold, S. R., Higgins, J. M., Weise, J., Desai, A., Pellicano, E., & Trollor, J. N. (2023). Confirming the nature of autistic burnout. Autism, 27(7), 1906-1918. https://doi.org/10.1177/13623613221147410

Doyle, N., McDowall, A., & Waseem, U. (2022). Intersectional stigma for autistic people at work: A compound adverse impact effect on labor force participation and experiences of belonging. Autism in Adulthood, 4(4), 340-356. https://doi.org/10.1089/aut.2021.0082

Graf-Kurtulus, S., & Gelo, O. C. G. (2025). Rethinking psychological interventions in autism: Toward a neurodiversity-affirming approach. Counselling & Psychotherapy Research, 25(1). https://doi.org/10.1002/capr.12874

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal:” Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534. https://doi.org/10.1007/s10803-017-3166-5

Kato, S. (2024). Encouragement as a form of social support promoting boundary crossing and the development of a courage scale. The Journal of Individual Psychology, 80(1), 34-59. https://doi.org/10.1353/jip.2024.a922703

Khudiakova, V., Sin, J., Suzuki, M., & Barnicot, K. (2026). Lived experience, family, and clinician perspectives on barriers to adult autism diagnosis and post-diagnostic supports: A mixed-methods systematic review. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-026-10055-x

Koç, M. S., & Uzun, B. (2024). The role of mindfulness in the relationship between social interest and psychological health. The Journal of Individual Psychology, 80(1), 15-33. https://doi.org/10.1353/jip.2024.a922702

Micai, M., Fatta, L. M., Gila, L., Caruso, A., Salvitti, T., Fulceri, F., Ciaramella, A., D’Amico, R., Giovane, C. D., Bertelli, M., Romano, G., Schünemann, H. J., & Scattoni, M. L. (2023). Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 155. https://doi.org/10.1016/j.neubiorev.2023.105436

Milton, D. E. M., Waldock, K. E., & Keates, N. (2023). Autism and the ‘double empathy problem.’ In F. Mezzenzana & D. Peluso (Eds.), Conversations on empathy (pp. 78-97). Routledge. https://doi.org/10.4324/9781003189978-6

Rasmussen, P. R. (2024). The Adlerian model: Core theoretical components. The Journal of Individual Psychology, 80(20), 99-115. https://doi.org/10.1353/jip.2024.a929765

Wichers, R. H., van der Wouw, L. C., Brouwer, M. E., Lok, A., & Bockting, C. L. H. (2023). Psychotherapy for co-occurring symptoms of depression, anxiety and obsessive-compulsive disorder in children and adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 53(1), 17-33. https://doi.org/10.1017/S0033291722003415