Neurodiversity-Affirming Therapy: What It Is and What It Leaves Out
A Clinical Look at Evolving Models for Treating ADHD, Autism, and Other Neurodivergent Conditions
“Neurodiversity-affirming” therapy is everywhere—from TikTok to Psychology Today profiles—but what does it actually mean? And does it help?
In this post, we’ll break down what neuroaffirming therapy aims to offer, how it differs from traditional approaches, and why some clinicians believe it may be overlooking critical aspects of mental health care—particularly for adults dealing with chronic distress or functional impairment.
What Is Neurodiversity-Affirming Therapy?
Neurodiversity-affirming therapy reframes conditions like ADHD, autism, and learning differences as natural variations in human cognition rather than problems to be fixed. It emphasizes adaptation, autonomy, and respect for neurological difference over correction or conformity.
Common principles include:
Avoiding pathologizing language (e.g., “disorder,” “deficit”)
Honoring nontraditional communication, pacing, and behavior
Emphasizing self-advocacy and client-led goals
Providing flexibility around stimming, scheduling, and attention needs
De-emphasizing normalization (e.g., eye contact, masking)
Why It’s Gaining Traction
Critics of traditional approaches have raised valid concerns about historical pathologization and the harmful effects of forcing conformity. The neurodiversity-affirming movement emerged as a direct response to these problems. For some who identify as neurodivergent, therapy has historically been a source of invalidation and they report being told to suppress what they believe are natural behaviors and “mask” to meet social expectations at the expense of their mental health.
When done thoughtfully, neuroaffirming care may:
Reduce shame and internalized ableism
Improve therapeutic alliance and session engagement
Allow clients to focus on what matters to them, not just to society
Offer support without forcing conformity
The Pushback: Clinical Concerns About Overcorrection
While the intent behind affirming care is valid, some clinicians have concerns about how the model is being applied. In some forms, it leans heavily toward accommodation without intervention, which may feel validating and may bring clients back, but is not necessarily helpful in the long run. Some worry the field has overcorrected in response.
Key Critiques of the Neurodiversity-Affirming Model
While many clinicians see value in neuroaffirming care, others have raised concerns about how it’s implemented in practice. These critiques don’t reject the approach outright but highlight possible limitations when core clinical principles are underemphasized.
Not enough focus on real-world change
Some argue that neuroaffirming therapy places more emphasis on identity validation and emotional safety than on building practical skills—such as managing time, regulating emotions, or meeting daily responsibilities. In these cases, therapy may feel supportive but may not help clients make meaningful changes in their day-to-day lives.Avoidance of feedback that could support growth
Critics note that some therapists may hold back on offering constructive feedback or encouraging behavior change out of concern it will be perceived as invalidating. While sensitivity is important, avoiding challenge altogether may limit a client’s ability to develop new strategies or respond more effectively to stress.Tendency to overlook other clinical issues
Framing all forms of distress as neurodivergence-related risks missing co-occurring problems like depression, anxiety, trauma, or substance use. Some clinicians caution that a singular focus on neurodivergent identity can obscure the need for additional assessment or targeted treatment.Therapy may become overly passive
Some implementations of affirming care lean so heavily on acceptance and non-directiveness that they may stall momentum. Without clear goals, structured interventions, or accountability, clients might feel supported but stuck—especially those seeking tools for change.Masking framed as inherently harmful
While masking can be exhausting and, in some cases, detrimental, some clinicians argue that learning when and how to adapt behavior is part of building relationships and navigating mixed-neurotype environments. Rather than avoiding masking entirely, therapy might support clients in using it strategically—without shame or self-erasure.Risk of increasing harmful behaviors
Some clinicians report cases where neuroaffirming therapy inadvertently validates genuinely problematic behaviors such as aggression, verbal abuse, or destruction of property as part of one’s identity rather than addressing them as harmful actions that require intervention. While emotion regulation difficulties are common in autism, critics worry that framing all challenging behaviors as simply neurological differences may enable clients to avoid accountability for actions that harm others or themselves, potentially worsening abusive or dangerous patterns rather than supporting meaningful behavior change.
Here’s what we know:
Despite its popularity, there is very little empirical research directly comparing neurodiversity-affirming therapy to more traditional models, especially for adults.
No standardized model exists: “Neurodiversity-affirming” is a philosophy, not a manualized intervention. It varies widely by provider.
Outcomes are hard to measure: While affirming approaches often prioritize identity development or reduced masking, these outcomes lack widely validated measurement tools.
Research still favors traditional interventions: Most current studies evaluating therapy outcomes for ADHD and autism focus on traditional approaches (like CBT, DBT, and ACT) that are adapted—not replaced.
⚠️ So far, affirming therapy is more defined by values than by data. While it aligns with best practices in client-centered care, the absence of rigorous comparative research leaves questions about long-term outcomes, functional gains, and clinical efficacy.
What Might a Balanced Approach Look Like?
Affirming care and structured therapy don’t have to be opposites. Many clinicians now strive for an integrated model that blends validation with accountability.
That might include:
Adapting how skills are taught—but still teaching them
Encouraging autonomy—while addressing distressing behavior
Creating safe space—without avoiding therapeutic challenge
Supporting identity exploration—without ignoring impairment
Conclusion: Affirmation May Not Be Enough
Neurodiversity-affirming therapy is a meaningful response to a history of pathologizing care. But when taken to extremes, it risks sacrificing the client’s ultimate goals, or worse, reinforcing patterns that are harmful for the client and/or others.
After all, clients come to therapy because they want something to change…and sometimes, change is uncomfortable. Pure validation can certainly create change, but not necessarily the kind that addresses the problems bringing them to therapy in the first place. While feeling understood provides important short-term relief, it may come at the expense of the long-term progress clients are ultimately seeking, creating a disconnect between the therapeutic environment and the demands they face in daily life.
Given the significant variability across the autism spectrum and among neurodivergent individuals, effective treatment requires individualized approaches that balance affirmation with intervention based on each person's specific needs, goals, and circumstances.
Looking for Therapy That Balances Affirmation with Progress?
At PSYCHē, therapists in our network offer structured, evidence-based therapy for neurodivergent adults and teens including ADHD, autism, and more. Whether you're seeking skills, insight, or support, our team helps you connect with the right clinician for you.
