Agnes S.K. Wong, Yani Hamdani

rehabINK Commentary

Neuroaffirming care considers autism and other neurodevelopmental differences as natural biological variations, rather than pathologies to be fixed. This view challenges the traditional medical model’s emphasis on “normalization” (Chapman & Botha, 2023). Instead, it prioritizes autonomy, self-advocacy, and overall well-being, values that align closely with core principles in OT ((Bex) Twinley, 2024). 

Neuroaffirming care has rapidly gained popularity as a concept in health care, including occupational therapy (OT), for autism and other neurodevelopmental conditions. Under the neurodiversity paradigm, clinicians, researchers, and self-advocates have increasingly argued for a shift from a deficit-oriented framework toward recognizing neurodevelopmental differences as part of diversity (Shaw et al., 2025). In OT, this shift is particularly prominent, perhaps partly due to its alignment with the profession’s long-standing commitments to related concepts such as “client-centred” (Law et al., 1995) and “strengths-based” care (Dunn, 2017). However, what does neuroaffirming care actually mean in frontline practice, and how is it different from other, more commonly discussed OT concepts? 

Drawing from my dual roles as a registered occupational therapist in Ontario and a postdoctoral fellow at the Centre for Addiction and Mental Health (CAMH) focusing on research in neuroaffirming care and autism, this commentary discusses emerging findings from an ongoing qualitative research project on neuroaffirming care., The project is also supported by my frontline clinical experience with immigrant and multilingual families. While neuroaffirming care, on the surface, resonates with OT’s core values, its implementation is far from straightforward. Conceptual ambiguities about what it is, inconsistent interpretations of what it entails, and practical barriers to implementation often make it difficult to put into practice. Beyond the need for clear practical guidance, I argue that neuroaffirming care can be understood as a stance that requires cultural humility and a meaningful shift in epistemology in the Canadian context.

Shared Values

As part of a larger mixed-methods, multi-perspective study, I have been conducting interviews with occupational therapists in Canada since last year to explore how neuroaffirming care is understood and implemented in practice. Using purposeful sampling, seven occupational therapists (OTs) with at least three years of experience working with autistic populations have participated to date. Individual interviews were conducted  via Webex (30–50 minutes), and transcripts are being analyzed using an interpretive description approach (Thorne, 2025).

When asked what neuroaffirming care entails, participants repeatedly used terms such as “strength-based,” “client-centred,” and “attentive to sensory needs.” These descriptions reflect long-standing foundational principles in OT. Participants clearly described their alignment with neuroaffirming values, such as moving away from approaches that aim to suppress or fix behaviours. For example, approaches that aim to increase eye contact or to reduce stimming purely for appearance’s sake. Instead, they talked about supporting meaningful participation and overall well-being. Taken together, these responses suggest that neuroaffirming care is not a foreign concept to these OTs. Rather, it resonates with approaches to practices that they value, and in many cases, apply.

Conceptual Ambiguities and Tensions in Practice

Participants’ responses, however, revealed conceptual ambiguities and inconsistencies when they were asked to distinguish neuroaffirming care from long-established OT concepts. This became especially apparent when I invited an OT to explain what neuroaffirming care is. The participant candidly admitted, “I’m not sure how different it (neuroaffirming care) is from something that I would have called a strength based approach back when I was like going through my primary OT education…” and “I don’t see neuro-affirmative care as very different than some of the stuff that I would have learned back in OT school.” These responses illustrated that they do not think the concept adds anything new to what they already know. 

This conceptual ambiguity deserves our attention. If neuroaffirming care overlaps substantially with long-standing OT values, what is gained by re-naming it as “neuroaffirming care”? Without clearer guidance on its distinguishing features, clinicians may interpret the concept in varying ways, leading to inconsistent practice.This uncertainty may also create barriers to the delivery of neuroaffirming care for neurodivergent people accessing it in a meaningful way. 

The significance of this issue becomes evident in another participant’s response, “I think the biggest thing that I do want to say is a lot of times I think people are afraid of  ‘doing it wrong’… I’ve met a few clinicians who are like, oh, I don’t even like pick autistic clients anymore because I’m just so afraid that I’m gonna say the wrong thing or do the wrong thing…” The OT expressed concern about the potential consequences and explained that some clinicians “don’t know enough about neuro-affirmative care to do it well”.Therefore they chose to “actively not providing care simply because they don’t know how to do it ‘right’” Ironically, a concept intended to promote inclusivity may contribute to clinicians’ anxiety and healthcare access barriers. The findings underscore the need for concrete, practical guidance and ongoing dialogue rather than relying on abstract ideas alone.

The Multicultural Context

The Canadian context adds additional complexity to understanding and implementing neuroaffirming care. Canada’s population includes many recent immigrants and families who speak languages other than English or French. In my clinical work with multilingual families, including those who, like myself, migrated from Asia, I have observed that some families face additional layers of caregiving stress. 

First, some families experience feelings of marginalization throughout the immigration process. Families of neurodivergent children can experience enacted and felt stigma (Shafi et al., 2024). For some, cultural expectations within their immediate or extended family can lead to pressure or blame, including assumptions that parents are responsible for their children’s diagnosis. Therefore, some families may choose not to disclose their children’s diagnosis to others and may feel compelled to prioritize their children’s behavioural conformity to avoid further scrutiny. Sensitive, thorough listening and recognition of these   complexities are essential for offering the appropriate healthcare support. 

Language barriers add another layer of challenge. Interpretation services may not be always readily available, and translated materials on neuroaffirming care are limited. Even when interpreters and translated information are present, some concepts may not have linguistic equivalents. Further, some people, including physicians, may have certain perspectives on the parenting of other cultures (e.g., some believe that Chinese parents are more stringent in parenting, so they may not believe in their reports  of children’s behavioral issues). These accumulated misunderstandings can affect therapeutic relationships, negatively impacting the access to and provision of  healthcare, making neuroaffirming care even less attainable. 

Culturally Responsive Through Cultural Humility 

Clinicians must listen to neurodivergent voices, particularly those from different cultural backgrounds, and allow those voices to shape neuroaffirming practice. In order to provide culturally responsive, neuroaffirming care, I believe that cultural humility with reflexivity and flexibility (Agner, 2020; Cherian et al., 2026; Kokorelias et al., 2025) is essential. 

Cultural humility (College of Occupational Therapists in Ontario, 2024) emphasizes lifelong learning (Agner, 2020). As clinicians, we need to humbly recognize that we do not fully understand another person’s cultural context, which can help open the opportunity for deeper engagement with the people we work with. For example, a word or non-verbal action may carry different meanings in another culture, so humbly asking for clarification and being open to questions are crucial to reducing misunderstandings. 

To practise cultural humility, constant reflexivity on how our background and assumptions may influence our clinical judgement and interpretations is crucial. For example, a family may prioritize their autistic child’s behavioral conformity due to the pressures from extended family. Instead of blaming the family for not being “neuroaffirming”, we need to reflect on our own possible biases and the broader sociocultural context. As for flexibility, it may mean being willing  to change the goals, interventions and communication styles to align with the families’ background and preferences. For example, rather than insisting on training the use of a fork and knife, the clinician can center the family’s perspectives and collaboratively develop goals that support the use of chopsticks or adapted chopsticks, recognizing that certain eating utensils may be culturally significant.

Neuroaffirming Care as a Stance 

Ultimately, neuroaffirming care in OT should not be considered merely as another label nor equated with long-standing core commitments such as “strengths-based” or “client-centred”. To me, neuroaffirming care can be considered as a stance when we are providing ethical and morally just therapy (Dallman et al., 2022), and such a stance requires an appropriate shift in epistemology (Chapman & Botha, 2023). For example, we must recognize that autistic individuals and immigrant families of autistic children have a deeper understanding of their own contexts than clinicians do. Their perspectives should meaningfully shape interventions, rather than defaulting to a traditional medical model that positions clinicians as the primary experts (Chapman & Botha, 2023). My aim is to move neuroaffirming care beyond an ideology and meaningfully enhance the well-being of neurodivergent individuals and their families in Canada.

Acknowledgement

I would like to thank my supervisors, Dr. Meng-Chuan Lai and Dr. Yani Hamdani, for their advice and guidance on my research projects on neuroaffirming care. The projects are funded by the CAMH AFP Innovation Fund and the CAMH Postdoctoral Research Award.

References 

Agner, J. (2020). Moving From cultural competence to cultural humility in occupational therapy: A paradigm shift. The American Journal of Occupational Therapy, 74(4), 7404347010p1-7404347010p7. https://doi.org/10.5014/ajot.2020.038067

(Bex) Twinley, R. (2024). Neurodivergent affirming practice in occupational therapy: Scoping review and qualitative content analysis of the literature. Neurodiversity, 2, 27546330241301740. https://doi.org/10.1177/27546330241301740

Chapman, R., & Botha, M. (2023). Neurodivergence-informed therapy. Developmental Medicine & Child Neurology, 65(3), 310–317. https://doi.org/10.1111/dmcn.15384

Cherian, K. T., Lambor, P. D., George, A., Neha, G., George, A. A., & Delos Reyes, R. C. (2026). Culturally responsive occupational therapy education and practice: A scoping review. Occupational Therapy Journal of Research, 15394492261418531.

College of Occupational Therapists in Ontario. (2024). Culture, equity, and justice in occupational therapy practice. https://www.coto.org/wp-content/uploads/2024/12/coto-culture-equity-and-justice-in-occupational-therapy-en.pdf

Dallman, A. R., Williams, K. L., & Villa, L. (2022). Neurodiversity-affirming practices are a moral imperative for occupational therapy. The Open Journal of Occupational Therapy, 10(2), 1–9.

Dunn, W. (2017). Strengths-based approaches: What if even the ‘bad’ things are good things? British Journal of Occupational Therapy, 80(7), 395–396. https://doi.org/10.1177/0308022617702660

Kokorelias, K. M., Wu, V., Colquhoun, H., Sangrar, R., Wijekoon, S., Nelson, M. L. A., Assaf, H., Ramachandran, M., & Singh, H. (2025). Cultural humility practices in occupational therapy services: A scoping review. The American Journal of Occupational Therapy, 79(2), 7902180080. https://doi.org/10.5014/ajot.2025.050738

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