Understanding Neurodiversity-Affirming and Trauma-Informed Care: A Different Path to Healing
Image credit: iStock Images, Anna Bergbauer
"What the caterpillar calls the end of the world, the master calls a butterfly." - Richard Bach
If you've chosen to read this, chances are you're looking for something different. Maybe you've tried therapy before and it didn't quite fit. Maybe you're a parent who's been told your child needs to be “fixed,” and something about that doesn't sit right with you. Or maybe you're neurodivergent yourself and you're tired of professionals who seem more interested in making you act “normal” than in understanding your complex life and helping you truly thrive.
I get it. I've been there myself.
As a late-diagnosed autistic person, a therapist, and someone who has walked the path of healing from trauma, I've experienced both sides of this equation. I've sat on the therapy couch as a client, and I've spent years trying just about every type of therapy available. Some of them helped, at least in giving me greater insight into why I was struggling so much, but most did not make the struggle any easier or produce any lasting improvement.
I know how hard it is to find help that actually helps. And I've learned that when it comes to supporting neurodivergent people—especially those of us who've experienced trauma—the traditional approaches often miss the mark. Sometimes they even cause harm, if for no other reason than because when they fail to help, you then believe you’ve “failed” at therapy too, on top of everything else. It’s easy to blame yourself and feel like you’re just too broken to fix.
Thankfully, this is not true. It’s just that you, like me, did not receive treatment that truly encompassed your whole self with understanding, appropriate training and awareness, and a toolbox of interventions and supports that actually work for neurodivergent people. Our issues are not (purely) “cognitive” or “behavioral,” and they don’t necessarily respond well to insight-based, left-brain, psychodynamic or insight-based modalities of treatment. We need help that embraces our entire beings, and that recognizes that being neurodivergent (especially with complex trauma on board as well) means that we live with complicated, delicate nervous systems and bodies, minds, and spirits that are highly sensitive to our environments and relationships.
That's why I'm passionate about neurodiversity-affirming and trauma-informed care. Not because it's trendy (though thankfully, more people are paying attention), but because the research shows it works better, and because it honors the lived experiences of the people it's meant to serve.
Let me explain what these approaches really mean, and why they matter so much.
The Paradigm Shift That's Changing Mental Health Care
Something profound is happening in mental health care right now. We're witnessing a quiet revolution—one that elevates the voices and experiences of the very people who have historically been harmed by the “help” they received. This shift is particularly important for neurodivergent individuals and trauma survivors, two populations that have too often been misunderstood, pathologized, and subjected to interventions that did more damage than good.
The old model asked, “What's wrong with you?” The new model asks, “What happened to you?” and “What do you need to go from surviving to thriving?”
That seemingly small shift changes everything.
What Is Neurodiversity-Affirming Care?
Let's start with the basics. Neurodiversity is the idea that human brains naturally come in different varieties. Autism, ADHD, dyslexia, dyscalcula, and other ways of being are natural variations in how we think, process information, and experience the world. Just as biodiversity is essential to a healthy ecosystem, neurodiversity is essential to human culture and innovation.
Here's what that means in practice: neurodiversity-affirming care doesn't see autism, ADHD, or other forms of neurodivergence as disorders that need to be cured. Instead, it recognizes that different brains have different needs, different strengths, and different ways of navigating the world. The focus shifts from trying to make someone “normal” to helping them thrive as their authentic selves.
What It's NOT
Let me be clear about what this approach is NOT:
It's not about pretending that everything is wonderful all the time, or denying that neurodivergent people face real challenges. It's not about refusing to provide support or saying that skill-building isn't needed. And it's definitely not about leaving people to struggle without help.
Being neurodivergent in a world designed for neurotypical people is genuinely difficult. Sensory overwhelm is real. Executive function challenges are real. Social misunderstandings are real. The anxiety and depression that so many of us experience are very, very real.
What It IS
Neurodiversity-affirming care acknowledges all of those difficulties while also recognizing that many of the problems neurodivergent people face come from a mismatch between our needs and an environment that wasn't designed with us in mind. It's about:
Respecting that brains work differently. There's no single “right” way to think, process information, or experience the world. Eye contact might be painful for you. Stimming might help you regulate. You might need time to process before responding. You might think in pictures rather than words. All of these are valid ways of being.
Focusing on strengths while addressing genuine challenges. Yes, let's help with the anxiety. Yes, let's work on communication skills. But let's do it in a way that builds on your natural strengths and interests, rather than trying to force you into a neurotypical mold.
Modifying environments instead of forcing conformity. Maybe the problem isn't that you can't handle fluorescent lights. Maybe the problem is the fluorescent lights. Maybe the issue isn't that you need more social skills training. Maybe you need help finding your people, the ones who get you.
Including neurodivergent voices. This is huge. For too long, interventions for autistic and ADHD people were designed entirely by neurotypical professionals, without any input from the very people those interventions were meant to serve. Neurodiversity-affirming practice means actually listening to what autistic and ADHD adults say about what helps us and what harms us.
Encouraging self-advocacy and empowerment. The goal is to help you understand yourself, advocate for your needs, and navigate the world as your authentic self… not to teach you to mask who you are.
The Research Backs This Up
Here's what the research tells us: Studies have found that neurodivergent individuals who receive identity-affirming care show significantly better mental health outcomes. We have lower rates of depression and anxiety compared to neurodivergent people who don't receive affirming care.
Other research shows that the wellbeing of autistic individuals depends on perceived support and acceptance, NOT on how much we reduce “autistic symptoms.” In fact, efforts to eliminate autistic traits (such as in ABA) often backfire, leading to worse mental health outcomes.
Multiple professional fields—occupational therapy, speech-language pathology, psychiatry, psychology—are now calling neurodiversity-affirming practice a “moral imperative.” That's not language professionals use lightly.
The Problem with “Treatment as Usual”
For decades, the most common approach to autism was Applied Behavior Analysis (ABA), which was considered the “gold standard” of autism intervention (by neurotypical researchers and clinicians). But there's a problem: the autistic community has been trying to tell us for years that ABA caused them harm, and increasingly, research is backing them up.
ABA was developed in the 1960s by Ole Ivar Lovaas with an explicit goal: to make autistic children “indistinguishable from their peers.” The same techniques Lovaas used on autistic children were also used in conversion therapy for LGBTQ+ individuals, something we now recognize as a human rights abuse. Yet somehow, the same reasoning that led us to abandon conversion therapy wasn't extended to autistic children.
Early ABA methods used punishments including electric shocks, withholding food, and physical punishment to “extinguish” autistic behaviors (even joyful ones) and replace them with “normal” behaviors. While modern ABA has moved away from these overtly abusive tactics, many of the underlying assumptions remain: that autistic ways of being are wrong and need to be eliminated.
What Autistic Adults Are Telling Us
The autistic adults who experienced ABA as children are now speaking out, and their stories are remarkably consistent. They describe:
Long-term emotional distress and a diminished sense of self
Being taught that saying “no” doesn't matter, that their lack of consent can be ignored
Chronic anxiety from being constantly monitored and corrected
Learning to mask their true selves, leading to burnout and identity loss
PTSD symptoms from compliance-focused interventions
Feeling that their natural ways of regulating (like stimming) were shameful
One former ABA client told researchers: “All of those things that I was doing wrong would automatically go through my head any time I was in a social situation. I would be inherently super judgmental and self-critical about everything I was doing to the point where even in some social situations, I just shut down.”
Research is now documenting these harms. Studies have found correlations between ABA therapy and PTSD symptoms. We're learning that masking (pretending to be neurotypical) is linked to depression, anxiety, burnout, and even suicidality in autistic adults.
The U.S. Department of Defense and other research organizations have questioned whether ABA actually works as intended. The problem is that most ABA research measures behavioral compliance (how many times a child makes eye contact, how quickly they stop stimming) rather than quality of life or wellbeing. And when we look at long-term outcomes, we see that teaching someone to suppress their autistic traits doesn't make them happier. Often, it makes them miserable.
Here's a sobering reality: only a minority of therapists feel comfortable working with autistic clients, and of those, few have any effective training or experience in how to help neurodivergent clients. That's not because autism is so complex or mysterious. It's because most therapists (and other healthcare professionals) were trained in approaches that pathologize neurodivergence rather than affirm it… if they received any training at all. Most of us had only a passing mention of ADHD, autism, and other forms of neurodiversity in one grad school course, and they were framed as “developmental disabilities” that were largely outside our scope of practice. No wonder most therapists feel uncomfortable and lost when it comes to working with neurodivergent clients!
What Is Trauma-Informed Care?
Now let's talk about trauma, because here's where things get really important for neurodivergent folks.
The landmark Adverse Childhood Experiences (ACEs) study revolutionized how we understand trauma. It showed that childhood adversity has profound, lasting impacts on physical and mental health throughout life. We now know that nearly 90% of U.S. adults report experiencing at least one traumatic event.
But trauma isn't just about the “big T” traumas: abuse, violence, disasters. It's also about “little t” traumas: chronic invalidation, marginalization, discrimination, social exclusion and isolation, bullying, and ongoing toxic stress from living in environments that aren't designed for us.
The Four R's of Trauma-Informed Care
The Substance Abuse and Mental Health Services Administration (SAMHSA) developed what they call the “4 Rs” framework for trauma-informed care:
· Realize how trauma affects individuals and communities
· Recognize the signs and symptoms of trauma
· Respond using trauma-informed approaches in all interactions
· Resist Re-traumatization by avoiding practices that trigger or repeat trauma patterns
At its core, trauma-informed care recognizes that trauma lives in the body and nervous system, not just in our thoughts. It understands that trauma responses – things like hypervigilance, emotional flooding, shutting down, or having difficulty trusting – are survival strategies, not character flaws.
A trauma-informed approach creates safety first. It emphasizes choice, collaboration, and empowerment. It asks “What happened to you?” instead of “What's wrong with you?” And critically, it works to prevent re-traumatization by examining whether our interventions themselves might be causing harm.
Why This Matters
Research on trauma-informed care shows that it works. Studies find that trauma-informed approaches improve patient engagement, treatment adherence, and overall outcomes. They reduce the use of coercive practices like seclusion and restraint. They improve staff wellbeing and reduce burnout. And they address not just symptoms, but root causes.
When healthcare systems implement trauma-informed care organization-wide, everyone benefits—not just trauma survivors.
The Critical Intersection: Why Neurodivergent People Need Trauma-Informed Care
Here's where it all comes together, and why understanding both neurodiversity-affirming and trauma-informed approaches is so crucial:
Neurodivergent people experience trauma at dramatically higher rates than the general population.
Let that sink in. The statistics are staggering:
60% of autistic adults report probable PTSD in their lifetime, compared to just 4.5% of the general population
Autistic adults are more than four times as likely to be diagnosed with PTSD as neurotypical adults
80% of adults with ADHD report trauma experiences
Children with ADHD have significantly higher rates of Adverse Childhood Experiences compared to children without ADHD
Why Are Neurodivergent People So Vulnerable?
There are multiple factors at play:
Neurobiological vulnerability. Research shows that autistic and ADHD brains have more reactive nervous systems with less flexibility. We don't habituate to stressors the way neurotypical people do. Brain imaging studies have identified specific alterations in the prefrontal cortex that make us more sensitive to stress. What might be a minor annoyance for a neurotypical person can trigger a full trauma response in a neurodivergent brain.
In fact, studies show that even mild stressors – things that wouldn't meet the criteria for “trauma” in neurotypical individuals – can produce PTSD symptoms in autistic people. Everyday experiences like entering a noisy environment or dealing with sudden changes can be genuinely traumatic for neurodivergent nervous systems.
Higher exposure to traumatic events. We're not just more vulnerable to developing PTSD, we're also more likely to experience the traumatic events themselves. Research shows that autistic people are 7.3 times more likely to experience sexual assault during adolescence. We have higher rates of bullying, social rejection, and victimization. We're more vulnerable to manipulation and abuse because we may struggle with reading social cues, recognizing danger, or understanding when someone is taking advantage of us.
Chronic invalidation as trauma. Here's something that often gets overlooked: growing up neurodivergent in a neurotypical world is itself traumatic. Imagine spending your entire childhood getting constant messages that something is fundamentally wrong with you. That the way you naturally move, think, communicate, and experience the world is “inappropriate” or “disruptive.” That you need to be fixed.
For many of us who were undiagnosed as children, this meant years or decades of thinking we were broken, without understanding why we struggled with things that seemed easy for everyone else. Our parents meant well but didn't understand our needs. Teachers punished us for things we couldn't control. We were told we were too sensitive, too intense, either too much or not enough.
That kind of chronic, lifelong invalidation is traumatic in itself.
Iatrogenic harm from treatment. And here's the really painful part: many of us experienced trauma from the very interventions that were supposed to help us. When therapy focuses on compliance, normalization, and eliminating autistic behaviors, when we're forced to suppress stimming, make eye contact that hurts, and act neurotypical even though it exhausts us, that causes psychological harm.
Research is now documenting PTSD symptoms specifically linked to compliance-focused behavioral interventions. Being taught that your “no” doesn't matter, that your natural ways of being are wrong, that you need to hide your true self to be acceptable… this creates deep wounds.
The Vicious Cycle
Here's what makes this even more complex: trauma worsens neurodivergent traits, and neurodivergent traits can make trauma responses more intense.
Trauma can exacerbate emotional dysregulation, executive function challenges, and sensory sensitivities. Meanwhile, PTSD can intensify core autistic traits like repetitive behaviors. Trauma symptoms are often misdiagnosed as autism symptoms, and autism is often misdiagnosed as trauma. Without proper understanding of both, interventions can miss the mark entirely, or worse, cause additional harm.
What Integrated Neurodiversity-Affirming and Trauma-Informed Care Looks Like
So what's the alternative? What does it actually look like to provide care that honors both neurodivergence and trauma history?
It starts with a fundamental paradigm shift:
From fixing to supporting
From compliance to collaboration
From normalization to accommodation
From pathology to difference
From expert-driven to co-created
Core Principles
1. Presume competence and honor autonomy. Every person deserves to have their consent respected, their “no” honored, and their voice heard. This includes nonspeaking individuals and people with intellectual challenges. All behavior is communication, and our job is to understand what someone is trying to tell us, not to force them into compliance.
2. Address root causes, not just behaviors. When someone is struggling, we need to ask why. Is it sensory overwhelm? Communication barriers? Unmet needs? Past trauma being triggered? Instead of trying to eliminate the behavior, we need to understand its function and address the underlying cause. Often, “challenging behaviors” are actually adaptive responses to impossible situations.
3. Nervous system regulation over behavior modification. Both trauma and neurodivergence involve nervous system dysregulation. We need approaches that work with the body and nervous system, not just cognitive strategies. This means co-regulation, body-based tools, sensory accommodations, and recognizing that sometimes talking isn't accessible when someone is dysregulated.
4. Strength-based AND challenge-aware. We celebrate neurodivergent strengths and perspectives while also acknowledging real struggles. We can focus on building skills and addressing challenges (like anxiety, depression, or executive function difficulties) without pathologizing someone's neurotype. The goal is to address the co-occurring conditions that genuinely cause suffering, not to eliminate core neurodivergent traits.
5. Safety and choice. Physical and emotional safety are foundational. This means collaborative goal-setting, transparency about what's happening and why, power-sharing rather than power-over dynamics, and creating space where it's safe to say no, safe to be authentic, and safe to have “hot mess” moments. Because that's where change happens.
6. Cultural humility and intersectionality. We must recognize how neurodivergence intersects with other identities: race, gender, sexuality, socioeconomic class, disability status, spiritual belief, cultural background, immigration status, and so on. Compounded marginalization creates compounded trauma. There's no one-size-fits-all approach. We need to learn from diverse voices within the autistic and neurodivergent community, particularly from BIPOC and LGBTQIA+ individuals who face additional layers of discrimination.
7. Preventing iatrogenic harm. We constantly ask ourselves: “Is this intervention respectful and beneficial to this person?” We avoid practices that increase masking or suppress authentic expression. We don't target harmless behaviors like stimming, special interests, or different communication styles. And we stay alert for signs that our interventions themselves are causing distress.
What This Means in Real Life
Let me get practical. What does all of this actually look like in a therapy session or in daily life?
In the Therapy Space
Movement and stimming are welcomed, not discouraged
Speaking is not the only form of communication that is available. In my case, I often use Brainspotting (in which I am certified), which does not necessitate talking at all
The sensory environment is adjusted to your needs: lighting, sound, physical space. When you work with me, it is by telehealth, so you can do sessions from your own home or wherever you are most comfortable and feel most safe
Sessions are paced to match your processing speed, with breaks as needed
Your experiences are validated without judgment
We celebrate your neurodivergent identity and connect you with neurodivergent culture and community
We process experiences of marginalization and discrimination as legitimate trauma
We teach about how neurodivergent nervous systems work and why they react differently
We build skills for navigating a neurotypical world WITHOUT requiring you to sacrifice your authentic self
Goals Shift
Instead of focusing on:
Making eye contact, we focus on comfortable communication in YOUR preferred style
Stopping stimming, we honor your regulatory needs and help you understand them
Compliance training, we build genuine skills for self-advocacy
Social skills defined as acting neurotypical, we help you find authentic connections and community with people who get you
Eliminating special interests, we leverage your interests for learning and joy
“Fixing” anxiety, we understand anxiety as a nervous system response and provide tools that are actually helpful
For Families
When I work with parents and families, we focus on:
Education about neurodivergence and how nervous systems differ
Reframing behaviors as communication
Lowering demands when someone is overwhelmed
Creating sensory-friendly environments
Celebrating rather than hiding neurodivergent traits
Processing parents’ own trauma, stress, and life experiences
Rebuilding trust after ruptures in the relationship
Living by the motto: “Less stress, more fun”
For Trauma Processing
Here's something crucial: traditional trauma treatments like exposure therapy often don't work well for neurodivergent people and can actually re-traumatize us. That's because neurodivergent nervous systems don't habituate to stressors the same way neurotypical nervous systems do.
We need modified approaches: slower pacing, sensory accommodations, alternative processing methods. I use techniques like somatic integration, Brainspotting, trauma-focused CBT, and stress management, adapted specifically for neurodivergent nervous systems. DBT skills can be helpful for emotional regulation (although I do not use strict DBT protocols). Narrative therapy helps people reclaim their identity and tell their story in their own words.
And critically, we recognize that marginalization itself is traumatic. The discrimination, invalidation, and chronic stress of living in a world not designed for you needs to be processed as the trauma it is.
The Evidence Shows This Works
I'm a therapist, but I'm also someone who believes in evidence. So what does the research tell us about these approaches?
Studies show that identity-affirming care leads to reduced anxiety and depression in neurodivergent individuals. Research consistently finds that acceptance and support (not symptom reduction) predict wellbeing. In fact, focusing on reducing core autistic or ADHD traits tends to backfire, leading to worse mental health outcomes.
We're learning that suppressing autistic traits leads to burnout, PTSD symptoms, and increased risk of suicidality. Meanwhile, trauma-informed supports improve outcomes for everyone, not just trauma survivors.
Neurodiversity-affirming approaches increase engagement, trust, and therapeutic alliance, meaning people are more likely to stick with therapy and actually benefit from it.
The evidence is clear: these approaches lead to better outcomes. Not in terms of compliance or “looking normal,” but in terms of actual wellbeing, quality of life, and mental health.
The Path from Surviving to Thriving
Here's what I believe deeply, both from research and from my own lived experience: healing yourself opens opportunities for healing for all of the people around you. It ripples outward in ways we can't always see or measure.
There's a teaching from some Native American traditions that when you heal yourself, you heal your descendants seven generations forward and your ancestors seven generations back. Whether or not you take that literally, the truth it points to is real: our healing matters. It affects our children, our families, our communities.
When neurodivergent people are supported in healing from trauma and reclaiming their authentic selves, it changes everything. We break cycles of invalidation and shame. Children grow up with affirmed neurodivergent identities and have better outcomes. Families learn to understand and celebrate neurodivergence. We create communities and cultures where neurodivergent people can truly thrive.
This is how we heal ourselves as a species. This is how we ultimately help the world heal.
You Deserve This Kind of Care
If you're neurodivergent and you've experienced trauma, you deserve care that honors both aspects of your experience. You deserve a therapist who understands how autism and/or ADHD affects your nervous system, who recognizes that your neurodivergence isn't something to be cured, and who can help you heal from trauma without forcing you to mask or suppress who you are.
If you're a parent or caregiver of a neurodivergent person, understanding these approaches can transform your family's wellbeing. You don't have to force your child to be “normal.” You can celebrate who they are while still providing support for genuine challenges.
This isn't just theory. It's about real lives, real healing, real thriving.
The path from surviving to thriving requires approaches that meet people where they are and honor who they are. It requires us to question long-held assumptions about what "help" should look like. It requires us to listen – really listen – to the voices of people with lived experience.
And it works.
