Why I Don't Identify with the Neuroaffirming Movement

Over the past few years, I've been thinking about the movement called ‘neuroaffirming’ (NA) or ‘neurodiversity affirming’ and what I think about it and whether I identify with it. I think I’ve finally come to my answer which is no, I don't.

That doesn't mean I don't respect autistic people or people with ADHD. It doesn't mean I think neurodivergent people should be "fixed," forced to behave like everyone else, or denied accommodations. Quite the opposite. But, I do think the NA movement lacks definition, empirical support, and ultimately harms both Autistic people and the credibility of our profession. I think what began as a useful reminder about treating people with respect has evolved into something much broader and less helpful.

Before I get into my reasons properly, I want to point out one issue here with language. I find these days that so many things have ‘language issues’ meaning that words don’t mean what they used to mean or what you think they mean.

It is logical that a cause is going to give itself the most flattering label possible. So I suppose I can’t fault it for that. ‘Pro-choice’ people label themselves ‘pro-choice’ not ‘anti-life’ and ‘pro-life’ advocates label themselves ‘pro-life’ not ‘anti-choice.’  Generally, people want to label themselves of their cause as ‘pro’ something, rather than against of ‘anti’ something. This is a well-studied phenomenon in political psychology, framing research, and linguistics. Most movements prefer to define themselves by what they are for, rather than what they are against. Rhetorically, it's much more effective. Think about the labels ‘marriage equality’, ‘climate justice’, ‘person-centred’, or ‘neuroafirming’. Each evokes something desirable. Positive labels create an immediate moral intuition: "Well, who could be against affirmation?"

So a person who wants to against a positive affirmation like this often has to do quite a lot of work to persuade someone. It’s like pushing a large rock uphill.  Well, let's start pushing...

Here I am going to offer 7 reasons why I don’t identify as NA.

1.        Lack of definitional clarity

My first reason is I simply don’t know what it means and I tend not to sign onto labels when they don’t have clear enough definitions.

Taken literally, ‘neuroaffirming’ just means ‘brain affirming’ which is odd really. But the full phrase ‘Neurodiversity affirming’ isn’t much better. It means, literally ‘I affirm brain differences’ or ‘I affirm/believe that brains are different’. But this of course is not what is usually meant by the term. The problem however, is what is meant by it? What is actually being affirmed? Are we affirming brains? Brain differences? Neurodivergent people? The neurodiversity movement? A set of political and clinical ideas? These are all quite different. Yet the single adjective ‘neuroaffirming’ tends to blur them all together.  But that is part of the problem – if you say you aren’t ‘neuroaffirming’ because you don’t affirm a set of political and clinical ideas, someone might interpret you to mean you don’t affirm Autistic people as worthy of dignity or respect. This creates confusion which I deem to be more unhelpful than clarifying.

Similarly, there is no agreement about what conditions even fall under the ‘neurodiverse’ umbrella. The term "neurodivergent" originally referred mainly to neurodevelopmental conditions such as autism and ADHD. But over time its boundaries have expanded. Depending on who you ask, neurodivergence may now include dyslexia, Tourette syndrome, OCD, PTSD, bipolar disorder, schizophrenia, personality disorders, chronic anxiety, depression, and more.

This raises an obvious question: what unites these conditions? Is the claim simply that they all involve differences in brain function? If so, that's true of virtually every psychiatric condition. But then the concept becomes so broad that it risks losing its explanatory value.

More importantly, am I really being asked to affirm all of these conditions in the same way? It's one thing to argue that ADHD represents a cognitive style with both strengths and weaknesses, or that many autistic traits should be understood as natural human variation. It's another thing entirely to say the same about obsessive-compulsive disorder or schizophrenia. People with severe OCD are often tormented by intrusive thoughts they desperately wish they didn't have. People with schizophrenia may experience terrifying delusions and hallucinations that profoundly disrupt their lives. These are not simply different ways of thinking that society has failed to accommodate. They are conditions that cause immense suffering and that many people actively seek treatment for.

A Facebook group I’m in called Neurodiversity Affirming Psychologists Australia (NAPA) has thousands of Australian psychologists in it. It describes the neurodiversity affirming paradigm in its bio: ‘[It] views neurotypes which diverge from typical (e.g., autism, ADHD, dyslexia, etc.) as naturally occurring differences in the human neurology. These processing differences often lend to experiences of disability due to the mismatch between the environment and their traits and skillset.’

Notice how vague this is: ‘Naturally occurring differences’. As opposed to what? Of course they’re naturally occurring. Cancer is also naturally occurring. So is Parkinsons and Down Syndrome. What does this even mean? Millions of things which are terrible are naturally occurring. Go out into nature and have a look at what you find – rape, violence, disease, tooth-ache, death. All naturally occurring. Nature is full of horrific things that we don’t like or want.

Then they say ‘disability due to mismatch’. Again, this doesn’t mean anything.  Of course it’s due to a mismatch between the environment and their traits. That’s what disability means. If there was no mismatch there would be no disability.  It’s just a redundant thing to say. You can see what they’re trying to do here though I think. In both cases they’re trying to hint at something but without explicitly asserting it. And they have to do so because to state clearly what they mean would risk exposing how ridiculous and/or trivial what they are really saying is. If they said what they really mean explicitly - that the non-verbal child who is smearing faeces on himself and routinely trying to strangle his sister is disabled because of ‘society’ - one would immediately recognise how silly it is.  So both of these claims are either trivially true (if taken at face value) or they are false.  But this is the kind of vague language you find everywhere in these groups and in this literature. And it’s because if they spelled out clearly what they are arguing, it would look silly.

This is why I find the label "neuroaffirming" difficult to adopt. If it simply means respecting people, then of course I'm on board. But if it means viewing an ever-expanding list of psychiatric conditions primarily as differences to be affirmed rather than disorders that often deserve treatment, then I think we've moved beyond compassion into a philosophical position that requires much stronger justification.

2.        My job isn't to affirm identities. It's to help people.

I've worked with clients who desperately wanted relief from obsessive thoughts. Clients who wished they could maintain friendships more easily. Clients who hated their impulsivity. Clients who felt overwhelmed by sensory input. Clients who wanted to communicate more effectively with their partners or children.

I've never met someone who came to therapy asking me to affirm an ideology.

Good therapy has always involved both acceptance and change. In fact, one of the central insights of approaches such as Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT) is that these are not opposites. We can fully accept ourselves while still working towards growth.

I worry that parts of the NA movement sometimes frame change itself as inherently suspect.

3.        Diagnoses are useful—but they aren't identities

One of the biggest philosophical differences between my approach and much of the NA movement concerns what diagnoses actually are.

Increasingly, diagnoses are spoken about as identities.  And look, I get it. Receiving a diagnosis after years of confusion can be enormously validating. It can provide explanations, community, and self-understanding.

But I worry when diagnoses become more than clinical descriptions. Psychiatric diagnoses are not like discovering your blood group or your DNA sequence. They are clinical constructs—attempts to group together recurring patterns of behaviour, cognition and experience in ways that help us predict outcomes, conduct research and guide treatment.

Despite what you might have seen on Instagram or Tik Tok, the brain doesn't present us with neat boxes labelled "autism" and "not autism." There are no biomarkers (nor I think will there ever be) to demarcate ‘neurotypical’ people form ‘neurodivergent’ people. Instead, human traits vary continuously. Social communication varies. Attention varies. Sensory sensitivity varies.

A diagnosis marks the point at which a particular constellation of traits becomes clinically significant enough to warrant a label. That doesn't make the diagnosis ‘fake’ but it is s social construct not a biological one (even though of course it can/may have a biological correlate simply by virtue of the fact that everything psychological is biological which in my mind is just trivially true).

4.        Difference and disability are not mutually exclusive

Perhaps my biggest disagreement with parts of the NA movement concerns the concept of disability. One of the movement's most valuable contributions has been reminding society that many difficulties experienced by autistic people arise because environments are designed for neurotypical people. I think that's absolutely true (although I don’t think ‘design’ is the right word, I think things just evolve in a far messier manner than that term implies). Schools can be inflexible. Workplaces can be unnecessarily noisy, etc.

But I don't think that explains everything. Freddie deBoer has argued persuasively that some discussions of neurodiversity have become uncomfortable acknowledging disability itself. In trying to reduce stigma they minimising genuine impairment.

There are autistic people who cannot speak. People who require lifelong care. People who engage in severe self-injury. People who cannot tolerate basic daily activities despite every reasonable accommodation. It seems inadequate to say that these individuals are disabled only because society has failed them. Society certainly plays a role. But disability is also real. Recognising disability is not an insult. It's not prejudice. It's not ‘ableism’. It's simply acknowledging reality.

In fact, I sometimes wonder whether denying disability can itself become a form of neglect. If we insist that autism is merely a different way of being, what do we say to parents caring for an adult child who will never live independently? What do we say to individuals who desperately wish their sensory overload or executive dysfunction would ease?

Their suffering deserves to be taken seriously.

I highly recommend this Substack piece by Canadian Autism-researcher Jonathan Machnee titled I Would Cure my Autism. John is Autistic, and is the most balanced and insightful voice on Autism I have come across. In this piece he outlines how he moved from being neuro-affirming, to now not being:

‘Eleven years ago… I would have said that I liked being autistic, that to cease to be autistic would be to cease to be me, and that I liked being me. I would have probably also given a long lecture about how the social struggles autistic people face are not due to any inherent problem with the autistic brain but with the barriers and the stigma society places on neurominorities.

I often look back at my old self—at the things that I said, and the reasons that I said them—with a mix of cringe and pity…. A lot of my enthusiasm for the neurodiversity interpretation of autism arose because I couldn’t handle the alternative. The idea that there wasn’t actually anything wrong with me, but that I lived in an intolerant society that could be reformed, was extremely comforting…

…As I acquired a lot more data from the much wider autism spectrum, I realized it would have been absurd to tell parents that autism is a benign difference whose challenges result from societal stigma when their child cannot communicate with them, wanders into traffic, regularly has violent outbursts, and would die if left to their own devices.

‘…I finally came to the conclusion that autism (the entire spectrum) wasn’t just a difference; it was a cluster of maladaptive traits, and the best thing that we could do as a society was to blunt the edges of the maladaptive behaviours that they caused. I didn’t flip a switch and stop being pro-neurodiversity; I went through the classic repeated spiralling cycles of denial, anger, bargaining, depression, and acceptance over the course of a few months. Once I Stopped, I was able to be honest with myself about my own condition.’

5.        The voices we hear are not always the voices we need (The Gentrification of Disability)

And this leads me to my fifth reason which is who tends to shape public conversations about autism and ADHD. Freddie deBoer argues that disability has undergone a kind of gentrification whereby public conversations about autism and ADHD are increasingly dominated by highly articulate, educated, independent adults. Here’s Freddie deBoar from his article The Gentrification of Disability:

‘The risk is that the experiences of those with the greatest impairments become increasingly invisible. The autistic person requiring 24-hour support, the child who cannot communicate verbally, the adult who engages in severe self-injury or will never live independently—these individuals rarely write opinion pieces or accumulate large social media followings. Yet they are often the people whose disabilities have the greatest impact on daily life…And since “autism is not a disorder” has become the enforced opinion, those whose autism plainly is a disorder have to be marginalized - by the very people who complain about the marginalization of the “neurodiverse." Autism has been gentrified.

...We could overcome this problem if the people in the arena were dedicated to fronting (excuse me, “centering”) the interests of the most afflicted. But we can’t have that. We can’t have that because contemporary disability ideology is obsessively fixated on telling people to center themselves.

…But the trouble with normalizing illness is that it inevitably cedes control of our narrative about illness to normal people.'

This to me is a huge issue. While there may be some people with Autism who don’t see it as a disability, most do. And the one’ s that do are the ones you rarely hear from or hear about.

I find this interesting for a movement that purports to be about social justice. In my mind, social justice must involve advocating for the weakest people in our society. If it’s not doing that, it’s not really social justice. But the almost all the advocacy I have seen from NA writers and activists is for ASD1. It’s for the strongest, highest functioning people, who are either barely disabled or partially disabled. In a world of finite resources, this is a problem.

6.        Many of the ideas in the movement are vague and/or sketchy 

There are several ideas nested within the NA movement – the double empathy problem, monotropsim, the social model of disability, Facilitated Communication, etc. which are tenuous.

Monotropism for example proposes that autistic cognition is characterised by intensely focused attention. That's an interesting cognitive theory, but compared with mainstream cognitive neuroscience, executive function research, predictive processing models, or Bayesian accounts of autism, the evidence base is poor.

The social model of disability – the idea that people are disabled not only by their impairments but also by unnecessary barriers in society - adds very little in my view to any conversation. I don’t dislike the idea because it’s untrue. I dislike it because its trivially true.

Of course disability has something to do with the environment you are in – that’s just what ‘disability’ means. That’s why a fish without gills would be considered disabled. Because it lives in water and needs gills to breathe.  But what some activists do (via concept creep) is move from this trivially true but easy to defend statement to the more controversial and frankly silly statement that ‘disability is created by society’ (This is called the motte and bailey fallacy).

But notice that these are very different propositions. Organisms don't have traits in isolation. Traits only make sense relative to environments. A polar bear in Antarctica might do well. A polar bear in the Sahara would do terribly.  From an evolutionary perspective, all biological functioning is inherently relational: traits are adaptive or maladaptive only in particular environments. That's one reason I find some formulations of the social model less illuminating than they're often presented to be.  Of course changing environments can reduce disability. That's why we build ramps, provide hearing aids, prescribe glasses, install air conditioning and make workplaces quieter. But acknowledging that environments matter isn't a revolutionary theory of disability—it's simply recognising that humans, like every other organism, interact with their surroundings.

7.        Cancellation and moral certainty

Finally, many clinicians report being reluctant to publicly question aspects of neurodiversity because they're worried about being labelled ableist, harmful, anti-autistic etc.

That's not how science should work. Good ideas survive criticism. Bad ideas require censorship. That doesn't mean criticism should be rude. But disagreement shouldn't be treated as violence. One of the reasons I became interested in psychology in the first place is because I love science. Science is not a collection of sacred beliefs. It is a method. Its strength lies precisely in the fact that every idea remains open to challenge.

The NA movement increasingly behaves less like a scientific framework and more like a moral framework or activist movement. Once a movement begins to define dissent as moral failure rather than intellectual disagreement, it risks becoming ideological. That doesn't mean every idea within the movement is wrong but it does mean we should be especially careful to separate evidence from advocacy.