Disclaimer: the person and tense in which I write in this post change throughout because I found myself fairly distressed trying to figure out who I was speaking to. Basically if you’re anyone who has any influence over someone who is neurodivergent and their treatment, pay attention.
Earlier this week I posted about some of the downfalls of ABA and was rightly called out on the fact that I forgot to include one that is incredibly important: ABA often pushes autistic people to behave more “normally” just for the sake of being less autistic.
This is a larger issue than just the autistic community. This affects everyone who is neurodivergent or mentally ill in any way. Because while the goal of therapy is ostensibly to help people live content and healthy lives, many therapists often forget that what they perceive as “good” or “happy” isn’t necessarily what their clients want. That means that acting neurotypical often becomes the goal. This is especially true for kids or other populations that can’t easily advocate for themselves, like people who are nonverbal.
Think for a second about treatment for people with autism. This is one of the easiest examples to use, because many “autistic” behaviors are very visual and obvious, but don’t do any harm to anyone. That includes things like hand flapping, spinning, or rocking. Many treatment plans include a goal to decrease these behaviors. Why?
Well there might be a few reasons. If someone is in school it’s true that these things can be distracting to other students. But NOT doing them is distracting to the student with autism. So why do neurotypical needs get prioritized over neurodiverse ones? And some stims aren’t even distracting but are still seen as bad because they make the person look different.
There should be one guiding principle in all treatment: has my client communicated that this behavior is something that makes their life worse? VERY occasionally this comes with the addendum that if a client can’t see that something is harming them you still might need to try to get rid of the behavior, but I can only see that applying in physically dangerous cases like self harm, extreme caloric restriction, purging, drugs, etc.
But the point of therapy isn’t to “cure” people. It’s to make them healthy. Healthy is not the same as normal, and often doesn’t mean living without any kind of mental differences. Healthy means that you can live your life in the manner you like and mostly achieve your goals. It means your life is the way you would like it to be, at least in the really big ways. Most if not all people who deal with any serious neurodivergence do that while also continuing to live with their neurodivergences, because a brain that is wired for anxiety or depression or OCD or a personality disorder doesn’t stop being wired that way. At best a person can hide it.
Hiding the way your brain works and trying to behave in ways that are counter to the way your brain works is painful and unpleasant. So again, let’s go back to the goal. WHY do you want to change a behavior? Is it because differences make you uncomfortable? Is it because you think that it must make the person unhappy? Is it because you think it’s making their life more difficult?
I have two words for you: communication and consent. I think many treatment programs forget to communicate with the client. Because that communication can help you find out why someone is doing something. What purpose does it serve? Do they like it? If so, leave it alone. If not, you still need to help them find a way to serve the same purpose. And if your client doesn’t want to change something then you don’t get to decide for them. Just because someone is neurodivergent or mentally ill does not mean that they cannot make their own choices, or that they don’t have preferences, or that they can’t tell you what upsets them and what doesn’t. Your perception of better or worse is irrelevant.
Being “normal” does not necessarily mean better. What is important is making sure that people are doing things that make them happy, that aren’t held back by their brains, that they aren’t hurting. It’s to give people the best life possible, which does not mean the most neurotypical life possible. It means a life that makes THEM happy.
Now of course for some people sticking out is unpleasant, and if they don’t like being different then by all means it’s no problem for their treatment goals to include looking more normal. But consent is the basis for all of this. Do not try to change someone’s brain without their consent. That’s called manipulation and it’s abusive and cruel and unnecessary.
The end goal isn’t neurotypicality. It’s happiness and fulfillment. It’s a life that someone with neurodivergence likes. What providers miss when they prioritize neurotypicality is that they might be actively hurting someone finds it easier to behave in a different way. If you need to stim and you can’t, it’s uncomfortable and sometimes painful. If you have extreme anxiety and socializing outside of your social circle is intensely anxiety provoking, it makes sense that you’ll want a small, close group of long term friends instead. If those people are forced to behave like “normal” people, they will be less happy and less capable of functioning.
This is why providers need to learn to ask questions more often: what do you want? Why? And then they need to learn to give their clients the time and space to give informed consent to their treatment. Even people who are non verbal. Even people you assume can’t understand. They still deserve the basic respect of having their desires for their life heard. Always. And your assumptions about what makes them happy are not more important than what they actually want, even if that means they’ll look autistic or anxious or delusional for the rest of their lives.