Autism Strategies and

Neurodiversity Affirming
Practices

Self-Study Course

Cari Ebert, MS, CCC-SLP

Pediatric speech-language pathologist specializing in
autism, apraxia, and parent coaching → author →
professional speaker → product developer → parent
of an Autistic child → neurodiversity-affirming parent
and provider
*******************************************************
Website: CariEbertSeminars.com
Instagram: @cari.ebert.seminars
Facebook: Cari Ebert Seminars
Podcast: SLP Talk Show 2

Disclosures
Nonfinancial Disclosure: Cari has an Autistic son and
shares personal experiences in her trainings.

Financial Disclosure: Cari is author of the book, The

Learning to Learn Program, and the handouts,
Understanding Autism, which she will briefly
reference in this training. Cari receives royalties from
all product sales on her website and she benefits
financially from all sales of this self-study course.

3
 Cari’s Autism Products

Learning Outcomes
As a result of this training participants will be able to:
1. Describe the differences in how Autistic children
develop and learn using neurodiversity-affirming
language.
2. Summarize the racial and gender disparities in
diagnosing autism.
3. Explain how the medical model of disability promotes
ableism.
4. Formulate neurodiversity-affirming therapy/IEP goals.
5

When a child gets diagnosed as Autistic, parents are

going to grieve….but that grieving process should not
occur because they lost their child to autism…but
rather because their parenting journey is going to be
different from what they originally expected

6
 Making the Shift
◼ The information we are going to discuss regarding
neurodiversity affirming practices is not meant to
make anyone feel guilty about how services have
been delivered in the past.
◼ Much of the information we were taught about
autism when getting our degrees is now outdated
and ableist.
◼ Professional development is a lifelong process of
learning and improving one’s skill set (reflect and
refine!).
7

Reflect and Refine

We do the best we can

until we know better.
And when we know
better, we do better!
-Maya Angelou

Making the Shift

Three core tenets of neurodiversity-affirming providers:

1. We understand that autism is neither good nor

bad…autism simply is
2. We recognize that autism isn’t something we “treat”
3. We embrace neurodiversity-affirming services
because we choose to be trauma informed providers
(we vow to do no harm)

9
 Listening to Autistic Voices
We are learning so much about how to best support
Autistic children because we are finally listening to
the true autism experts...actually Autistic people!

Autistic Person

10

Reframing Autism

Reframing Autism Topics

1. Understanding autism 8. Three models of
2. Disparities in diagnosing disability
autism 9. Echolalia and gestalt
3. Neurodiversity language processors
4. Identity first language 10. Stimming
5. Stigmatizing language 11. Deep interests
6. Functioning labels and 12. Presuming competence
severity ratings 13. Behavior
7. Infinity symbol 14. Social skills “training”
12
 1. Understanding Autism

Understanding Autism
Mayoclinic.org, Childmind.org, CDC.gov, Dr. Barry Prizant)

◼ Autism is not a disease or illness that needs to be

cured. Autism isn’t something we “treat” and there is
no “autism therapy.” Autism is a different, yet valid
way of being human.
◼ Autism affects all areas of development and is present
throughout the lifespan. A child does not “outgrow”
autism or become less Autistic if we do enough
therapy/provide enough “treatment.”
◼ Autistic children develop differently from non-Autistic
children–they have spiky developmental profiles. 14

Spiky Developmental Profile

8-Year-Old Autistic Child

Knows detailed Can identify the

information about flags from over
the solar system 100 countries

Needs assistance Has difficulty Struggles using

with fastening coat answering silverware and
and putting on shoes questions scissors
15
 Cari’s Explanation of Autism
Learn
Play differently Process sensory
differently
input differently

Acquire Autistic Acquire

milestones language
differently Children differently

Experience Communicate
Relate to others
the world differently
differently
differently
16

Autism Traits in Young Children

(Sources: Adapted from Autism Navigator & CDC)

There are 3 primary areas of developmental differences

in Autistic children:
1. Communication
2. Social Interaction
3. Interests and Behaviors

Autism is an array of characteristics and each child has a

unique mixture of traits. See additional one-page
handout.
17

18
 Aut󰈎󰈻󰈛 Tr󰇽i󰉃󰈼: C󰈡m󰈚󰉊󰈞ic󰈀󰉃󰈏o󰈞 D󰈎ff󰇵re󰈝󰇸󰈩s
◼ Uses few or no socially motivated gestures (e.g.,
pointing at interesting objects or events to share the
experience with others, showing objects to others,
waving “hi” and “bye-bye”)
◼ Starts talking later than other kids (which is why AAC
should be introduced immediately)
◼ Enjoys making unusual sounds or using an unusual
tone of voice
◼ Doesn’t appear to understand questions or
directions
19

◼ Doesn’t consistently respond when spoken to

◼ Communicates by using another person’s hand as a
tool to get their needs met
◼ Has difficulty interpreting facial expressions, tone of
voice, and body postures (non-verbal communication)
◼ Stopped saying words that were previously spoken
◼ May say words and/or use gestures, but has difficulty
using gestures and words at the same time
◼ Has a good rote memory for letters, numbers, TV
jingles, etc.

20

◼ Repeats what other people say verbatim; enjoys

repeating lines from favorite movies and shows
(delayed echolalia); is a gestalt language processor
◼ Is drawn to music; may sing or hum tunes before
speaking any words; is able to mimic the intonational
patterns of a speaker

21
 Aut󰈎󰈻󰈛 Tr󰇽i󰉃󰈼: S󰈡c󰈏a󰈗 I󰈞t󰈩󰈸󰇽󰇸ti󰈡󰈝 D󰈏ffe󰈹󰈩n󰇹󰇵󰈼
◼ Has reduced or selective eye contact with others
◼ Shows little interest in social reciprocity/turn-taking
games (e.g., peek-a-boo, pat-a-cake, or rolling a ball
back and forth)
◼ Resists cuddling and being held
◼ Does not consistently respond to own name being
called
◼ Prefers to play alone or with adults who engage in
child-led play; may not acknowledge other children
22

◼ Focuses intently on own interests (instead of saying

“child is difficult to engage” or “child is in own world”)
◼ Uses a limited range of facial expressions
◼ Appears unaware of the feelings of other people
◼ Does not appear to share enjoyment with others by
smiling, laughing, or looking at them
◼ May be overly social and affectionate with strangers
◼ Has social learning differences/does not learn
naturally through social interactions with other
people; does not attend to and imitate the actions of
others
23

Aut󰈎󰈻󰈛 Tr󰇽i󰉃󰈼: D󰈎ff󰇵re󰈝󰇸󰈩s 󰈏󰈝 I󰈞te󰈸󰈩󰈼t󰈻 & Be󰈋󰈀v󰈏o󰈸󰈼

◼ Has an intense fondness for certain objects; these
comfort items may be regulating to the child
◼ Focuses intently on own interests; does not attend to
what is happening in the environment
◼ Shows more interest in objects than people
◼ Is interested in how things work; likes gadgets, such as
vacuums and light switches, more than toys
◼ Plays in unique ways; studies toys from different angles;
enjoys gathering, sorting, and lining up objects; is
interested in how objects move
24
◼ Is fascinated with specific parts of objects
◼ Prefers consistency; thrives in predictable situations;
finds safety in the familiar
◼ May stiffen and flair their fingers or posture their
bodies in unusual ways
◼ Has strong interests in certain sensory experiences
(such as sniffing or licking objects, rocking back and
forth, spinning in circles, flapping hands)
◼ Has over- or under-reactions to certain types of sensory
input; struggles with hygiene tasks such as brushing
teeth and getting haircuts; is a selective eater; is
particular about clothing
25

◼ Sensory processing differences are common in Autistic

people, but not all people with sensory differences are
Autistic. Auditory and tactile hypersensitivity are most
predictive of autism in young children (Jussila et al.,
2020).

◼ About 25-35% of Autistic individuals will never acquire

complex speech (Rose et al., 2016). This is why
unrestricted access to multimodal communication/AAC
is necessary. 26

Quick Notes on AAC

➔ Augmentative and alternative communication (AAC)
should never be considered a last resort.
➔ AAC can include gestures, sign language, pictures,
emojis, written words, and voice output devices.
➔ Don’t ever place a higher value on spoken language
than on other forms of communication.
➔ We need to provide non-speaking, minimally
speaking, or inconsistently speaking children
unrestricted access to multi-modal communication.
➔ The goal is communication…not speech!
27
We don’t have a crystal ball, so no one
can predict which kids will talk and
which ones won’t

**Everyone develops language, but not

everyone develops speech
28

◼ In the medical world, it is referred to as “Autism

Spectrum Disorder” or “ASD.” The word “spectrum”
refers to the varying strengths and challenges that
Autistic people experience. No two Autistic people
present with exactly the same traits or behave exactly
the same way. The word “disorder” is a problem
because it indicates something is wrong (i.e., autism is
bad) and needs to be fixed.

*Neurodiversity affirming providers and parents are

now using the more neutral terms “autism” or
“autism spectrum” instead of the pathologizing terms
“autism spectrum disorder” or “ASD.”
29

◼ In the medical world, it is referred to as “Autism

Spectrum Disorder” or “ASD.” The word “spectrum”
refers to the varying strengths and challenges that
Autistic people experience. No two Autistic people
present with exactly the same traits or behave exactly
the same way. The word “disorder” is a problem
because it indicates something is wrong (i.e., autism is
bad) and needs to be fixed.

*Neurodiversity affirming providers and parents are

now using the more neutral terms “autism” or
“autism spectrum” instead of the pathologizing terms
“autism spectrum disorder” or “ASD.”
30
● My son Aaron is Autistic,
not broken. His brain is
wired differently.
● He does not have a
disorder. There is nothing
“wrong” with him and he
doesn’t need to be “fixed.”
● What he needs is supports
and services to help him
access the same
opportunities that non-
disabled 19-year-olds have.
● Aaron is different, not less.
31

◼ Autism occurs in every ethnic group and across all

socioeconomic levels.
◼ Autistic individuals may have co-occurring medical
conditions such as allergies, epilepsy, digestive issues,
sleep disorders, feeding disorders, immune/
autoimmune disorders, etc. (National Autism
Association). These medical conditions need to be
treated by medical professionals. But autism itself isn’t
a medical condition…it’s a brain difference.
◼ There are many different biologic/genetic and
environmental factors that make a person more likely
to be Autistic.
32

Theories on what “causes” autism

Refrigerator moms Tylenol
Vaccinations

Always blaming mom

33
 Making the Shift
The neurodiversity movement helps us understand that
there isn’t a “cause” of autism per se…rather, autism is
a natural variation in the human genome…a different
but valid way of being human

34

➔ Increased parental ages are associated with higher

likelihood of autism in children with high familial risk.
Some studies link both maternal and paternal ages,
while others link only to advanced
paternal age (Lyall et al., 2020).

➔ Autism runs in families. A child’s odds of being Autistic

increase if they have a sibling diagnosed with autism,
ADHD, or intellectual disability OR a parent with
anxiety, depression, schizophrenia, or bipolar disorder.
(Nicholette Zeldidiat, spectrumnews.org, 4/15/19)
35

➔ Current evidence suggests that environmental factors

such as vaccines, thimerosal exposure, maternal
smoking, and assisted reproductive technologies (IVF)
are unrelated to risk of autism (Modabbernia et al.,
2017).
➔ According to www.factcheck.org (Feb 2023), there is
currently no strong evidence that acetaminophen use
(Tylenol) during pregnancy causes autism or ADHD in
children. Some studies have shown a relationship
between acetaminophen taken during pregnancy and
autism/ADHD in children, but they do NOT
demonstrate causation. Correlation is not the
same as causation! 36
➔ Increased parental diagnosis
◆ Following their child’s autism diagnosis, many
parents are getting their diagnosis later in life
◆ Article: ‘A lot fell into place’: the adults who
discovered they were Autistic – after their child
was diagnosed | Autism | The Guardian

37

➔ Assortative mating is a nonrandom mating system in

which people with similar genotypes mate with one
another (Connolly et al., 2019).
◆ There is significant evidence of genetic similarity
between the parents of Autistic kids, meaning
neurodivergent people tend to seek out and
mate with other neurodivergent people.
◆ This helps explain the rising prevalence of autism.

38

Autism and Brain Differences

◼ MRI studies have highlighted some brain regions
that are structurally different in Autistic individuals.
◼ This helps us to understand that autism should be
viewed through a neurological lens, not a
behaviorism lens.
◼ Autistic people are wired differently.
◼ Autism is a brain difference, not a behavior disorder.

Reference: Brain structure changes in autism, explained by Angie Voyles

Askham, October 2020, SpectrumNews.org
39
2. Racial and Gender
Disparities in Diagnosing
Autism

Bias in Autism Research

Riley-Hall, 2012; Dean et al., 2017; Rynkiewicz, et al., 2016; Young et al., 2018

◼ While autism is 4 times more likely to be diagnosed in

boys than in girls (CDC), it doesn’t mean that autism
occurs more often in boys…it means Autistic girls
aren’t getting diagnosed as often as Autistic boys
◼ Autistic girls often go undiagnosed because they do
not “fit” the diagnostic stereotypes (due to use of
predominantly male samples in testing and research)
◼ Autism has historically been considered a boy’s
disorder, but we are missing the signs of autism in girls
41

Autism Traits in Girls

Dean et al., 2017; Rynkiewicz, et al., 2016; Young et al., 2018

● Autistic girls tend to be more socially motivated than

Autistic boys which means they:
○ are more likely to control their behavior in public
○ share more social smiles and use more eye contact
○ tend to have similar interests as other girls their age
(just with more intensity)
○ show more interest in peers
○ may imitate the social behavior of peers (“social
echolalia”)
42
● In preschool and elementary school, Autistic girls are
often taken in by a peer who acts as a “mother hen”
(this support often fades away by middle school)
● Autistic girls tend to have more internalizing traits, so
they might be quieter and more withdrawn than
Autistic boys (Abha Gupta, MD, PhD)
● Autistic girls exhibit less repetitive and restricted
behavior than boys do (Stanford study, 2005); they
may suppress natural stimming behaviors
● Autistic girls are better at masking Autistic traits,
making it less likely for them to be referred for an
evaluation
43

● Autistic girls are more likely to be diagnosed at a

younger age if they have significant disruptive
behaviors (i.e., externalizing
behaviors such as verbal
outbursts, physical aggression,
self-injurious behavior, or
eloping)
● Before receiving their autism
diagnosis, Autistic girls may be
misdiagnosed with anxiety, depression, or ADHD
● Autistic girls often go through life wondering what’s
wrong with them…and may not get diagnosed until
adulthood 44

“Realizing I was Autistic set me free. I was depressed

for over 15 years before finding out. I am now off all
psych medications for the first time since high school.”

-message from a an adult female follower on Instagram

45
 Racial Inequities in Autism
◼ For racialized communities, there is an ongoing lack of
culturally competent resources and services to
support families with Autistic children (Wong, 2021).
◼ Black and Hispanic children are less likely than their
white peers to be diagnosed with autism and to have
access to quality services (Durkin et al., 2017).
◼ For Black children, there is an average of a 3-year
delay between parents first reporting developmental
concerns and actually getting the autism evaluation
(Constantino et al., 2020).
46

◼ Historically, Black children have been misdiagnosed at

high rates. A 2007 study by Mandell et al. found that
black children are 5 times more likely to be
misdiagnosed with behavior disorders before receiving
the correct diagnosis of autism.

47

Autism and Hispanic Children

Among Hispanic children, there are many potential
barriers to identification of Autistic children including:
◼ stigma associated with the label
◼ lack of access to healthcare services due to
non-citizenship or low income
◼ non-English primary language

Source: CDC, National center on Birth Defects and Developmental Disabilities

48
 Good News!
◼ According to the CDC, one reason autism prevalence
in the United States is rising (up from 1 in 44 kids to
1 in 36 kids) is because for the first time ever autism
is being diagnosed more frequently in Black and
Hispanic children than in white children.
◼ Thanks to improved screening and autism services
for ALL kids, autism is no longer a diagnosis primarily
given to white males from middle- or upper-income
families (those with the best access to high-quality
healthcare and autism specialists).
49

Autism is on the Rise

Autism prevalence in 2000: 1 in 150 children
Autism prevalence in 2010: 1 in 68 children
Current autism prevalence: 1 in 36 children
◼ Reasons more Autistic kids are being identified today:
better understanding of the Autistic neurotype,
assortative mating, and improved screening for Black
and Hispanic children.
◼ BUT, we still need to improve screening and diagnosis
to identify Autistic girls…and when we do, expect
the autism prevalence numbers to skyrocket!
50

3. Neurodiversity
 Neurodiversity Movement
● The neurodiversity movement is a social justice and
civil rights movement that intersects with the
disability rights movement (Hughes, 2016).
● The neurodiversity movement has been gaining
momentum since it was first introduced by Singer in
1998 due to the voices, advocacy, and protest of the
Autistic community (Leadbitter et al., 2021).
● A central premise of the neurodiversity movement is
that variations in neurological development and
function are a natural and valuable part of human
variation and not pathological (Leadbitter et al., 2021). 52

To better understand
neurodiversity, let’s start with
biodiversity
◼ Bio = living organisms and diversity = differences so
biodiversity = differences in living organisms.
◼ Biodiversity refers to the enormous variety and
variability of life on earth (humans, animals, plants,
microorganisms).
◼ Biodiversity is essential to maintain
balance and support all life on Earth.

53

Now let’s talk about neurodiversity

◼ Neuro = brain, and diversity = differences, so
neurodiversity = brain differences.
◼ We know that people all look different
(different hair color/texture, different
skin pigmentation, different eye color,
variable heights and weights). Neurodiversity
helps us understand that our brains are different too!
◼ We live in a neurodiverse society that is becoming
increasingly more neurodiverse.
54
 Our Neurodiverse Society
Our neurodiverse society includes two neurotypes
(brain types):

1. Neurotypical
2. Neurodivergent

55

Neurotypical refers to a person who thinks, processes,

learns, and behaves in ways that are considered the
“norm” by the general population. Most neurotypical
people can get by without any specialized supports in
school (IEP) or at work (job coach).
Neurodivergent refers to a person who has enough
variation to their neurology that it warrants a diagnosis
(ADHD, autism, AuDHD, dyslexia, dysgraphia, dyspraxia,
dyscalculia, etc.) to help explain their brain differences,
learning differences, and need for individualized
supports. A neurodivergent person can’t be “cured”
because they don’t have a disease or illness. They have a
brain that functions differently. 56

Using the Terms

The term neurodiverse describes a group of people with
varying neurologies (neurotypical & neurodivergent):
-Our society is neurodiverse.
-We live in neurodiverse neighborhoods.
-A special education classroom is not neurodiverse.
A person is either neurotypical or neurodivergent:
-Cari has two neurotypical children and one
neurodivergent child.
-Some of our colleagues and friends are neurotypical
and some are neurodivergent.
57
 FYI
A person can be neurodivergent in more than one way.
For example, a person can have a diagnosis of ADHD
and dyslexia or another person might have a diagnosis
of autism and ADHD (which is referred to as AuDHD in
alphabet soup).

58

Another New Term

New vocabulary: neurodiverse, neurodivergent, and
neurotypical…there’s one more new word to
know…allistic.

Allistic refers to a person who is not Autistic.

Some neurodivergent people are Autistic and some are

allistic. An Autistic person is neurodivergent; a person
diagnosed with ADHD, dyslexia, or dyspraxia–for
example– is neurodivergent and allistic (meaning they
are not Autistic).
59

◼ It is estimated that about 15-20% of people in the

world are neurodivergent (Doyle, 2020).

◼ In a classroom with 20 students, it is likely that 3 - 4 are

neurodivergent (some are undiagnosed; these kids
learn differently from neurotypical kids in the class).
60
 Gen Ed Teachers and
Neurodiversity
● As our society becomes more neurodiverse, general
education teachers are going to need more training
in neurodiversity-affirming teaching practices.
● Being able to differentiate teaching to support both
neurotypical and neurodivergent students in the
general education classroom is a critical 21st century
teaching skill.
● Not all neurodivergent students can be referred to
special education!

61

62

The concept of neurodiversity:

◼ helps us view neurodivergent people as having
brain differences, not deficits.
◼ acknowledges that there is no “right” way of
being human.
◼ helps us understand that kids don’t all learn in
the same way or at the same time.
◼ encourages us to recognize and celebrate the
richness and complexity of the human brain.

63
 All brains are beautiful!

“The world needs all kinds of minds.”

Temple Grandin, Autistic animal scientist and professor of animal
science at Colorado State University
64

Famous Neurodivergent People

Steve Jobs
Character traits of people
Bill Gates
who have excelled in
Albert Einstein their field:
Sir Isaac Newton
- creative/innovative
Thomas Jefferson - determined
Wolfgang Amadeus Mozart - hyper-focused
Leonardo da Vinci - unconventional
Temple Grandin

65

Defining “Unconventional”
To be unconventional is to act, dress, speak, or
otherwise exist out of the bounds of cultural norms.
-vocabulary.com

Being Autistic is an unconventional way of being human.

It’s not wrong. It’s not bad. It’s just different.

66
 Understanding Neurodiversity
◼ Historically, society has expected Autistic individuals
to change and/or mask their Autistic traits (believing
that neurotypical is the ideal neurotype).
◼ For decades, therapists and educators have been
trying to make Autistic children act “less Autistic” by
teaching them to mimic neurotypical behaviors. We
now understand that an Autistic person cannot
become less Autistic (unless you are expecting them
to camouflage, or mask, their authentic way of being
human).
67

Explaining Autism
Autistic adults explain that being Autistic is like having a
different operating system: Mac vs. Windows or iOS vs
Android…one is not better than the other, they are
simply different!

Mac vs. Windows

68

Must Read
Reference:

Updated and
expanded edition
now available!
69
“Autism isn’t an illness. It’s a different way of being
human. Autistic children and adults aren’t sick; they
are progressing through developmental stages as
we all do. To help them, we don’t need to change
them or fix them…what’s most vital―for parents,
professionals, and society as a whole―is to work to
understand them, and then change what we do.”
Barry Prizant, Page 4

70

Trauma Informed
● Neurodiversity-affirming = trauma informed
● Trauma informed providers pay close attention to
how the Autistic child experiences the world rather
than how we do…or how we think they should
based on social “norms”
● Trauma informed providers view dysregulation
(sometimes called ‘challenging behavior’) through a
neuroscience lens rather than through a behaviorist
lens

71

4. Identity First Language

 Person-First Language
◼ When talking about individuals with disabilities,
diseases, and other health conditions, most of us
have been taught to use person-first language.
◼ Person-first language means the person is stated
first and the disability/disease is stated last (e.g.,
Person with AIDS instead of AIDS patient, Child with
Down syndrome instead of Downs child).
◼ Person-first language was written into law in the
Americans with Disabilities Act in 1990 and the
Individuals with Disabilities Education Act in 1997.
73

Making the Shift

Shannon Woolridge, NIH Office of Communications, 2023

◼ Language and societal views and values are always

changing and some people in the disability
community are opposed to person-first language.
They believe that if language is needed to separate
them from a trait, it suggests that the trait is
negative.
◼ So there is a shift in thinking and many in the autism
community prefer the use of identity-first language
because they feel that autism is a defining part of
their core identity.
74

Identity-First Language
(www.aucd.org)

◼ When using identity-first language the disability is

stated first and the person is stated last (Autistic
child instead of child with autism).
◼ Identity-first language emphasizes that the disability
plays a role in who the person is and cannot be
separated from them. It also reinforces disability as a
positive cultural identifier.
◼ Identity-first language attempts to remove the
stigma associated with the diagnosis/their way of
being human.
75
 Autism isn’t like a backpack
When we use person-first language
and say, Child with autism, it makes
autism sound like something that can
be carried around and set aside upon
request, like a backpack.
Autism
“Please set your autism aside for a
while because your way of being
human is bothering me right now.”
-Neurotypical Person
76

Identity-First Language
(www.aucd.org)

Identity-first language is generally preferred by self-

advocates in the Deaf, Blind, and Autistic communities.

Deaf child, not child with deafness

Blind child, not child with blindness
Autistic child, not child with autism

77

Let’s Ask the Autism Community

A 2022 poll of close to 7,500 Autistic people (including
non-speaking Autistic people) showed that 76% of
those surveyed preferred to be referred to as an
“Autistic person” viewing autism as a positive part of
their identity; 4% preferred to be described as “person
with autism”; 15% said either is fine; and 5% did not
respond.
(The Autistic Not Weird Autism Survey results;
learningdisabilitytoday.co.uk, I don’t ‘have autism’,
I am Autistic” – Mette)
78
 Autism: Diversity of Perspectives
Shannon Woolridge, NIH Office of Communications, 2023

◼ Generally speaking, we should consider using the

language that the community at large uses (the
Autism community generally prefers identity-first
language: Autistic child/student/person).
◼ BUT…we must also understand that there is a
diversity of perspectives within the community, so
we need to listen to individual preferences. Many
parents prefer person-first language (child with
autism) until they learn the why behind identity-first
language.
79

5. Stigmatizing Language

Stigmatizing Language
One of the most stigmatizing things about autism is that
it often talked about using negative, deficit-driven
language.
s Warning sig
flag n s
Red
Behavior problems

Suffers from Deficits

Traged
y
Rigid
81
 Our Words Matter
◼ It’s time to change the narrative!
◼ Current autism definition:
Autism is a disorder marked by deficits in
communication and social skills, and the presence
of restricted or repetitive behaviors.
-American Speech-Language-Hearing Association (ASHA)

82

Do you see any negative, stigmatizing

language?

Autism is a disorder marked by deficits

in communication and social skills, and the presence
of restricted or repetitive behaviors.

83

Replace stigmatizing words with

neurodiversity affirming language…

Autism is a disorder marked by deficits

in communication and social skills, and the presence
of restricted or repetitive behaviors.

Autism is marked by differences in communication

and social skills, and the presence of highly focused
deep interests and/or repetitive regulating
behaviors.
84
 Our Words Matter
◼ It is common for professionals to describe a child as
having symptoms, red flags, or warning signs of
autism.
◼ The term warning sign suggests that autism is a tragic
diagnosis that leads to negative outcomes. The truth:
Autistic individuals can and do lead happy and
fulfilling lives, with appropriate supports and services.
◼ The Center for Disease Control (CDC) actually has a
document called “Early Warning Signs of Autism
Spectrum Disorder.”
85

ing is wrong
Oh no! Someth
with my child!

86

◼ The term red flag is a warning of danger and leads

parents to think something is alarmingly wrong with
their child. The truth: autism is a label for the child’s
neurology…for their way of being human.
◼ Symptom is a term used to describe medical concerns
related to a disease or illness. The truth: autism is a
different neurotype, not a disease or an illness that
needs to be cured…therefore, it does not have
symptoms. (Note: Autistic children can have
co-occurring medical diagnoses, such as epilepsy, that
do have symptoms requiring medical intervention. But
autism isn’t a disease, so it doesn’t have symptoms.)
87
 Instead of saying

Red flags, Warning signs, or Symptoms of Autism

we can say…

Signs, Traits, or Characteristics of Autism

88

Another Term to Consider

Q: How do most people refer to a child who does

not talk?

A: Non-verbal

89

Non-Verbal vs. Non-Speaking

◼ Instead of describing a child as non-verbal, the
Autistic community has indicated a preference for the
term non-speaking.
◼ Here’s why: Verba is the Latin root word of verbal and
it means “words.” Therefore the term non-verbal
suggests that the person is without words. A
non-speaking person uses words to communicate, but
they are not spoken/mouth words.
◼ So that’s why we are shifting away from the term
non-verbal to the term non-speaking.
90
 Other Terms
Along with the term “non-speaking” we can also use
these terms to describe one’s use of spoken language:

◼ Minimally speaking: This describes a person who

uses fewer than 25 spoken words (Koegel et al.,
2020).
◼ Inconsistently speaking: This describes a person who
can communicate adequately with spoken words,
but when under duress, may not be able to access
their spoken language.
91

Strengths-Based Language
Neurodiversity-affirming providers should aim to use
strengths-based language. That means we describe and
document how the Autistic person does communicate
instead of focusing on how they don’t communicate.

◼ Deficit driven language: The child is non-speaking.

◼ Strengths-based language: The child uses gestures,
signs, pictures, and a speech generating device to
communicate.

92

6. Functioning Labels and

Severity Ratings
 Current Language
High-functioning autism = mild autism
Low-functioning autism = severe autism

Functioning Severity
labels ratings

94

How We Use the Labels

◼ The terms high-functioning autism and
low-functioning autism are subjective descriptors
used to separate Autistic people into two categories
(humans like binary things…good/bad, black/white,
high/low, mild/severe).
◼ Low-functioning autism is a term historically used to
describe Autistic people who are non/minimally-
speaking and those who have co-occurring
intellectual disabilities. These individuals are also
described as having severe autism.
95

◼ High-functioning autism is a term historically used to

describe Autistic people who can talk (use spoken
language as their primary means of communication)
and have cognitive abilities in the average or above
average range. These individuals are also described
as having mild autism.
◼ A person with high-functioning autism is thought to
be closer to “normal.”
Oh wow…he
doesn’t look
Autistic!

96
 Let’s Talk about “Normal” People
◼ Who gets to decide what makes a person “normal?”
◼ Is the word “normal” appropriate to use when
discussing human beings?

I have three children…two of my kids are

neurotypical and one is neurodivergent, but I
would argue that they are all normal!
The opposite of normal is…

97

Author and comedian Patsy Clairmont says that “Normal is just a

setting on your dryer.”

98

Synonyms for normal include:

➔ usual
➔ average
➔ standard
➔ typical
➔ expected

The problem with trying to make Autistic kids act more

normal/average/typical/as expected, is that we are
assuming that typical abilities are superior. And that
leads to ableism.
99
 Ableism
◼ Ableism is discrimination against disabled people
because of the belief that typical abilities are superior.
◼ All of us “typical people” in the therapy/special
education world have been hired to “fix” these
Autistic children. Whoa! We really need to stop and
unpack that…autism isn’t something we “treat.” We
provide supports and services, not treatment.
◼ Autism is a different neurotype…it is a different but
valid way of being human.

Different not less!

100

Severity Ratings
How Autistic are you?
Well…how neurotypical are you?
We don’t assign a level to how Autistic someone is
(mildy/severely Autistic) just like we don’t assign a level
to how neurotypical someone is.

Have you met Karen the new speech therapist? She

is severely neurotypical!
Have you met that new teacher Carlos yet? Well, he
is mildly neurotypical.
101

DSM-5 Autism Levels

◼ The Diagnostic and Statistical Manual-5th edition
(DSM-5) does outline specific autism levels:
Level 1 autism: individual requires support
Level 2 autism: individual requires substantial
support
Level 3 autism: individual requires very substantial
support (spicy autism ????)
◼ These levels may not be very helpful because an
Autistic person’s support needs can vary depending
on the task, environment, level of regulation, etc.
102
 Level 1 Level 2 Level 3

103

What if we
viewed autism
as a non-linear
spectrum?

104

Support Needs Profile

early elementary school

105
Support Needs Profile Example
early elementary school

106

Support Needs Profile

executive function skills Could w
e
a support use
needs pro
for all kid file
s?

107

Support Needs Profile Example

academics

108
 Support Needs Profile
◼ Each child’s support needs profile should be
individualized (i.e., don’t use the same template for
every child!).
◼ Basing therapy/IEP goals on the child’s support
needs profile would lead to meaningful goals.
◼ Instead of talking about functioning levels and
severity ratings…neurodiversity-affirming providers
and parents are making the shift to talking about the
child’s level of support needs for access and
participation in everyday activities.
109

Instead of using functioning labels or severity ratings,

describe the child’s strengths and areas where they
benefit from higher levels of support.
Example 1: Instead of classifying 18-year-old Aaron as
having high functioning autism, we could say…
At school Aaron is punctual, manages his time well, is
kind and considerate, and is learning to self- advocate by
asking for clarification or help when he needs it. He
requires more support in situations where sarcasm or
non-literal language is used, in PE class when learning
new movement games, and when asked to follow
complex directions.
110

Example 2: Instead of classifying 5-year-old Ava as

having severe autism, we could say…
Ava enjoys lining up her blocks, jumping on the
trampoline, and watching episodes of Bluey. She is able
to feed herself with her hands but is not yet using
utensils. Ava communicates her wants and needs
primarily by leading caregivers to desired items. She
pushes objects or people away and uses a high-pitched
screech to protest. Ava needs higher levels of support to
access the kindergarten curriculum, to communicate
with others, to remain safe during transitions, and to
get her sensory needs met throughout the day.
111
 7. Puzzle Piece vs. Infinity
Symbol

Logos of Autism
The puzzle piece has historically been the
logo associated with autism awareness.

How many of you have ever

owned something with a
puzzle piece on it?

113

The Puzzle Piece

◼ A brand’s logo should be carefully chosen to convey
their character, principles, mission, and core identity.
◼ The original puzzle piece symbol from 1963 had a
child crying inside of it, designed to represent the
mystery and sadness of the puzzling condition
known as autism.

From this To this

114
 The Puzzle Piece
◼ The puzzle piece logo contributes to the
stigma associated with autism…and we
have research to back this up.
◼ The puzzle piece imagery has been found to evoke
negative associations in the general public
(Gernsbacher et al., 2018). Participants in this study
explicitly associated puzzle pieces (both those used
as autism logos and those used more generically)
with incompleteness, imperfection, and oddity.

115

Issues With the Puzzle Piece

@NeuroClastic
◼ The childish puzzle pieces contribute to infantilism
(treating older children and adults like babies).
Regardless of support needs, Autistic children
become Autistic adults. Autistic adolescents and
adults are not perpetual children trapped in
adult-sized bodies.
◼ The interlocking puzzle pieces in mismatched
colors are a jumbled hot mess…in what world
do non-matching puzzle pieces link together?
116

Issues With the Puzzle Piece

@NeuroClastic
◼ The puzzle piece symbol suggests that an Autistic
person is a puzzle to be solved…that there is a
missing link to a cure. And if we could just find that
missing link, then we could rid the world of autism. If
we believe that Autistic people have incomplete
brains, then we view them as broken versions of
neurotypical people who need to be “fixed.” (YIKES!)
◼ The puzzle piece is brand recognition, and Autistic
people are not products to be capitalized upon. $$$
117
 Issues With the Puzzle Piece
◼ The color blue is usually associated with the puzzle
piece, perpetuating the myth that autism is a “boy
disorder.”

Have you ever

seen a pink
puzzle piece
to represent
autism?

118

Autistic People Decide

@NeuroClastic
◼ If an Autistic person likes the puzzle piece or if it has
has some special significance to them, respect their
choice.
◼ But neurodiversity-affirming allies to the Autistic
community should respect the community majority
and choose not to use the puzzle piece to “brand”
autism.

119

Infinity Symbol
◼ The infinity symbol is now the preferred visual
representation for autism and neurodiversity in
general.

◼ The infinity symbol indicates that the spectrum is not

linear (like a line), recognizing that Autistic
individuals have fluctuating strengths, needs, and
challenges.
◼ The infinity symbols removes the stigma of Autistic
brains being incomplete, like a missing puzzle piece.
120
 Infinity Symbol
◼ The infinity symbol promotes the endless
possibilities that exist for Autistic people, when
their differences are accepted instead of
pathologized.

121

Infinity Symbol
@NeuroClastic
◼ The color is relevant, as is true with any brand
identity. The gold infinity symbol represents autism
(like the gold element on the periodic table) while
the rainbow infinity symbol represents all
neurodivergent people.

AUtism Autism,
dyslexia, ADHD,
dyspraxia, etc.
122

Update Your Support

@NeuroClastic
◼ Some people have been using
the puzzle piece but their heart
is in the right place. So don’t be
judgemental.
◼ If you have been using the puzzle
piece, but now understand the
rationale behind shifting to the
infinity symbol, then be open and admit it. Be ready to
explain why you are making the shift.
123
 8. Models of Disability

Models of Disability
Amy Donaldson, Ph.D. & endever* corbin, 2022;
Davis & Crompton, 2021; The Nora Project, 2022

◼ Medical Model of Disability

◼ Social Model of Disability
◼ Biopsychosocial Model of Disability (hybrid model)

125

Medical Model of Disability

Amy Donaldson, Ph.D. & endever* corbin, 2022;
Davis & Crompton, 2021; The Nora Project, 2022

◼ Disability is caused by a problem that exists inside a

person’s brain and/or body
◼ The person’s disability is considered a disease or
condition that is pathological in nature
◼ The onus of responsibility for overcoming the effects
of the disability is placed on the individual to “get
better/try harder” and not stand out in a crowd
◼ Assumes having a disability = poorer quality of life
126
◼ Disability is considered to be a deficiency
◼ Disabled means less able
◼ People with disabilities need special settings to live,
learn, work, and play (exclusion)
◼ Disabled people have less meaningful relationships
◼ Disabled people play a less important and less active
role in society
◼ A disabled person’s impairment is the reason why
they don’t fit into society
◼ Disability is considered negative so euphemisms, such
as differently abled, are used to “soften” the language
127

Our Response to Autism According

to the Medical Model of Disability
◼ Autism is viewed as a disease/disorder that requires
intensive therapies (20-40 hrs per week)
◼ Autism treatment focuses on “fixing” deficits
identified on standardized tests and improving
behavior so the person acts more typical
◼ Autism awareness might exist but society does not
practice autism acceptance; exclusion is common
◼ The professional is expected to “fix” the Autistic
individual
128

Social Model of Disability

Amy Donaldson, Ph.D. & endever* corbin, 2022;
Davis & Crompton, 2021; The Nora Project, 2022

◼ Disability is viewed as a social construct (meaning it

has been created and accepted by people in a society)
◼ Disability occurs because of obstacles created by
attitudinal barriers toward differences; these
attitudes keep disabled people from fulfilling their
potential
◼ Physical or mental challenges are not the cause of
disability; lack of access and supports are the cause
of disability because they exclude disabled people 129
from society
◼ Government, businesses, and individuals create
barriers that disable
◼ This model stops blaming the individual for their
limitations/way of being human
◼ Acknowledges that human differences will always be
present, so the best plan is to find solutions, take
action, and remove barriers so that disabled people
are included rather than excluded from society

130

Our Response to Autism According

to the Social Model of Disability
◼ Autism is considered a different, but valid way of
being human
◼ There is no push for treatments to “fix” deficits
◼ Society is expected to value, accept, and adapt to the
differences of Autistic individuals without trying to
change them
◼ Inclusion is a priority

131

Biopsychosocial Model of Disability

Amy Donaldson, Ph.D. & endever* corbin, 2022; The Nora Project, 2022

◼ A holistic approach that considers integration of all

aspects of disability (biological, psychological, and
social factors)
◼ Disability is viewed as a human difference
◼ Disability is viewed as part of a person’s identity and
can be a source of pride
◼ Simultaneously recognizes the disabled person’s
challenges AND society’s role in valuing and accepting
differences
132
◼ Supports and services are provided to ensure disabled
people have the same access to life events and
experiences as non-disabled people
◼ Policy changes and a shift in society’s attitudes toward
disability are critical components to addressing
barriers and people’s implicit biases

133

Our Response to Autism According to

the Biopsychosocial Model of
Disability
◼ Autism is viewed as a disability (disability is not a bad word)
◼ Society practices autism acceptance (not just awareness)
◼ Inclusion and belonging are key
◼ Autism services provide individualized supports,
modifications, and accommodations to increase
access/participation and improve quality of life
◼ Focus is on stretching strengths (instead of fixing
deficits)
134

Stretching Strengths
(instead of fixing deficits)

135
 Stretching Strengths
(endless opportunities for Autistic individuals)
136

Autism is not a bad word! Disability is not a bad word.

Euphemisms like differently abled, handi-capable, and
see the able not the label contribute to the stigma
associated with being disabled. Neurodiversity-affirming
providers avoid using euphemisms.

“Anything that is human is

mentionable, and anything
that is mentionable can be
more manageable.”
-Fred Rogers

137

When a parent says, I don’t want my child to be

labeled…
Autism and ADHD are disability labels/diagnoses
that explain a child’s neurology.
If the correct labels aren’t used
because someone finds them
offensive or stigmatizing, then
other labels such as lazy, rude,
unmotivated, stubborn, and
naughty will be used instead.
138
 9. Echolalia and Gestalt
Language Processors
Lillian Stiegler, 2015; Marge Blanc, 2012

Echolalia
◼ In Autistic children, echolalia has historically been
viewed as meaningless use of language and considered
to be a deficit. We now understand this is not true.
◼ Many SLPs were actually trained to write goals to
extinguish the use of echolalia (aka “movie talk”) in
Autistic kids.
◼ We now understand that delayed echolalia is how some
kids acquire and use language.
◼ New Research: A systematic review of interventions for
echolalia in Autistic children (Blackburn et al., 2023)
140

A systematic review
of interventions for
echolalia in Autistic
children by Blackburn
et al., 2023

International Journal
of Language &
Communication
be viewed
Disorders Echolalia should
to functional
as a gateway
Read the discussion tio n in stead of as
communica
at the end of the havior that
a pathological be
article ex tin guished.
needs to be 141
 Language Development
◼ There are two different styles of language processing
and acquisition: analytic and gestalt.
Analytic means separating something into component
parts; analytic language development is from part to
whole
Gestalt means an organized whole; gestalt language
development is from whole to part
◼ While both neurotypical and neurodivergent people
can be gestalt language processors, it is thought to be
more common in Autistic people.
142

◼ Many SLPs did not learn

about gestalt language
processors in grad school
◼ Because this concept has
not been widely taught, it
is poorly understood
◼ However, this concept is
not new
Page 10
Two different styles
of language learning
1. Analytic
2. Gestalt
circa 2005 143

Analytic Language Learners

(O’Grady, 2005; Blanc, 2012)

Analytic language learners acquire language by:

◼ perceiving little units of language (i.e., words)
◼ learning one word at a time in the moment
◼ producing short, clearly articulated, one-word
utterances
◼ labeling people (mama, dada) and objects (ball, car,
shoe)
◼ Using single words to describe their wants, needs, and
feelings (up, hot, juice)
144
 Gestalt Language Learners
(O’Grady, 2005; Blanc, 2012)

Gestalt language learners acquire language by:

◼ perceiving larger, intonationally defined units of
language called gestalts or scripts; these gestalts are
usually tied to an emotional or dramatic experience and
most cannot be taken literally (@meaningfulspeech)
◼ memorizing and producing whole chunks of language
(some short, some long)
◼ producing speech that is often poorly articulated (may
be dismissed as babbling, gibberish, or jargon)
◼ using delayed echolalia 145

Analytic Language Gestalt Language

Processors Processors
■ Bottom-up language ■ Top-down, wholistic
learners language learners
■ Start with production ■ Echo chunks of
of single words and language focusing on
then gradually and intonational patterns,
systematically move to without understanding
word combinations the meaning of words
■ Known as word babies ■ Known as intonation
(Dore, 1974) and focus babies (Dore, 1974) and
on meaning of words are drawn to music
146

Analytic or Gestalt?
1. Toinfinityandbeyond!
se:
2. Buzz, Woody at all kids u
Gestalts th
3. Up
you
➔ Thank
4. Pickyouup P
➔ LMNO
5. Go
6. Gottagonow
7. Mama
8. Whosmamassweetboy?
147
 Natural Language Acquisition of GLPs
(Marge Blanc, MA, CCC-SLP)

◼ Stage 1: Language gestalts

◼ Stage 2: Mitigations
◼ Stage 3: Isolated single words and 2 word combos
◼ Stage 4: Original phrases and beginning sentences
◼ Stage 5: Original sentences with more complex
grammar
◼ Stage 6: Original sentences with a complete
grammar system
148

Stage 1: Delayed echolalia (use of whole language gestalts,

spoken exactly as they were first heard):
Whereistheball? Gofindthedinosaur!
Stage 2: Mitigated echolalia (shortening long gestalts,
dividing them into smaller chunks, and the re-combining
chunks into new utterances)
where is the ball the dinosaur find
Where is the dinosaur? Find the ball.
Stage 3: Isolating and then recombining single words
Where Find Ball Dinosaur Where dinosaur?
Stages 4-6: Generating original sentences (with beginning and
then more advanced grammar)
Where’s my dinosaur? I found the big ball. 149

Recommended Resources
Marge Blanc’s book: Natural
Language Acquisition on the
Autism Spectrum

The Natural Language Acquisition

Guide by Marge Blanc (free PDF)
The Natural Language Acquisition Guide - Communication Development Center

Follow @meaningfulspeech, @bohospeechie, and

@gemmajuneslp on Instagram for amazing content
on gestalt language processors
150
 Strategies to Support Gestalt
Language Processors
● Build an authentic connection with the child by
following their lead and honoring their play style.
● Know the child’s interests; determine their favorite
shows, songs, movies, toys, activities, etc.
● Collaborate with parents, caregivers, and other school
staff to determine the source of the child’s gestalts.
● Acknowledge, repeat, and build on the child’s
gestalts; don’t ignore or try to extinguish echolalia.
● Limit pronoun usage (especially you/I/me). 151

● Replace questions with comments and avoid

instructing the child to say words. Use more
declarative language!
● Attend to the child’s sensory needs to support
regulation.
● Provide more intonationally rich gestalts for the child
to echo (instead of modeling single words).
● Incorporate more musicality into language.
● Read books with repetitive and interesting phrases.
● Help the child break down their larger language units
(scripts) into smaller language units and then teach
them how to construct original word combinations.
152

● Engage in child-led play.

○ When allowed to choose the ‘how’ and ‘when’ of
social play activities Autistic children are just as
motivated to engage with their parents as allistic
kids (Yu et al., 2023).
○ Play doesn't always have to involve store-bought
toys. Shared enjoyment may occur more during
gross motor play, sensory-based play, or musical
play.
○ Child-led play is more natural and doesn’t include
explicit prompting (Give me the ball, Put it here,
Say ‘block’).
153
 10. Stimming

Stimming
◼ Stimming is engaging in repetitive movement (such as
rocking back and forth, hand-flapping, or twirling) or
repetitive vocalizing (such as humming, squealing, or
making odd sounds).
◼ According to the DSM-5, presence of repetitive
behaviors or speech is an autism trait.
◼ Stimming behaviors should not be stopped or
redirected unless they are dangerous to self or others,
destructive of property, or seriously disruptive to
others in the room.
155

◼ While stimming is short for self-stimulatory behavior,

these repetitive behaviors likely serve a function
beyond self-stimulation.
◼ Stimming is how Autistic individuals interact with
their environment.
◼ Autistic adults explain that these repetitive behaviors
help calm their anxiety, improve awareness of their
bodies, focus their attention, help deal with
overwhelming sensations, and self-regulate.
◼ Whether the function of the stimming behavior is
understood or not, autism acceptance means we
recognize stimming as part of the Autistic neurotype.
156
 11. Deep Interests

Deep Interests
◼ Autistic children typically have heightened interests in
specific objects or activities; in fact, it is one of the
DSM-5 criteria for diagnosing autism.
◼ When discussing autism programming, therapists and
educators often describe the child’s intense interests
as obsessions or fixations (words that carry negative
connotations).
◼ If we reframe our thoughts on this and select more
positive words, it is easier to view the child’s deep
interests as a tool for learning and connecting.
158

How we can modify our language

◼ Instead of saying, “She is obsessed with butterflies”
we could say, “She is passionate about butterflies.”

◼ Instead of saying, “He is obsessed with dinosaurs,” we

could say, “His deep interest is dinosaurs.”

◼ Instead of saying, “She fixates on letters and

numbers” we could say “She is fascinated
with letters and numbers.” 159
◼ Instead of saying, “He is obsessed with car washes”
we could say, “He enjoys learning and talking about
car washes.”

◼ Instead of saying, “He is obsessed with lining up

objects” we could say, “Lining up objects is a
regulating activity.”

160

12. Presuming Competence

Presume Competence
◼ Presuming competence is expecting a child to succeed
rather than assuming they will fail.
◼ For non-speaking children, we often assume that they
don’t understand what others are saying. This leads
adults to talk about Autistic children as if they aren’t
even in the room.
◼ We should always operate from a strengths-based
mindset and assume that ALL children can think,
learn, and understand, regardless of what
standardized testing has indicated.
162
 How to Presume Competence
◼ Check our own bias about how we view autism
◼ Avoid making judgments about a child’s abilities based
on standardized test scores
◼ Talk to and treat the child in a manner that is
appropriate for their age (don’t infantilize them)
◼ Ask for permission before offering assistance
◼ Tell the child what you are going to do before acting
◼ Speak directly to the child and include them in the
conversation when talking to others in the room
163

◼ Avoid speaking for the child

◼ Be sure the child has a way to communicate (it’s a basic
human right)
◼ Don’t provide too much support or be overbearing
◼ Focus on the child’s strengths, interests, and sensory
needs
◼ Build an authentic relationship with the child before
trying to teach new skills (focus on connection over
instruction!)
◼ Avoid using hand over hand assistance (it creates
prompt dependency and is a violation of body
autonomy) 164

Hand over hand assistance teaches the most

vulnerable members of society (disabled children)
that adults can do whatever they want, whenever
they want to your body

X 165
 What to Do Instead of Using Hand
Over Hand Assistance
Collaborate with an occupational therapist to see if
there is any type of adaptive equipment (e.g.,
weighted or built-up spoon, spring loaded scissors)
that will support the child’s success with the activity
If the child wants to complete the task but needs
help, get permission to touch them first
Once you have permission, try tapping their shoulder
or elbow to help the child “get started” (initiation can
be difficult for kids with motor planning struggles)
166

If more physical support is needed, use gentle hand

under hand assistance (your hand rests under the
child’s hand so they can remove theirs at anytime) OR
touch the object they are holding (spoon, crayon, etc.)
instead of touching their hand

167

Respectful interactions
are the key to building
an authentic relationship
with the Autistic child

Hutson
and Cari

168
 13. Behavior

169

Behavior
Many neurotypical behavioral expectations are in direct
conflict with the Autistic child’s neurological needs.
a. Whole-body listening expectations: eyes on the
speaker, listening ears are on, mouth is quiet,
hands are in lap or quiet by your side, feet are
quiet on the ground, body faces the speaker, brain
thinks about what is being said

NEWSFLASH: Autistic children often cannot listen

with their whole body because of their neurology
170

Listening Larry
is ableist and
his strategies
are not
appropriate for
neurodivergent
kids (or any
kids!)

171
Some kids can focus and learn better when
allowed to…
hold quiet fidgets in their hands
stand or move their bodies as needed without
having to get permission
engage in heavy work prior to seated tasks
chew on mouth fidgets
engage in child-led activities
sit in ways that are comfortable and have dynamic
seating options available (bean bag chairs, rocker
chairs, floor desks, wobble chairs, etc.)
172

Criss-cross applesauce is not

comfortable for everyone

Kids should be allowed to sit in ways that

are comfortable and regulating to them
173

We need to shift from whole body

listening to whole body learning

174
 Meet Little or no
Bumper, the Fidgeting
eye contact

whole-body hands

learner
(autismlevelup.com)

Standing,
pacing feet Enjoys talking and
learning about dinosaurs

b. Compliance expectations: when an Autistic child

is non-compliant, it is often assumed that they are
being willfully disobedient; kids do well when
they can (Dr. Ross Greene, Child Psychologist); we
need to determine what is causing the child to
become dysregulated and then address the “why”
behind the behavior instead of focusing on
extinguishing the behavior

176

Tantrum or Meltdown?

Aaron is upset. But why? Is

he naughty and being
intentionally non-compliant
(tantrum/behavior issue) or
is he dysregulated and
having a stress response
(meltdown/nervous system
issue)?

177
Neurodiversity-affirming providers seek to understand
the behavior, not extinguish it; once the why behind the
behavior is understood, providers change the
environment instead of trying to change the child

“When a flower
doesn’t bloom you fix
the environment in
which it grows, not
the flower.”
-Alexander Den Heijer
178

When a child
doesn’t thrive, you
fix the
environment in
which they learn,
not the child.

179

Reasons why an Autistic child might not comply with a

request or directive:
● The direction isn’t understood
● The activity isn’t meaningful
● The activity leads to a negative sensory response
● Child has difficulty with initiation/motor planning
● Basic bodily needs have not been met (child is
hungry, thirsty, tired, sick, constipated, etc.)
● Sensory needs have not been met
● Social-emotional needs have not been met (lack of
trust, no authentic connection, lonely, sad, bored)
180
 c. Use of behaviorist teaching methods
◼ Withholding recess or another preferred activity
due to perceived “bad” behavior
◼ Holding a comfort item hostage and making
child earn it back by doing a work task first
◼ Not supporting the child’s sensory/nervous system
needs (“quiet hands”, earning a sensory break,
placing communicative demands on a dysregulated
child (Jamie Burch, MA, CCC-SLP)
◼ Allowing the child to be unsuccessful by not
providing appropriate supports and then blaming
the child for being dysregulated
181

◼ Forcing the child to play in a prescribed way;

ignoring Autistic joy

◼ Using reinforcers, such as food, to manage

behaviors and coerce compliance

182

Why food reinforcers should not be

used with Autistic (or any) kids
● Kids are not pets to be trained.
● Using food reinforcers can create an unhealthy
relationship with food. A child should never be
taught that eating is dependent on compliance.
● Most food reinforcers are highly processed, filled
with sugar, and have little nutritional value.
● Being bombarded with junk food throughout the day
can affect the child’s blood sugar levels and can spoil
their appetite.
183
Problem with Reinforcers in General
● Using reinforcers to “train” Autistic children to
behave a certain way is not aligned with
neurodiversity-affirming practices.
● Instead of focusing on coercing compliance and
managing behavior, we should focus on establishing
an authentic connection with the Autistic child.
Respectful interactions provide the foundation
for neuro-affirming services. No control. No
manipulation. No dangling the carrot. No
dehumanizing practices. No trauma.
184

185

The Developmental Formula for

Supporting Autistic Children
(the order matters!)
1. Regulate the child’s nervous system by
meeting their basic bodily, sensory, and
emotional needs
2. Reach the child by establishing an authentic
connection REGULATION
3. Teach the child new skills CONNECTION
INSTRUCTION
186
 14. Social Skills “Training”

Social Skills “Training”

◼ Any social skills “training” should be bidirectional.
◼ The social “deficits” related to autism should be
reframed; we need to recognize that the problem lies in
the interaction between people with different neurologies
(Informed SLP, Feb 2021).
◼ Autistic people seem to read other Autistic people pretty
well, and neurotypical people seem to read other
neurotypical people pretty well. It’s the interaction
between different neurotypes (Autistic and neurotypical
people) that leads to communication breakdowns (that is
the double empathy problem).
188

Skills that often need to be explicitly taught to Autistic

kids as they get older include:
● Understanding figurative language (sarcasm,
metaphors, similes, personification, hyperboles)
● Understanding how others feel/perspective taking
● Expressing how sensory input correlates to their
emotions and behaviors (alexithymia is an inability
to identify and describe emotions and it is thought
to be more common in the Autistic neurotype)
● Executive function skills (mental flexibility, impulse
control, planning, organizing, waiting, problem
solving, etc.) 189
 4 Strategies to Facilitate
Bidirectional Social Skills
1. Teach all children about neurodiversity to help them
understand the prevalence of brain differences.
2. Talk about different ways of socializing and interacting
with others and provide more neurodiversity
affirming social group opportunities.
3. Make AAC highly visible to increase awareness,
understanding, and acceptance.
4. Make autism acceptance books readily available to all
kids. 190

Understanding Autism: Picture Books

● Just Right for You: A Story About Autism by Melanie
Heyworth
● Do You Want to Play? Making Friends with an Autistic Kid
by Daniel Share-Strom
● A Day With No Words by Tiffany Hammond
● My Brother Otto by Meg Raby
● A Friend for Henry by Jenn Bailey
● I See Things Differently by Pat Thomas
● My Autistic Mama by Kati Hirschy
● All My Stripes by Shaina Rudolph & Danielle Royer
● Liam’s First Cut by Taye Jones 191

192
 Social Stories
◼ Social stories are illustrated narratives that describe
different social situations.
◼ Neurodiversity-affirming providers may use social
stories to create predictability and reduce uncertainty
about potentially difficult or novel social situations,
like going to the dentist or participating in a fire drill.
◼ We must be cautious, however, not to use social
stories to teach neurotypical social norms, such as
making good eye contact or playing appropriately
with toys.
193

Review Activity

Let’s look at the following 5 statements that use

deficit-driven language…

and change the language to be more

neurodiversity affirming

194

Modify Our Language

Neuro-Affirming/Strengths-
Deficit-Driven Language
Based Language
Obsessed with car washes

Red flags of autism

Is rigid/inflexible

Is difficult to engage

Does not play appropriately

with toys
195
 Modify Our Language
Neuro-Affirming/Strengths-
Deficit-Driven Language
Based Language
Obsessed with car washes Has a deep interest in…
Is passionate about…
Red flags of autism Traits/signs of autism
Prefers consistency
Is rigid/inflexible
Finds safety in the familiar
Thrives in predictable situations
Is difficult to engage Focuses intently on own
interests
Enjoys lining up toys
Does not play appropriately
Is interested in how objects
with toys
move 196

Neurodiversity Affirming
Services and Goals

2 Autism Approaches
There are two autism approaches to consider (although
many parents will only be given the first option following
their child’s initial autism diagnosis)
1. Compliance-based autism treatment designed to
fix deficits and make the child behave in more
typical ways (medical model therapy/ABA)
2. Relationship-based approach that builds on the
Autistic child’s strengths and focuses on regulation,
connection, communication, and self-advocacy
(neurodiversity- affirming)
198
 Neurodiversity-Affirming
Services and Providers
◼ Neurodiversity-affirming services are relationship-
based and are in contrast to the medical model of
autism treatment that is designed to fix deficits
◼ Neurodiversity-affirming services are trauma informed
◼ Neurodiversity-affirming providers recognize that
brain differences do not equal brain deficits
◼ Neurodiversity-affirming providers use strengths-
based language to describe developmental differences
199

◼ Neurodiversity-affirming providers focus on

regulation, connection, communication, and
self-advocacy instead of on compliance
◼ Neurodiversity-affirming providers focus on teaching
meaningful skills in meaningful ways instead of on
teaching isolated skills out of context
◼ Neurodiversity-affirming providers acknowledge that
autism is not a behavioral disorder and thus do not
use behaviorist strategies to extinguish behaviors
◼ Neurodiversity-affirming providers recognize that
challenging behaviors are caused by dysregulation
instead of assuming willful disobedience
200

◼ Neurodiversity-affirming providers
do not base goals on neurotypical
norms and allow the child to
grow at their own pace

Forward is forward…no
matter the speed

◼ Neurodiversity-affirming providers presume

competence
201
◼ Neurodiversity-affirming providers identify
individualized modifications and accommodations
to improve access, participation, and quality of life
◼ Neurodiversity-affirming providers recognize when a
child is a gestalt language processor and modify
their strategies accordingly
◼ Neurodiversity-affirming providers honor all forms
of communication and do not place a higher value
on spoken language
◼ Neurodiversity-affirming providers offer unrestricted
access to robust AAC (when we delay or deny access
to AAC we become gatekeepers of communication)
202

A robust AAC system…

Kate McLaughlin, @the.aac.coach
◼ Has the ability to communicate about more than what
is happening in the here and now
◼ Is organized and easy to use
◼ Can grow language and literacy over time
◼ Provides access to a wide variety of words
◼ Has options for pre-programmed messages
◼ Has full alphabet and word prediction
◼ Is always available
◼ Is used for a wide range of functions (not just to
request and label) 203

Robust AAC systems to consider…

● LAMP Words for Life
● TouchChat
● CoughDrop
● Proloquo2Go
● TDSnap
● Avaz AAC
● PODD Books

204
 PECS is Outdated

205

Why PECS is Not Recommended

◼ It is not a robust AAC system.
◼ PECS books are cumbersome and the icons are difficult
to keep track of.
◼ PECS icons are always moving, making it difficult for the
child to establish a motor plan for using their
communication system.
◼ PECS focuses primarily on requesting in the initial
levels, but does not provide other communication
functions (commenting, asking questions, protesting,
suggesting, socializing, expressing thoughts, etc.).
206

◼ PECS sentence strips create unnatural,

robotic-sounding speech (“I_want _a_cookie”).
◼ Hand-over-hand assistance is encouraged with PECS,
which violates the child’s right to body autonomy.
◼ PECS focuses on compliance and is based on operant
conditioning. Neurodiversity-affirming practices are not
aligned with this behaviorist approach.
◼ PECS makes it difficult to access curriculum and literacy.
◼ PECS is difficult for communication partners to model in
everyday life.
◼ Non-speaking adults do not use PECS.
207
 It is acceptable to use pictures as a form of
AAC, just don’t use the behaviorally-based
exchange system known as PECS.

208

Neurodiversity Affirming Services

and Reimbursement
◼ To receive reimbursement for certain “medically
necessary” services, the medical world (which SPED
is derived from) still demands the use of ableist
language such as: disorder, deficit, impairment,
compared to same age peers, age appropriate, etc.
◼ For now, the way professionals document may be
different from how they speak to and about the
neurodivergent kids they are supporting in therapy
and in the classroom.
209

Neurodiversity Affirming Goals for

Autistic Toddlers and Preschoolers
[When provided with environmental accommodations/
sensory supports/visual supports/unrestricted access to
multimodal language]
➔ Child will engage in shared social interactions with
caregivers during child-led activities at home and at
daycare.
➔ Child will participate in story time at the library in
ways that are comfortable for them.
➔ Child will engage in positive social interactions with
three different caregivers, siblings, or peers. 210
[When provided with environmental accommodations/
sensory supports/visual supports/unrestricted access to
multimodal language]
➔ Child will participate in mealtime by eating half of each
meal when standing or sitting in the kitchen.
➔ Child will wear necessary winter clothing items (such
as shoes, coat, hat, gloves) when going outside.
➔ Child will remain buckled into the car seat when riding
in the family vehicle.
➔ Child will successfully transition between activities.
➔ At preschool child will participate in story time and
music time in ways that are comfortable for them.
211

[When provided with environmental accommodations/

sensory supports/visual supports/unrestricted access to
multimodal language]
➔ Child will expand their play scheme with trains.
➔ Child will initiate play when presented with their
favorite toys.
➔ Child will accept modeling and assistance from an
adult when struggling to put pieces into a favorite
toy (such as a puzzle or shape sorter).
➔ Child will remain near the adult during shared
reading time, for a few pages of each book.
➔ Child will seek out safe ways to achieve oral input. 212

[When provided with environmental accommodations/

sensory supports/visual supports/unrestricted access to
multimodal language]
➔ Child will comment to share interests with others.
➔ Child will use 5 different communicative functions
expressively (using any language modality) during
playtime, mealtime, or other routines.
➔ Child will share 2+ details about a recent event.
➔ Child will use words from preferred echolalic scripts
to create new word combinations.
➔ Child will generate original words and phrases during
playtime. 213
 Examples of Neurodiversity
Affirming Therapy Goals for Older
Autistic Students
➔ Given unrestricted access to multimodal
communication, child will demonstrate evidence of
learning during 3 different classroom activities.
➔ Given unrestricted access to multimodal
communication, child will self-advocate for personal
needs (e.g., say no, use restroom, express
overstimulation, ask for help).
➔ Child will seek out safe ways to achieve oral input.
214

➔ Given sensory inputs to support self-regulation, child

will participate in shared social experiences with an
three different adults.
➔ Child will self-advocate to indicate preferred ways to
socialize with others at recess/in the classroom.
➔ With adult supports, child will communicate (in any
modality) their sensory needs to improve
self-regulation during classroom activities.
➔ Child will communicate environmental needs for
self-regulation and successful learning (e.g., “I need
to stand” or “I need to move” or “I need to go
somewhere quiet”).
215

➔ Given visual and executive function supports, child

will complete multi-step activities.
➔ Given unrestricted access to multimodal
communication, child will participate in a whole
group learning activity by making comments and
asking/answering questions.
➔ When provided with visual supports, child will share
3+ details about a recent activity.
➔ Given unrestricted access to multimodal
communication, child will respond to comments,
questions, and directions across 3 different school
settings.
216
 Time to Wrap-Up!
Instead of spending all our efforts trying to make
Autistic kids act and learn like neurotypical kids, let’s
spend more effort accepting, building on, and
celebrating their differences.

Neurodiversity makes the world a brighter place!

217

Neurodiversity-affirming websites:
Autisticadvocacy.org therapistndc.org
autismlevelup.com

Neurodiversity-affirming Instagram accounts to follow:

@neurowild_ @learnplaythrive
@theautisticot @rdorseyslp
@neurodivergent_lou @theexpertally
@aneurodivergentway @therapistndc
@justkeepstimming @neurodiversityireland
@fidgets.and.fries @mrsspeechiep
@neuroclastic @speechdude
@autismlevelup @sensory.slp 218

Instagram accounts to follow for AAC:

@the.aac.coach
@aac.and.me
@rachelmadelslp
@aac_innovations
@drawntoaac
@aacchicks
@chickadee.aac

Instagram accounts to follow for supporting gestalt

language processors:
@meaningfulspeech @gemmajuneslp
@bohospeechie 219
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224

Autism and
Neurodiversity:
Addressing Concerns
and Offering
Implications for the
School-Based SLP by
DeThorne &
Searmith
Perspectives of the
ASHA Special Interest
Groups, SIG 16, 2021

225
A Primer on
Neurodiversity-Affirming
Speech and Language
Services for Autistic
Individuals by Gadd &
Crow
Perspectives of the ASHA
Special Interest Groups,
SIG 1, 2023

226

Affirming
Neurodivergence: No
More ‘Quiet Hands’ by
Jamie Burch
The ASHA Leader,
Nov/Dec 2023

227