Neurodiversity: From Neurodiversity

FROM PHENOMENOLOGY TO NEUROBIOLOGY AND ENHANCING TECHNOLOGIES

Phenomenology to Neurobi-
ology and Enhancing Technologies
addresses the totality of neurodiversity through positive explorations
of “invisible diversities”—from ADHD and savantism to autism and dys-
lexia. Edited by the director of the Stanford Neurodiversity Project, the
book emphasizes strengths-based approaches to clinical practice and
FROM PHENOMENOLOGY
investigates interventions to improve the lives of neurodiverse individu-
als. Following a compelling foreword by Temple Grandin, the book pro-
TO NEUROBIOLOGY
ceeds to address neurodiversity in four parts: frst, an introduction that
presents neurodiversity’s differences in brain function and behavior as
AND ENHANCING TECHNOLOGIES
part of the normal variation of the human population; second, presen-
tation of the strengths-based model of neurodiversity (SBMN), includ-

Neurodiversity
ing positive psychology, neurobiology, and SBMN in savantism, autism,
ADHD, and dyslexia; third, a discussion of neurodiverse individuals in
the real world, including higher education and employment; and fnal-
ly, a review of technologies that enhance our abilities to maximize the
potential of neurodiversity, including inclusive design and assessment
tools that provide support for neurodiverse young adults seeking mean-
ingful employment.
Neurodiversity: From Phenomenology to Neurobiology and Enhanc-
ing Technologies provides clinicians, educators, and other professionals
with cutting-edge, practical, and positive information to understand and
assist their patients, students, and other neurodiverse individuals to op-
erate from a position of strength.

Lawrence K. Fung, M.D., Ph.D., is Director of the

Stanford Neurodiversity Project and an Assistant Pro-
fessor of Psychiatry and Behavioral Sciences at Stanford
University School of Medicine in Palo Alto, California.
Fung

Edited by
Cover design: Tammy J. Cordova
Cover image: © royaltystockphoto.com Lawrence K. Fung, M.D., Ph.D.
Used under license from Shutterstock
Neurodiversity
From Phenomenology to Neurobiology
and Enhancing Technologies
Neurodiversity
From Phenomenology to Neurobiology
and Enhancing Technologies

Edited by

Lawrence K. Fung, M.D., Ph.D.

Director, Stanford Neurodiversity Project
Assistant Professor of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Palo Alto, California
Note: The authors have worked to ensure that all information in this book is
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Names: Fung, Lawrence K., 1970- editor. | American Psychiatric Association,
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Title: Neurodiversity : from phenomenology to neurobiology and enhancing
technologies / edited by Lawrence K. Fung.
Description: First edition. | Washington, DC : American Psychiatric Association
Publishing, [2021] | Includes bibliographical references and index.
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 Dedicated to
Michele, who has been my companion in this journey of neurodiversity;
Zachary, who has inspired me to devote my life to
the field of neurodiversity; and
Hannah, whose whipped coffee has gotten me through
some challenging times.
 Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Temple Grandin, Ph.D.

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
CHAPTER ONE
Neurodiversity: The New Diversity . . . . . . . . . . . . . . . . . 1
Lawrence K. Fung, M.D., Ph.D.
Nancy Doyle, Ph.D.

CHAPTER TWO
Positive Psychology and Strengths-Based
Approaches to Neurodiversity . . . . . . . . . . . . . . . . . . . . 19
Michael L. Wehmeyer, Ph.D.

CHAPTER THREE
Strengths-Based Model and Savantism . . . . . . . . . . . . . 39
Matthew Doll, Ph.D.
Darold Treffert, M.D.
Thomas Fabricius, M.D.
Edward Jedlicka, Ph.D.
Vivian Hazell, LPC
Tara Geier, M.A., BCBA
Bryan Mischler, LCSW
Erin Whittington, B.A.
CHAPTER FOUR
Strengths-Based Model of
Neurodiversity and Autism. . . . . . . . . . . . . . . . . . . . . . . 65
Lawrence K. Fung, M.D., Ph.D.

CHAPTER FIVE
Strengths-Based Model of
Neurodiversity and ADHD . . . . . . . . . . . . . . . . . . . . . . 109
Lawrence K. Fung, M.D., Ph.D.

CHAPTER SIX
Strengths-Based Model of Dyslexia. . . . . . . . . . . . . . . 123
Nicole S. Ofiesh, Ph.D.
Henry B. Reiff, Ph.D.

CHAPTER SEVEN
Neurobiology of Neurodiversity . . . . . . . . . . . . . . . . . 149
Lawrence K. Fung, M.D., Ph.D.

CHAPTER EIGHT
Neurodiversity in Higher Education: Support for
Neurodiverse Individuals and Professionals. . . . . . . . 175
Nancy Doyle, Ph.D.

CHAPTER NINE
Specialized Employment Initiatives for
Neurodiverse Individuals: A Model Program . . . . . . . 201
Jose Velasco, M.S.

CHAPTER TEN
Technologies and Difference: Insights from
Education Breakdown and Exclusion . . . . . . . . . . . . . 235
Jutta Treviranus, Ph.D.

CHAPTER ELEVEN
Using Technology to Provide Transition Support
for Neurodiverse Young Adults . . . . . . . . . . . . . . . . . . 259
Steven M. Keisman, M.A., M.S.

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
 Contributors
Matthew Doll, Ph.D.
Director of Behavioral Health, Outpatient Services, Treffert Center, Fond
du Lac, Wisconsin

Nancy Doyle, Ph.D.

Research Fellow, Birkbeck College, University of London; CEO and
founder, Genius Within, London, United Kingdom

Thomas Fabricius, M.D.

Research Director, Family Practice, Treffert Center, Fond du Lac, Wis-
consin

Lawrence K. Fung, M.D., Ph.D.

Director, Stanford Neurodiversity Project, and Assistant Professor of Psy-
chiatry and Behavioral Sciences, Stanford University School of Medicine,
Palo Alto, California

Tara Geier, M.A., BCBA

Behavior Analyst, Treffert Center, Fond du Lac, Wisconsin

Temple Grandin, Ph.D.

Professor, Department of Animal Sciences, Colorado State University,
Fort Collins, Colorado

Vivian Hazell, LPC

Senior Psychotherapist, Treffert Center, Fond du Lac, Wisconsin

Edward Jedlicka, Ph.D.

Senior Psychotherapist, Treffert Center, Fond du Lac, Wisconsin

Steven M. Keisman, M.A., M.S.

Senior Vice President, Identifor, Mendham, New Jersey

ix
x Neurodiversity

Bryan Mischler, LCSW

Psychotherapist, Treffert Center, Fond du Lac, Wisconsin

Nicole S. Ofiesh, Ph.D.

Co-founder and Chief Innovation Officer, Potentia Institute, Half Moon
Bay, California

Henry B. Reiff, Ph.D.

Professor of Education, McDaniel College, Westminster, Maryland

Darold Treffert, M.D.

Research Consultant, Treffert Center, Fond du Lac, Wisconsin

Jutta Treviranus, Ph.D.

Professor, Inclusive Design Research Centre, OCAD University, Toronto,
Ontario, Canada

Jose Velasco, M.S.

Vice President, Product Management, SAP Labs, Austin, Texas

Michael L. Wehmeyer, Ph.D.

Chair, Department of Special Education; Ross and Marianna Beach Distin-
guished Professor in Special Education; and Director and Senior Scientist,
Beach Center on Disability, University of Kansas, Lawrence, Kansas

Erin Whittington, B.A.

Senior Assistant II, Quest Lab Team Lead, Carmel Clay Public Library,
Carmel, Indiana
 Foreword
Temple Grandin, Ph.D.

In my work as a designer of livestock handling facilities, I have been work-

ing with neurodiverse individuals since the 1970s. Back in the 1970s, 1980s,
and early 1990s, most people were not aware of the term neurodiversity.
When I was designing equipment and working with major corporations, al-
most nobody knew I was an autistic person. They viewed me as different,
but I was recognized for the quality of my work. I learned to sell my work
instead of selling myself. I did this by showing potential clients a portfolio
of design drawings and photos of completed projects. It is likely that ap-
proximately 20% of the people who constructed the equipment I designed
would have been diagnosed as autistic, dyslexic, or ADHD or given some
other label if they had been children today.
None of my colleagues was formally diagnosed, but when I look back
on the different places where I worked, it has become obvious that many of
these talented people were autistic or dyslexic or had sensory processing
problems. Two of the autistic people I worked with had multiple patents.
To maintain confidentiality, I have to be vague in describing the equipment
they invented. Both of these people invented clever mechanical devices and
were owners of equipment companies. One of them sells products all over
the world, and both were poor students in high school. Another person
headed into a successful career after he took a high school welding class. He
then started selling his creations and built up his business with one satisfied
client at a time. Throughout a long career, I worked with welders, inven-
tors, and designer drafting people who would have been special education
students today. The most clever ones quickly progressed to inventing and
patenting major pieces of mechanical equipment. They then sold their in-
ventions to large corporations.

xi
xii Neurodiversity

We Need Neurodiverse People to

Prevent Loss of Essential Skills
Today, the people I worked with are retiring, and they are not being re-
placed because high schools have removed skilled trades, art, drafting, and
other hands-on classes. Vital skills are being lost because talented neurodi-
verse children are not having opportunities to develop their abilities. The
children who should become the replacements are often deprived of the op-
portunity to be introduced to hands-on skills.
I did not realize how serious the problem was until I visited four state-
of-the-art poultry or pork processing plants in 2017 and 2019. I had been
brought in to consult on animal handling. After touring these plants from
one end to the other, I learned that almost all of the specialized equipment
was now imported from Europe. European schools have kept their skilled
trades and have trained neurodiverse people who can build it. Other things
the United States no longer builds are elevators, ski lifts, and conveyors for
moving stuff in warehouses and factories. It is a part of engineering that I call
the “clever engineering department.” The parts of the factory that are still
built in the United States are the building, boilers, and refrigeration systems.
The reason for this is neurodiverse thinking. The more mathematically in-
clined thinkers excel in traditional college engineering classes; refrigeration
systems, boilers, and structural engineering of the building require this type
of education. The visual thinkers, like me and many of the people I worked
with, cannot do abstract math such as algebra. I had to drop a biomedical en-
gineering class because I could not do the math. Boilers and refrigeration sys-
tems require abstract math, but designing and building a complex packaging
machine requires a neurodiverse visual thinker.
In my own work with almost every meat company, I have observed the
same pattern. The clever engineering people I worked with at many com-
panies almost never touched boilers or refrigeration systems. The math-
skilled engineer and the visual thinking equipment designer have skills that
complement each other. Building a complete factory requires both kinds of
skills. It is also likely that many of the more mathematically inclined engi-
neers are on the autism spectrum. At autism meetings, grandfathers who
were either NASA engineers or computer scientists have told me that they
discovered they were autistic when a grandchild was diagnosed. Mathemat-
ical thinkers and visual thinkers have skills that complement each other. A
common denominator for both kinds of diverse minds is that they are
highly specialized; they are good at one skill and poor at another. People
who are extremely good at either mathematics or visual thinking skills are
often socially awkward.
Foreword xiii

Different Kinds of Thinking

Howard Gardner’s multiple intelligences (Gardner 1983; Gardner and
Hatch 1989) are featured in this book. There are nine types of intelligences.
They cover a wide range of skills that include thinking styles, interpersonal
skills, and athletic skills. A theme throughout this book is to develop a per-
son’s area of strength. This is called strengths-based learning. It is a concept I
fully support. My mother always helped me to develop my ability in art. Art
and visual skills were a foundation of my design career.
Since the publication of Gardner’s book in 1983, many studies now sup-
port my observation that there are visual thinkers and math pattern think-
ers. In my book Thinking in Pictures (Grandin 1996), I discussed how I see
everything in photorealistic pictures, but there are other autistic people who
think in patterns. Scientific studies show that some people are object visu-
alizers similar to me, whereas others are visual-spatial and mathematical
(Kozhevnikov et al. 2002, 2005; Mazard et al. 2004). The object visualizers
often go into fine arts or industrial design, and the visual-spatial processors
enter engineering or computer science. Psychology is a field that is popu-
lated mainly by verbal thinkers who think mostly in words (Perez-Fabello
et al. 2018).
The first step in helping neurodiverse minds to be successful is to rec-
ognize that different people think differently. Educators and parents need
to work to develop a person’s unique skills and recognize that verbal lan-
guage is only one way of thinking.

References
Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York,
Basic Books, 1983
Gardner H, Hatch T: Multiple intelligences go to school: educational implications
of the theory of multiple intelligences. Educational Researcher 18(8):4–10, 1989
Grandin T: Thinking in Pictures: And Other Reports From My Life With Autism.
New York, Vintage Books, 1996
Kozhevnikov M, Hegarty M, Mayer RE: Revising the visualizer-verbalizer dimen-
sion: evidence for two types of visualizers. Cogn Instruct 20:47–77, 2002
Kozhevnikov M, Kosslyn S, Shephard J: Spatial versus object visualizers: a new
characterization of visual cognitive style. Mem Cognit 33(4):710–720, 2005
Mazard A, Tzourio-Mazoyer N, Crivello F, et al: A PET meta-analysis of object
and spatial mental imagery. Eur J Cogn Psychol 16(5):673–695, 2004
Perez-Fabello MJ, Campos A, Felisbeeti FM: Object-spatial imagery in fine arts,
psychology and engineering. Think Skills Creat 27:131–138, 2018
 Preface

This book was completed at the strangest era of our time, as the world faces
both the coronavirus pandemic and the Black Lives Matter movement. Al-
though more people are now acknowledging that diversity is one of the
most precious aspects of humanity, diversity remains a very confusing con-
cept in practice. Most people treasure moral values of equality and justice,
yet racial and gender disparities in health care, education, employment, and
other opportunities continue to impact affected groups negatively and pro-
foundly. Although initiatives for diversity and inclusion have been imple-
mented in many large organizations, the total societal impact has not been
quite enough. Cultural change to embrace diversity in our society contin-
ues to be slow, and most of the change that has occurred has been focused
toward the visible diversities of skin color and sex.
What about the invisible diversities? We can only expect that it is even
more challenging to achieve cultural changes that embrace invisible differ-
ences. This is why we write this book. In particular, we are focusing on neu-
rodiversity, a concept that regards differences in behavior and brain function
as part of the normal variation of the human population. When we talk about
neurodiverse conditions, we include conditions such as autism, ADHD, and
dyslexia. Like racial disparities, inequalities in health care, education, em-
ployment, and other opportunities are significant issues facing neurodiverse
individuals.
Many neurodiverse individuals face significant mental health issues.
Co-occurring conditions such as depression and anxiety are common in this
population. Psychiatrists, psychologists, and other mental health providers
have used the medical model to identify symptoms, with the ultimate goal
of removing them. It is rare for providers to assess the strengths of their pa-
tients and to incorporate that information into their interventions. It is even
more uncommon for providers to use strengths-based approaches to en-
hance patients’ abilities to help them overcome their challenges.
This book is an introduction to the strengths-based model of neurodi-
versity (SBMN), designed to integrate and build upon existing theories of

xv
xvi Neurodiversity

positive psychology (Seligman and Csikszentmihalyi 2000), positive psy-

chiatry (Jeste et al. 2015), multiple intelligences (Gardner 1983; Gardner
and Hatch 1989), and developmental psychology (Chickering and Reisser
1993) and to apply them to devise strengths-based assessments and interven-
tions for neurodiverse individuals. Nancy Doyle and I describe, in Chapter 1,
what neurodiversity means and how we define this concept in the context of
leveraging the strengths of individuals with various neurodiverse conditions.
In Chapter 2, Michael Wehmeyer describes what positive psychology is, how
strengths-based approaches converge with social and person-environment
fit models, and how they are practiced in assessing character strengths and
self-determination. In Chapter 3, Matthew Doll, Darold Treffert, and their
colleagues provide accounts of how their six-pronged, core-component ap-
proaches to assessment, diagnosis, organized treatment, and support are ap-
plied to the strengths-based curriculum at Treffert Center in Wisconsin. In
Chapter 4, I describe the strengths of people on the autism spectrum and
discuss how the SBMN is applied in assessments and treatments of autistic
people. Similarly, in Chapter 5, I use the SBMN as the framework to de-
scribe the assessments and treatments of individuals with ADHD. In Chap-
ter 6, Nicole Ofiesh and Henry Reiff formulate the strengths of dyslexic
individuals using the MIND framework. (MIND is an acronym for four
strengths: Material reasoning, Interconnected reasoning, Narrative reason-
ing, and Dynamic reasoning.)
In Chapter 7, I reveal the neurobiology of neurodiversity using a systems
approach. Rather than describing the neurobiology of neurodiverse condi-
tions, I dissect the cognitive constructs behind various domains of intelli-
gences, including mathematical, reading, visual-spatial, musical, inter- and
intrapersonal abilities, and creativity. Then I describe the neural correlates
of the constructs in the general population and selected groups, including
people who are autistic, those who are dyslexic, and people with ADHD. In
Chapter 8, Nancy Doyle discusses the disparities for neurodiverse individ-
uals in higher education and explores what active ingredients may be needed
to level the playing field for neurodiverse students.
In the United States, about 80% of autistic adults are unemployed or
underemployed. In Chapter 9, Jose Velasco provides a detailed case exam-
ple of SAP SE’s Autism at Work program, a specialized employment pro-
gram that has changed the lives of many autistic adults. These individuals
in turn have contributed significantly to that company through remarkable
innovations and productivity.
The book concludes with two chapters related to technology and neu-
rodiversity. In Chapter 10, Jutta Treviranus discusses how the technology
mindset is biased against diversity and how this impacts neurodiverse indi-
viduals. In Chapter 11, Steven Keisman details obstacles facing neurodi-
Preface xvii

verse individuals as they find and sustain employment and explains how
artificial intelligence may be used to help them identify their strengths and
potential career options.
The field of neurodiversity is in its infancy. Much still needs to be in-
vestigated to further advance our understanding of its strengths; how those
strengths can be uncovered accurately, efficiently and practically; and what
interventions can be designed to improve the lives of neurodiverse individ-
uals. I hope this book provides some first answers as we begin to promote
neurodiversity as a necessary societal value, incorporate strengths-based
approaches into our clinical practice, and advance the understanding of the
phenomenology, neurobiology, and clinical research of neurodiversity.

Lawrence K. Fung, M.D., Ph.D.

References
Chickering AW, Reisser L: Education and Identity, 2nd Edition. San Francisco,
CA, Jossey-Bass, 1993
Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York,
Basic Books, 1983
Gardner H, Hatch T: Multiple intelligences go to school: educational implications
of the theory of multiple intelligences. Educational Researcher 18(8):4–10, 1989
Jeste DV, Palmer BW, Rettew DC, Boardman S: Positive psychiatry: its time has
come. J Clin Psychiatry 76(6):675–683, 2015
Seligman ME, Csikszentmihalyi M: Positive psychology: an introduction. Am Psy-
chol 55(1):5–14, 2000
 Acknowledgments

This book would not be a reality without the support and encouragement of
Dr. Laura Roberts. She is a champion of neurodiversity. Her trust in our
team has allowed us to embark on the Stanford Neurodiversity Project
(SNP), which secures our base to pursue works of passion such as this book.
I would like to thank the SNP’s first (anonymous) donor, who believes in the
importance of neurodiversity and empowers us to expand our work from a
pilot to a full project. Without her support, we could not have written this
book. I also want to thank my team in the SNP, especially Mark Gavartin,
Vicky Lam, Christy Matta, Isabelle Morris, and Marci Schwartz. Discus-
sions with this team have both challenged and refined my thinking about
neurodiversity every day. I thank John McDuffie at American Psychiatric
Association Publishing, who has shown tremendous support for this work.
Finally, I thank all of the patients and research participants with whom I
have interacted throughout the years. They give me the privilege to under-
stand their strengths and challenges. They will continue to be my constant
inspiration for how I can do better with neurodiversity advocacy, education,
research, and clinical service.

Lawrence K. Fung, M.D., Ph.D.

xix
 ONE
Neurodiversity
The New Diversity
Lawrence K. Fung, M.D., Ph.D.
Nancy Doyle, Ph.D.

For me, the key significance of the “Autistic Spectrum”

lies in its call for and anticipation of a politics of Neurological
Diversity, or “Neurodiversity.” The “Neurologically Different”
represent a new addition to the familiar political categories of
class/gender/race and will augment the insights of
the social model of disability.
Judy Singer (1999)

Neurodiversity is a concept that regards differences in brain function

and behavior as part of the normal variation of the human population.
It represents a new way of understanding and embracing diversity
based on cognitive differences. To operationalize the neurodiversity
movement, we propose the use of the strengths-based model of
neurodiversity (SBMN), which is composed of four components:
Gardner’s theory of multiple intelligences, positive psychology, positive
psychiatry, and Chickering’s seven vectors of development. This model
can be applied in clinical, educational, and employment settings. For
all these settings to benefit from the positive outcomes brought by the
neurodiversity movement, cultural change is a prerequisite. This
chapter illustrates various driving forces of this important movement.

1
2 Neurodiversity

At our core, we are who we are because we internalize our unique individual
identities. We perceive the world, communicate with others, and behave in
our own distinctive ways because of our identities, beliefs, and experiences.
We develop a sense of belonging and tend to identify ourselves as a part of
our family, school, workplace, volunteer organizations, and other social cir-
cles because we feel we have a role in these groups. This sense of belonging
leads to personal satisfaction. In many large organizations, the composition
of the membership is diverse. The extent to which one believes he or she be-
longs to an organization depends on many factors, but it is intuitive to accept
that that sense of belonging depends on the diversity represented in the or-
ganization, how the organization handles diversity issues, and members’
feelings about the acceptance of their own identities within the organization.
Diversity refers to the inclusion of a range of individuals who are different
from each other. The main subtypes of diversity include demographic, ex-
periential, and cognitive (de Anca and Aragón 2018).
Demographic diversity, which refers to diversities in race, gender, sexual
orientation, religious affiliation, educational background, functional back-
ground, and organizational tenure, has been the most visible subtype of di-
versity in human history. Breakthroughs in diversity movements involving
demographics have been about social justice and human rights. More than
150 years ago, in 1863, President Abraham Lincoln issued the Emancipa-
tion Proclamation, which abolished the slavery of African Americans in the
United States. In 1920, the 19th amendment of the U.S. Constitution was
approved, granting women the right to vote. In the early 1970s, the lesbian,
gay, bisexual, and transgender (LGBT) social movements began. In 1973,
the American Psychiatric Association proposed removing “homosexuality”
from the third edition of DSM (American Psychiatric Association 1980).
Based on the understanding of behaviors of human beings and cultures in
our society, these monumental movements created opportunities for people
with various demographic diversities and advanced human rights for billions
of people.
Experiential diversity refers to differences in life experiences that shape the
decisions people make, ranging from daily minutiae to major life decisions.
However, there is not much that people can do to control their personal life
trajectories. Also, because there are so many experiential trajectories, we can-
not really anticipate that experiential diversity will be the center of any sig-
nificant movements of social justice.
Cognitive diversity refers to differences in how people think. Many com-
panies have embraced the idea that cognitive diversity is the essential ingre-
dient of innovation. Therefore, companies have invested in this idea by
forming offices of diversity and inclusion. This trend is not a result of pro-
moting social justice but, rather, a strategy for companies to attract talent
Neurodiversity 3

and meet their bottom lines. “Companies in the top quartile for racial and
ethnic diversity are 35 percent more likely to have financial returns above
their respective national industry medians” (Hunt et al. 2015).
Neurodiversity is closely related to cognitive diversity. In this book, we
define neurodiversity as a concept that regards individuals with differences
in brain function and behavioral traits as part of normal variation in the hu-
man population. In this chapter, we describe definitions of neurodiversity
in previous movements. We discuss being in the midst of a new movement
of neurodiversity, which involves uncovering the strengths of neurodiverse
individuals and utilizing their talents to increase innovation and productiv-
ity of the society as a whole. We discuss the SBMN briefly in this chapter
and more extensively in Chapters 4 and 5.

Origin of the Term Neurodiversity

Judy Singer, a self-advocate and sociologist, is credited as being the first per-
son to have used the term neurodiversity in her 1998 honors thesis, titled
“Odd People In: The Birth of Community Amongst People on the Autism
Spectrum. A Personal Exploration of a New Social Movement Based on
Neurological Diversity” (Singer 1998). She then contributed a chapter
based on this work to the book Disability Discourse, a volume in a series fo-
cused on disability, human rights, and society (Singer 1999). The title of her
chapter was “‘Why Can’t You Be Normal for Once in Your Life?’ From a
‘Problem With No Name’ to the Emergence of a New Category of Differ-
ence.” In her work, Singer described the need to change the autism spectrum
condition from a medicalized disability to a new social movement. She dis-
cussed that the “rise of autistic advocacy” was similar to the movements
based on disability or difference but was different from the LGBT move-
ments in that the neurodiversity movement was greatly accelerated.
Singer explained that the rise of the neurodiversity movement might be
related to the invention and rapid development of the computer and the in-
ternet. She called computers an autistic invention and an essential prosthetic
device for autistic people. As Singer explained, without these technological
advances and the affinities of autistic individuals with computers, this group
would not have enough social, organizational, and networking skills to fur-
ther the autistic movement.
Singer described three objectives of the neurodiversity movement.
First, she advocated for recognition of the characteristics of autistic indi-
viduals by neurotypical individuals. She described how autistic individuals
were sometimes misjudged as incompetent or lazy. Second, she promoted
civil rights for autistic individuals. She explained that autistic individuals
4 Neurodiversity

were often teased, bullied, and discriminated against at school and in the
workplace. She pointed out that even autistic people who were highly skilled
and intelligent were not given the same rights to earn a living as neurotypical
people. Finally, Singer argued that autistic individuals should receive services
appropriate to their level of functioning. She stated that the variety of ser-
vices that were available to people on the autism spectrum were limited and
that many of these individuals were not benefiting from the services available
to them.
In addition to Singer’s work, Harvey Blume’s 1998 article in The Atlantic
was often cited as one of the first articles to use the term neurodiversity. He
wrote, “Neurodiversity may be every bit as crucial for the human race as
biodiversity is for life in general. Who can say what form of wiring will prove
best at any given moment? Cybernetics and computer culture, for example,
may favor a somewhat autistic cast of mind” (Blume 1998). The autism
rights movement (ARM) in the 1980s and 1990s encouraged stakeholders
to move away from the medical model of disability. The ARM was initiated
by Jim Sinclair, who argued that autism is “a variation in functioning rather
than a disorder to be cured” (Solomon 2008). Sinclair advocated for pro-
viding therapies that teach autistic individuals coping skills rather than treat-
ments that are meant to “normalize” their behaviors. He also advocated for
autistic people to be recognized as a minority group. A common criticism
of this movement was that most ARM activists were “high-functioning”
self-advocates and therefore did not represent autistic individuals at all lev-
els of functioning. Another criticism was that ARM trivialized the disabili-
ties of autistic individuals.

Ontology of Neurodiversity
Singer’s (1999) contention was that human minds are naturally diverse, with
between-person variations being part of the rich tapestry of human experi-
ence, intellect, and skill. Formed in the 1990s, the neurodiversity concept
aligned with the social model of disability (Oliver 1983), which proposed
that disability may be a socially constructed oppression, a feature of being
different or unusual as opposed to ill or injured. Although neurodiversity is
still often referenced solely in relation to autism (Kapp et al. 2013), it is in-
creasingly used in psychology and education as an umbrella term associated
with autism, dyslexia, dyspraxia (or developmental coordination disorder),
ADHD, and dyscalculia (Armstrong 2010; Grant 2009; Weinberg and
Doyle 2017). Even though the ontological status of included conditions is
still predicated on a medical model of deficit via DSM, the public percep-
tion of neurodiversity has shifted paradigmatically in recent years. A pro-
Neurodiversity 5

liferation of articles espousing the benefits of neurodiversity in the business

press (Austin and Pisano 2017; Bernick 2019; Comaford 2017) is supported
by an albeit much smaller yet consistent voice from academia (Meilleur et
al. 2015; Riddick 2001; Taylor and Walter 2003; White and Shah 2006).
As the “diamond in the rough” narrative gains traction, it is time for onto-
logical reflection from psychiatry and psychology, in an effort to understand
how our work may be enhancing and limiting inclusion outcomes for indi-
viduals with these variations. In this section, we outline the issues in lan-
guage, ontology, and epistemology that influence research and sociolegal
practice.
As is typical in emerging narratives, language is evolving rapidly, through
common discourse between stakeholders. The neurodiversity paradigm has
stimulated much discussion on social media and spawned a movement
among activists, seeking the right of self-determination, to choose nomen-
clature that reflects their experience, which may or may not relate to ill
health (Ortega 2009). With neurodiversity as the umbrella, individuals with
qualifying diagnoses may prefer the terms neurodiverse, neurodivergent, neu-
rodifferent, or neurominority; these terms are currently used interchangeably,
and debates are ongoing within the movement regarding which terms are
“correct.” Some disability campaigners have eschewed “person-first” de-
scriptors such as “person with autism,” which sound as though the person
has an illness, in favor of autistic or autist, dyslexic, or dyspraxic, which describe
the person’s diagnosis as an identity (note there is no equivalent for ADHD).
Conclusions are yet to be drawn, but clinicians should be aware of the deeply
felt positions regarding language and the identity level to which it speaks.
Diagnosis within this context may be interpreted as affliction, catharsis, or
vindication; it may empower or produce self-limiting beliefs, depending on
what the diagnosis has meant to the person and how the associated experi-
ences have resulted (positive or negative) in the past.
Identity-first language was found to be preferred in one study involving
3,470 autistic individuals, parents, and their broader support network in the
United Kingdom (Kenny et al. 2016). The term autistic was endorsed by
61% of autistic adults, 52% of family members/friends, and 51% of parents
(51%) but only 38% of professionals. In contrast, person with autism was en-
dorsed by 49% of professionals, 28% of autistic adults, and 22% of parents.
In a more recent study involving 198 autistic adults in Australia, partici-
pants were asked to rank-order six choices (person with autism, person on
the autism spectrum, autistic, autistic person, person with autism spectrum
disorder, person with autism spectrum condition). The term autistic was
found to be the most preferred and second-least offensive, whereas the term
person on the autism spectrum was shown to be the least offensive and second-
most preferred (Bury et al. 2020). In this book, we choose to use identity-
6 Neurodiversity

first descriptors for consistency. However, it is important to note that some

neurodiverse individuals do prefer person-first language, whereas others do
not have a strong preference either way. Using identity-first or person-first
language is meant to demonstrate respect toward neurodiverse people.
Therefore, it is ultimately the neurodiverse individual’s personal choice to
declare a preference.
The language debate highlights a key ontological tenet of the neurodi-
versity movement: the evolutionary critique. The traditional medical model
(Shelley-Tremblay and Rosén 1996) proposes that the high prevalence of
conditions, their heritability (D’Souza and Karmiloff-Smith 2017; Siegel
2006), and their persistent comorbidity (Hendren et al. 2018) are indicative
of evolved, advantageous benefits that sufficiently outweigh deficits. For ex-
ample, benefits include the capacity for detail and memory in autism (Meil-
leur et al. 2015), entrepreneurial flair in dyslexia (Logan 2009), and creativity
in ADHD (White and Shah 2006). In this model, the notion of disability or
deficit exists in relation to sociohistorical norms rather than neurophysio-
logical deficit or damage. To illustrate, we consider the skills of literacy, nu-
meracy, sitting still, single focus, eye contact, and small talk to be so essential
within education and development that those who have difficulty with these
skills must be “broken,” yet we do not acknowledge the situational essence
of these skills. In terms of human biological adaptation to environment,
such behaviors are modern in the context of the human species and may in-
deed prove to be temporary. On this basis, some campaigners have gone so
far as to argue that research aimed at “cure” or “intervention” is threatening
these individuals’ right to exist (Baker 2011; Krcek 2012). As the language
and ontology shift from diagnosis toward identity, tools such as DSM,
which may change criteria or remove conditions (e.g., Asperger’s disorder),
appear to some within the neurodiverse community as being adversarial be-
cause they make a patriarchal assertion that defines the boundaries of ac-
ceptable human form.
Moving forward, there will be opportunities for the neurodiversity par-
adigm to influence and be influenced by a collaboration of academics, prac-
titioners, and stakeholders. The social model of disability research suggests
that there should be “nothing about us without us” (Charlton 1998), calling
for greater involvement of service users within research design (e.g., involv-
ing actually autistic persons in autism-related research development). Prac-
titioners have access to research participants. Academics seek ecological
validity for their work. A grounded theory approach (Ralph et al. 2015)
(whereby we critique the questions we are asking through various lenses) can
support the rigor of the hierarchy of evidence (whereby we note the answers
to our questions) within the epistemological stance of critical realism (Hous-
ton 2014; Pawson 2006). Using iterative inductive, hypothetico-deductive,
Neurodiversity 7

and abductive reasoning (Van Maanen et al. 2007) within this “pragmatic
paradigm” (Simpson 2018), we can build on our understanding of naturally
occurring variations in cognition, neurobiology, and genetics and go further.
The end goals for both individuals and society are inclusion, equality, and
the fulfillment of human potential (Doyle 2018). To succeed, we must em-
brace the medical, evolutionary, social, and policy models at our disposal and
work toward a more unifying theory of neurodiversity.

Redefining Neurodiversity
In the 1980s and 1990s, the neurodiversity movement was organized by
high-functioning autistic individuals. The agenda was mainly set to benefit
the people advocating for themselves. We use the term neurodiversity with a
broader meaning: the diversity that views differences in brain function and
behavior as normal variations in the human population. We consider neu-
rodiverse conditions to include autism, dyslexia, ADHD, dyspraxia, dyscal-
culia, dysphonia, Tourette syndrome, synesthesia, and other behavioral and
neurobiological differences. Each of these conditions has been defined his-
torically within the medical model, which emphasizes the characterization
of symptoms or deficits. We emphasize that these are neurodiverse condi-
tions instead of disorders. Although we acknowledge the challenges of these
conditions, we recognize that these characteristics can be both strengths
and challenges depending on the context. Most importantly, we apply these
concepts across the entire spectrum of neurodiverse conditions.
To articulate the essence of the new definition of neurodiversity, we de-
signed the SBMN. The SBMN is a formulation of approaches to maximize
the potential of neurodiverse people based on their strengths and interests.
This model focuses on enhancing their abilities and engaging other stake-
holders to help them achieve developmental tasks during their formative
years. The four main components of the SBMN are Gardner’s theory of
multiple intelligences (Gardner 1983; Gardner and Hatch 1989), positive
psychology (Seligman and Csikszentmihalyi 2000), positive psychiatry
(Jeste et al. 2015), and Chickering’s seven vectors of development (Chicker-
ing and Reisser 1993).
For many years, human abilities have been benchmarked by the IQ test.
This test, however, has significant limitations. The IQ test assesses only a few
areas of human abilities, such as visual-spatial abilities, language aptitude,
and mathematical abilities. In contrast, Gardner’s theory of multiple intelli-
gences allows for more comprehensive understanding of human abilities.
First introduced in 1989, Howard Gardner and Thomas Hatch proposed
that separate psychological processes are involved in dealing with linguistic,
8 Neurodiversity

numerical, pictorial, gestural, and other kinds of symbolic systems (Gardner

and Hatch 1989). They reviewed the literature in several areas:

the development of cognitive capacities in normal individuals; the break-

down of cognitive capacities under various kinds of organic pathology; the
existence of abilities in “special populations,” such as prodigies, autistic in-
dividuals, idiot savants, and learning-disabled children; forms of intellect
that exist in different species; forms of intellect valued in different cultures;
the evolution of cognition across the millennia; and two forms of psycho-
logical evidence—the results of factor-analytic studies of human cognitive
capacities and the outcome of studies of transfer and generalization. (p. 5)

Gardner’s original list of intelligences included musical-rhythmic, visual-

spatial, verbal-linguistic, logical-mathematical, bodily kinesthetic, interper-
sonal, and intrapersonal (Gardner 1983). He later added naturalistic as an
eighth intelligence. He has also written about existential intelligence. Table
1–1 provides more details about the core components of the multiple intel-
ligences and their associated potential occupations.
The second component of the SBMN is positive psychology. Founded
by Martin Seligman and Mihaly Csikszentmihalyi, positive psychology is
designed to promote individual well-being, contentment, and satisfaction
through hope, optimism, and full immersion of oneself in experiences (Se-
ligman and Csikszentmihalyi 2000). Hart and Sasso (2011) reported that 53
definitions of positive psychology had been published since the late 1990s.
The top three themes of positive psychology they derived from these defi-
nitions included the following (Hart and Sasso 2011, p. 84):

1. Virtues, character strengths, positive personality traits and related attri-

butes and abilities, and talents
2. Phenomena indicative of happiness, positive emotional well-being, sub-
jective sense of fulfillment, and satisfaction with the quality of life
3. Developmental process of becoming, growth, fulfillment of capacities,
actualization of potential, and development of the highest/authentic self

As we apply positive psychology to interactions with neurodiverse indi-

viduals, we focus on the strengths that enable them to progress toward
meeting their personal goals. Positive psychology is designed to help indi-
viduals develop a healthy, strengths-oriented life by raising their awareness
of personal strengths, increasing their trust in personal abilities, helping
them learn to engage in relationships, and increasing their self-satisfaction
through success (Wehmeyer 2013). Positive psychology can also be useful
in moving neurodiverse individuals away from negativity and immobility.
Although co-occurring conditions, such as anxiety, depression, and execu-
TABLE 1–1. Gardner’s multiple intelligences

Neurodiversity
Intelligence Potential occupations Capacities and abilities

Bodily kinesthetic Athlete, dancer, artist, firefighter, Abilities to control one’s body movements and to handle objects skillfully;
surgeon gross and fine motor control
Existential Cosmologist, philosopher, theologian Appreciate and develop a deeper understanding of the existence of beings and
of matters that make up the universe
Interpersonal Salesman, therapist Relate with people based on their understanding of their emotions, needs,
language, and nonverbal gestures
Intrapersonal A higher intelligence needed for success Conscious awareness of self in various domains, such as appearance, emotions,
in many occupations behavior, and communication
Logical-mathematical Economist, accountant, mathematician, Appreciate the reasoning of abstract concepts, principles, and rules related to
engineer, programmer, scientist numbers
Musical-rhythmic Composer, musical performer, music Appreciate the core components of music (amplitude, expression, harmony,
teacher, acoustic engineer melody, overtone, pitch, rhythm, timbre) or produce the musical experience
via instruments
Naturalistic Botanist, farmer, ranger, Have an affiliation and tendency to be close to nature and a deeper experience
environmentalist, zoologist and understanding of the natural environment
Verbal-linguistic Historian, journalist, lawyer, linguist, Grasp deeper understanding of the meaning of words, functions of language
poet (e.g., communication, identification, physiological, recording, transmission
of thoughts, social), and use of language to perform intended functions
Visual-spatial Architect, artist, interior designer, Perceive visual and spatial details of parts and whole of objects and how they
navigator, physicist, sculptor interact with each other

9
10 Neurodiversity

tive dysfunction, are common in neurodiverse individuals, the practice of

positive psychology guides these individuals to identify themselves by their
strengths rather than their diagnoses or problems.
The third component of the SBMN is positive psychiatry (Jeste et al.
2015). In contrast to traditional psychiatry, positive psychiatry focuses on
uncovering positive attributes and strengths. Instead of assessing risk fac-
tors, it emphasizes protective factors. In traditional psychiatry, treatment is
typically about symptom relief through medication and short-term psycho-
therapy. In positive psychiatry, the goal is to increase well-being and growth
through psychoeducational approaches. Positive psychiatry’s approaches
are expected to reduce the emergence of mental health issues.
The final component of the SBMN is Chickering’s seven vectors of de-
velopment: developing competence, managing emotions, moving through
autonomy toward interdependence, developing mature interpersonal rela-
tionships, establishing identity, developing purpose, and developing integ-
rity (Chickering and Reisser 1993). Our approach is to practice the seven
vectors of development by 1) teaching neurodiverse individuals, either at
school or in the workplace, to work toward fulfilling their developmental
tasks; 2) encouraging other stakeholders (e.g., school officials or employ-
ers) to create neurodiversity-friendly environments; and 3) empowering
mental health providers to provide services that can support neurodiverse
individuals in fulfilling developmental tasks.
Collectively, the theory of multiple intelligences, positive psychology,
positive psychiatry, and Chickering’s seven vectors of development provide
a framework to practice the SBMN. This framework can be used to develop
strengths-based programs in educational, employment, and clinical set-
tings. In Chapters 4, 5, and 6, we illustrate the use of the SBMN for autism,
ADHD, and dyslexia, respectively.

Changing the Culture

Successful diversity movements serve to change the culture by generating a
wider acceptance of differences that results in a higher sense of equity and
belonging. All cultural changes have to go through stages of development
to achieve progression and sustained outcomes. Any person who knows that
a particular behavior change is good for him- or herself has to go through
precontemplation, contemplation, preparation, action, and maintenance.
Change is generally hard for anyone. However, if the environment is shaped
in a manner that facilitates change, the person will feel empowered, and the
challenges encountered will be less overwhelming. Similarly, in organiza-
tions that embrace neurodiversity and desire to make it part of their culture,
Neurodiversity 11

implementing changes that will benefit neurodiverse individuals will be

much easier if the managers and employees believe that neurodiversity is
beneficial for them and their organizations. More and more corporations are
becoming interested in the neurodiversity movement. Employees and exec-
utives are forming grassroots efforts to initiate discussions on neurodiver-
sity and to propagate the reasons why their organizations will benefit from
practicing inclusion and building neurodiversity-friendly environments. As
companies formalize their efforts to hire neurodiverse people, a sociocul-
tural evolution will gradually happen. Neurodiversity will not only be a dis-
cussion in businesses; it will also be an important topic for students at all ages
to learn and discuss. Neurodiversity will gradually become part of our soci-
etal culture.
Much has been achieved in women’s rights over the past 100 years. In
1920, the 19th amendment to the U.S. Constitution was ratified, empow-
ering all American women to possess the same rights and responsibilities of
citizenship. Today, women are holding key leadership positions in many
state and federal government agencies, small and large businesses, and aca-
demic institutions. One might ask: Will it take 100 years for neurodiversity
to become part of our culture? Will it take many years for neurodiverse in-
dividuals to truly receive equal rights and opportunities? Only time will tell.
However, as our society becomes more and more digital, the environmental
changes may become more and more friendly to neurodiversity. As the in-
ternet and digital technology advance, a major evolutionary transition that
merges technology, biology, and society is bound to happen (Gillings et al.
2016). Digital technology has already become part of the social fabric of our
society. Although digital technology can be a barrier for sustaining the hu-
man social interactions we are accustomed to, it has opened doors for neu-
rodiverse people to communicate with others, thus enhancing their ability
to be assimilated into their communities and into society at large.

Case Example
George is a neurodiverse college student majoring in computer science. He
identifies as an Aspie (i.e., person with Asperger’s disorder) who loves com-
puter programming and music. George took a course about the interface
between artificial intelligence and human experience last quarter and was
anxious about this required class because the assignments were known to be
open-ended. As good as he is at programming, he has been struggling with
assignments that require understanding of the “big picture.” Dr. Chan has
been teaching this course for 10 years and using the same assignments year
after year. In past years, one-quarter of the class struggled with getting the
essence of her assignments. This year, she is determined to help her students
with her assignments.
12 Neurodiversity

With the encouragement of staff members from the Office of Accessible

Education, George approached Dr. Chan and explained his tendency to not
get the “big picture.” Dr. Chan recognized George as someone who was tal-
ented in debugging Python programs but who found the open-ended objec-
tives of assignments confusing. She had recently attended a lecture on the
SBMN and recalled that autistic students are often good at attention to de-
tails. She leveraged this information and reformulated the assignments with
logical and coherent details. George had no problem with lots of details. He
worked hard in this class and eventually received an A. Dr. Chan found that
her change in the assignments helped not only George but other students as
well. For the first time in 10 years, she found that all of her students under-
stood all of her assignments. She ultimately was nominated for and won a
teaching award in the computer science department.

Conclusion
Despite the promises of neurodiversity, barriers to inclusion are currently
real, whether socially constructed, congenital, or acquired. Research shows
that neurodiverse people are more likely to be incarcerated (Snowling et al.
2000; Young et al. 2018), unemployed (Dickson 2012; Jensen et al. 2000),
and unable to achieve academic or career potential (de Beer et al. 2014;
Holliday et al. 1999; Kirby et al. 2011; Painter and Welles 2011). Provisions
for neurodiverse conditions or “invisible disability” are enacted in disability
legislation across the world (e.g., in the United States, the Individuals with
Disabilities Education Act in 2004 and the Americans with Disabilities
Amendments Act in 2008; in the United Kingdom, the Equality Act in 2010).
These laws oblige both educators and employers to make “reasonable” ad-
justments and accommodations to their environments. Accommodations
for neurodiversity are more nuanced than are those for physical disability
(e.g., access ramps for wheelchairs, screen readers for visual impairments,
and sign language interpreters for hearing impairments). Neurodiversity
accommodations may involve changes to the sensory environment, flextime
or additional time, assistive technology, extended training, and perfor-
mance coaching (Telwatte et al. 2017; Weinberg and Doyle 2017).
Treatment and intervention research for neurodiverse conditions, how-
ever, is predominantly medical (e.g., Amen et al. 2011; Doyle and McDow-
all 2019). Notably, one article reviewed the volume and location of dyslexia
research in the English language since 1995 (Doyle and McDowall 2015).
The authors reported that 62% of articles were published in neuroscience
journals, and out of more than 11,000 studies, only 42 single studies (no
randomized controlled trials) related to functional, occupational presenta-
tion. The paucity of applied psychological research for neurodiversity is
well reported (Adamou et al. 2013, Baldwin et al. 2014; Doyle and McDow-
Neurodiversity 13

all 2019; Kirby et al. 2011; Weinberg and Doyle 2017) yet remains unad-
dressed. Our society seems to be heavily invested in neuroscience research
instead of research associated with functional adaptation in neurodiverse
conditions. Legislative branches worldwide have not spurred sufficient re-
search in education or occupational fields to address barriers (Karmiloff-
Smith 2009; Santuzzi et al. 2014). Our epistemological frame is divergent
from the ontological paradigm shift, and research has not maintained pace
with practice. We therefore lack reliable evidence upon which to base in-
clusion activity.
In conclusion, much work has to be done at the legislative level to max-
imize the potential of neurodiversity. More research is needed to devise bet-
ter instruments to assess the many strengths of neurodiverse individuals.
Meanwhile, the SBMN provides a framework that enables practitioners to
develop their programs for the benefit not only of neurodiverse individuals
but also of everyone in society.

KEY CONCEPTS
• Neurodiversity is about recognizing that differences in brain function
and behavior are part of the normal variation of the human population.
• Neurodiverse conditions include but are not limited to autism, dyslexia,
dyscalculia, dysgraphia, dyspraxia, ADHD, Tourette syndrome, and syn-
esthesia.
• Neurodiverse conditions are conditions instead of disorders.
• Depending on the context, traits of neurodiverse conditions can be seen
as strengths or challenges.
• Much debate on the language related to neurodiversity is still ongoing.
Use of adjectives such as neurodiverse and neurodivergent is a per-
sonal decision that should be respected.
• The four major components of the strengths-based model of neurodiver-
sity are Gardner’s theory of multiple intelligences, positive psychology,
positive psychiatry, and Chickering’s seven vectors of development.
14 Neurodiversity

Recommendations for Educators,

Clinicians, and Other Professionals
• Get to know the neurodiverse people around you. Use Gardner’s theory
of multiple intelligences to discover the strengths of neurodiverse indi-
viduals in multiple domains.
• Clinicians: Consider incorporating positive psychology or positive psy-
chiatry into patient care. Guide patients in writing blessings journals, us-
ing signature strengths in a new way, and making gratitude visits. Engage
patients to speak about positive emotions; become immersed in activities
that give satisfaction; develop positive, trusting relationships; find mean-
ing and purpose in life; and celebrate personal accomplishments.
• Educators and professionals in educational settings: Become involved in
changing the school environment so as to help neurodiverse students
achieve their developmental tasks during these formative years. Help
make change by doing the following:
• Cultivate inclusion by educating neurotypical students and teachers
about neurodiversity.
• Assess and identify learning styles of neurodiverse students.
• Provide academic support, coaching, or tutoring accordingly.
• Recommend reasonable academic accommodations to help neuro-
diverse students succeed.
• Reach out to students who need assistance with regulating their
emotions.
• Help students move through autonomy toward interdependence by
being involved in peer mentoring programs and other group activities.
• Create more accessible environments for neurodiverse students in
their career exploration.
• Provide vocational counseling and programs designed to help neu-
rodiverse students navigate into the workforce.
• Employers and professionals in employment settings: Promote change
by doing the following:
• Cultivate inclusion by educating supervisors and employees about
neurodiversity.
• Assess and identify learning styles of neurodiverse employees.
• Provide vocational supports and coaching accordingly.
• Recommend reasonable accommodations to help neurodiverse stu-
dents succeed in the workplace.
Neurodiversity 15

• Reach out to neurodiverse employees who need assistance with reg-

ulating their emotions.
• Help neurodiverse employees move through autonomy toward inter-
dependence via mentoring programs and other group activities.
• Create more accessible environments for neurodiverse employees to
explore their career trajectories.

Discussion Questions
1. What are some commonalities among diversity movements throughout
history?
2. What are the psychological bases for the language used in the discussion
of neurodiversity?
3. What is the empirical evidence for the utility of each component of the
strengths-based model of neurodiversity?
4. What are the ethical implications of the neurodiversity movement?

Suggested Readings
Austin RD, Pisano GP: Neurodiversity as a competitive advantage. Harv
Bus Rev, May–June 2017
Baron-Cohen S: Editorial perspective: neurodiversity—a revolutionary
concept for autism and psychiatry. J Child Psychol Psychiatry 58(6):744–
747, 2017
Doyle NE, McDowall A: Context matters: a review to formulate a conceptual
framework for coaching as a disability accommodation. PLoS One
14(8):e0199408, 2019

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 TWO
Positive Psychology
and Strengths-Based
Approaches to
Neurodiversity
Michael L. Wehmeyer, Ph.D.

People with autism should be treated with the same dignity,

respect, and equality as people without autism.
Jean-Paul Bovee (2000)

Disability, throughout most of its history, has been understood within

the context of diseases and deficits. Social models of disability,
however, emphasize understandings of disability as derived from lived
experiences and stress that disability is rooted in attitudes, structures,
and environments in society and the restrictions inherent therein.
Strengths-based approaches to neurodiversity take, as a starting point,
the assumptions of the social model of disability and then translate them
into approaches that support, educate, or enable people with disabilities
to function successfully in typical contexts. This chapter examines the
historical development of strengths-based approaches to disability and
the convergence of social and person-environment fit models of
disability with positive psychology in moving the field toward
strengths-based approaches. The chapter then highlights progress on
mindfulness, character strengths, and self-determination as examples of
how strengths-based approaches are increasingly impacting disability
services and supports.

19
20 Neurodiversity

For much of history, disability, as a construct, was conceptualized as an in-

ternal pathology and viewed as a chronic or long-term health condition
(Wehmeyer 2013b). Unfortunately, the resulting societal perceptions of
people with disability were that they were somehow different from the norm,
and consequently, societal responses to disability were characterized by seg-
regation, discrimination, and maltreatment (Smith and Wehmeyer 2012).
This situation began to change in the 1980s because the medical com-
munity began to recognize that conceptualizing long-term or chronic
health problems solely within a disease model was inadequate and because
people with disability themselves began to reject these understandings of
disability and to organize around a civil rights agenda emphasizing equal
rights and access, social justice, and protection against discrimination. A
worldwide self-advocacy and civil rights movement took root (Driedger
1989; Williams and Shoultz 1982). Jean-Paul Bovee, whose quote began the
chapter and who is autistic himself, was an early leader in the self-advocacy
movement: “People with autism need to join the disability rights movement
and the People First movement. These groups know what we face is preju-
dice and discrimination. We need to fight for our humanity, our rights, re-
spect, and dignity that we deserved from the day we were born” (Bovee
2000, p. 252).
One outcome of the self-advocacy movement was the “advancement of
a positive disability identity and culture” (Caldwell 2011, p. 315). Historian
and disability rights pioneer Paul Longmore described the establishment of
disability identity and culture as the second phase of the disability rights
movement (Longmore 2003). Longmore and Umansky (2001) explained,

While public policy has sought to fashion disability as a generic category and
attempted to impose that classification on people with an assortment of
conditions, disability has never been a monolithic grouping. There has al-
ways been a variety of disability experiences....[These] experiences of cul-
tural devaluation and socially imposed restriction, of personal and collective
struggles for self-definition and self-determination...recur across the vari-
ous disability groups and throughout their particular histories. (p. 4)

What leaders in the self-advocacy movement emphasize is that by em-

bracing disability identity, they recapture their personhood and lay claim to
social justice, full citizenship, and participation. Self-advocates with neuro-
developmental disabilities (NDDs) have been at the forefront of movements
to embrace disability identity, as illustrated by the positions articulated by
the Autistic Self Advocacy Network (ASAN). ASAN’s positions illustrate
this in myriad ways. For example, ASAN states the following:
Positive Psychology and Strengths-Based Approaches 21

Within the broader context of the disability rights movement, ASAN seeks
to bring about more accommodation and acceptance of neurological diver-
sity in our society. We believe that self-advocacy is essential to this process
and that there must be meaningful involvement of Autistic individuals in
making policy at all levels: Nothing About Us Without Us. (Autistic Self-
Advocacy Network 2019)

Nothing about us without us is the universal rallying call for the disability civil
rights movement, and its use in the ASAN position statement situates the
neurodiversity movement within the historic context of that movement.
Neurodiversity and disability rights are inextricably linked by ASAN:

The disability rights perspective within the Autistic community is represented

in the neurodiversity movement, which promotes social acceptance of neuro-
logical difference as part of the broad landscape of human diversity and seeks
to bring about a world in which Autistic people enjoy the same access, rights,
and opportunities as all other citizens. (Autistic Self-Advocacy Network 2019)

What ASAN and the neurodiversity movement emphasize is what Bovee

stated in the quote at the beginning of the chapter: that autistic people de-
serve to be treated with dignity and respect.

Of course, there are real challenges associated with autism and other neu-
rological differences. The social model draws a distinction between the un-
derlying condition, which exists regardless of cultural attitudes, and the
disability, which consists of everything that goes into society’s representation
of the condition. In advocating recognition of the civil rights and dignity of
Autistics and others with disabilities,...we are seeking to create a world in
which all people can benefit from whatever supports, services, therapies, ed-
ucational tools, and assistive technologies may be necessary to empower
them to participate fully in society, with respect and self-determination as
the guiding principles. (Autistic Self-Advocacy Network 2019)

The ASAN position statement references the social model (of disability),
which provides the foundation for the strengths-based approaches discussed
in this chapter. Two models or conceptualizations of disability are typically
at the center of discussions about understanding disability: the biomedical
model and the social model. The latter became the dominant perspective of
disability with the growth of institutional care and the “need for regulation,
licensing, and due process in committal to institutions,” roles that were
taken on by the medical profession (Bach 2017, p. 38). It was logical that in
a system led by medical professionals, disability would be conceptualized
within a medical model. There are benefits to a medical model in the form
of advances in understanding underlying conditions and generating knowl-
edge for preventive action, but the main limitation of the model, according
22 Neurodiversity

to Bach (2017), is that in viewing disability primarily as an internal pathol-

ogy, the person becomes perceived to be in some way deficient, in some way
outside the norm. Psychology’s wide adoption of intelligence testing fur-
thered this perception of subnormality (and indeed mental subnormality be-
came a term referring to people who did not perform well on such tests).
The social model views disability as arising “from the discrimination
and disadvantage individuals experience in relation to others because of
their particular differences and characteristics” (Bach 2017, p. 40). In a so-
cial model, the so-called pathology is

not individual, but rather social in nature. The unit of analysis shifts from the
individual to the legal, social, economic, and political structures that calculate
value and status on the basis of difference. Informed by principles of human
rights and an equality of outcomes that takes account of differences, the social
model does not reject biomedical knowledge of impairments and research on
individual rehabilitation. Rather, it celebrates impairment as part of the hu-
man condition and looks at achieving equity for people with impairments in
terms of the social, cultural, and political contexts. (Bach 2017, p. 40)

It was during the transition from a biomedical model to a social model of

disability that strengths-based approaches to disability began to emerge,
and these emerging strengths-based approaches coincided with the emer-
gence of the field of positive psychology. The remainder of this chapter ex-
amines strengths-based approaches to disability, their application in positive
psychology, their and implications for disability services and supports.

Strengths-Based Approaches
to Neurodiversity
Strengths-based approaches to neurodiversity are predicated on social mod-
els of disability, but the two are not necessarily identical. “Social models of
disability” refers to an understanding of disability that emphasizes lived ex-
periences and the attitudes, structures, and environments in society and the
restrictions inherent therein. Strengths-based approaches take, as a starting
point, these assumptions of the social model and translate them into ap-
proaches to support, educate, or enable people with disabilities to function
successfully in typical contexts.
It is worth noting that strengths-based approaches are not unique to the
disability context. The field of social welfare, for example, introduced a
strengths model in the late 1990s (Rapp 1997) in regard to case management
practices for people experiencing severe and persistent mental health issues.
Positive Psychology and Strengths-Based Approaches 23

Hall et al. (2013) defined a strengths-based approach in social welfare as

providing a “foundation for clients and emphasiz[ing] personal growth, em-
powerment, and coping skills based on ideals that focus on strengths instead
of pathology.”
As noted, the medical community recognized in the 1980s that an un-
derstanding of long-term or chronic health issues, including disability, that
was based strictly on health impairments was insufficient. The conceptual-
ization of disability that has most influenced strengths-based approaches in
psychology and education is the World Health Organization’s International
Classification of Functioning, Disability and Health (ICF; World Health Orga-
nization 2001), the framework for which is presented in Figure 2–1. The
ICF provides “a multidimensional framework for the description of human
functioning and disability” (Buntinx 2013, p. 9). In the ICF, functioning is
used as an umbrella term for “neutral or non-problematic functional states,”
and disability is used as “an umbrella term for problems in functioning”
(Buntinx 2013, p. 9). Importantly, disability is presented in the ICF as part
of and not apart from typical human functioning. As can be seen in Figure
2–1, the ICF framework looks at the interactions of impairments to body
structure and functions (due to health or medical issues) with environmental
factors and personal factors on a person’s activity and participation.
It is important to note that, as stated by Bach (2017), “There remains
some question about the place of ‘impairment’ within the social and human
rights model of disability” (p. 40). Advocates such as Bach view the ICF as
still in the realm of biomedical models but recognize that it also reflects el-
ements of social models. Others are willing to accept the inclusion of impair-
ments in a social model as long as disability is clearly distinct from impairment
and refers to the restrictions caused by society. The ICF is often viewed as
more of a person-environment fit model of disability or as a social-ecological
model rather than a strictly social model. In both of these frameworks, dis-
ability is understood as resulting from a lack of fit or a gap between a person’s
capacities and the demands of the environment or context.
According to the ICF, whether an impairment results in disability is a
function not of the presence of the impairment itself but of the interaction
between personal and environmental factors that mediate the impact of the
impairment on activity and participation (see Figure 2–1). Activity refers to
a person’s execution of a task or action. Participation refers to a person’s in-
volvement in life situations. The ICF framework enabled the emergence of
strengths-based approaches to disability in psychology and education. In
this framework, disability is situated not within the person, as in biomedical
models, but in the gap between the person’s capacities and the environ-
ment’s demands. A person’s strengths is the starting point for supports to en-
24 Neurodiversity

Health condition

(Disorder or disease)

Body functions
Activity Participation
and structure

Environmental Personal
factors factors

FIGURE 2–1. The International Classification of Functioning, Disabil-

ity and Health framework.
Source. Reprinted from World Health Organization: International Classification of
Functioning, Disability and Health (ICF). Geneva, World Health Organization, 2001.
Used under a Creative Commons Attribution–NonCommercial ShareAlike 4.0
International License.

able that person to function successfully (i.e., engage in activities leading to

full participation).
Publication of the ICF in 2001 stimulated the development of strengths-
based approaches. At the same time, a new discipline, positive psychology,
was taking shape within psychology.

Positive Psychology
In 1998, Martin Seligman, then president of the American Psychological As-
sociation, called for a “reoriented science that emphasizes the understanding
and building of the most positive qualities of an individual” (Seligman 1999,
p. 559) and introduced a field that he referred to as positive psychology. Positive
psychology is “the pursuit of understanding optimal human functioning and
well-being” (Wehmeyer et al. 2009, p. 357). Seligman and Csikszentmihalyi
(2000), in an introduction to a special issue of American Psychologist on posi-
tive psychology, wrote the following:
Positive Psychology and Strengths-Based Approaches 25

The field of positive psychology at the subjective level is about valued sub-
jective experiences: well-being, contentment, and satisfaction (in the past);
hope and optimism (for the future); and flow and happiness (in the present).
At the individual level, it is about positive individual traits: the capacity for
love and vocation, courage, interpersonal skill, aesthetic sensibility, perse-
verance, forgiveness, originality, future mindedness, spirituality, high talent,
and wisdom. (p. 5)

A comprehensive review of the positive psychology literature identified

six major themes in definitions of the field (Hart and Sasso 2011, p. 84):

1. Virtues, character strengths, positive personality traits, abilities, and

talents
2. Happiness, positive emotional well-being, fulfillment, and quality of life
3. Development processes associated with growth, fulfillment, actualiza-
tion of potential, and the authentic self
4. The good life or the life worth living
5. Thriving and flourishing
6. Resilience or adaptive functioning/behavior

Among the constructs that are frequently identified in positive psychology

are subjective well-being, optimism, happiness, self-determination, hope,
emotional intelligence, resilience, creativity, lifestyle satisfaction, quality of
life, and positive affect.

Positive Psychology and

Neurodiversity
As the field of disability supports and services began to adopt and operation-
alize strengths-based approaches, it was logical that the emergence of posi-
tive psychology would influence the understanding of such approaches. The
disability field had a relatively rich history of applying some positive psycho-
logical constructs—particularly quality of life and self-determination—to
practice. In other areas, however, there was very little application. Shogren
et al. (2006b) conducted a content analysis of 30 years (1975–2004) of lit-
erature in the area of intellectual disability to examine the use of a strengths
focus in research during that period and, for research that had adopted a
strengths focus, to consider what positive psychological constructs were
represented. Research articles were coded in each of three 10-year periods
(1975–1984, 1985–1994, and 1995–2004) with regard to these factors. Re-
search using a strengths-based approach increased across time, from about
26 Neurodiversity

20% in the first decade to 50% in the third decade. Deficits-focused articles
decreased, although only slightly overall. The application of positive psy-
chological constructs increased among articles that used a strengths focus,
from 27% of articles in the first decade to 44% in the second decade and
63% during the final decade.
In 2013, The Oxford Handbook of Positive Psychology and Disability (Weh-
meyer 2013a) was published, providing a comprehensive examination of
the application of positive psychological constructs such as optimism, hope,
and resilience in the disability context and providing an opportunity to syn-
thesize the use of constructs that had received more attention—such as self-
determination, quality of life, adaptive behavior, and decision making. In a
chapter in that handbook, Shogren (2013) reported on a content analysis of
the positive psychological literature pertaining to the degree to which disabil-
ity was addressed. Reviewing all articles published in the Journal of Positive
Psychology from its inception in 2006 through 2012, Shogren found six articles
(4%) that mentioned people with disabilities. Most of those articles focused
on issues pertaining to chronic, long-term health issues (e.g., asthma, cancer).
Even though a focus on disability remains underrepresented within the
positive psychology literature, there is an increased focus on the application
of positive psychology in the disability sphere, with long-standing topics
such as self-determination continuing to be areas of concentration and with
newer topics (within the disability literature, that is) such as mindfulness
and character strengths beginning to be explored. There remains a dearth
of research on topics such as hope, optimism, and resilience within the dis-
ability context, but progress has been made overall. For example, a hand-
book on the application of positive psychology in the lives of people with
NDDs was published in 2017 (Shogren et al. 2017c), adding chapters on
topics not included in the Oxford handbook (Wehmeyer 2013a), including
mindfulness, character strengths, intrinsic motivation, and supported deci-
sion making. As a means of providing a snapshot of areas of progress, the
remainder of this chapter reviews mindfulness, character strengths, and
self-determination as they have been explored within the context of NDDs.

Mindfulness
Neither mindfulness nor character strengths was originally included as a
topic in The Oxford Handbook of Positive Psychology and Disability (Wehmeyer
2013a) because there was insufficient research on these constructs in the
disability context at the time. The situation has changed in the intervening
years, and an additional chapter on mindfulness and character strengths was
added to the online version of the handbook (Shogren et al. 2017a) and fea-
Positive Psychology and Strengths-Based Approaches 27

tured in the handbook on applications of positive psychology in NDDs

(Shogren et al. 2017c).
Mindfulness is a good example of a strengths-based approach because re-
search in mindfulness and NDDs focuses on applications of mindfulness in-
terventions to help individuals with NDDs function more successfully.
Mindfulness (in a Western context) has been defined as “paying attention in
a particular way: on purpose, in the present moment, and nonjudgmentally”
(Kabat-Zinn 1994, p. 4). Mindfulness has been defined as a two-part pro-
cess:

The first component involves the self-regulation of attention so that it is

maintained on immediate experience, thereby allowing for increased recog-
nition of mental events in the present moment. The second component in-
volves adopting a particular orientation toward one’s experiences in the
present moment, an orientation that is characterized by curiosity, openness,
and acceptance. (Bishop et al. 2004, p. 232)

Nirbay Singh et al. (2008) pointed out that mindfulness can be described not
only as a practice but also as a state, a trait, a process, and an outcome. In the
NDD context, however, it is most frequently used to describe a practice (or,
actually, a set of related practices). Singh and his colleagues (Singh and Jack-
man 2017; Singh et al. 2017) have pioneered the application of two mindful-
ness practices, Soles of Feet (SoF) and Mindful Observation of Thoughts
(MOT), to decrease stress, increase wellness, and improve self-regulation of
emotions and behavior for people with NDDs, their family members, and
caregivers. Singh and Jackman (2017) described the SoF practice as a means
to help a person attend to the emotions that arise in a context or situation
and to self-manage those emotions by “consciously redirecting attention
away from the emotionally arousing situation to a neutral place, the soles
of the feet” (p 289). As they practice SoF, individuals increase their capacity
to self-regulate their emotions. Singh and Jackman (2017) found that par-
ticipants with NDDs who learned and applied the SoF practice experienced
improvements in depression, anxiety, self-compassion, and compassion. A
number of studies have demonstrated that people with NDDs can learn and
use the SoF practice to self-regulate behavior (Singh et al. 2013). For ex-
ample, Singh et al. (2011a) taught three autistic adolescents to use the prac-
tice to manage their anger and to replace aggressive action with the SoF
meditation. The positive effects of this intervention were still in place after
3 years.
MOT practices involve meditative processes that help people disengage
from their thoughts through practices such as closing their eyes and focus-
ing on their breathing, visualizing their emotions or thoughts, and visual-
izing alternatives to acting on those emotions or thoughts. For example,
28 Neurodiversity

Singh et al. (2011b) sought to increase health and wellness outcomes for
people with Prader-Willi syndrome. Prader-Willi syndrome is a genetic
disorder associated with, among other issues, intellectual impairments and
hyperphagia (abnormally increased appetite) leading to obesity. The inter-
vention involved MOT components (mindful eating to manage rapid eat-
ing, visualizing and labeling hunger, and engaging in SoF to rapidly shift
attention away from hunger) along with physical exercise and food aware-
ness activities to enable participants to self-regulate their eating. All three
participants in the study were able to set and attain goals pertaining to a de-
sired weight and to maintain that weight over a 3-year period.

Character Strengths
Character strengths are described as “positive, trait-like capacities for think-
ing, feeling, and behaving in ways that benefit oneself and others, and...as
specific psychological processes that define broader virtues” (Shogren et al.
2017a, p. 2). A prominent framework for classifying character strengths is
the Values in Action (VIA) Classification of Strengths (Peterson and Selig-
man 2004). The VIA framework identifies 24 character strengths classified
within six virtues, as depicted in Table 2–1. In positive psychology, there has
been a recent trend in integrating mindfulness and character strengths
(Ivtzan et al. 2016). This should come as no surprise; Shogren et al. (2017a)
pointed out that two character strengths—self-regulation and curiosity—
are at the core of their definition of mindfulness.
Much of the work in the area of character strengths has involved mea-
suring these strengths and then using the results to design interventions
that focus on them. The VIA Inventory of Strengths (VIA-IS), for individ-
uals ages 18 years and older, and the VIA Inventory of Strengths–Youth
(VIA-Youth), for children and youth ages 10–17 years, use the VIA frame-
work depicted in Table 2–1 (available at www.viacharacter.org). These tools
have strong measurement properties (Macdonald et al. 2008; McGrath
2014). As a first step in applying character strengths to the disability con-
text, Shogren et al. (2017b, 2018a) examined the reliability and factorial va-
lidity of the VIA-Youth in youth with intellectual disability compared with
youth without disability. These analyses determined that, with supports,
young people with NDDs can assess their character strengths using the
VIA-Youth, and the measure performs similarly to its performance for
youth without disability. To provide such supports, Shogren et al. (2015a)
created a guide for helping youth with intellectual and developmental dis-
abilities complete the VIA-Youth. Because the emphasis was on ensuring
that the items remained the same (so that young people with NDDs would
Positive Psychology and Strengths-Based Approaches 29

have the same experience as youth without disabilities), the guide provides
suggestions for explaining the intent of items, gives examples, and so forth.

TABLE 2–1. Values in Action Classification of Strengths: virtues and

character strengths

Virtue Character strengths

Wisdom Creativity Judgment Perspective

Curiosity Love of learning
Courage Bravery Honesty
Perseverance Zest
Humanity Love Kindness Social intelligence
Justice Teamwork Fairness Leadership
Temperance Forgiveness Prudence
Humility Self-regulation
Transcendence Appreciation of beauty Gratitude Humor
and excellence Hope Spirituality

Another measure of character strengths is the Assessment Scale for Pos-

itive Character Traits–Developmental Disabilities (ASPeCT-DD; Wood-
ard 2009), which was designed to help caregivers provide information about
the character strengths of young people with NDDs who cannot self-report.
The ASPeCT-DD examines 10 character strengths and has strong psycho-
metric properties (Woodard 2009).
Some researchers have explored the application of character strengths
to people with NDDs. Kirchner et al. (2016) measured the character
strengths of people with NDDs using the VIA-IS and examined the rela-
tionship between character strengths and life satisfaction for that group.
Samson and Antonelli (2013) used the VIA-IS to explore the role of humor
as a character strength for persons with Asperger syndrome. Both studies
found links between certain character strengths and higher life satisfaction.
Niemiec et al. (2017) illustrated the use of character strengths in interven-
tions within education. For example, one intervention was to “use your sig-
nature strengths in new ways each day,” a strategy in which teachers work
with students to identify their signature strengths (typically the five highest
ranked strengths from an assessment) and then to use each strength daily.
Niemiec and colleagues found only limited applications of interventions
utilizing character strengths in the disability literature, but they illustrated
the use of the Aware-Explore-Apply intervention (designed to help students
identify and use character strengths) with youth with NDDs in transition-
30 Neurodiversity

planning contexts. Clearly, the application of character strengths informa-

tion and interventions to the disability context is in its earliest stages.

Self-Determination
Unlike character strengths, the self-determination construct has a relatively
long and rich literature on its application to the disability context, so much
so that it is not feasible to comprehensively review it in this context. The rel-
ative importance of this focus was ably represented in the quotes in the chap-
ter introduction from Longmore and Umansky (2001) and the ASAN
position statement (Autistic Self-Advocacy Network 2019), both of which
explicitly stated the right to and importance of self-determination for people
with NDDs. Self-determination is a construct with a long history and mul-
tiple applications, beginning with discussions in philosophy in the late 1600s
pertaining to self-determination and free will (Wehmeyer et al. 2017b). The
construct was first applied to psychology in the 1930s and 1940s in the con-
text of the emergence of personality psychology, emphasizing a focus on
self-caused action.
In the 1980s, the construct became a central focus in motivation theory,
and in particular self-determination theory (SDT; Ryan and Deci 2017).
SDT is a well-researched meta-theory of motivation that explains how and
why people act volitionally. SDT posits that a person’s experience of auton-
omy, competence, and relatedness, referred to as basic psychological needs,
fosters autonomous motivation, leading to enhanced well-being and satisfac-
tion with life (Wehmeyer 2020). As such, when positive psychology emerged
as a discipline in the early 2000s, self-determination was immediately in-
cluded under its umbrella. The special issue of American Psychologist on posi-
tive psychology edited by Seligman and Csikszentmihalyi that was mentioned
earlier included an article by Ryan and Deci (2000) on SDT and its applica-
tion to positive psychology.
The self-determination construct became important to the disability
context in two ways. First, through the disability civil rights movement de-
scribed earlier, people with disabilities began to demand the right to auton-
omy and self-determination. Second, as psychology and education began to
adopt strengths-based approaches, the issue of promoting self-determination
surfaced as critically important. Within the psychology and education con-
text in disability, perhaps the most well-known theory of self-determination
is causal agency theory (Shogren et al. 2015b). Causal agency theory was
proposed to align theory in self-determination from education with the
motivation to describe a model for the development of self-determination
and to facilitate the development and validation of educational interven-
Positive Psychology and Strengths-Based Approaches 31

tions that promote it (Wehmeyer et al. 2017a). Causal agency theory de-
fines self-determination as a “dispositional characteristic manifested as acting
as a causal agent in one’s life” (Shogren et al. 2015b, p. 258). Causal agents
make or cause things to happen.
Research has shown that people with NDDs are less self-determined
than their nondisabled peers (Shogren et al. 2018b); that if provided oppor-
tunities, both educational and experiential, people with NDDs can become
more self-determined (Wehmeyer et al. 2012a, 2012b); that enhanced self-
determination contributes to more positive school, employment, and com-
munity inclusion outcomes (Shogren et al. 2012, 2015c); and that higher
self-determination status contributes to more positive life satisfaction and
quality of life (Nota et al. 2007; Shogren et al. 2006a; Wehmeyer and
Schwartz 1998). Youth and young adults with NDDs may be at particular
risk for limited opportunities to learn and practice skills related to self-
determination and, thus, may experience limited self-determination. Chou
et al. (2017) compared the self-determination status of groups of youth with
autism, intellectual disability, and learning disabilities. They found that au-
tistic youth had significantly lower scores in the domain of autonomous
functioning and, as a result, in overall self-determination.

Case Example
Today, Jean-Paul Bovee is a widely recognized advocate for the rights of peo-
ple with NDDs. In his life, Jean-Paul has overcome many barriers to self-
determination, from those related to his personal experience with autism, to
those imposed upon him by society. Jean-Paul’s mother reported that he,
like many children with NDDs, was passive as a child, preferring others to
do things for him (Donnelly et al. 2000). When Jean-Paul was growing up
on a farm in the 1970s, his family provided structure that enabled him to bet-
ter self-regulate his emotions and his responses, set expectations for him that
were comparable to those of his siblings, and encouraged him to explore his
interests in sports, reading, and music. Unfortunately, school was not an ex-
perience that offered similar opportunities for success. He was teased and
experienced bullying, particularly as he got older and entered secondary ed-
ucation. He says that as a result of these experiences, his “self-concept and
self-esteem were shattered” and that he did not like himself because he had
internalized the teasing and bullying (Donnelly et al. 2000).
Because of the support of his family, Jean-Paul persevered through these
difficult years and in high school became involved in various extracurricular
activities, from honor clubs to student government to serving as a mascot
for the sports teams. He found ways in which his unique talents could con-
tribute, and his History Bowl team achieved state and regional successes
(Donnelly et al. 2000). These successes and his involvement in student gov-
ernment, in turn, led to receipt of a scholarship to a university in his state.
Jean-Paul had difficulty adjusting to college and, once more, it was involve-
32 Neurodiversity

ment in activities such as student government and other extracurricular ac-

tivities that helped him break out of his isolation and excel. He decided that
he wanted to get his driver’s license and, despite the fact that others were
skeptical, he focused and worked diligently to attain that goal.
Jean-Paul completed his undergraduate degree and went on to earn two
master’s degrees. He has worked professionally for a number of years and
lives on his own. He has passionate interests in ethnic food, history, travel,
sports, and books. In writing about his life and his experiences as an autistic
person, Jean-Paul provided a roadmap to a better life. He emphasized that
people with NDDs “need to learn to cope in a world where they are a mi-
nority” and that they should be supported to make “their own choices about
what to do in the community” (Bovee 2000, p. 251). In talking about his per-
sonal experience with autism, he said, “I am proud of who I am, and autism
is a part of who I am. In fact, you cannot separate the autism from what I
do, think or am” (Bovee 2000, p. 252).

Conclusion
When Jean-Paul Bovee is viewed through a lens of deficits and disorders, his
passions are framed as obsessions and are seen as deficits to be remedied or
behavior problems to be eliminated. When viewed through a social model
of disability and strengths-based approaches, his passions become elements
that enhance and enrich his life, help him obtain a scholarship to higher ed-
ucation, and provide opportunities to be with others who share similar pas-
sions. The trajectory of his life could have been very different if Jean-Paul’s
family had not held high expectations for him and provided structure and
freedom, and if he had not found groups of students who were interested in
the same things he was passionate about, such as government and history.
On the other hand, how much sooner would Jean-Paul have discovered
these strengths if his classmates had recognized him as a person and not as
someone different to be picked on or bullied? How many years of self-doubt
and self-criticism might have been eliminated if people had recognized Jean-
Paul’s strengths and not perceived deficits?
Strengths-based approaches to disability operationalize social and person-
environment fit models that recognize that disability is not a problem within
the person but, rather, is a function of the complex, multifaceted interaction
between a person, the person’s strengths and abilities, the available supports
that enable the person to function, and the demands of the environment.
Strengths-based approaches build on advances in positive psychology to en-
able people with disabilities to obtain optimal outcomes in their lives. These
strengths-based approaches and the application of positive psychological
constructs to the disability context are, in many ways, in their earliest stages,
but there have been significant shifts in these directions in the past two de-
Positive Psychology and Strengths-Based Approaches 33

cades. The progress in applying strengths-based approaches such as mind-

fulness, character strengths, and promoting self-determination exemplifies
the direction in which efforts to help people with NDDs live full, rich lives
must proceed. As Jean-Paul Bovee’s mother noted, he “knew his faults and
his weaknesses,” but “letting his strengths shine took his focus off the people
that made fun of him” (Donnelly 2013, p. 27).

KEY CONCEPTS
• Self-determination: Acting as the causal agent in one’s life; making or
causing things to happen in one’s life.
• Dignity: A state of worthiness; being valued and respected because of
one’s inherent humanity.
• Respect: A state of being admired or given due regard; being held in
positive esteem.
• Positive psychology: The field of study focused on human strengths
and promoting optimal human functioning.
• Strengths-based approaches: Approaches that are based on social
models of disability and emphasize self-determination.
• Social models of disability: Models of disability that emphasize lived
experiences and the attitudes, structures, and environments in society
and the restrictions inherent therein.

Recommendations for Educators,

Clinicians, and Other Professionals
• Focus on strengths and abilities and hold high expectations for the per-
son’s full participation.
• Identify supports that can enable people with neurodevelopmental dis-
abilities to function successfully in typical environments and contexts.
• Promote self-determined learning, self-regulation, and self-advocacy.
• Structure learning and supports around activities that are meaningful
and based on student interests and preferences.
• Support goal setting and attainment and focus on the process, not only
the outcome.
• Support people with neurodevelopmental disabilities to find communi-
ties that share their passions and interests.
34 Neurodiversity

• Support active involvement in educational and life planning and in de-

cisions that impact quality of life.
• Structure environments that support autonomy and choice and that en-
sure learners feel competent and cared for.

Discussion Questions
1. How does a shift to a social model of disability change the disability sup-
ports and services systems?
2. What barriers might limit opportunities for people with neurodevelop-
mental disabilities to fully participate, and how does focusing on posi-
tive psychology and strengths address these barriers?
3. Discuss the roles that people with neurodevelopmental disabilities have
and should have had in changing paradigms in the ways in which dis-
ability is understood.

Suggested Readings
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neurodiversity and partnering with the autism community. Perspect
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Dykshoorn KL, Cormier DC: Autism spectrum disorders research: time
for positive psychology. Autism Open Access 9:235, 2019
Longmore PK, Umansky L: The New Disability History: American
Perspectives. New York, New York University Press, 2001
Morraine P: Autism and Everyday Executive Function: A Strengths-Based
Approach for Improving Attention, Memory, Organization, and
Flexibility. London, Jessica Kingsley Publishers, 2015
Mottron L: Should we change targets and methods of early intervention in
autism, in favor of a strengths-based education? Eur Child Adolesc
Psychiatry 26(7):815–825, 2017
Shogren KA, Wehmeyer ML, Singh NN: Handbook of Positive Psychology
in Intellectual and Developmental Disabilities: Translating Research Into
Practice. New York, Springer, 2017
Wehmeyer ML (ed): The Oxford Handbook of Positive Psychology and
Disability. New York, Oxford University Press, 2013
Wehmeyer ML: Strengths-Based Approaches to Educating All Learners
With Disabilities: Beyond Special Education. New York, Teachers College
Press, 2019
Positive Psychology and Strengths-Based Approaches 35

Wehmeyer ML, Zhao Y: Teaching Students to Become Self-Determined

Learners. Alexandria, VA, ASCD, 2019
Wehmeyer ML, Shogren KA, Little TD, Lopez SJ: Development of Self-
Determination Through the Life-Course. New York, Springer, 2017
World Health Organization: International Classification of Functioning,
Disability and Health. Geneva, World Health Organization, 2001
Zager D, Wehmeyer ML: Teaching Adolescents and Young Adults With
Autism Spectrum Disorders: Curriculum Planning and Strategies. New
York, Routledge, 2020
Zhao Y: Reach for Greatness: Personalizable Education for All Children.
Thousand Oaks, CA, Corwin, 2018

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 THREE
Strengths-Based
Model and Savantism
Matthew Doll, Ph.D.
Darold Treffert, M.D.
Thomas Fabricius, M.D.
Edward Jedlicka, Ph.D.
Vivian Hazell, LPC
Tara Geier, M.A., BCBA
Bryan Mischler, LCSW
Erin Whittington, B.A.

Different kinds of minds can complement each other.

Temple Grandin, Ph.D., October 8, 2019

Teach to the talent; to help often; to comfort always.

Darold Treffert, M.D.

The Treffert Center was created in 2016 as an institute for the col-
lection, organization, and worldwide dissemination of historical and
current information on savant syndrome and other forms of the excep-
tional mind. The Treffert Center includes a school with integrated
classrooms for neurodiverse students that utilizes a strengths-based
curriculum. This chapter describes a six-pronged, core-component
approach to assessment, diagnosis, organized treatment, and support
that can be applied successfully to a variety of neurodiverse students
using a strengths-based approach.

39
40 Neurodiversity

Neurodiverse individuals have many strengths that are often overlooked.

Sometimes this oversight is related to delayed speech, distinct communica-
tion styles, or simply a failure of inclusion. Moreover, strengths in these in-
dividuals are often seen as interesting but as unrelated to the condition.
A broader perspective on neurodiversity considers the term as being re-
flective of everyone, including those who are labeled as “neurotypical.” All
variation is contained under the “normal” curve, with some variations oc-
curring less or more frequently than others. Temple Grandin, one of world’s
most prolific autistic self-advocates and a professor, talks of different types
of thinkers: visual thinkers, pattern thinkers, and verbal thinkers. Howard
Gardner, a developmental psychologist and professor, proposed eight types
of intelligences: verbal-linguistic, logical-mathematical, visual-spatial, mu-
sical-rhythmic, naturalistic, bodily kinesthetic, interpersonal, and intraper-
sonal (Gardner 1983, 2011; Gardner and Hatch 1989). Given the potential
for varied degrees of neurological combinations, the fact remains that we can
all be considered neurodiverse, rather than either neurotypical or neurodi-
verse. When they are used to describe such a dichotomy, these terms serve
to replace and reinforce previous dichotomous understandings of “learning
differences.” However, neurotypical and neurodiverse currently serve as more
progressive terminology to convey the wide variety of strengths that exist.
What is considered pathology has now become a more complex discussion
as the varying degrees of neurodiversity stretch our understanding of indi-
vidual differences versus pathology.
Labels can be viewed as an identity rather than a diagnosis in some cir-
cumstances; however, when significant impairment is evident, or is more
likely to exist without early intervention, the need for accurate assessment
and appropriate intervention is much clearer. We have had the privilege and
honor to work with and learn from individuals and families with remarkable
skills and resilience. We find that, even in the most profoundly impacted
individuals, there exists an “island of intactness” that we may grow and nur-
ture. This strengths-based focus works well for both individuals and the
professionals who work with them, no matter what the areas of concern. To
articulate how a strengths-based focus can be implemented in practice, we
have developed the Treffert Approach. We have used this approach with
success in our clinical work and are now sharing it with other providers,
child and adult daycare centers, schools, higher education and technical
colleges, vocational rehabilitation organizations, and businesses.
Since the 1988 movie Rain Man, which markedly increased recognition
and awareness of autism and savant syndrome, much has happened in the
recognition and treatment of autism. Some savant skills, rather than being
considered frivolous, are sought after in the workplace. Microsoft and many
other companies are recruiting neurodiverse people with savant exception-
Strengths-Based Model and Savantism 41

alism in coding and computing, for example. Although there is still much
work to be done, many communities have begun to be more welcoming and
accommodating to neurodiverse people than in the past.
Using an organized approach to assessment, treatment, and support can
be helpful in conveying the core components needed for the long-term suc-
cess of neurodiverse individuals. The Treffert Approach comprises six core
areas that are modified and applied depending on setting and use. It is not a
series of steps but, rather, a series of interrelated “pillars” that guide the user
to consider key perspectives. These six components, described in the follow-
ing sections, are accurate assessment, strengths-based focus, nature and nat-
ural environment, nurturing relationships, sensory awareness, and systems.

Accurate Assessment
The first pillar in the Treffert Approach is to call things by the right name—
accurate diagnoses and descriptions are key to understanding and interven-
tion. Using a multidisciplinary evaluation can help the clinician determine
what basic disability or disorder underlies a person’s special abilities. This
helps expand the understanding of the interplay between strengths and
challenges. A few of the many challenges that a multidisciplinary team can
address include delayed language acquisition, communication disorders,
learning differences, sensory disorders, medical conditions, trauma, and co-
morbid disorders such as ADHD, Tourette syndrome, OCD, bipolar disor-
der, and schizophrenia.
Accurate diagnosis is especially pertinent to autism because the word
autism has lost its specificity. Autism was originally used in 1943 by Dr. Leo
Kanner, the psychiatrist and physician commonly referred to as the “father
of child psychiatry.” He used the term to describe a group of youngsters to
whom he had attached the diagnosis of early infantile autism (Kanner
1943). Over the years, autism has been expanded to include what now is re-
ferred to as autism spectrum disorder. Although Kanner’s original term is no
longer limited, his original early infantile autism group may reflect differ-
ent etiology from individuals with a later onset of symptoms. The search
for multiple etiologies and “subtypes” within the field is ongoing, but the
axiom “If you’ve met one child with autism, you’ve met one child with au-
tism” reflects the diagnostic reality of neurodiversity. Even this one diag-
nostic category is more accurately named “the group of autistic disorders,”
because it appears that these disorders stem from multiple factors.
Autism as a disorder needs to be separated from autism-like symptoms
that may appear in other neurological disorders. An example of this is when
autism-like symptoms appear in people who were born blind. Autism-like
42 Neurodiversity

symptoms can appear, for a time, in children who read early or speak late and
can be confused with autism spectrum disorder itself (Treffert 2011a).
Accurate assessment leads to informed interventions. The importance of
this is evidenced by hyperlexia research. These early reading skills can be ev-
idenced in “neurotypical,” autistic, and autistic-like children. The latter group
may go on to outgrow their autism spectrum characteristics (Treffert 2011a).
However, they may not be challenged academically due to an initial misdi-
agnosis or poorly aligned interventions. Focusing on hyperlexia as a strength,
rather than focusing on the autism-like presentation, opens up a wide range
of interventions, as it does with children who speak late or not at all (Tref-
fert 2011a). Exceptional memory and pattern recognition skills can also be
found in many hyperlexic children. It is important to remember that all be-
havior is communication; the key to accurate assessment is to determine
what the behavior is communicating. Thus, the issue of accurate assessment
or lack thereof can have a profound impact on long-term outcomes.
Although most of us are trained in the traditional medical model of as-
sessment, focused on identifying deficits, a strengths-based focus can lead
to more hopeful and pragmatic recommendations. For example, when as-
sessing with a strengths-based focus, one does not need to look very hard to
see where some skills in autistic individuals are also used in academic learn-
ing. Three-dimensional block rotation and visual matrix analysis, which are
well-documented strengths in many people diagnosed with autism (Dawson
et al. 2007), are involved in mathematical analysis, reading graphs, and vi-
sualizing and understanding data. Behaviorally, many children on the spec-
trum are found to have “sticky attention”; in other words, they will become
fixated on something for lengthy periods of time. The academic correlation
of this is the ability to sit still and focus on learning new material without
feeling the need for interruption. This skill alone can account for significant
academic progress.
Many children on the autism spectrum display rigid thinking patterns.
Cognitive inflexibility is a hallmark of this cognitive style. Although flexible
thinking dramatically helps social interaction, it hinders some tasks, such as
mathematics and computer coding. A relatively rigid and precise thinking
style enhances performance in both areas. As computers turn code into ones
and zeros that, in turn, alter the flow of electricity through a computer chip,
precision is the key; a computer is incapable of determining intent from
sloppy code. Socially adept people can discern intent despite the imprecise
words and phrasing that dominate verbal conversation. Rigid thinking can
be assessed as a weakness on sociability scores or assessed as a strength on
tasks that require careful and logical thinking and reasoning. Recognizing
the neurodiversity of individuals can help to identify appropriate teaching
strategies and eventual job opportunities.
Strengths-Based Model and Savantism 43

Another example of strengths-based assessment is to focus on the de-

mands of a task and the skills and abilities needed to complete the task. For
example, a trend in some educational communities is to teach group prob-
lem solving as a substitute for mathematics education, often with no explicit
teaching of the skills needed to learn and perform in a group. This may lead
to avoidant and challenging behaviors in some students that, if not further ex-
plored, could lead to inaccurate assessment and interventions. The strengths
that characterize a more rigid, precise, detail-oriented cognitive style are
very useful for science, technology, engineering, and mathematics careers;
however, this cognitive style is much more challenging for social interaction,
especially in group learning. People who are very social have a cognitive
style that is fluid and more in tune with emotionally relating to others by
trying to understand their perspectives; this style is heavily dependent on a
flexible style of interpreting and understanding what is being communi-
cated. Facial expressions or mannerisms may negate the meaning of what is
being said verbally. The so-called social deficits might at times disappear
when a group of like-minded engineers gather to discuss a project and sud-
denly reappear when the sales team arrives. Thinking about strengths in the
context of neurodiversity allows for a richer and more detailed understand-
ing of a person than does our current deficit-based medical model of diag-
nostics.

Strengths-Based Focus
The Treffert Approach focuses on the strengths of an individual, as well as
those of the parents, teachers, clinicians, and community. A strengths-based
approach must expand from the person to the larger community for long-
term success and sustainable outcomes. We recognize the importance of
identifying areas of difficulty, but drilling down into struggles often leads to
increased frustration and the illusion of control. Control is not influence; in-
fluence is not control. We seek to support self-determination, and we rec-
ognize that focusing on even the smallest area of strength and expanding it
will help decrease areas of concern. Research has shown that sustained en-
gagement in cognitively stimulating activities that specifically target weak
skills has an impact on neural structure; focusing on strengths leads to even
greater gains. Given appropriate practice, students can improve their cog-
nitive ability (Willis et al. 2006). Strengths-based treatments leverage dif-
ferences rather than attempting to extinguish them, allowing children to
lead their own learning and use their unique skills. We recognize that al-
though high-focus interests may not last, they can be used to engage chil-
dren across educational tasks and subjects they face each day.
44 Neurodiversity

Children with hyperlexia, for example, have the unique ability to read,
code, categorize, and memorize, strengths that can be expanded into greater
cognitive understanding and social communication. Children can learn to
use this strength as a springboard for understanding and comprehending
passages that they read about social interaction. Their high-interest areas
are not simply splinter skills, which are abilities that are in isolation from
typical context or purpose, but a fundamental source of information for
them. They may leverage that to cultivate a shared understanding with their
peers and themselves. Specific strategies are outlined in our hyperlexia man-
ual to further understand how these strengths can be operationalized in ed-
ucational settings (Treffert et al. 2017).
The most common savant abilities are often referred to as splinter skills,
which include behaviors such as an obsessive preoccupation with and mem-
orization of music, game or sports trivia, license plate numbers, maps, his-
torical facts, or obscure items such as vacuum cleaner motor sounds. As
noted earlier, these are savant skills out of typical context. The next level of
savant abilities is the talented savants, who have musical, artistic, mathemat-
ical, or other special skills that are more prominent and highly honed, usu-
ally within an area of a single expertise. The third level of abilities is the
prodigious savants. These very rare persons have a special skill or ability, typ-
ically in the area of music, art, or mathematics, that is so outstanding as to
be spectacular were it to occur in a “neurotypical” person. There are prob-
ably fewer than 75 prodigious savants currently living worldwide who meet
this high-threshold special skill.
Musical ability is the most frequent savant skill. Artistic talent, usually
painting or drawing, is the next most frequent, although other forms of ar-
tistic talent, such as sculpting, can occur. Mathematical savant skills include
lightning-fast calculating and the ability to repeat multidigit prime num-
bers, sometimes in people who are unable to perform even simple arithme-
tic. Mechanical ability, such as constructing or repairing intricate machines
or motors, can occur, as can exceptional spatial skills, such as intricate map
memorizing that enables individuals to compute distances with precise accu-
racy from visualization. Other occasional skills include multilingual acquisi-
tion ability or other unusual language skills, exquisite sensory discrimination
such as smell and touch, perfect perception of the passing of time without
access to a clock, or outstanding knowledge of a specific field such as neuro-
physiology, statistics, history, or navigation. Although controversial, there
have been some reports of extrasensory perception skills occurring as well.
The special skills and abilities of savants can be used as tools to over-
come other areas of challenge. These strength areas can be used as the focus
of treatment efforts. In many cases, these extraordinary abilities can be used
as a way to engage the person to improve communication capacity, enhance
Strengths-Based Model and Savantism 45

social interaction, and master daily living skills with movement toward
greater independence. For example, famous architectural artist Stephen
Wiltshire was largely nonverbal at age 9 but one day requested paper from
his nurse. His interest in drawing was supported by his caregivers, and this
talent grew into his ability to fly over a city in a helicopter for part of an hour
and then spend the next several days drawing the city in such accurate detail
as to have the same numbers of flutes in a column and windows in a building,
as well as dimensions and street directions accurately represented. Stephen’s
journey began with the ability to correctly reproduce cities, which was a
novel skill. As he continued to repeat his drawings, he began to interact with
those who would watch him draw. Over the course of time, he has also be-
gun to introduce more color into his art and has become more social and
engaged with his audience.
The process of identifying strengths and teaching to a talent is a funda-
mental underpinning of the Treffert Approach. Stephen Wiltshire’s journey
is a good representation of what is possible with a strengths-based focus, as
is Leslie Lemke’s story. Leslie was born premature and developed retrolen-
tal fibroplasia that resulted in blindness. He was placed in the care of May
Lemke through the foster program. She became his foster mother, tutor,
therapist, and mentor. He remained developmentally delayed but had an
amazing splinter skill of echolalia. He could repeat verbatim an entire day's
conversations while impersonating each individual speaker he had heard.
Although echolalia is typically dismissed as a developmental defect,
May had a hunch that this awareness of the details of sound could be trans-
ferred to music. She introduced Leslie to the piano at age 7. She would run
his fingers up and down the keyboard and identify notes, which allowed him
to learn to play by ear. His acute sense of the qualities of sound allowed him
to exactly re-create both dialogue and music after just one exposure. When
he was 14, his mother found him at the piano at 3 A.M. recreating a television
show he had seen earlier that evening. He played Tchaikovsky’s Piano Con-
certo No. 1 while voicing the introduction—“Tonights movie is Sincerely
Yours, starring Dorothy Malone...”—after hearing it exactly once.
Leslie initially was able to repeat any song that he had heard. Over time,
his ability grew into a wonderful ability to improvise. Now Leslie is creating
his own music. This is another example of how unique skills and talents can
be used to identify and nurture islands of genius and grow them into in-
creased independence. As these two remarkable individuals have shown us,
the passage from repetition to improvisation to creation correlates with in-
creased socialization and independence.
As an aside, the art world has come to accept the artwork and music of
extraordinary people such as Stephen Wiltshire and Leslie Lemke (and Ping
Lian Yeak, discussed in the next section), and the public views them more
46 Neurodiversity

and more as artists in their own right rather than as artists who happen to
be autistic or savants. No longer is their work “outsider art”; it is art that
stands on its own alongside that of other artists who happen not to be on the
spectrum.
It is important to note that the difference between what are considered
splinter skills and savant skills is related to context and does not negate the
ability for either to be utilized in a strength-based approach. In a conversa-
tion with one of the authors, Dr. Jeremy Chapman used two hypothetical
examples to illustrate this point: Individual A has an exceptional ability to
memorize and perform pop songs. This talent is embraced by society, and
she finds great success as a singer, winning contests, recording her own al-
bum, and garnering a large following. These accomplishments give her con-
fidence, self-efficacy, and financial independence. She also develops social
and communicative skills by interacting with her fan base and collaborating
with other artists, and her skills continue to grow from repetition, to impro-
visation, to creativity. Individual B has an exceptional ability to memorize
and recite license plates. Unfortunately, people are not as interested in live
recitations of license plate digits as they are in live “recitations” of pop
songs. Individual B is therefore at risk of being marginalized, never finding
a suitable job, and living a reclusive life due to anxiety, negative self-image,
and limited practice with social interaction.
The Treffert Approach helps people like Individual B avoid this out-
come by playing directly into their talents. By demonstrating interest in her
license plate talent, the staff builds rapport with her, earning her trust and
buy-in. She starts to gain self-worth. We encourage her to demonstrate her
license plate memorization talent in a natural environment, perhaps a hard-
ware store parking lot. In this way, we can address her anxiety and support
her exploration outside of her home. We then help her generalize her mem-
ory skills into the related—but more practical—skill of inventory manage-
ment. We assist her in applying for a job at the hardware store. We work
with the store to provide her with appropriate staff mentorship and sensory
accommodations. When the store discovers the value in having an em-
ployee with her skill, we help them implement systems-wide changes to hire
more individuals like Individual B, who then go on to mentor each other,
develop friendships, and continue to grow. In this way, we can view all splin-
ter skills as unique talents that can be systematically leveraged to benefit the
individual in terms of confidence-building, self-efficacy, social reciprocity,
and autonomy.
Savant skills can be used as tools or as a conduit toward engaging chil-
dren in increased language interchange and increased socialization. Recog-
nition and praise of these special skills are powerful reinforcing tools. To
counteract a child’s excessive preoccupation, other people can help the child
Strengths-Based Model and Savantism 47

channel repetitive behaviors toward more purposeful activities. Parents are

often very innovative in that regard. Work with savants is highly individu-
alized. Each professional can use whatever ideas and intuitions spring from
daily contact with that person.
Dr. Trevor Clark and colleagues have ongoing research in this area, and
these two books are exceptional resources: A Practical Guide for Teachers of
Students With an Autism Spectrum Disorder in Secondary Education (Costley et
al. 2012) and Exploring Giftedness and Autism: A Study of a Differentiated Edu-
cational Program for Autistic Savants (Clark 2016). Both Treffert’s and Clark’s
views assisted in the development of a public charter school, the Treffert Way
for the Exceptional Mind. This school stemmed from years of shared re-
search, evaluations, and educational approaches implemented in a local pub-
lic school and specific programming focused on assessment and treatment
work related to hyperlexia. Because the defining characteristics of autism
present in widely varying degrees and interact in numerous and unpredict-
able ways, one set of curriculum would not likely be successful.
The Treffert Approach has been used in educational settings during our
consultations and trainings with other organizations. Its initial use occurred
at the Treffert Center's inclusive Treffert Academy, which has a daycare for
children from birth to age 12, a 3-year-old preschool, and a public 4-year-old
kindergarten (4K) classroom. In 2018, the Treffert Way, a public charter
school, was started, which teaches kindergarten through seventh grade (with
plans to expand through twelfth grade). These settings serve as an incubator
for innovations and advanced techniques for inclusive instruction. We strive
to introduce the children to early experiences in the workforce and to engage
them in service learning, mentorships, and mentoring others to help them
learn what is possible for their futures. For our young adults, our Leadership
Group provides guidance using established skills to improve less developed
skills necessary for sustainable employment based on their unique talents.
They have even created a Dr. Treffert puppet and hope to have a new home
in the Treffert Studio.
In our efforts to build further on the ideas of neurodiversity and com-
munity, we have found that the best sources of advice for channeling unique
skills, as well as for dealing with problematic behaviors, are often parents
who have found useful techniques by trial and lived experience. Local par-
ent support groups can be a rich resource for such ideas and inspiration for
new families struggling with a neurodiverse youngster. These groups can
also be a rich source of understanding, encouragement, and support. Such
groups exist in almost every community, and many similar information and
support groups exist on the internet for autism, Asperger syndrome, and hy-
perlexia, as well as for even rarer conditions, such as Williams syndrome and
Rett syndrome.
48 Neurodiversity

Nature and Natural Environment

Nature and the natural environment play an important role at the Treffert
Center and in the Treffert Approach. The Treffert Center houses the Tref-
fert Academy, an inclusive daycare for all children ages 3–12 years. The ser-
vices for autistic children are provided in the context of a typical daycare
setting that includes both neurodiverse and neurotypical children. This ap-
proach embraces neurodiversity and brings out the strengths of all children
while focusing on the primary indicators of life success: self-regulation, so-
cial-emotional skills, and compassion. Teaching is done through motion and
play. Children are out in nature, our true natural environment, as often as
possible. The benefits of playing and learning in nature are abundant. Play
is “scaffolded” as needed to help neurodiverse children navigate the com-
plexities of spontaneous interactions with their peers.
For example, “Ginny” was a neurodiverse student who was spinning in
place twirling around and around. A teacher asked if she would like to have
others join her. Classmates then spun with her, creating a shared experi-
ence. Later on the playground, as some children jumped on the merry-go-
round, Ginny joined them and spun them around and around. Staff were
able to create an initial shared experience for Ginny, which was parallel play
with other twirlers. This later progressed to actual play with her peers. The
scaffolding that was able to take place with her peers in a natural environ-
ment would not have existed if Ginny had been at a traditional autism cen-
ter attended only by children on the spectrum. An academy boy recently
was overheard introducing a peer to a friend: “This is Timmy. He doesn’t
use his words yet, but he is okay.” In another setting, a child of one of the
chapter authors observed, “You know, I have noticed that the kids who have
siblings with special needs are the nicest ones.” Neuroinclusive environ-
ments are good for everyone.
The magic of a neurodiverse setting is that it provides unexpected and
unplanned moments that move individuals closer to each other within the
natural environment. When people are able to share experiences, especially
through collaborative actions, relationships grow, trust is developed, and
much richer and generalizable skills develop than in traditional treatment
approaches. The following story is an example: Exceptional artwork by sa-
vant artist Ping Lian Yeak decorates many of the halls and classrooms of the
Treffert Center. The children love him and his work and have been inspired
by him. During a visit to the Treffert Center, Ping Lian (age 18), who was
primarily nonverbal, was working on his art surrounded by children from
the Treffert Academy. A particularly precocious 4-year-old girl slowly
worked her way closer to Ping Lian, eventually coming shoulder to shoulder
Strengths-Based Model and Savantism 49

with him in his workspace. Ping Lian’s mother looked on, worried. Slowly
the girl’s and artist’s eyes met; they looked from the painting to each other
and clearly were sharing joint attention as Ping Lian and his new friend drew
together. Ping Lian’s mother was tearful as she looked on, stating that she
had not seen him do that before. The children’s versions of the horses that
Ping Lian drew later surrounded his artwork, all hung on Treffert Center’s
walls—amazing artwork by all.
The concept of natural environment also translates to how classrooms
are set up to teach the skills that may be necessary for children transitioning
from a young age into other daycare centers or into the school system. Cir-
cle time can engage the children in routine and teach them how to respond,
for example, to the unexpected removal of a toy by a classmate. Natural en-
vironment extends to young adults as well, helping them transition from
school to work through early exposure to the trades, manufacturing firms,
and other businesses.
For some savants, the natural environment is full-inclusion school class-
rooms, but others are placed in special education classrooms (for develop-
mental or educational disabilities). Still others, in some areas of the country,
are in gifted and talented classrooms with other neurodiverse children. In
each of those settings, a mentoring program can be helpful to focus on the
special abilities and challenges of each child or young adult with exceptional
skills. The natural environment allows for unlimited opportunities for stu-
dents to become more social by involving their peers—the people who can
often teach the best. For example, during a tour of the Treffert Way School
for the Exceptional Mind, the two students guiding the visitors were discuss-
ing their efforts to engage younger peers in play. One lamented that his peer
would not talk to him when he tried. The other student responded, “You
have to put in the time!” She went on to explain how over the course of sev-
eral months, she would slowly approach her peer on the playground and was
proud of how he now “looks forward to seeing me.”
Natural environment applies similarly to the workplace. Compared with
neurotypical students, neurodiverse students are often at an increased risk
for unemployment and underemployment. This disparity means not only
that our youth and adults who are neurodiverse are negatively impacted vo-
cationally, economically, and socially but also that they are less likely to ob-
tain positive occupational and social experiences that promote their overall
well-being. Neurodiverse adults are known to face significant challenges in
navigating typical interview processes and transitioning to the workplace,
yet their ability to think differently can make them an asset if they are given
the opportunity. Today, many large companies are recruiting, selecting, train-
ing, and supporting young neurodiverse students. These companies have re-
50 Neurodiversity

ported that these individuals have generated significant innovations in their

companies (Austin and Pisano 2017).
To assist neurodiverse students entering the workplace, it is imperative
that educational programs provide the relationships and early experiences
needed in the transition from high school to postsecondary options. The
Treffert Center's multidisciplinary staff have been working with local tech-
nical colleges, 2-year colleges, and 4-year universities to help these schools
better meet the needs of neurodiverse students. We also work and consult
with the local chamber of commerce on mental health and neurodiverse
workplace issues, which leads to training for human resource departments
and associations to create more diverse and inclusive work environments.
Our work with the state vocational rehabilitation department is designed
to help staff understand the unique talents and opportunities neurodiverse
individuals can offer a workplace. Students are typically invited to their first
Individualized Education Program (IEP) meeting at age 14, where they are
often asked, “What do you want to do for a living?” With no prior exposure
to or experience with what is possible, these individuals often have no idea
how to respond. Vocational training staff in attendance at the meeting often
have limited experience with the strengths of neurodiverse individuals and
may misread or misunderstand the exceptional talents and abilities that ex-
ist, focusing instead on “placement” as the measure of success rather than
quality of “fit” with the needed supports and mentors.

Nurturing Relationships
A student’s ability to develop relationships with both peers and adults con-
tributes to the development of a sense of self. Students benefit from learning
to accept others for who they are, respect differences, and appreciate com-
monalities. Meaningful, healthy relationships have been found to enhance
students’ development, engage them more fully in their education (Cullen
and Monroe 2010), and foster resiliency, a critical factor in academic success
(Dappen and Isernhagen 2005). Both peer and student/adult mentoring
programs have been shown to have the potential for dramatic academic ef-
fects for students, including being more confident of school performance
and less likely to skip school (Tierney et al. 1995). Research has validated
that students with learning disabilities who were mentored are more likely
to pursue an advanced degree program. Findings also show that, when stu-
dents feel like they matter to their teachers, their level of academic motiva-
tion increases (Ahrens et al. 2010). Factors such as empathy, warmth, and
the therapeutic relationship have been shown to correlate more highly with
client outcome than specialized treatment interventions (Lambert and Bar-
Strengths-Based Model and Savantism 51

ley 2001). Relationship building, which accounts for 60% of the variance in
psychotherapy outcome studies, is the most frequently cited component by
savants as to what helped them the most on their journeys.
Nurturing relationships is very important. Clinicians who work with chil-
dren on the autism spectrum know that the first meeting is often crucial to
forming a positive relationship and developing a therapeutic response. Show-
ing genuine interest and a sense of wonder in the other person sets the stage
for a positive relationship. It helps to remember connection, compassion, cre-
ativity, and community. Connection starts when one feels safe and open to new
ideas and guidance from others. Compassion is understanding what an individ-
ual is going through and developing the strategies and techniques to help that
person. Creativity is used to find a person’s gift and a way for that person to
share it. Community is when one feels accepted and develops self-esteem and
finds value and worth in being part of something greater than oneself.
To help students form healthy relationships, schools are increasingly in-
corporating social-emotional curricula and evidence-based practices. In
Wisconsin, the Department of Public Instruction has expectations and cur-
riculum in place (https://dpi.wi.gov/sspw/mental-health/social-emotional-
learning). The Treffert Academy uses movement and play to focus on three
main areas: social-emotional skills, self-regulation, and compassion. Various
strategies are used, but the Kindness Curriculum (https://news.wisc.edu/
preschool-kindness-curriculum-is-now-available-free) and Conscious Dis-
cipline (https://consciousdiscipline.com) are particularly effective core train-
ings that can help all children and the adults who care for them to create a
culture to support neurodiversity across the lifespan.
Teachers and counselors have the special ability to teach students the dif-
ferent types of emotions, as well as strategies to use their emotional brain and
logical thinking brain to process these feelings in a much more positive fash-
ion. When students use self-regulation strategies at school, discipline rates
decline, and more positive behaviors are presented daily. Teachers and coun-
selors can spend more time on academics and on proactive activities, rather
than just reacting to behaviors. Helping students identify these emotions and
their underlying causes empowers them to act to understand, express, and, if
need be, change their emotional states. Children who can regulate their
emotions are more successful academically and socially. These skills are best
taught through example and in relationships.
The Treffert Center has created the group Leaders in Creative Media.
This group focuses on the strengths of its participants in the areas of art, mu-
sic, acting, computer technology, and audio/video editing. Our leadership
team uses these passions to make a connection with and facilitate relation-
ships between group members. Bringing other members together in tasks fo-
cused on their gifts creates self-awareness, self-improvement, and immediate
52 Neurodiversity

positive change in these individuals. They begin socializing independently

because they can discuss their talents with others who share their passion.
There is additional synergy when they see how they can come together with
others with different passions to create unique and amazing projects. Using
passion to create these connections builds relationships that are intrinsically
motivating and reinforcing, facilitating skill development in a context that is
enjoyable and supportive. Group leaders use compassion based on a founda-
tion of evidence-based practices to understand the group’s needs and support
members when they struggle. Such techniques include visual modeling, sen-
sory breaks, and developing supportive environments in which members feel
safe to fail without judgment. Creativity is used to bring these members to-
gether and find unique ways to work toward treatment goals.

Sensory Awareness
Sensory understanding informs all that we as people do. We understand that
all behavior is communication, but sometimes it is difficult to figure out
what a specific behavior is communicating. Incoming information is pro-
cessed through our senses with only two channels for output—verbal and
nonverbal. The Treffert Center and its programs seek to understand and
help individuals integrate their senses and create environments that promote
sensory sensitivity. Sheila Frick and Tracey Bjorling at Vital Links in Madi-
son, Wisconsin (https://vitallinks.com), developers of Therapeutic Listen-
ing, present globally on the impact of sensory issues on development and
functioning and educate others in their sensory work. They partner with the
Treffert Center on various research projects in shared efforts to support ev-
idence-based practices in this area.
Sensory awareness is not simply about understanding that sensory pro-
cessing is a significant issue for children and adults on the autism spectrum.
It requires the knowledge that people gather information about the world
through all of their senses, including balance, proprioception, and gravity.
Patterns of over- and underwiring, past exposure to trauma, and sensory-
seeking and sensory-avoidant behaviors all contribute to the unique ways in
which we experience the world. As we learn more about how the body pro-
cesses information, additional senses may be identified. Although DSM-5
(American Psychiatric Association 2013) now includes sensory issues as part
of the diagnostic criteria for autism spectrum disorder, skepticism remains
within the field regarding appropriate interventions and opportunities to as-
sist people with sensory issues, such as synesthesia, blindness, and deafness,
among others. For example, some children with dysgraphia describe writing
as being literally painful to them; some teachers do not recognize the motor
planning required for these students and view the resistance as defiance. Se-
Strengths-Based Model and Savantism 53

vere sensory difficulties can lead to responses that resemble trauma reac-
tions. Adverse childhood experiences research points to the impact that
trauma has on individuals’ brain development, genetics, and experience of
the world. Interested readers are encouraged to review the work of Stephen
Porges on the polyvagal theory (Porges 2011).
It is also important to recognize that sensory differences exist in every-
one. Perhaps the simplest way to understand and convey this information is
to consider the aversions that developed perhaps as a result of some poorly
executed decisions during one’s playful youth, or intolerances for certain
smells or tastes that resulted during pregnancy or at other times. Unexpected
behaviors can often be better understood from a sensory perspective. Some
of the same behaviors seen in children who are trying to regulate (e.g., rock-
ing, flapping, repeating sounds) are the same skills that soldiers are taught to
use when enduring torture.
Often, individuals seen at the Treffert Center have unique sensory is-
sues. They might need to hum to themselves to block out a noisy room, or
they might be driven to take off their shirt when the tag becomes too dis-
tracting. Sensory differences can also lead to differences in a sense of play.
One child needed to triangulate his vision to a fine point by staring at the
lines in the world around him—in the tile floor, in the wall’s cement blocks,
or strung on telephone poles. When he surrendered himself to this trian-
gulated vision, he found it delightful, especially if he could run in sync with
the direction of the lines. One day, when he was “in his groove” running
with the telephone wires that bordered the playground, a classmate joined
him so that they both were giggling and running. The school bell rang to
signal the end of recess, and his classmate ran to line up. The child was de-
lighted that someone had finally realized the joy of running with the lines,
and he called after his classmate, “Thanks for running with me!”
Another example of sensory issues is demonstrated in this brief case: Af-
ter months of working with a child who was demonstrating significant dis-
ruptive behavior in a school setting, a therapist realized why the child was
disruptive. The trouble was a broken ballast in one of the lights, which was
disturbing to the child, who was only engaging in escape behavior. Upon be-
ing moved to a different room, the child stopped the problematic behavior.

Systems: Increasing the

Capacity for Success
A systems approach recognizes multiple factors that influence a person’s suc-
cess: genetics, family, language, and the culture in which the person devel-
ops, to name a few. The importance of these factors became apparent in our
54 Neurodiversity

work with neurodiverse individuals in various school and work systems.

When we attempted to support individuals in a variety of settings, they were
successful as long as we remained present. Once we faded and removed our-
selves from the setting, problems resumed and sometimes led to the removal
of students from settings in which they had previously been successful. We
realized that unless a system was accepting, understanding, and able to sup-
port neurodiversity on its own, the default setting of exclusion and misun-
derstanding would recur. Now, when we work with school and work systems,
we request that each system allow for “system” change in culture, process,
policy, and training. It will not suffice to continue to teach neurodiverse in-
dividuals to “fit in” when their skills and perspectives are every bit as valid as
those of their neurotypical peers and colleagues. A cultural shift toward sus-
tainable change in education and the workplace is required. The support and
freedom needed to implement lasting change and innovative solutions must
be addressed at a systems level.
Unfortunately, despite the efforts of well-intentioned staff, we have met
many children and their parents who at first had appeared to be supported
and successful in a school setting but who, through misunderstanding and
missed opportunities, end up traumatized by their school experiences due to
bullying, isolation, misunderstanding, and miscommunication. Staff train-
ing and the culture at schools and workplaces are among the many systems
issues that need to be addressed for long-term individual and community
success. One such issue frequently encountered is how behavior is per-
ceived in various settings. Many children are perceived as “misbehaving on
purpose” and being “oppositional” when they deviate from the expected
learning trajectory. If children know the answer by doing the math in their
heads, why must they “show their work”? If a child can learn while drawing,
why should the child be considered “disrespectful,” “inattentive,” and “defi-
ant”? We challenge ourselves and those we work with to question preexist-
ing assumptions, to take multiple perspectives, and to seek understanding.
An academic model must focus on and value a student’s strengths rather
than any weaknesses that keep the student from fitting the traditional mold
of a student. Teachers should be careful of how they communicate with stu-
dents, because even innocent remarks can cause the student to have beliefs
regarding ability that can affect effort and performance. A statement such
as “You’re just not good at math” or even the more positively stated “You’re
better at reading” can create that belief in a student. Then, because the stu-
dent believes that this statement must be true, when math concepts are pre-
sented, the student lacks effort and determination and does not fully engage
in the learning process. Most of us typically default to the “stop it” com-
mand rather than ask for the behavior we want to see. If we want children
to take risks, make mistakes, and learn how to problem solve challenges in
Strengths-Based Model and Savantism 55

a positive way, we must also have the same culture and expectations for our
staff. Children are adept at recognizing the “do/say” discrepancies in their
world. It is our contention that a system that is in sync, focused on every-
one’s strengths, and clearly communicates positive expectations will be
more successful than one that is focused on eliminating deviations from the
“norm.” Our version of the 80/20 rule is that we assume 80% of the time
things are moving in the right direction. Rather than focusing on reducing
the 20%, we focus on increasing the 80%. Applying these ideas to larger
community systems can be done in various ways. For example, many schools
have adapted social justice programs, used peer courts, and used positive be-
havioral interventions and supports with great success. Some communities
have expanded these supports to include local sports, community spaces, and
businesses. When the expected behavior is clearly defined, everyone does
better. In the absence of a systems approach to change, one tends to default
to what one has experienced in the past.
At times, system changes can lead to quick gains. For example, some
schools have reported that by increasing free time, play and movement, mu-
sic, and art, they have seen academic performance improve and behavioral
referrals decline. System-wide interventions, such as meditation, mindful-
ness, yoga, and biofeedback skills, can be taught in the classroom, benefiting
both students and teachers. One concept to emphasize: self-regulation starts
at the top. A regulated classroom and a dysregulated teacher or administra-
tion cannot coexist. The Zones of Regulation (www.zonesofregulation.com)
and the Superflex Curriculum (www.socialthinking.com) and other similar
evidence-based tools are good examples of classroom education that benefit
both children and adults.
What would it take to create a learning environment that focuses on
students’ strengths rather on than the differences that separate them from
the mainstream? Although careful communication is a beginning, the cur-
riculum must also focus on relationship building, executive function train-
ing, cognitive and noncognitive skills training, self-regulation training, and
postsecondary transition with early exposure to career opportunities and
options. Outside of formal education and therapeutic groups, how does a
community support and nurture neurodiversity? Libraries serve as a won-
derful resource for these interactions. The Treffert Library has hosted lo-
cal, national, and international art and music events showcasing savants and
educational events on neurodiversity to share our focus on diversity.
Another example that is replicable across libraries in any location is the
Questers program, which is a wonderful example of the sixth pillar in the
Treffert Approach. The Questers program at the Carmel Clay Public Li-
brary in Carmel, Indiana (https://carmelclaylibrary.org/questers), which is
based on the Digital Climbers program at the Muncie Public Library in
56 Neurodiversity

Muncie, Indiana (www.munciepubliclibrary.org/digitalclimbers), works as a

system in the Treffert Approach by encouraging and facilitating relationships
that span the community. This adaptive program offers various science-, tech-
nology-, engineering-, art-, and mathematics-based categories, and learning
through play is encouraged in a way that can be adapted for almost any learn-
ing style.
The Questers program offers a positive space where participants can ex-
perience learning in an informal, non-classroom way. They are given the
freedom to choose a topic, complete a challenge in their own time, and have
a safe and encouraging space to both succeed and, even more importantly,
learn how to fail. Through both tangible and digital challenges, participants
learn skills in such categories as critical thinking, spatial ability, coding, and
computer science through trial and error, encouragement to explore and
experiment, and guided instruction, depending on each individual’s needs.
Using different strategies and techniques, the expectation guides are able
to focus on accurate assessment of Questers participants by facilitating the
exploration of challenges in a variety of ways, including physical activities,
digital activities, learning aids, and one-to-one assistance.
Multisensory technology practices are engaged in the Questers program
to help explore new ways to solve challenges. Team challenges allow partic-
ipants to help each other by bringing their unique strengths to the table.
Challenges also use current best practices to teach life skills by using tech-
nology to make the abstract visible, guide communication, and teach pro-
cess. Avatars are created to help connect visually to the space and give it a
sense of belonging to the participant. Computational thinking practices help
participants break down the challenge process by completing games in small
segments to learn a skill, following individual steps (recipe style) to help ce-
ment understanding of the process, and help recognize patterns in skill sets.
Questers is also available in digital format for those participants who are un-
able to visit the physical space.
Examples of Questers challenges include building and programming ro-
bots, utilizing board games that focus on logic or mathematics, playing online
or physical games that teach algorithms and coding languages, designing or
creating art in digital and physical ways, and creating and telling stories. Par-
ticipants have an opportunity to work together or independently, depending
on their preference. Each participant is encouraged to work through a chal-
lenge in his or her own way. Quest Lab provides an array of options, includ-
ing flexible seating, auditory assistance, and space to move or be still. Staff
have been trained in the Treffert Approach.
Unless a broader perspective is taken and intervention provided, a sys-
tem that is left unchanged will often continue to perpetuate maladaptive
functioning, no matter who the identified patient is. The opportunity exists
Strengths-Based Model and Savantism 57

to use this broader systems perspective to create positive, strengths-based,

sustainable, inclusive, and resilient communities. Systems that support,
grow, and sustain this approach benefit us all.

Case Examples
We have learned through working with neurodiverse people that if we can
simply “be” with the individual before us, that person teaches us what we
need to do together. Regardless of whether the child has been diagnosed with
autism, oppositional defiant disorder, or another condition, in each case, we
are with a real person. Every person we have worked with has wanted to feel
accepted and connected, but each has had unique ways of sharing and re-
sponding.

The Architect
A young mother whose child was 4 years old shared that when he was as-
sessed, she was told that he would never speak, he would never be toilet
trained, and she would simply need to accept the child that she had been
given. The child had the amazing ability to make intricate block towers and
add items that required the ability to precisely balance them, such as a spoon
atop a block with an egg in the bowl of the spoon. He would do this for
hours, and the mother would work to help supply him with whatever he was
drawn to for his building, all the while talking and narrating to him the
names of the objects, the colors, and the shapes. As we worked with this fam-
ily, the young boy began to talk, to draw, to read, and to share his amazing
skills that turned out to be about structure and shape.
When taking walks, this amazing boy would want to enter a new space
and walk around, always looking at the ceilings and corners and lines of the
space. He would return home and draw the spaces from memory, complete
with lighting, furniture, and cars in the parking lots, but never with peo-
ple—structure was his passion. His mom was always there to guide and sup-
port him, to interpret the world and narrate it for him. Despite the poor
“fit” for her son in school, she cultivated a relationship with a retired archi-
tect, who shared that this young boy had more knowledge of space than
some of the college students he was teaching. We have met many parents
like this mother and learn from them every day.

A Playful Tree
Parents often despair when their child is not doing what peers enjoy. A
young couple had just invested in constructing a wonderful outdoor play
gym for their three children. The parents were delighted that their 3- and
4-year-old children loved the gym and spent time swinging, sliding, and
playing. However, their oldest son, who had been diagnosed with autism,
58 Neurodiversity

was not drawn to the gym. Instead, he would run toward the house giggling,
then run away from the house and turn around and giggle some more.
Working with the couple’s son, the therapist began developing a safe re-
lationship and would follow the child’s lead, running beside him as he ran
toward the house and then ran away. One day the boy said, through his
laughter, “The tree is playing with me.” At that moment the therapist took
the time to really notice that there was a pine tree on the other side of the
house that they could not see when they were close to the house, but that
came into their vision when they ran away from the house. This was the pine
tree’s way of playing peek-a-boo for this young boy. The parents were hope-
ful when they learned that their child was playing, just in a different way.
He helped his parents discover the games that he was already playing with
the things around him. With common understanding came the opportunity
for shared attention.

Using Relationships and Developmental

Status to Teach Social Awareness
Behaviors, or misbehaviors, are often tied to misunderstandings. A mother
expressed frustration with her 7-year-old son because he “never learns.” The
mother explained that when the child would misbehave, she would punish
him, but soon afterward he would do the same things all over again. Her son,
meanwhile, had his own frustrations with his mom. He told his therapist that
his mom would lie to him, and he wished she would stop. When the young
boy was asked for an example, he shared that his mom would say she was go-
ing to give him a popsicle, but then she would tell him he couldn’t have it.
During further questioning, the boy revealed that in between his being
told he could have a popsicle and the withdrawal of the offer, he had gone
into the bathroom and squirted hand cream on the counters, rubbing it all
around. He said he loved how it felt, and the smell was great. The child did
not understand that his actions had changed how his mother responded, de-
spite having said she would give him a popsicle. In sharing with the boy how
cause and effect work—by using the controller for his video games—he was
able to understand that his behavior was what changed his mother’s plan.

Leadership
The Treffert Center Leaders in Creative Media group is composed of amaz-
ingly talented individuals. One young man has a comorbid diagnosis of se-
lective mutism and autism spectrum disorder. He would often sit in the back
of the room, observing the group and the presenters, and rarely made a
sound. He would answer questions with one word or simply reply with a
blank stare. One day, a new activity was introduced to the group to get ev-
eryone up and moving and break the ice. This new activity was improvisa-
tional acting, not the easiest form of acting. Group members shared ideas for
character, place, and theme or conflict and volunteered to act in the scenes.
This young man was one of the first people to volunteer. What he pro-
duced was nothing short of miraculous! The conflict was getting pulled over
Strengths-Based Model and Savantism 59

by the police and having to negotiate his way out of a ticket. He combined
appropriate actions, body movements, intonation, social context, and the
ability to think on his feet during this improvisation. Here was a person who
would not answer a question when asked in a one-to-one setting, but who
could get up in front of a group of peers, communicate and interact with
another person, and make the whole audience laugh and enjoy the scene.
Group members witnessed firsthand his social skills, communication skills,
and self-confidence spike after this one session. In most of the sessions mov-
ing forward, he volunteered to act and even engaged in conversation with
his peers outside of the improvisational exercises. Individuals on the autism
spectrum often struggle with performance anxiety until they are performing
within the context of their gifts.

Conclusion
We all are neurodiverse, and each of us has a unique pattern of strengths
and challenges. The idea that some savant capabilities—a little Rain Man—
might reside in each of us arises from several observations. First and most
persuasively, some previously nondisabled, neurotypical persons have expe-
rienced the emergence of previously latent savant skills following a head in-
jury—a phenomenon called “acquired” savant syndrome (Treffert 2014).
Second, Miller et al. (2000) reported 12 cases of elderly persons who were
previously nondisabled with no extraordinary savant skills whose savant abil-
ities newly emerged, sometimes at a prodigious level, as frontotemporal de-
mentia began and progressed. Third, some procedures such as hypnosis or
sodium amytal interviews in nondisabled persons, as well as brain surface
electrode exploration during certain types of neurosurgical procedures, pro-
vide evidence that a huge reservoir of memories lies dormant and unaccessed
in each of us (Treffert 2006). Fourth, the images and memories that surface
(often to our surprise) during some dreams also tap that huge store of buried
memories beyond what is available in our everyday waking state (Treffert
2011b). Finally, often as we relax or “tune out” other distractions, perhaps
after “retirement,” for example, some previously hidden latent interests,
talents, or abilities quite suddenly and surprisingly emerge (Treffert 1983,
2011b). Sometimes that emergence is actually a rekindling of some earlier
childhood abilities, such as art, that were set aside for some reason during
maturation and “growing up.”
The most pressing research question—if buried potential does exist
within us all—is how to tap that without a neurological catastrophe. Might
there be other methods, short of injury or disease, to bring us in touch with
buried skills and memory function? Could specific cognitive techniques or
other procedures facilitate such a process in all of us? Some investigators
are using repetitive transcranial magnetic stimulation to temporarily dis-
60 Neurodiversity

able the brain functions of nondisabled persons in certain areas of their

brains to see if these more primitive, buried circuits can emerge in “normal”
persons. Perhaps there are also pharmacological “brain booster” methods.
Yoga and other meditation techniques do tap other levels of consciousness.
As work in these areas continue, we have found in our work with savants,
and all of the neurodiverse individuals we have had the honor to know, that
a systematic approach to understanding, supporting, and helping them has
been beneficial. The Treffert Approach consists of six key components that
we have found to be effective in addressing a multitude of concerns and
questions raised across settings: accurate assessment, strengths focus, natu-
ral environment, nurturing relationships, sensory awareness, and systems.
This culminates in an overall approach that capitalizes on the strengths of
neurodiverse individuals and a process for developing better ways to bring
those strengths forward. This approach can be applied not only to work with
savants and other neurodiverse people but also to staff, educational systems,
health care providers, vocational rehabilitation services, human resource de-
partments, and businesses.
If nothing else, our research on exceptional brain performance, including
that of savants and acquired savants, demonstrates the universality of
strengths both in individuals and in all of us collectively. We simply need to
look. The Treffert Approach provides a way to look at the multitude of vari-
ations in neurodiversity in a consistent fashion to guide what must be, by defi-
nition, uniquely designed strategies, to maximize life success and satisfaction.
The search for hidden potential that perhaps lies within each of us is an
intriguing area of research, and savant research may provide some clues to
finding that potential, as well as some useful insights to the interface be-
tween savant functioning and genius overall. Savant syndrome provides an
opportunity to propel us further along than we have ever been in better un-
derstanding the brain, the exceptional mind, and human potential. We feel
that utilizing a systematic approach, such as the Treffert Approach, allows
for a consistent structured response to the vast experiences of neurodiver-
sity and is a way to expand upon the strengths of neurodiversity.

Acknowledgments
We would like to acknowledge all the exceptional individuals and their fam-
ilies whom we have had the privilege to learn from over the years. Their
willingness to share their triumphs and struggles, as well as their dedication
and resiliency, is truly humbling. Thank you.
Strengths-Based Model and Savantism 61

KEY CONCEPTS
• The Treffert approach provides a consistent process for assessment and
interventions for individuals, groups, and organizations.
• The beginning of wisdom is to call things by their right name, and the first
step in treatment is to make the correct diagnosis. Accurate assessment
seeks understanding and uses multiple perspectives.
• By focusing on strengths rather than deficits, even the smallest area of
strength can be grown. We look to leverage strengths, to expand them
and use them to help address areas of concern. We also look to strengths
not only in individuals but in all aspects of our work and with those with
whom we work, including larger systems.
• Teaching, practicing, and mastering skills in natural environments leads
to greater generalization and success. A neurodiverse setting is good for
everyone. Learning in nature and natural environments prepares individ-
uals for the expected and unexpected aspects they will face in school,
relationships, and employment.
• Forming trusting, safe, and mutually respectful relationships is a pre-
requisite for understanding, taking risks, and creating change.
• We are all sensory beings. We experience information about our world
in its simplest form through all our senses, including balance, propriocep-
tion, and gravity. Patterns of overwiring and underwiring, past exposure to
trauma, and sensory-seeking and sensory-avoidant behaviors are all part
of how one experiences the world. Although DSM-5 now includes sen-
sory issues as part of the diagnosis for autism, there is controversy about
the best way to approach that reality.
• The Treffert Approach extends beyond individuals into the systems work-
ing with them by providing ongoing support and interventions in a vari-
ety of settings. Unless we can make an impact on the culture and the
approach of the system we work with, gains can be lost, and future gains
may be limited or more challenging. The systems approach includes all
aspects of care and culture. To reach the goal of sustainable change,
long-term success, and independence in all settings, including the work-
place, we must pay attention to system processes and increase the sys-
tem’s capacity to support and continue growth, problem solving, and
resilience.
• Education that focuses on the three primary predictors of life success—
self-regulation, social-emotional skills, and compassion, taught through
motion and play—is foundational for lifelong learning.
62 Neurodiversity

Recommendations For Educators,

Clinicians, and Other Professionals
• Try to understand a person’s interests as a way to initially engage that
person.
• Bridge off of these interests to help the person develop new skills or un-
derstanding.
• Try to identify unrecognized skills or abilities in your patient.
• Tailor expectations and pace to match the individual’s needs.
• Provide early exposure to jobs and opportunities.

Discussion Questions
1. How accurate are parent and teacher reports of strengths and interests?
How can the accuracy of these reports be better assessed?
2. How stable are strengths and interests?
3. Should strengths and interests be used as rewards?

Suggested Readings
Barnett K: The Spark: A Mother’s Story of Nurturing, Genius and Autism.
New York, Random House, 2013
Clark T: Exploring Giftedness and Autism: A Study of a Differentiated
Educational Program for Autistic Savants. New York, Routledge, 2016
Costley D, Keane E, Clark T, Lane K: A Practical Guide for Teachers of
Students With an Autism Spectrum Disorder in Secondary Education.
London, Jessica Kingsley Publishers, 2012
Fabricius T: Autism and the Savant Hypothesis: The Evolution of Human
Cognition and Mind. Dubuque, IA, Ilama, 2012
Grandin T: Thinking in Pictures: And Other Reports From My Life With
Autism. New York, Vintage Books, 1996
Grandin T: The Autistic Brain: Helping Different Kinds of Minds Succeed.
New York, Houghton Mifflin, 2013
Grandin T: Calling All Minds: How to Think and Create Like an Inventor.
New York, Philomel Books, 2018
Jordan R, Roberts JM, Hume K (eds): The SAGE Handbook of Autism and
Education. Thousand Oaks, CA, Sage, 2019
Kupferstein H, Rancer S: Perfect Pitch in the Key of Autism: A Guide for
Educators, Parents, and the Musically Gifted. iUniverse, 2016
Strengths-Based Model and Savantism 63

Porges SW: The Polyvagal Theory: Neurophysiological Foundations of

Emotions, Attachment, Communication, and Self-Regulation (Norton
Series on Interpersonal Neurobiology). New York, WW Norton and Co,
2011
Smith B: Mentoring At-Risk Students Through the Hidden Curriculum of
Higher Education. Lanham, MD, Lexington Books, 2013
Tammet D: Born on a Blue Day: Inside the Extraordinary Mind of an Autistic
Savant: A Memoir. New York, Free Press, 2006
Treffert DA: Mellowing. Self-published, 1983
Treffert DA: Extraordinary People: Understanding Savant Syndrome. Bloom-
ington, IN, iUniverse, 2006
Treffert DA: Islands of Genius: The Bountiful Mind of the Autistic, Ac-
quired and Sudden Savant. London, Jessica Kingsley, 2011

References
Ahrens K, DuBois D, Lozano P, Richardson LP: Naturally acquired mentoring re-
lationships and young adult outcomes among adolescents with learning disabil-
ities. Learn Disabil Res Pract 25(4):207–216, 2010
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Dis-
orders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013
Austin RD, Pisano GP: Neurodiversity as a competitive advantage. Harv Bus Rev
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Clark T: Exploring Giftedness and Autism: A Study of a Differentiated Educational
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Costley D, Keane E, Clark T, Lane K: A Practical Guide for Teachers of Students
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 FOUR
Strengths-Based
Model of
Neurodiversity and
Autism
Lawrence K. Fung, M.D., Ph.D.

[I]f we can recognize, realistically and on a case-by-case basis,

what an individual’s strengths are, we can better determine the
future of the individual.
Temple Grandin, Ph.D.

The strengths-based model of neurodiversity (SBMN) has tremen-

dous potential to benefit individuals on the autism spectrum. The prin-
ciples of SBMN allow mental health providers to form a structure to
assess people on the autism spectrum based on character strengths as
well as specific talents in specific areas. They also guide providers to
devise approaches to build the identity of the individuals based on their
strengths instead of their challenges. To maximize the potential of the
strengths-based approach, the principles of SBMN can be applied to
families of autistic individuals, the organizations where the individuals
work, and the larger community. The collective sum of the results
from these efforts will help in changing culture to one that embraces
neurodiversity.

65
66 Neurodiversity

Autistic individuals often appear to be relatively less flexible in behavior than

others. Yet behaviors that might be viewed by others as challenges can also
serve as strengths (Table 4–1). For instance, behavior that might be viewed
as perseveration can also be viewed as persistence and self-determination,
depending on the context. Similarly, people on the spectrum are often thought
to have challenges in “seeing the big picture”; however, if the task at hand re-
quires attention to details, they might be among the first to complete the
work. For example, a person does not need to see the big picture if the task is
to debug a computer program. Many people on the spectrum have few inter-
ests, yet they will learn all the details of those interests, even the details that
neurotypical people might ignore. When the situation arises in which some-
one else needs those details, the autistic person will solve the problem for ev-
eryone. Autistic people also tend to have challenges in perspective taking and
are overly concrete, making them less apt to social interactions. However,
when they have friends, people appreciate their honesty and loyalty. As these
examples demonstrate, the characteristics of autism are well defined, but these
qualities can be both strengths and challenges. By deliberately assessing for the
strengths of individuals on the autism spectrum, we can uncover their poten-
tial and steer them toward developing their identity based on those strengths.

TABLE 4–1. Strengths and challenges of individuals on the autism

spectrum
Strengths Challenges

Persistence Perseveration
Attention to details “Big-picture” thinking
Strong fund of knowledge Few interests
Following rules Solving problems that bend rules
Logical thinking Understanding pragmatics in social interactions
Concrete/Honest Perspective taking
Loyal Overly concrete in social interactions

Since the first cases of autism were described by Leo Kanner in 1943,
many studies have reported strengths in people on the spectrum (Table 4–2),
including domains of abilities such as memory, music, art, verbal skills, math,
and spatial skills. Chapter 1 described the SBMN, which incorporates four
main components: positive psychology (Seligman and Csikszentmihalyi
2000), positive psychiatry (Jeste et al. 2015), Gardner’s theory of multiple in-
telligences (Gardner 1983; Gardner and Hatch 1989), and Chickering’s
seven vectors of development (Chickering and Reisser 1993). In this chap-
TABLE 4–2. Strengths of autistic individuals, as documented in selected reports

Strengths-Based Model of Neurodiversity and Autism

Symbols/ Spatial FM/A
Study N Any Memory Music Spelling Reading Math Dates skills skills

Asperger 1944/1991 4 75% 50% 25% 25%

Bennett and Heaton 2012 125 42% 28% 10% 10% 15% 9% 10%
Bolte and Poustka 2004 254 13%
Howlin et al. 2009 137 26%
Jones et al. 2009a 100 73%
Kanner 1943 11 54% 54% 36%
Meilleur et al. 2015: 254 63% 52% 17% 22% 17% 32%
Moderate functioning
Meilleur et al. 2015: High 43 87% 47% 38%
functioning
Rimland 1978 540 10%
Rapin 1996: High- 51 71% 28% 26% 45% 35% 22%
functioning
Rapin 1996: Low- 125 44% 23% 10% 14% 26% 14%
functioning
FM/A=fine motor/artistic.
Source. Modified from Meilleur et al. 2015.

67
68 Neurodiversity

ter, the SBMN is applied to autism. Topics include what strengths are com-
mon among individuals on the spectrum, how strengths are assessed in this
population, what strengths-based approaches are available, and how such in-
terventions are implemented.

Strengths in Individuals on
the Autism Spectrum
Many influential scientists have been identified as having traits of autism.
Albert Einstein, the most prominent physicist of all time, is believed to have
had autism traits (James 2003). He once said: “I do not socialize because so-
cial encounters would distract me from my work, and I really only live for
that, and it would shorten even further my very limited lifespan” (James
2003). Einstein's challenges in social interactions, persistence in solving the
most difficult problems, deep interest in theoretical physics, and genius in-
tellect proved to make him one of the most productive and influential sci-
entists ever. Einstein developed the theory of general relativity, derived the
famous equation E=mc2 as a consequence of this theory, and discovered the
law of the photoelectric effect (which won him the Nobel Prize in 1921). In
1916, Einstein predicted the existence of gravitational waves, produced from
a collision of two black holes (Einstein 1916). A century later, this phenom-
enon was experimentally observed after a 40-year work shared by Rainer
Weiss, Barry Barish, and Kip Thorne, who won the 2017 Nobel Prize in
Physics for this work (Abbott et al. 2016). In 1924, Einstein predicted the
existence of a fifth state of matter (also known as Bose-Einstein condensate),
which was experimentally produced 70 years later by Eric Cornell, Carl
Wieman, and Wolfgang Ketterle. These scientists went on to win the 2001
Nobel Prize in Physics. One of Einstein’s biographers remarked that he
“never really needed human contacts; he deliberately freed himself more
and more from all emotional dependence in order to become entirely self-
sufficient” (James 2004). Because Einstein “freed himself from emotional de-
pendence,” he was able to focus on advancing science, ultimately teaching us
more about the world and the universe than anyone ever had.
Sir Isaac Newton, one of the most influential scientists of all time, is also
considered to have had traits of autism. One of Newton’s biographers stated
that he was “singularly unable to form intimate friendships” (More 1934).
However, Newton’s book Philosophiæ Naturalis Principia Mathematica (Math-
ematical Principles of Natural Philosophy), first published in 1687, laid the foun-
dations of classical mechanics, and he also developed the fields of calculus
and optics. We remember Newton, despite his personal challenges, as some-
Strengths-Based Model of Neurodiversity and Autism 69

one who made seminal contributions to many scientific disciplines that pos-
itively changed our lives over the past few hundred years.
Several other Nobel Prize winners are also considered to have had traits
of autism. Paul Dirac shared the 1933 Nobel Prize in Physics with Erwin
Schrödinger “for the discovery of new productive forms of atomic theory”
(www.nobelprize.org/prizes/physics/1933/summary). Dirac was known to be
echolalic and extremely taciturn (James 2004). Marie Curie, the acclaimed
physicist and chemist who conducted pioneering research on radioactivity,
was the first woman to win a Nobel Prize, the first person and the only
woman to win the prize twice, and the only person to win it in two different
scientific fields (Physics in 1903 and Chemistry in 1911). She was described
as having tremendous difficulty engaging in conversation and a tendency to
misinterpret other people’s reactions to her. Irène Joliot-Curie (Marie Cu-
rie’s daughter) and her husband were awarded the Nobel Prize in Chemistry
in 1935 for their discovery of artificial radioactivity. Joliot-Curie was de-
scribed as a very reserved person who had difficulty making friends. She was
also described as “rather awkward in her movements” (James 2003, p. 38).
Hans Asperger wrote in his 1944 doctoral thesis,

[W]e have seen that autistic individuals, as long as they are intellectually in-
tact, can almost always achieve professional success, usually in highly spe-
cialized academic professions, often in very high positions, with a preference
for abstract content. We found a large number of people whose mathemat-
ical ability determines their professions: mathematicians, technologists, in-
dustrial chemists and high-ranking civil servants. (Frith 1991, p. 89)

Although Asperger reported that many people on the autism spectrum

were accomplished in mathematics and the sciences, many others are tal-
ented in the humanities and sciences. One of Asperger’s patients, Elfriede Je-
linek, is a gifted Austrian playwright and novelist. Jelinek won the Nobel
Prize in Literature in 2004 for her “musical flow of voices and counter-voices
in novels and plays that with extraordinary linguistic zeal reveal the absurdity
of society’s clichés and their subjugating power” (Nobel Foundation 2004).
In 1970, when Jelinek was 24 years old, she published her first work, “we’re
decoys baby!” The novel had no capitalizations, no punctuation, and plot in-
volutions (de la Durantaye 2005). Lewis Carroll, author of Alice’s Adventures
in Wonderland, was described as having struggled in communicating with his
peers. Because of this, he spent more time with children than adults. This
environment cultivated his vivid imagination, which enhanced his writing
(Fitzgerald 2005).
Michelangelo, the celebrated sculptor, painter, architect, and poet of the
High Renaissance, has also been said to have had autism traits. He was de-
scribed as having “single-minded work routine, unusual lifestyle, limited
70 Neurodiversity

interests, poor social and communication skills, and issues of life control”
(Arshad and Fitzgerald 2004). Andy Warhol, a prominent artist in the twen-
tieth century, is also considered to have had traits of autism (Fitzgerald
2005). Warhol, the father of pop art, is most famous for his series of paint-
ings “Campbell’s Soup Cans.” The repetitive style of his art and his chal-
lenges in communicating with others have been stated to be consistent with
some of the core features of autism.
As illustrated, prominent people throughout history have demonstrated
that their persistence in pursuing their deep interests helped them excel in
their chosen fields, from the sciences to literature and fine arts. The strengths
discussed in this section are not only absolute strengths but also relative
strengths; they are not only about the technical excellence that autistic peo-
ple demonstrate but also about strengths in their personal characteristics.

Character Strengths in Autism

Honesty is one of the most mentioned character strengths in people on the
autism spectrum (Jaarsma et al. 2012). This trait has been recognized by au-
tistic individuals (Atherton et al. 2019; Russell et al. 2019) and experts in
the field of autism (de Schipper et al. 2016; Mahdi et al. 2018). In a series
of semistructured interviews with adolescents on the spectrum, Atherton et
al. (2019) examined participants’ theory of mind experiences and strategies
and revealed four core themes: honesty, humor, imagination, and anthropo-
morphism. Results from their interpretive phenomenological analysis high-
lighted that theory of mind in individuals on the spectrum is one of difference
rather than deficit. For example, honesty in autism appears to be less de-
pendent on systemizing than on personal experience and choice. Using a
questionnaire developed by the World Health Organization’s International
Classification of Functioning, Disability and Health research, de Schipper et al.
(2016) extracted functional ability and disability concepts from responses
among 225 autism experts representing 10 disciplines and 43 countries.
These experts reported the following character traits associated with au-
tism: strong sense of morality (e.g., honesty, lack of judgmental attitude),
trustworthiness, loyalty, and kindness.
Kirchner et al. (2016) assessed character strengths in 32 young autistic
adults and 32 neurotypical control subjects using the Values in Action In-
ventory of Strengths (VIA-IS; Peterson and Seligman 2004) and explored
associations with levels of satisfaction with life. As shown in the rightmost
two columns of Table 4–3, the most frequently endorsed signature strengths
(i.e., five top-ranked strengths within an individual’s strength ranking, often
used in positive psychology) in the autism group were open-mindedness,
authenticity, love of learning, creativity, and fairness. Among these five sig-
TABLE 4–3. Comparing strengths and most frequently endorsed signature strengths* of young adults on the autism

Strengths-Based Model of Neurodiversity and Autism

spectrum and TD control subjects using the Values in Action Inventory of Strengths
Correlations
Autism TD with SWLS
Character strength Description of item rank rank Autism TD

Emotional strengths
Zest (enthusiasm) Approaching life with excitement and energy ** **
Hope (optimism) Expecting the best and working to achieve it ** **
Bravery (courage) Not shrinking from threat, challenge, difficulty, or pain **
Humor (playfulness) Liking to laugh and joke, bringing smiles to other people 1 ** **
Love Capacity to love and be loved, valuing close relations with others 5 **
Social intelligence Being aware of the motives and feelings of self and others, knowing what ** **
to do to fit into different social situations
Interpersonal strengths
Kindness (generosity) Doing favors and good deeds for others, helping others and taking care 4 **
Teamwork Working well as a member of a group or team, being loyal to the group ** **
Fairness Treating all people the same according to notions of fairness and justice 5 1
Leadership Taking care of a group and its members, organizing activities and seeing
that they happen
Forgiveness Forgiving those who have done wrong, giving people a second chance **
Modesty Letting one’s accomplishments speak for themselves, not regarding oneself
as more special than one is

71
TABLE 4–3. Comparing strengths and most frequently endorsed signature strengths* of young adults on the autism

72
spectrum and TD control subjects using the Values in Action Inventory of Strengths (continued)
Correlations
Autism TD with SWLS
Character strength Description of item rank rank Autism TD

Intellectual strengths
Creativity (originality) Thinking of novel and productive ways to do things, including but not 4
limited to artistic achievements
Curiosity (interest) Taking an interest in all ongoing experience, finding subjects and topics
fascinating, exploring and discovering
Open-mindedness (judgment) Thinking things through and examining them from all sides, not jumping 1 1
to conclusions; being able to change one’s mind in light of evidence
Love of learning Enjoyment of mastering new skills, topics, and bodies of knowledge 3
Strengths of restraint
Persistence (perseverance) Finishing what one starts, persisting in a course of action in spite of **
obstacles
Prudence Being careful about one’s choices; not saying or doing things that might
later be regretted

Neurodiversity
Self-regulation Regulating what one feels and does
Perspective Being able to provide wise counsel to others, having ways of looking at the **
world that make sense to oneself and to other people
Authenticity (honesty) Speaking the truth and presenting oneself in a genuine way 2
TABLE 4–3. Comparing strengths and most frequently endorsed signature strengths* of young adults on the autism

Strengths-Based Model of Neurodiversity and Autism

spectrum and TD control subjects using the Values in Action Inventory of Strengths (continued)
Correlations
Autism TD with SWLS
Character strength Description of item rank rank Autism TD

Theological strengths
Spirituality (religiousness) Having coherent beliefs about the higher purpose and meaning of life **
Gratitude Being aware of and thankful for the good things that happen **
Appreciation of beauty Noticing and appreciating beauty, excellence, and/or skilled performance
in all domains of life
SWLS=Satisfaction With Life Scale; TD=typically developing.
*Five top-ranked strengths within an individual’s strength ranking.
**Indicates significant correlations with satisfaction with life.
Source. Adapted and modified from Kirchner et al. 2016.

73
74 Neurodiversity

nature strengths, three are intellectual (open-mindedness, love of learning,

creativity). In contrast, among neurotypical control subjects, the most fre-
quently endorsed signature strengths were emotional (humor, love), inter-
personal (kindness, fairness), and intellectual (open-mindedness). For both
groups, hope and zest had the strongest associations with satisfaction with
life. In the autism group, kindness, social intelligence, teamwork, and humor
were most strongly related to satisfaction with life, whereas in the control
group, persistence, curiosity, perspective, and humor were most strongly
correlated. Notably, although autistic young adults perceive that they are
strong intellectually, emotional and interpersonal strengths were most associ-
ated with personal satisfaction. Therefore, in order to improve the overall
well-being of autistic individuals, interventions need to encompass approaches
that maximize their emotional, interpersonal, and intellectual capacities.
Parents of 427 youth and young adults with intellectual disability and/or
autism (ages 13–21 years) assessed their children using the Assessment Scale for
Positive Character Traits–Developmental Disabilities (ASPeCT-DD) (Carter
et al. 2015). From the interpersonal strengths listed, compassion was the one
parents rated highest as describing their children. Other highly desirable qual-
ities parents mentioned were being social, loving, helpful, and loyal. In another
study using ASPeCT-DD, 163 young adults (ages 18–30 years) were recruited
to assess the strengths of their siblings with intellectual disability or autism
(Carter et al. 2020). The three strengths rated highest were kindness to oth-
ers, caring for other people, and having a sense of humor. Overall, parents
and siblings provided additional insights into the character strengths of in-
dividuals on the autism spectrum.
The parents of 98 autistic children reported their children’s strengths,
which were categorized into five meta-themes: personality characteristics,
cognitive functioning, social personality, behavioral characteristics/coping
mechanisms, and skills (Sabapathy et al. 2017). Most parents reported more
strengths in the cognitive functioning and personality characteristics meta-
themes. Experts in the field of autism have found other specific strengths in
people on the spectrum as well (de Schipper et al. 2016); in particular, they
reported mathematical abilities, technical abilities (computer skills, engineer-
ing), attention to detail, visual perception, artistic skills (e.g., music, drawing,
visual arts), and creative talents (e.g., looking at the world differently).

Specific Domains of
Competencies in Autism
Domains of abilities generally follow a normal distribution. This is true for
both the overall population and the autistic population. In other words, indi-
Strengths-Based Model of Neurodiversity and Autism 75

viduals on the spectrum do not have a specific profile of abilities. Some may
be good at a particular domain, but others may not be good in the same do-
main. In this section, strengths of individuals on the autism spectrum are
organized based on the construct proposed by Gardner’s theory of multiple
intelligences (logical-mathematical, verbal-linguistic, visual-spatial, musical-
rhythmic, naturalistic, kinesthetic, existential) (Gardner 1983). SBMN in-
terventions that can be used to improve interpersonal and intrapersonal
abilities are described in a later section of this chapter.

Logical-Mathematical Abilities
Early studies found that most individuals with Asperger syndrome had av-
erage mathematical ability (Chiang and Lin 2007). Later studies found clus-
ters of autistic children with strong mathematical abilities; in one study that
involved 130 autistic children ages 6–9 years, 20% demonstrated hypercal-
culia and 39% showed hypercalculia and superior abilities in letter-word
identification and passage comprehension (Wei et al. 2015). Compared with
the general population, people on the autism spectrum tend to have less uni-
form performance among various domains of academic achievements. In a
sample of 30 autistic children without intellectual disability, 13% had higher
achievement scores in mathematics than in their full-scale IQs (FSIQs),
whereas 40% had lower achievement scores in mathematics than in their
FSIQs (Estes et al. 2011). In a larger sample comparing 114 autistic children
and 96 matched control subjects, compared with the matched control group,
the autism group showed marginally lower verbal IQ scores and significantly
lower scores on numerical operations, mathematical reasoning, and reading
comprehension (Chen et al. 2019). However, hierarchical clustering analysis
yielded a subgroup of high-achieving autistic children (63%) who showed
superior mathematical skills compared with their reading comprehension
skills. In contrast, the low-achieving autistic children (37%) were found to
demonstrate lower mathematical abilities compared with reading compre-
hension.
Similar to autistic children, adolescents on the spectrum showed discrep-
ancies between mathematical skills and IQ. In a group of 99 autistic adoles-
cents (ages 14–16), 73% had at least one area of literacy or mathematical
achievement that was highly discrepant (>14 points) from their FSIQs (Jones
et al. 2009b). On the one hand, the authors found that 16% presented with
average FSIQs alongside superior skills in numerical operations; 14% of the
total were found to have superior reasoning in mathematics but average
FSIQs. On the other hand, the authors reported that 15% had worse rea-
soning in mathematics relative to their FSIQs; 6% of the total had signifi-
cantly lower skills in numerical operations. Although the participants had a
76 Neurodiversity

wide IQ range (50–119), both of the groups showing “arithmetic peak” or

“arithmetic dip” presented with average FSIQs.
In the only longitudinal study of academic achievements in individuals on
the autism spectrum, Kim et al. (2018) used data from 111 children referred
for possible autism diagnosis at age 2 years. The children completed assess-
ments at ages 2, 3, and 9 years and had valid basal scores on achievement test-
ing. The achievement testing was completed again at age 18. Participants
were divided by FSIQs: the higher-IQ group had FSIQs ≥85, and the lower-
IQ group had FSIQ scores <85. At age 9 years, 9% of the higher-IQ group
showed significantly higher (≥15 points) arithmetic skills compared with
their FSIQ scores; at age 18, this percentage increased to 19%. Remarkably,
in the lower-IQ group, the percentage of children demonstrating higher
arithmetic skills compared with their FSIQs increased from 13% to 53%.
The authors found that preschool cognitive levels predicted elementary and
high school academic achievement in autistic individuals. Furthermore,
school-age cognitive levels were shown to moderate changes in academic de-
velopment from elementary to high school in students on the autism spec-
trum (Kim et al. 2018).
Overall, unlike most neurotypical individuals, autistic individuals tend
to have discrepancies between their general intelligence and their mathe-
matical skills. A significant percentage (≤53%, depending on age) of chil-
dren and adolescents on the autism spectrum were found to have higher
mathematical skills compared with their FSIQ scores. However, a portion
(≤40%) of autistic individuals revealed lower mathematical skills compared
with their FSIQs.

Verbal-Linguistic Abilities
Hyperlexia has often been considered one of the strengths of people on the
autism spectrum. Hyperlexia is characterized by the following four features
(Needleman 1982): 1) the presence of a co-occurring neurodevelopmental
condition; 2) advanced reading skills, relative to general intelligence; 3) early
reading skills without explicit teaching; and 4) deep interest in reading ma-
terial. Ostrolenk et al. (2017) conducted a systematic review encompassing
22 studies (including 912 subjects, of whom 315 were hyperlexic) and 82 in-
dividual hyperlexia cases. Based on four of the included studies (Burd and
Kerbeshian 1985; Grigorenko et al. 2002; Jones et al. 2009b; Wei et al.
2015), the prevalence of hyperlexia is between 6% and 20% in the autism
population. Although hyperlexia has been associated with autism, this con-
dition was also described in cases of other neurodevelopmental conditions.
Ostrolenk et al. (2017) found that 84% of case studies of hyperlexia had
mentioned an autism diagnosis or described characteristics of autism.
Strengths-Based Model of Neurodiversity and Autism 77

In a study of 130 autistic children (ages 6–9 years), 9% demonstrated hy-

perlexia (superior in letter-word identification and rapid letter naming) and
39% showed both hypercalculia and superior abilities in letter-word iden-
tification and passage comprehension (Wei et al. 2015). In another study of
30 autistic children at age 9 years, 40% had high achievement in spelling,
37% had high achievement in word reading, 30% had low achievement in
spelling, and 27% had low achievement in word reading (Estes et al. 2011).
Jones et al. (2009b) tested the IQ and literacy of a group of 99 autistic
adolescents (ages 14–16 years). The authors found that only one participant
had significantly higher skills in reading comprehension, 14% of the sam-
ple presented with superior reading skills, and 13% had superior spelling
abilities, relative to their FSIQ scores. The authors also found that 37% of
participants had poorer reading comprehension, 10% had poorer reading
skills, and 16% had lower abilities in spelling, relative to their FSIQs. Par-
ticipants with “reading peak” were found to have borderline IQs, and those
with “reading dip” presented with low average FSIQs.
In Kim et al.’s (2018) longitudinal study of academic achievements in au-
tistic individuals mentioned earlier, the authors also investigated the trajec-
tory of literacy. The results were completely different from what was found
for mathematical skills. At age 9 years, 16% of the higher-IQ group showed
significantly lower (≥15 points) word reading skills compared with their
FSIQs; at age 18, this percentage increased to 25%. In contrast, in the lower-
IQ group, the percentage of children demonstrating higher word reading
skills, compared with their FSIQs, increased from 44% to 69%; similarly,
the percentage of children demonstrating higher spelling skills relative to
their FSIQs increased from 54% to 67% (Kim et al. 2018).

Visual-Spatial Abilities
The lack of eye contact during social interactions is one of the most com-
mon characteristics of autistic individuals. Autistic children tend to orient
to nonsocial objects (Klin et al. 2009). Superior abilities to perceive details
of nonsocial materials quickly have been demonstrated in individuals on the
autism spectrum (Dakin and Frith 2005; Kaldy et al. 2016), including tod-
dlers (Kaldy et al. 2011), children (O’Riordan et al. 2001; Plaisted et al.
1998), and adults (O’Riordan 2004).
Compared with typically developing children, autistic children demon-
strated faster reaction times (Plaisted et al. 1998) and more accurate detec-
tion (Kaldy et al. 2011) in feature-conjunction tasks. Faster, more efficient
search abilities of nonsocial objects are associated with higher levels of au-
tism symptoms (Gliga et al. 2015; Joseph et al. 2009; Keehn and Joseph
2016; Keehn et al. 2013b), suggesting that nonsocial attentional processes
78 Neurodiversity

may be associated with core features of autism. In addition to autistic chil-

dren, infants with an older autistic sibling were also found to have higher
abilities in visual search tasks (Gliga et al. 2015). Importantly, not all autistic
children have superior visual search abilities. Only the children with high
levels of autism features and motor skills at or above age expectations out-
performed all others on complex visual search tasks (Lindor et al. 2018).
Parents of autistic individuals have also noticed their children’s relative
strengths in visual-spatial abilities. In a study involving 254 individuals on
the spectrum (mean age 11 [range 2–39 years]; mean FSIQ 87 [range 40–
130]), 63% of the parents endorsed that their child had special isolated skills
(Meilleur et al. 2015); 32% of the children had strengths in visual-spatial
skills, and 18% had strengths in drawing. Meilleur and colleagues also re-
vealed, from another group of individuals on the spectrum (mean age 21
[range 14–36 years]; mean FSIQ 105 [range 71–125]), that 38% of the par-
ents endorsed that their children’s visual-spatial skills were their special iso-
lated skills.
Superior visual-spatial abilities have been explained by two main hypoth-
eses. Mottron et al. (2006, 2013) proposed the enhanced perceptual function
hypothesis, which stated that both low-level (discrimination) and mid-level
(pattern detection) perceptual processes are enhanced in autistic individuals.
Based on Posner’s model of attention (Petersen and Posner 2012; Posner
and Petersen 1990), Keehn et al. (2013a) found evidence of atypical atten-
tion in the networks for alerting, orienting, and executive control in individ-
uals on the autism spectrum.

Musical-Rhythmic Abilities
Autistic people often exhibit differences in sensory perception. It comes as
no surprise that some also have high musical cognition abilities, as described
by many, including Kanner (1943) in his description of his first cohort of au-
tistic patients. Many people on the spectrum have increased auditory per-
ceptual capacity, as illustrated by their detection of either unexpected or
expected sounds (Remington and Fairnie 2017). Compared with typically
developing subjects, high-functioning autistic adolescents showed poorer
auditory filtering, less audiovisual integration, and less specialization for na-
tive phonemic and metrical categories (DePape et al. 2012). Although these
sensory differences can be manifested as significant challenges, as in the case
of anxiety and agitation secondary to sensory overload, alterations in sensory
perception can also be displayed as strengths (e.g., perfect pitch, also known
as absolute pitch [AP]) in some autistic individuals.
AP is the ability to identify or re-create a given musical note without us-
ing a reference tone. AP is a rare trait in the general population (1 in 10,000
Strengths-Based Model of Neurodiversity and Autism 79

people; Takeuchi and Hulse 1993), but it occurs much more frequently in
individuals on the autism spectrum (1 in 20; Brown et al. 2003). According
to the weak central coherence theory, cognition in autism is driven by the
need to process detail at the expense of integrating details within the large
framework of context (Happe 1999). AP in autism is often thought to be con-
sistent with the weak central coherence theory and is analogous to abilities
with regard to attention to detail in the visual domain (Baron-Cohen et al.
2009). In a study examining the relationship between AP and traits of autism,
16 musicians with AP, 18 musicians without AP, and 16 nonmusicians were
recruited (Dohn et al. 2012). The authors found that musicians with AP did
not differ from those without AP on diagnostically crucial social and com-
municative domain scores. However, pitch identification scores correlated
with autistic traits as measured by the Autism-Spectrum Quotient (AQ)
questionnaire. Furthermore, compared with musicians without AP and non-
musicians, musicians with AP were found to have significantly higher AQ
scores in imagination (i.e., they were less imaginative) and attention switch-
ing, both of which indicate a higher prevalence of autistic traits.
In addition to having increased scores on AP, autistic individuals have
also been found to possess enhanced pitch processing and categorization.
Bonnel et al. (2003) demonstrated that autistic adolescents performed better
in judging the pitch of pure tones in a “same or different” discrimination task
and in a “high or low” categorization task. The same group also revealed that
compared with typically developing control subjects, adolescents and young
adults on the autism spectrum but with IQs in the normal range displayed
superior pitch discrimination for simple tones (Bonnel et al. 2010).

Naturalistic Abilities
Temple Grandin, professor of animal science at Colorado State University,
is one of the most prolific scientists on the autism spectrum. She is an au-
thority in the field of humane slaughter of farm animals (Grandin 1994,
2001, 2010, 2017). She struggled in interacting with her peers when she was
young. However, she was able to make friends with people who shared her
interests, such as her interest in animals. Today, half the cattle in the United
States are handled in facilities she has designed.
People on the autism spectrum are known to have differences in their
theory of mind abilities. When autistic people performed theory of mind
tasks, they did better in judging the mental states of nonhuman agents with
anthropomorphic features (i.e., animals and cartoons) than human agents
(Atherton and Cross 2018). Compared with neurotypical control subjects,
autistic subjects were better able to recognize emotion expression for static
animated images (Brosnan et al. 2015). Also, adolescents on the spectrum
80 Neurodiversity

were better at recognizing emotions in animal faces (human faces shown in

animal filters) than in human faces (Cross et al. 2019).

Other Abilities
When Kanner (1943) reported his first cohort of autistic children, he stated
that “the children’s memory was phenomenal” (p. 245). He was fascinated
by the range of memory abilities, from “the excellent memory for events of
several years before” to “phenomenal rote memory for...precise recollec-
tion of complex patterns and sequences” (p. 247).
Kim Peek, who inspired the character of Raymond Babbitt in the movie
Rain Man, was a megasavant known for his exceptional memory (Treffert
and Christensen 2005). Peek was known as a “walking computer.” He began
memorizing books when he was 18 months old. He had deep interests in
many topics, including geography, world history, literature, classical music,
sports, and movies. He learned 9,000 books by heart and memorized all of
the area codes and zip codes in the United States.
Memory abilities, however, are not universal in autistic individuals. In a
recent meta-analysis of 64 studies that compared the short-term and epi-
sodic long-term memory of 2,923 autistic individuals and 2,877 typically de-
veloping control subjects, Desaunay et al. (2020) found that the autism
group had lower overall performance in short-term memory recall of verbal,
visual, and visual-spatial material. In contrast, the difference in the perfor-
mance of long-term memory between the two groups was not clear.

Assessments of
Strengths in Autism
Most of the assessment tools in the field of autism are based on the deficit
model. This section describes tools that have been used to assess the char-
acter strengths (Table 4–4) and other abilities (Table 4–5) of autistic indi-
viduals. These instruments can be valuable for assessing people who are on
the spectrum in order to understand their strengths and can help other stake-
holders (e.g., family members, employers, teachers, mental health profes-
sionals) use the strengths-based approach to facilitate activities that can build
upon the strengths of the neurodiverse individuals.
TABLE 4–4. Assessments used to evaluate character strengths in people on the autism spectrum

Strengths-Based Model of Neurodiversity and Autism

Self-report vs. Age
Categories of informant range, Examples for Reference and website
Assessment tools strengths assessed report Items, N y use in autism for questionnaire

Behavioral strengths
Strengths and Emotion, conduct, Self-report 25 4–10 Findon et al. Goodman 1997;
Difficulties hyperactivity/ Informant report 11–17 2016; Russell https://sdqinfo.org
Questionnaire inattention, peer (parent) 18+ et al. 2013
(SDQ) relationship, prosocial Informant report
behavior (teacher)
Character strengths
Values in Action Emotional, Self-report 240 10–17 Kirchner et al. Peterson and Seligman 2004;
Inventory of interpersonal, 18+ 2016 www.viacharacter.org
Strengths (VIA-IS) intellectual, strengths
of restraint, theological
Assessment Scale for Empathy, optimism, Informant report 26 No age Carter et al. Woodard 2009
Positive Character forgiveness, kindness, limit 2015, 2020
Traits– humor, gratitude, self-
Developmental efficacy, courage, self-
Disabilities control, resilience
(ASPeCT-DD)

81
TABLE 4–4. Assessments used to evaluate character strengths in people on the autism spectrum (continued)

82
Self-report vs. Age
Categories of informant range, Examples for Reference and website
Assessment tools strengths assessed report Items, N y use in autism for questionnaire

Self-determination
Arc’s Self- Autonomy, self- Self-report 72 Chou et al. Wehmeyer and Kelchner
Determination Scale regulation, 2017 1995; www.ou.edu/
(SDS) psychological education/centers-and-
empowerment, self- partnerships/zarrow/self-
realization determination-assessment-
tools/arc-self-
determination-scale
American Institutes Capacity (ability, Self-report; 24+3 (self) 8+ Carter et al. Wolman et al. 1994
for Research Self- knowledge, informant 18+3 (parent) 2013; Chou et
Determination Scale perceptions) and report (parent); 30+3 (teacher) al. 2017
(AIR-S) opportunity related to informant
three components of report
self-determination: (teacher)
thinking, doing, and

Neurodiversity
adjusting
TABLE 4–5. Assessments used to evaluate various abilities and strengths in people on the autism spectrum

Strengths-Based Model of Neurodiversity and Autism

Age Examples for use Reference for
Assessment tools Categories of strengths assessed range, y in autism assessment

Intellectual abilities
Differential Ability Scales–II Verbal abilities, nonverbal abilities, nonverbal 2.5–17.9 Bishop et al. 2011 Elliott 2007
reasoning abilities, spatial abilities, working
memory, processing speed
Stanford-Binet Intelligence Scales, Fluid reasoning, knowledge, quantitative 2–85 Coolican et al. 2008 Roid 2003
5th Edition reasoning, visual-spatial processing,
working memory
Wechsler Intelligence Scale for Verbal comprehension, visual-spatial, fluid 6–16 Oliveras-Rentas et al. Wechsler et al. 1992
Children, 3rd Edition reasoning, working memory, and processing 2012
speed
Wechsler Adult Intelligence Scale, Verbal comprehension, perceptual reasoning, 16–90 Spek et al. 2008 Wechsler 1997
3rd Edition working memory, and processing speed
Wechsler Abbreviated Scale of Vocabulary, block design, similarities, matrix 6–90 Jones et al. 2009b Wechsler 1999
Intelligence reasoning, nonverbal fluid abilities,
visuomotor/coordination
Logical-mathematical abilities
Wechsler Objective Numerical Numerical operations, mathematical 4–16.9 Jones et al. 2009b Rust 1996
Dimensions reasoning

83
TABLE 4–5. Assessments used to evaluate various abilities and strengths in people on the autism spectrum (continued)

84
Age Examples for use Reference for
Assessment tools Categories of strengths assessed range, y in autism assessment

Logical-mathematical abilities (continued)

Woodcock Johnson III (WJ-3) Applied problems, calculation 5–95 Kurth and Woodcock et al. 2001
math subtests Mastergeorge 2010;
Wei et al. 2015
Wechsler Individual Achievement Numerical operations, mathematical 4–85 Chen et al. 2019 Wechsler 2001
Test, 2nd Edition (WIAT-II) reasoning
math subtest
Wide Range Achievement Test 3 Numerical operations, mathematical 5–75 Kim et al. 2018 Wilkinson 1993
(WRAT-3) math subtests reasoning
Verbal-linguistic abilities
Wechsler Objective Reading Reading comprehension and spelling 6–16 Jones et al. 2009b Rust et al. 1993
Dimensions
WIAT-II verbal subtests Word reading and reading comprehension 4–85 Chen et al. 2019 Wechsler 2001
WJ-3 verbal subtests Letter-word identification and reading 5–95 Kurth and Woodcock et al. 2001

Neurodiversity
comprehension Mastergeorge 2010;
Wei et al. 2015
Comprehensive Test of Efficiency of retrieval of letters from long- 6–9 Wei et al. 2015 Wagner et al. 1999
Phonological Processing Rapid term memory and the production of word
Letter Naming subtest sounds
TABLE 4–5. Assessments used to evaluate various abilities and strengths in people on the autism spectrum (continued)

Strengths-Based Model of Neurodiversity and Autism

Age Examples for use Reference for
Assessment tools Categories of strengths assessed range, y in autism assessment

Verbal-linguistic abilities (continued)

WRAT-3 verbal subtests Word reading and spelling 5–75 Kim et al. 2018 Wilkinson 1993
Neale Analysis of Reading Ability Reading comprehension 6–12.11 Kim et al. 2018 Neale 1999
Test of Word Reading Efficiency Sight word efficiency and phonemic decoding 6–24 Jones et al. 2009b Torgesen et al. 1997
efficiency
Visual-spatial abilities
Visuospatial Processing Speed Task Visual-spatial processing speed Cardillo et al. 2020 Kirchner and Thorpe
2006
Computerized Block Design Task Visual-spatial recognition and reconstruction Cardillo et al. 2020 Cardillo et al. 2017;
Caron et al. 2006
Visuospatial Working Memory Visual-spatial working memory Cardillo et al. 2020; Cardillo et al. 2018
Task Mammarella et al.
2019
Gottschaldt’s Hidden Figure Test Visual-spatial pattern recognition Conson et al. 2020 Capitani et al. 1988;
Gottschaldt 1926
Hidden Figure Identification Visual-spatial pattern recognition Conson et al. 2020 La Femina et al. 2009
Mental Rotations Visual-spatial recognition and processing Conson et al. 2020 La Femina et al. 2009;
speed Trojano et al. 2015

85
TABLE 4–5. Assessments used to evaluate various abilities and strengths in people on the autism spectrum (continued)

86
Age Examples for use Reference for
Assessment tools Categories of strengths assessed range, y in autism assessment

Visual-spatial abilities (continued)

Rey-Osterrieth Complex Figure Visual-spatial recognition, working memory, Kuschner et al. 2009 Rey 1941, 1968
and reconstruction
Musical abilities
Musical Ear Test Melody and rhythm Dohn et al. 2012 Wallentin et al. 2010
Salk and McGill Music Inventory Emotional responses to music, musical Levitin et al. 2004 Levitin et al. 2004
creativity and reproduction

Neurodiversity
Strengths-Based Model of Neurodiversity and Autism 87

Assessments of Character
Strengths in Autistic Individuals
The Strengths and Difficulties Questionnaire (SDQ; Goodman 1997) has
been used to measure mental health well-being around the globe (de Vries
et al. 2018). The SDQ has 25 items that assess behavioral observations from
patients, their parents, and their teachers. It has been used to assess autistic
children, adolescents (Russell et al. 2013), and adults (Findon et al. 2016).
In the study by Findon et al. (2016), 126 parents and 98 individuals with au-
tism participated; both the parent report and self-report SDQ subscales cor-
related with measures of anxiety, depression, and hyperactivity. Importantly,
parent reports were found to predict mental health challenges significantly
better than self-reports. Autistic adults underreported difficulties. Although
the SDQ contains questions that assess character strengths (kindness, gen-
erosity, empathy), its use has been applied to uncovering psychopathology.
The VIA-IS (Peterson and Seligman 2004) is a self-report questionnaire
assessing 24 character strengths, covering five factors: emotional strengths,
interpersonal strengths, intellectual strengths, theological strengths, and
strengths of restraint. For VIA-IS character strengths and descriptions, see
Table 4–3 earlier in this chapter. Each scale consists of 10 items, for a total
of 240 items, which are rated using a five-point Likert scale. The VIA-IS has
been used to compare the character strengths of autistic adults with those of
neurotypical control subjects (Kirchner et al. 2016).
The ASPeCT-DD (Woodard 2009) is a 26-item informant-based scale
describing various character traits across 10 domains (i.e., empathy, optimism,
forgiveness, kindness, humor, gratitude, self-efficacy, courage, self-control, and
resilience). Response options are on a five-point Likert-type scale. A total score
(possible range 1–5) is calculated using the overall mean of the scores for the
individual items; higher scores reflect stronger reported character strengths.
The ASPeCT-DD has been used by parents (Carter et al. 2015) and siblings
(Carter et al. 2020) to assess autistic children and adolescents.
Self-determination has been assessed by two major instruments: Arc’s
Self-Determination Scale (SDS; Wehmeyer and Kelchner 1995) and the
American Institutes for Research Self-Determination Scale (AIR-S; Wol-
man et al. 1994). The Arc’s SDS is a 72-item self-report instrument that mea-
sures four domains of self-determined behavior: autonomy, self-regulation,
psychological empowerment, and self-realization (Wehmeyer 1996a). It was
constructed based on the functional theory of self-determination. Results are
given as four domain subscores and a total self-determination score. Higher
scores indicate higher levels of self-determination. The SDS was developed
and normed with adolescents with cognitive differences (Wehmeyer 1996b).
88 Neurodiversity

The AIR-S is an instrument with self-report and informant-report (par-

ent and teacher) versions. It was constructed based on self-determined learn-
ing theory and is composed of three Capacity sections (ability, knowledge,
and perceptions), Opportunity sections (opportunity at school and at home),
and three Opportunity components (thinking, doing, and adjusting). The
Capacity subscale of the self-report version consists of two domains: “Things
I Do,” related to self-determination, and “How I Feel,” about performing be-
haviors associated with self-determination. The Opportunity subscale of the
self-report version assesses the opportunities participants have to engage in
self-determination behaviors at home and at school. The AIR-S was devel-
oped and normed with students ages 6–25 years with and without disabilities.
The Capacity subscale of the parent version of AIR-S contains one part:
“Things My Child Does.” The Opportunity subscale of the parent version
assesses parents’ impression of their children’s opportunities to engage in
self-determination behaviors at home and school. The teacher version of the
AIR-S also has three Capacity sections (knowledge, ability, and perceptions).
Like the parent version, the Opportunity subscale of the educator version
determines teachers’ impressions of the opportunities their students have to
engage in self-determination behaviors at home and school.

Specific Strengths Assessments

in Autistic Individuals
Much of the identity of an autistic person can be shaped in various ways by
that person’s intrinsic talents and acquired abilities. Assessments in strengths
are commonly achieved using IQ tests such as the Stanford-Binet Intelli-
gence Scales, 5th Edition (Roid 2003); Wechsler Abbreviated Scale of Intel-
ligence (WASI; Wechsler 1999); Wechsler Intelligence Scale for Children,
3rd Edition (WISC-III; Wechsler et al. 1992); Wechsler Adult Intelligence
Scale, 3rd Edition (WAIS-III; Wechsler 1997); and Differential Ability
Scales–II (DAS-II; Elliott 2007) (see Table 4–5). These tests consist of sub-
tests that assess various abilities. For example, the DAS-II School-Age cog-
nitive battery has 17 subtests under 6 categories:

1. Verbal abilities (comprehension, vocabulary, definitions, similarities)

2. Nonverbal abilities (picture similarities, pattern construction)
3. Nonverbal reasoning abilities (picture similarities, matrices, sequential
and quantitative reasoning)
4. Spatial abilities (pattern construction, copying, recall of designs)
5. Working memory (recall of sequential order, recall of digits backward)
6. Processing speed (information processing, rapid naming)
Strengths-Based Model of Neurodiversity and Autism 89

These IQ tests are excellent for determining overall verbal and analytical
abilities, but they do not assess character strengths and other areas such as
musical, athletic, artistic, naturalistic, interpersonal, and intrapersonal abili-
ties. Also, they do not evaluate many abilities in a deeper fashion. Some stan-
dardized achievement tests and specific assessments strive to fill this void. In
the sections that follow, we discuss assessments for logical-mathematical,
verbal-linguistic, visual-spatial, and musical abilities that have been used to
assess individuals on the autism spectrum (see Table 4–5).

Assessments for
Logical-Mathematical Abilities
The Wechsler Objective Numerical Dimensions (Rust 1996) has two sub-
tests: Numerical Operations and Mathematical Reasoning. The Numerical
Operations subtest consists of computational problems such as addition,
subtraction, multiplication, division, and algebra. For Mathematical Rea-
soning, participants are presented with written passages and/or pictures,
each of which poses a mathematical problem that involves number concepts,
algebra, geometry, or statistics.
The Woodcock-Johnson III (WJ-3) has two math subtests: Calculation
and Applied Problems (Woodcock et al. 2001). The Calculation subtest is
composed of problems on mathematical operations, whereas the Applied
Problems subtest consists of word problems testing concepts such as num-
bers and graphs.
The Wechsler Individual Achievement Test, 2nd Edition (WIAT-II;
Wechsler 2001), has two subtests to examine mathematical abilities. The
Numerical Operations subtest assesses basic skills, such as identifying, writ-
ing, and counting numbers, and arithmetic skills, including solving calcula-
tion problems and simple equations. The Mathematical Reasoning subtest
includes skills such as counting, identifying geometric shapes, and solving
single-step and multistep word problems.
In the Wide Range Achievement Test–3 (WRAT-3; Wilkinson 1993),
the arithmetic section is designed to provide a general screening of a person’s
ability to count, solve simple oral problems, and calculate written mathemat-
ical computations.

Assessments for
Verbal-Linguistic Abilities
The Wechsler Objective Reading Dimensions (Rust et al. 1993) consists of
three subtests: Basic Reading, Spelling, and Reading Comprehension. The
90 Neurodiversity

Basic Reading subtest assesses the ability to read a list of single words with
progressively more difficult words. The Spelling subtest examines the ex-
aminee’s ability to spell dictated words. The Reading Comprehension sub-
test evaluates the examinee’s aptitude to read written passages and then
answer questions related to the text. Verbal abilities are similarly assessed in
the Word Reading and Reading Comprehension subtests of the WIAT-II
(Wechsler 2001); the Word Reading and Spelling subtests of the WRAT-3
(Wilkinson 1993); and the Letter-Word Identification and Passage Com-
prehension subtests of the WJ-3 (Woodcock et al. 2001). The approach for
reading comprehension in the WJ-3 is unique in that examinees are asked
to fill in the blanks for missing words in text passages.
The Neale Analysis of Reading Ability (Neale 1999) is used to examine
verbal abilities. The test assesses oral reading and comprehension, discrim-
ination of initial and final sounds, names and sounds of the alphabet, graded
spelling, auditory discrimination and blending, word lists, and silent read-
ing and writing.
The Test of Word Reading Efficiency (Torgesen et al. 1997) comprises
two subtests: Sight Word Efficiency and Phonemic Decoding Efficiency.
The former assesses speed reading of real single words, and the latter eval-
uates phonemic abilities by having subjects read pronounceable nonwords
as quickly as possible.
The Rapid Letter Naming subtest of the Comprehensive Test of Pho-
nological Processing (Wagner et al. 1999) examines the efficiency of re-
trieval of letters and production of word sounds. Rapid naming ability was
shown to predict later reading abilities (Lervag and Hulme 2009).

Assessments for Visual-Spatial Abilities

Visual-spatial abilities in autistic individuals have been evaluated using var-
ious assessments. One of the most popular tasks is block design, which is
used in both the WISC-III (Wechsler et al. 1992) and the WASI (Wechsler
1999). The block design task involves constructing figures using patterns
generated from the sides of cubes. The Rey-Osterrieth Complex Figure
test (Rey 1941, 1968) assesses visuoconstructive abilities and visual-spatial
memory by asking examinees to copy a complex figure and then reproduce
it from memory 3 minutes later. In the Gottschaldt’s Hidden Figure Test
(Gottschaldt 1926; see also Capitani et al. 1988), examinees are presented
with a series of complex geometric figures and asked to identify and trace the
lines of simple figures embedded within the complex patterns. In the Hidden
Figure Identification test (La Femina et al. 2009), examinees are asked to
identify a target stimulus figure embedded in one of six abstract figures for
each item; the total time needed to complete the 12 items is recorded. In
Strengths-Based Model of Neurodiversity and Autism 91

Mental Rotations (La Femina et al. 2009; Trojano et al. 2015), examinees
are presented with a stimulus target shaped as the capital letter L or S, with
small white or black circles at the ends of the letters, and asked to identify
the correct one from six choices; the correct choice is the same as the stim-
ulus target but rotated on the horizontal plane by 45°, 90°, 135°, or 180°.
The total time needed to complete nine items is recorded.
The Visuospatial Processing Speed Task is a paper-and-pencil task that
assesses visual-spatial processing speed (i.e., speed and efficiency in pro-
cessing visual-spatial information) (Kirchner and Thorpe 2006). The Com-
puterized Block Design Task (Cardillo et al. 2017) is a modified version of
a matching task designed by Caron et al. (2006). The Visuospatial Working
Memory Task (Cardillo et al. 2018; Mammarella et al. 2019) is a comput-
erized simple span task for assessing spatial-simultaneous working memory
(Mammarella et al. 2013).

Assessments for Musical Abilities

The Salk and McGill Music Inventory has been used to assess musical abili-
ties in children with neurodevelopmental conditions such as autism (Levitin
et al. 2004). It is an informant-based questionnaire with both multiple-choice
and free-response questions. The questions are classified into six categories:
demographic and physical profile, interest in music, emotional responses to
music, musical creativity and reproduction, musical training, and age at on-
set of musical behaviors.
Musical aptitude in autistic individuals has been assessed with the Mu-
sical Ear Test (Wallentin et al. 2010), which consists of two subtests: “Mel-
ody” and “Rhythm.” Examinees are asked to determine whether two short
musical phrases are identical. The melodic subtest has 52 pairs of melodic
phrases, played on a piano; the rhythm subtest has 52 trials with rhythmical
phrases, played using woodblock beats.

Other Assessments
The Student Developmental Task and Lifestyle Inventory (Winston and
Miller 1987) is based on the theoretical framework of Chickering’s seven
vectors of development (Chickering and Reisser 1993). Used to assess the
psychosocial development of college students, it is composed of three basic
developmental tasks and three scales. The tasks are consistent with three of
the seven vectors in Chickering’s theory, namely Developing Competence,
Developing Mature Interpersonal Relationships, and Establishing and Clar-
ifying Purpose. The scales explore other developmental tasks experienced by
many college students: Salubrious Lifestyle, Intimacy, and Response Bias.
92 Neurodiversity

Interventions Based on the

Strengths-Based Model in Autism
The SBMN is designed to be applied to multiple stakeholders and at vari-
ous levels: individual, familial, organizational, and societal. Interventions
targeting each of these levels are discussed in the following sections.

Interventions Targeting
Autistic Individuals
The SBMN is intended to have sustaining, effective, and positive outcomes
for people on the autism spectrum. After carefully examining individuals us-
ing both traditional and strengths-based assessments, such as those discussed
in the previous section, mental health providers can adopt the following in-
terventions to empower autistic patients to develop their strengths.

Positive Psychology Interventions

Positive psychology is a field of psychology that promotes positive emotions
and character traits (Seligman and Csikszentmihalyi 2000). It is concerned
with maintaining psychological health and well-being rather than correcting
psychopathology. It focuses on developing strengths that can enable people
to grow their individual interests and abilities. Positive psychology is also
about becoming immersed in one’s passion and experiencing satisfaction
from it. Positive psychology interventions targeting character strengths
have been shown to increase happiness in individuals with mood conditions
(Proyer et al. 2015) and individuals on the autism spectrum (Groden et al.
2011; Zager 2013).
To help autistic young adults navigate the transition to adulthood, Na-
dig et al. (2018) implemented a 10-week transition support program focus-
ing on self-determination, social communication, and working with others.
The curriculum was customized to suit participants’ self-expressed needs.
The Self-Determination module has five components: preferences, interests,
and strengths; problem solving; self-advocacy; self-regulation; and choice
making. The Social Communication module consists of the following com-
ponents: initiating, listening, making an impression, perspective taking,
and nonverbal communication. The final module, Working With Others,
is composed of five parts: knowing your context, what makes good partners,
preventing and resolving conflict, getting the bigger picture, and team-
work. The efficacy of this curriculum was demonstrated in a randomized
controlled trial (RCT). Groups of four to six autistic participants and two
Strengths-Based Model of Neurodiversity and Autism 93

facilitators met weekly for 10 weeks. Compared with the waitlist control
group, the intervention group was found to have significantly better scores
in the interpersonal problem-solving subdomain of the Arc’s SDS and to
have higher quality of life as assessed by the Quality of Life Questionnaire,
Abridged Version.
Another evidence-based strengths-based intervention for autistic adults
is the Acquiring Career, Coping, Executive control, Social Skills (ACCESS)
Program (Oswald et al. 2018), a group intervention tailored to enhance
critical skills and beliefs that promote young adult functioning, including
social and adaptive skills, self-determination skills, and coping self-efficacy.
The ACCESS program has nineteen 1.5-hour weekly lessons in three mod-
ules. The Stress and Anxiety Coping Skills module was designed to identify
distorted thoughts and physical feelings associated with stress, anxiety, and
other negative emotions via techniques derived from cognitive-behavioral
therapy and cognitive restructuring therapy. The Self-Determination Skills
module was constructed to develop skills to initiate and set goals, imple-
ment and organize a plan, and self-advocate. The Adaptive and Social Skills
module was designed to develop skills needed at work through a structured
vocational activity. The efficacy of the ACCESS program was assessed in a
pilot RCT (Oswald et al. 2018) involving 44 autistic adults and their care-
givers. Compared with waitlist control subjects, adults in the treatment group
showed significantly improved adaptive and self-determination skills and
greater belief in their ability to access social support to cope with stressors.

Interest-Based Interventions
When autistic individuals are interested in a particular topic, they are more
easily engaged in interventions that can help with their challenges in social
interactions. For example, music is a common interest for people on the spec-
trum. In an RCT of music therapy, autistic children were recruited to receive
either music therapy or a nonmusical intervention (Sharda et al. 2018). Both
interventions involved 45-minute individual weekly sessions for 8–12 weeks.
In the music therapy group, the therapist made use of instruments, songs, and
rhythmic cues to target desirable behaviors, including communication, turn-
taking, sensorimotor integration, social appropriateness, and musical inter-
action. In contrast, the nonmusical intervention was a play-based behavioral
treatment that emphasized emotional engagement, attention, support, and
positive treatment expectancies. Compared with play-based behavioral treat-
ment, individual music therapy resulted in improved communication post in-
tervention (Sharda et al. 2018).
Autistic individuals often show interest in animals. Companion animals
were found to act as buffers against social anxiety (O’Haire et al. 2015).
94 Neurodiversity

Animal-assisted therapy is a goal-oriented, semistructured treatment pro-

vided by a certified professional incorporating an animal trained and certi-
fied to work with people with differences in mental and physical abilities.
Animal-assisted interventions have been shown to increase social interaction
and communication in autistic children (O’Haire 2013). In an RCT of dog-
assisted therapy, 10 weekly 60-minute one-to-one sessions were shown to
enhance social awareness and communication in autistic adults with average
to high intelligence (Wijker et al. 2020).

Interventions Targeting Families

Behavioral treatments, such as applied behavior analysis and pivotal response
training, have been used in the field of autism for many years. These inter-
ventions can be implemented using either deficits- or strengths-based ap-
proaches. Steiner (2011) compared deficits- and strengths-based approaches
in teaching parents to implement the pivotal response training. During the
strengths-based approach, parents were found to display improved affect,
to make more positive statements about their children, and to exhibit more
physical affection toward their children than during the deficits-based ap-
proach.
Integrated strengths-based programs targeting families have been devel-
oped for transition planning with autistic adolescents. The Better OutcOmes
and Successful Transitions for Autism (BOOST-A) is an online program that
uses cartoon animations and visuals to engage adolescents on the spectrum
and provide structured guidance in four modules (Hatfield et al. 2018). The
first module, About Me, completed by the parent and adolescent, is com-
posed of six activities that identify the adolescent’s career interests and sen-
sory preferences in relation to the work environment. The second module,
My Team, also completed by the adolescent and parent, identifies people
who would support them in transition planning, guides parents to book the
first meeting, and helps the adolescent to identify how he or she wants to be
involved in the team meeting. The third module, First Meeting, involves the
adolescent, the parent, and the team members. The team reviews the ado-
lescent’s strengths and interests, presents potential job pathways to the ado-
lescent and parent, and sets goals recommended by BOOST-A. The fourth
and final module, My Progress, involves a series of meetings among the team
members, the parent, and the adolescent; the adolescent is expected to play
an increasingly more active role in reviewing goals, discussing challenges,
and framing learning experiences that build resilience (Hatfield et al. 2018).
In a quasi-RCT involving 49 adolescents in the intervention and 45 in the
control group, BOOST-A was found to enhance some employment-related
Strengths-Based Model of Neurodiversity and Autism 95

outcomes, including parent-reported self-determination at home, career

exploration reported by both the adolescent and the parent, and parent-
reported transition-specific self-determination (Hatfield et al. 2017).

Interventions Targeting Organizations

Educational Settings
Groden et al. (2011) focused on five character traits: optimism, humor, self-
efficacy, kindness, and resilience. They designed specific activities to nurture
children and adolescents with autism and other developmental conditions
in the classroom setting. To promote optimism, teachers helped students
focus on positive aspects of their lives and change their beliefs about adver-
sity through activities using the following four methods: modeling, positive
scanning, positive affirmations, and cognitive picture rehearsal. To nurture
humor, teachers included activities to introduce different levels of humor
(e.g., reading comical books with students, watching humorous musical vid-
eos, organizing theme days such as “wear your pajamas day”). To enhance
self-efficacy in their students, teachers taught strategies to improve the stu-
dents’ executive functions (e.g., time management, reinforcing controllable
components) and self-management skills (self-monitoring, self-evaluating,
goal setting). Students were guided to replace negative thinking with posi-
tive and realistic thinking. To teach kindness, teachers incorporated various
innovative activities to their curriculum. Some examples were drama, role-
playing, animal therapy, a kind deeds program, positive affirmations, and
volunteering in the community. To promote students’ resilience (i.e., the ca-
pacity to cope and feel competent), teachers were encouraged to cultivate
the school environment to help students learn to regulate themselves, de-
velop their abilities and talents, learn from their mistakes, increase auton-
omy, and enhance their personal connectedness with the community.

Workplace Settings
Eighty percent of autistic individuals are unemployed or underemployed.
This rate is significantly higher than that of typically developing peers and
all other groups with neurodevelopmental disorders (Baldwin et al. 2014;
Howlin et al. 2004; Roux et al. 2013; Shattuck et al. 2012; Taylor et al.
2015). This disparity has negatively impacted autistic youth and adults at
vocational, economic, and social levels and has limited their access to op-
portunities that are vital to their flourishing and well-being as adults. Au-
tistic adults are known to face significant challenges in typical interview
processes and transitions to the workplace. Since 2013, companies such as
96 Neurodiversity

Microsoft, SAP SE, and DXC Technology have been proactively recruiting,
selecting, training, and supporting young autistic people through targeted
initiatives focused on high-functioning autistic adults. These companies
have reported that autistic individuals have generated significant innovations
in their companies. A case study at SAP found that autistic individuals sup-
ported by its Autism at Work program (see Chapter 9) helped develop a tech-
nical fix worth an estimated $40 million in savings (Austin and Pisano 2017).
Froman (2010) applied Seligman and Csikszentmihalyi’s (2000) positive
psychology concepts to the employment setting and demonstrated the rela-
tionship between positive psychology and organizational outcomes. Many
of the key themes were consistent with the SBMN. Froman described how
immersing oneself in a fulfilling experience could drive self-determining at-
titudes and behaviors that would result in positive employment outcomes.
Another important concept of positive psychology is resilience. When ap-
plied to organizations, this concept is referred to as human resource resiliency.
Related specific strategies include supportive environment, ethical and trust-
worthy culture, and investment in the human and social capital of employees.
Human resource resiliency is especially important during times when the or-
ganization is struggling. Depending on the stability of the organization and
the economy in general, changes, restructuring, and job losses in organiza-
tions are inevitable. Organizations that have a resilient human resource at-
mosphere are better able to handle challenging times with their employees.
Research also found that teams that have high performance demonstrated
significantly more positive functioning and higher team connectivity (i.e.,
how much team members influence each other’s behavior) than teams with
average and low performance (Losada and Heaphy 2004). Overall, the ap-
plication of positive psychology principles in the workplace has shown de-
sirable organizational outcomes.

Interventions at the Societal Level

Autism is only one of the neurodiverse conditions. To maximize the poten-
tial of neurodiversity, we should introduce the SBMN to the society at large.
A culture change to embrace the strengths of neurodiverse individuals will
benefit all people. Therefore, we need to bring people together and find
common ground. As discussed by Ortega in 2009, the neurodiversity move-
ment in the late 1990s and early 2000s introduced significant differences be-
tween self-advocates and parents of children on the autism spectrum, as well
as health care professionals caring for autistic individuals (Ortega 2009).
Self-advocates demanded to be left alone and opposed attempts to find a
cure for autism. Parents and professionals wanted the opposite. Can we find
Strengths-Based Model of Neurodiversity and Autism 97

a common ground for all to work together? We speculate that the SBMN
may serve this purpose (Donaldson et al. 2017).
The SBMN is about bringing all stakeholders together and systemati-
cally creating an environment that treasures diversity at the neurological
and behavioral levels. As we illustrate throughout this book, developing the
strengths and interests of neurodiverse individuals not only benefits neuro-
diverse people; it benefits everybody. To be effective, the SBMN needs to
be advocated and practiced at all levels. In this chapter, we articulated ap-
proaches to practicing the SBMN on the individual level and in families,
schools, and the workplace. At the societal level, we need to introduce the
SBMN to self-advocates, parents, and leaders of small and large organiza-
tions, as well as to people who hold leadership positions in the public sector,
and demonstrate the positive impacts that have resulted from the practice
of the SBMN in various settings.

Case Example
Robert was a 30-year-old autistic computer programmer who worked in a high-
tech company. He graduated from a state university with a bachelor’s degree in
computer science and mathematics. He had been working in the same company
for 5 years. Robert tended to work alone. He was always polite to his coworkers,
but he seldom spoke with them and did not hang out with them outside of work.
Robert was diligent and detail oriented. He had never missed a day of work. Al-
though Robert was conscientious and had a good work ethic, he had not had a
promotion since he joined the company. He was frustrated about this because
all of his peers who started at the same time had been promoted. Robert became
increasingly more anxious. He started losing sleep, and his appetite decreased.
He decided to seek help from Dr. Wise, a psychiatrist who specialized in prac-
ticing positive psychology with adults on the autism spectrum.
Robert explained to Dr. Wise about his frustration at work. After several
exploratory sessions, Robert uncovered that his strengths in the workplace
were not well recognized because of inadequate communication with his team
and his supervisor. Dr. Wise suggested working on positive communication.
Over the next few months, they worked on active listening, active construc-
tive responding, and other communication strategies. Robert became more
attuned to what was going on with his teammates and better able to under-
stand what his supervisor was looking for. He started enjoying his work in a
team environment and contributing much more to the team than ever before.
In less than a year, Robert got his first promotion, and his supervisor nomi-
nated him for a company-wide award for the innovative work he had done.

Conclusion
The SBMN has tremendous potential to benefit people on the autism spec-
trum. Although this approach is in its infancy, we have demonstrated that
98 Neurodiversity

it can potentially result in changing our culture to one that embraces neu-
rodiversity. This consequence will provide many more opportunities not
only to people on the autism spectrum but also to those with other neuro-
logical and behavioral differences. This culture change will also bring di-
verse ideas to society, resulting in more innovations and higher productivity.
Neurodiversity is not only about practicing social justice. It can become a
competitive advantage for organizations. Ultimately, this culture change will
benefit us all.

KEY CONCEPTS
• People on the autism spectrum often have significant character strengths
and specific abilities, skills, and talents that need to be uncovered.
• Specific assessments such as the Values in Action Inventory of Strengths,
Arc’s Self-Determination Scale, and the American Institutes for Research
Self-Determination Scale are validated tools to assess specific character
strengths in individuals on the autism spectrum.
• Current strengths-based interventions for people on the autism spectrum
are based on positive psychology and understanding of the person’s in-
terests and strengths.
• Strengths-based interventions have been applied to enhance innova-
tion in educational and employment settings.
• A new approach in bringing all stakeholders together in the neurodiver-
sity movement is based on leveraging the benefits brought to society by
implementing the strengths-based model of neurodiversity.

Recommendations for Educators,

Clinicians, and Other Professionals
• Invite neurodiversity experts to educate your staff about autism, neuro-
diversity, and the strengths-based model of neurodiversity.
• Cultivate a neurodiversity-friendly environment in education and em-
ployment settings.
• Invest in incorporating positive psychology into your curriculum and
practice.
• Assess people on the spectrum based on their strengths, not only their
challenges.
Strengths-Based Model of Neurodiversity and Autism 99

• Consider initiating specialized support programs for people on the au-

tism spectrum in education and employment settings.

Discussion Questions
1. What strengths-based assessments are most useful in evaluating autistic
individuals in the educational setting?
2. What are some criteria that will make currently available strengths-
based assessments better? How specific do they need to be for practical
use in the autism population?
3. How can we improve on currently available strengths-based interven-
tions for children, adolescents, and adults on the autism spectrum?
4. What are some of the major hurdles for the use of strengths-based as-
sessments and interventions in the workplace?
5. What are some prime examples of successful diversity campaigns in his-
tory? What made them effective in creating cultural change?

Suggested Readings
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with autism spectrum disorder without intellectual impairment. J Autism
Dev Disord 46(10):3330–3337, 2016
Mottron L, Bouvet L, Bonnel A, et al: Veridical mapping in the development
of exceptional autistic abilities. Neurosci Biobehav Rev 37(2):209–228, 2013
100 Neurodiversity

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 FIVE
Strengths-Based
Model of
Neurodiversity and
ADHD
Lawrence K. Fung, M.D., Ph.D.

If I’m not interested in something, I just don’t grasp it.

Sir Richard Branson

ADHD is one of the most common neurodiverse conditions. Despite

having challenges in educational and employment settings, numerous
individuals with ADHD have overcome their obstacles and demon-
strated their strengths of character. High levels of energy, hyperfocus,
and creativity are often found in people with ADHD. This chapter de-
scribes use of the strengths-based model of neurodiversity (SBMN)
for assessing individuals with ADHD based on their strengths, and
then provides several examples of strengths-based interventions used
in school and work settings.

ADHD affects about 3%–7% of people worldwide (Polanczyk et al. 2007;

Simon et al. 2009; Thomas et al. 2015). Although the characteristics of
ADHD are well defined, people can find these qualities to be both strengths

109
110 Neurodiversity

and challenges, depending on the context (Table 5–1). For example, many
people with ADHD are impulsive; although this behavior is often viewed
as a significant challenge, in some contexts it can lead to positive outcomes
due to rapid decision making. Similarly, people with ADHD are often
known to be hyperactive; however, if the task at hand requires tremendous
energy and stamina, they are more likely to complete the work first. Many
individuals with ADHD have difficulty focusing on tasks that are of no in-
terest to them, yet they will hyperfocus on tasks that do interest them; this
ability to hyperfocus can become a competitive advantage in any setting.
Also, people with ADHD tend to be easily distracted, but the flip side of
this can be creativity. Furthermore, many people with ADHD are known
to use their high levels of energy to handle multiple tasks at the same time.
Executives with ADHD often show strengths in seeing the “big picture”
and acting “cool in a crisis.” By deliberately assessing the strengths of peo-
ple with ADHD, we will be able to uncover their potential and steer them
toward developing their identity based on their strengths.

Strengths in People With ADHD

Many successful and famous people, including the successful business mag-
nate Sir Richard Branson, whose quote began the chapter, have disclosed
their ADHD diagnosis (Lee et al. 2020). Among the many strengths of in-
dividuals with ADHD, creativity has been reported most frequently (Boot
et al. 2017; Mahdi et al. 2017; Sedgwick et al. 2019; White and Shah 2006,
2011). In addition, the abilities of people with ADHD to hyperfocus on
things that interest them have also been discussed (Mahdi et al. 2017; Sedg-
wick et al. 2019). Impulsivity has been found to be a major driver of action
by entrepreneurs with ADHD, and hyperfocus has been shown to be a ma-
jor agent for the consequences, both positive and negative, of entrepre-
neurial action (Wiklund et al. 2016). These findings are important because
they can be used to formulate strengths-based interventions for children
and adolescents in educational settings and for adults in employment set-
tings. Furthermore, these research findings can stimulate medical and psy-
chiatric providers to steer their patients toward focusing on their strengths
rather than their challenges.

Character Strengths
Compared with age- and sex-matched typically developing (TD) control
subjects, children with ADHD were found to demonstrate higher novelty
seeking (Kang and Kwack 2018) and, as expected, lower cooperativeness,
Strengths-Based Model of Neurodiversity and ADHD 111

TABLE 5–1. Strengths and challenges of individuals with ADHD

Strengths Challenges

Rapid decision making Impulsivity

High energy Hyperactivity
Creativity Distractibility
Hyperfocus on tasks that interest them Difficulty focusing on tasks that do not
Resilience interest them

Multitasking
Big-picture thinking
Cool in a crisis

self-directedness, and persistence. Compared with a group of children with

other psychiatric conditions, children with ADHD demonstrated higher
novelty seeking and self-directedness but lower persistence (Drechsler et al.
2018; Melegari et al. 2015). Children with ADHD were also found to have
higher novelty seeking but lower harm avoidance than autistic children (Ker-
ekes et al. 2013). In a study of twins with ADHD or autism, the cross-trait,
cross-twin correlations with novelty seeking, persistence, self-directedness,
and cooperativeness were more than twice as strong in monozygotic pairs
as in dizygotic pairs (Kerekes et al. 2013); this result suggests that common
genetic effects influence both ADHD and autism and their personality di-
mensions.
In a case series of six successful adults with ADHD, positive aspects of
ADHD were investigated using a phenomenological approach with open-
ended interviews (Sedgwick et al. 2019). Utilizing thematic content analysis,
the authors reported six core themes—resilience, courage, transcendence,
humanity, energy, and cognitive dynamism—and six subthemes—divergent
thinking, hyperfocus, nonconformism, adventurousness, self-acceptance,
and sublimation. In a large qualitative study involving 76 participants from
five countries (Brazil, India, Saudi Arabia, South Africa, and Sweden), a high
level of energy and drive, creativity, hyperfocus, agreeableness, empathy, and
willingness to assist others were the most consistently reported strengths as-
sociated with adults with ADHD (Mahdi et al. 2017).

Creativity
Creativity often involves divergent thinking, which allows for generating mul-
tiple ideas to solve a problem. Depending on the context, convergent thinking,
which is the ability to associate and integrate loosely connected concepts, is
112 Neurodiversity

also needed for innovation. Compared with TD control subjects, adults with
ADHD have been found to exhibit higher levels of divergent thinking but
lower levels of convergent thinking (White and Shah 2006). Adults with
ADHD performed better than TD adults on the Unusual Uses Task, a mea-
sure of divergent thinking, but worse on the Remote Associates Test, which
assesses convergent thinking. Predictably, adults with ADHD did not score
as well on the semantic inhibition of return task, which measures executive
inhibitory control. However, this lower performance in inhibition was found
to mediate divergent thinking and creativity.
The Abbreviated Torrance Test for Adults (ATTA; Goff and Torrance
2002) is a commonly used measure of creativity. Compared with TD adults,
adults with ADHD demonstrated higher levels of original creative thinking
on the verbal section of the ATTA and increased levels of real-world cre-
ative achievement (White and Shah 2011). Furthermore, on FourSight:
The Breakthrough Thinking Profile (Puccio 2002), subjects with ADHD
were shown to score higher in idea generation but lower in idea develop-
ment and problem clarification.
Motivation for demonstrating creativity has also been studied in adults
with ADHD. When no reward was presented in a competition, no differ-
ence in idea generation was found between individuals with ADHD and
TD control subjects (Boot et al. 2017). However, when a bonus was in-
cluded in the competition, adults with ADHD generated more original
ideas than did the control group. These findings indicate that goal-directed
motivation can be effective for motivating adults with ADHD to demon-
strate their creativity in the real world.

Assessment of Strengths in ADHD

Based on key principles of positive psychology (Seligman and Csikszentmi-
halyi 2000), strengths-based assessments have been implemented and stud-
ied (Rashid and Ostermann 2009). Designed to complement the medical
model, which is based on evaluation of deficits, strengths-based assessment
is a multimodal approach that explores a person’s strengths as well as chal-
lenges; therefore, the strengths-based model of assessment is about appre-
ciating the whole person and leveraging strengths to counter challenges
when they emerge. Strengths-based assessments focus on four key aspects:
1) challenged characteristics, 2) strengths and assets, 3) environmental fac-
tors that precipitate challenging situations, and 4) environmental resources
that support positive functioning. This section explores various aspects of
strengths-based instruments used to assess individuals with ADHD.
Strengths-Based Model of Neurodiversity and ADHD 113

Character Strengths
The Temperament and Character Inventory (TCI; Cloninger et al. 1994)
is a 238-item self-rating instrument designed to assess adults. It was con-
structed from Cloninger’s biopsychosocial theory of personality (Cloninger
et al. 1993), which assumes that personality involves four temperament di-
mensions (harm avoidance, novelty seeking, reward dependence, and per-
sistence) and three character dimensions (self-directedness, cooperativeness,
and self-transcendence). The TCI has been used to assess autistic adults and
adults with ADHD (Anckarsäter et al. 2006).
The Cloninger Junior Temperament and Character Inventory (JTCI;
Luby and Svkakic 1999) is an instrument of temperament and emerging
character developed for use with children ages 9–13 years. Similar to the
TCI, it is based on Cloninger’s model of personality. The JTCI assesses tem-
perament of children in the same four basic dimensions as those assessed
with the TCI. The inventory consists of 108 true/false items to be answered
by parents, teachers, or the children themselves. The JTCI has been used to
assess character for children with ADHD (Kang and Kwack 2018; Kerekes
et al. 2013) and other conditions such as autism (Kerekes et al. 2013).

Self-Determination
Two measures of self-determination in autism—the Arc’s Self-Determination
Scale (SDS; Wehmeyer and Kelchner 1995) and the American Institutes
for Research Self-Determination Scale (AIR-S; Wolman et al. 1994)—were
described in Chapter 4. To our knowledge, these instruments have not been
used in assessing individuals with ADHD. However, the Self-Determination
Student Scale (SDSS; Hoffman et al. 2015) has been used to measure self-
determination in students with ADHD (see “SBMN Interventions Based on
Strengths-Based Model in ADHD,” later in this chapter). The SDSS is the
original 92-item self-report instrument that assesses the cognitive and affec-
tive domains of self-determination. The 43-item SDSS-SF is a short form
of the SDSS. The instrument was conceptualized around the Action Model
for Self-Determination, which is structured with five components of indi-
vidual characteristics: 1) know yourself and your context, 2) value yourself,
3) plan, 4) act, and 5) experience outcomes and learn. Each of these compo-
nents is further delineated by subcomponent knowledge, skills, and beliefs.

Creativity and Divergent Thinking

Creativity can be defined as the ability to generate ideas that enhance one’s
experience in all possible ways. The Torrance Tests of Creative Thinking
114 Neurodiversity

(TTCT; Baer 1993; Kim 2006) were designed to assess creativity, divergent
thinking, and other problem-solving skills. The TTCT have four subscales:
1) Fluency, which measures interpretable, meaningful, and relevant ideas
generated in response to the stimulus; 2) Flexibility, which quantifies differ-
ent categories of ideas; 3) Originality, which assesses the rarity of the ideas;
and 4) Elaboration, which evaluates the level of detail in the ideas. The
ATTA is an abbreviated version of the TTCT and consists of three tasks—
one verbal and two figural—that yield scores for the same four subscales as
the TTCT. The TTCT have been used to assess creativity in children with
ADHD (Healey and Rucklidge 2005).
The Creative Achievement Questionnaire (Carson et al. 2005) is a self-
report instrument consisting of 96 items divided into three sections. The
first section asks respondents if they think they have more talent, ability, or
training than an average person in 13 domains: visual arts (painting, sculp-
ture), music, dance, individual sports (tennis, golf), team sports, architec-
tural design, entrepreneurial ventures, creative writing, humor, inventions,
scientific inquiry, theater and film, and culinary arts. The second section
lists seven choices of achievement levels for each of 10 standard domains of
artistic and scientific domains (visual arts, music, dance, creative writing,
architectural design, humor, theater and film, culinary arts, inventions, and
scientific inquiry). Respondents are asked to report their level of achieve-
ment for each domain. The third section contains three questions asking
respondents how others perceive them regarding characteristics of creativ-
ity. This questionnaire has been used to assess divergent thinking in indi-
viduals with ADHD and other psychiatric conditions (Zabelina et al. 2014).
The FourSight is a self-report instrument that assesses four phases of
creative problem solving: problem identification, idea generation, solution
development, and solution implementation (Puccio 2002). Each item cor-
responds to a phase of problem solving. The responses are weighted and
summed to yield a score for each thinking type. The FourSight identifies
four styles of problem solving: Clarifiers define and structure the problem;
Ideators generate ideas; Developers elaborate and refine ideas and solutions;
and Implementers incorporate a refined idea into a final product or solution.
Research suggests that problem identification and solution development
require convergent thinking, whereas idea generation involves divergent
thinking (Brophy 2001).
The Unusual Uses Task is designed to assess divergent thinking (White
and Shah 2006). This task requires participants to name as many uses as pos-
sible for two common household objects (a brick and a bucket) in 2 minutes.
Fluency, flexibility, and originality are scored. Fluency is defined as the number
of nonredundant uses stated per object. Flexibility is the number of categories
stated and the number of shifts in categories between responses. Originality is
Strengths-Based Model of Neurodiversity and ADHD 115

defined as the uniqueness of each response, as determined by the frequency

of each response as compared with the entire sample. The subscores for flu-
ency, flexibility, and originality are converted to Z scores and combined to
produce an overall measure of divergent thinking (Carson et al. 2003).
In contrast to the Unusual Uses Task, the Remote Associates Test is de-
signed to assess convergent thinking (White and Shah 2006). The test is
composed of 18 word trios (e.g., mine, lick, sprinkle) adapted from Med-
nick (1962). Participants are instructed to generate a word that relates to all
three words in the set (e.g., salt). Participants are given 5 minutes for the
entire test. The proportion of correct responses is used as an index of con-
vergent thinking.

SBMN Interventions Based on

Strengths-Based Model in ADHD
Interventions in Educational Settings
Interventions for college students with ADHD have largely been support-
ive. Many colleges provide coaching for time management and study skills.
Some programs utilized cognitive-behavioral therapy to reduce symptoms
of ADHD. In this section, we focus on the use of strengths-based interven-
tions in educational settings. Anastopoulos and King (2015) reported the
development and assessment of the Accessing Campus Connections and
Empowering Student Success (ACCESS) program (not the same ACCESS
program described in Chapter 4), an 8-week intervention that included
weekly group CBT sessions (90 minutes each) and weekly individual men-
toring sessions (30 minutes each). The 8-week intervention was followed by
maintenance treatment with two booster CBT group sessions and five or six
30-minute individual mentoring sessions every 2–3 weeks. The group ses-
sions were lecture-based discussions with three major components: ADHD
knowledge, behavioral strategies, and cognitive therapy. Mentors were mas-
ter’s degree students, doctoral students, or postdoctoral fellows who had a
background in psychology. In the individual sessions, mentors discussed
goals for academic performance and personal success, provided guidance on
what resources students might consider to support their goals, monitored
their progress, and provided students with personal coaching. Preliminary
results indicated that the ACCESS program was effective in increasing stu-
dents’ knowledge in ADHD, enhancing their use of organizational skills,
and decreasing maladaptive thinking. Furthermore, the program appeared
to reduce core symptoms of ADHD, improve emotional well-being, and in-
crease their use of relevant campus resources.
116 Neurodiversity

As interventions target the reduction of the core symptoms of ADHD,

more and more investigators and educators are noticing the benefits of us-
ing strengths-based approaches to leverage the intrinsic abilities of people
with ADHD by promoting their competence and resilience (Climie and
Mastoras 2015). Martin Seligman proposed the PERMA model as a way to
focus on the fundamental components of strengths-based interventions:
Positive emotions, Engagement, Relationships, Meaning, and Achievement
(Seligman et al. 2009). In the classroom setting, the strengths-based ap-
proach involves identifying individuals’ abilities, nurturing their strengths,
and enhancing their engagement, motivation, and self-esteem (Sherman et
al. 2006). Positive academic curricula emphasize reading and success with
social skills programs, which help students to fit in with the rest of their class
(Jenson et al. 2004). Teachers can cultivate positive experiences with stu-
dents by teaching self-management strategies and celebrating successes with
students. This approach is intrinsically motivating and rewarding. Some
specific strategies for teachers to increase the frequency of positive and au-
thentic praise for students with behavioral challenges were described by Jen-
son et al. (2004).
Another important facet of the strengths-based approach is to cultivate
resilience in people with ADHD. Research has been conducted to demon-
strate the efficacy of curricula to boost the resilience and character strengths
of students in the educational setting (Seligman et al. 2009). For example,
the Penn Resiliency Program, one of the most widely researched programs
designed to prevent depression in young people, was investigated in chil-
dren with ADHD (Howard 2014). Although the program did not reduce
disruptive behaviors, it was effective in improving academic performance in
elementary school students. Another strategy to enhance resilience in indi-
viduals with ADHD is to help them experience success by identifying and
nurturing their “Islands of Competence” (Goldstein et al. 2013). When in-
dividuals discover their strengths, they are more willing to work on their
challenging areas.
Positive psychology has been applied to a variety of support programs
for college students with ADHD. Farmer et al. (2015) developed the Per-
sonal Strengths Program (PSP) and evaluated it in seven college students
with learning disabilities and/or ADHD. Based on positive psychology and
self-determination and designed to help students identify strengths and use
them to overcome academic challenges, the PSP consists of 1-hour weekly
sessions covering a range of topics over 8 weeks. A personal strengths coach
meets with each student in these sessions to develop goals, provide coach-
ing, and monitor progress. The coach addresses the student’s needs flexibly
and covers topics such as self-awareness, character and learning strengths,
and communication skills. Students’ level of self-determination was mea-
Strengths-Based Model of Neurodiversity and ADHD 117

sured by the SDSS before the PSP, after three sessions were completed, and
after the full PSP was completed. The findings from this pilot study were
mixed, possibly due to the small sample size. The change in SDSS scores
did not support a positive effect on self-determination related to participa-
tion in the PSP. However, all participants subjectively reported that the
PSP was a beneficial experience.

Interventions in the Workplace

Adults with ADHD often face challenges in the workplace. Those who are
successful in employment settings exhibit high levels of motivation, per-
sistence, and creativity (Nadeau 2005). They find the career that fits their
abilities and establish supportive environments around them both person-
ally and professionally.
As described in Chapter 4, Froman (2010) applied the positive psychol-
ogy concepts of Seligman and Csikszentmihalyi (2000) to the employment
setting and demonstrated the relationships between positive psychology
and organizational outcomes. Many major concepts were consistent with
the SBMN.

Case Example
Michael, a 32-year-old civil engineer, sought help from Dr. Folkman after
being informed by his supervisor that he would not be promoted to man-
ager after having worked for 5 years in the company (one of the largest civil
engineering corporations in the United States). Michael had been working
diligently for years but felt that he had never been able to complete his work
promptly. Although the quality of his reports was high, his output was far
below what was expected by his supervisor. Michael recalled that, as a child,
he was bright in mathematics and other science subjects but struggled with
reading and writing. When he struggled, Michael made up for it by working
extra hard for longer periods.
Dr. Folkman conducted a full psychological evaluation. She began with
a clinical interview and administered a few neuropsychological tests. Michael
was also asked to complete the Myers-Briggs Type Indicator personality in-
ventory and the Strong Interest Inventory. Results from neuropsychological
testing indicated that Michael had a full-scale IQ of 133. His abstract rea-
soning and vocabulary were excellent despite his challenges in reading and
writing. He performed exceptionally on visual-spatial and mathematical
questions but poorly in tests that evaluated reading and writing skills. Mi-
chael’s processing speed was found to be low, and his verbal working memory
was below average. Overall, Michael’s psychiatric history and testing results
were consistent with diagnoses of ADHD and dyslexia, which are common
co-occurring conditions. His Myers-Briggs results showed that his person-
ality was characterized by introversion, intuition, thinking, and judging. His
118 Neurodiversity

responses to the Strong Interest Inventory suggested that engineering was

in line with his interests.
Dr. Folkman discussed the assessment findings with Michael over the
next two sessions. She provided an overview of ADHD and dyslexia and de-
scribed the neuroscience behind these conditions. She also recommended
that Michael attend an adult ADHD support group. Over the next few weeks,
Dr. Folkman worked with Michael to analyze his strengths and challenges at
work. She recommended that he consider a medication consultation.
Interest and IQ testing both indicated that Michael’s career choice of
engineering was appropriate. However, because his challenges with writing
reports quickly and accurately had impeded his promotion, Dr. Folkman
suggested that he think about finding a workplace that treasures his
strengths. As Michael considered that possibility, he decided first to see a
psychiatrist for medication consultation. The psychiatrist prescribed a stim-
ulant medication, to which Michael responded well. He felt better able to
stay focused at work. His executive function also improved after working
with Dr. Folkman on organizational skills.
In a 4-month period, the combination of strengths-based intervention,
medication management, and supportive psychotherapy helped Michael to
turn his career around. His diagnosis of ADHD allowed him understand his
challenges. The strengths-based approach helped him think constructively.
The stimulant medication was instrumental in improving Michael’s level of
concentration. Over the next few months, Michael’s productivity increased
dramatically. His supervisor noticed the significant change and informed
Michael that promotion to the manager position was a possibility.

Conclusion
People with ADHD have much to contribute from their intrinsic strengths
of creativity, high energy, resilience, multitasking. By using the SBMN, we
systematically discover their strengths and help them develop in their for-
mative years. Strengths-based assessments and interventions are emerging.
Our field has many potential opportunities to incorporate positive psychol-
ogy and positive psychiatry into our clinical practice so as to improve the
quality of life for individuals with ADHD.

KEY CONCEPTS
• Individuals with ADHD often have significant strengths in creativity and
resilience. When they identify tasks that interest them, they can achieve
much with high energy and hyperfocus.
• Specific assessments such as the Temperament and Character Inventory,
Arc’s Self-Determination Scale, Torrance Tests of Creative Thinking, and
Strengths-Based Model of Neurodiversity and ADHD 119

Creative Achievement Questionnaire are validated tools to assess various

strengths in people with ADHD.
• Current strengths-based interventions are based on positive psychology
and understanding of the person’s interests and strengths.
• Strengths-based interventions have been used to enhance innovation in
educational settings.

Recommendations for Educators,

Clinicians, and Other Professionals
• Invite neurodiversity experts to educate your staff about ADHD, neu-
rodiversity, and the strengths-based model of neurodiversity.
• Cultivate a neurodiversity-friendly environment in education and em-
ployment settings.
• Incorporate positive psychology into your curriculum and practice.
• Assess individuals with ADHD based on their strengths, not only their
challenges.
• Consider initiating specialized support programs for people with ADHD
in education and employment settings.

Discussion Questions
1. What strengths-based assessments are most useful in evaluating indi-
viduals with ADHD in the educational setting?
2. What are some criteria that will improve currently available strengths-
based assessments? How specific do these assessments need to be for
practical use with the ADHD population?
3. How can we improve on currently available strengths-based interven-
tions for children, adolescents, and adults with ADHD?
4. What are some major hurdles for the use of strengths-based assessments
and interventions for individuals with ADHD in the workplace?

Suggested Readings
Climie EA, Mastoras SM: ADHD in schools: adopting a strengths-based
perspective. Can Psychol 56(3):295–300, 2015
120 Neurodiversity

Farmer JL, Allsopp DH, Ferron JM: Impact of the Personal Strengths Pro-
gram on self-determination levels of college students with LD and/or
ADHD. Learn Disabil Q 38(3):145–159, 2015
Healey D, Rucklidge JJ: An exploration into the creative abilities of chil-
dren with ADHD. J Atten Disord 8(3):88–95, 2005
Mahdi S, Viljoen M, Massuti R, et al: An international qualitative study of
ability and disability in ADHD using the WHO-ICF framework. Eur
Child Adolesc Psychiatry 26(10):1219–1231, 2017
Nadeau KG: Career choices and workplace challenges for individuals with
ADHD. J Clin Psychol 61(5):549–563, 2005
Rashid T: Positive interventions in clinical practice. J Clin Psychol 65(5):461–
466, 2009
Rashid T, Ostermann RF: Strength-based assessment in clinical practice.
J Clin Psychol 65(5):488–498, 2009
Sedgwick JA, Merwood A, Asherson P: The positive aspects of attention
deficit hyperactivity disorder: a qualitative investigation of successful
adults with ADHD. Atten Defic Hyperact Disord 11(3):241–253, 2019

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 SIX
Strengths-Based
Model of Dyslexia
Nicole S. Ofiesh, Ph.D.
Henry B. Reiff, Ph.D.

There are some benefits to [dyslexia] actually. I think in my way

of thinking, I think much more about conceptual things.
Probably in many ways much quicker than people who are
more sequential in their thinking...and so there are some
benefits to that. I found out in running my business that I could
conceive of things [maybe] more quickly than other people
could. And it helped obviously to determine and develop a
company and come up with novel ideas and such.
Charles Schwab, Founder and Chairman of the Board, Charles
Schwab Corporation (from Child Mind Institute video)

The goal of this chapter is to promote individual well-being among

dyslexic people. By understanding the dichotomy between the chal-
lenges they face and their extraordinary abilities, society can redefine
what it means to be dyslexic and recognize that dyslexia is more than
a reading issue; it is a way of interacting with the world. As the field
of neurodiversity recognizes these abilities, which are often seen to an
atypically higher level than in those without dyslexia, support can be
provided so that dyslexic people are fully equipped to navigate the en-
tire lifespan (Cortiella and Horowitz 2014; West 2009). Only then
can everyone benefit from the incredible amount of talent that is lost
when the focus is solely on the challenges of being dyslexic.

123
124 Neurodiversity

Dyslexia Defined
Learning to read is one of the first skills required of children as soon as they
enter school. Dyslexic individuals have challenges with performing tasks as-
sociated with rote sequential memory, phonological and orthographic pro-
cessing, working memory, rapid naming speed, and perceptual speed, which
happen to be the core components that underlie successful reading. Con-
sider the experience of a young child struggling at age 5 years with some-
thing seemingly everyone else in the classroom is mastering. The idea of
putting symbols together to form a word that has both an auditory and a
visual representation can be confounding at least and devastating at most.
In preschool and elementary school, this learning task begins with learning
the sounds and letters of the alphabet, which is taught as having 26 letters.
In reality, because each letter has two symbols, an uppercase and a lower-
case, the requirement is to learn 52 letters. Compound this with the fact
that some letters also convey hard and soft phonemes (e.g., the letter C can
sound like /kuh/ or /ss/), and the entire task can become overwhelming.
The cognitive demands that are made on the core components of the brain
when reading overload the dyslexic brain.
While other children are blending and segmenting sounds to make new
words, reading stories, and investigating interesting topics, the dyslexic
child is grappling with the basics of blending letter-sound representations
and recognizing word patterns. Some rely heavily on memorizing what the
whole word looks like, which is eventually ineffective. Dyslexic children
quickly become outliers when confronted with reading. They struggle to
keep up, not only in reading but often across the curriculum, because learn-
ing in most subjects relies on reading. The overall intelligence, thinking
abilities, and oral vocabulary that are usually solidly intact among dyslexic
children present a confusing picture to teachers and parents. In many cases,
the precocious nature and academic self-concept of these children erode
quickly when they begin learning to read (Riddick 2010; Smith 1989).
Dyslexia is found in 15%–20% of the population (Cortiella and Horow-
itz 2014; Horowitz et al. 2017; International Dyslexia Association 2020c).
It is characterized as a language-based learning disability because of its per-
vasive impact on all aspects of language; dyslexic people can read, write,
spell, and pronounce words incorrectly even when they know the words’
meanings. Secondary consequences may include problems with reading
comprehension and reduced reading experiences that can impede growth of
vocabulary and background knowledge (International Dyslexia Association
2020a). Not all reading disorders are considered to be dyslexia. However, in
DSM-5 (American Psychiatric Association 2013), dyslexia is subsumed un-
Strengths-Based Model of Dyslexia 125

der the category of specific learning disorder with impairment in reading.

The International Dyslexia Association (2020d) reports that 30% of dys-
lexic individuals have a comorbid diagnosis of ADHD.
Research has shown that weak phonological processing is just one of the
components at the core of dyslexia, rather than being the primary cause. Al-
though not all core components are present in every case of dyslexia, we
now know that in addition to atypical performance in phonological and or-
thographic processing, dyslexic individuals can demonstrate low performan-
ces in perceptual speed, working memory, rapid naming, rote and sequential
processing, and visual attention (Eide and Eide 2012; Hancock et al. 2016;
International Dyslexia Association 2020b; Khan et al. 2014; Manis et al.
1996; Mather and Wendling 2011; Vukovic and Siegel 2006). Therefore,
dyslexia can manifest differently depending on which core deficits are most
pronounced. Because these same constructs relate to learning all basic
skills, growing numbers of clinicians and educators acknowledge that dys-
lexic people struggle with other foundational academic skills.

More Than a Reading Disorder

The differences in the brain structure of dyslexic individuals impact more
than their reading (Eckert et al. 2017). Even when a dyslexic person “cracks
the reading code,” other struggles persist (Eide and Eide 2012; Shaywitz et
al. 2008). He or she may have trouble, for example, with some or all of the
following: reading fluency, memorization of math facts in the face of good
mathematical reasoning, taking timed exams, performing timed sequential
tasks, comprehension of expository text as a result of slower reading, and
spelling (Ofiesh et al. 2005).
Dyslexia is not a one-size-fits-all phenomenon. When a child has read-
ing problems in early elementary school, distinguishing dyslexia from a de-
velopmental lag can be difficult because many students without disabilities
have difficulty learning to read. Even if a child is tested by a school for a read-
ing disorder and receives intensive reading instruction, there still may not
be enough time to make a difference before that child enters middle school,
where the reading and task demands increase. Moreover, when it is pre-
sumed that dyslexic students need support solely in reading, they will con-
tinue to struggle with basic skills in other areas, even as their higher-order
problem-solving and critical thinking skills advance. For example, the core
cognitive and neurological components of dyslexia can also impact retrieval
or mastery of basic math facts because of the role of rote sequential memory
and processing speed. Taking notes can also be acutely challenging during a
lecture because those skills require working memory, which is one of the
126 Neurodiversity

core deficits often associated with dyslexia. However, despite this knowledge
of the brain-based components of dyslexia, these challenges are largely ig-
nored, and the emphasis is placed solely on reading. Some above-average or
gifted children are able figure out the basics of reading without a dyslexia di-
agnosis in elementary school because their high oral vocabulary, compensa-
tory strategies, and problem-solving abilities mask the inordinate amount of
struggle they experience before reaching middle or high school. For many
reasons, individuals sometimes enter college before they are diagnosed, but
because of the increased learning demands, they become at risk for dropping
out of college (Connor 2012).
Adults encounter a host of obstacles as they attempt to navigate life ac-
ademically, professionally, and personally. Standardized tests used as gate-
keepers to many professions, regardless of whether advanced degrees are
required, rely on limited formats and often do not reveal the significant
strengths of many dyslexic people. On these assessments, they are assessed
largely for their reading ability, which we already know is limited, but only
peripherally for their reasoning and analytical abilities, content knowledge,
and understanding. Making judgments about individuals based on these
tests—which may not be related to on-the-job skills—can overlook skills
and abilities that may be equally important. Denying admission to college
or to employment is a loss not only for dyslexic individuals but also for the
organizations that have failed to recognize the contributions these individ-
uals could be making. The practices and policies of many college admis-
sions councils, standardized test developers, and businesspeople associate
performance on tightly timed tests with top talent and more. Valuable re-
sources are being wasted when we put dyslexic people on the margins.

Opportunity Creates or Denies

the Path to a Purposeful Life
We have coined the term “the missing middle” for a particular span in the
lives of dyslexic people. The missing middle defines the challenges after the
high school years and before late aging. During this time, these individuals
encounter obstacles that limit their opportunities to lead purposeful lives.
These obstacles have less to do with reading and more to do with institu-
tionalized social barriers such as poverty, high-stakes testing, and stigma as-
sociated with academic achievement and performance. These challenges
have to do with when, what, and how ability and achievement are assessed
in order for people to access the opportunities that lead to meaningful work
and lives.
Strengths-Based Model of Dyslexia 127

One of the first barriers to success starts with the reality that many public
schools do not have the resources to identify and support dyslexic students.
Statistics suggest that dyslexia is more prevalent in the lowest socioeco-
nomic strata, a situation that has a significant impact on our society in terms
of financial cost, health equity, and lost opportunities for all individuals to
thrive (Cortiella and Horowitz 2014; Harper et al. 2019; Sanford et al.
2011; Skiba et al. 2005; World Health Organization and World Bank
2011). In 2013, 12% of children living below the poverty line and 6% of
those living at or above the poverty line had dyslexia, dysgraphia, or dyscal-
culia (Child Trends Databank 2014). Public schools in low-income neigh-
borhoods are known to be underresourced and understaffed. The lack of
identification and support for dyslexic students in these schools can lead to
poor attendance or dropping out of school. Under these circumstances, it
becomes difficult for these students to obtain the skills and education they
need to break out of a cycle of poverty once they reach adulthood, and thus
the experience is perpetuated generation after generation.
When one looks at the staggering figures on illiteracy and its association
with poverty, crime, chemical dependency, and race, it becomes clear that
the opportunity to learn to read is a basic civil right that is too often denied
to many (Celeste et al. 2019; Cortiella and Horowitz 2014; Davis 2019).
Without opportunities to learn to read, attend postsecondary education,
and work or apprentice, people have significantly curtailed chances to create
a meaningful life. Even for those who complete high school, the challenges
do not end. For most dyslexic people, the picture told by report cards and
standardized, timed test scores woefully mischaracterize their potential for
the college admissions process and presents an additional hurdle to scale. It
is hard to make sense of a written record with peaks and valleys, especially
if the diagnosis comes late. Some youth do not navigate this time well or end
up in a school that is not commensurate with their ability. Some leverage
their athletic, musical, artistic, or other talents and abilities to gain admis-
sion to high-caliber universities. Most dyslexic students who make it to col-
lege come from college-educated parents who have the financial means to
provide the support their children need to succeed in school (Cortiella and
Horowitz 2014; Reiff et al. 1997). These families can intervene with fee-
based services in the community. Educated parents with academic and social
capital know how to navigate the costly process of private diagnostic evalu-
ations that are necessary to receive accommodations on standardized tests,
licensing, and graduate examinations.
Another commonly noted hurdle faced in this middle span of life is sig-
nificant underperformance on timed tests. Even with the accommodation
of extended time, students with learning disabilities in general still under-
perform on tests compared with their peers. Researchers speculate that the
128 Neurodiversity

difference in academic performance might speak to the lack of effective in-

struction at the elementary and secondary levels (Cohen et al. 2005; Gregg
2009). Several researchers have documented that results on timed, high-
stakes tests indicate no correlation between intelligence, problem solving,
and the need for more time (DiTrapani et al. 2016; Ofiesh et al. 2005).
However, most test takers with learning disabilities in college need more
time in order to demonstrate their knowledge (Gregg and Nelson 2010;
Sireci et al. 2005).
In their books, Brock and Fernette Eide (Eide and Eide 2012) and
Thomas West (2004, 2009) described numerous successful thinkers and ac-
complished entrepreneurs who are extraordinarily creative yet performed
poorly on school and standardized tests, usually because of the tests’ linear
formats and tightly timed designs. Some of these people did not make it
through college because of these tests, yet they went on to craft impressive
careers. Ironically, in an article titled “Creativity Under the Gun,” Amabile
et al. (2002) noted, “When creativity is under the gun, it usually ends up get-
ting killed....Complex cognitive processing takes time, and, without some
reasonable time for that processing, creativity is almost impossible.” Horn
and Blankson (2012) wrote, “In homogeneous samples of young adults,...
measures in which there is much emphasis on speediness correlate near zero,
perhaps negatively, with tests that require solving difficult problems” (p. 91).
These barriers are part of society’s institutionalized beliefs about oppor-
tunity and ability. They cannot be solved in a school of education that fo-
cuses on kindergarten through twelfth-grade learning, a school of medicine
focused on the etiology of dyslexia, or a reading research agenda focused
on early intervention. They cannot be solved in these academic arenas be-
cause their goal is to address dyslexia as a reading-only deficit to be fixed in
elementary school with solid reading instruction. There is absolutely no
question that early reading screening and intervention would significantly
improve the lives of many dyslexic individuals, but this approach does little
to support them in the other areas impacted by the unique way their brains
process information. Sadly, the vast majority of teacher education programs
have yet to include content on the role of the brain in how people learn and
achieve. Without this understanding, dyslexic people and others will con-
tinue to be misunderstood and lack an awareness of “what’s right” with
them. This is why this span in their lives is so important to address.
Up to one-third of the general public attributes learning issues to inacu-
rate reasons, such as watching too much television or having a poor diet, and
more than 50% attributes them to laziness (Cortiella and Horowitz 2014).
In fact, large segments of the population, including people in the prison sys-
tem and many high school dropouts, have undiagnosed dyslexia and never
received reading support (Addenbrooke 2017; Amitay and Gumpel 2015;
Strengths-Based Model of Dyslexia 129

Mallett 2014). When dyslexic individuals, their families, and the profession-
als who work with them understand the research on the unique characteris-
tics and realities associated with the condition, the stigma associated with it
can begin to be eliminated (Higgins et al. 2002; Reiff et al. 1997).

Different Brains
In 1946, the authors of The Psychology of Normal People wrote that “No two
people are exactly alike on any trait yet studied. Indeed, the universal exis-
tence of individual variation is one of the most thoroughly demonstrated
principles of modern psychology” (Tiffin et al. 1946, p. 10). However, as-
sumptions of normality remain and are pervasive in society and especially
in today’s classroom and workforce. Such assumptions have a place in sci-
ence when they are needed to interpret aggregate data, but individually,
there is no “average” learner, and society misses out on the contributions
of diverse individuals when we apply an assumption of normality to them
(Rose 2015). We must begin with an understanding of the brain and how
people learn and use information. Only then can society engage in practices
that allow for appreciation of the unique cognitive diversity among all of
us. Since the beginning of this era, much of what has been learned through
science has yet to impact how we educate, test, and measure ability to widen
opportunities for all people. This is baffling. To design education and teach
individuals without an understanding of the brain is like constructing a
building without having some understanding of engineering. This is most
important for neurodiverse people, including those with dyslexia.
Under the direction of Nicole Ofiesh (coauthor of this chapter), Stan-
ford University’s Schwab Learning Center was redesigned to help students
with dyslexia and ADHD understand how they learn and, specifically, their
unique cognitive maps. They learn about the relationship between func-
tions of the brain such as emotion, processing and perceptual speed, work-
ing memory, executive function, and attention, and about how these can
impact school and work. The students also learn about the “hidden poten-
tial” of their dyslexia via an assessment of the MIND strengths with a learn-
ing specialist (Eide and Eide 2012). (MIND is an acronym representing
Material, Interconnected, Narrative, and Dynamic reasoning.) By engag-
ing in this learning process, individuals are able to demystify their positive
and negative experiences. They leave with tools to strengthen areas that
need to be strengthened, an awareness of how to leverage their gifts, and
an understanding of learning and the brain. The impact of this knowledge
on their lives can be tremendous. This type of self-awareness is something
that would be good for every adult, regardless of context and conditions.
130 Neurodiversity

Strengths of Dyslexic Individuals

Sally and Bennett Shaywitz, in their Sea of Strengths model (Shaywitz 2005;
Shaywitz et al. 2006), and West (2009), in his book In the Mind’s Eye, were
some of the first to highlight the unique talents of dyslexic individuals. Eide
and Eide (2012) used data extensively to understand more deeply how these
strengths show up at school and work. The patterns of strengths that have been
identified do not show up in every dyslexic person, but they are present in about
two-thirds of the dyslexic population. These patterns are also not exclusive to
dyslexia but are seen to a higher degree among dyslexic people. The research
exploring the strengths of dyslexia comes from different scientific fields; there-
fore, it makes sense that scientists apply the meaning of the findings within the
context of their fields. In The Dyslexic Advantage, Eide and Eide (2012) devel-
oped the MIND framework to illustrate the broad research on the unique
ways dyslexic people process information and what that means in everyday life.
In this section, we associate the Eides’ categories with additional terms that
help to organize the research findings. Given the multifaceted nature of hu-
man variation, some findings play out in more than one way. This is especially
true with creativity, various forms of which have been rated as high among
dyslexic people, but creativity is also defined and measured in numerous ways.

Visual-Spatial Capabilities
(Material Reasoning)
Visual-spatial processing is the most well-known and studied strength of
dyslexic individuals (West 2004, 2009). Examining visual-spatial processing
is challenging because different types of tools are used to measure it (Gilger
et al. 2016; Hancock et al. 2016), and the meaning of the findings in every-
day life takes multiple investigations (Everett et al. 1999). However, most
studies support the theory that dyslexic people hold a visual-spatial advan-
tage over typical readers, as demonstrated in functional MRI analysis and
cognitive tasks (Diehl et al. 2014). Dyslexic subjects consistently outper-
form others with the speed at which they are able to “holistically visualize”
and solve complex three-dimensional designs such as the Impossible Fig-
ures Task (Attree et al. 2009; Diehl et al. 2014; Gilger et al. 2016; Penrose
and Penrose 1958; von Karolyi 2001; von Karolyi et al. 2003). This task re-
quires a person to look at pictures of arrays of cubes and quickly decide
whether they represent figures that could exist in the real world. Research-
ers interpret these studies to mean that dyslexic people who excel in this
area are more gifted than others at the speed of global visual-spatial pro-
cessing and therefore more highly attuned to visual representations of cau-
Strengths-Based Model of Dyslexia 131

sality. Most dyslexic people struggle with reading fluency and some with
motor-based processing speed, so this finding is important because it cor-
rects the myth that slow reading means overall slow thinking. It is unfortu-
nate that many are denied extended time on standardized examinations.
Some test developers even go so far as to claim that performing a multiple-
choice test quickly relates to how quickly one will respond on the job.
Clearly, gross generalizations about reading and speed are false. Slow read-
ing speed does not mean that dyslexic people are slower in performing all
cognitive tasks or that faster is better. In fact, in some cases, the precise
mechanisms that cause slow reading among dyslexic people result in faster
problem solving for tasks of a visual-spatial nature (Diehl et al. 2014), such
as reading images in radiology or space planning in architecture.
Eide and Eide (2012) suggested that dyslexic individuals who show
strengths in three-dimensional processing are inclined to excel at careers in
which this ability is highly valued, such as mathematics, astrophysics, archi-
tecture, art, design, and mechanics, as well as medical fields such as radiol-
ogy, orthodontics, and dentistry. Studies have shown this to be true (Bacon
and Bennett 2013; Corlu et al. 2007; Holgate 2015; Wolff and Lundberg
2002). In one study (Chan 2008), performance on several visual-spatial
tasks was found to differentiate between students enrolled in fine arts and
architecture programs and students in other art disciplines with fewer vi-
sual-spatial demands. Because these talents also appear alongside the chal-
lenges dyslexic people may face in school, a growing number of colleges and
universities are seeking ways to honor and support these challenges to en-
sure students’ success (Hickman and Brens 2014; Holgate 2015; Murphy
2011; Parsons 2015).

Wider Neural Tuning and Attention

(Interconnected Reasoning)
One of the first studies of the visual field in dyslexia found differences in
how well subjects identified letters presented simultaneously to their cen-
tral and peripheral fields of vision (Geiger and Lettvin 1987). In this study
and several others, compared with individuals without dyslexia, dyslexic
subjects were found to use and rely on their peripheral fields to a greater
degree for most visual processing (Dautrich 1993; Geiger and Lettvin 2000;
Geiger et al. 2008; Lorusso et al. 2006; Perry et al. 1989; Schneps et al.
2007). Therefore, dyslexic individuals are said to have a significantly wider
visual perceptual mode (i.e., sensory processing and interaction with atten-
tion). It is thought that this contributes to their struggle to identify specific
letter strings or words due to the interference of the surrounding text (Gei-
132 Neurodiversity

ger and Lettvin 2000). In other words, attending to the periphery not only
makes it difficult to pull visual details into one place (e.g., letters to form a
word) but also makes the dyslexic person exceptionally good at grasping
surrounding or contextual features that are a distraction to reading and ig-
nored by stronger readers. Good readers rely on their central fields of vi-
sion and are better with focused visual attention.
This finding of wide and diffuse perception also applies to auditory
stimuli using speech. Similar to the findings regarding visual processing,
dyslexic subjects were also found to be better than typical readers at recog-
nizing speech despite the interference of a surrounding auditory speech
mask (referred to as the “cocktail party” effect) but challenged at isolating
phonemes (Geiger et al. 2008). Some attribute these findings to attentional
processes, distinct from perception, but the impact seems to be the same.
Collectively, researchers suggest that dyslexic people have “wider neural
tuning” (Geiger et al. 2008) both with visual and auditory processing and
with attention. They distribute their attention widely to take in a vast range
of auditory and visual stimuli and concepts.
These strengths may contribute to why many dyslexic people are often
excellent “big-picture thinkers” or “context thinkers” rather than being fo-
cused on details. They tend to be able to see the “forest through the trees.”
The wider neural tuning also seems to be the foundation for the talent of
linking together seemingly disparate ideas or concepts that are obvious to
dyslexic individuals but elude most others, because dyslexic people’s atten-
tion is innately focused on what is all around them in their world. This link-
ing of ideas, or connecting, is one of three core components of creativity
measured by the Widening, Connecting, and Reorganizing Creativity Test
(Antonietti 2011). “Connecting” is described as “connecting different men-
tal fields through unusual combination of ideas, that support new possibil-
ities and original solutions” (Cancer et al. 2016). Creativity among dyslexic
people is largely supported by research. However, this type of original, cre-
ative thinking is what Eide and Eide (2012) called “interconnected reason-
ing,” and it has a unique place in adults’ ability to drive solutions and
innovate (Cancer et al. 2016; Everett et al. 1999).
Related to this is the concept of divergent thinking. Divergent thinking,
as explained by Guilford (1967), is the opposite of convergent thinking and
includes originality, flexibility, fluency, and elaboration. It is one’s ability to
come up with any number of unique and novel ideas to solve problems and
innovate. According to Guilford, it is the hallmark of creativity. Although
some studies have found that dyslexic people did not outperform typical
readers in isolated subtests of creativity (Alves and Nakano 2014; Ritchie et
al. 2013), the overwhelming majority of studies have found that both chil-
dren and adults with dyslexia excel in creative thinking more than individ-
Strengths-Based Model of Dyslexia 133

uals without dyslexia. Researchers report that dyslexic people are more open
to new ideas and ambiguity (LaFrance 1997) and are better at connecting
and generating unusual combinations of ideas (Cancer et al. 2016), original
thinking, richness of detail, and elaboration (Bigozzi et al. 2016; Corlu et
al. 2007; Tafti et al. 2009).
Creativity is often associated with the fine arts, and although we have
noted that dyslexic people are found in high numbers in artistic fields, the
types of creativity noted here relate to the unique and innovative approach
to problem solving so greatly needed in today’s economy. Some of the jobs
that benefit from creativity are inventors, scientists, computer and software
designers, musicians, historians, philosophers, and anthropologists. Carol
Greider, director of the Department of Molecular Biology and Genetics at
Johns Hopkins University School of Medicine, has dyslexia. She received
her Nobel Prize by learning how chromosomes are protected by telomeres;
this scientific discovery is important for understanding the science of aging,
cancer, and certain types of genetic disease (Crockett 2015). Greider has
talked about getting low scores on her SAT and GRE examinations and re-
ceiving many rejection letters from schools. However, two schools did de-
cide to interview her because she had many A grades and had laboratory
experience. She added, “Perhaps my ability to pull more information out
of context and put together difficult ideas may have been affected by what
I learned to do from dyslexia” (quoted in Dyslexia Advantage Team 2020).

Image-Based Thinking
(Narrative Reasoning)
Two areas of cognition converge to contribute to the documented ability of
many dyslexic people to think in pictures or through storytelling. These
two cognitive areas are episodic memory and scene memory, both of which
involve the ability to recall visual images. Eide and Eide (2012) call this the
ability to “connect mental scenes” and refer to it as “narrative reasoning.”
Typical readers are generally stronger than those with dyslexia in proce-
dural and semantic memory, which governs their ability to recall informa-
tion such as math facts, names, and dates; these facts are without dimension
and are linear systems used for long-term memory. Episodic memory is also
used for long-term storage; however, it is colorful, experiential, richly nu-
anced, and laden with context. It contributes largely to the depth of mem-
ories of personal experiences. The atypically high episodic memory found
in many dyslexic people is thought to contribute to talents with storytelling
and thinking using experience and case studies. Parents notice this when
their dyslexic children have difficulty recalling basic math facts and spelling
but can recall all of the details about the chairs and décor of the diner where
134 Neurodiversity

they had lunch on a family vacation, as well as about a sibling’s clothes, the
rental car, and the temperature outside. Across many languages and cul-
tures, the differences between these types of memory have been noted be-
tween dyslexic readers and neurotypical readers (Tafti et al. 2009).
Further understanding of the talents behind image-based thinking comes
from research that indicates that dyslexic people also outperform typical
readers in their ability to scan and recall scenes. Using actual scenes such
as real-world photographs and low-pass filtered pictures (i.e., blurred im-
ages), dyslexic subjects were found to both scan scenes more rapidly and to
distribute their attention more widely to more efficiently recall images
(Schneps et al. 2012). Most dyslexic people think in pictures or images
(Shaywitz 2005). This can appear as slower verbal retrieval for speaking and
writing but can be a powerful gift when it comes to capturing experiences
for writing and storytelling. Marazzi (2011) noted that verbal thought is lin-
ear and develops at the speed of language, about 150 words per minute,
whereas image-based thought consistently develops at a speed of roughly
32 images per second, the same speed as visual perception. Marazzi believed
that the rate of thinking in images and pictures among dyslexic individuals
contributes to their experiences of knowing an answer without being able
to document how they arrived at it and referred to this as “glance intelli-
gence.” West (2009) compiled detailed accounts of visual thinkers who strug-
gled in school yet made significant contributions to society.

Seeing Things Out of Place and

Creative Intuition (Dynamic Reasoning)
Eide and Eide (2012) define their last type of reasoning, dynamic reasoning,
as mentally spotting patterns to fill in incomplete scenarios from the unwit-
nessed past and likely future events. In this sense, there is no visual repre-
sentation in mind. The pattern is essentially intuitive and invisible, unlike
the type of visual-spatial thinking associated with “material reasoning.” As
mentioned previously, the research implications often linked to those asso-
ciated with the visual-spatial strengths of dyslexic individuals are visible or
tangible. Schneps (2014), however, believed that the implications of the vi-
sual-spatial strengths found through the Impossible Figures Task and one
study using a drawing by M.C. Escher are separate from all the other types
of reasoning discussed. According to the Eides, dynamic reasoning is the ap-
plication of episodic memory, or the actual memory of a lived experience, to
episodic simulation, or what one would imagine based on an experience.
Support for this type of reasoning draws on research from the other types of
reasoning pointed out during extensive interviews of dyslexic subjects who
had struggled throughout school only to become, for example, highly suc-
Strengths-Based Model of Dyslexia 135

cessful entrepreneurs, venture capitalists, and economists, as well as farmers.

These accomplished people consistently describe processes or hunches that
contain neither pictures nor words and lead to accurate predictions, new in-
sights, and discoveries. Some might call this type of somatic reasoning “in-
tuitive thinking,” which was discussed extensively in Malcolm Gladwell’s
(2005) book Blink: The Power of Thinking Without Thinking.
Part of the mechanism underlying dynamic reasoning may be what is
referred to in the literature as “creative intuition” which would make sense,
given that emotion with creativity is a key component of creative intuition
(Hague 2003), and this has been noted as high among dyslexic individuals.
This also directly relates to the Eides’ explanation that dynamic reasoning
is episodic simulation (Eide and Eide 2012). Further related to episodic
simulation, Hardman (2020) stated, “Creative intuition...operates through
an act of sympathetic identification.” She then wrote, “according to Jung
[1959] it is characterized by an attitude of ‘expectancy, by vision and inter-
penetration.’ It is not simply perception or observation, but is an active, cre-
ative process that ‘puts into’ an object as much as is taken out.” There is less
empirical research in this area as it pertains to education in general. Cre-
ative intuition is substantially less valued although very relevant as we un-
derstand important ways of thinking, especially for dyslexic people (Waks
2006). In the case of dynamic reasoning, as with previously described types
of reasoning, two of the associated trade-offs are speed and efficacy.
Given all of the research on the strengths of dyslexic individuals, the role
of tightly timed standardized tests that are insensitive to these strengths be-
comes important to rethink. All of the various types of reasoning require
more time, and the need for extra time has to do with more than being able
to read. Opportunities for dyslexic individuals to make valuable contribu-
tions to society will continue to be denied until we reconsider how we pro-
vide access to all types of professions and to meaningful work. Partchev and
De Boeck (2012) investigated the role of speed on both matrix tasks and ver-
bal analogies tasks and wrote the following:

For a kind of task that requires more time to be solved, such as matrix tasks
in comparison with verbal analogies, individual differences in speed seems
[sic] to be negatively correlated with accuracy. Slow responders are better
responders. A possible explanation is that one needs to take one’s time for
these items in order to find the correct solution, and that intuitive and im-
pulsive responses do not pay off. (p. 30).

In a study on intelligence tests, DiTrapani et al. (2016) concluded, “Since

this investigation found no positive link between speed and ability, we con-
clude that there is no evidence to claim that responding quickly on an in-
telligence test is a positive indicator of ability” (p. 91).
136 Neurodiversity

Therefore, even if we were to teach all dyslexic people to read early on,
most would still require more time on college entrance and professional li-
censing examinations to demonstrate what they know because some of their
brain structures remain the same. They also need a variety of targeted strat-
egies, accommodations, and technologies that go beyond reading to navi-
gate the lifespan. The problem is not in the person; it is in the tools we use
to assess competence and knowledge (Reiff and Ofiesh 2016). When bright,
intelligent people are denied opportunities to participate in school and work
because of outdated notions of testing and admissions, everybody loses.
More than ever, our society needs diverse ways of thinking to solve the com-
plexities of this world.

Case Example
Most dyslexic students, even those who have been successful enough to ma-
triculate at the college level, do not have a clear sense of their strengths and
are unable to articulate them. Henry Reiff, a professor of special education
and a coauthor of this chapter, offers a way to help students with dyslexia
and other learning differences develop this ability. Through independent
study, students review their psychoeducational evaluations with a trained
professional. They reflect on childhood experiences as a context for the eval-
uations, learn what the evaluations mean, and apply this heightened aware-
ness to their experiences in and out of the classroom. The following is a
series of snapshots from one student’s project.

Although he was clearly a bright child, Dan found reading very frustrating
starting in elementary school. He had good word identification skills but ex-
treme difficulties with comprehension. He was ashamed of how he per-
formed on tests and tried to hide his work from his parents. He was evaluated
when he was 9 years old. He became so stressed and anxious that he ended
up getting a bloody nose near the end of the assessment. “All I wanted to do
was go home and never think of school or reading again.” The results con-
firmed that he had a learning disability, but of course that did not mean much
to Dan. He did not understand why he started seeing more teachers and tu-
tors. He learned to use strategies to compensate for his weak comprehen-
sion, but he was upset that he had to work so hard and confused as to why
he had to use all of these “extra” strategies. Starting in fourth grade, he
worked harder than other students, which usually meant that weekends were
completely devoted to studying. His parents kept their expectations high,
and their support motivated him to succeed. Dan continued to be upset and
still compared himself with his peers and siblings who worked less and did
better. He pressured himself to meet his parents’ expectations.
Dan was tested again when he was 16 years old, but even then, no one
reviewed his testing with him. When he was a senior in college, he analyzed
Strengths-Based Model of Dyslexia 137

the results as part of his independent study. With his learning specialist, he
identified strengths and weaknesses. He learned that he had average or high-
average scores in knowledge, fluid reasoning, auditory processing, and speed
of visual patterns. He also had particular difficulty with short- and long-term
retrieval, rapid picture naming, and two-dimensional visual-spatial thinking.
These discrepancies helped him understand that although his reasoning was
strong, problems with retrieval and processing of symbols were affecting his
ability to comprehend what he read. He learned that he had difficulty with
understanding the details of abstract and complex tasks, as well as with read-
ing fluency, written expression, and language processing.
The evaluator recommended individualized learning strategies and ways
for Dan to talk about his academic performance and feelings. The strongest
recommendation was to be well enough aware of how he learns, by knowing
his strengths and weaknesses and their impact on day-to-day performance,
to explain it to faculty. Before the independent study, Dan had not learned
how to do this. Afterward, Dan’s strong work ethic gave him the courage to
self-advocate. His skills improved as he was able to articulate his specific
strengths and challenges. In a paper at the end of the independent study, he
wrote, “By completing this independent study and writing this paper, I have
thoroughly examined my evaluation. This has gotten me to better under-
stand my strengths and weaknesses as well as feel comfortable and confident
in my ability to tell future employers about my dyslexia and needs.” Dan
graduated college with honors and completed his Master of Social Work de-
gree. He is currently employed as a social worker and loves his job.

Interventions Based on the

Strengths-Based Model
For many years, the diagnosis and treatment of disabilities, including dys-
lexia, were based on a medical model that defined reading challenges as
deficits (illness) and remediation as an attempt to cure that “illness.” This
approach not only began with the idea that there was something inherently
wrong with the child who struggled to read but also was less than successful
in meeting the needs of that child. Even when we teach dyslexic people to
read, their dyslexia is not “cured.” Therefore, we must understand the com-
plete lived experience of dyslexic individuals. With awareness, they can
learn to leverage their inherent strengths in order to compensate and de-
velop new strategies to help them meet the challenges they will face in
adulthood. Dedicated research and funding to understand the strengths of
dyslexia, not solely diagnosis and reading intervention, are imperative. In
addition to their social and emotional benefits, strength-based approaches
still effectively address academic challenges. Dyslexic individuals need to be
aware of their own strengths so that they may capitalize on them and main-
138 Neurodiversity

tain a sense of independence and autonomy. As the case study of Dan makes
clear, self-awareness is the essential foundation for self-advocacy.
Shifting to a strengths-based model will help more children to get the
early support they need by requiring schools to embrace a fuller under-
standing of the different types of dyslexia. Although difficulty with sound-
symbol association and orthography is common, other causes include poor
rote sequential memory and problems with visual attention and perception,
working memory, perceptual speed, and difficulties with other types of de-
coding. A one-size-fits all approach cannot address the variations of types
of dyslexia (Coyne et al. 2013; Phillips and Smith 1997). Individualized ap-
proaches are the bedrock of working with most students, and multiple types
of assessments are necessary to ascertain the unique needs of each child,
identifying both strengths and areas to strengthen. Although the Individu-
als with Disabilities Education Improvement Act of 2004 mandates multi-
disciplinary and nondiscriminatory assessments, most school systems use
the same types of tests (e.g., Woodcock-Johnson Battery). Researchers have
long questioned the validity of standardized tests of cognitive aptitude and
academic achievement and question whether they adequately identify in-
telligent persons who have trouble reading (Macht 1998).
In addition to broadening methods of identifying children with dyslexia
for early intervention, teachers are encouraged to explore different meth-
ods for assessing performance in the classroom. Assessments created along
the lines of the Universal Design for Learning (UDL) allow all individuals
to demonstrate their strengths and gifts to a much greater degree than tra-
ditional assessments (Meyer et al. 2014; Ofiesh et al. 2006). This is about
unlocking individual potential while maintaining high standards so that ev-
eryone will at least have the opportunity to excel at what they know and can
learn to leverage their strengths. The UDL approach does not lower aca-
demic or professional standards, because universally designed assessments
maintain rigor and construct validity. Without universally designed assess-
ments, we perpetuate the denial of opportunities for a purposeful life to in-
dividuals who are, in fact, more than able to excel.
The importance of broadening our understanding of dyslexic individu-
als becomes crucial when it is revealed that they tend to have less successful
or satisfying outcomes in adulthood in terms of educational level and rate
of unemployment. Consistent with this research, dyslexic adults who are
able to improve their reading skills fare better than those whose reading dif-
ficulties persist (Eloranta et al. 2019).
To implement a strengths-based model, the academic community should
devote a discipline in wellness and neurodiversity. Scientific research on
high-functioning dyslexic adults and the predictors of success has been re-
ported; however, no home yet exists for the intersection of diverse learners,
Strengths-Based Model of Dyslexia 139

education, and work for dyslexic individuals. Our culture seems to expect all
individuals to be successfully equipped for society after high school. In the
educational sphere, solutions are generated from schools of education, spe-
cifically special education, and focus only on educational solutions in prekin-
dergarten through twelfth grades. In medical schools, the focus is typically
on the etiology of and medically or psychologically driven solutions for a
condition—usually therapy, surgery, or medication. Sociological research
focuses on the social and environmental conditions that oppress people
with disabilities, typically in developing countries. Stigma persists as a bar-
rier to well-being and economic opportunity. Dyslexia and other learning
disabilities impact more than learning. These are lifelong conditions that
require understanding in all facets of life, including higher education and
the workforce. Only with a concerted multidisciplinary research effort can
people with invisible disabilities such as dyslexia be considered greater as-
sets than liabilities in society. We can begin to generate myriad ways to help
them articulate their strengths.
Clinicians and educators should rethink their methods of assessment.
Dyslexic individuals will continue to be limited in their access to education
and training until we assess ability and our knowledge changes. One-size-
fits-all assessments often inadvertently discriminate against talented people
because of the design of the assessment; for example, few heavily emphasize
visual-spatial processing. Accommodations essentially retrofit poorly de-
signed assessments to allow more individuals to show what they know and
can do. This is done in much the same way as ramps are added to building
entrances to provide access to wheelchair users; a poorly designed building
or one designed for the mythical “average person” must be retrofitted for
the wheelchair user, and the location of the ramp is an afterthought.
UDL should be implemented. Universally designed buildings are de-
signed from the beginning with human variation in mind. Similarly univer-
sally designed assessments are created at the onset so that the broadest
population of individuals can demonstrate what they know and can do in dif-
ferent ways. Brilliant, analytical, design-minded thinkers and capable people
will otherwise be steered away or kept from professions in which they could
make valuable contributions.
Test-optional schools are on the rise (FairTest 2019) that allow greater
access to higher education for all. Yet many competitive schools are still
committed to what is referred to as the common application or “common
app” process, which discriminates against many potentially successful stu-
dents. Equally concerning are schools that offer test-optional admissions but
retain scholarships and funding for those with high standardized test scores.
Institutions of higher education would benefit from augmenting their appli-
cation processes with portfolios that allow students to showcase who they
140 Neurodiversity

are and what they can do. Require teachers and counselors to understand the
role of cognition in how people learn. Early identification of reading diffi-
culty is critical to address the relationship between poverty and dyslexia. We
need to offer dyslexia screening for all children as soon as they enter school;
new legislation throughout the United States has provided support for uni-
versal dyslexia screeners. Equally important is helping people understand
what is solidly intact in their learning abilities. For some dyslexic individu-
als, the flip side of their reading challenges is having other skills and abilities
to a greater degree than their peers. Teachers can significantly help reduce
anxiety by helping dyslexic students develop awareness of their personal
strengths and gifts.
Self-awareness of learning should be promoted. Self-awareness is one
of the greatest gifts dyslexic individuals can have. Teachers are hampered in
their ability to nurture students’ strengths by a lack of understanding about
the diverse ways people process information at school and work. New web-
sites such as www.neurolearning.com allow all individuals to take an online
survey to identify their strengths and offer a way for teachers to support
those strengths. Counselors can better understand and communicate with
their patients when they become aware of how cognition and language play
out in therapy. For example, a word-retrieval or processing-speed problem,
commonly seen in dyslexia, can be easily misinterpreted as a reluctance to
engage or a lack of awareness. People who struggle with processing lan-
guage but who think in pictures before their words come out would benefit
from interactions that allow them to discuss ideas via pictures or sketches.

Conclusion
The National Research Council’s (2012) book Education for Life and Work
describes who we need in the twenty-first century workforce. We need peo-
ple who can apply knowledge, problem solve, and think creatively. This is
exactly the kind of thinking that dyslexic individuals and even those with
some forms of ADHD bring to our universities and workforce. The nonlin-
ear thinking commonly associated with dyslexia will be an advantage in the
increasingly nonlinear world of technology and the internet (West 2009).
Given the opportunity, dyslexic people will excel more than ever as technol-
ogy replaces the requirements of human beings to perform rote sequential
processing.
We have known for many years that human variability is the norm, but
we have also veered toward interpreting most variation as “not normal.”
When a person is perceived as anything but “typical” or “normal,” stigma
follows. What can we do to reduce the stigma and redefine what it means to
Strengths-Based Model of Dyslexia 141

have dyslexia? By understanding their holistic experience, we can come to

appreciate that dyslexic individuals often have extraordinary strengths that
can be nurtured (West 2009). We need more investigation and data on these
strengths instead of so much on “what is wrong.” We already have much data
on strengths from the cognitive and behavioral sciences, but through an in-
terdisciplinary approach with neuroscience, engineering, medicine, com-
puter science, and psychology, we can address this question expeditiously,
especially with large data sets. No academic domain has brought us to a full
understanding of the lifespan of a dyslexic person. Dyslexia is not just about
reading or learning; it goes well beyond the classroom. It is a way of looking
at the world. If we deny dyslexic people the opportunity to demonstrate their
abilities, how will they reach their potential? “Opportunity must precede
ability...but society operates on the opposite premise...you must demon-
strate your absolute ability before given an opportunity to reach your poten-
tial” (Van Der Klift and Kunc 2017, p. 88).
The barriers faced by dyslexic people across society pose threats to so-
cial justice, academic capital, and health equity. Despite years of research
that legitimizes invisible disabilities, many still believe that these diagnoses
stem from conditions of choice (e.g., lack of motivation), environment, or
overall intelligence. Cortiella and Horowitz (2014) wrote the following:

Neuroscientists and other clinical and educational professionals have re-

cently begun discussing ways that having LD [learning disability] (e.g., dys-
lexia) might be advantageous for certain types of information processing, and
highly successful individuals with LD and ADHD have publicly disclosed
their struggles and successes, pointing to the importance of self-awareness,
perseverance and self-advocacy for those in need of hope and encourage-
ment. Examining the data as well as the values, strengths and talents of those
with LD is critical to helping create opportunities for them to achieve suc-
cess and satisfaction in school, at work, at home and in the community.
As the nature of LD continues to be better understood and the particular
needs of those with these neurological differences are better defined, success
in all aspects of life should become more achievable for a larger number of
Americans with LD. It is important to consider the well-being of individuals
with LD as society changes, school transformation efforts are implemented,
instructional technologies are adopted, and assistive technologies are intro-
duced. Each of these will influence the reality of individuals with LD, and
the implications for research, practice and public policy must be considered
from the perspectives of those who live with LD in an increasingly complex
world. (p. 42)

The work ahead to promote a strengths-based model of dyslexia is not

easy. When one attempts to disrupt long-standing models of what is “nor-
mal” on behalf of dyslexic people, other groups simultaneously challenge
the research and notions of a strength-based model and lobby for ideas that
142 Neurodiversity

are out of date and designed to uphold the status quo. With foresight and
dedication, change can happen through research and practice. Individuals
must come together to embrace a strengths-based model of dyslexia (Lopez
and Louis 2009). It is important to create with great care a more humane
and just world and to widen the paths to success for many dyslexic people.
Without doing so, the cost to our workforce, society, and individual lives is
great. When individuals with dyslexia or any type of disability are denied
opportunities to develop and use their strengths, we waste human potential.
This is a problem for all of us. Help with learning to read and becoming
self-aware is possible. We will all benefit when dyslexic people are able to
reach their full potential.

KEY CONCEPTS
• Focusing on deficits and shortcomings negatively affects self-esteem and
self-image. Focusing on the positive creates self-awareness to nurture in-
herent strengths.
• Dyslexia comes in all shapes and sizes and requires multiple forms of
assessment.
• Economically disadvantaged dyslexic children are less likely than oth-
ers to be identified in a timely manner and are less likely to receive spe-
cific research-based interventions. As a result, they are more likely to
become adults with deficient reading skills and poor outcomes across
the lifespan.

Recommendations For Educators,

Clinicians, and Other Professionals
• Devote an academic discipline in wellness and neurodiversity.
• Rethink our methods of assessment.
• Implement Universal Design for Learning.
• Support the rise of test-optional schools, which allow greater access to
higher education for all.
• Require teachers and counselors to understand the role of cognition in
how people learn.
• Promote self-awareness in learning.
Strengths-Based Model of Dyslexia 143

Discussion Questions
1. What are the presumed causes or roots of dyslexia?
2. What controversies exist surrounding the identification and diagnosis
of dyslexia?
3. What are the implications of dyslexia, other than difficulties in reading?
4. What are the challenges faced by dyslexic adults, and how might we ad-
dress those?
5. Why is understanding brain-based learning important for both teachers
and their dyslexic students?
6. What are the advantages to a strength-based approach in working with
and appreciating dyslexic individuals?
7. How does the Universal Design for Learning benefit dyslexic students?

Suggested Readings
CAST: Top ten UDL tips for assessment. CAST Professional Learning, 2015.
Available at: https://slds.osu.edu/posts/documents/top-10-udl-tips.pdf.
Accessed January 7, 2021.
Eide B, Eide F: The Dyslexic Advantage: Unlocking the Hidden Potential
of the Dyslexic Brain. New York, Plume, 2012
Reiff H, Ofiesh N: Teaching for the Lifespan: Successfully Transitioning
Students With Learning Differences to Adulthood. Thousand Oaks, CA,
Sage/Colwin, 2016
Shaywitz S: Overcoming Dyslexia. New York, Vintage, 2005
West T: Thinking Like Einstein. New York, Prometheus Books, 2004
West T: In the Mind’s Eye: Creative Visual Thinkers, Gifted Dyslexics, and
the Rise of Visual Technologies, 3rd Edition. New York, Prometheus, 2009

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 SEVEN
Neurobiology of
Neurodiversity
Lawrence K. Fung, M.D., Ph.D.

My autism is the reason I’m in college and successful. It’s the

reason I’m good in math and science. It’s the reason I care.
Jacob Barnett, autistic math and physics prodigy

The neuroscience of neurodevelopmental conditions has been

investigated based on those conditions’ diagnostic criteria in
psychiatry and medicine. As an extension of the strengths-based
model of neurodiversity, I have organized this chapter by the domains
identified in Gardner’s theory of multiple intelligences. The chapter
dissects the cognitive construct for each domain—mathematical,
verbal-linguistic, visual-spatial, musical-rhythmic, interpersonal, and
intrapersonal—to associate each with the neural circuit(s) involved
and describes the neural correlates of these abilities for typically
developing individuals and those with neurodiverse conditions.

In previous chapters, we have discussed the characteristics of neurodiverse

conditions, including autism, dyslexia, and ADHD, and described how the
strengths-based model of neurodiversity is applied in these conditions.
This chapter focuses on the neurobiology of most domains identified in
Gardner’s theory of multiple intelligences: mathematical, verbal-linguistic,

149
150 Neurodiversity

visual-spatial, musical-rhythmic, interpersonal, and intrapersonal abilities

(Gardner 1983; Gardner and Hatch 1989). For each domain, we discuss the
cognitive neuroscience that supports this construct. Much of the bases of
this chapter is supported by systems neuroscience. We end the chapter with
a discussion of creativity, an emerging area relevant to neurodiversity.

Neurobiology of
Mathematical Abilities
This section describes the constructs of mathematical cognition and learning
and their neural correlates. Then, the brain organization of autistic children
with superior mathematical abilities and calendrical calculation abilities is
discussed, followed by the neurobiology of dyscalculia, a condition charac-
terized by difficulty learning or comprehending mathematics.

Cognitive Constructs of
Mathematical Abilities
To improve understanding of mathematical abilities at more fundamental
levels, we dissect mathematical operations into cognitive functions that form
the basis of mathematical cognition and learning. Mathematical cognition can
be conceptualized as being composed of number sense, working memory
operations, and receptive language (Menon 2016a). Mathematical learning
requires cognitive operations that support formation of declarative memory,
sustainment of attention, and cognitive control (Menon 2016a). Number
sense is the ability to recognize numbers and symbols, understand represen-
tation of number forms, synthesize information from visual and auditory
modalities, and appreciate numerical quantities and distance effects. Distance
effect refers to the inverse relationship between the difference between two
numbers and the time to recognize which is larger (e.g., it takes longer to
compare 5 vs. 6 than to compare 5 vs. 2). Having number sense supports the
ability to manipulate symbolic and nonsymbolic quantities.
To perform mathematical operations, people need to actively store and
manipulate working memory. Verbal information processing is involved in
mathematical cognition. For example, children are taught to count items
by using words and to understand that the last number word used in count-
ing is the total number of items in the collection to be quantified. This con-
cept is called the cardinality principle. Another example of the involvement
of verbal processing in mathematics is seen in learning multiplication ta-
bles: Children are taught to learn their multiplication tables by first count-
Neurobiology of Neurodiversity 151

ing (which involves verbal information processing) and then memorizing

the numerical relationships. The reinforcement of the learning is often con-
firmed verbally. Higher functions of mathematical cognition, such as nu-
merosity or understanding of very large numbers, often involve the ability
to understand abstract representations of sets and rules. In logic, these rules
are deduced from more fundamental rules called axioms or postulates.

Neurobiology of Mathematical
Cognition and Learning
Using the constructs of mathematical cognition and learning, we describe
the neural correlates for each cognitive function associated with basic arith-
metic operations (Table 7–1). Figure 7–1 shows the neurocognitive systems
involved in mathematical operations in the brain. After receiving visual in-
puts (numbers) through the primary visual cortex (V1), the fusiform gyrus
(Wimmer et al. 2016) and inferior temporal cortex (ITC) (Grotheer et al.
2016) recognize the representation of the number forms. Together with the
intraparietal sulcus (IPS) (Vogel et al. 2017) in the parietal cortex, the fusi-
form gyrus and ITC build visual-spatial representations of numerical quan-
tity. Short-term representations of these numbers are then handled by the
frontoparietal circuits involving the IPS and superior parietal lobule in the
parietal cortex, the supplementary motor area, the premotor cortex, the dor-
solateral prefrontal cortex (DLPFC), and the basal ganglia (Menon 2014).
Furthermore, the frontoparietal circuits monitor performance and inhibit
undesired responses. As discussed, verbal information processing is crucial
for basic counting and arithmetic operations such as multiplication.
The middle temporal gyrus (MTG) and superior temporal sulcus (STS)
are known to be the language centers involved in mathematical operations
(Rosenberg-Lee et al. 2015). Long-term memory or declarative memory, in-
cluding both episodic and semantic memory systems, are anchored in the
medial temporal lobe, the anterior temporal cortex, and the angular gyrus
within the parietal cortex (Chiou and Lambon Ralph 2018; De Smedt et al.
2011; Price et al. 2015). The medial temporal lobe, anterior temporal cortex,
and angular gyrus allow for storage and retrieval of numerical problems as
part of the long-term memory. Attention control is anchored at the ventro-
lateral prefrontal cortex (VLPFC) and the salience network, comprising the
anterior insula and dorsal anterior cingulate cortex (ACC). The VLPFC and
salience network guide and maintain attention during goal-directed prob-
lem solving and decision making (Uddin 2015). Together with the central
executive network, the salience network integrates and manipulates quantity
and mnemonic information.
TABLE 7–1. Neural correlates of mathematical cognition and learning

152
Anatomical region References

Number sense
Visual object recognition FG, ITC, V1 Grotheer et al. 2016; Wimmer et al. 2016
Automated representation of number forms FG, ITC Grotheer et al. 2016
Synthesis of information from visual and auditory modalities IPS Vogel et al. 2017
Numerical quantity judgments FG, IPS Cutini et al. 2014
Distance effects FG, IPS Vogel et al. 2017
Working memory
Spatial attention IPS Knops et al. 2014
Short-term representations that allow manipulation of multiple BG, DLPFC, PMC, SMA, Menon 2014
discrete quantities
Active storage and manipulation of working memory SMG Menon 2016b
Language
Verbal information processing MTG, STS Rosenberg-Lee et al. 2015
Declarative memory

Neurodiversity
Long-term memory formation; generalization beyond individual AG, aTC, MTL Chiou and Lambon Ralph 2018; De Smedt
problem attributes; storage and retrieval of numerical problems as et al. 2011; Price et al. 2015
facts
TABLE 7–1. Neural correlates of mathematical cognition and learning (continued)

Neurobiology of Neurodiversity
Anatomical region References

Attention control
Performance monitoring and manipulation of (numerical) BG, DLPFC, FEFs, insula, Menon 2014; Menon and Uddin 2010;
information in working memory PMC, SMA, SPL Supekar and Menon 2012
Guiding and maintaining attention in the service of goal-directed SN (aINS, dACC) and Uddin 2015
problem solving and decision making VLPFC
Cognitive control
Integration and manipulation of quantity and mnemonic information CEN (DLPFC and PPC), Cai et al. 2014, 2016; D’Esposito et al.
lPFC, SMG, SN 1995
Note. AG=angular gyrus; aINS=anterior insula; aTC=anterior temporal cortex; BG=basal ganglia; CEN=central executive network; dACC=dorsal anterior
cingulate cortex; DLPFC=dorsolateral prefrontal cortex; FEFs=frontal eye fields; FG=fusiform gyrus; IPS=intraparietal sulcus; ITC=inferior temporal cortex;
lPFC = lateral prefrontal cortex; MTG = middle temporal gyrus; MTL = medial temporal lobe; PMC = premotor cortex; PPC = posterior parietal cortex;
SMA=supplementary motor area; SMG=supramarginal gyrus; SN=salience network; SPL=superior parietal lobe; STS=superior temporal sulcus; V1=primary
visual cortex; VLPFC=ventrolateral prefrontal cortex.

153
154 Neurodiversity

SMA

PMC SPL

DLPFC
AG
BG
VLPFC
AI

MTL V1

vTOC
ATL
Visual
input

FIGURE 7–1. Schematic circuit diagram of basic neurocognitive

processes involved in arithmetic.
To view this figure in color, see Plate 1 in Color Gallery.
Note. AG=angular gyrus; AI=anterior insula; ATL=anterior temporal lobe; BG=
basal ganglia; DLPFC=dorsolateral prefrontal cortex; MTL= medial temporal
lobe; PMC =premotor cortex; SMA= supplementary motor area; SPL =superior
parietal lobe; V1=primary visual cortex; VLPFC=ventrolateral prefrontal cortex;
vTOC=ventral temporal-occipital cortex.
Source. Adapted from Menon 2014.

Brain Organization of Autistic Children

With Superior Mathematical Abilities
Various studies have been performed to understand the superior mathemat-
ical abilities of autistic children. In a study of number sense, autistic children
were found to have impairments in nonsymbolic acuity (dot array) but intact
symbolic acuity (assessed using Arabic numerals) (Hiniker et al. 2016). Iuc-
ulano et al. (2014) investigated mathematical abilities in autistic children and
age-, gender-, and IQ-matched typically developing (TD) control subjects
Neurobiology of Neurodiversity 155

and found that, compared with their TD counterparts, autistic children more
frequently used sophisticated decomposition approaches for single-digit ad-
dition problems. Using functional MRI (fMRI), the authors found that au-
tistic children engaged similar cortical regions as TD control subjects but
had different activation patterns related to mathematical problem complex-
ity in brain regions responsible for declarative memory (medial temporal
lobe) and cognitive control (posterior parietal cortex). In addition, the left
ventral temporo-occipital cortex, which includes the fusiform gyrus, was
found to be different between the autism and TD groups; it was the only
brain region in which the activation patterns predicted mathematical prob-
lem-solving skills in autistic children. In contrast, activation patterns of the
DLPFC predicted mathematical problem-solving skills in TD children.
Collectively, these findings suggest that reduced attention to faces, a behav-
ioral characteristic of autism (Osterling and Dawson 1994), within critical
periods of neural plasticity could promote better representations for num-
bers over other stimuli such as faces (Ansari 2008).

Brain Organization of
Autistic Individuals With Superior
Calendrical Calculation Abilities
Extraordinary calendrical calculations occasionally have been demonstrated
by autistic savants. In one case report, a young autistic man with calendrical
calculation abilities was given 15 dates within a 16-year period, and he was
asked to provide the day of the week that corresponded to the date. He was
given a date every 6 seconds (Boddaert et al. 2005). His responses were
100% correct. The calendrical calculation tasks induced significant activa-
tions of a large left frontotemporal network, including the left inferior cor-
tex, middle frontal cortex, precentral frontal cortex, left anterior cingulum,
left superior temporal area, left middle temporal area, and left hippocampus.
In another man on the autism spectrum with both savant skills in calendrical
calculation abilities and artistic abilities, a structural MRI study revealed
thicker superior parietal cortex than in neurotypical control subjects (Wal-
lace et al. 2009).

Neurobiology of Dyscalculia
Dyscalculia is a neurodevelopmental condition characterized by difficulties in
mathematical operations, including understanding numbers, learning how
to manipulate numbers, learning mathematical rules, and performing calcu-
lations. Individuals with dyscalculia typically have normal IQ and reading
156 Neurodiversity

aptitude. Rosenberg-Lee et al. (2015) studied the neurobiology of children

with dyscalculia. Compared with TD children, children with dyscalculia
were found to have poorer performance in solving mathematical problems,
especially subtraction problems. However, children with dyscalculia were
shown to have significantly greater activity in brain regions responsible for
number sense (IPS, superior parietal lobule, and fusiform gyrus) while work-
ing on the arithmetic tasks. In adults, Bulthé et al. (2019) found hypercon-
nectivity between V1 and the inferior occipital cortex and between V1 and
the fusiform gyrus in subjects with dyscalculia, compared with TD control
subjects. As discussed, V1 and the fusiform gyrus are involved in number
sense. The inferior occipital cortex is thought to be associated with process-
ing of faces (Jonas et al. 2014).

Neurobiology of
Verbal-Linguistic Abilities
In this section, we describe the cognitive and functional constructs of read-
ing and their neural correlates. Then, we discuss the brain organization of
people with developmental dyslexia, a condition characterized by difficul-
ties in reading, as well as hyperlexia, a rare syndrome characterized by a
child’s giftedness in reading at a very young age.

Cognitive Functions of Reading

Reading is a highly orchestrated process that involves several cognitive com-
ponents. First, words are visually processed. Then, the processed word forms
are mapped and translated to sounds, which are subsequently processed as
speech sounds and nonspeech sounds. The words are then retrieved from the
person’s lexicon and processed as speech semantically and syntactically.

Neurobiology of Reading
Each of the cognitive functions of reading is performed by one or more spe-
cific brain regions (Price 2012) (Figure 7–2). Table 7–2 summarizes the neu-
ral correlates of language, as described here. After visual input is received by
V1, the visual word forms are then processed by the left ventral-temporal
occipital cortex (vTOC), which includes the fusiform gyrus and the ITC.
Sublexical reading is handled by the posterior vTOC. Articulatory recoding
is processed by the left ventral pars opercularis. Acoustic processing is per-
formed by the left superior temporal gyrus (STG). Processing of familiar
Neurobiology of Neurodiversity 157

FIGURE 7–2. Illustrative sketch of the location of language-related

activations.
To view this figure in color, see Plate 2 in Color Gallery.
a=anterior; A=auditory cortex; AG=angular gyrus; c=caudate; CB=cerebellum; d=
dorsal; GP=globus pallidus; IFS=inferior frontal sulcus; IOG=inferior occipital
gyrus; ITG=inferior temporal gyrus; (l)=larynx; m=medial; MFG=middle frontal
gyrus; MTG=middle temporal gyrus; OCC=occipital; OT=occipitotemporal; p=
posterior; PM=premotor; PO=parietal operculum; PoC=postcentral; pOp=pars
opercularis; pOrb=pars orbitalis; PreC=precentral; PT=planum temporale; pTri=
pars triangularis; PUT=putamen; SFG=superior frontal gyrus; SMA= supplementary
motor area; SMG=supramarginal gyrus; STG=superior temporal gyrus; STS=
superior temporal sulcus; (t)=tongue; Th=thalamus; TPJ= temporoparietal junction;
v=ventral; VI=lobule VI (medial anterior); VII=lobule VII (lateral posterior).
Source. Adapted from Price 2012. Used under Creative Commons license.
Adaptations: Abbreviations have been moved to the figure note and reordered
alphabetically; color key has been split in two for space.
158 Neurodiversity

TABLE 7–2. Neural correlates of language

Function Construct Anatomical region

Visual word form processing Visual word forms Left vTOC

Mapping orthography onto Sublexical reading Posterior vTOC
phonology
Phonological processing Articulatory recoding Left ventral POP
Auditory processing of Acoustic processing Left STG
speech and nonspeech Familiar sounds Posterior STS
sounds Auditory imagery Left PT
Short-term word memory Left POP
Word retrieval Word selection Left SFG, left MFG
Word suppression aACC
With minimal semantics Left pSTG
Speech comprehension Accessing semantics Posterior MTG
Sematic associations Left anterior MTG, left
ITC, anterior vTOC
Influence of context Left SFG
Integrating and predicting Left and right AG
Selection and retrieval Left pOrb
Phonological output General action selection Left dPM
Sequencing motor plans SMA, pre-SMA
Overt articulation Motor execution SMA
Orofacial motor activity PreC/PoC
Timing of motor output CB[VI]
Breathing control aINS, TH-vl
Auditory and motor feedback Auditory processing Posterior STG
during speech production Auditory expectation Left POP
Note. aACC=anterior zone of anterior cingulate cortex; AG=angular gyrus; aINS=anterior
insula; CB[VI] =cerebellum (paravermal lobule VI); dPM=dorsal premotor cortex; ITC=
inferior temporal cortex; MFG=middle frontal gyrus; MTG=middle temporal gyrus; POP=
pars opercularis; pOrb = pars orbitalis; PreC/PoC = precentral/postcentral cortex; PT =
planum temporale; SFG = superior frontal gyrus; SMA = supplementary motor area;
STG=superior temporal gyrus; STS=superior temporal sulcus; TH-vl=thalamus–ventral
lateral; vTOC=ventral temporal-occipital cortex.
Source. Adapted from Price 2012.

sounds is achieved by the posterior STS. Activation of the left planum tem-
porale is associated with auditory imagery. Short-term word memory is
performed by the left pars opercularis. Word retrieval requires selection of
words and suppression of specific words. Selection of words is achieved by
the left superior frontal gyrus and the left middle frontal gyrus (MFG),
Neurobiology of Neurodiversity 159

while suppression of words is processed by the anterior zone of the anterior

ACC. Word retrieval with minimal semantics is accomplished by the left
posterior STG. Speech comprehension involves accessing semantics by the
posterior MTG and making semantic associations by the left anterior
MTG, left ITC, and anterior part of the vTOC. Influence of context is han-
dled by the left superior frontal gyrus. Integrating or predicting speech cor-
relates with activity in the left and right angular gyri. Finally, the selection
and retrieval of words is achieved by the left pars orbitalis.
The output of speech sounds involves the left dorsal premotor cortex,
supplementary motor area (SMA), and pre-SMA. The articulation of words
requires the SMA to control motor execution, the precentral/postcentral
cortex for orofacial motor movements, the cerebellum to coordinate the
timing of motor output, and the anterior insula and ventral lateral thalami
to control breathing during word production. Processing of auditory stimuli
during speech production is handled by the posterior STG, while expecta-
tion of auditory stimuli is processed by the posterior part of pars opercularis.

Brain Structure and Function of Children

With Developmental Dyslexia
Children with dyslexia were shown to have less gray matter volume in the
left STS, left ACC, right precentral cortex, right MFG, and right anterior
STG when compared with age-matched TD children. However, after read-
ing level was matched, the right precentral cortex was the only region of
interest that demonstrated smaller volume (Krafnick et al. 2014). These re-
sults suggested that the lower gray matter volume observed in the left STS,
left ACC, right MFG, and right anterior STG of children with dyslexia
were likely to be the consequence of reading experience rather than the in-
trinsic neurobiology of dyslexia.
Local gyrification index was also found to be different in children with
dyslexia and age-matched TD children (Caverzasi et al. 2018). In particular,
the left lateral temporal and middle frontal regions revealed the most signif-
icant differences. Local gyrification index was found to correlate with neu-
rite density and orientation dispersion index, suggesting that differences in
gyrification in children with dyslexia are related to atypical neurite morphol-
ogy and synaptic pruning.
The neurobiology of dyslexia was also examined functionally by fMRI.
The left vTOC (also known as the visual word form area) of TD children
revealed an anterior-to-posterior gradient of increasing selectivity for words,
whereas this neural correlate was absent in dyslexic children (Olulade et al.
2015). Furthermore, a pattern of increasing selectivity for words along the
160 Neurodiversity

medial-to-lateral axis of the left inferior frontal cortex (IFC) in TD children

was also observed. The most lateral aspect of the IFC and the anterior as-
pects of the left vTOC are functionally connected during word processing
tasks in TD children. In contrast, dyslexic children did not show the IFC
gradient and IFC-vTOC connectivity (Olulade et al. 2015). Finally, word
processing was found to increase activity in the paravermal lobule VI of the
cerebellum in TD children but not in dyslexic children (Ashburn et al.
2020); however, the cerebellum did not appear to be affected functionally
during reading in dyslexic children.

Brain Organization of
Individuals With Hyperlexia
Hyperlexia is a rare neurodevelopmental condition characterized by early pre-
cocious reading abilities (e.g., word decoding, pronunciation) relative to com-
prehension skills and a high affinity to written material. The neurobiology of
hyperlexia is understudied. In one fMRI study, a 9-year-old boy with hyperlexia
demonstrated increased activity in the left IFC and left STG compared with
age- and reading age–matched TD control subjects (Turkeltaub et al. 2004).
Activity in his right ITC was significantly higher than that in the reading age–
matched TD group. Using structural MRI, the size of the brain of a super sa-
vant was found to be at the 99th percentile, although his cerebellum was small
and malformed (Treffert and Christensen 2005). Another striking finding
from this super savant was that he did not have a corpus callosum, which
connects the two hemispheres, or the anterior and posterior commissures.

Neurobiology of
Visual-Spatial Abilities
Visual-spatial abilities have been characterized through many approaches.
One of the most common assessments for visual-spatial abilities is the Em-
bedded Figures Test (EFT; Witkin et al. 1971), which requires the partici-
pant to identify a simple target embedded within a more complex figure.
Another commonly used testing approach is the modified block design task
subtest from Wechsler scales, which assesses perceptual cohesiveness, vi-
suomotor speed, global perception, visual memory, visual search, and speed
of visual encoding (see Chapter 4). Much of the neurobiology of visual-
spatial abilities is based on these tests.
The projections from V1 to higher areas in the cortex can be roughly
divided according to two major parallel pathways: a ventral pathway leading
from V1 to the temporal lobe that is important for representing “what” ob-
Neurobiology of Neurodiversity 161

jects are and a dorsal pathway from V1 to the parietal lobe that is important
for representing “where” objects are located. In fMRI studies of TD ado-
lescents, activations attributed to the local search aspects of the EFT were
left lateralized in parietal cortex and premotor areas (Manjaly et al. 2007).
Enhanced perceptual performance in autistic individuals has been re-
ported in the past few decades (de Jonge et al. 2006; Edgin and Pennington
2005; Jolliffe and Baron-Cohen 1997; Shah and Frith 1983, 1993). To ex-
plain this phenomenon, the enhanced perceptual functioning model pro-
posed that enhanced perception in autistic people can be manifested by
enhanced low-level (e.g., discrimination) and mid-level (e.g., pattern detec-
tion) cognitive processing and increased autonomy of perception with re-
spect to top-down processes (Mottron et al. 2006).
Lee et al. (2007) used fMRI to examine the neural basis of EFT perfor-
mance in autistic children and age- and IQ-matched TD control subjects.
Both groups achieved the same performance level in the EFT; however, au-
tistic children activated only a subset of the brain regions activated in the TD
subjects. In the frontal cortex, activation of the left dorsolateral, medial, and
dorsal premotor regions was observed in TD children, but only the dorsal
premotor region was activated in autistic children. Similarly, in the parietal
and occipital cortices, TD children showed bilateral activation, whereas au-
tistic children exhibited unilateral activation in the left superior parietal cor-
tex and the right occipital cortex. Finally, activation of bilateral ventral
temporal cortices was observed in TD children but not in autistic children.
In autistic adolescents, EFT activated the right V1 and bilateral extrastriate
areas (V3, V4, V5). In contrast, TD adolescents activated distinctly different
brain regions (left lateralized in parietal cortex and premotor areas) (Man-
jaly et al. 2007). While performing the EFT, high-functioning autistic in-
dividuals, compared with age- and IQ-matched TD adolescents and young
adults, demonstrated decreased activation in the left DLPFC and inferior
parietal areas and increased activity in parietal and occipital areas associated
with visual-spatial processing (Damarla et al. 2010).
Collectively, these results suggested that autistic individuals and TD
control subjects used different neural networks to perform visual-spatial
functions. In a meta-analysis of 26 neuroimaging studies involving a total of
727 subjects (about half with autism and half TD), Samson et al. (2012)
found that, compared with TD control subjects, autistic individuals exhib-
ited higher activation of cortical areas associated with visual perception (e.g.,
fusiform gyrus). These results supported the original enhanced perceptual
functioning model, demonstrating that perceptual processing in autistic in-
dividuals plays a prominent role across a wide range of visual-spatial tasks.
Furthermore, the neural organization of perceptual processing is atypically
organized in autistic individuals.
162 Neurodiversity

In addition to perceptual processing, attentional processing has been

proposed as another potential explanation for the autism advantage in vi-
sual search (Kaldy et al. 2016). Briefly, attentional processing can be con-
ceptualized to include alerting, orienting, and executive control. Autistic
individuals were found to exhibit differences in modulation of arousal, nov-
elty processing, attentional disengagement and shifting, and performance
on complex executive control tasks (Keehn et al. 2013). These tendencies
collectively result in different strategies in visual search. Most recently, the
relationships between visual search abilities and neurochemistry in autistic
children were investigated (Edmondson et al. 2020). Region-specific neu-
rochemicals were examined in the right frontal eye fields; right temporo-
parietal junction, which includes the STG and STS; and bilateral visual
cortices. In autistic children, concentration of GABA, the brain’s main in-
hibitory neurotransmitter, in the visual cortices was found to correlate pos-
itively with visual search and negatively with sociocommunicative function.
However, this correlation did not hold for TD children. Furthermore, de-
creased N-acetyl aspartate, creatine, glutamate and glutamine (Glx), and
GABA/Glx ratio were found in the right temporoparietal junction, suggest-
ing neuronal dysfunction in this important network hub.
Another visual-spatial ability is the capacity to perform mental rotation
of objects. Compared with TD control subjects, autistic individuals demon-
strated a relative advantage for mental rotation (McGrath et al. 2012).
During the mental rotation task, the autism group exhibited reduced activa-
tion in the frontal, temporal, occipital, striatal, and cerebellar regions com-
pared with the TD group. The autism group was found to have decreased
negative functional connectivity between the right fusiform gyrus, left Brod-
mann area (BA) 19 (part of the extrastriate cortex), left inferior semilunar
lobule of the cerebellum, and multiple interhemispheric and interregional
areas. Autistic individuals also exhibited decreased positive connectivity rel-
ative to TD control subjects between the right cuneus and right caudate seed
regions and a number of correlated regions.
These results suggest underconnectivity of neural circuits is responsible
for visual-spatial functions in autistic individuals. In the same cohort of in-
dividuals, white matter tracts were also assessed (McGrath et al. 2013). The
structural integrity of the white matter tracts connecting brain regions that
showed aberrant functional connectivities was assessed. Fractional aniso-
tropy of these white matter tracts was found to be reduced in autistic indi-
viduals compared with TD control subjects. In particular, this result was
most significant for the white matter tracts connecting the left BA19 to left
caudate head and left BA19 to left thalamus.
Neurobiology of Neurodiversity 163

Neurobiology of
Musical-Rhythmic Abilities
(Focusing on Absolute Pitch)
Absolute pitch (AP), also called perfect pitch, is the ability to identify or re-
create a given musical note without using a reference tone. This trait is rare
in the general population (1 in 10,000; Takeuchi and Hulse 1993); its prev-
alence in autistic individuals is much higher (1 in 20; Brown et al. 2003). In
this section, we describe the neurobiology of AP in TD individuals and dis-
cuss how the neurobiology of AP may be associated with autism.
Much is known about the neural basis of AP in TD individuals. AP is
believed to involve “categorical perception” and “pitch labeling.” The brain
regions involved for these components have been identified through neu-
roimaging, whereas the underlying functions have been shown in electro-
physiology studies. It is known that pitch perception involves primary areas
such as Heschl’s gyrus and associated areas such as the STG, including the
planum polare and planum temporale (BA41, BA42, and partially BA22).
fMRI studies revealed that the STG was associated with the categorical
perception of tones (Dohn et al. 2015), whereas the left posterior DLPFC
was associated with pitch labeling in musicians possessing AP (Sedley et al.
2012). Structurally, AP possessors displayed increased cortical thickness in
a number of areas, including the STG (Dohn et al. 2015). Interestingly, the
gray matter volume of the right Heschl’s gyrus was highly correlated with
AP proficiency (Wengenroth et al. 2014).
Electrophysiological studies have shown functional responses to pitch
perception in the auditory cortex. When studied using magnetoencephalo-
graphy, oscillatory responses to pitch in the gamma frequency band occurred
in Heschl’s gyrus from 60 Hz upward (Sedley et al. 2012). Furthermore, in
a study that utilized electroencephalography combined with proton mag-
netic resonance spectroscopy, the power of gamma band oscillations and
perception in multisensory integration was predicted by GABA concentra-
tions in the STS (Balz et al. 2016). GABAergic interneurons are known to
produce gamma band oscillations (Bonifazi et al. 2009). In sum, pitch pro-
cessing is associated structurally with the frontal and temporal cortices and
functionally with gamma band oscillations, which, in turn, are mediated by
the GABAergic system.
While the neural basis of AP in autistic individuals is largely unknown,
abnormal neural functions in the auditory cortices have been associated
with nonauditory impairments in autism. For example, STS abnormalities
164 Neurodiversity

have been associated with social deficits in autism (Zilbovicius et al. 2006).
Magnetoencephalography studies demonstrated that, compared with TD
participants, autistic participants showed slower response latency in the left
Heschl’s gyrus and impaired rapid auditory processing (Demopoulos et al.
2017). Also, the left auditory evoked response latency delay was significantly
correlated with verbal IQ in autistic individuals (Demopoulos et al. 2017).
Most recently, relationships between characteristics of autism, AP, and
electroencephalographic (EEG) connectivity in professional musicians
were studied (Wenhart et al. 2019). Graph theoretical analysis of resting-
state EEG connectivity revealed that, compared with musicians without AP,
musicians with AP had increased autistic traits, increased path length (delta
2–4 Hz), reduced clustering (beta 13–18 Hz), and reduced small-worldness
(gamma 30–60 Hz) during resting state. These results suggest that musi-
cians with AP exhibited underconnectivity with reduced functional integra-
tion in brain networks. In particular, for AP possessors, EEG connectivity,
as measured by weighted phase lag index, was found to be increased in the
left frontal and parietal regions and reduced between the bilateral temporal
regions. These results suggested underconnectivity of the left STG and the
right inferior frontal occipital fasciculus, which has already been associated
in both AP (Dohn et al. 2015) and the relationship between underconnec-
tivity of bilateral temporal regions and autism (Tsiaras et al. 2011).

Neurobiology of
Interpersonal Synchronization
Interpersonal synchronization is a phenomenon characterized by time- and
form-aligned behaviors that occur naturally in social interactions. For exam-
ple, two people match their behaviors, such as gestures, facial expressions,
and language, while communicating with each other (Louwerse et al. 2012).
This mimicking behavior is important socially because synchronizing with
a social partner or a group has been shown to result in more prosocial be-
haviors and positive effects on social bonding and cognition (Mogan et al.
2018). Furthermore, physiological (e.g., matching heart rate) and behavioral
synchronization has also been shown to predict experience of group cohe-
sion (Gordon et al. 2020).
Functional near-infrared spectroscopy (fNIRS) is a neuroimaging tech-
nology designed to detect cerebral hemodynamic activation of the human
cortex (Ferrari and Quaresima 2012). The instrumentation has been ad-
vancing rapidly in recent decades. The machine-human interface looks like
a helmet. The most advanced model of fNIRS is wireless, thus allowing the
user to have more freedom to move. Shamay-Tsoory et al. (2019) proposed
Neurobiology of Neurodiversity 165

that social alignment is mediated by a neural network that monitors and re-
sponds to errors in synchronized movement, emotional contagion, and so-
cial conformity. Using fNIRS, coordination of neural activation on activities
of shared interest was studied (Fishburn et al. 2018). The time course of ce-
rebral hemodynamic activation of one participant predicted that of the part-
ner when they completed a puzzle together.
Affiliative bonding between students and teachers was recently demon-
strated by measuring brain activations simultaneously (Zheng et al. 2020).
Results from fNIRS studies have shown a significant increase in brain syn-
chronization at the right sensorimotor cortex between the teacher and the
student in the resting state after but not before the instructional period. Fur-
thermore, the synchronization increased after a turn-taking mode of teach-
ing (i.e., teacher and student sat side by side; the teacher presented a problem
on the computer screen; the student read the problem and thought about
it for approximately 20 seconds; the teacher finally guided the student to
solve the problem). In contrast, when the instructions were given in a lec-
ture or video mode, the interpersonal synchronization did not increase.
Collectively, these findings suggested that interpersonal synchronization in
brain activations was associated with affiliative bonding and that this rela-
tionship was mediated by social interactions.
Interpersonal synchronization was assessed in autistic children (Wang et
al. 2020). In particular, interpersonal synchronization in the frontal cortex
was found to increase more when autistic children were engaging coopera-
tively with their parents than when they were performing on their own. Com-
pared with children with less severe autism symptoms, those with more severe
symptoms demonstrated less interpersonal synchronization when they inter-
acted with their parents. Studies investigating interpersonal synchronization
were also performed in adults. Compared with TD young adults, autistic in-
dividuals were found to have more difficulty synchronizing tapping behavior
with others and to exhibit higher theta-wave activity in the frontal cortex
during the task, especially when the partner tapped irregularly (Kawasaki et
al. 2016). Interestingly, the magnitude of the theta-wave activity correlated
positively with the extent of autism characteristics. Collectively, these stud-
ies supported the evidence of interpersonal synchronization as a neural cor-
relate underlying social interaction differences in autistic individuals.

Neurobiology of Intrapersonal
Abilities and Autism
Intrapersonal abilities are the capacities to understand self.The sense of self has
been associated with the salience network, which is composed of the frontoin-
166 Neurodiversity

sular cortex and the ACC, and with the default mode network, comprising the
ventromedial prefrontal cortex, posterior cingulate cortex, and temporopari-
etal junction (Uddin 2015). The ventromedial prefrontal cortex has been
shown to be central in multiple aspects of social cognition, including recogni-
tion of facial emotions, theory of mind, and processing of self-relevant infor-
mation, through its interactions with the posterior cingulate cortex, precuneus,
dorsomedial prefrontal cortex, and amygdala (Hiser and Koenigs 2018).
Autistic individuals are known to have an altered sense of self (Uddin
2011). Compared with TD adolescents and young adults, age- and IQ-
matched autistic individuals have been found to have overconnectivity in
three connections: the anterior insula to the retrosplenial cortex, the ante-
rior insula to the frontal pole, and the DLPFC to the retrosplenial cortex
(Hogeveen et al. 2018). Functional connectivity between the anterior insula
and the retrosplenial cortex was found to correlate positively with the dif-
ference in parent report and self-report of internalizing symptoms.

Neurobiology of Creativity
Creativity can be defined as the ability to generate new ideas, which can en-
hance people’s experience in all possible ways. As described in Chapter 5, the
Torrance Tests of Creative Thinking (TTCT; Baer 1993; Kim 2006) were
designed to assess creativity, divergent thinking, and other problem-solving
skills. The TTCT have four subscales: Fluency, Flexibility, Originality, and
Elaboration.
Creativity, as measured by TTCT, has been found to be increased by en-
hancing alpha power using transcranial alternating current stimulation of
the frontal cortex in TD adults (Lustenberger et al. 2015). This effect was
determined to be specific to 10-Hz but not 40-Hz stimulation. Greater cre-
ativity, as measured by an abbreviated version of the TTCT, was found to
be associated with the inferior frontal gyrus (IFG) and inferior parietal lobe
(Sunavsky and Poppenk 2020). The IFG is part of the central executive net-
work, and the inferior parietal lobe is part of the default mode network.
Hence, this result suggests that these networks may work together in cre-
ative ideation. Other neuroanatomical regions implicated in creativity in-
clude the anterior lobe of the cerebellum and the parahippocampal gyrus,
which may be associated with the roles of working and long-term memory
for creative ideation. In a study focusing on cortical thickness, visual creativ-
ity was found to correlate negatively with cortical thickness in the left MFG,
right IFG, right supplementary motor area, and left insula (Tian et al. 2018).
The TTCT have been used to assess individuals with neurodiverse con-
ditions. Dyslexic children and adolescents showed higher creativity scores
Neurobiology of Neurodiversity 167

than did TD control subjects. Interestingly, the TTCT scores were found
to be higher in dyslexic college students compared with nondyslexic control
subjects (Kapoula et al. 2016). As stated in the previous paragraph, creativ-
ity was shown to be associated with the IFG (Sunavsky and Poppenk 2020),
which was also found to be hypoactive in dyslexic individuals (Hancock et
al. 2017). Further studies are needed to determine the relationship between
the IFG and creativity in dyslexic individuals.
Autistic individuals appear to manifest creativity in a different way than
dyslexic individuals. Exceptional talents for drawing and realistic spatial de-
pictions have been observed in a small fraction of autistic individuals (Tref-
fert 2009). Furthermore, people on the autism spectrum were found to be
more able to demonstrate reality-based creativity than imaginative creativity
(Craig and Baron-Cohen 1999). The neurobiology of reality-based creativ-
ity in autistic individuals may be associated with their visual-spatial abilities,
as discussed in Chapter 4.

Conclusion
This chapter discussed the neurobiology of mathematical abilities, verbal-
linguistic abilities, visual-spatial abilities, musical abilities, inter- and intra-
personal abilities, and creativity. I summarized the known salient differences
in the neurobiology of these abilities in autistic and dyslexic individuals. The
understanding of the neural correlates of the strengths of neurodiverse con-
ditions is at its infancy. Much work has to be done to further understand
the neural network differences in autism, dyslexia, ADHD, and other neu-
rodevelopmental conditions responsible for the strengths that we can un-
cover in neurodiverse people.

KEY CONCEPTS
• The neurobiology of neurodiverse conditions has been studied based on
their diagnostic criteria. This chapter describes the neurobiology of spe-
cific abilities in typically developing (TD) and neurodiverse people.
• Specific abilities can be dissected, and their neural correlates can be un-
derstood accordingly. For example, mathematical abilities involve cir-
cuits including
• The primary visual cortex, which receives the visual input
• The fusiform gyrus and inferior temporal cortex, which recognize the
numbers
168 Neurodiversity

• The intraparietal sulcus, which receives visual-spatial representations

of numerical quantity from the fusiform gyrus and inferior temporal
cortex
• The frontoparietal circuits, which monitor performance and inhibit
undesired responses
• The middle temporal gyrus and superior temporal sulcus, which are
language centers involved in mathematical operations
• The medial temporal cortex, anterior temporal cortex, and angular
gyrus, which allow for long-term storage and retrieval of numerical
problems
• The ventrolateral prefrontal cortex and the salience network, which
maintain attention during problem solving and decision making.
• Although both TD and neurodiverse individuals use similar brain re-
gions for the same cognitive functions, their activation patterns are not
the same. For example, the ventral temporal-occipital cortex (vTOC)
was found to be activated during mathematical problem solving in au-
tistic children, whereas the dorsolateral prefrontal cortex was activated
in TD children. This suggests that autistic individuals spare the vTOC
for mathematical problem solving rather than facial recognition, which
is the typical function of the vTOC for TD children.
• One common observation across the strengths seen in autistic individu-
als (e.g., mathematical manipulations, calendrical calculations, perfect
pitch) is that these individuals use symbolic notations to organize contin-
uous measures (e.g., numbers, time, pitch). Therefore, they may learn im-
precise abilities such as nonverbal communication more readily if
symbolic notations can be used in the training.
• A positive attitude toward mathematics has been found to predict math-
ematical achievement (Chen et al. 2018). Increased engagement of the
hippocampal learning-memory system was found in individuals who
had a positive attitude toward mathematics. Teachers’ efforts to inspire
students’ positive attitude toward mathematics will potentially determine
the success of the students’ learning of the subject.
Neurobiology of Neurodiversity 169

Recommendations for Educators,

Clinicians, and Other Professionals
• Neuroscientists are encouraged to study the relationship between brain
function and strengths (rather than only challenges or deficits) of neu-
rodiverse people.
• Translational scientists are urged to utilize the neuroscience of human
abilities to formulate research questions that can be led to clinically rel-
evant interventions.
• Clinicians and educators are invited to incorporate the neuroscience of
neurodiversity into their work with patients and students, respectively.

Discussion Questions
1. Based on what we know about the neurobiology of interpersonal syn-
chrony and mathematical skills, what are some brain-behavior relation-
ships we can hypothesize to explain the challenges and strengths of
autistic individuals in mathematical and logical abilities?
2. Some people have challenges in mathematics, reading, or both. What are
some neurobiological concepts we can propose to explain these chal-
lenges?

Suggested Readings
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superior mathematical abilities in children with autism. Biol Psychiatry
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Mottron L, Bouvet L, Bonnel A, et al: Veridical mapping in the development
of exceptional autistic abilities. Neurosci Biobehav Rev 37(2):209–228, 2013
Price CJ: A review and synthesis of the first 20 years of PET and fMRI
studies of heard speech, spoken language and reading. Neuroimage
62(2):816–847, 2012
Sunavsky A, Poppenk J: Neuroimaging predictors of creativity in healthy
adults. Neuroimage 206:116292, 2020
Treffert DA, Christensen DD: Inside the mind of a savant. Sci Am 293(6):108–
113, 2005
Uddin LQ: Salience processing and insular cortical function and dysfunction.
Nat Rev Neurosci 16(1):55–61, 2015
170 Neurodiversity

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 EIGHT
Neurodiversity in
Higher Education
Support for Neurodiverse
Individuals and Professionals
Nancy Doyle, Ph.D.

I will not follow where the path may lead, but I will go where
there is no path, and I will leave a trail.
Muriel Strode

On terminology: I (N.D.) recognize that the term neurodiverse can be applied at the
species level as well as the individual and that therefore many people prefer to
identify as “neurodivergent” or as a “neurominority.” For consistency with my
coauthors and the editors of this book, I have referred to neurodiverse learners
throughout; however, I acknowledge that this language is evolving, and many
readers will be aware of alternatives.

175
176 Neurodiversity

Higher education is a key function of a meritocratic society and often

an aspirational goal for individuals; for many people, a sense of hu-
man progress and attainment rests in the achievement of degrees and
advanced degrees. Higher education is an institution of our society,
symbiotically woven into the fabric of our economy. We pay to study,
we study so we can earn, and we seek what Abraham Maslow (1943)
termed “self-actualization” through academic pursuits, progress akin
to a top promotion. It is therefore no surprise that higher education
contains and replicates many of the same biases, in terms of diversity
and poverty, that exist in employment. Higher education is the very
mechanism by which society can include or exclude, and efforts within
education can serve as an active lever for alleviating economic injus-
tice and leveling the playing field. The numbers are clear in terms of
social exclusion for all neurodiverse conditions; therefore, interven-
tion is an imperative. In this chapter, the active ingredients of leveling
the playing field for neurodiverse students are explored from a psy-
chological perspective. Although a number of different intervention
activities can legally be called disability accommodations, we really
need to understand the mechanisms and contexts in which these work.
Theoretical framing is presented, followed by practical implementa-
tion advice. The work of Genius Within, a social enterprise with ex-
perience coaching and training more than 10,000 neurodiverse adults
in education and employment, is presented as a case study.

Education is predicated on skills that do not always translate to the work-

place. Higher education offers a foundational knowledge base for the most
valued professions—such as law, medicine, engineering, teaching, technol-
ogy, finance, and public service—and the same educational process is used
for all. Seminars, lectures, and presentations, followed by examinations and
essays, are the pathways to professional credibility and economic power. To
succeed without accommodation in higher education, one is required to be
hyperliterate; reasonably numerate, depending on subject; able to sit still,
remember, and concentrate for sustained periods; and able to engage in
free-flowing social communication. In many cases, however, such socially
normed skills may be less relevant to later careers. A top surgeon needs
lightning reflexes and high visual acuity, whereas an engineer needs imag-
ination and the ability to mentally rotate and plan a large design, relying on
visual-spatial intelligence. Yet, despite the different requirements of these
careers, we assess students of both professions using long written essays and
assessments that require verbal comprehension, working memory, and swift
processing of two-dimensional sequential detail, which may not be required
Neurodiversity in Higher Education 177

for an actual final product in the workplace. In structuring our higher ed-
ucation systems around literacy and examinations and away from natural-
istic multisensory interactions, we have created a paradox: the people who
succeed may not be the best people for the job, and the people who fail may
instead be the best people for the job. Neurodiverse students often fall in
the latter group. Neurodiverse students have experienced this imbalance
throughout their educational experience. Sir Ken Robinson (2006), a pro-
fessor of education, stated that we “start educating the whole child and then
gradually move up the body, into the brain, and then over to the left side.”
Indeed, those language centers in the brain do seem to be the highest status
from the teenage years onward. Children who excel at dance, arts, crafts,
metalwork, and building Lego worlds are not generally considered to be as
“smart” or “academic.”

At Genius Within, we once provided a positive assessment for a young man

who, at age 7 years, had taken apart his own bicycle and successfully rebuilt it
to understand how it worked. When we assessed him at age 11, however, he had
failed all of his standardized tests because his spelling was basic and his concen-
tration was slim to none when he was not engaged. He had been previously di-
agnosed with dyslexia and ADHD, yet this knowledge did not improve his
confidence. Having a label for his difficulties was not enough to inspire him to
develop his visual-motor abilities into a science or engineering career.

The diagnostic process typically focuses on all of the things that are
wrong in order to prove the need for support, which has a negative psycho-
logical impact on the patient. Most neurodiverse students receive a dense re-
port filled with inaccessible terminology, such as “phonological processing
deficit” and “social communication deficiency.” The results are described as
standard scores or percentiles, terms not easily understood by laypeople.
The report is likely composed of justified blocks of text, with few tables or
graphs. The message is basically this: “You have a condition that you are not
bright enough to understand, and you need to rely on an expert.” Our neu-
rodiverse learners may thus be discouraged from even making it to higher
education—they may not even graduate high school. Those who do go on
to higher education begin with less “self-efficacy.” Self-efficacy is defined as
our ability to believe in a positive outcome from our actions and is a central
tenet of social cognitive learning theory, a framework for how humans learn
naturally (Bandura 1986). Without self-efficacy, we slip into a self-fulfilling
prophecy in which our doubt is our undoing, and we fail to achieve our po-
tential.
Lack of self-efficacy among neurodiverse higher education students is
well documented (Goudreau and Knight 2018; Holliday et al. 1999; Sol-
berg et al. 2012) and needs to be buffered in order to make a difference in
178 Neurodiversity

their lives. Instead of receiving a negative assessment, neurodiverse stu-

dents need to be given a “positive assessment”—a diagnostic process that
draws out their elements of strength as well as struggle and builds in voca-
tional, career guidance to contextualize realistic, aspirational goals. The
aim of the positive assessment is to provide hope. Students and their sup-
porters must navigate the educational paradox to achieve their potential.
Our goal with all interventions for neurodiverse students must be to pre-
pare them for transition to the world of work with their self-efficacy intact.
This chapter describes such activities in more detail.

Legal Considerations
Making disability accommodations for students is a legal duty, not a public
service project. Since the 1990s, developed economies have increasingly
recognized the undue burden placed on individuals who are “different” for
reasons of physiology or neurology. The social model of disability (Charl-
ton 1998) asserts that “context is king” and that disablement is the act of a
society that insists, for example, on stepped access to buildings, auditory
signals for crosswalks, or visual messaging only. This model is presented in
contrast to a medical model, which assumes that society is fine and that the
individual is broken and in need of fixing. Neurodiversity has heretofore
been considered within the medical model yet is increasingly being recog-
nized as a mismatch in “fit” or “learning style” as opposed to something that
is inherently deficient. Legislation developed worldwide (Americans With
Disabilities Act Amendments Act of 2008; Australian Government 1992;
South African Department of Labour 1998; United Kingdom Parliament
2010) now aligns with the United Nations Convention on the Rights of
Persons With Disabilities (2006), which states that educators and employ-
ers must make reasonable accommodations to enable all people to achieve
their full potential. The emphasis is on what must be done by the organi-
zation, not the individual. The aim is to achieve full potential, not to merely
scrape by with a passing grade.
“Universal design,” according to the United Nations’ statute, means
“the design of products, environments, programmes and services to be us-
able by all people, to the greatest extent possible, without the need for ad-
aptation or specialized design” (United Nations Convention on the Rights
of Persons With Disabilities 2006, p. 4). Professional lecturers, however,
are unlikely to be trained in neurodiversity learning protocols. Subject spe-
cialists who are teaching and assessing courses do not necessarily know how
to provide buffers or make accommodations. Accommodation services are
set apart from teaching and are targeted at making the person change rather
Neurodiversity in Higher Education 179

than the system. Examination boards have yet to ditch multiple-choice

tests, which in part measure grammar and processing speed, when the goal
should be to target long-term memory and comprehension; this change
must be a long-term goal to fulfill the aspiration of universal design. The
message to the neurodiverse student is this: If you want to pass your course,
we will provide additional education to squeeze your square peg of skills
into the round hole of assessment; this will cost you more time and effort
and perhaps also more cash.
Accommodations in higher education need to be based on interventions
that will sustain and suit the modern workplace, as well as prepare students
for independent living. Instead of investing in remedial spelling classes, we
can provide students with technology that types while they speak. Instead of
having students work through linear essay structures, we can present them
with mind-mapping software that allows their ideas to come out spatially
connected. In modern higher education, assistive technology is quickly be-
coming ubiquitous, and the technological revolution is in full swing. It is
quite possible that literacy is a transition technology and that dyslexia as a
stand-alone condition will cease to be an issue within the next 20 years. If
that sounds dramatic, consider that we already have glasses and smartphone
applications that will read out whatever we are looking at. However, even
when technology has updated the form of our communication, some people
will still not fit in—a new neurodiverse population, perhaps. We will always
have to deal with the outliers emerging from the new normalized system,
just as we do now, and they all will require accommodations to learn at their
best. Therefore, the principles of accommodation and flexibility will always
be required.
The following section sets out the accommodation and support systems
that are currently legally appropriate in higher education settings, with the
caveats that 1) as our norms of communication and learning evolve, so must
our interventions, and 2) contextual accommodations should be prioritized
whenever possible to prevent adding more burdens to students’ studies.

Effective Support Programs in

Higher Education
Universal Design Applied to
Neurodiversity
All environments in developed economies are somewhat contrived and un-
natural, potentially in conflict with humans’ evolutionary habitat. Being in-
180 Neurodiversity

side, in close quarters, for hours at a time with no natural light and no ability
to move, and surrounded by chatter, is not normal for our species. Many ed-
ucational and workplace settings deviate from a natural environment, and
although many neurotypical people might find the impact to be manage-
able, neurodiverse individuals might experience more constriction. For
people with ADHD, the sedentary lifestyle is inhibiting (Shelley-Tremblay
and Rosen 1996); for autistic individuals, the senses become overwhelmed
(Markram and Markram 2010); for dyslexic individuals, the background
noise affects concentration (McLoughlin and Leather 2013); for those with
dyspraxia (Kirby et al. 2011), the reliance on fine motor control can be
problematic; and for individuals with Tourette syndrome, the distractions
may increase tics (Averns et al. 2012). Also, the expectations for how stu-
dents process information can present problems for neurodiverse learners;
for example, some have talents in visual thinking, perhaps to the detriment
of acoustic processing (Bacon and Handley 2010).
In accommodation ergonomics, we talk about the “degrees of distrac-
tion” by reviewing a location in a workspace and noting the degrees around
the individual from which distractions may come. A corner position confers
90° of distraction, the middle of an open-plan room or lecture hall confers
360° of distraction. We also have plenty of good practical advice about
learning materials. For example, for dyslexic people, a double-spaced doc-
ument is easier to read if it uses a 12-point or larger sans-serif font and if
the text is broken up with bullet points, graphics, and useful headings (Bart-
lett et al. 2010). (Note how unusual this style is in academic writing and in-
deed in psychological assessment reports!) Also, highly contrasted text (e.g.,
black writing on a white background) may be easier for students with visual
impairment, but it can cause difficulties for those with Meares-Irlen syn-
drome, which causes perceptual processing difficulty due to high visual acu-
ity (King et al. 2008).
For these reasons, universal design for neurodiversity must address the
sensory environment. Accommodations should include, among others, pro-
viding flexible access to multisensory stimuli, arranging for students to have
the ability to move frequently and to find quiet decompression space, and
providing support with management of memory and executive function.
The following is a list of good practice recommendations related to univer-
sal design (the list is not exhaustive).

1. Design of environments
• Acoustics that avoid echo
• Lights that are as natural as possible
Neurodiversity in Higher Education 181

• Reserved seating in locations to the front and side for people who
require a reduction in ambient noise, to reduce the degrees of dis-
traction
• Reserved seating at the back for people who need to move or stand,
so they will feel less self-conscious
• Multiple exit points to avoid crowding on entry and exit
• Transfer spaces as wide and free-flowing as possible
• Decompression spaces or “quiet zones” to recover
2. Multisensory learning processes
• Adapting single-mode delivery, such as a monologue, to include ad-
ditional learning materials that include diagrams, text, or a summary
• Encouraging students to mind map while listening or to annotate
while viewing an image
• Providing “conferring breaks,” in which students are permitted to
talk briefly with people near them or to spend time quietly process-
ing what has been transmitted so far
• Using a microphone that transmits the lecture electronically so that
students can listen through headphones that block background noise
• Using webinar technology that allows students to select what they
are looking at and to alternate between viewing slides or images and
the face of the presenter
• Using closed-captioning on video presentation to support visual
processing of words
• Using materials that allow students to adapt the font, font size, and
background color of materials to make them more readable
• Avoiding long lectures without movement breaks
3. Testing accommodations and access arrangements
• Extra time1 in written examinations, particularly those employing
multiple-choice quiz format, in which comprehending grammar and
grammatically obtuse sentences may be a distraction from the true
purpose of assessing long-term memory of key concepts and facts

1Extra time is only appropriate when the method of assessment does not match the
eventual skill performance required. For example, in an assessment of a medical stu-
dent’s ability to perform a physical examination with a live role model, providing ex-
tra time would not be appropriate because a time-sensitive requirement in the job
role is being assessed. However, if the student is asked to list the essential elements
of a physical examination in writing, writing skills are being assessed rather than
visual-motor perception and performance; therefore, the method of assessment does
not match the ultimate skill performance, and the accommodation is reasonable.
182 Neurodiversity

• Ability to take tests in quiet spaces away from large halls, where small
noises and movement are more likely to cause excessive distraction
for neurodiverse students compared with neurotypical peers
• Ability to take breaks during examinations to move and stand up, or
to use a standing desk

The listed universal design accommodations will naturally reduce the

demands on the executive function of some neurodiverse students. For in-
dividuals who hear, see, or smell more acutely or who find it hard to select
the focus of their attention, screening out ambient clutter is a huge drain
on their executive function. This can lead to lower grades for neurodiverse
learners; it is not their comprehension of the material that is suffering, but
the basic mechanics of transmitting knowledge. Indeed, many neurodiverse
learners excel at higher-order thinking skills such as comprehension, criti-
cal evaluation, and perceptual organization (Grant 2009). Universal design
of environments and lecture materials will improve the acquisition and re-
tention of knowledge, such that neurodiverse learners can reach their full
potential rather than being overloaded with clutter.

Assistive Technology for Neurodiversity

Assistive technology includes software that types as a person speaks and
speaks what has been typed, provides specialist checks for spelling and gram-
mar, and turns mind maps into essay flow. In the past decade, these mate-
rials have become ubiquitous, and many are now embedded in standard,
everyday equipment such as smartphone and computer operating systems.
Research has found that the use of assistive technology is very popular with
student populations (Draffan et al. 2007, 2014); however, some authors cau-
tion that such technology is less popular with older populations and that
success may be moderated by effective training in how to apply the tools
(Doyle 2018).
Speech-to-text and text-to-speech software allows learners to choose
which sense they prefer to use to create and absorb materials. For this rea-
son, application does not need to be limited to those with dyslexia or dys-
praxia. Certainly, speech-to-text conversion is useful for reducing the
burden on fine motor control or spelling, but it also allows free flow of
thoughts onto the screen, which can be useful for people with ADHD or au-
tism who experience a “hyperfocused” state or for people with tics that affect
their typing. Text-to-speech conversion can improve the absorption rate by
allowing simultaneous visual and auditory stimulation, which increases con-
centration for individuals with working memory difficulties or reading de-
lays. The grammar- and spell-check systems were originally designed to
Neurodiversity in Higher Education 183

help dyslexic individuals, because a standard spell-checker does not differ-

entiate between homophones (e.g., “whether” and “weather”), although the
process of additional checking is useful for anyone who has attention lapses
while writing. With mind-mapping software, students can record their ideas
in any order, each within a separate block, and later move those blocks
around in order to get the “flow” right. This is useful for all students who
struggle with signposting and structuring, but it is particularly useful for vi-
sual thinkers and those who get to the answer before articulating how they
arrived there.
In general, assistive technology has the power to greatly reduce the de-
mands on executive function, fine motor control, and the mechanics of lit-
eracy, leaving learners free to analyze, appraise, and create. For this reason,
best practice is for professionals to offer assistive technology and training
in how to absorb that technology into a routine, without making assump-
tions about which tool is best suited to which condition. Universities could
provide a technology room, where new students can see demonstrations
and practice with available products so they can make an informed decision
about what will suit them best. Students’ needs might change as the stu-
dents progress; for example, some might find that they improve their spell-
ing and no longer need feedback, and others might increase their ability to
structure essays without mind mapping. Assistive technology will augment
and hone, but not replace, cognitive abilities.

Coaching for Neurodiversity

Coaching is described as a goal-oriented activity to empower and facilitate
the self-efficacy of coachees (Baron et al. 2011; Moen and Allgood 2009)
rather than to create dependence or further need for expertise. Jones et al.
(2016) performed a meta-analysis of 17 coaching studies and found that
coaching operated through cognitive and behavioral domain mechanisms,
as well as by improving the regulation of emotion in the workplace. Thee-
boom et al. (2013) also performed a meta-analysis (κ=18) and demonstrated
medium to large effect sizes for a range of outcomes, including cognitive
and behavioral domains, well-being, coping, attitudes, and self-regulation.
In the educational context, coaching is sometimes referred to as study skills
tuition, which speaks to a subtle but important difference in execution and
pedagogy. McLoughlin and Leather described coaching as an “andragogi-
cal approach” that relies on metacognitive experience (Leather et al. 2011;
McLoughlin and Leather 2013), but they highlighted that deviations from
this style are common in practice. Coaching psychology literature describes
the active ingredient to success in coaching as the “coaching alliance” (Gyl-
lensten and Palmer 2007; O’Broin 2016; Palmer and McDowall 2010), in
184 Neurodiversity

which the partnership quality between coach and coachee can determine ef-
fectiveness. Advice on how to foster and maintain a good coaching alliance
is predicated on listening skills, setting outcomes, good contracting at the
start, and maintaining appropriate boundaries. Coaching interventions for
neurodiverse students in higher education and employees in the workplace
need to be couched in dialectic protocols, using exercises and techniques
designed to facilitate self-development and metacognition (one’s ability to
be cognizant of one’s own thinking style, also the basis for many therapies
such as cognitive-behavioral therapy [Flavell 1979]). Coaching is therefore
distinct from tuition, which is a more didactic process aimed at knowledge
transfer. In coaching, the coach and coachee are not considered to be as
much “expert” and “novice,” and therefore the improvements will be more
empowering and active in fostering self-efficacy.

Mentoring
Mentoring is a relationship “in which an individual with more expertise pro-
vides knowledge and information to a less experienced individual” (Peyton
et al. 2001, p. 351). Mentoring reduces the focus on goals and increases the
value of relational exchange. Mentors from a similar social grouping (e.g.,
race, gender, neurodiversity) tend to be more effective (Blake‐Beard et al.
2011). An approach that “if I can do it, you can do it” works; it is a strong
and powerful message and a valuable tool for bringing neurodiverse students
into their zone and up to the power of their full potential. Peer mentoring
networks are frequently set up to aid transitions (Carragher and Mc-
Gaughey 2016) either into or out of higher education. Training the mentors
before engaging them is recommended, because a mentor’s own personal
anecdotal experience will not necessarily apply to a mentee, and mentors
must be able to separate their own experience from that of others. Essential
baseline skills for mentors include understanding the principles of mentor-
ship, listening to the experience of other mentors, and knowing how to ap-
proach boundaries, safeguarding, and supervision. Mentoring programs
should be overseen by a professional to whom mentors can turn if they have
any concerns, as a safeguarding measure.

Peer Group Coaching

Most academic institutions rely on one-to-one coaching or mentoring,
which is expensive for students or their educators (Carragher and Mc-
Gaughey 2016; Goudreau and Knight 2018; Tee et al. 2010). Group coach-
ing has been found to create a significant improvement in cognitive skills for
adult learners and employees, including those with neurodiversity, across a
Neurodiversity in Higher Education 185

wide range of ages and settings. Group coaching is not the same as teaching;
the facilitator asks questions rather than giving answers. The facilitator role
is to ensure that all members are heard, to contribute to their comfort level,
and to ensure that the conversation stays on topic and is solution focused.
Within a group coaching context, wisdom and new ideas emerge from the
conversation between equals with lived experience, which creates a differ-
ent dynamic, one more closely aligned with a natural learning environment.
Peer group coaching can blend the best from coaching and mentoring,
thereby reducing the risk of unsupported relationships in mentoring and
increasing the effect of role modeling within coaching. Role modeling and
vicarious learning are essential activities in the development of self-efficacy
(Bandura 1986), and the group coaching format mirrors this format closely
(Doyle and McDowall 2019).

Theoretical Frameworks for

Psychosocial Interventions
Effective psychosocial interventions are based on social cognitive learning
theory (Bandura 1997) to facilitate the self-development of mastery and self-
efficacy, with the application of principles from goal-setting theory (Locke
and Latham 2002) and elements from the broader research on coaching psy-
chology, such as the coaching alliance (Doyle and McDowall 2019; O’Broin
2016). Through narrative systematic review (Doyle and McDowall 2019),
improvements in core executive function from group coaching participants
were observed to be generally equal to or greater than the improvement
achieved with adaptive, computerized training games. The format also im-
proves self-efficacy (Doyle 2017; Grant 2009). This finding makes the
group coaching format highly recommended for neurodiverse students,
who almost universally have depleted executive function or self-efficacy
(Doyle and McDowall 2015; Leather et al. 2011; Locke and Latham 2002).
In contrast to the brain training paradigm, however, coaching interventions
produced improvements that were more likely to translate to functional,
contextual outcomes, such as comprehension and stress management. The
group coaching interventions also were observed to contain the forum for
the development of metacognition (Flavell 1979), which is an essential psy-
chological ingredient for the self-development required in advanced study
(Garner 2009). For these reasons, I include here the theoretical framework
synthesized from the narrative review, to inform designers of coaching,
mentoring, and peer-coaching interventions. Figure 8–1 demonstrates the
“active ingredients” of the coaching protocol, based on this theoretical
framework.
 186
Role modeling and vicarious learning
(SCLT2 and SCLT3), as well as
iterative goal refnement and
Context for intervention is developed Verbal persuasion activities (SCLT1)
personalization (GS1), are delivered
within a social identity, with input lead to well-clarifed outcomes and
through coaching, either using the
from a supervisor or employer (GS3). impact understanding (GS1).
peers in the group or in 1:1 settings
using previous experience of success
and local role models. Coachee practices new skills,
behaviors, techniques, or reframing
in live workplace leading to mastery
(SCLT4), improving more generalized
work performance,and embedding
the transfer outcomes.
Disability accommodation required to Coachee sets goals that relate to
Coachee develops improvements in
improve work performance. Coachee everyday work performance. Coach
one or more psychological domains,
understands self as an employee and offers activities that encompass
concurrently positively reframing
a person with unusual characteristics cognitive, behavioral,emotional, and
potential and success (GS2).
that do not easily ft the socially psychosocial domains of experience
All new domain improvements are
valued norms of success (i.e., they as intervening variables that can
related to work performance goals.
experience this as disability). be improved.

Neurodiversity
FIGURE 8–1. A framework for coaching neurodiversity.
Diagram incorporates the four tenets of social cognitive learning theory (SCLT; Bandura 1986) that are observed as present in natural learning
situations—verbal persuasion (SCLT1), role modeling (SCLT2), vicarious learning (SCLT3), and mastery (SCLT4)—as well as the three tenets
of goal-setting (GS) theory (Locke and Latham 2002)—goal clarity (GS1), self-efficacy (GS2), and socially contextualized goals (GS3).
Neurodiversity in Higher Education 187

The overlapping, iterative interplay of social contextualization and indi-

vidual psychology illustrates how we learn. We need to observe and under-
stand before we decide what to try, and we need to practice before we perfect;
we move through cycles of determining, executing, and reflecting. All learning
models, from Kolb’s learning cycle (Kolb 1984) to Dweck’s growth mindset
(Haimovitz and Dweck 2017), follow these principles to a greater or lesser ex-
tent. Building intervention programs around coaching psychology as opposed
to didactic instruction is thus more likely to increase individuals’ self-efficacy.
Self-efficacy takes the experience of exclusion from something determined by
the structure in which one was born to something over which one has agency.
A lack of self-efficacy is the psychological mechanism by which the structural
forces of “normal” assert their influence on individual outcomes, and by hack-
ing it in small, controlled social scenarios, we can help students build the resil-
ience they need to succeed in spite of their socially reinforced divergence.

Acquiring Coaching or Mentoring

Although many academic institutions fund specific support services, as is
their legal duty, the services they offer can be hit or miss because some pro-
grams are more popular and well instituted than others. Executive functions
coaching has received a lot of academic attention for students with ADHD,
in particular (Prevatt and Yelland 2015), as has literacy support for dyslexic
students (Kirby et al. 2008). Both services, however, require diagnosis and
disclosure, which many students resist. Voluntary disclosure of neurodiver-
sity in adulthood is low for several reasons, including stigma, lack of aware-
ness, and misunderstanding (Wilton 2006). Many people do not see their
condition as a disability, and when offered a referral to the disability service,
it does not seem appropriate to them. Others do not realize that their con-
dition still affects them in adulthood; for example, they may view dyspraxia
as having been an issue in early childhood development but as no longer rel-
evant now that they can tie their shoelaces. Additionally, diagnosis is unre-
liable, and co-occurrence between conditions may be the norm rather than
the exception (Doyle 2017). Therefore, without a joined-up, holistic ap-
proach to their functional needs, students could end up going from one ser-
vice to another without obtaining any real support for their challenges.
To counter these barriers, academic institutions need to offer a service
that will cut across many aspects of invisible disablement to help neurodi-
verse students with day-to-day problems they are experiencing rather than
a condition that some may not even know they have. To illustrate, one neu-
rodiversity coaching study found that 92% of coaches requested help with
memory/concentration issues, 82% with organizational skills, 78% with
time management, and 67% with stress management (Doyle and McDow-
188 Neurodiversity

all 2015); these issues were their main focus in coaching, regardless of stu-
dents’ conditions (e.g., ADHD, tic disorder, dyspraxia) (Doyle 2017). Given
the uniformity and success of peer group coaching protocols, the most ef-
ficient way for academic institutions to ensure access to coaching is to offer
these topics as part of a rolling program of workshops that can be selected
by neurodiverse students. This arrangement will be cheaper and easier to
administer and may also lead to better outcomes.
Mentoring is more difficult to contrive because the relationship quality
is paramount. Nevertheless, many academic institutions have made use of
mentoring via welcoming committees, workshops delivered by more ad-
vanced students, and in-person and online question-and-answer forums.
These are fruitful activities for a neurodiversity focus, and some closer
bonds may form with repeated opportunities. Essentially, academic institu-
tions need to move from a one-to-one remedial model to a proactive social
model in which coaching and mentoring opportunities are incorporated
into a welcoming program and momentum is maintained throughout the
course of study, with appropriate supervision, facilitation, and guidance.
The higher education environment can exacerbate anxiety for neurodi-
verse students who have relied on routines and scaffolding from parents in or-
ganization, timekeeping, and self-care. The transition to independence may
therefore be a larger leap for these students than for their neurotypical peers,
which may in itself feel stigmatizing. Within psychosocial programs, coaches
and mentors can help students by supporting transitions into and out of the
higher education environment, working on development of social skills or
coping mechanisms, and teaching independent living skills. Coaching and
mentoring alone are insufficient for all of the needs of neurodiverse students,
however, and academic institutions must also prepare for the additional men-
tal health needs that may arise. Neurodiversity frequently co-occurs with, and
is sometime misdiagnosed as, anxiety, depression, or eating disorders, partic-
ularly in girls (Edwin 2014; Hendren et al. 2018; Mandy and Tchanturia
2015; Quinn 2005; van Steensel and Heeman 2017). For this reason, higher
education support services would be well advised to ensure that access to
specialized mental health support is provided and that the people running
coaching and mentoring programs understand referral routes.

Transitioning From Higher

Education to the Workplace
Transitions from the higher education environment to the workplace have
historically been a further mechanism by which the attainment gap of neu-
Neurodiversity in Higher Education 189

rodiverse individuals is increased (Painter and Welles 2011; Taylor and

Walter 2003). Individuals applying for work will feel reassured by knowing
which accommodations will transfer and which will not, as well as what tar-
geted coaching and mentoring support will be available. For example, in a
workplace, coaching and assistive technology may be available, as well as
flextime, remote working, and some adjustments to the work environment.
Extra time to complete tasks, however, is not reasonable in an employment
context and will not translate. The key phrase is “reasonable,” and in this
context, in which there are very few definites, the assessment of reasonable-
ness comes down to understanding the interplay between individual abili-
ties and the demands and flexibility of the role and environment (Landy
1997; Lewin 1936). Coaching in this context must involve building a rela-
tionship with a representative of the organization to establish congruent
reasonable goals. The coach, representative, and employee needing accom-
modations make up the “coaching triad” (Law 2010; O’Broin and Palmer
2007). Organizational psychologists, for example, can offer a workplace
needs assessment, which triangulates what the employer can compromise
and how employee’s performance can be augmented with tools and coach-
ing. A workplace needs assessment can be requested by the employee and
offered by the employer; providing such an assessment is a sign of a respon-
sible and supportive employer. Neurodiverse job seekers should be encour-
aged to remember that the employment process works two ways: they should
accept roles in companies that they like, as well as getting the companies to
like them.

Case Example
Genius Within, a social enterprise based in the United Kingdom and the
United States, on whose work the award-winning docuseries Employable Me
(Wollaston 2016, and its U.S. version, The Employables) was based, has pro-
vided a range of support interventions for neurodiverse students, adults,
employers, and educators since 2010. Genius Within has provided coach-
ing to more than 10,000 people, and the practice has been found to improve
employment outcomes, retention, course completion, and promotion rates
(Doyle 2018; Doyle and McDowall 2015). Table 8–1 illustrates how Genius
Within has adapted the theoretical framework and coaching protocol shown
in Figure 8–1 into group coaching session plans evaluated with mature neu-
rodiverse learners. In a quasiexperimental field study with triple-blind con-
trols (N=119), the plan was found to significantly improve participants’
cognitive ability, self-efficacy, stress management, and learning strategy use
(Doyle 2018).
190 Neurodiversity

TABLE 8–1. Recommended group coaching

session plan
Week and topics covered* Coaching methods

Week 1: Why are we here?

Overview of research and purpose Visual and oral presentation group
Meeting each other discussion
Setting outcomes Development of metacognitive
Thinking about thinking awareness through silence,
observation, and discussion
Remembering that we remember well!
(Coutinho and Neuman 2008)
Notice your internal world—which senses
you use to think in
Developmental task: Think of a time or an
example of something you remember
well
Week 2: Natural strategies for memory
How do we remember when we remember Metacognitive exercises such as
well? Kim’s Game (Fisher 2006)
What state do we need to be in to debriefed in groups and pairs with
remember well? clean questions (Tosey et al. 2014)
Memory for names
Memory for space
Memory for image
Memory for sound
Memory for numbers
Developmental task: Practice a strategy at
least three times
Week 3: How do we think about time?
Using space and time to remember Clean Space, metacognitive exercise
Developmental task: Note your current for resolving conflicts between
time-management tools, such as diaries desired outcomes and practical
and electronic reminders, and note how realities (Lawley and Manea 2017)
these fit with your models for time
Neurodiversity in Higher Education 191

TABLE 8–1. Recommended group coaching

session plan (continued)
Week and topics covered* Coaching methods

Week 4: Emotional resilience

Strategies for concentration and paying Triune Brain and Drama Triangle,
attention (taking things in) two models for understanding how
Developmental task: Practice moving from our emotional states are affected by,
“drama” to “calmer” and can be improved via,
physiology and relationships at
work (Burgess 2005)
Week 5: Strategies
Time and organization Goal setting (Whitmore 1992) and
Putting into context Clean Space (Lawley and Manea
2017)
Developmental task: Practice strategies Think about what you are like when
you are organizing, planning, or
prioritizing at your best; elicit
examples of mastery from
exemplars and past experience
Week 6: Rerun strategies
What has worked well? Pair and group debriefing using
What has not worked well? Clean Questions (Tosey et al. 2014;
Walker 2014) and Clean Feedback
Reflecting on what we have learned and
(Walsh et al. 2015)
what we will do next
*Information from this column was presented as notes to participants.

The Genius Within program has been successfully cascaded to peer

mentoring networks in higher education settings and with people who are
long unemployed, as well as with people who are incarcerated. Based on our
experience, we have also provided awareness training to other professionals
and contributed to best-practice guides (Advisory, Conciliation and Arbi-
tration Service 2016). The following are essential to deliver: a focus on the
individual’s mastery—what the person can do well—and peer support and
encouragement. The positive assessment process is best placed at the start,
so the individual can begin with hope. The Genius Within program is cur-
rently focused on developing systemically inclusive (“next-level neurodiver-
sity”) programs in which principles of double-loop learning are applied to
the administration of accommodations at the individual level. Our technol-
ogy platforms provide insight into themes and patterns within the require-
ments, such that we are able to offer iterative, ongoing advice in progressing
192 Neurodiversity

toward universal design. This approach has the potential to improve inclu-
sion for future generations and is not prescriptive according to current so-
cial/clinical norms but will evolve with our technology and needs.
The following creative story from a Genius Within client illustrates the
journey of a neurodiverse person from shame, embarrassment, and isola-
tion to support, acceptance, and career self-actualization.

Once upon a time, there were two women with different agendas. The se-
cretive one had a secret...the other one had expectations. The secretive one
was coping on a daily basis but was fearful and struggling with written pro-
cedures, the other one was oblivious of this struggle. One day the two
women had a meeting. They stood at opposite end and did not understand
each other.
The secret was causing the misunderstanding and the secretive one was
fearful to speak out. The other one knew something was different but could
not find out what it was. The secretive one revealed the secret she had been
hiding for six months. The secret was dyslexia...
Both of the women stepped back and drew swords. The reason was fear,
exposure, not knowing how to progress on either side. The secretive one
was scared as she thought her career was in jeopardy. The other one had to
do some research.
The brave ones journey—The brave one felt defensive, scared, angry,
attacked and that nobody could understand her. She felt lonely and on her
own. The brave one felt a lot of anxiety that she would be trapped in the
forest with no directions and did not know what would happen next. The
brave one stepped into the light and choose to embrace it and go with the
journey, one day at a time.
The other ones journey—The other one could not sleep that night, as
she was worrying about the secretive one (now the “Brave One”). The other
one felt scared as she did not know how to progress and didn’t have the
knowledge to help the brave one. The other one knew she had to hold the
hand of the brave one to guide her through the forest. The other one went
to where all the helpers live. They sent a circle of support. Coping strategies
to help the brave one, software technologies, disability awareness training,
headphones so that the helpers could talk to the brave one and guide her on
her way. The other one felt that she had done her best to hold the hand of
the brave one and then she could take the steps on her own, and she did...
Together, the brave one and the other one started to build an under-
standing of each other and build a friendship. The brave one learned new
skills, grew in confidence, took off her shield of fear and strode bravely out
of the forest with the support and encouragement from the other one.
The brave one and the other one play together all the time, the brave
one is confident, efficient, accurate helpful, supportive, extremely good at
her job and feels confident to speak up and is happy she came out of the for-
est, she now plays in the light.
The other one is happy and very proud of the brave one. She feels that
she will always go into the forest to hold the hand of someone that is hiding
there.
Neurodiversity in Higher Education 193

If you are in the forest, please ask someone in your team to hold your hand and
bring you to the light.
The morale of the story (please read backwards)—
seye tnereffid htiw dlrow eht ta kool lla ew emas eht reve si eno oN .gninreal
ni secnereffid dnatsrednU
This is how difficult it can be for someone with dyslexia to understand...

Conclusion
Although sufficient randomized controlled trials of accommodations for
neurodiversity in higher education and the workplace are lacking, the best
evidence to date suggests that these activities must be socially contextualized
in order to bear fruit. We should include in accommodation plans activities
based on social cognitive learning theory, goal-setting theory, and the rela-
tional principles of the coaching alliance. These theories bring us to peda-
gogy: the need for dialectic exchange over didactic principles associated with
teaching in younger years. In all higher education pursuits, learners move
from more formal and mechanistic retention of facts, skills, and behaviors
to critical thinking, independent assessment of their own ability, and the cre-
ative development of knowledge. In this transition, the rules of the game are
changing, which can be confusing to many neurodiverse learners, who may
have struggled to understand the rules of the first game! This gear shift is
aided and smoothed by effective coaching and mentoring programs, which
provide a forum in which reflection on “how” a person is learning is as valid
as “what” that person is learning. A true dialectic exchange is not easy. Sep-
arating one’s own personal experience and bias from those of the learners
whom one is facilitating takes training and practice, as well as self-awareness
and supervision. Simply providing a room and a schedule for coaching and
mentoring will not suffice. The skills and competencies of coaches and men-
tors must be developed thoroughly to ensure a positive, safe outcome for
learners (Lai and McDowall 2016; Lawley and Linder-Pelz 2016).
The key element for neurodiverse students in higher education is to
move their social identity from one of a medicalized, deficit-based diagnosis
to that of a competent, valuable member of society with specialized skills to
offer. Neurodiversity at the species level refers to the idea that all people’s
neurocognitive ability profiles are different and that some people are gener-
alists and some are specialists. Within higher education, students may be
free for the first time to hone that specialism and step into their light, finding
their genius within. By ensuring that the process is proactive and positive
and that appropriate accommodations are made, we can deliver a much-
needed healing and self-affirming experience to students. We can build self-
efficacy and make the difference between career aspirations being met or
194 Neurodiversity

falling short. Neurodiversity is a moral, social, and economic imperative; ev-

erybody loses when human potential is squandered (Doyle 2018).

Acknowledgments
I must acknowledge the work of my organizational psychology and pro-
fessional coaching colleagues at Genius Within, who have diligently con-
tracted, applied, evaluated, and honed our work over more than a decade.
Together we have learned how to blend the academic principles of individual
differences psychology, person-environment fit, and goal-setting theory
into a successful program that is making strides toward inclusion for those
with neurodiversity and invisible disability. I also thank my clients, who have
shown their best sides in aspiring, working, and developing to their poten-
tial. Many of my clients have stepped up to share their learning, agree to
filming, and provide evaluation so that together we may go where there is
no path and leave a trail. And in learning to research and write, so that I
may leave that trail, I must acknowledge Professor Almuth McDowall, my
academic mentor and role model, under whose stewardship my own self-
efficacy has flourished. Thank you all for your committed hard work.

KEY CONCEPTS
• Self-efficacy is the belief in one’s own ability to act and succeed.
• Social cognitive learning theory describes the process, based on obser-
vation of naturalized learning in children, of how humans naturally ac-
quire new skills and abilities.
• Disability accommodations are changes to or flexibility with organiza-
tional practices, environment, or processes to ensure equity of opportu-
nity for people.
• In universal design, the design of systems and processes leads to insti-
tutionalized systems that are accessible to people with a wide range of
abilities and disabilities.
• Assistive technology is software and hardware that minimizes the impact
of cognitive or physical demands.
• Coaching involves goals-led interactions between people predicated on
building the confidence of and empowering action from the coachee.
Neurodiversity in Higher Education 195

• Mentoring is a relational exchange between a peer and a novice in

which information and reassurance are passed on informally.
• The coaching alliance describes the quality of the relationship within a
coaching intervention. This should include the employer in a workplace
context.
• Metacognition is the ability to think and reflect on one’s own internal
thinking patterns and how this differs from others’ thinking.
• Pedagogy is the principles underpinning a method and practice of
teaching.

Recommendations for Educators,

Clinicians, and Other Professionals
• Practice within your competence. If you are a clinician, do not offer work
or career advice. Bring in specialists to whom you can refer or from
whom you can acquire appropriate training. Likewise, if you are a work-
place specialist, do not provide advice on medication.
• Seek sufficient training in coaching and mentoring, which are not in and
of themselves transportable skills from teaching or clinical practice.
Coaching psychology research has demonstrated that the most active
ingredient of a coaching intervention is the alliance between coach and
coachee (employer/employee in a workplace setting) (Gessnitzer and
Kauffeld 2015), and therefore a deeper understanding of the specific
boundaries and communication techniques is needed for this context.
Principles such as confidentiality and the power balance are differenti-
ated in coaching; this takes practice and supervision when transferring
from other professions.
• Include a wide range of specialists in the design of environments, coach-
ing plans, or assessment programs. For example, when Genius Within
contracts to conduct assessments within higher education establish-
ments offering courses in medicine or other vocational majors, we first
discuss accommodations with the practice placement supervisors. This
prevents us from recommending activities or equipment that would not
translate to the work environment.
• Remember your own unconscious bias. For educated professionals, it is
easy to fall into the trap of seeing the system that facilitated your own
success as “normal” and complete, yet academia is not a reflection of the
world at large, and many careers rely on skills that you may not have had
196 Neurodiversity

to master in order to succeed. Play up the skills your students display

and relate them to the world of work, rather than simply focusing on the
process of essays and examinations.
• When designing learning and assessments, consider the many commu-
nication methods employed in the workplace. Can an essay be swapped
for a presentation? Can students choose which method they prefer to
communicate their knowledge? Can a lecture be broken into small-
group discussion to reduce the listening and concentration demands?

Discussion Questions
1. How can we adapt educational norms to match lifelong requirements in
citizenship and employment? What needs to change in our current sec-
ondary and higher education systems to provide a closer match?
2. What are your own experiences of coaching and mentoring? What were
the active ingredients of success for you personally? Have you experienced
positive transitions supported by mentors and role models in your own life?
3. What are the parameters of “reasonableness” in developing accommo-
dations in learning, assessment, and examinations? Can you give exam-
ples of where an adjustment is reasonable and not reasonable?

Suggested Readings
Armstrong T: The Power of Neurodiversity. Cambridge, MA, De Capo, 2010
Pollak D (ed): Neurodiversity in Higher Education: Positive Response to
Specific Learning Differences. Chichester, UK, Wiley-Blackwell, 2009

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 NINE
Specialized
Employment Initiatives
for Neurodiverse
Individuals
A Model Program
Jose Velasco, M.S.

When I hear people say we need to think outside the box,

my initial reaction is “Wait! There’s a box? Why didn’t
anybody tell me?”
Jeffrey Day, Ph.D., Duke Autism Employment Summit,
Duke University, May 2018

Neurological differences have always been part of humanity

and a part of workplaces, but it has not always been recognized
and now that it is recognized it stands besides other forms of
diversity as a powerful addition to any company.
John Elder Robison, Autism at Work Summit,
November 2019

201
202 Neurodiversity

The abysmal unemployment rates for an abundant pool of qualified

candidates on the autism spectrum is not consistent with the abundant
demand for talent from employers to satisfy their human capital needs.
The dominant explanation for this gap between supply and demand in-
volves two challenges. The first revolves around limitations in tradi-
tional enterprise processes to source, train, employ, and retain staff on
the autism spectrum. The second challenge revolves around the read-
iness of candidates on the autism spectrum for the labor market. The
compound effect of these challenges is being mitigated through the
implementation of autism hiring programs at enterprises that address
both enterprise accommodations via modified processes and upskilling
to reduce readiness gaps of autistic candidates. Implementation of
these programs is happening at all levels and across industries. Com-
panies ranging from a car wash in Florida to a multinational high-tech
company are collaborating with private, public, nonprofit, and educa-
tion sectors, many of which are represented in this collaboration by in-
dividuals on the autism spectrum. These programs, while still evolving
and mitigating challenges, are showing very positive results in a variety
of areas, including impact on enterprise product/process innovation
and quality, human capital management, company brand, and commu-
nity. The programs are also having a very significant influence on the
quality of life, independence, and self-determination of the autistic
community. This chapter reflects the practices to hire and sustain in-
dividuals in the workplace between 2014 and 2019, when the author
was responsible for the Autism at Work program at SAP SE in the
Americas Region.

Many things define us as adults, but employment is a key factor that enables
our independence and self-determination. Unfortunately, the unemploy-
ment rate in 2019 of 7.3% for people with disabilities was twice the rate for
people without disabilities in the United States (U.S. Department of Labor
2019). The situation is even more dire for people on the autism spectrum,
who are unemployed or underemployed at a rate of 85% according to a
study by the National Autistic Society (Griffiths et al. 2016).
The number of people on the autism spectrum continues to grow. Ap-
proximately 50,000 youth on the spectrum exit high school every year in the
United States. Estimates suggest that nearly 44% of these students enroll in
postsecondary institutions after high school (including 32.2% at 2-year or
community colleges; 21.0% at vocational, technical, or business schools; and
17.4% at 4-year colleges or universities) (Newman et al. 2011). Findings
from a recent study indicate that 0.7%–1.9% of current college students
Specialized Employment Initiatives for Neurodiverse Individuals 203

without a diagnosis would qualify if they were assessed for autism spectrum
disorder (White et al. 2011). Assuming that, say, 1.3% of college students
without a diagnosis are on the autism spectrum, and based on current levels
of college-level registrations (21.9 million students), there could be close to
285,000 students on the spectrum. In this chapter, to reflect the language
preferred by employees on the autism spectrum at SAP SE, I use person-first
language (e.g., individuals on the autism spectrum).
This chapter focuses on an approach to systematic labor market inclu-
sion of people on the autism spectrum. This inclusion is manifested through
opportunities that range from student enterprise exposure experiences to
full-time employment and are driven by business, community, and personal
value. My goal is to expand the dialogue about autism and neurodiversity
in the workplace, shifting from a disability-centric conversation to one cen-
tering on abilities. An earlier (and very valid) “in spite of autism” conversa-
tion that focused on the challenges people on the spectrum overcome is
now complemented by a “because of autism” perspective that focuses on the
strengths of people on the autism spectrum.
At the international company SAP SE, the Autism at Work (AaW) pro-
gram spans areas such as product innovation and quality, human capital man-
agement, and purpose-bond activities with like-minded customers and
partners. Although this chapter focuses on the AaW program as a reference
implementation, it is important to recognize that a broader movement to-
ward neurodiversity in the workplace is taking place in a number of countries
across industries and employment domains, and therefore other models are
in place that implement variations on the approaches presented in this
chapter. This movement comprises K–12 educators, higher education insti-
tutions, private- and public-sector nongovernmental organizations (NGOs),
health care professionals, philanthropists, and sports, entertainment, and
cultural organizations. Spearheading this movement are the founding mem-
bers of the AaW Employer Roundtable (EY, DXC Technology, Microsoft,
JP Morgan Chase, and SAP SE), as well as other members, currently totaling
approximately 30 institutions.
These organizations have taken the topic of autism in the workplace to
the White House, U.S. Congress, World Economic Forum, and United
Nations, among others. Hiring programs for people on the autism spec-
trum have been implemented in 16 countries. Of the conferences that focus
solely on autism in the workplace, perhaps the most prominent is the Au-
tism at Work Summit, which was launched in the United States in 2016 by
SAP SE and has since expanded to Argentina, Australia, India, New Zea-
land, and the United Kingdom. These annual summits, co-sponsored by
SAP SE, Microsoft, DXC Technology, EY, JP Morgan Chase, Ford Motor
Company, the Els for Autism Foundation, the Olitsky Family Foundation,
204 Neurodiversity

and Stanford University, have attracted more than 300 NGOs, companies,
universities, K–12 educators, and government institutions, among others.
This community includes both neurotypical and neurodiverse members.
I wish to highlight that individuals on the autism spectrum are a diverse
and interesting group of people. The anecdotes and examples used in this
chapter are intended to illustrate situations but are by no means intended
to draw generalizations about people on the spectrum. As the saying goes,
“If you know one person with autism, you know one person with autism.”

Overview of the SAP SE

Autism at Work Program
SAP SE is one of the largest software companies in the world, specializing
in business solutions for enterprises of all sizes. The company has approxi-
mately 100,000 employees and more than 440,000 customers in 180 coun-
tries. The mission-critical systems that SAP SE customers run touch 77%
of the world’s transaction revenue.
In May 2013, as part of its diversity and inclusion strategy, SAP SE an-
nounced an aspirational objective to have 1% of its workforce represented
by people on the autism spectrum. The AaW program is considered a busi-
ness transformation initiative, designed to leverage the skills of qualified in-
dividuals on the spectrum.

Program Motivation
One of the most common questions asked about the AaW program is this:
“Why is SAP SE hiring employees on the autism spectrum?” The short answer
is because it is possible to provide an alternate path to success for employees
who need it. As simple as that. The longer answer is a bit more complex be-
cause it includes a mix of empathy, purpose, and business pragmatism, which I
will try to illustrate with one example. A few years ago, I met with two manag-
ers who had hired people on the autism spectrum in two different functions of
our company: engineering and a nontechnical business support function. I
asked them the same question: “Why?” I got two different but equally valid re-
sponses. The first one was “because of the skills.” The manager who provided
this response explained that the candidate’s skills were a perfect match for the
business need she was trying to fill. The second manager explained that he had
hired the candidate because “companies like ours need to be inclusive of those
who have had a difficult path to a job. If our company provides support and
time, they can be successful.” Thus, these managers hired neurodiverse em-
Specialized Employment Initiatives for Neurodiverse Individuals 205

ployees to their teams for two reasons: business purpose and business pragma-
tism. One manager was a talent developer, whereas the other (perhaps under
more pressure) needed ready-made talent. Both perspectives are not only valid
but needed.
SAP SE launched the AaW program for five key reasons:

1. To attract the best talent: Talent exists in many different expressions, in-
cluding the neurodiverse expression.
2. Innovation: Alan Kay, an American computer scientist known for his work
on object-oriented programming and graphical user interface design
windows, once said that a different perspective is worth 80 IQ points. I
feel that innovation improves through the systematic incorporation of
different perspectives into our creative processes.
3. To tap an abundant and underutilized source of talent: Higher education in-
stitutions such as Stanford University, Landmark College, Rochester
Institute of Technology, Mercyhurst University, St. Joseph’s University,
Drexel University, Carnegie Mellon University, and others are creating
programs to support individuals on the autism spectrum. Talented indi-
viduals on the spectrum will be graduating from these institutions.
4. To capture the special skills of people on the autism spectrum: It is well known
that many individuals on the spectrum have great abilities that include
(among many other things) an ability to focus on areas of interest for
long periods and the ability to identify deviations in systems and data.
Traits such as these, in addition to formal or informal training in subject
matter areas such as software, can be leveraged in enterprises both large
and small.
5. Retention: Many companies in the high-tech sector have turnover rates
in the 15%–20% range (Booz 2018). If hiring a new employee results in
a replacement cost that ranges from 40% to 800% of the yearly salary
of the employee being replaced (McFeely and Wigert 2019), retention
is a critical part of a human capital management strategy.

Program Origins
It is through the bold steps of a few people that new paradigms are intro-
duced and embraced. The neurodiversity in the workplace movement is
one of those paradigms. As mentioned earlier, the official AaW program
was launched in 2013, but before this global effort was put in place, an “or-
ganic” program to hire people on the autism spectrum was launched in
Bangalore, India, in late 2011, sponsored by V.R. Ferose, the then manag-
ing director of SAP SE Labs at that location. At that time, five individuals
on the autism spectrum were hired as software testers in what is known in-
206 Neurodiversity

ternally as the suite testing center. Ferose was inspired by a media segment
that covered the journey of Danish neurodiversity pioneer Thorkil Sonne,
founder of Specialisterne, a company that specializes in preparing individ-
uals on the spectrum for careers in information technology (IT), specifi-
cally software testing. The SAP SE global AaW program that launched in
2013 was in great part possible because of the early learnings and successes
of the Bangalore pilot.

Guiding Principles
SAP SE leverages the unique abilities that people on the autism spectrum
bring to the workplace in an inclusive environment using the following
guiding principles.

• SAP SE AaW implements a full inclusion model. Employees on the au-

tism spectrum work side by side with neurotypical colleagues in an in-
clusive way and are not part of teams exclusively composed of employees
on the spectrum (Figure 9–1).
• SAP SE does not predesignate jobs for people with autism or assign an
employee class to a role type. Instead, we believe that if a person has the
skills needed for a job, that person can apply for that job.
• SAP SE does not use labels or classifications within the autism spectrum
(e.g., Asperger’s disorder or pervasive developmental disorder not oth-
erwise specified) as a basis for or against candidate selection. The selec-
tion process is based solely on the candidate’s skills and abilities. SAP SE
relies on partner companies for the identification, selection, and train-
ing of candidates on the autism spectrum.
• SAP SE provides equal career opportunities. Employees on the autism
spectrum have access to all of the standard career services and career
ladders offered by the company.
• SAP SE AaW operates under a “meet in the middle” principle. Col-
leagues on the autism spectrum receive training to integrate into neu-
rotypical environments, and neurotypical employees are trained to
better understand colleagues on the spectrum. Employees on the spec-
trum are not expected to be the only ones making adjustments.
• Colleagues on the autism spectrum help determine the direction of AaW.
SAP SE has an advisory group composed of employees on the spectrum
who help support decisions as fine granular as imagery used to represent
the program or as transcending as preferred language used at SAP SE to
refer to people on the autism spectrum (person-first was selected over
identity-first language).
Specialized Employment Initiatives for Neurodiverse Individuals 207

Exclusion Segregation Integration Inclusion

FIGURE 9–1. Inclusion models.

Source. Copyright © SAP SE and its affiliates. Used with permission.

• SAP SE shares experiences learned from the implementation of its AaW

program and collaborates with others in the improvement and dissemi-
nation of best practices. The company’s vision to make the world run bet-
ter and improve people’s lives is reflected in this guiding principle, which
at its core focuses on improving the lives of individuals on the autism
spectrum.

Program Roadmap
As the AaW program was being blueprinted, we at SAP SE realized that kick-
ing off the program in all target locations simultaneously, with the limited level
of in-house experience we had at that time, would not be prudent. For that rea-
son, SAP SE created a multiyear roadmap that included the following phases:

1. Pilot phase (2013–2016): During this phase, the intent was to learn and
develop basic practices that include local cultural/social interpretation
of autism in different locations.
2. Transition phase (2017–2019): Learnings from the pilot phase were con-
solidated, and standardized models were created for future deployments.
3. Mainstream phase (2020–2022): Program-contained practices are shifted
to mainstream processes or partner processes as needed. Please see the
“Hiring Process Variants” section for more information about the pilot
and mainstream phases.

Opportunities to Grow and Prosper

During the pilot phase, we learned a number of things. One was that the
majority of people we employed through the AaW program had lacked job
exposure opportunities while in high school and college, which had im-
pacted their ability to enter the labor market. For this reason, we expanded
the original jobs-only scope of the program to include internships, full- and
208 Neurodiversity

part-time jobs or contract opportunities, vocational school (in some coun-

tries), and educational opportunities for students (in some countries).
SAP SE offers three types of opportunities for people who are on the au-
tism spectrum:

1. Employment opportunities: SAP SE offers full- and part-time employment

and full- and part-time contractor opportunities.
2. College student opportunities: SAP SE offers internships lasting 1–6 months
(multiple internships are possible in some countries), vocational school (co-
ordinated work-study programs are available in select locations), and ap-
prenticeships (2-, 4-, or 6-week Enterprise Readiness Academy [ERA]).
3. High-school opportunities: These enterprise-life exposure opportunities for
high school students are carried out by AaW volunteers as a corporate so-
cial responsibility activity in partnership with high schools, government
institutions, and NGOs. These activities have three formats: 1-day visits
(high school students join their teachers to visit SAP SE for a volunteer-
managed day visit); one-semester visits (high school students join teachers
once monthly for a semester-long volunteer-managed engagement); and
a summer academy (1- to 2-week training program that includes robotics,
design thinking, and business etiquette training).

SAP SE currently employs people with autism spectrum disorder in a

variety of roles (Table 9–1). As described earlier in the “Guiding Principles”
section, SAP SE does not have predesignated opportunities for people on
the spectrum. The roles listed represent areas of need in which a person on
the spectrum has been found to match that need.
These jobs have various requirements regarding years of experience and
domain expertise. They also vary in suitability for employees who, for ex-
ample, work better in areas in which rules are well defined (e.g., back-office
finance support) or that require flexible thinking (e.g., consulting). Some
jobs are autonomous, in that the person works mostly alone, whereas other
jobs are in highly collaborative areas (e.g., software development or project
management). Some jobs are task oriented (e.g., invoice processing) and
others are creative (e.g., multimedia). Lastly, some jobs require a flexible
schedule (e.g., product manager), whereas others have more fixed schedules
(e.g., human resources associate).
The educational and professional profiles of candidates or of existing em-
ployees vary by location and the type of work being carried out at each loca-
tion. Employees’ ages range from early 20s to late 50s; 19% of employees are
women; and education levels include post–high school certificates, associate
degrees (2 years of college), university degrees, and advanced degrees (mas-
ter’s and doctoral levels). Domain expertise includes electrical engineering,
Specialized Employment Initiatives for Neurodiverse Individuals 209

TABLE 9–1. Roles at SAP SE that have been filled by people on the
autism spectrum
Audience relations DevOps engineer IT project management
associate associate
Associate consultant Employee communications Marketing operations
associate associate
Business analyst Finance operations Multimedia specialist
associate
Business process Global data protection Networking specialist
consultant specialist
Channel sales developer Graphic designer Procure-to-pay
associate
Cloud engineering Human resources service Product manager
specialist associate
Customer support Information developer/ Software developer
associate knowledge manager
Data analyst Intellectual property Software tester
analyst
Development consultant IT technical support System administrator
associate
DevOps=engineers specializing in unifying software development (Dev) and operations
(Ops); IT=information technology.

mathematics, statistics, computer science, art, business, media, communica-

tions, chemical engineering, and physics. Most neurodiverse employees were
underemployed, partially employed, or unemployed prior to working at SAP
SE. Many employees had no work experience, whereas others had 20 or
more years of experience.

Partnerships
The AaW program is implemented through partnerships that help with hir-
ing and sustaining applicants and employees on the autism spectrum. These
partnerships include NGOs and, in some locations, governmental organiza-
tions. Partner roles vary by location, but generally, multiple touchpoints oc-
cur throughout the recruiting to employee-sustainability process.
A small number of partners also played a role in the blueprinting phase
of the global AaW program implementation by assisting SAP SE in under-
standing country-specific disability community trends, potential govern-
ment supports, and status of the local candidate pipeline. The roles of these
partners are covered in the sections that follow.
210 Neurodiversity

Hiring Process at SAP SE

The standard hiring process for any job applicant starts when a candidate
finds a position on the corporate jobs portal and applies for that role. The
process then moves to a screening phase, which may yield one or more in-
terviews. If the candidate is deemed a good fit for the role in question, an
offer is extended and the onboarding is started.

Enhanced Hiring Process for

Candidates on the Autism Spectrum
Because candidates on the autism spectrum may have challenges with the tra-
ditional recruiting process, SAP SE has enhanced standard processes that in-
clude accommodations required to satisfy the needs of such applicants. The
main addition to the standard process is a preemployment training program,
the ERA (see section “Opportunities to Grow and Prosper” earlier in this chap-
ter). The AaW hiring process has the following steps: sourcing, screening, pre-
employment training, job application support, accommodated interviews, and
supported onboarding. Once a person has been hired, special sustainability ser-
vices are available (see section “Sustainability Services” later in this chapter).
Although this end-to-end process is available at SAP SE, a person on
the spectrum does not have to utilize this entire process. For example, if a
person on the autism spectrum applies for a job as a software developer in
the corporate portal without having gone through the specialized sourcing,
screening, and preemployment training process, and then decides to re-
quest support from the AaW team during the interview process, this can be
done. Also, if a person does not wish to use the sustainability services of-
fered after beginning work, he or she is free to carry on without these ser-
vices and request them at a later time if desired.

Hiring Process Variants

There are two process variants associated with the enhanced AaW recruiting
process: the pilot variant, which is utilized when a new AaW location is being
launched, and the mainstream variant, which is implemented once one or two
iterations of the pilot process have taken place. The pilot-to-mainstream se-
quence allows for any gaps found in the local implementation of the program
to be worked out. Figure 9–2 depicts details about these process variants.
The key difference between these two process variants is the time when
job opportunities are identified for candidates. In the pilot variant, managers
and jobs are predetermined before the candidates are identified. The jobs are
locked in weeks or months ahead of the actual hiring. This modality allows
Specialized Employment Initiatives for Neurodiverse Individuals 211

PILOT PROCESS
1 2 3 4
Find teams and Candidate search Preemployment Onboarding and
positions at SAP SE and prescreening training (ERA) support circle
Find managers Candidate 2-, 4-, or Onboard
and teams who search and 6-week process
want to join prescreening candidate
AaW pilot training Support circle

Get job Training for

requisitions host teams
Training for
other employees

MAINSTREAM PROCESS
1 2 3 4 5
Determine Candidate search Preemployment Candidates apply Onboarding and
demand and prescreening training (ERA) for jobs on portal support circle
Understand Candidate 2-, 4-, or ERA candidates Training for
where SAP SE search and 6-week apply for jobs host teams
will hire people prescreening candidate
in a given year training AaW team Training for
Profles identifed promotes top other employees
in phase 1* plus ERA candidates
available openings Onboarding and
for all applicants support circle

SAP SE Government (vocational rehabilitation) Local partner (NGO)

FIGURE 9–2. SAP SE Autism at Work (AaW) hiring process variants.

*Phase 1 is determining demand.
ERA=Enterprise Readiness Academy; NGO=nongovernmental organization.
Source. Copyright © SAP SE and its affiliates. Used with permission.

the time needed by the AaW team to source local partners to help support
the candidates’ search, preemployment training, and sustainability phase.
In the mainstream variant, the AaW program identifies job profiles but
not the hiring managers ahead of time. Once the candidates complete the
preemployment training program, they start applying to open jobs that
match their abilities in the corporate portal.
212 Neurodiversity

Location-Specific Timing
Each SAP SE location implementing AaW around the world has different
timing for the hiring process steps. For example, the preemployment training
program in the United States takes place during the summer, when 20–25
trainees participate in the ERA. This does not mean that the program hires
people on the spectrum only during the summer; SAP SE hires year-round.

Sourcing
The intake of candidates on the autism spectrum takes place in six different
ways. Some candidates on the spectrum are self-advocates who seek opportu-
nities by reaching out directly to program staff or to SAP SE’s AaW partners.
Another group of candidates is referred by family or through organizations,
such as service providers, vocational rehabilitation departments, universi-
ties, and others. The family or organization referring a candidate is asked
to instruct the candidate to contact the AaW partner directly. This does not
mean that the candidate must carry out this task alone; it only means that
the candidate, with the appropriate family or advocate supports (as needed),
initiates contact with the partner teams that are in charge of capturing can-
didates for later screening.
In most cases, the sourcing method used to identify qualified candidates
on the autism spectrum differs from the method used to source neurotyp-
ical talent. Most often, candidates on the spectrum are referred to SAP SE
by parents, advocates, and support organizations. In contrast, neurotypical
candidates approach SAP SE on their own initiative. For example, after
SAP SE onboarded a cohort of recent graduates on the spectrum in 2015,
five of these new hires were asked how they had come to know about the
AaW program. All five stated that they were prompted by a parent, an advo-
cate, or a vocational rehabilitation professional. This prompting may have
happened because the parent or advocate learned about the AaW program
through media coverage. Older applicants on the autism spectrum with some
work experience have not typically relied on family, allies, or service provid-
ers to prompt them to apply.

Screening
In the United States, in preparation for the ERA (which typically hosts 20–
25 attendees during the summer program), the AaW partner (an NGO) and
SAP SE analyze a pool of around 250 candidates and generate a list of about
40–50 candidates that can be used by the AaW partner to confirm the can-
didates’ participation interest in the ERA.
Specialized Employment Initiatives for Neurodiverse Individuals 213

During this phase, the AaW partner carries out conversations with the
candidates not only to assess them but also to better understand their back-
ground and motivation. For most people, a resume does not represent their
full range of skills and experiences. In the case of candidates on the autism
spectrum, this is even more accentuated. For this reason, we also use this
time to fortify the candidates’ resumes. Some things that usually are not in-
cluded in a resume are of great value, such as membership in Mensa (the old-
est and largest high-IQ society), participation as a lead actor or singer in a
theater play, ability to speak five languages, or having earned the rank of Ea-
gle Scout. These skills can tell a hiring manager that a person is very smart,
or has the potential for making presentations, or is dedicated. During this
phase, we also try to understand the candidates’ motivation (not their family’s
or an ally’s motivation) regarding the possibility of a job at SAP SE, feelings
about working in a large corporate environment, ability to relocate, and af-
filiation (if any) with the vocational rehabilitation organization in their state.
Although the entire screening process can be arduous, the most chal-
lenging situations are those in which the individual’s executive function skills
or lack of professional experience get in the way. Some candidates are not
responsive to telephone or email contacts; AaW partner staff have been
known to make 10–15 attempts to contact a candidate. This situation can be
mitigated in some cases by having a backup contact person with whom the
AaW partner can get in touch, but not every candidate has a contact person,
for a variety of reasons. Unfortunately, some stellar candidates with great
opportunities to land jobs never responded to repeated attempts to contact
them. Individuals need to practice these skills repeatedly during high school
and college and at home when possible.

Preemployment Training
The preemployment training program, the ERA, serves two key purposes:
1) to help SAP SE get to know the candidate on the autism spectrum and
2) to help each candidate get to know the company better and become a self-
advocate. More specific candidate goals include understanding the types of
supports available and learning to request them, creating a trainee-owned
business-profile/portfolio to share with hiring managers, learning about the
software industry and about corporations and teamwork, completing a final
team project (simulation of a company and product being launched), in-
creasing self-confidence through immersion in an enterprise setting, and
building relationships and networks.
The ERA currently has a duration of 6 weeks. Three of those weeks are
delivered in a virtual (real-time online) mode and 3 weeks are delivered on-
214 Neurodiversity

site at SAP SE. This combination of virtual and on-site modalities provides
the attendee with real-life experience in two settings, both of which are typ-
ical work settings at companies such as SAP SE.
The duration of a training day varies by setting. During the virtual pe-
riod (weeks 1, 2, and 6), the duration is 5 hours (including 1 hour for lunch).
During these weeks, attendees are given overnight assignments that are dis-
cussed the following day. The on-site classes (weeks 3, 4, and 5) require the
attendee to be at SAP SE for 8 hours per day (including time for lunch).
The on-site class uses a traditional classroom setting but with relatively
short instructor-led cycles of about 30–45 minutes each. These segments are
complemented by exercises, group discussions, research assignments, and
project work.
The class has four main content blocks—Badges, Enterprise Profes-
sional Skills, Enterprise Hard Skills, and Understanding How Industry and
Organizations Work—and the Final Project Practicum.

1. Badges: Badges are self-paced, well-documented collections of activities

spanning professional domains involving soft and hard skills (technol-
ogy, data science, and general business). These on-demand badges are
used as a means for the attendee to acquire the necessary knowledge to
participate confidently in the final project.
2. Enterprise Professional Skills: These skills include, among many others,
time management, collaboration, communications, workplace relation-
ships, interviewing, the career lifecycle, creating a business profile (e.g.,
resume, LinkedIn, social media, project portfolio), and managing a per-
sonal brand.
3. Enterprise Hard Skills: These skills include the use of digital collabora-
tion tools, office productivity tools (Microsoft Office), design thinking
innovation methodology, agile/scrum methodology, and a concentra-
tion in one of three tracks (general business, data science, technology).
4. Understanding How Industry and Organizations Work: Attendees learn
about the software industry, including how companies’ departments and
functional areas work and interact. They then learn about teams through
a variety of different topics, such as team collaboration and communica-
tions, team culture and rituals, manager profiles, and team structures and
work models.
5. Final Project Practicum: All that the attendees learned from the four con-
tent blocks comes together during the simulation of the launch of a new
company. The final project, created for teams of four or five people, is
presented to an audience that may include up to 70 participants from
SAP SE and other enterprises, universities, governmental organizations,
Specialized Employment Initiatives for Neurodiverse Individuals 215

and NGOs. This large audience offers a valuable opportunity for many
organizations to learn about the AaW program. Some attendees may
then decide to initiate similar specialized employment programs in their
own organizations.

Table 9–2 provides a basic outline for the 6-week ERA. Some details
from previous sections are included.

Job Search
After conclusion of the ERA, the job search process begins. For this phase,
the trainee works with a job coach from the AaW partner organization or a
member of the SAP SE AaW team to identify jobs in SAP SE’s corporate
portal that are possible matches to the applicant’s skills. Not every candidate
needs this type of support, but for certain candidates (e.g., recent graduates)
who have difficulty matching their skills and experience to a job description,
this can be an invaluable resource. Without this help, the individual could
end up applying to dozens of jobs without being called for an interview, an
experience that may increase frustration and have an adverse impact on the
applicant’s self-confidence.
The following example illustrates this latter point. In 2015, prior to
having the support of a job coach for his job search, a recent engineering
graduate applied for a senior-level role in the sales department. Although
he had some skills that were a match for the position (e.g., “has a good un-
derstanding of technology”), many others were not a match (e.g., “has deep
understanding of software sales”). Other job characteristics also were not a
good match, the most salient one being “the job requires 100% travel.”
When asked how he felt about a job that required 100% business travel, the
individual responded, “I am good at traveling. I have gone many places with
my parents.” He was informed that business travel was significantly more
complex than leisure travel, with completely unexpected situations to han-
dle at times (e.g., flight delays and cancellations while still having to serve
the client’s account). This young man had submitted dozens of applications
with no positive outcome, which led him to experience a high level of dis-
appointment and frustration.
The job search process is now a particularly important topic addressed
in the Enterprise Professional Skills section of the ERA. A key topic cov-
ered in this training is the importance of maintaining a positive attitude, be-
cause most people apply for dozens of jobs before landing an opportunity.
Establishing the normalcy of the experience (“everyone goes through this”)
helps the candidate avoid disappointment early in the process.
216 Neurodiversity

TABLE 9–2. SAP SE Autism at Work Enterprise Readiness Academy

typical 6-week training program
Virtual sessions
Preparation for 6-week class
Materials to prepare for both virtual and in-person lessons are provided before
Week 1. Topics include technology, business, analytics, and social skills.
Week 1 Week 2 Transition Week
Instructor led Instructor led Preparing to travel to
Welcome, getting started Enterprise soft skills SAP SE
Industry, organizations, Business profile Practicums
SAP SE Building a portfolio Hands-on badge time
Working in teams Digital collaboration Reading assignments
Digital collaboration tools tools
Practicums Practicums
Hands-on badge time Hands-on badge time
Daily assignment Daily assignment
Daily exercise Daily exercise

On-site at SAP SE
Week 4 Week 5 Week 6
Instructor led Final project (teamwork Final project (teamwork
Welcome to SAP SE on new company on new company
facilities simulation) simulation)
Agile and scrum methods Business track Business track
Design thinking Data science track Data science track
Final projects Technology track Technology track
introduction Project presentation to a
Practicums wide of audience
Hands-on badge time

Online
Week 7
Career lifecycle
Keeping and changing jobs
Job search and interview essentials
Practicums
Finalize the business profile and business portfolio
Interview workshops
Source. Copyright © SAP SE and its affiliates. Used with permission.
Specialized Employment Initiatives for Neurodiverse Individuals 217

Interview
Because the interview process can be difficult for candidates who are on the
autism spectrum, it is amply covered during the ERA. A process known as
an “accommodated interview” has been put in place at SAP SE to support an
applicant who has been invited to interview. The accommodated interview
process is a good example of the “meet in the middle” guiding principle (see
the section “Guiding Principles” earlier in this chapter). An individual on the
spectrum and the interviewing staff prepare and are supported through this
process.

People Involved in Interview Process

The following people are involved in the accommodated interview process:

1. A candidate on the autism spectrum: An ERA trainee would be informed

about the interview process. For candidates who did not go through the
ERA, the interview might be the first time they visit SAP SE facilities,
and therefore they might feel a bit more anxious than an ERA trainee.
2. The interview facilitator: The facilitator, who is a job coach from our AaW
partner company or a member of the SAP SE AaW team, has several
roles in the interview process:
• Coordination: The facilitator coordinates the location, transportation,
dates, and times.
• Supporting the interviewer: With the authorization of the interviewee,
the facilitator may share details and possible accommodations with
the interviewers.
• Preparing the candidate: If requested by the candidate, the facilitator
may support the candidate in preparing to have a successful inter-
view experience.
• Arranging follow-ups: Any subsequent activities can be coordinated
either directly with the candidate or, if the candidate prefers, with
the interview facilitator in the loop or as primary contact.
3. The AaW location lead: This individual may help coordinate the partici-
pation of the interview facilitator and address any exceptions that can-
not be handled by the facilitator directly.
4. One or more interviewers: The interviewer(s) might be an SAP SE man-
ager and other employees who are part of the team where the candidate
is applying to work.
218 Neurodiversity

Potential Supports for Candidates

In preparation for the interview, the manager and the interview facilitator
meet to discuss the supports that are available to the interviewee:

• Inclusion of an interview facilitator. Some candidates think that they will

perform better in interviews if they have a “familiar person” involved in
the interview setup and during the actual interview. The facilitator can
act as a go-between to ease communication between the interviewer and
the candidate, such as by rewording any unclear questions. The pres-
ence of the interview facilitator not only benefits the candidate but also
can help the manager better understand what the candidate has to offer,
because the facilitator has known the candidate for a longer period of
time and may know to ask the candidate to elaborate on a certain topic.
• Communicating a detailed interview schedule and interviewer list ahead of time.
Details include the sequence of the interviews and the names and titles of
the persons who will be interviewing the candidate. Managers are asked to
limit the number of interviewers in a face-to-face interview to one or two
individuals per interview (in addition to the facilitator). When multiple in-
terviews are needed with a candidate, the recommendation is not to exceed
three separate interview sessions, with a 20- to 30-minute break between
interviews. The final protocol, participants, and detailed schedule are com-
municated to the candidate in advance to minimize uncertainty and anxiety.
• Focusing interview on the candidate’s portfolio and sharing interview questions
(or general interview topics) with the candidate in advance. In preparation for
the interview, the manager should receive the candidate business profile
and business portfolio (both documents created during the ERA; see Ta-
ble 9–3 later in chapter) ahead of time. These documents can be of sig-
nificant value to the manager and the interviewee because the discussion
can center around known topics, thereby resulting in a more predictable
experience. However, if the portfolio does not provide enough context,
a manager may elect to prepare other questions not related to the port-
folio. Managers are encouraged to provide these (or general questions)
ahead of time. This is an important accommodation because some can-
didates may have a challenge with spontaneity (creative strategies) and
may require more time than most to answer unexpected questions. Al-
lowing the candidate to bring notes to interviews to better organize
thoughts ultimately results in a better experience and a better way for
the interviewer to understand the candidate’s capabilities. During the
interview, the manager could ask additional questions to further explore
a previously presented topic.
Specialized Employment Initiatives for Neurodiverse Individuals 219

Some managers might even ask a candidate to write an essay or report

and submit this a few days before the interview. This allows the manager
to assess other important skills in a more work-like environment.
• Determining whether an alternate interview setting is needed.

Location: Most candidates who have attended the ERA feel comfort-
able with a traditional interview setting (meeting room or office).
However, it is always a good idea to offer candidates an alternate in-
terview setting. For sensory reasons, some candidates feel “more
verbal” when walking, in which case a “walking interview” might be
appropriate. Past interviews have been conducted on a courtyard
bench or in the cafeteria when nobody was there. The interview fa-
cilitator or AaW lead can provide the interviewer with hints about
the best interview setting for a particular person.
Communication mediums: A few people on the autism spectrum may
have a comorbid condition, such as a hearing-speech delay, that pre-
vents them from responding quickly to questions that are asked. In
some cases, people are able to respond more quickly in written for-
mat (typically by typing). A candidate should be allowed to type an-
swers instead of answering them verbally.
Environmental factors: A candidate may have sensitivity to certain types
of lighting (fluorescent) or sounds. It is important to determine
whether special accommodations may be necessary to allow maxi-
mum comfort for everyone.
As a result of the preinterview interaction, the manager and the interview
facilitator (and/or the candidate) establish the following details about the in-
terview: date and time, location and setting (e.g., walking, sitting outdoors),
transportation needs, names of interviewers and their roles, sequence of in-
terviews, questions or topics to be addressed, and any communications or
environmental accommodations (e.g., lighting, sound).

Preparing the Interviewers

In preparation for the interview, the AaW lead makes available (and as
needed meets and discusses) an interview guide that interviewers may read
to further their comfort. This guide contains some highlights, such as the
following, about things they may observe about a neurodiverse interviewee:

• Interviewee might interpret language literally. Asking, “How did you

find your last job?” may result in an answer of “I looked on a map.” A
220 Neurodiversity

better question would be “How did you learn about this job opportunity?
Was it through a friend or family member?”
• Interviewee might not appear interested. Some candidates may not be
able to express emotions in the same way that a neurotypical person does.
This does not mean they are not interested or excited about a job oppor-
tunity. It might be a good idea to ask, “How do you feel about this op-
portunity?” and then ask some follow-up questions such as “What makes
this position interesting for you?”
• Interviewee might not be able to establish eye contact. This does not
imply disrespect. Some candidates find it difficult to establish eye con-
tact. For some people on the autism spectrum, focusing on making good
eye contact almost eliminates the ability to process information from
the outside world. An SAP SE employee on the spectrum explained the
difficulty: “I can do the eye contact thing, appearing to be like everyone
one else socially. I just can’t see my inner whiteboard on which I process
information while I’m doing it. It’s like looking out a window and focus-
ing on what’s happening out there while trying to put a model together
at the same time.” If a candidate does not establish eye contact, the in-
terviewer should not stress about it. Interviewers are assured that the
candidate is interested and listening to them, and it may be that by
“eliminating” one sense (sight), the candidate is able to focus better on
the interview.
• Interviewee might have a soft or prolonged handshake. This also does
not imply disrespect. The candidate might have a sensory difficulty that
affects the “pressure” of a handshake. The candidate also might continue
the rocking motion of a handshake due to difficulty focusing on several
things at the same time (e.g., shaking hands, saying hello, looking the
other person in the eye). Interviewers are encouraged to feel comfortable
about ending the handshake.
• Interviewee might stand close to the interviewer. Some candidates may
have a challenge in measuring comfortable body distance when they
first meet someone. The interviewer should feel free to invite the can-
didate to sit down, creating a comfortable distance for everyone.
• Interviewee might have a repetitive movement, such as rocking back and
forth. The functions and meanings of these movements vary, and are be-
yond the scope of this guide, but some of these movements serve as a
comfort-seeking strategy and are not always a sign of stress. Quite the
contrary, they may be a sign of interest in a given conversation or event.
For example, rocking from one foot to the other may calm a rattled ner-
vous system or help someone with an imbalanced vestibular system to
feel more grounded.
Specialized Employment Initiatives for Neurodiverse Individuals 221

• Interviewee might be very honest or blunt. The interviewer should expect

transparency from the candidate. A candidate might be straightforward to
the point of being a great asset to an employer. Many neurodiverse can-
didates may share their thoughts in a way that many neurotypical people
do not.
• Interviewee might share lots of information about a special interest.
Most people on the autism spectrum have an area or two of strong inter-
est about which they are highly knowledgeable and passionate. It might
be hard for them to refrain from sharing what they know about an area
of special interest. Sometimes, this is a comfort-seeking strategy in dis-
tressing, unfamiliar, or otherwise anxiety-provoking situations. It may be
useful to let these individuals share their special interest first, or after a
certain number of questions are answered, or if they seem to be agitated,
because sharing about a familiar topic can help to calm them down.
• Interviewee might have untypical voice modulation. Some candidates
might have difficulty speaking. Some might have issues with cadence,
speak too softly or loudly, have long pauses between words, or be less
verbal. The interviewer needs to be patient. It would be helpful to try
to learn ahead of time from the interview facilitator or the interviewee
about preferable communication styles.

In addition, the following recommendations are shared with interview-

ers in advance:

• Ask ice-breaker questions. Consider explaining to candidates that you

want to get to know them better. Ask about interests and why they se-
lected their college major. If the candidate appears nervous and informa-
tion is not flowing well, ask questions about a hobby or another topic the
candidate seems comfortable with. Be prepared to switch back to “inter-
view topics” with a “Now let’s talk about your experience....”
• Avoid ambiguity or sarcasm in communications. Be aware of potential
literal interpretations by interviewees on the autism spectrum. For ex-
ample, an interviewee might interpret “You are way over your head” as
the impossible physical task of having one’s body above one’s head. A per-
son being asked “to be transparent” (honest, forthcoming) might inter-
pret this as being asked to be translucent. Using direct, unambiguous,
and less complicated language is best until the interviewer gets to know
the candidate’s communication skills. It is acceptable to rephrase a ques-
tion if the interviewee did not seem to understand. Please also remember
that the more direct and unambiguous communication styles of some
candidates can be of great value in an organization.
222 Neurodiversity

• If candidates talk too much, let them know—they may find it hard to
judge how much information is needed. Simply say, “Thank you, you’ve
told me enough about that now, and I’d like to ask you another question.”
• If a candidate is talking too little, prompt the candidate with a differ-
ently worded question to extract all the relevant information. Because a
candidate might be silent for a moment before speaking, allow a bit of
time before asking, “May I ask you the question in a different way?”
• Avoid hypothetical or abstract questions. For example, instead of “How
do you think you’ll cope with working if there are lots of interruptions?”
a better question would be “Think back to your last job. Can you tell
me how you coped with your work when people interrupted you?”
• Avoid rapid-fire questions. Ask questions one at a time or, if needed, tell
the person that you have a two-part question you would like to ask.
• Ask questions about the applicant’s AaW final project (if the candidate
went through the ERA). A good way to kick off the conversation might
be to ask about that project.
• Avoid open-ended questions whenever possible. For example, “Tell me
about yourself” is very vague, and the candidate may not be able to judge
exactly what you want to know. A better question would be, “Tell me about
any jobs or volunteer work you have done in the last 5 years,” or even more
precisely, “Tell me about any jobs or volunteer work you have done in the
last 5 years. What did you do in each one, and what did you learn?”
• Ask questions based on the candidate’s real past experiences. Here are
two examples: “In your last job, did you do any software testing or de-
velopment?” and “What processes or procedures did you use to do this
effectively?”

Onboarding
After being offered and having accepted a position, the applicant goes
through the standard SAP SE onboarding process. At the heart of this pro-
cess is an orientation session that includes all new AaW employees (some
may be neurodiverse, some not). As an accommodation to this process, new
employees may elect to have a job coach (AaW partner) join them through-
out the day, facilitating the completion of forms and helping the employees
bring the right parties for certain decisions (e.g., health care coverage) that
may need to be considered in conjunction with family members.

Sustainability Services
At the conclusion of the onboarding process, the sustainability phase begins.
During this phase, the new employee has access to career support services,
Specialized Employment Initiatives for Neurodiverse Individuals 223

well-being and growth services, and specialty services. Additionally, support

structures and accommodations should be considered as needed for each
employee.

Career Support Services

Career Planning
Once employees have been with SAP SE for some time, they may be inter-
ested in exploring career opportunities in a different area or perhaps grow
within the area where they are employed. The employee may contact stan-
dard career planning support services (both the AaW program and non-
AaW job coaching are available to any employee).

Job Search
After determining a new area of interest, the employee on the autism spec-
trum can contact the AaW team to request support for finding a new role
in the company.

Supported Interviews
As was the case with ERA graduates, the AaW program supports accom-
modated interviews for employees who request them. The process is essen-
tially the same as described earlier (see the section “Interview”).

Transitions
Transitions might occur when an employee has found a new opportunity or
when an unexpected change occurs. Either way, circumstances might result
in a change in, for example, manager, team mission, location, or facilities.
In any of these cases, the AaW team supports employee transitions.

Well-Being and Growth Services

Relocation Support
On occasion, an employee may wish to find a new job at a new location.
Through an AaW partner, the employee can identify a partner in the new lo-
cation to help them with local support needs and getting established. These
third-party supports may include but are not limited to life skills supports,
such as finding a new apartment and reliable transportation to go to work.

Well-Being Check-Ins
The AaW program offers optional check-in services that can be configured
to occur once or twice per month. These services, delivered by the AaW
224 Neurodiversity

partner, consist of a face-to-face virtual or on-site conversation to check how

the employee is doing at work or as requested by the individual regarding
his or her personal life. The objective of these check-ins is to catch situations
before they become larger challenges in the future.

Job and Life Skills Coaching

During a well-being check-in, a coach may determine that an employee
needs additional coaching supports. These needs are discussed with the AaW
lead for the location and are mitigated as needed.

Growth Opportunities
The AaW program may organize growth seminars, ranging from cooking
to money management to ways to cope with stress and anxiety.

Disclosure Support
Occasionally, SAP SE employees on the autism spectrum may find the need
to disclose to a peer or manager that they are on the spectrum. These em-
ployees may seek support from the AaW program regarding how to dis-
close themselves or may ask a member of the AaW team to participate in a
meeting in which they wish to disclose.

Specialty Services
SAP SE offers standard benefits to employees on the autism spectrum,
which include physical and mental health, an employee assistance program,
and access to other services through the AaW program. Sometimes, de-
pending on location, staff with clinical backgrounds are available.

Support Structures
Previous sections covered a wide variety of accommodations that are part of
the sourcing, screening, preemployment training (ERA), job search, inter-
viewing, and onboarding processes at SAP SE. These adaptations considered
the journey of the candidate prior to getting a job. In contrast, this section
focuses on key support elements of the AaW program once the employment
period commences.
Because experiences that take place outside of the workplace have a di-
rect impact on individuals’ employment experience and well-being, it is im-
portant to consider support structures and services that extend beyond the
workplace. The following example illustrates this point:
Specialized Employment Initiatives for Neurodiverse Individuals 225

SUPPORT CIRCLE

External
Team
HRBP personal
manager
support

Team New colleagues Job/Life New colleagues Personal

workplace skills personal life
buddy counselor
support circle coach support circle

Mentor Family

FIGURE 9–3. Autism at Work (AaW) support circle.

HRBP=human resources business partner.
Source. Copyright © SAP SE and its affiliates. Used with permission.

Oscar joined SAP SE as a software developer after successfully completing

a bachelor’s degree in computer science with a grade point average of 3.6.
During his time at the university, Oscar lived in the college dormitory, his
parents paid his tuition, and he was on the meal plan at the university’s caf-
eteria. Although he was a gifted computer scientist, Oscar did not have any
experience with paying bills, finding a place to live and signing a contract,
driving to work, shopping for food, or meal preparation.

To support employees on the autism spectrum, such as Oscar, in a ho-

listic manner, SAP SE conceptualized and launched the AaW support circle
(Figure 9–3) in 2014. Table 9–3 includes details on specific roles in the sup-
port circle model.

Accommodations
A number of questions need to be considered to ensure that new employees
on the autism spectrum are provided with the supports that they need in
order to be successful at work. Answers to these questions may lead to ac-
commodations for the employee on the autism spectrum or to team training.

• Environmental accommodations: Is the new employee in need of location,

light, sound, or other environmental accommodations? (Example: John,
a new employee on the autism spectrum, has hypersensitivity to the type
of lighting in his cubicle.)
226 Neurodiversity

TABLE 9–3. Role descriptions for SAP SE Autism at Work support

circle
Role Description

Team buddy Teammate of new colleague on the autism spectrum

Appointed by manager
Helps new employee with personal and team adaptation
Helps employee with job, role, and daily business tasks
Helps employee manage workload (organize/prioritize)
Typically needed as the employee learns the job
May also be needed when there is a change in the
business function of the team (e.g., when new work
scope is introduced)
Mentor Employee-volunteer, not part of team where employee
works
Part of mentor network, which usually engages with
employees on the autism spectrum on a many-to-many
basis through group activities, allowing new employees
to get to know the mentors over time and to build a
relationship before reaching out to a specific mentor in
the network when and if the time comes for personal
supports
Provides socialization opportunities (e.g., lunch, social
activities, events)
Expands new employee’s network by occasionally
organizing guest speaker presentations or by
introducing other experienced employees in domain
areas of interest to the new employee
May act as problem navigator (but not problem solver),
directing employee to available resources that are part
of the program or that are available to employees at
large
Job coach Works for external partner (typically a nongovernmental
organization) specializing in disability employment
Has skills and knowledge on integration of individuals
with invisible disabilities into the workplace
Acts as liaison to personal support circle (e.g., therapist,
family)
Makes expertise available to managers, buddies, teams,
mentors, and employees on the autism spectrum
Serves as problem navigator in the external support circle
Specialized Employment Initiatives for Neurodiverse Individuals 227

TABLE 9–3. Role descriptions for SAP SE Autism at Work support

circle
Role Description

Team manager Aligns with individual, buddy, mentor, and coach to make
appropriate accommodations in the job
Human resources Helps in matters related to human resources
business partner Supports accommodation and performance planning/
review
Source. Copyright © SAP SE and its affiliates. Used with permission.

• Work-style accommodations: Does an employee have a second diagnosis

such as ADHD or dyslexia that may require other accommodations? Is
the new employee in need of learning, communication, or other work-
style–specific accommodations? (Example: John prefers to sit in a chair
a few feet behind his colleagues during meetings.)
• Adaptation of job functions: Does the role allow for fine-tuning of respon-
sibilities (e.g., extending, changing, or removing responsibilities from
the original position)? (Example: After Jane was onboarded, her manager
realized that she is very good as a “position ‘A’ specialist” and moved her
from being a “position ‘B’ specialist.”)
• Communication and culture adaptation: Is the team culture (communica-
tion and meeting styles) being embraced by the new employee? Is the
team adapting to the style of the new employee? (Examples: John sends
an email to his manager. When the manager does not reply immediately,
John sends a second email with an exclamation mark and an email return
receipt. Jane walks to other people’s cubicles and asks for help. She does
not realize that her colleagues might be with someone else or concen-
trating very hard on other things. That team’s members prefer to re-
ceive a formal meeting request to block time for conversations.)
• Skill/Task adaptation: Are the skills of the new employee filling the pre-
identified role needs, or are there gaps? Does the employee understand
objectives? (Examples: John is being challenged by the complexity of the
tasks given to him. Jane is found not to have the depth of skills needed
for her job function.)
• Teamwork adaptation: Is the new employee integrating into the team flow
(in regard to assignments and methodology)? (Example: Due to social
anxiety, John is having difficulty participating in team meetings.)
• Endurance and pace adaptation: Is the new employee able to sustain the
workload throughout the day? Is the new employee “keeping up” with
the pace of the team and its work? (Examples: John becomes really tired
228 Neurodiversity

after 4 hours of work. Jane is struggling to maintain the pace of the team
where she works.)

Program Impact
SAP SE’s AaW program impacts various areas both inside and outside of
the company. These areas include products and processes, lives, the govern-
ment, human capital management, and the customer and partner ecosystem.

Impact on Products and Processes

Employees on the autism spectrum have filed for patents and have been rec-
ognized through innovation awards. One employee on the spectrum was the
sole 2019 winner of the most prestigious innovation award that SAP SE be-
stows on employees. Employees on the spectrum contribute daily to func-
tions and processes that are considered the “heartbeat” of the company,
spanning areas such as cybersecurity and digital forensics, global data pro-
tection, software quality assurance, and data science, among many others.

Impact on Lives
Most of the SAP SE employees on the autism spectrum in the United States
were unemployed or severely underemployed prior to joining the company.
Having a permanent job has provided a means to achieve independence and
self-determination. Employees on the spectrum have relocated, purchased
homes and cars, and started new relationships.
For neurotypical employees who have been part of the support network
of employees on the autism spectrum, the experience has been rewarding
as well. For some managers, having a neurodiverse team member has meant
adapting to meet a new communication style (e.g., by becoming less am-
biguous). Some managers feel that these changes have allowed them to be-
come better managers and their teams to become more cohesive.

Impact on Government
A significant number of employees on the autism spectrum received U.S.
government benefits while unemployed prior to joining SAP SE. Obtain-
ing a position at SAP SE has allowed those individuals to become taxpayers,
thereby contributing to personal, family, and community well-being.

Impact on Human Capital Management

SAP SE employees on the autism spectrum have a global retention rate in
excess of 90%. This retention rate is similar to that of our neurotypical em-
Specialized Employment Initiatives for Neurodiverse Individuals 229

ployees. This level of engagement demonstrates employees’ passion for their

jobs, their feelings about the culture of the company, and their willingness to
contribute to a better workplace. It is estimated that more than 1,000 em-
ployees have been engaged in activities associated with the AaW program.

Impact on Customer and

Partner Ecosystem
The AaW program has been the subject of more than 2,700 media segments
and editorials, with an estimated reach of more than 7.1 billion people. As a
result of this coverage, more than 1,700 organizations, including more than
700 employers, have reached out to SAP SE for information about the pro-
gram. During the 6-year period from 2013 to 2019, SAP SE partnered with
companies such as Dell in the launch of an Autism at Work Hackathon and
partnered with Microsoft, EY, JP Morgan Chase, and DXC Technology to
launch the Autism at Work Summit. The summit is a collaboration platform
between private and public sectors, academia, K–12 educational systems,
higher education institutions, researchers, civil societies, and philanthropists.

Conclusion
The AaW program has helped transform an already strong culture of diversity
and inclusion at SAP SE by mainstreaming neurodiversity in the workplace.
The value of sourcing, hiring, and sustaining individuals on the autism spec-
trum has been demonstrated at SAP SE. Although not all the benefits associ-
ated with the program may be visible or understood for a number of years, the
program’s impacts on lives, products, culture, and the ecosystem provide a very
strong foundation for the value that can be derived from such programs and
the sense of accomplishment to all who are touched by this initiative.
For these benefits to be realized, however, it is important that such en-
terprise programs be formalized, funded, and staffed appropriately, and for
partnerships with private, public, nonprofit, and education sectors to be a
strong priority because these support outcome amplification and risk mit-
igation. It is also important to highlight that neurodiversity in the work-
place, as a relatively new paradigm, requires continuity of support to allow
it to move forward. This continuity rests largely on enterprises that hire
neurodiverse staff but can only be taken to the next level by an ecosystem
whose members span industries and sectors. Such an ecosystem will need
to have a level of formalization through the establishment of associations
or consortiums, providing much needed governance models that will sup-
port resource optimization.
230 Neurodiversity

Acknowledgments
This chapter is dedicated to the many individuals on the autism spectrum
finding their place in the workplace and to those people who support their
journey. A very special thanks to all of my colleagues on the autism spec-
trum at SAP SE and to the SAP SE AaW managers, mentors, buddies, and
volunteers. Without them, this program would not have been possible. A
very special thank you as well to Dr. Lawrence Fung for the opportunity to
be part of this book and for his friendship and guidance in writing this chap-
ter. Lastly, all my love and gratitude to my wife, Deya; my daughter, Elena;
my son, Jose Jr.; my mother, Maria Elena; my father, Hugo Alejo; and Drs.
Adolfo Isassi and Deyanira Flores de Isassi.

KEY CONCEPTS
• In 2013, SAP SE set an ambitious goal of having 1% of its workforce be
represented by employees on the autism spectrum. This goal created
incredible industry and community momentum in the then-nascent
neurodiversity movement. The lessons learned from the more than
6 years of the program span significantly more space than these pages
allow. Three key learnings have shaped the direction of the program:
• People on the autism spectrum can excel in a wide variety of func-
tions. Companies should not stereotype their abilities and chal-
lenges. The original announcement of the AaW program in 2013
indicated that SAP SE would be “employing people with autism as
software testers, programmers, and data quality assurance special-
ists.” Since then, the roles occupied by employees on the spectrum
have grown 10-fold to close to 30 different types of jobs in func-
tions ranging from human resources to data protection to software
development to customer support.
• Challenges for people on the autism spectrum begin much earlier
than the day they start looking for a job and are unable to pass an
interview. Their challenges in finding and retaining a job start early
in life, due to a lack of labor-market exposure opportunities during
high school and postsecondary education. Most SAP SE employees
on the spectrum shared that they did not have a summer job or an
internship or an opportunity to be exposed to the enterprise world
during this time. This situation further impacts the ability of many
talented individuals on the spectrum to find a job. Companies large
Specialized Employment Initiatives for Neurodiverse Individuals 231

and small can help mitigate this problem by implementing student

programs ranging from mentorships to paid internships that allow
students to get this much-needed exposure to the workplace.
• Sharing became an unanticipated priority of the AaW program.
The creation of a sustainable ecosystem inclusive of organizations
from private and public sectors, nongovernmental organizations,
educators, service providers, researchers, clinicians, and others is
the next step in the evolution of neurodiversity. A subtle but im-
portant element of the discovery journey at SAP SE has been the
realization that sharing our experiences with employers and any
other entity interested in neurodiversity is as important as the pro-
gram implementation at SAP SE.

Recommendations for Educators,

Clinicians, and Other Professionals
• Foster a passion. Support a young person on the autism spectrum who
demonstrates an area of interest early in life. Many of SAP SE’s employ-
ees on the spectrum are still engaged in hobbies that translated into or
supported their professional career, such as video games, professional
sports, anime and Japanese culture, acting, writing, and singing. These
interests were supported by the employees’ families and advocates,
opened up new social circles with others who had common interests, and
eventually developed into adjacent skills. For example, one SAP SE em-
ployee who enjoyed playing video games became a video game developer.
When he was unable to find a job in the gaming industry after finishing
his degree, he was able to apply his adjacent coding skills in a nongaming
area at SAP SE. This employee is a member of SAP SE’s video gaming
club, which meets regularly at the office, where employees with similar
interests can interact.
• Provide early exposure to workplaces. Most individuals on the autism
spectrum do not have an opportunity to gain exposure to a workplace
environment during their educational years. Young adults need expo-
sure to these environments by visiting a workplace, participating in a
virtual visit via an online session, listening to invited guests speak about
what their companies do and the different types of jobs available, or
working in mentorship opportunities. SAP SE has hosted more than
500 visits from high school students on the spectrum that, according to
232 Neurodiversity

their teachers, were transformational. These experiences provide valu-

able insights to young adults that fill basic knowledge voids that could
result in challenges down the road. For example, during a preemploy-
ment training session at SAP SE, a recent college graduate on the autism
spectrum who was interested in applying for a job openly asked, “What
is human resources?” Only two attendees (out of a group of 15) were
able to adequately answer that question. Getting this type of knowledge
ahead of time is of utmost importance.
• Ensure the best interest fit possible when helping a person on the autism
spectrum look for a job. It is important that the job aligns with both the
skills and the interests of the person. When encouraged to get “a” job
by supporters and family, a person may accept a role that leads to high
levels of dissatisfaction, which will be reflected in productivity issues or
workplace conflicts.
• Provide support in the workplace. A person providing workplace sup-
ports for someone on the autism spectrum needs to have some degree
of familiarity with workplace dynamics in the domain/setting of the em-
ployee’s job. Also, the person providing workplace supports should have
a level of education and experience that is similar to or higher than that
of the employee on the spectrum. In some cases, individuals on the spec-
trum have rejected the services of job coaches who did not have formal
credentialing or were significantly less experienced in the workplace en-
vironment than they were. It is also important that a support circle be
put in place so that in different situations an employee on the spectrum
may reach out to different members of the support circle (job coach,
mentor, buddy, or manager).

Discussion Questions
1. What elements of this chapter do you find most interesting?
2. What additional supports, beyond the ones described, do you think an
autism employment program needs to implement before and during
employment?
3. What strategies do you feel are needed for young adults on the autism
spectrum to gain knowledge of the workplace?
4. What additional roles (if any) of the support circle need to be added, and
why?
5. If you were a hiring manager, how would you change the culture of your
team to be more inclusive of neurodiverse individuals?
Specialized Employment Initiatives for Neurodiverse Individuals 233

6. What interview techniques do you think need to be implemented in ad-

dition to the ones provided to improve the experience of neurodiverse
individuals?
7. What additional training do you think is needed to raise a company’s aware-
ness about and enable them to hire people on the autism spectrum?
8. How would you improve the described process of sourcing, screening,
hiring, and supporting individuals on the autism spectrum?
9. What additional public supports can companies tap into to make an au-
tism hiring program financially sustainable?

Suggested Readings
Annabi H, Crooks EW, Barnett N, et al: Autism @ Work Playbook: Finding
Talent and Creating Meaningful Employment Opportunities for People
With Autism. Seattle, ACCESS-IT, The Information School, University
of Washington, 2019
Robison JE: Look Me in the Eye: My Life With Asperger’s. London, Ebury,
2009
Silberman S: Neurotribes: The Legacy of Autism and the Future of Neu-
rodiversity. New York, Avery/Penguin Random House, 2015

References
Booz M: These three industries have the highest talent turnover rates. LinkedIn
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solutions/blog/trends-and-research/2018/the-3-industries-with-the-highest-
turnover-rates. Accessed January 2021.
Griffiths AJ, Giannantonio CM, Hurley-Hanson AE, Cardinal D: Autism in the
workplace: assessing the transition needs of young adults with autism spectrum
disorder. Journal of Business and Management 22(1):5–22, 2016
McFeely S, Wigert B: This fixable problem costs U.S. businesses $1 trillion. Gallup
Workplace, March 13, 2019. Available at: https://www.gallup.com/workplace/
247391/fixable-problem-costs-businesses-trillion.aspx. Accessed January 2021.
Newman L, Wagner M, Knokey AM, et al: The Post-High School Outcomes of
Young Adults With Disabilities Up to 8 Years After High School: A Report From
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prevalence and associated problems. Autism 15(6):683–701, 2011
 TEN
Technologies and
Difference
Insights from Education
Breakdown and Exclusion
Jutta Treviranus, Ph.D.

When I’m here, I’m not the problem. Pollution is the problem.
Anonymous designer who learns differently, comparing her experience
in school with her experience in an environmental youth movement

235
236 Neurodiversity

In this chapter, we have adopted Ursula Franklin’s (1999) definition of

technology. She defined technology as practice: how things are socially and
morally done. She saw technology as a complex system: “Technology
involves organization, procedures, symbols, new words, equations,
and, most of all, a mindset” (pp. 2–3). Although many beneficial
technical tools are available that scaffold learning, compensate for skill
gaps, and address accessibility barriers (Treviranus 2018), the
dominant technology mindset is biased against diversity and the
accompanying complexity, or “deviation from the norm.” This mindset
pervades all aspects of our society and predates the technical systems
we currently view as information and communication technology. This
mindset and its impact are amplified and automated by current data
analytics and artificial intelligence systems.
For persons who are neurodiverse, the most influential encounter
with this mindset is during school. As one individual with a learning
difference stated, “School is about learning a certain way. I don’t learn
that way. School and I are a misfit.” This misfit with traditional
schooling and the “solutions,” “fixes,” or technologies employed to
cause students with learning differences to conform to normative
expectations can have profound and lasting effects. The more a
student “deviates” from the average, the less likely it is that the
“proven treatment” or “solution” will garner the desired results, and
the harder it is for the student to conform to expectations. In this
chapter, we briefly discuss some of the origins of this mindset and its
pervasive impact. To illustrate the impact that the mindset has on
youth who learn differently, we summarize the contributions and
stories of youth who took part in the Social Justice Repair Kit project
and then responded to this question: “Why did I break up with
school?” We conclude with recommendations for changing technology
and schooling.

If we were to trace the most significant rise and entrenchment of the mindset
biased against human diversity, it would likely be to the industrial era.
During the 1800s, several prominent and influential scholars were individ-
ually and collectively attempting to find answers to questions about human
society such as these: How do we bring order out of chaos? How do we tame
diversity and complexity? How do we achieve efficiency? Following break-
through discoveries of mathematical laws in physics, chemistry, and astron-
omy, they became convinced that these same laws might apply to humans.
This same era can also be characterized as the first wave of so-called big data,
with numerous demographers gathering, cataloging, and analyzing data re-
garding the human population (Swanson and Stephan 2004).
Technologies and Difference 237

Average person

Most people
Some people Some people

FIGURE 10–1. A traditional bell curve.

One highly influential discovery was the Pareto principle, also known
as the 80/20 rule. The principle was named for Vilfredo Pareto who, in
1896 (Pareto 1896–1897), discovered that 80% of the land in his native It-
aly was owned by 20% of the population. The 80/20 principle is based on
a phenomenon or pattern that generally holds true in any random sampling
of population data. When reduced to one variable and flattened to two di-
mensions, it looks like the bell curve applied in grading (see Figure 10–1).
In the research of the Inclusive Design Research Centre over the past
two decades, we have found that if you take any group of people and plot
their individual needs and characteristics on a three-dimensional multivar-
iate scatter plot, you get a starburst (also known as a “normal distribution“)
(Figure 10–2). The starburst has a dense core in which about 80% of the
points cluster around the center, covering about 20% of the space. Spread-
ing away from this central cluster are the remaining 20% of the points, cov-
ering about 80% of the space. These outer points are at greater and greater
distance from each other. The outside edge of the starburst is jagged.
It is this naturally occurring distribution or pattern that Vilfredo Pareto
discovered to arrive at his principle. This observation has been applied in
numerous fields to optimize efficiency. Management consultant and author
Richard Koch more recently popularized the rule in the domains of busi-
ness and commerce, asserting that one could encompass 80% of the needs
by covering only 20% of the space, and thereby expend only 20% of the
effort (Koch 1998). This central cluster is the sweet spot of easy or quick
wins and “low-hanging fruit.” When it comes to design, Koch’s advice was
238 Neurodiversity

FIGURE 10–2. The human starburst or normal distribution.

to ignore the “difficult 20%” (that take up 80% of the space and effort) and
focus on the sweet spot in the center.
This determination of the difficult 20% is self-reinforcing. It includes
people who find themselves at the margins, not served and too far from av-
erage, and whose needs are therefore not met (Figure 10–3). This group in-
cludes all people who, due to situation, birth, or accident, experience a
mismatch between what they need and what is available. Any one of us could
find our most critical needs to be part of the difficult 20% at any time, pos-
sibly when least expected.
The efficiency principles noted by Pareto have influenced every aspect
of our human society, with escalating consequences for both the 20% and
the 80%. The advice has become inextricably linked with our sense of
value, worth, fairness, and even truth.
Technologies and Difference 239

Design works

Design is
diffcult to use

Can’t use design

FIGURE 10–3. Starburst showing the needs that are not met and the
needs that are inadequately met.

Further influenced by Adolphe Quetelet‘s (1835/2013) notion of the

average man, our markets have been designed to leverage economies of
scale and address the needs of the 80% (average consumer, or the largest
customer base) through mass production, mass marketing, and quantified
statistics. In the area of computing, this has become entangled with Moore’s
law, which holds that the power of digital systems doubles every 2 years
while the relative cost decreases, as observed by Gordon Moore (Moore
1965; Schaller 1997). The disparity between the treatment of the 80% and
that of the 20% has contributed to a growing digital divide. For the 80%,
our digital devices have increased in functionality, reliability, and availabil-
ity while decreasing in cost. For the 20%, the opposite is the case. With no
economies of scale, costs increase while availability is precarious. Only the
240 Neurodiversity

courageous business will venture into the vast terrain of the difficult 20%.
Because most digital functions rely on connectivity and interoperability,
and because businesses are more interested in competing than collaborat-
ing, the functionality and reliability of the digital products for the 20% dis-
integrate.
This same pattern is found not only in the products but also in the nec-
essary training to use and maintain the devices. If you lose your sight or
your dexterity, for example, it may cost you 10 times more to get online
than it costs other people. Many functions you take for granted will not be
available to you. One may devote extensive time and energy to learning a
specialized process and then find that investment futile because the devel-
oper has determined that the product or process is unsustainable and has
removed it from use. Similar phenomena are experienced by minority cul-
tures, speakers of endangered languages, and remote communities.
This divide is not limited to digital products. Our mass-produced goods
and services are designed to satisfy primarily the 80% (Figure 10–4). This
means that they are a misfit or mismatch for the difficult 20%. If you are
among the 20%, you will be scrambling to find products and services that
work for you and will need to pay more for any you do find.
Applications of Pareto’s and Quetelet’s principles have had the most
damaging effect on our current notions of evidence and, thereby, knowl-
edge and truth (Ziliak and McCloskey 2008). We have equated evidence
and truth about human beings with statistical significance, meaning that
they roughly hold true for the more uniform or average 80%, and anything
else is deemed to be anecdotal or nongeneralizable. In fact, we have de-
signed the favored research methods in such a way that the methods cannot
be used on the 20% or on the 80% of the research terrain covered by that
20%. Sanctioned research methods require that the group studied be ho-
mogeneous, the context be controlled, and the factors be isolated. There-
fore, the methods work for the 80% that cluster around the average. The
remaining 20% are anything but homogeneous, and their context is never
predictable or controlled. This has an impact not only on the 20% at the
margins but also on any researcher who may wish to study these individuals
or their truth. The researcher will not achieve statistical significance, the
work is less likely to be published in high-impact academic journals, and the
researcher is less likely to receive research funding, be promoted, or get
tenure in a university or college. Thus, the 20% at the margins are less
likely to be recognized, understood, or served. This also means we discour-
age exploring the less-populated 80% of the research terrain, resulting in
dangerous blind spots and knowledge gaps.
Technologies and Difference 241

DESIGN DESIGN
Misft Fit

PRODUCTS PRODUCTS
• Availability • Availability
• Reliability • Reliability
• Functionality • Functionality
• Cost • Cost
KNOWLEDGE KNOWLEDGE
TRUTH: EVIDENCE TRUTH: EVIDENCE
Ignored Regression to the mean
Not recognized Normalization and homogeneity
Not understood Statistical signifcance and power
The standard
EDUCATION EDUCATION
Exclusion Competition
Mismatch and failure Ranking and conformance

WORK WORK
Exclusion and barriers Replaceable workers

DEMOCRACY DEMOCRACY
Charity and pity Majority rules
Protest and transgression

FIGURE 10–4. Disparity in design, markets, research, education,

work, and democracy between the 20% and the 80%.
242 Neurodiversity

The ripple effects of this phenomenon on our applications of knowl-

edge are endless: from medical treatments fit for the 80% that are misap-
plied and result in death and illness among the 20% to the inequitable
impacts of investment decisions, insurance practices, and security processes.
Lately, we have applied this conventional paradigm (that eschews diversity
and complexity) to artificial intelligence, machine learning, and big data an-
alytics (O’Neil 2017). This practice amplifies and automates our bias against
the 20% and means that our artificial intelligence systems have difficulty
changing contexts and dealing with the unexpected.
Because evidence is being used as a defense against destructive irrational
ideologies in our call for evidence-based governance, this interpretation of
the 80/20 principle increasingly influences our public planning and policy.
We assess the value of any decision or plan by assessing evidence of its im-
pact (Kalil 2011). The largest impact is deemed worthy. According to this
formula, an initiative is worthy of public investment if it has a positive im-
pact on a homogeneous majority. Any initiative (even a critical one) for the
difficult 20% will never meet the threshold of value or worth. Reaching an
impact threshold to justify investment is made more difficult by the fact that
people and needs that occupy the outer edge of the starburst are more dif-
ferent from each other, meaning that any one measure cannot muster im-
pact beyond a small minority (and potentially a minority of one).
Effects of applying the 80/20 principle ripple into our systems of formal
education, which are designed around the idea of standardizing the learning
of the average student (in part to produce a replaceable worker) (Barlow
1967). This means that education is a mismatch for anyone in the difficult
20%. They are either excluded or relegated to special education. Anything
“special” is most vulnerable to budget, time, and resource constraints or cuts.
Similarly, our systems of employment filter out and are not designed for the
20%. At best, our equity efforts set them up for failure by recruiting them
into work situations that were not designed for them.
When democracy is under threat, we defend it by applying the same
principle. We emphasize that the “majority rules” and downplay the pro-
tection of rights and freedoms for everyone. This only adds to the vicious
circle experienced by the minorities excluded from the well-populated cen-
ter of the starburst.
For those who are neurodiverse, many of their needs will fall outside of
the center of the normal distribution. The most influential differences will
relate to education, employment, and applications of statistical evidence,
including policy decisions, research, and smart technologies. Smart tech-
nologies, adaptive technologies, and artificial intelligence applied in learn-
ing analytics all base decisions on statistical probability. Most “solutions”
or treatments that purport to address neurodiversity prove their efficacy by
Technologies and Difference 243

employing statistical methods that further marginalize people who are at

the diverse edges of the normal distribution.

Social Justice Repair Kit Project

To explore the impact of a systemic mindset biased toward the average on
neurodiverse populations, we have chosen the domain of primary and sec-
ondary schooling. We have summarized findings from a project that works
with neurodiverse youth. The Inclusive Design Research Centre at OCAD
University in Ontario, Canada, through an Oak Foundation–funded proj-
ect called the Social Justice Repair Kit (www.sojustrepairit.org), works with
local partners around the world to provide scaffolds, tools, resources, and
awareness training to ensure that youth with learning differences can partic-
ipate fully in youth movements. These supports include accessible open data
monitoring, analysis, and synthesis, as well as scaffolded communication
tools. By engaging youth with learning differences in youth movements, the
project is providing alternatives to exploitative groups and recruitment into
extralegal activities and paving a way back to engagement in productive
learning.
People with learning differences (or “learning disabilities”) are grossly
overrepresented among vulnerable youth (Hyun et al. 2014). They are dis-
proportionately found in the social safety nets that address homelessness,
hunger, and unemployment, as well as in criminal justice systems. Where
there are gaps in human rights protections, these young persons are most
vulnerable to exploitation for child labor, sex, crime, and terrorism. When
they are given a chance to tell their story, a common thread is a loss of faith
in their ability to learn and in the value of education.
Youth movements can provide a cathartic and productive outlet for the
frustration, anger, and disappointment felt by youths with learning differ-
ences who have disengaged from education. These movements can channel
energies toward productive change and provide powerful opportunities for
authentic learning. If they are supportive and welcoming of youth with
learning differences, they can be a path out of the vicious circles of margin-
alization. However, if the learning opportunities are not designed inclu-
sively, they can be, in the words of one youth, one more “setup for failure.”
Rather than consulting with individuals who successfully navigated the
school system, we worked with and gained insights from the students with
learning differences who disengaged from formal learning. We attempted
to learn from the scenarios in which schooling failed them. In addition to
enabling us to work with youth groups and co-design and co-create tools,
resources, and data, the project provided an opportunity to consult youths
244 Neurodiversity

about what caused them to disengage from formal education or, as one youth
asked, “When and why did I break up with school?” These discussions hap-
pened through engagement with our partner organizations in Africa and
South, Central, and North America, as well as in other parts of the world.
The youth participants were from a range of socioeconomic standings, some
with informed and supportive parents and many with less informed parents
or guardians. Many were “street involved.” Many were engaged in social
safety nets, including homeless shelters, food banks, criminal justice sys-
tems, and harm reduction clinics. We spoke to youth who were forced mem-
bers of violent cartels in Colombia; teenagers who were in the sex trade in
Mexico City; refugee youth living in refugee camps in South America, Eu-
rope, and Africa; child miners in African nations; and indigenous youth in
criminal justice systems in Canada. These discussions occurred in informal
opportunistic conversations and in group discussions during youth events.
The collected stories and quotes are anecdotal or ethnographic. They are
too diverse to conduct any form of quantitative analysis or draw any gener-
alizable conclusions. However, they do help to surface patterns and areas of
further study.
The stories painted a troubling picture of the state of support globally
for students with learning differences. In general, there appears to be a sig-
nificant mismatch between the needs of students with learning differences
and formal education, including efforts to serve these students. It would not
be hyperbolic to say that these youth are casualties of our formal education
system design.
We have collected and thematically summarized the quotes and stories
of some of these youth, parents, and youth workers. The quotes and stories
are anonymized. Wherever possible, the youth have reviewed and approved
the inclusion of the quotes and stories in this chapter. The patterns of the
“breakup” varied between countries that recognized learning differences as
a disability requiring accommodation and countries that did not. However,
it did not appear that students in countries that recognized learning differ-
ences were appreciably better off.

Disproportionate Vulnerability
Many seasoned youth workers independently reported that a large propor-
tion of youth they work with have some form of learning difference and that
learning difference is one of the primary triggers for becoming street in-
volved or vulnerable to recruitment to extralegal or exploitative activities.
Youth workers also reported a related phenomenon: that a disproportionate
number of indigenous youth with learning differences commit suicide.
This is not to say that there are no other contributing factors, such as men-
Technologies and Difference 245

tal health, family crisis, poverty, displacement, and conflict or refugee con-
ditions. However, according to the staff we spoke to, learning differences
appear to increase the vulnerability considerably.
One surprising assertion was that school experiences of these youth
made them more vulnerable. One youth worker put it this way: “Our
schools prepare the kids with learning disabilities to be exploited and be-
come addicted.” Her point was that the students learn to obfuscate or hide
their weaknesses. They become “masters of disguise, avoidance, and lies.”
They are compelled to do this to avoid painful experiences of failure and
shame. These learned behaviors, together with a sense of worthlessness,
prepare them to be seduced by gangs and drugs. She also pointed out that
this sense of insecurity often causes a false bravado that is prone to dares.
One youth said “school prepared me to be a con artist.” When questioned
whether school was exceptionally responsible for this process, another
youth pointed out, “I’m normal everywhere but at school.”

“Losing Hope in Myself”

A common story told by the youth is of a gradual but inexorable loss of hope
in self as a learner in the school system. Whether they characterize the loss
as involving self-esteem, determination, “belief in self,” or “sense of pride,”
the common narrative is that there is a persistent wearing away of self-
worth. When students compared schools they attended—and many re-
ported being moved from school to school—both more structured and less
structured programs contributed to this loss of self-worth. One youth re-
ported that the more competitive the school or class was, the worse off he
was. This was especially the case when the competition was on a group ba-
sis: “I was a liability for the spelling and math competition. I was blamed
for our class not winning. I felt ashamed to let the class down.” The same
phenomenon was noted by parents and students when class or school rank-
ing was based on test outcomes. Students whose families were not able to
navigate through the process of qualifying for accommodations were espe-
cially affected because their performance could not be excluded from the
total metrics.
Segregated special education stigmatized and isolated students within
the school. Students reported that they felt they were at the lowest rung of
the implicit school hierarchy. Students reported being “lumped with” stu-
dents with behavioral disabilities and intellectual disabilities. They re-
ported overtaxed teachers who “came to me last.” Bullying was common.
One youth recounted that his textbooks were repeatedly stolen by a gang
of classmates who taunted him, saying that he was “too dumb to use the
books.” He was too ashamed to tell his parents because the textbooks cost
246 Neurodiversity

a great deal and the family could not afford to replace them, so he did with-
out. Several youth admitted that they had to become the bullies to survive.
Integrated classes, especially when teacher time was constrained, fared
no better. Students reported they were at the bottom of the perceived class
pecking order. This became painfully apparent when class ranking was made
public or teachers signaled the learning difference in explicit or implicit
ways. One youth retells the shame he felt when the teacher spoke about his
accommodation as part of a lecture on “tolerance of difference.” “Hopeful”
stories included one youth who relayed a friendship with a classmate who
“kept me around to show how smart he was.” Other students expressed it in
their own way: “I was one of the broken toys that no one wanted.” “I was
just a burden on my family, so I left to relieve them of the burden.” Yet an-
other youth pointed out, “It’s like I’m in a race where I’m always last. No
matter how hard I try, I’m always at the end.” Another youth had a similar
characterization: “It’s like I’m in a race with my feet tied together.” Some
youth expressed a preemptive loss of self-worth. In a country where school
is informally optional or a luxury, when asked why they chose not to attend
school, one youth said that it “would only prove that I’m stupid.”

Students With Disabilities

and Equity Programs
Another surprising theme was the damage done by equity efforts. Learning
differences are a latecomer to equity advocacy groups. In many countries,
the strongest opponents to recognizing learning differences as a justice-
seeking group are other disability advocacy groups. This is apparent in met-
rics used to determine foreign aid. Many indicator-linked aid programs do
not recognize learning disabilities among the “accessibility for persons with
disabilities” metrics, which means they have no incentive to include services
for individuals with learning differences among the performance indicators
or to spend funds or effort on serving this population.
In many cases, no mechanism exists to identify students with learning
disabilities, and any claims are dismissed as undocumented or uncertified.
Policy makers also argue that the interventions are unclear and uncertain.
Some learning disability advocacy groups argue that fighting to be included
in the indicators would be joining a “race to the bottom” with other efforts
that were reluctant to allow a new member to join the hard-won status. This
situation is further complicated because the failure to recognize learning
disabilities means that the student metrics are added to the aggregate met-
rics and “bring down the totals.” This puts students with learning differ-
ences in a double bind.
Technologies and Difference 247

A number of youth spoke about the effect of equity awareness programs.

One participant complained that he was often asked “What is your super-
power?” in a derogatory way or was challenged to solve impossible math
problems. Others spoke about the difficulty people had in understanding
their learning differences: “It’s easy to see what the problem is with some-
one who is blind or in a wheelchair. People think I’m just lazy or I don’t
care.” Another youth observed, “School is about learning; my problem is
learning. The kids who are blind don’t have problems learning. It’s like I’m
the least qualified to go to school.” A youth worker who had a learning dif-
ference himself stated, “When you have an invisible disability, there is in-
visible injustice.”

Doubly Marginalized
In countries or school districts where Individualized Education Programs
are instruments for receiving accommodation, disengaged youth often re-
ported that their parents did not have the time or know-how to arrange as-
sessments. They described onerous processes to be “certified.” Several
youths said they were “certified” for primary school but that their parents
could not afford to repeat the process for middle, high school, or college,
and each new school would not accept the prior assessment.
The negative impacts of the treatment of learning differences are inten-
sified or compounded by other forms of discrimination. This means that
youth are often doubly marginalized. One youth reported, “It’s hard enough
for my parents to fight discrimination because we are black and Muslim. I
can’t ask them to also fight for my learning disability.”
Surprisingly, more youth with learning differences in criminal justice sys-
tems were from affluent, “privileged” families than we expected. They spoke
of entangled and complex failed relationships with their parents that in-
volved monies, attention, and being an embarrassment. “I hated listening to
my parents lie about me. They told their friends made-up stories about my
success. I think I did it [criminal activity] to finally break through the lies.”

The Problem With Solutionism

Another unexpected theme repeated in many countries and many scenarios
was the harm done by programs, interventions, or services that claim to
have a solution or “fix” for a learning disability. As explained by one youth,

My parents and teacher wanted me to try a program that had been proven
to work for all kids like me. It was expensive and took a lot of time. It didn’t
work on me. I felt like they blamed me. I did try hard. I think my teacher
248 Neurodiversity

gave up on me after that. When my parents found the next thing that would
fix me, I didn’t want to even try it.

One parent made this point:

The more evidence, research, and backing there is that the intervention
works, or is a best practice with empirical backing, the more it disadvantages
kids for whom it doesn’t work. These kids are so different, how can anyone
make such claims? I’ve learned to run away when anyone says, “We have
data to prove effectiveness.” You don’t have data on my kid!

One criminal justice tutor characterized “proven” learning disability inter-

ventions as “opportunities to invest in resentment of the student.” The gen-
eral sense is that top-down proven methods or empirical claims regarding
effectiveness further marginalize students who are misfits for the interven-
tion. The more proof there is that something should work, and the more
time, effort, and monies are invested in the “solution,” the more failure is
attributed to the student.

Who Is to Blame?
Many youth expressed frustration that they were always the “things that
need fixing.” Many welcomed the opportunity to talk about the role that
schools played in their situation: “We are told not to dwell on the past, so
there is no way to make sure other kids don’t go through this.” “Why is it
always that the kid needs rehabilitation, not the system?” “School and ed-
ucation are assumed to be always right, true, and blameless.” “I did some-
thing wrong, but I was just a kid, and I didn’t feel I had a choice.” Several
alluded to the self-fulfilling effect of attitudes toward learning differences.
One said, “Everyone told me I was bad and stupid, so I did what they ex-
pected me to do.”

The “Torture” of Assessments

A common theme was the “learned phobia” of assessments or tests. One
student said, “My brother has a rare form of leukemia. He had to go
through hundreds of horrible tests. I feel ashamed, but I felt the same. Why
did we have to take so many tests? Each test just showed what I couldn’t do,
how I wasn’t good enough. And they have no cure.” When offered a certif-
icate completion program, many youths said the impediment was their fear
of tests: “I’m not trying anything where there will be tests; I’m hyper aller-
gic to tests.” “How many times do they need to prove that I’m defective?”
Technologies and Difference 249

Tests, evaluations, or assessments were collectively viewed as instruments

for being judged and falling short.

“What I’m Good At”

Our questions—“What are you good at? What do you enjoy?”—elicited
some disheartening replies: “I’m good at failing”; “I’m good at escaping”;
“I’m good at hiding.” One youth said, “I don’t let people know what I enjoy
anymore; they will use it against me.” When we asked him to explain, he
said, “They won’t let me paint, listen to music, or go out with friends until
I get better at reading and math. I never get better enough.” A criminal jus-
tice worker told us we should have expected this. He characterized these
youth as “the lost boys.” He explained that their entire school career was
focused on what they cannot do and where they cannot go. “The map they
are given for where they need to go is impossible for them, and no one gave
them a map for an alternative path.” Describing the programs to increase
literacy and numeracy, one tutor observed, “What they can’t do is now a po-
litical agenda, a matter of national urgency. Not only are they letting down
their family, their teachers, their school, but also their country.”
When we circled back to the question, one youth said, “No one cares
that I’m good at art and making things. STEM [science, technology, engi-
neering and mathematics] is the only thing worth anything.” An incarcer-
ated youth from an indigenous territory argued, “For decades you have
tried to wipe out our knowledge and art. Don’t ask me what I’m good at—
you won’t respect it, or you’ll steal it.”

The Importance of Youth Movements

Our discussions consistently affirmed the importance of youth movements
in acting as a chance to repair the “breakup” with learning. Among the ex-
planations of why she preferred learning in an environmental youth group
rather than school, even though the tasks were academically challenging,
one youth said, “They don’t claim to know what is good for me.” The sense
is that youth groups do not give formulaic or deterministic advice about
learning: “The focus is on addressing challenges in whatever way you can.”
“All efforts are welcome.”
They also appear to positively channel frustration and provide a form
of catharsis and purpose: “It’s okay to be pissed.” A mother reported, “My
daughter attempted suicide. Now she has a reason to get up, people are de-
pending on her. It’s been a lifeline.” One youth put it this way: “I’m not the
problem anymore. The problem is pollution.”
250 Neurodiversity

Despite the potential benefits of youth groups, a troubling phenomenon

that was repeatedly told is that students with learning differences were fre-
quently prevented from attending youth groups during their school career
because they needed to focus on their academics and remedial work. Several
youth said they would have been “saved from crashing” if they had been al-
lowed to participate earlier in youth movements. “I learned way more here
than I ever learned from the hours and hours of forced homework.”

Recommendations, or
“What to Learn From Failure”
The recommendations for changes to formal education were surprisingly
consistent. Youth participants were quick to state that they welcomed chal-
lenges: “Don’t be afraid to be hard on us. Just don’t set us up for failure.”
When we pressed for what that meant, one youth replied, “Don’t expect me
to be like all the other students. You need to know me. I’m not all the other
students.” Another youth agreed: “Yeah! Don’t make it a crime to be differ-
ent.” Timing was also a common theme: “You need to get to us before we
lose hope in ourselves.” “Make sure there is just as much success as there is
failure.”
The students had many comments when questioned about tests: “Stop
comparing us to other students.” “I wish they would test the progress I
make, not the progress I’m supposed to make.” “The tests are never about
the things I’m good at, the ways I’m worth something.” A youth worker rec-
ommended, “If they are looking for determinants of success and aversion
of risk, the factor isn’t performance in the Rs; it’s self-esteem, self-worth,
confidence, and belief in self. That’s what they should measure and opti-
mize.” A criminal justice tutor recommended, “Help them establish a foot-
hold, a sense of personal competence in something, and then build from
that. Don’t go straight to fixing what they can’t do.”

Conclusion:
Changing the Mindset
The emergence and advance of machine intelligence and the impact that it
will have on the future of work demand a rethinking of education. The en-
tangled complexity of our current society demands diverse perspectives and
approaches to address current challenges. Unlike during the industrial era,
which required conformant, replaceable workers, we now must optimize
diverse human potential. From this viewpoint, neurodiversity is a human
Technologies and Difference 251

asset to be capitalized in our systems of education. Unfortunately, there is

a rising trend to apply technical tools to reinforce a push toward confor-
mant and standardized learners (Hao 2019).
Undeniably, Pareto discovered a recurring and instructive natural phe-
nomenon, but it may be that his insights have been misapplied by subse-
quent analysts. Pareto initially discovered that 80% of the land in Italy was
owned by 20% of the citizens. These 20% were dubbed the “vital few” in
the Pareto distribution, which also holds that 20% of the factors cause 80%
of the effects (Koch 1998). Pareto focused on ownership and wealth. His
principle has been applied to satisfy greed and the quest for power and in-
fluence. Like any tool, it can be exploited for many purposes.
Pareto, Koch, and others ignored the application of the principle to ex-
perience, insights, and perspectives. Our popular applications of the lessons
of this natural phenomenon have led us to ignore a critical vital few—namely,
the people who have been dubbed the difficult 20%, who have the greatest
lived experience of difficult terrains. The conventional application has re-
sulted in disparity, inequity, and fragmentation. Because we have marginal-
ized the “difficult” vital few, we have not learned to understand and navigate
diversity and complexity away from the conventional and more homoge-
neous middle.
It is in this 80% of the knowledge terrain, occupied by 20% of our mar-
ginalized humanity, that we find innovation, as well as unexpected disruptive
influences. To venture into this terrain, we require people with experience
in dealing with diversity and complexity. It is the vital few, misidentified as
the difficult 20%, who offer new competencies and approaches. For those
vital few who have learning differences, neurodiversity has meant that they
have needed to practice unusual resourcefulness on a daily basis to address
the many false assumptions manifest in the systems they encounter. To be-
long, they have needed to foster social cohesion across diversity. These are
valuable skills. Capitalizing on human differences requires collaboration to
weave together the collective effort of as broad a diversity of skills and per-
spectives as possible.
The assumption underlying inclusive approaches to the design of tech-
nology is that we must support and leverage human difference (Community
Members of the Inclusive Design Research Centre 2019). Rather than ig-
noring the difficult 20% as recommended in most business schools, inclu-
sive designers recognize them as the vital few. A phenomenon that Pareto
and Koch missed is that if you design a system to stretch to encompass the
occupants of the outer terrain of our human starburst, you create a system
that is better for everyone. Such a system is inevitably more innovative, re-
sponsive, agile, and generous (Jacobs 1999) and is better at handling change
and the unexpected.
252 Neurodiversity

Plan for the center Plan with the edge

END OF LIFE
Cost

Cost
Time Time

FIGURE 10–5. Pattern of cost over time when planning with the
edge versus planning only for the center.

The vital few cover 80% of the terrain of human needs, meaning that
they bring 80% of the currently missing insights. If we hope to save costs in
the long run, working with them to address their needs from the start means
that we create a system that can weather contextual changes, does not need
to be retrofitted to address excluded needs, and thereby costs less in the long
term (Figure 10–5). This is a pattern we have found in the many projects of
the Inclusive Design Research Centre. Planning only for the average, to the
exclusion of people at the margins, results in a system that is less adaptive
and flexible. The system will not be able to adapt to contextual changes or
unanticipated needs. To address these changes and requests requires patches
or provisional modifications. The system becomes brittle and difficult to
support and update and reaches a point where it is not sustainable. If people
who are currently marginalized by a system are engaged in designing the
system, the system is compelled to be adaptive and to encompass a large
enough range of needs that it can flex in response to changes. While a sys-
tem designed with people who are currently marginalized may cost more
and take longer to develop initially, it is less costly over the long term.
The 80% of the space and effort outside the conventional middle is a vast
and shifting terrain that cannot be reached in a straight line. It must be ap-
proached without predetermined assumptions and presumptions. A linear
logic model does not work. We use a model called the “virtuous tornado” as
a planning tool, iterating further and further to the edge, constantly recali-
brating and evaluating progress, and asking “who are we missing?” to recruit
the necessary knowledge and lived experience we need (Figure 10–6).
When designing with diversity in a complex adaptive scenario, failures
and mistakes are often as valuable as successes for charting the course. For-
mulas do not hold. Entangled complex systems are impervious to simple
fixes. Categories, labels, and singular notions of quality and rigor often do
more harm than good. Value is not assessed based on statistical significance,
Technologies and Difference 253

More resilient designs More inclusive designs

More innovative designs

More adaptable designs More accessible designs

Cycle 5
5
Cycle 4

Cycle 3 4
3
Cycle 2
2
Cycle 1 1
Evaluate Implement
Refne Develop
Injections of needs and characteristics Co-design

FIGURE 10–6. The “virtuous tornado,” a planning process that

supports a nonlinear logic model.
To view this figure in color, see Plate 3 in Color Gallery.

which reverts to the mean, but instead on whether the design works for in-
dividuals whose needs are at the extreme edges of the normal distribution.

Acknowledgments
We wish to acknowledge the support of the Oak Foundation and the many
partners in the Social Justice Repair Kit project. Participants and partners
for this chapter are too numerous to list individually and include many
youths with learning differences who contributed their insights regarding
the breakdown of formal education and helped in co-designing the recom-
mendations in this chapter. Many are featured at the Social Justice Repair
Kit project website: www.sojustrepairit.org.
254 Neurodiversity

KEY CONCEPTS
• Both society as a whole and members who are neurodiverse are served
by addressing the bias against human diversity in formal education,
technology design, and intelligent decision systems. This requires a
fundamental, not just an incremental, shift in our mindset.
• Research methods that produce generalized conclusions based on sta-
tistical analysis of findings from a controlled homogeneous group of
subjects do not suit the needs of people with learning differences, who
are often small minorities or outliers in a data set.
• Self-esteem, self-determination, and self-knowledge are critical factors
in maintaining engagement in learning and need to be developed
alongside academic competencies, especially for students with learn-
ing differences.
• Attitudes toward and consequences of failure and mistakes should be
reformed. Failures and mistakes should not be deterministic but should
be leveraged as learning opportunities.
• Problem- and project-based learning that is engaging and does not fo-
cus on the deficits of the student may be more effective in advancing
learning than remediation. Extramural initiatives and formal school-
ing can provide this engagement.
• Assessments and tests that are standardized may do more harm than
the insights gained warrant, when evaluating students with learning
differences.

Recommendations for Educators,

Clinicians, and Other Professionals
• Rethink our approaches to human difference in formal education. To
address the digital disruptions that we currently face as a society, the in-
evitable disruptions to come, and the increased complexity of global
challenges, we need to view differences as an asset. Our society will be
better served by optimizing diverse human potential than by attempting
to create a uniform standard of learning. Many scholars agree that the
most valuable skill, now and in the future, is learning to learn. Lifelong
learning and continuous renewal of skills will be the new norm. This re-
quires sustaining a positive view of learning and confidence in oneself
Technologies and Difference 255

as a learner. A promising area of education research is to explore the

edges of the spectrum of learning differences.
• Reduce digital disparity and continue to innovate. We must upend our
design focus from the largest or average customer base to those who have
difficulty with or cannot use current designs. This inevitably includes
anyone who is different from the average, including people who are neu-
rodiverse. We must also be mindful of the complex adaptive systems that
are the context of any design. This implies considering the “externalities”
or full social cost of any design. Individuals who have experienced mar-
ginalization by current designs are the best stress testers and early warn-
ing signs of the risks and unintended consequences of a design.
• Insights into learning design should be based on individual data that are
not decontextualized, especially for students with learning differences.
Learning analytics based on statistical averages do not apply well to stu-
dents with learning differences. Artificial intelligence automates many
decisions and nudges human behavior. When decisions are based on sta-
tistical probability, they automate and amplify the bias against human di-
versity caused not only by data gaps—algorithmic bias introduced by
human developers—but also by reliance on statistical probability for pre-
diction (Trewin et al. 2019). This bias against diversity is associated with
the inability of current machine learning systems to operate in new con-
texts and to manage unexpected scenarios. It manifests in life-altering
decisions about hiring, promotion, admission to education, credit, insur-
ance, legal sentencing, funding, and public policy. The negative influ-
ence on those who are different from average, including anyone who is
neurodiverse, is pervasive and insidious.
• Allow students to identify their personal learning goals. Help them to
differentiate their knowledge and skills rather than conform to a stan-
dard. Learning analytics systems are trained using large data sets and sta-
tistical algorithms. The further a learner is from the statistical average,
the harder it is to train the system to understand and serve that learner’s
unique needs. Commercially available adaptive and personalized learning
systems are used to vary the pace and path toward a standardized learn-
ing goal rather than move the learner toward a personal learning goal,
thereby standardizing rather than differentiating learning. This homog-
enizes human skills and knowledge, reducing the approaches to address-
ing the complex adaptive challenges we currently face.
• Create intelligent systems that recognize, understand, and serve human
diversity rather than automating and amplifying the bias against minori-
ties and outliers. Our decision systems must move beyond binary deci-
sions or ranking based on popularity. This will serve people who are
neurodiverse and produce more ethical and innovative intelligence.
256 Neurodiversity

Discussion Questions
1. How can we design education to foster and optimize diverse human po-
tential rather than standardizing learning? What new competencies and
skills are associated with neurodiversity?
2. How can we design systems that work for the full range of human diver-
sity, including neurodiversity? How can we scale by diversifying rather
than by formulaic replication?
3. How can we design intelligent systems that serve neurodiverse individ-
uals and represent small minorities and outliers? Will this improve the
ability to handle complexity and change?

Suggested Readings
Inclusive Design Research Centre: The Floe Inclusive Learning Design
Handbook (website). Available at: https://handbook.floeproject.org.
Inclusive Design Research Centre: The Inclusive Design Guide (website).
Available at: https://guide.inclusivedesign.ca.
Treviranus J: Learning differences and digital equity in the classroom, in
Second Handbook of Information Technology in Primary and Second-
ary Education. Edited by Voogt J, Knezek G, Christensen R, Lai KW.
Cham, Switzerland, Springer, 2018, pp 1025–1046
Treviranus J: The Three Dimensions of Inclusive Design: Part One.
FWD50, March 28, 2018. Available at: https://medium.com/fwd50/
the-three-dimensions-of-inclusive-design-part-one-103cad1ffdc2.
Trewin S, Basson S, Muller M, et al: Considerations for AI fairness for peo-
ple with disabilities. AI Matters 5(3):40–63, 2019
Watkins C, Treviranus J, Roberts V: Inclusive Design for Learning: Creating
Flexible and Adaptable Content With Learners. Burnaby, BC, Common-
wealth of Learning, 2020. Available at: http://oasis.col.org/bitstream/
handle/11599/3690/2020_Inclusive_Design_for_Learners.pdf.

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 ELEVEN
Using Technology to
Provide Transition
Support for
Neurodiverse Young
Adults
Steven M. Keisman, M.A., M.S.

Building up a weakness just makes you less disabled. Building a

strength can take you to the top of the world.
John Elder Robison

259
260 Neurodiversity

Engaging in meaningful employment is often cited as a major

determinant of whether a person is living a fulfilling and purposeful
life. Meaningful employment, however, remains an elusive goal for
many neurodiverse young adults. As an example, 80%–90% of adults
on the autism spectrum are estimated to be currently unemployed or
underemployed.
The path to meaningful employment starts with an accurate
assessment of a person’s abilities and interests. All too often, this
assessment is based on a “deficit model” that identifies the multitude
of shortcomings a neurodiverse person has, leading to an ever-
expanding list of things the person cannot do. Thus, a downward
spiral of real or perceived “cannots” leads to restricted employment
opportunities. The opposite approach of a “strengths-based model”
is needed for the neurodiverse audience. Identifying strengths based
on executive function, multiple intelligences, and career interests
allows for a more holistic understanding of a neurodiverse person’s
capabilities and thereby enhances the pinpointing of things a person
“can” do so that the appropriate jobs requiring such capabilities can
be identified.
Many technological tools have been developed over the years to
help assess individuals’ executive function, multiple intelligences, and
career interests. These tools, however, were designed for the
neurotypical population and are often difficult or inappropriate for
neurodiverse individuals. Alarmingly, a person’s inability to engage
effectively with the assessment tool can result in an incorrect
assessment of his or her abilities and interests. Identifor was created
to address this specific challenge for the neurodiverse audience. By
eschewing pen-and-paper-based multiple-choice tests, Identifor
created a more natural engagement medium based on games that
collect data as individuals play and make decisions. Analysis of the
data is presented in their “Dashboard” to reveal their relative and
comparative executive function, multiple intelligences abilities, and
career interests.

Neurodiversity is the concept that neurological differences (e.g., dyspraxia,

dyslexia, ADHD, dyscalculia, autism, Tourette syndrome) should be recog-
nized and respected like any other human variation. The term neurodiver-
sity was first coined by Harvey Blume in a short article in The Atlantic more
than 20 years ago. He suggested that neurodiversity “may be every bit as cru-
cial for the human race as biodiversity is for life in general” (Blume 1998).
Simon Baron-Cohen, director of Cambridge University’s Autism Re-
search Centre, clarifies the classification of neurodifference, viewing it as a
variation of human wiring rather than a disease. The term disorder is applied
when an individual shows symptoms of dysfunction and the underlying
Using Technology to Provide Transition Support 261

cause is unknown; disease is used when a disorder can be attributed to a spe-

cific causal mechanism; and the classification of disability can be applied to
individuals who score below average on a standardized measure of func-
tioning or when a specific environment or activity causes discomfort. Using
the term difference, on the other hand, references a trait variation (Baron-
Cohen 2019).
Great optimism is being placed on a shift in the approach used to address
the needs of this cohort. Today’s approach moves from a medical model or
deficit approach—What is broken? How is this person disabled? How do
we fix or work around this weakness?—to a strengths-based approach—
What are this person’s strengths and abilities? How do we leverage them?
The strengths-based approach is often referred to as person-centered plan-
ning. Temple Grandin, a leading voice for autistic communities and a sup-
porter of this change, has cautioned against “label-locked” thinking that
stresses deficits: “I’m certainly not saying we should lose sight of the need
to work on deficits but the focus on deficits is so intense and so automatic
that people lose sight of the strengths” (Grandin and Panek 2013, p. 102).
This shift in perspective is changing the conversation between families,
educators, clinicians, and, more recently, employers. It builds upon the Re-
habilitation Act of 1973, the Americans With Disabilities Act (ADA) of
1990, and great effort by government programs, advocacy groups, and var-
ious other agencies responsible for helping the country become more ac-
cessible and accepting of people with disabilities and neurodifferences.
Great focus and considerable resources have been devoted by both govern-
ment and nonprofit agencies, such as Workforce Employment Networks,
state vocational rehabilitation agencies, and Work Incentive Planning and
Assistance Projects, aimed at improving employment outcomes for people
with cognitive differences.
Through intentional Autism at Work initiatives, an increasing number
of businesses are recognizing the many abilities and contributions people
with neurodifferences can make (see Chapter 9). They are finding ways to
fill job vacancies and improve productivity, especially in employment re-
lated to computer programming and testing, by maximizing and applying
assets shared by many people on the autism spectrum. These assets include
the following, which are neither limited to nor applicable to all persons on
the spectrum: unusually strong preference for facts, patterns, repetition,
and routine; accuracy in visual perception; strong long-term memory; at-
tention to detail; precision; understanding of rules and sequences; logical
thinking; tolerance for repetitive activities; and intense focus and concen-
tration in areas of interest. JP Morgan, EY, SAP, Specialisterne, DXC Tech-
nology (Dandelion Program), and Ultra Testing are just a few of the major
corporations widening the playing field by making space for neurodiversity
262 Neurodiversity

in the workplace and creating an inclusive culture that encourages openness

about how each person works best. They are screening for and recruiting
the best talent without being blinded by neurological conditions or labels
that are not relevant to a job’s requirements.
Sarah Loucks, who is the Autism at Work Global Lead at SAP, shares
her perspective:

Because of autism, we are able to capture the inherent abilities that are often
associated with people on the autism spectrum, including visual learning
skills like the ability to recognize patterns, and attention to detail—the abil-
ity to spot deviations in data, information, and systems. These employees
frequently have high diligence and low tolerance for mistakes, as well as a
strong affinity with predictable, structured, process-oriented environments
that results in strong process optimization capabilities. (Loucks 2018)

Success for workers on the autism spectrum is slowly expanding to ben-

efit people with other cognitive disabilities and neurodifferences who often
share capabilities and non-task-specific qualities, such as punctuality and
excellent attendance, honesty, loyalty, willingness to work hard, strong ad-
herence to rules, staying out of office politics, and other qualities that are
often difficult to find in the general workplace, thereby increasing the em-
ployment value of these individuals. To take advantage of these assets, some
business leaders are exploring various models and ideas, such as flipping
their business approach from “We know what we need—find the person
with the talent” to “What talent is out there and how can we use that in our
business?”
Despite enormous efforts being made to widen the employment field,
quite a few obstacles conspicuously lie in the way. The employment out-
comes are even bleaker for intermediate and more greatly impacted individ-
uals, including those who have communication challenges or lack capabilities
in STEM (science, technology, engineering, and mathematics) fields, espe-
cially computer skills. Also, very few individuals with neurodifferences work
full time—not by choice, but because of putting government entitlements
at risk, inadequate reliable public transportation, and lack of mechanisms
available to locate open positions in neurodiverse-friendly companies and
businesses.
Despite progress having been made in these efforts, employment oppor-
tunities for neurodiverse individuals, especially those with cognitive differ-
ences, remain inadequate. Although today’s tight labor market has motivated
efforts by employers to look for workers in new and different ways, the
80%–90% rate of unemployment or underemployment for adults on the
autism spectrum is still common, as noted by David Kearon, director of
adult services for Autism Speaks (Castaneda 2017).
Using Technology to Provide Transition Support 263

Importance of Employment in
Leading a “Meaningful Life”
What is a purposeful life? This type of question often leads to existential
thoughts that defy a precise, quantifiable answer. For neurodiverse individ-
uals, there are obstacles that impede even the simplest of theories. There is
a spectrum of capability and function that standardized tests often fail to
capture adequately, leading to a reality in which neurodiverse adults find it
more difficult to recognize and develop their core competencies. A pur-
poseful life includes meaningful employment. Human beings want to use
their talents and abilities in ways that they enjoy and as means to contribute
to larger goals. These include contributions to the immediate society
around them and may include finding ways to impact and be impacted by
a larger, more far-reaching world.
A purposeful life might include key relationships and an array of activ-
ities that connect a person to the surrounding community. A primary need
in a meaningful life is having a sense of fulfillment and pride in work—this
includes employment as a charitable donation of time or simply for enjoy-
ment. For many adults, a purposeful life features hobbies, friendships, com-
munity involvement, intellectual activities, physical activities, family and
social relationships, and careers.
Meaningful employment is most often a top consideration in judging
one’s contentment in life. There are variables specific to each individual
when considering meaningful employment. Some people consider salary to
be a major priority in judging their career. Others consider the type of work
and contribution to a goal as a more pressing factor when choosing the field
in which they devote their professional time. Often, how individuals rank
the importance of the facets of a job will dictate whether they consider their
career meaningful. For instance, some people might take a position outside
of their field of study because the career trajectory offers more growth or
the salary and benefits are more advantageous, whereas others might take
a position that pays far less because it offers them the ability to work in a
field that truly resonates with them. For most neurotypical adults, these
choices are individual decisions made based on their own education, deter-
mination, desired career, and life goals. For adults with neurodifferences,
many of the options that are typically open to those without cognitive issues
are obstructed.
Recently, a great deal of focus, particularly in the area of autism, has been
placed on a strengths-based neurodiversity model targeting what a person
can do. This focus replaces the long-established medical model highlighting
individuals’ weaknesses and challenges. A primary focal point that drives
264 Neurodiversity

this conversation is the issue of how we define a meaningful life for individ-
uals with “all kinds of minds” and how we determine both what is necessary
and what is desirable for a person to live well and thrive, regardless of level
of function or impact of neurodiversity. In almost all interpretations and
analyses of the construct of a meaningful or purposeful life, employment is
at or near the top. Paul Shattuck, director of the Life Course Outcomes
Program at the A.J. Drexel Autism Institute, describes the importance of
employment for people on the autism spectrum: “We find that for many
people, employment is not just about a paycheck. It’s about opportunities
for social inclusion, meeting other people, for self-expression and identity
formation” (Rudacille 2017).

Neurodiverse Employment
Obstacles
For people with neurodifferences, employment opportunities are often elu-
sive. Barriers to meaningful employment start early. To help students with
disabilities or neurodifferences prepare for the demands of the “real world,”
schools are legally obligated under federal law to create meaningful post–
high school plans as part of the students’ Individualized Education Programs
(IEPs) and Individual Transition Plans (ITPs). Customized ITPs must be in
place beginning at age 16 years, or at age 14 years in several states, that rep-
resent specific goals and objectives designed to help build a bridge to assure
a more productive life once students complete their education.
The School-to-Work Opportunities Act of 1994, a policy update to
Part B provisions of the Individuals with Disabilities Education Act of 1990,
prescribes a specific process for discovering, developing, and applying the
potential of all secondary-level students with disabilities; identifying career
assessment essential in assisting them to make informed choices; and set-
ting realistic goals for their successful transition to adulthood (Leconte and
Neubert 1997). School districts, usually well meaning in their efforts to
prepare students for post–high school life, are often stymied by the process
of determining what makes sense for each child and then creating an ITP
that includes specific work, school, and independent living goals that the
student would like to achieve. The career development model designed by
Leconte and Neubert decades ago, as shown in Table 11–1, is essentially
still followed today (Leconte and Neubert 1997; Utah State Board of Edu-
cation 2017). Under this model, the overarching emphasis is to determine
where the student stands in terms of career awareness, orientation, explo-
ration, preparation, placement, or growth/maintenance.
Using Technology to Provide Transition Support 265

TABLE 11–1. Seven major uses of informal and formal career postsec-
ondary transition assessment data
1. Determination of career development: To determine where the student
stands in terms of career awareness, orientation, exploration, preparation,
placement, or growth/maintenance
2. Measurement: To identify abilities, interests, capabilities, strengths, needs,
potentials, and behaviors within the areas of personal/social, functional/
academic, community/independent, employment, and employability areas
3. Prediction: To match an individual’s interests and abilities with appropriate
training, community employment, or postsecondary training
4. Prescription: To identify strengths and needs and to recommend types of
adaptive techniques and/or remedial strategies that will lead to improved
career preparation and development
5. Exploration: To “try out” different work-related tasks or activities and to
determine how interests match abilities for work-based experiences,
community jobs, postsecondary education, or other adult activities
6. Intervention: To implement the techniques or remedial strategies that will
help a student explore career or work options
7. Advocacy: To develop a career profile to help students, their families, and
others identify concrete ways to assist students in achieving their goals
Source. From National Collaborative on Workforce and Disability: “Vocational
Assessment and Its Role in Career Planning.” InfoBrief, Issue 20, May 2008.

Effective career preparation requires an accurate evaluation of elements

critical to planning “real life” in a personalized way. It is imperative to rec-
ognize, develop, and find ways of applying a person’s unique qualifications,
skills, and abilities. However, many school districts administer nothing more
than a generalized, self-reporting, open-ended questionnaire that asks ques-
tions such as “What kind of people do you prefer to work with?”; “What is
your ideal job?”; “Do you prefer to work alone or with others?”; “Is it more
important to you to earn a lot of money or to help others?” Advocates and
lawyers report that the vast majority of goals and measures they have seen
for neurodiverse individuals are vague or even nonsensical and fail to live up
to their legal requirements. Plans often include too few goals, or superficial
ones, and ITPs frequently demonstrate low expectations (Butrymowicz and
Mader 2017).
Not surprisingly, the transition tools available for neurodiverse individ-
uals offer little more than the same instruments as those used for their neu-
rotypical peers or are ineffective and unproductive tools designed for
students with neurodifferences. Furthermore, most interest inventories are
surveys of self-reported interests and skills. Some commonly used interest
266 Neurodiversity

tests include the Campbell Interest and Skill Survey, Career Exploration In-
ventory, Career Occupational Preference System Interest Inventory, and
Harrington-O’Shea Career Decision-Making System–Revised. The Picto-
rial Inventory of Careers DV-2000 and Reading-Free Vocational Interest
Inventory–2 offer “reading-free” interest testing for teens who lack reading
or English literacy skills (National Collaborative on Workforce and Dis-
ability 2008; Timmons et al. 2004). Other assessments used with young
adults with cognitive differences include the Brigance Transition Skills In-
ventory, Occupational Aptitude Survey and Interest Schedule, Becker Work
Adjustment Profile, Clifton StrengthsFinder, Myers-Briggs Type Indicator,
Holland career codes (see subsection “RIASEC Career Code,” later in chap-
ter), Strong Interest Inventory, Big Five personality traits model, and DISC
(Dominance, Influence, Steadiness, and Compliance) personality test (Lof-
fredo 2017; Scheuermann et al. 2018).
Standardized testing and the use of Scantron assessment tools often fail
to meet the needs of neurodiverse individuals. IQ tests, grade-based stan-
dardized tests, and career aptitude tests all fail to deliver actionable data for
neurodiverse students. For this cohort, these tests do not yield accurate re-
sults, but the results are nevertheless used to build profiles for the students.
Rather than determining areas in which a student excels and shows interest,
these assessments lead to negative implications that shape the picture of
things the student cannot do and result in reports of low aptitude and low
IQ and potentially a DSM classification.
This method of education and assessment for neurodiverse students does
not answer the question of what they can do. It fails to help educators and
parents guide the students in directions that will help them fully realize their
strengths and pinpoint fields that fit their aptitude for meaningful employ-
ment once they leave high school. Neurodiverse students often test poorly
for reasons outside their aptitude. Because tests are standardized, the method
for testing and the environment are conducive to the needs of the majority.
This scenario means that the environment is not necessarily suitable for as-
sessing those who do not fall into the typical or most common testing type.

Alternative Approaches To
Assessment
Unlike the deficit model that is associated with current evaluation tools, a
strengths-based model seeks to uncover a person’s strengths, which allows
employment assessment and vocational plans to be better tailored to each
person. We believe that in the context of employment, it is critical to reveal
Using Technology to Provide Transition Support 267

a person’s strengths on three dimensions: executive function, multiple in-

telligences, and career interests.

Executive Function
Executive functions are used daily to complete work in every workplace.
They are responsible for focusing on the here and now, anticipating the fu-
ture, and taking action required for completing a task. George McCloskey,
a leading voice in the understanding and practical application of executive
functions, explained that

[t]he term Executive Functions refers to a diverse group of cognitive pro-

cesses that act in a coordinated way to direct perception, emotion, thought
and action. While the mainstream literature refers to executive functions as
the “CEO” of the brain, studies of brain functioning suggest that executive
functions are not a unitary trait, but a set of multiple cognitive capacities
that act in a coordinated way. Executive functions are responsible for a per-
son’s ability to engage in purposeful, organized, strategic, self-regulated,
goal-directed behavior. As a collection of directive processes, Executive
Functions cue the use of other cognitive capacities including reasoning, lan-
guage, visual and spatial, and memory capacities. (McCloskey 2011, p. 1)

McCloskey listed 33 specific self-regulation capacities assigned to seven

different clusters: attention, engagement, optimization, efficiency, mem-
ory, inquiry, and solution. Table 11–2 highlights problem behaviors likely
to be exhibited in school settings by a student experiencing difficulties with
any of these 33 self-regulation executive function clusters.

Multiple Intelligences
Howard Gardner, a developmental psychologist and professor, is best
known for his theory of multiple intelligences. Gardner theorized that every
person has some combination of nine competencies (or intelligences) and
that no person has the exact same measurement of abilities. Some people
will have great strengths in certain areas but severe deficits in others. Every
combination is unique to the person, which can explain why many people
on the autism spectrum have very heightened functions with certain skills.
Gardner (1993) identified the following intelligences.

1. Verbal-linguistic. Individuals with high capabilities in this area are good

with language. They excel in reading and writing skills, tend to have a
larger vocabulary, and are good at recognizing sounds. They tend to re-
member word meanings and are more interested in stories, words, and
rhythm of words.
268 Neurodiversity

TABLE 11–2. Problem behaviors exhibited in schools by students

experiencing difficulties with self-regulation executive
function clusters
Attention cluster
Perceive/cue: Does not see signs, directions, etc.; does not hear directions; does not
touch or handle materials; seems unaware of own thoughts and actions
Focus/select: Does not attend to information being presented
Sustain: Has difficulty working on tasks for extended periods of time
Engagement cluster
Energize: Puts little energy or effort into work on school tasks
Initiate: Is slow to get started with tasks, pauses for long time before responding
Inhibit: Blurts out comments in class, acts impulsively, cannot wait for turn
Stop: Continues even after being told to stop
Interrupt/pause: Does not return to work on a task after a brief interruption
Flexible: Resists the idea of doing things a different way or feeling or thinking a
different way, insists on doing things the same way
Shift: Has difficulty going from one activity to another or moving from one
thought or feeling to another
Optimization cluster
Monitor: Does not check work for errors, has difficulty realizing when he/she has
made a mistake, has a hard time identifying inaccurate thoughts or feelings
Modulate: Has difficulty adjusting activity level, is overactive or underactive, gets
overstimulated or understimulated, overreacts or underreacts to situations
Balance: Has difficulty finding the balance between extremes (speed vs. accuracy,
quality vs. quantity, general vs. specific, depth vs. breadth, talking vs. listening,
sharing too much vs. sharing too little, being humorous vs. being serious)
Correct: Has trouble correcting mistakes or apologizing for inappropriate behavior
Efficiency cluster
Sense time: Seems unaware of the passage of time, does not know how long he/she
was working on a task or thinking about something
Pace: Has difficulty changing pace to go slower or faster as conditions dictate
Sequence: Has difficulty getting the steps of a routine in the right order, performs
sequenced tasks out of order
Execute: Has difficulty effectively using routines most children the same age have
automated; lacks follow-through on tasks even when interested and attending
Memory cluster
Hold: Has difficulty holding onto information for more than a few seconds
Manipulate: Has difficulty actively working with information being held in mind
Store: Has difficulty with storing information so it will be available for later use
Retrieve: Has difficulty retrieving stored information when needed
Using Technology to Provide Transition Support 269

TABLE 11–2. Problem behaviors exhibited in schools by students

experiencing difficulties with self-regulation executive
function clusters (continued)
Inquiry cluster
Gauge: Has difficulty “sizing up” what is needed to complete a task, under- or
overestimates the difficulty of tasks
Anticipate: Has difficulty looking ahead or anticipating what will be next, has
difficulty considering the consequences of his/her actions before acting
Estimate time: Is very poor at estimating the time or estimating how long it takes
to do things
Analyze: Has difficulty examining things in more detail to understand them better
Compare/Evaluate: Has difficulty evaluating the quality of his/her work or
thinking, has difficulty comparing one thing with another on various dimensions
Solution cluster
Generate: Has difficulty coming up with a new idea or finding a novel solution to
a problem
Associate: Has difficulty understanding or seeing how two or more things or ideas
are similar
Organize: Has difficulty with arranging things or thoughts in an orderly manner
Plan: Has difficulty working out in advance a way of doing things or thinking about
things
Decide: Has difficulty choosing among options, cannot choose how to think, feel,
or act
Prioritize: Has difficulty assigning an order of importance to things or activities
Source. Identifor: “Executive Functions: Ability to Process Information, Plan Actions,
Execute Plans.” Identifor, 2019. Available at: https://www.identifor.com/resources/docs/
Executive%20Functions.pdf. Accessed January 6, 2021. Used with permission.

2. Logical-mathematical. People with strengths in this area favor logical think-

ing, numbers, and problems that have a finite and clear right or wrong an-
swer. They often like to analyze how something works and enjoy puzzles
and complex number problems.Those who have very high skills in this area
may be able to do complex mathematical equations in their head.
3. Visual-spatial. Individuals strong in this area often visualize things clearly
in their mind, making them good at detecting small changes in a room
or person, such as a moved object or a change of clothes. Designers and
artists are often talented in this area.
4. Bodily kinesthetic. Individuals with this strength are good at controlling
their own movements, such as through balance, hand-eye coordination,
and dexterity. Someone who has a high degree of this intelligence may
be an excellent athlete or a graceful dancer.
270 Neurodiversity

5. Musical-rhythmic. Individuals with high intelligence for music might be

able to play instruments by ear or have a good capacity for learning in-
struments. They often play multiple instruments or excel at one instru-
ment. They may sing or enjoy music.
6. Interpersonal. This intelligence is the competency of interacting with oth-
ers. Those strong in this area excel at reading other people’s body lan-
guage and speaking in a diplomatic way. Often, they shine in group
environments or as part of a team and have an aptitude for sales and any
position in which chatting with other people is part of the process.
7. Intrapersonal. Individuals demonstrating these skills can understand their
own capability, be more self-disciplined, and be able to stay focused on
tasks. They often show strength-enhancing perspectives and assess their
own needs and goals independently.
8. Naturalistic. Individuals demonstrating these skills often have compe-
tency in agriculture or biology. Often, they are interested in plant life,
farming, nature in general, or animals.
9. Existential. Individuals with strengths in this intelligence show capability
in philosophy and are often interested in areas such as religion and psy-
chology. They seek knowledge for knowledge’s sake and often enjoy ask-
ing larger questions, for which there is no definitive answer.

The multiple intelligences offer an added way to understand individu-

als’ strengths, as well as the areas in which they may not excel. For instance,
a scientist with high naturalistic and logical intelligences would have a dif-
ficult time if he or she were forced into a career in which the only intelli-
gence needed was musical.
Exploring multiple intelligences allows students and their parents to
better understand the way in which each person’s unique brain works. Hav-
ing knowledge of their heightened intelligence levels may lead students to
their individual true talent or passion.
Awareness of multiple intelligences also suggests a better way for stu-
dents to learn. We know that some people learn better through reading,
whereas others learn more thoroughly through lectures or one-to-one
teaching techniques. These variations are part of individuals’ core intelli-
gence areas. Understanding of individuals’ higher aptitudes also allows ed-
ucators and parents to tailor lesson plans so that students can benefit more
from their curriculum.

RIASEC Career Code

The Holland career code has been a leading instrument in career assess-
ment since it was first developed by John Holland in the late 1950s (Nauta
Using Technology to Provide Transition Support 271

2010). Typical career assessments ask students and job seekers to identify
what they like and dislike in an effort to help them narrow down fields that
would be a reasonable match for their personality types. These assessments
rely on the individuals to recognize and truthfully assess their own strengths.
According to Holland’s theory, people should seek out the career environ-
ments in which their set personalities will best fit and flourish. The idea is that
if people are doing tasks they like, they will enjoy their work. The career
codes fall into the following six categories, referred to as RIASEC:

1. Realistic: These are doers, people who like to work with their hands, often
like nature or enjoy the outdoors, may like sports, and like to fix things.
2. Investigative: These individuals enjoy investigating problems, learning,
and observing. They tend to do well in scientific fields and those in which
they are allowed to use analytic intelligence.
3. Artistic: These individuals are creative by nature and usually enjoy work-
ing in freer environments, often with the capacity to write stories, draw
pictures, or do other creative activities.
4. Social: These people enjoy being around others and may excel at work-
ing as a helper, teacher, or customer service representative.
5. Enterprising: These people are often found in leadership roles. They like
to manage and organize people and are often best in business environ-
ments.
6. Conventional: These individuals often shine at following orders and
completing work, without taking a leadership role. They are often good
with computer skills, office work, and paperwork.

For many decades, the Department of Labor Occupational Information

Network has linked RIASEC codes for millions of participants with infor-
mation about the jobs they enjoy. Consequently, RIASEC codes are often
used to suggest career options for students exploring postgraduation endeav-
ors. As is true with multiple intelligences, each person may have strengths in
more than one RIASEC category and deficits in multiple areas. Typically, a
person’s multiple intelligences and RIASEC codes overlap, and together the
results can be helpful in pinpointing career fields of interest.

Traditional Assessment
Technologies
Many tools have been developed over the years to assess people on their ex-
ecutive function abilities, multiple intelligences, and career interests. Al-
272 Neurodiversity

though most tools take the form of pen-and-paper surveys or tests, some
organizations have started using technology to make the assessment admin-
istration less manually intensive. A web search reveals a plethora of sites of-
fering online assessment tools. The following list provides a sampling of
some of the tools revealed (URLs are provided in the “References” section
of this chapter).

• Executive function: K&M Center’s Executive Functioning Quiz (K&M

2019), Cambridge Cognition’s series of assessments (Cambridge Cog-
nition 2019), CogniFit cognitive tests (CogniFit 2019), and the seven
cognitive tests assembled by Matt Davis at Big Think (Davis 2018).
• Multiple intelligences: PersonalityMax’s (2019) Multiple Intelligences
Test, Find Your Strengths! by LiteracyWorks (2019), the Multiple In-
telligences Quiz provided by the Government of Alberta (2019), and the
Multiple Intelligences and Learning Style Test presented at PsychTests
(2019).
• RIASEC: The Holland Code (RIASEC) Test presented by the Open-
Source Psychometrics Project (2019), the RIASEC Test provided by the
Hawaii Public Schools (2019), and the Holland Code Career Test pro-
vided by Truity (2019).

A number of these tools are software manifestations of pen-and-paper

forms. Some are very wordy and require the test-taker to read large quanti-
ties of text (Figure 11–1). All are created and intended for the neurotypical
audience.
Many, if not most, neurodiverse people would find using these assess-
ment tools very challenging. These individuals often have difficulties with
multiple-choice tests. Furthermore, the terminology used in the assessment
tools may not have any meaning for someone who has not been exposed to
the concept (e.g., “Plan a marketing strategy for a new company” or “Use
precision machines to build custom metal parts”). Additionally, because of
nuances, required vocabulary, self-reporting with limited experience, the
need to complete answers that correctly correspond to the subject’s choice,
and other barriers, assistance from another person is often needed, which
jeopardizes bias-free results. Consequently, the neurodiverse community is
not served well by existing tools, and many of these individuals’ true abilities
and interests remain hidden simply due to the absence of assessment tools
that they can use.
Using Technology to Provide Transition Support 273

1. Worry about things. • Very • Moderately • Neither accurate • Moderately • Very

inaccurate inaccurate nor inaccurate accurate inaccurate
2. Make friends easily. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
3. Have a vivid • Very • Moderately • Neither accurate • Moderately • Very
imagination. inaccurate inaccurate nor inaccurate accurate inaccurate
4. Trust others. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
5. Experience my • Very • Moderately • Neither accurate • Moderately • Very
emotions intensely. inaccurate inaccurate nor inaccurate accurate inaccurate
6. Get angry easily. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
7. Love large parties. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
8. Believe in the • Very • Moderately • Neither accurate • Moderately • Very
importance of art. inaccurate inaccurate nor inaccurate accurate inaccurate
9. Use others for • Very • Moderately • Neither accurate • Moderately • Very
my own ends. inaccurate inaccurate nor inaccurate accurate inaccurate
10. Like to tidy up. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
11. Often feel blue. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
12. Take charge. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
13. Experience my • Very • Moderately • Neither accurate • Moderately • Very
emotions intensely. inaccurate inaccurate nor inaccurate accurate inaccurate
14. Love to help others. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
15. Keep my promises. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
16. Find it diffcult to • Very • Moderately • Neither accurate • Moderately • Very
approach others. inaccurate inaccurate nor inaccurate accurate inaccurate
17. Am always busy. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
18. Prefer variety • Very • Moderately • Neither accurate • Moderately • Very
to routine. inaccurate inaccurate nor inaccurate accurate inaccurate
19. Love a good fght. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate
20. Work hard. • Very • Moderately • Neither accurate • Moderately • Very
inaccurate inaccurate nor inaccurate accurate inaccurate

FIGURE 11–1. Sampling of executive function assessment tools.

274 Neurodiversity

Identifor Assessments:
More Approachable for
the Neurodiverse Audience
Identifor (www.identifor.com) is a free assistive technology platform that uses
gaming, data analytics, and artificial intelligence to make career assessments
more approachable for the neurodiverse audience. Instead of pen-and-paper
or Scantron tests, Identifor uses specially designed games that gather de-
tailed data on how the player reacts to stimuli and makes decisions. Industrial
psychologists collaborated with gaming technology authorities, clinicians,
educators, and people with neurodiversities to fine-tune and differentiate
Identifor’s platform from other systems of testing and measurement that are
often tedious, difficult, or unable to gauge the true capabilities of the neuro-
diverse community.
Using the Identifor platform is simple. Individuals simply play games to
measure the executive function, multiple intelligences, and RIASEC frame-
works discussed earlier. The games are intuitive, and no reading is required.
Examples of games are shown in Figure 11–2. When instructions are re-
quired, they are provided by a video with a narrator telling the user what
needs to be done to play the game. Forty games are currently available, and
others are being added over time.
As a person plays more games, the data set increasingly provides a more
accurate picture of his or her abilities and interests. Once the individual has
played the requisite minimum number of games to enable collection of the
minimum data set, a comprehensive, personalized, and strengths-based
“Dashboard” is revealed, providing quantifiable data that are helpful for de-
veloping more robust and meaningful IEPs and ITPs for this cohort. Anal-
yses of the data reveal individuals’ talents so they can assess career options
that are compatible with their strengths.
In addition to providing game-based insights, Identifor includes tools
to develop a situational understanding of a person through survey-based in-
put from the individual, if possible, or from various people involved in that
person’s daily life, including parents, educators, family members, and any-
one else deemed appropriate by the person and his or her parents. These
additional insights help to form a fuller picture. For this purpose, Identifor
includes two comprehensive surveys that enhance the understanding of an
individual using an observational approach:

• McCloskey Executive Functions Scale (MEFS) (McCloskey 2016): The

MEFS is based on a comprehensive model of executive function devel-
 Using Technology to Provide Transition Support
FIGURE 11–2. Sampling of Identifor’s games.
To view this figure in color, see Plate 4 in Color Gallery.
Source. Images © Identifor. Used with permission.

275
276 Neurodiversity

oped by Dr. George McCloskey. The scale of this survey allows far more
depth in data analysis to provide a better overall picture of the individual’s
executive function.
• Community Based Functional Skills Assessment for Transition Aged Youth With
Autism Spectrum Disorder (VCU Rehabilitation Research and Training
Center 2014): This survey helps highlight functional life skills for stu-
dents as they transition to post–high school life. The goal is to gain a
greater understanding of the student’s strengths, including knowledge,
social skills, and additional areas of importance, to ensure a healthy, suc-
cessful transition. This survey was developed by Autism Speaks in col-
laboration with Virginia Commonwealth University.

This additional observational information augments data collected through

the games to provide a more holistic understanding of the person’s abilities,
strengths, and interests.
In addition to providing insights that help individuals and their parents
and educators understand the person’s strengths, Identifor also works with
Rangam Associates, a workforce solutions company, to help potential em-
ployers understand these strengths. Through various autism-related pro-
grams, Rangam works to place adults with neurodifferences in jobs with
Fortune 500 and other companies. One of these programs, “SourceAbled”
(www.sourceabled.com), is dedicated to helping employment seekers with
neurodiversities access a wide range of employment opportunities. Rangam
supports the individual before, during, and after the interview. Furthermore,
Rangam trains the hiring managers and their teams on how to work with the
neurodiverse population so they become more aware and adept at working
with neurodiverse colleagues. Rangam is integrating Identifor’s platform
into their assessment process to uncover the abilities and talents missed by
traditional tools. Additionally, Rangam is bringing Identifor’s Dashboard to
employers to help them understand the unique executive functions, multiple
intelligences, and RIASEC profiles of job candidates, thereby helping em-
ployers think more expansively about the abilities of a person and what is re-
quired to do a job well.

Case Example
Benjamin, now 17 years old, was diagnosed on the autism spectrum when he
was age 2. He is verbal, goes to a school for special needs children, and enjoys
music and conversing with friends. He is described as a very curious young
man who always asks, “What is this?” or “Why?” and is always able to figure
out how to accomplish a task. He likes meeting people but has difficulty re-
membering names and faces, as evidenced by his repeatedly asking for the
names of people he has met previously but does not interact with regularly.
Using Technology to Provide Transition Support 277

Furthermore, once he learns someone’s name, he does not tend to continue

a conversation with that person. He prefers to ask the next person’s name and
then wander off on his own after hearing the last person’s name.

Figure 11–3 presents Benjamin’s executive functions profile. The left

side of the chart shows Benjamin’s relative abilities. Because all seven abili-
ties total to 100%, each section of the circle shows how a person’s specific
executive function ability compares with the other six abilities. Benjamin’s
strongest executive function category is “Solution,” and his weakest is “En-
gagement.” Compared with many individuals on the autism spectrum, Ben-
jamin’s executive function profile is more balanced, as indicated by the
relatively similar sizes of the executive function categories. Many individuals
have abilities that are much stronger in some areas than others.
The bottom panel of Figure 11–3 shows Benjamin’s comparative abili-
ties—that is, how Benjamin compares with others on these seven executive
function dimensions. For Benjamin’s strongest executive function (Solu-
tion), he ranks in the 87th percentile among all people who have used the
Identifor platform. This visual comparison helps people understand how
they compare with others in the world, and Identifor’s tool allows the user
to apply various filters to make the comparison more relevant (e.g., one filter
is autistic boys ages 16–22 who are verbal).

Benjamin’s parents comment that the results are not surprising because
their son always seems to figure out how to accomplish things (his Solution
strength) but may not take the most direct way to get there (his relatively
lower ranking for Optimization). The relatively lower Engagement ranking
is also consistent with the behavior of not continuing a conversation with
people after learning their names.

Figure 11–4 shows Benjamin’s multiple intelligences profile, which, com-

pared with his executive function profile, shows greater variation in his rela-
tive abilities. Benjamin’s standout strength is his musical ability, and he ranks
in the 100th percentile of all Identifor users. This finding is also consistent
with observations that Benjamin enjoys music. His parents were surprised to
see Benjamin’s comparative ranking and initiated additional observations of
his musical behavior. On further assessment, Benjamin was revealed to have
perfect pitch—not only the ability to identify a specific note but also the
ability to name even the most obscure minor chords. Interestingly, Figure
11–4 also shows that Benjamin ranks in the 38th percentile on interpersonal
skills, which is consistent with the observation that he does not remember
people’s faces and names.
Figure 11–5 presents Benjamin’s RIASEC profile. It indicates that he is
an artistic individual who is social in nature and conventional in approach.
278 Neurodiversity

Effciency 16%
Memory 14%
Engagement 11%
Executive
function Solution 17%
Attention 15%
Optimization 13%
Inquiry 15%

Attention 74

Effciency 78 Solution 87

Engagement 56 Optimization 63

Inquiry 75 Memory 68

FIGURE 11–3. Benjamin’s executive functions profile.

Top, This chart shows his relative abilities. The largest section, for example,
indicates his strongest ability. Bottom, This graphic illustrates his abilities as
compared with other Identifor gamers.
To view this figure in color, see Plate 5 in Color Gallery.
Source. Images © Identifor. Used with permission.
Using Technology to Provide Transition Support 279

Logical 23%
Linguistic 21%
Spatial 19%
Multiple
intelligence Interpersonal 10%
Musical 26%

Interpersonal 38

Linguistic 81 Spatial 74

Logical 88 Musical 100

FIGURE 11–4. Benjamin’s multiple intelligences profile.

Top, This chart shows his relative abilities. The largest section, for example, shows
his strongest ability. Bottom, This graphic compares his abilities with all other
subjects in the filtered set of results.
To view this figure in color, see Plate 6 in Color Gallery.
Source. Images © Identifor. Used with permission.
280 Neurodiversity

Artistic 70

Conventional 60 Social 60

Enterprising 40 Realistic 30

Investigative 40

FIGURE 11–5. Benjamin’s RIASEC (Realistic, Investigative, Artistic,

Social, Enterprising, Conventional) profile.
To view this figure in color, see Plate 7 in Color Gallery.
Source. Images © Identifor. Used with permission.

Identifor’s tool goes on to suggest jobs that others with similar profiles have
found rewarding. Some of these jobs include childcare worker, flight atten-
dant, and radio announcer. Identifor’s tools allow users to explore each job
by learning more about the tasks, knowledge, skills, and other characteris-
tics that lead to success in the role.
The suggested jobs to explore are based on Identifor’s gamification of
the RIASEC Career Interest Profiler, which creates the RIASEC codes that
have separately been shown to be consistent with the written interest pro-
file. Each career is linked to the U.S. Department of Labor’s Occupational
Information Network, which is a free online database containing hundreds
of occupational definitions. By matching an individual’s RIASEC profile
with current and future professions, Identifor helps the person better pre-
pare for a future career. Teachers and parents can take a key role in helping
students gain the necessary skills and experience to aid in their development
for a set goal.

Benjamin’s parents report that Benjamin loves art—both creating art (e.g.,
painting, cutouts) and observing art (Van Gogh and Munch are among his
favorite painters). Benjamin also loves planes and travel. He can recite all the
details (e.g., airlines, flight numbers, scheduled and actual departure and ar-
Using Technology to Provide Transition Support 281

rival times, gate numbers) of every flight he has taken. He likes being around
airports and planes.

Beyond Assessment: Technology

to Support Everyday Life
Identifor believes that getting each person into the right job is only the first
step in helping individuals achieve a meaningful life. The other steps re-
quire supporting them in what they are doing as they pursue their interests.
Consequently, Identifor offers the Companion app, downloadable from the
AppStore or Google Play (www.identifor.com/about/daysupport). This app
aims to provide personal support throughout the day through the use of an
artificial intelligence–driven human avatar (Abby).
Abby answers questions and helps in a manner similar to Apple’s Siri, Mi-
crosoft’s Cortana, or Amazon’s Alexa. Unlike the other tools, however, the
Companion app (using the Abby avatar) is not a general-purpose tool for ev-
eryone and everything. Companion was designed to meet the needs of a neu-
rodivergent audience by addressing needs missed by general-purpose tools,
especially when parents and educators are no longer available. Abby provides
answers to questions such as “How do I make pasta?”; “How do I ask some-
one out for a date?”; and “How do I wash my laundry?” Companion’s mod-
ules assist users in the following ways:

• Calendar. Companion’s calendar function goes beyond any phone or

computer calendar in its ability to remind the user in the way the user
wants. Any event can have several pre- and postevent reminders. Com-
panion reminds the user through an alert, a text, or a call to a specified
number, or Abby can pop up to remind of the event.
• Medication. Parents often fret when their neurodiverse children start be-
coming more independent young adults and spending time away from
their support network. Medication is often cited as a major concern for
parents when their children start to live independently. Companion al-
lows users to set medication reminders and prompts the users using the
full suite of tools mentioned for calendar entries.
• Money. This virtual wallet helps with knowing how much and what de-
nominations are needed when spending. It determines tip amounts for
restaurant bills and makes splitting the bill with others quick and easy.
• Navigation. Companion’s navigation function allows users to receive
driving, walking, and public transportation directions for getting from
point A to point B and has the capacity to call a ridesharing service.
282 Neurodiversity

• Weather. This function displays the current and forecasted weather for
the day and suggests the clothes one should wear based on climate con-
ditions.
• Routines. The routines function helps users remember any set of rou-
tines and when to do them. These could be associated with work (e.g.,
start and end times, breaks), school (e.g., when classes are held and
where, test dates, breaks), or any imaginable routine for everyday life
(e.g., daily bedtimes, weekly laundry).

Accurate vocational assessment is instrumental to help guide any young

adult to a more meaningful and independent life after graduation. Because
strengths are often hidden, the need for understanding individuals with neu-
rodifferences in this way is even more critical. Assessment, however, is only
the first step for successful employment for this cohort. Only with proper
support can employment outcomes for workers with neurodifferences truly
make a difference and move the employment needle in a meaningful way.

Conclusion
Having an accurate assessment of a person’s abilities and interests is the
critical starting point for helping that person develop the appropriate tran-
sition, educational, and vocational plans that initiate the discovery and pur-
suit of a meaningful life. The assessments of executive function, multiple
intelligences, and career interests are involved and complicated undertak-
ings for even the average neurotypical young adult using existing tools and
technologies.
Identifor was created to address the needs of the neurodiverse audience.
Its approach, based on games and data analytics, is to observe what a person
does and then impute their abilities and interests rather than ask them what
they think they want. This approach builds on the large body of research
showing that inferred behavior and interests often lead to a more accurate
assessment approach than directly asking someone a question (especially
when respondents are unaccustomed to the concept).
The primary purpose of a public education, according to the Individuals
With Disabilities Education Act, is to prepare an individual for employ-
ment (Individuals with Disabilities Education Act Amendments of 2004).
The law clearly specifies postschool employment as the measure of ac-
countability for individuals with disabilities (Hendricks 2010). Meaningful
employment opportunities should be a choice for people with neurodiffer-
ences who want to work. Research, however, demonstrates overwhelmingly
Using Technology to Provide Transition Support 283

disappointing vocational outcomes, especially high rates of unemployment

and underemployment (Autism Speaks 2019).
This chapter provides an appraisal of the current employment landscape
for neurodiverse people and explores the challenges, stumbling blocks, and
barriers to their successful transition to the workforce. It examines the ben-
efits of applying a strengths-based, person-centered planning approach, re-
placing the more traditional medical model that emphasizes deficiency and
weakness, beginning as soon as a neurodiverse student becomes of transition
age (ages 14–16 years), and looks at successful employment initiatives re-
cently developed at major corporations.
Awareness of distinctive characteristics, including strengths, weaknesses,
and specific interests, can lead to an appropriate job placement (Hendricks
2010). However, the discovery process used in high school transition pro-
grams and in private and government agencies, such as the division of vo-
cational rehabilitation, are often inadequate. Traditional assessment tools
unfortunately use a self-reporting format, are usually slightly modified from
those for the neurotypical population, and are not adjusted for individuals
with minimal experiences or limited self-awareness. Furthermore, they of-
ten require Scantron responses, which are notoriously problematic for neu-
rodiverse individuals. These limitations impede the depth and accuracy of
pertinent information necessary for building a bridge to successful employ-
ment for young adults with neurodifferences and all levels of cognitive, so-
cial, and behavioral functioning.
Recent literature has suggested that young adults on the autism spectrum
are particularly in need of support in three domains: self-advocacy, executive
function/self-regulation, and social skills (Gillespie-Lynch et al. 2017). Most
supports end when students with special needs graduate from high school;
for many of these individuals, this is when they most need support. Effective
assessment would allow for improved specific and more general job prepa-
ration; however, proper on-the-job supports and accommodations are also
needed. Artificial intelligence–based technology that can strengthen em-
ployees’ executive function and help support them on the job and in everyday
life would further strengthen employment outcomes.
Schools and employment agencies charged with finding and placing
young adults with neurodifferences in meaningful employment would ben-
efit from investigating technology, including Identifor, that addresses the
core employment and independence challenges of this group. In fact, assess-
ment tools that look into executive function and other dimensions, such as
multiple intelligences and individual skills, abilities, and interests, may pro-
vide unique insight and benefits for all teens, those with and without neuro-
differences, through more effective career planning.
284 Neurodiversity

Investigation and development of other effective career assessment

tools and workplace support technology specific to individuals with neuro-
differences are necessary. Furthermore, a substantial need for rigorous eval-
uation of current tools is also warranted to determine, beyond anecdotal
evidence, whether they have favorable employment outcomes and benefi-
cial, cost-effective, lasting effects.

KEY CONCEPTS
• Meaningful employment is a key element of a prosperous, productive,
successful life for young adults with neurodifferences.
• More effective job matches for people with intellectual and develop-
mental disabilities are found using a person-centered, strengths-based
approach instead of the traditional starting point: “what’s broken?”
• Executive function, multiple intelligences, and the Holland career code
(RIASEC) are better elements for predicting a successful employment
match rather than traditional methods of evaluation, such as IQ or dis-
ability classification.
• Career planning begins with assessment. Relatively few career assess-
ment tools have been specifically designed for the neurodiverse popu-
lation. Instead, quite often individuals with neurodifferences either
sample various jobs until they find a good fit or utilize modified self-
reporting-based instruments designed for neurotypical peers. These
tend to be difficult to use, biased, and unreliable.
• Usually, the actual steps required of a job are the easiest part for people
in this cohort. They frequently struggle, however, with the “hidden cur-
riculum” and soft skills found in every work environment. Areas of fo-
cus that ideally should be addressed before graduation from high
school include self-management, organization, time management, self-
prompting, stress tolerance, handling change and the unexpected and
transitioning from preferred to less preferred activities, seeking help,
personal hygiene, medication compliance, and handling down-time.
Assistive technology targeting this area is slowly becoming available.
Using Technology to Provide Transition Support 285

Recommendations For Educators,

Clinicians, and Other Professionals
• Adopt a strengths-based mindset when working with neurodiverse young
adults. Seek to identify what they are “really good at” rather than just
identifying their weaknesses. Knowing areas of strengths allows for the
exploration of vocational areas that naturally leverage what each person
can do.
• Employ the appropriate assessment tool to obtain the most accurate
analysis of each person’s abilities and interests. Identifor can help many
neurodiverse people who struggle with traditional assessment tools by
revealing the underlying abilities and interests that are currently hidden
within them.

Discussion Questions
1. Why is accurate strengths-based assessment critical in any person-
centered planning approach?
2. What are specific ways in which the transition aspect of the Individual-
ized Education Program can better prepare students to move from
school to postschool activities?
3. Why is work such an important element when defining a “meaningful
life” for someone with a neurodifference?

Suggested Readings
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Basic Books, 1993
McCloskey G: Executive functions: a general overview. Philadelphia Col-
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PDF_Files/School_Neuropsychology/Executive_Functions-
A_General_Overview_McCloskey.pdf. Accessed October 29, 2019.
Nauta MM: The development, evolution, and status of Holland’s theory of
vocational personalities: reflections and future directions for counseling
psychology. J Couns Psychol 57(1):11–22, 2010
286 Neurodiversity

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288 Neurodiversity

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Utah State Board of Education: Vocational transition assessments, Spring 2017.
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 Index
Page numbers printed in boldface type refer to tables or figures.

Abbreviated Torrance Test for Adults American Institutes for Research

(ATTA), 112 Self-Determination Scale
Absolute pitch (AP), 78–79, 163–164 (AIR-S), 82, 87–88, 113
Accessing Campus Connections and American Psychiatric Association, 2.
Empowering Student Success See also DSM-5
(ACCESS) program, 115 American Psychologist (journal), 30
Accommodations, and legislation, 12, Americans With Disabilities Act
178–179. See also Education; (ADA), 261
Employment Animal-assisted therapy, 93–94
Acquiring Career, Coping, Executive Arc’s Self-Determination Scale
control, Social Skills (ACCESS) (SDS), 82, 93, 113
Program, 93 Artificial intelligence–driven human
Action Model for Self-Determination, avatar (Abby), 281
113 Artistic talent, and savantism, 44.
Activity, and strength-based approach See also Creativity; Music
to disability, 23, 24 Asperger, Hans, 69
ADHD Asperger syndrome, 29
assessment of, 112–115 Assessment. See also Diagnosis
character strengths and, 110–111, employment and alternative
113 approaches to, 266–281
comorbidity of with dyslexia, 125 “learned phobia” of, 248–249
creativity and, 111–112 methods of for dyslexia, 139
prevalence of, 109 of strengths in ADHD,
recommendations on, 119 112–115
strengths-based interventions for, of strengths in autism spectrum
115–118 disorders, 80, 81–86,
strengths and challenges of, 109– 87–91
110, 111 Treffert Approach and, 41–43
suggested readings on, 119–120 Assessment Scale for Positive
Affiliative bonding, and neurobiology, Character Traits–Developmental
165 Disabilities (ASPeCT-DD), 29,
Africa, and Social Justice Repair Kit 81, 87
project, 244 Assistive technology, and higher
Alice’s Adventures in Wonderland education, 179, 182–183
(Carroll 1865), 69 Atlantic, The (magazine), 4, 260

289
290 Neurodiversity

Attention Barish, Barry, 68

executive function clusters and, 268 Baron-Cohen, Simon, 260
neurobiology of, 151, 153 Becker Work Adjustment Profile, 266
visual-spatial abilities of autistic Behavioral strengths, and autism
children and, 78, 162 spectrum disorders, 81. See also
Auditory perceptual capacity, 78 Social behavior
Autism rights movement (ARM), 4 Bell curve, 237
Autism spectrum disorders Better OutcOmes and Successful Tran-
accurate diagnosis of, 41–42 sitions for Autism (BOOST-A),
assessment of strengths in, 80, 94–95
81–86, 87–91 Big Five personality traits model, 266
brain organization and mathemat- Biomedical model, of disability, 21–22
ical abilities, 154–155 Bjorling, Tracey, 52
creativity and, 167 Blindness, and autism-like symptoms,
employment and programs for, 41–42
204–228 Blink: The Power of Thinking Without
enhanced perceptual performance Thinking (Gladwell 2005), 135
and, 161 Blume, Harvey, 4, 260
genetic influences on ADHD and, 111 Body distance, and interviews with
interpersonal synchronization and, neurodiverse individuals, 220
165 Body kinesthetic strength, and
interventions based on strength- multiple intelligences theory, 269
based model of, 92–97 Bovee, Jean-Paul, 20, 21, 31–33
neurobiology of, 162, 163–64, Brain. See also Neurobiology
165–166 autistic children with superior math-
prevalence of in college students, ematical abilities and, 154–155
202–203 developmental dyslexia and, 159–
rate of unemployment and, xvi, 160
202, 260 hyperlexia and, 160
self-determination and, 31 language-related activations and,
sensory awareness and, 52–53 157
social movements and, 3–4 neurocognitive processes involved
specific domains of competencies in arithmetic, 154
in, 74–80 Branson, Richard, 110
types of strengths in, 66, 67, 68–70, Brigance Transition Skills Inventory,
71–73, 74–80 266
use of terms for, 5, 41 Bullying, in schools, 245–246
Autism-Spectrum Quotient (AQ)
questionnaire, 79 Calendar, and Companion app, 281
Autism at Work (AaW) program, 203, Calendrical calculation abilities, and
204–229, 261 brain organization of autistic
Autism at Work Summit, 203 individuals, 155
Autistic Self Advocacy Network Campbell Interest and Skill Survey, 266
(ASAN), 20–22 Canada, and Social Justice Repair Kit
Aware-Explore-Apply intervention, 29 project, 244
Index 291

Cardinality principle, 150 autism spectrum disorders and

Career development model, 264, 265 inflexibility of, 42
Career Exploration Inventory, 266 control of and neural correlates of
Career Occupational Preference mathematical cognition and
System Interest Inventory, 266 learning, 153
Career support services, and Autism at innovation and diversity of, 2–3
Work program, 223 reading and, 156
Carroll, Lewis, 69 strengths of autistic children and, 74
Case examples Colleges. See also Higher education
of assessment of executive interventions for ADHD and, 115,
functions, 276–281 116–117
of dyslexia, 136–137 prevalence of autism spectrum
of interventions for ADHD, 117–118 disorders in students, 202–203
of interventions for autism Colombia, and Social Justice Repair
spectrum disorders, 97 Kit project, 244
of neurodiversity and cultural Community Based Functional Skills
change, 11–12 Assessment for Transition Aged
of self-determination in positive Youth With Autism Spectrum
psychology, 31–32 Disorder, 276
of Treffert Approach, 57–59 Companion animals, for autistic
Causal agency theory, and self- individuals, 93
determination, 30 Companion app, 281
Chapman, Jeremy, 46 Comprehensive Test of Phonological
Character strengths. See also Processing, 84, 90
Personality Computer(s). See Technology; Websites
ADHD and, 110–111, 113 Computerized Block Design Task,
autism spectrum disorders and, 70, 85, 91
74, 81–86, 87–88 Conditions, and redefinition of
positive psychology and, 28–29 neurodiversity, 7
Civil rights, and social models of Connecting, and creativity in dyslexic
diversity, 20, 30 individuals, 132
Clark, Trevor, 47 Conscious Discipline program, 51
Clifton StrengthsFinder, 266 Constitution, U.S., 2, 11
Cloninger Junior Temperament and Convergent thinking, and ADHD,
Character Inventory (JTCI), 113 111–112
Coaching. See also Mentoring Cornell, Eric, 68
accommodations in higher Creative Achievement Questionnaire,
education and, 183–184, 186, 114
187–188, 189–193 Creativity. See also Artistic talent
employment support and, 226 ADHD and, 111–112, 113–114
Cognitive-behavioral therapy (CBT), dyslexia and, 132–133
for ADHD, 115 neurobiology of, 166–167
Cognitive functioning. See also Criminal justice system, and youth with
Executive functions; learning disabilities, 247, 248, 249,
Mathematical cognition 250. See also Legal system
292 Neurodiversity

Csikszentmihalyi, Mihaly, 8 Disease, use of term, 261

Culture. See also Society Disorders. See also ADHD; Autism
employment support programs spectrum disorders
and, 227 redefinition of neurodiversity and, 7
neurodiversity and changes in, xv, use of term, 260
10–12, 98 Distance effect, 150
strengths-based model of dyslexia Distraction, degrees of in
and, 141–142 accommodation ergonomics, 180
Curie, Marie, 69 Divergent thinking
ADHD and, 111, 112, 113–114
Declarative memory, 152 dyslexia and, 132–133
Dell (corporation), 229 Diversity. See also Neurodiversity
Democracy, and 80/20 principle, cultural change and, xv
241, 242 80/20 principle and bias against,
Demographic diversity, 2 237–243
Department of Labor Occupational social movements and, 2
Information Network, 271 subtypes of, 2–3
Development, as component of Dog-assisted therapy, 94
SBMN, 10 DSM-5
Diagnosis, of autism spectrum reading disorders and dyslexia in,
disorders, 41–42, 52. See also 124–125
Assessment sensory issues in diagnosis of autism
Difference, use of term, 261. See also spectrum disorders, 52
Neurodifferent DXC Technology, 96, 203, 229, 261
Differential Ability Scales-II (DAS-II), Dynamic reasoning, and dyslexia,
83, 88 134–136
Digital Climbers program, 56 Dyscalculia, neurobiology of, 155–156
Digital divide, and technology, Dyslexia
239–240 brain structure of children with
Dirac, Paul, 69 developmental, 159–160
Disability. See also Disability rights in case examples, 117–118, 136–137
movement; Intellectual disability; creativity and, 166–167
Learning cultural acceptance of strengths-
self-determination theory and, 30 based model of, 141–142
social model of, 4, 19, 21, 22–24, definition of, 124–125
178 different brains concept and, 129
use of term, 261 interventions based on strengths-
Disability Discourse (Singer 1999), 3 based model of, 137–140
Disability rights movement, and Autis- missing middle concept and,
tic Self Advocacy Network, 21 126–129
DISC (Dominance, Influence, reading disorders and, 125–126
Steadiness, and Compliance) recommendations on, 142
personality test, 266 status of recent research on, 12
Disclosure support, and Autism at strengths of individuals with,
Work program, 224 130–136
Index 293

suggested readings on, 143 alternative approaches to assessment

as way of interacting with world, for, 266–281
123, 141 creativity of dyslexic individuals
Dyslexic Advantage, The (Eide and Eide and, 133
2012), 130 importance of in “meaningful life,”
263–264
Echolalia, 45 multiple intelligences and potential
Education. See also Colleges; Higher types of, 9
education; Special education; natural environment and, 49–50
Treffert Approach obstacles to inclusion of
80/20 principle and, 241, 242 neurodiverse in, 262, 264–266
group problem solving and recommendations on, 231–232, 285
mathematics, 43 suggested readings on, 233, 285
interventions for ADHD and, Engagement, and executive function
115–117 clusters, 268
interventions for autistic children Environmental accommodations, and
and, 95 employment, 225. See also Natural
interventions for dyslexia and, 127, environment
128, 138–140 Episodic memory, and dyslexia, 133
recommendations for change, 250, Equity programs, for students with
254–255 disabilities, 246–247
self-regulation and assessment of Escher, M.C., 134
executive function, 268–269 Europe, and Social Justice Repair Kit
Social Justice Repair Kit project project, 244
and, 243–250 Executive functions, assessment of,
suggested readings on, 256 267, 268–269, 272, 273, 277–281.
use of character strengths in See also Cognitive functioning;
interventions, 29 Memory
Education for Life and Work (National Existential strengths, and multiple
Research Council 2012), 140 intelligence theory, 270
Efficiency, and executive function Experiential diversity, 2
clusters, 268 Exploring Giftedness and Autism: A Study
80/20 principle, and bias against of a Differentiated Educational Pro-
diversity, 237–243, 251–252 gram for Autistic Savants (Clark
Einstein, Albert, 68 2016), 47
Els for Autism Foundation, 203 Eye contact, and autism spectrum
Emancipation Proclamation (Lincoln disorders, 220
1863), 2
Embedded Figures Test (EFT), 160, 161 Family, and interventions for autism
Emotional strengths, and autism spectrum disorders, 94–95. See also
spectrum disorders, 71 Parent support groups
Employable Me (Wollaston 2016), 189 Ferose, V.R., 205–206
Employment. See also Autism at Work Ford Motor Company, 203
program; Unemployment; FourSight (self-report instrument),
Workplace 114
294 Neurodiversity

Franklin, Ursula, 236 recommendations and suggested

Frick, Sheila, 52 readings on, 195–196
Functioning, use of term by World societal importance of, 176–178
Health Organization, 23. See also transitioning to workplace from,
Cognitive functioning; Executive 188–193
functions universal design of support
programs for, 179–182
Games, and Identifor assessments, 274 Holland, John, 270
Gardner, Howard, xiii, 7–8, 9, 40, 267 Holland career codes, 266, 270–271, 272
Genetics, influence of on ADHD and Human resource resiliency, 96
autism spectrum disorders, 111 Hypercalculia, 75
Genius Within program, 176, 177, Hyperfocus, and ADHD, 110
189, 191 Hyperlexia
Gladwell, Malcolm, 135 assessment of, 42
Gottschaldt’s Hidden Figure Test, 85, 90 autism spectrum disorders and,
Grandin, Temple, xiii, 40, 79, 261 76–77
Greider, Carol, 133 neurobiology of, 160
Group coaching, and higher education, strength-based approach to, 44
184–185, 188, 190–191
Guidelines Identifor technology platform,
of SAP SE Autism at Work program, 274–282, 283
206–207 Identity-first language, 5
for universal design of support Image-based thinking, and dyslexia,
programs in higher education, 133–134
180–181 Impairment, and social model of
disability, 23
Handshake, and interviews with Impossible Figures Task, 134
neurodiverse individuals, 220 Impulsivity, and ADHD, 110
Harrington-O’Shea Career Decision- Inclusion, models of for employment
Making System–Revised, 266 initiatives, 207
Hatch, Thomas, 7–8 Inclusive Design Research Centre,
Hidden Figure Identification test, 85, 237, 243, 252
90–91 Indiana, Treffert Approach and
Higher education. See also Colleges; libraries in, 55–56
Education Individualized Education Program
assistive technology and, 182–183 (IEP), 50, 247, 264. See also
coaching or mentoring programs, Special education
183–185, 186, 187–188, 189– Individuals with Disabilities Education
193 Act of 1990, 264, 282
key elements of programs for Individuals with Disabilities Education
neurodiverse students, 193–194 Improvement Act of 2004, 138
legal considerations and disability Individual Transition Plans (ITPs),
accommodations in, 178–179 264
psychosocial interventions and, In the Mind’s Eye (West 2009), 130
185, 187 Innovation, and cognitive diversity, 2
Index 295

Inquiry, and executive function Jelinek, Elfriede, 69

clusters, 269 Job search, and Autism at Work
Intellectual disability, and character program, 215
strengths, 74 Joliot-Curie, Iréne, 69
Intellectual strengths, of autistic Journal of Positive Psychology, 26
individuals, 72, 83 JP Morgan Chase, 203, 229, 261
Intelligence, and IQ tests, 75–76, 83,
135. See also Multiple intelligences Kanner, Leo, 41, 66, 80
theory; Standardized tests Kay, Alan, 205
Interconnected reasoning, and Kearon, David, 262
dyslexia, 132 Ketterle, Wolfgang, 68
Interest-based interventions, for Kindness Curriculum, 51
autistic children, 93–94 Koch, Richard, 237–238, 251
International Classification of Functioning,
Disability and Health (World Labels, and use of terms for
Health Organization 2001), 23, 24 neurodiversity, 40
International Dyslexia Association, 125 Language. See also Reading; Verbal-
Internships, and Autism at Work linguistic abilities
program, 208 interviews with neurodiverse
Interpersonal strengths. See also individuals and, 221
Intrapersonal abilities; Personal neurobiology of, 152, 157, 158
relationships; Social behavior savantism and unusual skills in, 44
multiple intelligences theory and, use of terms for neurodiversity, 3, 5,
270 40, 175
of young adults on autism spectrum, Leaders in Creative Media (Treffert
71 Center), 51–52
Interpersonal synchronization, Learning, and learning disabilities
neurobiology of, 164–165 dependence of on reading, 124
Interventions, strength-based. See also equity programs for students with
Animal-assisted therapy; Music disabilities, 246–247
therapy; Positive psychology neurobiology of mathematical cog-
for ADHD, 115–118 nition and, 150, 151, 152–153
for autism spectrum disorders, Legal system, and legislation. See also
92–97 Criminal justice system
for dyslexia, 137–140 disability accommodations in
Interviews, and Autism at Work education and, 178–179
program, 217–222, 223 provisions for neurodiverse
Intrapersonal abilities. See also conditions and, 12
Interpersonal strengths Lemke, Leslie, 45
multiple intelligences theory and, Lesbian, gay, bisexual, and transgender
270 (LGBT), and social movements, 2
neurobiology of, 165–166 Libraries, and Treffert Approach, 55–56
Invisible disability, and legal system, 12 Life satisfaction, and self-
“Islands of competence,” and determination, 31
interventions for ADHD, 116 Lincoln, Abraham, 2
296 Neurodiversity

Local gyrification index, and dyslexia, Mental Rotations test, 85, 91

159 Mental subnormality, use of term, 22
Logical-mathematical abilities Mentoring, and mentors. See also
of individuals on autism spectrum, Coaching
75–76, 83–84, 89 accommodations for neurodiversity
multiple intelligences theory and, in higher education and, 184,
269 187–188
Longmore, Paul, 20 college-based interventions for
Loucks, Sarah, 262 ADHD and, 115
employment support programs and,
Marginalization, and special education 226
programs, 247 Treffert Approach and, 50
Maslow, Abraham, 176 Mexico, and Social Justice Repair Kit
Mathematical cognition, 150, 151, project, 244
152–153 Michelangelo, 69, 74
Mathematics, and mathematical Microsoft, 40–41, 95, 203, 229
abilities MIND framework, and dyslexia, 129,
autistic children and, 75–76, 154–155 130
group problem solving and Mindfulness, and positive psychology,
education in, 43 26–28
neurobiology and, 150–156 Mindful Observation of Thoughts
neurodiversity and development of (MOT), 27–28
essential skills, xii Mind-mapping software, 183
savant skills and, 44 Moore, Gordon, 239
McCloskey, George, 267, 276 Motivation
McCloskey Executive Functions Scale creativity in adults with ADHD
(MEFS), 274, 276 and, 112
Meares-Irlen syndrome, 180 self-determination theory and, 30
Mechanical ability, and savantism, 44 Multiple intelligences theory. See also
Medical model Intelligence
of disability, 178 assessment of executive functions
of dyslexia, 137 and, 267, 269–270, 272, 277,
Medication, and Companion app, 281 279
Memory. See also Declarative memory; as component of SBMN, 7–8, 9
Executive functions; Working different kinds of thinking and, xiii
memory limitations of IQ tests and, 7
abilities of autistic children and, 80 Music, and musical-rhythmic abilities.
dyslexia and types of, 133–134 See also Absolute pitch; Music
executive function clusters and, 268 therapy
neurobiology of, 151 assessment of in autistic individuals,
Mental health care, and higher 78–79, 86, 91
education, 188. See also multiple intelligences theory and,
Interventions 270
Mental rotation, and autism spectrum neurobiology of, 163–164
disorders, 162 savantism and, 44
Index 297

Music therapy, for autistic children, 93 definition of, xv, 1, 3, 260

Musical Ear Test, 86, 91 development of essential skills
Myers-Briggs Type Indicator, 266 and, xii
general recommendations on,
Narrative reasoning, and dyslexia, 14–15
133–134 objectives of social movements and,
Natural environment, and Treffert 3–4
Approach, 48–50. See also ontology of, 4–7
Environmental accommodations redefinition of, 7–8, 10
Naturalistic skills, and multiple shift in societal perspective on,
intelligences theory, 270 261
Navigation, and Companion app, 281 suggested readings on, 15
Neale Analysis of Reading Ability, 85, use of terms for, 3, 5, 40, 175
90 Neurominority, use of term, 3
Neurobiology Neurotypical, use of term, 40
creativity and, 166–167 Newton, Isaac, 68–69
interpersonal synchronization and, Nobel Prize, 68, 69, 133
164–165 Novelty seeking, and ADHD, 110, 111
intrapersonal abilities and, Number sense, 150, 152
165–166
mathematical abilities and, Occupational Aptitude Survey and
150–156 Interest Schedule, 266
musical-rhythmic abilities and, Ofiesh, Nicole, 129
163–164 Olitsky Family Foundation, 203
recommendations and suggested Onboarding, and Autism at Work
readings on, 169 program, 222
verbal-linguistic abilities and, Open-ended questions, and interviews
156–160 with neurodiverse individuals,
visual-spatial abilities and, 160–162 222
Neurochemistry, and autism spectrum Optimization, and executive function
disorders, 162 clusters, 268
Neurodevelopmental disabilities Oxford Handbook of Positive Psychology
(NDDs), 20 and Disability, The (Wehmeyer
Neurodifferent and neurodivergent, 2013), 26
use of terms, 5
Neurodiverse, use of term, 40, 175 Parent support groups, and Treffert
Neurodiversity. See also Autism Approach to education, 47
spectrum disorders; Diversity; Pareto, V., 240, 251
Dyslexia; Education; Participation, and strength-based
Employment; Interventions; approaches to disability, 23, 24
Neurobiology; Positive Peek, Kim, 80
psychology; Research; Savantism; Peer group coaching, 184–185, 188
Strength-based model of Penn Resiliency Program, 116
neurodiversity; Treffert Approach Peripheral vision, and dyslexia,
cultural change and, xv, 10–12, 98 131–132
298 Neurodiversity

PERMA (Positive emotions, Poverty, and prevalence of dyslexia, 127

Engagement, Relationships, Practical Guide for Teachers of Students
Meaning, and Achievement) With an Autism Spectrum Disorder
model, 116 in Secondary Education, A (Costley
Personality. See also Character strengths et al. 2012), 47
Cloninger’s biopsychosocial theory Prader-Willi syndrome, 27–28
of, 113 Preemployment training program,
strengths of autistic children and, 74 210, 213–215, 216
Personal relationships, and Treffert Prodigious savants, 44
Approach, 50–52. See also Inter- Psychiatry, positive psychology
personal strengths; Social behavior compared to traditional, 10
Personal Strengths Program (PSP), Psychology. See also Positive
116–117 psychology
Person with autism, use of term, 5 social model of disability and, 22
Person-first language, 5–6 verbal thinking and, xiii
Philsophiae Naturalis Principia Mathe- Psychology of Normal People, The (Tiffin
matica (Newton 1687), 68 et al. 1946), 129
Phonological processing, and dyslexia, Psychosocial interventions, and higher
125 education, 185, 187
Pictorial Inventory of Careers Public planning and policy, and 80/20
DV-2000, 266 principle, 242
Pivotal response training, 94
Play. See also Games Quality of life, and self-determination,
behavioral treatment for autistic 31
children based on, 93 Questers program, 55–56
sensory awareness and, 53 Quetelet, Adolphe, 239, 240
Porges, Stephen, 53
Positive Character Traits– Rain Man (movie 1988), 40, 59, 80
Developmental Disabilities Rangam Associates, 276
(ASPeCT-DD), 74 Reading. See also Dyslexia; Hyperlexia;
Positive psychology Language
character strengths and, 28–29 dependence of learning on, 124
as component of SBMN, 8, 10 neurobiology of, 156, 159
definition of, 24–25 screening for dyslexia and, 128
interventions for ADHD and, Reading disorders, and dyslexia,
116–117 125–126
interventions for autism spectrum Reading-Free Vocational Interest
disorders and, 92–93, 96 Inventory-2, 266
mindfulness and, 26–28 Reality-based creativity, and autism
recommendations on, 33–34 spectrum disorders, 167
research on and development of, Rehabilitation Act of 1973, 261
25–26 Reiff, Henry, 136
self-determination and, 30–32 Relocation, and Autism at Work
suggested readings on, 34–35 program, 223
themes of, 25 Remote Associates Test, 112, 115
Index 299

Repetitive movements, and interviews, assessment of in individuals on

220 autism spectrum, 82
Research positive psychology and, 30–32
80/20 principle and, 240, 241 Self-Determination Student Scale
on positive psychology, 25–26 (SDSS), 113
on strengths of autistic individuals, Self-directedness, and ADHD, 111
67 Self-efficacy, and accommodations for
on treatment and interventions for neurodiversity in higher
neurodiverse conditions, education, 177–178, 185, 187
12–13 Self-regulation
Resilience assessment of executive functions
interventions for ADHD and, 116 and, 267, 268–269
positive psychology and, 96 systems approach to education
Rey-Osterrieth Complex Figure, 86, 90 and, 55
RIASEC career code, 270–271, 272, Seligman, Martin, 8, 24–25, 116
277, 280 Sensory awareness, and Treffert
Robinson, Ken, 177 Approach, 52–53
Sensory environment, and universal
Salk and McGill Music Inventory, 86, 91 design for neurodiversity, 180–
SAP SE (company), and Autism at Work 181
program, 203, 204–29, 261, 262 Shattuck, Paul, 264
Savantism, and savants Sinclair, Jim, 4
acquired forms of, 59 Singer, Judy, 3–4
calendrical calculation abilities in Singh, Nirbay, 27
autistic individuals, 155 Social behavior, and neurobiology,
case examples of, 57–59 164–166. See also Interpersonal
common types of, 44 strengths; Intrapersonal abilities;
hyperlexia and, 160 Personal relationships
natural environment and, 49 Social justice, and diversity
special skills and abilities, 44–47 movements, 2. See also Social
Treffert Approach and, 60 movements
SBMN. See Strength-based model of Social Justice Repair Kit project,
neurodiversity 243–250
School-to-Work Opportunities Act of Social model, of disability, 4, 19, 21,
1994, 264 22–24, 178
Schrödinger, Erwin, 69 Social movements, 2, 3–4, 11, 21
Screening, and Autism at Work Social welfare, and strength-based
program, 212–213 approaches to neurodiversity,
Self, and intrapersonal abilities, 165, 166 22–23
Self-advocacy movement, and autism Society, interventions for autism
spectrum disorders, 20 spectrum disorders at level of,
Self-awareness, of learning in dyslexic 96–97. See also Culture; Social
individuals, 140 behavior; Social justice; Social
Self-determination movements
assessment of ADHD and, 113 Socioeconomic status, and dyslexia, 127
300 Neurodiversity

Soles of Feet (SoF), 27 components of, 1, 66

Solutionism, and programs for definitions of neurodiversity and, 7
learning disabilities, 247–248 dyslexia and, 130–136
Sonne, Thorkil, 206 interventions for ADHD and,
“SourceAbled” (software program), 276 115–118
South America, and Social Justice interventions for autism spectrum
Repair Kit project, 244 disorders and, 92–97
Special education, and stigmatization interventions for dyslexia and,
or isolation of students with 137–140
learning differences, 245. See also introduction to, xv–xvii
Individualized Education Program mindfulness and, 27
Special interests, and interviews with recommendations on, 98
autistic individuals, 221 social model of disability and, 22–24
Specialisterne (company), 206, 261 suggested readings on, 99
Speech comprehension, and Strengths and Difficulties
neurobiology of reading, 158, Questionnaire (SDQ), 81, 87
159. See also Language Strong Interest Inventory, 266
Speech-to-text, and text-to-speech Student Developmental Task and
software, 182 Lifestyle Inventory, 91
Spell-check systems, 182–183 Suicide, and indigenous youth with
Splinter skills, and savantism, 44, 46 learning differences, 244
Standardized tests. See also Intelligence, Superflex curriculum, 55
and intelligence (IQ) tests Support programs, in higher
accommodations for neurodiversity education, 179–187. See also
in higher education and, 181– Accommodations; Autism at
182 Work program; Interventions;
dyslexia and, 126, 127–128, 131, 136 Parent support groups
problems with for assessment of Support structure, of Autism at Work
neurodiverse students, 266 program, 224–225, 226–227
Stanford-Binet Intelligence Scales, 83 Sustainability services, and Autism at
Stanford University, 129, 204 Work program, 222–228
Starburst distribution pattern, and Symbolic acuity, in autistic children, 154
accommodations for System Applications and Products in
neurodiversity, 237, 238, 239 Data Processing (SAP), 95, 96
Storytelling, and dyslexia, 133–134 Systems approach, and Treffert
Strength-based model of neurodiversity Approach, 53–57
(SBMN), and strength-based
approaches. See also Behavioral Technology. See also Assistive
strengths; Character strengths; technology; Websites
Interpersonal strengths; Positive cultural change and, 11
psychology; Treffert Approach digital divide and, 239–240
assessment of ADHD and, 112–115 Franklin’s definition of, 236
assessment of autism spectrum dis- Identifor assistive platform, 274–282
orders and, 80, 81–86, 87–91 Treffert Approach to education
benefits of, 32–33, 65, 97–98 and, 56
Index 301

Temperament and Character Ultra Testing, 261

Inventory (TCE), 113 Unemployment, rate of for individuals
Test(s). See Standardized tests with disabilities, xvi, 202, 260. See
Test-optional schools, and dyslexia, 139 also Employment
Test of Word Reading Efficiency, 85, 90 United Nations Convention on the
Text-to-speech software, 182 Rights of Persons With
Theological strengths, and autism Disabilities (2006), 178
spectrum disorders, 73 Universal design, and support
Therapeutic relationship, development programs for neurodiversity in
of positive, 51 higher education, 178, 179–182
Thinking, and thought. See also Universal Design for Learning (UDL),
Divergent thinking; Image-based 138, 139
thinking Unusual Uses Task, 112, 114–115
ADHD and types of, 111–112
autism spectrum disorders and rigid Values in Action (VIA) Inventory of
patterns of, 42 Strengths, 28, 29, 71–73, 81, 87
multiple intelligence concept and Verbal-linguistic abilities
different kinds of, xiii autism spectrum disorders and,
Thinking in Pictures (Grandin 1996), xiii 76–77, 84–85, 89–90
Thorne, Kip, 68 multiple intelligences theory and,
Three-dimensional block rotation, 42 267
Torrance Tests of Creative Thinking neurobiology of, 156–160
(TTCT), 113–114, 166–167 Verbal processing, of mathematical
Tourette syndrome, 180 operations, 150–151
Treffert Academy (daycare and VIA Inventory of Strengths-Youth
preschool), 47, 48, 51 (VIA-Youth), 28
Treffert Approach, and Treffert Center “Virtuous tornado” model, 252, 253
assessment and, 41–43 Visual matrix analysis, 42
case examples of, 57–59 Visual-spatial abilities. See also Language
description of, 39 assessment of autism spectrum
development of, 40 disorders and, 85–86, 90–91
key components of, 60 dyslexia and, 130–131
nature and natural environment in, multiple intelligences and different
48–50 kinds of thinking, xiii, 269
personal relationships and, 50–52 neurobiology of, 160–162
recommendations on, 62 neurodiversity and development of
savantism and, 60 essential skills, xii
sensory awareness and, 52–53 Visuospatial Processing Speed Task,
strength-based focus of, 43–47 85, 91
suggested readings on, 62–63 Visuospatial Working Memory Task,
systems approach and, 53–57 85, 91
Treffert Way, 47 Vital Links, 52
Tuition, and coaching in higher Voice modulation, and interviews with
education, 184 neurodiverse individuals, 221
302 Neurodiversity

Warhol, Andy, 70 Wider neural tuning, and dyslexia, 132

Weak central coherence theory, 79 Wieman, Carl, 68
Websites. See also Technology Wiltshire, Stephen, 45
interventions for dyslexia and, 140 Wisconsin, and education programs, 51
online assessment tools and, 272 Women’s rights movement, 11
Wechsler Abbreviated Scale of Woodcock Johnson III (WJ-3), 84,
Intelligence (WASI), 83, 90 89, 90
Wechsler Adult Intelligence Scale, 83 Word retrieval, and neurobiology,
Wechsler Individual Achievement 158 159,
Test, 2nd Edition (WIAT-II), 84, Working memory, 152
89, 90, 160 Workplace. See also Employment;
Wechsler Intelligence Scale for Unemployment
Children, 83 interventions for ADHD in, 117–118
Wechsler Objective Numerical interventions for autistic individuals
Dimensions, 83, 89 in, 95–96
Wechsler Objective Reading transitioning from higher education
Dimensions, 84, 89–90 to, 188–193
Weiss, Rainer, 68 World Health Organization, 23, 24
Well-being and growth services, and
Autism at Work program, 223–24 Yeak, Ping Lian, 48–49
West, Thomas, 128, 130 Youth movements, importance of,
Widening, Connecting, and 249–250
Reorganizing Creativity Test, 132
Wide Range Achievement Test 3 Zones of Regulation, 55
(WRAT-3), 84, 85, 89, 90
 SMA
SMA

PMC
PMC SPL
SPL

DLPFC
DLPFC
AG
AG
BG
BG
VLPFC
VLPFC
AI
AI

MTL
MTL V1
V1

vTOC
vTOC
ATL
ATL
Visual
Visual
input
input

PLATE 1. (Figure 7–1) Schematic circuit diagram of basic

neurocognitive processes involved in arithmetic.
Note. AG=angular gyrus; AI=anterior insula; ATL=anterior temporal lobe; BG=
basal ganglia; DLPFC= dorsolateral prefrontal cortex; MTL= medial temporal
lobe; PMC =premotor cortex; SMA=supplementary motor area; SPL=superior
parietal lobe; V1=primary visual cortex; VLPFC=ventrolateral prefrontal cortex;
vTOC=ventral temporal-occipital cortex.
Source. Adapted from Menon 2014.
PLATE 2. (Figure 7–2) Illustrative sketch of the location of language-
related activations.
a=anterior; A=auditory cortex; AG=angular gyrus; c=caudate; CB=cerebellum;
d=dorsal; GP=globus pallidus; IFS=inferior frontal sulcus; IOG=inferior occipital
gyrus; ITG=inferior temporal gyrus; (l)=larynx; m=medial; MFG=middle frontal
gyrus; MTG = middle temporal gyrus; Occ = occipital; OT = occipitotemporal;
p = posterior; PM = premotor; PO = parietal operculum; PoC = postcentral;
pOp=pars opercularis; pOrb=pars orbitalis; preC=precentral; PT=planum tempo-
rale; pTri = pars triangularis; PUT = putamen; SFG = superior frontal gyrus;
SMA= supplementary motor area; SMG=supramarginal gyrus; STG = superior
temporal gyrus; STS = superior temporal sulcus; (t) = tongue; Th = thalamus;
TPJ = temporoparietal junction; v = ventral; VI = lobule VI (medial anterior);
VII=lobule VII (lateral posterior).
Source. Adapted from Price 2012. Used under Creative Commons license. Adapta-
tions: Abbreviations have been moved to the figure note and reordered alphabetically;
color key has been split in two for space.
 More resilient designs More inclusive designs

More innovative designs

More adaptable designs More accessible designs

Cycle 5
5
Cycle 4

Cycle 3 4
3
Cycle 2
2
Cycle 1 1
Evaluate Implement
Refne Develop
Injections of needs and characteristics Co-design

PLATE 3. (Figure 10–6) The “virtuous tornado,” a planning process

that supports a nonlinear logic model.
PLATE 4. (Figure 11–2) Sampling of Identifor’s games.
Source. Images © Identifor. Used with permission.
 Effciency 16%
Memory 14%
Engagement 11%
Executive
function Solution 17%
Attention 15%
Optimization 13%
Inquiry 15%

Attention 74

Effciency 78 Solution 87

Engagement 56 Optimization 63

Inquiry 75 Memory 68

PLATE 5. (Figure 11–3) Benjamin’s executive function profile.

Top, This chart shows his relative abilities. The largest section, for example, indi-
cates his strongest ability. Bottom, This graphic illustrates his abilities as compared
with other Identifor gamers.
Source. Images © Identifor. Used with permission.
 Logical 23%
Linguistic 21%
Spatial 19%
Multiple
intelligence Interpersonal 10%
Musical 26%

Interpersonal 38

Linguistic 81 Spatial 74

Logical 88 Musical 100

PLATE 6. (Figure 11–4) Benjamin’s multiple intelligences profile.

Top, This chart shows his relative abilities. The largest section, for example, shows
his strongest ability. Bottom, This graphic compares his abilities with all other sub-
jects in the filtered set of results.
Source. Images © Identifor. Used with permission.
 Artistic 70

Conventional 60 Social 60

Enterprising 40 Realistic 30

Investigative 40

PLATE 7. (Figure 11–5) Benjamin’s RIASEC (Realistic, Investigative,

Artistic, Social, Enterprising, Conventional) profile.
Source. Images © Identifor. Used with permission.
 Neurodiversity: From Neurodiversity

FROM PHENOMENOLOGY TO NEUROBIOLOGY AND ENHANCING TECHNOLOGIES

Phenomenology to Neurobi-
ology and Enhancing Technologies
addresses the totality of neurodiversity through positive explorations
of “invisible diversities”—from ADHD and savantism to autism and dys-
lexia. Edited by the director of the Stanford Neurodiversity Project, the
book emphasizes strengths-based approaches to clinical practice and
FROM PHENOMENOLOGY
investigates interventions to improve the lives of neurodiverse individu-
als. Following a compelling foreword by Temple Grandin, the book pro -
TO NEUROBIOLOGY
ceeds to address neurodiversity in four parts: frst, an introduction that
presents neurodiversity’s differences in brain function and behavior as
AND ENHANCING TECHNOLOGIES
part of the normal variation of the human population; second, presen-
tation of the strengths-based model of neurodiversity (SBMN), includ-

Neurodiversity
ing positive psychology, neurobiology, and SBMN in savantism, autism,
ADHD, and dyslexia; third, a discussion of neurodiverse individuals in
the real world, including higher education and employment; and fnal-
ly, a review of technologies that enhance our abilities to maximize the
potential of neurodiversity, including inclusive design and assessment
tools that provide support for neurodiverse young adults seeking mean-
ingful employment.
Neurodiversity: From Phenomenology to Neurobiology and Enhanc-
ing Technologies provides clinicians, educators, and other professionals
with cutting- edge, practical, and positive information to understand and
assist their patients, students, and other neurodiverse individuals to op -
erate from a position of strength.

Lawrence K. Fung, M.D., Ph.D., is Director of the

Stanford Neurodiversity Project and an Assistant Pro -
fessor of Psychiatry and Behavioral Sciences at Stanford
University School of Medicine in Palo Alto, California.
Fung

Edited by
Cover design: Tammy J. Cordova
Cover image: © royaltystockphoto.com Lawrence K. Fung, M.D., Ph.D.
Used under license from Shutterstock