What it Means to Be Neurodiversity-Affirming, and How That Looks in Music Therapy

March 04, 2026

Written by Jordan Elias, MT-BC

Throughout my training and practice as a music therapist, I have encountered a surprisingly wide range of views on what good therapeutic work with autistic individuals actually looks like. Some of those views I don’t necessarily agree with. I remember learning about interventions designed to increase eye contact (something measurable and trackable) without any serious consideration of why reduced eye contact might be functional for a particular person, or what increasing it was actually supposed to achieve. The assumption underneath was clear enough: a person who makes a "normal" amount of eye contact would live a better life. But what is a normal amount? And better by whose measure? That last question is, I think, the central one. It is what separates a medical-model approach to autism from a neurodiversity-affirming one. And it is what shapes everything I try to do in therapy.

Two Different Questions

The medical model of autism thinks about autistic traits as symptoms of a disorder. Differences in social communication, repetitive behaviors, sensory sensitivities are considered deficits that need to be reduced, managed, or ideally eliminated. Progress means moving a person closer to neurotypical functioning. The goal of intervention, in this framework, is normalization.

The neurodiversity paradigm starts from a different perspective. It frames variations in how brains develop and function — in attention, sensory processing, cognition, communication, social interaction — as natural neurobiological differences rather than pathologies. Disability, in this view, often arises not from the person, but from the mismatch between a person and an environment that was not designed with them in mind. The relevant question shifts from 'what is wrong with this person?' to 'what does this person need in order to live well?'

The neurodiversity movement emerged in the late 1980s and 1990s, growing significantly from autistic-led online communities and conferences, and built on the social model of disability. Foundational figures include Jim Sinclair, Judy Singer, Harvey Blume, and Ari Ne'eman. The term "neurodiversity" was popularised around 1998, though its core ideas had been circulating in online spaces earlier. Steve Silberman's NeuroTribes (2015) is still to me one of the most thorough accounts of how much harm was done when the field framed autistic difference as deficiency and how much was missed as a result.

The movement has not been without controversy. Some advocates of the medical model argue that neurodiversity frameworks risk minimizing the very real support needs of some autistic individuals. In response, many researchers and practitioners, including those within autistic communities, have argued for integrative approaches: respecting and supporting neurodivergent traits while still treating co-occurring conditions (chronic pain, epilepsy, anxiety) that genuinely require medical attention. These are not incompatible; acknowledging disability does not require pathologizing anyone.

On Masking

One of the most important concepts in understanding the lived experience of autistic people is masking: the practice of suppressing natural autistic behaviors in order to appear more neurotypical. This includes things like forcing eye contact, suppressing stimming, modulating tone of voice, and mirroring social scripts that do not come naturally. It is not always a conscious strategy. For many people, it begins in early childhood, reinforced by subtle and not-so-subtle signals from the people and systems around them. It becomes automatic.

The cost is significant; masking is strongly associated with exhaustion, anxiety, depression, and a diminished sense of self. It is also most prevalent among the people least likely to receive an early autism diagnosis, including women, people of colour, non-binary individuals, because their masking is effective enough that professionals miss it. And what begins as an adaptive strategy can become, over the years, a person who no longer knows what they actually feel or what they actually need, because every authentic signal has been suppressed for so long.

This should be a central concern in therapy. Many autistic adults arriving in a therapist's office are not primarily struggling with autism. They are struggling with the consequences of a lifetime of being asked to hide it. Research consistently links masking to worse mental health outcomes, and there is growing evidence that interventions aimed at reducing or eliminating autistic behaviours, including some applied behavioural approaches, can reinforce rather than relieve this burden (Pearson & Rose, 2021; Raymaker et al., 2020).

Where the Research is At

Recently, one study (Crompton et al., 2020) directly challenged the long-standing assumption that social communication difficulties are located exclusively within autistic individuals. Using 72 participants, they found that autistic pairs communicated just as effectively as non-autistic pairs, but that mixed pairs — one autistic, one not — showed significantly faster information degradation and lower rapport. This provided empirical grounding for Damian Milton's "double empathy problem" theory (2012): the idea that communication difficulties in cross-neurotype interactions arise from bidirectional misunderstanding, not from a unilateral deficit in autistic people.

The implications were that if autistic people communicate effectively with each other, they are not inherently deficient at communication. The problem, such as it is, may be as much about the non-autistic side of the exchange as the autistic one.

A 2025 replication of this work with 311 participants and more demographic diversity confirmed the core finding: autistic pairs communicated as effectively as non-autistic pairs. But it did not replicate the mixed-pair breakdown. The mixed-neurotype interactions showed no selective failure. This complicates the narrative, and the researchers had a good sense for why that might be: intersecting differences in age, gender, ethnicity, and education were distributed across all interaction types. A young autistic woman and an elderly autistic man may not naturally click any more easily than she would with a non-autistic peer. Neurotype is one variable among many, and the autistic community diverse. The researchers also noted that younger participants were more likely to mask, potentially inflating cross-neurotype information transfer in short-term, structured laboratory tasks that may simply not capture the cumulative toll of real-world interaction.

What both studies agree on, however, is the part that matters most: autistic people are not inherently impaired at communication. That challenges diagnostic criteria, decades of theory-of-mind research, and the foundational premise of many deficit-oriented interventions.

A recent qualitative study from Australia (Pugsley et al., 2026) adds another dimension. Investigating attitudes toward autism genetics research, it found deep community concern that genetic research might enable prenatal screening leading to selective termination, reinforce a medical framing of autism as something to eliminate, and divert funding away from more urgent needs like healthcare access, mental health support, education, employment. Alongside these fears, participants expressed a more conditional hope: genetic insights might help understand co-occurring health conditions, or reduce diagnostic skepticism. But only if autistic people were meaningfully involved at every stage of the research process. The study is a useful reminder that research agendas and community priorities are often seriously misaligned, and that the consequences of that misalignment are not abstract. There is a need for more research led by, and in collaboration with people of diverse neurotypes.

Neurodiversity-Affirming Goals

Neurodiversity-affirming therapy is built around the question: what does this person need to live well? Objectives are co-created between therapist and client, oriented toward the client's own identified goals. None of it exists to fix autism.

In practice, the work tends to move through several interconnected areas. Autistic burnout, which is distinct from ordinary exhaustion, and arising from prolonged masking, sensory overload, and navigating unwelcoming environments, is often the presenting issue. Recovery requires more than rest; it requires understanding what drove the burnout and making real changes to reduce the conditions that caused it.

Unmasking is slow, careful, and deeply personal work. It involves learning to notice when you are performing versus when you are present, developing enough safety in certain contexts to let the performance down, and gradually building a sense of self that does not depend on other people's comfort with you. For many people, this includes grief: for the years spent hiding, for relationships that required it, for the identity that was suppressed. It also, over time, includes something relief and a discovery of self.

Try this: hum or play a single, simple phrase. Four or five notes, or even just one note held and released repeatedly. Do this for a minute with no intention to vary it. Let your attention rest lightly on what does change anyway: the quality of the sound, your breath, the feeling in your chest, the room around you. Afterwards: what moved, even though you weren't trying to move it? Did something in the body soften, or something in the breath shift?

Self-acceptance and identity integration, particularly for autistic adults who received a formal diagnosis later in life, involves making sense of a past that suddenly looks different, integrating an identity that was always present but unnamed, and building a relationship with oneself that is not grounded in shame. Beyond these, the work addresses executive functioning difficulties, emotional regulation, depression and anxiety that frequently arise as secondary consequences of systemic exclusion, and social connection on terms that are authentic rather than performed.

Why Music

There is a large body of research about music and the brain. Engaging with music activates motor, auditory, emotional, and cognitive networks simultaneously. Playing an instrument involves sequencing, working memory, bilateral coordination, and sustained attention — the same cognitive processes many autistic and ADHD brains find difficult to recruit for less intrinsically motivating tasks. Learning music is, among other things, practice in executive functioning. But more importantly, it is practice in executive functioning in a context where difficulty feels meaningful rather than punishing, and where progress is audible and real.

Deep listening and is a simple and powerful exercise. Listen to a familiar piece of music and track only one instrument throughout. Then listen again and follow a different one. What tends to happen is that people notice things they have never noticed before: a countermelody that was always there, the way two instruments answer each other, a rhythmic pattern running underneath everything else. The emotional experience of the piece often deepens. And then there is the reflection that follows: what is it like to direct attention deliberately? What competes for it? What does it feel like when something genuinely holds it? Attention is a limited and unevenly distributed resource. Understanding your own relationship to it is genuinely useful.

Soundscapes and field recordings offer something different in music therapy. Recording sounds from your environment and shaping them into something is music production in its most accessible form. No technical skill is required. No instrument to learn. What gets made is something that captures something real about how you experience a particular place or state. The reflection afterward: what did you choose? what did you leave out? what does this feel like to listen back to?

Songwriting does not require being a songwriter. It requires having something to say and finding a form to hold it. In practice this can mean writing a single verse about a feeling, building a chord progression that matches a mood, or setting existing words to music. The creative process often allows for honesty that feels too exposed in ordinary conversation. And what gets made becomes a record: something you can return to, to share or not share, revise, and build on.

Playlist building is something many people do instinctively without thinking of it as therapeutic. In a session context it becomes a tool for developing emotional literacy. What songs belong here? What do they have in common? Do you reach for music that matches how you feel, or music that shifts it? Are you drawn to lyrics that name the experience, or to sound that mirrors it without words? The playlist becomes an artifact of the self, reflective of how a person understands their own inner life.

Group music-making, and community-based projects like shared listening, collaborative composition, discussion structured around music offer something that forced socialization does not: a reason to be in the room together that has nothing to do with performing normalcy. The music is the thing. The connection happens around it.

Living Well

What neurodiversity-affirming music therapy tries to hold onto, above all, is a different set of questions from the ones I was taught to ask. Not: how many seconds of eye contact? But: what does this person need to live well? Not: how closely can this person approximate neurotypical functioning? But: what gets in the way of them living the life they want, and what supports might help?

These are questions that require listening more carefully, being more willing to follow the client's lead, and accepting that the goal of therapy is not a version of the person that makes their environment more comfortable. It is a version of their life that is more sustainable, more authentic, and more genuinely their own.

If you're curious about what neurodiversity-affirming music therapy looks like in practice for yourself or someone you care about, please feel free to reach out about an initial consultation to explore whether it might be a fit. I particularly work with musicians facing creative blocks, neurodivergent individuals, and people navigating illness, trauma, and loss. Music experience is not required. You can connect with me through the contact page.