A Neurodivergent View: Give Us Strategies … With Choices

Editor’s note: This year marks the Centennial of the founding of ASHA and the communication sciences and disorders professions. In celebration, the Leader will, throughout the year, explore how evolving perceptions of disability are part of that history. We kick off our exploration by examining the social model of disability, and the key role of neurodiversity-affirming, strengths-based services in this approach. In this series of articles (see below), we look at neurodiversity-affirming intervention and supports, featuring autistic SLPs’ insights from their own experiences—in their own words, unedited—to reflect their authentic voices and experiences. We start with a definition of the social model, and how it applies to assessment, from two SLPs who presented at ASHA’s recent online conference, “Using a Strengths-Based Approach in Schools.”

Imagine True Inclusion: Defining the Social Model of Disability

Brain Power Unleashed: Creating a Neuro-Inclusive Workplace

Positively Disrupting Social Groups: A Neurodiversity-Affirming Glow-Up

How Do We ‘Authentically’ Involve Autistic People in Research?

How Do We Identify Client Needs Through a Neurodiversity-Affirming Lens?

When I proposed sharing my perspective as a neurodivergent speech-language pathologist at the 2024 ASHA Convention, I had no idea I’d be facing about 1,500 people, while livestreamed. If I’d known that—and that it would also spur invites to write this Leader article and speak on the ASHA Voices podcast—I would have kept my big mouth shut. I keep reminding myself that sharing my story is more important than my anxiety, introversion, and overall reticence to let people I don’t know into my life. While I remain intensely uncomfortable talking about myself, I am doing it so that others can have more understanding of what I and other neurodivergent individuals face.

When I began practicing as an SLP over 20 years ago, we didn’t have coursework about neurodivergence. Even though our understanding of autism has changed since, too much remains the same. Many graduate CSD catalogs don’t have specific classes about autism, although pieces may be embedded in other coursework. While we now acknowledge that autism occurs in females more frequently than we thought, our formal testing still mostly reflects the male phenotype. Our processes of identifying autism and training people to provide robust services are still lacking.

I started “specializing” in working with autistic kids and teens not due to choice, or self-awareness of my own difficulties, but because they were everywhere I worked. In the early 2000s I found myself working with older SLPs who were even more uncomfortable with autism than I was, and thus these kids fell into my hands, and I needed to know what to do to help them.

My practice and awareness have significantly evolved over the years. My daughter is neurodivergent, people (I thought jokingly) told me I was too, and my caseload of autistic kids in the schools kept growing. More information is always emerging, and I made autism one of my “restricted” interests. I did that through my 48th birthday without ever admitting my own neurodivergence. In 2023, at age 48, I attended an ASHA session about identifying autistic women and it changed me. After the almost immediate panic attack, I started reflecting on my own life.

Growing up undiagnosed

I had a horrible time in high school, following a moderately miserable time in middle school and a mildly unpleasant elementary school stay. Why? Because in the 1980s the only label they had for me was gifted. Being constantly praised for my intelligence by teachers and parents didn’t help me make friends. In fact, it made me (looking back) obnoxious; everyone told me I was better than others, so I parroted that language to other kids. By high school I was physically, verbally, and emotionally bullied and suicidal. The solution was to keep telling me how awesome I was.

I obtained my BS and MS in my home state of Pennsylvania. In undergrad I found alcohol and the social relief and freedom that being under the influence provided me. After four years of drinking to deal with my social problems, I finally quit, realizing that I had a seven-day-a-week drinking habit. When I started my master’s, I understood that people had their own separate mental states and feelings, but still didn’t know what to do about them. I continued to speak my truth, regardless of others, which led to more social rejection.

I entered a PhD program in the Midwest and encountered a completely different set of social rules. I recognized that I would never be successful if I continued with my current social routines, and, with the help of my future husband and a trusted advisor, started learning to mask. This made me able to appear more palatable to others but had a significant impact on my mental health.

Unmasking assumptions

Recently, some advocates in the neurodiversity movement have suggested that providing interventions for autistic people could be damaging because it assumes we need “fixing.” They say that, instead, the world needs to be more accepting. While I embrace the strengths-based approach, it makes me cringe when people say SLPs should avoid providing services to neurodivergent people altogether. It compels me to speak out publicly like I did at the convention.

Masking was and is my solution to daily life—and is a result of years of real and perceived social failures. I do it because I never had the opportunity to learn other strategies. Every day I hide my personality and pretend to be “typical” to make others happy and comfortable. When I started masking is also when I started taking medications for anxiety and depression. I am my own worst critic, and I don’t let go of things, especially if I feel I have failed.  Someone recently commented to me about something I said: “Well that’s not the worst thing you’ve ever said.” That statement has eaten away at me since then.

With the ideas of anxiety and masking in mind, think about what neurotypicals see as a simple social situation. When they see someone they know walking toward them, 
it’s easy. They smile and say “hi.” Small talk may or may not follow. I, on the other hand, see someone coming and my first thought is more likely, “Oh crap, a person!” And then my brain does this ... (see graphic above).

There is nothing I would love more than the world to accept me 
“as is,” but 49 years of experience have told me this is not practical. I didn’t have any help, and while some view me as successful, I often view myself as a failure. My masking leaves me stressed out, exhausted, and not knowing who I am underneath all the rules and regulations I have created for myself to survive in the world. And even with all the masking, I still don’t do things “right.” It eats away at me, with self-doubt and recriminations constantly nibbling at my subconscious.

Yes, the world should be more accepting and neurodiversity-affirming. In reality, the world’s history of problems with discrimination related to racism, sexism, homophobia, and other -isms persist. Yet some people think the world is suddenly going to accept me “as is?” I think not.

Affirming neurodiversity

Instead of expecting the world to change for my clients, I aim to provide neurodiversity-affirming therapy that helps them understand what they don’t know about the social world—what nobody had helped me understand. This approach starts with accepting the person as they are and forming a relationship with them, then learning about their strengths. As SLPs, we can provide information about social strategies without taking away a person’s sense of self, or their ability to choose what they do with their new knowledge.

One of my first questions to my students is, “What are you into?” It helps that I am a card-carrying geek. I am well-versed in Disney, sci-fi, D&D, and Minecraft, and have a general understanding of online multiplayer games. I like RPGs. I go to DragonCon. I follow trends in social media and know a little about anime (thanks to my daughter). My office reflects my hobbies and personality, and most people can find at least one thing in it that they identify with.

Today I commonly disclose to my students that I am neurodivergent. It makes me more human to them, and less like another adult telling them what to do. There is a level of honesty and understanding between us because we have all “lived it.” I have found my true passion with high school students and can help them not make the same mistakes that I did. We share social successes and failures. Sometimes they help me as much as I help them: Over the past few months of me preparing for a presentation, writing, and dreading speaking on a podcast, my students and I have brainstormed strategies for doing the things that make us uncomfortable.

The road as a professional has not always been smooth. Like most neurodivergent people, I still make social mistakes, but they aren’t as explosive as they were when I was younger (edited for fear of offending the reader—what I really wanted to say is that I now have more SNAFUs and fewer FUBARs). I am driven to help other neurodivergent people and give them the skills and knowledge they need, so hopefully they won’t have the negative experiences I did. I am making a difference with my students, and I know it.

Below is a note from a student I served in elementary school and again in high school. It is one of my most prized possessions. I hope that my story and voice, as uncomfortable as they may be to hear, can influence others to provide support to those who need it.

Jennifer Cripps-Ludlum, PhD, CCC-SLP, is a clinician in the Atlanta-area Gwinnett County Public Schools. [email protected]