Neurodivergent-affirming psychological evaluations and Why They Matter
I am often asked about neurodivergent-affirming evaluation services and how they might differ from a typical psychological evaluation that does not have this same value named. To answer this question, I want to talk a little bit about the words I am using first. Specifically, I want to describe the difference between "Neurodiversity" and "Neurodivergence," with help from Dr. Nick Walker, author, educator, and professor of psychology at California Institute of Integral Studies. Dr. Walker explains that the term "neurodiversity" refers to the diversity of human minds and is a biological fact (similar to species diversity, biological diversity, etc.). Referring to a person as "neurodiverse," then, doesn't make a lot of sense, because it is not a quality that one individual person can hold. "Neurodivergence," on the other hand, refers to "...having a mind that functions in ways that diverge significantly from the dominant societal standards of 'normal.'" Therefore, a person can be neurodivergent (ND). To read more helpful definitions and writings from Dr. Walker, please see her website here: https://neuroqueer.com/neurodiversity-terms-and-definitions/
Now that we've defined these important terms, I'd like to talk about a neurodivergent-affirming psychological evaluation. I strongly believe that all neurotypes are equal and valid. Therefore, I approach each evaluation from a strengths-based, affirming perspective, noting that whatever patterns arise from the evaluation are naturally-occurring variations of human expression. Therefore, one pattern or neurotype is not "superior" to another, and all neurotypes are deserving of care, compassion, and celebration. When a person walks out of my office, I want them to feel heard, understood, and seen. I want them to feel validated and as if they are the "expert" on themselves, rather than having me assign them an arbitrary label without context. "BUT WAIT," You might be thinking, "What about the DSM-5 diagnostic criteria? Don't we need to assign a label in order to get people support?" And yes, part of my job is to assign a diagnosis if the evaluation data is consistent with a diagnosis and this is because an accurate diagnosis can lead to proper care, treatment, and open doors for services. However, in addition to following the guidelines as determined by the DSM-5 and other psychological organizations, research, etc., I also do my work to assure that I know the specific strengths associated with different neurotypes as well as finding the strengths of each individual person who comes into my office. For example, understanding that when the DSM-5 lists "restricted, repetitive behaviors" as a criteria for autism, these can also be understood as deep special interests that bring a person (and their loved ones) much joy. There is no reason that we cannot celebrate neurodivergent joy while also assigning an appropriate diagnostic label. I also recognize that the DSM-V assigns a label to things that fall outside of society's "norms" and standards, and that often those norms and standards are outdated and/or harmful. One example of this is research (which I'll talk about in my next blog post) suggesting that autistic people are effective communicators with other autistic people, whereas communication between autistic and allistic (non-autistic) individuals is less effective. Therefore, this has me questioning the idea that autistic individuals display "deficits" in their social communication ability, and rather that there is often a "mismatch" between neurotypical expectations for communication and autistic communication patterns. Finding the right "fit" for friends and conversational partners then, can go a long way, and is much easier than trying to force a neurodivergent person to adopt neurotypical communication norms.
Understanding these types of patterns has a direct impact on how I communicate results to people, how people understand themselves after an evaluation, and the stories they go home with. If I say, "Your child does best with straightforward, honest, sincere, explicit communication" instead of "Your child has a deficit in social pragmatic communication and can't pick up on nuance," the story changes. I like to focus on HOW to connect with an individual and work together to support them, rather than WHAT IS WRONG with an individual. This places the responsibility for change on systems, families, schools, and communities, rather than on individuals themselves (because, after all, we need each other).
While it can certainly be tricky to reconcile the DSM-5 criteria, current research, and evidence-based practice standards with a strengths-based, affirming approach to psychological evaluation, it is always worth it to me. This is evidenced in the type of feedback I receive as well as the stories I have heard about what can happen when clinicians do not hold the value of neurodivergent-affirming services. I have heard stories of people receiving a diagnosis in a completely disempowering way, only receiving an email with their diagnosis and a list of "deficits." Others have told me they received many incorrect diagnoses after a clinician only spent half an hour with them. As a psychologist, I feel a responsibility to fully understand what my clients are telling me. When people leave my office, they frequently tell me that they felt seen, heard, and empowered. When people feel empowered, they are more likely to feel safe asking for help, share about their neurotype with supportive others in their life, and receive the care and support they need. They may also be less likely to suffer even more anxiety and depression from being labeled as "different" because they have been understood in a way that resonates with them, and they have been told about their wonderful strengths and resiliency factors that are huge, important parts of knowing them as a human being.