Like all kids, neurodivergent children and teens come to therapy for a variety of reasons. The challenges regularly raised by these young people, their parents and carers, often include poor emotion regulation, anxiety and social difficulties. If you are lucky enough to work with this population, they may have described the common neurodivergent feeling of being an outsider in a confusing world. The neurodivergent tendency to interpret and respond to environmental cues (especially social and sensory ones) differently from their peers, can cause them to feel disparate, misunderstood and for some, sadly, broken.
‘Neurodiversity’ is a term used to describe differences in individual brain function. It is regarded as normal variation within the human population (Singer, 1999). It is assumed that most people experience and interpret the world similarly, hence the term ‘neurotypical’. Neurotypical individuals may notice and respond to sounds, smells and sights in a similar way. They might choose to focus on similar stimuli in the environment to one another, such as social cues. Neurodivergent individuals, however, perceive and experience the world differently to neurotypical people. They may interpret sensory stimuli differently (e.g., a noise that is barely noticed by a neurotypical individual might feel painful to someone who is neurodivergent) or focus on something less common in each situation (e.g., the child who mostly focuses on the lighting sequences during a theatre production). In our current professional climate, neurodiversity is most associated with autism and ADHD. It can, however, encompass other differences in brain function such as sensory processing and learning style, to name only a few.
Combined with the Social Model of Disability (Oliver, 1983) the neurodiversity-affirming paradigm suggests that being neurodivergent is not the cause of the familiar co-occurring mental health issues that enter our therapy spaces, such as anxiety, depression and frequent overwhelm. Rather, it is society’s response, in particular poor acceptance of neurodivergent needs and behaviours, that can cause a young person to feel broken or ‘less’ than their peers. The paradigm encourages neurodivergent people to recognise, embrace and celebrate their differences. Individuals are guided to recognise what is natural for their neurotype rather than trying to imitate neurotypical ways, which can be incredibly draining and negatively impact mental health.
Supporting a ‘good life’
Many young neurodivergent people, however, are desperate to fit in and reluctant to embrace their neurodiversity. Evolutionarily, humans strongly desire to fit in and to feel as though we belong to a tribe or social group. Because so many Autistic individuals need alone time to regulate, many neurotypical people can mistake this as an overall preference for always being alone or having no desire to belong with others. This is far from true. Like all humans, Autistic people have a strong need to belong and feel socially safe. A newly published article exploring the most important factors supporting a ‘good life’ for Autistic children, according to Autistic adults’ and parents’ perspectives, highlighted, “being accepted by others in a way that allows the child to be themselves” (Simpson et al., 2024). Unfortunately, many describe a long history of social rejection, accompanied by that dreaded sense that they are different, broken or unable to fit in.
In an ideal world, our communities will become more neurodiversity-affirming and prioritise appropriate accommodations. As a psychologist, good communication about neurodivergent needs and accommodations with families and schools is essential and reliable resources are becoming increasingly available. Opportunities for neurodivergent youth to find like-minded peers, particularly via strengths and areas of interest, are also recognised as an important strategy. For the purposes of this article, I’d like to focus on what can be done within the therapy room itself.
Creating safety through acceptance and commitment therapy (ACT)
Encouraging neurodivergent young people to celebrate their unique differences can often feel like a complicated task against a backdrop of social stress. ACT places unconditional compassion-focused acceptance at the very centre of all therapeutic interactions (Tirch et al., 2014). It emphasises a love of difference and an embracing of individuality. An ACT-friendly environment implements acceptance, compassion and playfulness through a psychologist’s language and behaviour. By prioritising a sense of compassion in a young person’s presence, a child can feel safe, heard, and believed, regardless of the presenting issue. Using ACT relationships with neurodivergent youth thanks to its emphasis on social safety, the love of diversity and the tendency for some quirky strategies (Wassner, 2024). Indeed, the efficacy of ACT with neurodivergent populations is growing (Byrne & Mahony, 2020; Maughan et al., 2023; Yao et al., 2024).
Many arrive to their first session following a period of personal difficulty, often involving some level of social stress. This can be among peers but also in relation to how they believe they are viewed by adults. For example, a person with ADHD and high impulsivity may have received countless reprimands over the years, impacting their sense of self. When a young person presents to therapy with high levels of social threat, attempts to implement some structured therapeutic tools via worksheets and rigid programs can often diminish rapport and lead to disappointing outcomes for two reasons. Firstly, these types of programs may not account for the fact that neurodivergent individuals perceive and experience the world differently to neurotypical people, so they may not respond to explicit teaching of skills in the way other young people might. Secondly, they often neglect to prioritise social safety via acceptance, which is paramount to one’s ability to feel calm and regulated. A young person with a long history of social rejection will likely have a hypervigilant threat system, impacting their capacity for new skill building. Hence, the focus on psychological safety via compassion-focused acceptance, becomes vital and must override our temptation to ‘complete’ explicit skill-building in session.
While many types of therapies focus on symptom reduction, the primary goal of ACT is valued living. Young people can be guided to think about what a rich and fulfilling life might entail for them while acknowledging that difficulty is expected in life. As such, attempts to rid ourselves of unwanted moments and feelings is not realistic. Through an ACT lens, young people are guided to enhance their willingness to experience difficulties whilst behaving in a way that brings them closer to that valued life. The ACT principle of ‘acceptance’ emphasises acceptance of inner difficulties such as thoughts, feelings, urges, beliefs and memories. Indeed, anxiety is likely to show up when we approach the ‘hard stuff’, and we recognise that this is not easy.
Young people can be supported to focus on what is important to them and move towards it, even in the face of difficulty. We acknowledge that when something feels hard, we may turn away and avoid the problem. This, however, pulls us further away from what is truly important to us. Instead, we look towards accepting the discomfort for a greater good. For example, a young person who values academic achievement but gives up quickly when faced with a poor grade could be guided to say, “I can be disappointed in my maths grade and choose to work hard for the next test”. A young Autistic girl who is keen to make friends but highly anxious in social situations could be directed to say, “I can feel anxious about approaching Jade and still sit down next to her”.
A willingness to do things differently or flexibly in the face of difficulty is referred to as ‘psychological flexibility’. This may seem like a counter-intuitive strategy for Autistic individuals, particularly considering the tendency to approach life with rigidity. Rigid behaviour is understandable as it can feel safe in an unpredictable world that has been designed for neurotypical individuals. The good news is that psychological flexibility is a skill that can be taught once social safety has been established.
Working in the ACT framework
With so many components inside an ACT framework, it can be overwhelming to work out where to start. There is no single answer to this. The most important factor is to read where the young person is at. An ACT approach provides psychologists with the guidance to assess the child’s ability to feel safe in a session and the extent to which they are able to engage with the session. Planning sessions is of course important, but a young person’s capacity to engage and learn can fluctuate from moment to moment. Often, a treatment plan will require flexibility. A psychologist who role-models flexibility may be more effective in implicitly encouraging this skill development.
A skilled ACT therapist will be constantly paying attention to, or ‘noticing’ the young person’s capacity to feel safe and regulated before deciding which aspects of a session plan to implement. If a child is dysregulated or unable to discuss their challenges, it can be useful to start with assisting the young person to notice this. Mindfulness is one of the key principles of ACT and can be used as an incidental ‘noticing’ exercise, rather than formal meditation. Messages around acceptance of inner difficulty may also be gently introduced via incidental language around noticing difficulty, with compassion. e.g., “that must have been upsetting”; or, “I can see why that annoyed you so much”. If a therapist makes a clinical judgement that a child can engage in conversation about difficulty, it creates an opportunity to model acceptance-based language that focuses on normalising difficulty.
Working with unwanted thoughts and feelings is another important part of an ACT therapeutic intervention. When we experience inner difficulty, our instinct is to do whatever we can to get rid of it. ACT theory suggests that it is the struggle with painful thoughts and sensations (avoidance) that can create overwhelming levels of difficulty. The ACT principles of ‘cognitive defusion’ and ‘self as concept’ expand on this and can complement acceptance and mindfulness techniques. These become crucial in helping children manage their struggles over time. They should, however, be reserved for later stages of therapy when the young person has a strong, trusting connection with the therapist and is feeling regulated at the time. Themes that are typical to the young person’s anxiety can be highlighted (gently and compassionately) and then explored. With a young neurodivergent population, themes may revolve around perfectionism, social rejection, fairness, self-concept, family roles and future worries.
Engaging in a neurodiversity-affirming approach
ACT is grounded in compassion, acceptance and an openness to difference. This provides a wonderful start for building rapport thanks to its emphasis on social safety in the therapy room. When therapists provide a neurodiversity-affirming approach to sessions, the child’s sense of social safety is further enhanced. ACT strategies that focus on noticing, accepting and defusing from difficult feelings and cognitions can then be discussed in a way that relates to neurodivergent learning preferences. In so doing, we are assisting these young people to spend more time engaging in a life that is meaningful and workable for them.
The APS also helps psychology professionals to support neurodivergent people via a range of other resources, including:
Register now for the APS Neurodiversity-affirming ACT for autistic kids and teens webinar, which will help psychologists adapt therapeutic interventions in a way that is meaningful to neurodivergent young people.
References
Byrne, G., & O'Mahony, T. (2020). Acceptance and commitment therapy (ACT) for adults with intellectual disabilities and/or autism spectrum conditions (ASC): A systematic review. Journal of Contextual Behavioral Science. 18: 247-255.
Maughan, A. L., Lunsky, Y., Lake, J., Mills, J. S., Fung, K., Steel, L., & Weiss, J. A. (2023). Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial. Autism, 28(2), 367-380. https://doi.org/10.1177/13623613231172241 (Original work published 2024)
Oliver, Michael (1983). Social Work with Disabled People. Practical social work. London: Macmillan. ISBN 978-0-333-32707-4.
Simpson, K., Allen, C., Wheeley, E., Pellicano, E., Heyworth, M., Houting, J. d., Bowen, R., Adams, D. (2024, October 16). Factors Supporting a “Good Life” for Autistic Children: Autistic Adults’ and Parents’ Perspectives. https://doi.org/10.31219/osf.io/zn5g8
Singer J. (1999). ‘Why can’t you be normal for once in your life? From a ‘problem with no name’ to a new category of disability’. In Corker M., French S. (Eds.), Disability discourse (pp. 59–67). Open University Press.
Tirch, D., Schoendorff, B., & Silberstein, L. R. (2014). The ACT practitioner’s guide to the science of compassion: Tools for fostering psychological flexibility. Oakland, CA: New Harbinger.
Wassner, J. (2024). Acceptance and Commitment Therapy for Children: Applications and Strategies for Anxiety, Depression, Autism, ADHD, OCD, and More. London: Jessica Kingsley Publishers.
Yao, D., Chen, J., Cao, J. et al. Application of the Acceptance and Commitment Therapy in Autism Spectrum Disorder and Their Caregivers: A Scoping Review. Rev J Autism Dev Disord (2024). https://doi.org/10.1007/s40489-024-00460-3
Disclaimer: Published on Insights in 2025. The APS aims to ensure that information published is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Views expressed are the author's own and do not necessarily reflect the position of the APS. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in Insights does not replace obtaining appropriate professional and/or legal advice.