Article summary
- Neurodiversity-affirming care will become a mandatory PsyBA competency from 1 December 2025, requiring all psychologists to demonstrate an understanding of neurodiversity and the ability to adapt practice for people with disability and/or neuro-developmental differences.
- Identity-first language ("Autistic person") is increasingly preferred, aligning with a strengths-based approach, though practitioners should always ask for client preferences.
- Neurodiversity-affirming care includes practical adjustments, such as sensory accommodations, structured sessions, alternative communication methods and respect for client autonomy.
- Co-occurring conditions are common among Autistic people and often missed; comprehensive assessments are vital, using appropriate tools like HADS or PHQ-9.
- New APS autism e-learning modules support psychologists in building competency across foundations, assessment and co-occurring conditions.
As of December this year, neurodiversity-affirming practice will become a core competency included in the Psychology Board of Australia competencies. That's why now is the time to upskill in this space.
In just a few months, incorporating understanding of neurodiversity as a psychologist (i.e. understanding and affirming neurodiversity) will no longer be considered a nice-to-have capability. It will be a required competency for psychologists.
Incoming updates to the Psychology Board (PsyBA) of Australia’s competencies (effective 1 December 2025) will, among other things, require all psychologists to demonstrate an understanding of neurodiversity (download the PDF and see competency 7.9 for details).
The new competency calls for psychologists to:
Understand neurodiversity, strengths-based, trauma-informed and positive approaches to supporting people with developmental disability. Demonstrate the ability to adapt psychological practice and make reasonable adjustments for people with disability, including understanding of alternative and augmentative communication.
While neurodiversity encompasses the diversity of all humans, this article focuses specifically on one neurodivergent client group: Autistic clients. For psychologists who don’t routinely work with neurodivergent individuals, the recent PsyBA competency updates may appear to be a niche area of focus.
However, as Dr Jessica Paynter FAPS explains, these changes signal a wider shift across the profession – one that calls for deeper inclusivity, greater flexibility and meaningful co-design with the communities psychologists serve.
"We know Autistic people experience high rates of mental health issues. That means all psychologists need to be prepared to support these clients," says Dr Paynter, who is an Associate Professor at the School of Applied Psychology at Griffith University and clinical psychologist with 20+ years' experience.
The evolving understanding of autism
One of the most significant shifts in recent years has been the move from a deficit-based, medical model of autism to a strengths-based, neurodiversity-affirming framework.
"We've made the positive change to stop trying to 'fix' or 'normalise' Autistic people," says Dr Paynter, who is also the former president (2023-2024) of the Australasian Society for Autism Research and an APS Fellow.
"A decade or so ago, there was a focus on trying to make people 'less Autistic'. It's incredibly invalidating and demonstrably harmful. Now, instead, we work with Autistic people to understand and support their goals, build on their strengths, and create environments that are inclusive and adaptive."
Research and understanding has also expanded beyond the stereotype of young boys, historically overrepresented in autism research.
"There's much more acknowledgement of Autistic people who don't have an intellectual disability, who might be female or non-binary, or have other intersectional differences, such as being from a culturally and linguistically diverse background."
Recognition of diversity in the presentation of autism is also becoming more common, she adds.
“We’ve increased our understanding that not every Autistic person likes trains, or lines up blocks, towards a more nuanced understanding of the diversity of strengths and challenges Autistic people may present with.”
The client is the expert on themselves. We bring the clinical knowledge, but it’s their goals, strengths and preferences that shape the work. – Dr Jessica Paynter FAPS
Language has also evolved. While person-first language (e.g. "person with autism") was once dominant, identity-first language (e.g. "Autistic person") is now preferred by many in the Autistic community.
"There's been a lot of research over the past decade or so that's highlighted that many Autistic people see autism as integral to their identity and not something that can or should be separated.
“Using the terms individuals prefer aligns with the strength-based approach and acknowledges that autism is part of who people are, as opposed to something they 'have.’"
However, it's still best-practice to check with people, as no two Autistic people are the same, and individuals will have their own preferred language.
"It’s like someone's pronouns," says Dr Paynter. "Ask what the person prefers and respect that."
Upskill in autism support with this APS learning series, designed in consultation with experts from practice and lived experience.
Principles of neurodiversity-affirming therapy
In practice, a neurodiversity-affirming therapy approach requires clinicians to collaborate with clients.
"The client is the expert on themselves," says Dr Paynter. "We bring the clinical knowledge, but it’s their goals, strengths and preferences that shape the work."
While the approach will vary from client to client, a neurodiversity-affirming approach might look like:
- Accepting the person’s preferred communication style and approach as valid. For example, not requiring or expecting eye contact.
- Including a client's interests and talents therapeutically.
- Learning about and using alternative communication methods (e.g. pictures, diagrams, writing) – and using a client's communication preferences.
- Providing structure, predictability and sensory accommodations, (e.g. allowing clients to adjust lighting and noise for their preferences).
Some clients may also prefer to work with a neurodivergent psychologist with lived experience.
"If you are neurodivergent yourself, and are comfortable being open about your own [neurodivergent] identity, we’ve found it is valued by clients," says Dr Paynter.
Her own research has resulted in a Therapy Accommodations Tool – a free checklist that helps clients identify what will make therapy more accessible for them.
"You can ask clients what the sensory needs might be, what the communication needs might be, what structures or information in advance would make therapy more helpful for them.
"Having things like session outlines can be helpful to reduce anxiety and offers predictability."
Importantly, she adds, none of this should be based on assumptions, and she encourages psychologists to remain curious and humble.
"You don’t have to have all the answers. Just start by asking: what would make this space more accessible for you? What do you like about therapy? What don't you like? What do you wish could be different? Now we're shaping approaches that are much more informed by our clients' strengths and needs."
While there are some accommodations that will be mostly beneficial to Autistic clients, many will be applicable to a broad spectrum of clients, she adds.
"Many clients would benefit from things like routine, structure, predictability, clear payment structures, etc. Many of these things are just good practice, but they might be particularly salient for people who are Autistic."
She adds that while many accommodations may seem small, they can have a significant impact.
"If you are open to learning about autism from Autistic people, reduce uncertainty, minimise sensory overwhelm and listen well, you’re already making therapy more accessible."
Explore Dr Paynter's research paper 'How can we make therapy better for Autistic adults? Autistic adults’ ratings of helpfulness of adaptations to therapy.'
Co-occurring conditions: the rule, not the exception
Many Autistic people experience co-occurring conditions such as anxiety, depression, intellectual disability, or language disorders.
It's thought that between 60-95% of Autistic people are also living with other medical or other conditions. These could include, but are not limited to, ADHD, OCD, anxiety disorders, language disorders, eating disorders and more,
These co-occurring conditions are often missed due to diagnostic overshadowing, says Dr Paynter.
"Just because someone is Autistic doesn't mean that's the full story," she says. "We have to consider the whole person including co-occurring conditions because they are extremely common."
Dr Paynter emphasises the importance of comprehensive assessments that explore both differential diagnoses and the client’s broader mental health context.
"About 50% of Autistic people will present with what's called alexithymia, which is difficulties recognising and expressing emotions. That can make it harder for us to identify conditions like depression. It’s important that we understand the person’s usual functioning and investigate if there are changes."
In terms of depression, using measures evaluated with Autistic people, such as the HADS or PHQ-9, may be more appropriate than other measures that use metaphorical or vague language, she says.
Evidence-based training and practice
Paynter is a key contributor to the APS's autism e-learning modules, which have recently been updated to reflect contemporary research and co-designed co-designed with Autistic people.
"We now have more research on what actually works for Autistic adults," she says. "And we’re embedding that into training, alongside lived experience perspectives."
The APS learning series includes four modules:
These resources align with the new Psychology Board competencies.
"This isn’t optional anymore," says Dr Paynter. "It’s a professional standard."
However, it’s not something to be intimidated by. A foundational understanding in this area equips you to begin working in this area, and supervision can help you to continue your learning, says Dr Paynter.
"Also, sometimes people say, 'But I don't work with Autistic clients.' But we know Autistic clients are far more likely to have depression and/or anxiety – and people with disabilities in general are more likely to have mental health care needs.
"If you work with adults with mental health, you're going to see an Autistic client. It might not be your focus area, but they still may walk in your door. "
Further resources for psychologists