What is Neuro-Affirming Care, and Why Does it Matter?
1/14/26 | By: Dana Harron
Neuro-affirming care means taking into account and being responsive to neurodiversity factors such as ADHD, autism, AudHD, and traumatic brain injuries. It starts from the assumption that everyone who walks into your office has a different nervous system and that this isn’t a problem to be fixed, but a reality to take into account. In practice it means factoring neurodiversity factors into communications, pacing, and the environment where therapy takes place. For example, telehealth often isn’t ideal for people who have ADHD or trauma and need to have a more immersive experience in order to benefit.
Neuro-Affirming Care Includes All Brains
Many people who haven’t “qualified” for a diagnosis about their neurodiversity factors feel left out of neuro-affirming care. The truth is that diagnoses are overly categorical, whereas nervous systems actually lie along spectrums going in many different directions. A client may be diagnosed with ADHD, but have a tendency towards the “stickiness” of an OCD brain as well. If that person doesn’t have a diagnosis of OCD, their obsessive compulsive tendencies still need to be accounted for and cared about.
Neuro-Affirming Care Shouldn’t Just Include Brains
Neuro-Affirming Care Does Not Necessarily Mean Targeting the Neurodiversity Factors
One of my sub-specialties is working with people who have ADHD. What I don’t enjoy and am not good at, though, is helping people with ADHD who are there to work on the ADHD. I find that an executive functioning coach is a much better fit for setting up systems and routines and helping people to get organized. What I’m excellent at, though, is following a narrative that might be non-linear and understanding how having ADHD impacts other experiences in a person’s life. When I’m talking with a parent who has ADHD, I get that keeping track of all the birthday party invitations and school due dates is more of a burden for them than it would be for another person.
Neuro-Affirming Care For People with ADHD
Neuro-affirming care for ADHD means understanding that attention will not be based upon effort. I am grateful to be able to follow a narrative that loops around and back again, and I believe this is an essential skill for working with people who have ADHD. People with these brains may need additional support structuring treatment such as extra encouragement to use phone reminders. You aren’t there to fix or solve someone’s ADHD, often a font of creative insight and the progenitor of fun and spontaneity in life. Your job is to help them thrive within the context of who they are.
Neuro-Affirming Care For People with Autism
If your client has autism, it’s important to account for sensory needs and differences in communication. Honor the gifts that autism may bring as well as its challenges, making sure that you don’t lose sight of the person in front of you as a complete human being who has lots of different things about them. Don’t forget that autism can impact everyone differently, so check your assumptions with your client.
Neuro-Affirming Care For People with Obsessive-Compulsive-Disorder OCD
Some describe people who have OCD as having “sticky” brains. It can be hard to let go of something when it doesn’t feel complete, which can leads to compulsive behavior. Thoughts can also hang around longer than a person might want and can feel intrusive, like they come out of nowhere. If you are working with somebody who has OCD you might be working with them to lessen the impact of it on their daily life, or you might not. It might impact your treatment relationship in that people could be more particular about starting on time, or making sure superbills are precise. You might need to allow space for checking and double checking about appointment times and locations, but you also might not. OCD effects everyone differently; check in with your client to see how their unique brain processes uncertainty and ambiguity.
Neuro-Affirming Care for People with Traumatic Brain Injury
It is so surprising to me that TBI is often missed when people discuss neuro-affirming care. If your client has had a head injury that impacted their brain, it will be extremely important to know in what way the brain was affected! Find out if there is an existing report from a neurologist neuro-psychologist and, if it’s ok with your client, get the report and read it carefully. Make sure you check in with your client about how they are effected by their TBI and account for that in your approach. They may need slower pacing, and possibly shorter sessions if they get cognitive fatigue. There may also be grief and loss work to be done about the life they were living before their injury, but there might not be. Sometimes a life-altering event doesn’t just mean loss, but the acquisition of new ways of being that can be truly life-enhancing.
Neuro-Affirming Care For People with Psychological Trauma
Yes, psychological trauma is a brain thing. People who have had trauma often have a hyper-active amygdala (threat detection system) and HPA axis (threat response system). That means that when there’s ambiguity, the brain will fill in the gaps with things like, “my therapist doesn’t like me” or “my therapist doesn’t value my time”. This is their brains trying to make sure they stay safe; try not to take it personally and account for this difference by being easy to read. Some of us (me) don’t really have a poker face which I have found really helps with this population. If you have more of a neutral resting face, you may need to be explicitly transparent about what you are thinking and feeling.
Neuro-Affirming Care For People with Alexithymia
People with affect alexithymia have a lot of difficulty knowing how they feel. Their nervous systems do not automatically and easily attend to interoceptive cues, the signals we get from the body that let us know when we are hungry, tired, angry or sad. These clients cannot easily tell you how they feel, and often being asked feels uncomfortable and shame-inducing. Therapy is can be seen as being mostly about feelings and so these people can often feel like they are set up to fail in the therapeutic environment. Be explicit and clear that you understand that reading feeling cues is hard for them, and if this is a treatment goal (remember it might not be, people with alexithymia also have other stuff happening!) then make sure to approach it gradually and collaboratively.
Neuro-Affirming Care for People With Dementia and Memory Loss
At this point in my little rant, you know that every brain is different and you need to check in with your client or people in their lives (with consent) to see how they are impacted. But I do want to make the point that people with dementia often key in to emotional tone in the absence of other information. They may not be as likely to remember what you said, but their bodies will remember how you made them feel. Take care that you are regulated and calm when you are working with a person who has dementia, and keep in mind that their cognitive functioning will ebb and flow.
There will likely be some grief and loss work, especially with folks who had been very identified with the cognitive part of themselves. The brain may fill in the gaps with fear or paranoia in an attempt to keep the person safe; be readable and transparent. It can also be helpful to include subtle reminders of what’s going on throughout your speech without being asked: instead of “I like the color blue” you might go with “As a therapist at xyz location, I like the color blue”.
Neuro-Affirming Care for People With Psychosis
People who have psychosis often get hit twice – first by their brains and then again by the systems that are designed to serve them. Be the bastion of compassionate care in an underfunded, under-resourced world. You can disagree with somebody without invalidating them: “I’m not the arbiter of reality, but my perspective is different.” You can keep a friendly and respectful tone even when someone’s perspective doesn’t agree with your version of reality. If someone has a negative or scary hallucination with you in the room, it can be disorienting but try to treat it more as a nuisance than a threat; don’t give it any more power.
Neuro-Affirming Care for Other Learning Differences
There are many more types of brains. If you are working with someone with Sensory Integration Disorder, for example, you simply cannot have a busy and bright office. If somebody’s reading is impacted, you’ll have to go over your consents with them verbally. Many people also have more than one thing going on with their brains at the same time, whether it’s diagnostically recognized as in the overlap between OCD and Tic Disorders, more culturally recognized as in the case of AudHD, or idiosyncratic to the person in front of you.
Whatever the case, the unique needs person’s nervous system it needs to be accounted for in your environment, expectations and approach. That’s what neuro-affirming care is. It matters because you probably want to do a good job, and in order to do that you have got to have a handle on the full scope of who the person in front of you is.