While new year resolutions have never been for me, I understand other people enjoy or benefit from making resolutions for the new year. Perhaps they enjoy the novelty of it, perhaps they like to have an overarching goal for the year, perhaps the new year inspires or motivates them.

Whatever the reason, many people make new year resolutions and if we do, we need to make sure we don’t reinforce neuronormative expectations or standards onto ourselves.

There is no one right timeline that we have to follow.

I’ve made “finally get my driver’s licence” my new year resolution many times and I’m now 31 without a driver’s licence. I’m not embarrassed (anymore) because I’ve gotten to the point where I recognise there is no single right timeline when it comes to getting your driver’s licence.

I’ve accepted that my disabilities and neurodivergence make driving so much more challenging for me and I do not need a driver’s licence to “be an adult”. I might get my licence eventually but I haven’t put a deadline on it because it’ll happen (or not happen) according to my own timeline, whenever that may be.

I feel like we can apply this to a lot of resolutions.

If your resolution is to go to the gym every day, are you forcing yourself into a timeline that isn’t sustainable and forgiving of inconsistency? If your resolution is to write a book, are you considering that writing can be and is allowed to be inconsistent? If your resolution is to post regularly on social media, are you reminding yourself that your regular may look different to someone else’s regular?

Be flexible with your deadlines.

Be flexible with your timelines.

Remember that eating looks different for everyone.

I can’t begin to express the number of times I’ve seen “eat healthier” as a new year resolution. I don’t believe it’s a bad thing to want to eat to nourish your body and mind but because of diet culture and weight stigma, our understanding of what eating healthily looks like is rooted in harmful myths, bias, thinness as an ideal and of course, neuronormativity.

For neurodivergent people, our relationship with food including eating and cooking looks different because it’s impacted by our sensory differences, executive functioning differences, interoceptive differences, masking, burnout and more.

This means how Western society defines healthy eating may not apply to us so we need to make sure we don’t reinforce a narrow understanding of “eating healthily” onto our goals.

I’ll be the first to admit that what and how I eat certainly doesn’t fit into Western society’s idea of healthy eating but it’s healthy for me.

I use food as a source of sensory input and stimulation which means I snack a lot — it’s healthy for me because I’m meeting my needs. I also eat the same food over and over again to accommodate my sensory differences even though for other people, that wouldn’t be their definition of healthy. I rely on takeaway and quick meals you can put in the oven or microwave because otherwise I won’t eat at all.

It’s healthy for me.

If you’re going to make resolutions when it comes to food, make sure you define “eating healthily” by what meets your needs and benefits you.

Explore what success means and looks like for you.

Success is defined as meeting a defined set of expectations or the achievement of a purpose. Unfortunately, we often define success by neuronormative expectations and purposes. We often define success by getting a full time job, climbing the career ladder, getting a PhD or buying a home. And for many people including neurodivergent and disabled people, these can be unattainable for some, unsustainable for many.

And for many of us, it simply isn’t our definition of success.

I used to think my definition of success was getting my driver’s licence and a PhD, becoming an expert on a topic where everyone knew who I was, securing a full time job and getting married before I retire with thousands of dollars in the bank. While I wouldn’t mind a few of them happening, I wouldn’t say I’m unsuccessful if I don’t achieve it.

I define success differently because many of those things are either unsustainable for me or they don’t align in what I find valuable or meaningful. And that’s the point — success is determined by achieving a purpose but only an individual can determine the purpose; only an individual can determine what is meaningful to them.

We do not need to have the same definition of success as someone else.

If you’re someone who makes new year resolutions, remember to consider your own needs, differences, values and capacity.

Do not let other people you see on social media tell you what your goals should be, do not let society tell you productivity is the most important sign of success, do not let the world force a rigid timeline onto your life.

As per my usual fascination and passion for anything to do with the neurodiversity paradigm, I decided to put together a list of principles. I believe some of us are probably already familiar with these principles but since this is an emerging framework, I do believe it’s helpful to define Neurodiversity Affirming Practice more — to guide our own practice and to guide others in becoming neurodiversity affirming.

Intersectionality

Intersectionality is the first principle for a reason — it’s the most important principle because all of our work, all of our approaches, all of therapies needs to recognise intersectionality.

When we do not see all of one’s identities, we do not see the whole person. When we don’t see the whole person, we can end up reinforcing barriers, discrimination and unfair expectations, standards and norms. When we don’t see the whole person, we are missing the context that we need to understand and support someone.

We also cannot challenge neuronormativity without challenging cisnormativity or heteronormativity and we can’t dismantle ableism or sanism without dismantling all forms of oppression.

Respecting autonomy

Respecting autonomy is about honouring an individual’s right to control their own body as well as make their own decisions. Respecting autonomy includes an individual having the right to say no and the right to determine what is helpful for them as well as what is distressing for them.

It’s about recognising that there are multiple courses of actions when it comes to supporting an individual and only an individual gets to determine what is helpful whether it’s medication or accommodations. It’s about respecting an individual’s right to define their own experiences because individuals are the experts of their own experiences.

We respect autonomy when it comes to:

• bodily autonomy
• defining goals
• making decisions
• defining recovery
• defining their experiences
• choosing how to work with their differences

Presuming competence

Presuming competence is about recognising that an individual has capacity to understand, think, learn and do things. Instead of walking into a room and defining an individual by their challenges and our own assumptions or biases, we walk into a room believing an individual is competent.

Instead of assuming an individual cannot communicate, we figure out how we can support them. Instead of assuming an individual cannot learn, we figure out how we can support them.

Presuming competence looks like:

• considering someone’s needs and differences
• meeting a person where they are
• identifying barriers and obstacles

Validating Differences

Validating differences is about moving away from labelling our differences as deficits and instead, recognising the diversity in how we function from the way we feel to the way we learn to the way we think and the way we communicate.

If we bring it back to neurodiversity, there is no right or standard mind or brain so if neurotypical people are not the benchmark for functioning, how can there be deficits? It’s important to remember that validating our differences doesn’t mean denying our challenges or needs, we just don’t want to imply our challenges or needs are a failing, deficits or a problem with the individual.

Rejecting Neuronormativity

Neuronormativity is a set of norms, standards and expectations reinforced throughout society These norms centre a particular way of functioning including thinking, feeling, communicating and behaving. This way of functioning is seen as the superior and right way.

We need to reject neuronormativity in order to make room for all our ways of functioning. We need to reject neuronormativity in order to stop labelling individuals as having deficits. Just like we want to challenge and defy cisheteronormativity, we want to challenge and defy neuronormativity. Above all, defying neuronormativity also requires dismantling whiteness and rejecting capitalist expectations.

Reframing Expectations

Neurodivergent individuals are often judged and held against neuronormative standards and expectations which is why we need to reframe our expectations in regards to how individuals should develop, communicate, learn, think, play, socialise and function.

We also need to reframe neuronormative expectations around success, productivity, executive functioning, independence and even how we do therapy. We need to reframe neuronormative expectations that disadvantages anyone who functions differently.

Promoting Self-Advocacy

Promoting self-advocacy is crucial to ensuring neurodivergent individuals can navigate a neuronormative society while meeting their needs and honouring their differences. It is about giving individuals the tools and information to advocate for themselves in all aspects of their lives including education, employment, healthcare and relationships.

Supporting self-advocacy skills looks like:

• teaching individuals to identify their needs
• teaching individuals about their differences
• exploring strategies and tools together
• space for individuals to express concerns
• honouring an individual’s decisions
• giving individuals choices

Prioritising Lived Experience

Neurodiversity Affirming Practice prioritises lived experiences and recognises individuals as the experts of their own experiences, learning from lived experience and prioritising lived experience within your learning. It means respecting self-diagnosis and allowing individuals to define their own experiences.

Nurturing Positive Self-Identity

Nurturing a positive self-identity is important for all neurodivergent individuals because too often, we are exposed to a narrative that tells us we are unwell, abnormal or broken. We can nurture a positive self-identity by unpacking shame, connecting with community, validating differences, identifying strengths and reframing both our language and expectations.

Adapting Systems & Environments

We live in a neuronormative society that isn’t set up for neurodivergent people which is why we need to focus on identifying and removing barriers as well as creating adjustments and adaptations. It’s about moving away from changing the individual to recognising what we can change within the environment.

When we stop assuming differences and distress as the root of any challenges or difficulties, we can stop making neurodivergent individuals fit into society and instead, find ways to adjust society to fit neurodivergent individuals. We need to work with our differences, not against our differences and build a life that is meaningful for us.

Honouring All Forms Of Communication

We need to recognise there are multiple ways to communicate and spoken communication is not the superior or only way to communicate. Every person deserves access to communication.

We can honour all forms of communication by:

• providing neutral information on neuronormative communication
• identifying communication needs and preferences
• providing access to preferred communication methods
• teaching AAC as well as teaching parents, caregivers and individuals about AAC

Most importantly, neurodiversity affirming practice is about moving away from the pathology paradigm and instead, adopting the neurodiversity paradigm as our lens for understanding and supporting neurodivergent individuals.

In comparison, the neurodiversity paradigm views hearing voices and experiencing visions as a part of the diversity of being human and human experiences. While the pathology paradigm views hearing voices or experiencing visions as a distressing experience that must be treated or fixed, the neurodiversity paradigm doesn’t make that choice for individuals; it recognises and honours the experiences, meanings and choices of each individual.

This is important because there are many individuals who do not find their voices or visions distressing and there are many individuals who choose to live with their voices or visions. There are both first hand stories and studies that show how the association of distress with voices or visions varies within different cultures and for each individuals. Just look at the Hearing Voices Movement and the stories shared.

There needs to be a framework within therapy that honours the diversity of these experiences which is exactly what Neurodiversity Affirming Practice can provide.

Unfortunately, Neurodiversity Affirming Practice is a framework usually only applied to Autism, ADHD and learning differences but if we were to apply it to individuals who hear voices or experience visions, perhaps this is what it would look like:

We do not frame hearing voices or experiences visions as an inherently harmful or dangerous way of being but instead, we recognise it as an altered state or a different way of being that can be disabling or distressing.

We do not automatically assume the reason for these experiences is illness and instead, understand that there are multiple explanations for voices and visions.

We consider cultural meaning, context and experiences when making sense of hearing voices.

We respect an individual’s choice when it comes to medication without assuming someone lacks insight if they don’t want to use medication.

We do not assume hearing voices or experiencing visions is always distressing and instead, allow individuals to define what experiences are distressing for them as well as what functional or dysfunctional looks like for them.

We presume competence and respect their autonomy.

We recognise that ‘recovery’ doesn’t have to include getting rid of voices and only individuals get to define what recovery looks like for themselves

We do not impose our own beliefs on someone else’s experience and instead, seek to understand their own meanings and sense-making.

We support individuals in finding strategies and tools that support their well-being and we recognise the importance of community care and access to support and a support system.

Every neurodivergent individual deserves access to neurodiversity affirming care so I hope more mental health providers can make the paradigm shift and adopt Neurodiversity Affirming Practice.

And not just for Autistic people or ADHDers but also for individuals who hear voices or experience visions.

While I recognise I am not someone who hears voices or experiences visions, I am someone who thinks and writes a lot about Neurodiversity Affirming Practice so I recognise this is an emerging framework and I hope I have done this justice.

Consider this.

One particular executive functioning skill is working memory — the ability to hold different information in your head so you can remember things in order to get shit done like remembering the steps of a task or instructions you were told twenty minutes ago or what groceries to get off the top of your head.

You’ve got people who can remember every single step after they’ve read it.

You’ve got people who have trouble who can’t remember grocery lists unless it’s written down.

You’ve got people who have a working memory that’s quite fast so they can recall things quickly.

You’ve got people who have a working memory that needs more time to remember things.

Do some of them have working memory deficits or do all of them have a different working memory because every individual is different?

Let’s apply this to paying attention which is another executive functioning skill.

You’ve got some people who can pay attention for a long period of time and you’ve got some people who can only pay attention for a short period of time.

You’ve got some people who can switch their attention to another task super easily and you’ve got some people who find it difficult to switch their attention to another task.

Do some of them have attention deficits or do all of them pay attention differently?

This is neurodiversity — the idea that every single brain is different so if every single brain is different, there can be no “normal” brain.

If there is no such thing as a normal brain, we cannot have deficits because a deficit implies we are lacking something but if every brain is different and neurotypical folks aren’t the ideal brain, we can’t be lacking.

Just to be clear, I’m not saying we don’t experience disability, difficulties, struggles or challenges due to our executive functioning differences.

I’m just saying we do not have deficits because neurotypical people are not the benchmark for how people should function.

I wanted to talk about the term “hidden disabilities” or “invisible disabilities” because for me, I don’t really find the term accurate even though I recognise it’s helpful for public awareness.

Hidden disabilities or invisible disabilities is a term to refer to disabilities that are not visible or obvious. Some common hidden disabilities are Autism, ADHD and dyslexia, as well as physical disabilities like IBS, EDS, RA, POTS or Celiacs.

Here’s the thing.

I feel like “hidden disabilities” puts the onus on the disabled individual as if we are hiding our disabilities. I feel like the term “hidden disabilities” generalises certain disabilities.

There are plenty of people who are visibly Autistic or visibly ADHD — there’s nothing hidden about us and for those who are perhaps less visible, it’s because they’ve been taught to mask for safety and survival.

As someone with EDS, IBS and Rheumatoid Arthritis, even these are considered hidden disabilities but they really aren’t hidden or invisible.

I’m sure people notice when I’m escaping to the bathroom for the tenth time or I’m trying to get my shoulder back in after it slipped out of the place again. I’m sure people notice when I say no to particular foods when I’m invited to dinner and I’m sure people notice when I have to stay home for five days after a big weekend out. I’ve no doubt people notice when I’m wincing with every step and bend. They simply don’t associate these things with disability because my disability doesn’t look a certain way.

I use mobility aids on occasion and I’ve been offered priority lanes, I’ve been offered a seat while I wait, I’ve been seen as a disabled person. While this has its disadvantages when it comes to discrimination and more, there are also some upsides like having my disability acknowledged. When I don’t use my mobility aids, I’m taken less seriously as a disabled person — people make assumptions about me and overlook my needs. I think this shows that many people have this idea of what a disability looks like so when they don’t see their idea of a disabled person, they make assumptions.

It isn’t because our disabilities are hidden or invisible.

It isn’t even because people aren’t paying attention because they are.

If people weren’t paying attention, they wouldn’t tease or bully us, they wouldn’t question us or tell us to act more normal or to get over it or to stim less or to pay attention.

If people weren’t paying attention, they wouldn’t point out our differences or point out when we’re running late or why we’re limping or why we’re leaving early or why we’re saying no.

Oh yes, people are paying attention but most of the time, they associate these things with personal failings or flaws rather than a part of our disability.

Our disabilities are not hidden or invisible.

Our disabilities are misunderstood, denied and ignored by society.

I feel like instead of using hidden disabilities to create more visibility and awareness, we should be educating society on what it means to be disabled and challenging people’s assumptions around disabilities.

Are our disabilities hidden or are people ignoring our needs and challenges?

Are our disabilities hidden or are people making assumptions based on what they observe?

Are our disabilities hidden or do people have a lack of understanding of disabilities?

Our disabilities aren’t hiding.

Our disabilities are quite visible to us.

Our disabilities are quite visible to the people around us if they just listen to us.

Evidence Based Practice is the integration of best research evidence, clinical expertise and the client’s circumstances, preferences and values and applying it to clinical decisions, practice and care. It’s about making sure that treatments, therapies, interventions, practices and clinical decisions are based on scientific evidence. As a disclaimer, I’m talking specifically about Evidence Based Practice when it comes to therapy, social work, psychology, psychiatry, speech therapy and the like.

I’m not a fan of Evidence Based Practice because research forms the foundation of practice and I don’t believe in relying on research when research is often flawed, full of biases and replicates white supremacy, ableism, racism and more. There are a number of limitations when it comes to Evidence Based Practice and I want to briefly share a few of them.

Evidence Based Practice is fueled by capitalism.

Evidence based practice relies on evidence that is already there which doesn’t account for evidence that isn’t available yet or hasn’t been studied yet. This is because what gets researched and who gets researched all depends on who is funding the research.

Evidence Based Practice results in providers and clinicians prioritising research over lived experience.

There are so many examples and stories where individuals have been gaslighted, denied or treated horribly because providers and clinicians prioritise research over lived experience. Since research is viewed as the be-all-end-all when it comes to making decisions, lived experience is ignored or seen as inferior because research knows better. And this is a problem because research isn’t superior especially when research excludes lived experience and excludes communities.

Evidence based practice is hierarchical.

There’s an evidence hierarchy and this reinforces the silencing of lived experience by creating barriers to what research is seen as valid. While there are a few different versions of the evidence hierarchy, systematic reviews and randomised controlled trials (RCT) are usually always regarded as the best type of evidence.

RCTs are studies where one group of individuals receive an intervention while another group receives a different intervention or no intervention at all while systematic reviews are a well, review, of a bunch of research studies based on certain criteria. The problem is that systematic reviews are only as good as the research question and the available research so a lot of studies end up being excluded from systematic reviews because they may not meet the inclusion criteria. The problem with RCTs is that they are costly so they require financial support which means only certain research is funded. In addition to this, RCTs rely on controlling variables and this brings its own limitations and flaws. While there is research that is lived experience based, they are often given less value and weight because RCTs and systematic reviews are the gold standard.

Put simply, systematic reviews and RCTs are not always the best available evidence even though evidence based practice ranks them as such. As a result, many studies and research that may be more valuable or accurate are excluded or left out due to this hierarchy.

Evidence Based Practice excludes communities marginalised by society.

When capitalism controls what research is done as well as who is actually researched, certain communities remain excluded from research about them. If research doesn’t include certain communities, how on earth can something be best practice?

If research is conducted only on Autistic children, it isn’t best practice for Autistic adults.

If research is conducted only on white Autistic adults, it isn’t best practice for Autistic people of colour.

Evidence Based Practice continues to reinforce Western ways of knowing where scientific research is seen as superior. As a result,Indigenous and First Nations People’s knowledge and their way of knowing as well as any form of lived experience that exists outside of research are excluded from Evidence Based Practice. Just because it doesn’t exist within research doesn’t mean it doesn’t exist at all. Just because something isn’t confirmed through research doesn’t mean it isn’t true. We cannot deny how research has been used as a tool of oppression and marginalisation against so many communities.

In addition to this, the majority of research is conducted by individuals outside of the communities research is about. This means many researchers hold biases which end up reflected within research. This reinforces racism, ableism, sanism, transphobia and more. That’s not to say that there aren’t researchers with lived experience but they continue to be the minority; it’s something but it isn’t enough.

Until research is free from racism, ableism, sanism, transphobia and more and is truly led and designed by lived experience and the communities it is about, there will always be limitations. We genuinely need to think twice before placing evidence based research over lived experience and anecdotal evidence when research excludes communities, our stories, our experiences and our lived experience.

Lived Experience Informed Practice

We cannot rely solely on research so we must learn to prioritise lived experience and what communities are saying. Since Evidence Based Practice doesn’t actually make room for this or prioritises this, we need a new framework.

I believe that framework is Lived Experience Based Practice; a new process for making clinical decisions and supporting individuals. There are four components to Lived Experience Informed Practice.

Lived Experience

Just like Evidence Based Practice is based on research evidence, Lived Experience Informed Practice is based on lived experience. When it comes to Lived Experience Informed Practice, lived experience is the foundation of the practice and I believe this is an important distinction because EBP doesn’t necessarily prioritise lived experience that exists outside of research.

When making clinical decisions, supporting individuals and ensuring we are using best practices, we must listen and learn from individuals with lived experience as well as seek both training and resources by individuals with lived experience. This is where we ask what the impacted communities are saying because after all, research can take decades to repeat what the communities have been saying for years.

Research and Clinical Evidence

Lived Experience Informed Practice does not ignore or exclude research and clinical evidence when it comes to informing our practice. We can draw on research and clinical evidence to inform our decision making and practice but our decisions and practice isn’t solely based on research evidence. In addition to this, we do not rank evidence on whether it was systematically reviewed or an RCT, we rank evidence on whether it reflects lived experience and the community it is intended for.

We ask ourselves:

• Who designed the questions the research is asking?
• Who is answering the questions the research is asking?
• Who is excluded from the research?
• What is the research actually measuring?

Think of it this way. Evidence Based Practice and Lived Experience Practice are both a recipe and within the EBP recipe, research evidence is a crucial ingredient while lived experience is an optional ingredient; some people use it and many people do not. On the other hand, within LEIP, lived experience is a crucial ingredient while research evidence is a preferred yet optional ingredient.

I don’t do a lot of cooking so apologies if this analogy isn’t entirely reflective of true recipes but think of research as corn starch and Lived Experience Informed Practice as a cake. If you need a tougher cake that will withstand a scrutiny, you would add some cornflower aka research. However, even without the cornflower, the cake is just as delicious; it’s still a great cake.

That’s why research is optional because lived experience can stand on its own, it’s valuable on its own, but sometimes research can add more backing and more credibility within a society that values research over lived experience.

Evidence Based Practice says that research evidence must be utilised but Lived Experience Informed Practice says that if the research evidence doesn’t align with lived experience or reflect what the community is actually saying, we don’t have to use research evidence. Put simply, lived experience is the evidence because we cannot expect research to study everything and represent the entirety of our lived experience and our different communities.

Client Values, Choices, Circumstances and Differences

Lived Experience Informed Practice doesn’t just consider, it prioritises the individual’s own differences, circumstances, choices and values when it comes to any form of decision making and informing what is actually best practice for someone. LEIP encourages us to ask who the research is for, who the research is about and who is the individual in front of us which is what brings us to the new pillar.

Intersectionality

Intersectionality is a crucial component of Lived Experience Informed Practice because most research is based on a small group of individuals where there is little consideration of other identities in regards to class, disability, gender, race and more. As a result, a lot of research evidence simply isn’t applicable for certain communities and groups and for many, it’s even harmful.

When we are supporting an individual and considering what is best practice, we must consider the individual in front of us. And we can only do this by recognising intersectionality and seeing the whole of the individual, not just one part of the individual. We must acknowledge and recognise each person’s multiple identities and how these identities impact their experiences.

I recognise this framework may not be perfect but I believe it’s a start. At least, a way for people to start challenging Evidence Based Practice and an opportunity to follow a new framework. I’ve doubt there are individuals who are already valuing lived experience over research evidence but there’s nothing wrong with putting a name to it and defining it. I want to finish this article with this:

Evidence Based Practice asks, what does the research say?

Lived Experience Informed Practice asks, what does lived experience say and what does the community say?

I know which answer I would trust more. Do you?