AOTA Recap- The Ethics of Neurodiversity Affirming and Trauma Responsive Care for Children
Yes. It’s been a while…
But, I’m so excited to be reporting back from an exhilarating weekend at the AOTA conference in Philadelphia where I got to hear some amazing presentations and connect with dear friends and colleagues from around the country! In this post, I’m re-capping the presentation I gave with two of my colleagues, keep reading, it was so good!
Neurodiversity & Trauma Responsive Care
I’m sitting at the airport on my way home from a lovely American OT Association conference (a whopping several thousand OT practitioners gathered together in Philadelphia this year) and my mind is buzzing with new ideas, questions, and potential projects.
I was lucky to be able to present with two dear colleagues, Ashley Wagner, OTD (St. Louis MI) and Normandy Rindahl, OTD (San Antonio, TX) about our shared passion area- The Ethical Responsibility of Trauma Responsive and Neurodiversity Informed Care in Pediatric OT Practice. This talk came together over the course of several conversations about the links we see in our practice between neurodivergence and post traumatic stress. We began to wonder to what degree the lines between the two were blurred or even if there is a line between them.
Madison Dewey, OTD, along with Dr. Wagner and Dr. Catherine Hoyt wrote an OT Practice article about this very topic. They define neurodivergent as a term “used to describe an individual whose brain structure or function differs from the majority” and that often applies to people with neurodevelopmental diagnoses such as autism and attention deficit hyperactivity disorder (ADHD). Because neurodivergence can be congenital or acquired, they, and I, are coming to understand developmental trauma or post traumatic stress as a form of neurodivergence, similar to autism or ADHD due to the brain-changing nature of early trauma.
When young children experience adversity such as sudden or unexplained loss of attachment figures, abuse, or neglect while lacking supportive, regulated, attuned adults to help them, they are at risk for developmental impacts from these experiences. Often these impacts, as we’ve discussed before, are in the areas of co-regulation, self-regulation, relationship and social performance. These impacts result from changes in systems such as the sensory integration system, the core regulatory networks, and attachment and relationship systems.
Neurodiversity Affirming Care
During our presentation, Dr. Rindahl spoke about neurodiversity affirming care as
“Intervention that views neurodiversity as naturally occurring and not the primary focus of intervention” (2025). Variations in neurotypes are natural in our human population and simply having a neurotype that differs from the “norm” is not reason alone for intervention. Dr. Rindhal spoke about the importance of intervention focusing on play & meaningful occupation, regardless of our own judgements of what those occupations are or what that play looks like.
For many Autistic children, play looks different from what we are taught in school to expect and, there’s often a push by therapists, either internally or externally, to force or coerce children to play in a way that’s more aligned with our expectations. A neurodiversity affirming stance guides our practice toward viewing our client’s play as valuable and meaningful, joining them and offering relationship without the expectation of conformity or masking- hiding parts of themselves to appear more neurotypical and thus be more included.
A central goal of neurodiversity affirming care is to foster positive self-identity and to create physical and emotional spaces where neurodivergent children and families can freely express themselves with the communication, activity, and interests that are meaningful to them. While this goal may sound obvious- why would a therapist not want this- we are learning so much from the Autistic and neurodiversity communities about how traditional therapy misses this mark, often in big bold ways. More on that to come!
Trauma Responsive Care
I spoke about trauma responsive care during our presentation and talked about the ways in which understanding the impact trauma can have on developing children and creating systems and practices that respond to the unique needs of children with developmental trauma is essential to making therapeutic progress. Trauma responsive care focuses on building safe and trusting relationships with children, regardless of how long that takes because we know that relationships are central to therapeutic growth. Within these relationships, therapists promote play in whatever form it takes and, over time, build key developmental skills such as sensory integration, co-regulation, self-regulation, and interpersonal skills.
Trauma-responsive care, importantly, seeks to not only understand and share information about how trauma impacts children and families but also actively seeks to avoid re-traumatization. This is a key connection point to neurodiversity affirming care.
Neurodiversity Affirming Care is Trauma Responsive…and Vice Versa
A major overlap between neurodiversity affirming care and trauma responsive care is that the populations of children who have experienced developmental trauma and neurodevelopmental diagnoses overlap. In our clinical practice, we see consistently that trauma changes the brain leading to neurodivergence and that neurodivergence, when not approached throughout childhood in an affirming manner, leads to high levels of stress, adversity and even trauma. The groups of people to whom NDA and TR care are targeted are almost one and the same.
What if we approached all children with neurodevelopmental diagnoses as having experienced high levels of stress and adversity while simultaneously treating all children who have experienced developmental trauma as though their brains have been deeply impacted by their experience and they are perfectly imperfect.
Instead of focusing treatment on increasing masking- hiding themselves and behaving in a way that is socially typical, we focused on building connection and felt safety.
An Ethical Case for Neurodiversity Affirming & Trauma Responsive Care
Dr. Wagner, who serves on AOTA’s ethics commission, spoke during our presentation about the ethical responsibility we have, as therapists, to provide neurodiversity affirming and trauma responsive care.
As OTs, we have a duty toward
Beneficence - demonstrating concern for the well-being and safety of our clients and families and taking action to support them
Nonmaleficence - refraining from actions that cause harm and ensuring that the benefits of treatment outweigh any physical and emotional risks
Autonomy - respecting the right of our client’s self-determination, privacy, confidentiality, and consent and providing treatment that aligns with with their views, values, and beliefs
Our basic thesis was that-when we practice the principles of NDA and TR care, we are inherently demonstrating concern for our clients well being and actively supporting it, we restrain from doing things with or to our clients that might harm them in the moment or in the long term, and we are respecting their right to determine their treatment course and engage in treatment that is confidential and tailored to their beliefs and values.
Further, if we choose to pursue treatment models or interventions that violate any of these ethical responsibilities, we are inherently not engaged in neurodiversity affirming or trauma responsive care. Interventions such as forcing children to make eye contact despite their negative response to it or coercing children engage in a scripted social interaction with behavioral reinforcers promote masking and conformity over felt safety and lead to relational ruptures that interfere with therapeutic growth.
Where do we go from here?
This was one of the most fun presentation experiences I’ve had, the collaboration was amazing and our audience was brilliant and so engaged despite the room being about 80 degrees! I’m looking forward to continuing this discussion and integrating more neurodiversity affirming thinking into my work here on the blog!
Resources & References
Most of this information came directly from our presentation at the 2025 AOTA Inspire Conference. Please feel free to reach out if you’d like to see our slides or get more information!
Check out Dr. Rindahl’s work here
Disclaimer
The information provided on this blog is for informational purposes only. It is not intended to assess, diagnose, treat, or prevent any medical or mental health conditions. The content shared on this site should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental health professional, or other qualified healthcare provider with any questions you may have regarding a medical or psychological condition. Never disregard professional advice or delay seeking it because of something you have read on this blog.
