Helping Neurodivergent Individuals Succeed in a Neurotypical World

Liliana Valvano, LMSW, spends her days bolstering the power of unique brains.

As an associate in Psychiatric Social Work with Columbia University's Lieber Recovery Clinic, Valvano works with neurodivergent clients, primarily autistic adults, helping them develop their strengths and talents and build rich and purposeful lives.  

Valvano has worked to create several therapy groups focused on developing a fuller understanding of gender, sexuality, and neurodiversity. She has also adapted preexisting therapeutic interventions, such as dialectical behavior therapy (DBT), for neurodivergent populations.   

Presently, mental health care and support options for autistic adults are extremely limited, an unfortunate reality Valvano hopes to change.   

“I became interested in the intersection of disability and LGBTQIA+ identities through my own lived experience as part of these communities,” Valvano says. “Having a disability, or being neurodivergent, is not an inherently tragic experience. Stigma, societal barriers, and systemic oppression are the real tragedies.”  

Valvano asserts that neurodivergent people have immense strengths that are often undermined in efforts to promote normalization. Her work focuses on helping neurodivergent people "unpack internalized stigma, harness their unique strengths, and build authentically meaningful lives."

Columbia Psychiatry News spoke with Valvano about the meaning of the term neurodiversity, the growing movement to shift mainstream views of neurodivergent identities, the intersection between LGBTQIA+ and neurodivergent populations, and the role social workers can play in helping neurodivergent individuals thrive.  

How is neurodiversity defined and where does the term originate?   

People may be familiar with the term biodiversity, which refers to the natural variance of life forms in a given habitat. Neurodiversity borrows from this idea to explain a similar concept: the natural variance of human brains. Some people are autistic, some people have dyslexia, some people have ADHD, and thus are what we conceptualize as ‘neurodivergent.’ Some people do not have any of these things and are what we conceptualize as ‘neurotypical’ We recognize that while all brains are different, some fall within a range that is considered normative or neurotypical, and some are outside of the normative bounds making them divergent, but not inherently disordered. The term ‘neurodiversity’ is credited to Judy Singer, an autistic sociologist who coined the term in her 1998 dissertation.   

 What makes a neurodiversity paradigm different from the medical models we are used to?    

The medical model conceptualizes neurodivergence as a series of deficits rather than unique qualities, placing the onus on the individual to be treated or cured, rather than on society to make space for those who are different. For example, autistic people may “stim,” engaging in various behaviors to get sensory stimulation, such as fidgeting, swaying, or humming. A medical model focuses on eliminating these behaviors, rather than understanding the autistic person’s inner world and advocating for a society that accepts those who present differently. Ultimately, the objective is to make the neurodivergent person blend in. The neurodiversity model embraces that a person’s divergences are worth celebrating and advocates for society to change to accommodate neurodivergent people, rather than asking neurodivergent people to change to accommodate society.    

Why was Asperger’s Disorder to describe high-functioning autism removed from the DSM in favor of Autism Spectrum Disorder? 

The term "Asperger's syndrome" was coined by Austrian pediatrician Hans Asperger in the 1940s to describe a subtype of autism characterized by higher-than-average intellectual ability and less substantial language difficulties compared to classic autism. However, in 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) merged Asperger's into the broader category of autism spectrum disorder (ASD). Research suggested that there was significant clinical overlap between Asperger's and other forms of autism, and criteria used to distinguish Asperger's syndrome from other autism spectrum disorders were not consistently applied across clinicians. Some argued that maintaining separate diagnostic labels for conditions like Asperger's perpetuated stigma and discrimination. By emphasizing the commonalities, the hope is to promote greater acceptance and understanding of individuals across the spectrum.  

There is also a darker reason for the push to eliminate the term. Historical research conducted by scholars such as Edith Sheffer has raised questions about Asperger's associations with the Nazi regime and his involvement in Nazi efforts to euthanize individuals with disabilities, including children. Asperger was a member of several organizations that supported Nazi ideology, and he collaborated with the regime's policies regarding individuals with disabilities. He referred children to the Am Spiegelgrund clinic, where many of them with severe mental disabilities were killed.

How do neurodivergent and LGBTQIA+ experiences overlap?

 Significant emerging research has demonstrated a higher rate of trans and gender-expansive identification among autistic people. While this might seem surprising to some, autistic people are often unsurprised by this. Gender can be understood as a series of roles and social cues; for example, “women sit like this; boys play with that.” Missing social cues is a categorizing factor of autism, so it makes sense that gender-related social cues may be unidentifiable to autistic people. Autistic people may also have sensory preferences that result in a more gender-ambiguous presentation, such as wearing loose, softer clothing or having shorter hair. Many of my clients describe a feeling of being “gender ambivalent”—they just simply do not care to keep up with what feels like a game of complex cues to which they never received the rules. Others may have special interests (a term that refers to the extremely passionate interests autistic people develop) that have a gendered connotation, such as makeup, or collecting model planes. These interests can constitute a large part of an autistic person’s identity and may impact gender presentation. Lastly, autistic people are often critical, logical thinkers and may be less apt to accept social norms that are uncomfortable simply because “that is the way things are done.” Autistic people have even conceptualized the terms “auti-gender” and “neuroqueer” to explain the way that their experiences of autism and gender are completely intertwined.  

How did your education prepare you for your career?

My education in ethnic studies equipped me with a strong, intersectional social justice lens I carried forward into my clinical education in social work. However, I was disappointed to find that in graduate school, I was presented with a depiction of autism as a pathology in need of treatment. This did not align with the complex narratives of disability I was familiar with. Autistic self-advocates made clear that treatment and assimilation were not their goals. Instead, autistic adults sought to be accepted, supported, and valued for their distinct capabilities. This desire was comparable to that of the LGBTQIA+ community—to be celebrated rather than stigmatized. Neurodiversity education needs to be a central part of clinical curriculums. Many clinicians are not aware of the signs of autism in adults and do not know how to support the autistic adults they see. Suppose they received any education in grad school. In that case, it is typically from a medical or child development model, so clinicians may be somewhat prepared to identify signs of autism in a 2-year-old but have little to no knowledge of what autism looks like through the lifespan.

Further, they may have internalized biased perceptions that are not challenged in their education. Clinicians may perceive autistic people as incapable of living full lives, working in certain industries, having sexual or romantic relationships, being LGBTQIA+—or believe that autistic people have to learn how to social mask or not stim to be successful in the world. Society is rapidly evolving regarding neurodiversity acceptance, and many workplaces are open to welcoming and supporting autistic folks. There are even autistic dating apps! Life is not as limited for autistic people as it was even just 10 years ago.    

How does a neurodiversity paradigm serve the well-being of the community?   

Often I speak to parents, clients, and other clinicians they ask, “What benefit could an autism diagnosis have?" Many of the clients I see describe feeling like an alien and internalizing a deep sense of self-hatred for being so “weird.” An autism diagnosis and a neurodiversity paradigm tell the individual there is nothing wrong with you; you are, in fact, different, but there are others like you, and there is a thriving community waiting for you. The neurodiversity paradigm offers a further alternative–you are perfectly fine the way you are, your differences come with strengths, and with enough resilience and advocacy, you can find your place in the world, even if that requires extra support. 

— Liliana Valvano, LMSW, contributed to the authorship of this article.