Supporting Neurodiverse Staff, Colleagues and Patients

Editor’s note: This text-based course is an edited transcript of the webinar, Supporting Neurodiverse Staff, Colleagues and Patients, presented by Gabrielle Davis, MPH, MA, RRT, RRT-ACCS, RRT-NPS, TTS, LPC, NCC, FAARC. 

It is recommended that you download the course handout to supplement this text format.

Learning Outcomes

• Recognize and support neurodivergent patients, while gaining a deeper understanding of neurodiversity and its implications in healthcare
• Identify and apply strategies to dismantle barriers that limit equitable access to care for neurodivergent individuals
• Discuss the skills to implement affirming and inclusive care practices, ensuring that neurodivergent patients receive respectful and equitable respiratory care

Why This Topic? Why Now?

I chose to present this topic for several reasons. About a year ago, I attended a national conference where an educator—a college professor—asked the presenter a question that has stayed with me ever since. While I do not recall the specific topic the presenter was discussing, the professor’s question stood out: “What do we do with students who have IEPs? Should they not be discouraged from working in healthcare? Should they even be allowed to care for patients?”

Hearing those words deeply angered me. The question implied that individuals with Individualized Education Programs (IEPs) or other accommodations were inherently unfit to pursue careers in healthcare. Unfortunately, it was the final question of the session, and although I raised my hand to respond, there was no time for me to speak. That moment stayed with me, fueling my decision to address this topic—not just out of frustration but because it is an issue that demands attention.

I am someone who has ADHD, a condition I was diagnosed with later in life. Despite the challenges it presents, I have been able to achieve incredible things in my career and personal life. The idea that someone’s need for accommodations or support automatically disqualifies them from providing exceptional patient care is unfair and untrue. It perpetuates harmful stereotypes and undermines the potential of countless capable individuals.

It is essential to challenge these misconceptions and remind others that success in healthcare—or any field—is not defined by the absence of challenges. People with IEPs, ADHD, mental health conditions, or other needs for assistance prove every day that they are not only capable but can thrive in their chosen professions. By acknowledging this, we create a more inclusive and supportive environment for everyone.

Community-Powered Presentation

This presentation is community-powered, meaning it was shaped by input from individuals with lived experience related to this topic. While literature and evidence-based research are invaluable, they often exclude the voices of people from minoritized groups—particularly those with certain conditions—due to longstanding mistrust, including medical mistrust. By incorporating insights from the community, this presentation highlights perspectives that might otherwise be overlooked.

One key idea to consider as we explore this topic is that diagnosis itself is a privilege—one that not everyone has access to. For example, I am 42 years old and was only diagnosed with ADHD in 2017. My diagnosis came not through seeking medical help but because a teacher in my mental health therapy program pulled me aside and raised the possibility. Despite having access to insurance and other resources throughout my life, no one had ever brought it up before. It took someone paying close attention to connect the dots.

When I received my diagnosis, everything about my past suddenly made sense—the difficulties I had focusing on one thing, my need for extra time to complete tasks, and my tendency to juggle multiple things at once. ADHD manifests in diverse ways, and having a diagnosis provides clarity. However, not everyone is fortunate enough to have the opportunity to gain that clarity, which underscores why diagnosis is a privilege.

Another critical point is that language and science are constantly evolving. It is essential to stay informed about how terms and concepts shift over time. For instance, ongoing discussions in the neurodiversity community address the distinction between “neurodivergent” and “neurodiversity.” Some individuals do not wish to be labeled “neurodivergent,” even if science might categorize them differently. In these cases, it is vital to honor the language someone uses to describe themselves. It is not our role to correct or challenge how a person chooses to identify.

Lastly, this presentation is an educational offering, not a formal training. I use the term “educational offering” intentionally, as training often implies completion or mastery. In past presentations, I have had participants ask, “When do I get my certificate?” CEUs are valuable—clearly, or I would not be here—but it is important to understand that this is not the final destination. Instead, consider this one step on a much longer educational journey.

Let’s Talk Terms!

Let’s begin by defining some key terms, starting with neurodiversity. I say a definition because if you search for the term online, you will find countless interpretations. The one I use most often, particularly when speaking to those new to the concept, is straightforward: neurodiversity refers to the natural diversity of human brains. It emphasizes that every brain is unique. Notably, this definition does not mention diagnoses, which is intentional.

This distinction is important because when people hear terms like neurodiversity or neurodivergent, their understanding often defaults to ADHD or autism. While these are prominent examples, they are only part of the broader neurodivergent spectrum. The term encompasses a wide range of conditions, including dyslexia, dyspraxia, Tourette’s syndrome, and even mental health conditions such as bipolar disorder or generalized anxiety disorder. Each of these conditions can manifest differently from person to person. For instance, with ADHD, one individual might struggle with maintaining focus, while another thrives on multitasking but struggles with hyperfocus or emotional regulation.

One important concept within neurodiversity is acquired neurodiversity, which refers to changes in the brain resulting from life experiences, particularly trauma. Research indicates that approximately 70% of Americans have experienced some form of trauma, which can leave lasting effects on the brain. A commonly recognized example is post-traumatic stress disorder (PTSD), often associated with combat veterans. However, trauma affects people in many other ways and can stem from everyday experiences such as accidents, abuse, or even chronic stress.

Let me share a personal story to illustrate this. When I was 17, I had my first car, a 1988 Cougar. One day, while driving to my grandmother’s house, I stopped at an intersection to turn left. I noticed the car in front of me had children playing in the backseat—this was 1999, and seatbelt usage was not as rigorously enforced. I smiled at their antics, but then I glanced in my rearview mirror and saw a car speeding toward me. My immediate reaction was to press both feet on the brake to avoid being pushed into the car ahead. The impact spun my car into the opposite lane, but thankfully, I was not seriously hurt. However, the experience left a deep impression. For years, I avoided using my rearview mirror, angling it downward to avoid looking into it. I relied solely on my side mirrors, a habit born from that single traumatic moment.

Years later, in 2014, I was T-boned by another driver who ran a red light. Again, I was not seriously injured, but the trauma compounded my anxiety around driving. Now, whenever a car merges into the lane next to mine on the freeway, I instinctively assume it will swerve into my lane. This has led to unnecessary swerving on my part, even when no real danger exists. These experiences have made driving an activity I dread, not because of the act itself but because of how my brain now processes potential threats.

Trauma does not just affect conscious memories—it can also leave subconscious imprints. For example, I once worked with a client who had a debilitating fear of dogs. When I asked if she had ever been bitten or chased, she could not recall any such incident. However, after speaking with her family, she discovered she had been bitten on the foot at eight months old. She had no memory of the event, but her body retained the fear. This demonstrates how trauma, even when not consciously remembered, can shape our behaviors and responses.

This brings us back to the term neurodivergent. It stands in contrast to neurotypical, a word that has sparked debate. Referring to someone as neurotypical implies there’s a “normal” brain, but as we know, “normal” is a subjective and often unhelpful concept. As the saying goes, “Normal is just a setting on a washing machine.” Every brain is different, and these differences make humanity diverse and innovative.

Language within the neurodiversity movement continues to evolve. For instance, some people prefer the term neuroexpansive over neurodivergent. A group of Black disabled women coined Neuroexpansive as a response to how neurodivergent has been weaponized against marginalized populations. It rejects the framing of neurodivergence as a deficit and highlights the expansive possibilities of diverse brain function. For example, people with ADHD might hear statements like, “You cannot be trusted with this task because you are too distracted,” or “We cannot hire you because you are not reliable.” These statements perpetuate ableism, and while discrimination is illegal, it still happens.

Other terms are more playful, like neurospicy or neurosassy. I love these terms and often use them to describe myself. They provide a lighthearted way to embrace one’s neurodivergent identity while challenging the stigma around it.

As language and science continue to evolve, it is important to stay informed. If you are in a leadership position in healthcare or any field, listen to your colleagues and staff. When you encounter new terminology, take the initiative to learn about it—Google is free, after all. Proactively understanding these terms fosters inclusivity and ensures that everyone feels seen and respected.

Potential Challenges: Students/Colleagues

• Pushing to ‘work faster/harder’ constantly
• Being late and scheduling (coming to work or completing work)
• Being narrow-focused in providing/receiving instructions
• Completing modules or writing/reading in a loud space or tons of commotion
• Forced to be a trainer although they never received training in the same role
• Insisting on eye contact
• Varying ways of ‘reporting’
• Using colloquialisms or ‘common’ phrases

One of the potential challenges in working with students or colleagues is the pressure to constantly work faster or harder—especially when expectations are not clearly communicated up front. For example, outside of the mental health care space, I once worked with grocers. During a discussion on neurodiversity, one of them asked, “What do I do if someone takes four hours to complete a task that should take two hours?” Naturally, my first question was, “Why should it take two hours?” After some back and forth, the answer was, “Because it always has.”

When I pressed further, I learned that no one had ever explicitly told the person how long the task should take or offered guidance on how to complete it efficiently. Instead, they were told to “work faster.” This highlights an important point: definitions and expectations vary from person to person. My version of “fast” might not match yours, so clarity is key.

This is especially important when onboarding students or new hires. For instance, if you are a program director or manager, you need to be specific about expectations right from the start. Job descriptions, for example, often use vague terms like “morning shift” or “night shift.” For someone like me, with experience in hospitals where a morning shift typically runs from 7:00 a.m. to 7:00 p.m., I might assume that is what you mean. What if your morning shift starts at 6:00 a.m.? To avoid confusion, provide precise details—write the exact start and end times.

Another area where specificity matters is task instructions. Most workplaces have established ways of doing things, but new hires will not automatically know them. Be open to explaining processes in detail and, when appropriate, asking for feedback: “Is there another way to approach this?” or “What do you think could work better?” Encouraging input not only fosters collaboration but can also lead to improved workflows.

The environment where people work and learn also plays a significant role. For example, I spent nearly two decades working in hospitals, from 2000 to 2017. Many of the mandatory modules—on topics like sexual harassment or fire safety—had to be completed in break rooms, often with conversations and other distractions in the background. For people who struggle with focus, this can be a huge barrier. Simple accommodations, like providing noise-canceling headphones or allowing people to complete modules at home, can make a big difference. Additionally, naming the challenge upfront—acknowledging that the environment might be loud and suggesting alternative quiet spaces like a library—shows consideration and inclusivity.

Another challenge arises when individuals are promoted into newly created roles without formal training. For example, when I worked, we did not always have specialized roles like respiratory therapy leads or specialists. Often, someone was promoted into a role that did not previously exist, meaning they had to define the position and its responsibilities as they went. This can be especially challenging when they are later tasked with training someone else in a role they essentially created from scratch. Offering support, mentorship, and clear guidance can help ease this transition.

Cultural and neurodiverse factors also need to be considered. For instance, some neurodiverse individuals may find maintaining eye contact difficult or uncomfortable. Additionally, cultural norms influence the appropriateness of eye contact. In some cultures, avoiding eye contact is a sign of respect, while in others, it may be interpreted differently. Rather than assuming constant eye contact is necessary, be flexible and open to different forms of communication.

Reporting styles are another area where variation is common. In my own experience, the way I gave reports evolved. When I was new to the field, my reports were lengthy and detailed—sometimes overly so. As I gained experience, my reports became shorter and more concise while still covering the essentials. That said, even experienced colleagues might prefer a longer, more detailed approach. Accepting these variations ensures that everyone’s communication style is respected.

Finally, be mindful of using colloquialisms or common phrases. While these expressions might feel natural to you, they may not be universally understood. For instance, during a recent presentation, I learned that some of the phrases I commonly use did not make sense to others in the room. This reminds us that language can be exclusionary if we’re not careful. When in doubt, take the time to clarify your meaning or avoid overly specific idioms altogether.

By fostering clear communication, offering accommodations, and remaining open to diverse ways of thinking and working, we can create environments where everyone—regardless of their background or neurodiversity—can thrive.

Common Colloquialisms

A few years ago, I encountered a phrase I had never heard before: from soup to nuts. I was attending a webinar, and the presenter casually mentioned it in her talk. Immediately, my brain fixated on the unfamiliar phrase, and I felt compelled to figure out what it meant. I paused my attention on the presentation and opened Google to research it. As I went down the rabbit hole of definitions and origins, I realized I had missed about ten minutes of the webinar content.

Once I discovered the meaning—from soup to nuts refers to a complete process from start to finish, like a meal that begins with soup and ends with nuts for dessert—I found myself distracted by another question: Who actually eats nuts for dessert? So, I dived even deeper into irrelevant research while the webinar continued without me.

This experience highlights an important point about language and the unintended effects of using idiomatic expressions that might not be universally understood. Phrases like these can confuse listeners, pull them out of the moment, and detract from the message you are trying to convey.

Let’s look at some other examples of commonly used expressions and the potential issues they pose:

1. “Pounded into my brain” or “Don’t throw me under the bus”
   • Taken literally, these phrases sound harsh or even violent. While most people understand them metaphorically, their intensity can still be jarring, especially for individuals unfamiliar with the idiomatic usage.
2. “Let’s call a spade a spade”
   • This phrase has a troubling history rooted in racism, specifically targeting Black people. For a long time, I used this phrase without knowing its origins. It was not until someone pointed it out to me that I learned about its racist undertones. That realization led me to remove it from my vocabulary.
3. “It’s crazy in here”
   • The word crazy has been weaponized against individuals with mental health conditions, often used to dismiss or belittle their experiences. For me, removing this word from my everyday language has been one of the most challenging adjustments. It is commonly used in American English, and replacing it takes conscious effort. Over time, I have started using alternatives like wild or chaotic, but the habit did not change overnight.

These examples illustrate how language, even when used innocently, can carry unintended connotations or create confusion. For some phrases, the issue lies in their violent or extreme imagery. For others, the problem stems from their historical or cultural baggage. Still others, like crazy, perpetuate stigmas that we may not even realize we’re reinforcing.

How to Approach Language More Thoughtfully

The key is to question everything. Many of us grew up hearing and using phrases without knowing their origins or implications. Taking the time to research and reflect on the language we use can help us communicate more inclusively and respectfully. For instance:

• Be mindful of context. Consider whether the phrases you use might confuse or alienate your audience. If there’s even a small chance, opt for clearer, more direct language.
• Educate yourself. If you encounter a new or unfamiliar phrase, take a moment to look up its origins. This can be eye-opening, as I learned with call a spade a spade.
• Replace problematic terms. As I did with crazy, find alternatives that convey your intended meaning without perpetuating harm or stigma.

Adapting your language is a gradual process, but it is a worthwhile effort that promotes understanding and inclusivity. By questioning what we say and making conscious choices about the words we use, we can ensure that our communication uplifts rather than alienates us.

Considerations: Training-Employees/Students

When it comes to employees and students, one key consideration is whether the training process is standardized across the board. Most organizations have protocols, policies, or procedures in place for training—somewhere, someone has written them down. However, when it comes time to implement that training, there’s often a disconnect. Trainers typically teach in two ways: the right way, as outlined in the procedure, and their way, which reflects their personal habits or preferences. While this might seem harmless, it can create inconsistencies and confusion for trainees.

Personalizing the Training Process

It is worth asking: Can we adapt training to better suit individual learning styles? For example, on a new employee’s first day, you could ask how they best learn—whether through hands-on practice, visual aids, or written instructions. While it might not always be possible to fully accommodate their preferences, simply asking the question has value. It not only demonstrates that their needs are being considered but also allows them to mentally prepare to adapt if necessary. Furthermore, it provides insight for future training processes, helping you refine methods for the next employee.

Are Trainers Equipped to Train?

An often-overlooked aspect of the training process is whether trainers themselves have been adequately prepared. Training is more than teaching someone how to perform a task—it’s an interpersonal skill. Effective trainers know how to:

• Make others feel welcomed and included. A sense of belonging can significantly impact a trainee’s confidence and willingness to learn.
• Ask meaningful questions. Questions that encourage reflection or clarify understanding are essential in fostering growth.
• Receive and incorporate feedback. Training is not a one-way street; it is a dialogue. Trainers should be open to adjusting their methods based on input from their trainees.

Unfortunately, many trainers are thrust into their roles without receiving any training on how to train. This oversight can lead to awkward interactions or, worse, a trainee feeling unwelcome or unsupported.

Advance Preparation for Trainers

Another frequent issue arises when trainers aren’t given advance notice of their role. Imagine walking into work and being assigned a trainee without any prior warning. This not only catches the trainer off guard but also risks creating a suboptimal learning experience for the trainee. To address this, consider the following:

• Notify trainers in advance. For example, if there’s a position open, inform the trainer ahead of time: “We’re hiring for this role, and you will be responsible for training the new hire.” This allows them to mentally prepare and, if necessary, review the procedures they’ll be teaching.
• Identify backup trainers. Have a designated backup who can step in if the primary trainer is unavailable. Notify both trainers during the hiring process so they’re ready to fulfill their roles when the time comes.
• Ensure trainers volunteer for the role. In healthcare, it is common for people to be “voluntold” to train. While this can fill immediate gaps, it misses the opportunity to engage individuals who are genuinely interested in or suited for the role. By actively seeking out volunteers, you create a pool of trainers who are motivated and prepared to teach.

The Right People in the Right Roles

While there are people who excel at training, it is equally important to recognize that not everyone is suited for the role. Some individuals lack the interpersonal skills or patience required to guide others effectively. On the other hand, there are often untapped individuals who would thrive in a training role if given the chance. Actively engaging staff members and encouraging interest in training can expand the pool of qualified trainers while avoiding burnout among the usual go-to individuals.

Considerations: Patients

Considerations for Patient Communication and Consent

Building trust and rapport with patients starts with asking for consent—even for seemingly small actions. For instance, when approaching a patient’s room, consider saying, “Hi, I’m knocking at the door and standing in the doorway. Is it okay if I come in?” This simple request immediately establishes respect for their personal space and autonomy, setting a positive tone for the interaction. Asking for consent in these moments reinforces the idea that the patient is an active participant in their care, not just a passive recipient.

Encouraging Understanding Without Questioning

When explaining information to a patient, it is helpful to shift from yes/no questions about understanding to open-ended or declarative statements that encourage engagement. Instead of asking, “Do you understand?” (which might elicit a hesitant or automatic “yes”), try saying:

• “Please stop me if you have questions or need clarification.”
• “Let me know if I’m going too fast, and I’ll slow down.”
• “If something is not clear, feel free to ask me now, or you can let your nurse know, and they can reach out to me later.”

These statements remove the pressure of admitting confusion while still inviting dialogue. They empower the patient to take control of their learning process, making the conversation feel more collaborative.

Requesting Consent for Accompanied Visits

If you are entering a patient’s room with others—such as a student or another healthcare professional—always ask for consent. For example:

• “Is it okay if I come in? I also have a student with me who’s observing today.”

This approach respects the patient’s right to control who is present during their care. It contrasts with statements like, “We’re here, and this is my student,” which assume consent and may make the patient feel overlooked or pressured. Requesting consent in these situations protects both the patient’s comfort and the student's learning environment.

Including Family Without Shifting Focus

Family involvement in care can be valuable, but it is critical not to shift the spotlight away from the patient. This is particularly important when working with individuals with autism or mental health conditions, as it is not uncommon for providers to direct communication toward family members instead of the patient. For example:

• Rather than asking a caregiver, “What do you think is going on?” address the patient directly: “How are you feeling today?” or “Can you tell me what’s been going on?”
• You can include family members with statements like, “Let’s make sure we’re all on the same page about the care plan,” while keeping the patient at the center of the conversation.

This ensures the patient feels seen and respected, regardless of their condition, while valuing the family’s input as a secondary perspective.

Repeating Information in Different Ways

Patients may not always process information the first time it is presented—especially in stressful or unfamiliar settings. To support understanding:

• Use varied phrasing when repeating information. For example, if explaining a treatment plan, you might say, “This medication will help with your pain,” and later add, “The goal of this medication is to make you more comfortable while we work on your recovery.”
• Check in periodically: “Is this making sense so far?” or “Would you like me to go over anything again?”
• Provide written instructions or visual aids when possible, so patients and their families have something to refer back to after the conversation.

Always prioritize asking for consent, even for small actions such as entering a room or bringing additional people, like students or other staff members, into the space. These seemingly minor gestures build trust, respect the patient’s autonomy, and set a positive tone for the interaction. When explaining information, shift from yes/no questions to open-ended or declarative statements that encourage questions and engagement. This approach fosters better understanding and empowers patients to participate in their care actively.

Ensure the patient remains the central focus of all interactions, even when family members are present. While family input can be valuable, directing communication primarily toward the patient reinforces their agency and dignity, regardless of their condition. Additionally, consider repeating information multiple times and in different ways. This helps reinforce understanding, especially in stressful or unfamiliar situations. Pair verbal explanations with written instructions or visual aids whenever possible, giving patients and families a resource to revisit later. By incorporating these strategies, healthcare professionals can strengthen rapport, enhance patient-centered care, and contribute to better outcomes.

Non-Verbal Cues

Recognizing and Responding to Nonverbal Cues

Effective communication goes beyond words; nonverbal cues play a critical role in understanding and connection. If someone is nonverbal or struggles to articulate their thoughts, it is important to adapt your approach. For example, if you notice signs of discomfort or confusion, avoid pointing it out directly with statements like, “It seems like you do not understand.” Instead, rephrase your explanation or present the information in a different way. This allows the individual to remain in the loop without feeling singled out or embarrassed.

Pay close attention to nonverbal cues, as they often indicate whether someone is engaged or disconnected. Signs that you may have lost their attention or created discomfort include:

• Body language: Crossed arms, shifting in place, leaning away, or creating physical distance are all indicators that the person is disengaged or uneasy.
• Facial expressions: Frowning, pursed lips, raised eyebrows, eye rolls, or a shaking head can signal confusion, disagreement, or discomfort.
• Gestures: Fidgeting, tapping, or other closed-off gestures (such as clenching hands in pockets) may indicate frustration or discomfort.
• Eye Contact: Avoiding or limiting eye contact (if eye contact existed previously) may indicate hesitation or discomfort. Eye contact is particularly telling if it changes suddenly—though remember that cultural norms around eye contact vary.
• Tone of voice: A person’s tone can shift dramatically if they’re disengaged. Clear, steady speech may give way to mumbling, quieter responses, or even silence.

Understanding Minimal Encouragers

Minimal encouragers are subtle but essential nonverbal cues that show someone you are listening and engaged. These might include nodding, maintaining eye contact, or offering brief verbal affirmations like “Uh-huh” or “I see.” When these encouragers disappear—or are absent from the beginning—it could indicate that the person feels unheard, unvalued, or disconnected.

Tailoring Your Response

If you notice any of these cues, it is crucial to adjust your approach to bring the person back into the conversation. Here are some strategies:

• Rephrase and revisit: If you suspect they did not understand something, restate it in a different way. Instead of saying, “Let me explain that differently because I think you did not get it,” try, “Here’s another way to think about it,” or “Let’s go over this again from another angle.”
• Acknowledge and invite feedback: If you are unsure whether they’re following along, invite them to share: “Am I covering everything you need?” or “Did I miss something important?” This approach fosters collaboration and ensures they feel heard.
• Pay attention to their listening style: Some individuals might demonstrate understanding by maintaining prolonged eye contact, which can feel intense for some. If this makes you uncomfortable, address it gently: “I want to make sure I’m explaining things clearly—let me know if I missed anything.” This shifts the focus back to the conversation and reassures them of your engagement.

The Importance of Adapting

Everyone interacts with communication differently, shaped by their experiences, culture, and comfort level. By remaining attentive to nonverbal cues, adjusting your communication style, and inviting dialogue, you can create a more inclusive and understanding environment. These small but intentional efforts help ensure that both parties feel connected, respected, and aligned.

Considerations: ADA

Other Considerations: The ADA and Neurodiversity

it is important to note that the Americans with Disabilities Act (ADA) has not been updated since 2008 to reflect a broader understanding of neurodiversity. This lack of modernization is deeply problematic because the current framework primarily focuses on physical disabilities or accommodations like additional time for tasks. Neurodivergent conditions, which may require less conventional accommodations, often fall into a gray area within the ADA’s guidelines.

When we talk about reasonable accommodations, the term itself can be contentious. What is considered "reasonable" if the accommodation is not explicitly addressed by the ADA? This gap creates ambiguity for both employees requesting support and employers attempting to provide it.

Accommodations That Benefit Everyone

An important point to recognize is that accommodations designed for neurodivergent individuals often end up benefiting others as well. For example, I recently worked with an organization where an employee requested adjustments for light sensitivity. While replacing the lighting was not feasible, the company provided inexpensive, reusable tinted glasses instead. These glasses cost less than $2 each and ended up being useful for more than just the original requester.

This principle of universal benefit extends to many accommodations. Consider automatic doors: they were initially designed to help individuals using wheelchairs, but they’ve proven helpful for countless others. Parents juggling strollers and young children, shoppers carrying heavy bags, and older adults who struggle to open heavy doors all benefit from this innovation.

The same can be said for elevators in hospitals. Before elevators, staircases were the only option, creating significant barriers for individuals with mobility challenges. Today, elevators are a standard feature in nearly every multi-story building, benefiting people of all abilities.

Shifting the Lens: Equity vs. Equality

When thinking about accommodations, it is essential to approach them through an equity lens rather than an equality lens. Equality implies providing the same resources to everyone, while equity focuses on giving people what they specifically need to succeed. For neurodivergent individuals, this might mean personalized solutions that acknowledge their unique challenges.

it is also critical to acknowledge that not all accommodations are feasible. There may be instances where you have to say, “I’m sorry, we are unable to provide that accommodation right now.” This does not mean you have failed—it’s a reality of balancing resources and logistics. In these situations, it is important to give yourself grace. You cannot solve every issue, and recognizing your limits is part of creating a sustainable and thoughtful approach to accommodations.

The ADA’s outdated framework for neurodiversity highlights the need for broader societal and organizational efforts to address the unique needs of neurodivergent individuals. While not all accommodations are possible, many—such as inexpensive solutions or universally beneficial changes—are both doable and impactful. By thinking creatively and approaching these issues with an equity mindset, we can create environments that not only support individuals but also benefit entire communities.

Tips to Support

Social Etiquette and Creating Inclusive Workplaces

Understanding and fostering social etiquette in the workplace and in educational settings is vital for building an inclusive environment. Throughout my career, I have worked in diverse locations, including Detroit, Illinois, and Idaho. Moving to Idaho, however, felt like stepping into a different country—it was entirely unfamiliar. One notable experience stands out from my time in the ICU there.

Every day at 3 p.m., all the respiratory therapists would seemingly disappear. For months, I could not figure out where they went. As the only person in my department who looked like me, I hesitated to ask non-job-related questions. Eventually, I discovered that everyone was taking a collective snack break. While this was a normal routine for them, no one had thought to inform me or include me. It was not malicious—it was simply overlooked because it was ingrained in their culture.

This experience taught me the importance of explicitly sharing workplace norms, especially with new employees or students. Overlooking these small yet impactful social customs can unintentionally alienate others. For someone else, this situation could have led to feelings of not being liked or welcomed. By fostering open communication about workplace and social etiquette, you help others feel included and valued.

Addressing Stigma and Creating Safer Spaces

Many individuals, particularly those with neurodiverse conditions, hesitate to disclose their needs due to stigma. it is not required for anyone to share such personal details, but creating a safer space—a term I prefer over “safe space,” as true safety can only be governed individually—can encourage openness.

In my current job, I work on a team of five, and it was the quickest I have ever felt comfortable sharing my needs. Usually, it takes me six to nine months to open up about having ADHD and how it impacts my work. With this team, I felt safe enough to share within weeks. Their response was simple yet effective: “Okay. What do you need? How can we help?”

I explained that I struggle with abbreviations on video calls and meetings and that taking notes while leading a meeting or attending a webinar is difficult for me. They accommodated me by providing a pre-existing list of common abbreviations and even sending me Zoom messages in real-time with explanations when new ones came up. These accommodations were easy for them to implement and immensely helpful for me. Importantly, these changes weren’t formalized under the ADA—they were born out of an environment where I felt supported enough to ask for what I needed.

Understanding Different Definitions of Safety

Safety is a deeply personal concept that varies for each individual. For example, when I moved from Chicago to Idaho, many people commented, “I bet you are glad to be out of there.” For me, however, Idaho did not feel like a safe space. Safety, to me, meant being in a familiar environment surrounded by people who understood and supported me. Others may define safety differently, especially neurodiverse individuals, who may feel safest near those who have previously offered them understanding and support.

Providing advance notice about changes can also create a sense of safety. Notifying staff about upcoming fire drills, construction, or changes to routine helps them prepare physically and mentally. In healthcare, where such notice is not always possible, providing logic behind changes can help. If someone understands why something is happening, they may be more likely to accept and adapt to it.

Avoiding Assumptions

It is important not to make assumptions about people’s needs or goals. For instance, while encouraging someone to apply for a leadership role might come from a good place, it may not align with their aspirations. Some people find fulfillment in their current roles and do not seek additional responsibilities, and that’s perfectly valid. Share your observations and let them decide; do not push them into something they’re not ready for.

Similarly, avoid assumptions about what accommodations someone might need. Instead, foster open communication and allow them to share their preferences. Even simple accommodations, like addressing light sensitivity with inexpensive glasses, can make a significant difference.

Avoiding Sarcasm and Euphemisms

Lastly, be mindful of how sarcasm and euphemisms might be interpreted, especially by neurodiverse individuals or those unfamiliar with certain cultural norms. Sarcasm, while a common communication style, can be confusing or even hurtful if taken literally. For example, phrases like “That’s just great” in a sarcastic tone might be misunderstood. While avoiding sarcasm entirely can be challenging—especially for those who use it frequently—adopting clearer, more direct language fosters better understanding and connection.

Creating inclusive environments requires attention to both overt and subtle dynamics. From sharing workplace norms to fostering safer spaces and avoiding assumptions, these efforts build trust, encourage participation, and promote equity. By considering the varied needs and experiences of colleagues, staff, and students, we can work toward a culture where everyone feels valued and supported.

Common Euphemisms

The Importance of Direct and Thoughtful Language

Language carries weight, and the phrases we use—even those that seem harmless or commonplace—can have unintended consequences. Being direct and mindful of the words we choose not only reduces confusion but also helps avoid causing unintended harm.

Direct Language vs. Euphemisms

When discussing sensitive topics, it is important to prioritize clarity. For example:

• “They passed away” vs. “They died.” While "passed away" is often used to soften the reality of death, being direct by saying “they died” leaves less room for misinterpretation.
• “He is between jobs” vs. “He is unemployed.” The phrase “between jobs” can obscure the reality of unemployment, which may unintentionally downplay someone's situation. Being straightforward acknowledges their experience without unnecessary ambiguity.
• “She is feeling under the weather” vs. “She is sick.” While phrases like "under the weather" are commonly understood, their literal interpretation can spark confusion. A 19-year-old once pointed out to me, “If you think about it, everything is under the weather.” Technically, they’re not wrong, but this example highlights how being direct avoids unnecessary misinterpretations.

Phrases with Harmful Histories

Many common expressions have origins or implications that can be hurtful or harmful. For instance:

• “I’m gassed.” This phrase, used to express exhaustion, was pointed out in one of my conversations as having ties to the Holocaust. While not everyone may associate the phrase with this context, it is worth considering its potential impact.
• “Gone a bit baddie” or “That’s bonkers.” These terms, like "crazy," have historically been used to marginalize or demean people with mental health challenges. Even when used casually, they can reinforce harmful stereotypes or stigmas.

Recognizing Puzzled Reactions

Sometimes, people’s body language or expressions can indicate confusion or discomfort with a phrase you have used. If you notice puzzled looks or hesitation, take the opportunity to clarify. For example:

• If someone looks confused after hearing “He is between jobs,” you can follow up with, “I mean, he’s currently unemployed.”
• If you use a phrase with negative connotations and notice a reaction, acknowledge it: “I realize that phrase might not be the best choice—let me explain more clearly.”

Avoiding Harmful Expressions

Even phrases spoken lightly can have lingering effects. Words like “baddie,” “crazy,” or “bonkers” may seem innocuous but can sit with someone far longer than you realize. These terms, often weaponized against people with mental health challenges, can perpetuate stigma. The goal is not to be perfect but to strive for sensitivity and thoughtfulness in our speech.

Practical Tips for Mindful Communication

1. Be direct when possible. Use clear and straightforward language, especially for sensitive topics. This minimizes confusion and ensures your message is understood as intended.
2. Reflect on the origins of phrases. Many idiomatic expressions have negative or harmful histories. While you may not know every origin, being open to learning and adapting your language is key.
3. Pay attention to reactions. If you notice someone looks puzzled or uncomfortable, take it as an opportunity to clarify or adjust your phrasing.
4. Avoid stigmatizing terms. Words like “crazy” or “baddie” might feel casual, but they carry harmful connotations. Replace them with neutral or descriptive alternatives whenever possible.
5. Acknowledge mistakes. If you use a problematic phrase and realize it later, address it openly. This demonstrates a willingness to learn and grow.

Communication Tips for Workplaces and Interviews

Effective communication is the cornerstone of a supportive and inclusive environment. Patience is a critical component, even in fast-paced settings like hospitals. While time may be limited, making the effort to provide clear, concise instructions can prevent confusion and errors. For example, instead of saying, “Check everyone’s oxygen,” be explicit: “Check everyone’s oxygen using the pulse oximeter and document the readings.” Even if it feels overly specific, clear communication helps ensure tasks are completed accurately.

Job descriptions should also reflect clarity and modern standards. Use precise details such as shift times instead of vague terms like morning shift or afternoon shift. If weekend work is required, specify whether it is “every other weekend” or “every third weekend.” Additionally, reevaluate outdated requirements. For example, including phrases like “must lift 50 pounds” in office-based or non-physical job descriptions is unnecessary. Updating these descriptions ensures they accurately reflect the role’s demands and avoids perpetuating irrelevant or exclusionary criteria.

In interviews, move away from archaic definitions of professionalism that emphasize attire over qualifications. Judging candidates based on their clothing, particularly when the job involves wearing uniforms like scrubs, is both outdated and unfair. Focus on their skills, experiences, and responses rather than their outfit. It is also essential to ensure equity and relevance in interview questions. Regularly review and update questions to ensure they’re inclusive, free from bias, and directly related to the job’s requirements.

Creating inclusive and thoughtful interviews involves several steps. In group interviews, ensure the panel is diverse, with representation across genders and other identities. Mispronouncing a candidate’s name can cause disengagement, so practice names in advance and confirm pronunciation during the interview by asking, “Do I have this right?” If not, take the time to learn and use the correct pronunciation moving forward. Normalize sharing your pronouns and asking candidates for theirs to set a respectful and inclusive tone. Provide an overview of the interview process upfront, such as, “We’ll spend 60 minutes together, and I have 12 questions for you.” This helps candidates feel prepared and reduces anxiety.

Encourage candidates to take their time answering questions by saying, “You do not need to respond immediately—feel free to take a moment to think.” This fosters a more thoughtful and confident exchange. Additionally, remind candidates they can take notes during the interview. This small but meaningful gesture can help them organize their thoughts and feel more in control of the process.

By prioritizing clear communication, modernizing outdated practices, and fostering inclusivity, workplaces and interviews can become more equitable and supportive. These changes benefit individuals by creating a welcoming environment and enhance the organization by promoting fairness and collaboration.

Tips for Interviewing

During most interviews, it is common for the interviewer to take notes, so why shouldn’t the interviewee be allowed to do the same? Encouraging candidates to take notes during the interview helps them process questions and organize their responses. Additionally, a best practice is to provide interview questions in advance. While this suggestion often receives pushback from leaders—who worry it gives candidates an unfair advantage—it’s worth considering the benefits. Sharing common questions, such as “Tell me about your strengths and weaknesses” or “Describe a time when you faced a challenge and how you handled it,” allows candidates to prepare and present their best selves. This is not about providing clinical or technical questions in advance, but rather creating an environment where candidates can thoughtfully showcase their qualifications. After all, in most jobs, employees rarely need to respond to situations with the immediacy required in interviews, so giving them time to prepare aligns more closely with real-world expectations.

Another valuable question to ask during an interview is, “What makes a workplace feel safe or unsafe for you?” While you may not be able to fully meet their vision of a safer workplace, their response can offer insights into their values and needs. This information is useful not only for evaluating the candidate but also for shaping future policies and practices—even if they are not ultimately hired. Encouraging thoughtful responses and creating a supportive interview process fosters mutual respect and allows both parties to engage meaningfully.

Tips for Sensory

Supporting individuals with sensory needs involves practical solutions that promote comfort and inclusivity. For sound sensitivity, offering a quiet break space can make a significant difference. When quiet spaces aren’t feasible, providing noise-canceling headphones is an effective alternative. These headphones do not have to be expensive brands like Bose or Beats; affordable, reusable options are widely available, and many can be wiped clean for hygiene purposes.

For movement-related needs, allowing the use of fidget toys and offering flexible seating options, even briefly, can help individuals self-regulate. Healthcare environments often limit choices for seating or movement, but creating a comfortable space in break rooms can provide some relief. For instance, having chairs of varying heights ensures everyone can find a seat that suits them. Encouraging brief moments for physical movement outside of task-related rushing can also be beneficial.

Tactile accommodations might include allowing modifications to work uniforms, such as adding felt to scrub necklines for those with skin sensitivities. Providing tactile items like fidget toys in break areas is another simple yet effective solution. Many professionals, including mental health therapists, use fidget toys during their workday, and these items can be easily stored in pockets for convenience.

Lighting is another key consideration. Offering blue light screen covers or glasses can alleviate light sensitivity. Some organizations have even created sensory kits that include noise-canceling headphones, fidget toys, and light-filtering glasses. These kits can be purchased pre-made or assembled in-house at a lower cost, making them accessible for various settings. Sensory bags are increasingly common in workplaces, hospitals, hotels, and even retail environments, where they may be offered upon request.

Encouraging employees and students to take their breaks rather than skipping them is essential, especially in demanding fields like healthcare. Breaks aren’t just a luxury; they’re necessary for maintaining mental and physical well-being. While it is common for healthcare workers to skip breaks out of concern for burdening their colleagues, organizations should emphasize the importance of rest and recovery.

Neurodiversity Affirming Practice

• Core Principles
  • Intersectionality
  • Respecting autonomy
  • Validating differences
  • Presuming competence
  • Reframing expectations
  • Promoting self-advocacy
  • Rejecting neuronormativity
  • Prioritizing lived experience
  • Nurturing positive self-identity
  • Adapting systems and environments
  • Honoring all forms of communication

Watch Your Words!

Mindful language use is crucial in creating inclusive environments. Avoid using terms with stigmatizing or harmful connotations, particularly those related to mental health. For example, phrases like “this weather is so bipolar” misuse a serious condition and can deeply harm individuals who live with it. Similarly, casual remarks like “I’m a little OCD” or “take your happy pills” trivialize conditions like OCD and depression, which can be life-altering and debilitating for many.

In professional settings, it is especially important to avoid derogatory or dismissive terms. For instance, calling someone “psycho” or referring to a patient as “crazy” is not only disrespectful but also perpetuates harmful stereotypes. Such language can alienate colleagues or patients who may have experienced these terms as weapons against them or their loved ones. Even when used casually or jokingly, phrases like “bat-blank crazy” or “stop acting so schizo” are deeply problematic, particularly in healthcare or educational settings where trust and professionalism are paramount.

When communicating about a patient, stick to objective, clinical terms found in their chart or your observations. Avoid making assumptions or using colloquial terms, as these can harm your relationships with both colleagues and patients. It is impossible to know everyone’s personal history or how they may react to certain words. While true "safe spaces" may not exist, we can govern our own actions by being mindful of our language and fostering a more inclusive environment.

By implementing sensory accommodations and adopting mindful language practices, workplaces and educational settings can foster inclusivity and support individuals with diverse needs. Small changes, such as providing sensory tools, updating outdated language, and avoiding stigmatizing phrases, can have a significant impact on creating a respectful and welcoming environment for all.

Neurodiversity-affirming practices are rooted in principles that align closely with the framework of disability justice. There are ten principles of disability justice, and while all are significant, a few stand out as particularly relevant to this work. If you are interested in learning more, the QR code provided leads to additional information about the ongoing fight for disability justice in America.

Intersectionality

One critical principle is intersectionality, which is about recognizing that people have multiple, overlapping identities that shape how they experience the world. For example, I’m not just a person with ADHD—I’m also Black, queer, a woman, and I live in a fat body. All these parts of who I am come together in ways that influence how I move through life. Sometimes, certain spaces might feel safe or comfortable because of one part of my identity, but not for others.

For instance, as a Black person, I might face racial biases in certain settings, and as someone with ADHD, I might also deal with misunderstandings about how I work or communicate. Add in being queer and a woman, and it can feel like there are a lot of different layers to navigate at once. Living in a fat body adds yet another layer, especially when it comes to assumptions people make or the way healthcare is approached. All these identities do not exist separately—they mix and interact in ways that make my experiences unique.

Understanding intersectionality means keeping in mind that no one is just one thing. It is about seeing the whole person and recognizing how their different identities shape their experiences. For neurodivergent people, this is especially important because their challenges and needs might look different depending on the other parts of who they are. For example, a Black neurodivergent person might face both the stigma of neurodivergence and the impact of systemic racism, which creates a very different experience from someone who does not have those same layers.

When we think about inclusion, it is important to make room for all these different identities and how they overlap. It is not about treating everyone the same—it is about really listening to people and understanding how their unique mix of identities impacts their lives. That way, we can create spaces that feel welcoming and supportive for everyone, not just one part of who they are.

Prioritizing Lived Experience

Another key principle is prioritizing lived experience, which means valuing the voices of people who live with neurodivergence. While academic research and literature can provide useful information, there’s nothing more authentic than hearing directly from those who experience it firsthand. People with lived experience offer insights that no textbook or study can fully capture because they’re speaking from their day-to-day realities—their successes, challenges, and everything in between.

Resources created by neurodivergent individuals are incredibly valuable because they come from a place of personal understanding. They reflect real needs, practical solutions, and the nuanced ways neurodivergence impacts life. For example, a neurodivergent person sharing how they manage sensory overload or communicate at work provides actionable advice that feels relatable and grounded in reality. Whenever possible, we should prioritize learning from these voices rather than relying only on external analysis or theories written by people who do not share the experience.

It is not about dismissing academic research—it’s about balancing it with the perspectives of those who live it every day. By centering lived experience, we get a more complete, human understanding of what neurodivergence means and how to better support individuals in meaningful ways.

Recognizing Wholeness

Recognizing Wholeness is another essential principle. Neurodiversity is just one piece of a person’s identity, and it is important not to define someone solely by that one characteristic. People are complex, with many layers to who they are—interests, skills, values, and other parts of their identity that make them unique.

Recognizing wholeness means seeing and valuing the complete person—not just one part of their identity. It is about creating spaces where people can show up as their authentic selves without feeling like they’re being reduced to a single narrative or stereotype.

Sustainability

Sustainability is not just about protecting the planet—it is also about supporting people. To truly advocate for neurodivergent individuals, we need to adopt practices that prioritize their long-term well-being. This means understanding how neurodivergence affects them and making thoughtful changes to minimize stress and negative impacts in our interactions and shared environments.

Sustaining people goes beyond just meeting basic needs; it is about creating conditions where they can genuinely thrive. For neurodivergent individuals, this might include offering accommodations, fostering inclusive spaces, and ensuring that environments are flexible and supportive. Whether providing sensory-friendly workspaces or being mindful of clear communication, these efforts help people feel valued and empowered, not just tolerated.

Sustainability for people means moving past a survival mindset—where individuals are simply “getting by”—and instead focusing on helping them flourish in every aspect of life, whether at work, school, or within the community. By investing in practices that support long-term growth and well-being, we create a culture that uplifts everyone.

Collective Access

Collective access is vital. This principle highlights the importance of creating environments that support a wide range of needs, including cognitive, visual, auditory, motor, and speech-related accommodations. The idea is that accessibility is not just an individual responsibility—it’s a shared effort that benefits everyone. By working together to remove barriers and create inclusive spaces, we ensure that everyone has the opportunity to participate fully and equitably.

Collective access goes beyond meeting minimum standards. It is about recognizing that accommodations often serve more than just the individuals who request them—they enhance the environment for entire communities. For example, providing cognitive supports like clear instructions or sensory-friendly tools can improve focus and comfort for everyone in a workspace or classroom. Similarly, ensuring visual and auditory accessibility can make events or materials easier to engage with for a wider audience.

By embracing collective access, we take a proactive approach to inclusion, building environments that reflect the diversity of those who inhabit them. It reminds us that equity and justice aren’t one-time goals but ongoing commitments that require us to listen, learn, and act. When we prioritize accessibility and inclusivity, we create spaces where everyone feels valued, supported, and able to contribute their full potential.

Collective Liberation

Collective Liberation emphasizes that supporting neurodivergent individuals is not only about helping a specific group—it is about uplifting everyone. When we fight for equity and create spaces where neurodivergent individuals can thrive, the entire organization benefits. Inclusivity fosters collaboration, innovation, and mutual respect, making it easier for all employees to feel valued and supported, regardless of their identity.

By addressing barriers and implementing accommodations, we create a culture where diverse perspectives and strengths are welcomed and celebrated. This environment encourages people to bring their authentic selves to work, resulting in stronger teams and more meaningful contributions. The fight for equity is not just about fairness; it is about building a community where everyone benefits from understanding, respect, and shared success.

Sample of Neurodivergent Inclusion Policy

"This policy outlines our commitment to providing a workplace that embraces neurodiversity and challenges neuronormativity. Our workplace is dedicated to creating an inclusive environment for neurodivergent people where neurodivergent people feel welcome, accepted, and supported (livedexperienceeducator.com)."

Commitment to Inclusion and Support

• We strive to create a workplace where neurodivergent individuals can fully participate and thrive without facing stigma or discrimination.
• Accommodations are provided to ensure equitable opportunities for success, acknowledging that supporting one group often benefits the entire organization.
• We recognize the importance of learning from individuals with lived experience and incorporating their insights into our policies and practices

Guiding Principles

1. Embracing Neurodiversity:
   We challenge neuronormativity by recognizing and valuing the unique contributions of neurodivergent individuals. This means rejecting a "one-size-fits-all" approach and embracing diverse ways of thinking, working, and communicating.

2. Universal Benefits of Accommodations:
   Accommodations like flexible schedules, sensory-friendly environments, and clear communication practices often improve the workplace for everyone. By meeting diverse needs, we enhance productivity, collaboration, and employee satisfaction across the board.

Core Practices

1. Accessibility:

   • Provide accommodations for sensory, cognitive, and communication needs, including noise-canceling headphones, flexible seating, and quiet spaces.
   • Offer training to all staff to promote awareness and understanding of neurodiversity.

2. Clear Communication:

   • Use direct and inclusive language in all interactions.
   • Ensure transparency in processes like onboarding, meetings, and evaluations, with space for feedback and clarification.

3. Flexibility:

   • Allow for flexible work schedules and breaks to support individual productivity and mental well-being.
   • Provide tools such as sensory kits or assistive technology as needed.

4. Feedback and Collaboration:

   • Regularly seek input from neurodivergent employees to inform and improve policies.
   • Encourage open dialogue and create systems for anonymous feedback to ensure all voices are heard.

Implementation and Accountability

• Training: All staff, particularly managers and supervisors, will receive training on neurodivergent inclusion and best practices.
• Policies: Accommodations and inclusive practices will be clearly outlined and communicated during onboarding and revisited regularly.
• Monitoring: The effectiveness of this policy will be assessed through regular surveys, feedback sessions, and updates informed by lived experiences.

R.A.T.S. Framework for Inclusion

The R.A.T.S. framework—Relationship and Rapport, Accommodations, Time, and Sensory Support—offers a practical approach to fostering inclusion and accessibility in diverse environments. When in doubt, remember to focus on R, relationships, and rapport. Building strong connections with others provides valuable insights into their experiences, enabling you to identify ways to support them effectively and leverage your resources or privileges to help.

Relationship and Rapport Building

Strong relationships are the foundation of understanding and support. By taking the time to genuinely connect with others, you can gain deeper insight into their unique challenges and needs. This relationship-building allows you to move beyond assumptions and instead create meaningful, individualized solutions. Relationships are not just about listening—they’re about acting on what you have learned to make environments more inclusive and supportive.

Accommodations

The Americans with Disabilities Act (ADA) has not been updated since 2008, leaving many needs of neurodivergent individuals and others unmet. It is crucial to look beyond what the ADA defines as “reasonable accommodations” and instead focus on what is truly needed. When we move past the bare minimum and provide thoughtful accommodations, we make environments better for everyone—not just for those with neurodivergent conditions but for all individuals navigating shared spaces.

Time

Explicit communication about time, needs, and expectations is essential. Never assume someone “just knows” something because of their age, experience, or tenure. Share critical information early, repeat it often, and clarify as necessary. Clear and transparent communication ensures everyone has the tools they need to succeed.

Sensory Support

Sensory experiences play a significant role in accessibility. For example, at a recent AARC conference, I wore sunglasses indoors because of light sensitivity caused by the bright overhead lights. Similarly, sensory accommodations such as noise-canceling headphones, quiet spaces, or flexible seating can significantly improve accessibility for many individuals.

During my presentation at the same conference, I noticed an attendee with a service dog and a leading cane, indicating visual impairment. Recognizing the need for immediate adjustments, I modified my presentation on the spot. I announced that I would read more directly from the slides to ensure accessibility for everyone. The response was overwhelmingly positive—several people, including the attendee with the cane, stood up to thank me, sharing that this adjustment allowed them to participate fully for the first time. This experience highlighted the importance of anticipating and addressing accessibility needs, even when they aren’t immediately visible. While I made these changes on the fly, it reminded me of areas where I can improve and be more proactive in creating inclusive spaces.

The Importance of Accessibility and Understanding

For me, being diagnosed with ADHD in 2017 was a transformative experience. It gave me clarity and validation, enabling me to better understand the adjustments I had been making throughout my life. Despite being told that certain achievements were out of reach for me, I have built a meaningful career—first in respiratory therapy and now in mental health, where I run a private practice. My journey underscores an important truth: a diagnosis or condition does not define what someone can or cannot do. It might mean working harder or differently, but it does not mean the goal is unattainable.

As you interact with individuals with diverse conditions, remember that these conditions do not stop people from achieving their goals. Instead, they highlight the importance of support, understanding, and collaboration in fostering success. Advocating for neurodivergent inclusion and better clinical practices requires systemic change and individual action. By questioning outdated systems, choosing respectful language, and fostering collaborative communication with patients, we can create environments that support diverse needs and empower individuals to thrive. Every small adjustment we make contributes to a culture of inclusivity and care.

Questions and Answers

Thank you for sharing your personal examples of how neurodivergent individuals can advocate for themselves. How can we advocate more for inclusion, especially in clinical or workplace settings?

This is such an important question. Advocacy for inclusion begins with examining and questioning the systems already in place. For example, I once spoke with professors about challenges they faced in clinical settings, like students who struggled with social cues. These students were not harming patients but were seen as "different" in how they built relationships. One takeaway I shared was that we need to avoid boxing people into specific expectations—like assuming the ICU is the only viable path in healthcare. Not everyone wants to work in the ICU, and that's perfectly fine. We must create space for diverse skills and paths.

From a student perspective, creating safer spaces early on is key. For instance, I once attended a session where students asked questions about accommodations for exams, such as needing more time or using a standing desk. While the session leader provided information about accommodation forms, we later found significant barriers to accessing those accommodations, such as requiring doctor approvals or insurance. This underscores the importance of interrogating outdated systems: when were they last updated, and how can we make them better? Regularly seeking input from students and staff can lead to meaningful improvements.

On your slide about harmful phrases, you highlighted how language can create a silencing effect. Could you expand on why this is important?

Absolutely. Language has immense power, and harmful phrases—like using terms such as "bipolar" or "OCD" casually—can perpetuate stigma and silence individuals who live with these conditions. For example, jokingly saying someone is "so bipolar" trivializes a serious and life-changing condition. Similarly, calling medication "happy pills" dismisses the importance of treatment. In diverse settings, it is crucial to think critically about language and choose words that foster understanding rather than harm. This self-awareness can create a culture of respect and inclusivity.

In a clinical setting, how would you adjust your approach if a patient shows signs of sensory overload during suctioning or an ABG draw?

The first step is to acknowledge the situation and communicate openly. For example, you might say, “This might be uncomfortable or even painful—what can we do to make it a little easier for you?” Many patients, especially those who have undergone frequent procedures, may already have strategies that help them cope. Including them in the conversation gives them a sense of control. For suctioning, there may be fewer options due to its inherently uncomfortable nature, but for needle-related procedures, patients often have preferences that can reduce their discomfort.

Building on that, what about addressing sensory overload in the environment, such as bright lights or loud TVs?

That’s a great point. Creating a low-stimulus environment can significantly reduce sensory overload. When entering a room, I always try to explain what I’m doing: “It’s bright in here—I’m going to turn down the lights a bit. Does that work for you?” or “Let’s turn off the TV for more clarity during this conversation. Is that okay?” If the patient declines, I offer alternatives, such as writing things down or finding another way to communicate. Including the patient in these decisions is essential because hospital stays often strip individuals of their sense of control. Anytime we can return even a small measure of control to them, it builds rapport and trust.

References

Beatty, J. E. (2016). 10 principles of DJ-ing (2nd ed.). Squarespace. https://static1.squarespace.com

Bernstein, E. S. (2020, December 3). Why you need to stop using these words and phrases. Harvard Business Review. 

https://www.institute4learning.com/

Doyle, N. (2020, March 24). The world needs neurodiversity: Unusual times call for unusual thinking. Forbes. https://www.forbes.com.

Ngwagwa. (2021, December 15). Neuroexpansive™️ thoughts. Medium. https://medium.com/@ngwagwa