“Therapy isn’t for neurodivergent people”: Introducing the ACCEPTED Model for Neuroaffirming Therapy

Practitioners

6 Mar

An AuDHD friend recently told me, “Therapy isn’t for neurodivergent people”. I was saddened to hear her believe this, but not surprised. Traditional psychological therapies do not always meet the needs of autistic and ADHD individuals. In this blog, we’ll look into why, and what can help.

Why do we need to adapt traditional therapies?

Many therapies were originally developed before we had an understanding of neurodevelopmental differences such as autism and ADHD. Some aimed to treat the neurodivergent traits themselves, believing they were a pathology of some kind, and some continue to do so.

Although the majority of therapies have moved on from this position, misconceptions remain. Therapists from a variety of therapeutic backgrounds may still see client difficulties through a solely trauma lens - rather than understanding that neurodivergence and trauma frequently intertwine, and have done so across generations.

Other therapeutic approaches have acknowledged autistic and ADHD characteristics and how these might interplay with mental health needs, but have not fully considered how neurodivergence may impact the needs of a client in therapy.

Overall, neither the practical nor the theoretical approach of many therapies and therapists has been adapted to the needs of autistic, ADHD, or AuDHD clients.

We must listen to the voices of neurodivergent people who are asking for therapies that honour their cognitive, emotional, behavioural and sensory differences

When therapy is not adapted, neurodivergent people often report experiencing discrimination, additional distress, and even re-traumatisation. Many neurodivergent people struggle to access psychological treatment that helps, and find themselves either repeatedly accessing unhelpful therapy but not understanding why it doesn’t help (especially common for late-diagnosed people with a history of mental health difficulties), or giving up entirely.

Clearly, this isn’t good enough. We must listen to the voices of neurodivergent people who are asking for therapies that honour their cognitive, emotional, behavioural and sensory differences, both in terms of the therapy delivery and the collaborative therapeutic formulation (understanding of the problem) with their therapist.

How can traditional therapy be adapted?

As a Clinical Psychologist I have been working clinically with autistic and ADHD folk for over 15 years. Through my clinical experience, focus groups with neurodivergent adults, and guided by theory and research, I created a unique framework, ‘ACCEPTED’ to support clinicians to adapt their therapy for neurodivergent people.

Neurodiversity training often focuses on the Why of adapting therapy, but not the How. That’s where our approach differs. The ACCEPTED framework provides a clear structure and practical ways to create a neuroaffirmative therapeutic environment, adapted to the needs of autistic and ADHD people.

Introducing The ACCEPTED framework: How to adapt therapy for autistic and ADHD folk

In this blog, I’ll take you through the ACCEPTED framework and highlight initial adaptations you can integrate into your therapeutic work to make it more neuroinclusive.

If you’d like to explore this framework in greater depth, including additional practical strategies for adapting therapy for neurodivergent clients, you can learn more about the training we offer here.

A - Awareness: Psychoeducation and mapping individual needs

In the ACCEPTED model, the first step, A, stands for Awareness. This step is foundational because it helps you and the client to understand autism and ADHD, and how neurodivergence shows up for them specifically.

This section can also be about raising the subject of possible neurodivergence for clients who haven’t yet understood this could be a helpful part of their formulation, or who may be wondering. We discussed this process recently with Dr Natalie Stott on her podcast, Mastering Therapy. Many therapists may also be newly learning about neurodivergent characteristics alongside their client.

Mapping out individual needs relating to their neurodivergence supports someone to move away from thinking about autism and ADHD using a deficit-based medical model and toward understanding a client's unique neurodivergent profile of strengths and differences.

One way of understanding the individual needs of neurodivergent people can be to complete a Needs Wheel alongside the client. This can help to understand and then visualise a client's specific needs across several domains.

C - Communication

Effective therapy depends on clear communication, but the Double Empathy Problem can disrupt this process, leading to mutual misunderstandings between you and your client.

Research, clinical experience and our own focus groups with neurodivergent adults suggest there are ways you can adapt your communication in therapy to make it more accessible. These can include:

Check communication preferences early on.
Be direct and avoid ambiguity.
Use fewer open-ended questions, which can sometimes be overwhelming.
Offer choices and examples to help the client navigate complex topics.

C - Community

Neuroaffirming therapy acknowledges the importance of autistic and ADHD clients finding their village to reduce isolation and increase belonging.

Therefore, an important part of adapting therapy is to signpost and support clients to access communities and information where they can find shared experiences and validation.

This includes recommending:

Local services: Depending where the client is based
Podcasts e.g. The ADHD Adults or The Late Discovered Club.
Online communities that foster connection and reduce the isolation often felt after a late diagnosis, such as The Neurodivergent Parent Space.

E - Experiential

Traditional talking therapy can sometimes fail to address executive function and other cognitive differences that autistic and ADHD clients struggle with, for example, difficulties with memory, initiating homework tasks outside of sessions, or the ability to visualise imaginary situations.

Autistic clients in particular may often find body-based or somatic tasks difficult, due to alexithymia or interoception differences.

The ACCEPTED model emphasises experiential learning, providing frequent opportunities to model strategies explicitly within the session and to practice until strategies become muscle memory.

This also involves adapting specific therapy techniques:

Soothing the nervous system: Using more concrete imagery or using special interests, photos and music to create soothing, instead of imagination.
Mindfulness: Introducing the idea of active mindfulness; recognising that slowing down can be physically uncomfortable for some neurodivergent people and may require significant modification.
Role play: practising concrete examples of self advocacy, or anxiety tolerance techniques, for example.

P - Predictability

For many neurodivergent individuals, certainty and predictability are key to reducing anxiety (see our blog post here as to why autistic people value predictability in particular).

Therapy should create a predictable environment where the client knows what to expect, as well as support to make their own environment more predictable. This includes:

Consistency of location and timing of sessions.
Providing clinic details in advance to reduce sensory and logistical overwhelm.
Naming unpredictability within the therapy approach.

T - Therapist Style

Regardless of what model of therapy you use, this category is about adapting your style of therapy to suit your neurodivergent client.

Neuroaffirmative accommodations can be incorporated into the process of therapy:

Making the process of therapy, such as your thoughts about the therapeutic relationship or other unspoken dynamics, more explicit.
If you use goals, using value-based goals can be helpful for neurodivergent people.
Working towards self-understanding using an ND lens, compassion and acceptance can often underpin therapy goals.
Offering shorter, or regular breaks, in sessions.

E - Emotions

Emotional regulation can be harder for neurodivergent people, and is often a core difficulty underlying mental health conditions and wellbeing.

Therefore, therapy must be adapted to how neurodivergent people process and regulate emotions:

Emotional identification: Supporting clients in naming and expressing their internal experiences, especially when experiencing alexithymia and interoceptive difficulties.
Meltdowns and Shutdowns: Differentiating between high-arousal meltdowns (flight/fight) and dissociative shutdowns (withdrawal/non-speaking) triggered by overwhelm and sensory sensitivity.
Self-compassion: Addressing the role of self-compassion in emotional regulation, as neurodivergent people are typically more self-critical than other clients (see our blog on this here).

D - Dynamic Assessment

The final component of the ACCEPTED model, Dynamic Assessment, emphasises the importance of:

Using appropriately adapted assessment tools and outcome measures
Understanding how distress and risk may present differently for neurodivergent people.
Recognising that a neurodivergent person’s skills and functioning can fluctuate day-to-day, influenced by factors such as burnout, sensory load, and environmental demands.
Using energy accounting to increase predictability in the client’s own environment.

Moving toward Acceptance

The ACCEPTED model offers a practical, evidence-based and neuroaffirming framework for adapting therapy for autistic, ADHD and AuDHD young people and adults.

By using the ACCEPTED framework to guide therapy, clinicians can create safer, more accessible, and more effective therapeutic spaces for their neurodivergent clients.

Find out more

If you would like to deepen your understanding or bring this approach to your service, you can find out more about the training we offer for practitioners here, or contact us to arrange training for your team.

Here is what some previous training attendees have said:

“Really knowledgeable facilitators who offer lots of practical examples that have made me think beyond standard adaptations”

“Comprehensive course grounded in evidence, practice and lived experience”

“It was brilliant training, thank you!”

“Thank you for a very thoughtful and thought-provoking day of training. Looking forward to the next one!”

Dr. Lauren Breese