Identifying Neurodiverse Affirming Therapists: Green Flags to look for

Laura Petix 0:00 Unless that teacher takes it apart, teacher or therapist takes it upon themselves to search for and pay for a professional development course that teaches them specifically about neuro diversity and inclusion, and how to be a neuro diverse affirming provider and how to create goals and approaches that are neurodiverse affirming. They’re not learning it anywhere else. They’re not learning it as part of the foundational curriculum. Speaker 1 0:29 Welcome to the sensory wise solutions podcast for parents, where parents can get real actionable strategies to support kids with sensory processing disorder. I’m Laura, OT, and mom to Lilyana, a sensory sensitive kid who inherited my anxiety and my love for all things Disney. Consider me your new Oh, T mom, bestie. I know my stuff. But I also know what it’s really like in the trenches of parenting a child with sensory processing disorder. Speaker 2 0:58 Okay, mom, enough about me. That’s the podcast. Laura Petix 1:05 Hello, and happy December, everyone, welcome back to the podcast, we’re gonna get right into it. So one question that I often get asked is, How can I tell if my child’s therapist is neurodiverse affirming or if the clinic is neurodiverse affirming. I do wish there were something like a certification badge, that clinics could post on their windows kind of like restaurants that have like ratings that they have to put from like the health department. But I wish there were some regulation body that could like you know, give a stamp of approval that was like this clinic or this therapist is neurodiverse affirming based on this set of standards, that ideally would have a board full of neurodivergent people, that would be cool, right? But it’s not like that. So we kind of have to do some digging, and detective work to know if our kids therapist or the people that they’re working with have our kids best interests in mind. So I want to first start out by acknowledging the fact that some of you listening to this may not even have the luxury or privilege of getting to even decide which therapist your child gets assigned to at a clinic. For many of you, the fact that you got off the year long waitlist or finally got your insurance to cover like 12 visits of OT at all, is the most you can ask for so it feels like beggars can’t be choosers situation. So I want to call that out here. And I know that battle. So for if that’s the case for you, this episode might not be that helpful and may even feel triggering for some of you if you’re not in a position to make changes or choose your provider. So if that’s the case, I I would not feel offended if you’re like this is not the episode for me. If you are working with a therapist or have been in OT for a while, and you’re just not sure if the therapist is the right fit. And maybe you want to think if you should pause OT or ask for a different therapist, or even want to know if like how to just talk to your child’s ot about the support that they’re receiving in the clinic. Like if you have concerns, and you just want to know how to navigate those kinds of discussions, check out my episode 24. So if you go to the ot butterflied.com/ 24, that episode is all about how to make the most out of the OT services that you currently have. And it also gives you some points to consider if like taking a break from ot might make sense for you. So that one’s there for you. Another thing that I want to talk about before we get to into the episode is some context that will help you understand why it might be hard to find a neurodiverse affirming therapist. So here’s what you need to know about becoming an OT these days. So I started working as a clinic based ot straight out of grad school like it was in February 2016. Technically, when I got my when I passed my boards and I like had to what is it I had to petition to take my boards early. Otherwise you had to wait like an extra month or two but I was like I want my license. Now I wanna start working now. So I worked the earliest that you possibly could coming out of grad school. And right from the get go I worked at a clinic with a wide range of neurodivergent and disabled clinic EK, disabled children I’m sorry, since 2016. And I would actually say before then because I had internships and I was also an ABA therapist in 2012. And I became a parent to Liliana in 2017. And realize my daughter had sensory challenges and anxiety in 2019. But the word neurodivergent, or are neurodiversity and neuro diverse were not even introduced to me were not part of my vocabulary until late 2020, or 2021, which I only heard of and learned about through social media. So that’s, that’s a really important thing I had been working with neurodivergent kids and neurodivergent population. Almost a decade, I guess, if I was if you count 2012, as my first time working with kids who are autistic, and not fully engrossing myself into the vocabulary in the world of neurodiversity, till 2021. That’s, that’s a big gap. And it took me that long to even hear about those words, let alone put it into practice and daily life. So even now, after over two years of really, really engrossing myself in all of the neurodiversity content and listening to neurodivergent voices, I am still learning something new. A lot of the time, like, very often, I learned something new about the neurodiversity movement, and new language and new terms and new ways of thinking about things. Even though I now feel confident in identifying myself as neurodivergent. There’s still a lot I have to learn about interacting with and discussing and supporting neurodiverse families, especially on my platform. So 100% of the research and the knowledge that I have about neurodiversity has initially stemmed from social media. So I’ve taken some courses on neurodivergent supports that have been more quickly professional in nature. But the way I learned about them that they even existed was from someone sharing about it in social media. The only way I learned to become curious about this thing was because someone was talking about it on social media, I really need that to sink in. Because while the neurodiversity movement is growing, and it’s not just something from 2020, neurodiversity was coined as a term back in the 90s. And so we’ve come a long way with the movement. But the majority, if not all, of OT grad schools, at least in the United States, is all I can speak of the majority of them are still teaching our future OTS approaches that are not aligned with the neurodiversity movement. This, this goes for teachers getting their credentials in their masters as well as SLPs. Unless the therapist or teacher or professional who recently graduated from whatever curriculum, whatever grad school program, unless that teacher takes it apart, teacher or therapist takes it upon themselves, to search for and pay for a professional development course that teaches them specifically about neuro diversity and inclusion, and how to be a neurodiverse affirming provider and how to create goals and approaches that are neurodiverse affirming. They’re not learning it anywhere else. They’re not learning it as part of the foundational curriculum. I will say on the bright side, I do see more schools offering workshops and like guest speakers on neurodiversity, and even hiring some associate professors who are neuro divergent. And so they’re starting to infuse more of those concepts and language. But it’s not it’s not like a universally accepted or integrated thing into the coursework. So this then brings me to a really important point, knowing that most of the quote if you want to call them progressive, or just the more modern way of understanding neurodiverse affirming approaches, knowing that these approaches are being talked about and promoted mostly and initiated mostly through social media. I think it’s safe to say that the younger slash newer therapists may actually have more of a leg up on being neurodiverse affirming over some of the more seasoned therapists who have been out of grad school for longer periods of time. Again, because the further back we go in terms of when you graduated grad school, the less neurodiverse affirming approaches are showing up in coursework, if any, at all. And I really say this because I know that there are parents out there who are hesitant, or worried or concerned when their child gets assigned a new therapist, like a new ot who like is like, just fresh straight out of grad school still clutching their degree in their hand. And you know, all of us had to start somewhere, I was one of those therapists who was straight out of grad school and was assigned clients. And I remember distinctly, there were a couple of families, I can think of who politely but very aggressive, not aggressively, politely, but very, they very much insisted, to not be on my caseload, because I was a new therapist, and they would have preferred to be on some of the therapists who were more seasoned at the clinic. And yes, to be fair, of course, as a new student out of grad school, who just got her license, there were a lot of things I did not know as a new therapist, and I still had a lot of practical strategies and methods to learn. But if you were to ask me now, I would rather go with a brand new therapist, who still had to learn some therapy skills, but could pick those up much easier, who happened to be neurodiverse affirming versus a well seasoned therapist who knew lots of methods and approaches, but had never heard of the neurodiverse affirming movement or know what even neurodivergent is? That’s me, that’s my personal opinion. And so, people listening to this, you’re listening to this on a podcast, which tells me that you probably are somewhat active on social media. But there are many OTS or any other therapists or teachers who are not on Instagram, and avoid social media. And maybe not even listen to OT or educational related podcasts or do anything else outside of work, they probably have stronger boundaries and leave work at work. And they sign up for the professional development courses that are offered through their clinics or through their schools. But outside of that, they’re not really actively searching for these things online or outside of what’s brought to their within their clinic walls, or their classroom walls or whatever. So if they’re not listening to like, the the buzz about neurodiversity online and through the media, they’re they’re not really that getting that information, unless one of their colleagues or someone that they talk to often keeps bringing this up, and they’re talking about it. But if they’re a therapist or teacher who just you know, keeps themselves shows up does their work. Chances are, they don’t really know much about what’s going on with the neurodiversity movement, you have to actively seek this stuff out. So with all of that in mind, I’m going to talk about some, quote green flags to look out for to notice, to pay attention to when you’re looking for a therapist or teacher, I said, or speech therapist, anyone who is neurodiverse affirming. You might look out for these signs, when you have a face to face meeting or you visit the clinic, or maybe as you talk to them on the phone or converse with them via email. You might look out for some of the language that I’m going to talk about what a lot of these you would maybe have to sort of notice over time over seeing the clinic and the environment and seeing how they interact with their child over time. You may see some neurodiverse affirming language or things that you can notice on a website. But I have to stress that you really should not judge a clinic or a therapist by what’s on their website or their bio, because many people and clinics don’t update it for years. And if they do, it’s not always the individual therapist who’s updating the website or really choosing what to say. So I would not really judge based off of like, you know, a website or a quick bio that you find on Google. And one last thing that I actually do want to call out having a neuro diverse affirming practice, as you’ll see when I talk about some of the things that you want to notice for and look out for, it means that they most likely aren’t working through insurance, or are finding ways around insurance because insurance is not really on board with a lot of the neurodiverse affirming practices. The goals that we’re going to talk about, for it to be considered are diverse, affirming some of the approaches some of the accommodations Insurance isn’t really on board with that stuff. Which puts you again in that, quote, privilege boat if you can afford to work that therapist outside of your insurance parameters. It’s not to say that every single therapist you work with who happens to take your insurance is not neurodiverse affirming. But a lot of the ones affiliated with the hospital, affiliated with like an insurance based clinic. And even the ones who work in schools, the OTS that work through the school district, they are bound by certain regulations and parameters to include particular goals. And they have certain metrics that they have to measure and work through more of like a medical model. And even the school based model, which is more, which is less neurodiverse affirming than what a private sensory integration clinic would be able to offer. So you could have the most kind, inclusive, thoughtful therapist who is neurodiverse, affirming at heart, but on paper, and through their hospital or insurance, or clinic or school district, they have to abide by like certain protocols to play the quote insurance game. And so they have to constantly look at and call out impairments, and assess your child according to normative samples that don’t really align with neurodiverse affirming approaches. So it makes it really tricky. As therapist, I don’t want to call out therapists here for not being neurodiverse affirming when it’s really the system that they’re really bound by. But still, I don’t want that to hold you back from considering some of the green flags to look out for. Okay, so first and foremost, one of the things you can look for notice is the language that they use when talking about the diagnoses that fall under the neurodivergent umbrella. So you would ideally want to see more identity first language like an autistic person, rather than person with autism, or using the term special needs, which a lot of neurodivergent individuals have recently said that they don’t feel like that fits, that that fits for them anymore. You would also expect as they talk about some of behaviors that are related to neurodiversity, that they relate to them more as traits and behaviors rather than, quote symptoms, right, we’re trying to see neurodivergent individuals as just differently wired people and not through deficits, and not through impairments or symptoms that we need to treat or fix. So you want to notice the language that they use when talking about disabilities or neurodiversity. Another green flag that you can look out for is this would depend on you actually being in the environment and seeing the clinic or the workspace that they’re in noticing a lack of a whole body listening posters on the wall. Or noticing that they have the new updated neurodiverse affirming one, which by the way, you could find at everyday regulation.com They whole body listening, I had a whole episode on this, I’ll link it to the show notes. But whole body listening is those posters that says eyes on the teacher hands and lap quiet body, quiet feet, quiet mouth and like expecting kids to look a certain way to prove quote that they’re listening. And we know that there are so many different ways to be actively listening. And so we are trying to disrupt that. The standard of using whole body listening posters in the classroom into the clinic and replace it with the new neurodiverse affirming one, which allows kids to show that they can listen in different ways. So the green flag is that they don’t have the whole body listening posters, the old ones, or that they have the new ones, again, which is which is actually created by the same team who had the old one. So they actually listened. And they were once operating under this what we thought at that time was the gold standard. But now that they learned that neurodiverse affirming means that kids can listen in different ways. They made the changes and I think that that’s fantastic. The next green flag to look out for is noticing that the therapists goals that they create are not centered solely on developmental milestones or neuro normative expectations. So for example, Like making eye contact or making a goal specifically about about pencil grasp by a certain age, or making a goal specifically about how to have a conversation. Right and, and there’s there’s nuance again, because of course, if you’re working with a speech therapist, they’re there to help your child communicate. And if you’re working with a an OT, they’re, they’re there to help your child maybe work on fine motor skills, which can include grasp, but there are very specific ways to word goals that can be more neurodiverse affirming and isn’t focused specifically on making the child appear more neurotypical. So knowing that there’s more than one way to hold a pencil, knowing that there’s more than one way to have a conversation, knowing that you don’t have to make eye contact every time you’re talking to someone. But this one, again, especially around goals, this one is particularly difficult when working with insurance and schools, like with IEPs. Because again, they have very stringent, very specific language and objective measurements and metrics that they have to include in order for the service to qualify. So this is really tricky. But I highly recommend following at Learn play, thrive, which is Meg, and Meg has an Instagram account and creates a professional learning courses for therapists and teachers to help write more neurodiverse affirming goals. And Meg is a fantastic resource. So the thing that I have, that I like parents to think about is well, here, let me back up. parents asked me a lot. Okay, so is it even worth it? For me to keep fighting for my child to get ot services, if the OT service provider is non neurodiverse? affirming? So if they’re going to create these goals that I disagree with, and they’re going to do these approaches that are more medical model deficit space and don’t align with what I want for my child? Is it worth it for me to to pursue that knowing that I won’t have a choice, right, especially if you have to work through your medical insurance? And you’re like, I don’t think that they’re going to be able to offer me flexibility on the goals and things like that. My answer is that first, this is really tough to make this decision. If every single goal that your ot was working on and suggesting and the approaches for those goals, solely focused on molding and training your child to appear or act or behave in a way that’s outside of how their brain is wired, aka, like making your child act, neurotypical then I would argue that that seems unhelpful. If the therapist is open to suggestions, or maybe not all of their goals or approaches are for our focus on neurotypical standards, and they can still help with the nervous system regulation, or give you ideas for environmental modifications, and provide you with parent education and an neurodiverse affirming way, it could totally still be worth it. I would never say therapy is not worth it. But certainly considering the risks and benefits in terms of how much energy and resources it would take for you to get that for your child is important to consider. I definitely know of a handful of therapists that are my colleagues, my friends, people that have worked with my daughter in the past that know me who, you know, on paper into a piece insurance, they do have to write certain goals into the reports and phrase things a certain way and make sure that they’re at least measuring this one thing, you know, every few months, but the way that they interact with the kids and the approaches that they take, and the way that they view neurodiversity is neuro diverse affirming. So don’t base it all off on a report you really need to know and have good rapport with the therapist to get a good feel on how much this is going to align with what you’re looking for and how helpful it’s going to be. On the note of goals, it’s another green flag if the therapist maybe doesn’t have to work with the parameters of insurance, like when I worked in the two clinics that I’ve worked at so far, they were private based, so they were not relying on insurance to reimburse so we could create really any goals that we wanted to work on. So I loves getting to cocreate goals with the parents. And even the kids when they were older, like third, fourth, fifth grade, I would include them in writing the goals with me. So we would agree on it. And they understood why they were there, that’s neurodiverse affirming. Another green flag is that they either include your child in the conversation, when, you know debriefing with you about the session, or they pull you aside separately and not talk about your child in front of your child, especially when discussing challenges or behaviors that are coming up. So I, this is a really, this was a hard habit to break in the clinic, I’m speaking again from a private based clinic, but in the clinic, when we’re between sessions, right, we would have like a whole hour blocked off for this family, we would usually stop the session at 50 minutes, then have five minutes to debrief, then we will have five minutes to like reset our our stations and like start and welcome the next family and also squeeze in a bathroom break. Right. So all of that in between it, I got really in the habit of you know, walking my kids out to mom and dad put helping the kids put their shoes on and then talking to Mom and Dad about what we did. And I got in the habit of saying of being maybe a little bit too candid about what I was seeing and talking more about deficits, because I was going so fast. And again, this was like probably the when I was mostly in the clinic, it was before I learned how to become neurodiverse affirming. And now that I’ve learned what it means and now that I also have a neurodivergent child myself, I really value having the privacy to speak more candidly with a therapist and hearing more about what they did in this session without worrying about my child hearing about that. Or if you don’t have that space to talk privately. And you don’t have maybe a phone call time to talk to that parent, I’m sorry, I’m switching now between talking to therapists and parents. But if you don’t have the time, or the space to have a private conversation between you and your child’s therapist, at the very least I would love for them to maybe include the child in the conversation, rather than like just talking about them as if they’re not there, if that makes sense. And so another thing to look out for that I would love to see is when they do talk to you about any behaviors or challenges that are coming up at school for your child or at home for your child that they’re always including and sharing the underlying either sensory processing or nervous system contributors to those behaviors and focusing on targeting it from that approach. So they’re not always separating and saying, you know, this is something that I hear from parents all the time they’ll say my son’s ot thinks has difficulty focusing or the way that he keeps hitting us or hitting kids on the playground is behavioral and not sensory. And when I hear this, I get so frustrated, because Okay, not everything is related to a sensory trigger. Not everything, I bet you a lot of things are, but not everything is related to a sensory trigger. But what they’re insinuating by saying something is quote, just behavioral, is that your child is intentionally doing it. What we want is a therapist who looks at behavior and says, Hmm, okay, this behavior doesn’t seem to be directly related to this child’s sensory profile. I don’t really see that I wonder what other skills gap is here, what where is the gap in skills that’s happening and what accommodations or supports might they benefit from. So not everything is going to have a sensory trigger, but but separating sensory and behavior is not applicable. Everything that your child does is a behavior. And we want a therapist who views behavior just as the the observed data point and we want to understand where that’s coming from. Another green flag to look out for is when therapy therapists can be flexible in the way that they run their sessions. So not always so stuck or focused on a structured rigid list of things to get done. So maybe if your child comes in dysregulated, forcing them to do a seated fine motor maze isn’t really going to be beneficial for their learning. But I will say parents, this does mean that you may need to really be forthcoming. and explicitly, almost give permission to the therapist. Because I remember, as a therapist feeling inherent pressure to always report like the productivity to the parents. At that time. If I spent like 30, more than 30 minutes in the gym like swinging, I felt like I had to do some tangible checklist thing of like a fine motor worksheet or like, you know, an exercise thing that we did, or something where it was more objectively productive to the parents, even though I knew a full hour in the sensory gym was productive, but I always felt insecure about how to communicate that to parents. And so it was only after a couple of years of of my practice, that I realized I just needed to advocate more and educate the parents more on regulation, time and how much spending the time in the clinic gym could benefit their growth and reaching their goals in a better way. So I used to say something like, you know, oh, I noticed the past few times, Maddie has been really dysregulated and not really liking the transition into OT and it’s that’s really impacted or decreased her willingness to participate in the fine motor stuff that we need to be working on. So I want to take a slower approach today and spend some more time in the gym, to see if we can get her to a more regulated state, I’m still going to infuse some fine motor stuff, but I want you to know, we’re going to spend less time at the table today and more time in the clinic, is that, okay? So, you know, we still have to check in with the parents and be transparent to them. But some therapists, especially the new ones, are a little nervous about how to navigate this, or how to prove to the parents what you did what they did in session with your child. But if they can be flexible, and spend the time connecting with your child, before sitting down and doing XYZ task and doing this, this, this, this this, that, to me is a green flag of a therapist who understands the nervous system well, which is neurodiverse affirming. Another green flag is that the therapist or caregiver or teacher who’s working with your child hasn’t has open access to sensory regulation opportunities like unconditionally, so it’s not used as a reward. And it’s absolutely not taken away as punishment. And that one kind of goes without explanation. Something else to look out for is when you bring something up to this therapist and say, you know, they’re having a really hard time going to potty at school or they’re having an issue, you know, getting ready for bed or whatever it is that you talk to your therapist about a new behavior or a worsening behavior or something that you’re looking for support for and you’re talking to the therapist. I would love to hear therapists initiate the conversation by first talking about ways to adjust the environment, ways to modify the task, so that their first line of action or solution is to explore the external modifications and ways that we can meet your child where they’re at not initially focusing on, okay, here’s how we change the child’s behavior. Here’s how we rewire their brain. Here’s how we build that skill. Yes, we want to build the skill. And we’re that’s going to be more of a long game. And that’s something that they can talk about, and some approaches to practice and clinic. And maybe they’ll give you tips on how to build that skill. Whether it’s executive functioning, whether it’s a sensory processing skill, whether it’s an emotional regulation skill, but their first line of action, or entry point into helping you support your child through this new problem or this worsening problem is saying, okay, something about this as hard for your child, how can we make it easier and more likely that they’re going to succeed, given the skills that they currently have, because obviously, they’re an OT to build some skills, but that’s going to take some time. And they might get to a point where they’re saying we have exhausted as many of the accommodations and the modifications that we can have. It’s time to either decrease our expectations of the child right now because maybe their expectations are based on neuro normative samples, or they’re they’re going to give you the encouragement and say we’re doing everything we possibly can. This takes time. It’s a trust the process That’s kind of thing I would rather that than the therapist keep coming up with ways to change your child to, to meet some sort of neurotypical standard that’s being placed on them in the classroom or in the community, or whatever that is. Another green flag is something that’s hard for you to really know right away, it’s something that you notice over time based on maybe how your child acts around this therapist is that the therapist feels like a safe space for your child to be able to quote unmask and that this therapist doesn’t actually encourage masking. You know, like, and if you’re unfamiliar with the term masking, it’s like, it’s usually in relation to autistic individuals. But any neurodivergent individual who quote masks is basically holding it together. They are withholding their stems, their self regulatory behavior, they are forcing eye contact, they’re pretending like they’re listening to you that because they know that they have to look at you. But they’re masking that internal need to stem and rock or fidget. And so if your child can have a therapist who creates the safe environment for your child to figuratively take off their mask and be the neurodivergent child that they are that they don’t have to hold it together, that would be amazing. Okay, those were all the tips that I had for you. But I had one last thing that you could look out for this is more on the red side flag, I wanted to keep this whole episode on like, in the positive light of like, things to look out for that are good positive green flags. But I could not, I couldn’t leave this part out. But this is more of a red flag. And it’s a subtle red flag. Again, this is usually something that you can see visually, you’ll see it on their website, you’ll see it on fliers that they use, maybe you’ll even see it in their logo, if they integrate a piece of this into their logo. I’m talking about using puzzle pieces to symbolize autism or autistic services. And or clinics or organizations that support or promote Autism Speaks. This includes the lighted up Blue campaign or any walks that are funded, or is a fundraiser for Autism Speaks. I’m not going to get too much into it here. But just know that Autism Speaks does not have the autistic families and individuals best interest in mind, based on how they allocate their money that they make off of those families. So if you want to learn more, you can Google this article that says before you donate to Autism Speaks, consider the fact and it’s by the autism Self Advocacy Network, a s a n and that is a fantastic network that has a lot of neurodiverse affirming information and insights on there that we do want to support that organization. But yeah, look more into it Autism Speaks as the one that does the lighted up Blue Campaign, and they have that like blue puzzle piece. But again, if you see this, like in the clinic that your child goes to, it doesn’t mean the whole clinic is like terrible and to run away. It’s it’s just another like thing to think of. But the reason why I’m sharing this is because I for the brief time that my daughter was receiving ot services at a clinic. They had Autism Speaks posters, and lighted up blue campaigns and puzzle pieces, like all over the clinic. But the therapist that my daughter was working with was the most fantastic neurodiverse affirming therapist ever. And it’s just sometimes it’s like that you don’t the therapist, or the teachers don’t always get control over what the bigger system that they’re a part of supports. So again, it’s really more about your child’s relationship with their particular therapist. But this is just one of those things that I think is important for parents to know because I didn’t know until maybe a couple of years ago that we are now not using the puzzle piece. I did not realize that but then when I listen to autistic voices, it made so much sense. And that Autism Speaks isn’t the best organization to support if you really, really want to support autistic families and autistic individuals. And so, if you’re new to this journey, it’s something for you to think about. All right, I will talk to you next week. Speaker 1 39:52 If you enjoyed this podcast, please consider rating it and leaving a review which helps other parents find me as well. Want to learn more mean I share tons more over on Instagram at the OT butterfly See you next time Transcribed by https://otter.ai