08/06/2026
The medical model often follows a familiar pathway - the difficulty is located within the person.
1. SLTs diagnose a disorder.
2. Prescribe intervention.
3. Determine dosage.
4. Measure change.
This model makes sense in medicine; if someone has an infection, we identify it, prescribe treatment and monitor whether symptoms improve. But communication is not an infection, and neurodivergence is not a disease. Yet SLT has often borrowed the logic of medicine and applied it to communication. In doing so, we can unintentionally position , and otherwise neurodivergent people as the problem and the target of change.
With this thinking, the approach has often been "How do we change the person? or "How do we help them become more typical?"
A neurodiversity-affirming approach begins somewhere different. Drawing on social model thinking, Disability Justice, lived experience knowledge and decolonial perspectives, we seek to understand a person in context. We recognise that communication never happens in isolation. It is shaped by relationships, environments, culture, power, identity and access.
We ask: What is happening between this person and the world around them?
This means:
• Understanding how race, class, poverty, gender, migration, trauma and educational experiences shape communication and its interpretation.
• Learning from those most impacted. The knowledge of autistic people, disabled people, users, , and should shape our practice.
• Valuing interdependence rather than treating independence as the ultimate goal. Communication is relational, multimodal and collaborative.
• Creating collective access. Access should be built into environments from the beginning.
• Seeing the whole person. Not a collection of targets, but a human being of value whose sensory experiences, identity, relationships, culture, fatigue, distress and joy all matter.
The question is not about changing the person it is about identifying and fostering the conditions that allow this person to communicate, participate, connect and flourish as themselves.
The outcomes we measure shift too.
Medical model outcomes often prioritise:
• symptom reduction
• behavioural change
• normative performance
• therapist-defined goals
Neurodiversity-affirming outcomes prioritise:
• autonomy and agency
• communication access and choice
• self-advocacy in all forms
• emotional safety
• meaningful participation
• identity development
• quality of life
• belonging
Perhaps the most important shift in neuro-affirming SLT is instead of us asking, "Is the intervention effective?" we ask "Is this person's life better?"
Clinical knowledge and skill are necessary - but this alone is insufficient.
www.divergentperspectives.co.uk