5 Ways I Provide Neurodiversity Affirming Therapy for ADHD and Autism

By: Kimberly Harkey

Seeking therapy for ADHD or Autism can feel overwhelming, especially when traditional therapeutic approaches don’t always reflect the lived experiences of neurodivergent people. As a neurodiversity-affirming therapist, my goal is to create a space where ADHDers, Autistic individuals, and other neurodivergent folks feel respected, understood, and supported—not “fixed.” Neurodiversity reminds us that every brain is different, and neurodivergent identities such as ADHD and Autism are natural variations in human thinking, feeling, and processing.

In this blog, I’m sharing five ways I provide neurodiversity-affirming therapy for ADHD and Autism, focusing on collaborative communication, sensory-friendly accommodations, and individualized support. If you’re looking for therapy that adapts to your brain rather than expecting your brain to adapt to therapy, these approaches may help you understand what to look for and what you deserve in a therapeutic relationship.

Appointment Reminders

I try to start thinking about how to provide neurodiversity affirming care before we start out work together. How can I help you show up for your first and subsequent appointments? This one seems simple and yet, I find it one more way to honor that neurodivergent folks experience time differently. Time blindness in ADHD is a real thing (as every ADHDer reading this knows). I know though that appointments are hard to keep and schedules can be hard to organize. So, I do a few things to try to set anyone with ADHD or Autism up for success:

• I send an email reminder 28 hours in advance. Sure, this email may get missed in the sea of emails, but I want to give ADHD and Autisic clients time to think about their appointment before getting in the 24 hour cancellation fee window. My hope is this gives neurodivergent clients a moment to double check their schedules before then rather than getting their reminder at the 24 hour mark. 
• I send a text reminder 2 hours prior. Ideally this gives a reminder closer to and helps client start to orient themselves toward our appointment if possible.
• If clients aren’t in the session by 5 minutes after, I reach out. I don’t wait until the 15 minute mark when it’s too late. I reach out and invite them to join. This is their hour and I want them to join and get to use their time.

I do have a cancellation fee if people cancel within 24 hours of their appointment or no show an appointment. This fees helps me honor our time together. However, I try to do everything I can up front to set people up for success in getting to their appointments. I also give everyone 1 free pass on the fee to give ADHDers and Autistic clients room to settle into the routine of meeting without needing perfection.

Fidgets, Stimming, and Movement Encouraged

This seems obvious, but I let all clients (ADHD, Autism, anyone) use any fidgets they want during session. When we meet in person, I bring fidgets and I’m also ok with clients bringing their own. If ADHDers need the extra stimulation during session, they can rock, pace, fidget, or whatever their body needs.Autistic folks can stim however largely or quietly they want to.  Allowing movement gives space for ADHD and Autistic folks to show up as themselves and explore within safe space what movement they need to regulate their body.

This includes moving where you’re sitting during session. Want to sit on the floor? Go for it. Need to move from the couch to a chair? Great! Does the rocking chair suddenly look intriguing? Get up and move. You don’t have to sit in the same place or the same seat the entire session. I offer multiple seating options to give you the opportunity to find what feels right to you. I invite you to honor what you need in each moment of our work together.

Beyond simply allowing movement, I also help clients explore what types of sensory input actually supports their regulation. For some ADHD and Autistic folks, rhythmic movement or tactile stimulation can increase focus; for others, certain textures or motions may be grounding during emotionally intense moments. Part of neurodiversity-affirming therapy is helping clients notice these patterns without judgment and building a sensory toolkit that works for their unique nervous system. Whether that means experimenting with different fidgets, identifying stims that feel soothing, or creating a predictable sensory routine for sessions, these strategies empower clients to show up authentically and stay connected during the therapeutic process

Eye Contact Optional

Many neurodivergent people feel pressured to maintain eye contact because it’s often treated as a marker of attentiveness or respect, but research consistently shows that this expectation is rooted in neurotypical norms—not universal human experience. For many Autistic individuals, eye contact can make it harder—not easier—to engage in conversation. Studies have shown that forcing eye contact makes social interactions worse, not better, for Autistic people.  ADHDers may also struggle with eye contact because the effort it takes to focus thoughts doesn’t always leave effort for also maintaining eye contact.  By removing pressure around eye contact, therapy becomes a space where clients can focus on the conversation itself—not on masking or performing social norms that may not fit how your brain works.

No pressure here to force eye contact. You can turn your camera off, turn it toward the ceiling, or look off to the side for most of the session. If you want to move during the session, you don’t have to be tied to looking at me at the same time. Your worth is not determined by your ability to make eye contact. Your success in therapy is not determined by your eye contact in therapy. I fully believe growth happens when we step outside the box of expectations society has placed on us and give ourselves freedom to find what works for us.

Prioritizing Your Unique ADHD or Autistic Brain

It is downright exhausting as someone with ADHD or Autism to show up in spaces designed exclusively for neurotypical folks. You are constantly asked to do things in a way and at a speed that your brain was not designed to do them. I feel passionate that therapy does not need to be one more space where neurodivergent folks have to mask and have to pick up all the extra work of advocating for more inclusive spaces. I am dedicated to tailoring our therapeutic work in a way that feels like it flows with you rather than making you fight against the current. 

I value figuring out the ideal flow with you through honest conversations. Some of the topics we can collaborate on in your care include:

• ADHD can make focusing to read feel laborious. Before recommending a book, I’ll ask if you enjoy reading and how doable it feels. 
• Autistic folks are more likely to experience aphantasia. Before using a metaphor, I’ll ask how you feel about metaphors and if your brain can create visual images. 
• Autistic and ADHD folks can struggle with interoception. Before asking where you feel something, I’ll ask about how you experience feelings and what tells you how you feel.
• We’ll talk about pacing and use of silence to find what feels right to you in our work together- Do you want space to collect your thoughts ? Do you want us to sort through them together? 

We’ll work together to create a space that allows for your healing and growth. Along the way, I offer you the chance to learn about yourself, your needs, and find ways to advocate for yourself both in and outside of session.

Feedback Forms for Careful (Autism) and Rapid (ADHD) Thinkers

I start talking about feedback in session 1. After all, we are building this space together. I want to hear any and all feedback you have about our work, so that we can adjust to fit your needs. I find an after session feedback form helpful for anyone in therapy, but I especially find it helpful for folks with ADHD and Autism. Autistic folks can often be careful thinkers that need time to reflect and want to be sure about the words they are going to use before sharing them. They may also not be sure how they feel in the moment and need time to identify their feelings. Sending a feedback form that can be filled out hours later leaves room to take time to reflect before sharing and gives a written space to find the right words without having to recall them in person. I always follow-up in session, but starting the conversation can be done in the feedback form and that has shown to be very helpful.

ADHD folks can also have a hard time identifying feelings in the moment and may have a hard time wrangling in their thoughts to give feedback in the moment. The feedback form gives a space for ADHD folks to write as much as they need about how they felt after therapy or what they found helpful in therapy. We will still discuss their feedback when we meet in our next session, but the form helps with the initial barrier of getting the words out.

Therapy is a collaborative process. It can be a safe space to practice speaking up for your needs in a relationship. This can include letting your therapist know that a specific intervention didn’t feel right, that you found a certain thing they said to be very illuminating, or that you know you hear feedback best when it is presented a certain way. 

In conclusion: Neurodiversity Affirming Therapy for ADHD and Autism

Neurodiversity-affirming therapy for ADHD and Autism isn’t about changing who you are—it’s about helping you understand your brain, build on your strengths, and navigate challenges with compassion and practical support. Whether it’s offering flexible communication options, encouraging movement and stimming, or honoring how neurodivergent people experience time, each of these practices is designed to create therapy that works with you.

If you’re seeking therapy for ADHD or Autism that respects your neurotype, values your autonomy, and provides meaningful accommodations, know that supportive and affirming care is possible. You deserve a therapeutic space where your needs are understood, your voice matters, and your lived experience guides the work we do together.

Appendix: Definition of Terms

I want to take a quick minute and break down a few terms for this blog. The terms neurodivergent and neurodiversity so often get mixed up and used interchangeably, so I want to clearly define them when talking about neurodiversity affirming care.

Neurodiversity is a term often credited to sociologist and autistic self advocate Jane Singer to emphasize that no two brains are alike. 

Neurodivergent was coined by Kassiane Asasumasu and described a person’s brain that works in a way that is outside the norm, including labels such as ADHD, Autism, PTSD, OCD, Dyslexia, GT, and TBIs. It’s a much broader term than people realize when they apply it to just ADHD and Autism.

Neurodiversity affirming care benefits both neurotypical and neurodivergent brains. It operates on the assumption that all brains are different, normalizes differences in how brains work, and helps individuals find a way to work with their brains instead of against them.