Neurodiversity in Practice: A Guide for Complementary Practitioners and Trainers by Jayney Goddard MSc, PG Dip Ed, FCMA, FRSM, Founder and President, The Complementary Medical Association. This article is valued at one hour of CMA CPD.
Last week, I was sitting with my writer’s group when the conversation turned to neurodiversity. Someone was describing a character they were developing, and the question of language came up — what terms are respectful, what’s outdated, what to avoid. I listened, and then I said something I think more of us should be willing to say: “I’m honestly not sure of the correct and most respectful terminology myself.”
It was a small admission, but it stayed with me. Because if I — someone who has spent four decades working in the complementary medical sector, founding and leading a standards-setting body and writing regularly on practitioner and trainer care — found myself uncertain, then almost certainly so do many of our Members. And that uncertainty matters. Because the people we serve include neurodivergent clients, neurodivergent students, we often become aware of neurodivergent Practitioners and Trainers among our Membership.
So I went away and did the reading. What follows is what I learned, distilled for the CMA community. It covers current terminology, the science underpinning the neurodiversity paradigm, why neurodivergent people so often find their way to complementary medicine, and — most practically — the small adjustments we can make in our clinics and training schools that have a disproportionately large effect.
What Do We Mean by Neurodiversity?
The term “neurodiversity” was coined by the Australian sociologist Judy Singer in her 1998 honours thesis, and has since become the umbrella term for a paradigm shift in how we understand the human brain. The core idea is simple: just as biodiversity describes natural variation among species, neurodiversity describes natural variation among human minds. Autism, ADHD, dyslexia, dyspraxia, Tourette’s syndrome and others are not faults to be corrected but differences to be understood, accommodated and, where helpful, supported.
This is not the same as denying that neurodivergent people face genuine challenges. Many do, and many find aspects of their wired-in differences disabling — particularly in environments built for the neurotypical majority. The neurodiversity paradigm simply asks us to locate the problem more accurately. It is often the mismatch between a person and their environment, rather than the person themselves, that produces the suffering.
For practitioners working in complementary and integrative medicine, this framing is not unfamiliar. We have long understood health as relational, contextual and whole-person, rather than locating pathology purely within the individual. The neurodiversity paradigm invites us to extend that same lens to the brain.
A Note on Current Terminology
Language in this area has moved on quickly, and well-meaning practitioners sometimes find themselves using terms that are now considered outdated or unwelcome. Here is where things currently stand.
“Neurodivergent” and “neurotypical” are the contemporary umbrella terms. Neurodivergent describes anyone whose brain functions differently from what is considered typical; neurotypical describes those whose neurology falls within the typical range. “Neurodiverse” is also widely used, though strictly speaking a group is neurodiverse — an individual is neurodivergent.
“Autistic” is generally preferred over “person with autism” within the autistic community itself. A landmark study by Kenny and colleagues (2016) in the journal Autism found that autistic adults, family members and professionals in the UK overwhelmingly preferred identity-first language. That said, individual preferences vary, and the most respectful approach is always to follow the person’s lead.
“Asperger’s syndrome” is no longer in clinical use. The DSM-5 folded it into autism spectrum disorder in 2013, and the term has further fallen out of favour following the documenting of Hans Asperger’s involvement with the Nazi regime’s child euthanasia programme. Some people who received this diagnosis still identify with it; others have moved on.
“High-functioning” and “low-functioning” are increasingly avoided. They tend to obscure rather than describe — many so-called “high-functioning” autistic people struggle profoundly with daily life, while many described as having greater support needs have rich inner lives that the old label flattens. “Higher support needs” and “lower support needs” are now generally preferred where descriptors are necessary at all.
“On the spectrum” is still in current use and is not considered outdated. The autism spectrum is a well-established clinical and community concept.
If you make a mistake — and we all will — do what most autistic and ADHD adults say they appreciate: apologise briefly, correct yourself, and move on. The over-elaborate apology is itself uncomfortable.
The Double Empathy Problem
One of the most important conceptual developments in autism research in recent years comes from Dr Damian Milton at the University of Kent. In a 2012 paper in Disability & Society, Milton — himself autistic — proposed what he called the “double empathy problem.” The traditional view held that autistic people struggle to read or empathise with neurotypical people. Milton’s insight was that the difficulty is mutual: neurotypical people equally struggle to read autistic communication. It is not a one-way deficit but a two-way mismatch.
Subsequent research has strongly supported this. Crompton and colleagues (2020) found that information transfer between autistic people is just as efficient as between neurotypical people; it is transfer between mixed pairs where breakdown occurs. The implication for practitioners is significant. If you find a neurodivergent client “difficult to read,” the difficulty is not located inside them. It is in the interface between two different communication styles, and the work of bridging that interface is shared.
Sensory Considerations in the Clinic
For many neurodivergent people — particularly autistic and ADHD individuals — sensory processing differs in ways that profoundly affect their experience of clinical spaces. The DSM-5’s 2013 revision added sensory differences as a core diagnostic feature of autism, reflecting decades of research. A 2017 review by Robertson and Baron-Cohen in Nature Reviews Neuroscience synthesised the evidence: differences span every sensory modality and have clear neurological correlates.
Complementary clinics often present particular sensory challenges. Aromatherapy oils, scented candles, music intended to soothe, soft furnishings that hold smell, dimmed or warm lighting, the close physical proximity of bodywork — every one of these can be either a profound comfort or an active source of distress, and which it is may not be predictable from appearance or self-report.
A few practical considerations:
- Ask before you scent. A simple question at intake — “Are there any smells or sounds that are difficult for you?” — costs nothing and signals competence immediately.
- Offer choice over lighting and music. Many neurodivergent clients find dimmed lighting comforting; others find it disorienting. Music that one client finds calming, another finds intrusive.
- Be explicit about touch. This is good practice with every client, but especially important here. Describe what you will do, where, and for how long, before you begin.
- Allow processing time. Don’t rush to fill silences. After a question, wait. Many autistic and ADHD adults need longer to compose a response, and rushing produces poorer answers.
- Offer written follow-ups. Verbal aftercare instructions are easily lost. A short written summary, emailed afterwards, supports retention and reduces anxiety considerably.
None of this is exotic. Most of it is what good practitioners do already, simply made more deliberate.
Co-Occurring Physical Health Conditions
Here is something every complementary practitioner should know, because it explains a great deal about who is likely to walk through your door. Neurodivergent people have significantly higher rates of several physical conditions that conventional medicine often manages poorly.
A 2022 study by Csecs and colleagues, published in Frontiers in Psychiatry, found that autistic and ADHD individuals had markedly higher rates of joint hypermobility, dysautonomia and chronic pain than the general population. The relationship between three conditions in particular — hypermobile Ehlers-Danlos syndrome, postural tachycardia syndrome and mast cell activation syndrome — and neurodivergence is now a recognised research area in its own right. For readers unfamiliar with this trio, a brief introduction may be helpful.
Hypermobile Ehlers-Danlos syndrome (hEDS) is the most common of a group of heritable connective tissue disorders that affect collagen, the protein providing structure to skin, joints, blood vessels and internal organs. People with hEDS typically have joints that move beyond the usual range, soft and often stretchy skin, slow wound healing, chronic joint pain, and a tendency towards dislocations, fatigue and gastrointestinal symptoms. It is frequently missed or diagnosed late, particularly in women.
Postural tachycardia syndrome (PoTS) is a form of dysautonomia — dysfunction of the autonomic nervous system, which regulates heart rate, blood pressure, digestion and other involuntary bodily functions. In PoTS, the heart rate rises abnormally on standing (by at least 30 beats per minute in adults, or 40 in adolescents, within ten minutes of standing). Symptoms can include dizziness, palpitations, fainting, severe fatigue, brain fog and exercise intolerance. It is often misdiagnosed as anxiety.
Mast cell activation syndrome (MCAS) is a condition in which the body’s mast cells — immune cells involved in allergic and inflammatory responses — release their chemical mediators inappropriately or excessively. This produces a wide range of symptoms including flushing, itching, abdominal pain, diarrhoea, headache, food intolerances, anxiety, and in severe cases anaphylaxis-like episodes. Common triggers include foods, fragrances, temperature changes and emotional stress — which has particular relevance for complementary clinics where scent is often part of the environment.
Together, this trio is sometimes informally called “the trifecta,” because the three conditions so often co-occur — and, as Csecs and colleagues have demonstrated, they co-occur in turn with autism, ADHD and Tourette syndrome at significantly elevated rates.
Gastrointestinal issues are also more common. A 2014 meta-analysis by McElhanon and colleagues in Pediatrics found that children on the autism spectrum had over four times the rate of GI symptoms compared with neurotypical peers, and adult research has found similar patterns.
What does this mean for complementary practitioners? It means that the chronic-pain client who arrives with a folder of unexplained GI symptoms, palpitations and a long history of being told it’s “all stress” may well be neurodivergent — diagnosed or not. It means our nutritionists, herbalists, osteopaths, acupuncturists and bodywork practitioners are seeing this population disproportionately. It means we have a responsibility to understand the wider picture so that we can refer wisely, treat sensitively, and avoid compounding the harms our clients have often already experienced elsewhere.
Why Neurodivergent People Often Seek Complementary Medicine
There is no single reason, but several themes recur in clinical experience and in the small but growing literature.
The first is healthcare access. A 2022 study by Doherty and colleagues in BMJ Open surveyed more than 1,200 autistic adults in the UK and found significantly higher rates of barriers to healthcare than in the general population — including difficulty making appointments by phone, distress in waiting rooms, and poor communication with clinicians. Many had simply stopped trying. Complementary practitioners often offer the very things that NHS experience has not: longer appointments, calmer environments, the chance to be heard in full.
The second is the validation of subjective experience. Conventional medicine’s tendency to dismiss what cannot be easily measured is particularly painful for people whose interoceptive experience differs from the norm. Complementary medicine’s willingness to take the client’s report seriously is, for many neurodivergent people, deeply restorative in itself.
The third is sensory regulation. Many complementary modalities — massage, acupuncture, yoga therapy, breathwork, reflexology — are at heart sensory and somatic practices. For neurodivergent people whose nervous systems run hot or cold, these can be genuinely regulating in a way that talking therapy alone often is not.
None of this is to claim that complementary medicine is uniquely suited to neurodivergent care, or that mainstream medicine has nothing to offer. Both are untrue, and the best outcomes come from intelligent collaboration between the two. But it does mean that the complementary practitioner is often, whether they realise it or not, one of the few healthcare professionals a neurodivergent client feels safe with. That carries genuine responsibility.
Masking, and Why It Matters
A final concept worth knowing about: masking, also called camouflaging. This is the conscious or unconscious suppression of neurodivergent traits in order to appear neurotypical — making eye contact when it feels uncomfortable, suppressing stimming behaviours, mimicking expected social responses, rehearsing conversations in advance.
The psychologist Laura Hull and colleagues have done extensive work on this, developing the Camouflaging Autistic Traits Questionnaire (CAT-Q) and demonstrating across multiple studies that high levels of masking are associated with exhaustion, anxiety, depression and — most seriously — suicidality. A 2018 paper by Cassidy and colleagues in Molecular Autism found that camouflaging was a significant independent predictor of suicidality in autistic adults.
The clinical implication is straightforward but important. If your neurodivergent client appears to be coping well in the room — making steady eye contact, smiling, conversing fluently — this may not be evidence that they are fine. It may be evidence that they are working extremely hard. Building in permission to not mask, to stim, to wear sunglasses or noise-cancelling headphones, to sit on the floor, to bring a fidget object, can transform the therapeutic encounter. None of these accommodations costs anything. All of them communicate, without words, that this is a safe place.
Considerations for Training Schools
Many CMA member schools train students who are themselves neurodivergent, and that proportion is rising as adult diagnosis becomes more common — particularly among women and people of colour, who have historically been under-diagnosed.
The Equality Act 2010 typically treats autism and ADHD as disabilities, meaning that reasonable adjustments are not optional but legally required. More importantly, getting this right is part of producing well-supported, competent practitioners who will go on to serve their own neurodivergent clients with insight.
Practical adjustments include written copies of verbal instructions, advance information about new clinical placements, extended assessment times where indicated, flexibility on group-work formats, and quiet spaces during long teaching days. None of these is expensive. All of them dramatically improve outcomes for neurodivergent students — and, in my experience, for plenty of neurotypical ones too.
Encouraging disclosure is harder. Many students will not disclose for fear of being seen as less capable. Building a culture in which neurodivergence is spoken about openly — perhaps by inviting a guest lecturer, perhaps by including neurodiversity in your equality and diversity training, perhaps simply by adding a sentence to your enrolment paperwork that invites disclosure without demanding it — signals safety without requiring anyone to come forward before they are ready.
A Final Thought
A great deal of complementary and integrative medicine is, at its core, the practice of meeting a person where they are. Of slowing down. Of paying attention. Of treating the individual rather than the diagnosis. Of taking subjective experience seriously. These are precisely the qualities that neurodivergent clients and students most need from those who care for them.
The question, then, is not really whether we are equipped to support neurodivergent people. We are, in many ways, ideally placed. The question is whether we know how to apply what we already do well — with the right language, the right sensitivity, and an awareness of the specific patterns of need that this population so often brings.
I hope this article has been a useful first step. Terminology will continue to evolve; the research will continue to refine our understanding. What will not change is the fundamental work of the complementary practitioner: to see the person, to listen carefully, and to respond with skill.
That, we have always known how to do – and I firmly believe this is something we can be justifiably proud of.
CMA Practitioners: Earn 1 hour of CMA CPD with this article
Reading this article and completing a written reflection on it qualifies for one hour of Continuing Professional Development (CMA CPD). To claim it, spend around forty minutes writing a short reflective piece (a paragraph or two on each of the following) covering:
- Two or three points from the article most relevant to your own practice;
- One change you intend to make in your clinic, communication style, or training environment as a result;
- How you will know that change has been embedded.
To log this activity, sign in to the CMA membership portal, navigate to My CPD, click Add new activity, and upload your written reflection along with the title of this article and the date you completed it. Your CPD record will update automatically.
References
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: an investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8
Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: suggestions for autism researchers. Autism in Adulthood, 3(1), 18–29. https://doi.org/10.1089/aut.2020.0014
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, 42. https://doi.org/10.1186/s13229-018-0226-4
Crompton, C. J., Ropar, D., Evans-Williams, C. V. M., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–1712. https://doi.org/10.1177/1362361320919286
Csecs, J. L. L., Iodice, V., Rae, C. L., Brooke, A., Simmons, R., Quadt, L., Savage, G. K., Dowell, N. G., Prowse, F., Themelis, K., Mathias, C. J., Critchley, H. D., & Eccles, J. A. (2022). Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in Psychiatry, 12, 786916. https://doi.org/10.3389/fpsyt.2021.786916
Doherty, M., Neilson, S., O’Sullivan, J., Carravallah, L., Johnson, M., Cullen, W., & Shaw, S. C. K. (2022). Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open, 12(2), e056904. https://doi.org/10.1136/bmjopen-2021-056904
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal”: social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5
Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442–462. https://doi.org/10.1177/1362361315588200
McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics, 133(5), 872–883. https://doi.org/10.1542/peds.2013-3995
Milton, D. E. M. (2012). On the ontological status of autism: the “double empathy problem”. Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008
Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671–684. https://doi.org/10.1038/nrn.2017.112
Singer, J. (1998). Odd people in: the birth of community amongst people on the autistic spectrum. Honours thesis, University of Technology, Sydney. (Subsequently expanded as Singer, J. (2017). NeuroDiversity: The birth of an idea. Self-published.)
Further Reading
You will find further deep dives into a variety of conditions in the Complementary Medical Association’s Library of Conditions. You can access this here.