OT Interventions for Higher Ed Neurodivergent Students

Editor's note: This text-based course is a transcript of the webinar, OT Interventions for Higher Ed Neurodivergent Students, presented by Christopher Edwards, OTR, OTD.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

After this course, participants will be able to:

• Explain and describe neurodiversity and the neurodivergent movement.
• Describe the barriers facing neurodivergent-identifying individuals in postsecondary education.
• Identify ways to help and prepare neurodivergent-identifying individuals for success in postsecondary education.

Introduction

I am a Doctor of Occupational Therapy, and I want to start by telling you a little bit about how I got here, because it matters for everything I am about to share with you. While attending OT school at Springfield College in Massachusetts, I became increasingly interested in neurodiversity. I am also clinically diagnosed with autism myself, and that diagnosis, along with the rest of my identities, shaped my occupational performance in ways I didn't fully understand until I started reflecting on them. During my time in undergrad, I struggled with sensory overstimulation, sensory trauma, social trauma, executive functioning, and self-advocacy. I didn't have language for any of it at the time. I just knew that college felt harder for me in ways I couldn't always explain.

That reflection is what led me to research how neurodiversity-affirming principles can be leveraged to help neurodivergent-identifying individuals succeed in postsecondary education. I have since designed a study exploring knowledge and attainment of self-advocacy skills among neurodivergent-identifying postsecondary students, and I co-authored a chapter in Bryden Carlson-Giving's Neurodiversity-Affirming Occupational Therapy, which I draw on heavily throughout this presentation. When I'm not with clients or engaged in research, I like to play sports, go for hikes, and try new recipes.

Before I go further, I want to be transparent about a few things. First, in the spirit of full disclosure, I identify as neurodivergent myself. Throughout this course, I will use neurodiversity-affirming language and explain exactly what that means and why it matters. I also want to name that my experience as a neurodivergent individual is shaped by my identities as a white, cisgendered male. That lived experience is different from the lived experience of someone who exists at the intersection of race, ethnicity, sexual orientation, and disability, and I want to hold that with humility as we go.

What I want you to walk away with today are three things: a real understanding of neurodiversity and the neurodivergent movement, a clear picture of the barriers facing neurodivergent-identifying individuals as they move into postsecondary education, and a set of concrete ways you can help prepare these individuals for success once they get there. I want to be careful with my language here, too. What I offer throughout this course are suggestions for intervention, not universal interventions, because the applicability of anything I say depends heavily on the setting you work in, the population you serve, and the individual sitting in front of you. Some of you are school-based OTs supporting a transition-age youth heading toward higher education. Some of you work as faculty or staff at colleges, universities, or specialty schools. Wherever you're coming from, I think you'll find that what I'm about to share applies across those settings more than you might expect.

I also want to name something directly: this population, the transition-age individual moving from high school into and through higher education, isn't a population that occupational therapy has historically been deeply involved with in the sense of ongoing treatment and intervention. That's part of why I'm here today, and part of why I think this course matters. We have an entire body of theory, ethics, and practice frameworks that already support this work; we simply haven't extended our reach into this space as far as we could. My hope is that by the end of this course, you'll see not just the need for this work, but your own scope and standing to actually do it.

Neurodiversity-Affirming Language

I want to start here because the use of neurodiversity-affirming language can be an intervention in and of itself. Research suggests that the words we use genuinely influence our thoughts, beliefs, and assumptions about the world around us. Language doesn't just describe reality; it shapes how others see themselves and how they choose to show up in the world. Consider an example: someone might label another person as "sensory sensitive" and, out of what feels like consideration, stop inviting them to a concert or a sporting event. That same person might internalize the label and begin declining invitations on their own, out of fear of being seen as a burden. The label became the barrier.

Neurodiversity-affirming language seeks to affirm, validate, and support the everyday experiences of neurodivergent thinkers. Going back to that same example, if we instead recognize that a person has heightened awareness or attention to lights and sounds, rather than labeling them as "sensitive," we are more likely to appreciate that trait and actively help that person navigate a concert successfully. I want to make one important distinction here: neurodiversity-affirming language is not necessarily meant to be positive or negative. The goal isn't to spin every neurodivergent trait into something glowing. The goal is to validate neurodivergent life experiences in a genuinely supportive way.

Here's another example. Many self-advocates who would traditionally be labeled as "high functioning" or "low functioning" would prefer to be described as having differing levels of support needs. Labeling someone as high or low functioning implies there is no way to leverage that person's skills or adapt the environment around them, and historically, that language has been used to stereotype people. Describing someone as having low or high support needs helps us adapt our thinking to find ways to actually support that individual. It becomes a conversation about what a person can do with the right supports, rather than what they can't do because of a diagnosis, a trait, or a different ability.

The goal, ultimately, is to recognize, break free from, and reframe the unhelpful thought patterns and stigmas that hold us back from taking real, actionable steps toward accessibility. This also helps us maintain a trauma-informed frame of reference, which shifts the conversation away from stigma and toward tangible solutions.

I designed the graphic that accompanies this section of the course, and I've updated it over time during my doctoral capstone project, drawing on a wide range of resources from neurodivergent researchers and thinkers. You might look at some of the reframed terms and think, "wait a minute, I use that term to describe myself." I understand that reaction completely. Personally, I prefer to describe myself as sensory sensitive. I've considered using "heightened awareness and attention to detail" instead, but honestly, it doesn't capture my lived experience the way "sensory sensitive" does. That's the point, though: this isn't about erasing every term that might sound stigmatizing on paper. This is about being client-centered. Pay attention to how your own clients describe their experiences, and work within that framework. If a client wants help reframing their own language, support that. If they don't, respect where they are.

I want to raise this because some neurodivergent advocates and their caregivers have pointed out that disability-first language can actually help someone access the care they need. So even as you lean into neurodiversity-affirming language, stay client-centered above all else.

Many of the more traditional descriptors tend to be stigmatizing, whether we are consciously aware of that or not, and they shape how we treat other people. The central goal here is to separate the person from the diagnosis, and to recognize that every individual is more complex and more capable than their medical history alone would suggest.

Here's what this means for your work: language is one of the lowest-cost, highest-impact interventions available to you. It doesn't require a referral, a new evaluation, or additional funding. It requires you to slow down, notice the words you default to, and ask whether those words describe a deficit or a difference that simply needs the right support wrapped around it. I'd encourage you, before your next session with a neurodivergent client, to actually write down the language you tend to use to describe that client's traits, and then ask yourself whether that language is client-centered or whether it's borrowed from a chart, a diagnosis, or a stereotype you picked up somewhere along the way.

The Evolution of the Neurodiversity Movement

I think the history of this movement matters because I didn't encounter the term "neurodiversity" myself until my second trimester of grad school, in the latter half of 2022. At the time, I assumed it was a fairly new concept. It isn't. Evidence points to its conception in the early 1990s, with the founding of the Autism Network International, although the movement's roots may reach even earlier. In general, the growth of this movement has tracked closely with the advancement of technology and the internet.

As for who coined the term "neurodiversity," many people credit Australian sociologist Judy Singer. The evidence, though, points to the term's true origins developing through an early online forum of autistic advocates called InLv, or Independent Living. Singer herself has publicly said that she shouldn't be given sole credit for coining the term. In the early 2000s, American autism advocate Kassiane Asasumasu coined the related terms "neurodivergent" and "neurodivergence."

So what do all of these terms actually mean? Neurodiversity is the concept that there is no single way of thinking or being; it recognizes the diversity and variability inherent in neurocognitive function. Neurodiverse refers to the collective. All of us on this call, all of us reading this course, are neurodiverse. We each carry a different brain signature that shapes how we think, feel, and experience the world. Neurodivergent, by contrast, is an identity. It's a way a person chooses to identify themselves, and a person can identify as neurodivergent whether or not they carry a classical neurodivergent diagnosis.

In 2008, Nick Walker coined the term "neuroqueer" to describe someone who subverts societal norms around behavior, gender, and sexuality. A person can be neuroqueer without identifying with the LGBTQIA+ community at all. I identify as neuroqueer myself, even though I also identify as heterosexual and cisgender, because I don't live my life in a way that would traditionally be considered masculine, and that is both a conscious and a subconscious choice I've made, though I'll admit I don't always have full control over that.

Today, the neurodiversity movement has grown into an important social justice movement, one that promotes an ecological model of disability and has pushed for more equitable policies and laws around access to jobs, education, and healthcare. There is still a great deal of work left to do, and that work is part of why you're here: to contribute to this conversation and support this cause using your expertise as OTRs.

The Neurodiversity Paradigm

The neurodiversity paradigm is non-dichotomous. In other words, it's a spectrum, not a binary, and it is not limited by diagnostic criteria. You do not need a specific diagnosis to identify as neurodivergent. Instead, this paradigm exists to advocate for thinking and processing differences as an integral part of human diversity. It celebrates inclusion, acceptance, anti-oppressive practices, and social justice, and aims to be trauma-informed.

Critically, the paradigm recognizes the intersections of race, ethnicity, gender, sexual orientation, and identity, and different ability, and I think that point is enormous for practitioners to sit with. We may see someone come to us who identifies with multiple marginalized identities simultaneously, and who may experience related prejudices all at once. A Black woman living with autism, for example, may experience prejudice tied to all three of her minority identities, whereas I, as a white, cisgendered, neurodivergent man, experience prejudice tied to only one. An individual might arrive with these compounding experiences and seek help for only one identity or trait, but we cannot claim to be holistic practitioners if we ignore the other identities a person carries. We need to adjust our language, our thinking, and our interventions based on the whole person, not just the neurodivergent piece, or the autism piece, or the ADHD piece.

The neurodiversity paradigm also actively cultivates strengths, self-determination, and inclusion, all while accounting for the influence of these intersecting identities.

The Neurodivergent Brain

Neurodiversity is often discussed purely as a social movement, but it is grounded in neuroscience. Research using neuroimaging technologies has identified natural variations in brain structure and function that influence how individuals learn, process information, regulate emotion, think, and experience their environments. These patterns of neural organization are sometimes referred to as brain signatures. In the same way a fingerprint identifies a person, neuroimaging studies, including fMRI research, have demonstrated measurable differences in neural activity and connectivity across individuals and neurotypes, regardless of diagnosis or identity.

What I'm really getting at is this: whether you identify as neurodivergent, neurotypical, or anything in between, you are going to have a brain signature that differs from everyone else's, including people who share your same diagnoses. My brain signature is different from that of another autistic person. For this reason, differences in cognition, perception, attention, learning, and behavior should be expected in every single interaction you have, no matter who you're working with. Every brain carries its own combination of strengths, preferences, challenges, and ways of interpreting the world. That is simply natural variation in human neurology, and it is the foundation on which the entire concept of neurodiversity rests.

I sometimes describe this to students and colleagues as the difference between a manual brain and an automatic brain. Some brains process a large amount of environmental and social information automatically, with little conscious effort. Other brains, including mine, have to run a lot of that same processing manually, consciously working through decisions that come effortlessly to someone else: how loud is this room, do I need to make eye contact right now, did that comment mean what I think it meant. None of that is a deficiency. It's simply a different operating system, and it costs real cognitive energy over the course of a day. Keep that manual-versus-automatic distinction in mind as we move into the barriers section, because it explains a lot of what's actually driving burnout in this population.

Common Associated Diagnoses

I don't want anyone getting hung up on this next part. A number of diagnoses are commonly associated with neurodivergence, including autism spectrum disorders, dyslexia and dyscalculia, dyspraxia, tic disorders such as Tourette Syndrome, anxiety and depression, post-traumatic stress disorder, mood disorders including OCD and bipolar disorder, and sensory processing disorder, among others. I'm sharing this list purely as an example of the kinds of traits I'll be referencing throughout the rest of the course, not as an exhaustive or diagnostic framework.

Strengths of Neurodivergent Thinkers

Neurodivergent thinkers bring a remarkable range of strengths to the table. Many are creative. Some are musically attuned, hyperlexic, gifted storytellers, or have a genuine affinity for the visual arts. Neurodivergent individuals often demonstrate excellent problem-solving and spatial visualization skills and tend to be detail-oriented. They also tend to have a strong work ethic, the ability to juggle multiple tasks, and, yes, a tendency to procrastinate, which, despite the anxiety it can create, has been described in research on neurodivergent students in graduate STEM programs as sometimes leading to genuinely remarkable results.

Neurodivergent thinkers also tend to value loyalty, justice, and honesty, and are frequently tremendous empathizers, something I want to come back to a little later, because it gets misunderstood a lot. Many are highly tech-savvy and pick up new technology quickly. I will say, though, that this is exactly where my brain differs from that of a lot of my peers: I am not tech-savvy. I never have been. It's a good reminder that even though people with my diagnosis are almost always assumed to be tech-savvy, that assumption doesn't hold for everyone, including me. Some of this material was adapted from a presentation I gave alongside Dr. Lori Vaughan, and I want to give her a shout-out here. She also co-authored the book chapter I mentioned earlier, and I love her dearly for the work we've done together.

Neurodiversity and Postsecondary Education

Now we get to the heart of why you're here.

There is a growing number of neurodivergent college students, and while that growth adds real, positive diversity to campus communities, it also creates an urgent need for inclusive and affirming learning environments, especially as degree inflation continues. More and more jobs require some form of postsecondary education, which means we can expect more neurodivergent individuals to pursue postsecondary degrees. The report I've relied on for this course, from the Center for Education and the Workforce at Georgetown University, predicts that 72% of all jobs will require some college education by 2031. That timeline could move faster or slower than projected, but the trajectory is clear. Consider our own profession as an example: a few years ago, there was a real conversation about whether practitioners would need to hold an OTD to keep pace with the academic trajectory of other allied health professions. Even though most OTD programs don't require dramatically more education than a master's, that shift is itself an example of degree inflation in action.

Engagement in postsecondary education is often characterized by anxiety, poor-quality sleep, lack of structure, loneliness, and sensory overstimulation. I want to be completely clear that these experiences are not exclusive to neurodivergent students; plenty of new undergraduates across all neurotypes experience them. What matters is that we stay aware of the cumulative, compounding nature of these experiences for neurodivergent students specifically, because they can significantly impact learning potential and engagement, including attendance, participation in classroom discussions that often factor into grades, group work with peers, and every other dimension of educational attainment.

Many students also feel out of place in what is, realistically, a highly competitive educational environment. That perception isn't unfounded. How you're doing academically, the connections you've made, and your relationships within the college community genuinely affect your access to desired classes, teaching assistantships, scholarships, campus jobs, and internships. There is an enormous amount that goes into being a successful college student that is never written down anywhere. It's a hidden social expectation.

There's also a hidden curriculum at play: unwritten, often unintentional institutional expectations about how students should behave, study, and interact with one another. This hidden curriculum tends to generate more stigma and stereotyping, which in turn increases masking and scripting and decreases overall physical and mental health, because what I call the manual brain goes into overdrive. Neurodivergent students are constantly expending mental energy managing their actions, speech, and behaviors, including regulatory behaviors that might actually help them engage with their environment more successfully if they weren't so busy hiding them from the people around them. I'll use myself as an example again: I used to use one of those adult chewy fidget tools, and when I got to college, I stopped using it almost immediately, because I felt like I would be stigmatized for it. As soon as I got on campus, I noticed a couple of weird looks, and I decided I didn't want to do that anymore.

The eventual outcome of these pressures is that neurodivergent individuals internalize neurotypical norms, engage in self-silencing, and can experience an identity crisis as a result. As a neurodivergent student myself, I internalized what I think of as the myth of the ideal student: someone with strong executive functioning in time management, goal setting, planning, and emotional regulation; strong reading, writing, and public speaking skills; rapid and efficient information processing; and the ability to conform to expected norms around schedules, timelines, socialization, and communication. Chasing that myth ultimately leads to burnout through overworking and masking.

It's important to understand that masking can be either conscious or subconscious. Masking is when a neurodivergent person works to suppress or hide their natural qualities. For me, the drive to maintain eye contact has been so deeply ingrained that, regardless of how anxiety-inducing it is, I often don't even register that I'm hurting myself by doing it until I'm already in panic mode, already exhausted, already shut down. That's a clear example of subconscious masking. People mask to fit in, to uphold social norms, to feel a sense of belonging, to keep themselves safe from bullying or judgment, or simply to make friends. Masking can look like forcing yourself to tolerate discomfort in front of others, minimizing or hiding stims even when those stims support regulation, mirroring the facial expressions or gestures of the people around you, forcing eye contact despite real discomfort, or downplaying and avoiding personal interests altogether. I also want to name that while masking carries real costs, choosing not to mask carries its own risks, and that tension is something neurodivergent students are constantly navigating.

Self-identity is impacted too, and I want to slow down here, because this is one of the pieces I think gets the least clinical attention despite being one of the heaviest for students to carry. Neurodivergent students entering higher education have to take on adult roles and construct entirely new social identities, often while difference or otherness remains a prominent part of how they see themselves. Students frequently struggle with whether to disclose their neurodivergence to faculty, to staff, and to peers, particularly in group work settings. The trouble is that staff and faculty rely almost entirely on information the student chooses to provide. Some students want to build an identity that's distinct from whatever they carried through high school. Others fear stigmatization or labeling by faculty and staff, often as a direct result of prior educational experiences. Either way, this can delay or prevent disclosure altogether, which tends to result in a poorer overall college experience. I want to be careful here: I am not saying a student shouldn't be free to construct their own identity apart from their high school years. What I am saying, and what we'll get into further when we talk about self-advocacy, is that being able to accept allyship and accept support when it's needed is absolutely crucial.

Cumulative past experiences compound all of this. Neurodivergent students often carry memories of being told they weren't behaving like their peers, weren't trying hard enough, or were "dramatic" or "too much." I've heard that language a lot in my own life. These cumulative experiences elicit feelings of threat and shame and reinforce masking behaviors. A learning environment where differences are genuinely accepted and where every student can contribute and feel they belong can reduce that sense of threat, foster self-compassion, and elicit more compassionate responses from others in return.

One meaningful way we can support neurodivergent postsecondary students is by recognizing neurodiversity as a genuine issue of diversity, equity, and inclusion. Neurodivergent individuals face stigma and discrimination in ways that closely mirror the experiences of other marginalized groups, and, as I mentioned earlier, those experiences frequently intersect with other forms of discrimination as well. Stigma and bullying contribute directly to poorer educational outcomes for neurodivergent students, which is exactly why including neurodiversity as a formal dimension within DEI initiatives is such an important starting point. I want to reiterate here that I am white and cisgender, and neurodivergence is the only marginalized identity I personally hold. Precisely because so many neurodivergent individuals hold additional intersecting identities, neurodiversity needs to be included in those broader initiatives.

I want to pause on all of this and connect it back to your daily practice for a moment, because it's easy to hear a list of barriers like this and feel a little overwhelmed by its scale. You are not going to single-handedly redesign a university's curriculum or rewrite its hidden social expectations. What you can do is become the person in a student's life who names these dynamics out loud, who says, "this hidden curriculum you're bumping into isn't a personal failing, it's a structural gap, and here's how we work around it together." That reframe alone, delivered consistently over time, can meaningfully reduce the shame and threat response that drives so much of the masking and burnout I just described.

Why Do We Care? Application to OT

So why should we advocate for greater involvement with this population? Let's be honest: the transition-age population, specifically the period from the end of high school through the completion of college, isn't a population most of us are currently very involved with in terms of direct treatment and intervention.

Here's why we should be. Neurodiversity-affirming practice sits at the very heart of occupational therapy. It's consistent with Healthy People 2030; according to the Office of Disease Prevention and Health Promotion, one of that initiative's central goals is to improve health and well-being for people with disabilities, calling for homes, schools, workplaces, and public spaces to become more accessible in order to improve quality of life for neurodivergent individuals. It's also consistent with AOTA's Vision 2030, which seeks to enrich the lives of all individuals through meaningful engagement in occupation.

Neurodiversity-affirming practice is directly highlighted in AOTA's 10 Best Practices, which call on us as OTRs to refrain from providing interventions aimed at reducing or eliminating restrictive or repetitive behaviors, activities, or interests in autistic individuals without first evaluating and understanding what those behaviors mean to the person, and without accounting for the personal and environmental factors behind them. One thing we always talked about in school is that behavior is communication, so we need to understand why a behavior is occurring before we decide it needs to change, or before we jump to providing accommodations around it.

Our own OTPF tells us that education is an occupation. We're called to be involved in it and to be client-centered while doing so. That means if a neurodivergent-identifying client wants to pursue postsecondary education, it is well within our scope to provide client-centered interventions that help the individual succeed in that environment, whether that means addressing, adapting, or leveraging context, performance patterns, performance skills, or client factors to make postsecondary education more accessible. Finally, this work aligns directly with our Code of Ethics. We are called to recognize and address systemic disparities by identifying and working to eliminate barriers to participation, to improve equity and inclusivity, to celebrate and support each person's autonomy, independence, and self-direction, to value and preserve the inherent worth and uniqueness of every individual, and to promote and advocate for the occupational rights of all individuals, groups, and populations by helping them access the services and opportunities they need for meaningful participation in occupation.

When I put all of that together, what I see is a profession that already has every ethical and theoretical justification it needs to serve this population well. What's often missing isn't permission; it's exposure. Most of us simply haven't been trained to think of the transition-age neurodivergent student as someone within our scope, so we don't build the referral pathways, assessment tools, or intervention plans this population actually needs. Advocacy, in this sense, isn't just something we do for our individual clients. It's something we owe to our own profession, in terms of pushing our training programs, our fieldwork placements, and our continuing education to take this population seriously.

What Can We Do? (Pre-College)

So, practically, what can we actually do?

We want to align our interventions with the Universal Design for Learning, the Person-Environment-Occupation-Performance model, the Social Model of Disability, the Ecological Model of Disability, and other neurodiversity-affirming models and frameworks. There's a lot of overlap between what we can do pre-college and what we can do once a student is already enrolled in and moving through college, so keep that in mind as we go.

The goal here is to provide accommodations and leverage an individual's existing traits and skills, rather than trying to reshape them to fit some mythological mold of the "typical" postsecondary student. Now, I know what some of you are thinking: don't we already do this? When I first started researching neurodiversity-affirming practice in grad school, I thought the same thing. Then I started reminiscing on my own experiences. For a huge number of postsecondary students, regardless of neurotype, college is the very first time they've ever touched a washer or dryer, used a stove or an oven, tied a tie, used an iron, applied for a job, coordinated their own healthcare, or budgeted for their own basic needs. Budgeting was, quite honestly, a disaster for me at times. Now layer in the sensory, problem-solving, and motor differences a neurodivergent postsecondary student might be navigating on top of all of that. I personally had such a visceral repulsion to washing dishes for several months, tied directly to my sensory differences, that it created a genuine rift between me and my roommates, one that eventually led us to go our separate ways. The accommodation I eventually found for myself was simple: I started wearing gloves to wash dishes.

Beyond ADL and IADL training incorporated into transition planning, another meaningful intervention is cultivating interoception skills through breathing exercises, mindfulness, yoga, meditation, and journaling. And, critically, we can teach and practice self-advocacy skills directly, something I'll dig into much further in a moment. I was always told to advocate for myself, but I was rarely given any real direction on how to actually do that, so my hope is that by the end of this course, you'll have concrete interventions you can use with the people you work with.

We can also foster self-efficacy and autonomy, and we need to genuinely consider sensory needs alongside alternative forms of communication. If we're asking someone to practice communication, does that communication truly need to happen in person? Is it acceptable for someone to type out an email instead? If eye contact isn't necessary for a given interaction, don't force it; instead, help that individual find alternative communication approaches that feel comfortable to them rather than defaulting to what's considered typical.

Partnering with local colleges to help find peer mentors, or to help build college transition programs altogether, is another meaningful step, as is helping students explore the resources a school already provides, things like learning management systems and whether those systems support tools such as screen readers. Role-playing and practicing "I" statements can help too, though I want to reiterate that this needs to be done in a neurodivergent-affirming way; if a student is uncomfortable with a particular exercise, don't force it. The goal is always to help someone communicate their feelings, needs, and traits in whatever way genuinely works for them, before they even set foot on campus. And throughout all of this, keep goals student-led.

I want to name something practical here, too: a lot of this pre-college work is really occupation-based ADL and IADL training, wearing a different hat. If a student has never done their own laundry, never coordinated a doctor's appointment, or never managed their own medication schedule, those are legitimate occupational therapy goals, not "soft skills" outside our scope. Treat them with the same rigor you'd apply to any other functional skill-building goal, and build in the sensory and executive functioning supports that make each of those tasks actually achievable for that specific student, rather than assuming a generic checklist will work for everyone.

How Can We Support Neurodivergent Individuals Through College?

Once a student is enrolled, student-led goals remain just as important. We should advocate for the implementation of Universal Design for Learning, which recognizes that learner variability is the norm rather than the exception and which emphasizes presenting information through multiple formats, text, visuals, audio, and hands-on activities, while offering flexible ways for students to demonstrate learning, whether through papers, presentations, podcasts, or creative projects.

A strength-based approach should guide everything we do, alongside starting or sustaining a mentorship program. This benefits both parties: it supports the student transitioning into college while also giving the peer mentor valuable work and volunteer experience they can include on their resume when applying for internships or jobs later on. It's genuinely a win-win.

Communication deserves real attention here, too. How can we help adjust and leverage a student's communication style to support their success through their transition programs? Understanding what admissions and advising offices actually provide, and honestly, understanding every office on a given campus, matters more than people realize. It can be incredibly difficult for incoming students to figure out where to go and when. I've had friends describe being bounced from office to office, told by one person to go somewhere else, then told by that office to go somewhere else again. Helping your client navigate this is crucial. Understanding how to access accommodations matters enormously here, too, and advocating for a single point of contact at the institution can make a meaningful difference.

We should also advocate for courses, curriculum design, and assessment practices that are neurodiversity-affirming and grounded in Universal Design for Learning, as well as sensory-friendly physical spaces and robust life skills programming. ADLs and IADLs remain hugely important here because college isn't just an academic experience; there's a great deal more a student has to manage simultaneously. Helping students understand the real differences between counseling services, disability services, and health services, and knowing exactly where to go for each, matters as well. And through all of it, we continue fostering self-advocacy.

I think it's worth stating plainly that a lot of what I've just described isn't something you can accomplish in a single semester of direct client contact. This is longitudinal work. It might mean checking in with a student across multiple years, adjusting supports as their course load changes, their living situation changes, or new demands arise that neither of you anticipated during their first semester. Build that expectation into how you scope your involvement with this population from the start, rather than treating a successful first semester as evidence that ongoing support is no longer needed.

Self-Advocacy Introduction

Self-advocacy, according to research, is not an innate skill but an absolutely essential one. It's critical for communicating needs, accessing accommodations, improving academic success and quality of life, building autonomy and self-determination, and supporting goal-directed, self-regulated behavior among neurodivergent students entering postsecondary education.

Self-Advocacy Skills

There are several distinct skills that make up self-advocacy, and I want to walk through each of them briefly. Effective communication is a person's ability to exchange information in a way that ensures the message is received clearly. It's worth looking at this through a neurodiversity-affirming lens: how can we leverage the communication skills a person already has, including AAC use or written communication strengths, to help them advocate effectively?

Self-awareness is the ability to understand your own strengths, assets, supports, and needs, and to understand how those traits interact to shape your experience of life. Navigating resources describes the ability to prioritize your needs and connect with the people or organizations that can help meet them. Accepting allyship refers to the ability to accept help from potential allies; if a client struggles with this, resist the urge to simply label them as stubborn. Understand why accepting help is difficult for them. For some clients, that difficulty is rooted in trauma or past experience, and recognizing that shifts how we intervene entirely, moving us toward a trauma-informed approach.

I want to sit with that last point a little longer, because I think it's the one clinicians move past too quickly. "Stubborn" is a label that shuts down a conversation. "Something about accepting help doesn't feel safe to this person right now" is a clinical observation that opens a conversation up. If you find yourself reaching for a personality-based explanation for why a client is resisting a support you know they need, treat that as a signal to slow down and ask what that support has cost them in the past, rather than pushing harder in the same direction.

Understanding disability law refers to a person's knowledge of disability law and their ability to apply that knowledge, which matters enormously when advocating for accommodations and holding institutions accountable for compliance. Awareness of potential resources speaks for itself, and understanding your personal strengths and challenges refers to your knowledge of how your individual challenges affect your ability to engage in informed decision-making and self-advocacy overall.

Self-Advocacy Intervention

When it comes to intervention, we want to affirm, support, and leverage neurodivergent communication first and foremost. If communication is one of the fundamental building blocks of effective self-advocacy, think carefully about how you can leverage your client's existing communication skills. If a client prefers written communication, help them practice drafting professional, clear emails and messages. If they use an AAC device, consider how that device might need to be adapted to a new environment, and collaborate with the rest of their team to make those adjustments.

Another core intervention is helping clients identify their own strengths, needs, and weaknesses, engaging them in activities that build understanding of their bodies and how different experiences make them feel. Prepare your clients for the real differences between receiving accommodations in elementary, middle, and high school and in college. I can speak to this personally: no one warned me that I would have to actively pursue my own accommodations in college. I assumed my IEP team would simply coordinate directly with my college's disability and accessibility services. Instead, every bit of that communication had to go through me. Prepare your clients for that shift, and help them build the proactive steps they'll need to take on their own behalf.

Finally, challenge self-stigmatizing beliefs and help clients reframe negative self-talk, with the ultimate goal of fostering acceptance of allyship and a genuine understanding of their strengths and weaknesses. Role-playing and practicing "I" statements remain valuable tools here, too. Again, please make sure this work stays neurodivergent-affirming throughout.

I want to leave you with a note on sequencing, because I think it matters clinically. Don't start with the hardest self-advocacy skill first. If a client struggles significantly with accepting allyship because of past trauma, starting there is likely to backfire and reinforce their guardedness. Start instead with self-awareness, building a shared, affirming vocabulary for their own strengths and needs, and let accepting allyship develop naturally once that foundation of trust and self-understanding is in place. Self-advocacy isn't a single skill you either have or don't; it's a stack of interdependent skills, and your job is to figure out which layer of that stack a given client actually needs to build first.

Conclusion

Today, we discussed and defined neurodiversity and the broader neurodivergent movement, tracing its roots and the surrounding language. We discussed the barriers facing neurodivergent students as they transition into and engage with postsecondary education, from hidden curricula and masking to cumulative experiences and identity strain. We discussed why this work is so directly relevant to occupational therapy, and walked through concrete strategies for supporting neurodivergent students both before they arrive on campus and once they're there. And we discussed why self-advocacy is so essential, along with specific ways to foster those self-advocacy skills in the people you work with.

I'll close with something I heard in the Q&A that I think is worth sharing here, too. Someone asked me about empathy, since it's sometimes framed as a limitation for neurodivergent individuals rather than a strength. I want to be direct: empathy is a genuine strength for neurodivergent individuals, and framing it as a limitation is itself a stereotype worth reframing. Neurodivergent people empathize deeply, including with each other's sensory experiences. When I hear someone say a room is too loud or that they're overstimulated, I genuinely feel that with them, and I'll often offer to step out with them or hold their spot until they're ready to come back. That capacity for empathy is part of what makes this population, and this work, so meaningful to me.

This population, the transition-age individual moving from high school into and through higher education, isn't one our profession has historically been deeply involved with. I hope that after today, you leave with a clearer sense of why that needs to change, and with real, usable strategies to help make that happen for the neurodivergent students and clients you work with.

If you take nothing else from this course, I'd ask you to hold onto this: neurodiversity-affirming practice doesn't require a specialized certification or an entirely new caseload. It requires a shift in how you frame the traits already sitting in front of you, a willingness to leverage a client's existing strengths rather than remediate them into someone they're not, and a commitment to treating self-advocacy as a teachable, buildable skill rather than something a student should simply already know how to do. That shift is available to everyone of you, starting with your very next session.

References

See additional handout.