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How Social Workers Can Be Neuroinclusive
By Miriam Edelman, MPA, MSW

Autism Advocacy Month and the first Autistic Advocacy Month are occurring now (April 2026). Throughout their lives, autistic people may be marginalized, bullied, and excluded. As a result, they may have mental health issues, including suicidal thoughts and behavior. Like the greater world, however, therapy is not created with autistic people in mind. Social workers are often trained to conduct therapy, which is geared to neurotypical people. They need to be prepared to treat autistic people and should tailor their practice to be neuroaffirming and neuroinclusive.

Methods of Being Neuroaffirming
Social workers should be neuroaffirming. Autism’s official name is autism spectrum disorder. The word “disorder” represents “the language of deficits, disorders, and developmental delays.” Social workers can refer to autism as a “condition,” a term representing “the language of differences and strengths.” Changing terminology attributes the challenges faced by autistic people to “lack of social and structural design that supports neurotypes that fall outside of the narrow window of neurotypical.” Therefore, social workers should realize that their autistic clients may suffer from major mental health problems due to the ableist and intolerant world and that those challenges are not the clients’ fault.

To become neuroaffirming, social workers must learn about neurodivergent conditions, including autism. Without this knowledge, it would be very difficult, if not impossible, to treat neurodivergent clients successfully. Social workers may have to learn about neurodivergence on their own, as they may not have learned much about neurodivergence and autism in school. They should seek out continuing education, which they need to maintain their licenses, about neurodivergence and autism. Social workers should be trauma-informed, as neurodivergent people may have experienced and continue to undergo a substantial amount of trauma. Professionals assisting autistic people who meet academic and continuing education requirements may extend their expertise and become Certified Autism Specialists.

Social workers may feel uncomfortable and inadequate working with autistic people. Some mental health professionals made the following comments about their comfort level (even fear) of treating autistic people:

• “I’ve worked with a lot of diverse populations of all ages, but this is the one area that I would not feel competent to work with.”

• “I probably wouldn’t know where to start in terms of psychotherapy. I would need more training into the mind of an autistic patient.”

• “I don’t think I would feel that comfortable [working with autistic adults] because I don’t really have the skills. I don’t see myself helping that person because of my training. It would be a disservice to that client.”

• “I think people are afraid to treat people with autism because they don’t know what to do. I think if clients have anxiety or depression or schizophrenia, then there’s a better road map and they feel better trained to do that. They’re not trained to deal with people with autism or to manage that. So I think that people are scared to do it.”

Social workers can use the social model of disabilities, accommodating their autistic clients rather than forcing them to conform. As autism manifests differently among people, the same methods may not work for all autistic individuals.

Addressing clients’ sensory issues is crucial. If social workers do not, their clients may be distracted and stressed, preventing therapy from being as effective as it can be. Social workers can provide the following adjustments to physical or virtual environments:

• A low-sensory lobby and therapy room (if sessions are in person). The lobby should not have bright lights and loud noises.

• Dull lighting: Bright lighting can cause physical problems for some neurodivergent people.

• Changes to the office’s level of noise and conceivably using noise machines and/or music: As some neurodivergent people may be distracted by certain noises, social workers can try to make their office less noisy. For example, they could not bring their dog to sessions. However, some neurodivergent individuals could be thrown by quiet environments, which causes their thoughts to be loud. With those clients, social workers could have a little noise.

• Offering of fidget items that clients can use during sessions.

• Treatment in a variety of treatment settings (eg, different parts of a room, virtual)—if social workers are able to.

• An area where clients can recharge after the session (if sessions are in person).

Methods relating to the logistics of sessions include the following:

• Meeting with autistic clients at the same time every week. Social workers may already do so in their standard practice, but this consistency may be especially important to autistic people, who may tend to like routine.

• Having longer or shorter sessions. Therefore, do not have the standard approximately 50-minute sessions.

• Having breaks: Breaks can prevent some neurodivergent clients from being overwhelmed.

Social workers can tailor communication to their autistic client inside and outside of sessions by doing the following:

• Altering methods of communication: Ask clients for their communication preferences. If meeting virtually, ask questions both orally and through written chat. Autistic clients can be more open to written communication, although therapy often involves oral conversations. Instead of being angry and irritated with emails between sessions, be open to the written communications. Do not use AI when emailing your clients.

• Using plain language instead of therapeutic jargon.

• Avoiding metaphors.

• Providing written or visual explanations.

• Allowing clients to respond in a variety of ways (eg, speaking, writing, drawing).

Social workers should accept other different behaviors of autistic clients by doing the following:

• Being nonjudgmental of autistic clients and their autism-related behavior.

• Not forcing autistic clients to be on camera during virtual sessions. Autistic people may not like to be on camera. However, it can be crucial to see clients to make sure that they are in a jurisdiction where social workers are licensed. Therefore, clients could be on camera for just the very beginning of the session.

• Not forcing autistic clients to make eye contact.

Social workers can also adhere to the social work principle of the client as the expert of themselves and collaborate with them on treatment and support plans. Methods involving therapy include the following:

• Not treating all autistic clients the same. As Dr. Stephen Shore said, “When you meet one person with autism, you’ve met one person with autism.” Autistic people are different with varying needs. As an autistic person said, “Virtual therapy … can be really good. It can also totally unnerve an autistic person.”

• “Meeting clients where they are,” which is a key social work value, and going at their pace. Improvise, and co-create with the autistic clients.

• Validating autistic clients’ experiences.

• Including autistic clients’ interests and hobbies during therapy sessions.

• Adapting evidence-based practices by tailoring treatment methods to autistic clients. For example, in modified CBT, social workers can focus more on changing behaviors than thoughts. In CBT, social workers can focus on clients’ interests, avoid metaphors, and incorporate social skills. Recognizing that CBT and other usually effective treatments may not work, social workers can be creative, developing and implementing innovative modalities.

• Asking for feedback. Social workers should not assume that they know what could benefit their clients. Part of asking for feedback may be asking what the client would like to talk about.

• Giving feedback and new perspectives to autistic clients. According to the research study, entitled “‘Therapy Through the Lens of Autism’: Qualitative exploration of autistic adults' therapy experiences,” “Autistic adults in both samples further noted that asking their therapist for feedback and gaining new perspectives on their situations and problems were critical elements of effective therapy.”

• Providing practical suggestions. The qualitative study cited Maddox et al (2020), which “found that a common criticism of psychotherapy made by autistic adults is that sessions tend to focus on processing emotions and experiences rather than practical recommendations.” Social workers should recognize that their autistic clients may have already tried but were not successful with typical suggestions.

• Describing therapy “homework” in different ways. As autistic clients may connect “homework” with negative school experiences, social workers can use alternative words, such as “practice” or “experiment.”

Social workers should not be afraid of and/or turned off by autistic people, their suicidal thoughts and behavior, and their desire for revenge. Autistic individuals should be able to feel safe and supported while experiencing these challenges.

Final Thoughts
Nonneuroinclusive practices may be counterproductive, exacerbating circumstances for autistic people. Social workers should learn how to be neuroinclusive and help autistic clients live to their full potential.

— Miriam Edelman, MPA, MSW, is a Washington, D.C.-based policy professional.