Why This Checklist Exists
Neurodiversity-affirming practice is not a trend. It's a clinical and ethical framework that reflects a meaningful shift in how the disability and autistic communities understand themselves — and how they want to be treated by the healthcare providers who work with their children.
For pediatric OTs, SLPs, and PTs, the shift toward neurodiversity-affirming practice requires changes at multiple levels: the language you use in documentation and with families, how you frame goals, what you're actually targeting in treatment, and how you engage children and caregivers in the therapeutic process.
This checklist is written for working pediatric clinicians — not as a values statement, but as a practical tool. It's organized by practice area so you can use it to audit your own approach, identify where your practice is already aligned, and find the specific places where updating your language or framing would make a difference.
It's not exhaustive. Neurodiversity-affirming practice is a living conversation, not a fixed list. But this is a grounded, actionable starting point.
Language Checklist
Language is where most clinicians start, and for good reason: the words we use in reports, goals, and conversations with families shape how children are understood and how they understand themselves.
Identity-first vs. person-first language
- Have you asked the family (and the child, if age-appropriate) about their language preference? Many autistic individuals and families prefer identity-first language ("autistic child") over person-first ("child with autism"). Others prefer the reverse. Ask, don't assume.
- Are your reports and communications consistent with the family's stated preference?
- If you're writing for an insurance audience that requires person-first language, are you using the family's preferred language in direct communication even when documentation differs?
Deficit framing vs. difference framing
- Review your last five evaluation reports. How many times do phrases like "fails to," "lacks," "unable to," "abnormal," or "deficient" appear?
- Are you describing what the child does and how they function, or primarily cataloguing what they can't do?
- Can you reframe "does not make eye contact" as "uses peripheral gaze and body orientation to indicate attention" without losing clinical accuracy?
- Are sensory differences described as dysfunctions to be corrected, or as neurological differences to be understood and accommodated?
"Red flags" and alarm language
- Have you replaced "red flags" with more neutral language like "areas of concern," "developmental differences," or "features to monitor"?
- Are you using alarm framing ("urgent," "critical," "must address immediately") when the clinical situation doesn't warrant it?
- Do your communications with families center the child's strengths alongside areas where support would be helpful?
Goal Writing Checklist
Neurodiversity-affirming goal writing is one of the most substantive clinical shifts — it requires thinking carefully about why you're targeting something, not just whether you can measure it.
Functional vs. normalization goals
- Is each goal oriented toward the child's functional participation in activities that matter to them and their family, or toward making the child's behavior look more neurotypical?
- "Will make eye contact during conversation 4 out of 5 opportunities" — does this goal serve the child's communication, or does it serve observer comfort? If the child communicates effectively without eye contact, is this a goal that belongs on the plan?
- "Will tolerate seated circle time for 15 minutes without self-stimulatory behavior" — is the goal about the child's wellbeing and learning, or about reducing behaviors that neurotypical environments find disruptive?
Whose goals are these?
- Have you explicitly asked the family what functional outcomes matter most to them?
- Have you asked the child (where age and communication allow) what they want to be able to do?
- Are the goals on the treatment plan actually the family's goals, or goals that reflect your clinical assumptions about what "should" be targeted?
Stim and self-regulation
- Are you distinguishing between self-stimulatory behaviors that are harmful (self-injury, behaviors that prevent the child from participating in things they want to do) and those that are regulatory and benign?
- Are you targeting stim reduction in cases where the stim is not harmful and the goal is primarily about appearance?
- Have you considered that supporting the child's ability to self-regulate (including through stim) may be more appropriate than targeting stim suppression?
Clinical Approach Checklist
Assent and child agency
- Do you explain to children what you're going to do before you do it, in language appropriate to their age and communication profile?
- Do you have a system for children to indicate they need a break, want to stop, or are uncomfortable — and do you honor it?
- Are you using motivating activities the child actually enjoys, or activities you've predetermined are "therapeutic" regardless of the child's interest?
Sensory needs
- Have you assessed the child's sensory environment (at home, in your session) and identified what supports or interferes with their regulation and participation?
- Are you providing sensory accommodations proactively rather than responding only when dysregulation occurs?
- If a child needs to move, vocalize, or use sensory tools to participate, are you building those needs into your session structure rather than managing them as disruptions?
AAC and communication
- If a child uses AAC (speech-generating devices, PECS, sign, or other systems), are you fully accepting that system as valid communication in your sessions?
- Are you modeling AAC use yourself during sessions?
- Are you explicitly communicating to families that AAC does not prevent or delay speech development, and is not a "last resort"?
Family Communication Checklist
- Do you lead family updates with the child's strengths and what's going well before discussing areas for growth?
- Are you framing the child's neurodivergence as a difference to be understood and supported, rather than a problem to be fixed?
- Do you validate parental concern while also being honest when some behaviors reflect neurological difference rather than dysfunction?
- Are you giving families practical strategies that work with their child's actual neurological profile, rather than strategies designed for a neurotypical child?
- When families use language or framing you'd approach differently (e.g., "my child is broken," "I just want him to be normal"), are you gently and respectfully offering a different perspective rather than either agreeing or shutting the conversation down?
A Note on Ongoing Learning
Neurodiversity-affirming practice evolves as the autistic community and broader disability community continue to articulate what respectful, effective care looks like. The most important thing any clinician can do is stay in the conversation — read first-person accounts from autistic adults, engage with ASAN (Autistic Self Advocacy Network) resources, follow researchers and clinicians doing this work thoughtfully, and be willing to update your practice as your understanding deepens.
This checklist is a snapshot of current best practice as understood in 2026. Some things on it will be refined over time. Use it as a starting point, not a final word.
At Coral Care, neurodiversity-affirming practice is a core expectation for every provider on our platform. If this framework resonates with how you approach your clinical work, we'd like to talk.
