From the pathological model to the neurodiversity paradigm

When we talk today about the diversity of human functioning: behaviour, learning, communication, interaction, … then there are currently two very different visions in society, in the workplace, in education, and in the academic world: the pathological model and the neurodiversity paradigm.

The pathological model primarily approaches these neurological differences as deviations, disorders, and shortcomings from the norm (neuronormative vision) that need to be diagnosed and treated, or even cured. On the other hand, the neurodiversity paradigm is gaining popularity, a (neuro-affirmative) perspective that precisely states that these variations are a natural and valuable form of human diversity.

The neurodiversity paradigm actually originated in the 1990s as a reaction from the autistic community to the way the pathological model has functioned in the past. By focusing on ‘disorders’ and ‘illness,’ neurodivergent individuals (the minority group) were categorised and thus pushed aside in the workplace, in education, and in society. The dominant majority could thus continue to see their own functioning as the norm, without feeling the need to take into account the diverse needs and unique talents of those who functioned differently. This is changing today because there is precisely a greater need for other norms due to the VUCA world we find ourselves in.

This article unravels the fundamental differences between these two approaches and examines how the neurodiversity paradigm offers a more equal and respectful view of the richness of neurodiversity, without starting from specific labels.

The pathological model: defect and treatment

The pathological model, often rooted in neuronormative medical science, approaches neurological differences through a lens of deficit and dysfunction. Characteristics that deviate from the neurotypical norm are seen as symptoms of an underlying disorder that leads to limitations and problems. The focus here is often on:

• Diagnosis: Identifying specific ‘disorders’ based on established criteria (DSM).
• Treatment: Interventions aimed at reducing symptoms and adapting to the neurotypical norm. This includes medication, behavioural therapies, and training aimed at improving ‘deficiencies.’
• Emphasis on problems: The focus is often on the challenges and difficulties experienced by neurodivergent individuals, both for themselves and for their environment.

This model has undoubtedly contributed to providing explanations and support for people with neurological differences. However, critics point to a number of significant disadvantages:

• Stigmatisation: Labelling individuals as ‘sick’ or ‘abnormal’ can lead to stigmatisation, shame, and a negative self-image.
• Exclusion or segregation: In addition, these people are prevented from participating in mainstream education and the mainstream labour market. And even when they do enter the mainstream labour market, they are recruited within a special recruitment program, which means they never truly feel part of the whole.
• Focus on shortcomings: The emphasis on what someone cannot do can overshadow the strengths and unique talents of neurodivergent individuals. In the workplace, this often manifests as not hiring a talented person or giving a poor evaluation because they work differently or have difficulty improving on certain challenges.
• Lack of acceptance: The model implies that neurodivergent ways of being are inferior and need to be corrected. Practices such as ABA training exist to unlearn neurodivergent behaviour. This is comparable to the therapies in the past that aimed to ‘cure’ people of homosexual thoughts.
• Here, it is society that says someone has a limitation, and not the individual themselves. The individual is often not involved in decisions that concern them.

The neurodiversity paradigm: variation and enrichment

The neurodiversity paradigm, on the other hand, embraces differences as a natural form of human variation of the brain and mind, where there is no single right way to be, and differences are seen as an enrichment for society. It states that neurotypes such as autism, ADHD, and dyslexia are not diseases that need to be cured, but rather different ways for the brain to process information and experience the world. The core principles of this paradigm are:

• Acceptance: Recognising and valuing the diversity of neurotypes.
• Strengths: Focusing on the talents, interests, and perspectives that neurodivergent individuals may possess.
• Support: Providing an environment and support that aligns with the specific needs of neurodivergent individuals, without the intention of ’normalising’ them. And experience shows that these adjustments are also good for neurotypical individuals.
• Inclusion: Striving for a society in which neurodivergent individuals are fully accepted and integrated. Not having to mask, being able to fully utilise their talents, and where their diverse perspectives and behaviours are seen and valued as an added value.

The neurodiversity paradigm emphasises that what is seen as a ’limitation’ in one context can be an advantage in another. Think, for example, of the attention to detail often seen in people with autism, or the creativity and out-of-the-box thinking that can be associated with ADHD. This does not mean that a person cannot feel for themselves that their challenges are limiting. But it is up to the person to decide, not society. The person is involved in this model in decisions that concern them (consent – nothing about us without us).

Criticisms and challenges related to the neurodiversity paradigm

An important critical question related to the neurodiversity paradigm is: How far should a society adapt to individual differences? Are there limits to the extent to which collective norms can or should be stretched? The question of whether some individuals deviate too far from the norm also raises discussion. First and foremost, we must recognize that many neurodivergent individuals have adapted to the norm for decades, resulting in burnouts. And that it is now time to find a middle ground. How far a company, school, or society wants to go is something that is decided together and not, as in the past, about the minority group.

In addition, it is valuable to recognise that a diagnosis can, for some people, lead to greater self-knowledge and understanding. It can provide an explanation for lifelong experiences and provide access to specific forms of support and communities of like-minded individuals. But that in itself is, of course, the consequence of setting social norms and adhering to the existence of a normal way of thinking, behaving, communicating, etc. The neurodiversity paradigm does not necessarily stand in the way of individual understanding, because a psychiatric diagnosis is not the only way to better understand oneself and be accepted in society for who one is.

Ultimately, it is less about defining a ’norm’ and deviations from it, but more about the question: what makes us who we are, and how can we live and work together in a good way, where everyone’s potential flourishes?

The impact of both models

The choice between the pathological model and the neurodiversity paradigm significantly impacts various aspects.

Self-image

Neurodivergent individuals approached from the neurodiversity perspective often experience more self-acceptance and a more positive self-image. While the pathological model emphasises what you are not good at or how you deviate from the norm. That is why so many people experience an identity crisis and go through a grieving process after a diagnosis, because they were labeled as ‘abnormal and defective.’

Education and work

The neurodiversity paradigm advocates for inclusive teaching methods and work environments that leverage the strengths of neurodivergent individuals.

In the workplace, the practical implications of both models are clearly evident. From the perspective of the pathological model, neurodivergent employees are often expected to present a diagnostic certificate to HR to be eligible for ‘reasonable accommodations.’ Obtaining such a diagnosis takes a lot of time and sometimes money, making it accessible only to the happy few, and help often comes far too late (the person has already left or has a burnout).

The neurodiversity paradigm, on the other hand, challenges us to critically examine the social norms in the workplace. What unwritten rules and expectations prevent neurodivergent employees from fully utilising and showcasing their talents? Consider the emphasis on non-verbal communication in meetings, the open-plan office as the standard work environment, or rigid deadlines without room for individual work styles. By questioning these norms and creating a more inclusive environment that takes into account diverse neurological profiles, organizations can fully utilize the potential of all their employees.

Academic research

Research within the neurodiversity paradigm focuses more on understanding cognitive differences and identifying supportive factors, rather than solely on diagnosing and ’treating’ disorders. They also no longer start from the norm; on the contrary, it is that norm that is being questioned.

Societal perception

The neurodiversity paradigm contributes to a broader societal acceptance and understanding of neurological diversity.

The future according to us

Beyond labels and diagnoses

A crucial aspect of the neurodiversity paradigm is that it is independent of specific diagnoses and the associated labels. It is about recognising the natural variation within the human brain and mind. Whether or not someone has a formal diagnosis, the paradigm acknowledges that a wide spectrum of neurological differences exists. The focus shifts from categorising individuals based on ‘abnormalities’ to understanding and valuing everyone’s unique cognitive profiles.

A paradigm shift comparable to the one concerning homosexuality

Until the 1970s, homosexuality was classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) under the pathological model. Today, we widely recognise that it is a natural variation within human diversity. A similar paradigm shift is conceivable for neurodiversity, where we increasingly recognise that it involves different ways of being and experiencing the world, which are not inherently pathological but rather can make a valuable contribution to the richness of humanity.

Conclusion

The pathological model and the neurodiversity paradigm represent two fundamentally different ways of looking at different neurotypes. Although the pathological model was dominant in the past and still plays a role in certain contexts, the neurodiversity paradigm offers a more equal, respectful, and empowering approach. By shifting the focus from ‘defect’ to ‘diversity’ and from ’treatment’ to ‘consent,’ we can create a society in which everyone, including neurodivergent individuals, can fully realise their potential and make their unique contributions.