What does neuroaffirmative (dance) movement therapy with autistic/ADHD people look like?
Summary:
This article presents a new model for neuroaffirmative dance movement therapy, which might effectively support autistic and ADHD individuals. This approach values insights from autistic scholars and people with lived experience and highlights the importance of shared knowledge in understanding neurodivergent experiences.
Most recent research on neuroaffirmative paradigms for therapy focuses on traditional talk therapy and not body-oriented movement psychotherapies such as dance movement therapy, yet this modality has enormous potential as a supportive adjunct to centre autistic and ADHD well-being.
Below is my initial attempt to synthesise the elements of a neuroaffirmative dance movement therapy practice. Let me clarify at the outset that I do not claim ownership of this list. It is not “mine”, rather it incorporates perspectives from autistic, dance movement psychotherapy/therapy and creative arts scholars, lived experience practitioners and experts-by-experience, as well as my personal perspectives as a neurodivergent dance artist/therapist.
Autistic researchers are breaking the mould of competitive individualism characterising much of academia as related to the therapy sciences. Brilliant minds have co-created ground-breaking research (such as this paper on sensitive care in clinical settings) and asserted the importance of honouring collective knowledge (as highlighted in this recent paper tracing the collective roots of neurodiversity theory) and listening to lived experience.
Even in private practice, where the ‘tool’ for transmission remains the individual self of the therapist, we might reframe our perspective as collective, since arguably we are never ‘on our own’ with supervisors and consultants supporting our practice.
The neurodiversity movement provides a template for greater epistemic humility on the part of both therapists and researchers.
Neuroaffirmative dance movement therapy
with autistic/ADHD/AuDHD/PDA clients
might look like….
No attempts to ‘treat’ or ‘cure’ neurodivergence
The focus in dance movement therapy must always be on accepting and supporting individuality and being since this allows autistic/ADHD people to flourish.
The aim is not to use a myriad of ‘theories about causes as justification for targeting and pathologising core traits’, which increases the risk of suicide long-term (McGreevy et al., 2024). As Milton (2017, in McGreevy et al., 2024) writes: the ‘autistic life-world is… invaded by a never-ending tide of interventions that try to eradicate autistic styles of diversity”.
Ultimately, this may require root-and-branch shifts in how dance movement therapy training is delivered since many MA degrees and accreditation bodies explicitly link competence and fitness to practice with knowledge and application of the DSM/ICD medical model.
Promoting neurotypical behaviour as standard leads to “increased mental strain, alienation from one’s authentic self, depression, and a higher suicide risk”
(McGreevy et al., 2024).
2. Supporting neurodivergent pride
In their ground-breaking 2023 paper on neurodivergent-informed therapy, Chapman and Botha (2022) emphasise going beyond acceptance towards the acquisition of neurodivergent pride as a critical aspect of neuroaffirmative therapy.
With our many tools, including the incorporation of performative and choreographic elements of dance within strictly therapeutic settings, dance movement therapy may be a good modality with which to foster client pride. Leading with client self-directed movement allows us to hold space for clients’ strengths, passions, special interests (monotropism) and unique ways of being. However, we cannot support clients’ autonomy and well-being when we are focused instead on someone’s inability to meet neuronormative standards.
Keep in mind that the average child with ADHD receives 20,000 more critical comments before the age of 10 than their peers, with the attendant devastating impact on self-image, self-esteem and self-confidence.
3. Listening to autistic/ADHD people & reading research by autistic/ADHD scholars
Dance movement therapists need to inquire what the research priorities of autistic and ADHD people are.
Not teachers.
Not parents.
Not educational institutions.
Not academia.
Not the rest of the mental health field.
Not even the bodies that prescribe evidence-based therapies at national level.
Non-autistic/ADHD researchers in academic institutions have tended to focus on attempts to identify causes or genetics.
Autistic/ADHD people themselves have a much greater focus on well-being. Recently, Cage et al. (2024) identified the five most important topics for autistic adults in Scotland as:
mental health and well-being
identifying and diagnosing autistic people
support services
non-autistic people’s knowledge; and
attitudes and issues impacting autistic women.
4. Adopting a ‘not-knowing’ or ‘unknowing’ stance
Dance movement therapists must “bring their humanity, abandon any aloofness in their persona, and learn to see beyond otherness.” (McGreevy et al., 2024). In working with any neurodivergent client, it is essential to adopt a perspective of curiosity, humility and openness. Fortunately, dance movement therapy places emphasis on the ‘not-knowing’ stance of the therapist and on the development of attendant skills to hold space for emergence.
Relevant skills include centralising the sensorimotor experiences of the body as a guiding principle in clinical work to ‘propose an integrated approach to psychotherapeutic languaging as well as coherent identity formation' (Caldwell, 2021).
Such skills allow for the unfolding of a client’s own embodied authority, while providing a measure of protection so that we do not impose our frame of understanding onto the client’s own experience and narrative. Working with sensorimotor experience and movement language provides more space for complexity, the unsayable, the in-between.
A second aspect of not-knowing involves the conscious awareness and interrogation of our own explicit and implicit beliefs and biases in order to refrain from imposing our own views about any of the following:
diagnostic terms relating to autism/ADHD/neurodivergence
disability
the merits/disadvantages of diagnosis using the medical model
self-diagnosis
investigating causes
identity.
We may support clients to explore the meaning attached to any of the above IF (and only if) it is important to them. In doing so, we acknowledge multiple, complex layers of identity; with pain, shame and stigma resulting from internalised oppression often co-existing with pride, appreciation for community and validation.
Finally, we need to be open to always learning and to not letting professional ego get in the way of dismantling/rebuilding our frame of understanding.
5. Collaboration and co-creating goals
Adopting a stance of unknowing/not-knowing necessitates keeping preconceived neuronormative goals out of the therapy room. Goals come from the client and their wants, needs, desires, and unique lived experience, whether these are articulated at the beginning of therapy, or emerge during work. This applies as much to work with children and young people as to work with adults.
6. Subjective embodiment for ‘the restoration of bodily autonomy’
A neuroaffirmative approach to therapy is incompatible with an approach that focuses on external motor assessments and ableist ideas of “functional” and “dysfunctional” movement. Although dance movement therapy uses various tools for movement observation and analysis, in recent years there has been sustained critique of many of these (see for example Beardell et al., 2024 and this American Dance Therapy Association webinar on cultural blind spots in movement observation). There have also been attempts to develop both (i) practical, culturally appropriate and holistic tools for movement observation, such as the Mara app, and (ii) methodologies in which any form of movement observation/analysis is deemed entirely unnecessary.
In dance movement therapy the main focus is the lived subjective body. It is the only body-oriented modality I have encountered that values the language of the subjective (‘lived’) sensing-moving-expressing body over external assessments by third parties (therapists). Dance movement therapists insist that we do not understand movement ‘in dualistic terms as a symptom of a neurodevelopmental disorder distinct from the regulating or executing mind’. The research of Professor Sabine Koch and others suggests that this approach derives primarily from the work of phenomenologists such as Merleau-Ponty, Husserl and Sheets-Johnston rather than from cognitive and sports psychology which has informed movement therapy approaches (such as psychomotor therapy) based on motor skill assessments.
7. Valuing all forms of communication
A dance movement therapist values all forms of communication as equally valid. There is no push to translate a particular form of communication into words even though we might consider this to be important at times as a form of integration. Movement is respected as a language as is art, gesture, sound, voice, silence and rhythm. This has particular implications for many of us who experience selective mutism or who have experienced trauma that reduces our ability to speak (including trauma arising from being coerced or pressured to speak in ABA or social skills training programmes).
8. Depathologising stimming
For years, autistic and ADHD people have been critiqued, criticised, stereotyped or even abused in neurotypical efforts to change or prevent our movements.
Dance can be the depathologising container in which we support clients to work with traits that have been historically shamed, pathologised or punished. A 2016 American Journal of Dance Therapy paper, exploring capoeira as a means to facilitate ADHD expression, provides a template for this (Levin, 2016). With such safe holding and through the lens of artistry, our movements can be experienced and valued for what they are - unique forms of expression. Perhaps, we may also begin to heal from this legacy of harm.
In particular, we affirm stimming as a movement language to be expressed not repressed or suppressed. Even where stimming is expressing distress and self-harm, we have the means to listen to what is being said while working with regulation, by offering attuned presence and the ‘3 c-s’ (compassion, connection and curiosity, McGreevy et al. (2024)) alongside sensory or rhythm-based interventions.
As we honour our own movement language in a safe setting, we can perhaps start to support the process of ‘un-shaming’ the internalised shame resulting from years of outer critique while simultaneously supporting other elements of the neurodivergent therapy paradigm - neurodivergent culture, the promotion of community and emancipation from neuronormativity (Chapman & Botha 2022).
10. No social skills training!
Work with ABA or any other social skills-based approach is incompatible with neuroaffirming dance movement therapy. The goal of our work is not to change ADHD/autistic people to fit neurotypical norms. Any work looking at ways of moving/relating is done with a view to promoting a client’s goals and not those of normative society.
11. Supportive space to unpick embodied relationship to trauma, masking & traits
Recently there have been attempts to distinguish trauma from neurotype. The popular blogger Neurodivergent Geek pointed out that distinguishing between ADHD neurotypes and distress symptoms is critical to define ADHD in neuro-affirming ways (based on identity and not the medical model). Increasingly, masking is perceived as both necessary/inevitable in some settings due to multiple traumatic incidents/interactions and a cause of trauma/suicidality (McGreevy et al., 2024). I would argue that our interest as dance movement therapists should be to facilitate experiential body-based inquiries in safe therapeutic spaces to support interested clients to discover their own autonomous perspectives via their own lived experience. Dance movement therapy methodologies that support this might include authentic movement and the Moving Cycle, which has been described as a body-based form of ‘free association’ in which the therapist’s clinical skills play a critical role in safely attuning to levels of arousal and dissociation.
ADHD is not: inattention, hyperactivity, impulsivity, and mood instability. ADHD does not impair ability to think. These are *distress symptoms* that occur in ADHD neurotypes.
Trauma Geek
11. Valuing sensory language, sensory joy and the sensory self
DMT goes beyond the identification of sensory sensitivities to prevent distress triggers in the environment that are the focus of related fields, such as occupational therapy. Discovering sensory profiles is undoubtedly important. However expressive arts therapies and dance movement therapy have something else to offer of particular importance to neurodivergent clients.
Malchiodi powerfully articulated how sensory processing and integration can be considered a main mechanism of action in expressive arts therapies, where elements of movement, rhythm, play, enactment and sound facilitate:
interoception (awareness of the internal felt sense)
exteroception (experiences of taste, touch, hearing, seeing, and smelling)
proprioception (awareness to the world around us); and
vestibular functioning, and gravitational security (our stability within an environment).
She cites eight factors that indicate why sensory-based expressive arts therapies should be “go-to” therapies for trauma treatment, all of which are highly relevant for neuroaffirmative practice (Malchiodi, 2020). These factors are: (a) letting the sense tell the story (since trauma is encoded as a form of sensory, implicit reality) (b) self-soothing mind and body (c) engaging the body as central not as adjunct to therapy; (d) bypassing the limits of words; (e) recovering self-efficacy, mastery and control; (f) re-scripting through action-oriented experiencing; (g) imagining new meaning; and (h) restoring aliveness and vitality.
The “something more” we have to offer as dance movement therapists is an understanding of movement as a sensory language, a means to access sensory joy, and a form of thinking in its own right. This implies a somewhat different conception of the sensory ‘dynamic-animated body’ self that sets DMT apart from other psychotherapies. As Lauffenburger asserts, “movement, not thinking, is the basis for the development of self.” It is a concept of the self that may resonate with many autistic/ADHDers.
A related aspect to the focus on the sensory is the function of sessions as safe spaces for clients to ‘just be’; whether this ‘just being-ness’ involves stimming, forms of sensory play or something else. Psychodynamic paradigms that understand human distress in terms of psychopathology tend to place a greater focus on change. The concept of the therapy space as a safe place to ‘be’ is controversial and has been derided by some (verbal) therapists as unethical or even narcissistic. Arguably, it is an imperative for autistic/ADHD people trying to survive in a hostile environment and an integral part of therapy.
12. Framing dysfunction as relational not individual
According to Chapman and Botha (2022), neurodivergence-informed therapy reconceptualises dysfunction as relational rather than individual. Dance is a particularly effective medium to explore dynamics of relational co-creation and mutual understanding (the “double empathy” problem). We affirm the right of individuals to connect and disconnect in ways that are right for them. This includes all aspects including eye contact, which is never to be forced.
13. A human rights-based approach
Traditional ‘interventions’ lay blame at the foot of the ADHD/autistic person and do not acknowledge the impact of a hostile world. The UN has noted that interventions targeting autistic and ADHD people have amounted to human rights abuses, even torture, and have caused immense harm. Then there is micro traumatic relating that includes “the seemingly benign, almost invisible, hurtful everyday messaging that communicates impairment and otherness … [which] pervades autistic lives and silences, excludes, and marginalizes (McGreevy et al., 2024). Dance movement therapist Amber Gray, who originated the concept of mixed polyvagal states that later informed the work of Stephen Porges and has worked extensively with torture survivors, has articulated a frame for somatic/human rights psychotherapy.
14. Valuing our own movement intelligence and creativity
Last but not least, if we are able to model (including through our own artistic practice) that we value our own being, our neurotype and particular form of movement intelligence, we might perhaps model an example that encourages others to do the same.
As neurodivergent dance movement therapists, we may ourselves be making the slow and gradual shift from shaming our natural selves to welcoming and affirming our unique being and valuing our own creative intelligence while holding space for our disability and challenges. For many of us, this is an ongoing process of unlearning that requires great self-compassion and sometimes, external support. We must also de-shame the concept of needing ongoing support (not just therapy) to survive in a neurotypical world.
This is not just to relieve individual suffering and promote culture but also to support creativity. As Ken Robinson noted in his popular Ted talk, ‘Do schools kill creativity?’ while recounting the story of famous choreographer Gillian Lynne (Cats, Phantom of the Opera), in today’s world creativity is as important as literacy. We have already lost too many autistic and ADHD individuals. We simply can no longer tolerate a society that ‘ruthlessly squanders’ autistic and ADHD lives and talents.
Olivia Streater, 19th March 2024
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