What does neurodiversity really imply for education?

I didn't enjoy a single part of school.

Everything was challenging – interacting, socialising, coping with the busy, noisy environment, dealing with unfairness and people breaking the rules and getting away with it (e.g. a student did not submit their homework on time and the teacher gave them another week to complete it with no detriment), trying to manage having different hobbies from everyone else, not relating to what other students were talking about.

No one suspected I might have autism. No one recognised how anxious I was. I think it was because I was so quiet that I was invisible. I never caused any problems to anyone. I went through the whole of secondary school never getting even one detention. I was polite and well-behaved and had no obvious difficulty with schoolwork so my difficulties were unnoticed.

(Alis Rowe, autistic woman and founder of The Curly Hair Project, from A Different Way to Learn, Neurodiversity and Self-directed Education) 

I hear a lot of stories like Alis Rowe's in my clinical practice. Stories of young people who aren't thriving at school. It isn't necessarily that they find the academic demands of school too challenging (although that certainly is a factor for some). It's the non-academic elements of school which cause the most trouble. Being with peers all day. The chaotic and noisy playground. Paying attention to things which you're not interested in. The smells of the dining hall. Waiting in line and the way that adults talk to children.

Children express their distress about school in a range of ways. Some are disruptive at school, whilst others are quiet during the day and then become distressed after pick-up. Some complain of tummy aches in the mornings, whilst some refuse to go to school at all.

I have a particular interest in this client group because this was my story too.

The Brain or Blame dilemma

I was very unhappy at school when I was aged 5 and aged 13. Both times, I became reluctant to go. My parents managed this by changing my school. In a different environment, I was happier and more able to learn. I went on to excel at school and university. 

I was lucky. For most children who are unhappy at school, it's unusual for the school environment to be considered the problem. Instead, we tend to locate the problem in the child themselves. The problem is seen as either 'behavioural' or 'emotional'. Children are incentivised with awards or punished for poor attendance. Sometimes they are sent to psychologists and offered treatments for anxiety. We treat their emotional reaction as the problem. If this doesn't work, their parents are fined and threatened with court orders.

The other way that the system copes with children who aren't thriving is to identify them as having 'special educational needs' – a term which essentially says that they are not well-suited to what mainstream school is offering. These children often go onto waiting lists to see health professionals. I've worked in one of these clinics. We assessed young people and we sent them back with a report, often a diagnosis, and a list of recommendations. We never knew whether those recommendations were helpful. The reports were sent to the school and the children were discharged from our service.

Professor Mary Boyle, emeritus professor of clinical psychology at the University of East London, calls this dichotomy the Brain or Blame dilemma. The Brain or Blame dilemma suggests that our society only offers a few explanations for those who struggle. We tend to either blame them (parents need to use Tough Love, children should try harder) or say that there's something wrong with their brain using the medical model (they have a 'mental disorder' or 'special educational needs'). After 'Blame', the medical model comes as a huge relief. It effectively says, 'It's not your fault. There's something wrong with your brain. You can't help it'.

It's not surprising that families are so desperate for this. A diagnosis can be the key to help and extra funding. It can mean that people around a child stop blaming them or their parents for their difficulties.

However, there's a downside. Both Brain and Blame locate the problem in the child and their family. This means that we don't have to ask ourselves difficult questions about why so many children are not thriving in the education system. We don't ask ourselves whether the education system is fit for purpose or whether it meets the developmental needs of children. When we locate the problem in individuals, we neutralise any pressure for systemic change. We assume that the problem isn't the system, it's the children.

Window dressing

This is a particularly salient dilemma for psychologists because we are often the ones who are being asked to legitimise the 'brain' side of this dilemma. We are being asked to say, yes, this isn't your fault. You have a diagnosable disorder. It's because there's something wrong with your brain. 

The discomfort of many psychologists with this role can be seen in the move to replace the pathologising language of DSM and ICD. People will write reports with terms like 'autism spectrum condition' rather than 'autism spectrum disorder', even though the official diagnostic term is indeed 'disorder'. These changes in terminology make no difference to fundamental assumptions of the medical model, which is designed to identify disorder or disease so that the appropriate treatment can be chosen. They are essentially window-dressing.

Psychiatric diagnoses were not designed in order to describe or appreciate difference. Their purpose is to identify who might need treatment or an intervention.

Diagnoses are used to determine who should get extra help in school, and so it's not surprising that there's a massive pressure on neurodevelopmental services. Waiting times of several years for an NHS assessment are not uncommon. Private clinics are proliferating which offer quicker diagnoses, usually for a fee of several thousand pounds. A diagnosis can unlock extra financial support for their school and access to disability benefits, meaning that those who can pay for a diagnosis are then able to get more support more quickly than those who cannot. Many families see a diagnosis as their only hope.

In those circumstances, I know from experience that it is very hard to be the clinician who says no. There is a pressure to lean towards giving the diagnosis. When I worked in a neurodevelopmental service I would talk to senior colleagues about tricky decisions and they would say 'Do they want the diagnosis? Then give it to them.' I know from talking to other psychologists that this isn't uncommon.

Neurodiversity

I was concerned by my experience in the neurodevelopmental clinic. I felt that the health service was being used to de-politicise the problems in the education system. I felt that whilst we might achieve something for the individuals who got a diagnosis, we were leaving those who did not get a diagnosis without anything except blame. I knew from my experience that the difference between someone who received a diagnosis and someone who didn't could be as small as one criteria – and yet this distinction was being treated as if it was of the utmost importance in that person's life. 

In my search for something different, I found neurodiversity. At its most basic level, neurodiversity (a term coined by Judy Singer in the 1990s) is the idea that humans are all different, and that this difference does not have to be seen as a disorder.

The basic idea of neurodiversity is at odds with the diagnostic model. It's fundamentally a dimensional, non-pathologising approach. It refers to differences between everyone.

However, the medical model is deeply rooted in our culture. There are aspects of it which are often taken for granted in general discourse – for example, that differences between people fall into distinct diagnostic categories, rather than being best understood as dimensional. The way that the public understands the term 'diagnosis' means that many assume that a diagnosis based on behavioural symptoms (like autism or ADHD) means that an underlying biological cause has been identified. These assumptions are pervasive in our culture, and so it's no surprise that when talking about neurodiversity, they show up.

It shows up in the way that people still get divided into categories and how it is assumed that these categories reflect a neurological difference. Rather than understanding neurodiversity as dimensional and something which refers to the whole population, the world is sometimes divided into the 'neurodivergent' (which refers to people who get a diagnosis or self-diagnose) and the 'neurotypical' (those who do not), with the assumption being that this division reflects distinct underlying neurological differences.

It's common to hear it said that people belong to different 'neurotypes', an idea which assumes that a category such as 'ADHD' or 'autism' defines a distinct type of brain. Parents are sometimes told their children need to form connections with their 'neurokin' – people who share their diagnosis. There is frequent talk in the press about those with a neurodevelopmental diagnosis being 'differently wired', (e.g. Williams, 2023) leading many of the public to assume that receiving a diagnosis means that professionals have reliably identified that they have a brain which works differently (and always will work differently) to other people. 

In some ways, this can be more deterministic than the medical model. Receiving a diagnosis is sometimes presented as the only way a person can truly understand themselves. For many, those diagnoses have become an identity. For late-diagnosed adults, this identity is one they choose. For children, it is usually chosen for them.

There is no evidence that people can be divided into neurologically distinct groups based on psychiatric diagnosis and in fact, recent research is pointing us in a very different direction. Neuroscientists are finding that neurological differences in those with developmental differences are transdiagnostic (Kushki et al., 2019).

Behavioural geneticists are finding that genetic differences are a matter of many different genetic variations, all of which have a tiny effect and which are present through the whole population (Plomin, 2018). The days of thinking that there is a straightforward correspondence between genes, neurobiology and psychiatric diagnosis are behind us.  These findings suggest that we will never be able to diagnose autism (or other types of neurodiversity) based on a brain scan, because the diagnostic category does not reliably map onto neurological differences.

Neurodevelopmental diagnoses are based on symptoms, and it is becoming clear that there can be different pathways to a similar set of symptoms. We know that the majority of psychological and behavioural differences between people are dimensional, rather than categorical. The frustration which scientists have felt with the limitations of diagnostic classification system have led to several new alternative dimensional frameworks being developed (Insel, 2014, Kotov et al., 2017).

There is also evidence that the term 'neurotypical' is a misnomer. As Schaefer et al. (2017) showed in their population-representative study cohort study in New Zealand, by midlife the large majority (83 per cent) had experienced at least one diagnosable 'mental disorder'. If we define the 'neurotypical' as those who never fit criteria for a 'disorder' then they are in the minority – and therefore not really 'typical' at all.

One size cannot fit all

To me, this means that we need to think far beyond diagnosis when seeking to understand neurodiversity. Developmental differences in areas such as executive functioning and emotional regulation mean that a standardised system may not work well for many children, whether they fit diagnostic criteria or not.  It means that we need to think about how our education system could accommodate the whole range of developmental variation – and we need to acknowledge that this variation could be far wider than many of us appreciate.

It means we should be taking individual differences as our starting point. It's not enough to provide a standardised system and to either blame or pathologise children when it doesn't work for them. It's also not enough to take one group of children, give them a diagnosis and say that they (and only they) need something different, whilst assuming that the system works fine for everyone else. Neurodiversity is the norm, not the exception. 

I think the only way in which more children could thrive would be to create a system which is far more flexible than it is at present. One size cannot fit all.

Looking for alternatives led me to self-directed education. Most people have never heard of self-directed education, but it's been practiced for decades by home educators and there are schools which run on these principles which have been open for over a century, for example, Summerhill School in Suffolk.

The idea behind self-directed education is a simple one. The learner retains responsibility for their learning. They are the one who chooses what to learn, how to learn it and when to stop. This is very different to school, where the teacher (or the government) decides what a child should learn, how and when they should learn it.

Even though you probably haven't heard of it, most of us do know about self-directed education. It's what we do with our young children. In a good nursery, adults set up an environment full of things which children like to do, and within that, the children can choose how they spend their time. Adults are available and involved, but they do not insist on the child following their agenda. Young children are self-directed learners. 

Self-directed education continues the principles of a good early years setting upwards as children get older. The opportunities become more sophisticated, but the principles are the same. The child retains the right to choose what they do.

Self-directed learning is also how most adults learn. They find information online, they watch documentaries, they read books. They talk to other people. They stop when they have had enough. They set themselves extraordinary challenges, including writing books and running marathons. They rarely decide that they must go and sit in a classroom and listen for hours on end – and when they do, they often complain about how hard it is to concentrate.

Self-directed education is evidence-informed. It takes the principles of Ryan and Deci's self-determination theory and puts them into practice. Adults create the circumstances for intrinsic motivation so that children can drive their own learning.

For many things about the way that mainstream school is organised are not evidence-based. There is no evidence that between the ages of 5-18, humans learn in a different way to earlier and later life. There is no evidence that it's necessary to make young people all do the same thing or that they should be constantly compared against each other. There is evidence that for some children, the standardised school system causes distress and disability – which we (by which I mean psychologists and other professionals) are then legitimising by locating the problem in the children.

That is why I wrote a book about neurodiversity and self-directed education. I wanted to tell the stories of families who had taken a very different way with their children. They told me what self-directed education looked like in their homes. It looked very different to school. 

To show you what I mean, I'll use an extract from the book. Malachi is five years old and is autistic with complex medical needs. His older brother Jacob, aged 10, is dyslexic. They are both self-directed learners and do not attend school. This story was told to me by their mother.

Malachi} has things that he's really passionately interested about for a period of time and then that's kind of out the window. Then he doesn't really know what to do with himself for a while and he sort of wanders around. He likes being with me. He likes asking lots of questions, and just sort of pottering around. He likes going on trains and bus rides. He likes to sit in a coffee shop. He likes things like shelling eggs and he really loves kneading dough. Then there's other things that he just really isn't interested in that you would assume he might be interested in, like watching TV shows.

He is quite sensory-seeking in a lot of ways but then he's avoidant in other ways. We thought about Forest School for a while and the idea of being outside and doing fires. We'd agreed that I would stay with him. He tried it for a little while. I think we had been three times and he said, 'I've done it now.' I said, 'You know, the idea is that you keep going.' And he's like, 'No, no, but I've done it. I've been there. I've seen the place. It's done. I know what's gonna happen.' So he doesn't do that anymore.

He loves playing with Jacob and they play together a lot: video games, or they make up games. Jacob frames the whole game, even down to when he'll say, 'And now you say this'. And then Malachi will say it. Jacob scaffolds the whole play for him and Malachi really loves that. But if you just say to Malachi, 'Do you want to just play?' Or, 'What do you want to play?' He'll say, 'I don't know. I just don't know.' But when Jacob is scaffolding things for him, then he'll say, 'Oh, yeah, I could say this.' And I can see that he comes out of himself a lot more than within that frame that Jacob has created for him.

Malachi's education is very different to school. There's no mention of phonics or of his ability to follow instructions. Instead, his mother is providing him with opportunities – like forest school – but his choices are respected, even when they are video games.

It can be hard to believe that this form of education works, but in fact, there is research which shows that children educated in this way can and do go on to higher education (Riley, 2021). Many of the families in my book told me how as their children became teenagers, they started to set themselves goals and work towards them in a way which had seemed impossible when they were younger. There was a qualitative shift in their learning which became more mature.

Self-directed education is on the increase, particularly in families of children who struggle in the school system. It provides an alternative to the 'brain or blame' dilemma which families often find themselves caught in. It allows families to start where their child is, even if that place is very different to other children of their age.

I'll finish with a quote from Alice, whose autistic son is 15 and doesn't go to school. She talks here about how her son, who spent many years playing video games, has started to engage with new experiences.

Over this past year, it's been like moving out into the world, slowly moving out into the wild. To see that person functioning in that way is phenomenal. Part of the reason he can is because he knows he has choices. He can come to me tomorrow and say, 'I'm not doing carpentry anymore' and I'll say, 'That's great'. Everything he does is a free choice.

What we've given him is autonomy, which is what he has to have. If he doesn't, he's out of control. He's learning to live with his autonomy. And I think sometimes it is too much for him. There's too much to choose, he gets overwhelmed by who he'll be in the future and where he will go. And that's when it's just time for a big hug and to let him know that you know it's all okay.

Dr Naomi Fisher is an Independent Clinical Psychologist, author and EMDR-Europe trainer specialising in trauma, autism and alternative approaches to education. Her two books, Changing Our Minds and A Different Way to Learn, focus on the psychology of self-directed education.

Key sources

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Fisher, N. (2023). A Different Way to Learn: Neurodiversity and Self Directed Education. Jessica Kingsley Publishers.  
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Kushki, A., Anagnostou, E. et al. (2019). Examining overlap and homogeneity in ASD, ADHD, and OCD. Translational Psychiatry Vol. 9 Issue 1 Pages 318
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Williams, R. (2023). Wired Differently. The Guardian, August 23rd.