Why do you talk about neurotypical culture and not neurodivergent culture?

Someone asked me that and I immediately thought, that's a great question! There are several reasons I approach things the way I do.

1. One of my big goals is to help people come up with replacements for the (usually unintentionally) ableist social skills curricula that are currently getting used. They seek to teach neurotypical norms, so a replacement needs to be about neurotypical culture.

2. If someone comes to see a speech therapist, they're generally looking for sessions where I'm working directly with the neurodivergent person, not the neurotypical one, so my resources match that accordingly. (Although I agree that neurotypical people could stand to learn about neurodivergent people every bit as much as neurodivergent people could learn about neurotypical people!)

3. To be honest, you also can't teach "neurodivergent culture" as some monolith. The idea of there being one neurotypical culture is already a stretch, even if you're confining it to the majority cultural practices of a specific region. Once you move to neurodivergence, there are just way too many different ways in which it's possible to be neurodivergent to pin it down to a culture. And depending on the specific neurodivergence, their needs and practices can actually completely conflict with each other. There are definitely themes among neurodivergent people overall, but if you really wanted to learn about a specific culture, you would need to learn about that specific neurodivergence.

How Can I Learn More About Neurodivergence Generally?

If you want to take a deep dive into the subject generally, honestly, I'd recommend the Wikipedia page on neurodiversity. They do a really sweeping job of covering a whole lot in just one article and it's hard to beat.

How Can I Learn More About a Specific Neurodivergent Culture?

A good place to learn is any place run by people with that neurodivergence themselves. Read, watch, listen, and learn! Because autism is the neurodivergence I have the most experience explicitly and intentionally learning about, I'm going to use the lens of how I learned about Autistic culture to give you ideas that you can apply to learning about other neurodivergent cultures.

First off, books by authors who have a specific neurodivergence themselves are definitely important to learn from. Books most directly related to Autistic culture that I have loved are "Loud Hands: Autistic People, Speaking" and "And Straight on Till Morning: Essays on Autism Acceptance". I have also heard excellent things about "Neurotribes: The Legacy of Autism and the Future of Neurodiversity" although I haven't read it myself.

Reading lots of blogs or following social media pages from people with the specific neurodivergence you're learning about is always a good move. I've always loved Judy Endow's writings. My favorite of her posts is "Assigned Friends". Julia Bascom also has some incredible writings. My very favorite of her blog posts is "Quiet Hands".

I also think it's useful to read a bit about gatherings run by and for people with the neurodivergence you're learning about, because that's a space they have in which to be the most themselves. AutCon is a conference by autistic adults for autistic adults. The list in their FAQs of what they have in place at the conference to keep the environment "autism friendly" is actually a really good reflection of Autistic cultural norms and values.

You might find answers from vloggers on YouTube, like I found with the great "Ask an Autistic" playlist covering common questions. Social media forums often have areas where you can go to ask questions about neurodivergence. For instance, Reddit has a whole "Ask Autistics" subreddit where you can ask questions of actually autistic people, and I know there's a similar page on Facebook.

How I Got Started With Social Communication

The first place I learned about social communication norms was in my Mandarin Chinese classes in college. Culture and language are inextricably linked and I found myself learning a great deal about my own culture in the process. I remember my professor telling us about an older Chinese greeting which translates to "Have you eaten?" One day someone asked him that and he was hungry and hadn't eaten, so that's what my professor said. Much to his surprise, the person who asked him that dropped everything, brought him back to their house, and fed him then and there.

Our professor explained that's when he learned that "Have you eaten?" was a greeting like "How are you?" where the other person isn't really asking it as a question. Instead it was more or less a way of saying "hi". That blew my mind - not about older Chinese cultural practices, but about my own. Because I realized it's true!

When someone asks "How are you?" when they're greeting you in neurotypical American culture, unless you're in a context where it's expected that you'll talk about your feelings (sitting down to catch up with a close friend, going to see a mental health counselor, etc) they're not actually asking for a full answer. In fact, if you give a particularly negative answer (such as "Honestly, I've been really sad, my grandma is in the hospital and dying") that person is going to feel like their greeting just turned into an unexpected moment where now they're socially obligated to drop what they're doing and attend to your problem, whether they actually have time to or not. Just like what happened to my professor!

And then I realized there's a social script for answering a question like that. You're expected to say something short that's neutral or positive. The acceptable length and detail of the response varies based on how much time both people seem to have and how close you are. For instance, if it's a greeting while you're walking past each other, it's expected that your response will be a sentence or even just a word, combined with a follow up question about the other person. "I'm fine, how are you?"

That was the moment that I really started analyzing my own culture's practices. I was honestly even more fascinated by the unspoken cultural norms around me than I was by those of the places I was learning about. I remember going to a family gathering and feeling like I was an anthropologist studying American culture in the South, because all of a sudden everything was so clear. I had always been a few years behind my peers in terms of social communication, so I had already been trying to consciously analyze other peoples' interactions for years to figure out where I was going wrong. The lens of culture, however, provided the paradigm I felt like I needed to unlock everything.

When I entered into the world of learning about autism, I heard of an essay by an autistic adult called "An Anthropologist on Mars" and found the discussion forum for autistic adults called "Wrong Planet". To me, just the titles themselves showed the cultural divide between autistic people and neurotypical people. There was no better or worse culture - just different.

Aaaaaaand then I went to graduate school to become a speech therapist. I was exposed to so many out of touch practices and outlooks related to autism there, and while my previous experiences did inoculate me somewhat, as a beginning clinician some of it did make it into my practice. (I'm so sorry, kids, I wish I could go back and do it better.) But the whole time I had this niggling feeling that something was wrong. Bit by bit, I began to tease out the ableist crud I'd been taught and get rid of it. (Because when you know better, you do better.)

One of the biggest turning points for me was when I talked to my sister, who is Autistic, about some of the interesting things I'd been learning about social communication. I talked to her about how people use what you're looking at to guess what you're thinking about, and how they will use eye gaze to indicate their thoughts themselves - sometimes purposefully, sometimes not. I can't remember her exact response, but it was something along the lines of, "Wait, what?! I wish they would have told me that back when I was a kid instead of just showing me pictures of smiley faces and asking me how they were feeling!"

That's when I became convinced that this information could be useful to neurodivergent folks. Yeah, there was loads of ableism embedded into most social communication instruction, as I'd already found out the hard way. But it didn't have to be like that! The way I'd talked to my sister about it, just sharing an interesting fact, didn't have any implication of superiority of one culture over another. (In fact, my attitude was more of a "Isn't that weird and fascinating?") And it had been useful to her! And the way I had been taught Chinese social communication norms back in college had been completely neutral (and a real life saver in trips to China) as well.

But there wasn't anyone teaching neurotypical social communication through that lens. It seemed like pretty much all the therapists and teachers I saw were either using the social communication curricula that were laced with ableism, or they had decided that since there was so much ableism in existing methods, the teaching of social communication must be inherently ableist and you shouldn't teach it at all. (And let me tell you, being in the middle ground of that divide is not a pleasant place to be.)

So I decided to just cobble together my own way of teaching social communication. I went based on struggles I'd read from neurodivergent authors, what I'd learned in my culture classes, my own experiences, my sister's experiences, and of course, my clients' experiences. Bit by bit it came together.

It's not pretty and it's not perfect. In fact, my Social Communication Ideas page on this site should really be considered a living document, because it is going to always be in flux as I learn new things. But I do consider it proof of concept that it is possible to teach social communication in non-ableist ways.

How Speech Therapy Can Support Mental Health

I'm so often met with confusion when I tell caregivers and counselors that this is an area we can help with - with good reason! When people hear the term "speech therapy" they understandably think we only work on pronouncing words. In reality "speech therapists" are really more like "communication therapists".

There are nine broad domains we can work on: alternative communication modalities (AAC), articulation & phonology, cognition, fluency, hearing, language, social communication, swallowing, and voice. Of those, only one - swallowing - does not directly support either mental health or the client's ability to communicate with a counselor. (Although of course being able to consume desired food/drink without choking certainly can be indirectly helpful!) Here's a brief overview of how the other eight domains can be beneficial.

"Alternative Communication Modalities" (AAC)	When a person either can't speak or speech is too difficult/unreliable for them, we provide them with alternative and augmentative communication methods (AAC). Augmentative methods could be something like a voice amplifier to increase the volume of a person's voice to a level at which it can be heard. Alternative methods are things like communication boards or devices so that the person can touch buttons with words/symbols that correspond to the words they want to say. By both teaching a person how to use these and by providing them with the words/symbols needed to support their mental health (emotion words, ways to report problems, etc), speech therapists can play an important role in decreasing frustration, increasing the ability to communicate with a therapy, and helping users be able to talk about their feelings.
Articulation & Phonology	These are "speech sound disorders". That includes cases with a person who can't pronounce their "r"s, for instance - but it also includes cases such as apraxia of speech, where the person's brain struggles to get the message to their mouth of how to form words at all. Even with "milder" articulation disorders that only affect one speech sound, speech therapy can support mental health by improving an area a person is self conscious or teased about. (Given that we're supporting the person's own goals for their speech.) And with more significant disorders, we can be helping the person be able to make themselves understood verbally at all, as well as helping eliminate a serious source of frustration in their lives.
Cognition	There are many ways in which cognition affects our ability to communicate, but the biggest are in memory and executive function. I could do a deep, deep dive on this one, because the effect of these is so massive and unnoticed. Long-term memory likely makes sense from the perspective of counseling, considering you'd need it to process past events. But the hidden sides of this domain - working memory, metacognition, attention, inhibiting impulses, self-monitoring, planning, initiating, and many others - have impacts that both lead to negative real life consequences and are also blamed on moral failings. People with these struggles are labeled "disrespectful", "irresponsible", "ditzy", and "lazy", and if they're children they're called "behavior problems" or "kids who just need some discipline". As you might imagine, the mental health effects of living with these labels are broad and painful.
Fluency	Even though we now know that fluency disorders, such as stuttering and cluttering, are not caused by anxiety, there is still a deep relationship between fluency disorders and mental health. Not only can they make it difficult to communicate generally, but they can also cause so much self consciousness and frustration that the person might start to avoid talking in certain contexts at all. This has a massive impact on their mental health and on their ability to communicate with counselors. (Although again, it's critical to note here that this has to be done in a way that is empowering the person with a fluency disorder to address their own goals, not trying to make them change even if they are fine with how they talk.)
Hearing	The "hearing" element is not referring to the ears themselves, but rather, the brain's ability to interpret sound as speech. This includes working on auditory processing and helping people with reduced hearing to be able to use the hearing that they have and/or the aids that they have to their fullest to help their brains interpret spoken language. (Again, though, only as a support to the goals of the person themselves!) If a counseling session is via spoken language, having a speech therapist work on hearing can be very helpful.
Language	Language breaks down into receptive language (understanding) and expressive language (language a person speaks, writes, signs, etc). There are so many categories of ways in which we can help here. The biggest I typically do is working on teaching: 1. Feelings vocabulary The first set of feelings words I try to establish are happy, sad, mad, scared, hurt, tired, and sick. But I don't stop there! True emotional literacy requires having access to words for all categories and intensities of feelings. I call them "intermediate emotional vocabulary words". So the next words I prioritize are: angry, annoyed, anxious, ashamed, bored, calm, comfortable, confused, disappointed, disgusted, distracted, embarrassed, excited, focused, frustrated, guilty, healthy, hyper, jealous, nervous, overwhelmed, proud, relaxed, safe, shy, silly, stressed, surprised, terrified, thrilled, uncomfortable, unsafe, and worried. Teaching emotional vocabulary words like this helps a child to both understand their feelings and to share them with others. 2. Words for thinking about thinking Metacognition is what they call it - but for me, I just think of these as building the foundation for my kid to be able to succeed in counseling and in expressing themselves. The first thing many therapists teach, for instance, is the connection between thoughts, feelings, and behaviors. This is great! ...but only if your kid understands what those words actually mean. I remember a therapist giving me a handout from a workbook they were using to teach one of my kids mindfulness concepts. I went through and found SO many words in those explanations that my kids didn't know! From then on I asked them to tell me what lesson they were going to working on that week ahead of time, so that I could pre-teach some of the vocabulary, and suggest ways to simplify some of the other language. 3. Reducing the frustration of communication This applies both to the frustration of not being able to get across what you want/need and the frustration of not understanding what others are telling you (or thinking that you understood and then getting in trouble because you didn't understand right).
Social Communication	This can be an area of great benefit - but first, it's important to ensure it's being done in a neurodivergence affirming way. If there is social skills therapy that is conducted in an ableist way that pushes learners to try to hide their neurodivergence (known as "masking" or "camouflaging"), or that their way of doing things is inferior/incorrect compared to the neurotypical way of doing things, that can be quite harmful for mental health. We have studies showing the connection between camouflaging / masking autistic traits and poorer mental health outcomes for both children and adults. And unfortunately right now, the majority of the social skills therapy I've seen has at least some ableism in it. That said, neurodivergence affirming social communication treatment can be incredibly helpful. For one thing, teaching the communication skills required for interpersonal safety - which is inherently social communication - is going to help prevent future trauma. Compliance is drilled onto most neurodivergent people in school and other therapies (such as ABA), and so learning the times you need to be non-compliant, and how to respond to them is absolutely critical. For instance, if someone tells you not to report abuse or an adult tells you to drop it when you tell them about a safety problem, you absolutely need to be non-compliant. Understanding the communication of neurotypical people in the dominant culture in your area - both how to interpret what they say/do and how they will interpret what you say/do - can also be very beneficial. For instance, if you know how to tell when someone's words are likely genuine and when they likely aren't, that can help prevent a lot of grief. Being able to predict what others will do in social situations can also decrease the anxiety of uncertainty.
Voice	Speech therapy for voice can be beneficial in two different categories. One is helping people with disorders affecting their vocal folds, which helps alleviate the frustration and depression fed by how hard speaking is, can decrease pain, and of course help improve communication. The other category is that speech therapy for voice can help people to achieve their goals, such as improved vocal techniques for singers, or helping someone learn how to align their voice's pitch with their gender without causing strain on their vocal folds.

I could write an entire post on almost all of these, but hopefully this has been a good initial overview of just some of the many, many ways in which good speech therapy can support mental health!