Neurodiversity-affirming developmental care — formative SAQs

SAQ 1 (10 marks)

A 10-year-old autistic child attends with headphones. School wants a "better behaviour" letter. The child asks not to be forced to make eye contact. There is no acute medical emergency. [1]

1. Define neurodiversity-affirming developmental care in one sentence and name three core actions at the first encounter. (3) [1] [5]
2. Explain the double empathy problem and how it changes your interpretation of "poor social skills." (3) [2]
3. Outline a closed-loop plan for school and clinic (goals, adjustments, owner, review). (4) [7] [6]

Model answer

Affirming care respects neurotype and preferred language, redesigns person-environment fit, opens supports the child and family want, and still practises full medical vigilance — it is not anti-diagnosis. First actions: safety check; ask language/communication preference; reduce sensory load; map mismatch; co-write goals with both voices. [1] [5]

Double empathy: misunderstanding between autistic and non-autistic people is often mutual, not a one-way deficit in the child. "Poor social skills" may reflect relational mismatch and inaccessible environments rather than pure child failure. [2]

Plan: co-define 2-4 goals (e.g. communication access, reduced meltdowns, safe attendance); recommend concrete adjustments (quiet assembly alternatives, movement breaks, written instructions); name school and medical-home owners; set review date; document hospital/school passport; screen for co-occurring medical/mental-health needs. [7] [6]

SAQ 2 (10 marks)

A high-achieving autistic adolescent looks "fine" in clinic and class but collapses after school with exhaustion, skill loss and intensified sensory distress. Staff praise her for fitting in. [3] [4]

1. Name the mechanism and the burnout concept this describes. (3) [3] [4]
2. List red flags that would convert this visit from counselling to urgent care. (3) [6]
3. Give a stepwise affirming management plan that does not celebrate camouflage as success. (4) [4] [7]

Model answer

Camouflaging/masking (suppressing autistic traits or performing non-autistic scripts) carries mental-health cost. Autistic burnout is chronic exhaustion, reduced function and increased sensory sensitivity after sustained overload — not laziness. [3] [4]

Convert for regression with encephalopathy, new seizures, active suicidal plan, severe self-injury, medical instability or safeguarding concern. [6]

Reduce camouflage demand where possible; redesign school load; screen mental health accessibly; treat co-occurring sleep/anxiety/ADHD as indicated; co-write participation goals; closed-loop letter with owner and review; update communication passport; safety-net for crisis. Do not set "look more typical" as the primary outcome. [4] [7]