**3.1 Culturally adapted EBPs**

Cultural adaptations of EBPs, which have emerged as an area of study in other fields (e.g., clinical psychology, see Lau [28]), seem to be absent as a focus of EBP discourse in the context of delivering quality service and support to autistic students *Naturalistic Developmental Behavioral Interventions as Value-Based and Culturally Adapted… DOI: http://dx.doi.org/10.5772/intechopen.108124*

for better life outcomes. In particular, a fundamental assumption about the universal applicability and effectiveness of EBP to all populations in the field of mental health care and service appears to be a flawed one when evidence of EBP effectiveness is solely based on the results of certain populations (e.g., White students of suburban middle-class families) [29]. Likewise, there seem to be similar issues about the legitimacy of implementation and dissemination of EBPs to populations of color in special education considering that most EBPs have been developed without even taking account of the cultural context of ethnic minority communities and cultural identity of those presumably being served (e.g., autistic individuals).

Castro and colleagues define the concept of cultural adaptation as: "a planned, organized, iterative, and collaborative process that often includes the participation of persons from the targeted population for whom the adaptation is being developed" ([30], p. 215). Cultural adaptation also concerns the process of adjusting an evidencebased intervention protocol by taking language, culture, and context into account to make it compatible with the cultural patterns, meanings, and values of those being served [31]. Culturally adapted EBPs for autistic individuals can help not only clarify and specify what ought to take place in adaptation for obtaining an optimal balance between adaptation and clinical implementation fidelity that leads to important implementation outcomes such as acceptability and appropriateness, but also define and clarify the necessary knowledge, skills, and roles of those facilitating the implementation process and the timeline and sequence of adaptations in the implementation process [32].

#### **3.2 What is neurodiversity?**

Many critiques of behavioral intervention can be tied to the fact that applied behavioral analysis (ABA) usually uses the medical model of disability to "treat" autism. Under this view, autism is seen primarily as a medical issue, with "reduction of autism symptoms" and appearing more "normal" as intervention targets. This is in direct contrast to the model of neurodiversity, which sees autism as a different—but not inherently bad—type of brain wiring. In her writing, Judy Singer [33], the sociologist who coined the term "neurodiversity," described it as similar to biodiversity, in that different types of brains contribute to the ecological fitness of a society. Harvey Blume's essay in *The Atlantic,* which introduced the term to the public in 1998, also used the word in this way: "Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment?"

Today, the term "neurodiversity" is used in multiple different ways [34]. The first is similar to the way Singer [33] and Blume [35] described neurodiversity: as a biological fact. Everybody's brain is different, which by default implies that there is diversity in human neurology (hence, *neuro-diversity).* The second way "neurodiversity" is often used refers to the ways this biological fact is utilized in everyday life (known as the neurodiversity *paradigm* (Walker [34] or neurodiversity *approach* [36]). According to Walker [34], there are three fundamental aspects of the neurodiversity paradigm/approach: neurodiversity is a beneficial form of diversity; there is no "average" or "normal" brain; and social dynamics affecting other forms of diversity (such as gender and race) are also at play when it comes to neurodiversity. Dwyer's [37] breakdown of the neurodiversity paradigm/approach is similar: there are no ideal minds; neurodivergent people should be accepted, not normalized; and society plays a large role in disabling neurodivergent individuals. Dwyer [36] also highlights

that many advocates have adopted their own personal definitions of neurodiversity. For example, Bailin's [38] definition of the neurodiversity *approach* is inherently political: "primarily a call to include and respect people whose brains work in atypical ways, regardless of their level of disability." All of these definitions of neurodiversity relate back to autistic activist Jim Sinclair's [39] *Do not Mourn For Us* speech (see [40] for a historicization of this speech) where Sinclair implored parents to accept their autistic children and to stop seeing autism as a tragedy, explaining that autism is not something that can (or should) be removed from an individual. They highlighted that autism is a way of being (not an appendage or a "shell") and that autistic individuals are not stuck behind an impenetrable wall, incapable of building relationships with others. Sinclair acknowledges that parents may need to grieve the loss of their idea of an "ideal" child, but having an autistic child in and of itself is not a reason to grieve. This emphasis on acceptance of difference is the backbone of neurodiversity.

#### **3.3 Common misconceptions about neurodiversity**

Though neurodiversity hinges upon the biological fact of differences in brains, many misconceptions arise when the neurodiversity approach is applied to individuals with disabilities such as autism. Den Houting [41] brings up three common misconceptions. First, some critics feel that the neurodiversity approach views autism and other neurological disabilities as simply *differences* and not disabilities, implying that this approach effectively erases disability (e.g., [42]). Advocates highlight that this is just simply untrue—while the neurodiversity approach does see neurological variation as differences that should be respected, they still acknowledge the potentially disabling properties of such differences [38, 41, 43–45] (den Houting, 2018). While some contend that the disabling aspects are solely due to the social environment (e.g., [41]), others reject a strict social model and recognize that impairments localized in the individual can themselves be disabling (e.g., [37, 43]).

Another common critique is that the neurodiversity approach really only applies to those who have higher IQ and who can verbally self-advocate (e.g., [42]; numerous posts on the National Council for Severe Autism's blog, e.g., [46]). Den Houting [41] argues this ignores the fact that ability profiles of autistic individuals are not always consistent, or they might be great at something 1 day but struggle with it the next. Therefore, to assume that someone who can speak verbally is all-around "high-functioning" is incorrect. Ballou [43] and den Houting [41] also highlight that some neurodiversity self-advocates are in fact minimally verbal autistics (though den Houting acknowledges that there is a need for greater representation of non- or minimally speaking individuals within the movement). Ballou also makes the point that even if some individuals cannot traditionally self-advocate verbally, their other communicative acts should still be listened to and respected.

The last critique discussed by den Houting [41] is that, because neurodiversity advocates call for acceptance, they think neurodivergent people do not need any support. While this is not espoused by nearly any proponent of the neurodiversity paradigm, den Houting [41] sees this critique as stemming from a disagreement regarding the outcomes of support services. Those who support the neurodiversity approach call for supports that emphasize quality of life (e.g., [47]) and accommodations (e.g., [48]), whereas its critics tend to utilize the medical model wherein autistic individuals should be remediated and normalized. It is therefore

a mischaracterization to say that neurodiversity proponents do not want disabled individuals to receive supports; they just want supports in place that are accepting and validating of one's neurotype.

#### **3.4 Strength-based approaches to interventions/supports for autistic individuals**

Though many early interventions for autistic individuals use the medical model to understand and "intervene upon" autism, there are researchers who feel that the neurodiversity paradigm and early intervention *can* coexist, particularly if clinicians listen to autistic perspectives regarding intervention goals, procedures, and outcomes [49–52]. Therefore, understanding neurodiversity is crucial for professionals who work with autistic people, as it can help the field move away from a focus on deficits and normalization and toward figuring out what autistic people actually want and need. One way for interventionists and support professionals to embrace neurodiversity in their practice is to use strengths-based approaches. Such approaches recognize that everyone, no matter what challenges they might face, has strengths and that such strengths must be acknowledged and leveraged in education, support services, and employment to ensure individuals enjoy a high quality of life.

In typical intervention/education for autistic children, deficits are identified through standardized tests and questionnaires, and plans such as individualized education programs (IEPs) are created in order to remediate these problem areas. These plans typically leave little room to document strengths [53], implying either that disabled children do not have strengths or that their strengths do not matter in comparison to their deficits. For example, a child's joint attention abilities may be overshadowed or even ignored if the child often needs to run and jump around the room while listening, as their IEP might call for them to sit still. Furthermore, some challenges faced by autistic individuals can be viewed as strengths depending on the context [54]. For example, perseverance on specific topics is often perceived as a problem, though it could be reconceptualized as excellent focus and expert knowledge. Autistic individuals have been shown to have a multitude of different strengths [55, 56], and capitalizing these interests and passions can be a way to motivate individuals to learn things they may have not been interested in doing previously [57, 58].
