Imagine a girl, perhaps seven years old, having a really hard time at school. Her energy and impulsiveness are making it hard for her to focus on school work. She calls out answers in class - and even though she is often right, she gets into trouble for not waiting to be picked by the teacher. Her female friends’ games are starting to become more sedate, but she doesn’t feel welcome joining the boys playing football in the playground.
This girl, her parents and her teacher all think she might have attention deficit hyperactivity disorder (ADHD), and the teacher is happy to make a referral to child and adolescent mental health services (Camhs).
But waiting lists in her area mean that it will be 12 months before she can even start the diagnostic process. And because she is a girl, there’s a chance that her ADHD won’t be picked up at all.
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This pattern is all too common across the country, despite legal frameworks stipulating support at the point of need, and it risks preventing neurodivergent young people from receiving the understanding, acceptance and resources they need to thrive in school and beyond.
But many have hope that this pattern can change; that there will be a new path that comes in the form of the neurodiversity paradigm.
What is neurodiversity?
Put simply, neurodiversity is the fact that there is natural variation between people in how our brains take in, process and respond to information. Each individual is unique, but we can also think of people in terms of “neurotypes” - or categories - within which there is a degree of shared experience.
“Neurotypical” is thought to be the most common neurotype and probably describes most pupils in a mainstream classroom.
The education system was largely designed with these children in mind, and a majority of their teachers are probably neurotypical, too. In an average classroom, their educational needs will normally be met within standard curricula and pedagogy.
Using the same framework, people who are not neurotypical, on the other hand, can be referred to as “neurodivergent”: people with ADHD, autism, dyslexia or dyspraxia are all neurodivergent - though, of course, individuals may not use that language to describe themselves.
Neurodivergent people’s needs at school may not easily be met within standard practice. Yet we know from the data that we can safely describe our classrooms and schools as neurodiverse - educating children from a range of different neurotypes.
For instance, Scottish schools’ data indicates that about six children in every classroom have additional support needs. In England, meanwhile, around 16 per cent of pupils receive support for special educational needs.
We can assume that the large majority of these children are neurodivergent. But what does this mean for classroom practice?
The fact that neurodiversity occurs naturally in our population gives rise to a range of consequences in terms of how we understand the differences between us, and how teachers might respond to them in an education setting.
This applied version of neurodiversity is known as the “neurodiversity paradigm” and it has three central tenets.
The neurodiversity paradigm
First, each person, regardless of neurotype, has equal value and there is no one way of being that is inherently better than another.
Neurotypical people may be in the majority but that doesn’t mean that their way of processing the world is “correct”. This reminds us that when working with neurodivergent young people, we need to focus on accommodations and environmental change, not attempting to change the individual.
Second, neurodivergent people, like any other minority, are subject to prejudice, discrimination and minority stress. These social dynamic factors - how someone is treated by other individuals and within social systems - dictate a lot of the experience of neurodivergent young people.
Accommodating neurodiversity within schools, therefore, means shifting the attitudes and beliefs that we hold about each other. It also means that neurodivergent people should be seen as the experts in their own experience.
Third, neurodiversity adds value. This is often taken to mean “neurodivergent pupils have talents” but, while this may be true, it fails to capture the real transformational power of the neurodiversity paradigm. Instead of focusing on the individual, we need to think in collective terms, about how diversity in our classrooms enriches experiences and opportunities for everyone.
Neurodiversity is said to drive both creative problem-solving and empathic relationships - two things that we certainly want to cultivate in young people.
However, it’s important to point out that not everyone supports the neurodiversity paradigm.
While the term “neurodiversity” was coined over 20 years ago by Australian sociologist Judy Singer, the idea is only now becoming part of mainstream conversations. Its implications have barely been explored and we are far from a clear consensus.
In particular, many people are worried that neurodiversity’s positive messages about accepting differences and celebrating diversity might mean that children’s support needs are neglected. A clear diagnosis, some argue, is therefore the best way to ensure that students get the help they need.
Are diagnoses useful?
There is no doubt that securing a clinical diagnosis is a crucial moment for a young person. Diagnosis can help young people to find their community with the chance to make new connections, and can open up opportunities for self-understanding and self-compassion.
Yet there are also problems with diagnosis. Although efforts to break down gender- and social class-based barriers are underway and starting to make a difference, we know that not all ethnic groups in the UK have equal access to diagnosis.
This means that pupils who are already disadvantaged by racism and community deprivation are further hindered by the lack of an accurate diagnosis and the support that may follow.
Efforts to tackle this via expanding diagnostic equality will only put more pressure on under-resourced clinical services, increasing already long waiting times even further.
Another challenge to the gate-keeping role of diagnosis comes from a growing body of evidence that clinical diagnostic categories map poorly on to needs or outcomes.
For example, a Centre for Attention, Learning and Memory (CALM) study at the University of Cambridge found that while a large, neurodiverse sample of hundreds of children can be categorised into sub-groups based on cognitive performance, children with a specific diagnosis such as ADHD, autism or developmental language disorder were found to be distributed across all of those groups.
The same team found that clinical diagnoses also do not map neatly on to underlying neurological features. What this shows us is that our diagnostic categories don’t seem to rest on solid biological foundations, nor do they provide useful information about thinking skills - and that is a real problem if we are relying on diagnoses to tailor school support.
Providing support in the classroom
So what does all of this mean for teachers? I often hear diagnosis described as being like a key that unlocks a package of support and understanding. But the truth is, we already have that key in our pockets: teachers don’t need a clinician to grant them access to an understanding of the pupils they teach.
The neurodiversity paradigm reminds us to expect and accept diversity in our classrooms, and to respond to it with accommodations to the environment rather than modifications to the individual.
Teachers need to know they can take action without waiting for a doctor’s permission slip to do so.
Many actions do not require elaborate training or expensive resources, either. Taking the time to experiment with the lighting in your classroom, offering movement breaks or the option to stand for parts of a lesson, or allowing pupils to bring in quiet fidget and stim toys can benefit dozens of children while costing nothing.
Other adaptations may be slightly more effortful, such as providing a written copy of instructions to refer to during independent working - but if you are going to the trouble of creating such resources for one pupil (as many teachers are), why not make it available to everyone who wants it, whether they have a diagnosis or pupil support plan or not?
We will also find neurodiversity in the staffroom just as we do in the classroom - neurodivergent teachers have a huge amount to offer in creating a more effectively inclusive school, and that insight should be harnessed.
Another key determinant of wellbeing for neurodivergent pupils is the attitudes and actions of their peers. That’s why we are creating LEANS: Learning About Neurodiversity in Schools - a free, comprehensive resource pack to enable primary school teachers to educate whole classes about the concept of neurodiversity and its implications.
The goal of LEANS is to increase knowledge and thereby understanding, making school a place where neurodivergent young people can be embraced and encouraged by everyone around them. In line with the neurodiversity paradigm, it has been developed by a neurodiverse team and a recent trial in four schools has just been completed, with some promising initial results.
Neurodiversity: a new hope
Ultimately, clinical oversight of diagnostic pathways risks eclipsing educational expertise. Teachers are accomplished at building relationships with their pupils, creating flexible pedagogy and applauding the variety of ways pupils approach their learning. If they see that a pupil is struggling, they - and that young person - should not have to wait months or years before a diagnosis gives them permission to take action.
The neurodiversity paradigm tells us to expect these differences, and signposts how to respond to them: through acceptance, environmental adaptation and celebration.
Sue Fletcher-Watson is director of the Salvesen Mindroom Research Centre for neurodiversity research and chair in developmental psychology at the University of Edinburgh. In 2023 she is co-chairing the It Takes All Kinds of Minds (ITAKOM) conference on neurodiversity, which welcomes educators.
She is grateful to Dr Dinah Aitken, Dr Alyssa Alcorn, Dr Duncan Astle and Fergus Murray for their thoughts on this article. Read more about her work at www.ed.ac.uk/salvesen-research and email leans@ed.ac.uk to join a mailing list for updates on the LEANS project.
