Autism, Identity and Clinical Practice: Supporting Positive Identity Development in Neurodivergent Children and Young People

Purpose Developing a positive neurodivergent identity is increasingly recognised as crucial for individuals’ well-being. As part of service improvement, we completed a qualitative investigation of the experiences of clinicians in a Child and Adolescent Mental Health Service Neurodevelopmental Conditions team providing support for autistic children's developing positive neurodivergent identity. Methods Nine semi-structured interviews with clinicians were held to explore their experiences of supporting children and young people's positive identity development. Interpretative Phenomenological Analysis was used to explore and understand clinicians’ experiences. Results Four superordinate themes were identified: (1) A flexible neuroaffirmative concept of positive autistic identity; (2) Being honest and balanced: acknowledging challenges for young autistic people; (3) Developing an identity through relationships with others; and (4) Professional vulnerability in navigating neurodivergent identities: The importance of self-reflexivity. Conclusion In line with our theoretical understanding of identity development, the child's network and environment was seen as crucial for their developing identity. In line with research into assimilating an identity as part of a neurominority, a flexible but neuroaffirmative approach was seen as vital. Novel clinical experiences included the need for staff support and reflective spaces to consider their own relationship to neurodiversity. Lay Abstract Research shows that viewing yourself positively (your identity) helps neurodivergent people to have better well-being overall. We wanted to understand what the professionals working with children and teenagers in an NHS child and adolescent mental health service think about supporting young autistic people to think positively about their identity as neurodivergent people, so that we could learn about what is helpful and what is challenging. We interviewed nine people from different professions (such as doctors, psychologists and social workers) who worked in a team for autistic children and teenagers, asking the professionals about their experience of supporting the children and teenagers to develop positive beliefs about being autistic. We analysed the interviews using a method that helps us understand different people's experiences. We found four main themes in the interviews: (1) Understanding and explaining autism and neurodivergence in flexible, positive ways; (2) Understanding how challenging it can be to grow up as an autistic young person; (3) Understanding the different people in a child's life who influence how they see themselves; and (4) Professionals needing to have time and support to think about their own relationship to neurodiversity. Our findings fit with theories that explain how identity develops in childhood, with people around each child being important influences on how they see themselves. The findings fit with a need to hold positive views about autism and neurodivergence in society and in healthcare. We also found that staff may need more support and professional spaces to think about their own identity and relationship to neurodiversity.