If you're a parent trying to find the right psychological support for your neurodivergent child, you're not alone—and you're not imagining it if the process feels confusing, overwhelming, or even disheartening at times. Many families are navigating a landscape filled with outdated models, long waiting lists, and therapeutic options that may not meet the nuanced needs of children with autism, ADHD, or other neurodivergent profiles.

This blog post is designed to help you understand the difference between traditional and neuroaffirmative approaches to therapy, clarify what best practice looks like in modern, evidence-based care, and empower you to ask the right questions when seeking support that genuinely honours your child's individuality, strengths, and lived experience. Among the most commonly offered and asked-about interventions are play therapy and Cognitive Behavioural Therapy (CBT)—both widely available and frequently recommended for children and adolescents. As such, this blog will focus on these two modalities in particular, unpacking their aims, methods, limitations, and relevance to neurodivergent profiles.

It is essential that therapeutic interventions are not only accessible and compassionate but also clinically effective. Families often invest significant emotional, financial, and time resources into therapy, and it is critical that the intervention is not simply passive engagement or 'expensive childminding' under the guise of treatment. Interventions must be rooted in clearly articulated goals, measurable outcomes, and neurodevelopmentally-informed frameworks to ensure they support meaningful change in a child's functioning, wellbeing, and autonomy. This is particularly vital when supporting neurodivergent children, whose therapeutic needs may differ considerably from neurotypical peers and require tailored, evidence-informed approaches that foster self-understanding, emotional resilience, and real-world coping strategies.

What Is Play Therapy?

Play Therapy refers to a broad umbrella of approaches where play is the primary mode of communication and therapeutic change. It is most often used with children aged 3–11, but adapted forms do exist for adolescents.

There are two major types:

• Non-directive (Child-Centred) Play Therapy: Developed by Virginia Axline, where the child leads the session, and the therapist follows, offering reflection and emotional containment.
• Directive Play Therapy: The therapist introduces structured play activities (e.g., puppets, roleplay, storytelling) to explore specific themes (e.g., trauma, anxiety).

Play therapy can support emotional expression, attachment, and self-regulation, particularly when verbal expression is very limited.

Evidence Base:

• Widely used but the evidence base is mixed.
• Better outcomes shown in trauma, attachment disruption, and early developmental distress over long-term treatment (Ray et al., 2015).
• Meta-analyses find modest effect sizes, especially compared to structured therapies like CBT.

When might Play Therapy be inappropriate or ineffective for Neurodivergent Children?

1. Adolescents with Higher-Level Insight & Goal-Oriented Needs

• Teens seeking help with anxiety, mood, or identity distress may experience non-directive play therapy as infantilising.
• They often benefit more from appropriately adapted CBT, DBT, ACT, or trauma-informed integrative therapy.

2. When a Child is Masking or Struggling with Insight-Based Needs

• E.g. an autistic child who uses advanced verbal masking but is experiencing panic or OCD-like thoughts: play therapy can miss the target without identifying the internal cognitive process and considering or validating the autistic experience.

3. Demand-Avoidant or PDA Profiles

• Non-directive play might trigger intolerance of uncertainty if there's no clear structure.
• On the flip side, highly directive play might be seen as controlling — requiring a nuanced formulation-based approach.

4. When the Goal Is Specific Skill Acquisition or Phobia Treatment. Play therapy may not adequately treat specific clinical presentations such as phobias, OCD, or school refusal, where exposure-based CBT is more appropriate.

What Is CBT/DBT for Children?

CBT (Cognitive Behavioural Therapy) and DBT (Dialectical Behaviour Therapy) are structured, manualised, goal-directed therapies.

• CBT focuses on identifying and challenging unhelpful thoughts and behaviours and teaching emotional regulation, problem-solving, and coping skills.
• DBT (adapted for children) includes mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, with strong focus on validation and self-compassion.

These therapies have a strong evidence-base, especially for:

• Anxiety and OCD
• Depression
• Self-harm/suicidal ideation
• Autistic children and adolescents with co-occurring anxiety and low-esteem, especially when appropriately adapted (Moree & Davis, 2010; Wood et al., 2018)

Potential Limitations: Requires verbal ability, emotional insight, and meta-cognition/cognitive-flexibility —requires specific training and appropriate adaptation for younger, developmentally delayed and neurodivergent clients.

When might CBT/DBT approaches be inappropriate or ineffective for neurodivergent kids?

• CBT is not ideal for very young children, children with significant receptive language difficulties, or those with profound intellectual disability.
• DBT may be too complex or abstract unless highly scaffolded and personally tailored.
• Both approaches require flexibility, creativity, and neurodivergence-informed training and experience.

Neuroaffirmative Approach: Integration Is Key

A neuroaffirmative and integrated approach is grounded in a shift away from deficit-based, one-size-fits-all models toward formulation-led, flexible, and rights-based care. Several evidence-informed frameworks, clinical guidelines, and position papers now support this way of working, particularly in the UK, Ireland, and internationally. 

Best practice in Ireland and the UK encourages:

• Formulation-based care rather than modality-driven. Individually tailored interventions informed by each child's unique profile of strengths and support needs
• Considering the child's holistic neurodevelopmental profile, sensory needs, emotional maturity, and passions and preferences.
• Integrating play-based tools and materials within a neurodivergence informed CBT framework or using CBT approaches and principles within tailored neuroaffirmative, creative, visual, and sensory-based practice.

1. Psychological Society of Ireland (PSI) – Guidelines on Neurodiversity & Assessment

While PSI has no single document on neuroaffirmative therapy (as of 2024), its ethics, child psychology guidelines, and autism position statements emphasise:

• Individualised, context-sensitive formulations
• Avoidance of deficit-based language
• Collaborative goal-setting with children and families
• Inclusion of neurodivergent voices in service design
• PSI supports the integration of multiple evidence-based modalities to meet diverse cognitive, communication, and sensory needs.

"Intervention should be individually tailored, developmentally appropriate, strengths-based, and designed in collaboration with the child and their family."
— PSI Clinical Guidelines (2022)

2. NICE Guidelines (UK) – Autism, ADHD, Depression, Anxiety

For autism NICE CG170 (Autism in under 19s: support and management) Recommends:

• Avoiding unadapted CBT
• Adapting interventions for communication and sensory needs
• Prioritising structured support that promotes emotional regulation, self-understanding, and reduced distress, not "fixing behaviours"

For ADHD (NICE NG87) Recommends:

• Psychoeducation and coaching
• Individualised behavioural strategies
• Avoidance of standard CBT as first-line unless adapted and collaboratively planned

For anxiety/depression in youth NICE Recommends CBT/DBT for moderate-to-severe presentations, but:

• Must be developmentally appropriate
• Culturally and linguistically tailored
• Adapted for neurodivergent processing styles where relevant

3. WHO's ICF Framework – International Classification of Functioning, Disability and Health

• Encourages focus on function and participation, not "disorder"
• Considers: Environment, relationships, communication, and attitudes as central to support
• Aligns with neuroaffirmative values: Reduce barriers to wellbeing rather than attempting to "normalize" a person

4. Neurodiversity-Affirming Clinical Literature & Models

While not always codified in official guidelines, many peer-reviewed frameworks and position papers from neurodivergent clinicians and researchers are now influencing best practice.

Examples include:

• Kapp et al. (2013, 2020): The neurodiversity paradigm as a human rights movement, challenging pathologisation
• Woods et al. (2022): Calls for trauma-informed, identity-affirming therapy for autistic people
• Murphy et al. (2021, Irish Journal of Psychology): Discusses the importance of culturally responsive and neuroaffirmative assessments/interventions in Irish practice
• Dr. Wenn Lawson, Damian Milton: Advocate for "monotropism", double empathy theory, and self-directed, interest-based supports
• Couch et al. (2020): Explores co-production of services with autistic people, especially in mental health

5. Integration of Modalities: Formulation-Guided Practice

This approach is endorsed by:

• British Psychological Society (BPS): Emphasis on formulation rather than diagnosis as the basis for intervention planning
• Division of Clinical Psychology (UK): Promotes personalised psychological care and integration of models based on need, not diagnostic category
• INSAR and Autistica guidance: Recommends co-produced, adapted interventions over standardised protocols

Best Practice Recommendations

What the Guidelines Now Push Back Against

❌ Deprecated Approach                                          ✅ Affirmative Alternative

Standardised, inflexible CBT                                      Adapted, visually supported, interest-based CBT

Behavioural compliance therapy (e.g. ABA)             Emotion-focused, autonomy-affirming models

Deficit framing (e.g. "fixing social skills")                    Strengths-based, acceptance and identity support

No adaptation for communication style                    AAC-informed, sensory-aware, developmentally matched

Therapist-led, unidirectional practices                       Co-created, collaborative, feedback-informed therapy

BIBLIOGRAPHY

Couch, K. A., Deighton, J., & Pellicano, E. (2020). Transforming psychological services for autistic people: The need for co-produced practice. Autism, 24(7), 1603–1606. https://doi.org/10.1177/1362361320931236
➤ Emphasises the importance of co-designing services with autistic individuals to ensure relevance, safety, and effectiveness, especially in mental health interventions.

Kapp, S. K. (2013). Autism spectrum diversity: Autistic community and the neurodiversity movement. Autism, 17(3), 271–282. https://doi.org/10.1177/1362361312445422
➤ Introduces the neurodiversity paradigm, arguing against pathologizing autism and in favour of recognising neurological differences as valid and valuable forms of human diversity.

Kapp, S. K. (Ed.). (2020). Autistic community and the neurodiversity movement: Stories from the frontline. Palgrave Macmillan. https://doi.org/10.1007/978-981-13-8437-0
➤ A foundational text compiling lived experiences and academic analyses of the neurodiversity movement, situating it as a human rights issue rather than a medical problem.

Lawson, W. (2011). The passionate mind: How people with autism learn. Jessica Kingsley Publishers.
➤ Advocates for interest-based, self-directed learning in autistic individuals, rooted in monotropism theory, highlighting why directive therapies like CBT must be adapted carefully.

Milton, D. (2012). On the ontological status of autism: The 'double empathy problem'. Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008
➤ Proposes that autistic and non-autistic people experience reciprocal difficulties in understanding each other, challenging the traditional view of autism as a social deficit. Highlighting the intrinsic difficulties for autistic-neurotypical relationships and the relevance and significance of encouraging and facilitating autistic-autistic relationships and supports.

Moree, B. N., & Davis, T. E. (2010). Understanding and treating selective mutism: A cognitive-behavioral approach. Journal of Anxiety Disorders, 24(6), 612–619. https://doi.org/10.1016/j.janxdis.2010.04.006
➤ Supports CBT for anxiety-based conditions like selective mutism, demonstrating that structured, skills-based interventions are more effective than play-based approaches in many clinical presentations.

Murphy, D., Ringwood, M., & O'Connor, C. (2021). Cultural responsiveness and neurodiversity-affirming assessment: Current practices in Ireland. Irish Journal of Psychology, 42(3–4), 200–216.
➤ Provides an Irish context, urging psychologists to adopt culturally and neurodevelopmentally appropriate assessments and interventions that align with neuroaffirmative best practice.

National Institute for Health and Care Excellence. (2013). Autism spectrum disorder in under 19s: Support and management (NICE guideline CG170). https://www.nice.org.uk/guidance/cg170
➤ Recommends structured, evidence-based therapies like CBT (when appropriately adapted) and cautions against the use of unmodified, non-directive play therapy for autistic children due to insufficient evidence.

Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107–123. https://doi.org/10.1002/pits.21798
➤ Provides empirical support for play therapy's benefits in regulating behaviour and emotions in very young children, particularly those with trauma or adjustment issues—but highlights variability in outcomes for neurodivergent groups.

Woods, R., Milton, D., Arnold, L., & Graby, S. (2018). Redefining critical autism studies: A more inclusive interpretation. Disability & Society, 33(6), 974–979. https://doi.org/10.1080/09687599.2018.1454380
➤ Calls for therapy that is trauma-informed, identity-affirming, and community-led, aligning with neurodivergent people's lived experiences and rejecting standardised or deficit-based models.

Woods, R. (2020). Pathological Demand Avoidance and the DSM-5: A Rebuttal to Judy Eaton's Response. Good Autism Practice, 21(1), 74–76.This piece challenges critiques of the inclusion of Pathological Demand Avoidance in diagnostic manuals, defending its recognition and the need for nuanced understanding

Woods, R. (2022). Autism & Mental Health. Inclusion for All? Working with Autistic People. Oxford, 31 March 2022.
In this conference presentation, Woods discusses the intersection of autism and mental health, advocating for approaches that recognize the full humanity of autistic individuals.