The authors set out to address a critical gap in how we support autistic young people during their transition to adulthood.

The paper aims to explore how occupational therapy practitioners can support belonging amongst autistic clients whilst focusing on transition skill development. Specifically, the authors wanted to demonstrate how fostering a feeling of belonging in transitional pursuits can be achieved through collaborative efforts with autistic children and young adults.

Methods

Rather than collecting primary data, Dallman and Wright conducted a literature review examining transition outcomes, self-determination theory, and belonging research in the autistic community. They then applied the neurodiversity-affirming model of care—which includes five pillars: anti-oppressive and anti-ableist practice, leadership of those most impacted, acceptance-based approaches, trauma-informed care, and body-mind liberation—alongside the Distinct Belonging framework’s ten principles. 

The Results

Dallman and Wright argue that many existing interventions actually undermine belonging. Applied behaviour analysis, for instance, often facilitates camouflaging—where autistic individuals mask their traits to conform to neurotypical expectations. The authors point out that “camouflaging includes, in part, masking or hiding one’s autism characteristics to shield one’s condition from public scrutiny,” and whilst this might be functional in some contexts, it represents an inauthenticity that prevents people from being their true selves.

The authors make the case that belonging should be recognised as an essential transition outcome, not just a nice-to-have. They reference research showing that student-peer connections carry greater significance than academic or organisational considerations

The paper distinguishes between strengths-based and deficit-based approaches, recommending a focus on strengths based interventions. They also suggest that interventions should include support to develop meaningful and positive relationships, self-advocacy, inclusions and validation of identity. The tables within the article give many examples of how interventions can focus on belonging for many areas of occupation at both the individual and community level. An individual example for ADLs was encouraging the individual to explore clothing choices that affirm their identity and personal needs and for the community was advocating that companies expand their product lines to be more diverse. 

Practical Takeaways

Perhaps the most important takeaway is that, the authors remind us to position autistic clients as experts of their own experiences. This means co-creating interventions, regularly seeking feedback on effectiveness, and supporting self-advocacy and leadership development from early elementary school onwards. They recommend prioritising belonging alongside skill development and give a number of suggestions in the tables within the article on how to do this. They emphasise that interventions should mimic everyday life and avoid addressing transition skills in isolation, this means moving away from clinic-based, decontextualised practice towards embedded, community-based approaches especially for our older children.

The paper also challenges us to examine whether our interventions inadvertently promote masking.  This is a theoretical perspective paper, so the idea hasn’t been formally tested; however, it’s not uncommon for researchers to start with a theory and then test whether the theory holds true. I expect that we will see more empirical research on this topic in the future.

This Canadian research team set out to do something quite different from typical intervention studies—they wanted to create a practical model that shifts the focus towards changing the school environment to support inclusion. The team started from a position that aligns with inclusive education principles: rather than trying to develop students’ skills to fit into existing school structures, schools should be adapted upfront to meet diverse needs. Their aim was to answer the question: What are the key features of school environments and occupations conducive to meaningful occupational participation for autistic students and their peers?

Methods

The team used a design-based research approach, which is an iterative, practical method for developing solutions that are grounded in scientific literature but adapted for real-world use. Think of it as cycling through phases of exploration, design, and evaluation, making improvements each time based on feedback from the people who’ll actually use it.

They completed two full cycles between 2018 and 2024. The first cycle focussed on autistic students specifically. It included a literature review on effective practices, focus groups with 14 school staff to understand their concerns about participation, a pilot study in one mainstream school, and interviews with 12 occupational therapists who used the model. The evaluation at the end of cycle one revealed something important: the model was actually helping a broader range of neurodivergent students, not just those who are autistic. School teams and occupational therapists said they’d be more likely to invest in these changes if the model explicitly targeted neurodivergent students more broadly.

The Results

The iterative process resulted in a neuroinclusive school model that includes nine desirable features supporting meaningful participation and well-being for neurodivergent students and their peers.  The features are divided into the physical environment, social environment and activities. There is a really nice figure in the article on page 287 and I would recommend having a look at it in your own time, as obviously I can’t show you the visual in the podcast.

Important elements within the school

• Physical environment: being free from excessive stimuli, providing appropriate visual support and having clearly defined spaces
• Social environment: celebrating neurodiversity and providing safe and caring spaces. 
• Activities: should harness passions and strengths, offer a variety of options, be predictable and structured and include a mix of both stimulating and restorative activities. The authors noted that the key with activities is flexibility to respect each individual’s unique needs regarding when, where, and how to self-regulate.

The main limitation of the model has only been evaluated once in a pilot study and from occupational therapists’ perspectives—not yet comprehensively from students’ or families’ viewpoints. The team is planning further evaluation during 2024-2025 and I look forward to reading their updates. They also welcome suggestions for improvements, especially from neurodivergent people themselves, and have stated this as an evolving model rather than a finished product.

Practical Takeaways

This model offers occupational therapists a framework for shifting from child-focussed to environment-focussed practice. Rather than asking “how do we help this child fit in?”, we ask “how do we change the school so this child can participate meaningfully?”

The model isn’t a prescriptive checklist but rather a starting point for analysing and choosing strategies consistent with unique needs of school teams, students, and families. The authors recommend a tiered response approach—focussing first on changes benefiting all students, then implementing personalised strategies as needed whilst involving students in finding adaptations that make sense for them.

For your practice, this means collaborating with school teams to make systemic changes rather than providing one-to-one skill-building interventions. The evaluation showed that occupational therapists and school teams found the model helped them change perspectives, focussing on strengths and environmental modifications rather than deficits. Importantly, modifications were perceived as beneficial not just for neurodivergent students but for many learners.

The model, especially if you use the figure, could  facilitate conversations with educators about why environmental changes matter and it provides concrete examples of what neuroinclusive practice looks like across all areas of the school. I think it could also be a useful image to include in training that you are doing with staff. So overall lots of practical applications!

For those of you working in schools, you’ll know firsthand that we’re seeing more children struggling with school anxiety and attendance. This research takes a crucial step back from looking at individual children to examine the bigger picture—specifically, how the education system itself might be generating distress for neurodivergent learners. Their specific research question was: What are the systemic contributors to—and lived expressions of—school anxiety among neurodivergent children, as told by neurodivergent children and adults, parents, and professionals?

The researchers wanted to understand what creates school anxiety for neurodivergent children, not just at the classroom level, but across the entire system—from policy right down to daily experiences.

Methods

The team used a critical realist approach with participatory methods. This meant they centred neurodivergent voices throughout the research process and recognised that whilst school anxiety exists as a real phenomenon, how we understand it is shaped by social and cultural contexts.

They conducted focus groups and one-to-one interviews using creative methods designed to be neuro-inclusive. Participants could engage through multiple formats: a semi-structured interview guide, a statement-sorting task about contributors and expressions of anxiety, and draw-write-tell activities. For children, questions were framed around a fictional character called Charlie to create psychological distance from potentially distressing personal experiences.

The research was conducted in phases, deliberately starting with neurodivergent children, then adults, followed by parents, and finally professionals. This meant later groups could respond to themes raised by earlier groups, ensuring neurodivergent perspectives shaped the entire process. 

Data were analysed using reflexive thematic analysis, looking both at what participants explicitly said and the underlying patterns and assumptions in their accounts.

Participants

The study, which was based in the UK, included 31 participants: 8 neurodivergent children aged 10-16, 5 neurodivergent adults, 8 parents, and 10 professionals. Among the neurodivergent participants, 90.5% were autistic and 66.7% had ADHD. Over half had attended specialist schools, and nearly 29% had experienced sustained non-attendance lasting at least half a year.

The professional group was predominantly teachers (70%), with most having over 16 years of experience. Interestingly, 20% of professionals suspected they were neurodivergent themselves, and 75% of parents either identified as neurodivergent or suspected they might be.

It’s worth noting that all participants were white, which is a limitation we’ll return to. Children were recruited through a specialist school, whilst adults, parents, and professionals came via online support groups, professional networks, and charities.

The Results

The researchers developed four hierarchical themes that reveal how systemic factors cascade down to create individual distress.

Theme 1: Navigating an Inaccessible System Rooted in Neuro-Normativity

• Participants described an inherently rigid education system fundamentally misaligned with neurodivergent needs which prioritises compliance and standardised productivity over inclusion.
• Government policies around attendance, curriculum standards, and accountability measures like Ofsted created inflexibility. 
• One parent described how the school’s argument was “this is what life is like…it was their responsibility to ‘train the kids”.
• This one-size-fits-all approach meant neurodivergent children faced constant anxiety-inducing demands: overwhelming sensory environments, unpredictable transitions, rigid timetables, and narrow definitions of success focussed on exam performance.
• Teachers recognised these constraints, with one noting that accountability pressures actually incentivise excluding non-conforming children: “When it is all about results, it is much easier to get rid of children that are going to bring results down.”

Theme 2: A Constrained System: Internal Dynamics of Support

• Support became gatekept and reactive rather than preventative. 
• Accommodations were often only provided after a crisis or formal diagnosis, rather than being embedded from the start. One child captured this perfectly: to get support, you need to “go to a normal school and be treated like a normal person until they find out I guess’ and another said “do terrible in it so you can come here (special school) and go crazy.” 
• Parents described that when support did arrive, it was often tokenistic or actively harmful—based on behaviourist approaches that enforced compliance rather than addressing root causes. 
• Parents described children being physically dragged into school or forced to stay on-site whilst parents waited in car parks. This created blame cycles between parents and teachers. 
• Parents became exhausted advocates, often leaving employment to support their children, whilst being pathologised as “overprotective.” Teachers, meanwhile, felt overwhelmed by unsustainable workloads and under-resourcing, sometimes viewing parents as adversarial. 

Theme 3: Internalised Rejection: Navigating Hostile Social Expectations

• The neuro-normative system legitimised interpersonal rejection. Children experienced bullying, social exclusion, and what they described as teacher favouritism towards those who conformed. 
• Their intentions were frequently misunderstood, and anxiety expressions (particularly non-verbal ones) went undetected or were dismissed as defiance.
• One child said: “Unless you verbally speak about it and get them to listen to you, teachers probably won’t help because they don’t know what is going on.” This misunderstanding led to punitive responses to meltdowns and distress, further compounding anxiety.
• Over time, this rejection became internalised as shame. Children became hyper-vigilant about anything that might mark them as different, with one parent noting her daughter constantly worried: “you won’t talk to anybody about my autism, will you?” 

Theme 4: Survival Strategies: When Only Non-Attendance Remains

• Navigating this system took a severe physical and mental toll. Children experienced insomnia, chronic illness, catastrophic thinking, and in some cases, suicidality. One parent described their son’s physical symptoms: “We even took him for an ECG once, because he said it was beating so hard he was scared.”
• Children developed survival strategies. Some had meltdowns—described by one child as “if you make a big, huge snake mad, well it is going to attack you.” But meltdowns were unsafe in a system demanding conformity, so many withdrew instead, either by hiding within school or being unable to attend entirely.
• For those forced to attend, camouflaging became essential—constantly monitoring behaviour to appear neurotypical. But as one child explained: “Masking drains your mental health, like a battery being used like an electric drill. You are just gone.” The effort became unsustainable, with distress erupting at home. Withdrawal, therefore, wasn’t refusal—it was necessary self-preservation.

Practical Takeaways

For me this is a really important piece of research to reach the eyes of policy makers and school leaders. We can also use it to advocate for system change. Whilst we can’t single-handedly change education policy, we can advocate within our schools for flexible, needs-based approaches rather than diagnostic-dependent accommodations. We can push for preventative support rather than waiting for a crisis. 

The results should make us consider how our own assessments and interventions might inadvertently reinforce neuro-normative expectations. Are we helping children “cope” with an inaccessible environment, or are we advocating for environmental change? I’ve lost count of the times I have read goals that say a child will be able to cope with sensations, and I really wish that sometimes I could write a goal for the teacher or school to change within a child’s plan. 

They also give us more evidence to help educators to recognise camouflaging and withdrawal as adaptive responses to systemic inaccessibility, not as behaviours to be eliminated. If a child is withdrawing or masking, it signals that the environment feels unsafe. Our role may sometimes need to shift to helping adults understand this rather than “treating” the child. 

The authors acknowledge that the sample likely reflects ascertainment bias, with participants holding critical views more motivated to take part than those who are having a positive experience. Not all neurodivergent children struggle in mainstream schools, and some teachers successfully navigate inclusive practice despite systemic constraints. The research doesn’t claim universal experience but rather identifies areas that require systemic change.