February 6, 2024

All the Difference: A Conversation about Neurodiversity with Brian Middleton, M.Ed., IBA, BCBA, LBA

Brian Middleton is a late-diagnosed autistic and ADHD (AuDHD) individual and practicing behavior analyst who provides continuing education and consulting services through Mindful Behavior. In childhood, he was diagnosed with nonverbal learning disorder, a common misdiagnosis for Level 1 autism. He believes that if accurately diagnosed, he probably would have received the now-defunct Asperger's Syndrome diagnosis. His childhood and young adult years were marked by many struggles, which were compounded by various factors. As an adult, however, he found some structure working as a special education teacher. In that role, he discovered autism through his work with autistic children, which he describes as "eerie" because it was like seeing his own childhood. He notes that receiving his autism diagnosis opened up his world because, in his words, “I knew what was wrong with me.” It wasn't until after his diagnosis that he was introduced to the neurodiversity movement by way of the book Neurotribes, after which he realized how mistaken he was in thinking there was something “wrong” with him.

Can you share some personal insights into your experience as an autistic individual and how this informs your approach as a behavior analyst?

Well, to start with, understanding the basics of behavior analysis matters. Radical behaviorism, established by B.F. Skinner, looks at how stimuli impact behavior. The term "radical" emphasizes Skinner's view that thoughts, feelings, memories, and other internal processes are all aspects of behavior—a notion considered groundbreaking at the time. So, when I started studying behavior analysis, this unique approach critically changed my understanding of behavior because another way to describe the relationship between stimuli and behavior is to say the environment impacts behavior. Once I understood this relationship, I realized that the individual's unique needs and preferences influence how environmental factors interact with them. Exploring these critical pieces and combining them with my own experience helped me better understand what I needed, and I seemed good at translating that into supporting others with their needs.

My exposure to behaviorism came after I had already figured out many of these principles naturally as a special education teacher; the behavioristic perspective just improved my understanding and application. The issue I see with how applied behavior analysis is commonly utilized is that it frequently does not take into account the needs and unique differences that autistics or other neurotypes have. Instead, the approach appears to pathologize behavior rather than treating it as an indication of something going on. Well-intentioned people often presume that one size fits all, when in reality, that approach doesn't even fit most.

Neurodiversity has gained importance not only in the field of ABA, but also in education, workplaces, and broader societal discussions. As these terms are frequently used interchangeably, could you provide a brief definition for neurodiversity and elaborate on the distinctions between neurodiversity and neurodivergence?

First, let's start with an important fact: Neurodiversity as a concept is not new. The ideas were present in other cultures, sciences, and disciplines before they were given this name and framework, just not described in the way they are now. So, to describe neurodiversity simply, it is the reality that there are multiple neurobiological types. More pointedly—everybody is different. People acknowledge this is true, but we don't consistently accept it, especially within our different cultural groups. Neurodiversity is simply looking at the way that different humans experience things in different ways. It describes the diversity of human experiences. Instead of pathologizing or saying that one experience is less than or more than another, it's simply saying that because we're all different our experiences are neither less than nor more than. They just are. Does this mean there's going to be an absence of challenge or struggle? Of course not. There's always going to be a struggle. The question is, do we culturally know how to work together to overcome the struggles that we face both individually and as a community? Neurodiversity takes the attitude that this is an "us" thing rather than a "you versus me" thing.

Second, the term neurodiversity can be a little odd without context, particularly when considering related terms like neurotypical and neurodivergent. Neurotypical refers to people who are typically accepted by society. And that's the critical piece right there—typically accepted by society. Neurodivergence literally means people who diverge from the accepted norm. Some would point to a bell curve and say that anything outside of a certain set of standard deviations is what is considered normal, but the neurodiversity perspective would say the entire bell curve is normal. Normalcy as a concept within society is determined by the society.

For example, a student who engages in stimming behaviors would be considered normal in a neurodiversity-aligned classroom, where stimming is accepted rather than pathologized. Interestingly, that was my classroom. My students accepted each other and included each other. Was there conflict? Definitely! However, there was also resolution to the conflict and a sense of community. Too often, the cultural norm is to exclude anybody who is not accepted. Let's expand what is accepted so that people can support each other.

It's important to understand that when we're talking about neurodiversity, we're talking about the nature of the individual. There's often a debate between nature and nurture, which seems rather silly to me given that both are important factors to consider. Neurodiversity, as a concept, takes into account the nature of the individual and tries to meet that individual's needs through a matched approach to nurture. Metaphorically speaking, you wouldn't feed a cat a herbivore diet because they are obligate predators (meaning they must eat meat to survive). Similarly, you wouldn't feed a guinea pig a carnivore diet since they are obligate herbivores (meaning they must eat plants to survive). In the same way, you tailor nurturing to match a person's neurobiological needs.

Approaching intervention from a perspective that honors an individual’s unique neurodiversity — rather than through a deficit-focused lens — marks a significant shift, sometimes referred to as the neurodiversity vs. pathological paradigm. Could you offer some background and insight on both of these frameworks?

I touched on this a little in my last answer; however, this is a really important piece for us to dive deeper into. The pathology paradigm looks at different behaviors as an indication there's something wrong with or within the person. (Keywords might include abnormal, aberrant, cure, fix, and intervention.) The neurodiversity paradigm looks at behaviors as an indication that there is something wrong with the environment. Can the person be a part of the environment? Of course. Does that mean that accountability for individual behavior is removed? Most definitely not! The contrast is, instead of it being a you versus me problem, or in gamer terminology, person versus person (PvP) problem, it's an us problem, or in gamer terminology, a person versus environment (PvE) problem.

When we look through the lens of how the environment impacts behavior, it changes everything at a fundamental level. Behavior indicates something that allows us to look a little deeper into what is going on. Sometimes it's a very obvious solution: teaching functional communication skills, showing different ways of doing things, identifying knowledge or skills, and then training it. Sometimes the solution takes a little more work, like looking at how sensory differences impact behavior. Some people have preferences for high-complexity foods with lots of texture and flavor differences. Others have preferences for lower-complexity foods with more uniform textures and flavors. Why are we pathologizing this? We don't pathologize when we talk about cultural differences with food, yet when it's an individual’s preferences don't match the “cultural norm,” that person's preferences are pathologized. If someone had an allergy or an intolerance to a specific food, the expectation would be that the environment would adapt to them. Yet when a person has an intolerance to other sensory aspects, we resort to dismissing, at best, and pathologizing, at worst, those differences.

As a teacher, behavior analyst, parent, member of my community, friend, and sibling, I apply the ideas that neurodiversity is trying to help us understand. Everyone is different, and when we accept and help each other, everything gets better for everyone.

We often see the word “neurodiversity" paired with intersectionality. What is intersectionality and how does it relate to neurodiversity?

Intersectionality is a critical thing to understand. It's the idea that different things intersect with each other. For example, my experience growing up was one where I had access to resources that other people don't typically have. My parents could afford to homeschool my six siblings and me in a place where we had easy access to nature. Regrettably, both of my parents are trauma survivors, and certain actions were taken that didn't turn out to be as beneficial as my parents thought they were. There was some abuse and neglect, and those experiences affected my siblings and me. When you factor in our neurobiological differences, it becomes an example of intersectionality. On one hand, we were immensely privileged with access to resources others might not have. On the other hand, there were areas where we faced disadvantages or encountered struggles due to the structure of the environment and how it interacted with our identities.

With the increasing number of practitioners and agencies claiming to be “neurodiverse-affirming,” how can one go beyond the buzzword and assess whether these entities genuinely embody and practice the values associated with neurodiversity?

The buzzwording is definitely a problem. The issue lies in the fact that there is no one technology, therapy, or system that is neurodiversity-affirming. Anyone who claims to practice “neurodiversity-affirming [insert therapy or practice]” means one of two things. The first is the most obvious: they're using it as a buzzword. The second is less apparent: they're using an attitude-based approach to how they implement the technologies and services that their therapy or practice utilizes. 

What is affirming to one person's neurobiological structure isn't necessarily going to be affirming to another person's. For example, when providing support for an autistic individual, I will take one approach. If I'm working with somebody who is autistic and ADHD, I will take a different approach. Likewise, if I'm working with someone with OCD, schizophrenia, or any other type of intersectional experience, my approach is going to be different—different in that I am matching their needs. If I did not customize my approach to the individual, that would not be neurodiversity affirming. It also would be the opposite of compassionate, and it would be unscientific. I've seen people claim they are compassionate behavior analysts but not neurodiversity-affirming behavior analysts. They either don't understand what neurodiversity is about, or they're not individualizing and acting defensive when people provide feedback to them. 

The difficulty in navigating neurodiversity-affirming or aligned approaches is that there will be people buzzwording away with it, which makes it a bit necessary to signal that the services are individualized. Typically, what I recommend parents do is look at how engaged the therapist is with both the family and the individual, ensuring a match with their needs. If there's minimal or no individualization, then it's not really affirming or aligned. If there is individualization, but it's very limited, there's a limited amount of affirming or alignment. It's not an easy thing to navigate, but it is a critical to be aware of.

As someone with expertise in both behavior analysis and special education, could you offer advice for parents seeking to ensure that their child’s Individualized Education Plan (IEP) is crafted in a way that respects and supports their child’s neurodiversity? 

First, I wouldn't really call myself an expert. I have a lot of knowledge and experience, but I lean away from describing myself as an expert because I'm constantly learning. Second, understand that any time a school is placing expectations on a child, and those expectations do not match the child’s current skills, that's an area where accommodation or modification is necessary. That isn't to say the child should always be accommodated or that modification should be provided no matter what. The goal of Individualized Education Plans (IEPs) is to ensure that students can access learning. Therefore, there will be accommodations or modifications, some of which will fade as skills are acquired and others that might need to be present throughout the individual's time in school.

Parents are critical to ensuring that these accommodations, whether they are short-term, midterm, or long-term, are present in the IEP. In an ideal world, the school would advocate for your child, and you would not have to push for these things. Unfortunately, because education is so politicized and there are limited resources, your advocacy for your child is essential. The thing that schools resistant to providing support do not want you to know is that ultimately parents have all the power. As your child gets older and is able to advocate for themselves more, they may gain more power, but ultimately the law gives parents the most power in these dynamics.

There have been so many times that I have gone into an IEP meeting and watched parents get steamrolled by the school because they didn't understand they had the power. This doesn't mean you should go into an IEP meeting ready to fight, but it does mean that when you go into an IEP meeting, you can kindly push back if there's something that doesn't feel right or if it feels like the school is trying to dodge their responsibility. The law is actually on your side most of the time in these situations. That doesn't mean there won't be conflict; it just means that the conflict is potentially resolvable.

That's why I began by pointing out that anytime the school has an expectation for your child to do something, and their disability affects their ability to do this thing, that is where the IEP comes into place. If you have that as a reference point, you can keep returning back to that and place the demand and expectation on the school to make the appropriate accommodations and modifications so that your child can access a free and appropriate education (FAPE). And that phrasing, along with its accompanying acronym, is critical. “Free and appropriate education” is the central term used in education law. Using these acronyms and related terms can signal to the school that you're serious about the matter.

Let's say a school decides to play hardball and they want to push back over every tiny little thing. This is where procedural safeguards come in. Procedural safeguards ensure recourse for parents and students, so that a free and appropriate education is accessible. In this process, you have tools. One of the most important tools to be aware of is that you can invite anybody you want to an IEP meeting; the school cannot restrict who attends. This means that, if needed, you can reach out to education advocates or find people who can support you through this process.

For practitioners working within the constraints of insurance-funded ABA, where coverage is often tied to medically-necessary goals, what advice do you have for incorporating a neurodiverse-affirming intervention approach while still aligning with the funder's requirements?

Practice being flexible in utilizing behavior analytic concepts within the context of supporting individuals. Medical necessity simply looks at whether the treatment or support addresses diagnostic characteristics. Since behavior analysis takes a function-based approach to services, that means we can be very neurodiversity-aligned in our approach as long as we adapt to the needs of the individual. Does it mean that we sometimes have to push a little bit to get the support the individual needs? Definitely. Yet neurodiversity as a concept is very much aligned with the foundational philosophies of behavior analysis.

One area in which I have successfully created shifts is how I describe what is commonly called problem or maladaptive behavior. "Problem" or "maladaptive" are pathology paradigm perspectives. From a function-based perspective, the behaviors we support are functional; therefore, by definition, “problem” or “maladaptive” is an inaccurate description. Instead, I refer to the costliness of a behavior. If there's aggression or self-injury, that behavior is very costly. Teaching alternatives or addressing the antecedents to those behaviors is critical. I also describe behaviors as “behaviors of concern” or “behaviors of note.” Typically, “behaviors of concern” are those I target for reduction, while “behaviors of note” are indications of what's going on in the environment.

An example of a behavior of note would be vocal protest. Vocal protest is a fantastic skill that we want learners to have the ability to access. If I'm observing high levels of vocal protest, that indicates to me that something is amiss in the environment, and it may not be supportive to the individual. On the other hand, there are certain types of vocal protests that can be behaviors of concern. If the individual engages in what I call targeted vocal protest—vocal protest that includes aggression, name-calling, high-volume screaming or yelling, and the like—then I'll keep track of those types of protests and help build a repertoire of vocal protests that are contextual to the environment. That being said, there are times when a protest that meets the definition of a targeted vocal protest is contextually appropriate. If one of my learners is being attacked, bullied, or harassed, that type of vocal protest is not only appropriate, but also vital for them to access.

What is your definition of a good behavior analyst? 

A good behavior analyst examines the environment and its interaction with the individual, seeking to identify ways to enhance outcomes for both the individual and those within the environment. They approach their role as a scientist rather than merely a technology deliverer. A good behavior analyst is teachable and open to new perspectives. They recognize the critical role of context in understanding behaviors. A good behavior analyst does not use compliance training; instead, they focus on building rapport and assent to enable the learner to access their environment. They establish and maintain safety boundaries while compassionately engaging with the individuals they support.

What is one way neurotypicals can foster greater inclusivity for autistic individuals?

Follow the Platinum Rule – Do to others as they would have done to them.

Can you recommend any resources for autistics, parents, or the providers who support them? 

Mindful Behavior has a variety of resources. And if you’re on Instagram, I recommend following @unfurling_littles, @jersey_behavior, and @naturallyeffectivebehavior; all of whom post amazing content and do superb work in the ABA community. Lastly, although I may disagree with certain aspects in some cases, each of the following books has significantly shaped my understanding of behavior. I value the knowledge they offer and highly recommend them.

Connect with Brian (@beardedbehaviorist) on Facebook, Instagram, TikTok, and LinkedIn. You can also find him on YouTube, and learn more about his work by tuning in to Oh Behave! and the ACT natural podcast, available on most major podcast platforms.