Clinical environments are often organised around neurotypical/general population expectations of communication, attention, pacing, and sensory tolerance. For neurodivergent people, including autistic individuals, people with ADHD, these expectations can increase distress, reduce engagement, and shape how behaviour is interpreted by clinicians. McGreevy et al. (2024) propose an experience-sensitive approach that centres neurodivergent perspectives and frames behaviour in relation to different cognitive styles rather than as decontextualised deficit. This approach argues that many experiences commonly interpreted as emotion regulation deficits are better understood in relation to the upsetting, overstimulating, and stigmatising experiences young people face in everyday contexts (Pavlopoulou et al., 2025a, 2025b).
Why clinical environments can become barriers
Many current clinical pathways are organised around neuro-normativity: implicit assumptions about how a person should communicate, maintain attention, regulate emotion and tolerate sensory input. Clinical settings are not neutral: bright lights, background noise, unclear routines, long waiting times, rapid questioning, pressure to sustain eye contact, and vague expectations about what engagement should look like can all affect how a neurodivergent person behaves. Sensory processing differences are highly relevant: atypical sensory experiences are common and can shape attention, comfort, and participation across settings (Robertson & Baron-Cohen, 2017). In a systematic review and meta-synthesis, Brede et al. (2022) found that autistic adults often experienced mental health services as lonely, difficult, and poorly adapted, with a strong need for flexibility, collaboration, and empowerment.
From deficit models to contextual understanding
The experience-sensitive framework represents a shift away from interpreting neurodivergent behaviour primarily through deficit-based models. Behaviours are approached as meaningful responses to situations rather than as isolated markers of impairment. This move is consistent with the double empathy problem, first articulated by Milton (2012), which proposes that communication difficulties between autistic and non-autistic people often reflect a mutual mismatch in understanding rather than a one-sided failure. This framework emphasis that not only to observe behaviour but also examine how their own assumptions and the clinical context shape what behaviour appears to mean. A person who avoids eye contact may be regulating cognitive or sensory load. A child who becomes agitated during an assessment may be responding to uncertainty, overload, or poorly scaffolded demands. An adolescent who appears withdrawn may be protecting themselves from social misunderstanding.
Extending the framework beyond autism
A recent study of neurodivergent adolescents’ perspectives on emotion regulation in autism and ADHD found that accounts of dysregulation are often based on adult observations anchored in neurotypical expectations of emotional responding. Their findings suggest that emotional distress frequently emerges in the context of everyday burdens, including social conflict, pressure to mask, self-doubt, overstimulation, and sensory mismatch (Pavlopoulou et al., 2025a). A companion qualitative paper by Pavlopoulou et al. (2025b) similarly found that adolescents with ADHD and/or autism described upsetting experiences in terms of social dislocation, alienation, conflict, masking, embarrassment, and overstimulation. Together, these findings suggest that what looks clinically like poor regulation may often reflect the cumulative burden of repeated mismatch between person and environment. This is especially important in neurodivergent presentations, where sensory sensitivity, attentional variability, impulsivity, overwhelm, and fluctuating self-regulation can all interact.
Assessment and formulation
An experience-sensitive approach changes what assessment is trying to do: rather than documenting only what behaviours occur, it asks why these responses may have arisen in that context. It recommends looking at sensory load, cognitive demands, pace, predictability, relational safety, and environmental fit. Assessment becomes more than symptom counting, it becomes a process of understanding the interaction between neurodivergent characteristics and the immediate ecology of the clinical encounter.
Engagement and outcomes
When neurodivergent behaviour is repeatedly interpreted through a deficit lens, clinical encounters can become alienating, reducing trust, limit disclosure, and discourage future help-seeking. Autistic adults often report harmful service experiences when flexibility and collaboration are absent (Brede et al., 2022). Similarly, a study showed how stigma contributes to health and healthcare disparities for autistic individuals across the life course (Hotez et al., 2024). By contrast, a framework that centres lived experience, recognises environmental contributors to distress, and uses respectful language is more likely to support engagement. Pavlopoulou et al. (2025a) found that neurodivergent adolescents emphasised the importance of accepting environments, flexible supports, co-regulation, and the ability to manage distress without stigma. These are not peripheral issues; they are central to whether care feels safe, usable, and effective.
Conclusion
An experience-sensitive approach asks clinicians to move beyond neurotypical assumptions and interpret behaviour in context. The goal is not to lower standards of clinical assessment but to improve them by increasing explanatory precision, responsiveness, and humanity. For neurodivergent people, this framework offers a way of making clinical environments more accurate, less distressing, and more likely to support meaningful engagement.
Where next?
See Dr. Georgia Pavlopoulou talk on ‘An Experience-Sensitive Approach to neurodivergence in clinical environments’ at our webinar Brief Interventions That Make a Difference: Practical Approaches for Young People and Families – An International Expert Conference
Across five focused sessions, leading experts will explore practical and scalable approaches to supporting young people and families: from single-session intervention models and intensive one-session CBT for phobias, to compassionate approaches to suicide risk and crisis care in overstretched services, as well as experience-sensitive clinical work with autistic young people.
References
Brede, J., Cage, E., Trott, J., Palmer, L., Smith, A., Serpell, L., Mandy, W., & Russell, A. (2022). “We Have to Try to Find a Way, a Clinical Bridge” – autistic adults’ experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis. Clinical Psychology Review, 93, 102131.
Hotez, E., Phan, J. M., & Truong, D. M. (2024). Addressing stigma-related health disparities for autistic individuals through cultural competemility: Insights from research and lived experience. Current Psychiatry Reports, 26(12), 761–770.
McGreevy, E., Quinn, A., Law, R., Botha, M., Evans, M., Rose, K., Moyse, R., Boyens, T., Matejko, M., & Pavlopoulou, G. (2024). An experience sensitive approach to care with and for autistic children and young people in clinical services. Journal of Humanistic Psychology.
Milton, D. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883–887.
Pavlopoulou, G., Chandler, S., Lukito, S., Kakoulidou, M., Matejko, M., Jackson, I., Balwani, B., Boyens, T., Poulton, D., Harvey-Nguyen, L., Glen, Z., Wilson, A., Ly, E., Macauley, E., Hurry, J., Baker, S., Sonuga-Barke, E. J. S., & the RE-STAR team. (2025a). Situating emotion regulation in autism and ADHD through neurodivergent adolescents’ perspectives. Scientific Reports, 15, 37464.
Pavlopoulou, G., Chandler, S., Lukito, S., Kakoulidou, M., Jackson, I., Ly, E., Matejko, M., Balwani, B., Boyens, T., Poulton, D., Harvey-Nguyen, L., Baker, S., & Sonuga-Barke, E. J. S. (2025b). Upsetting experiences in the lives of neurodivergent young people: A qualitative analysis of accounts of adolescents diagnosed with ADHD and/or autism. JCPP Advances.
Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671–684.
