The Alignment of the Model with the Neurodiversity Movement

Date 25th June, 2025

Authors: Carrie Alvarado, PhD, OTR,

An increasing number of researchers and therapists involved in autism are collaborating with members of the autistic community to ensure that their measurements and methods are meaningful, co-created, and centred around the priorities of autistic individuals. While there are many models of autism therapy, their effectiveness and ethical application vary widely. Some supports are self-reflective, attuned, and responsive to the expressed needs and collective trauma of the autistic community. Conversely, many traditional autism “interventions” have become controversial, viewed by the very community they profess to serve as pathologising and demoralising. These interventions often rely heavily on coercion to enforce compliance and “normalised” behaviour, which has been reported to have traumatised autistic children and disempowered many families who ascribed to their use. 

Given this history of disempowerment, it is understandable that the autistic community, along with the clinicians and parents who support autistic children, are seeking better options; options that honour children and are protective of their well-being. The neurodiversity movement has sparked a significant paradigm shift in autism support. Now, the responsibility lies not with the child to conform to neurotypical standards, but with families, clinicians, educators and the broader community to foster a culture of neuroharmony (Vermeulen, 2017). In this inclusive environment, all types of minds and needs are valued and nurtured for the benefit of everyone.

Pediatric Autism Communication Therapy (PACT) is one innovative form of support dedicated to furthering this culture of not only autism acceptance but of autistic empowerment. Since its translation from research to clinical practice in the late 2010s, PACT has continued to demonstrate a strong influence in reducing autistic stress and enhancing autistic agency. As the first cohort of children who underwent PACT with their families matures and shares their experience, we can better illustrate the therapy’s impact on their sense of connection and relatedness.

A 21-year-old who benefited from PACT in childhood states:

“I think experiencing shared attention (in early PACT years) gave me that skill of knowing how to share; let's call it a shared experience…I’m that open person who gets on with everyone… It's like, come on, join us. It was an exposure to those sensitive adults; I thought, this person is interested in me, knows what I'm thinking and sees what I see. It was just having fun, it was play, just enjoyment, your style, things you're really interested in and building a relationship. Yeah, the child finds a way, like he's always… once you join it with me, I'll join you, and it’s a connection….Even my teachers seemed like friends in that relationship building; you felt like you were connected to someone. Even if it's just like a very small thing.”

In addition to the voices of those who have experienced PACT, a growing international cohort of parents is expressing their appreciation for this approach. They see PACT as a therapeutic support that aligns more closely with their instincts about what is healthy for their children and their family relationships. These parents are searching for a model that actively engages and listens to them, validating their strengths, in addition to their children’s. They appreciate the naturalistic format of PACT, which centres around relationships and everyday interactions between themselves and their children, ensuring that the time invested is meaningful and reflects and protects their families’ culture, cohesiveness and priorities. Some parents who engage in PACT identify as neurodivergent themselves and find that the ethos of this model resonates with their own feelings of validation and empowerment. Many neurodiverse parents who utilise the PACT framework with their children describe a sense of reframing and healing regarding their own developmental experiences.  

An autistic aunt shares her experience in witnessing PACT sessions between her autistic nephew, Cameron, and his parents:

“As an autistic person myself, I am familiar with the challenge a lot of us have in maintaining a calm nervous system. It was heartwarming watching Renee and Sammy become partners in observation through PACT, uncovering Cameron's likes and dislikes, which helped to build a sense of connection and safety with him - a nervous system that can connect, can learn. It's been such a joy watching Cameron grow into a confident communicator - sometimes with hand leading, coded socks, or screen shots, but always with a sense of confidence that we're here to receive whatever message he's sending, however he chooses to send it.

Parents report that the changes they have experienced since incorporating PACT supports have been overwhelmingly positive for themselves, their child, and their family. They describe their child’s developmental progress as “life-changing”. In PACT, the focus is on improving the “goodness-of-fit” between the environment and the child's needs to ensure that children have optimal opportunities to develop their authentic selves. Instead of encouraging masking and social conformity, PACT respects and promotes both the physical and communicative autonomy of the child. Through reflective video feedback, this model enhances parents’ ability to recognise their child’s spontaneous, intrinsically motivated actions and communications, however nuanced, as meaningful and important.

PACT presumes competence in both the parents and the child by positioning the parent-child dyad at the centre of the therapeutic relationship. It highlights strengths in both to ensure that current competencies are recognised and fostered. Additionally, parents engaged in PACT report a newfound ability to accept and celebrate their child’s diversity, truly seeing their child as a capable and competent, fully whole human being. 

A father reports on his four-year-old daughter, Emma:

"It was a pretty dark time for me around 18 months when I saw her start to regress, and I started to realise that she was probably autistic. This (PACT support) is starting to feel like the inverse; it’s starting to feel instead of taking it down and wondering about her limitations, I'm really starting to see this connection and this improvement, and now it's like I'm thinking that...I don't want to be too optimistic, or too hopeful… but it really seems like she's going to be somebody that will be able to… have, emotionally, a full life".

The aim of PACT is to reduce stressors for the autistic child, lessen their load and amplify their joy by increasing their comfort and confidence. It seeks to support mental health and validation within the family system, while clearing the child’s path toward self-actualisation. PACT endeavours to help children and families in embracing their autistic identity. As a result of being surrounded by a relational ecosystem that values their voice and understands their support needs, child participants often become happier and more confident in their neurodivergence.

A mother shares how PACT helped her learn to meet her daughter, Rafaela, where she is:

"She hasn't told me 'It's because you don't understand me' in over a month. And the truth is, I really didn't understand her. I expected her to act a certain way that just wasn't her. Now I let her be herself so I can learn from her."

PACT focuses on enhancing the access of both the child and caregiver to coregulatory support, providing the child with a supportive relational infrastructure that ALL humans depend upon to navigate and explore their world and their interests safely and with growing self-efficacy.

The methods through which various therapies achieve their desired outcomes vary greatly, particularly in autism supports, and should be closely scrutinised. PACT places informed assent at the core of its therapeutic approach. Parents are encouraged to follow the child’s needs and interests, ensuring that the child experiences relational safety and sees themselves as the autonomous and capable “driver” in their own life. The child’s ability to set boundaries, pursue their interests and ideas, and engage in coregulative relationships with their parents leads to increased engagement, shared social problem-solving, and improved responses to environmental stressors. This connection is spontaneous, never coerced, and can foster social confidence and self-advocacy in the family, and eventually in the child. By nurturing the child’s internal compass and natural motivations to communicate and connect, PACT supports have shown to elicit positive changes for both the child and family that sustain and generalise as the child matures. 

A mother, who is a physician and who sought out her own autism diagnosis after her journey with PACT with her newly diagnosed son, reports:

"My son was diagnosed with autism at the age of three. His neurologist told us that he would never be independent or make friends, and that (traditional behavioural therapy) was his only hope for a meaningful life. Of course, this terrified us, and we put him in (traditional behavioural therapy) immediately. We yanked him out after about 2 weeks, because framing therapy as "doing work" with a deficit-based approach was breaking his spirit. Luckily, we found PACT. Intuitively, it just felt right that mindfully playing with our son was the best way to help him. And, as an (not yet diagnosed) autistic mom, I needed to learn imaginative play too! The PACT parent sessions helped us reframe the doom and gloom mindset given to us at diagnosis and reinforced by (traditional behavioural therapy). Now, Isaac is in the first grade and thriving! He is a happy little comedian. He has a lot of friends and even a "girlfriend!" He is mainstreamed at school, participates in multiple sports and clubs (diving, soccer, gymnastics, musical theatre, art), and is being evaluated for the gifted and talented program. Isaac gets the credit for all his accomplishments because he is an awesome kid who earned them. But without PACT teaching us how to help him see the awesomeness in himself, I fear the doom and gloom prediction from his neurologist would have been correct. He will always have struggles, but PACT helped cultivate a desire to connect, a positive attitude, and resilience as a part of his core personality. Looking back, (traditional behavioural therapy) and the deficits-based model “othered” my son, and the PACT approach fostered not just our acceptance and curious exploration of his strengths and challenges, but his too.”

In summary, PACT is a developmental-relational therapeutic approach that aims to be a responsive and attuned ally of the Neurodiversity-affirming Movement by both honouring autistic strength and acknowledging the challenges faced by autistic individuals. PACT is eager to continue to learn and grow based on insights from autistic community members with lived experience. The researchers and clinicians involved with PACT- a mixed group of neurotypical and neurodivergent individuals- benefit from regular collaborations with autistic parents, colleagues and community members. Our aim is to minimise distress, to amplify autistic quality of life and to strengthen the resiliency of families. We believe that the best way to achieve this goal is to follow the lead of the experts, the autistic community themselves, with humility and a commitment to evolved humanity.