As conversations about autism continue to evolve, so does our understanding of how to best support autistic individuals throughout their lives.

In a recent paper published in The Journal of the American Academy of Child & Adolescent Psychiatry,¹ Dr. Stuart Lustig, MD, MPH, national medical executive for behavioral health strategy and product design at Cigna Healthcare, and his colleagues Darren Sush, PsyD, BCBA-D, and Lauren Presti Morrison, LCPC,  advocate for integrating a neurodiversity-affirming perspective into autism care and Applied Behavior Analysis (ABA) practice.

We sat down with Dr. Lustig to discuss what neurodiversity means, how it reframes our understanding of autism, and why it matters for families, clinicians, educators, and payers.

What is the neurodiversity perspective, and why is it important today?

Neurodiversity is the idea that human brains vary naturally, and that the range of differences in brain functions and behaviors – such as in people with autism, ADHD, dyslexia, and Tourette syndrome – is part of the normal spectrum of human diversity.

The term was first popularized by sociologist Judy Singer in 1998. It suggests that autistic traits are not simply deficits but reflect unique ways of perceiving, processing, and interacting with the world.

This perspective has gained visibility as autistic self‑advocates, researchers, and clinicians have pushed for a more respectful and strengths‑based understanding of autism. Instead of focusing only on impairments, the neurodiversity perspective recognizes that traits such as deep focus, analytical thinking, honesty, creativity, and intense interests can be meaningful strengths for many autistic individuals.

How does the neurodiversity perspective differ from the traditional biomedical model of autism?

Historically, autism has been viewed through a biomedical lens focused on pathology, deficits, and symptoms to be “corrected.” Under that model, interventions often aim to align the behaviors of individuals with autism with those of their neurotypical peers.

While the biomedical approach remains important for identifying and addressing significant clinical needs, it does not fully capture the lived experience of autistic individuals.

In contrast, a neurodiversity‑affirming approach blends developmental, behavioral, and social frameworks. It accepts autism as a natural variation and emphasizes supporting individuals in ways that enhance quality of life, autonomy, and well‑being.

What are some examples of autistic traits reframed as strengths?

In our paper, we highlight how characteristics identified in the DSM‑5‑TR can also be understood as opportunities. For example:

 

When viewed in this context, these traits are not deficits to eliminate, but differences that can contribute positively to families, communities, workplaces, and society.

Where does Applied Behavior Analysis (ABA) fit into this discussion?

ABA is one of the most widely used evidence‑based interventions for autism, and insurance coverage is mandated in all 50 states when it is deemed medically necessary. ABA focuses on meaningful behavior change in social communication, adaptive skills, and reducing behaviors that may interfere with safety or quality of life.

However, because ABA is often tied to insurance reimbursement, it can be perceived as aligned with a deficit‑based biomedical model. Critics have raised concerns about approaches that focus too heavily on conformity or compliance. This is why it is essential for ABA providers – and health plans – to integrate neurodiversity‑affirming principles so that ABA services respect each person’s preferences, autonomy, and dignity.

What does neurodiversity‑affirming ABA look like in practice?

At its core, neurodiversity‑affirming ABA seeks to support autistic individuals as they are, instead of trying to make them “less autistic.” It prioritizes:

 

Importantly, this model still recognizes that some challenges – such as safety risks, self‑injury, or barriers to daily functioning – require targeted intervention. Neurodiversity‑affirming care does not ignore clinical needs. It simply addresses them in ways that respect the individual and reduce stigma.

You mentioned masking and code‑switching in the paper. Why are these concerns for autistic people?

Masking refers to suppressing autistic traits, such as stimming or direct communication, because of societal pressure to appear “typical.” Code‑switching involves consciously adjusting speech or behavior to fit expected social norms.

Research shows that extensive masking is associated with anxiety, depression, and burnout among autistic individuals. For many, the constant effort to hide who they are can be exhausting and harmful.

Neurodiversity‑affirming providers help families and schools understand these pressures and create environments where autistic individuals are not expected to camouflage their differences to be accepted.

What role do health insurers like Cigna Healthcare play in advancing neurodiversity‑affirming care?

We think neurodiversity-affirming care starts with respecting each person’s autonomy and goals, while still addressing needs that affect safety, daily functioning, and quality of life. From a health plan perspective, that means setting clear expectations for what “good” autism services look like, helping families navigate to the right providers, and measuring outcomes in ways that reflect real-world progress, not just compliance or norm-based performance.

For example, we have established an ABA Clinical Framework to help define quality care, guide customers toward a selected group of ABA providers (including those operating under measurement-based care contracts), and support families in connecting to care through operational assistance. For certain customers, we also broaden support with Little Otter, which takes a whole-family approach that includes individual and family therapy, parent training, and psychiatry to help plug gaps in the autism care journey.

We also recognize that support for neurodivergent people and their families can include everyday tools that build coping skills and emotional resilience. That’s why Cigna Healthcare is also collaborating with Headspace on an exclusive version of the mental health and well-being app for Cigna customers, including custom content that highlights neurodiversity and different ways of thinking. This collection is designed to be useful for people who are neurodivergent, as well as for their family members and caregivers. While it is not a substitute for professional help, the app offers resources focused on managing stress and anxiety, provides guidance for communicating your feelings more effectively, and encourages you to slow down and relax through mindfulness-based practices.

What practical steps can clinicians take to adopt a neurodiversity‑affirming approach?

In our article, we outline several strategies that providers can integrate into practice:

These practices are not only compatible with ABA – they can strengthen it.

What is your hope for the future of autism care?

My hope is that we continue moving toward a model that understands autism in its full complexity – where we address genuine needs while also honoring and supporting neurodivergent strengths.

By aligning clinicians, families, autistic self‑advocates, and payers around a shared vision, we can promote autonomy, dignity, and meaningful improvements in quality of life for autistic individuals of all ages.

 

^1.This article was first published online by the Journal of the American Academy of Child & Adolescent Psychiatry in December 2025: Sush DJ, Lustig SL, Morrison LP, A Neurodiverse Perspective on Autism
Spectrum Disorder and the Medical Necessity of Applied Behavior Analysis. © 2025 Published by Elsevier Inc. on behalf of the American Academy of Child and Adolescent Psychiatry.

Adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (Copyright © 2022). American Psychiatric Association. All Rights Reserved.