Neurodivergent Speech Therapist in Kent - Jamie Louise Hollis - ADHD SLT

When Bias Hides in Plain Sight: Ableism in Diagnosis and Healthcare

Ableism doesn’t just show up in obvious ways. Sometimes it’s hidden in clinical decisions, delays in referrals, or the assumptions professionals make based on race, gender, or class. For many neurodivergent people, the first experience of ableism happens not in school or work, but in healthcare.

Too often, the signs of ADHD or autism are missed, dismissed, or misdiagnosed, especially for:

women and girls

Women and girls, who may be labelled with anxiety, depression, or personality disorders instead.(Young et al., 2020).

People from the Global Majority

People from the Global Majority, whose behaviours are more likely to be judged through a cultural or racial lens. Those from the Global Majority can often be pathologised or overlooked due to implicit bias and a lack of culturally competent care.

Neurodivergence in these groups is often interpreted as (Fadus et al., 2020):

  • A parenting issue

  • A character flaw (e.g., “lazy,” “aggressive,” “unmotivated”)

  • A personality issue (“too sensitive,” “too emotional,” “too quiet”)

additional barriers

Even when people seek help, they’re often told:

  • “You’re doing fine, you’ve made it this far.”

  • “You just need more confidence.”

  • “We all feel like that sometimes.”

This gatekeeping and tone policing can be deeply invalidating, especially when it comes from the very people who are supposed to help.

What this means in practice

  • White boys are the most likely to be assessed and supported for ADHD or autism early.

  • Black girls, Muslim girls, and other marginalised groups are significantly less likely to be believed.

  • Bilingual and multilingual children are often mislabelled as having language delays (Jan de Jong, 2024) or behavioural problems.

Ableism in diagnosis

Ableism in diagnosis doesn’t always sound like “you don’t have it.” Sometimes, it sounds like:

  • “But you’re too articulate to be autistic.”

  • “You made eye contact, so it can’t be ADHD.”

  • “You’ve masked so well, we nearly missed it.”

This is why representation in research and training matters. If clinical guidelines and screening tools are built around white, cisgender, middle-class boys, everyone else is left invisible.

 

Until we address this bias, many neurodivergent people will remain undiagnosed, unsupported, and unseen.

Ableism Isn’t Colour-Blind: The Impact of Cultural and Racial Bias

While conversations about ableism are slowly gaining visibility, they are still overwhelmingly shaped by white, Western perspectives. ADHD and autism are significantly underdiagnosed or misdiagnosed among Asian, Black, Muslim, and other Global Majority communities. This disparity isn’t just a gap in access; it’s a reflection of deep-rooted racial and cultural biases within our healthcare, educational, and social systems.

the centering of whiteness

A 2024 report from Anise Health on Asian American mental health revealed that cultural stigma, language barriers, and systemic racism frequently delay or derail access to neurodiversity-affirming care. Similarly, Belcher et al. (2022) highlight how Black children are more likely to be labelled as disruptive rather than neurodivergent, often facing punishment instead of support. These patterns are not coincidental; they are symptoms of a system that centres whiteness and pathologises difference.

Silenced Stories: When Advocacy Ignores Intersectionality

Research and advocacy spaces often amplify white neurodivergent voices, ignoring the layered experiences of people whose identities intersect across race, culture, gender, and class (Brantley, 2025). When the loudest narratives are white, the solutions offered inevitably fail to address the needs of marginalised communities. Cultural competence is not a bonus, it is foundational.

For many families, culturally informed care is not just helpful, it’s essential. Without it, support remains inaccessible, and ableism thrives.

For many families, culturally-informed care is not just helpful, it’s essential. Without it, support remains inaccessible, and ableism thrives.

We can’t dismantle ableism without confronting the racism baked into its structures. That means listening to and centring Global Majority voices, challenging Eurocentric norms in diagnosis and care, and ensuring that neurodivergence is recognised and respected across all communities.

ableism and neurodivergence

Ableism significantly impacts neurodivergent individuals by creating barriers to their well-being, success, and self-worth. From exclusionary policies and negative stereotypes to subtle biases in daily life, ableism can:

⚡️ Harm mental health
❤️‍🩹 Reduce self-esteem
📉 Limit access to crucial opportunities

Below, we explore specific ways ableist thinking affects neurodivergent people, shaping their well-being, access to resources, and personal growth.

Social, Emotional, and Mental Health Impact

Neurodivergent individuals, such as those with ADHD and autism, often face challenges related to social, emotional, and mental health (SEMH) (Meisinger & Freuer, 2023; Mukherjee & Beresford, 2023).

Why?

🫥 Lack of support in schools and workplaces
😮‍💨 Ableist practices that heighten struggles
🔴 Exclusion due to a lack of accommodations

the need for inclusive spaces

Schools that fail to provide adjustments contribute to emotional harm and academic exclusion. Addressing these barriers is key to creating inclusive spaces where neurodivergent individuals thrive, access resources, and overcome stigma.

lack of understanding

Many ableist assumptions come from a lack of awareness about neurodivergent needs.

Example:
A child with ADHD recalls being repeatedly told:
“Sit still and stop fidgeting.” (Sikirica et al., 2014)

❓Why This Is a Problem

  • These phrases aim to encourage focus but ignore the difficulties ADHD individuals face in staying still or concentrating.

  • While these expectations might suit neurotypical students, they marginalise those who process the world differently.

🌀 What Should Change?

A supportive approach acknowledges individual needs and provides accommodations instead of enforcing rigid neurotypical standards.

Pathologizing and Mislabelling

Ableist thinking often frames neurodivergent traits as ‘deficits’ instead of natural differences.

Example:

Many autistic individuals avoid eye contact, yet this is often treated as a problem that needs ‘fixing’ rather than a valid communication style.

⛓️ Forcing neurodivergent individuals to adopt neurotypical behaviors—like maintaining eye contact—suggests their natural way of communicating is inadequate.

😞 This is harmful because...

  • It contributes to anxiety and stress.
  • It undermines authenticity.
  • It reinforces the idea that neurodivergent communication is ‘wrong’.

😊 What Should Change?

An inclusive approach values natural communication preferences, allowing neurodivergent individuals to express themselves without pressure or judgment.

Peer Rejection and Social Exclusion

Autistic and ADHD children are more vulnerable to peer rejection and bullying due to ableist attitudes that stigmatize neurodivergent traits (Cuba Bustinza et al., 2022; Hwang et al., 2017).

🤝🏻 neurodivergent bonding

Many neurodivergent individuals form strong bonds with other neurodivergent peers, seeking safe, supportive relationships (Milton, 2012; Spender et al., 2023).

😕 mutual misunderstanding

Meanwhile, neurotypical peers may struggle to understand or accept behaviors linked to ADHD or autism, leading to exclusion and isolation.

⚖️ neurodivergent-friendly spaces

This mirrors broader societal biases, reinforcing the urgent need to create neurodivergent-friendly social environments that promote acceptance and understanding.

Racialised Ableism: The Double Bind for People of the Global Majority (POGM)

Ableism cannot be fully dismantled without examining how it intersects with white supremacy. The definition of the “ideal, rational, productive human” was historically constructed around white, neurotypical, and non-disabled standards (Campbell, 2009; Chapman, 2023). For People of the Global Majority (POGM), ableism is not an isolated experience, it operates as a compounding layer of systemic control, surveillance, and institutional gaslighting.

To make these abstract systemic patterns concrete, see below for a visual breakdown of how each role operates across racialised ableism:

How Power Operates: The Intersectional Ableism Playbook

1. The Central Narcissist: The Productivity Machine & Normative Standard 🎭

  • Visual: The cracked stone mask (symbolising the fragile, rigid facade of institutional neutrality, meritocracy, and the “ideal body/mind” standard).

  • Dynamics: Positions the non-disabled, neurotypical, white worker as the universal baseline of human value. Any critique of inaccessible environments or colonial productivity expectations is met with institutional DARVO, pathologising the individual rather than the barrier.

2. The Golden Children: The Conditional “Good Disabled Person” 👑

  • Visual: Crowned figures (symbolising proximity to safety and status on conditional terms).

  • Dynamics: Disabled and neurodivergent individuals who are conditionally rewarded solely for performing high-masking compliance, minimising their access needs, or acting as “inspiration” while never disrupting the status quo or challenging systemic racism.

3. The Flying Monkeys: Gatekeepers & Tone Enforcers 🐒

  • Visual: The winged monkeys (symbolising systemic enablers and administrative barriers).

  • Dynamics: Bureaucratic gatekeepers, assessment panels, HR systems, and everyday tone-policers. They downplay distress, police passionate communication as “unprofessional” or “hostile,” and demand impossible burdens of proof before granting basic adjustments.

4. The Scapegoat: Unmasked Truth-Tellers & Neurodivergent POGM 🐐

  • Visual: The scapegoat carrying the boulder (symbolising the weight of systemic blame and exhaustion).

  • Dynamics: Neurodivergent POGM and unmasking individuals who bear the brunt of institutional hostility. While white neurodivergence may eventually be viewed through a medical or vulnerable lens, neurodivergence in POGM is disproportionately criminalised, viewed as aggressive, or adultified. They are punished simply for refusing to carry the system’s unacknowledged dysfunction.

See below for a concrete visual breakdown of how each role functions within the system.

 

An educational illustration of a cracked stone mask with hollow eyes, representing the fragile ego and veneer of meritocracy in white narcissism and systemic oppression.

The Central Narcissist

(The Systemic Mask) Demands unearned authority and claims pure meritocracy. Any evidence of structural harm is met with collective DARVO, fragility, and cries of victimhood. It refuses accountability at all costs.

An educational illustration showing simple yellow stick figures wearing crowns, representing the Golden Children role who are granted conditional privilege for upholding systemic power dynamics.

The Golden Children

(The Favoured Enforcers) Granted conditional proximity to safety and status on the strict condition that they never challenge the status quo. They parrot the narrative to shield the system from scrutiny.

An educational illustration depicting winged monkeys flying in a swarm, symbolising the flying monkeys role who act as enablers, tone-policers, and minimisers within systemic and narcissistic abuse dynamics.

The Flying Monkeys

(Apathy & Tone Enforcers) Everyday enablers doing the system’s dirty work under the guise of neutrality. They police dissent, minimise abuse as "just a joke," and demand quiet to keep everyone comfortable.

An educational illustration of a weary grey goat carrying a massive boulder tied to its back with ropes, symbolising the scapegoat role bearing the projected shame, blame, and structural burden of an abusive system.

The Scapegoat

(Truth-Tellers and People From the Global Majority) People of the Global Majority (POGM) and vocal advocates who shatter the illusion of fairness simply by existing honestly. The system attacks the truth-teller rather than facing its own pathology.

Understanding the Compounded System

Understanding these overlapping power hierarchies is essential for genuinely neurodiversity-affirming support. Interpersonal coercive control, systemic ableism, and white supremacy share identical playbooks of power, isolation, and projection.

To explore how these coercive dynamics, DARVO tactics, and patriarchal hierarchies specifically impact neurodivergent women and gender-marginalised people, visit The Anti-Misogyny and Empowerment Hub.

Challenging Ableism

Creating a more inclusive and accessible environment starts with challenging ableist attitudes and practices. Here are some practical ways to promote equity and respect for neurodivergent and disabled individuals.

📣 Promote Inclusive Language and Behaviour

  •  Use person-first language (e.g., “person with ADHD”) or identity-first language (e.g., “autistic person”)—whichever aligns with individual preferences.
  • Advocate for respectful interactions that acknowledge different communication styles.

📏 Challenge Stereotypes and Misconceptions

  • If someone expresses a stereotype or misconception about neurodivergent individuals, gently correct them with accurate information.
  • Explain why these stereotypes are harmful and how they contribute to ableist attitudes.

💪 Encourage Self-Advocacy

  • Empower neurodivergent individuals to voice their needs and preferences.
  • Offer support and encouragement, creating spaces where self-advocacy is valued.

🏫 Advocate for Accommodations and Support

Support inclusive practices in schools, workplaces, and social settings.
Advocate for reasonable adjustments, such as:

  • Quiet spaces for sensory regulation.
  • Flexible work hours to accommodate executive function challenges.
  • Clear, direct communication for better understanding.

🔍 Reflect on Your Own Privilege

  • Consider how neurotypical privilege impacts your interactions with neurodivergent people.
  • Recognize that what may seem minor to you can have a huge impact on someone’s daily life.

👥 Model Inclusive Behaviour

  • Show others what inclusivity looks like by demonstrating respectful and supportive behaviour.
  •  Be patient, open-minded, and willing to adapt your communication and actions.

🌍 Building an Inclusive Future

To truly challenge ableism, we must continuously address systems and practices that exclude neurodivergent and disabled individuals.

Ongoing learning and advocacy:

🙌 Advocate for structural change to create more accessible environments.
💫 Stay open to learning by listening to disabled and neurodivergent voices.
🦚 Explore more resources to deepen your understanding.

💡 Want to learn more? Check out the resources on this site or reach out to discuss how we can collaborate to support inclusion and accessibility.

👉 To dive deeper, explore how ableist approaches impact neurodivergent individuals.

You can also go back to the main Neurodiversity page to explore more or read more about speech and language therapy.

ableism

what is ableism?

Ableism is discrimination or prejudice against disabled people, including neurodivergent individuals. (Examples of neurodivergent conditions include ADHD and autism). It is based on the idea that typical abilities are more valuable than those of disabled people.

every day ableism

It can show up in biased language, attitudes, policies, and practices that exclude or disadvantage people who don’t fit neurotypical or able-bodied norms (Ginapp et al., 2023).

In daily life, ableism takes different forms. It influences how people use language, make assumptions, and design systems that only accommodate ‘typical’ expectations.

Types of Ableism

Ableism appears in many aspects of daily life, affecting the experiences of disabled and neurodivergent people. It can be:

🚫 Overt

Direct and Intentional – Clear discrimination that is easy to identify.

Overt ableism is clear and intentional discrimination. It includes actions like:

  • Using offensive language
  • Excluding someone based on their disability
  • Enforcing policies that disadvantage disabled people

Because overt ableism is direct, it is often easier to recognise.

⚠️ Covert

Subtle and Unintentional – Hidden discrimination that is less obvious but still harmful.

Covert ableism is more subtle and often unintentional, but it is still harmful. It includes:

  • Making assumptions about someone’s abilities
  • Using dismissive or invalidating language
  • Designing spaces that aren’t accessible

 

Unlike overt ableism, covert ableism can be harder to notice, but it still reinforces exclusion and discrimination.

Below are some examples of covert and overt ableism. 

⚠️ Content Warning

Some of the terms in this section are offensive. They are included here only to provide clear examples of ableist language and its impact.

❗️ overt examples

🤬 Using Slurs or Derogatory Language

The casual use of slurs like “retard” or “spaz”, even when not directed at a disabled person, reinforces harmful stereotypes. This kind of language devalues and marginalises disabled people, making them feel unwelcome, disrespected, and excluded (Spread the Word, 2019).

❌ Refusing Reasonable Accommodations

When an employer or school refuses to provide reasonable adjustments, such as:


🕗 Flexible work hours
🗂 Accessible learning materials
🪻 Sensory-friendly spaces

…it is a clear example of overt ableism, as it directly disadvantages disabled and neurodivergent individuals.

🚪 Denying Access to Public Spaces

Buildings that lack ramps, lifts, or accessible restrooms exclude people with physical disabilities, preventing them from fully participating in daily life and society.

✋ Denying Job Opportunities

Rejecting a qualified candidate because they are disabled or neurodivergent, assuming they won’t be able to handle the workload, even without assessing their capabilities.

✂️ Segregating Disabled Students

Placing disabled or neurodivergent students in separate spaces without providing equal access to education or support, instead of offering accommodations in mainstream settings.

🕵️‍♀️ covert examples

⁉️ Microaggressions

Small, seemingly harmless comments or actions, such as:

  • “You don’t seem autistic to me.”
  • Assuming someone needs help without asking.

 

Even if unintentional, these statements reflect hidden biases and can be deeply hurtful. Research shows that microaggressions contribute to social exclusion and emotional harm (Idle et al., 2024).

🙈 Unconscious Bias

Unconscious bias appears as assumptions about someone’s abilities based on their disability.

For example:

  • A manager assumes an employee with ADHD is less reliable or organised, despite their strong performance.
  • Because of this bias, the employee is overlooked for promotions or challenging projects.

😏 Backhanded Compliments

These sound positive but contain hidden assumptions or stereotypes.

  • “You’re so brave for doing that despite your disability.”
    This implies ordinary tasks are extraordinary for disabled people.
  • “You’re so articulate for someone with autism.”
    While this may sound kind, it suggests surprise that an autistic person can communicate effectively, reinforcing damaging

references by category

ADHD AND MENTAL HEALTH

Autism

Friendships and Social Relations

Discrimination, Stigma and Harm

misdiagnosis/missed diagnosis