Neurodivergent affirming practice in occupational therapy: Scoping review and qualitative content analysis of the literature

Background: Issues pertaining to neurodiversity and neurodivergence have only begun to be commented on in the occupational therapy discourse in recent years. A seminal piece made a notable proposal for the occupational therapy profession to shift its service paradigm to develop inclusive support for neurodivergent populations; the extent and success of this were yet to be measured. Aim: To examine and describe the current qualitative, conceptual/theoretical, or opinion-based literature to identify key factors related to neurodivergent-affirming (or neurodivergent-inclusive) occupational therapy practice. Methods: A combination of methodological guidance were utilised: (1) Arksey and O’Malley’s five-stage methodological framework, (2) Levac et al., and (3) Pollock et al. Findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-ScR). Qualitative content analysis according to Elo and Kyngäs was conducted. Findings: Eight resources met the criteria for inclusion. Four key categories were identified: (1) paradigm shift and therapeutic practice approaches; (2) advocacy and empowerment; (3) understanding and embracing neurodiversity as part of ethical and collaborative practice, and (4) systemic barriers, external challenges, and social context. Conclusions/Significance: Findings suggest future directions include developing holistic approaches and building evidence through further research. This study serves as a knowledge synthesis to inform future research.