Rooted in Relationship: Why Neuroaffirming Care Comes Before Neuro-Informed Strategy by Kimberly Bartlett, LICSW, LCSW, RPT-S™ The growing awareness of neurodiversity has brought many valuable conversations into therapeutic spaces. As more professionals and caregivers begin to recognize the broad range of neurodevelopmental experiences—Autism, ADHD, sensory differences, learning disabilities—terms like neuro-informed and neuroaffirming are becoming more common. But while the language is evolving, we must be intentional in how we embody these approaches in our work with children. In my practice as a therapist for neurodivergent children, I ground all care in a neuroaffirming philosophy first. This means that before we discuss supports, goals, or adaptations, we focus on building something far more essential: emotional safety, belonging, and unconditional acceptance. Only once these are firmly in place do I consider integrating elements of neuro-informed care—such as strategies or supports tailored to the child’s unique nervous system. Neuroaffirming vs. Neuro-Informed: A Sequence That Matters It’s important to understand that neuroaffirming care is not the same as neuro-informed care, and the order in which they are used matters greatly. Neuroaffirming care says: “You are inherently worthy and welcome as you are.” It centers the child’s right to exist and relate to the world in ways that may not fit neurotypical norms. This care resists the impulse to change or correct and instead seeks to understand and celebrate the child’s authentic ways of being. Neuro-informed care, on the other hand, incorporates specialized knowledge about how neurodivergent brains process information, respond to sensory input, and regulate emotions. It includes evidence-based supports that can be incredibly helpful—but only when applied through a lens of respect, choice, and relational attunement. There are also many instances that children are not positioned to benefit from neuro-informed strategies that seek to directly adjust their current experiences. There are alternatives to supporting these individuals when that is the case that is equally worthy and differently beneficial. In other words, being neuro-informed without being neuroaffirming can risk slipping back into compliance-based or deficit-framed approaches. That’s why neuro-informed strategies must come second—not as a first intervention, but as a response to what the child needs, once we’ve truly gotten to know them and only when they can benefit from them. My role as a therapist is to assess and guide families around these recommendations. First: Create Safety, Trust, and Attunement When a child enters therapy, especially a child who is neurodivergent, they often carry a history of feeling misunderstood, pressured to mask, or expected to behave in ways that are deeply uncomfortable or unsustainable. My first responsibility is to create a space where the child feels safe to exist without needing to perform or please. As a Registered Play Therapist – Supervisor™ I use my therapeutic playroom to help create a physical space that can uniquely support neurodivergent children and youth. Neuroaffirming care moves from understanding to honoring. It centers the inherent value of neurodivergent experiences and identities. Rather than assuming a child must be “taught” to behave neurotypically to succeed, neuroaffirming care asks: What does this child need to feel safe, understood, and accepted? How can I support this child’s self-expression and autonomy? What environmental or relational shifts could make this space more accommodating to their way of being? In my practice as a Registered Play Therapist – Supervisor™ I incorporate this approach by means of: Letting the child lead where possible—through play, special interests, or quiet connection. Matching the child’s pace for connection. Respecting and accommodating a child’s communication preferences, sensory needs, and pacing. We build a relationship rooted in attunement, consent, and mutual curiosity. Only then can we begin to explore whether specific supports or strategies might enhance their daily experiences—not to “fix” who they are, but to help them navigate a world that isn’t always designed for them. Then: Integrate Neuro-Informed Supports—Collaboratively Once a child has developed a trusting relationship with me—and once I’ve gained a deep, holistic understanding of their nervous system through observation, relational assessment, and caregiver input—neuro-informed strategies can be thoughtfully introduced. This might include: Co-regulation tools that align with the child’s sensory profile. Communication supports tailored to expressive or receptive needs. Structured routines or visual systems that reduce overwhelm. Collaborative problem-solving with caregivers to reduce stressors. Importantly, these supports are never imposed as requirements for acceptance. Instead, they’re offered as invitations—tools the child can try, adapt, or decline, based on what helps them feel more empowered and connected. Development Follows Safety This framework is grounded in a simple but powerful truth: development unfolds in the presence of emotional safety. When children feel consistently accepted, understood, and free from the pressure to conform, they begin to explore, create, connect, and grow—on their own terms. And when we add neuro-informed supports after this foundation is in place, those strategies are far more likely to be effective—because they are received in the context of trust and consent, not compliance. Closing Thoughts: Honor First, Support Second It is tempting, especially in systems that value outcomes and progress, to rush into types of action that align with outside pressures. But when working with neurodivergent children, we must resist this urge. Our priority is to show them they are worthy of care just as they are. Once that message is clear—and once a strong relationship is in place—then and only then can we explore what supports might be helpful. Because when neuroaffirming care comes first, neuro-informed strategies have a much greater chance of being received as tools of empowerment, not tools of assimilation.

There are so many ways that children, teens and families can utilize sandtray and sandplay therapy at Evergreen Play Therapy due to the Integrative Play Therapy approach. When you come into the playroom you’ll see the Sandplay area with shelves full of figurines and objects from fantasy, nature, knights, animals, religious symbols and many more. Our aim is to provide a range of objects that can represent archetypes and other symbols that are critical to people’s experiences. These objects are the basis for self-expression in the sand. The tray is made out of quality wood and painted blue inside. The tray provides a vessel to contain the person’s unconscious and safely hold it in the “world” of the sand. Sandplay is aimed at helping a person bring the unconscious forward. Sometimes words get in the way and the focus of this style of treatment allows symbols to be used to express feelings and experiences that can be on an unconscious level. Creating a 3-d concept of something unconscious allows the person to experience those feelings in a more aware manner that is still controlled and safe. “The purpose of the symbolic process is to help the psyche mature and heal, to move the client through the individuation process in order to confront the necessary conflicts, connect with the deepest layers of the Self, and return to life transformed by this hero’s journey,” said Patricia Dunn-Fierstein of Sandplay Therapists of Amercia. Sandtray Therapy incorporates a range of theoretical models, which means it’s adaptable to people. Sandtray Therapy can include therapist directed activities or prompts. It can be collaborative with a client at the sandtray. Families can be incorporated into sandtray therapy sessions.