Neurodivergence and communication

Neurodevelopmental disorders are the conditions that the two main diagnostic systems, the American Psychiatric Association’s DSM-5-TR and the World Health Organization’s ICD-11, group in a developmental chapter. Neurodivergent is a different and wider idea: a mind that functions in ways that diverge from dominant societal standards, with no medical criteria for who counts (Walker, 2014; Network of the National Library of Medicine, 2026). How far the term reaches, and whether it names a difference or a disability, is disputed. For communication, the practical question is whether written text, explanations, teaching and questions should change for readers in these groups. The evidence is thin and mostly descriptive: several guidelines rest on user ratings or practitioner advice rather than outcome tests, and the main theory of autistic and non-autistic miscommunication, the double empathy problem, is contested.

History

No history of the diagnostic categories or of the neurodiversity movement is yet written. A history of how the groupings and the term neurodivergent developed is still to be written.

Core concepts

Neurodevelopmental disorders in DSM-5-TR

The American Psychiatric Association’s public pages list six groups of neurodevelopmental disorders: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, communication disorders, intellectual disability, motor disorders and specific learning disorder (American Psychiatric Association, 2026a). Two of the groups divide further. Communication disorders are speech sound disorder, language disorder, stuttering (childhood-onset fluency disorder) and social communication disorder (American Psychiatric Association, 2026b). Motor disorders are tic disorders (including Tourette’s), developmental coordination disorder and stereotypic movement disorder (American Psychiatric Association, 2026c).

Neurodevelopmental disorders in ICD-11

ICD-11’s block 6A00-6A0Z has nine categories: disorders of intellectual development, developmental speech or language disorders, autism spectrum disorder, developmental learning disorder, developmental motor coordination disorder, ADHD, stereotyped movement disorder, other specified and unspecified (Find-A-Code, 2026b). The two systems largely agree, because ICD-11 was largely aligned with DSM-5: 6A03 developmental learning disorder corresponds to DSM-5 specific learning disorder, and 6A01 corresponds to its communication disorders (Tebartz van Elst et al., 2025). ICD-11 renames intellectual disability as intellectual development disorder and divides neurodevelopmental disorders into primary, idiopathic ones and secondary ones (Tebartz van Elst et al., 2025).

Three differences stand out.

• Tic disorders. ICD-11 classes primary tic disorders as neurological (code 8A05.0) but still lists them in the developmental chapter as a cross-reference, whereas DSM-5 classes Tourette syndrome as a developmental disorder (Find-A-Code, 2026b; Tebartz van Elst et al., 2025).
• Secondary syndromes. ICD-11 codes secondary neurodevelopmental syndrome separately (6E60), again cross-referenced from the block (Find-A-Code, 2026b).
• Social (pragmatic) communication disorder. ICD-11 has no separate category; pragmatic-predominant language impairment is a qualifier of developmental language disorder, code 6A01.22, with social communication disorder and social pragmatic communication disorder listed as synonyms (Find-A-Code, 2026a). The code centres on understanding and using language in social contexts while other language components stay relatively intact, and it should not be used when autism better explains the pragmatic impairment (Find-A-Code, 2026a).

What neurodivergent covers

Walker defines neurodivergent as “having a mind that functions in ways which diverge significantly from the dominant societal standards of ‘normal’”, and allows causes acquired through experience, not only innate ones (Walker, 2014). The word is credited to Kassiane Asasumasu in 2000, and Walker’s page warns that neurodiverse describes groups, not individuals (Walker, 2014). A Scottish national health-service implementation team separates the two vocabularies: a neurodevelopmental disorder involves extreme function with significant impairment, whereas a neurodivergent person need not have a disorder (Shah et al., 2022).

In the psychological literature, ADHD, autism, developmental coordination disorder (DCD) and dyslexia are the conditions most often placed under the neurodiversity banner (Doyle, 2020). The National Library of Medicine network’s reading-club page says no medical criteria define neurodivergence, so other conditions can fall under it, and lists autism, ADHD, Down syndrome, learning differences, Prader-Willi syndrome and Tourette syndrome (Network of the National Library of Medicine, 2026). Some authors extend the term to mental health conditions, Tourette syndrome, dyscalculia, dysgraphia and acquired brain injury (Doyle, 2020).

Terms

A Scottish health-service team notes that preference between person-first (“person with autism”) and identity-first (“autistic person”) language is unresolved (Shah et al., 2022). In a US survey (n = 728), 87% of autistic adults preferred identity-first language and 13% person-first, and professionals were more likely to use person-first (Taboas et al., 2022).

Questions, controversies, and new developments

Is the category itself settled?

No medical definition of neurodivergent exists (Network of the National Library of Medicine, 2026), and sources differ on whether it means a disability or a naturally occurring difference. Doyle says the nomenclature is debated on exactly this point, and argues that neurodiversity should not be a synonym for disability (Doyle, 2020).

The double empathy problem

Milton’s double empathy problem frames miscommunication between autistic and non-autistic people as a mutual breakdown in reciprocity and understanding, not a deficit located only in the autistic person (Milton, 2018). An empirical test came from a diffusion-chain study (n = 72), in which a story is passed along a chain of people. Detail retention fell significantly more steeply in mixed autistic and non-autistic chains than in all-autistic or all-non-autistic chains, and rapport ratings were lower in mixed chains; autistic chains did not differ significantly from non-autistic chains in information transfer (Crompton et al., 2020).

A registered-report replication (N = 311, three sites) found no difference in information transfer between single-neurotype and mixed-neurotype chains, contrary to the original. Rapport was higher in non-autistic chains, and disclosing a diagnosis improved rapport (Crompton et al., 2025). Separately, a critique in Psychological Review argues the concept is poorly conceptualised, conflated with other constructs, and should not be applied in practice before it is better grounded (Livingston et al., 2025).

Figurative language, literal wording and plain text for autistic readers

A meta-analysis of 41 studies found autistic people comprehend figurative language less well than non-autistic peers, but the gap was small and nonsignificant when the groups were matched on language ability; the authors conclude that core language skills play a critical role in figurative language comprehension (Kalandadze et al., 2018). See also Language for how words and sentences are understood in general.

Web guidelines co-developed with autistic users at every stage (the AASPIRE guidelines) advise specific, precise wording without idioms or ambiguity, and content as short as possible without losing precision, to reduce cognitive burden (Raymaker et al., 2019). Nearly all evaluators rated them easy to use and understand (Raymaker et al., 2019). That is a user rating, not a test of outcomes. In a survey of autistic adults, email was generally preferred for contacting unknown people or organisations, phone calls were very unpopular, and the authors recommend written options (Howard & Sedgewick, 2021). A 2025 preprint of 16 autistic software engineers reported a preference for written communication (Sasportes et al., 2025).

Questions and interviews

Autistic adults’ recall difficulties are most apparent with open, unsupportive questions and shrink when questioning is more supportive; with more supportive questioning autistic people can recall as much as typically developing people (Norris & Maras, 2022). In a mock-interview study (25 autistic and 25 non-autistic adults), splitting questions into subsections, asking for specific details and giving the questions on paper improved autistic candidates’ performance and narrowed the gap without lowering other groups’ performance (Maras et al., 2020). These measure performance, not stated preference. For ADHD, one small self-report sample of 50 adults found most reported frequent decision-making difficulty, and decision paralysis correlated with executive dysfunction (Oroian et al., 2025).

ADHD readers

In a randomized study of 210 adults, ADHD adults comprehended a long digital text less well than non-ADHD adults, and stage-specific reading instructions (scaffolding) narrowed the gap (Brann & Sidi, 2024). A 2013 study of adolescents found group differences in comprehension and sustained attention, with an interaction of presentation type, spacing and sustained attention; spacing and screen presentation reportedly helped only those with good sustained attention (Stern et al., 2013). A lab study with only 6 ADHD participants out of 21 found that AI summaries, visual clutter and continuous scrolling derailed reading (an interview report, not a comprehension test), and that ADHD readers were fastest with default sans-serif at 14-16 px while others were fastest with a serif at 18 px, with small effects of font size on comprehension (Borano Llana et al., 2026).

Dyslexia and reading disability

In an experiment with 64 children with and 64 without dyslexia, a dyslexia-friendly letterform gave no reading benefit, and larger letter spacing without larger word spacing slowed reading (Galliussi et al., 2020). Dyslexia Scotland says specialised dyslexia fonts lack consistent evidence, and recommends at least 12pt, 1.5 line spacing and left alignment without full justification; it notes that tinted backgrounds and colour adjustments help some but not all readers (Dyslexia Scotland, 2025). A meta-analysis found text-to-speech tools give a small-to-moderate benefit to reading comprehension for students with reading disabilities, a wider group than dyslexia alone (Wood et al., 2018). An Open University learning-design blog advises simple everyday words, active voice, one thing at a time, summaries, bullets and numbering instead of continuous text, and avoiding long dense paragraphs; it cites no study (Ince, 2024). For the general evidence on plain language and structure see Writing for comprehension.

Easy Read for intellectual disability

A 2026 systematic review of 29 studies found the evidence base for Easy Read health information underdeveloped and mostly low quality, though users valued it (Wilson et al., 2026). In a randomised trial of 60 adults with intellectual disabilities, neither linguistic simplification nor mediation alone or together significantly improved comprehension of easy read text, and the authors say comprehension depends on individual language processing capacity, beyond text form (Buell et al., 2020).

Teaching and explanation

A UK rapid evidence review reports explicit and direct instruction, task breakdown, clear prompts and visual supports as effective for autistic pupils, but says explicit and systematic programmes show only promising results on a still-limited evidence base; it presents the strategies as shared with inclusive classroom strategies that benefit children with different types of special educational needs, so they are not unique to autism (Antalek et al., 2025). See Explanation and understanding for how explanations work for learners in general.

Should a system infer or ask about neurodivergence?

When language models were told that the user is autistic, they disproportionately advised avoiding situations stereotyped as stressful; autistic interviewees were split on whether that was affirming or infantilizing, and autistic users disclosed to models hoping for personalization while recognising the risk of stereotyping (Wohn et al., 2026). One proof-of-concept design lets users set a structured communication profile of seven dimensions (literalness, verbosity tolerance, metaphor use, sensory load, interaction pacing, emotional explicitness and autonomy preservation) instead of the system inferring a diagnosis; its effects are shown only by ablation and a model-as-judge, not by user testing (Muniganti et al., 2026).

Neurodivergent people’s use of AI assistants

In an analysis of 61 neurodivergent Reddit communities, users reported that language-model output is too neurotypical and needs editing to keep their own voice or to capture their thinking, and that they adapt prompts themselves; one autistic user dropped a coaching prompt because it asked many questions (Carik et al., 2024). Eleven autistic adults strongly preferred a GPT-4 chatbot over a human confederate for workplace social advice, while a specialist coach thought some of the advice questionable, so what users want and what is normatively good can diverge (Jang et al., 2024). In an autoethnography by neurodivergent power users, a participant rejected an overly sweet, therapist-like tone; participants asked for concise answers but the model produced long ones, wanted the model to flag when it may be wrong, and found default professional rewriting could erase their voice; the authors recommend built-in validation because checking output costs energy (Glazko et al., 2025). Rizvi’s dissertation advises autism-inclusive AI to involve autistic users, avoid assumptions about their abilities and obtain their feedback on preferences (Rizvi, 2025). People building human-like AI mostly did not consider what communication norms their design implies for neurodivergent users (Rizvi et al., 2025).

Conflicting needs

Clinical commentary says autistic and ADHD traits can pull opposite ways (routine versus novelty) in people with both, and that little research exists on how people live with this (May, 2024). The W3C cognitive accessibility note handles varied needs by offering personalization and short summaries of long content, and lists a pattern “Provide Alternative Content for Complex Information and Tasks” (Seeman-Horwitz et al., 2021).

Broader connections

Adapting to individual readers is the subject of Inclusive design. Writing for comprehension and Explanation and understanding cover the general evidence on wording, structure and explanations. The double empathy dispute connects to Language and to how shared understanding is built between people with different habits of communication.

Further reading

• Crompton et al. (2025), “Information transfer within and between autistic and non-autistic people”: a registered replication of the 2020 diffusion-chain test of the double empathy problem (Crompton et al., 2025).
• Raymaker et al. (2019), the AASPIRE web guidelines: web guidelines developed with autistic users at every stage (Raymaker et al., 2019).
• Shah et al. (2022), definitions from Scotland’s National Autism Implementation Team: separates neurodevelopmental disorder from neurodivergent (Shah et al., 2022).
• Tebartz van Elst et al. (2025), reclassification of neurodevelopmental disorders in ICD-11: compares ICD-11 with DSM-5 (Tebartz van Elst et al., 2025).
• Wilson et al. (2026), systematic review of Easy Read health information: a systematic review of 29 studies of the evidence base (Wilson et al., 2026).