In 2025, therapists across Australia are being asked to do something that feels, at first glance, contradictory:

Support neurodivergent children in strengths-based, developmentally respectful ways - while also providing documentation that focuses on impairments, deficits, and functional limitations.

The NDIS has made it clear: Therapy must focus on measurable impairments. Reports must use the language of limitation and justify how therapy addresses those limitations directly.

For many paediatric therapists, this feels deeply at odds with the way we’ve been trained, the approaches we value, and the relationships we’ve built with the children we support.

So what do we do?

We don’t abandon what’s right, and we don’t pretend the system isn’t changing.

Instead, we build a bridge between the two.

A Balanced, Values-Aligned Approach

In our recent webinar, Rachel Ottley, Elaine Becker and I shared how hard it feels to hold this tension. We explored the challenges of using milestone checklists, discomfort with deficit-based reporting, and a desire to stay true to what we know works - especially for neurodivergent children.

Here’s what we’ve learned through practice, supervision, and study:

✅ Best practice doesn’t ignore impairments - it reframes how we assess and describe them.

✅ Being neuro-affirming isn’t about refusing to report challenges - it’s about doing so with clarity, respect, and a full picture of the person.

✅ There are models - like PEO, DIR/Floortime, and the Perception-Action Approach - that guide this balance well.

✅ Occupational fit - success in daily life - isn’t just about the child’s abilities, but also their environments and the activities they’re engaged in.

Most importantly, we don’t need to choose between therapeutic integrity and funding compliance.

We can do both. And do them well.

🧠 Want help making sense of the NDIS changes—and staying neuro-affirming in your everyday practice?

I’ve created a free guide to support occupational therapists, physiotherapists, and speech pathologists navigating this shift.

It’s called: Neuro-Affirming Paediatric Practice in an Impairment-Focused NDIS

Inside, you’ll find:

• A breakdown of what the NDIS is asking for
• The core tensions therapists are naming
• Clinical reasoning prompts and practical reframes
• A one-page reflection tool for reflection and planning

👉 Download the free guide here

Whether you’re a new grad or a seasoned clinician, I hope it gives you clarity and confidence to practice in alignment with your values.

Let me know what you think and share your thoughts in the comment - how are you approaching this balance in your own work.