Ecological Diversity & Neurodiversity: Why Context Shapes Everything

Part 3 of my series 'Exploring Neurodiversity in MSK Practice'

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Why I’m Writing This Series (a short reminder)

If you’ve chosen a career helping other people, then understanding human diversity — how people think, feel, sense, move, and communicate — can transform your practice. It doesn’t replace your clinical knowledge; it expands it. It helps you support your clients more effectively and look after your own wellbeing in the process.

Becoming more neuroaffirmative doesn’t just benefit neurodivergent clients — it improves care for everyone. When we design our clinical environments, communication, and expectations with a wider range of humans in mind, our work becomes more inclusive, more humane, and more sustainable.

This series is my attempt to share ideas that have helped me as a clinician, educator, and neurodivergent person — ideas that make MSK practice more compassionate, more accessible, and more effective for all the people we serve.

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In Part 1, we explored paradigms. In Part 2, disability and environment. In Part 3, we move to something even more fundamental:

Humans are ecological beings. We are shaped by, and respond to, the environments we move through.

This idea is central to ecological models of neurodiversity, particularly in the work of Chapman¹ and Walker².

For MSK clinicians, this is not a new idea. Pain science, behaviour change, and trauma‑informed practice all recognise that:

• Context shapes physiology
  E.g. a patient’s shoulder pain may be severe in a noisy gym, but decreases in a quiet treatment room — the sensory context changes muscle tone and threat perception.

• Environment shapes behaviour
  E.g. a client who “never does their exercises” completes them consistently once the plan is simplified and visually structured — the executive demands were the issue, not motivation.

• Relationships shape outcomes
  E.g. a client with chronic pain shows improved movement when they feel believed and not judged — relational safety reduces protective guarding.

When we apply this ecological lens to neurodiversity, we stop asking “What is wrong with this person?” and begin to ask:

“What is happening in the environment that makes this interaction harder than it needs to be?”

This is the heart of neuroaffirmative practice.

1. What Do We Mean by “Ecological Diversity”?

Ecological diversity is the idea that humans, like all organisms, thrive in different conditions. There is no single ‘optimal’ environment — only environments that fit different nervous systems in different ways.

Different nervous systems require different:

• sensory environments

• communication styles

• pacing

• predictability

• social expectations

• movement demands

This idea is central to Chapman’s argument that neurodiversity is best understood through a social‑ecological lens¹ rather than a medical or behavioural one.

In this view:

• Autism is not inherently a deficit.

• ADHD is not a disorder.

• Dyspraxia is not dysfunction.

• Tourette’s is not pathology.

They are forms of human variation that interact with environments in different ways, a perspective also reflected in Walker’s work on the Neurodiversity Paradigm².

When the environment fits, people thrive. When it doesn’t, people struggle.

2. Why Ecological Thinking Matters for MSK Practice

MSK clinicians already understand ecological principles intuitively:

• A runner’s pain changes depending on the surface they train on.

• A patient’s flare‑ups depend on sleep, stress, and workload.

• A person’s movement quality changes depending on who is watching.

When we apply this same ecological logic to neurodiversity, we see:

• Sensory ecology
  Some nervous systems thrive in low‑stimulus environments; others need movement, sound, or rhythm to regulate.⁴

• Social ecology

  Some people regulate through connection; others through solitude or parallel presence.³

• Cognitive ecology

  Some people need structure; others need flexibility. Some need predictability; others need novelty.⁶

• Communication ecology

  Some people communicate best through directness; others through nuance, metaphor, or detail.³

None of these are “right” or “wrong”. They are ecological preferences — and they matter clinically.

3. Ecological Mismatch: The Hidden Driver of Distress

A key idea in ecological neurodiversity is mismatch. This occurs when a person’s nervous system is placed in an environment that does not meet its needs.

This is not dysfunction.
This is not pathology.
This is ecological incompatibility.

Examples:

• An autistic client in a bright, noisy waiting room → sensory mismatch⁴

• An ADHD client given a vague rehab plan → executive mismatch⁶

• A dyspraxic client asked to copy complex movements quickly → motor‑planning mismatch⁹

• A PDA client given rigid instructions → autonomy mismatch¹⁰

• A highly literal client given metaphorical explanations → communication mismatch³

In each case, the “problem” is not the person. It is the fit between the person and the environment. This is the same logic as the Social Model of Disability (see Part 2) — but applied more broadly, more relationally, and more dynamically.

4. Ecological Fit: What Happens When We Change the Environment

When we adjust the environment to meet a person’s ecological needs, everything changes:

• Distress reduces

• Communication improves

• Movement becomes easier

• Executive load decreases

• Pain reduces

• Trust increases

• Outcomes improve

This is not “special treatment”. It is accurate treatment. And crucially — ecological adjustments help everyone, not just neurodivergent clients.

Examples:

• Adjusting sensory load

  Helps autistic clients, anxious clients, clients with chronic pain, and clients with trauma histories.⁴

• Providing structure and predictability
  Helps ADHD clients, fatigued clients, depressed clients, and overwhelmed clients.⁶

• Using explicit communication

  Helps literal thinkers, second‑language speakers, and anyone under stress.³

• Allowing movement during sessions

  Helps ADHD clients, hypermobile clients, and clients with pain.

5. What This Means for MSK Clinicians

Ecological thinking invites MSK clinicians to shift the questions we ask. Rather than wondering how to fix a person, we begin to ask what this particular nervous system needs in order to function effectively — a shift from deficit to ecological fit.

When a client appears “non‑compliant”, the ecological lens helps us see that the issue may not be motivation at all, but a mismatch between the plan and the person’s cognitive or sensory ecology. Similarly, when a client presents as anxious, the question becomes not “Why are they anxious?” but “What in this environment is unpredictable, overwhelming, or unclear?” And when someone struggles to follow exercises, we look not for personal shortcomings but for the executive supports that would make the task easier and more achievable.

Ecological diversity reminds us that pain, behaviour, movement and communication are all shaped by the environments people inhabit — and people thrive when their environments fit their needs.

For clinicians, this means that changing the environment is often the most effective intervention we have.

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References & Further Reading

¹ Chapman, R. (2023). Neurodiversity and the Social Ecology of Mental Health.
² Walker, N. (2021). Neuroqueer Heresies.
³ Milton, D. (2012 or 2014+) Double Empathy Problem.
⁴ Dunn, W. (1997). The Sensory Profile.
⁵ Mahler, K. (2017). Interoception: The Eighth Sensory System.
⁶ Barkley, R. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved.
⁷ Botha, M. & Frost, D. (2020). “Extending Minority Stress Theory to Autistic People.”
⁸ Hull, L. et al. (2017). “Camouflaging in Autism Spectrum Conditions.”
⁹ Kirby, A., & Sugden, D. (2007). Children with Developmental Coordination Disorder
¹⁰ O’Nions, E. et al. (2014). “Development of the Extreme Demand Avoidance Questionnaire (EDA-Q).”

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Future parts to this series

This article is the third in a series titled ‘Exploring Neurodiversity in MSK Practice’. I am releasing the series in the lead-up to my presentation at this year’s Therapy Show (26 November 2026, Birmingham NEC) — ‘Changing the Room, not the Person: Neurodiversity and MSK clinical Practice’.

In each article, I aim to unpack a key concept, grounded in the work of its originating scholars. At the time of writing, I plan to explore the following areas in greater detail:

• The Pathology Paradigm vs the Neurodiversity Paradigm

• The Social Model of Disability

• Ecological Diversity & Neurodiversity (this article)

• The Double Empathy Problem

• Sensory Processing

• Executive Function

• Communication Across Neurotypes

• Masking & Burnout

• Co‑Regulation & Safety

• Practical Environmental Tweaks (applied from all of the above)

If you’d like to follow the rest of the series, you can subscribe below to receive notifications when they’re published.