Guidelines for neuroaffirmative practices for autistic people: a co-production study

The neurodiversity paradigm has prompted a critical re-evaluation of clinical practices directed toward autistic individuals, emphasizing interventions that respect identity, autonomy, safety, and diverse ways of being. Although neurodiversity-affirming approaches have advanced internationally, there are currently no practical guidelines that are co-produced and adapted to the Brazilian context. This study aims to develop, validate, and evaluate the implementation of Practical Guidelines for neurodiversity-affirming interventions for autistic individuals in Brazil. The research will be conducted in three complementary phases. In Phase 1, a pre-committee of stakeholders, including autistic adults, family members/caregivers, and experienced professionals, will engage in a co-production process to collaboratively develop a preliminary list of principles and recommendations, informed by scientific literature and international documents on neurodiversity-affirming practices. In Phase 2, this preliminary list will be submitted to a modified Delphi process with approximately 80 participants from the same stakeholder groups. Participants will rate each item in successive rounds regarding clarity, relevance, alignment with neurodiversity-affirming principles, and applicability, until a minimum consensus of 75% is achieved. In Phase 3, a pilot implementation study will be conducted in a specialized clinic serving autistic individuals. Professionals will participate in a training workshop on the guidelines and will complete, pre- and immediate post-intervention, measures assessing stigma toward autism, knowledge about autism, ableism, as well as intentions to change practice and to use the guidelines. Quantitative and qualitative data from all phases will be analyzed using descriptive statistics, pre–post comparisons, and thematic analysis of open-ended responses. The study is expected to produce co-produced, validated, and culturally adapted Practical Guidelines to support neurodiversity-affirming clinical practices in Brazil, contributing to more ethical, inclusive, and responsive services for the autistic community.