Neuroaffirming care across languages and cultures

In Chinese, the word for autism is 自闭症. The characters mean self, closed, disorder. A parent hearing that word for the first time hears all three meanings at once. There is no linguistic distance. The word says what it says.

In English, we have had decades to separate the word from its origins. In Chinese, Korean and Japanese, that distance does not exist yet. So neuroaffirming practice, no matter how carefully you have built it, cannot simply be translated word for word.

In Episode 53 of the Neurodivergent Pulse podcast, host Laetitia Andrac speaks with Sharen Lui, a neurodivergent Clinical and Developmental Psychologist, Chinese-speaking parent, and founder and Director of Sprout Psychology Melbourne. Sharen has been conducting autism and ADHD assessments in Cantonese, Mandarin and English since 2015. Her work sits at the intersection of cultural humility, connection and affirming care for multicultural families.

What does the Chinese word for autism actually mean?

The diagnostic word itself can reshape how a family understands their child. That happens before you have said anything else. For families navigating an autism diagnosis in Chinese, the neuroaffirming language that professionals use in English does not carry across. Sharen traced this back to the linguistic history of the word autism in English. Its Greek origins carry a similar meaning to the Chinese characters. But English has had time to develop distance from that literal root.

"Chinese is different. Chinese, we don't have that same linguistic distance because our characters carry the meaning, each word by word. So 自 is the self, 闭 is the closed, and 症 is the disorder."

For a parent hearing 自闭症 for the first time, it can sound as though their child is closed off, withdrawn and disconnected from their family. That is not what autism means. But the word can make it sound that way. And that is only one reason why affirming practice cannot be lifted from English and placed into another language.

Sharen's hope is to move the conversation somewhere different: "My hope is that we can gradually shift the conversation beyond what's wrong to how this person experiences the world, what do they need." That shift requires more than new vocabulary. It requires a different frame. Language is not a soft concern sitting alongside clinical work. Our research on neurodivergent families in Australia found that 62% of parents of neurodivergent children said affirming, respectful language is very important. A further 26% said it is quite important. The words used in an assessment room travel home with the family. For more on what neuroaffirming support looks like in practice, psychologist Adelle Sushames explores how to move from deficit-based to strength-based approaches.

Why CALD families hesitate after an autism diagnosis

When a family withdraws after autism is mentioned, the most common professional reading is resistance or denial. Sharen offers a more compassionate reframe. Working with CALD families on autism support means understanding what the diagnosis carries in their cultural world first. Only then can you draw conclusions about their response.

If there's a fear, fear is a protective mechanism. It serves to protect. And so before we judge or think that, families are withdrawn, resistant, and denying, we need to understand the meaning of neurodivergence and what that carries in that family's cultural world.

She names what that fear can look like: "If autism is associated with shame, disability, even poor parenting, or quite actually commonly, a frightening future for them, then stepping away, removing the thing that is scary, is a way of protecting the child."

This experience of feeling unseen is not unique to CALD families. Research shows 93% of parents of neurodivergent children say their experience feels misunderstood or invisible to others. When that invisibility is compounded by language barriers and cultural difference, the gap between a family's reality and what a professional sees can become very wide.

By the time many East Asian families seek help, things have often already reached a point of significant distress. The diagnostic word enters the family's vocabulary as a medical term. It is associated with something serious enough to require intervention. It rarely arrives as an identity or a difference that can be understood with pride. Meeting families where they are means understanding that first.

How to build rapport with CALD families in assessment

Connection before recommendations is not a nice idea for when you have time. It is what makes everything else possible. This is as true in neuroaffirming therapy as it is in assessment. The relationship is not separate from the clinical work. Autistic family consultant Maisie Soetantyo makes a similar argument for parents. She explores curiosity and radical acceptance as the most practical tools available. Sharen is direct about this: "You start interacting with the family as soon as they have an intake with you. You know, intake is full of questions, right? But I think that there are ways to ask those questions in a very therapeutic way."

In a 50-minute session with a waitlist, and possibly an interpreter, that can feel like a lot to ask. Sharen's answer is that it does not require more time. It requires a different orientation to the time you have. Here is what that looks like in practice:

• Slow down. Check what the family understands before you move on.

• Ask what they are worried about, not just what they are hoping for.

• Ask what they call the difficulty in their own words.

• Resist the urge to correct their interpretation straight away.

• Observe their reactions as you go, not just their answers.

• Treat intake as therapeutic, not just administrative.

• Ask about development from early on. It can quietly release blame.

That last point matters. When assessment questions trace development back to pregnancy and early infancy, it signals something important to a parent who may be carrying guilt. As Sharen puts it: "Nothing made them autistic, right?" That small statement can lift a very specific kind of weight from the room.

Why families don't follow through, and what's actually going on

When a family does not follow through on recommendations, the professional's first question is often: why aren't they doing more? Sharen's reframe shifts that question entirely. The more useful question is: what is making this so hard? Reframing behaviour as communication is a useful starting point for professionals who want to approach these moments with more curiosity and less judgement.

"There is an underestimation of the load," she says. She is clear that this applies to all neurodivergent families, not only those from culturally diverse backgrounds. The cognitive and emotional weight of navigating assessments, appointments, school systems and extended family is enormous. Often this happens in a second or third language. Understanding Zoe's research on neurodivergent families found that 64% of parents with neurodivergent children often feel exhausted and 64% feel overwhelmed. That compares with 42% and 32% of parents with neurotypical children. The load is real, and it is rarely visible to the systems meant to help. When professionals understand that load, the room becomes less blaming.

Flexibility, Sharen says, means holding the family's outcome at the centre, not your process. "You hold the flexibility of seeing through what outcome means for the family, not ourselves." That is a different kind of clinical thinking. It asks you to stay curious about what success looks like for this family, not just whether they completed the home programme.

Tools that help families turn observations and reports into clear next steps can lighten that load between appointments. Understanding Zoe is built for exactly this. It helps families make sense of what they are seeing and what to do next. That includes families who need neuroaffirming care in language that does not yet exist in their first language.

How extended family involvement can be a strength, not a barrier

Extended family involvement is often read by Australian systems as over-involvement. Sharen sees it differently. Grandparents, siblings and extended family who are deeply present in a child's life are not a complication. They are a form of advocacy.

Sometimes it looks like an entire family quietly reorganising itself around one person's needs.

Migrant families have already navigated enormous change. They know how to adjust, problem-solve and keep moving through uncertainty. That is resilience, even when it does not look like the individual saying "these are my rights." Sharen notes that the phrase "it takes a village to raise a child" comes from many cultures, not one. The village is already there. The question is whether the system can recognise it as strength.

When a family does embrace a neuroaffirming understanding of their child, acceptance does not sit with one person. It becomes something the whole family carries together, and it travels through the community. That is a different kind of reach than any individual intervention can offer. For more on building a village around neurodivergent families, Laetitia explores what community looks like and how to create it deliberately.

Questions to ask, and assumptions to stop making, with CALD families

You do not need to share a family's language or culture to work well with them. What you need is curiosity and the willingness to notice when your own assumptions are running the session. When working with CALD families on autism assessment, that curiosity is the foundation of everything. Sharen is clear: "We can't be an expert in every culture. But you do think, I think we, if we have enough humility to recognise when our own framework is not the only way of understanding what is happening."

Here is where to start:

• Ask what the family understands about what is happening for their child.

• Ask what they are worried about.

• Ask what they call the difficulty in their own words.

• Ask what their family believes about it.

• Notice what the family's goals are, not just what your recommendations are.

And here is what to stop:

• Stop assuming silence means agreement.

• Stop reading hesitation as denial.

• Stop interpreting non-compliance as not caring or not trying.

Sharen's advice when you catch yourself making one of those assumptions: "pause, pause, pause. Reflect and bring it to someone, say, like, with consent, of course. Where does that come from?" The same principle that applies to autism applies to culture. If you know one autistic person, you know one autistic person. The same is true for culture. There is no formula, and that is the point.

A note to the parent carrying this alone

If you are a parent whose family is telling you the diagnosis is nothing, that your child will grow out of it, Sharen has a direct and tender message. You do not have to convince everyone today.

You don't have to convince everyone today.

She goes further: "Take some time to understand what this means to you and your child. We know that the diagnosis don't change suddenly who they are. It now gives us a way of understanding why things are harder, what they need, and what could help them thrive."

Extended family may need longer. "They'll grow out of it" often comes from fear, unfamiliarity, or a wish to protect someone they love. That response is not so different from the families Sharen describes stepping away from sessions. It is the same protective instinct, coming from a different direction. If this resonates, you may also find comfort in Jessica Otter's story about trusting yourself when family doubt the diagnosis. What matters first is that your child has someone working to understand them. Everything else can come gradually.

What cultural humility actually means in an autism assessment room

Cultural humility in autism practice is not a checklist. It is an orientation. Sharen's parting message for professionals at the beginning of this work captures it: "Curiosity never, never really fails," she says. "I love being taught by people I interact with."

Do not rush to explain what you see through the framework you already have. Keep listening. Keep questioning what you take for granted. Let families teach you. That is not a soft skill sitting alongside the clinical work. It is the clinical work. For more on building this orientation, listen to our conversation with psychologist Adelle Sushames on neuroaffirming allyship, where she explores what affirming practice looks like beyond training certificates.

Sharen and her team at Sprout Psychology Melbourne have developed downloadable Chinese-language neuroaffirming resources that you can share in your network. Follow Sharen at @multilingual.psych and the practice at @sproutpsychology for more.

Frequently asked questions

What does 自闭症 mean in English?

自闭症 is the Chinese word for autism. It translates literally as "self-closed disorder." The three characters mean self (自), closed (闭) and disorder (症). The English word autism has developed distance from its Greek roots over decades. Chinese characters carry their meaning directly. For a family hearing this word for the first time after an autism diagnosis, the literal meaning can shape how they understand their child before any professional has said another word.

Why do Chinese families often resist an autism diagnosis?

What looks like resistance is often a protective response. When autism is associated with shame, disability, or a frightening future, stepping away from the diagnosis is a way of protecting the child and the family. Neuroaffirming care means understanding what the word carries in that family's cultural world before interpreting their response. Fear is not denial. It is a signal that the family needs more time, more connection, and a different kind of conversation.

What is cultural humility in autism practice?

Cultural humility in autism practice means recognising that your clinical framework is not the only way of understanding what is happening for a child or family. It is not about knowing every culture. It is about staying curious, noticing when your assumptions are running the session, and letting families teach you. As Sharen Lui puts it, no professional can be an expert in every culture, but humility and curiosity rarely fail.

How do I support neurodivergent families from different cultural backgrounds?

Neuroaffirming practice with culturally diverse families starts with asking, not assuming. Ask what the family understands about what is happening for their child. Ask what they are worried about. Ask what they call the difficulty in their own words. Slow down, observe reactions, and treat intake as therapeutic rather than administrative. Understanding Zoe is built to help families make sense of what they are seeing and what to do next, including those who need affirming language that does not yet exist in their first language.

Why don't CALD families follow through on autism recommendations?

The most common reason is not a lack of care. It is an underestimated load. Navigating assessments, appointments, school systems and extended family expectations is cognitively and emotionally exhausting. This often happens in a second or third language. When working with CALD families on autism support, the more useful professional question is not "why aren't they doing more?" but "what is making this so hard?" Flexibility means holding the family's outcome at the centre, not your process.

Connect with Sharen Lui

• Website: Sprout Psychology Melbourne

• Instagram (personal): @multilingual.psych

• Instagram (practice): @sproutpsychology

• Free resource: Downloadable Chinese-language neuroaffirming resources developed by Sharen's team