High Support Needs and Autism with Sienna Macalister

Apr 27, 2025

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This week Monique chats with Sienna Macalister (they/them), who listeners may know by their Instagram handle @sienna.stims, about being an Autistic person with high support needs. Sienna is a non-binary, ‘unreliably speaking’ Autistic advocate, diagnosed with Autism Level 3. They are multiply neurodivergent and have a number of co-occurring health conditions, including Ehlers Danlos Syndrome (EDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Neurofibromatosis Type 1 (NF1). Sienna is passionate about creating a world where Autistic people are not just accepted but celebrated, with a deep affinity for exploring neurodivergence with nuance.

Monique and Sienna cover:

What does ‘unreliably speaking’ mean?
What neurodivergence means to Sienna and the importance of understanding the term to mean more than just Autism and ADHD.
Sienna’s experience of early diagnosis of Autism and the diagnostic overshadowing this led to, particularly around diagnosis of their health conditions.
The evolution of Sienna’s neurodivergent identity.
Sienna’s experience of using mobility, communication, and health and wellbeing supports.
Support needs, disability, and therapeutic intervention as a valid part of the neurodivergent experience, and the difference between affirming and non-affirming therapies.
The role of lateral violence and internalised ableism in excluding people with higher support needs from the cultural conversation on Autism.
Sienna’s suggestions to increase inclusion and representation for Autistic people with higher support needs.
Sienna’s current special interest – budgie breeding!

Find Sienna on TikTok and Instagram @sienna.stims, on their professional Instagram @sienna.macalister_media, or on YouTube @sienna_stims.

Sienna’s writing is features in the anthologies Someone Like Me, edited by Clem Bastow and Jo Case, and Hyperfocus, edited by Spectrum Writing.

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