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00:00Hi, I'm Matt Lerner. I'm an associate professor and program area leader at the A.J. Drexel Autism
00:04Institute. I'm here today to answer your questions from the internet. This is Neurodivergent Support.
00:13Alafia Oluwu asks, what exactly does it mean to be neurodivergent? Great question, Alafia.
00:20Neurodivergent is not a diagnosis. It doesn't exist in the DSM, Diagnostic Statistical Manual.
00:25It is a description that has sort of emerged from the community. It's really meant to describe
00:31the whole set of differences of ways of either perceiving the world, interacting in the world,
00:38ways of being in the world, and really ways brains working, right? That's the neuro part,
00:43that is kind of different from the norm in a way that might make it more difficult to kind of click
00:51in and feel connected and kind of at pace with the rest of the social world.
00:57Nemgem asks, do you see the words physically jumping around the page and moving or just in
01:03the wrong location? So this is the question about dyslexia. I'd like to give you an illustration
01:07of kind of what that looks like. Up here, you probably see the words the way that you typically
01:13see them on a page. They're standing still, they're in the place that you expect them to be,
01:18they stay there, and you kind of read them in order. Down here, you see the way that many,
01:24not all, but many dyslexic people view these words. So you can see they might be a little bit
01:28jumbled around, maybe the order is flipped or switched, but they're kind of not staying put
01:33and doing the things in the order that you need to be able to read them fluently and fluidly.
01:38And so folks with dyslexia are often doing this extra cognitive effort of trying to figure out not
01:44just what does this say, but when I look at it, what do I think it's sort of meant to say?
01:50And how do I get the letters to look the way they're supposed to look so that it does?
01:55The Aspie World asks, autism social masking, what is it and why do we do it?
02:01There's a term called masking or camouflaging. Sometimes it's called pan or passing as non-autistic.
02:08Essentially, these are all different terms for when autistic people are either working hard to
02:15present as not autistic or to kind of minimize their autism features, or when autistic people are
02:22doing that, whether or not they're doing it intentionally, maybe because that's just kind
02:26of how they've learned or where they've learned. What it is is still, there's a lot of research into
02:31it. But it's generally this idea of sort of effortfully trying to impede doing things that
02:37autistic people do to fit in. So many autistic people like to use, you know, fidgets and things
02:46like this, right? And, you know, maybe they'll not have a fidget nearby. Or many autistic people
02:52might have a particular topic or thing that they like to talk about socially or like to talk
02:57about their interest. Maybe they won't do that in certain contexts. Many autistic people,
03:03for instance, say that eye contact, the thing I'm doing with you right now into this camera,
03:08is uncomfortable or is hard to do. But many autistic people who are masking or camouflaging might force
03:14themselves to do that even if it's uncomfortable. All of those are efforts to try to sort of fit into
03:20this neurotypical world. Some emerging research suggests that that is really, that can be taxing,
03:25that it's sort of using up a lot of cognitive resources, brain resources, effort, emotional
03:31resources to try to do that to fit in. But one thing we hear a lot from the autism community is
03:36that over time it can be taxing. There's some evidence, some emerging evidence, that it can be
03:41related to things like anxiety and depression. Because if you're working that hard, you're sort of
03:47spending yourself out. So finding ways to help autistic people not have to mask quite so much so that they
03:53can be their authentic selves seems like an important goal. Tesla Cox asks, how do I tell my
04:00real doctor that I've been diagnosed neurodivergent with ADHD from TikTok doctors? Okay, let's break this
04:07one down a little bit. You can't be diagnosed neurodivergent. Like we said, it's not a formal
04:12diagnosis. Number two, I'm not sure what a TikTok doctor is per se. The important thing here,
04:19though, that Tesla Cox is getting at is, you know, there is a wealth of information now,
04:27deluge of information online about neurodivergence, about different ways of being, people sharing their
04:33own experiences, sometimes people who are clinicians providing their own insights online on the internet.
04:38And it's great to have access to the end of that information. The key thing to understand, though,
04:42is that that information is not always accurate in reference to our actual diagnostic categories that
04:49you could get from a doctor and get covered by your insurance or anything. In fact, some studies
04:53have suggested studies of both presentations of autism on TikTok, presentations of ADHD on TikTok have
05:01shown that well over 50% of the features said to be associated with ADHD or autism in TikTok aren't part
05:09of the diagnostic category. So what does this mean? What do you do? Number one, probably wouldn't go to
05:14your real doctor and say, TikTok told me I have this. But what you might do is say, gosh, I was, you know,
05:21watching these videos on TikTok and it kind of struck a chord with me and it made me want to know more.
05:26And I think that's what this stuff can be good for. It can help you to open the door to say, gosh, if there are
05:32things that have been harder for me than I thought or things that were hard for me, but it never occurred to me that it
05:38wasn't hard for everybody. What do I do with that? That's a really good thing to take to a doctor to get
05:45their feedback. Sirius Toe 9303 asks, is love on the spectrum a good representation of autism and are
05:51there better ones? That's a great question. Love on the spectrum is one of a small but growing number
05:56of shows that has actually autistic people being portrayed. Some aspects of the portrayal and those
06:02relationships are kind of made for TV, like a lot of reality TV. But I think what's really valuable
06:09about it is that it's taking seriously the fact that the best way to know autistic people or any
06:16neurodivergent person is to actually get to know them and see them and see how that community presents
06:22itself. So if the question is, are there better ones? I think the best representations are by autistic
06:28people representing themselves in their own experiences, either act, autistic actors acting
06:34or autistic people living and sharing their own experience so that we are not caricaturing but
06:41truly trying to appreciate all of the different ways that autistic and other neurodivergent people
06:46live and experience their world. Kobaney-Wittet1 asks, what are signs of autism? The features of autism
06:53fit into two general categories, social communication and restricted and repetitive behaviors and kind
06:58of sensory stuff. So social and communication might be kind of really straightforward difficulties with
07:05communication, language development, kind of speaking and communicating in kind of the ways that
07:11are expected for a person's development, as well as more complex and subtle social challenges like
07:16coordinating and social interaction, friendship making and connection, eye contact, nonverbal cues,
07:23picking up social nuance, all features like that. That's the social communication side. In the other
07:27side, the kind of restrictive repetitive behavior side, you might have somebody who has like a really
07:31restricted interest or focus. It could be like a topic that they're really interested in or it could be
07:36you know a child who runs a car back and forth over and over again on the table or on their hand. You also
07:41might have repetition of certain words or phrases over and over again. There's this concept called
07:48echolalia where somebody kind of hears something and then kind of keeps echoing it back over and over
07:53and over. And this also kind of loads on with the sensory features of autism. Some folks on the spectrum
07:59again are going to be very sensitive to touch or smell or taste or sounds or lights and that those kind
08:07of sensitivities can make it very difficult to be in those environments. People might cover their ears and
08:13need earplugs to be able to manage certain settings. Lights like like the ones in the room that I'm in
08:18right now might feel very bright and overwhelming. They also might engage in something called stimming
08:22which is a way in which you know folks on the spectrum might use something like this and kind of
08:26you know over and over again kind of move it around uh as a way to kind of feel good but it really it's a
08:31way to kind of regulate and manage that sensory experience. Folks on the spectrum have lots of different
08:36kinds of stims. They might hum auditory stims. They might have visual stims like looking at their hands and
08:42finger flicking out of the corner of their eye and some folks have larger stims like rocking
08:46or even hand flapping or pacing back and forth. Zoe Blade asks what is and isn't stimming? So
08:52stimming is a term uh in the autism world autism field sort of a colloquial term for uh self-stimulatory
09:01behavior. You know kind of traditional uh sort of ideas of stimming are it might be things like
09:06rocking flapping there's this finger flicking thing that many autistic kids do but it might also
09:13involve taking a toy and kind of you know playing with it like this over and over again and some
09:20people do auditory stimming like humming or maybe saying a word over and over again so again there can
09:25be visual there can be tactile there can be auditory. The best evidence about stimming is that it is a tool
09:33that autistic people are using to kind of regulate their sensory system which can often get a little
09:40bit overwhelmed and kind of putting that energy uh somewhere. Jay Cartier 3 asks is autism really on
09:49the rise are we just better at identifying it these days? When we think about the rise in autism we think
09:54about four sets of factors that could be happening. Number one change in diagnostic criteria.
10:02So when you look at the the DSM or to diagnostic bible you know back in the 1980s or even earlier
10:09there were fewer ways to have autism and they generally required much more significant
10:16challenges to be on board. You know somebody who is developing language at a sort of usual rate
10:23and is integrated into school would have a lot of trouble even getting an autism diagnosis. Those folks
10:29were there but they weren't getting autism diagnoses back in the 80s 70s earlier. It really wasn't until
10:36the DSM-IV in the mid-90s that we even had these sort of broader criteria broader ways of having an
10:42autism diagnosis. And so that change alone has dramatically expanded the ways to even be diagnosed
10:50as autistic. So that's contributed a huge amount to the rise. The second is a broader awareness and
10:58these things go hand in hand. And so yeah somebody who's going to their you know doctor somewhere in the
11:03middle of like a rural county in the middle of the country that doctor you know 20-30 years ago may
11:08have never seen an autistic person and may have never even thought to look for autism. But now we know
11:14more about autism there are more representations in the media there's much broader awareness and once
11:21you once folks start to see somebody who's autistic in their practice or in their world they go oh yeah
11:26I can kind of notice that. The third thing has to do with changes in stigma and how autism is viewed.
11:33So because of the first two things all of a sudden you know the ideas it used to be that you know getting
11:39diagnosed with autism was quite scary for families. For some it might still be but much more commonly
11:45the idea was what is that and what's going to happen to my child. The last thing the fourth is a
11:51true rise in autism even after correcting for population growth and understanding that the
11:56populations grow over time. The best we can tell from really good epidemiological research over many
12:03many years looking at millions of people is that the vast majority of the rise in autism is attributed
12:09to the first three things. That is most of why autism is on the rise. Quinn the Cats asks this is about
12:15to sound like the dumbest question ever but what exactly is ADHD? It's not a dumb question Quinn the
12:20cats. There are kind of three types of ADHD and they kind of each answer the question. One is ADHD
12:28inattentive type. So meaning folks with ADHD inattentive type struggle to pay attention, maintain
12:34attention. They might seem to sort of you know wander off or have trouble kind of staying engaged in a
12:42conversation or on topic and might struggle academically as a result of this. Then there's
12:47what's called ADHD hyperactive type and these are kids who kind of move all around the all around the
12:55place have trouble controlling their bodies have trouble sitting still. There's a item on kind of the
13:00ADHD questionnaire that says acts as if driven by a motor and I feel like this is the one when I
13:04talk to parents often they're like yeah that one he acts like he's driven by a motor and the motor
13:09doesn't stop. And then there is ADHD C which is the most common which is the combined type which is
13:15basically the inattentive stuff and the hyperactive stuff all mushed together. A redditor asks what did
13:21people with autism do in the past? So the answer is that people with autism in the past did the same
13:28things other people did. They existed out in the world. There's a book called Autism in History that
13:35profiles a lord kind of sub lord from the countryside. It makes the case that this particular person
13:42was autistic. The idea is that he happened to be in an environment where his quirky way of being
13:49was notable. He showed up a lot of the stuff comes from court documents but he had kind of all these
13:55supports and resources and things around him and he kind of went about his life in his kind of very
14:00unique and particular way. So in that book the court documents describe him as saying odd sorts of
14:05movements. They would say he would sort of ramble on in ways that they considered to be you know
14:09incoherent but they said not unintelligible that you know they sort of were streams of meaningful words
14:15and sentences but that they didn't really have a way to contextualize what he was saying and meaning.
14:20Sort of in the same way that somebody on the spectrum might you know have a
14:23real strong what we call perseverative interest like a fixation just sort of talk about that
14:27without necessarily checking that the other person is following along with what they're saying.
14:31DescriptionMean9351 asks people keep saying that I can't have Tourette's because I developed it at
14:37two. People say you have to be born with it. You can develop tics later on and there are lots of
14:43different reasons and ways that tics can kind of onset later. But yes a person can start to develop
14:50tics at two or even or even later than that. I screwed up real bad asks my tics feel half voluntary?
14:57Question mark. So this is about Tourette's and other tic conditions. So tics are kind of an interesting
15:03phenomenon. The one way that people think about tics is there's this sort of like surge of a feeling
15:09a need to do a thing and that that surge is like a wave that's cresting over a person and can't and kind of
15:15can't be stopped. The kind of historical way of thinking about it that psychologists sometimes say
15:21is that it's easier to stop a tic once it starts than to stop a tic from starting. So half voluntary.
15:28The idea is is that the sort of surge of the wave of kind of compulsion that comes from the tic is
15:35might be able to be kind of diverted, right? Maybe maybe the idea is that you know if a person can feel
15:40it coming on they might be able to say all right I'm gonna you know do this motion but not that or
15:45I'm going to do my best to kind of hold it back. So there's almost like this it's like you can you can
15:49put a canal along the wave that you can kind of pick something about it even if you can't pick it.
15:54Paper Joshi asks I never understood how hyper focus is a symptom of ADHD. It's a really good question.
16:01So ADHD broadly has to do with you know sort of difficulties sustaining attention kind of hyperactivity
16:09maybe working memory problems. So how is it the case that folks with ADHD can hyper focus if their
16:15problem is focus? Well one way to think about it is ADHD can almost be seen as a as difficulty with
16:23the sort of lever that regulates your focus. Often what we have to do throughout our day is take our
16:31focus and kind of pivot it somewhere else and say I'm focusing over here. I'm focusing over here.
16:36I have to give you my attention now and I have to keep doing it for as long as you need me to pay
16:41attention to you. That is what our brains are doing. Folks with ADHD might struggle to kind of do
16:48that shifting at the rate and the way that people want. So they might kind of get stuck in like I
16:52can't really hold my focus here so I'm going to kind of keep bouncing bouncing around. But they also
16:57when they do find something that is motivating that is engaging that is that they're interested in it's
17:02sort of like then they're locked into that and can't quite yank that lever off of that topic.
17:07A redditor asks does reading improve with practice for dyslexics? The thing for dyslexic people is that
17:15the strategies that they need to use to get the words to behave the way that they need them to be
17:21able to read are learnable are teachable. They can take effort but then that effort like a muscle can get
17:26flexed and built over time. And so in a similar way as that right folks if they are practicing
17:32using those skills and strategies effectively things can get a little bit easier. But fundamentally
17:38they're still managing kind of a different way of perceiving that information to make it work for them.
17:45Qgirl50 asks is autism genetic? Have they identified a gene? A lot of very smart autism researchers over the
17:53last 20 years have done the kind of work that you do in a petri dish with a DNA sequence. They've done
17:58the kind of work where you look at really gigantic populations of people and look at kind of genetic
18:02markers. And what they found is actually more and more and more specific genes areas on the human genome
18:09that seem to be related to autism that have again this idea of sort of like an autism load to them.
18:14And there's certain ones where they call them loci sort of areas on the gene
18:20of the of the DNA strand that if there's a little bit of a difference maybe you can might see a little
18:26bit of autism features. Sometimes if there's a lot of a difference you might see more features. So
18:32all together what this suggests to us is a lot actually well over 50 some estimate at least 70
18:40percent or more of variation amount of autism sort of out there in the community in the world is
18:45attributable to genetic factors. Titanic Man asks is there a reason why some people with Tourette's
18:51have swear words specifically as their tick? Of all the words that could be their tick why is it almost
18:56always profanity? So this is partially a myth and misunderstanding and partially not. So it turns out
19:03a lot of tics are not profanity. Many folks with Tourette's have much subtler presentations you know they might be
19:11really small tics a little motor tick you know a slight smirk or a twitch of the eye or you know
19:16kind of a little head tick that um can happen and and those are actually much much more common.
19:22They're not as attention grabbing and so people don't necessarily notice them and call attention
19:27to them quite as much. And so yeah it's not the case that most people with Tourette's for instance have
19:33swear words as their tics. It is the case though that there are a subset of folks where their tics
19:39are profanity. It's a little bit complicated as to why and there's there's a lot of interesting
19:44research kind of trying to understand this question. The best that I understand is that
19:48is that to some extent tics do have to do with this this kind of motivation and self-regulatory system
19:54right there's this sort of urge sort of surge that he said before and then this kind of you know pullback
20:00and the thing is there are lots of things that we try to self-regulate about during the day
20:05right we try not to have road rage we try not to steal our siblings candy when it's sitting next
20:13to them and we try not to swear. There's you know some evidence that suggests that you know that
20:19process might be getting wrapped up for those folks that that's that there's there's this sort of
20:23self-regulatory thing I'm not going to do it and the brain is kind of like all right I'm going to push
20:29through the thing I'm really not don't want to do right now I'm not meant to do right now and it becomes
20:33that thing and then it gets stuck that's one of the I think more intriguing ideas as to why when
20:40it's profanity why it's that Estella like salt uh says genuine question if adhd is viewed as a problem
20:49to where medication is taken for it why is it not the same with autism this is a genuine curiosity I'm
20:57not saying that either should be medicated please don't take this as I'm saying autism should be
21:01medicated appreciate the sensitivity Estella the answer actually is that has less to do with the
21:07idea that the medical field thinks that one should and the other shouldn't it actually has to do with
21:11the available medications that exist adhd since the 80s has stimulant medications and then now other
21:18types of medications that help to manage attention and focus and self-regulation for autism the sort of
21:26quest for medication has even you know assuming that you're sort of believe in medication as being
21:33important which you know many do has been a lot more fraught as I've described autism has these sort
21:38of two uh core areas right social communication restricted repetitive behavior and we've really
21:44haven't found many things that can really uh uh on their own help with the social communication
21:51piece social stuff is a lot more complicated than regulating attention same thing for restricted
21:56repetitive behaviors there's sort of some evidence of some things that can help a little bit if folks
22:01are like really really struggling a lot with those things but but for the most part that's a lot more
22:07difficult too there are a couple of medications that are fda approved to address things like significant
22:16aggression in folks on the spectrum but that's really only for a subset of people who are
22:20experiencing those challenges and importantly you might notice that's not a core part of autism
22:25a reddit user asks is there a way to treat adhd without meds great question so yes there are
22:30behavioral and psychological treatments uh for adhd and within you know kids and adults in uh
22:37childhood there are a number of kind of what are called like behavioral parent training or uh you know
22:43parent management type approaches which involve uh helping to kind of boost what's called like the
22:50salience or the ways in which you know things that kids with adhd might miss that they kind of
22:54need to do help helps them kind of attend to it by giving them lots and lots of reward and support
23:00and attention for kind of getting it right because many adhd kids they kind of might know what to
23:04do or have a sense of what to do but they kind of miss it in the moment or they can't figure out
23:08how to translate that knowing into doing bass billions asks what does on the spectrum mean
23:15autism is also called autism spectrum disorder in the dsm even though lots of different things are
23:22spectra spectrums lots of different conditions autism has sort of come to be referred to as sort of the
23:29spectrum and what's really interesting is that autism has undergone an incredible evolution over the
23:36last several decades as recently as the 70s or 80s people thought of autism as the most categorical
23:44thing you could go to uh you know psychiatry conferences and famous psychiatrists would say
23:50things like well if there's anything that can be diagnosed in a waiting room by watching a child
23:55for a few minutes surely it's autism because the idea is that autism was seen as so different so
24:00categorical that you could kind of just spot autism when you see it and now it's swung all the way
24:07the other way from being this really seen this so dramatically different that you could just sort of
24:11spot autism anywhere to being the spectrum the spectrum the thing that is not about categorical
24:18difference at all and i think this tells us a lot about our evolving understanding of autism but also
24:23our evolving understanding of the individual differences between people a reddit user asks how
24:28does the brain structure of autistic people differ lots of really interesting research has gone
24:34into this i think one of the big things they would say we do know more and more about these days is the
24:40idea of kind of the connections of autism there's this fancy term a connectopathy it's a 10 million
24:47dollar word there but the idea that autism can be defined by a difference in the way the brain
24:52interconnects with itself and while this is still evolving broadly speaking there's this idea that
24:58autism has a lot more connections autistic brains have a lot more connections kind of locally kind of close
25:06by little short distance neuron connections but that globally kind of long distance connections
25:12across different regions of the brain there seem to be fewer of them and there's actually even some
25:17thought that this might help to explain some some parts of what we understand about autism because
25:23maybe those short distance connections you know they might might be telling us something about some of
25:28the difficulties in sensory processing right be like you know if you've got all these short distance
25:32connections going fire fire fire fire it might be harder you know if things are really loud or
25:37things are really bright to manage that but then those longer distance connections which are used
25:41maybe for more broader processing or development or learning those if they're sparser might take longer
25:48it might be more difficult for those connections to kind of grow and and learn arcticos02 says
25:55what age do you think it would be appropriate to diagnose someone with autism so one thing we do know
26:00is that autism is by and large with you at birth so by the time somebody is born their brain is sort
26:08of wired up in that direction if they are going if they are there are autistic those developmental
26:13trajectories can change one way or another in a variety of different ways but that's that's by
26:18and large what we know so one of the goals actually is to get diagnosis as early as possible so that
26:23there can be support as early as possible early intervention and other kinds of supports which you can
26:28get in every state in america we want to make sure that those things are available so that folks have
26:32the best opportunity for years it was thought that three might be kind of on the earliest side you know
26:39then would sort of push to two and and i would say you know clinically it's now possible using some of our
26:45best diagnostic tools to diagnose toddlers even down to like 18 months some even down to 12 months using
26:52our clinical tools but increasingly diagnostic science in autism has really been picking up and
26:58there's there are now some cutting-edge studies using tools like some kinds of brain imaging and eye
27:03tracking that are promising for diagnosing autism as young as six months and maybe even younger so
27:09let's see where that goes judicia i review um asks does autism correlate with iq or does high iq correlate
27:18with autism headline here is that autism does not really correlate uh with iq autism does not
27:26discriminate by race color iq or other uh features autism exists everywhere in the world across the whole
27:35spectrum of being i think the interesting kind of tricky question here is that very often because of
27:41the different ways of thinking and processing that autistic people have performance of of autistic people
27:46on iq tests can be really different you could have these big splits or sort of islands of ability
27:51where somebody might seem to have really strong verbal ability but then much less strong ability
27:57in other areas like processing speed or self-regulation or visual perception or it might be the other
28:03way they might have great you know visual perceptual or processing ability and less ability in spoken language
28:10pip d burley asks what myths about autism annoy you what is the reality versus the myth there are a lot of
28:16myths about autism but probably the one that is often most uh frustrating is the idea that autistic
28:22people lack empathy and can't understand the feelings of others this is very common kind of colloquial
28:28idea that comes out of sort of observing autistic people kind of seeming disconnected and sort of seeming
28:34not to pay attention to the needs of other people seeming off to be in their own world right
28:38autism literally from the greek you know means self-ism autos is self and so there's this notion i think
28:44this implicit notion that autistic people are self-ish that they're sort of focused on their own needs
28:49and can't really feel those of others but actually one actually autistic people will tell us all the
28:55time that that's not true that that's not their experience at all that maybe they might struggle to
28:59communicate their understanding in the same way but that they can very much and and increasingly
29:04research even on very young and even you know minimally verbal autistic people shows us that myth
29:09really is myth that autistic children and adults do co-feel they can empathize often sometimes quite
29:17profoundly in fact so much so that they're overwhelmed by you know the feeling of another person and that
29:23itself might interfere with the ability to express it that's all the questions for today hope you learned
29:28something until next time
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