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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 this 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 percent of the features said to be associated with ADHD or autism in TikTok
05:09aren't part of the diagnostic category. So what does this mean? What do you do? Number one,
05:13probably wouldn't go to your real doctor and say, TikTok told me I have this. But what you might do
05:19is say, gosh, I was, you know, watching these videos on TikTok and it kind of struck a chord with me
05:24and it made me want to know more. And I think that's what this stuff can be good for. It can help you
05:29to open the door to say, gosh, if there are things that have been harder for me than I thought, or things
05:35that were hard for me but it never occurred to me that it wasn't hard for everybody, what do I do with
05:40that? That's a really good thing to take to a doctor to get their feedback. Sirius Toe 9303 asks,
05:48is love on the spectrum a good representation of autism and are there better ones? That's a great
05:52question. Love on the spectrum is one of a small but growing number of shows that has actually autistic
05:58people being portrayed. Some aspects of the portrayal and those relationships are kind of made
06:03for TV like a lot of reality TV. But I think what's really valuable about it is that it's taking
06:12seriously the fact that the best way to know autistic people or any neurodivergent person is to actually
06:18get to know them and see them and see how that community presents itself. So if the question is,
06:23are there better ones? I think the best representations are by autistic people representing
06:29themselves and their own experiences, either autistic actors acting or autistic people living and sharing
06:37their own experience so that we are not caricaturing but truly trying to appreciate all of the different
06:43ways that autistic and other neurodivergent people live and experience their world.
06:47Kobaney-Wittet1 asks, what are signs of autism? The features of autism fit into two general categories,
06:55social communication and restricted and repetitive behaviors and kind of sensory stuff. So social and
07:00communication might be kind of really straightforward difficulties with communication, language
07:06development, kind of speaking and communicating in kind of the ways that are expected for a person's
07:12development, as well as more complex and subtle social challenges like coordinating and social
07:17interaction, friendship making and connection, eye contact, nonverbal cues, picking up social nuance,
07:24all features like that. That's the social communication side. In the other side, the kind
07:28of restrictive repetitive behavior side, you might have somebody who has like a really restricted
07:31interest 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.
07:40You also might have repetition of certain words or phrases over and over again. There's this concept
07:47called echolalia where somebody kind of hears something and then kind of keeps echoing it back
07:52over and over and over. And this also kind of loads on with these sensory features of autism. Some folks
07:58on the spectrum, again, are going to be very sensitive to touch or smell or taste or sounds or lights
08:06and that those kind of sensitivities can make it very difficult to be in those environments.
08:11People might, you know, cover their ears and need earplugs to be able to manage certain settings.
08:15Lights like like the ones in the room that I'm in right now might feel very bright and overwhelming.
08:20They also might engage in something called stimming, which is a way in which, you know, folks on the spectrum
08:24might use something like this and kind of, you know, over and over again kind of move it around
08:29as a way to kind of feel good. But it really, it's a way to kind of regulate and manage that sensory
08:34experience. Folks on the spectrum have lots of different kinds of stims. They might hum
08:38auditory stims. They might have visual stims like looking at their hands and finger flicking out of the corner of their eye.
08:43And some folks have larger stims like rocking or even hand flapping or pacing back and forth.
08:48Zoe Blade asks, what is and isn't stimming? So stimming is a term in the autism world,
08:56autism field, sort of a colloquial term for self-stimulatory behavior. You know,
09:02kind of traditional sort of ideas of stimming are, it might be things like rocking, flapping.
09:08There'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.
09:19And some people do auditory stimming like humming or maybe saying a word over and over again. So
09:25again, there can be visual, there can be tactile, there can be auditory. The best evidence about
09:30stimming is that it is a tool that autistic people are using to kind of regulate their sensory system,
09:39which can often get a little bit overwhelmed and kind of putting that energy somewhere.
09:45Jai Cartier 3 asks, is autism really on the rise? Are we just better at identifying it these days?
09:51When we think about the rise in autism, we think about four sets of factors that could be happening.
09:57Number one, change in diagnostic criteria. So when you look at the DSM or Diagnostic Bible,
10:07you know, back in the 1980s or even earlier, there were fewer ways to have autism and they generally
10:13required much more significant challenges to be on board. You know, somebody who is developing language
10:20at a sort of usual rate and is integrated into school would have a lot of trouble even getting
10:27an autism diagnosis. Those folks were there, but they weren't getting autism diagnoses back in the
10:3380s, 70s, earlier. It really wasn't until the DSM-IV in the mid-90s that we even had these sort of
10:40broader criteria, broader ways of having an autism diagnosis. And so that change alone has dramatically
10:47expanded the ways to even be diagnosed as autistic. So that's contributed a huge amount to the rise.
10:54The second is broader awareness. And these things go hand in hand. And so, yeah, somebody who's going
11:01to their, you know, doctor somewhere in the middle of like a rural county in the middle of the country,
11:06that doctor, you know, 20, 30 years ago may have never seen an autistic person and may have never even
11:11thought to look for autism. But now we know more about autism. There are more
11:16representations in the media. There's much broader awareness. And once you, once folks start to see
11:23somebody who's autistic in their practice or in their world, they go, oh yeah, I can kind of notice
11:27that. The third thing has to do with changes in stigma and how autism is viewed. So because of the
11:34first two things, all of a sudden, you know, the ideas it used to be that, you know, getting diagnosed
11:39with 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,
11:50is a true 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
12:02many, many years, looking at millions of people is that the vast majority of the rise in autism
12:08is attributed to the first three things. That is most of why autism is on the rise.
12:14Quinn the Cats asks, this is about to sound like the dumbest question ever, but what exactly is ADHD?
12:19It's not a dumb question, Quinn the Cats. There are kind of three types of ADHD and they kind of each
12:25answer the question. One is ADHD inattentive type. So meaning folks with ADHD inattentive type struggle
12:32to pay attention, maintain attention. They might seem to sort of, you know, wander off or have trouble
12:40kind of staying engaged in a conversation or on topic and might struggle academically as a result of
12:46this. Then there's what's called ADHD hyperactive type. And these are kids who kind of move all around
12:54the place, have trouble controlling their bodies, have trouble sitting still. There's a item on kind
12:59of the ADHD 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
14:05of movements. 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
14:15words and sentences, but that they didn't really have a way to contextualize what he was saying and
14:19meaning. Sort of in the same way that somebody on the spectrum might, you know, have a real strong,
14:24what we call, perseverative interest, like a fixation, just sort of talk about that without
14:27necessarily 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
14:49develop tics at two or even, or even later than that. I screwed up real bad asks, my tics feel half
14:56voluntary? Question mark. So this is about Tourette's and other tic conditions. So tics are kind of an
15:02interesting phenomenon. The one way that people think about tics is there's this sort of like surge of
15:08a feeling, a need to do a thing, and that that surge is like a wave that's cresting over a person
15:14and can't, and kind of can't be stopped. The kind of historical way of thinking about it that
15:19psychologists sometimes say is that it's easier to stop a tic once it starts than to stop a tic
15:25from starting. So half voluntary. The idea is, is that the sort of surge of the wave of kind of
15:32compulsion that comes from the tic is. Might be able to be kind of diverted, right? Maybe,
15:37maybe the idea is that, you know, if a person can feel it coming on, they might be able to say,
15:41all right, I'm gonna, you know, do this motion, but not that, or I'm going to do my best to kind
15:46of hold it back. So there's almost like this, it's like you can, you can put a canal along the wave,
15:52that you can kind of pick something about it, even if you can't pick it. Paper Joshi asks,
15:56I never understood how hyperfocus is a symptom of ADHD. It's a really good question. So ADHD
16:02broadly has to do with, you know, sort of difficulties sustaining attention, kind of
16:08hyperactivity, maybe working memory problems. So how is it the case that folks with ADHD can hyperfocus
16:15if their problem is focus? Well, one way to think about it is ADHD can almost be seen as a, as
16:22difficulty with the sort of a lever that regulates your focus. Often what we have to do throughout
16:29our day is take our focus and kind of pivot it somewhere else and say, I'm focusing over here.
16:35I'm focusing over here. I have to give you my attention now, and I have to keep doing it for
16:39as long as you need me to pay attention to you. That is what our brains are doing. Folks with ADHD
16:45might struggle to kind of do that shifting at the rate and the way that people want. So they might kind
16:51of get stuck in like, I can't really hold my focus here. So I'm going to kind of keep bouncing,
16:56bouncing around. But they also, when they do find something that is motivating, that is engaging,
17:00that is, that they're interested in, it's sort of like, then they're locked into that and can't quite
17:05yank that lever off of that topic. A Redditor asks, does reading improve with practice for dyslexics?
17:11The thing for dyslexic people is that the strategies that they need to use to get the words to behave the
17:20way that they need them to be able to read are learnable, are teachable. They can take effort,
17:24but then that effort, like a muscle, can get flexed and built over time. And so in a similar way as
17:30that, right, folks, if they are practicing using those skills and strategies effectively, things can
17:36get a little bit easier. But fundamentally, they're still managing kind of a different way of perceiving
17:43that information to make it work for them. Qgirl50 asks, is autism genetic? Have they identified a
17:50gene? A lot of very smart autism researchers over the last 20 years have done the kind of work that you
17:55do in a petri dish with a DNA sequence. They've done the kind of work where you look at really gigantic
18:00populations of people and look at kind of genetic markers. And what they found is actually more and
18:05more and more specific genes, areas on the human genome that seem to be related to autism, that have,
18:12again, this idea of sort of like an autism load to them. And there's certain ones where they call them
18:18loci, sort of areas on the gene of the DNA strand, that if there's a little bit of a difference,
18:25maybe you can might see a little bit of autism features. Sometimes if there's a lot of a difference,
18:30you might see more features. So altogether, what this suggests to us is a lot, actually well over 50,
18:37some estimate at least 70% or more of variation amount of autism that's sort of out there in the
18:44community, in the world is attributable to genetic factors. Titanic Man asks, is there a reason why
18:50some people with Tourette's have swear words specifically as their tick? Of all the words
18:54that could be their tick, why is it almost always profanity? So this is partially a myth and
19:01misunderstanding and partially not. So it turns out a lot of tics are not profanity. Many folks with
19:08Tourette's have much subtler presentations. You know, they might be really small tics, a little motor
19:13tick, you know, a slight smirk or a twitch of the eye, or, you know, kind of a little head tick
19:18that can happen. And those are actually much, much more common. They're not as attention grabbing.
19:24And so people don't necessarily notice them and call attention to them quite as much. And so yeah,
19:29it's not the case that most people with Tourette's, for instance, have swear words as their tics.
19:34It is the case though, that there are a subset of folks where their tics are profanity. It's a little
19:41bit complicated as to why. And there's a lot of interesting research kind of trying to understand
19:45this question. The best that I understand is that to some extent, tics do have to do with this kind
19:51of motivation and self-regulatory system, right? There's this sort of urge, sort of surge, like
19:57you said before, and then this kind of pullback. And the thing is, there are lots of things that we
20:02try to self-regulate about during the day, right? We try not to have road rage. We try not to
20:10steal our siblings' candy when it's sitting next to them. And we try not to swear. There's, you know,
20:17some evidence that suggests that, you know, that process might be getting wrapped up for those
20:22folks. That there's this sort of self-regulatory thing. I'm not going to do it. And the brain is
20:27kind of like, all right, I'm going to push through the thing I'm really not, don't want to do right
20:31now. I'm not meant to do right now. And it becomes that thing. And then it gets stuck. That's one of the,
20:36I think, more intriguing ideas as to why, when it's profanity, why it's that.
20:43Estella Like Salt says, genuine question. If ADHD is viewed as a problem to where medication is taken
20:51for it, why is it not the same with autism? This is a genuine curiosity. I'm not saying that either
20:58should be medicated. Please don't take this as I'm saying autism should be medicated. Appreciate
21:02the sensitivity, Estella. The answer actually is that has less to do with the idea that the
21:08medical field thinks that one should and the other shouldn't. It actually has to do with the available
21:12medications that exist. ADHD, since the eighties has stimulant medications and then now other types
21:19of 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 many do, has been a lot more fraught. As I've described, autism has these sort of two
21:39core areas, right? Social communication, restrictive, repetitive behavior. And we've really
21:44haven't found many things that can really on their own help with the social communication piece. Social
21:52stuff is a lot more complicated than regulating attention. Same thing for restricted repetitive
21:56behaviors. There's sort of some evidence of some things that can help a little bit if folks are like
22:02really, really struggling a lot with those things. But for the most part, that's a lot more difficult
22:09too. 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 experiencing
22:21those 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,
22:29there are behavioral and psychological treatments for ADHD and within, you know, kids and adults. In
22:37childhood, there are a number of kind of what are called like behavioral parent training or, you know,
22:43parent management type approaches, which involve helping to kind of boost what's called like the
22:50salience or the ways in which things that kids with ADHD might miss that they kind of need to do
22:55help helps them kind of attend to it by giving them lots and lots of reward and support and attention
23:00for kind of getting it, right? Because many ADHD kids, they kind of might know what to do or have
23:04a sense of what to do, but they kind of miss it in the moment or they can't figure out how to translate
23:09that knowing into doing. Bass Billions asks, what does on the spectrum mean? Autism is also called
23:17autism spectrum disorder in the DSM. Even though lots of different things are spectra, spectrums,
23:24lots of different conditions, autism has sort of come to be referred to as sort of the spectrum.
23:30And what's really interesting is that autism has undergone an incredible evolution over the last
23:37several decades. As recently as the 70s or 80s, people thought of autism as the most categorical
23:44thing. You could go to, 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,
24:00so categorical, that you could kind of just spot autism when you see it. And now it's swung
24:06all the way the other way from being this really seen this so dramatically different that you could
24:11just sort of spot autism anywhere to being the spectrum, the spectrum, the thing that is not
24:16about categorical difference at all. And I think this tells us a lot about our evolving understanding
24:21of autism, but also our evolving understanding of the individual differences between people.
24:26A Reddit user asks, how does the brain structure of autistic people differ? Lots of really interesting
24:33research has gone into this. I think one of the big things I would say we do know more and more
24:39about these days is the idea of kind of the connections of autism. There's this fancy term,
24:45a connect-opathy. It's a $10 million word there. But the idea that autism can be defined by a difference
24:51in the way the brain interconnects with itself. And while this is still evolving, broadly speaking,
24:56there's this idea that autism has a lot more connections. Autistic brains have a lot more
25:03connections kind of locally, kind of close by, little short distance neuron connections. But that
25:10globally, kind of long distance connections across different regions of the brain, there seem to be
25:15fewer of them. And there's actually even some thought that this might help to explain
25:19some parts of what we understand about autism. Because maybe those short distance connections,
25:25you know, they might be telling us something about some of the difficulties in sensory processing,
25:30right? Being like, you know, if you've got all these short distance connections going fire, fire,
25:33fire, fire, fire, it might be harder, you know, if things are really loud or things are really bright
25:38to manage that. But then those longer distance connections, which are used maybe for more broader
25:43processing or development or learning, those, if they're sparser, might take longer, might be more
25:49difficult for those connections to kind of grow and learn. Arcticos02 says, what age do you think
25:56it would be appropriate to diagnose someone with autism? So one thing we do know is that autism is,
26:03by and large, with you at birth. So by the time somebody is born, their brain is sort of wired up
26:09in that direction if they are going, if they are autistic. Those developmental trajectories can change
26:15one way or another in a variety of different ways, but that's, that's by and large what we know. So one
26:19of the goals actually is to get diagnosis as early as possible so that there can be support as early
26:24as possible, early intervention and other kinds of supports which you can get in every state in
26:29America. We want to make sure that those things are available so that folks have the best opportunity.
26:33For years, it was thought that three might be kind of on the earliest side, you know, then would sort of
26:40push to two. And I would say, you know, clinically it's now possible using some of our best diagnostic
26:46tools to diagnose toddlers, even down to like 18 months, some even down to 12 months using our
26:52clinical tools. But increasingly, diagnostic science in autism has really been picking up and there's,
26:58there are now some cutting edge studies using tools like some kinds of brain imaging and eye tracking
27:04that are promising for diagnosing autism as young as six months and maybe even younger. So let's see
27:10where that goes. Judicia Eye Review asks, does autism correlate with IQ or does high IQ correlate
27:18with autism? Headline here is that autism does not really correlate with IQ. Autism does not discriminate
27:27by race, color, IQ or other features. Autism exists everywhere in the world across the whole spectrum of
27:35being. I think the interesting kind of tricky question here is that very often because of the
27:41different ways of thinking and processing that autistic people have, performance 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 in
27:58other areas like processing speed or self-regulation or visual perception. Or it might be the other way.
28:03They might have great, you know, visual perceptual or processing ability and less ability in spoken
28:09language. Pip D Burley asks, what myths about autism annoy you? What is the reality versus the myth?
28:15There are a lot of myths about autism, but probably the one that is often most frustrating is the idea
28:21that autistic people lack empathy and can't understand the feelings of others. This is very common kind of
28:28colloquial idea that comes out of sort of observing autistic people kind of seeming disconnected and
28:33sort of seeming not to pay attention to the needs of other people, seeming off to be in their own
28:37world, right? Autism literally from the Greek, you know, means self-ism. Autos is self. And so
28:43there's this notion, I think this implicit notion that autistic people are self-ish, that they're sort of
28:48focused on their own needs and can't really feel those of others. But actually, one, actually autistic people
28:54will tell us all the time that that's not true, that that's not their experience at all, that maybe
28:58they might struggle to communicate their understanding in the same way, but that they can
29:02very much. And increasingly, research, even on very young and even, you know, minimally verbal
29:07autistic people, shows us that myth really is myth, that autistic children and adults do co-feel,
29:14they can empathize, often sometimes quite profoundly. In fact, so much so that they're overwhelmed
29:21by, you know, the feeling of another person. And that itself might interfere with the ability
29:25to express it. That's all the questions for today. Hope you learned something. Until next time.
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