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0:00
Hi, I'm Matt Lerner.
0:00
I'm an associate professor and program area leader at the AJ Drexel Autism Institute.
0:03
I'm here today to answer your questions from the internet.
0:07
This is neurodivergent support.
0:10
Alafia Olu asks, "What exactly does it mean to be neurodivergent?"
0:10
Great question, Alafia.
0:10
Neurodivergent is not a diagnosis.
0:10
It doesn't exist in the DSM, diagnostic statistical manual.
0:23
It is a description that has sort of emerged from the community.
0:28
It's really meant to describe the whole set of differences of ways of either perceiving the world, interacting in the world, ways of being in the world, and really ways brains working, right?
0:42
That's the neuro part that is kind of different from the norm in a way that might make it more difficult to kind of click in and feel connected and kind of at pace with the rest of the social world.
0:57
Nem asks, "Do you see the words physically jumping around the page and moving or just in the wrong location?"
1:04
So, this is a question about dyslexia.
1:07
So, I'd like to give you an illustration of kind of what that looks like up here.
1:06
You probably see the words the way that you typically see them on a page.
1:14
They're standing still.
1:14
They're in the place that you expect them to be.
1:18
They stay there and you kind of read them in order.
1:20
Down here, you see the way that many, not all, but many dyslexic people view these words.
1:25
So, you can see they, you know, might be a little bit jumbled around, maybe the order is flipped or switched, but they're kind of not staying put and doing the things in the order that you need to be able to read them fluently and fluidly.
1:37
And so folks with dyslexia are often doing this extra cognitive effort of trying to figure out not just what does this say, but when I look at it, what do I think it's sort of meant to say?
1:48
And how do I get the letters to look the way they're supposed to look so that it does?
1:53
The Aspie World asks, "Autism social masking, what is it and why do we do it?"
2:00
There's a term called masking or camouflaging.
2:05
Sometimes it's called pan or passing as non-autistic.
2:09
Essentially, these are all different terms for when autistic people are working, either working hard to present as not autistic or to kind of minimize their autism features, or when autistic people are doing that whether or not they're doing it intentionally, maybe because that's just how they've learned or where they've learned.
2:27
What it is is is is still there, there's a lot of research into it, but it's generally this idea of sort of effort trying to impede doing things that autistic people do to fit in.
2:39
So, many autistic people like to use, you know, fidgets and things like this, right?
2:46
And, you know, maybe they'll not have a fidget nearby, or many autistic people might have a particular topic or thing that they like to talk about socially, or like to talk about their interest, maybe they won't do that in certain contexts.
2:59
Many autistic people, for instance, say that eye contact, the thing I'm doing with you right now into this camera, is uncomfortable or it's hard to do.
3:08
But many autistic people who are masking or camouflaging might force themselves to do that even if it's uncomfortable.
3:18
All of those are efforts to try to sort of fit into this neurotypical world.
3:18
Some emerging research suggests that that is really that can be taxing, that it's sort of using up a lot of cognitive resources, brain resources, effort, emotional resources to try to do that to fit in.
3:18
But one thing we hear a lot from the autism community is that over time it can be taxing.
3:18
There's some evidence, some emerging evidence that it can be related to things like anxiety and depression because if you're working that hard, you're sort of spending yourself out.
3:47
So, finding ways to help autistic people not have to mask quite so much so that they can be their authentic selves seems like an important goal.
3:57
Tesla Cox asks, "How do I tell my real doctor that I've been diagnosed neurodivergent with ADHD from TikTok doctors?"
4:07
Okay, let's break this one down a little bit.
4:07
You can't be diagnosed neurodivergent.
4:07
Like we said, it's not a formal diagnosis.
4:07
Number two, I'm not sure what a TikTok doctor is per se.
4:07
The important thing here though that Tesla Cox is getting at is, you know, there is a wealth of information now, a deluge of information online about neurodivergence, about different ways of being, people sharing their own experiences, sometimes people who are clinicians providing their own insights online, on the internet, and it's great to have access to that information.
4:40
The key thing to understand though, is that that information is not always accurate in reference to our actual diagnostic categories that you could get from a doctor and get covered by your insurance or anything.
4:55
In fact, some studies have suggested, studies of both presentations of autism on TikTok, presentations of ADHD on TikTok, have shown that well over 50% of the features said to be associated with ADHD or autism in TikTok aren't part of the diagnostic category.
4:55
So, what does this mean?
4:55
What do you do?
4:55
Number one, probably wouldn't go to your doctor, your real doctor and say, "TikTok told me I have this."
5:17
But what you might do is say, "Gosh, I was, you know, watching these videos on TikTok and it kind of struck a chord with me."
5:23
And it made me want to know more.
5:25
And I think that's what this stuff can be good for.
5:27
It can help you to open the door to say, "Gosh, if there are things that have been harder for me than I thought, or things that were hard for me, but it never occurred to me that it wasn't hard for everybody, what do I do with that?"
5:41
That's a really good thing to take to a doctor to get their feedback.
5:49
SiriusTow9303 asks, "Is Love on the Spectrum a good representation of autism, and are there better ones?"
5:51
That's a great question.
5:53
Love on the Spectrum is one of a small but growing number of shows that has actually autistic people being portrayed.
5:59
Some aspects of the portrayal and those relationships are kind of made for TV, like a lot of reality TV.
6:03
But I think what's really valuable about it is that it's taking seriously the fact that the best way to know autistic people or any neurodivergent person is to actually get to know them and see them and see how that community presents itself.
6:20
So if the question is, are there better ones?
6:20
I think the best representations are by autistic people representing themselves in their own experiences, either autistic actors acting or autistic people living and sharing their own experience so that we are not caricaturing but truly trying to appreciate all of the different ways that autistic and other neurodivergent people live and experience their world.
6:20
CobainiWitet1 asks, "What are signs of autism?"
6:20
The features of autism fit into two general categories: social communication and restricted and repetitive behaviors and kind of sensory stuff.
6:20
So social and communication might be kind of really straightforward difficulties with communication, language development, kind of speaking and communicating in kind of the ways that are expected for a person's development, as well as more complex and subtle social challenges like coordinating in social interaction, friendship making and connection, eye contact, non-verbal cues, picking up social nuance, all features like that.
6:20
That's the social communication side.
6:20
In the other side, the kind of restricted repetitive behavior side, you might have somebody who has like a really restricted interest or focus.
6:20
It could be like a topic that they're really interested in, or it could be, you know, a child who runs a car back and forth over and over again on the table or on their hand.
7:39
You also might have repetition of, you know, certain words or phrases over and over again.
7:49
There's this concept called echolalia where somebody kind of hears something and then kind of keeps echoing it back over and over and over.
7:49
And this also kind of loads on with these sensory features of autism.
7:56
Some folks on the spectrum again are can be very sensitive to touch or smell or taste or sounds or lights and that those kind of sensitivities can make it very difficult to be in those environments.
8:09
People might, you know, cover their ears and need earplugs to be able to manage certain settings.
8:14
Lights like like the ones in the room that I'm in right now might feel very bright and overwhelming.
8:21
They also might engage in something called stimming, which is a way in which, you know, folks on the spectrum might use something like this and kind of, you know, over and over again, kind of move it around as a way to kind of feel good, but it really it's a way to kind of regulate and manage that sensory experience.
8:21
Folks on the spectrum have lots of different kinds of stims.
8:21
They might hum auditory stims.
8:20
They might have visual stims like looking at their hands and finger flicking out of the corner of their eye.
8:47
And some folks have larger stims like rocking or even hand flapping or pacing back and forth.
8:47
Zoe Blade asks, "What is and isn't stimming?"
8:56
So, stimming is a term in the autism world, autism field, sort of a colloquial term for self-stimulatory behavior.
8:56
You know, kind of traditional sort of ideas of stimming are might be things like rocking, flapping.
9:08
There's this finger flicking thing that many autistic kids do, but it might also involve taking a toy and kind of, you know, playing with it like this over and over again.
9:23
And some people do auditory stimming like humming or maybe saying a word over and over again.
9:23
So again, there can be visual, there can be tactile, there can be auditory.
9:33
The best evidence about stimming is that it is a tool that autistic people are using to kind of regulate their sensory system which can often get a little bit overwhelmed and kind of putting that energy somewhere.
9:43
J Cartier 3 asks, "Is autism really on the rise?"
9:47
"Are we just better at identifying it these days?"
9:51
When we think about the rise in autism, we think about four sets of factors that could be happening.
9:56
Number one, change in diagnostic criteria.
10:03
So when you look at the DSM, our diagnostic bible, you know, back in the 1980s or even earlier, there were fewer ways to have autism and they generally required much more significant challenges to be on board.
10:16
You know, somebody who is developing language at a sort of usual rate and is integrated into school would have a lot of trouble even getting an autism diagnosis.
10:27
Those folks were there, but they weren't getting autism diagnoses back in the 80s, 70s, earlier.
10:36
It really wasn't until the DSM4 in the mid '90s that we even had these sort of broader criteria, broader ways of having an autism diagnosis.
10:36
And so that change alone has dramatically expanded the ways to even be diagnosed as autistic.
10:36
So that's contributed a huge amount to the rise.
10:36
The second is broader awareness.
10:36
And these things go hand in hand.
10:36
And so yeah, somebody who's going to their, you know, doctor somewhere in the middle of like a rural county in the middle of the country, that doctor, you know, 20, 30 years ago may have never seen an autistic person and may have never even thought to look for autism.
11:12
But now we know more about autism.
11:15
There are more representations in the media.
11:17
There's much broader awareness.
11:20
And once you, once folks start to see somebody who's autistic in their practice or in their world, they go, "Oh, yeah, I can kind of notice that."
11:28
The third thing has to do with changes in stigma and how autism is viewed.
11:30
So because of the first two things, all of a sudden, you know, the idea is it used to be that, you know, getting diagnosed with autism was quite scary for families.
11:39
For some it might still be, but much more commonly the idea was, what is that and what's going to happen to my child?
11:46
The last thing, the fourth, is a true rise in autism, even after correcting for population growth and understanding that the populations grow over time.
11:56
The best we can tell from really good epidemiological research over many, many years looking at millions of people is that the vast majority of the rise in autism is attributed to the first three things.
12:10
That is most of why autism is on the rise.
12:13
Quinn the Cats asks, "This is about to sound like the dumbest question ever, but what exactly is ADHD?"
12:17
It's not a dumb question, Quinn the Cats.
12:21
There are kind of three types of ADHD, and they kind of each answer the question.
12:26
One is ADHD inattentive type.
12:33
So, meaning folks with ADHD inattentive type struggle to pay attention, maintain attention, and they might seem to sort of, you know, wander off or have trouble kind of staying engaged in a conversation or on a topic and might struggle academically as a result of this.
12:45
Then there's what's called ADHD hyperactive type, and these are kids who kind of move all around the all around the place, have trouble controlling their bodies, have trouble sitting still.
13:02
There's an item on kind of the ADHD questionnaire that says, "Acts as if driven by a motor."
13:02
And I feel like this is the one when I talk to parents, often they're like, "Yeah, that one."
13:05
"He acts like he's driven by a motor and the motor doesn't stop."
13:09
And then there is ADHDC, which is the most common, which is the combined type, which is basically the inattentive stuff and the hyperactive stuff all mushed together.
13:17
A Redditor asks, "What did people with autism do in the past?"
13:22
So, the answer is that people with autism in the past did the same things other people did.
13:29
They existed out in the world.
13:32
There's a book called Autism in History that profiles a lord, kind of sub-lord from the countryside that makes the case that this particular person was autistic.
13:42
The idea is that he happened to be in an environment where his quirky way of being was notable.
13:48
He showed up, a lot of the stuff comes from court documents, but he had kind of all these supports and resources and things around him and he kind of went about his life in his kind of very unique and particular way.
14:00
So in that book, the court documents describe him as having odd sorts of movements.
14:04
They would say he would sort of ramble on in ways that they considered to be, you know, incoherent, but they said not unintelligible.
14:11
That, you know, they sort of were streams of meaningful words and sentences, but that they didn't really have a way to contextualize what he was saying and meaning.
14:22
Sort of in the same way that somebody on the spectrum might, you know, have a real strong what we call perseverative interest, like a fixation, just sort of talk about that without necessarily checking that the other person is following along with what they're saying.
14:22
DescriptionMean9351 asks, "People keep saying that I can't have Tourette's because I developed it at two. People say you have to be born with it."
14:22
You can develop tics later on and there are lots of different reasons and ways that tics can kind of onset later.
14:22
But yes, a person can start to develop tics at two or even or even later than that.
14:22
I screwed up real bad asks, "My tics feel half voluntary?"
14:22
So this is about Tourette's and other tic conditions.
14:22
So tics are kind of an interesting phenomenon.
14:22
The way, one way that people think about tics, is there's this sort of like surge of a feeling, a 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 can't be stopped.
14:22
The kind of historical way of thinking about it that psychologists sometimes say is that it's easier to stop a tic once it starts than to stop a tic from starting.
14:22
So half voluntary, the idea is that the sort of surge of the wave that of kind of compulsion that comes from a tic is might be able to be kind of diverted, right?
15:36
Maybe, maybe the idea is that, you know, if a person can feel it coming on, they might be able to say, "All right, I'm going to, you know, do this motion but not that, or I'm going to do my best to kind of hold it back."
15:46
So there's almost like this, it's like you can you can put a canal along the wave that you can kind of pick something about it even if you can't pick it.
15:54
Paper Joshi asks, "I never understood how hyperfocus is a symptom of ADHD."
16:00
It's a really good question.
16:00
So, ADHD broadly has to do with, you know, sort of difficulties sustaining attention, kind of hyperactivity, maybe working memory problems.
16:09
So, how is it the case that folks with ADHD can hyperfocus if their problem is focus?
16:15
Well, one way to think about it is ADHD can almost be seen as a as difficulty with the sort of lever that regulates your focus.
16:27
Often what we have to do throughout our day is take our focus and kind of pivot it somewhere else and say, "I'm focusing over here."
16:34
"I'm focusing over here."
16:34
"I have to give you my attention now and I have to keep doing it for as long as you need me to pay attention to you."
16:40
That is what our brains are doing.
16:43
Folks with ADHD might struggle to kind of do that shifting at the rate and the way that people want.
16:50
So they might kind of get stuck in like, "I can't really hold my focus here, so I'm going to kind of keep bouncing, bouncing around."
16:55
But they also when they do find something that is motivating, that is engaging, that is that they're that's interested in.
17:01
It's sort of like then they're locked into that and can't quite yank that lever off of that topic.
17:06
A Redditor asks, "Does reading improve with practice for dyslexics?"
17:10
The thing for dyslexic people is that the strategies that they need to use to get the words to behave the way that they need them to be able to read are learnable, are teachable.
17:23
They can take effort but then that effort like a muscle can get flexed and built over time.
17:26
And so in a similar way as that, right, folks if they are practicing using those skills and strategies effectively, things can get a little bit easier, but fundamentally they're still managing kind of a different way of perceiving that information to make it work for them.
17:51
Qgirl50 asks, "Is autism genetic?"
17:48
"Have they identified a gene?"
17:48
A lot of very smart autism researchers over the last 20 years have done the kind of work that you do in a petri dish with a DNA sequence.
17:57
They've done the kind of work where you look at really gigantic populations of people and look at kind of genetic markers.
18:02
And what they found is actually more and more and more specific genes, areas on the human genome that seem to be related to autism that have again this idea of sort of like an autism load to them.
18:19
And there's certain ones where they call them loci, sort of areas on the gene of the of of the DNA strand that if there's a little bit of a difference, maybe you can might see a little bit of autism features.
18:26
Sometimes if there's a lot of a difference, you might see more features.
18:31
So altogether what this suggests to us is a lot actually, well over 50, some estimate at least 70% or more of variation, amount of autism that's sort of out there in the community, in in the world, is attributable to to genetic factors.
18:50
TitanicMan asks, "Is there a reason why some people with Tourette's have swear words specifically as their tic?"
18:52
"Of all the words that could be their tic, why is it almost always profanity?"
18:58
So this is partially a myth and misunderstanding and partially not.
18:58
So it turns out a lot of tics are not profanity.
18:58
Many folks with Tourette's have much subtler presentations.
18:58
You know, they might be really small tics, little motor tic, you know, a slight smirk or a twitch of the eye or, you know, kind of a little head tic that can happen and and those are actually much much more common.
19:22
They're not as attention grabbing and so people don't necessarily notice them and call attention to them quite as much.
19:28
And so yeah, it's not the case that most people with Tourette's, for instance, have swear words as their tics.
19:37
It is the case though that there are a subset of folks where their tics are profanity.
19:37
It's a little bit complicated as to why and there's there's a lot of interesting research kind of trying to understand this question.
19:37
The best that I understand is that is that to some extent tics do have to do with this this kind of motivation and self-regulatory system, right?
19:37
There's this sort of urge, sort of surge, like you said before, and then this kind of, you know, pullback.
19:37
And the thing is, there are lots of things that we try to self-regulate about during the day, right?
20:05
We try not to have road rage.
20:09
We try not to steal our sibling's candy when it's sitting next to them.
20:12
And we try not to swear.
20:15
There's, you know, some evidence that suggests that, you know, that process might be getting wrapped up for those folks that that's that there's there's this sort of self-regulatory thing.
20:24
I'm not going to do it.
20:25
And the brain is kind of like, "All right, I'm going to push through the thing I'm really not don't want to do right now."
20:31
"Not meant to do right now."
20:33
And it becomes that thing.
20:33
And then it gets stuck.
20:34
That's one of the I think more intriguing ideas as to why when it's profanity, why it's that.
20:40
Estella like salt says, "Genuine question, if ADHD is viewed as a problem to where medication is taken for it, why is it not the same with autism?"
20:54
"This is a genuine curiosity. I'm not saying that either should be medicated. Please don't take this as I'm saying autism should be medicated."
21:01
Appreciate the sensitivity of Estella.
21:06
The answer actually is that has less to do with the idea that the medical field thinks that one should and the other shouldn't.
21:06
It actually has to do with the available medications that exist.
21:13
ADHD since the 80s has stimulant medications and then now other types of medications that help to manage attention and focus and self-regulation for autism.
21:24
The sort of quest for medication has even, you know, assuming that you're sort of believe in medication as being important, which, you know, many do, has been a lot more fraught.
21:38
As I've described, autism has these sort of two core areas, right, social communication, restricted repetitive behavior, and we've really haven't found many things that can really on their own help with the social communication piece.
21:38
Social stuff is a lot more complicated than regulating attention.
21:54
Same thing for restricted repetitive behaviors.
21:56
There's sort of some evidence of some things that can help a little bit if folks are like really, really struggling a lot with those things, but but for the most part that's a lot more difficult, too.
22:07
There are a couple of medications that are FDA approved to address things like significant aggression in folks on the spectrum, but that's really only for a subset of people who are experiencing those challenges.
22:21
And importantly, you might notice that's not a core part of autism.
22:24
A Reddit user asks, "Is there a way to treat ADHD without meds?"
22:27
Great question.
22:29
So, yes, there are behavioral and psychological treatments for ADHD and within, you know, kids and adults in childhood.
22:36
There are a number of kind of what are called like behavioral parent training or, you know, parent management type approaches, which involve helping to kind of boost what's called like the salience or the ways in which, you know, things that kids with ADHD might miss that they kind of need to do, helps them kind of attend to it by giving them lots and lots of reward and support and attention for kind of getting it right because many ADHD kids they kind of might know what to do or have a sense of what to do, but they kind of miss it in the moment or they can't figure figure out how to translate that knowing into doing.
23:13
BassBillions asks, "What does on the spectrum mean?"
23:13
Autism is also called autism spectrum disorder in the DSM.
23:20
Even though lots of different things are spectra, spectrums, lots of different conditions.
23:25
Autism has sort of come to be referred to as sort of the spectrum.
23:30
And what's really interesting is that autism has undergone an incredible evolution over the last several decades.
23:38
As recently as the 70s or 80s, people thought of autism as the most categorical thing.
23:44
You could go to, you know, psychiatry conferences and famous psychiatrists would say things like, "Well, if there's anything that can be diagnosed in a waiting room by watching a child for a few minutes, surely it's autism."
23:56
Because the idea is that autism was seen as so different, so categorical that you could kind of just spot autism when you see it.
24:03
And now it's swung all the way from being this really seen as so dramatically different that you could just sort of spot autism anywhere to being the spectrum.
24:12
The spectrum, the thing that is not about categorical difference at all.
24:17
And I think this tells us a lot about our evolving understanding of autism, but also our evolving understanding of the individual differences between people.
24:24
A Reddit user asks, "How does the brain structure of autistic people differ?"
24:32
Lots of really interesting research has gone into this.
24:34
Well, I think one of the big things I would say we do know more and more about these days is the idea of kind of the connections of autism.
24:43
There's this fancy term connectopathy.
24:47
It's a $10 million word there, but the idea that autism can be defined by a difference in the way the brain interconnects with itself.
24:51
And while this is still evolving, broadly speaking, there's this idea that autism has a lot more connections.
24:59
Autistic brains have a lot more connections kind of locally, kind of close by, little short distance neuron connections, but that globally kind of long distance connections across different regions of the brain, there seem to be fewer of them.
25:15
And there's actually even some thought that this might help to explain some some parts of what we understand about autism because maybe those short distance connections, you know, they might might be telling us something about some of the difficulties in sensory processing.
25:29
It might be like, you know, if you've got all these short distance connections going fire, fire fire.
25:34
It might be harder, you know, if things are really loud or things are really bright to manage that.
25:37
But then those longer distance connections which are used maybe for more broader processing or development or learning, those if they're sparser might take longer or might be more difficult for those connections to kind of grow and and learn.
25:57
Arcticos02 says, "What age do you think it would be appropriate to diagnose someone with autism?"
25:57
So one thing we do know is that autism is by and large with you at birth.
26:03
So by the time somebody is born their brain is sort of wired up in that direction if they are going if they are are autistic.
26:12
Those developmental trajectories can change one way or another in a variety of different ways, but that's that's by and large what we know.
26:18
So one of the goals actually is to get diagnosis as early as possible so that there can be support as early as possible early intervention and other kinds of supports which you can get in you know every state in America.
26:29
We want to make sure that those things are available so that folks have the best opportunity.
26:32
For years it was thought that three might be kind of on the earish side.
26:36
You know then would sort of push to two and and I would say you know clinically it's now possible using some of our best diagnostic tools to to diagnose toddlers even down to like 18 months some even down to 12 months using our clinical tools.
26:52
But increasingly diagnostic science in autism has really been picking up and there's there are are now some cutting edge studies using tools like some kinds of brain imaging and eye tracking that are promising for diagnosing autism as young as 6 months and maybe even younger.
27:07
So let's see where that goes.
27:10
Judicia review asks, "Does autism correlate with IQ or does high IQ correlate with autism?"
27:19
Headline here is that autism does not really correlate with IQ.
27:22
Autism does not discriminate by race, color, IQ or other features.
27:30
Autism exists everywhere in the world across the whole spectrum of being.
27:35
I think the interesting kind of tricky question here is that very often because of the different ways of thinking and processing that autistic people have, performance of a of autistic people on IQ tests can be really different.
27:47
You can have these big splits or sort of islands of ability where somebody might seem to have really strong verbal ability but then much less strong ability in other areas like processing speed or self-regulation or visual perception.
28:02
Or it might be the other way.
28:03
They might have great, you know, visual perceptual or processing ability and less ability in spoken language.
28:07
Pip D. Burley asks, "What myths about autism annoy you?"
28:12
"What is the reality versus the myth?"
28:15
There are a lot of myths about autism, but probably the one that is often most frustrating is the idea that autistic people lack empathy and can't understand the feelings of others.
28:26
This is very common kind of colloquial idea that comes out of sort of observing autistic people sort of seeming disconnected and sort of seeming not to pay attention to the needs of other people, seeming off to be in their own world, right?
28:37
Autism literally from the Greek, you know, means self-ism.
28:44
Autos is self.
28:42
And so there's this notion, I think, this implicit notion that autistic people are selfish, that they're sort of focused on their own needs and can't really feel those of others.
28:50
But actually, one actually autistic people will tell us all the time that that's not true, that that's not their experience at all, that maybe they might struggle to communicate their understanding in the same way, but that they can very much.
29:02
And and increasingly research even on very young and even you know minimally verbal autistic people shows us that myth really is a myth that autistic children and adults do co-empathize often sometimes quite profoundly in fact so much so that they're overwhelmed by you know the feeling of another person and that itself might interfere with the ability to express it.
29:25
That's all the questions for today.
29:26
Hope you learned something.
29:28
Until next time.