Episode 1 - Lesley

Episode 1 - Lesley: Audio automatically transcribed by Sonix

Episode 1 - Lesley: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Malia:
You're listening to the artistic Tea Party podcast, I'm Malia

Cat:
And I'm Cat. And together, we will be your hosts as we explore some of the hottest topics in the autistic and neurodivergent communities at large.

Malia:
We'll be speaking with parents, therapists, and experts, educators and more to dig into the more nuanced discussions being had in and about the disabled community.

Cat:
So join us as we sip and spill the tea.

Malia:
This is the Autistic Tea Party podcast.

Cat:
AuTeach has been hard at work to bring you some of our greatest content yet, join us this summer for 12 weeks of free and brilliant webinars every Wednesday starting June 16th at 8:00 p.m. Eastern Standard Time. When I tell you that you're not going to want to miss a single talk, I'm not saying that lightly. We've got therapists, educators, parenting experts and more so head to auteach.com now to see the line up and get your tickets to the event. We are so excited that for our very first episode ever, we were able to speak with Dr. Lesley, or as some of you may know her at @lesleypsyd on TikTok, we got a chance to dig into some of the common debates that come up around and the similarities and differences between autism and ADHD. We hope that you all find this super helpful and learn as much as we did. So, without further ado, here's the episode. Leslie, would you like to tell the listeners a little bit about yourself, what you do and what your content on to talk is about?

Lesley:
Sure. I am a licensed clinical psychologist. I've been licensed since two thousand and ten, and I've done most almost all of my work with neurodivergent populations. I started doing neuropsych assessment and then moved into autism specific treatment. And then now I've kind of expanded out. I do assessment and treatment for a neuro divergent individuals across the lifespan. I do have a little bit of a focus on LGBTQ neurodivergent adults, and my TikTok content is mostly about ADHD and autism. It's also a lot of my son Ben, who loves being on his board and loves me, kind of illustrate some of the concepts. And it's really intended to kind of humanize the field of mental health therapy and also give people more access to information that has been kind of behind some gates in the past that

Cat:
We were really excited to have you on, particularly because sort of leading into like our first question that we wanted to talk about, which is, as you know, on Tiktok, the ever present debate about autism versus ADHD has been, I'd say, like every, what, three or four weeks it rears its head again. And then there's this big knockdown drag out. We've just kind of want to get your thoughts on that, because I really appreciated your perspective throughout this whole thing on it, because it seems like a lot of times something the autism community has tried to continuously point out is that a lot of times when people describe ADHD, they're describing overlapping symptoms that we find in autism. And there is almost a sort of hesitance to even consider the idea that perhaps it is one the other or both and that that's possible. So could you explain to us sort of the. Distinct differences between ADHD and autism and then where the overlap is.

Lesley:
Sure. The major overlap between those two conditions is the idea that they are neurodevelopmental, neuro, meaning neurological, brain based, born with you and developmental meaning, we see them in the developmental period. So they're not triggered by something in adulthood or caused by something that happens to us. They're born in. And any time you have a neurodevelopmental condition alongside others, it can get a little confusing because those symptoms or traits emerge over time. I also think that one of the challenges with ADHD and autism and the reason there is this very spirited debate is that the autism community is still gaining their voice. The ADHD community has had our voice for many years because we are not predominantly a communication based disorder. So the research has advanced. There have been more active disability rights movements in ADHD. There have been a lot more funding for adult ADHD research and there have been more people who have been able to advocate the autism community or actually the non autism community is just catching up to the idea that autistic people actually do grow up and are not just children. And so what's happening is I think we're seeing the autism community really have their first moment to speak. And any time that happens for a marginalized community, the other communities that have had that place to speak often don't like that because it will shift the power dynamic.

Lesley:
So I think that's why it's happening. The major differences between the two is that ADHD really focuses around this idea of executive functioning. So if we think about the control panel of any kind of machinery, and this is going to be a very inelegant example, but very generally, the control panel tells us how to do things, when to do them, why to do them, to what extent, when to stop really controls all the ways that we behave. So that executive function system is where that impairment lies with ADHD, and that can affect other things like sensory stimulation or social interaction. But social interaction and sensory stimulation are not the core difference. They are affected by this executive function disturbance. Autism Spectrum Disorder seems to be a neuro type where there are these kind of core differences in how the individual experiences the world and they are not centralized on executive function, they are centralized on communication, sensory differences, social differences, some ways of learning that are a little different. And so that's how they're very different. The difficulty can be that they can look similar to the untrained eye. And so that's where we get all the debate and argument

Cat:
And the like. Can you speak about like and I don't know if there's numbers or statistics behind this, but the chances of the two being co-occurrence, is that relatively common?

Lesley:
It's extremely common. Some estimates say that up to 60 percent of individuals on the autism spectrum also have comorbid ADHD. It is slightly lower and they don't have the exact number, but it's slightly lower for primary diagnosis of ADHD. One of the complicating factors is that about 10 years ago, there was a genomic study that was released that found that ADHD and autism share very similar genetic differences. And that was kind of taken that little bit of evidence was in and run with. And it got very confusing for folks because we also shared genetic markers with oak trees, but they are not the same. So that's the beginning of understanding important differences. That's very different from oak. Trees are valid as well, but we are not oak trees. So I think the challenges are so much exciting research that when something new comes out, the media, especially when they have a flashy headline, we want to run with it. And when you're a mom of a or a dad of a young child and you hear that, that might be something encouraging. And so we have to do better as the practitioners and the scientists at delivering the science to the public in a way that is not sensationalized, because that's what's causing a lot of this confusion.

Malia:
So. With all of the contention, I guess it's between the communities, what? I know that the big thing is like the language, like the language that kind of distinguishes one from the other. And I know that you have used certain language in some of your tick tock videos that you use to describe your ADHD. That is different than what other people with ADHD might use to describe. That is similar to what autistic people use. Can you tell us a little bit about some of that?

Lesley:
Sure. My my favorite distinction to make is masking versus suppressing or containing. I use suppression or containment for ADHD symptoms, not masking. And here's why. If you imagine. Being in a pool, which would be lovely right now, it's very hot in Virginia and having a very full beach ball and having to submerge that beach ball and hold that under the water for the first two seconds, that's pretty easy. But if I told you to do that for five hours, it would be very difficult to focus. You would be very tired and depleted and at some point that beach ball would explode back to the surface. That is what suppression of ADHD symptoms is like. It is a suppression, a holding, a sense of baring, of coping. There's all these different words, but it's this tension and then it comes out usually at home. That's why we see a lot of ADHD kids overfunctioning at school and then having meltdowns at home, sensory regulation and and and social communication and masking is actually a very different phenomenon. It's not a holding down. It's a creation of another Way of interacting in the environment, that can happen in many ways, you see many individuals on the autism spectrum, my own child included, who will take bits and pieces from media, from cartoons, from friends that they love, and they'll incorporate different coping mechanisms into this mask. And that's why the idea of masking for me is a very important term to respect for the autism community, because that's what it really is described like for folks that I've worked with. I create this persona that assists me in interaction, and that's very different than a suppression of a trait that then reemerges. So I'm very particular about language. I've been very open about that, that I'm perhaps annoyingly particular about language. I understand, though, that communities also have the right to self determine what what word fits for them. And so for me, suppression and coping is helpful for others that may not fit. And that's OK to

Cat:
And I say we because I know many people in the artistic community when this is the first time I ever witnessed this debate again in real time, I was really impressed with how you handled it. And we were like, oh, OK, we got it "we're Team Lesley", OK, because that was really it was such a funny experience because it really separated like I mean, it was pretty polarizing there. And there were a lot of people who really kind of like ran the other way and distanced themselves from the autistic community. But Robyn always brought this up, Robyn, where people are saying that it's a word, it's hard to find another word to describe that experience. And then what Robyn brought up, too, is that the autistic advocates that came before us, it was hard for them. They made up that term for their experience and everything. And so it was really good to see people kind of rally around that and respect the language of our community and how difficult it was for the people, the disability rights activist, autistic ones that came before us to actually put the labor into coming up with those terms.

Cat:
It was really nice to see that respected by some people, but also so I wanted to circle back to this idea of masking when you said because from my experience with masking another interesting component to it, where you said your son picks up bits and pieces from friends and from movies and from, you know, for me it's music or like other people that I'm around books, things like that. And an interesting struggle that I've had. And I'm not sure if this is true, too, but it's also difficult for autistic people to know where they begin and the mask ends because it seems like those things sort of meld into one experience, and especially if you're someone who has gone undiagnosed most of your life. The moment that you do get that diagnosis or you self diagnose or something, it's almost as rediscovery process about who you are as a person because they are so intertwined and it's hard to know where the mask. And so is that a common experience? Do you think, for people or that you've heard of?

Lesley:
But that's one of the most common experiences in one of the most common questions that I get asked from my clients who are autistic is part of the work of therapy and work of unmasking is also a grief process, because as people rediscover themselves, they may discover that there were parts of themselves that are beautiful and wonderful and have been so fully masked that rediscovering them is is almost like a lost realizing a lost time. I could have been doing this one. One of the easiest examples of this is a client that I was working with recently who came into session and had a vision of all kinds of digital toys and some fabrics. And she had basically gone on a buying spree. And we did what I call a survey, and I do that a lot with my clients. We went through all the things and found the things that felt good and felt right for her so that she can regulate. And she found it, makes me a little bit emotional, to talk about it. So she found this piece of fabric and she held it to her face. I just need one moment because I'm baby, by the way, I cannot watch talent shows so proud of them. I cry every time I put them into your face. And she said I could have gone to birthday parties and gone to parties if I had had this little thing someone had allowed me to do. So it's so powerful to to really watch people get reacquainted with that. But we have to really think we have to protect that as professionals. Because the other thing I see in my office is a lot of my clients that do get diagnosed go out into the world and begin to do this work of unmasking and then get marginalized for them. And until well, all of a sudden you're autistic. You never did this before. You never rocked before. You never stand before. So it's our job as professionals, I think, to really care for them in that space and wait until they're safe enough to feel like they can work on that unmasking over time.

Malia:
I totally get that. I literally was told by my therapists, like, you need to stem often. Like, sure, maybe you grew up suppressing it and like you don't even think about it now, but like, I should probably do it. And, you know, if anybody says anything, you know, they can fight me.

Lesley:
So I'm going to be a good therapist.

Malia:
They're they're incredible. One thing that, you know, speaking of like sensory things and whatnot, like a big thing and like the whole the back and forth of our communities is sensory issues. And how they're different and I don't think we can go forward without talking about it because it is nuanced and even whatever people do, even a good job, the creators who are not therapists, it's like so much to remember that it's like I wish I had a place where it was like written down or something and so love to. Bring that all the people who are going to listen to it have a place that they can come back to to understand that, yeah,

Lesley:
You know, I think the most important thing to remember with anything sensory system related is that everyone who is currently alive has a sensory integration system. It is not something that you have if you have a diagnosis. We all take in massive amounts of information into our senses every day, and we all have very unique ways of doing that. So someone without a diagnosis, a neurotypical person, has a sensory window for different things. You may have a totally neurotypical brain or what we refer to as neurotypical and not like tomatoes because they're squishy and gross. That does not mean you have a sensory integration issue. That's just your particular interaction with that sensation. What happens with some of the neurodevelopmental disorders is that that sensory system interacts in a way that is very different than most people, not a little different here or there. But the experience of the world is globally different to an extent that it's noticeable and it may impact functioning. That's the preamble. Here's the difficult part is how do you know how do you know what what this means? And does do ADHD folks have sensory issues? Well, yeah, they can. Yeah, anybody can have a sensory issue. But the differences between sensory processing differences with autism and ADHD really goes back to that initial question. The executive function system is the primary difference for ADHD. So, for instance, I don't know if you can tell, but I have to have a chair that rocks my chair rocks not because I need to rock to feel grounded, because when I have this stimulation of the chair rocking, I can focus on you more.

Lesley:
It allows my brain. It wakes up the part of my brain that allows me to focus. That's why fidgeting for me is a better term than stemming for ADHD, because the fidget helps wake up that part of the brain. But I'm not struggling currently to process what I'm hearing and smelling and seeing. And the fan is going and I can hear that. But that's not distracting. So individual sensory experiences. Can either distract me from what I'm doing or they can help me attend, but it's all related to executive function. The core differences with sensory integration with the autism spectrum seem to be very different. They're really about the window of tolerance being either a lot wider or a lot narrower than other people. And so in that way, if there's a if there's a stimulus that's not within that window of tolerance, the functioning of that person decreases. It's not just the focus. They may actually have an internal emotional reaction. They may not be able to speak. If they don't have if they're not within that window of tolerance, they may become angry and not understand why they may have a physical sensation that causes them to injure themselves with certain textures of clothing. So it's a qualitatively, really different experience. What I find is that many, many, many teachers who say, but I do have these qualitative differences in sensory processing might need an evaluation for autism, might be that they have two overlapping conditions. Yeah, I don't know if I answered the question, but we got somewhere

Cat:
I don't know we did and we got the interesting thing because that's something that we see a lot. And I feel like it's from an autistic perspective. I think that there's a lot of things that are also part, you know, ableism and also a stigma of a label. Right? Where part of the hesitation to call a spade a spade is that you don't like being called a spade and so you don't want to do it. Right. But then you also get people who are like, oh, you have you get like stacking diagnoses, like you have a sensory processing, you have a social disorder, You have OCD, you have anxiety and ADHD. And you're just like you've literally just in the most roundabout way conceivable all but called a person autistic. And it's interesting. I don't know what I guess I don't understand why from a diagnostic perspective, that makes more sense. Then. Just saying that a person is autistic, do you think it comes from not understanding how autism can present and then in a lower support needs way, or do you think it is from sort of institutional place as well?.

Lesley:
For sure, both for sure. One of the things that I don't talk about a lot on Tick Tock and I probably need to, is that the core of your knowledge clinically as a diagnostician is a person who is diagnosing these disorders, comes from your graduate training that that you form a core of your way of approaching diagnostics? Now, the way that this field is supposed to work is that we have continuing education. We need to continue to improve, but there is no police for them. So if you are an ethical diagnostician who is reading research and attending conferences and listening to folks who are autistic, who want to put a little emphasis on that, because we're lacking in just a little bit, you may draw back to your training. And I will tell you, my training wasn't that long ago and I was taught that there is high functioning autism and low functioning. And when a child is getting a low functioning level, you need to be very careful to help the parent prepare because those kids are probably not going to be self sufficient and that if they are in between, you might want to give them higher functioning because that helps the parents emotion. That was not that long ago that we were using this language that is really, really disturbing. We think about it now. Now the field has progressed, but if an individual clinician has not, in fact, this to happen to a client of mine, two weeks ago, they went and got a diagnosis, got the correct diagnosis, but we're told congratulations in this binary range of autism. You're way up here, Gratz. Thumbs up. That's great. And we had to kind of deconstruct that a little bit. So I think that there's there's both there's the knowledge base you have to keep updating. It doesn't just download from the universe. You have to put effort in. And then there is an incredible amount of internalized ableism that is supported. Not just ableism, there's internalized racism and classism. There's a lot of barriers to care. There's a lot

Cat:
Of is well, that's sort of it. Since we're on this, let's just keep this depressing train rolling right into the discussion of self-contained education. Versus general education, self-contained classroom settings listeners may not know is just a classroom in which everybody is disabled are learning disabled to some level. So I saw a tick tock that you made a few days ago, talking essentially about the problems with self-contained education and sort of systemic issues with the school to prison pipeline and then social isolation and things like that. Can you explain a little bit about some of the problems with the self-contained education, but also why it is so hard to move away from it at this point in time?

Lesley:
Yeah, well, some of the good news is that we have data about why extensive self-contained classrooms don't work because we did it. We did it in the 60s and the 70s. We removed all of the children with emotional disabilities and autism and severe ADHD. And we put them in therapeutic treatment programs, which we still have as a service. But they used to be a separate school. I have a little bit of insight into those because my mother ran a program for twenty five years and I got to go hang out there as a kid. So I've got to be in those classrooms. And I had days off back in the day when apparently there was no boundaries between work and home life. And then as a young professional, I got to work in self-contained classrooms doing behavioral work early in my early in my career. And the data suggests a couple of things. Kids do better. All kids disabled nondisabled children. When their classroom includes a variety of human beings, they just do. The actual grades of the students improve when we use inclusion, because what happens is differentiated learning becomes a requirement for every teacher. Instead of having regular ed teachers, which I hate that term, you know, like this stuff only and then special ed teachers which know this stuff only, we are then requiring teachers to have a variety of skills because all neurotypical kids, I don't know if everybody knows this, don't learn the same. So it increases the differentiated learning in the school environment. It also increases social skills for both neurotypical and divergent kids, and it improves access to higher levels of learning.

Lesley:
One of the things we do know about self-contained classrooms is that they tend to lower expectations for all children in those classrooms, regardless of ability. That does not mean that there's not a place for self-contained classrooms. I have a very particular view about education that I don't think will happen any time soon, but I think it should be completely deconstructed and built from the bottom up, basically, that there should be a variety of learning environments available to all students and it should be placed in the learning environment that is best for them. Obviously, we want to stay with the least restrictive environment, but that may mean that while no one I think that all public school teachers should have an aide in every single classroom that is trained and highly trained in intensive classroom management skills that are based on communication, and I think that would solve a lot of our issues. But the other problem was self-contained classrooms, is that we know that, by and large, children with more severe disabilities and children of color get placed in this classrooms because the teacher doesn't want to deal with them and because of internalized racism. And we just know that. And it's OK to say that and doesn't mean that everyone's a horrible person, but we will never be able to stop those processes until we as a system are able to acknowledge that the numbers are incredibly disproportionate. Yet there is goodness, too. Well, we can get to totally agree.

Cat:
I think that that's I mean, there's a lack of it. As somebody who has been you know, I've worked in classrooms as a one on one, even the parent educator and things like that. I've seen this play out because this is is difficult. And you can understand from sort of both perspectives where, you know, when you do have a child who is not resourced, that is disabled in the classroom with more neurotypical children, that it is distracting for the other children as much as it's distracting and not resourced well for them. And so you can understand the frustration that that's there and that it's primarily caused by a lack of resources and ability to have, like you said, the AIDS in the classroom and just leads to frustration all around. You know, also, let's pay teachers more. How about that?

Lesley:
Huge. That is really a huge issue is that we have a lot of criticism for teachers that is well earned. But most criticism is actually not related to teachers at all. They are just the face of the challenge. The real challenge is that there is no teacher shortage. There's a shortage of people that are willing to work under those conditions. Yeah, those children that that for safety reasons have to be removed from a classroom, even though that's hurting their learning. That's not happening usually because the teacher is a horrible human being, because there's just no resources. So we have to keep focusing on the system itself, not holding teachers accountable, but not the rest of you.

Malia:
So you're a parent. So if for other parents who have more divergent kids and they're overwhelmed by the system, by everything outside of school, just parrot life and everything that comes with that, what things you typically suggest for them, like books or videos or just tips that you've, you know, accumulated over the years?

Lesley:
I think Tiktok itself and acts like it can be an incredible resource to connect directly with parents, especially now that I think the age of Instagram and the age of presenting ourselves in a different way is changing that. People like me who are professionals and do this for a living and appear to be all together, also get to showcase the times that I get stressed and stuck and have to reach out for support. So really trying to get access to media in those communities, finding other parents who are struggling in the same ways that you are and asking for support for yourself in addition to parenting, support and ideas and literature, but also just someone to talk to about the struggle. There are some books that I absolutely love. I tend to work more with them specific books. But if you have an ADHD child, any of the books by Sari Solden, your name is spelled out i. S o l d and they give you a good foundation of where you're headed and how to prevent ADHD from becoming an internalized shame process, which is what we see with a lot of kids and teens. I've had some really good reviews lately from my clients on a couple of books. One called Loud, one called Sincerely from Your Autistic Child. I would look for specifically for autism, looking for books that are written by autistic individuals. You can see there's lots and lots of books by all of us, by all the psychologists. You can throw a rock on Amazon, find.

Lesley:
I would primarily look for the experiences of people in the community because that's going to give you more insight into your child's experience. But the other process that I suggest for parents when they're feeling overwhelmed is actually a process that I call the bridge. And it's really easy. It's just four steps. So it's imagine where you are now. Both it's going well and what's not going on. So when does your relationship with your child shine? When does your child seem regulated and happy? What is really hard for them? What's really hard for you? And then imagine across the bridge what you wish. Out like to move through your day, there's a reason I don't ask parents, what do you want your child to do instead? Less important? What do you want your life to feel like? How do you want your child to feel in their environment? And then ask yourself in the middle of that bridge, what is getting in the way of that? Usually it's three things. There's a missing skill. Weather cannot be a skill, there's a missing support, and then when there's emotional dysregulation, is there a missing therapy? And that's where you target as a parent. So what skills to me does my child need to acquire? How can I help them acquire? What supports do they need when they're not going to attain that skill? And what therapies can I engage in to help them cross that bridge for me and my work life? That process has been more effective than any book you can find.

Cat:
I was gonna say that that's a really great way to frame it and to look at it, too, because it seems to me that that's not such an outcome oriented way of going about things as it is something that helps build intrinsic motivation in kids, which is something that we have this discussion a lot on, you know, "Aba Stinks" Tiktok. But the whole idea that it's working for some specific defined outcome as opposed to sort of how you framed that, how would you like your day to feel? How would you like these things to pan out for you? But it's not a specific like, you know, you get an A on this test. We'll give you this if you get there. And then there's this sort of like I was thinking about this a while ago, too, but it's really interesting to me that that's so commonly accepted because at the same time, it's like it really create a sort of environment of people who only do things for an outcome. And there's not really a intrinsic motivation to just do things because you're like that would be nice for that person. That would be kind for that person. And so it's sort of like this individualistic outlook on things. And I really appreciate it.

Lesley:
Yeah. And I am in a little bit of a unique perspective because ABA is how I started my career, I did ABA for many years

Cat:
I did not know that. I was a reformed RBT.

Lesley:
Yeah, I was a skills trainer at the time that we were. Yeah. So I've before now this is an ancient right. So this is before became thing. They didn't exist. And luckily for me, I was working with a team that looked very different than what you would see. Now most of the things we were utilizing at that time would not be anything I would go anywhere near now because one of the issues is inherent in some of the behavioral theory is what we only teach. Do this for that initially and then we generalize. But how many of these kids ever experience generalizations? Very few. It's very difficult to move from if this then that to generalization. One of the ways that we see that work best is if you think about how we educate children from first through third grade and what happens in fourth grade from first through third grade, we're teaching how to read, how to write, how to sit in your chair, how to listen to do things, the actual physical skills. And at that point it is a little bit mechanistic. Let's do this and then this. But very quickly, in our education, we shift from now that you've got this basic skill, we're going to use that skill to experience the world experience learning in that way. So just in that way, when kids are infants, we do lots of things that are more mechanistic. So when they smile, we might smile back. When they cry, we give attention. There's a lot of early back and forth, but as they move out of infancy, if we retain that mechanistic way of moving forward, we're actually holding them back because at that point they're ready, they're ready to move forward with expanding the ways that they interact with their world.

Lesley:
And so that's some of the beauty of the way that the science is going and the way that a lot of our practitioners are going. And on social media, there's some great examples of that, of really looking at relational learning. One of the reasons that this has been an issue is because for so long the trope was autistic individuals can't learn through relationships. That was really, truly a belief for a very long time that it's not possible. So we're not going to do that now. Thank goodness that's hopefully gone. And so we're moving away from that. So, yeah, I like I like the process of crossing the bridge, because when we think about what do we want our child to feel like that it's all children. But also that's also another thing we tend to do is when we think people ask all the time, how do I get my child to learn this skill? And I'll tell them I have no idea because I don't know what your child's language ability is. I don't know what that means through the world. And we don't want to exclude these children and adults who don't have access to verbal communication, who don't have access to mobility. And so thinking about moving. The world is a way to include everyone and target interventions for whatever their goals are.

Cat:
So we have an interesting like I was looking the other day, and it's always distressing when you Google autism because it is especially, especially when you're Googling autism in relation to children and emotions, because a lot of that stuff that comes up as will, my child ever show emotion. Will my child ever love me? When will they say they love me? And it got me to thinking, what are some ways that children who aren't or divergent show affection that may differ from neurotypical children?

Lesley:
Now, there are so many. I think when I talk to parents about this, I do start with one small caveat that I try to phrase as gently as I can. Sometimes it doesn't go over very well, but it's very necessary that when we have children, it is our responsibility to care for them. And when we are seeking validation for ourselves above their well-being, we need to be able to. Not that that's abnormal. We all want we all want the. I love you. But when that is your goal for their treatment is that someday with treatment, my child will say I love you. That's a little red flag that we may have unresolved things that we need to to counter in therapy. So if you're a parent that feels that it's OK, just notice that and make some time for you with a professional to kind of work through what that is. And I see myself. So I'm I'm also in that category. But to I think, you know, one of the most exciting things about being alive in this time is that the research is showing us that there is an unlimited way, unlimited ways to be in the world. So one of the biggest things to do as a parent is keep your eyes open for the moments I have seen. I have done parent child therapy. I'll give you an example. I've done parent child therapy with a child on the spectrum and a parent who is neurotypical, whose primary issue was we are not connecting, we are not connecting. The child have actually become quite physically aggressive, mostly because of some therapies that were not appropriate.

Lesley:
And I taught some aggression by accident. So we were trying to unwind that. And the father's challenge was she just never wants to do anything with me. But what he was looking for was the neurotypical expression of that. So I want to look at me. I want her to tell me I want to play with you. What we did over time is we allowed her in a variety of toys in the room to move through the room freely. Sometimes that meant throwing sand. Sometimes that meant hitting the chalkboard. But I wanted her father to just be. And all he did was be in the room with her, moving around with her. And then there was a moment. Where she was rocking and she had a piece of paper in front of her and he started rocking with her and she looks at him as if like, what are you doing? And he rocked with her. And then he took the paper and made an airplane. And she took the airplane and threw it in the last like you had never heard before, and that is one of the ways now that they cannot. She is also but she does not connect through vet calls him by his first name because she doesn't believe his own death, which is one of his concerns. But now they make paper and that's how they do. So a lot of times it's really not about what is my autistic child doing to validate me. It's how can I unwrap my ideas of what connection is supposed to be and look for what's already there to know my child in an authentic way.

Cat:
I don't know if there's anything to this, but do you think that like because I was just finding it kind of interesting, you know, the stage of development where children are sort of in parallel play mode where it seems to me like I've come up with as a peer educator a lot with autistic children. It seems like a good way to connect where I find a lot of parents and they overstep that boundary a lot with kids where they try to be like, well, let's do this together and I'll color on the same page. And this inevitably ends in a meltdown because I know something up because they didn't know the plan and all that kind of stuff. But is that like sort of a way that people can connect in that way, or is there anything to that, like idea of parallel play with autistic children?

Lesley:
Yes, one hundred percent. Yes. That parallel play is unique in the past, has been regarded as a stage. Children go through and come out of that. And they that was kind of one of our able assumptions and a lot of children do. And then they want to interact. But a lot of neurotypical children don't want to play back and forth either. I think you just might see it in a more pronounced way with individuals on the spectrum. But absolutely, parallel play can be a safer way to engage with children. I think it's also a way for parents to slow down and to not look at play as something to be accomplished. We played poneys. The play is just something that happens. In the moment, there's no rule it doesn't have to go a certain way. One of the things that I find most fun to do with some of my family clients is have them dump Legos in the center of the table and everybody build their own thing. There's no other rules. And every time the parents will raise a hand and say, oh, OK, so when we're building or we like asking each other questions and I'll just say, no, just don't build your stuff co-exist. Just be. Yeah. And sometimes that results in conversation and interaction and sometimes everyone builds a cool Lego structure and then we put it away. Yeah, that's OK. There's no right way to be a human right.

Malia:
So this is a really important one because I've seen this a lot, the talk because there are comorbidities way beyond just ADHD when it comes to autism, the discussion of medications and even the topic of medications when there is no known other known diagnosis outside of autism. Are there any benefits to medicating a child that has an autism diagnosis or when would that be appropriate?

Lesley:
So one of the most important things for me when I speak with parents is to remind them that medications treat traits or symptoms that they don't treat diagnoses. I know that seem strange because we think of methylphenidate treats, ADHD methylphenidate does not treat ADHD methylphenidate. Is a stimulant to the central nervous system, specifically affecting parts of the executive function system, taking methylphenidate doesn't make you less ADHD. It just assist you with some of those symptoms that get in your way. So we don't there are there are no medications that treat autism. That's what that's what I get asked all the time, is what medications treat autism? Well, the good news is we don't need a medication to treat autism because it's OK to be autistic. We don't need to be less autistic. However, some people on the autism spectrum have a particular constellation of experiences that they find extremely distressing. One of those can be folks that find that their version of needing things to happen in a particular way. Is so extreme that it can actually create mood related symptoms and it can lead to a depression despite their despite coping mechanisms, despite supports, there are some individuals who have experience of feeling cognitively rigid, so much so that it distresses them if that is the case, something like that.

Lesley:
There are some medications that have pretty darn good effectiveness for that symptom. And this is see, this is where I get really hung up on language because I just don't want anyone to ever suggested that. I'm saying if your child is autistic, you should medicate them for the autism. That's not the case. No. Yeah. Sometimes individuals who are autistic, who also have ADHD benefit from stimulant medications. Being autistic in a non autistic based world can also be set you at higher risk for things like experiencing traumatic experiences or experiencing anxiety and depression. And there can be medications that also assist in treating those things. And each individual really should have a treatment plan that fits them as an individual and not something that is just prescribed for their overarching diagnosis. And age wise, we don't usually recommend medicating children. Under age six, although that can happen and I have recommended it for some very severe cases, but typically you really want to give some of the things a little bit of a chance to help support and cope and see where we are left with.

Malia:
that makes a Lot of sense.

Cat:
So, for example, when you're talking about medications that treat, like you said, they they treat to a certain extent, but also like. For someone, let's say, for example, like for myself, I am someone who was diagnosed late in life in my 30s and I have dealt with years and years and years, I mean, my entire life with anxiety and because I was not aware of what was causing the anxiety. You spent a good deal of your life thinking that you are exclusively dealing with things like anxiety disorders and coping with that. How do we begin to unmask in a way that can help us discern what is like an anxiety disorder and what is anxiety induced by living in a world that doesn't allow for divergent people to really cope? A lot of times

Lesley:
I think that you are asking a question that we are still in the very beginning of answering. And I don't know, we are still debating whether anxiety and depression are, in fact biologically based for some individuals or if it is an epigenetic kind of. Collaboration there where you can have a predisposition, but you need something in the environment to trigger that, we're still not sure. We do know that medications effectively treat anxiety and depression for a lot of people. So I think that question is really difficult. One of the ways this this happens for ADHD as well as my brain wants to pull me that way. I'm going to stay focused and then I'll get a at. One of the ways to do that is to imagine the things or or scenarios or experiences that make you the most anxious after you get this new diagnosis and then kind of rewind the tape and imagine, OK. If I assume this is an auto related challenge and not something I was born with in terms of anxiety, how would I cope with that? What kind of supports would I need? And then probably one at a time, which can be cumbersome and kind of take time, go in that direction.

Lesley:
So access that extra coping. And I'll give you an example here in a second and see what happens. So if you feel better, if things are starting to move in a direction, all of a sudden that may be a good indication that your anxiety was a symptom rather than a separate diagnosis. I have a really good well, you know what? I have a really good example of my client with the with the fabric on the cheek is also diagnosed with generalized anxiety disorder. And as she's discovering how much her sensory integration system is affected specifically by noise and light, she's experimenting with herself. So she is going to a place that would have been overstimulating with it, with an exit strategy in mind, so that that anxiety is lower. I can leave if I want to. I do not have any obligation to say neurotypical spaces if they over want me, and then using sensory input, unmasking in ways that are safe. And she's finding that the anxiety that she was medicating is actually going. So that might be one way.

Malia:
Do you think that there is a benefit for you from your perspective of being in our divergent therapists for Neuro?

Lesley:
Yes and no. This is a fully safe place. So I do definitely. Yes, for part of it. Because one of the things that I especially when I'm working with late, I was also diagnosed I was diagnosed at 30 with ADHD, especially with late diagnosis individuals. When they are communicating their symptoms and their grief, they don't have to do as much labor describing. They don't have to try as hard. So they'll say like, well, to start to describe a symptom and I'll nod and they'll say, oh, you understand? Oh, yes, I've lost a job for that reason, or I lost my story, lost my debit card three times this year and it's only halfway through the year. So, yeah, I think in terms of the labor of my clients is less that we can be in that space together. And I think that helps them just breathe and relax. I also think it helps with the variety of coping mechanisms I have. I have a little bit more of a of a treasure chest to pull from mentally, and that helps. I will say, though, that there are some pretty significant downsides to being a therapist with my ADHD is classified as severe, even though I may not appear that way. There are times where it is quite inconvenient to forget to reply to an email or forget an IEP meeting that I was attending or blurt out something that I was thinking in the middle of someone describing their grief. So I also have to do quite a bit of set up. When I meet clients, I disclose immediately because my symptoms and traits are severe enough that they will notice. That helps me also do the self acceptance work that it is OK to self disclose. And if that doesn't work for someone, they don't have to work with me. That's OK. So I think there's pluses and minuses on both sides.

Malia:
That sounds like there's a lot of room for your own RSD and all of all of that. So much. I was like, I can feel it

Cat:
It Hurts so bad.

Lesley:
I got yeah, I have I have a client that I work with who is autistic, who we've been working with for quite a while, each other. And I appreciate them more than I can ever express because he and I told him in the very beginning, I want you to know this is a safe place for autistic people. There is nothing you can do that will make me angry. As you are comfortable and asking you do that. It doesn't matter what happens. I will never be angry with you. This is your place. And so he knows all my tells. When I am struggling to inhibit a blurt, he will just tell me. Just say it. I'll stop myself. All right. Just go ahead and be like, OK, thank you. You say the thing and over time has built this beautiful kind of back and forth. And we actually remarked on it together that look at this space we have created where you are fully yourself and still are able to provide me with competent therapy and I am fully myself and don't have any fear of being rejected. And that is my dream for all of our mental health services that we can achieve that everyone.

Cat:
I'm taking notes for discussions with my husband.

Malia:
I mean, I can say is somebody who's in therapy, most of the time, I feel like it's better for something to just be blurted out than to be said in a way that's like perfect and like that therapist, perfect, perfectly thought out, formulated, whatever. Sometimes I'm just like, just just give it to me. I already know. I know. Something's coming. It's fine. I know what you mean. Even if you blurt it out in a way that someone else might take, is you being whatever like not nice or something like. Yeah, I will tell

Cat:
You it's like a special, it's a special place to be with. And so I have autism and ADHD, but mine's like way more inattentive stuff. And my husband is very like the person who will interrupt and work things out. And it's a special experience to be trying to finish a sentence and watching him stop himself from interrupting, like because his mouth starts to form words. It's I mean, it is like he is just dying inside and I'm like, OK, just say the thing, you know, the beach ball. Exactly. The beach ball. That is that's a real struggle conversation.

Lesley:
He says, my client says it's my eyebrows. This one, that eyebrow. Just say

Cat:
It's coming. That's really that's really great, though. And I think that that's that would be an amazing thing if we could get to a place where access needs aren't so much as competing as they are. Coexisting peacefully because competing access needs is a real thing. And I think we can get to a space where it's like mutually respectful, like that would be ideal

Lesley:
And and we need our communities. So the ADHD community needs the autism community. And I think the autism community needs the ADHD community to rally, because this is this is a time for activism that we've already not that we don't have it now, but we've been through our initial metamorphosis. We rally behind our autistic siblings now to to make that full circle so we can really embrace each other.

Cat:
And it creates a weird divide when you're talking about 60 percent of individuals having both. It's been a real weird experience and someone who does have both to be used to sit in the middle. I don't know. I don't really feel comfortable there, you know, so it's it's interesting, but hopefully we can work towards that and make some actual progress.

Malia:
Leslie, this has been, like, amazing. And I feel like I haven't talked as much as I wanted to because I was just like this whole thing is like validating in real time, just like, oh,

Cat:
My gosh, I was just going to say, do you feel like you just got therapy? Because, like, I do like I feel like that was a whole lot of stuff I needed to hear. Yeah. You know, an hour or so.

Malia:
And I hope that everyone else who hears it feels I mean, even half of what we're feeling right now, because there's no way that, like, this conversation could. Happen on tick tock, even in a live stream, because I mean and I seems you're just talking about people, I mean, in videos, you're just talking about people. So like, yeah, I've really been looking forward to this. I mean, this. Yeah. Just so much since we started talking about this and brainstorming these ideas. This is stuff that I think not only the autistic community I hope really loves and appreciates, but also the ADHD community, because I agree that, you know, there definitely needs to be more coming together. And I think even though some of these, like, debates can be super polarizing and whatnot, like to a degree too many degrees, I feel like they need to happen so that, like, good discussion can come from these heated moments. But I think that contributes makes things more heated than they

Cat:
Have a pressure cooker when you

Cat:
Only have 60 seconds and then it's just out in the void and you just kind of wait to see, like what that boomerang brings back. It's like, oh,

Lesley:
Real time is way more fun.

Cat:
It is. So before we let you go, where can people find you on social media and where to reach out and connect with you after the show?

Lesley:
So primarily right now I'm on Tiktok @lesleypsyd.I am technically on Instagram. Leslie underscore psyd. But I will tell you, I'm not that great on Instagram. So you want to go there and I'll try to

Cat:
Check it out. Your post from three years ago

Lesley:
Had my 20 year old niece to run my content. I should have some new things coming out in the next year or so. I'm looking to expand what I'm doing, but if that happens, it'll all be on tick tock. So that's the best place to look for me

Cat:
Saying thank you so much for being with us and giving us some of your time. This is going to be a really helpful episode for a lot of people. So we appreciate your input and for really also standing with you as a community. A lot of the times when this stuff comes up and showing that we really do need each other and not throw anybody under the bus, we really appreciate your voice in all of this.

Lesley:
Well, I appreciate being included. You all are some of my favorite people, and auteach in general. And I'm really excited to see where the next few years really takes our communities. Definitely won't.

Malia:
Thank you for tuning into the autistic Tea Party. AuTeach has so many exciting events happening this summer, one of which is an anti-racism workshop titled Intro to Doing the Work Anti-Racism in a Racist Society.

Malia:
Join Educators Zee, Sadie, and I on Saturday, June 12th, at 1:00 p.m. Pacific Standard Time, 4:00 p.m. Eastern Standard Time.

Malia:
This workshop is designed to expand your anti-racism vocabulary and learn important concepts in critical race theory. You will also hear stories from BIPOC creators for more information and to sign up, see the link in the show notes or visit our auteach.com. We can't wait to see you on June 12th. Thank you for tuning in this week. We hope you had as much fun listening to this episode as we had making it.

Cat:
For more information and resources, please visit auteach.com. That's a u t e a c h .com And join our mailing list to stay in the loop about updates and events.

Malia:
We look forward to bringing you a new episode next week. Until then, this has been the Autistic Tea Party.

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