Professor Answers Neurodiversity Questions

Hi, I am Matt Lerner.

I am an associate professor and program area leader

at the AJ Drexel Autism Institute.

I'm here today to answer your questions from the internet.

This is Neurodivergent Support.

[upbeat music]

alaafia_oluwa asks, What exactly does it mean

to be neurodivergent?

Great question, Alaafia.

Neurodivergent is not a diagnosis,

It doesn't exist in the DSM, Diagnostic Statistical Manual.

It is a description

that has sort of emerged from the community.

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,

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.

Nem_Jem asks, Do you see the words physically jumping

around the page and moving

or just in the wrong location?

So this is the question about dyslexia.

So I'd like to give you an illustration

of kind of what that looks like.

Up here, you probably see the words the way

that you typically see them on a page.

They're standing still.

They're in the place

that you expect them to be.

They stay there.

And you kind of read them in order.

Down here, you see the way that many, not all,

but many dyslexic people view these words.

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.

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?

And how do I get the letters

to look the way they're supposed to look so that it does?

TheAspieWorld asks, Autism social masking:

what is it and why do we do it?

There's this term called masking or camouflaging.

Sometimes it's called PAN, or passing as non-autistic.

Essentially these are all different terms

for when autistic people are 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 kind of how they've learned

or where they've learned.

What it is, still, there's a lot of research into it,

but it's generally this idea of sort of effortfully trying

to impede doing things that autistic people do to fit in.

So many autistic people like to use, you know,

fidgets and things like this, right?

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 is their interest.

Maybe they won't do that in certain contexts.

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,

but many autistic people who are masking or camouflaging

might force themselves to do that,

even if it's uncomfortable.

All of those are efforts

to try to sort of fit into this neurotypical world.

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.

But one thing we hear a lot from the autism community

is that over time it can be taxing.

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.

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.

TeslaCox asks, How do I tell my real doctor

that I've been diagnosed neurodivergent

with ADHD from TikTok doctors?

Okay, let's break this one down a little bit.

You can't be diagnosed neurodivergent.

Like we said, it's not a formal diagnosis.

Number two, I'm not sure what a TikTok doctor is per se.

The important thing here though,

that TeslaCox is getting at is, you know,

there is a wealth of information now,

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 the end of that information.

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.

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.

So what does this mean?

What do you do?

Number one probably wouldn't go to your real doctor

and say, TikTok told me I have this.

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,

and it made me wanna know more.

And I think that's what this stuff can be good for.

It can help you to open the door to say, gosh,

if there are 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?

That's a really good thing to take to a doctor

to get their feedback.

Serious_Toe9303 asks,

Is 'Love on the Spectrum' a good representation

of autism and are there better ones?

That's a great question.

Love on the spectrum is one of a small

but growing number of shows

that has actually autistic people being portrayed.

Some aspects of the portrayal

and those relationships are kind of made for TV,

like a lot of reality TV.

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.

So if the question is, are there better ones,

I think the best representations

are by autistic people representing themselves

and 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.

CobainyWhitte1 asks, What are signs of autism?

The features of autism fit into two general categories,

social communication and restricted and repetitive behaviors

and kind of sensory stuff?

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 and social interaction,

friendship making and connection, eye contact,

nonverbal cues, picking up social nuance,

all features like that.

That's the social communication side.

In the other side,

the kind of restricted repetitive behavior side,

you might have somebody

who has like a really restricted interest or focus.

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.

You also might have repetition of, you know,

certain words or phrases over and over again.

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.

And this also kinda loads on

with these sensory features of autism.

Some folks on the spectrum again

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.

People might, you know, cover their ears

and need earplugs to be able to manage certain settings.

Lights like, like the ones in the room that I'm in right now

might feel very bright and overwhelming.

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

kinda move it around as a way

to kind of feel good.

But really, it's a way to kind of regulate

and manage that sensory experience.

Folks on the spectrum have lots of different kinds of stims.

They might hum, auditory stims.

They might have visual stems,

like looking at their hands and finger flicking

outta the corner of their eye.

And some folks have larger stims, like rocking

or even hand flapping or pacing back and forth.

ZoeBlade asks, What is and isn't stimming?

So stimming is a term in the autism world, autism field,

sort of a colloquial term for self stimulatory behavior.

You know, kind of traditional sort of ideas of stimming

might be things like rocking, flapping.

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.

And some people do auditory stimming,

like humming or maybe saying a word over and over again.

So again, there can be visual.

There can be tactile.

There can be auditory.

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.

JaiCartier3 asks, Is autism really on the rise?

Are we just better at identifying it these days?

When we think about the rise in autism,

we think about four sets of factors that could be happening.

Number one, change in diagnostic criteria.

So when you look at the the DSM,

or the 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.

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.

Those folks were there,

but they weren't getting autism diagnoses

back in the '80s, '70s, earlier.

It really wasn't until the DSM-IV in the mid '90s

that we even had these sort of broader criteria,

broader ways of having an autism diagnosis.

And so that change alone has dramatically expanded

the ways to even be diagnosed as autistic.

So that's contributed a huge amount to the rise.

The second is a broader awareness.

And these things go hand in hand.

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.

But now we know more about autism,

there are more representations in the media,

there's much broader awareness,

and 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.

The third thing has to do with changes in stigma

and how autism is viewed.

So because of the first two things, all of a sudden,

you know, the ideas, it used to be that, you know,

getting diagnosed with autism was quite scary for families.

For some it might still be,

but much more commonly the idea was what is that,

and what's gonna happen to my child?

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.

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.

That is most of why autism is on the rise.

QuinnTheCats asks,

This is about to sound like the dumbest question ever,

but what exactly is ADHD?

It's not a dumb question, QuinnTheCats.

There are kind of three types of ADHD,

and they kind of each answer the question.

One is ADHD, inattentive type,

so meaning folks with ADHD inattentive type

struggle to pay attention, maintain attention.

They might seem to sort of, you know,

wander off or have trouble kind of staying engaged

in a conversation or on a topic.

They might struggle academically as a result of this.

Then, there's what's called ADHD hyperactive type.

And these are kids who kind of move all around the place,

have trouble controlling their bodies,

have trouble sitting still.

There's a item on kind of the ADHD questionnaire

that says, Acts as if driven by a motor.

And I feel like this is the one when I talk

to parents often, they're like, Yeah, that one.

He acts like he's driven by a motor,

and the motor doesn't stop.

And then there is ADHD-C, which is the most common,

which is the combined type,

which is basically the inattentive stuff

and the hyperactive stuff all mushed together.

A redditer asks, What did people with autism

do in the past?

So the answer is that people with autism in the past

did the same things other people did.

They existed out in the world.

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.

The idea is that he happened to be in an environment

where his quirky way of being was notable.

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.

So in that book, the court documents describe him

as having odd sorts of movements.

They would say he would sort of ramble on in ways

that they considered to be, you know, incoherent,

but they said not unintelligible,

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,

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.

DescriptionMean9351 asks,

People keep saying

that I can't have Tourettes because I developed it at two.

People say you have to be born with it.

You can develop ticks later on.

And there are lots of different reasons

and ways that ticks can kind of onset later.

But yes, a person can start to develop ticks at two

or even later than that.

iscreweduprealbad asks, My ticks feel half voluntary?

Question mark.

So this is about Tourettes and other tick conditions.

So ticks are kind of an interesting phenomenon.

One way that people think about ticks

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 kind of can't be stopped.

The kind of historical way of thinking about it

that psychologists sometimes say is that it's easier

to stop a tick once it starts

than to stop a tick from starting.

So half voluntary.

The idea is that the sort of surge of the wave,

that kind of compulsion that comes from the tick is

might be able to be kind of diverted, right?

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 gonna, you know, do this motion

but not that,

or I'm going to do my best to kind of hold it back.

So there's almost like this...

It's like you can put a canal along the wave

that you can kind of pick something about it,

even if you can't pick it.

PaperJoshi asks,

I never understood

how hyperfocus is a symptom of ADHD.

It's a really good question.

So ADHD broadly has to do

with, you know, sort of difficulties sustaining attention,

kind of hyperactivity, maybe working memory problems.

So how is it the case that folks

with ADHD can hyperfocus if their problem is focus?

Well, one way to think about it is ADHD

can almost be seen as difficulty

with the sort of lever that regulates your focus.

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, I'm focusing over here.

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.

That is what our brains are doing.

Folks with ADHD might struggle to kind of do that shifting

at the rate and the way that people want.

So they might kind of get stuck in, like,

I can't really hold my focus here

so I'm gonna kind of keep bouncing around.

But they also, when they do find something

that is motivating, that is engaging,

that they're interested in,

it's sort of like then they're locked into that,

and can't quite yank that lever off of that topic.

A redditer asks,

Does reading improve with practice for dyslexics?

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.

They can take effort,

but then that effort, like a muscle,

can get flexed and built over time.

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.

Qgirl50 asks, Is autism genetic?

Have they identified a gene?

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.

They've done the kind of work

where you look at really gigantic populations of people

and look at kind of genetic markers.

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.

And there's certain ones where they call them loci,

sort of areas on the gene 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.

Sometimes if there's a lot of a difference,

you might see more features.

So all together, 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 world is attributable to to genetic factors.

TitanicMan asks, Is there a reason

why some people with Tourettes

have swear words specifically as their tick?

Of all the words that could be their tick,

why is it almost always profanity?

So this is partially myth

and misunderstanding and partially not.

So it turns out a lot of ticks are not profanity.

Many folks with Tourettes have much subtler presentations.

You know, they might be really small ticks,

little motor tick, you know, a slight smirk,

or a twitch of the eye or, you know,

kind of a little head tick that can happen,

and those are actually much, much more common.

They're not as attention grabbing,

and so people don't necessarily notice them,

and call attention to them quite as much.

And so yeah, it's not the case that most people

with Tourettes for instance,

have swear words as their ticks.

It is the case though that there are a subset of folks

where their ticks are profanity.

It's a little bit complicated as to why,

and there's a lot of interesting research

kind of trying to understand this question.

The best that I understand is that

to some extent ticks do have to do with

this kind of motivation

and self-regulatory system, right?

There's this sort of urge, sort of surge,

like you said before,

and then this kind of, you know, pullback.

And the thing is, there are lots of things that we try

to self-regulate about during the day, right?

We try not to have road rage.

We try not to steal our siblings candy

when it's sitting next to them.

And we try not to swear.

There's, you know, some evidence that suggests that,

you know, that process might be getting wrapped up

for those folks,

that there's this sort of self-regulatory thing,

I'm not gonna do it,

and the brain is kind of like,

alright, I'm gonna push through the thing

I really don't wanna do right now,

I'm not meant to do right now.

And it becomes that thing,

and then it gets stuck.

That's one of the, I think, more intriguing ideas

as to why when it's profanity, why it's that.

estellalikessalt 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?

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.

Appreciate the sensitivity Estella.

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.

It actually has to do with the available

medications that exist.

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 the sort of quest

for medication has even, you know,

assuming that you sort of believe

in medication as being important,

which, you know, many do,

has been a lot more fraught.

As I've described,

autism has these sort of two core areas, right?

Social communication, restrictive repetitive behavior,

and we've really, we haven't found many things

that can really on their own help

with the social communication piece.

Social stuff is a lot more complicated

than regulating attention.

Same thing for restricted repetitive behaviors.

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 for the most part that's a lot more difficult too.

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 the subset

of people who are experiencing those challenges.

And importantly, you might notice

that's not a core part of autism.

A Reddit user asks,

Is there a way to treat ADHD without meds?

Great question.

So yes, there are behavioral

and psychological treatments for ADHD

and within, you know, kids and adults.

In childhood, 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?

'Cause 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 out how to translate

that knowing into doing.

basbillions asks, What does 'on the spectrum' mean?

Autism is also called autism spectrum disorder in the DSM.

Even though lots of different things

are spectra, spectrums, lots of different conditions,

autism has sort of come to be referred to

as sort of the spectrum.

And what's really interesting

is that autism has undergone an incredible evolution

over the last several decades.

As recently as the '70s or '80s,

people thought of autism

as the most categorical thing.

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.

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.

And now it's swung all the way the other way

from really seeing this so dramatically different

that you could just sort of spot autism anywhere

to being the spectrum, the spectrum,

the thing that is not about categorical difference at all.

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.

A Reddit user asks, How does the brain structure

of autistic people differ?

Lots of really interesting research has gone into this.

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.

There's this fancy term, a connectopathy.

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.

And while this is still evolving, broadly speaking,

there's this idea that autism

has a lot more connections.

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.

And, actually even some thought that this might help

to explain some, some parts

of what we understand about autism.

'Cause maybe those short distance connections, you know,

they might be telling us something

about some of the difficulties in sensory processing.

It might be like, you know,

if you've got all these short distance connections going,

fire, fire, fire, fire, fire, it might be harder, you know,

if things are really loud

or things are really bright to manage that.

But then, those longer distance connections,

which are used maybe

for a more broader processing, or development, or learning,

those, if they're sparser, might take longer.

It might be more difficult for those connections

to kind of grow and learn.

ArktokosO2 says,

What age do you think it would be appropriate

to diagnose someone with autism?

So one thing we do know is that autism

is by and large with you at birth.

So by the time somebody is born,

their brain is sort of wired up in that direction,

if they are autistic.

Those developmental trajectories

can change one way or another

in a variety of different ways.

But that's by and large what we know.

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,

we wanna make sure that those things are available

so that folks have the best opportunity.

For years it was thought that three

might be kind of on the earliest side, you know.

Then, we sort of push to two,

and I would say, you know, clinically it's now possible

using some of our best diagnostic tools

to diagnose toddlers even down to like 18 months,

some even down to 12 months using our clinical tools.

But increasingly, diagnostic science

and autism has really been picking up

and 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 six months and maybe even younger.

So let's see where that goes.

Judicialreview asks, Does autism correlate with IQ

or does high IQ correlate with autism?

Headline here is that autism

does not really correlate with IQ.

Autism does not discriminate by race, color,

IQ, or other features.

Autism exists everywhere in the world

across the whole spectrum of being.

I think that 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 autistic people on IQ tests

can be really different.

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.

Or it might be the other way.

They might have great, you know, visual perception

or processing ability

and less ability in spoken language.

PipDBurley asks

What myths about autism annoy you?

What is the reality versus the myth?

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.

This is very common kind of colloquial idea

that comes out of sort of observing autistic people

kind 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?

Autism, literally from the Greek, you know, means self-ism.

Autos is self.

And so there's this notion, I think this implicit notion

that autistic people are self-ish,

that they're sort of focused on their own needs,

and can't really feel those of others,

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

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-feel.

They can 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.

That's all the questions for today.

Hope you learned something.

Until next time.

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