Trenna Sutcliffe, M.D.
Appearances
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Correct.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Autism spectrum disorder.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I have so much to say about autism, the diagnosis and how we make it and how it's changed so much over the years. So autism spectrum. So first, it's a spectrum, huge spectrum of what this means when we talk about autism spectrum.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It goes from what people remember it from decades ago as from nonverbal, very little communication skills, being somewhat isolated, not interacting with other people, mannerisms such as flapping your hands. That's sort of a classic description that we do remember from over the last couple of decades. Nowadays, many children who have a lot of speech and language skills
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
who do communicate a lot, but struggle with the social communication that we have with each other, who have many, many strengths, but do struggle with social skills and do have some restricted interests and repetitive behaviors, they also qualify under this umbrella term called autism spectrum disorder. And this term, autism spectrum disorder, that term came out in 2013 with the DSM-5.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So how we diagnose it is based on, again, clinical traits, but the definition and the checklist of those traits have actually changed many times over the last few decades. So currently, it is you work with an expert who has a lot of experience with autism, and they do an analysis of someone's behavior.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And the two areas that we look at, social communication skills, and the other is the repetitive behaviors restricted interests. So for social communication skills, our current diagnostic criteria requires that a patient has differences in three specific areas. One is their social reciprocity. So this is the back and forth of social interactions. It's how do you initiate socially?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
How do you respond socially? The second area is related to nonverbal communication skills. So it's how someone uses their nonverbal communication, eye contact gestures, as well as how they understand and interpret somebody else's nonverbal communication. And then the third area is related to how they understand relationships.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So it's about building friendships, playing with peers, how they understand the social context of being in a group. So those are the three key areas when it comes to the social communication piece. And in order to get the diagnosis, you do have to have differences in all those three areas.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Depends on the level of severity in the child. So first of all, it's important that whoever's doing the assessment really understands that child.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It can be a physician or it can be a psychologist. That's generally who does it. So physician would either be a developmental behavioral pediatrician or a psychiatrist. That's most often. Occasionally, it's a pediatric neurologist or somebody else with some sort of similar background and training, but generally DBP or psychiatrist.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And if it's not a physician, then it's a psychologist that usually does the assessment. And so the assessment could be multiple things. There's no gold standard, like the assessment has to include certain components. But again, like I mentioned, it's important that the clinician get to know the child. I think it's important to understand the child's profile. The label is only one piece of it.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
If someone tells me their child has autism, I actually really don't know much about their child.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Because you tell me your child has autism, I really don't know what your child is like if someone tells me that on the street. Then we come up with treatment plans for like a child with autism. It's like, well, there's a saying, you've met one child with autism, you've met one child with autism. And so to really make a difference with the treatment plan,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
you need to understand that profile of that child, that child's strengths and challenges. And so for me, there's multiple goals with the assessment. One part of the assessment is to make a diagnosis because the diagnosis can be a tool to help the adults around that child better understand that child.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It gives some sort of structure of like how to approach that child and leverage their strengths and work on skill building. It can help get resources at school or through insurance. So the diagnosis is a tool. However, to really make a difference, you want to understand What about that child is unique and different? And how do you support that child?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So you were asking, how do you do an assessment? So when it is a more significant case with significant impairments, we frequently can make the diagnosis. I'll just be honest, you can make it pretty quickly. You should take a good history. You should definitely meet with the child, work with the child in the clinic.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But there are many children where a trained clinician can do that diagnosis pretty quickly in a child with very significant autism. It'd be obvious to you if you were in a restaurant, you saw someone with autism. It's obvious to many people. But for children who have
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
milder symptoms it is really important that there probably is multiple visits to see the child on multiple days that different types of assessments are done directly with the child in addition to taking history with the parents and in addition to collecting information from other people involved in that child's life such as teachers or therapists it's important to get different perspectives
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's complicated. I'll say it has a lot to do with the new diagnostic criteria. So before 2013, we had Asperger's syndrome. We don't use that diagnostic label anymore. And we also had something called PDD-NOS, Pervasive Developmental Disorder Not Otherwise Specified, a mouthful.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And PDD-NOS was a term we used when it had similarities to autistic disorder because all three of those names were under the umbrella of autism. And so there were a lot of kids who received this PDD-NOS because they were like,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Something's different. They're sprinkled with bits of autism, but they didn't quite meet all the criteria. When you didn't meet all the criteria, you got PDD-NOS and then there was Asperger's syndrome, which generally described an individual who had good cognitive skills. average or high cognitive skills, intellectual skills. They had a lot of speech and language skills.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
They actually have huge vocabulary, but again, their social reciprocity, back and forth conversation, picking up on social cues, that was atypical. And they also had a lot of restricted interests. They would have things they were really interested in, but then they would dive deep into those things. So in 2013 with the DSM-5, we put all of that together under autism spectrum disorder.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And so now the kids who have the more clear cut, very traditional autistic disorder, they're picked up at two years of age or two and a half, three years of age. And it's the kids who have the stronger cognitive skills. They have speech and language present. They're picked up later. By the way, nowadays with the new diagnostic criteria, language impairment,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
may or may not be present in the diagnosis. When you give the diagnosis of autism spectrum disorder, you also have to clarify whether there is intellectual disability, so with or without intellectual disability, and then we say with or without language impairment. With all of these changes, the spectrum, it's very broad.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I can't believe it's one in 36 because I've been doing this for 25 years. I can never keep track of the numbers. Every time I go to an annual meeting, the number changes. And it's one in 36 now that we diagnosed.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
The point being that the numbers have changed drastically. And yes, people will say part of it is because the definitions change, there's more awareness, there's more resources, there's more clinicians making the diagnosis. But people in the field believe that those changes don't explain the drastic changes in the numbers and there has to be something else involved.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And there is a lot of research in this area looking at the impact of the environment and epigenetics and what roles those two things have in increasing the rate of autism in our population.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There is thoughts around pollution, maternal infection, prolonged fever during pregnancy, the health of the placenta, stress, parental age. There is a lot of environmental factors that have been implicated. But what I want to say is just to take a step back first, just kind of talk about the cause of autism, the genetics and the environmental piece, just to make it really clear.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
The word autism describes a constellation of symptoms. There are many, many causes for autism. There isn't a single cause. What causes autism is very complex, and we actually have more questions than answers. It's felt, though, that it is like a 10-hit model, meaning we don't know that the number is 10, but the idea that there's multiple... It's not a two-hit model.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There's many factors involved, and it's almost felt like it's gene, gene, gene, environment, environment, environment, and then now it's like epigenetics, epigenetics, epigenetics. And so it's multiple hits and the order of the hits and the timing of the hits are also felt to be very important.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It'll be anywhere from 70% to 98%, depending again on the definitions used at the time, but it's well over 90%.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I believe so.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Correct. There's definite genetic component to this. But may I say, so it's not one gene?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It is not one gene. It is multiple genes. So anybody with autism, they have multiple genes that have been changed. So there's multiple genetic changes in anybody with autism. And the other thing is, every person who has autism, they probably have a different group of genes that have been changed. It's actually hundreds, and some people say up to like a thousand genes have been
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
associated with autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I agree.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. So we don't know all the genes. We know that there is this genetic component. It's like each child with autism has a different fingerprint with their genetic makeup. And so there's these genetic changes, but some of the hits I mentioned are environmental. So there is research to show maternal stress, pollution. maternal diet, parental age, these things also are associated with autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And again, there's a long list. So there's a long list of things that are associated, but none of them alone, each one alone is not the key to autism. It's the combination.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I wish I had all the answers. I don't. I think it's complex. There have been changes in, you talk about diet, pollution, toxin exposure. I think that's one piece of it. It is one piece. With epigenetics, as you know, it can be epigenetic changes, which Just to clarify for everybody, the DNA sequence is not changed.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's about tags on the DNA that can change the expression of genes or proteins called histones that are changed that end up resulting in changed gene expression. But the changed gene expression can actually be inherited or passed through generations as well.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I think it's controversial. I think it's controversial, but there is some thought about that, about the idea of the germ cells in a fetus, in a grandparent being exposed to smoking, toxins, changes in food, how that grandparent exposure affects can actually change methylation in the germ cells of a parent who's a fetus, who then that germ cell goes on to be a child with autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I don't know if that made sense. It was sort of confusing.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Okay. Well, initially I did an undergrad and master's degree in genetics and then went on to medical school. After medical school, I went on and did a residency in pediatrics, but ultimately wanted to do developmental behavioral pediatrics for numerous reasons because it just was a really good fit with my interests and passions. So I did actually a year in
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I am. The key thing is that we do know the environment impacts the methylation and the epigenetics. So it's the idea of it crossing generations. It's the idea of the methylation in a germ cell is altered or changed because of some sort of environmental exposure in, again, that parent or grandparent.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
That's profound. And I'm thinking about a number of different things. One, I'm thinking about, because you're talking about this one in three.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. And so one of the issues, though, is how we define the condition. That's the thing. So there is still that, although I believe that there is this piece with genetics and the environment and how we are evolving. And there's this phenotype.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
This phenotype where there is differences in social communication skills and repetitive behaviors of restricted interests, this phenotype, which is on a huge spectrum as well. I should make sure this is the thing. When we're talking about these numbers like 1 in 36 and this number continues to increase, it's not just the kids who are like nonverbal autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's this really wide phenotype is increasing. And so it is important we understand the cause of why this phenotype is increasing. And then what should we or should not be doing about that?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
pediatric neurology, and then a full fellowship in developmental behavioral pediatrics before moving to California.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I believe there's an increase in that number as well, but the numbers that are put out there, the really profound numbers actually describe the entire spectrum and they don't actually subdivide into the different parts of the spectrum.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So we subdivide autism spectrum into three buckets, level one, level two, level three. So the more significantly impaired children would fall into level three, where they require very substantial support. There are very few research studies that actually look into these sub-buckets And I have to be honest, I'm not sure clinicians are always great at identifying kids in the sub buckets either.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Like you and I are talking about a very specific profile that should be very obvious to identify. But there's other kids in sub bucket three that are sometimes put in sub bucket two, depending on what clinician they see.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I'm not sure if anyone's looked into it, but yeah, I don't know. But even if they did, it wouldn't be apples to apples. It's not.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
By the way, one of the reasons they actually went from the Asperger syndrome, PDD-NOS, autistic disorder, because that was actually quite controversial when they actually decided to put all three of those things under one umbrella called Autism Spectrum. was because clinicians did a really poor job of deciding- Which bucket you were in. Which bucket you were in.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So you would have a child, and one clinician would call it Asperger's syndrome, another person would call it autistic disorder, another person would call it PDD-NOS. So they decided, okay, rather than having these three names, let's put it all under autism spectrum. So then they put it under autism spectrum, but then they have level one, level two, level three.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But I would still say that clinicians still struggle sometimes where there is a little bit of overlap. It's not always clear.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So it did make a difference with respect to resources. Children with Asperger's syndrome frequently did not get support or support covered. You needed autistic disorder to get support.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Waste bucket? Yeah, people didn't know what to do with that. So if by putting everything under autism, then it's like, okay, if you have autism, you should receive services. It was a tool. The label's a tool to understand and get resources. Now we have level one, level two, level three now. Level one is it says requires support. Level two is requires substantial support.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Level three is require very substantial support. My concern is that, again, when a child is level one, they don't always get the support they need because they have so many strengths. So kids in level one, frequently they have good cognitive skills. They have a lot of language skills.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
They struggle with some social skills and they may have some difficulties with executive functioning and coping skills at times. But again, it's considered mild and a lot of those kids don't get support. And I think that's unfortunate because they also are the kids that respond to intervention so well. If they get a little coaching on how do you cope with distress? How do you cope with change?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
How do you practice some social skills? Not that they have to change. We don't need to change everything about them, but giving them a little bit of support about how to, again, be adaptive in a community. Giving that support goes a long way with that group. But frequently they don't get the support because they're called level one.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There are. There are a lot of them. And I think they found a path that made sense to them. They obviously learned what their strengths were, and their strengths may have been around memory, detail-oriented, following rules that are black and white. They may have had really wonderful cognitive skills in certain areas that were less around inferring and social skills and more concrete. And yeah,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
We don't have studies to say this for sure, but my guess is they have lived happy, successful lives, a lot of them, some of them, doing things that they enjoy doing or are passionate about. They probably have found ways to not engage in large social settings, but there's a lot of careers out there that are a good match.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Correct.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And they also have relationships and marriages, which I want to emphasize that. People with autism get married.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So I talk to parents all the time about this because I evaluate children. I evaluate children for autism or ADHD. And very often when I'm evaluating the child, at some point while I develop this relationship with the family, the parents say, gosh, so much of my child is in me.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
As you are describing my child and my child's strengths and challenges, and I see me, and this is exactly what I went through when I was young. And then they share how hard it was, and they say, gosh, no one understood me, or I felt bad because I was misunderstood, or I thought it was my fault. I didn't try hard enough. So I have to say it can be validating for an adult.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
To learn that it wasn't their fault and this is part of their wiring. I have many, many parents who ask me, should I go get assessed now?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I ask questions. I think information is power. I think it's good for them to be thinking about it, whether or not they go on to actually get assessed. With the autism piece, often they don't. With the ADHD piece, they often do because they realize actually their ADHD traits are impacting their function and success at their job.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So sometimes they will actually go to a psychiatrist to get an assessment. But I do share with them the genetics and the family history. So what do I say? I validate. I say, yes, you're telling me that growing up you had many traits that today we would classify as under one of these diagnoses, you're right.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It is possible because these things do run in families and there is a highly genetic component. And I think sometimes just that conversation can be therapeutic itself in that someone feeling validated and they have that aha moment, like, okay, this explains a lot. And then they can feel good as well because they're like, okay, this explains a lot.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And I've gone on and I currently have my family and I'm doing well in many parts of my life. But it helps them also understand like, ah, but now I understand why sometimes I do have these challenges at work or with my spouse.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's interesting just sometimes having a perspective where now you can see your challenges through a different lens sometimes helps a person just actually now think about, okay, now I can adjust or understand the triggers or can reflect and think about how do I want to respond the next time. So I think, again, that information's empowering.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
how I look at it clinically.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Even if they don't ever go to therapy or do anything else, just actually starting to become informed about it can help.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I agree with that so much. So I actually ask that question all the time. I do wonder every time a child has a few of these traits, whether or not we're coming up with the diagnosis every time someone is just a little bit different. And rather than realizing there is neurodiversity, we're all different. We have to give a name to it all the time.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's an interesting debate and you will have your different perspectives. I mean, the name gives us a way to get resources and help people. But I also concern that we have to give everything a name. I actually wonder in the next DSM whether we'll end up taking a step back, whether the pendulum will swing a little bit.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I don't know.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I would say a couple of decades.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It can be. But level one, we were talking about level one autism. So I'm concerned that the kids in level one autism might actually be part of several different diagnostic buckets. Children who are identified with level one autism, they see one clinician, that person may diagnose autism. They see a second clinician, that person may diagnose ADHD plus anxiety. They don't even call it autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So with all of these diagnoses, anxiety, ADHD, autism, they're behavioral clinical diagnoses. So it's based on checklists of a number of traits and characteristics. Now, you need to be working with a clinician, a physician who has enough experience to
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I see this all the time in my clinic. I have kids who come to clinic and they may see three other clinicians before they saw me, really great clinicians. high standards experts, but there's a lot of blurry lines with the level one autism and you will hear different diagnoses.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So back to your thoughts around future DSMs, I wonder how we're going to address level one autism and is it the same condition? How many different conditions are in that bucket?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
IEP.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Education plan.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I agree. And that's why, again, I agree that the kids in level one should be receiving services. Otherwise, what's the point of giving the diagnosis?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So they should be receiving services.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I'm going to start off by saying we diagnose anxiety in kids, and there's that bucket. And there's many kids who just clearly fall in the anxiety bucket and meet criteria, and it's really clear to see that. There are kids who have ADHD and clearly meet diagnostic criteria for ADHD and fall in that bucket. And then there are kids who clearly fall into the autism bucket.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
diagnosing these conditions, trained in these conditions, but essentially that person needs to be an expert on what the clinical picture looks like because there's no biomarkers for any of these conditions. That's the key thing. There are no blood tests, there are no brain scans to say who has anxiety, who has ADHD, who has autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I'm going to focus on the autism bucket first. So we say that about half of kids with autism also have a diagnosis of ADHD. If you look at the numbers, you can find reports for anywhere from like 40% to 70% of kids, but we say about half of kids with autism actually do have a diagnosis of autism.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Interestingly, before the DSM-5, before 2013, we were not allowed to give both those diagnoses together. So they were mutually exclusive. If a child had autism, we did not give a diagnosis of ADHD. So starting in 2013, we did, and we give it a lot. So a lot of children with autism have ADHD symptoms as well, and we give that diagnosis. And about 40% of kids with autism also have anxiety.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
This makes sense when you think about the parts of the brain involved. When you think about ADHD, we're thinking about executive functioning skills. We're thinking about prefrontal lobes. When you're thinking about anxiety, you're thinking about the amygdala.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And then when people have done neuroimaging studies in kids with autism, we find there's many areas of the brain involved, but in particular, frontal lobes, the amygdala, as well as the cerebellum, temporal lobes, there's many, many areas of the brain involved. But kids with autism do have challenges with executive functioning and anxiety, although those are not part of the diagnostic criteria.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So those are associated symptoms, associated traits, associated diagnoses. So they're comorbidities, not part of the core diagnostic criteria, but there's a lot of overlap.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. A lot of them have all three. I don't know the exact number for that one.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
This is the thing. These kids, they present with the core features of autism along with the executive functioning challenges and are anxious.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Kids who have ADHD and anxiety, their numbers towards autism are not as high. So there are a lot more kids with ADHD who are not diagnosed with autism. But there's a lot of overlap between ADHD and anxiety. So ADHD frequently has a partner, is what I tell families. If you have ADHD, you often have either anxiety or some other mood challenges. Or you have learning differences.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So learning disabilities are frequently present to kids with ADHD. Or you have oppositional behaviors. So there's often a second condition present in kids with ADHD.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So there is a diagnosis out there called oppositional defiant disorder. That is a diagnosis that I don't use quickly or often in young kids when I see oppositional behaviors. This is my personal approach, is that I will say I see a child with oppositional behaviors. What does that mean? It means someone who argues, doesn't follow rules. Disobeys, lies.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So kids with these types of behaviors, I want to understand the why before I jump into saying that they have oppositional defiant disorder. Technically, maybe they meet the criteria. Again, it's the checklist criteria for that name. But to me, that name doesn't help me. It's just a name. It's like, okay, I have a kid with ODD, we call it. It's like, how does that help me? What do I do with that?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I have families come to me all the time and I explain to them I have these clinical boxes and labels and diagnoses in my clinic. And these boxes and labels are man-made. We create these lists of criteria. But neurobiology in the brain is much more complex than these boxes.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So if I see a child with oppositional behaviors, I'm like, okay, what's the function behind that behavior? And so I can come up with reasons for why a child is oppositional. So we all have seen kids who have meltdowns, who fight, who yell, who argue. It's like, what's the function behind that? And so it may be that child is actually anxious.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I'll tell you a lot of oppositional behavior in kids is driven by feelings of anxiety and embarrassment. It may be the child is impulsive. That child lies and argues and yells no quickly because they're impulsive and they have untreated ADHD. It could be that child struggles with understanding social contacts and social skills. They actually have trouble with their social reciprocity.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But they're presenting with what looks like oppositional behavior. That child may be sensory overloaded and have challenges processing sensory information and therefore becomes overwhelmed and dysregulated and oppositional. The list goes on. The point is, is like when I see a child with oppositional behavior and a family says, oh, well, someone told us it was ODD. I'm like, now what?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I agree. And so this is one of the challenging things about my field. And again, I'm going to come back to my boxes. I see a family and I'm actually pretty transparent with the families I work with regarding that we don't know everything. I am really honest with them and transparent because they're like, doctor, what is the diagnosis?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And the thing is, is families, they want to find a diagnosis because it helps. It's scary when you don't know what's happening. But I really walk them through that there are these labels and diagnoses, but the risk is that they can see someone in my field and they do testing and you give a diagnosis. Like I have kids, they come with a report, this child has ODD. And I'm like, okay, well,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
What does that mean? What are we going to do about it? And so the why is so, so very important with, again, comes back to how do we create treatment plans? And it comes back to, again, like I said, you've met one child with ODD, you've met one child with ODD. And ODD to me means actually, I don't even know what to do with that. There's no treatment for ODD.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So the key thing is to have a clinician who looks at the, and for me, a child, and looking at their traits at home, at school, in multiple environments, collecting data through talking to parents' history, getting information from people other than the parents. So that's using rating forms or talking to teachers and therapists.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But however, if I know if the child has impulsivity, I can treat that. If the child has social difficulties, okay, I know what kind of treatment plan to create there. If the child's anxious, I know what type of therapies to give. So it's really important to think about the why.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It was actually one of the things when I left the traditional medical model and started my clinic, one of the things that I really noticed when I was making that transition and one of the things I wanted to remember when I started to work with families in my clinic was Was that it's not just about the diagnosis, it's the journey afterwards. And it's really about personalized care.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And you can make such a big difference in child development, human well-being by really understanding that specific child. And unfortunately, sometimes when you're on the treadmill in a medical model, it's really hard to have the time to really get to know a child. And I felt like I was, you have autism, here's a list of 15 recommendations, good luck.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And you have ADHD, here's a list of 15 recommendations, good luck, without really getting to know the why behind that child's behavior.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
No, I agree. I agree. I don't think we've done enough in pediatrics in this area. But I agree, you have to know the story and understand the whole child. And so one thing about developmental behavioral pediatrics, which, by the way, is a very young specialty.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So developmental behavioral pediatrics was only recognized as a subspecialty by the American Board of Pediatrics in 1999. So it's a very young specialty. But a key thing about this field is it's what we call a biopsychosocial specialty. And so what that means is we think about the biology, the genetics, the brain, the biology, the medication. We think about the biology.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
The psycho part is the mental health piece. So it's the idea of to support child development and behavior, you need to consider the physical wellbeing as well as the mental wellbeing. And then the social piece is the fact that we don't live in isolation. We live in communities. We live in dynamics.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And in order to help kids with their development and behavior, what better way to promote human well-being and health than to start early on and impact child development and behavior and self-esteem and learning? The way to do it is you not only think about the biology, you think about the mental health, and you think about the social, which is about family dynamics, parents,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
parenting, school and education. This is key. This is the bridge between education and medical health, which honestly is hard to do in the traditional medical model, bridging to education, but it is really, really important. That's where our kids are learning and developing and growing and exposed to experiences. And so DBP looks at that whole picture.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Ideally, we get to see the child in their real-life environment, so maybe even observing them in a real-life place like school, and then doing assessment in the clinic to collect information about them. And with that, that clinician decides whether or not they meet diagnostic criteria, a list of traits or characteristics described in a book called the DSM.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And I really believe that that is the way to support child development and behavior, whether there's a diagnosis or not.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, my husband got there in 04. I was there in 05. So I did my DBP training at the Hospital for Sick Children in Toronto. So I'm Canadian. Trained to sick kids, an incredible place to train with volume of cases and complexity of cases. So it was a fantastic place.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, it is. It is a fantastic place to train. And so I did pediatrics, pediatric neurology, and developmental behavioral pediatrics there. My interests and passions were always genetics, the human brain, developing human, neuroplasticity. I did a lot of research in neuroplasticity. And then 20 years ago, moved to California in the Bay Area and took a job at Stanford.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But the field of DPP was brand new. So as I said, like it is just starting out. So they did not have a developmental behavioral pediatrician yet at Stanford. So I was the first there. After me, they hired an incredible developmental pediatrician by the name of Heidi Feldman, who then created the division of DPP at Stanford. And she's still there and they have a fantastic team. group there now.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But I arrived, there was nobody else. I was at Stanford for a number of years and did research, clinical work, as well as medical education teaching. And then after that, I focused on the clinical piece and went to a large clinical organization, did clinical work. But then 10 years ago in 2014, decided to leave the traditional model and start my own multidisciplinary clinic.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I felt that I could help my families and patients more and or differently. I wanted to make an impact. That's one of my passions is always to make a difference. And I felt that I was a little bit stuck in the model and it's just the medical model. There's so many good things about it, but to help the families the way I wanted to with my values, which I can describe, I needed to leave.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And what did I value? So one, I believe in promoting health and wellbeing and And that's all about DBP, development of behavior. It's about promoting health. Where medical centers have been in the past, primarily focused on treating disease. So that was one thing. Two, I really believe in multidisciplinary teams and really having an integrated team.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
In this area, as I described, understand the whole child requires not just a physician, requires therapists, psychologists, teachers, different types of professionals. And I really believe that to make a difference, those professionals have to be integrated. If you want a touchdown, all the players need to be reading the same playbook.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And so I felt like a lot of the families I was seeing, they would come see me in the medical center, the doctor. But there was the school and there was the therapist and we had all these different silos. So I really believed I needed to bring the silos together. Another thing is I believe in community collaboration. So that's actually the bridge to education.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And that's actually really hard to do in a standard medical model is to really have collaboration with the school. So now I do school observations. I go to IEP meetings. I work with teachers and classrooms because I know that to move the needle with the patients I see, I need to do that.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I need to see what they look like at school. And then I believe that the family is the patient, not just the child. If I am going to make a difference in a child's life, I work with the parents a lot. It's amazing how powerful parenting can be and training parents. And again, this is the social piece, the dynamics.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And then we decide whether that child meets that criteria. But one of the key things is about whether or not those traits are creating impairment. And that's a key criteria for any of these diagnoses. For example, anxiety. We all have feelings of anxiety. Anxiety is actually a very appropriate, normal feeling that we should all have. But it's all about how much impairment is it creating?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Understanding the whole family situation is really important to make a difference in a child. And then lastly, I believe I love learning and being innovative and thinking outside the box. And so I decided to set something up where I can continue to ask questions and challenge the system and try to make it better.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So we have a few different programs. We have a behavioral team where we focus mostly on kids with autism. However, probably about 20% of the kids who work with our behavioral team don't have a diagnosis of autism, but do benefit from behavioral therapy, social skill groups. parent training that focuses on behavioral models.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
We have a mental health therapy team that supports kids and teenagers with anxiety, depression. So we offer different types of therapy for that, mood, dysregulation, ADHD. We have psychologists who do testing for diagnostic assessment, and then we have a medical team. But it's not just giving medicines. I do prescribe medicines. But again, it's like that is a portion of what I do.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I look at the whole child and it's really understanding the therapies, the parenting, the school piece, and medication when it's important and can help.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Applied Behavioral Analysis.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. So ABA means a million things these days, and just like autism means so much as well. So ABA is a behavioral intervention that traditionally has been used with kids with autism. It is about taking a skill and breaking it down into smaller sets, smaller subsets. So traditionally, it was very direct, adult directed, repetitive, working on a small skill.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
All these small skills add up to a bigger skill.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So an example would be, oh, you put me on the spot and I got to think of an example. Now that's really good. Okay, let's think of something. It may be something to do with greeting someone. Okay, appropriate greeting. And appropriate greeting would be integrating verbal as well as eye contact, as well as maybe turning your body towards the person.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So when you greet them, when you meet a new person. And so for someone with significant autism, that's difficult. And they need to learn how to turn their body and make the eye contact and do the vocalization and how to integrate that. So for that skill, you'd work on the different subsets.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And so you might be first working on, if you want to greet someone and acknowledge them, you're first going to look at them and have that joint attention. So you're going to teach a child how to make eye contact. Initially, we did ABA with something called discrete trial. That's why it's controversial.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Discrete trial, which is still used today and still can be very helpful when it's combined with more naturalistic forms of ABA. Discrete trial would be about teaching a child to make eye contact and they get a reinforcer every time. So make eye contact, get a reinforcer, positive reinforcer. So it's positive reinforcers. It is a lot of repetition, practicing, teaching a child a new skill.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And then you would add the other layers to it, the eye contact and then the greeting and the vocalization, turn your body. You would add all that together to come up with this larger thing of how do you approach someone? So discrete trial has been around for decades. That's the part that's controversial because people say, oh, this is very repetitive and it's not based on relationships.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So over the years, there have been more naturalistic ABA methods created. Naturalistic in that it occurs more in a child's natural environment. It is not just at a structured table where you and I are practicing eye contact. Natural environment, also trying to understand the child's natural motivators. So for example, it might happen at a park.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And it might happen, we know that child loves to be on the swing. So rather than sitting at a table and me saying like, make eye contact, here's your reinforcer, make eye contact, here's your reinforcer. Now we're in a park, this child wants to be pushed on the swing. Well, we're going to help this child learn that if you want me to push you on the swing, you got to push.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
How does it impact function and impact someone doing their job? And for a child, their job is to learn and go to school, make friends, practice communicating and interacting with other peers, and be a positive contributor in their community, which is school. So it's about how these traits impact their function in that job.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
look at me and somehow acknowledge me so I go push you. Otherwise, I don't know that you want to be pushed on the swing. And so those are more naturalistic forms. One of the most naturalistic forms is something called pivotal response treatment, PRT, which is actually training the parents in these skills, because that's really what it's about.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's not about whether this child can make eye contact with therapist A at the table. It's about how does this child understand how to use eye contact, when it's appropriate to use it, and the power of it in natural settings. And so when you train the parents how to do it, then they can practice at the park. At the coffee shop, on the playground, the parents.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So that is the most naturalistic form, teaching the parents. This comes back to parents, how powerful it is if you teach parents. But parents work with the child in a natural setting with natural motivators.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes. When you said that, I'm thinking like, it's just a single parent. It's time and resources and driving to therapies. Again, it depends on how significantly impaired your child is and how many therapies they need.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
They can be. It depends on the state. So how it's covered is different in different states. I'm from California. So in California, ABA is covered if you have a diagnosis of autism. That's where the diagnostic piece is important. So then it is covered.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, there's actually so many things you can say about that. So I'll first start by saying that siblings of children with autism are themselves at risk for either autism or autism-like traits or something called the broader autism phenotype. They may actually not have autism, but they may have a few traits of it. And or at risk for other developmental disabilities.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So kids who are siblings also at risk for language delays, anxiety. So already they have, again, that predisposition, that load to have some developmental differences. So that's one.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There is a big genetic piece to this. So they truly do have these conditions, language delay, autism traits, ADHD. It's very often you see a sibling with one of those other conditions, and there's that genetic piece. But you're right, there's a behavioral component, coping component, anxiety component that may be related to family stress, attention-seeking behavior.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
At the same time, I also see the opposite. I also see many siblings who have incredible empathy for people who are different because they have a sibling who has a developmental disability.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So I do recommend it. It should be a part of a child's treatment plan. The tricky part is you want it done with people who are well-trained, who understand autism, who understand behavioral therapy well. That's the why it's sometimes controversial is because there is such a huge demand for therapy for kids with autism because the numbers are so high.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's hard to find enough people to provide therapy. It's also an industry. And there's people who take jobs in this industry who actually are not well-trained or well-supervised or really understand the nuances. Because if you know one child with autism, you know one child with autism. And if you're just following a recipe, you might run into people, therapists who are not making a
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
huge difference and are not that helpful, but I do offer it. I do recommend it.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There's a burden. I don't know the exact numbers, but it's grown. But because it's growing, it's scaling. And when you scale... You dilute. Yeah. You run into issues with quality when you scale. So it's hard. But that's the thing. How do we keep up?
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So what my advice would be for them would be start with your pediatrician. You start with your pediatrician, but you need to find, your hope is with the pediatrician that they are able to connect you to resources and the network because you really need to find a team. It's finding a team.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's hard.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
No, it's not easy to find.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, you try to create your team. But the thing is, I talk to families all the time. This is so stressful for a parent who's in a situation like this because they don't know anything about this. They could be highly educated. And then we're talking about families who actually, if you speak a different language and don't have higher education, this is a disaster.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But even for families who are well-educated, trying to understand and quarterback this, basically you need a quarterback to help you decide, is this ABA helpful or not? Should I be focused on speech and language therapy or ABA therapy right now? What should I be advocating for at my IEP meetings? You really need someone to help you with that roadmap. So we need to help families more with that.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So for autism, although the typical age for diagnosis is more like three or four, we can confidently make that diagnosis as young as 18 months of age. And I'll be honest, in the last 20 years, there's been one or two cases where I've made it at 15 months of age because it was very significant and obvious.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I think of myself as a Sherpa sometimes, guiding people along this journey, and it's the roadmap. Every year we pivot and turn. Where should we spend more time? Is it in social skill groups? Is it speech therapy? What should we be asking for? And so your question is like, yeah, this is hard to find. And so if you can't find it, You're looking for somebody. It may not be a doctor.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It might end up being a really good ABA therapist or a psychologist in your community who can help connect you. There are state programs.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So one thing is that you make sure that they have the philosophy, one size does not fit all. So that is key, is that this person needs to understand personalized care and that they don't just give the same treatment recommendation, same thing to every single child. It's not black and white. So you need to make sure that that provider is flexible in their thinking and their treatment approach.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
so that they can provide individualized care is one. Two would be that they would be proactive in helping you create some sort of team. So it may not be a team like I have under one roof, but they're open to the idea of collaboration meetings with the child's speech therapist or teacher
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So someone who is open to it, but will also be proactive in arranging collaboration meetings, maybe once a season. Three would be, I think someone who has skills in, I mentioned the parent training piece. I think that's a really important piece. It's not just parent education. It actually is parent training because I've seen that really make a difference.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Most often at that young age, we do wait a few more months to watch how the child develops because kids are a moving target. But with autism, it can be 18 months, two years of age, although half of the cases of autism are diagnosed over six. With ADHD, you can make a diagnosis as young as four years of age.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, this is the journey. This isn't a quick thing. This is years. This is a journey. And the whole point is to have it integrated and generalized in the child's life. We were just talking how ABA in some structured clinic, that's not our goal. The goal is to have a child showing us these skills in real life, in their real life, in their classroom.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Before I answer that, I'm just going to emphasize. So kids who come to my clinic with ADHD often come to me, not always, but often come to me because it was a little bit more complicated than straightforward.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes. If it was straightforward, hopefully their pediatrician can manage it.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. But still, the percent of kids who are treated with medication depends on the age of the child and the severity of the ADHD. So younger kids in my clinic, I will use behavioral interventions first.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So I see preschoolers who come to me because they've been asked to leave multiple preschools because they are hyperactive. And in that preschool years, although you could technically make the diagnosis, I share with the family that we're probably going down this path.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Whatever we're going to call this in the next couple of years, let's start working towards helping your child build skills to regulate, manage their hyperactivity, manage their impulsivity. So we start with first-line treatment for ADHD in kids under six is behavioral parent training. So under six, it's behavioral parent training. We do that first and try to get that to help.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
We may or may not need to add a medication. The guideline for six and older, first-line treatment is medication plus medication. behavioral parent training. And so medication makes a big difference. Medication can be very, very helpful. And I read the family where they are at on this journey and their family values and how they're processing the information.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And I listen to their questions and concerns and I build trust. And so some families are ready to start medication right away. Other families have questions. I work at developing a relationship with that family, answering their questions. And most often we do move towards medication because we know it helps. Most of them say, I wish I started sooner.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But again, I'll just tell you from my clinical experience, I rarely jump onto the diagnosis with a four or five-year-old because they're still a moving target. Although I may start interventions, behavioral interventions and parenting support, but there are a lot of four-year-olds who are pretty busy. So I generally wait closer to school age, although technically you can make it as young as four.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, for sure.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I love all the points you brought up because it is a risk-benefit ratio that you have to consider. There's risks in everything we do. There's risks in all medications. There's risks in everything. So you have to consider both risks and benefits. When I'm working with a family, I talk to them about the research.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And we actually have a lot of research around safety and long-term outcome and the outcome of individuals with ADHD who are left untreated. But actually, more importantly, I get to know their child, though. So this thing, as I get to know them, I share with them the research, the safety research, all sorts of information about the medication.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But what's really important, so this is the idea about me going and watching the child in class, me talking to the teachers, getting to know that family more, really understanding. They come to see me for a reason. If things were great, they wouldn't come to see me. They've come to see me for a reason.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And even though the school, maybe initially was the school who said, your little guy is way too busy and you need to see a doctor about this. But when I get to know the family, I find out, well, actually, dinner is really stressful and bedtime routine is really stressful. Everyone's in tears in the morning. And so I get to know them.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And it's actually that personal part that helps them understand their child. And I come back to self-esteem and interpersonal.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes, that's exactly it. Sometimes we don't use medication. I am the first to say, if your child doesn't need it, we're not going to use it. although we know that medication can make a really big difference.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
ADHD medicines, we're talking stimulants and non-stimulants. First-line treatment considered is stimulants. Within stimulants, we have two different medications. We have one called methylphenidate and one called amphetamine. Methylphenidate, we have many brands. That's the Ritalin, which has been around since I believe the 1950s. We've got Ritalin, we've got Focalin, we've got Concerta.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
We have lots of different methylphenidates.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Concerta, and there's many more brands. They're all different brands.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
How the medication's released.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Timing of release and the mechanism of release.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Five to six, I think. A lot of people will wait till five or six to really see how that child is evolving, although technically you could make it younger. And then with anxiety, there's separation anxiety. There's something called selective mutism in young kids, in preschoolers. So anxiety, there's many different types of anxiety, but there's definitely anxiety conditions in preschoolers.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, it's the same active ingredient, methylphenidate. But it's interesting, kids respond differently to the different medications, the brands, because the release mechanisms are different. So some kids are sensitive.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, that's exactly right. And there's no science, unfortunately, to tell us which one's going to work for your child. So you have to basically try a few.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Amphetamine. So that's Adderall, which has been around since the 1930s. And then there's, you mentioned Vyvanse, Vyvanse, Dexedrine. So there's medications in that group.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes. Vyvanse is actually called a prodrug. It's actually just got a little molecule attached to it that needs to be cleaved in order for it to work. But they're all, yeah, the same.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So the way these medications work is they increase dopamine and norepinephrine in the synapses between the brain cells in the parts of our brain that are important for executive functioning, attention, inhibiting impulses.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So the part of the brain, the prefrontal lobes, where all the executive functioning, attention happens, our brain cells have to communicate in order to see that behavior, attention. These medications, although they're called stimulants, what they do is they increase the levels of dopamine and norepinephrine in these synapses, the gap between the neurons, and they improve the electrical activity
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
activity and communication between brain cells.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So the side effects can be annoying, but they're not life-threatening. The most common one is decreased appetite at lunchtime if you're taking a medication that lasts the whole day. So there's medications that last three or four hours, which we used to use a lot. a couple of decades ago when I first started doing this. But about 20 years ago, we started using extended release a lot more.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And so extended release is that it lasts eight hours or 10 hours for the day or 12 hours a day. And so those medications impact your appetite at lunch. Breakfast and dinner are usually fine. There's this chance that it impacts sleep onset, which is really important because sleep is super important kids, but it can impact sleep onset.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And if that's a problem, we adjust the timing of the medication in the morning.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. They're really easy to use because you take it in the morning. They start to work. The extended release will start to work within an hour. And then they're working for the majority of the day. Then they come out of your system at the end of the day. And so tomorrow, unless you give the medication to your child again.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's like they've never been on it.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. So when I first meet a young child, I generally start with methylphenidate, and that's what most clinicians do with little kids. And the reason for that is that the meta-analyses show that Kids tolerate methylphenidate a tiny bit better than amphetamine, although amphetamine is a little bit more bang for your buck when you're treating the symptoms. That being said, no kid is a statistic.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Every kid's different. So I have just as many kids on Adderall as I have on Ritalin.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. So I use every single brand out there, but I start with methylphenidate because it's shown to be tolerated better.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I want kids to be actually practicing skills when they're on the medication.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes. So let me say a couple of things. So in theory, when they're on the medication, it's easier for them to practice paying attention, controlling your impulses, controlling your hyperactivity. In addition to that, this is where the behavioral parent training part comes in, which is actually now a recommendation that every family should have, should be doing.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes. Amazing how powerful parents can be in modifying the behavior of their child. So parents undergo the training and the child might undergo some sort of therapy, regulation group. When they're older, they undergo executive functioning coaching to learn organization and planning. So what it is, is you are trying to develop these skills.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So when we practice something over and over and over again, not only we develop new behavioral strategies, behavioral patterns, new habits, we actually positively impact the developing brain. That's neuroplasticity, which is one of my passions is neuroplasticity. But we impact the brain through experience and our behaviors.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So when a child has ADHD, it is a wonderful time to practice new skills and you actually impact neural networks.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I don't commit.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. So what I tell families, I have no crystal ball. I can't commit. But I do have many, many patients who do eventually come off medication. Some of them, maybe they shouldn't have come off medication. They actually should stay on their medication. But I have many patients who come off and do really well.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So again, just to emphasize, anxiety is actually a normal emotion that we should all have. So it's all about whether it's created enough impairment. So in the anxiety bucket, there's multiple different types. So someone may have generalized anxiety where that's exactly it. It's generalized. It's seen in multiple places as pretty pervasive.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
No, I see a lot of kids who do find strategies to compensate and who do no longer need their medication as teenagers or young adults. I have a lot of kids who are like that. But I think it's really important that they start early developing strategies and new behaviors. I think that is really important, strengthening those neural networks.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There are non-stimulants that we use. One is called Stratera, which also acts on norepinephrine and increasing the norepinephrine levels in the synapses. And then there's a couple of old blood pressure medications we use. One's called Guafacine. The other one's Clonidine. Those are alpha-2 agonists. So they act in a different way with closing channels in the postsynaptic neurons.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So it's a different mechanism. But all of those medications also help with the communication between neurons in the attention center in the brain. The difference is the non-stimulants have to be taken every day, unlike the stimulants, in order for them to work. So meaning they're taken every day and you need a steady state in your body.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Oh, you mix them often. You do. And so often they do not have the side effects with the poor appetite. And sometimes they can be really good with kids who have some emotional dysregulation, impulsive emotions. So we'll often use them with a child who has a little bit of that irritability, emotional dysregulation. And sometimes we're using both the stimulant and the non-stimulant at the same time.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There's no medication that treats the core symptoms of autism. The core symptoms don't require medication. It's therapy. We use medication in kids with autism to treat target behaviors and symptoms. So we use medication for the symptoms, no matter the label. So whether or not the child with autism has ADHD or not, we still may use an ADHD medicine.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
If they're hyperactive or impulsive, we still may use it, whether or not the label's there.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Correct. So the target symptoms we usually treat, it is the attention hyperactivity impulsivity, where we'll be using the stimulants, or the challenges with emotional regulation, where we'll use a non-stimulant. We may use an anxiety medicine, so a selective serotonin reuptake inhibitor, SSRIs, such as Prozac or Zoloft. We may use that. For anxious feelings,
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
People can have specific phobias towards dogs or spiders or other things. I mentioned separation anxiety, so that is a condition. And again, yes, many toddlers have separation anxiety. That's very normal. It's about how severe and significant the anxiety is and how pervasive it is and whether it is impacting function.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
We also use that sometimes for rigidity. So kids with autism who struggle with rigidity and transitions, it's often anxiety related. So we'll use the SSRIs there. And then kids who have really aggressive behaviors and may injure themselves, then we are talking about atypical antipsychotics. I'll just share with you, I don't use a lot of those myself.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
At that point, if the child is having those difficulties, I often work with a psychiatrist.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Well, with the stimulants, It can be pretty quick. They're like, we're glad we did this. And this is making a big difference. The impact of stimulants is right away. You see the benefits right away.
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
They share with me that it helps them with their focus. They feel more successful at school. And they share side effects.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So I will sometimes have high school students who tell me that they feel less social and funny when they're taking their ADHD medicine. So they're a little less impulsive and spontaneous. And so we talk about that. And I listen because it doesn't have to be black and white, all or nothing. Our goal isn't to make someone 100% focused 100% of the time. It's like, okay, so we want to improve focus.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
None of us are focused completely all the time. So when I have people come to me with side effects, I'm like, okay, well, probably the dose is wrong. Or maybe we should change to a different medication. This one particular medication may not be the right match for you. So we should need to change it and find one with less side effects.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So I think that the key thing is having a relationship between the doctor and the patient, lots of communication, and the idea that if the patient is experiencing side effects, that they tell somebody so that you can adjust. You change the dose, you change the timing, you change the brand. It's just weighing pros and cons.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So when it's impacting the ability for a child to go to childcare or preschool, then it's something we need to help. Other types of anxiety, there's something called selective mutism. Children who are able to speak very well and speak well at home or with familiar adults, but do not speak and are mute outside that familiar environment.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It is. So there is a difference, class three versus class one, for sure. It's harder to see. It's harder to see in class three. Class one, a lot of superpowers. Memory could be one of them. Attention to detail, really good with remembering rules and following routines or a set order of operations. There's a lot of strengths with the kids in class one.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yes, it is.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, definitely. With that profile, like I said, I called it a learning profile, a thinking profile. And so things where you need a little bit more inferring, there's abstract inferring or the social piece, it may not be their strength, but where you need to dive deep into some details, persevere, stick with something, hyper-focus on that. you do really well.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And so a lot of people, once they find their passion as a young adult, if they find a career where they can actually dive in, they can dive deep and do really, really well.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I think that there's a lot of overlap. I think people sometimes get stuck on the label and name. And although there's so many positive things, we're talking about the diagnosis you need to get resources. I think I get concerned that people get stuck on a name and don't actually see the person beneath that name. I think that's my key thing.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I've had so many experiences where families are like, but they told me it's autism. It has to be autism. If you think otherwise, what's wrong with the system? And this is hard because in this field, there's a lot of gray. And so I think that's what it's about. There's gray. It's a moving target. We've changed the names and the definitions multiple times in the last couple of decades.
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
They probably are going to change again. So it's for us to be flexible with our thinking that the definitions may change again. But there are these learning styles. And so if you've met one person with one of these names, you've met one person.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And it's really important to understand that person in order to help them with leveraging their strengths and then understanding what kinds of gaps you want to like fill and what kinds of skills you want to work on.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
There's also obsessive compulsive disorder, where people have obsessive thoughts or compulsive behaviors. So there's many types of anxiety conditions out there, and children have these.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I think it's both those things you mentioned. It is definitely training more people and trying to think about how to use and recruit people who are also going to support, for example, the developmental behavioral pediatrician or the psychiatrist or the psychologist.
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
For example, we need more DBPs, but we also need then like more nurse practitioners or other allied professionals who can support the team. So it's being creative and innovative with how you create the teams. and find enough people to be on these teams, but then how it's reimbursed and making sure there's access to these teams will be really important.
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I really believe in the bridge to education as well, which is not something that is part of an insurance model.
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
I'm going to go back to the bridge. Because it is. It's like the insurance, they'll say that parts of this intervention are educational. So they're not responsible for it. And then the educational people will say that this part is this medical thing. It's actually not interfering with the classroom.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
But you need to realize to help that child move the needle, you have to have both systems working and talking together and collaborating together if you really want to move forward. And so it's a totally different system, but I really believe in bridging education, mental health, and medical if you want to make an impact on child well-being and health.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It does.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Thank you.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Those are great questions because it is definitely a spectrum. There's a bell curve. We're all on a bell curve. For all of these diagnoses, there's a bell curve. And so it's when does it become leaving the average range, the typical profile, and over into what we call a disorder.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And actually, I don't like to use the word disorder for these conditions either because I think they're just learning differences and thinking differences as well. But when does it become a disorder? So questions around impairment. So for me, one of the number one things I talk about with families is self-esteem. How is it impacting that child's self-concept, how they see themselves?
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
How is it impacting their relationships with peers? That's another key one. So does it impact social interactions? Does it impact how they connect with peers? Does it impact the feedback they're getting from peers? How does it impact their ability to learn and access learning opportunities at school or on the playground?
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So are these traits impacting their ability to fully engage in learning, be successful, show their potential? The self-esteem thing is very important to me, though. So for a child who has a biologic condition, these are all biologic. There's neurochemicals, there's genetics involved. These are biologic conditions.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And for a child to have a biologic condition and be in class and then feel bad because they are worried they're not doing well enough...
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
And they're getting a lot of negative feedback from teachers and peers, not because those people are trying to be mean or negative, but they have to constantly remind that child because that child is forgetting things, losing things, forgot to put their name on the piece of paper, completely off task. Losing, yeah. So it's losing, forgetting, it's not completing tasks.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's not sustaining attention in a conversation. It's actually avoiding tasks that require a lot of sustained attention. So there's a lot of these traits where it's impacting this child's ability to be successful day to day at school.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah, you speak to the child and you do talk to others, both of those things. When you talk to the child, there's multiple different ways of doing it. Not always easy to get the answer. With younger children, we sometimes use approaches where we actually are talking about a third person. So there's a number of different techniques where you are working with a child.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Of course, you're building relationship rapport with a child. There needs to be trust. But there's a number of ways that we assess it where we actually may talk to them about another child so that you have another third person, because it's sometimes easier to talk about a third person than yourself. So talking about situations, about how...
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
how another child would feel at school or why does another child feel uncomfortable at school or why does a child come home crying some days? And then you hear their stories.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
So when the children talk about that, they actually relate to their own situations and they start to say like, well, Johnny came home from school crying because nobody wants to play with him because he always messes up rules to the game.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
It's mostly primary elementary school age. So I feel like by the time I get to a second grader, they are second, third, fourth, fifth. They're able to share these stories.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah.
The Peter Attia Drive
#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.
Yeah. When they're older, they'll talk about themselves. It's hard to reflect on your own feelings and thoughts. For a child to identify their own emotions and the why behind their emotions is challenging.