Join Dr. Regan for an episode about what "spectrum" means and why the pattern of neurologic characteristics in each individual is so important to understand. Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians Read the episode transcript: 1 00:00:05,930 -- 00:00:07,750 Hello and welcome. 2 00:00:07,760 -- 00:00:09,690 This is Dr Theresa Regan, 3 00:00:09,690 -- 00:00:11,610 your host for this podcast, 4 00:00:11,620 -- 00:00:13,310 autism in the adult. 5 00:00:13,320 -- 00:00:15,600 I am a neuropsychologist, 6 00:00:15,610 -- 00:00:18,080 a certified autism specialist, 7 00:00:18,090 -- 00:00:27,620 the parent of an autistic teenager and the director of an adult diagnostic autism clinic in central Illinois. 8 00:00:28,240 -- 00:00:33,720 I am happy that you're joining me today for our episode about spectrum. 9 00:00:33,730 -- 00:00:35,590 What does that mean? 10 00:00:35,600 -- 00:00:39,010 And Why is pattern important? 11 00:00:39,900 -- 00:00:47,540 So let me explain a little bit of background as far as where I'm coming from with spectrum and pattern. 12 00:00:48,380 -- 00:00:50,720 So as a neuropsychologist, 13 00:00:50,730 -- 00:00:58,270 I specialize in understanding how brain pathways and brain health impact things like thinking, 14 00:00:58,270 -- 00:01:01,080 skills but also emotions, 15 00:01:01,080 -- 00:01:11,420 personality and behavior by looking at how someone's brain is able to process verbal information or learn new information, 16 00:01:11,430 -- 00:01:16,910 pay attention how they're able to balance emotions or plan for the future. 17 00:01:16,920 -- 00:01:29,250 The neuropsychologist can make conclusions about the health of the brain or specific ways that the brain has connected informed pathways across different locations. 18 00:01:30,400 -- 00:01:42,550 So we know that the brain is divided up into various areas and the locations can have specific functions specific jobs. 19 00:01:42,550 -- 00:01:48,990 So the left hemisphere versus the right hemisphere or the center of the brain versus the outside. 20 00:01:49,090 -- 00:01:56,820 There are also specific nuclei in the center of the brain and there are lobes that we talk about the frontal lobe, 21 00:01:56,820 -- 00:01:57,430 the parietal lobe, 22 00:01:57,430 -- 00:01:58,570 etcetera. 23 00:02:00,000 -- 00:02:08,790 So the brain is really special in that the neurology is patterned and localized and there's a function to it. 24 00:02:10,010 -- 00:02:22,300 So one of the ways that a neuropsychologist makes conclusions about those patterns and what's going on in the brain is by looking at the way that the brain behaves. 25 00:02:22,310 -- 00:02:24,780 So how does it do with reading? 26 00:02:24,780 -- 00:02:28,660 How does it do with um staying calm and centered? 27 00:02:28,660 -- 00:02:35,240 And that gives um revelation about the connections, 28 00:02:35,250 -- 00:02:36,230 the anatomy, 29 00:02:36,230 -- 00:02:37,760 how the brain is wired. 30 00:02:39,440 -- 00:02:43,220 So a huge focus of what neuropsychologist analyze is. 31 00:02:43,220 -- 00:02:46,370 Not any one score. 32 00:02:46,380 -- 00:02:53,070 Like let's say we give a memory task and a reading task and we look at something called praxis, 33 00:02:53,080 -- 00:02:56,900 we're not gonna look at any one score. 34 00:02:56,900 -- 00:02:58,530 What did this person get correct? 35 00:02:58,530 -- 00:02:59,960 What did they get wrong? 36 00:02:59,970 -- 00:03:01,050 Um No, 37 00:03:01,050 -- 00:03:05,470 we're looking for this data to fall into a pattern. 38 00:03:05,480 -- 00:03:10,020 It's the pattern that is really where the revelation is. 39 00:03:10,140 -- 00:03:15,940 And once we get a significant amount of data from a checkup, 40 00:03:16,500 -- 00:03:21,290 we look for how these pieces of data hang together. 41 00:03:21,300 -- 00:03:27,400 So the pattern should be consistent with the way that the brain is organized anatomically. 42 00:03:27,410 -- 00:03:38,490 So in the same way that a neurologist would check your vision or reflexes your walking patterns to make conclusions about the health and functioning of the brain. 43 00:03:38,670 -- 00:03:45,400 A neuropsychologist also uses information um about patterns. 44 00:03:45,400 -- 00:03:47,620 So we look at cognitive scores, 45 00:03:47,630 -- 00:03:55,560 we make behavioral observations and we uh make conclusions about how the brain is functioning. 46 00:03:57,360 -- 00:04:08,640 Different types of situations will have different patterns because various pathways might be impacted uh in a sequence that's really kind of unique. 47 00:04:08,650 -- 00:04:10,000 For example, 48 00:04:10,000 -- 00:04:38,930 if someone has a traumatic brain injury with a left sided brain bleed and a diffuse axonal injury ... that has a different neuropsychological pattern than someone who presents with the Parkinson's condition and because of this neuropsychologist are very practiced at looking for pattern and understanding how important pattern is and understanding the neurology of the individual. 49 00:04:41,600 -- 00:04:44,220 In the case of the autism spectrum. 50 00:04:44,230 -- 00:04:53,000 Certain neurologic characteristics hang together in one person because of differences in the development of the nervous system. 51 00:04:54,040 -- 00:05:00,680 The characteristics hang together behaviourally because they fall within specific pathways. 52 00:05:00,680 -- 00:05:29,740 They cluster together anatomically in some way because scientists have noted that these neurologic characteristics sometimes hang together and one person they say oh we should call this cluster of neurology something so that we can start talking about it and learning more about it and then it's been decided that we'll call this clustering the autism spectrum. 53 00:05:31,120 -- 00:05:36,310 So when do we actually call that neurology autism. 54 00:05:37,330 -- 00:05:46,890 So what the scientific community has done is determined seven diagnostic criteria to look at in the assessment process. 55 00:05:46,900 -- 00:05:59,490 And they've also developed general guidelines and as with any of um the diagnostic conditions that we have in the D. 56 00:05:59,490 -- 00:05:59,730 S. 57 00:05:59,730 -- 00:05:59,960 M. 58 00:05:59,960 -- 00:06:00,470 Five, 59 00:06:00,480 -- 00:06:04,380 the diagnostic and statistical manual fifth edition. 60 00:06:04,390 -- 00:06:16,970 You know there are committees that get together and they look through research and our current understanding and they determine then what the criteria are. 61 00:06:16,980 -- 00:06:33,290 But there are always discussions and disagreements about uh when do we call this autism when do we call this depression when do we call this dyslexia whatever the state is that they're trying to describe. 62 00:06:33,830 -- 00:06:38,250 So one thing is to know that there are seven diagnostic criteria. 63 00:06:38,260 -- 00:06:40,940 And then there are also uh, 64 00:06:40,950 -- 00:06:45,590 disagreements and discussions about whether other things should be included, 65 00:06:45,600 -- 00:06:46,230 um, 66 00:06:46,230 -- 00:06:47,200 etcetera. 67 00:06:48,230 -- 00:06:49,520 But for our purpose, 68 00:06:49,520 -- 00:06:54,260 what I want to emphasize is that there's this structure, 69 00:06:54,440 -- 00:07:02,860 these criteria and the first three are social in nature and all three of those must be met. 70 00:07:03,800 -- 00:07:09,520 The last four criteria are grouped into what's called repetitive and restricted behaviors, 71 00:07:09,560 -- 00:07:12,710 and only two of the four must be met. 72 00:07:13,430 -- 00:07:30,400 So one type of pattern that we see in autism is that individuals may have unique patterns of which specific criteria are met in order to get this to meet this diagnostic threshold. 73 00:07:30,410 -- 00:07:35,570 And that can mean that individuals on the spectrum can really present differently. 74 00:07:35,580 -- 00:07:39,190 So one person may meet all seven criteria. 75 00:07:39,200 -- 00:07:42,550 Another may meet five or six criteria, 76 00:07:42,550 -- 00:07:46,320 depending on how many of that last grouping they present with. 77 00:07:47,480 -- 00:07:48,820 Think about this. 78 00:07:48,830 -- 00:07:52,430 There could be two people who both meet five criteria, 79 00:07:52,440 -- 00:07:59,440 but they meet different groupings of the criteria and therefore they present with somewhat different characteristics. 80 00:07:59,450 -- 00:08:05,770 So they may meet all three of the social criteria. 81 00:08:05,780 -- 00:08:08,940 And then two of the last four. 82 00:08:08,950 -- 00:08:10,300 But which two? 83 00:08:10,310 -- 00:08:16,070 And that brings this uniqueness of what the features are for these individuals. 84 00:08:17,250 -- 00:08:23,540 So the combination of which criteria are met will create a pattern for that individual. 85 00:08:23,540 -- 00:08:27,110 And this is part of what I consider. 86 00:08:27,120 -- 00:08:29,150 When I'm thinking about spectrum? 87 00:08:29,160 -- 00:08:30,650 What does spectrum mean? 88 00:08:30,660 -- 00:08:31,110 Well, 89 00:08:31,110 -- 00:08:31,460 to me, 90 00:08:31,460 -- 00:08:41,160 it's pattern and that the pattern in one person versus another person who meets criteria for the threshold of diagnosis, 91 00:08:41,170 -- 00:08:44,310 that's gonna have some unique flavors to it. 92 00:08:44,320 -- 00:08:46,920 So the neurologic foundation, 93 00:08:47,150 -- 00:08:50,640 the criteria are met in both individuals, 94 00:08:50,640 -- 00:08:54,820 but they can be met with a different pattern of features. 95 00:08:56,970 -- 00:09:10,420 It is not true that individuals with seven criteria met have more significant impact in their daily life than someone where five criteria are met. 96 00:09:10,430 -- 00:09:14,930 This does not have to do with how much someone is impacted. 97 00:09:14,940 -- 00:09:18,930 It just has to do with the breadth of the neurologic features. 98 00:09:18,940 -- 00:09:19,650 Um, 99 00:09:19,650 -- 00:09:23,630 some of which will really be beneficial to that individual. 100 00:09:23,630 -- 00:09:29,230 They'll help in their daily life and other things that will be challenges. 101 00:09:29,240 -- 00:09:31,950 But the number of criteria, 102 00:09:31,960 -- 00:09:34,730 those do not determine, 103 00:09:35,040 -- 00:09:35,860 uh, 104 00:09:35,870 -- 00:09:38,580 what some people call quote severity, 105 00:09:38,590 -- 00:09:39,430 um, 106 00:09:39,440 -- 00:09:40,530 of autism. 107 00:09:40,530 -- 00:09:44,900 A lot of people who come for a diagnosis want information about, 108 00:09:44,910 -- 00:09:46,250 about severity. 109 00:09:46,250 -- 00:09:47,980 And that's not what we're talking about. 110 00:09:47,980 -- 00:09:50,670 We're talking about pattern because, 111 00:09:50,670 -- 00:09:51,040 you know, 112 00:09:51,040 -- 00:10:00,890 it's so important to understand each person as an individual and it's not enough to go for a diagnosis and then be told, 113 00:10:00,890 -- 00:10:01,070 well, 114 00:10:01,070 -- 00:10:02,220 yes or no, 115 00:10:02,230 -- 00:10:06,230 you fit the criteria or you don't really, 116 00:10:06,230 -- 00:10:09,880 what you're coming for is revelation of this pattern. 117 00:10:09,890 -- 00:10:10,410 Well, 118 00:10:10,410 -- 00:10:12,530 what does this look like in me? 119 00:10:13,080 -- 00:10:15,650 How does this impact my daily life? 120 00:10:15,660 -- 00:10:20,510 What are my strengths and challenges within this neural neurologic pattern. 121 00:10:20,520 -- 00:10:23,000 And that's where the gold is. 122 00:10:23,000 -- 00:10:24,540 That's where the spectrum is. 123 00:10:24,540 -- 00:10:31,020 That's where self awareness and understanding lie in this revelation of pattern. 124 00:10:32,630 -- 00:10:36,580 In addition to the pattern across the seven criteria, 125 00:10:36,580 -- 00:10:40,920 we also want to look at the pattern within each criteria. 126 00:10:40,930 -- 00:10:43,400 So there are different layers of pattern. 127 00:10:43,410 -- 00:10:49,880 Let's say someone meets the same five criteria that another person meets, 128 00:10:49,890 -- 00:10:55,400 but they can still meet each individual criteria with unique features. 129 00:10:55,400 -- 00:10:57,470 So let's take this and talk about it. 130 00:10:58,250 -- 00:10:59,320 For example, 131 00:10:59,320 -- 00:11:01,730 let's take the first criteria. 132 00:11:01,740 -- 00:11:14,400 And this has to do with difficulty in the area of social approach social reciprocity and the back and forth flow of conversation during social interactions. 133 00:11:14,410 -- 00:11:19,560 And usually this criteria is called the social reciprocity criteria. 134 00:11:19,560 -- 00:11:22,450 And reciprocity means exchange. 135 00:11:22,720 -- 00:11:32,010 Um so what we're looking for here is not whether someone can exchange information about topics and facts, 136 00:11:32,020 -- 00:11:42,360 but whether they lean toward being able to exchange information for social purposes for emotional purposes and to take turns. 137 00:11:42,360 -- 00:11:48,010 So there's kind of an equal exchange um in connecting with another person, 138 00:11:48,750 -- 00:11:56,920 one autistic individual may meet this criteria because he rarely approaches others at all for any kind of social exchange. 139 00:11:56,920 -- 00:11:58,600 So this approach, 140 00:11:58,600 -- 00:12:05,060 piece of the criteria may be very limited when he does approach, 141 00:12:05,070 -- 00:12:09,500 he really only wants answers to questions directly asked. 142 00:12:09,510 -- 00:12:14,530 Um or he will uh answer a question if somebody else asks it, 143 00:12:14,530 -- 00:12:18,300 but he basically exchanges facts and data, 144 00:12:18,300 -- 00:12:24,170 but he doesn't really fully engage in exchanging social and emotional information? 145 00:12:25,480 -- 00:12:26,320 For example, 146 00:12:26,320 -- 00:12:30,020 if someone is explaining why they're looking forward to christmas, 147 00:12:30,110 -- 00:12:43,450 this autistic individual may say something like uh huh rather than really fully engaging in that social peace um or saying something like I've always loved christmas too. 148 00:12:43,450 -- 00:12:45,730 What's your favorite christmas tradition? 149 00:12:48,100 -- 00:12:54,750 In contrast to the autistic individual who does not tend to approach or engage socially, 150 00:12:54,760 -- 00:13:05,020 another individual may do so to really an extreme level a level that does not create good social exchange because it's done too frequently. 151 00:13:05,440 -- 00:13:22,480 This individual may respond to the Christmas comment by talking in a monologue for 15 minutes about the differences in Christmas traditions across the world and the impact of Pagan practices and celebrations on current Christmas traditions. 152 00:13:23,220 -- 00:13:32,830 Now the first and the second individual both struggle to appropriately exchange the social piece of interaction, 153 00:13:32,840 -- 00:13:43,820 one because of infrequent exchange and the other because of too much approach and exchange and too much talking, 154 00:13:43,830 -- 00:13:48,480 not taking turns and asking for the other person's input. 155 00:13:48,830 -- 00:13:58,720 Um and really allowing there to be the social emotional piece instead of uh kind of a large exchange of factual information. 156 00:13:59,610 -- 00:14:03,980 So this is an example of the pattern within a criteria. 157 00:14:03,990 -- 00:14:08,210 Um so it can look unique from person to person on the spectrum. 158 00:14:09,510 -- 00:14:15,750 Another example of an internal pattern within a criteria would be the 7th criteria, 159 00:14:15,750 -- 00:14:18,770 which is about sensory processing. 160 00:14:19,570 -- 00:14:24,090 Now this criteria does not have to be present for a diagnosis, 161 00:14:24,100 -- 00:14:25,740 but when it is present, 162 00:14:25,740 -- 00:14:33,030 the pattern may be one of high levels of reactivity to sensory information. 163 00:14:33,040 -- 00:14:34,040 So this could be, 164 00:14:34,040 -- 00:14:35,280 for example, 165 00:14:35,290 -- 00:14:40,650 someone that's really very sensitive to touch or light. 166 00:14:41,510 -- 00:14:46,490 It could be a pattern of under reactivity to sensory information. 167 00:14:46,490 -- 00:14:51,480 So when they experience something from the sensory environment, 168 00:14:51,480 -- 00:14:54,920 they just don't notice it as much as other people would. 169 00:14:55,990 -- 00:15:02,420 And it could also include an unusual fascination with sensory aspects of the environment. 170 00:15:02,430 -- 00:15:09,640 So really loving to watch visual movement or to smell certain objects, 171 00:15:09,640 -- 00:15:11,820 that this sensation, 172 00:15:11,820 -- 00:15:15,280 this part of the environment is really fascinating. 173 00:15:16,970 -- 00:15:22,140 So one autistic individual may show extreme sensitivity to sound, 174 00:15:22,160 -- 00:15:29,380 a very narrow range of food textures in their diet and an extreme need for high levels of movement. 175 00:15:29,390 -- 00:15:32,160 This vestibular sensory process, 176 00:15:32,750 -- 00:15:38,960 but a second individual may show a different pattern within sensory processing. 177 00:15:38,990 -- 00:15:52,780 So they might show a very high pain tolerance that they don't even notice that their finger was broken until they realized they couldn't hold a pencil to complete a form even though the injury occurred the day before. 178 00:15:54,100 -- 00:16:06,330 Ah This person may also be highly sensitive to movement to the point where they'd rather sit still and do table work than moving around or playing sports or going outside. 179 00:16:07,400 -- 00:16:11,110 So even though people meet the same criteria, 180 00:16:11,120 -- 00:16:13,870 they certainly may meet those in different ways. 181 00:16:13,880 -- 00:16:17,660 And that individual pattern is really important. 182 00:16:19,780 -- 00:16:23,310 Given these examples of patterns across the criteria, 183 00:16:23,310 -- 00:16:24,210 for example, 184 00:16:24,220 -- 00:16:25,930 how many are met, 185 00:16:25,940 -- 00:16:28,290 what pattern of criteria are met. 186 00:16:28,300 -- 00:16:30,900 and also within each criteria. 187 00:16:30,910 -- 00:16:35,070 What do the specific sensory differences look like for this individual? 188 00:16:35,070 -- 00:16:36,160 For example, 189 00:16:36,170 -- 00:16:39,700 you can get a sense of what spectrum can look like. 190 00:16:40,080 -- 00:16:43,510 So this is how I view the term spectrum, 191 00:16:43,520 -- 00:16:53,160 I really don't find it useful uh as any kind of um continuum of what people would call severity. 192 00:16:53,170 -- 00:17:01,590 Um but rather spectrum is a way of knowing that the same neurologic criteria are met for all of these individuals, 193 00:17:01,590 -- 00:17:05,900 but the specific neurologic manifestations, 194 00:17:05,900 -- 00:17:27,550 the way that this neurology manifests will vary from person to person and that level of individual insight with people that's so important to um kind of reveal that it's not enough just to have a global uh term that we're going to call things, 195 00:17:27,550 -- 00:17:30,920 we really want to know people on an individual level, 196 00:17:31,700 -- 00:17:59,240 it makes more sense to look at how much struggle someone's having based on a pattern rather than the number of characteristics or to analyze how they are so gifted in this particular academic subject or this particular part of work or life um life skills and ways that that is a manifestation of their unique neurology. 197 00:17:59,740 -- 00:18:03,370 So whether we're looking at struggles or gifts, 198 00:18:03,380 -- 00:18:05,820 challenges or strengths, 199 00:18:05,830 -- 00:18:17,830 we like to know the pattern this person has both and in a unique pattern that's different than this next person that we see on the spectrum. 200 00:18:18,990 -- 00:18:25,150 When we're able to examine what the pattern of neurologic features are for one specific person, 201 00:18:25,170 -- 00:18:30,620 then we can work towards increased self awareness of pattern for that individual, 202 00:18:30,620 -- 00:18:32,320 maybe for family around them, 203 00:18:32,320 -- 00:18:41,050 who want to understand better but feel confused and to focus on strategies that may specifically address um, 204 00:18:41,060 -- 00:18:43,760 the strengths and challenges of this person. 205 00:18:43,770 -- 00:18:44,350 You know, 206 00:18:44,350 -- 00:18:59,260 how can we amplify the things that they're just so strong in and how can we help with things that are challenges or things that are draining and really making some of life more difficult than we wanted to be? 207 00:19:01,350 -- 00:19:01,910 Part of. 208 00:19:01,910 -- 00:19:05,310 What I think is most valuable about the diagnostic process. 209 00:19:05,320 -- 00:19:12,370 Is this kind of feedback from the clinician to the individual about not just yes or no, 210 00:19:12,370 -- 00:19:13,620 Is there a diagnosis, 211 00:19:13,620 -- 00:19:16,520 but what does autism look like in me? 212 00:19:16,520 -- 00:19:18,090 How is that manifest? 213 00:19:18,100 -- 00:19:23,040 And oftentimes people coming in for a diagnosis will know some of that, 214 00:19:23,070 -- 00:19:26,580 but the clinician should be skilled enough to say. 215 00:19:27,250 -- 00:19:29,300 And I also see this in you. 216 00:19:29,310 -- 00:19:39,850 I see that this pattern in your nervous system likes this and I'm wondering about this issue here so that there's more revelation about pattern. 217 00:19:39,860 -- 00:19:42,320 It's more um identified. 218 00:19:42,320 -- 00:19:43,550 It's more specific. 219 00:19:43,550 -- 00:19:44,760 It's clearer. 220 00:19:44,770 -- 00:19:49,990 Um and that is part of what makes the assessment process so valuable. 221 00:19:52,040 -- 00:20:01,220 Let's end with a few more examples just to highlight what I mean by pattern and differences between two individuals on the spectrum. 222 00:20:02,860 -- 00:20:06,220 So let's take Julio who is a 50 year old male. 223 00:20:06,220 -- 00:20:10,250 He's working as a structural engineer for a local company, 224 00:20:10,260 -- 00:20:11,740 he's married to Mona, 225 00:20:11,740 -- 00:20:17,960 they have three daughters and the last of their daughters has just moved out to attend college. 226 00:20:17,960 -- 00:20:22,190 So they are in this early empty nest season. 227 00:20:22,200 -- 00:20:37,880 Life is changing and Mona really starts to spend quite a bit of time alone with Julio when he's not at work and she brings him in to see a psychologist because she feels that Julio is depressed. 228 00:20:39,410 -- 00:20:42,170 Mona notes that with her Children gone, 229 00:20:42,170 -- 00:20:48,180 she's really struck by how limited Julio converses with her at home. 230 00:20:48,230 -- 00:20:52,540 It's very quiet now and she can't really get much out of him. 231 00:20:52,550 -- 00:20:55,160 He's likely to come home after work, 232 00:20:55,170 -- 00:20:55,820 eat dinner, 233 00:20:55,820 -- 00:21:03,320 go to the basement to work on his tabletop Battle replicas most recently highlighting the Battle of the Bulge, 234 00:21:03,330 -- 00:21:05,780 a famous battle from World War Two. 235 00:21:06,680 -- 00:21:17,480 Now when she invites him to watch a tv show with her after dinner instead he'll sit in the rocking chair and watch the show but does not like to talk or a visit during the program. 236 00:21:18,330 -- 00:21:29,330 His facial expressions and tone of voice is either serious or really kind of flat or empty of emotion and she has a hard time gauging what he's thinking. 237 00:21:29,940 -- 00:21:42,740 She's used to the more energetic conversations that she would have with her daughters and she concludes that Julio is depressed during this life season of change. 238 00:21:42,750 -- 00:21:47,890 He's thinking about uh Retirement in the next 10 years. 239 00:21:47,890 -- 00:21:52,390 He is with Mona now in an empty nest. 240 00:21:52,390 -- 00:22:00,960 And she hypothesizes since he doesn't talk very much that his thought process has to do with depressed mood. 241 00:22:04,120 -- 00:22:04,420 Now. 242 00:22:04,420 -- 00:22:08,970 We didn't talk about all the autistic characteristics in Julio, 243 00:22:08,970 -- 00:22:13,230 but you can get a flavor of how this is manifest in their home. 244 00:22:14,330 -- 00:22:15,340 In contrast, 245 00:22:15,340 -- 00:22:18,150 let's take Maddie who was a 27 year old, 246 00:22:18,150 -- 00:22:19,040 single female. 247 00:22:19,040 -- 00:22:24,490 She has no Children and she has always loved to be the center of attention. 248 00:22:24,620 -- 00:22:31,860 She's put on plays and music performances for her family as a child and then she focused on magic tricks. 249 00:22:31,870 -- 00:22:33,350 When she was in middle school. 250 00:22:33,350 -- 00:22:35,690 She really wanted to wow everyone. 251 00:22:36,940 -- 00:22:46,320 And what became apparent is that she really liked to have the role of an entertainer and she liked to have an audience. 252 00:22:46,330 -- 00:22:51,330 Um that could see all of her gifts and talents. 253 00:22:52,760 -- 00:22:57,100 She also liked to take control of the topics of conversation, 254 00:22:57,110 -- 00:23:00,760 so making sure that it's something she's really interested in, 255 00:23:00,760 -- 00:23:05,910 like greek mythology or sewing costumes for theater or cosplay events. 256 00:23:05,940 -- 00:23:10,560 She has a hard time understanding how she impacts others. 257 00:23:10,570 -- 00:23:23,570 What does this person need from me during the interaction and some people feel like maybe she's really controlling because she likes things to go her own way and doesn't care about other people. 258 00:23:24,350 -- 00:23:26,980 But this is really a misunderstanding. 259 00:23:26,990 -- 00:23:34,850 She feels comfortable in a specific social role and she also likes to know what's going to happen next. 260 00:23:34,860 -- 00:23:42,400 So she likes to choose the activities that they do together or the topics that they're talking about. 261 00:23:43,580 -- 00:23:44,760 She over plans, 262 00:23:44,760 -- 00:23:49,660 vacations with family and will hand out a schedule of activities to everyone. 263 00:23:50,470 -- 00:23:55,050 She'll leave the room of someone who wants to talk about their own interests. 264 00:23:55,110 -- 00:23:57,390 And even though she talks successively, 265 00:23:57,390 -- 00:24:02,890 she also complains about noises that other people make when they talk. 266 00:24:02,900 -- 00:24:03,610 Uh, 267 00:24:03,620 -- 00:24:09,510 so she wants people to be quiet and people around her are very confused, 268 00:24:09,520 -- 00:24:14,510 like how can you talk so much and also want us to be quiet. 269 00:24:14,520 -- 00:24:25,900 But that's a very common phenomenon and sensory processing that the person is much more upset by surrounding noise than their own noise. 270 00:24:26,770 -- 00:24:27,950 She wears noise, 271 00:24:27,950 -- 00:24:35,240 canceling headphones around others and people feel because of this pattern that she's very self absorbed. 272 00:24:35,250 -- 00:24:35,850 They really, 273 00:24:35,850 -- 00:24:38,130 she's misunderstood essentially. 274 00:24:38,140 -- 00:24:38,970 Um, 275 00:24:38,980 -- 00:24:42,220 she doesn't ask other people how they're doing or what they need, 276 00:24:42,220 -- 00:24:47,180 how their weakened was she often corrects others when they make errors of detail, 277 00:24:47,180 -- 00:24:52,390 like saying something cost $50 when it actually cost 50-37. 278 00:24:54,170 -- 00:24:59,050 So both of these people did not realize their diagnosis. 279 00:24:59,060 -- 00:25:00,200 Uh, 280 00:25:00,210 -- 00:25:02,660 and then at a certain age in life, 281 00:25:02,660 -- 00:25:16,060 they were given a diagnosis and the information about their neurology helped them understand and those around them what, 282 00:25:16,070 -- 00:25:19,890 how the neurology manifest both in things, 283 00:25:19,890 -- 00:25:35,260 they were really good at the things that were gifts that were strengths and also things that were characteristics that they didn't intend to isolate themselves from anyone or hurt anyone's feelings, 284 00:25:35,260 -- 00:25:41,360 but they really just had different needs socially and with this increased awareness. 285 00:25:41,380 -- 00:25:46,380 People were able to understand and interact in a more satisfying way. 286 00:25:48,600 -- 00:25:52,370 So both individuals struggled to socially connect with others. 287 00:25:52,480 -- 00:25:55,800 But while Julio was under engaged with his wife, 288 00:25:55,810 -- 00:26:03,570 Maddy ended up being over engaged in her social exchanges and she wasn't as attentive to the needs of others. 289 00:26:06,110 -- 00:26:19,070 Being aware of why two autistic individuals can both meet criteria but look quote so different on casual observation can help us connect with the concept of spectrum. 290 00:26:19,730 -- 00:26:35,570 We also can become more aware of why one autistic individual may benefit from one thing as a recommendation while another needs something different that we have this unique patterning and that part is very important. 291 00:26:37,410 -- 00:26:43,370 There are the same neurologic foundations but with different specifics in the characteristics. 292 00:26:45,380 -- 00:26:52,180 So whether we're talking about an autistic individual who is really self aware, 293 00:26:52,190 -- 00:27:18,730 who has strategies that really help them during rough spots and who is able to focus and use their strengths to great advantage and to um really meet their goals and to help others or if we're talking about someone who is not diagnosed or newly diagnosed and still learning this concept of the individual pattern, 294 00:27:18,830 -- 00:27:30,720 The individual spectrum of qualities really is an important revelation to focus on understanding each individual because that's where the power is right. 295 00:27:30,730 -- 00:27:31,860 I see you, 296 00:27:31,860 -- 00:27:32,830 I hear you, 297 00:27:32,830 -- 00:27:34,660 I get you better. 298 00:27:34,660 -- 00:27:36,570 I think we can connect more. 299 00:27:36,580 -- 00:27:37,320 Um, 300 00:27:37,330 -- 00:27:42,870 that's really the magic about thinking about pattern within the spectrum. 301 00:27:44,960 -- 00:27:50,120 I am really glad you joined me to hear about pattern and spectrum today within autism. 302 00:27:50,750 -- 00:27:58,820 And next time we'll be starting a new series and we're going to focus on misdiagnosis on the autism spectrum. 303 00:27:59,790 -- 00:28:05,180 In addition to those who are on the spectrum who don't carry any diagnosis, 304 00:28:05,190 -- 00:28:09,880 many others carry a misdiagnosis or several, 305 00:28:09,890 -- 00:28:10,580 um, 306 00:28:10,580 -- 00:28:13,440 diagnoses that really are not correct. 307 00:28:13,450 -- 00:28:17,280 And often this is within areas of mental health. 308 00:28:17,910 -- 00:28:21,930 So we're going to start by talking about why this occurs on the spectrum. 309 00:28:21,940 -- 00:28:30,680 And then we're going to review various conditions that are common culprits for misdiagnosis such as borderline personality disorder, 310 00:28:30,690 -- 00:28:32,030 bipolar disorder, 311 00:28:32,040 -- 00:28:33,870 attention deficit and more. 312 00:28:34,430 -- 00:28:38,200 I hope you'll join me for our next series on misdiagnosis. 313 00:28:38,210 -- 00:28:39,740 And thanks for tuning in.

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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