Full PreFrontal

Ep. 199: Donna Henderson, Psy.D. - If This Is Autism…

June 21, 2023 Sucheta Kamath Season 1 Episode 199
Full PreFrontal
Ep. 199: Donna Henderson, Psy.D. - If This Is Autism…
Show Notes Transcript

During the 2007 season of America’s Next Top Model, contestant Heather Kuzmich introduced American viewers to her diagnosis of Autism Spectrum Disorder and the  challenges that go along with it. Having to live in a house with twelve strangers while navigating the social politics of housemates who were also her competitors proved to be quite a bit of challenge for Kuzmich and yet she won viewers’ hearts and ended up in the top five. While this success story offers inspiration and hope to many; for those with ASD diagnosis, the struggle is real and they need help and support from not just experts, but from communities as well.

On this episode, practicing clinical psychologist and co-author of two books “Is This Autism? A guide for clinicians and everyone else” and “Is This Autism? A companion guide for diagnosing”, Dr. Donna Henderson returns to discuss effective ways to manage the ASD condition as it poses many challenges including black-and-white thinking, rigid rule-following, obsessiveness, and perfectionism that can take a toll on one's quality of life.


About Donna Henderson, Psy.D.
Dr. Donna Henderson has been a clinical psychologist for over 30 years. She is passionate about identifying and supporting autistic individuals, particularly those who camouflage, and she is co-author (with Drs. Sarah Wayland and Jamell White) of two books: Is This Autism? A guide for clinicians and everyone else and Is This Autism? A companion guide for diagnosing. Dr. Henderson’s professional home is The Stixrud Group in Silver Spring, Maryland, where she provides neuropsychological evaluations for children, adolescents, and adults who would like to understand themselves better. She is a sought-after lecturer on the less obvious presentations of autism, autistic girls and women, PDA, and on parenting children with complex profiles. She also enjoys providing neurodiversity-affirmative training and consultation for other healthcare professionals.

Website:

  • http://drdonnahenderson.com/

Book:

About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

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Sucheta Kamath: Welcome back to Full PreFrontal exposing the mysteries of executive function. I'm your host Sucheta Kamath. And we talk about all things executive function, a one's capacity to manage self, manage goals, manage relationships, and most importantly, manage the relationship with the future self. One of the things that I often think about why this podcast is, I not only want you to understand that executive function skills are complicated things to understand. But there are experts who have been added for years. However, the words in the lens they might use might be different and not explicitly, the term executive function might be used. The second thought is, I hid this distinction between disability in ability and ability, I feel we are all on a spectrum. And some of us are good at something some of us are bad at that thing that somebody else is good at. And then some people truly struggle because they haven't developed those abilities. And then some people may be really, really have significant struggle that they may never develop the ability. And that's why we have experts who teach people how to lead their lives. And then there are people who self discover. I also have been thinking a lot about this concept that I came across by one of the guests. Previous guests are Roy Richard Grinker, who is a anthropologist, who he says, One of the Freud's wishes was that doctors could help lead people out of misery, not into perfect, not into a perfect life, but into ordinary state of unhappiness. And I just love this because I think this idea that people, first of all are permanently miserable, is erroneous. Second, having difficulties is something we have deep, incredibly versatile response that No, I don't want it. But three is only people who have a diagnosis have some sort of miserable life, because people can have actually fabulous life. We just think they don't have what we have. So they should be miserable. So with that, it is our joy and delight to have the privilege of her have Donna Henderson returned to the podcast for the second time. And those who might be listening to podcast episodes, just like I do out of sync i One recommendation and suggestion I have is please listen to the last week's podcast with her her because it's just she sets the stage for how to conceptualize the autism spectrum disorder. So once again, let me tell you a little bit about her. And then we can welcome her to the podcast. So Dr. Donna Henderson has been a clinical psychologist for over 30 years. She is incredibly passionate about identifying and supporting autistic individuals, particularly those can camouflage. And she is a co author with Dr. Sarah Wayland and Jamell White of two books. Is This Autism? A Guide for Clinicians and Everyone Else And Is This Autism? A Companion Guide for Diagnosing. One of the expertise she brings is, as a psychologist who does diagnosing day in and day out. She's really really incredibly talented in deciphering the subtle nuances. And she is a sought after lecture on particularly this less obvious presentation of autism, and how it presents itself in autistic girls and women. So Donna, welcome to the podcast again. Thank you for being here.

Donna Henderson: Well, thank you for having me again. It was fun last time, and I'm looking forward to this.

Sucheta Kamath: Yes. And since we interviewed so even though we are publishing these episodes back to back, we have had a one month gap and I just wanted to quickly share. Meanwhile, I had a quick trip to Texas and I was invited to give a one day a seminar on a relationship between executive function and autism. And one of the interesting things that came up one of the participants asked me that sutra, I have a five year old and I asked him to get in line. And he wants to say the word taco, he is obsessed, and he perseverates. That means he says the same thing again and again. Taco, taco, taco, taco, taco, what should I do? So I had some interesting perspective on that. And I think as we kick off this discussion, I thought it one if you could maybe start off with this framework of autism and then maybe even give our listeners some idea as to how to rethink rather than thinking that the child should stop saying taco. What can the teacher think as a good goal for this child?

Donna Henderson: Right? Wow. So in that situation, and that's so common, right? We the adults want a job I have to stop doing something that maybe we find annoying or just unusual. But we also have to step back and ask ourselves, Is it really necessary that the child stop this behavior? Is it really getting in the child's way? Or someone else's way? Sometimes? Yes. And sometimes no. But if there is asking the question, I've had teachers who are just unbelievably, you know, focused on a child not playing with paper clips, while they work, that sort of thing, like it's not bothering anybody, just let them do it. Right. But also, the other question we have to ask ourselves is, what purpose is that behavior serving for the child, it is serving a behavior, it's on us to help the child figure out what and to help them find a substitute if for some reason, they can't keep engaging in it. So I don't know why it would bother anybody if the kid was saying taco, taco, taco. But let's say, for example, it was, and they had to stop and the teacher would need to work with the child to come up with some alternate most likely repetitive behavior. So it might be a repetitive motor behavior, for instance, to substitute instead, because it's helping the kid self regulate. Right?

Sucheta Kamath: And, you know, to your point, I think what standing out for me, as you're describing this is, number one, really using a critical investigative lens. Yeah. So when you meet behavior, don't latch on to behavior, but look at some source behind it, or there must be a reason for that behavior. So I think a lot of people forget that they are and they try to control the behavior. And the second thing you said is, if you don't understand we talked about this, before we kicked out the session that I am, I was quite surprised that you think people have been working with autism, they would understand the framework of diagnosing autism. And so if you don't know the repetitive behavior is the hallmark trying to tell them to not repeat the behavior, which is the hallmark is telling them Don't be autistic.

Donna Henderson: Right? Well, I always liken it to I'm a lefty. And I always liken it to you know, 100 years ago, left handed people were told they have to write with their right hand. Right? We were told we have to work against our natural wiring, for no good reason. Except it was the social norm at the time, right? And so anytime we're asking a kid to go against their natural wiring, we ought to a have a really good reason for that. And be help the kid with a workaround if, if they need it, and not just ask them to write with their non dominant hand or speak for no good reason.

Sucheta Kamath: So maybe can you tell us a little bit more about this, the social norm, because I think one of the things about this norm is a highly propelling fuel that we want people to assimilate by looking or behaving normally. And what we are beginning to think about the definition of normal, which is expanding the definition of normal I had many years ago, I had a client who had severe stuttering, and he was a young boy. And when he encountered difficult words, he had developed these are called secondary characteristics, they are associated with the, you know, block, or this difficulty in producing a word or sound. So he would have to climb a chair, jump, and only then he could produce. Now, this was absolutely disruptive, not just to him, it was getting a negative attention. But it was definitely disruptive to find a chair in the middle of like you're walking in New York City, you know, Times Square, there's no chair to jump off of right. And so a lot of my work with him was really thinking about the this idea that you're feeling that the word is going to be very difficult, and you're really not wanting to stutter, and you have kind of created this association that the struggle will be gone if I jump. And so that kind of work took a lot of time, but that that's called metacognitive training, right? So I'm just curious if you can talk a little bit about this strong influence in the context of autism, this desire to when you have social difficulties, you are violating social norms all the all the time. So how do you think about what normal acceptable behavior which is what people are trying to make people exhibit normal behavior, which is like give eye contact? We think people who don't give eye contact are shy or rude, but neither can be true for a person with autism.

Donna Henderson: Right. So, I mean, there is no such thing as normal behavior as an absolute right. It depends on your culture, your subculture, your, the situation you're in in the moment You know, the other people who are there, it changes absolutely constantly, you know, if I asked you what is normal behavior, you'd have to say, in what context, give me the situation. And even then you might not be able to answer it just, you know, cultural differences and all of that sort of thing. So, I mean, it just underlines how unbelievably hard it is for people who don't implicitly understand expected social behavior, who really benefit from explicit instruction about social behavior, how unbelievably hard that is, because we can't possibly give them a script for every single situation. It's, it's endless, right? And it's all very context dependent. And I think context is a really big issue for people who have autistic nervous systems, it's harder for them to intuitively and automatically use context to sort of understand and respond to different situations, if that makes sense.

Sucheta Kamath: I love that. And I think it is so consistent with some of the conversations I had, again with this anthropologist who looked at history of normal. And one of the things he said, stigma isn't in our biology, it's in our culture. Yeah, it is a process we learn from within our communities. And we can change that change what we teach. So that's exactly what you're saying. I just love that. So, so maybe once again, before we dive into some of the ways to think about managing Autism Spectrum Disorder, can you just restate what is autism spectrum disorder.

Donna Henderson: So as we talked about last time, it's basically being born with a different kind of nervous system than most people have that makes you perceive and understand and respond to the world in different ways than most people do. And those differences can cause trouble for you between, you know, in trouble in communication, you can be misunderstood, you can misunderstand things, and it can cause a lot of overwhelm.

Sucheta Kamath: Excellent. So one of the things I thought will take some time, my wheelhouse is executive function, executive function management, and autism leads to self management deficit or challenges, particularly, because of some of these present some of the presentation can create obstacles in goal attainment. And then also one of the goals is to not feel isolated or separate for the way you're wired. And so not having the abilities to demonstrate social competence can lead to social exclusion. So I was thinking, for starters, what is, in your opinion, the connection between executive function in autism?

Donna Henderson: So a lot of autistic people have difficulty with executive functioning, not all of them, but a lot of them do. And of course, there's overlap between autism and ADHD. And both, you know, both of them tend to, yeah, so they co occur. And they both tend to have difficulty with executive functioning, of course, I think one of the things that's unique about autism and executive functioning is that autistic people need to use more executive functioning, just to get through the day, right. And this is separate from her sort of, this isn't a good way to say it, but like how much executive functioning skill you have is one thing, but how much you need is a whole nother thing. So before we even think about how much executive function skill someone has, we have to wonder about how much they need. So sometimes your life circumstances makes you need more executive function skills. So for instance, I have three children, and a regular job. And then I do all my extracurricular activities like this lovely interview. And so because of all of that, I need more executive functioning now than I did when I was a young single person just working. One straightforward job, I had no children, no husband, I didn't need nearly as much executive functioning then as I do now. So that's an example of sometimes life circumstance makes you need more executive function, right? But sometimes our wiring makes us need more executive functioning. So if you're an autistic person, you need to use up more executive functioning on camouflaging for instance. Just getting yourself through basic social interactions is going to require some planning some decision making just some inhibition for sure, sort of inhibiting your tendency or your desire to not make eye contact and look away and force yourself to look or inhibiting your stomach. Eating or your repetitive behaviors. So all these aspects of camouflaging are taking up executive functioning, which leaves less executive functioning leftover for other daily activities. I think also for autistic people, their sensory management can be a real drain on their attention and their inhibitory control. And so if there's a noise that's really, really, really bothering me, that's going to drain my attentional control and my inhibition as well, because I'm just focusing so much on trying to ignore that. And then if we think about adjusting to change as part of executive functioning, sort of your ability to change course, as you need to, autistic people have to do that way, way, way more frequently than non autistic people. Like if there's some small change, let's say the school bus arrives, and there's a substitute bus driver, that's a small change. For non autistic kids, that requires almost zero, if not zero, executive functioning, that adjusting to that change is no big deal. But for an autistic kid, adjusting to that change, can use up a ton of their sort of executive functioning energy for the day, so to speak. And so that that's what I mean by they might use a lot more than non autistic people, before we even start about their skills. Does that make sense?

Sucheta Kamath: Oh, absolutely. And I think this is so interesting. You know, we have had Steve Kniffley, talk about a particularly students, minority students, and its relationship, you know, even being a minority requires you to exert your executive function. Yeah, because you have to adjust to the dominant cultures, expectation, you have to, as you said, camouflage some of the way your difference, or mute some of your presentation of self in everyday life. And I often think about that, that when you adjust to the expectations or in quotes, norms that are relevant to the context, you're exercising your executive function doesn't mean you're good at it. Yeah. But it is like literally using gas in your car more you drive less you have it. So you are going to have a tanking effect. So when it comes to critical part of your life decision making, you may not have any gas, because you have consumed all that gas, taking decisions about just simply belonging.

Donna Henderson: Yeah, I've lost it. I've heard it called code switching, right switching exam, I've heard people say it's almost like, I'm talking in a language that I'm pretty fluent in. But it's not my mother tongue. It's not my primary language. And so it does require that extra effort. And then if you have autistic people who are another type of minority in addition to being autistic, then there's sort of double code switching, right? There's just a whole lot going on there. And the amount of executive functioning that takes can be absolutely tremendous. Yeah.

Sucheta Kamath: So I love the way you're kind of making us realize that there's a great need to activate your executive function skills doesn't mean you can be or are good at it. So can we talk a little bit about breakdown of this, for example, how much I have to do versus how much I need to do more of a can determine your use of executive function. So when you're not doing a lot, I often see this, you know, this journey of mine began with people with brain injury. And it was very interesting, because typically, if you see, you ask a person with with a brain injury after their injury, when they come to a neurologist office, right, three words, repeat these three words after 10 minutes. Well, that is neither complex, not abstract, or multifaceted, right. So I think, as a clinician, one of the things I saw that a lot of people got compensated for, because they were in an environment of a clinical setting. You're working with one person at a time, there is no noise. They're getting full attention. They're seeking or inciting responses from you. Yeah, no problem. Yeah, go out. There's noise. There are multiple people asking questions of you. And so this multifaceted demand of the environment is where people who had brain injuries would really really suffer or struggle. So to me Autism Spectrum Disorder, it pretty much manifests like that. So can you tell us a little bit about twofold questions. The question here, one is, how do clinicians or people who actually work with this think about inciting some of the demands on cognition or adjustment and second, what kind of advice or suggestions when must give because they already are trying to cope or code switch? So they are doing it, they may not be doing it well.

Donna Henderson: So I'm not 100% sure I understand your second question, but so I'll start with your first question. And you're exactly right when they're in anybody, autistic or not, is in a clinicians office, we take away all the ambiguity, right? I mean, first of all, it's a sensory controlled environment. There's, it's one on one, you don't have to deal with multiple people. It's usually dealing with a person who is very good at scaffolding interactions for you. And we just take away all the ambiguity, right? It's very black and white, we say, here's what you're gonna do. This is how you do it. Okay, next task, here's what you're gonna do. This is how you do it, we sort of, as we say, push the context button for them. And then we take away almost all the ambiguity, and it's when there's ambiguity, that we need our executive function. And we need our sensitivity to context as well. And so it's really helpful if we can at least try to mimic that in our offices a little bit. By having more unstructured time. And by doing some less structured tasks. It's still not mimicking real life even remotely, which is why it's important for us as clinicians to be talking to parents and teachers or co workers, if we're talking to adults or bosses, people who see the person in their real life to understand what they're like when they're struggling, what's hard for them? Because we may not see it in our office.

Sucheta Kamath: Yeah, I love that. I think the the unstructured aspects of interactions that are part of I like to describe this as controlled chaos. I said, How much part of your therapy is controlled chaos? And if you don't have controlled chaos, you're never going to activate self regulation. Right? Yeah. Because otherwise you're lecturing people how to self regulate when there's nothing to be regulated.

Donna Henderson: Right. Right. Exactly. And, you know, how on earth would they generalize that to out there in the real world? You know.

Sucheta Kamath: So I think that's, that's great idea that you're talking about this environment being so controlled. So let's talk about the other important topic that you just brought up, which is this idea of context, blindness context is so critical for processing information, but also determining goals and adaptive adaptability principles. Why should I switch? Or why should I adjust? And what are the clues that that are telling me to adjust? And if you're a context blind, then you're actually behaving in the same way, which is my favorite example is shouting in the library. Using the same tone? Yeah, I'm really shouting but you're not whispering? Yeah. And so not knowing to whisper is the context blindness. Right?

Donna Henderson: Right. And we should be clear, Peter Vermaelen came up with the phrase context blindness. Although he's also been clear that autistic people aren't blind to context, they see the context, but they don't automatically use the context to understand and respond to a situation. So I still use the phrase context blindness, because I'm used to it. But it's not exactly the right phrase to use mean, what he says now is, it's being an absolute thinker in a relative world. And for people to understand how unbelievably important this concept is, you first have to understand how most of us perceive and respond to the world. And the world is ambiguous. We're surrounded by ambiguity all the time. So let me ask you some questions. What's a nice gift to get for someone? For what occasion? Right? What should you get at the store?

Sucheta Kamath: Which store and when? What time of the year? Or when do you need? 

Donna Henderson: How much salt do you put in when you're cooking?

Sucheta Kamath: What dish?

Donna Henderson: How do you spell the word one?

Sucheta Kamath: Um, say use it in a sentence?

Donna Henderson: What is the word Park mean?

Sucheta Kamath: Tell me more. Use it in a sentence. 

Donna Henderson: How close should you stand to someone?

Sucheta Kamath: Depends where you are. And who are you with?

Donna Henderson: What do you do if someone's crying?

Sucheta Kamath: How well do you know them?

Donna Henderson: Right? I mean, we could do this all day long. Every situation.

Sucheta Kamath: I love that. Did I pass my context test?

Donna Henderson: You passed. Because the answer every time all day long, is it depends. It depends on the situation. And context is another word for situation right context tells us it helps us make sense of the world and it tells us how to respond to it. And it affects everything. It affects our perception, like our literal perception of the world. So what Let's say someone is walking away from you, they appear to be getting smaller and smaller that you intuitively don't think, Wait, are they getting smaller? No, you intuitively use context to know, people don't shrink. And so they're not getting smaller, they're moving further away, right? We use context to process our sensory input. So for instance, let's say I feel something lightly, lightly trickling down my arm. Okay? If I'm in the shower, context automatically tells me this is water. Right? It's a nice feeling. But if I'm hiking in a dense wood context would probably make me think it's a bug or a spider, which I might not enjoy as much. Or blood. Exactly right. So context helps us direct our attention to things that are important and to things that and away from things that aren't important. And it helps us process input relatively and not absolutely. And so you can think of hypersensitivities as due to non context sensitive processing of stimuli. So this sensation becomes all or nothing rather than relative. Right? Absolutely. And this goes for internal sensations too. Like if your heart rate goes up, context, automatically, that's the key word here automatically tells you what's why your heart rate went up, and like, did you just run a mile and you're out of breath? Are you about to do a presentation and you're nervous, or you're watching an exciting movie context helps us make sense of what we're feeling. And context also helps us communicate? Because language itself is ambiguous, right? You know, words have more than one meaning that that bark felt rough, versus that bark was loud. Right? And we use language in non literal ways. Sometimes, like if I say, Oh, my God, we had the plague at our house last week, during really mean the plague? Probably not, hopefully not. Right. So we use the context of the sentence, we use the context of our culture of our personal experience, so many layers of context to make sense of language. Just yesterday, I had a Zoom meeting with a really, really bright eight year old, and we were starting the meeting, and she had a book open on the table. And her mother said, okay, honey, it's time to put the book down now. And the girl said, the book is down. And she wasn't being a stinker. And I said, I think your mother may be meant to close the book. And she said, Oh, okay. And she was perfectly happy to comply. She wasn't being a stinker. She that, you know, she didn't use context to understand intuitively what her mother meant. And nothing is more ambiguous in our world than social interactions. We have so much ambiguity in social interactions, like, are you talking too much? Is this the right amount of eye contact? Do I hug? Do I shake hands? Should I tell the truth? Do I follow this rule or make an exception to this rule? What should I wear? What's the right volume? What does that smile mean? What are his intentions, like, you know, we could go on and on, there's so much ambiguity in all of it. And so most of us use context sub consciously sub cortically, effortlessly, without any awareness to sort through all of this. So we'll call that like top down processing. But as autistic people seem to use more of a bottom up processing, it's not that they don't see the context that they don't have that sub process of instantly using it. And so they get flooded with all the details, irrelevant, irrelevant details, and have to sort of build their way up to the big picture. Which is why for instance, sometimes an autistic person might tell you a story and include way, way, way, way, way, way, way too much detail, or not even any detail at all. They can't judge how much context you need as the listener. Does that make sense?

Sucheta Kamath: Very much so. And it's so funny, you said that I was. It's hilarious, but I was doing a presentation to a group of educators and talking about what is the implication of organization planning as a deficit. And there was a push back the twofold. This was I had done some assessment for the adult educators and turned out as a group 69% of them were struggling with organization planning compared to other abilities. And they were trying to tell me that no, no, I'm so organized. I am neat and tidy and I were saying, well, organizational skills have tiers of competence. So there's something called abstraction, which is categorical analysis, synthesis skills. These are more higher order organizational skills. And it is mostly coming comes into play when you look at disorganized information and you impose structure. This is I said, Imagine you're applying for a $2 million grant for literacy outcomes in your district, you have to think about five years down the road, how would I organize such a big thing? That's different than finding blue shirt next to a blue shirt? You know? Yeah. So one adult in the room raises the hand. And before that, I had done an illustrative example of organizing, organized and disorganized retrieval. So I had given you know, the test about the name as many things as you can that begin with letter F and begin with letter T, in one minute, and then as many words as you can, without any, just to show the distinction. I was saying, did you come up with less numbers with F and T than any word? Yeah, that was the illustration not to be taken seriously. I was not timing them. Or this was not a psychological test. Even though it is a psychological. This gentleman raises his hand and says, Let me tell you, so check it out. There are 3000 words or bla bla bla, words, he had Googled, meanwhile, in that begin, in English language that begin with letter F, there are 6749 words that begin with letter T. So you're going to have less numbers begin with f. This was his conclusion after my whole presentation, which was nothing to do with that was just an activity. Yeah. So it was so interesting to me that to your to your point about context, blindness, it was a means or a vehicle to begin or kickoff a meeting or kickoff or discussion was not the central focal point. Yeah.

Donna Henderson: He got really stuck. He missed the real point, he missed out in the dark on a little detail that took them on a detour. And when kids do this, I think adults automatically assume it's a lack of attention to many and what is not what it is, right.

Sucheta Kamath: It was great effort.

Donna Henderson: Right, exactly. It certainly takes your attention away from where everybody else wants your attention to be. But that's not the crux of the issue there. Right. The crux of the issue there is he wasn't using context to understand the real point and to let the little details and the irrelevant details disappear. Right. That's a great example.

Sucheta Kamath: And to your point. It was impulsive. It was inappropriate, it was irrelevant. And it only led to personal sabotage. It didn't cause any disruption other than it was weird to bring that up. After one hour. When the initial S and T little fun exercise was done as a let's talk about this kind of thing. Right. But he actually walked away feeling very smart. Huh, so he felt look, I'm so clever. I looked it up. I have precise number. I don't even know how you can come up with precise numbers like that, because we can. So I thought that was amusing to me. So I didn't even comment. Like if if I was going getting into technicalities, I will challenge that. You know what I mean? Right. Right. So but what is so interesting, but this is a person who's a leader. Hmm. So we the the real thing that you're talking about, there's a cost to this kind of poor ability to judge and evaluate the context, because you may miss be missing the forest for the trees?

Donna Henderson: Well, it's that you don't use the trees to understand that you're looking at a forest. Yes. You're like looking at every vein on every leaf on every tree. Not just that, but trees themselves. And then they're just like this example that you're bringing up there is just like one little disconnect after another one disconnect after another. And that takes its toll and just moving through the world with this type of processing, even before you get to all the disconnects with other people and the misunderstandings. It's exhausting. They work their way through more information than non autistic people do. So if you have this type of processing, you have to consider every detail even those that most people realize are irrelevant. And so you just use up a ton of your time and energy and effort and executive function, sorting through all of that stuff that so many of us just ignore and move on from and that can be exhausting. A lot of people who have this type of processing are not only tired all the time, but very, very anxious because it doesn't help you sort through the ambiguity, so the world remains ambiguous and unpredictable. And a lot of these kids who have this style need not only have anxiety, but they asked for a ton of clarification. These are the kids who are like, so I'm supposed to write my name here. Exactly. And can I write it in pencil? Can I write it in pen? Is it okay? If I write the date this way? Do I have to write the date that way? I mean, all these tiny little questions, and the adults think that's anxiety. And it may be anxiety. But what's often underlying it, if they're asking so many clarifying questions that most kids don't ask that that are intuitive for most kids, that may be this context, blindness. And like, one way I see it, one of the tests we give is a reading fluency test. And it's kids just have to read these very short, simple sentences and say true or false. That's it. And so, you know, there are some demonstration items. And the first demonstration item is, you know, I think it's an apple is blue. And most kids intuitively know false. Apples, not blue, right? Not meant to trick you.

Sucheta Kamath: But is this real apple? 

Donna Henderson: Well, they'll say an apple can be blue. And I repeat, but is it typically blue? No, but it right, I could paint an apple blue. It's possible. But it's because they're having to sort through every single possibility, right? And I have to give them extra clarification and say, it's just asking you typically, generally what's true, and then they'll get to the next one, which is something like, you know, a man has two legs. But a man could have one leg. It's possible. What if there's a man with one leg, but what's typical? What's typical. And for most kids, these are easy, easy, easy, easy statements. They're not meant to be tricky at all. But for these kids, they have to sort through every possibility and the statements are hard.

Sucheta Kamath: So you know, since you mentioned context, blindness and Peter's work, I think it's so funny, because in the book, he talks about this prototyping, right, so the way organizational higher order or, and I'm speaking more to the listeners now than you but you know, this, the higher order organizational skills is to create a mental template. And this mental template, it allows us to compare and contrast, anything that veers for from this prototype. So when you think about fruit in the brain, the most generic fruit is apple. So then you can say, oh, compared to Apple, watermelon is bigger, compared to Apple, blueberries smart. So most people who have context blindness, they do not have mental templates or prototypes. And that creates a huge problem, because they're like, blueberry can be big. If you are only one inch tall, you know what I mean? You have gotten those kinds of answers, which makes them look weird, or think weird, but they just cannot get past this. Just go with the flow. Like most people have two arms and two legs. Can men having one leg is the wrong answer. Right? So they cannot lead and then you'll find them arguing with you. So the test that takes five minutes might take actually 15.

Donna Henderson: Yeah, and they could they could not they could overgeneralize or under generalize with because of the problem with the mental templates, right? And so they can have one bad experience with one dog. And then that's it, every dog ever is going to be scary just from that one experience. So they could over generalize, right? Or they could under generalize and say they're doing math problems, and they're doing them fine. We're doing them, we're doing them doing the math problems. And then a math problem changes ever so slightly in how it's presented. So slightly, and then they're stumped. And they can't generalize from what they had been doing. So they both over and under generalize because of the problem with the mental templates. Yeah.

Sucheta Kamath: And, you know, to your point, I think, as we talked last time, that at the heart of autism is the first set of criteria is this social communication skills. And it can be very exhausting to be with somebody if you're a neurotypical, because this need for precision in the space of ambiguity is not possible. Yeah. You say, let's leave her in the, you know, after lunch. Well, what time? Right. And what if we have lunch at one? Yes. Does this mean after one? Well, I want to keep it open. Oh, no, no, no open, keeping it open feels like almost, you're being mean or withholding information. So I see that a lot in the relationship conflicts. And this reminds me of the book, by David Finch, the Journal of Best Practices, yeah. Which I thought is written by an adult with autism who is actually a husband of a speech language pathologist and And I thought it was so poignantly captured by him. Because, you know, to your point, it's like I like I like to call it Goldilocks effect. A Goldilocks just needed perfect. You know, the bed was too big. The porridge was too hot, you know? Never right. Yeah, I think that is where that experience for somebody with on the spectrum can be.

Donna Henderson: I think for some people on the spectrum. Yeah. And so I want to be clear, not every single autistic person who has these particular struggles, but can I tell you a story related to it? Oh, my gosh, this just flashed through my mind as you were talking about David Fincher in his wonderful book. I worked with a woman last year who was in her mid 40s, very, very highly educated woman who felt that she was autistic. And she was right. She absolutely was. And there was some marital difficulties, and her husband was not autistic. And we were having this conversation. And they have some arguments. And so I asked them to give me an example of an argument. One day, she asked him to make her lunch because she was busy. And he said, Sure, what would you like, and she said, I'd love the same lunch I had yesterday and told him what it was. So he made her the same lunch she had the day before. And then he saw that they had some nice plums on the counter. And she loves plums. So he threw a plum on the tray as well. And he brought it to her. And she got very upset, because she asked him to make the same lunch as yesterday. And it was different. And we said to her what was different. And she said, Well, there was a plum on it. And we said, so it was the same with a plus. And she said, to me, that is fundamentally different. And it threw me off entirely. And we both explained to her as non autistic people. To us, it's the same thing, plus an added bonus. And that blew her mind. She didn't understand how we saw it the way we did. And of course, we didn't understand how she saw it the way she did, right. And you can see where that could create such problems in a marriage between an autistic person and a non autistic person, or between a parent and a child between a teacher and a child. This, you know, miscommunication over such a simple thing, right? And one of the most important things we can do is to be very explicit in our language, which is hard for non autistic people. We're not used to being super super explicit in our language, but it will help our relationships with the autistic people in our lives if we can do that.

Sucheta Kamath: Such a great example. And you know, that remind me again of that inner prototype that I was talking about that once you have a prototype the plus, like, you know, a hen is a bird that has wings, but doesn't fly high. And eagle has bigger wings, but looks similar to you know, like that we are able to see similarities and differences in a nonchalant way. And it doesn't need to be concrete. Like you can have a unusually small eagle. Yeah. But you're not going to stay. Well. That's not an eagle anymore, because it's too small from all the Eagles I've ever seen. You know, right. Yeah. So working with the program is something we do all the time. Yeah. So let me ask you a question about so one of the speech pathologists work have read. Or just, you know, while googling is, is Tracy Vail, and she says, Keep these helpful tips in mind, and I'm just wanting to see what your reaction is to it. So use concrete language whenever possible and avoid slang. Would you do that?

Donna Henderson: So it depends on the person. You know, there are a lot of autistic people that you don't have to do that with. So you don't want to talk down to somebody for sure. But get to know the person you're interacting with. And if they, you know, respond poorly...

Sucheta Kamath: Did you just use context?

Donna Henderson: I think it might have, you know, I mean, I have two kids who are autistic and one of them is perfectly fine and comfortable and absolutely loves all kinds of complex and non literal language. But the other one really struggles with it. You know, when he was 10 years old, and we were walking home from the bus stop together. I said, So what's shakin, and he looked around and said your arms, which was not not a great moment for me as a person, but as a mother, I at first I thought Is he being a stinker? And no, he wasn't like and I started to learn, okay, I need to be very explicit when I talked to him, right? And we really don't realize how much we use implicit language in addition to using all kinds of nonverbal stuff, you know, like I when my my daughter was home a few months ago and she's, you know, 24 years old and super, super bright and capable and has intact language skills. They're even, you know, above average language skills. And I was she was sitting at the kitchen counter typing at a computer doing some work, and I was running around the kitchen trying to get dinner on The table and I was huffing and puffing, and I wish somebody would just set the table already. And finally she looked up and she said, I feel like you're telling me to do something. And I honestly don't know. And she was being genuine, right? And she has such exceptional language skills. It's so easy for me to forget that to me, I was communicating very clearly. But what I needed to say is Honey, I wish you would stop working and set the table for me. And she said, Oh, no problem. She had no problem doing it. She wasn't being a stinker. Right. And that's just a good example of all the subtle little ways we don't communicate directly. And we need to, there's actually a really good little book called, Is That Clear?: Effective communication in a neurodiverse world, that can be a helpful starting place for people.

Sucheta Kamath: Well, I love that you already made a book recommendation, which like last time you did. One last thing before we close out, I was going to ask you. So, you know, to your point, I feel like even support, help therapy, whatever we want to call it is so nuanced. And you know, one shoe doesn't fit all, and we shouldn't even try to do it. Do you believe that we should really try to assess the need, like to your point, we do not more make everybody non literal, if they are literal, yes, there are a lot of challenges that go with it. One, they may not have the capacity to not be non literal. But second, they may not have complex, nuanced linguistic exchanges in their world that requires this kind of. And the second point, we talked about it last time, during our conversation was it may be the expectation of the neurotypical for the autistic person to demonstrate all neurotypical skills, right. And it can lead to deep dissatisfaction. Like you're not being nuanced. Like I'm being playful, like, what's shakin. And then your child says arms and you're you can, if you didn't have that, you know, deep compassion and empathy, you might say, No, what I meant was, you know, right.

Donna Henderson: And, and that's easier with a child, but in a marriage or with a co worker, it's, it's harder, right? When it's an adult, we have even higher expectations, and all the burden of change is on them. Right? Because they're the minority group. Absolutely. Yeah, I do think it's really important, once we understand someone's autistic, not to assume that the goal is to get them to pretend to be less autistic, and to be less of themselves, and, and also to keep forcing them to work against their natural wiring. That's not fair. Obviously, they need to compromise. But for the most part, they're already doing way more compromising than they can tolerate. Right. And I think, you know, it's on the rest of us to to learn how to compromise and to be flexible, and to not have unrealistic expectations. For sure.

Sucheta Kamath: You know, it reminds me of Amy Schumer, whose husband is on the autism spectrum. And they were, I think she was pregnant. And she was on today's show, they were invited to be on today's show, because they, He's a chef, like a very celebrated chef. And she, they, he started teaching her I'm not remembering the context. But he started teaching her how to cook so they were putting small videos on tick tock or something. And so today's show host Hoda had her come. And honestly, it was such a painful conversation to watch. So she's asking a lot of questions as a host, you know, engaging, Amy is not coming to the to help to make him talk or translate. He's just not getting the direction of the question. Being very concrete. And as answering the part of the question, just as so you have, you have a show, you know, you're implying tell me everything right? And he's like, yes.

Donna Henderson: Right. Right, exactly. 

Sucheta Kamath: So it was funny that she didn't modify because she didn't know how to deal with it. Right. Sorry. What were you saying?

Donna Henderson: Well, sorry, no, I interrupted, but like the fact that he was so good. He is so good at something, right? He's so good at cooking, and he's probably good at so many other things, makes people think, Oh, well, he couldn't be autistic. And so then they get frustrated with the communication differences and the social differences and all of that, right. But somebody...

Sucheta Kamath: He was not good at communication. But that was almost forgotten. Because he suddenly now married a famous person. Yeah. And he was good chef. To your point. Right. So yeah, it's complete mismanagement of expectation, but it was excruciating to watch that interview. So and I don't mean excruciating, but I could see her you know, the host trying to say like, wow, what do I do now? This is bombing, right?

Donna Henderson: You have to get very, very, very explicit and say, Tell me, tell me about being a chef, you know, tell me how you became. Right, exactly.

Sucheta Kamath: So as we wrap up, thank you once again, for this tremendous wisdom. I really think you're the first one who has really talked on this show about context blindness, which is one of my favorite a truly neurocognitive perspective and has such meaningful impact on everyday life. And not often conversation happens about context blindness. But I love also the distinction that you made, it's not context blindness means there's no see context, no see context, it is really not be able to make meaning of the components of the context that really inform you about the value and critical importance of that context. So you may be not paying attention to those three things that really tell why, what is this context? 

Sucheta Kamath: Well, Donna, it's been such a pleasure talking about these important concepts. And particularly, I really love your compassionate way. And very thing that is a challenge for people on the spectrum, which is flexibility, and can lead to in flexibility. You're really inviting all of us to exercise our flexibility. And second thing I really love what you're saying that constantly remembering one solution doesn't work for all and you have to be nuanced about your approach. And you read need to really shift the burden from neurotypical to neuro atypical if that's the way we can frame it. But really think about the world is much larger, and everybody can thrive equally. So I love it. Thank you so much. listeners. Thank you for tuning in today. You see the importance and value of these incredible conversations if you loved what you heard, feel free to share with as many folks your friends family, and spread the joy and if you really, really are motivated, feel free to leave a comment so we can spread Donna's work with everybody. Thank you so much, Donna.

Donna Henderson: Thank you for having me. A lot of fun. Thanks.