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Why Are So Many Adults Getting Diagnosed with ADHD and Autism?: An interview with Dr. Monica Blied

Curt and Katie interview Dr. Monica Blied about adults getting diagnosed later in life with Autism and/or ADHD. We look at why people (especially individual assigned female at birth) are getting diagnoses later in life. We also explore skills, strategies, and accommodations to support neurodivergent individuals in navigating life. We also talk about unmasking and helping adults talk with their family members about diagnosis.

Transcript

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An Interview with Dr. Monica Blied

Photo ID: Dr. Monica BliedDr. Monica Blied is a clinical psychologist, adjunct professor of psychology at Pepperdine, and the founder of Faces of Health in Claremont, California. In her private practice, Dr. Blied provides psychological assessments for adults and children who suspect they have Autism, ADHD, and/or learning differences. With a special interest in supporting adults who are living with chronic medical and mental illnesses, Dr. Blied has also developed expertise in the mind-body health connection. She currently serves as the Chair-Elect (and former Treasurer) of the California Psychological Association’s Division of Education and Training, where she has been a member of the Executive Board for over 10 years. Since 2020, she has also served as a Medical Advisory Board member with Lupus LA, a role which allows her to continue giving back to her fellow Lupus Warriors. In 2022, Dr. Blied developed the Faces of Health app, which teaches mental health and stress management skills via brief, educational videos, all taught by women of color. In 2024, she added to her online educational suite a course on Adult ADHD and Autism, and another on Stress Management using Neuroscience. Learn more about her courses at facesofhealth.net and learn.facesofhealth.net.

 

In this podcast episode, we look the trend of adults getting diagnosed with ADHD and Autism

During a recent conference, Katie saw Dr. Blied talking about later in life ADHD and Autism diagnoses and loved what she had to say. We figured it was time to talk some more about neurodivergent adults.

Why is there an uptick in adults getting diagnosed with ADHD and Autism?

  • There is more information that is being shared on social media
  • Therapists and psychologists with ADHD and/or Autism are sharing information more freely
  • Increase in diagnoses in children, leading to other family members getting their own assessments

“The purpose of the DSM [is]…it is our guidebook for diagnosis and treatment. It’s there for a reason. And so if someone meets five out of nine criteria for major depressive disorder, for example, then they’re not just a little sad or, you know, a little weird with their happiness. They are clinically depressed. They have major depressive disorder. And similarly, if someone meets the diagnostic criteria for ADHD, they’re ADHD. Same thing for autism.” – Dr. Monica Blied

How can therapists support clients who believe they are neurodivergent, but may not meet the criteria?

  • Exploring what a neurodivergent identity means to the client
  • Provide psychoeducation on some differential diagnosis
  • Seek formal assessment for autism or ADHD

What strategies can therapists utilize in working with clients diagnosed as neurodivergent as an adult?

“[The first and second strategy I would recommend] is affirm and validate and then affirm and validate, because for especially for late diagnosed individuals, so much of their life they’ve been invalidated and told that there was something wrong with them or made to feel othered and outcast. And so if they can finally, in this therapy space, be validated and say like no, your experiences make so much sense. You are not alone…you’re not an alien, you’re no longer on this island…Let’s build a bridge and help you find some connections where you know that your spiciness is accepted and it’s actually what makes the world go round.” – Dr. Monica Blied

  • Confirm and validate experience, normalize
  • Somatic exercises to bring clients into their bodies (and out of their brain)
  • Executive functioning skills (e.g., using timers and the pomodoro technique)
  • Premack principles?
  • Use the principle of inertia (start with something small, to get in motion)
  • Understand available workplace accommodations (and where assessors and therapists can support in that process)
  • Learning how to tease out when skills, accommodations, or self-acceptance are needed
  • Support acceptance and unmasking
  • Help clients walk through the grief process that comes with diagnosis
  • Learn about autistic burnout and the 5 S’s from Dr. Joey Lawrence of Neudle Psychology
  • Provide support to clients to talk about diagnosis with their family members

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

drblied.com/adhd – and – facesofhealth.net

Dr. Monica Blied social media:

Instragram @dr.blied

YouTube Dr. Blied – Faces of Health

LinkedIn @drblied

LinkedIn @facesofhealth

Twitter/X @DrBlied

Facebook @FacesofHealth

5 S’s Dr. Joey Lawrence of Neudle Psychology www.neudle.com.au

 

Relevant Episodes of MTSG Podcast:

Neurodivergence: An Interview with Joel Schwartz, PsyD

What’s New in the DSM-5-TR? An interview with Dr. Michael B. First

Are You Actually Neurodivergent Affirming? An Interview with Sonny Jane Wise

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

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Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that go on in our practice, the emerging trends in the mental health field and space. And one of the parts of my practice that I’ve worked with throughout my career has been working with neurodivergent folks. I got my starts working with a lot of autistic clients and their families that has expanded into a lot of ADHD-ness over the years. One of the questions that I get a lot from adults later in life is just kind of, you know, my kid has these things, I’m starting to see a lot of things emerge in myself. And is it possible that I just went throughout my life without being diagnosed by this stuff, and then we send people to people like our guest today, Dr Monica Blied. Thank you very much for joining us today and sharing your expertise.

Dr. Monica Blied 1:13
Thank you so much for having me. I’m glad to be here.

Katie Vernoy 1:17
I’m super excited because, as I told you before we got started, I crashed your talk at a conference, and I just love the knowledge that you have, the way that you talk about things. And as someone who is exploring my own self diagnosis as a later in life neurodivergent folk, I’m just gonna soak all this up. But before we jump into it, I wanna ask the question that we ask everyone that comes on to the podcast: who are you and what are you putting out into the world?

Dr. Monica Blied 1:45
Yeah, who I am, I’m still trying to figure that out. Knocking on 40’s door, still trying to figure that out. But I think I carry many roles and responsibilities, including being a mother of three neurodivergent children. Being the wife of a neurodivergent husband, and I did know before we got married about him, I didn’t know about myself, and that’s how well we clicked. It came, we’re seven years in, and I’m like, oh, makes sense. I’m also a clinical psychologist in Southern California, I run a private practice, Faces of Health in Claremont, where I provide autism/ADHD assessments and therapy for chronically ill folks. Why chronically ill folks? I’m chronically ill myself, and so that’s one of my multiple identities and my responsibilities to help give back to the lupus community, specifically.

Curt Widhalm 2:43
One of the questions that we ask at the beginning of a lot of our episodes is not from a shaming place, but a place from as we learn new things in the field, as we’ve learned from our own mistakes, to help other people not make those same mistakes. But what is it that therapists tend to get wrong about later diagnosis, ADHD, autism, that kind of stuff.

Dr. Monica Blied 3:04
I think that when it comes to late diagnosis of ADHD and autism, it’s not the therapists who are getting things wrong, but the other providers. So, they’re the psychiatrists and the physicians and the people who surround a person who’s in therapy saying, like, there’s no way that you could be autistic, like we just had a conversation, or there’s no way you could be. ADHD. I actually had a client of mine come back to me, who’s uh psychiatrist, said this to her, like, you weren’t diagnosed at five years old, so there’s no way that you can have it. And it’s actually the therapists and I’m finding that are most savvy and keeping up with continuing education units and those sorts of things to know like, not only is late diagnosis possible, but it’s actually quite common. Something that some individuals may not be aware of is that up until 2013 a provider could not diagnose both ADHD and autism, even though there’s a really high concurrence rate between them, and also an overlap of genetic factors between ADHD and autism. And so when I talk about them, I usually talk about them together, because so many folks who are autistic are also ADHD, and vice versa. And we call this population AudiHD; like, AUDHD, and so that was kind of like a way around your caution, saying, like, I think that therapists are actually getting it right. And so they’re referring their clients to, you know, get formal diagnosis or just affirming their self identification, their self diagnosis.

Katie Vernoy 4:46
Why do you think there’s been such a surge in late diagnosis lately? Because it seems like and part of it’s what’s being served to me on Instagram and Tiktok and all the things, but it seems like everyone is now ADHD and autistic, and there’s so much stuff that is is coming to light. It just seems like this is, you know, something that is very, very different than what maybe was going on three, five years ago.

Dr. Monica Blied 5:11
You set the answer in your question, that there is the Tiktok and the other social media outlets where people who are already diagnosed or self identified again are saying, like, Hey, these are my experiences. And then others are watching that, like, oh, wait, that’s not typical? Like other people don’t do that? Like only, only autistic adults you know, or individuals assigned female at birth, do those you know behaviors or in the same thing with ADHD. So people are really resonating with the lived experiences, especially of ADHD, autistic and AuDHD therapists who are experts in mental health, and saying, like, Hey, this is my life, and this is what, you know, the features of these different conditions look like. And when you get that information, it’s so empowering. I think 10 years ago even, well, first, you know, Tiktok wasn’t really popping back then, you know Instagram and you know such, so on and so forth. But in addition to that, there was this kind of way of doing therapy where, you know, and it’s still present in some orientations, where it’s like a blank slate and you don’t share anything about you. But the more we’ve had people to actually share their experiences. No, I’m not a blank slate, like I said in the introduction to this podcast. I’m a person who’s chronically ill, AuDHD, you know, a mama like you know all these things, I’m going to bring my whole person into the therapy room, and that does mean that there will be some people who are turned off by that and not seek me out. And yay. That means I have less of a miserable experience being your psychologist, right? Because the people who do find me, we do connect, is going to be a really good fit. So I think that’s number one; experts who are coming out and saying, like, this is my lived experience. Also, we have individuals, because there is such a high CO occurrence rate in families with these conditions that their kids are being diagnosed. And so they’re like, wait, I had these experiences as a child too, or their other family members. There are just so many reasons. But it’s definitely not like everyone has it, and you know those sorts of things. It’s still a small segment of the population overall, but it depends on who you’re talking to, who you surround yourself with, because I’m all about neurodivergent people around me.

Curt Widhalm 8:04
In one of our previous podcast episodes, we were joined by one of the co authors of the DSM five and the DSM five TR, and they had made a kind of controversial statement in that episode that was like, there needs to be a line in the diagnosis somewhere where not just every I don’t remember the exact quote off the top of my head, but not everybody who’s just weird ends up needing to have a neurodivergent diagnosis. And there was plenty of online feedback calling out this guest. So, I’m wondering your stance on where you have conversations with people as far as like, Okay, this is some lived experience stuff. This is what neurodivergence is versus All right, maybe you just got some idiosyncratic things yourself, but that’s not necessarily neurodivergent. When you’re talking with people as part of an identity, how do you communicate this with them, as far as like, Okay, you might have learned some things along the way that make this a subclinical diagnosis. How did those conversations go?

Dr. Monica Blied 9:07
The purpose of the DSM, and not everyone believes in it, but as a licensed and trained psychologist, I do. It’s kind of like our guidebook for, not kind of like, it is our guidebook for diagnosis and treatment. It’s there for a reason. And so if someone meets five out of nine criteria for major depressive disorder, for example, then they’re not just a little sad or, you know, a little weird with their happiness. They are clinically depressed. They have major depressive disorder. And similarly, if someone meets the diagnostic criteria for ADHD, they’re ADHD. Same thing for autism. And so that’s what the DSM is there for. And as a therapist, and you know, I imagine that a lot of therapists are listening to this, if you’re looking at the DSM criteria on one hand and you’re listening to the experiences of your client on the other, I think that’s a good justification for them to start exploring formal diagnosis. Formal diagnosis can sometimes happen, you know, just in that therapy room, or if that person actually needs accommodations for work because they’re being harassed or discriminated against, or things are changing too fast, as far as teams or training or for school, or just for their own self satisfaction and to feel like there is an explanation for their experiences and a path forward as far as specific treatments; they might seek a formal assessment, you know. And so I qualified that with it’s not always necessary, but in those cases, it can be really helpful.

Katie Vernoy 10:59
I think the big question is, when someone is self diagnosed, they’re identifying with lived experience, and based on our our guest, they don’t meet the criteria in the DSM, there feels like there’s a gap there of what, what the, what therapists can do, really, for folks who don’t meet the criteria but have claimed the diagnosis or claim the identity. And so I, if you have thoughts on that, I’d love to dig into that part further.

Dr. Monica Blied 11:36
Yeah, I would love for the therapist to dig into why? What does this mean to you? Because I have had people who’ve come to me for diagnosis, and that’s not what it is. They’re not neurodivergent. But they have, you know, maybe rejection, sensitivity, plus, you know, a mood disorder or something else that’s going on. And often, what it’s the what’s the case is they have a friend group, you know, or some sort of group community where they they fit in, and things finally make sense. And so as a therapist, you can ask, why? What would this mean to you if you were? And what would this mean for you if you’re not actually neurodivergent? And so if they’re not actually neurodivergent, it could mean there’s more, you know, shame about their behaviors or their experiences. It could mean that now there’s nowhere that they really fit in in the world. It could mean so so many things. And so kind of exploring that further invalidating their wantingness to have an identity that maps on to their experiences, but then also educating, educating that like, Hey, these are neurodevelopmental disorders, which means these are things that you’re born with, and they show up in early childhood, even if they’re masked by other things, or you have compensatory behaviors. And there are a lot of things that look like ADHD, for example, that are not; so many things which, which is why ADHD, in particular, it’s important to get a formal diagnosis. So, trauma and major stress and sleep apnea, which not a lot of people you know are aware of, and symptoms of major depressive disorder or symptoms of generalized anxiety disorder and so many other things, the person could have severe social anxiety that does not actually map onto them being autistic, because they don’t have the repetitive behaviors or restricted interest. Or it could be that the person again needs a formal evaluation, because their repetitive behaviors are internalized. They’re not necessarily like, you know, tapping a pen over and over, or, you know, stripping pieces of paper, but they’re having these ruminative thoughts about every social interaction that keeps going on, or they’re counting up to a certain number, and they don’t need diagnosis for OCD, for example. And so that is a very long winded way to say that it depends. But just supporting and exploring further with that client, I would recommend.

… 14:41
(Advertisement Break)

Curt Widhalm 14:45
How do you encourage newer clinicians to be able to differentiate some of those things? In my experience, it took spending a lot of time around a lot of different neurodivergent folks before I could really start seeing the difference between some of the OCD presentations and some of the other kinds of neurodivergent presentations of things. So rather than, you know, just needing lots and lots of clients to make mistakes on, are there other pathways and avenues that you would recommend that people look into to get more experience or more knowledge about this?

Dr. Monica Blied 15:18
I have some, like, YouTube videos online where people can, you know, get more information on it. I’ve the immediate response that came to my mind when you said that, like, how can they differentially diagnose; is that, like, that’s what the diagnosticians are for. They can, like, kind of not stay in your lane, but you know, ease up on yourself a bit. You don’t have to know everything. That’s why we have testing psychologists and neuropsychologists. But if it helps for the individual therapist, just for their self knowledge or their wanting to gain that expertise, just kind of diving into the DSM and then also following individuals who do have that expertise, whether it be on social media, YouTube, like I said, and then learning from them, just soaking in whatever they can.

Katie Vernoy 16:15
I think for me, the thing that I struggled with the most was kind of trying to differentiate autism or ADHD from trauma. And I think that can be huge, obviously, and with with some of the clients, I did send them to get formal testing and mixed results on the things that came back, as far as quality of testing and kind of how that all worked out. So that’s a whole other conversation.

Dr. Monica Blied 16:41
Right.

Katie Vernoy 16:41
But I think if a clinician is sitting with a client and is trying to determine what is, what am I? What does this presentation mean? How do I get started while they’re getting this, you know, kind of formalized testing? What are some ways do you think that folks can try to differentiate between a trauma response and a neurodivergent presentation?

Dr. Monica Blied 17:02
Yeah, I would want them to keep it in mind that a lot, and I don’t know what the statistic is; I forget if it’s 80% or 90% of neurodivergent folks have had trauma experiences, you know, because just how we show up in the world, especially as children, makes us more vulnerable to traumas, especially with individuals who take advantage of us because we’re more, you know, trusting and open and thinking that the honesty that we put forth is what everyone does, more naive about the world, if you will. And so you know, if a person is specifically looking to like, Is this only trauma, or is this trauma plus ADHD or autism? There are some very specific characteristics that are a part of autism, that are a part of ADHD, that aren’t necessarily always present in trauma. It’s usually both/and, yeah, as I’m thinking about it, I don’t, I haven’t come across a person who had trauma, who who, like, suspected that they were neurodivergent, who was not actually neurodivergent.

Katie Vernoy 18:32
That’s interesting. That’s interesting because I think that there’s a there’s a self knowing, I think too, that that clients can bring in as far as: Oh, I’m starting to see like I’m not responding to things the same way. Or now that I’m starting to hear these things, I recognize that I was bullied or I was taken advantage of, or I had these things that that kind of are in my experience, that I didn’t recognize at the time. But I think it can be kind of a big deal to figure out, especially later in life, like, oh, some of that might have been some neurodivergence in there. And and so to me, I feel like it’s, this is such an important conversation, you know, kind of getting to the diagnosis. But I feel like, because there’s so many folks either self diagnosing or getting formal diagnoses later in life, I think it may make sense to shift into like, when a client walks in with a diagnosis, what therapists can do. If we’re looking at kind of the tools that therapists can use for folks who have some flavor of neurodivergence, what are some of the things that you recommend that that therapists have in their tool bag? Because I feel like, especially, you know nowadays that people can go to Tiktok and get all these tools, but like, you don’t know if they’re like, oh, this worked for one person, or if this is more kind of has an evidence base behind it.

Dr. Monica Blied 19:48
Yeah, I would say first going back to like, person centered therapy is affirm and validate and then affirm and validate, because for especially for late diagnosed individuals, so much of their life they’ve been invalidated and told that there was something wrong with them or made to feel other and outcast. And so if they can finally, in this therapy space, be validated and say like no, your experiences make so much sense. You are not alone, you’re not weird, you’re not you know, unless you self identify that way, you know you’re not, you’re not an alien, you’re you’re no longer on this island. Let’s, let’s build a bridge and help you find some connections where you know that you know your spiciness is accepted and it’s actually what makes the world go round. That’s kind of like my first and second recommendation. The next thing is to get into the body, because a lot of therapists will provide mindfulness training or meditation skills, but that’s really difficult to do if your default mode network in your brain is like, constantly on chatter. And you’re like, wait, what clear my mind that’s never happened, not even when I’m sleeping. I have really vivid dreams. And so if you can get into the body and say, like, okay, let’s pair this breathing with EFT tapping, or with bilateral tapping, which is, you know, really simple and requires very little explanation. Let’s go for a walk. Let’s just tap our feet while we’re sitting here together, one and then the other. If you can get into the body using some of that more somatic work, then it’s going to make the other stress management relaxation skills a lot more easy to do for that neurodivergent person. The other thing that I would recommend is helping them with executive functioning skills, because executive dysfunction is pretty prominent in both ADHD and autism. Most people think of ADHD executive dysfunction like, okay, poor time organizing and time management, having a hard time getting started with things. But it’s also present in autism, even if it looks different. And so maybe the autistic person looks organized as far as how they present their materials on the outside, but internally, they’re having a very difficult time with prioritizing tasks or transitioning from one thing to another important thing. And so if you can support them in evidence based practices behind executive functioning training, that could be really helpful. So that includes a Pomodoro technique, which applies the Premack Principle, and it’s a lot of, you know, words and and names. So, basically it’s like, how to get things done. So it’s a six step process. One decide on the task that needs to be done, and that’s kind of a big one, because it’s like, there’s a lot that I need to do, right? Just choose one thing, okay, and be proud of that, and then set a timer. It’s called the Pomodoro timer. Typically for about 25 minutes, work on that task, and then end the work when the timer rings, and take a short break. And the Premack Principle, it’s like you’re pairing an undesired behavior with the desired behavior. So the undesired is whatever that task was, whether it be like opening your mail, which is something that I really struggle with, or going through your emails, which someone else might you know have an issue with, or completing an assignment, or whatever the case might be. But pairing it with something that you do enjoy and so okay, for five to 10 minutes, I’m going to have a dance break, or I’m going to, you know, play with my fuzzy toy, or whatever the case might be. And then after that 10 minutes, go back to step two, setting the timer and doing that task, and repeat this until you complete four pomodoros four of these cycles. And then after that’s done, step number six, take a long break, typically 20 to 30 minutes instead of a short break. And so that is, you know, one evidence based practice for being able to get things done. As far as the problems with initiation, which a lot of people have, like problems just starting, there’s the law of motion by Newton, the things that you know are in motion will stay in motion unless you know acted on by an outside force. Some things…

Katie Vernoy 25:00
Yeah, inertia.

Dr. Monica Blied 25:01
Yeah. Inertia, yes. Thank you. And so just doing one small thing can actually jumpstart your your motivation to continue other things. And so, for example, yesterday, I was really into reading my book. I had the day off. I was really into reading my book. But I knew that I had so many other things to do. I needed to wash the dishes and put the, you know, clothes in the dryer and you know, other things, you know, around the house that, like, I personally despise and hate. And so I got up and I knew I needed to feed myself, so I said, Okay, I’m just going to turn on the water, the hot water for the dishes, while I’m, you know, getting some food or whatever. And lo and behold, like, literally, I did not intend this after I turned on the water, since I was already at the sink, I was just like, well, let me just go ahead and put some soap in the water and just make the water. Let me just go ahead and start a little bit of dishes. But it got my momentum going and I was able to do other things. I also took a break and read my book some more, and then I set a timer at; my timer was actually for two hours, two hours after reading more of my book, then I’m gonna go back and do something else. And so, you know, notice how I found what works for me. If I were to do it in 30 minute increments, I would have been really depressed about that, because I was, like, really into this new series, and that it was my preferred activity, my interest. But because I made it work for me, I was able to get a lot done yesterday. And so with any thing that you’re recommending to your clients, usually what I recommend is, like, I’m going to give you, you know, this strategy, the suggestion you could do one of three things. You can do it right away. So take it and run with it. You can throw it in the trash. Like, no, that’s not going to work for me, you know. And sometimes we do have clients that are just like that, like, yes, but for everything or but so giving them that option, or you can put it in your pocket for later. And so maybe this isn’t something that you, you know, want to do right now, but it’s kind of just stored in memory, you know, put it in your toolbox so that when the time comes, you can, you know, engage and you know, this tool.

… 27:38
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Curt Widhalm 27:41
You’re talking about a lot of skills for people to implement, and especially for those diagnosed later in life that have things like jobs that require them to be on somebody else’s schedule. How do workplace accommodations work with some of these kinds of things?

Dr. Monica Blied 27:58
Yes, okay, so that’s one of the reasons to get a formal diagnosis is then you’re covered by the ADA, if you’re in America, the Americans with Disabilities Act, because both autism spectrum disorder and ADHD are disabilities. So workplace accommodations, typically you would go, a person would go to their HR, so their direct management would not need to know specifically what their diagnosis is, but the HR would get that letter for accommodations, and they would have to implement it, and all the direct managers would know is that this person has a disability that’s covered, and they meet these things. The typical things that are suggested are, you know, being able to use headphones at work, having a sensory like low stimulating sensory environment or a separate office or cubicle, having additional time for training, being able to record any trainings, having any directions that are provided to you, both orally and written, being made aware of any major changes well in advance, so that you can, you know, adjust and accommodate your expectations for that, having flex work, so a hybrid work schedule, work from home plus work from the office at times. Those sorts of things are all that can be included in accommodations that are for work. Now, depending on the workplace, depending on the size of the company, there are different, you know, regulations around ADA. They don’t necessarily have to accommodate all of them, but just getting that process started gets you a long way of protecting your job and also making your job more doable to accommodate your different needs.

Katie Vernoy 29:57
It seems like there’s with the, the neurodiversity affirming movement, those types of things, a push toward accommodations and kind of living out loud, right, unmask, be who you are, own your your challenges. And I think there’s also not a competing but a parallel, move around, learn the skills, get yourself, you know, not as close to neurotypical as possible, but I think you know that some folks would argue that to be in in, you know, whether it’s a workplace or other parts of the society that neurodivergent folks need to show up and do the things, and you can’t accommodate everything, those kinds of things. And so to me, I feel like there’s a hard balance there, and I know that I recognize the answer is going to be it depends. But I’m curious about your thoughts around how to balance accommodations and neurodiversity affirming, acceptance, openness, those types of things, versus skills training and really trying to help folks be successful within a typically neurotypical environment.

Dr. Monica Blied 31:06
So when I think about skills training, I don’t think about things that help the person be more neurotypical, but skills that help them become more self accepting and to accommodate themselves within those environments. And so when I mentioned like wearing headphones, that’s one of the things that can accommodate a person, whether they’re in school or at work, even if people are just like, Well, why are you doing that? Like you just listen to music all day, or, you know you’re not paying attention, those sorts of things; finding out what is it that you need to thrive in this environment, and doing those things. That may be stimming. And stimming is not a typical behavior, you know, especially in the workplace, but I’m going to do this is a skill that I learned from my therapist, you know, or that I learned of my own that I’m going to do, even if you don’t like it. I’m going to have my, you know, fidget toy, or they have, like, fidget rings, you know, with different things, but I’m going to have these things to help me to put up with being in this environment that was not set up for me; doodling during meetings, for an ADHD person, because it actually helps you to focus better, those sorts of things. So that’s what I think about when I think about skills building. I’m not thinking about, okay, how do you make yourself blend in more? Because a late diagnosis, a late diagnosed person, already has years, sometimes decades, of those skills. No we’re going to as therapists, empower them and teach them the skills to help them to accommodate themselves, and that’s more aligned with self acceptance: What do you need? An example is and this skills building is not just for the workplace, but also for the household. So for me, I need additional time and preparation if there’s going to be a change in my routine. So I learned this the hard way when my husband had asked me to take our daughter to school. He takes our daughter to school every day. It’s on his way to work, and I already had a meeting that day, but the meeting wasn’t until 11, and he asked me this at 7am and even though there was like this four hour gap, it was such a hard transition for me to kind of rearrange the planning in my mind to accommodate this change. And so I made it work. Dropped off my daughter, got to my meeting a few minutes late, and the person was completely understanding. It was a lunch meeting, so it wasn’t like that big of a deal, but like, I was near tears because it was so stressful for me to have this unexpected change to my routine. And so in our household, he knows if you need me to drop her off or pick her up, I need to know at least a day in advance. And this is very common actually, for Audi HD, ers and for autistic folks, that knowing in advance any changes to a routine is one way that they can advocate for themselves and make people accommodate themselves of how our brains work differently.

Katie Vernoy 34:38
So we’ve talked about kind of later diagnosis that folks are figuring this out based on Tiktok or social media, or whatever those things are. And I’ll give the answer and then go to the next question, because I think that some of the pieces are, you know, folks who are assigned female at birth, just they’re missed, they just present differently. Those kinds of things. Yeah, and so part of that, it seems to be, is successful masking. And there’s a lot that’s out there around kind of unmasking and and showing up. And so this is kind of going it back into the neurodiversity affirming kind of piece. What does it even mean to unmask? Like I’ve I’ve pondered this for myself, I’m trying to sort out what it means, and I think that there’s so many different things, and maybe this is too big for for a quick answer, as we’re running out of time, but I I think that there’s something around unmasking that I’d like to learn about, because I feel like it’s such a confusing concept, especially for someone who I’m assuming has masked my whole life. So…

Dr. Monica Blied 35:42
Yeah, and so that’s the gift of diagnosis, whether it be a formal diagnosis or self identification. Most individuals, when they get that late diagnosis, they start to unmask. And people are just like all of a sudden, you have all these autistic behaviors, just like, no, like, I’m starting to unpack the and peel away the many, many layers of shame and fitting in; shame for who I am and how I am, and having to fit in so that I am accepted. And now I know that there’s nothing wrong with me. My brain was built differently. It’s wired differently, and I can love those things about me, but it’s a hard process. There’s like this relief that comes with the identification and diagnosis, and then there’s this grief that comes. And so helping to pull back those layers of grief and shame. That’s what the unmasking process is about. Like, the way that it looks to others is, Wow, you are really out there now, or with my husband, like you didn’t have problems with changes before. It was just like, because I would stuff down all those feelings, all the discomfort and near tears and things like that. There’s no more stuffing down. There’s this openness that just feels like a breeze through your body, whereas before, maybe it were these dark, cottony, dark gray rain clouds with silent thunder inside you that just could not escape. All of a sudden, there’s just the open breeze.

Katie Vernoy 37:42
Okay, I thought that was my last question. But I have one more, because I think it’s, it’s related. And so the like, all the stuffing down, all of the masking, leads to autistic burnout, or neurodivergent burnout. And so any thoughts you have on on navigating that?

Dr. Monica Blied 37:57
Yeah, yeah, I will actually go to another expert in our field, Dr. Joey Lawrence with Neudle Psychology in 2023 he had published the 5 S’s for autistic burnout, preventing autistic burnout. And I think this would apply for our ADHD folks as well. So neurodivergent individuals have to prioritize healing, have to take breaks, and those breaks could be through respite, so like getting away from everyone, or through receiving support from family and friends. And so he created the five principles of healing from burnout, Stop, first S is stop or slow down as much as possible. Two, seclude or reduce contact with people, especially people who deplete your energy or resources. And those people could be family members. And so I’d love to talk, you know next, before we end about family members, right? Three, the third S is special. Engage in your special interest for regulation and calming. I recommend doing that on a daily basis, doing it at work, doing it during breaks, all the time. And finding other people who also like your special interest. And so it could be joining a book club, or, you know, a gaming club online, you know, if that’s your thing. Because normally, individuals assigned female at birth have special interests that are more like societally accepted, like, you know, celebrities or video games, or, you know, those sorts of, you know pop culture, the third S is special interest. The fourth is stemming. Stemming is getting regulation through motor movement. And so that’s where the therapists come in, where you’re teaching these skills of, okay, let’s do a walk. Because walking is a bilateral movement, moving one side of your body then the other, and that helps to engage the three main parts of your brain so that they’re all talking with each other, and you can help problem solve and also calm down. And then the last one is get support S, and I would add in, find your people, find people that you can fully unmask around where, if you’re AuDHD, especially, you may be going from topic to topic to topic, and they’re just like, they’re there with you. And then when you’re like, What was I talking about, they’re like, Girl, I don’t know, you know. And then just keep going, you know. And there’s no like, you know, shaming that another person is doing, you know, against you. And I would add another S: smile. So there is research that was done, I think it’s almost been a decade ago. It was with medical students. And medical students are like super stressed out, right? And they took their blood to test cortisol levels before and after having them to just smile or put a pen horizontally in their mouth and just hold it there for like 30 seconds, because doing so stimulates the same muscles as a smile, so kind of tricks your brain to think that you’re smiling, And when they did that there were actually lower levels of serum cortisol in their blood, and so that means that their body actually calmed down. There was less stress evident within their body with just a smile. And so find people and places that support you smelling so it’s actually authentic, and then when it can’t be authentic, because, you know, like family. Now I’m saying put a pen in your mouth horizontally.

Curt Widhalm 41:53
Was there more that you wanted to say about families?

Dr. Monica Blied 41:59
What is effective in communicating to family members about the later diagnosis? This is such a hard thing, and this is what you can get support from your therapist for, because a lot of individuals have been gaslit by their family members and say, like, oh, that’s nothing. Or, you know, it’s religiously covered up like, oh, you know, don’t claim that. Don’t claim that on you and those sorts of things. So that can be a very invalidating environment, especially when the individual recognizes, like, I probably got it from you, like, I’ve watched you all my life, and so that’s where this self acceptance comes in. So I accept myself and I love myself, and I see myself, and I’m not going to let you project your fears on me, your fears of being fully seen as you are, in your diagnosis or your fears of what autism or ADHD means, because you have only seen the stereotypes in the media. I reject that, and I fully accept and see myself, and I’m going to be in those spaces where I can just breathe.

Curt Widhalm 43:22
Where can people find out more about you and the work that you do?

Dr. Monica Blied 43:26
Yes, I have a couple different websites. One is drblide.com spelled like my name, D, R, B, L, I, E, D.com, and the second is facesofhealth.net and so for facesofhealth.net, that’s where you can learn about my app, which is a great resource for therapists who are trying to learn about and teach somatic exercises and self brain spotting and grounding skills. They are two to three minute videos that are freely accessible to everyone. And lastly, learn that facesofhealth.net is new, and that’s where individuals can learn more about late diagnosis of ADHD and autism and how to support the individuals, including themselves, if they have that. I have a five module online course.

Katie Vernoy 44:19
Nice.

Curt Widhalm 44:21
And we will include links to all of Dr. Blied’s sites and our show notes over at mtsgpodcast com. Follow us on our social media. Join our Facebook group, the Modern Therapist Group, to keep the conversation going and until next time, I’m Curt Widhalm with Katie Vernoy and Dr Monica Blied.

… 44:38
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