Neurodiversity 23_ultra.pptx

Neurodiversity & Neurodivergence L9 (Theme 3) Dr Lisa Quadt (she/her) Research Fellow in Psychiatry Department of Neuroscience Disclaimers • I am multiply neurodivergent (autistic, ADHD), have multiple other (invisible) disabilities • I am from a privileged (WEIRD*) background • I will be talking...

Neurodiversity & Neurodivergence L9 (Theme 3) Dr Lisa Quadt (she/her) Research Fellow in Psychiatry Department of Neuroscience Disclaimers • I am multiply neurodivergent (autistic, ADHD), have multiple other (invisible) disabilities • I am from a privileged (WEIRD*) background • I will be talking about mental health, including suicide and self-harm, sometimes with a focus on medical students/doctors • Most graphics are not mine • Some research is not published, please do not share • A lot of content is from my BSMS colleague, autistic/ADHD/dyslexic Dr Seb Shaw * Western, Educated, Industrialized, Rich, Democratic (Henrich et al., 2010) Join at slido.com #1835978 ⓘ Start presenting to display the joining instructions on this slide. Learning Outcomes  Recognise that neurodivergent people present on a spectrum  Give examples of neurodivergent-specific healthcare needs and barriers  Describe neural differences and their potential impact  Describe how neurodivergence may present itself Neurodiversity Neurodivergence Can you think of examples of neurodivergent conditions? ⓘ Start presenting to display the poll results on this slide. • Individuals from any group can be neurodivergent and differ in all aspects of human characteristics • Prevalence highly debatable • Official numbers: 2% autism, ~8% ADHD • Likely much higher due to exclusionary diagnostic criteria & biases • Certain professions may “select” neurodivergent individuals • E.g., the academic neurotype  intense interests, hyperfocus, attention to detail, creativity The Neurodiversity Spectrum is often thought of as linear Less neurodivergent Very neurodivergent • Important to acknowledge individual strengths and challenges • There is just as much variance as in nonneurodivergent people • High-functioning vs low-functioning, Level 1-3 are unhelpful categories • “Spiky profiles” (Purvis, Doherty & Shaw, under revie Autism in the medical model vs autism as a neurodivergence Should autism be considered a disorder? ⓘ Start presenting to display the poll results on this slide. Medical Model of Autism DSM-5 A. Persistent deficits in social communication and social interaction across multiple contexts, e.g.: i. Abnormal social approach/failure of normal back-and-forth conversation ii. Deficits in nonverbal communicative behaviours iii. Deficits in developing, maintaining and understanding relationships B. Restricted, repetitive patterns of behaviour, interest, or activities, e.g.: i. ii. Stereotyped or repetitive motor movement Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behaviour iii. Highly restricted, fixated interests that are abnormal in intensity and/or focus iv. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment Autism as a neurodivergence • Differences, not deficits • Strengths/challenges are contextual • E.g., environment, culture, social, political, historical Disord er Superpo wers DisablemConsideration Support needs ent of externalacknowledged possible (NOT functioning labels) causes A myth to forget • Autistic people are either genius or severely intellectually disabled “It is recognised now that most autistic people are adult, do not have an intellectual disability and are likely to be undiagnosed.” (RCPsych, CR228) A myth to forget • Autism is more common in males (assigned at birth) than females (assigned at birth) “Systematizing” • Maths skills • Attention to detail • Map reading • Constructional abilities • Toy choices (vehicles, weapons, building blocks) “Empathizing” • Sharing and turntaking • Empathic response to distress • Theory of mind • Values in relationships • Cooperative, reciprocal language use • Talk about emotions What is the male:female ratio of autism? ⓘ Start presenting to display the poll results on this slide. A myth to forget • Autistic people (who are mostly men/have an extreme male brain) do not have empathy Language Survey in 2015: 61% of autistic adults preferred “identity-first” vs “person-first” language [7] Autistic person/people  Autistic identity is named first: “Identity-first” Person/people with autism  Person is named first: “Person-first” Language No data available about ADHD language preferences But many use identity-first language: ADHDer, AuDHDer, AuDHDistic… And others prefer person-first language: Person with ADHD, person with a diagnosis of ADHD Some new ideas: Variable Attention Stimulus Trait (VAST) Dopamine Attention Variability ExecutiveDysfunction (DAVE) ADHD Types & Experiences ADHD Types Inattentive type Combined/Mixed type • Interest-based focus ability • Disorganized/creative mess • Easily distracted (unless in hyperfocus) • Trouble following directions • “Daydreaming” • Forgetfulness Meets criteri a for both types Hyperactive type • Interest-based focus ability • Fidgeting/stimming • Impatient • Interrupting others/finishing sentences • Mind and body go “100 miles per hour” • Impulsivity Common ADHD experiences • Emotional dysregulation • Short fuse (ADHD rage) • Rejection sensitive dysphoria • Recognition sensitive euphoria • Hobby graveyards • Disordered eating • Difficulty accessing hunger/satiety signals • Binge-eating (forgets to eat, gets very hungry, difficulty preparing/planning meals) • Addictive behaviours • “Dopamining” • Executive function • Task-chains • “Floordrobes” • Time-blindness • Sensory differences • Craving input • Easily overwhelmed Neurodivergent Brains Neural differences in autistic people Cerebral Cortex • Increased number of connections • Differences in movement, sensation, planning, social behaviour Temporal Lobe • Differences in neurons and connections • Fusiform gyrus/facial recognition Amygdala • Differences in growth trajectory (anxiety) Hippocampus • Often larger • Differences in memory Cerebellum • Increased number of connections • Unclear what this means Which neurotransmitter plays an important role in ADHD? ⓘ Start presenting to display the poll results on this slide. Neural basis of ADHD Mind the body Symposium 01.12.2023 Neurodivergent specific healthcare “Did not seek advice for chest pain because of anxiety about the process of seeking help” "I feel so disrespected by healthcare professionals that I'd rather suffer at home than set myself up for ridicule” “I'm gonna die one day because I didn't go to the doctor because it The “Autistic SPACE” framework (Doherty, McCowan and Shaw, 2023 The “Autistic SPACE” framework Consider: Sight… Sound… Smell… Taste… Touch… Interoception… Consider: Consistency… Info in advance... Video walkthroughs… AccessAble site… Consider: Adopt a neurodiversity-affirmative approach, acknowledge struggles. Consider: Literal approach… Minimise idiom… Assume positive intent… Consider: Double Empathy Problem… Displayed in different ways… What have you learned today? ⓘ Start presenting to display the poll results on this slide. Audience Q&A Session ⓘ Start presenting to display the audience questions on this slide. Where can I seek peer support if I identify as autistic? (Or where could I signpost an autistic colleague?) www.autisticdoctorsinternation al.com * *now around 700 @Autistic_Doc Where else can I seek peer support if I am neurodivergent? (Or where else could I signpost a neurodivergent colleague?) Doctors’ Inclusive Neurodiversity Group (DING) https://www.facebook.com/groups/494247659564273 @Autistic_Doc