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Coping with COVID-19 Productivly

April 18, 2020, by Joel Schwartz, PsyD

Coping with COVID-19 - Staying in the Zone of Productive Worry

First and foremost, I understand your concerns. Although panic is not helpful, productive worry is. We must face the reality of this situation together. We will all likely know people who will have severe reactions to this virus. Many of us will lose people we love. And all of us will have significant disruptions in our lives – financial, social, medical, etc. We need to plan for the realities of this pandemic and cope with it as best as we can. For many of us, especially those with mental health difficulties, social isolation is extraordinarily painful. Being alone in our fear is extraordinarily difficult – so know that I am here for you.

The key to surviving and thriving in a time like this is to stay in a zone of productive worry. Too little worry makes us stall and not take precautions. Too much worry causes us to freeze or panic, keeping us from acting in ways we must to overcome adversity. Those of us who have faced psychological traumas and who have more sensitive nervous systems may be more prone to freezing than others; so continuing to work towards health may be essential in this moment.

Here are a few tips to help stay in the zone of productive worry:

  1. Limit your social media time and your time talking to others about the virus. Try to be aware that often we feed off each other’s anxiety instead of calming each other down. A constant barrage of bad news can create hopelessness and paralyzing anxiety. Try to check in with yourself to see if engaging in these conversations helps create productive plans or leads to a freezing response. One way to tell is if you feel stuck or can’t pull yourself away from a screen.
  2. Spend more time with things that calm you. Cuddle your pets, children and/or partners, listen to music, watch a favorite movie, etc. Spend some of your free time re-engaging with hobbies and creative endeavors. Participating in activities that are familiar makes us feel safe and calms down our nervous systems so we can act productively and be resilient.
  3. Continue to be healthy and keep active. Stretch, find places in your home to jog in place or do simple exercises. If it’s safe, take a brisk walk or run around your neighborhood. Stay hydrated. Try to keep high protein and plant-based snacks around the house, as carb-loading can make us feel sluggish, and let’s face it – many of us will be snacking due to stress or boredom.
  4. Engage with your loved ones. Play with them, make jokes, even use dark humor, connect in any way you can. Offer tips to each other. Share worries, but don’t get caught in a spiral of paralyzing anxiety.
  5. Be kind to yourself and others. We are all doing what we can in a highly volatile and confusing situation. Data will change moment to moment, and we will all make mistakes and many of us may lash out from fear. This is all very human. Apologize if you must, but don’t hold on to guilt or shame – as these emotions also contribute to freezing.
  6. Continue with your therapy. Although mental health tends to take a backseat in times of strife and economic burden, the best thing we can do for ourselves is to engage in self-care and keep in the zone of productive worry. Taking care of your mental health is essential toward this goal. Many of us therapists are offering tele-therapy options.

Thank you for reading. We are in this with you. We understand your worries. And we are here to help you through this frightening situation. If you would like to consult with a therapist, please reach out to me at Joel Schwartz. I am seeing clients in Colorado and California for video chat based tele-therapy.

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Music and ADHD

April 09, 2020, by Joel Schwartz, PsyD

Ten Minutes of ADHD-ing or What a 1930s Anti-War Novel Has to do With Neurodiversity

Before we begin, there are a couple of areas of shared culture I must introduce. First, it is essential to listen to a popular instrumental song by the Canadian progressive rock band, Rush, called YYZ. The title refers to the call letters of Toronto Pearson International Airport.

Next, in 1938, Dalton Trumbo published an anti-war novel, Johnny Got His Gun. (Spoiler Alert) This powerful book concerns a soldier, Joe, who is laying in the hospital recovering from horrific war wounds. Throughout the book, Joe slowly gains consciousness and realizes he is almost all but cut off from the world. His limbs have been amputated, and he is unable to see, hear, eat, or smell. Slowly, Joe reckons and copes with his new existence, ultimately finding a way to communicate again. The book was considered subversive and got Dalton Trumbo put on the Hollywood blacklist during the McCarthy era.

Finally, the Heavy Metal song, One, by Metallica is based on Johnny Got His Gun.

Got all that? Okay…:

I’m driving home in an early morning rainstorm, having just dropped off my son at school. The drive isn’t terribly unpleasant, but it is boring. I put my iPhone on random and fill my ears up with the sounds of familiar music to cope with the monotony.

YYZ by Rush comes on. The first moments of the song have drummer Neil Peart playing Morse code for Y-Y-Z on the cowbell – dah dit dah dah/ dah dit dah dah/ dah dah dit dit – right before the guitar and synthesizer join the introduction, the guitar also producing Y-Y-Z in Morse code. And my brain is off to the races.

I am imaging bits and pieces of old war movies where telegraphs are used. For some reason, this free-associates to images of scientist Nikola Tesla. At the same time, the song Hair of the Dog by the rock group Tesla blasts in my mind. Now you’re messin’ with a….a son of a bitch! And I’ve always thought the song sounds a lot like an AC/DC song. I am now tickled and smiling with the closing of this circle of free association since Nikola Tesla invented Alternating Current – which of course makes up the AC in AC/DC.

But now I’m back to Morse code and I’m thinking of how simplistic and elegant it is – how a series of beeps transmitted wirelessly became a robust and useful form of long-distance communication. For a moment I am awestruck by the collective technological accomplishments of humanity.

And then I remember Johnny Got His Gun. Near the end of the book, Solider Joe recognizes that he can communicate with the outside world by bobbing his head up and down in Morse code. There is a moment of elation and raw energy as Joe spills out 4 years of recovery and self-discovery.

He shares a manifesto of emotion and thought as he desperately tries to communicate the depth of his experience to the officer who is writing down the letters that Joe is desperately pounding out with his head. Joe ends by saying he wants a public forum to talk of the horrors of war – to warn the next generation that there are real world consequences when young people are sent to die for mere philosophical abstractions. The response Joe is given to his years long struggle for a voice is simply, “What you ask for is against regulations.”

As I’m replaying this scene in my mind, I am getting angry and sad. I am feeling the injustice of this moment in the novel, and it reminds me of the various injustices and invalidation I hear from my clients.

I am a clinical psychologist and psychotherapist, and most of my clients are autistic people. Many of them try so hard to be heard, to be validated - but they are intense boundary breakers with profound sensitives with little patience for institutional malarkey. Their whole being is “against regulations” and so they are almost always shot down when they are trying to be heard.

And I’m also thinking of my own suffering as an ADHDer – the constant misunderstanding and invalidation. And I’m in my car, bumper-to-bumper traffic, and I’m feeling deeply for my clients, for Soldier Joe, for my own inner child, and I’m tearing up. I’m about to cry in the middle of Los Angeles 405 mo(u)rning traffic.

I recognize that it probably isn’t safe to be so unfocused, so I make a deal with myself. I know if I get moving, I will be able to be in the moment. So I lean into the injustice and sadness by switching the song to Metallica’s One (which is about Johnny Got His Gun and is interestingly on an album called And Justice for All) and my car becomes a drum kit.

I am moving, head banging, using all my limbs to play along with Lars Ulrich’s drums and singing along to James Hetfield’s words. I get briefly annoyed because although I’ve been playing guitar for years, my fine motor and proprioceptive difficulties mean I will never nail that Kirk Hammett guitar solo. But as I move, I am In The Frigging Moment. I am ALIVE. I am seeing everything I need to. I can see paths through traffic and paths to safety if there’s an accident.

And my emotions have turned into productive anger and raw energy as I’m drumming and singing away; and the semblances of this blog begin to take shape in the back of my mind. I am also somewhat laughing at myself because I know I will not truly feel satisfied until I try to play that One solo later in the day. Until I do, there will be an annoying tickle in the back of my mind wanting to play.

tl;dr: In the midst of major ADHDing which showcased loose associations, lack of focus, hyperactivity, and impulsivity, I achieved the following:

  1. I wrote a blog in the back of my mind while listening to music,
  2. I connected deeply with the experiences of neurodivergent people which in the long run will lead to,
  3. me being a better therapist,
  4. I stored away some motivation to be a better guitar player, and
  5. I rode on an emotional roller coaster that left me with feelings of aliveness and vibrancy that lasted me the whole day.

The Neurodiversity Paradigm views neurological differences like ADHD and Autism as arising from naturally occurring genetic variations that have evolved for the betterment of humanity. Although these ways of being are not without areas of disability and comorbid dysfunction, their existence is overall a boon for human creativity and progress.

Without neurodivergence, we don’t have the autistic Nikola Tesla nor the ADHD Ozzy Osbourne (one of the inventors of Heavy Metal). The Neurodiversity Paradigm is in opposition to the medical model of mental illness, which posits that differences such as ADHD and autism are disorders to be gotten rid of – that there are non-disordered normal ways of being and deviations from these norms are psychiatric illnesses.

Under the Medical Model, my natural way of being is considered a pathology. Treatment would include psychiatric medication for life and behavioral interventions to make my brain and behavior seem more normal. And while I would not fault anyone for undergoing interventions to make their lives easier, and I have personally taken medications and been in behavioral therapy at various times in my life, I hope to have demonstrated in my 10 minutes of ADHDing how wrong the Medical Model is.

Although my thoughts and behaviors may seem odd, dysfunctional, or chaotic from the outside, these messy ways of being are directly responsible for deep wells of feeling, connection to others, humor, and creativity. If you take away the ADHD, you take away a fundamental way in which I function in the world.

You take away my natural creativity, my warmth, my depth, my intensity. And although these characteristics may somewhat limit my ability to successfully navigate a neurotypical world, in other ways they create a vibrant and dynamic life that is vastly successful in some areas.

Neurodivergent people are similar to Soldier Joe. We carry the wounds of invalidation and ableism throughout our lives, having been trained to hide our true natures to make others around us feel more comfortable. Decades of being told to sit still, to be less sensitive about some things, but more sensitive about others, to behave, learn, study, and cope in ways that are alien to our natural neurology has likely led to tragic stifling of creativity and expression.

And when we cannot live our lies anymore and break down into depressions or rages, we are told our truth is against regulations – that we are ill, not righteously angry and desperately trying to free our true selves from a shame filled prison. I am lucky enough to have worked through much of my shame.

But it took a long time.

Imagine how neurodivergent children feel every day. Imagine the internalized messages of shame and dysfunction they carry because they don’t have to the tools to critically examine the messages they are given. Imagine how well-meaning mental health professionals who’ve embraced the medical model further contribute in subtle and overt ways to this shame by focusing solely on behaviors deemed wrong from the outside, instead of understanding the usefulness and beauty of the processes beneath.

Although neurodivergent folks may not know Morse code, they are communicating needs in their own way. Are we willing to listen or is it just too much against regulations for comfort?

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Reframing ADHD

March 15, 2017, by Joel Schwartz, PsyD

Reframing ADHD

I recently joined a Facebook support group for adults with ADHD (which I have). I have been very saddened to see that so many there see themselves as deficient and that medications are the only answer to their problems. The pathology paradigm pushed by pharmaceutical companies has worked. We have created a class of demoralized people who feel unworthy and damaged unless drugged. (Note: I am not discounting that medications can do wonders for some nor am I minimizing how difficult it is to have ADHD. For many, medication may be part of the answer in managing this complex and multifaceted condition.)

Yes, having ADHD means that we are at a disadvantage when it comes to the way we are supposed to interact, study, and work in this society at this given time in history. The label in and of itself ADH Disorder, assumes ADHD is a result of a dysfunctional brain. There is no proof of this - since function/dysfunction depends on context and in some contexts ADHD people perform better than neurotypical people. When the ADHD person is given the freedom to make their own education and life, that person almost always does incredibly well. Although the research isn't clear, some have concluded that people with ADHD tend to have higher than average overall intelligence (often times lower scores can be attributed to lack of focus on the long-winded IQ tests - an inherent bias against ADHD people in testing itself). In hunter-gatherer tribes, those with commonly associated ADHD genes perform the best (Eisenberg, Campbell, Gray & Sorenson, 2008) . We are natural hunter/gathers forced into the boring life of farmers. WE are not deficient. Education and work spaces are. The 9-5 (and more if you are in America) hyper work life is. We are not. We are misfits, not unfit.

There is a convincing body of research suggesting parental judgment, stigma, and other forms of ableism contribute significantly to negative ADHD outcomes. Parents who see ADHD in a positive light tend to have better functioning ADHD children (e.g. Lench, Levine, & Warren, 2011).

We must remember that almost every human trait is deeply contextual - what hurts in one situation helps in another. So here as some ways to reframe traits typically seen as negative in ADHD people:

1. We do not have processing deficits. We find meaning and beauty in everything, meaning we don't screen out what others would. Because of this we are romantic, open to experiences, and highly creative. We pay attention to what others do not, and therefore make connections others do not. We process DIFFERENTLY, not INCORRECTLY.

2. We are not impulsive. We are experimental. We are passionate. We do not fit in with the boring world of soul-crushing rules and regulations that inhibit our natural creativity and freedom. If we are allowed to express ourselves naturally, we are great problem solvers, uniters, movers, and shakers.

3. We are not inattentive. We are attentive to EVERYTHING. See number 1. This is not a deficit. This is a sensitivity that, when harnessed, makes us interpersonally adept and aware, tuned into others, makes us great artists, and keeps us connected even when our conscious minds are elsewhere.

4. We are not irresponsible. We are playful. And if we are allowed to play, we will get amazing things done. But if we are shamed for being us, we will shut down and not perform.l

5. We are not too sensitive. We are compassionate, artistic, romantic, passionate, loving, affected by injustice, and caring.

6. We are not reactive. We are responsive. If we are react badly, it is because something negative ACTUALLY happened. Just because others are insensitive doesn't make us wrong. Don't shut us down.

7. Please feel free to add your own...

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detached

September 11, 2016, by Joel Schwartz, PsyD ·

Disorganized Attachment – An Explanation for Non-Clinicians

Many clients who end up in the therapeutic chair or couch are impacted by a disorganized attachment style. Disorganized attachment serves as a diathesis (risk factor) for many difficult psychological syndromes including depression, dissociative disorders, various personality disorders (especially Borderline and Narcissistic Personality Disorders), PTSD, and Complex PTSD. I have found it useful to explain the etiology and manifestation of disorganized attachment to my clients as a way to begin understanding their confusing and dysfunctional coping methods and behaviors. However, my search of the web has yielded little information for the non-clinician. As such, here is my jargon free explanation. Most of these ideas are from the research of Mary Main and her colleagues:

Usually, when infants and young children are frightened or sad they approach their parent or caregiver for safety and comfort, something called "Attachment." The attachment system is a biological imperative in most social mammals. That is, we are hard wired to seek security of other mammals in times of great distress (and to provide comfort to distressed others), and this hard wiring is as important to our survival as is eating and drinking - perhaps more so. In the first half of the 20th century, Harry Harlow and colleagues did a series of studies on Rhesus monkeys and found that the need for contact with a comforting figure took precedence over food. This is why we cling on to abusive partners and parents. Our need for "contact comfort" is deeper than the need for physical safety.

When a parent or caregiver is able to empathize, soothe, and care for their children, it teaches the children how to handle their own uncomfortable emotions and be caring and empathetic toward others. They also learn healthy boundaries and know how to seek out and rely on others for help. This is the basis of healthy interpersonal relationships and is called “secure attachment.”

However, when parents react to their children’s efforts to receive comfort, empathy, and security in a frightening way, it can adversely affect their children’s ability to cope with emotions and engage in healthy relationships. Sometimes, parents do not even mean to be frightening. Often, parents can be frightening when they are abusive. However, parents can also be frightening if they have unresolved traumas of their own, are excessively anxious and reactive, or have some other psychological difficulty that results in frightening behavior, or acting afraid of the child.

When the people who are supposed be a source of safety and security are also the source of danger and insecurity, it results in “fright without solution.” As a result, two things may happen: 1) Children in these situations tend to disconnect from reality – they dissociate. They may lose track of time, have out of body experiences, see reality as distorted, feel like events happen to someone else, or have strange and incomplete amnesia episodes. 2) They grow up coping in a confusing way – basically, they are programmed to both approach and avoid caregivers at the same time. As a result, when these children grow up, they experience intimacy as scary. When people try to be kind to them, they may freak out. They may really want to get close to someone, but are also scared at the same time and unable to open up or share.

I once had a client who described being frightened at a party. She ran away and hid in the coat closet. While there she was wishing so badly that her boyfriend would come and get her. But at the same time, she was afraid to be found. She wanted to be close to and far away from her boyfriend at the same time. Another client had a mother with disorganized attachment. She was not able to be close to her children without being mean and critical. She would hug, and cuddle them, telling them how much she cared and loved them, but at the same time would critical, rejecting, and cruel. It is because even with her children, she wanted to be close and far away at the same time.

When people who have disorganized attachment experience psychological trauma, they very frequently experience PTSD. But their PTSD is much more complicated and difficult to treat because when a securely attached person has PTSD, they can quickly trust their therapist and allow themselves to be cared for. When someone with disorganized attachment gets PTSD, it is difficult to treat because the process of learning to trust a therapist is frightening. They want to rely on a therapist and run away from the therapist at the same time. When the therapist tries to care and empathize, or the person feels themselves beginning to trust, that is the moment they start to get scared and want to run away or end treatment. Sometimes this dynamic is expressed in a manner that sabotages treatment, such as frequent no shows, provocative behavior, or a flight back into pathology or substance use. As a result, it often requires the therapist to work intensely on the therapeutic relationship for a long time before directly working with symptoms or other syndromes.

This manifests in the sexual arena as well. The person with disorganized attachment may crave closeness and distance at the time, so they engage in sexual behaviors that have both of these needs met. They may sleep with many partners to avoid deeper intimacy and connection. Or they may create distance between themselves and sexual partners during sex. Or they might find safety in the disconnected autonomy of cyber sex or pornography.

Working with people who have disorganized attachment can be difficult. Often, informing them about the reasons for their seemingly strange behaviors is an important first step.

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unplug

July 19, 2015 ·

Unplug Electronics and Plug in to Life!

I have been hearing from a lot of people lately that they feel “disconnected,” “lonely,” “irrelevant,” and “lost.” When I ask them what has changed, they all seem to attribute this to job stress, pressures of daily life, or just plain depression, like it’s an expected state of mind. When I ask, most of them do not engage in as much physical movement as they report that they used to do.

Some report that watching movies, TV, and video games, as well as social media as their go-to recharge activities. I am hearing this often enough that I cannot ignore the correlation. I believe that as a society, we are forgetting how to feel. Let me clarify, we are losing touch with our actual environment by replacing sensory input with virtual experiences. Behaviorally speaking, we are teaching ourselves not to have to use all of our senses, in essence a sort of reverse evolution.

I am not saying to go back to the horse and buggy days, but I do feel that we should consider limiting our exposure to electronics and media and supplementing each day with physical experiences and face-to-face interactions. And I mean EVERY DAY. We are designed to move. We are wired to communicate with others and connect with our immediate environment; touch, smell, listen, taste, and see what is around you. Some call this mindfulness; I call it being human. Use technology as a tool when needed, but take breaks and remember to plug in to life. I believe that you will soon find that you will feel more connected, less lonely, more relevant, and less lost. Let me know how it goes if you are inclined. I would love to hear from you.

autistic female

January 21, 2015 ·

Autistic Females - Hidden for Too Long

While it is true that there seems to be many more autistic males than females, new research combined with testimonials of many hidden autistic women suggest that the sex-gap may be narrowing. The diagnostic criteria for identifying autism in the DSM is highly male-centric. This continues a long trend in medical and psychological research of basing experience from a male standpoint. For example, Lai et. al. (2011) found the ADOS-II, considered the gold standard in autism assessment, correctly identified autistic females 20% of the time. A recent study found similar results using a computerized version of the ADOS-II (Rynkiewicz et. al. 2016).

Part of the problem is that the entire basis of the DSM, that meaningful diagnoses can be given based only on observable symptoms, is completely insufficient for identifying the problems that bring clients into the consulting room. What is missing is an important subjective dimension - the lived experiences of our clients in informing how they are to be treated. When we honor this, diagnosis and treatment become a meaningful conversation between clinician and client as opposed to the all-knowing professional making proclamations from on-high.

Another reason diagnosis can be difficult is that many autistic people learn to cope with their neurology, thus blinding professionals to their struggles. This is especially true of autistic females. Autistic females appear to be more socially adept than autistic males. Like their male counterparts, they frequently make social mistakes and are easily overwhelmed in social situations. However, unlike their male counterparts, autistic females tend to be much more socially motivated. Because of this, they tend to learn how to fit in. They are careful studies of social interactions and have learned to copy social behavior. However, because they are essentially faking social competence, it takes a lot out of them. It is a costume that feels constraining and hot to the point of crushing. Many professionals miss this key diagnostic feature as a result.

Autistic females become easily overwhelmed and tend to isolate for long periods of time or get hyperfocused on specific interests as a manner of coping with anxiety and an over-sensitive nervous system. Whereas autistic males tend to have highly narrow interests, such as a fixation on a certain type of vehicle, road maps, or weather patterns, female fixations tend to be more gender conforming and broad, and are therefore missed as diagnostic. Some examples of these fixations include fantasy novels, specific TV shows, fashion, music, body image, or animals. What differentiates this from a hobby is the extreme fixation and inability to “leave it at home” when out in the world. Also, because many females have been shamed or have been told they are annoying for talking about their intense interest, many have learned to hide these behaviors from the social world. One autistic woman I know is a passionate photographer - her phone storage constantly needing expanding as it is filled with pictures. This woman scans through her 1000s of pictures while in social situations as a way to screen out the rest of the world. To others, she looks like any other person engrossed in their phone. To her, it is an essential mode of survival.

Finally, many professionals base autism diagnoses on the concept of "theory of mind." In essence, early studies of autistic children (mostly males) showed they were unable to conceptualize that others' minds were different from theirs. Newer research has shown that, if properly motivated, many autistic children do, in fact, have theory of mind - they just do not recognize that they need to use it (e.g. see Chevallier, et.al. 2012). Because autistic females are socially motivated, they tend to have very good theory of mind. In fact, because of histories of rejection, an ability to hyperfocus, and being very sensitive to minute changes, autistic females may actually have overcompensated, thus possessing superior theory of mind at times. Many autistic females are highly intuitive and may identify as being an "empath."

Like autistic males, autistic females are susceptible to meltdowns, sensory overwhelm, and anxiety. Because this can look like extreme moodiness, autistic women are often misdiagnosed with Bipolar Disorder. Also, many autistic women's relationships tend be “all on” or “all off." They can vacillating between intense interest and focus to social withdrawal due to overwhelm or losing trust in others. Because of this, they are frequently misdiagnosed as having Borderline Personality Disorder. Autistic people in general require familiarity, and as a result are often diagnosed with Obsessive Compulsive Disorder, which often misses the primary reason for needing rituals and consistency. Finally, autistic people in general have difficulty with executive functioning and focusing on non-preferred topics, leading frequently to an incorrect ADHD diagnosis. As a result, autistic females are treated like mental patients and are given strong drugs that interact poorly with their extra sensitive nervous systems, often making them worse. Simply informing and educating these individuals about their diagnosis can bring about immediate positive change. It allows these women to view themselves as quirky and sensitive people, part of a tribe consisting of influential and artistic people, instead of lifelong mental patients.

Some common experiences of females on the spectrum are:

  1. Feeling like they are aliens, faking fitting in.
  2. Moving from social group to social group throughout life because they cannot find a place to fit in
  3. Social overwhelm above and beyond social anxiety – their brains may literally turn off or dissociate to avoid the bombardment of social stimulation
  4. Sensory issues – hypersensitive to touch (for example cannot wear certain fabrics, bothered by rumples in bed sheets, or require intense deep pressure to help regulate their anxiety), highly sensitive to smell (for example intolerance for any body smells or being able to smell bad food before others), light sensitivity, and picky eating due to difficulties with certain food textures and tastes.
  5. Intelligent and complex, but strangely incapable of doing well in certain subjects.
  6. Often confused at work because they are able to get the job done and perform well, but cannot fit in socially and are seen as a poor team player.
  7. Affinity for animals or objects over humans (sometimes manifesting in odd collections that may somewhat resemble hoarding or in owning many pets).
  8. Perceived to be snobby or self-centered because of difficulties with typical “back and forth” of social interactions and social rigidity.
  9. Transgender phenomena: compared to the neurotypical population autistic females have greater incidence of transgender issues. This may have something to do with the “extreme male brain” theory of autism proposed by Baron-Cohen. However, this idea has significant criticism. Recent evidence suggest that males on the spectrum are also prone to being transgender.

For more information, I highly recommend Aspergirls by Rudy Simone and the books of Tania Marshall. Understanding of autistic females is still in its infancy. As such, unless a professional has specific interest or training in identifying autistic females, they are likely to miss important nuances of the condition and give an incorrect diagnosis. If this resonates with you or describes one of your clients, I am available to provide assessments and consultations.

This article was written by Dr. Joel Schwartz click here to view the original article

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