Divergent Conversations

Dr. Megan Neff and Patrick Casale are two neurodivergent therapists in a neurotypical world. During this podcast, they’ll talk about their own personal experiences as Autistic-ADHDers. They will reflect on their lived experience as AuDHD mental health professionals, and entrepreneurs, as well as offer clinical guidance, and support. Episodes will be conversational in nature, and they’ll interview other ND Folx to amplify the voices of other neurodivergent advocates and individuals as they share their authentic stories. New episodes will come out weekly, on all major platforms. Megan told Patrick, ”I’ll bring the chaos, You organize it.” This perfectly sums up their working relationship and friendship. Reflections of two neurodivergent clinicians. Raw, Vulnerable, Affirmative As Hell.

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2 days ago

For individuals who've wondered if they are autistic (or know they are but haven't been formally diagnosed), it can be a complex journey to first decide whether or not to seek a formal autism diagnosis and then to learn how to restructure the way they see and interact with the world.
Getting diagnosed and embracing yourself as autistic can feel like tearing down a wall (or removing your mask). And you can finally see yourself clearly, but so can everyone else.
You might feel relief, you might feel grief, you might feel like you don't know what to do next, so if you're trying to decide if you want to get a formal diagnosis, then this episode is for you.
Top 3 reasons to listen to the entire episode:
Hear 2 different diagnosis stories from Megan and Patrick, including a before and after look at the way they showed up in the world.
Understand the many different ways that autism presents and is perceived across different ages, gender, race, and other backgrounds.
Identify what it means to unmask and how to do it for yourself.
There are many misconceptions and cultural stereotypes around autism that make a misdiagnosis or complete overlooking of autism very common. Even Patrick and Megan didn't get diagnosed until adulthood.
If you are wondering about a diagnosis for yourself, a family member, etc., then hopefully these stories can help you find the answers for you.
PATRICK CASALE: Hey, everyone, you're listening to another episode of the Divergent Conversations Podcast. I'm your co-host, Patrick Casale. 
MEGAN NEFF: And I'm Dr. Neff. 
PATRICK CASALE: And today, we are going to talk about our diagnosis stories and how we ended up, you know, desiring to go get evaluated and seen to figure out if we were autistic, ADHD folks, and just get some grasp of what was going on in our lives. Figured it's a good topic to talk about early on in this podcast journey, because I think it helps frame things for everybody too. 
And, Megan, I don't know if maybe you want to start us off and kind of take it away with the build-up of what led you to decide that you wanted to seek out a formal diagnosis and what was going on prior to that, that kind of made you start thinking, this is something I want to do?
MEGAN NEFF: Yeah, it's interesting, because I think you and I have different diagnosis journeys, in the sense that, when I've heard you talk about it there was an element of surprise to it. I think my experience might be more common among, particularly, women and genderqueer people of, I was like, I had already self-diagnosed. And I was just like, looking for that extra validation. Which honestly, I actually wouldn't have done if I wasn't publicly talking about being autistic. 
And my biggest fear, not my biggest fear, I don't like hyperbole words, pronunciation warning, hyperbole. Actually, I don't think I could say that word even if it was afternoon, hyperbole. How do you say that?
PATRICK CASALE: Now you're going to, "I'm going to be questioning how this [INDISCERNIBLE 00:01:58], hyperbole [CROSSTALK 00:02:03].
MEGAN NEFF: That word that I cannot pronounce. Oh, my goodness, my language use is just, like, people in my life have… this has been one of my Megan Anna quirks, is like, the way I make up words, the way I pronounce words, I add syllables to words. So, whatever that word is, wow, that was a tangent. 
So, one of my fears has been that psychologists or other people in the mental health field would look at me and be like, "She's not autistic." Blah, blah, blah, blah, blah. So, that was a lot of the motivation for seeking a formal diagnosis was, if I was going to be in the space advocating as an autistic person, I thought it was good to do due diligence around that. 
So, my story is probably more about myself diagnosis, actually, which really started with my child, which again, is pretty common story for the last generation of autistic women, and genderqueer people. And my kid's diagnosis was also a bit of a surprise, even though, it's so interesting, because my training as a psychologist, in some ways, made it easier to see my child and then otherwise made it harder, because probably for a couple years leading up to their diagnoses, there'd be a time where, because they'd already been diagnosed with ADHD. I'd been like, "This feels different than ADHD." And I'd maybe Google autism. And then, my husband and I would talk about it, and we'd come up with some reason why it wouldn't make sense. 
But then we had an… I'm noticing I'm struggling to talk about it. My child has given me permission to share their story. But as they're getting older, you know, their feelings on that might change. So, I'm trying to be descriptive while also being vague. 
But there was an experience that looking back was very much them interpreting something literally and having a really big reaction, which we'd been coding as dramatic and all the things autistic girls get coded us. And we went on a walk after the kind of meltdown and I was like, "Hey, did you actually believe what dad had said in that moment?" Okay, it's not going to work to be super vague about this. So, I'll tell the descriptors of the literal thing. 
We're a vegetarian family. We have been for years. And my child was asking, "Is there meat in this?" We had nachos one night, and there's a lot of kind of checking behavior. And my husband said, jokingly, "Yes, there's meat." Which it's a question that happens pretty much anytime we have any sort of fake meat. And that's what led to the big reaction. 
And based on context cues, based on knowing our family culture, like it would not be meat. So, that was what they had taken literally and had a big reaction to. And then, on our walk is when… And this is a very autistic thing. I think a lot of parents, like, think through, try to figure out their kid's diagnosis before just bringing it up to their kid. But I've always been very honest and open with my kids. They were also 10, 11 at this time. 
But I was like, "Hey, what if it's something like autism and not ADHD." And their response was really incredible around it, was like, "You know, I'd still be me, we would just, like, understand me differently or understand me better. It wouldn't change who I am." So, that started a rabbit trail of learning about autistic girls. And we decided that day, like, we went on a TikTok binge, actually, and we're learning all of these things about autistic girls. And her whole story made sense, my whole experience of parenting her made sense. 
I was very confused by parenting this child. And so many things clicked into place, which of course ignited my special interest energy. And that then led to hours and hours of research around autism in girls, and then, autism in women. And then, learning that, typically, when a child is autistic, one of the parents is on at least broader autistic phenotype, however, we feel about that term. 
And at first, I was like, scaring my husband's tree, because he's very introverted and like systems, so at one hand that made sense, but he understands social cues in a way I don't. So, then, I was looking at my family tree. And I was like, "Oh, I see it. And I see it in me." 
It was really cool. I have access to a ton of psychological data on me, because in my training I did an IQ test, I did like pretty much any personality test or assessment I would give to a client I've given to myself. So, I had a ton of data. So, I was doing the research, I was doing the, like, IQ in the screeners you can do online, but then I was looking through all of my psychological data, even things like when I did my IQ test my processing speed and working memory were so low compared to, like, my verbal intelligence and my other forms of intelligence, which is really classic of a autistic ADHD profile. 
So, that's kind of my story was, it started with my kid's discovery, which led to special interest, which all of a sudden my life felt like it clicked into place. And within a week of doing the research, I just knew. I knew I was autistic. 
I have a very distinct memory of sitting across from my husband and telling him, "I feel a piece of my body for the very first time in my life." And not because my body is suddenly magically an easy place to occupy, it's not but I wasn't at war with him anymore. I wasn't, like, the best way to describe it is I was bracing for impact constantly. And all of a sudden, I realized I was doing that, I realized I'd been doing that for 37 years. And I felt aligned. I felt aligned for the first time.
PATRICK CASALE: Thank you so much for sharing that and your daughter's story as well. And it sounds like once that realization came to place between the two of you, it was almost as if everything started to align and make sense. 
And I want to circle back to a couple of things that you said, because I think it's important for people who are listening. So, one, the moment where your husband was joking about like, "Yeah, there's meat in this." And that joke just completely being taken literally and the inability to parse that out or differentiate between that is so common, right? And gets often missed and leads to that meltdown, or that frustration, and that shutdown in general. And then you mentioned something prolific that your daughter said at how old 11, 10?
MEGAN NEFF: 10 at the time. Yeah, I mean, she's always been very, like 10 going on 30 You know, she's always been acting like a little philosopher.
PATRICK CASALE: I love that she was like, "Yeah, I'm still going to be me."
PATRICK CASALE: You'll just understand me in a different way. And I think that's really profound, one, and just beautifully said. 
MEGAN NEFF: Yeah. That moment has stuck with me for so long, because I think I was more afraid of the diagnosis than she was.
PATRICK CASALE: I was going to ask you about, you said that you were trying to rule out autism, right? Like, ADHD is here, but then my husband and I are, like, looking at autistic traits and then convincing ourselves like, "No, it can't be that."
MEGAN NEFF: Yeah, and I mean, I think there certainly could have been some ableism in that, I think it was more like, especially, when she was younger, would love to talk with people and very, like, seeking out of people, and now we know this, like autistic girls can be hyper-verbal, she definitely was. And it was more because of our stereotypes of autism, that we were like, "Yeah, pieces of this fit, but then that."
And then my husband, also, he at the time was in education. And this has been an interesting conversation with him around diagnosis, the kids that get identified in education systems, typically, are kids who also have pretty significant learning disabilities with autism, which our daughter does not. So, she presents differently than also, like the kids that he was used to, like, associating with autism, which again, we know this, right? When we look at highly intelligent, and I apologize, this research has been reported in the gender binary, so I am reporting that in the gender binary. But when we look at highly intelligent girls to boys, the diagnosis is nine to one, meaning what used to be considered Asperger's, nine boys to every one girl identified. 
Obviously, we know that's not the true ratio. That's the ratio being identified, which means these smart autistic girls, we just don't understand. We don't understand how it presents, what it looks like. So, it was more that I think that made it hard to recognize was the gender bias, I think.
PATRICK CASALE: Yeah, like, she's not fitting into this mold that is easily constructed. And this isn't adding up to us. And it's really interesting how you were able to kind of look through different lenses, both as a parent, both as a psychologist, to try to kind of parse that apart, and then, to be able to do your own research on yourself and have that data is really useful, something that people don't have access to a lot of the time. 
And so, it's fascinating to hear this story, and then, to have that moment for you. And I think that's really beautiful, just as a friend and colleague of yours to hear you say, like, "That was the first time I felt relief in my body." And I like that you named, it doesn't mean it's made it any easier of an experience, because I get exactly what you mean. But it's just that realization, right? Of like that mental fatigue, the almost gymnastics that we go through on a interaction by interaction basis that we're bracing for and we don't know that we're doing it until we have some acknowledgment or realization take place.
MEGAN NEFF: Yeah, yeah, absolutely. Like, it was a really interesting experiment around that time. So, I've always walked fast. When I was younger, it would be referred to as the McMohan walk, because that was my last name before. And I've always been a fast walker, like people that are time keeping up with me, which is funny, I'm 5'2, I'm short, but I'm just…
And it was a few days, like, after my discovery, and I was walking to get mail, and you know, there's kids playing, there's dogs, there's cars, and this was actually a relatively quiet neighborhood. But for me, it's a lot. And I just noticed how like I was tense, my shoulders were tense, and I was like walking as fast as I could to get mail. And it's like holding my breath while I'm out in the world. And I did this thing I was like, "What if I just relax, walk slow, and notice. Like, notice the sensory stuff?"
Because for me I had become very disassociated from my body. And so, it was a really interesting experience of letting myself notice the dog barking, letting myself notice my body was irritated by it, and letting that kind of flow through me. 
And so, I began, actually, noticing my sensory sensitivities more but it also, because I wasn't like this rigid icicle that could just be… you know, if you think about like rigid icicles, they break off when you apply tension, because I was able to melt into it a little bit more, I found more flexibility in how I was experiencing my sensory world. It's a hard thing to put into words, but it was a really interesting experience.
PATRICK CASALE: Everything about you is so meta. I love that you're, like, breaking this down in this way while this is happening. The sensory stuff is a whole, I think, an episode in itself for sure. And I like your mindfulness approach to a lot of this that we talked about last week. To our listeners, this could be helpful, just Megan's approach in general and how she's going through the day and kind of noticing how certain sensations are impacting her. But yeah, this is really interesting. 
And I think, you know, just recognizing that the research is so skewed. And obviously, we're missing the mark a lot of the time on people who don't look like me. And even then, both of us being late adult diagnoses, I mean…
MEGAN NEFF: Well, I was going to say you do look like you and you were late diagnosed. So, yeah, I want to hear more… I know I've heard parts of your story, but I don't think I've heard it as a cohesive narrative. 
PATRICK CASALE: I'm trying to think of if any part of my life feels like a cohesive narrative.
MEGAN NEFF: I know, as soon as I said that I was like, "Oh, that's a lot of pressure." I definitely did not do a cohesive narrative.
PATRICK CASALE: I think you did. Yeah, so I'm 36 now and I was diagnosed last year, was it last year? Maybe it was two years ago. Time is-
MEGAN NEFF: What is time?
PATRICK CASALE: What is time right now or in general? I think it was two years ago. And I had been diagnosed ADHD several years beforehand by someone and I had gone in to get testing, because I was having these experiences that I think often overlap with complex PTSD, of like, really low self-worth, low self-esteem, inability to feel like you can be loved or receive love and just a lot of inner personal shit going on that you could certainly look back at attachment wounding for sure and childhood trauma.
But I just remember a psychiatrist that I worked with at the hospital's setting that I was working at, at the time as a therapist, was like, "I think it's ADHD. Like, the constant, like, 'I want to be elsewhere, and something else can look different, and more exciting.'" And we were just having some conversation one day and I was like, "Okay, well, I guess that could make sense. I'll go take a look." I'm trying to really figure this out for myself. I had been misdiagnosed so many times, which I know we're going to do an episode on misdiagnosis at some point. But you know, misdiagnosed bipolar II, misdiagnosed with OCD, misdiagnosed with GAD or generalized anxiety disorder. You know, I'm trying to think of what else is in that mix, but-
MEGAN NEFF: And were these adult diagnoses?
PATRICK CASALE: Yeah, like in my 20s. So, some of them fit the profile to some degree, you know, like [CROSSTALK 00:18:00].
MEGAN NEFF: Yeah, I was going to ask you if they felt like true misdiagnoses or like, they just weren't capturing the whole picture.
PATRICK CASALE: I think it was, at the time, I didn't know any better. I think that I felt like it was accurate. Like, bipolar II, I was like, okay, my mom has bipolar disorder, I have a gambling addiction, I'm very impulsive, I'm having really bad mood instability. And then when you go on these anti-psychotics for a year or two-
MEGAN NEFF: Oh my gosh.
PATRICK CASALE: …it changes or they get worse. So, it's just like those little things that you don't think about in the moment if you have the understanding or even knowledge to pursue that. 
So, I was sitting in this psychologist's office going to get testing for ADHD, and she was like, "I think you're autistic." This is before we even started talking really, I'm just like, sitting on her couch. And in my opinion, you know, even as a mental health professional, I find it very uncomfortable during your first couple of meetings with anybody who's a new person in your life. 
So, yeah, I kind of was like, taken aback by that. And I said, "Like, why are you saying that?" "Oh, like your affect is just very, very flat and your emotions are very blunted. And, you know, a lot of one-word answers." And I'm like, "I just met you."
MEGAN NEFF: She just communicated to you in a really autistic way. Like, very matter of facts. So, like, "Oh, well, because this, this, and this, I think you're autistic." Like…
PATRICK CASALE: Right, then I'm like, "Well, no, I'm not here for that. Like, I'm here to get testing on ADHD." And I think she probably was like, "Ooh, good, I'm just going to-
MEGAN NEFF: She backed off.
PATRICK CASALE: …let you do what you want to do." And, you know, get this formal diagnosis of ADHD. It all makes sense. It all clicks. And for a couple of years I'm feeling like, okay, I've got a good sense of what's going on in my life and areas that I really need to kind of get some more clarity on and work through, because it's impacting me. 
What I started to realize like over the last couple of years was the constant, constant feelings of loneliness and disconnection in every social interaction that I experienced. And that was just like, with people who I know, like, logically, know, they care about me, they love me, they have my genuine best interests at mind, whatever, even my wife, or close friend group, and just really feeling like in every social situation I was just really struggling. And realizing that that has been my entire existence of socializing in a way where, you know, we talked last week about alcoholic needing to be involved or like, just simply feeling so much discomfort, like that crawl out of your skin discomfort of like, "I just got to get the fuck out of this situation."
And it made feeling connected really challenging. And, weirdly enough, this is probably not going to make a lot of sense for a lot of people, but my turning point of figuring this out was being at a conference in Hawaii, a therapist conference in Hawaii, a couple of years ago, and going to see the Anthony Bourdain movie that had just come out, because I have always been a huge, huge fan and was watching his experiences in the movie. And they were talking about like, his close friends and colleagues about like, the constant loneliness, and disconnection, and always wanting to be on the go, but always wanting to come back home and feeling that push-pull, but never really feeling belonging. And I just remember having lunch with a friend, and she was like, "I think you should just maybe go get tested and see if you're autistic."
And I was like, "I don't know." It was definitely my own ableism coming out, but I was like, "No, like, that's not a thing here, you know, that's not what I want to look at, and I don't think that's true." 
But I did pursue it. And all the testing and all the results made sense once I heard it, and I told you this. Like, I have this experience of simultaneous like cooccurring grief and relief. And just was that process of like, relief, right? Like, you almost said, like, the first time you had felt this feeling of relief in your body, for sure. Like, okay, this all makes sense. Childhood makes sense, all these interactions made sense, like, and then grief of, fuck, I don't know how to move through life now because [CROSSTALK 00:22:38].
MEGAN NEFF: And it's permanent.
PATRICK CASALE: And it's permanent, and it's framed in the way from the psychologist of like, "And you're going to need to constantly have adaptation to be able to get through life, because of how challenging life is going to be." And I'm thinking in my head, "I'm 34 years old. Life has already been fucking challenging, it hasn't changed."
MEGAN NEFF: Yeah, yeah.
PATRICK CASALE: So, yeah, I didn't have that really profound moment that your daughter had where it was like, "Yeah, but I'm still just me." And other people told me that like my wife, and some close friends were like, "But you're still you. Like, it doesn't change anything." And I was like, "But I think it changes everything, actually. For me. It changes everything." 
MEGAN NEFF: Yeah, yeah, totally. And when you say it changes everything were you thinking future?
PATRICK CASALE: Yeah, I think it was all about the future and seeing everything through this autistic lens now. And then I do this thing. And I don't know if you are, you know, guilty of this to some degree too, but starting to make associations of everything about like, is it because I'm autistic? Is this because it's my social? Everything.
MEGAN NEFF: Yeah, yeah.
PATRICK CASALE: So, it's an been an interesting journey. But I would say that it has given me permission once I've moved through the acceptance stage of who I am, and the identity, and the struggles that I experienced, that it has given me permission to just feel more comfortable in who I am too.
And I'm sure, you know, we can have a episode on unmasking and masking at some point in time. But it almost allowed me to start unmasking more, because I started to ask for what I needed, and state how I was feeling, and why I was doing something. Because, you know, we get this societal pressure to show up a certain way, socialize a certain way, communicate a certain way. And instead, I was just like, "Fuck this, that's not who I am. And I can't do it anymore." Because it feels like that pressure is just building, and building, and building, and it just feels insurmountable at the end of the day.
MEGAN NEFF: Okay, I'm having associations. I'm not sure it's going to make sense. But this idea of you feeling more comfortable, and then, grief, I kind of wonder if they're the flip side of the same coin, because I definitely experienced, like, I became more aware of my social awkwardness after my diagnosis. I think I always knew I was like intellectual and like, would be kind of overly academic in my conversation with people, and then, I could be awkward, but I think I intentionally didn't focus too much on that. 
But then after my diagnosis, I realized how awkward I could be. And like, all of a sudden, these awkward moments was like, "Oh, that's because I'm autistic, not because I'm like, some like, intellectual academic." Like, that's a much nicer, you know, narrative. And so, there's grief with that. 
And here's the thing that maybe won't totally tie in, but my thought is, what if part of the unmasking experience is we're grieving the burial of our masked self, in the sense that there's probably some fantasy that the mask that we're working so hard to hold on to is a real self, because we… like Pinocchio wanting to be a real boy. Like, wanting to be neurotypical. We're bearing that when we unmask. And there's grief in that. 
And I think on the other side of that is the comfort, but it takes the grief. I was just talking to someone the other day about this about how part of my freedom socially has come from, I know, not all the time, but 90% of the time I accept I'm awkward. So, if I'm public speaking, or even in this podcast, if I have an awkward moment, or I can't say a word, I embrace that of like, oh, that's my ADHD brain combining things or that's my autism. But I had to grieve that I wasn't my mask before I could be comfortable embracing my social awkwardness and other quirks.
PATRICK CASALE: Yeah, I've never thought about it that way. But I think you're spot on. And I wonder if that feels really commonplace for adult-diagnosed folks? Like, where you've spent decades of your life trying to act or present a certain way and trying so fucking hard to not be awkward, not be weird, socialize, pick up on cues, make eye contact, all the things, and then there is that realization of, "That's not really who I am." 
MEGAN NEFF: Yeah, yeah. 
PATRICK CASALE: Then there's the piece of, "Will I ever be that person again?" Part for me that feels comforting is like the answer that I have when I ask myself that is like, I don't think I want to go back to that life.
MEGAN NEFF: Yeah, yeah. And this is where I think there's a lot of identity and relational shifts that happen when a later in life diagnosed person is diagnosed and starts unmasking. Because if we're burying an old part of us, a masked part of us, if that's who we've been in our key relationships, like, especially, if we're in partnerships and marriages, that's going to have a, like, significant impact of like, you're getting to re-know yourself, and then your partner and your family's really getting to know you. This would be interesting. I would be curious about separations and divorces, like the year or two after diagnosis for an adult.
PATRICK CASALE: Yeah, yeah, just because of who someone starts to embrace in terms of their identity. And whether or not the other partner can accept or if it even feels like the same person. And yeah that would be very interesting.
MEGAN NEFF: How did your wife, like, how was this journey for the two of you?
PATRICK CASALE: Yeah, I was going to say that it sounds like both of us are fortunate to have partners where they were pretty accepting of this experience. And that's how my wife was. And she was one of the groups of people in my life who's just like, I don't think she had a word for it. Maybe like, I remember calling her, I had gotten the results, I was in New York speaking at a conference and visiting family, which, you know, is a thing. And I just remember calling her and being like, really upset, and really emotional, which was not my baseline. And I just remember her saying, like, "Yeah, I don't think I had a word for this. But I think I knew this about you. Like, that's who you are. Like, this is how you act and this is how you interact. I know what you struggle with."
But, you know, I think that just goes to say that I've felt comfortable enough around her to be my true self and to be able to unmask pretty regularly. And I think that felt complicated, though. I think it felt like, I don't think it felt like dismissal, because that's not how it felt. But it was just simply like, "Yeah, this is just our lives." And I was like, "Yeah, but everything feels so much more complicated for me now." 
And she's listened to other episodes I've done on autism diagnosis and how I experience social interactions and social gatherings. I know it can be upsetting, because she's from a South large black Southern family. [CROSSTALK 00:30:40], lots of family interaction, lots of gatherings, it's loud, I love them. It's challenging. 
And my ideal holiday is like, let's get the fuck away from our families, and her ideal holidays are let's spend as much time with them as possible. So, it's been great to communicate, this is what I need and this is what I can endure. Because you have to, I have to, I don't want to generalize, I have to build up these, like, reserves of energy for our experience and situations that are going to be loud, are going to be chaotic, there's going to be a lot of stimulation. Like, I have to go into it knowing that I am going to leave it depleted and paying for it for days, if not weeks at a time. 
So, it's still a work in progress. Andi think they're still figuring out, you know, how to best make partnership work. And you know, my wife is undiagnosed ADHD, but she's self-diagnosed herself. And I would agree with the diagnosis. 
There's also communication misfires, like mishaps where I'm receiving information differently than she's putting it out to me or the communication is just missing, because of the way we interpret communication. And they're oftentimes where she'll say something, and I think I hear it, and I have to say, "What did you say?" And she's like, "See, you're not listening again." It's just about processing it. 
So, still work in progress, but happily able to say that at least I know that there isn't shame or judgment here. And that feels really supportive. What about you? You know, you mentioned you kind of knew while going through your daughter's journey.
MEGAN NEFF: Yeah, I mean, the first time I brought it up to Luke he was like, "That doesn't sound right, because I'm the one who's always craving like emotional intensity, and I'm the therapist." And then as I was doing more research and like, kind of unpacking, like, okay, here's what I found, here's my thinking, he was like, "Actually, that makes a lot of sense." 
We met in college. He was like, "You know I was drawn to how direct you are." He comes from a more like, indirect culture and family. And so, he's like, "Yeah, I think I was drawn to how direct you are. But at times, I did think it was kind of strange, like how direct you are." But it's also I think, part of what he found attractive about me back then. And so, it was interesting even to review our history of what he was drawn to about me, a lot of what he was drawn to about me like my intellectualism, my direct nature, was very passionate, as you can imagine.
At the time, gosh, this could be a whole episode. So, my husband and I both grew up fundamentalist. Neither of us are in that tradition at all anymore. But I channeled a lot of my passion and direct nature toward Jesus, which was a socially acceptable thing to do as a fundamentalist girl. It was the only way to be a direct girl. And I would still get in trouble for being too direct, but it was all in the name of like this kind of social justice Jesus. And so, I think that was part of how he was experiencing my directness. 
But yeah, so I think for him it helped answer things. I think it'd be interesting to ask him, I think, there's probably a similar grief and relief of even things like, you know, when he'd come up and touch me I would shiver physically. And I think we're both confused by that of am I rejecting it? Like, why am I rejecting his touch? And I think for him to have a narrative of, "Oh, unexpected touch." It's not me that she's rejecting, it's unexpected touch. Like, I think little things like that. And actually, that's not a little thing, touch is a big thing in a marriage, were really helpful for him. 
But then again, there's grief of, I think there are things that he would probably enjoy having in a marriage that we don't have and probably won't ever have, like, the flirtatious banter, the impromptu touch. Like, there are things…. and if anything, I feel like I've been trying to give him permission of like, you know, you can grieve this too, because I'm doing my grief around it. 
PATRICK CASALE: Yeah, there's so many layers to this. And I can relate with the impromptu unexpected touch too, because my wife, Arielle will say the same thing. Like, "You shiver when I touch you." Or like, I think she's somewhat gotten more accepting of that. But like you just said, there's still got to be that grief of like, this is not something that can really be sustainable in our relationship and it's not something that I can provide or ever just get comfortable with. Like, that's just not something that can happen. So, yeah, it's really layered. 
And I'll take it a step further, you know, with diagnosis stories, like, family members too, when they when you start to talk about it openly and come out, and just announce, or talk with people about your diagnosis, or your experience, or you might even start reflecting on your childhood experiences more often, because you're starting to put the associations together. And I've never talked about it with my dad. Like, we haven't had a single conversation that's involved or included the word autism whatsoever. I know he sees my podcast, I know he sees my stuff. So, never have we talked about-
MEGAN NEFF: So, he knows, but it's not talked about. 
PATRICK CASALE: Yeah, which is-
MEGAN NEFF: Oh, interesting.
PATRICK CASALE: …which is most of everything in our dynamic. But my mom, on the other hand, who is a retired therapist was like, centering it around her and her parenting, "What did I miss? How did I miss this? "Like, "No, I don't think this could be accurate. No, I didn't notice this." And I'm like, "I'm not asking you for any of this right now. You know, like, it's not what I need from you, is how this makes you feel in terms of your parenting or lack thereof."
So, it's interesting to see how people receive information about something that is life-changing, because it's different. And it just shows up in different ways. And it can show up for their grief, or their own frustration, or their own ableism, or whatever's happening behind the scenes, but really is a complicated, complicated subject. And I can see why a lot of people don't want to pursue diagnosis, too.
MEGAN NEFF: Oh, absolutely, absolutely. And I think complicating it is, you know, autism is so genetic that, typically, when you're like, disclosing a diagnosis there's typically implications for some of the people you're communicating that to. And so, I think that adds another layer of complication as well, because either you seem totally normal to them, because the things you're experiencing they've always experienced. But also, there can be really strong internalized ableism when we're undiagnosed and older, and gone through our life and diagnosed. And so, I think all of that can get stirred up unconsciously and consciously, for the family members that are being told this. I mean, yeah, it is self-disclosure and family is really complicated really quickly.
PATRICK CASALE: Yep, yep. And that association, you know, genetically to say then, there can be so much internalized shame to any sort of diagnosis, not just in autism, ADHD diagnosis, but whenever we're talking about any condition, disabling condition, especially, people have their own histories and just lived experiences with how they feel about certain terminology too. And I know my association. You know, when I got diagnosed was I used to work in some group homes for people with developmental disabilities, intellectual developmental disabilities in New York when I was getting out of college. And my immediate association was like, "Yeah, but like, I don't struggle with any of these things." Which is my own ableism showing up at that time. But that was my first association when hearing like, "You're autistic?" We can have a whole… and I think we have this on the list a whole conversation about how could you be autistic because of A, B, C, D, E, F & G and you're too, "High functioning for that label." Which I hate that fucking label too.
MEGAN NEFF: Yeah, yeah, yeah. I think I've maybe shared this story with you before. So, maybe five years before identification, first year in the doctoral program, I was taking the MCMI, which is a common personality assessment, and it gives you a printout of future like diagnoses to look into further. And I think there're maybe two on my printout, autism spectrum disorder, and then I actually can't remember the other one. 
And I remember the moment of looking at that and being like, "What the hell? Like, no way." And exactly what you're saying, like, a ton of ableist associations came to my mind in that moment of like, "There's no way that's me." And sometimes it's helpful for me to go back and remember that moment, because I have done so much deconstruction, that I think I cannot have as much patience for people who are earlier in their journey of addressing ableism. So, being able to point back to be like, "Oh, my gosh, there was so much ableism in me that was showing up in that moment." It's helpful for me to be able to kind of access empathy for other people who are newer to this journey.
PATRICK CASALE: Yeah, absolutely. I mean, this is a journey that even as a mental health worker, and, you know, I'm still learning all the time. Hell, I'm still learning [CROSSTALK 00:41:54]. 
MEGAN NEFF: Oh, yeah. I still have ableism pop up left and right. Yeah, yeah. 
PATRICK CASALE: Because it's just so deeply rooted and conditioned, in essence, to society, too, and doing the work to deconstruct is crucial, but that doesn't mean that there are not moments where I'm like, "I need to walk that back." Or like, "That's not the phrase I wanted to use there and I need to really work on, you know, my vocabulary, and wording too." And I think it's just also acknowledging that too, and not just [INDISCERNIBLE 00:42:27]-
MEGAN NEFF: Yeah, yeah. 
PATRICK CASALE: …putting it or scraping it under the rug, you know, but…
MEGAN NEFF: Yeah, or even like who's included in the conversations. Like, I just did a webinar on alexithymia last week. And as I was reviewing the slides, I was like, I was seeing my bias of, I'm really primarily speaking about autistic people and ADHD people who don't have co-occurring intellectual disabilities and who are speaking, partly, because the research on alexithymia is geared toward that population, but partly because of my own bias. And because that's the world I subjectively know, it's primarily the world I work in. But it was definitely a moment of like, I've got a lot to do to learn and incorporate, because I'm filtering a lot of the research and resources I'm engaging with through this bias.
PATRICK CASALE: For sure, it's a great point. I think it's definitely worthy of a probably more conversation as we go. And you're heavy in the research side, too, and the clinical side, and I think it's important for us to just continue to have these conversations and address them as well. And, heavy stuff.
MEGAN NEFF: Yeah, yeah. I don't know if I'm reading you right, but it looks… are you trying to find a natural way to segue to a conclusion, but also, we've been talking about heavy stuff. So, are you kind of like, oh, fuck, like, okay, we've talked about heavy stuff now we have to transition to ending. Is that what's happening for you right now?
PATRICK CASALE: I told you that if we recorded routinely that we'd start picking up on each other's like, tales even more than we already do. Yeah, absolutely. I'm like, I'm very hyper-aware. We talked about my internal clock last week about like, Hey, we're getting close to time. Like, we've got stuff that we have to do at the next hour. And I'm also thinking, "Damn this is heavy." And I think every single one of these conversations is probably going to feel similarly. And then how do we wrap that up?
MEGAN NEFF: Yeah, yeah. Like, the energy put in social transitions. One of the metaphors I used early with my therapist is I feel like I don't have social ligaments, like the things that help you be flexible, so much energy when we need to, like, socially transition. So yeah, like that transition of, okay, we're kind of in a heavy space. Now, we have to do our awkward goodbye. That takes a lot of energy.
PATRICK CASALE: It does. And you know, I'm trying to be aware of where you're at too, energy-wise. And I'm like, I don't want to transition if we're not ready to transition. But I like that, the feeling of like [CROSSTALK 00:45:22]-
MEGAN NEFF: …talk about it, instead of like, trying to read it's like, I like that we're having a conversation about what was happening, instead of trying to, like, read nonverbals and…
PATRICK CASALE: Absolutely. So, I'm grateful for you for naming that. And that is where we are going to transition, because we're going to have a lot more of these conversations too. And I think we want to hear from those of you listening about your stories and about your diagnosis journey so that we can be there alongside you too, and just provide resources as well. And I hope this felt supportive and affirmative. And, you know, just sharing a little glimpse about who Megan and I are and how we've gotten to where we are today. I think it's a really good look into that window for sure. 
So, I appreciate everyone listening and I'm struggling right now. We are going to have new episodes coming out every single week of the Divergent Conversations Podcast on all major platforms. You can like, download, subscribe, and share. Megan, you want to add anything before we go?
PATRICK CASALE: All right, then. Thanks for listening. Goodbye.

Friday May 26, 2023

Ever wake up in the middle of the night with the thoughts of “Damn. I’m not going back to sleep tonight” crossing your mind? 
Sleep and neurodivergent brains have a complex relationship, and many neurodivergent individuals struggle with insomnia, restless sleep, sleep paralysis, being light sleepers, and having the weirdest sleep schedule in general, if you can call it a schedule at all. 
Fatigue is often common and more intense for neurodivergent individuals, which can be hard on those who are already struggling with executive functioning.
If you find that sleep is a challenge or seems harder for you to get than others, then this episode is for you.
Top 3 reasons to listen to the entire episode:
Understand the relationship between neurodivergence and sleep disorders and challenges on a personal and clinical level.
Learn how to make the most of sleepless nights so that you can reduce the stress of your “time zaps.”
Identify ways to improve the quality and consistency of sleep.
Sleep challenges are something neurodivergent individuals will often struggle with, so we encourage you to explore what will help take some of the stress out of sleepless nights and help create the best environment for relaxation and rest.
Dr. Neff Resources: 
Autism, ADHD, and Sleep: An Expert Guide on Neurodivergent Sleep: https://neurodivergentinsights.com/blog/autism-adhd-and-sleep
Sleep Workbook: https://neurodivergentinsights.com/neurodivergentstore/p/the-neurodivergent-sleep-workbook
MEGAN NEFF: Good morning, actually, good afternoon. 
PATRICK CASALE: Good afternoon. Well, good morning to you. Can you hear me? 
MEGAN NEFF: I can hear you.
PATRICK CASALE: Yeah, I'm exhausted. Sleep is challenging.
MEGAN NEFF: Yeah, no shit.
PATRICK CASALE: It's like, one of those situations where you fall asleep, finally, and that's a challenge. And then like, you wake up at 2:00, 3:00 in the morning, and you know that nothing is going to happen. Like, there's no forcing it. You can try all the tricks in the world, all the fucking things that you can do. And it's still the same outcome.
MEGAN NEFF: Yeah, that is interesting. I have that too. Like, there's some wake-ups where you just know like, fuck, I'm not going back to sleep from this one.
PATRICK CASALE: It's hard because, I mean, I almost experience that every day.
MEGAN NEFF: Every day you have that? 
PATRICK CASALE: Yeah, like probably I might have good quality sleep, which I would quantify as like, five hours total, maybe like four to five times a month, and every other night is like-
MEGAN NEFF: Wait, how many hours? Five hours?
PATRICK CASALE: Four, five tops.
MEGAN NEFF: You have that, so wait, four or five hours, you have that four or five times a month? 
MEGAN NEFF: Patrick, that's really, really bad. 
MEGAN NEFF: You don't need me to tell you this, but that's like, oh, my gosh. You're sleeping like you have a newborn but without the newborn.
PATRICK CASALE: Yeah. And it's been all my life, you know? So, it's challenging. And it's like, I constantly ask myself, like, how the hell do I even get through the day when I'm running on like, you know, a couple of scattered fragmented hours of sleep every night? And it's a great segue into what we're going to talk about today, which is-
MEGAN NEFF: Which is sleep.
PATRICK CASALE: Sleep and neurodiversity. So, you know, here we are. And I know we wanted to start recording as soon as we got in the room because we always have these conversations. So, I just want to welcome everyone to the Divergent Conversations Podcast. I'm your co-host, Patrick Casale.
MEGAN NEFF: And I'm Dr. McMahon. I mean, oh my gosh. Wow, that was weird. I'm Dr. Neff. That was my maiden name. I am Dr. Neff. I clearly have not fully woken up.
PATRICK CASALE: So, Megan is on the West Coast. It is about 12 o'clock here on the East Coast. So, Megan's waking up, I haven't slept. We're going to talk about-
MEGAN NEFF: We're trying to get our names right.
PATRICK CASALE: …the elusive topics of sleep while also trying to juggle saying our names correctly, and being on the air. So, we want to give everyone a real glimpse into what it's like every day as a neurodivergent person, entrepreneur, therapist, all the things, so today we are going to talk about sleep. Megan's going to take much more of the clinical side of it, I'm going to complain about how fucking tired I am and-
MEGAN NEFF: Oh, I'm going to do that too.
PATRICK CASALE: So, it's so challenging, right? Because our executive functioning is already having such a hard time as it is and then, through the mix, like, this inability to sleep, to rest. Like, I don't know about you, but I don't nap. I wish I could. I'm envious of all of you who can do that. I'm envious of my wife who like falls asleep and is like snoring with her eyes closed, like a minute after saying she's going to bed-
MEGAN NEFF: Oh, my goodness. 
PATRICK CASALE: And I'm like watching her like, "What the fuck? This is witchcraft. This is ridiculous." 
MEGAN NEFF: I know, I know. Yeah, my spouse has such a consistent sleep routine. He goes to sleep at like, between 9:00 or 10:00. And then he wakes up at like 5:00 or 6:00, he wakes up early. But he has like a solid sleep block that I'm so jealous of. I, for the life of me, cannot, even though I'm so exhausted all day, I cannot get myself to fall asleep before midnight.
PATRICK CASALE: Yeah, so what is happening for you? Like, you know, you're exhausted, you feel it physically, mentally, you know, you're tired. But you know, like, midnight still is six, seven hours away. What are you doing in that time period?
MEGAN NEFF: So, that's actually something I'm trying to work on right now because it feels like kind of a time's up, which I don't like, that impacts my mood. So, I'm typically working on something, I'm typically working on what I call bucket B work which is, like, I don't need to deeply focus. So, like, last night I was refreshing my infographics and getting them up on my website, and like kind of mindless stuff. So, I'm typically doing that kind of thing. Sometimes I'll get hooked into some sort of rabbit trail, which then keeps me up later, which is very common, particularly, among ADHDers. So, yeah. 
PATRICK CASALE: What's the most recent rabbit trail you've been on?
MEGAN NEFF: My most recent one is kind of fun. So, over the weekend… so, I have three talks in February that I'm prepping. And I think I've told that to you. And I have so much work I need to do for these in this week. And I was just really struggling. I'm like, "I know I should run through my slides. I know I should go record videos." And I cannot get myself to do it, which is not… when the urgency hits, typically, I'm able to get going. 
And I was talking to my spouse, I was just like, I was so tired. And one thing he said that was helpful. He's like, "You know, for February, you're actually doing pretty good." And he talked about how past January, February, he just knows, like, I'm kind of going to be a miserable person to live with during these months. So, he was saying, "You should, like, get on a flight and go somewhere sunny." Because I'm in Oregon, it's like the winters are, literally, depressing here. I'm not saying it metaphorically.
PATRICK CASALE: Overcast, gloomy, dark, gray, raining.
MEGAN NEFF: It's terrible. So, my most recent rabbit trail was looking into flights for like Hawaii, or California, or Arizona, and packages and try to figure out, could I get away for 10 days, sometime? So, I've spent way too much time not sleeping, trying to figure out a flight to go somewhere to get more energy, which is… There’s some irony in all that.
PATRICK CASALE: You and I have talked about, you know, for me the energizing contribution of traveling, and I still stand by this, and we should probably have an episode on this at some point of like, the neurodivergent travel experience, and why it can be energizing because I think it seems counterintuitive to say like, this autistic person really enjoys going out into the world, and traveling, and meeting people, and connecting but there's so much-
MEGAN NEFF: I don't like meeting people, but I like traveling.
PATRICK CASALE: Right, right. The stimulation piece, you know, it's just like the new location, the new environment, the new temperatures, the new sights, new foods for some people. You know, I really think that it can be so helpful in a lot of ways. And it sounds like you really need some warm weather in your life. 
I love rabbit trails that are travel related because I'm like, I get really wrapped up in like the fantasy of traveling and like all the places I want to go. What seems more interesting than the one I've been on recently, which was like Google searching, how to sell my group practice and like figuring out-
PATRICK CASALE: Yeah, I know, and some of my clinicians are going to hear this and be like, "What the fuck?" It's just that, you know, you have a bad day and that's where your brain is, is, "I don't want to do this anymore."
MEGAN NEFF: Well, that's interesting. Both of us, our rabbit trails are fantasy related.
PATRICK CASALE: Yeah, mine always are, I think, for the most part, and it's worry related, or that it's like, you know, I'm thinking worst case scenario, and going down that road. But usually, it's fantasy related. And I think there's something to be said about that. Especially, for autistic folks where fantasy is relatable and maybe safe, and maybe there's the ability to feel playful and connection. 
And I think that's why I so often default to like, my wife knows when I'm checked out in January, February, or in general, if the Lord of the Rings, or the Hobbit, or Game of Thrones is on TV, she's like, "Oh, I'm not going to talk to you today." And I'm like, "Yeah, cool." I'm glad we have that understanding.
MEGAN NEFF: Yeah, yeah. Both of us, I think, sound really fortunate and lucky, and that we have spouses that understand us and like, my husband's the same. He knows, like, if I've come back from a speaking trip, or from a long day, or if it's February, or January, like, I'm not going to be very verbal and I'm going to have less energy. And he's incredibly supportive and helps with the kids a ton. But yeah, I realize not everyone has a partner who understands his energy fluctuations and will get, like, irritated at their partner for not being more verbal or not being more energized, which I think is a really hard dynamic when I see that clinically.
PATRICK CASALE: Yeah, I think you know, we were talking about autistic burnout last time we met and talking about if you have the resources to protect your energy, and to recharge, and to step away and do all the things and a lot of people don't, that's also a really great point that not everyone has that support in their lives, whether it's from partnership, or close friendship or someone just doesn't have to… you don't have to explain yourself to them, you don't have to kind of feel guilty about how you're not showing up or how you're presenting. 
And it takes time, obviously, in any partnership, but to have that mutual understanding where your partner, your spouse is not having these expectations of you or like, feeling resentful, or why aren't you talking more? Why aren't you engaging more? Why aren't you more present? And they just kind of know, intuitively, like, "Oh, this is just where Patrick or Megan is at." 
It's really weird. My sister's name is Megan. So, saying Patrick and Megan in the same sentence just felt really strange.
MEGAN NEFF: Mm-hmm(affirmative) brings up sibling associations, totally.
PATRICK CASALE: Negative sibling association.
MEGAN NEFF: Oh, okay. 
PATRICK CASALE: And maybe she'll listen to this one day and curse my name, too.
MEGAN NEFF: You're making a lot of people pissed off at you in this episode.
PATRICK CASALE: That's because I'm so fucking tired. I think that it just means like [CROSSTALK 00:10:33].
MEGAN NEFF: I was going to say that your filter's probably off. 
PATRICK CASALE: Yeah, there's no filter. It's just like that nauseating feeling of disorientation and sleep deprivation. And so, do you mind, like, just sharing for folks who are listening, why it's so challenging for those of us who are neurodivergent to go to sleep, to get consistent sleep? You make a lot of graphics about it. They're very helpful. I share them with my group practice staff all the time. 
MEGAN NEFF: Oh, cool. 
PATRICK CASALE: But I would love to hear more about that.
MEGAN NEFF: Yeah, absolutely. I don't know if you did this, after I was diagnosed, I started Googling every weird thing about me to see if it was possibly related to my autism. And sleep is one of the first ones I Googled because I've always had just weird sleep stuff, like sleep paralysis, I don't know if you've ever experienced that? It's really disorienting. And just insomnia and other sleep issues. 
So, it's one of the first things I researched. And it's really interesting because when a person is diagnosed autistic or ADHD, rarely are they also told, "And this co-occurs with this handful of sleep disorders." 
So, first, from a like neurological, biological, we're just more vulnerable to sleep disorders. So, things like, we tend to have a flattened melatonin curve, so that kick of melatonin a lot of people get that cues them to go to sleep, a lot of us have a more flattened curve, or we're getting it later in the night. 
Also, there's a gene mutation a lot of us have that influences our circadian rhythm. So, a lot of us have a delayed circadian rhythm or just a dysregulated one. And then we're more vulnerable to things like narcolepsy, sleep apnea, and other sleep obstruction disorders. 
So, biologically, there's a lot going on that makes us vulnerable. But then, outside of that, there's things like sensory issues, if you're a heightened sensory person getting comfortable at night, being woken up by a snoring partner, or by something outside of the house, so we get woken up more easily and have a harder time just getting comfortable. 
I'm curious, it's probably also related to our more reactive nervous systems, like, you have to be in a relaxed state to be able to enter deep sleep and a lot of us have more hyper-vigilant nervous systems. So, there's a lot of vulnerabilities we have that makes sleep pretty difficult.
PATRICK CASALE: Yeah, absolutely. And I'm glad you're able to share that that way for everyone listening because there's a lot of things going on beneath the surface that are impacting you. And I know for myself, I'm restless. I have that constant anxiety and nervous energy, and it's very hard to get comfortable, so deep sleep is not something I'm much, you know, familiar with because the slightest noise, the slightest sound, like, my dog getting up to go get water, like, my dog whining or snoring too. It's just, like, every little thing builds on itself and it's so hard.
MEGAN NEFF: Patrick, you have a terrible sleep environment. If you were my client, like, we'd be working on your sleep environment. It's terrible.
PATRICK CASALE: It's terrible. And we have, like, a senior dog who sleeps on a bed on the floor but she's restless at night and will get up , to drink water, and like I will hear her get up, and then you'll hear her like click-clacking through the house, and like drinking all the water, and then coming back, and like scratching her blanket to go to sleep and you're just like, "Oh my fucking God." Like, if I was just asleep for an hour and that's what woke me up it's just infuriating and it's challenging. And you know, temperature sensitivity, all the things that come with it, even like having that restless leg syndrome, and just being really uncomfortable. 
So, really trying to figure out ways to make your sleep environment more sleep hygienic, or you know, whatever works for you in terms of just being able to get some rest because it's so crucial, and you know, otherwise you're just kind of flying by on autopilot all the time. And it doesn't feel good to kind of move through life like that.
MEGAN NEFF: I'm still like, seriously, trying to figure out how you do it with four to five hours of sleep because you do a lot. And that sounds really painful.
PATRICK CASALE: Yep, it's really painful. The thing that I hate the most, like, I'm so used to operating on that amount of sleep, where I can push through, and have the conversation that we're having right now, and do what I need to do today without it being too overwhelming. 
But I used to have an active, pretty intense gambling addiction. And I can remember nights where I stayed at a casino till 6:00 AM, till the sun came up, and then drove two hours home and, you know, then you're trying to fall asleep with that, it's just that feeling of like, you're nauseous, you're disoriented, like, everything hurts. It's just uncomfortable, and the whole day is ruined. And, you know, you have a day or two like that every month. And thankfully, it's significantly less than it used to be where that type of situation would be, like, almost weekly, but now it's once or twice a month where you just don't sleep. And you kind of know as it's happening, that this is what you're in store for. And it sucks, I mean.
And you know, I used to try to force myself back to sleep, that never works. So, just getting up, getting out of the environment, getting out of your bedroom, and I'll go lay on a couch, or go like try to do some mindfulness activities, I'll try to like, even do some, like, exercise if I have to, if I'm feeling really restless, but like, I've never found the magic solution yet. I'm still searching.
MEGAN NEFF: Yeah, yeah, yeah. So, when you wake up, I was going to ask you what you do when you wake up at three, and you're up for the rest of the night? So, it sounds like you kind of go do something relaxing?
PATRICK CASALE: I try. I used to do the thing that I think a lot of us do or have done where you're like, staring at the clock saying, "Okay, it's three o'clock, but if I fall asleep right now…"
MEGAN NEFF: Which totally feeds the insomnia loop, yeah.
PATRICK CASALE: Exactly. Yeah, then I'll get four hours of sleep or five hours of sleep till 8:00 AM. And it's 3:30, then it's 4:00, then it's 4:02, then it's like, it just builds on that like that loop is… you can't get out of it.
MEGAN NEFF: Yeah, so I used to work in oncology. And so, I was doing more health psychology. And so, sleep was actually a big issue that I worked with folks on and protecting that relationship to the bed, which is such a huge intervention of, once the brain starts to associate the bed with a stressful thing, that just totally feels that insomnia loop, and exactly what you're saying, that anxious rumination of like clock watching, and then, the anxious rumination of, "I'm going to be so tired tomorrow." All these things that activate our sympathetic nervous system, making it almost impossible to fall back to sleep. 
So, it's really the, like, neuroscience, and the science behind sleep, and brain associations. I think is really fascinating. It hasn't helped me completely crack the sleep code for me, but I do find it really interesting.
PATRICK CASALE: Yeah, I mean, I do too. And I think, yeah, the rumination piece is really challenging. And that's why I encourage anyone who's listening to get technology out of your bedrooms, and you know, really try hard to only associate your bedroom with sleep, which is something, you know, a lot of CBTI therapists and sleep specialist would say, like, have a cool dark environment and, you know, get your… I put my phone in a completely different room because otherwise I'll go on and I'll just start scrolling through it or answering messages at night. And that's just going to activate again. 
And so, doing the little things, but even doing the little things, and still having these experiences can be really frustrating. And some of it, it feels like you kind of are waving the white flag where you're just like, I don't know what else to do at this point. I've tried hypnosis, I've tried sleeping medications, I've done sleep studies, and it's just like, all right, here we are.
MEGAN NEFF: Did they ever find anything with sleep studies?
PATRICK CASALE: No, no, no form of apnea, just really bad insomnia. And you know, it's the combination of what you said, it's the constant worrying, rumination, and the ability to get relaxed. And then it's the sensory stuff. It's the inability to like, just be comfortable. And once your anxiety starts ramping up, everything is uncomfortable. Like, the smell of your pillow, the firmness of it, the texture of your blanket, whatever it is, it's just like, it's hard. I wish I had a solution. I really do.
MEGAN NEFF: Yeah, no, and that's part of what, like, sustains a stress cycle is typically someone like you, or me or the average autistic, or ADHD person has tried so many things before they go to a medical provider. And then, the medical provider will often, like, list out these things that they've already tried, they've already researched. And that gets back to, I do think when working with sleep issues some level of acceptance that my sleep is going to be shitty, I'm going to have days where I feel really tired, I actually think is really important. Because otherwise, we get so locked into that anxious fight with sleep.
PATRICK CASALE: I agree 100%. And you're so right about like, the average autistic or ADHD person has done the research. Like, we do the research, we go down those rabbit trails, and like we figure out, okay, you can try this, okay, you can try this. And then when someone lists it out for you, you get kind of frustrated because you're like, "I've already done this stuff." Like, "Have you tried mindfulness?" "Yes, I'm a fucking therapist. I know how to practice mindfulness." "Have you tried doing A, B, and C?" And you're just like, "Is there any medication that you can give me that could be helpful?" Which isn't really helpful anyway because a lot of those drugs and medications are so harmful for you, the Ambien, all of the medications in the world designed for sleep are also designed somewhat in terms of anesthesia and putting you under for surgery. So, it's not a healthy way to get sleep. It's just like, I need to get knocked out because otherwise, I'm going to go into like hallucinations, and delirium, and all this stuff that comes with sleep deprivation.
MEGAN NEFF: Yeah, it's good when you're like, near psychosis to like, okay, I need one good way to sleep. But yeah, as like every night solution. It's interesting, I don't know if, and I just want to clarify, I'm not recommending this. I'm just curious, your thoughts. And I don't know if cannabis is legal, where you are. It's legal in Oregon. And a lot of people I work with get sleep relief from cannabis. And it makes sense to me just because a lot of the sensory stuff quiets down. 
So, that's been interesting to see some of my people experiment with and benefit from. I'll be curious to see as there's more research around that. And I'm not talking about, like, getting high. It's like a very low dose. There's even cannabis teas. I guess, yeah, you all don't have access to, [CROSSTALK 00:22:31].
PATRICK CASALE: Yeah, it's weird, you know. And we could probably do a whole episode on, you know, substances, and neurodiversity, but I'm all for the legalization of cannabis all throughout the country and the decriminalization. My wife, I'm going to get myself in trouble with this episode today, works for the U.S. government. So, like, I can't do anything in my house that is illegal in the state or I would definitely be trying every single combination under the sun. So, the most I can do, at this point in time, is like CBD melatonin gummy-type situations. 
But it's interesting, you know, and I want to… we could probably talk about this in lived experience too. But anytime I smoked marijuana as a high schooler, like in college, I got unbelievably paranoid, freaked out, like, obviously, you're not controlling the strain when you are purchasing drugs when you are in high school. However, I'm always curious about experiences because I've heard this from a lot of autistic people of like, their experiences with marijuana were really negative. 
But I want to see now that we have so much more, like, we know the source, we can kind of identify the strain for which purposes it exists for to see if that would be helpful because at this point, the only thing that's helpful and it's not helpful, I've talked to you about this, is in the short term alcohol is helpful at times because it will knock me out but then it will fuck up your RAM and your circadian rhythm and every-
MEGAN NEFF: Yeah, it's not good sleep.
PATRICK CASALE: Not good sleep. But sometimes you're just like, I need to fall asleep. And this is what I'm going to default to. So, you know, I think cannabis would be the lesser of two evils for sure.
MEGAN NEFF: I would agree with that, cannabis verse alcohol sleep. Yeah, this episode, we're going to get into trouble with this episode. Psychologists recommends cannabis. No, I'm not recommending. Do your research, talk to medical providers.
PATRICK CASALE: Or a harm reduction-based therapist in general. And I agree, you know, do your research. Don't take medical advice from us. But I do think that trying to figure this out for all of you listening, because I'm sure if some of you are feeling like you identify with what we're saying, and have similar experiences, and you know how torturous and hellacious it is. 
And Megan and I talked about our privilege and being small business owners last week, when it comes to autistic burnout, some of you have to get up and fucking go to work the next day, regardless of how much sleep you received. 
And I know what it was like working at an agency job or just being employed elsewhere, not getting sleep, and having to call in because I could not function. Like, I could not get up. I couldn't drive safely like, and it's so hard when maybe you don't have the ability to just say, "Another night where I didn't sleep." But I have to get up and go to work.
MEGAN NEFF: Yeah, yeah. Absolutely, absolutely. As you were talking, I like have visceral memories and truth of when my kids were young. So, my son, I now understand, it's because he has sensory issues. But he didn't take to eating solid foods till 18 months, which means he nursed all the time, and we co-slept, and he would be literally like, latched on to me nursing most of the night because he was hungry, because he wasn't eating. 
And I also had an autistic three-year-old who had a ton of energy, and we had no idea what was happening. So, I was like, barely sleeping. And I would wake up just… and I'd have to get up, right? I had a baby, I had a three-year-old, I was a stay-at-home parent at that time in our life. I was on the verge of like, psychosis at one point of, I remember I went up to my parent's house because I was like, "I just need a night of sleep." Because I felt myself, like I felt my grasp on reality slipping and it was it was terrifying. It was really terrifying. 
And yeah, I mean, sleep, it's just a beast. And yeah, so for people out there who have had babies and are autistic, oh my gosh, I feel for you. So, I had two C-sections, I had complicated pregnancies. And then, for the life of me, I could not sleep when the babies slept. I would have terrible, terrible insomnia. So, my recovery from my surgeries were incredibly hard. 
So, I think, it's interesting, there's very little, if you like Google autistic pregnancy, or autism and pregnancy, you get all these things where like how not to have an autistic baby. But there's very little out there about being a person who's autistic, and pregnant, and sleep, I think, by far, like, worst issue during my pregnancies and postpartum period, which just made that whole season of life so excruciating.
PATRICK CASALE: That has to be so hard in so many different ways because you still have these responsibilities of, I have to get up, I have to take care of my kiddo. Like, I have to do this thing and just losing your grip on reality, just being in that constant grief, that pain cycle, that exhaustion, I feel for you and anyone else who's had that experience. And it's hard, and you're right, you Google this stuff, and you're going to see all this shame-based ableism bullshit of like, how not to do this thing, how it's a negative thing if this is your experience, and there's just not a lot of research done on lived experiences in general right now.
MEGAN NEFF: Yeah, yeah. So, it's kind of depressing.
PATRICK CASALE: I was just like, staring out my window like, oh, yeah. I mean, it's so challenging because so many of us rely on how our brains work too. And I feel like I'm moving in slow motion when I have these types of days or situations where I'm so used to, like, my brain rapid firing and moving really quickly. And if you're moving through quicksand, is how I kind of experience it, where like, everything just feels delayed and takes a bit longer to process or respond to. 
I got some messages today from my group practice staff, love you all, not selling it, promise, where I had to look at it like five or six times to be like, "Wait, what is this person asking me." And like, now that it's halfway through my day, I'm like, oh, it was actually like a really simple question to respond to. And I couldn't put those pieces together.
MEGAN NEFF: Yeah, yeah. Well, and for people who, like, control, actually, I thought about that too when we were talking about cannabis, I wonder if that's part of the paranoia for some autistic people, is it's like you're losing control of your thoughts and ability to put things into sentences. But with sleep deprivation, the loss of control of like being able to organize our thinking, I think that can feel really claustrophobic, especially, for autistic people where we value control a great deal. 
MEGAN NEFF: Yeah, I know for me part of what's so hard on us, like after a bad night of sleep, I can't be as productive and I feel really bad when I'm not mentally productive. It feel… like, I have this constant kind of existential awareness that time is passing and I'll never get this time back. And it leads to this kind of anxious need to always be doing something efficient or effective with my time. So, when I have a shitty night of sleep, and then the next day, I'm like, "Well, this is kind of a waste of a day." 
And so, then I've got this double, like two depressing things happening. One, because I didn't get sleep, my body's more depressed because of all of the sleep chemicals that… what the brain does during sleep. But then because I'm not being productive, which is what gives me a sense of accomplishment and like a mood boost, it's just extra. 
One thing that helps me is I will tell myself, like, "Don't trust your brain today." In the sense of like, whatever you say about yourself or your future, it's going to be filtered through this depressive lens, so just don't trust it.
PATRICK CASALE: Yeah, I love that. That's so helpful for me and probably for so many people listening. Because I think, you know, this is how my brain is working right now, as you're saying things and I'm like, "Oh, we could do an episode on that, oh, we could do an episode on that." Which is great. So, like, that's how scattered I feel. 
But I think that productivity piece is important to address because so many of us, we want to be productive, we want to have control over our day-to-day. And we get a sense of accomplishment for it, that dopamine hit is real for sure. And so often it's misidentified and wrongfully associated with like, hustle culture and like, just obsessed with achievement. And it's like, no, no, no, no, no. This is actually like how I feel a sense of self. Like, there's that sense of pride fullness. It's also like checking the thing off the list. And that's really helpful. It has nothing, very rarely, I don't want to use blanket statements. It very rarely is about like hustle culture, and grind culture, and like the next achievement, and the next achievement, and the next achievement. And I think that gets wrongfully missed a lot of the time.
MEGAN NEFF: Yeah, yeah, absolutely, absolutely. I was actually just thinking about this the other day, how I spent… so I was in psychodynamic, psychoanalytic depth therapy for three years before my autism discovery and then diagnosis. So, there's a lot of things I was trying to figure out about myself. And one of them was this inability to rest. And like exploring family of origin issues and trying to figure out like, what is it either in my childhood or myself that like, I cannot just be. Like, that is very, very painful for me, just being. And then realizing like, oh, that's ADHD. And maybe there's other depth things that layer on top of that, but at the end of the day, there's a neurological reason that when I'm playing a board game with my children, and my kids like, not realizing it's their turn, and I get impatient, I'm like, "It's your turn." There's a neurological reason for that.
PATRICK CASALE: That's another great episode. I think we should do that next week, about like, what you just said is so profound and it's so vulnerable too, of just like, your lived experience of how painful it is to not be able to just be or to really struggle with that in general. And I struggle with that too. And I imagine most of you who are listening also have a similar story or a similar feeling. I have always been described by parents, by friends, by early childhood, you know, folks who were in my life as someone who was not comfortable in their own skin. I was always, like, moving or doing something, and it's still true today. Like, I struggle so much to be present, or in the moment, or just experiencing life as it's happening. 
And the shitty thing about being a mental health professional and also an autistic ADHD person is you like, you can't always practice what you preach, in my opinion. And like we don't in this profession, a lot of the times, but even the things that we know to be true about like mindfulness, and stillness, and self-compassion, and all the buzzwords that we like to use, I fucking hate it. Like, I can't do it. And I try. And then you can create this like, inner frustration, shame spiral situation where you're like, why can't I just do this?
MEGAN NEFF: Yeah, yeah. Which then gets reinforced when we maybe go to a therapist and get taught these things. Like, you were saying earlier, like, "Well, have you tried this? Have you tried this? Have you tried this?" And A, like, maybe we've tried them, but B, we've tried them and they're really, really hard for us. 
So, I don't know if I came up with this term or if I learned it somewhere, but I actually started using it before I even realized I was ADHD, mindfulness on the go. I really like it, it's been because I have alexithymia, mindfulness has been huge for me because I know how I'm feeling because I'm identifying what scripts are playing in my mind. 
But I'm not sitting there doing like a 10-minute mindfulness exercise, it's like, as I'm going about my day, it's oh, what script is playing right now? It's just, I'm entering a different, like mind space, but I'm doing it on the go. And I find things like slight adaptations like that, of just take mindfulness and then find a way to do it on the go, or to do like, different versions of it, I think is really helpful for ADHDers, it's just, we're not trained as clinicians, how to adapt our interventions for ADHD and autism.
PATRICK CASALE: I love that, and if you did come up with that, you should trademark that shit and make that your own. But that makes me remember last week when we were talking, and you had your smoothie in your hand, and you were talking about like, just mindful of the sensation, the temperature of the smoothie, if you take a drink of it, like if you put it down, the weight of it in your hand, those are things that you can adapt and put into place instead of saying to yourself, "I've got to do this mindfulness activity for the next 10 or 15 minutes." And sit here. And I'm not having a fucking revelation or experience."
MEGAN NEFF: And feel like a failure because I can't do it, because my mind is all over the place, yeah. 
PATRICK CASALE: Exactly. And then you go to your therapist, and they're like, "Oh, did you try to take away your distractions? "And you're like, "How do you do that?"
MEGAN NEFF: Like, my mind is a distraction., yeah.
PATRICK CASALE: My entire existence is a distraction. 
MEGAN NEFF: Yeah, yeah. Okay, so I'm going to make a plug. And I like feel kind of sheepish giving an intervention because we've talked about how dismissive it can feel. And so, I have a sleep workbook. And I do worry about that. Like, people have told me it's helpful. But I also worry, like, I am talking about some of the conventional strategies. And I worry that I'm setting people up for those feelings around, I'm trying all these things and it's not helping. 
But here's one intervention that a lot of people find helpful. It's not going to be helpful 100% of time. Again, there's got to be some acceptance of like, we're just going to have some shitty nights of sleep. It's what has helped me the most, in addition to, like, my sleep environment. 
Cognitive shuffling, have you heard of this? It's really helpful, especially, for those of us with busy minds because it's like, something like counting sheep is not nearly active enough. So, cognitive shuffling, there's a few apps that will do it. Like, mySleepButton walks you through it, or you can do it yourself. So like, you would take a word like kitten, or, actually, I'm trying to find a word that doesn't have a double letter in it, ocean, and you start with the letter O, and then you think of all of the words you can think of that start with O, so like open, octopus. And then once you've expired that you move on to C, and you do all the words that you can think of that start with C. 
And what this does is it shuffles the brain enough and it fragments it that you can't have busy mind going at the same time. And it's mundane enough, it kind of mimics the first stage cycle of sleep by jumping from idea to idea, and so it can help with sleep onset. It's what I do when I wake up in middle of the night and I'm like okay, there's hope I could fall back to sleep, I used to do cognitive shuffling. And I actually, I would say eight times out of 10 do fall back to sleep when I'm using that.
PATRICK CASALE: That is a wonderful strategy. And it sounds like that would actually be so helpful. I'm writing it down right now, what was the app that you mentioned?
MEGAN NEFF: mySleepButton. And that's what I used first. And I think it was developed by neuroscientists. And again, it mimics that first stage cycle of sleep. What I also do, if someone needs an added layer of complexity, and if they don't have a fantasia, actually, imagining the thing, so like, for me, I'll do that, I'll be like octopus, and then I'll imagine either drawing an octopus, or I'll imagine an octopus. And then, the next word, like open, I would maybe draw a door opening in my mind.
PATRICK CASALE: I love this. And I'm writing this down too because I had one of my group practice therapists message our group chat today just disclosing like, massive, massive sleep issues, and struggling significantly, and wanting solutions. So, I'm going to share that immediately when I get off here because I think that is so helpful. 
And you're right, like, the simplistic like count sheep, or count backwards, or do these things, it's not stimulating enough, it's not getting the brain to really settle down as much as it needs to. So, I really love that solution. 
And I think you should plug your workbooks whenever the hell you want on here because you've worked so hard on these things. Like, Megan's workbooks are just unbelievable resources at your fingertips with these solutions, and these strategies, and these explanations. And Megan's deep dives that she's doing, you know, late at night, or whatever the hell you're doing these things. And I mean, I am always very impressed by just what you're creating. And as a colleague and a friend, I just really want to say that, and name that because I share your resources all the time with people.
MEGAN NEFF: Oh, well, thank you. Thank you. Yeah, that's the one workbook, maybe I should add, like, a disclaimer to it, there are a lot of strategies that I walk through, because for me, like learning new strategies they don't all work 100% of the time, but they have helped me improve my seatbelt a lot. So, I want people to have access to them. But I do worry that learning all these strategies, and then if they're still struggling with sleep, that that will just perpetuate the shame spiral.
PATRICK CASALE: I think that's with any of this stuff, for all of you that are listening and struggling with some of this. The acceptance piece, like Megan, mentioned a couple times is so crucial of like, I'm going to try these things and we're going to see what sticks. And having acceptance of or having a lot of shitty nights or hopefully less shitty nights than you need to.
But you know, I think when we hear like, this is what you should do, this is what you're supposed to do and then it doesn't work, it just creates further division, right? For those of us who already feel like, "But nothing works, why is nothing encapsulating my experience?" So, we see you, all of you that have had those experiences at your doctor, at your therapist, with your friends, colleagues, like we see you, and we know how shame-inducing it can be when it feels like you don't get it, you can't figure it out., this isn't right for me.
MEGAN NEFF: So, I'm having a thought as I'm listening to your talk. I think a lot of us have like a lowercase traumatized relationship to sleep. So, if we put sleep in like a relational term, and we think about if we zoom out from all these strategies, and these skills and we think about what is a person's relationship to sleep? If a person has a traumatized stressful relationship to sleep, and then if that gets reinforced by their efforts to improve it, like through medical visits, or through the different strategies they're trying, sleep is always going to be difficult until you heal the relationship to sleep, which is why I think acceptance is so important because that lays that framework of, I'm going to make friends with sleep. I might not like that sleep is an issue, but I'm going to heal my relationship to sleep because if we have a traumatized, strained relationship to sleep, sleep is always going to trigger stress associations, which is going to make sleep so incredibly difficult.
PATRICK CASALE: Couldn't can say it better myself, I agree 100%. And that's just really, really wonderful advice for everyone listening. And I'm going to take a lot of Megan's advice tonight and try to start implementing some of this stuff. Yeah, I love that. So, thank you for naming that and just kind of sharing that too. 
I don't know what I expected today, but I think this went pretty well even with the divergence going on, so I think that this was a really good conversation about a really challenging topic. And I'm sure we could have more conversations around this topic and expand on it as well. And, you know, answer your questions, and go more in-depth with the strategies and just really honing in on that acceptance piece. I think that's the big one that I'm coming away with, is the acceptance of your brains work differently, your regulation, your body's regulating differently, you're experiencing things differently, and some nights are just going to fucking suck, and just making peace with that it's not you, it's just we've got to adapt and figure out some strategies that work, specifically, for your experiences too.
MEGAN NEFF: Absolutely. 
PATRICK CASALE: So, for everyone listening to the Divergent Conversations Podcast on all major platforms, new episodes out every single week. We appreciate you showing up and we appreciate you just trying to make it through today and figuring out what comes next and strategies that work for you and specifically, for you. And we will see you next week. So, goodbye.

Episode 2: Autistic Burnout

Friday May 12, 2023

Friday May 12, 2023

Do you ever find yourself in a state of paralyzing burnout that can happen even when you're doing activities that you enjoy?
Have you ever taken a vacation to fight the fatigue of life only to find that your post-vacation burnout-recovery state is reversed sooner and more severely than others?
Do you wonder how you can reduce your burnout in a way that works and actually lasts?
Then this episode is for you.
Top 3 reasons to listen to this episode:
Understand what autistic burnout looks like and how it differs from the burnout that might be experienced from things like work.
Identify ways to provide self-care when you are experiencing autistic burnout, as well as how to incorporate sensory soothers.
Learn how autistic burnout and ADHD can affect each other.
Autistic burnout can be a very tiring and frustrating experience. It can have a significant impact on your productivity, relationships, and overall quality of life. Therefore, it is important to understand what it is, how it affects you, and how to deal with it effectively. By doing so, you can preserve your energy and improve your quality of life.
To cope with autistic burnout, it is crucial to identify the activities or practices that help you recharge and calm your senses. By incorporating these practices into your daily routine, you can manage your energy levels and reduce the likelihood of burnout.
Additional Resources:
Check out Dora M. Raymaker's study on autistic burnout: “Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew: Defining Autistic Burnout." 
Megan's Resources for Autism and Burnout: 
How to Spot Autistic Burnout: https://neurodivergentinsights.com/blog/autistic-burnout-symptoms
What Causes Autistic Burnout: https://neurodivergentinsights.com/blog/what-causes-autistic-burnout
Autistic Burnout Recovery: https://neurodivergentinsights.com/blog/autistic-burnout-recovery
Autistic Burnout Workbook:  https://neurodivergentinsights.com/neurodivergentstore/p/autistic-burnout-guide-and-worksheets
PATRICK CASALE: Hey everyone, you are listening to another episode of Divergent Conversations podcast. I'm your co-host, Patrick Casale.
MEGAN NEFF: And I'm Dr. Neff.
PATRICK CASALE: And we are going to talk about autistic burnout today, because Megan and I are both in it
MEGAN NEFF: This will make for an interesting conversation [CROSSTALK 00:00:22].
PATRICK CASALE: All these conversations are and we're going to look at each other and say, "Did that feel too fucking dark again?" But in reality, I think, that's the purpose here. So, I'm in it for sure. And, you know, Megan, I'm always going to defer to you when we're talking clinically, because I think you're by far the expert when it comes to all the research that you do and all the effort that you put in. So, what is autistic burnout for all of our listeners who may not really have a good grasp of that?
MEGAN NEFF: Yeah, no, that's a great question. And we should definitely add a link to this in the notes. I think her first name is Dana Ashlie? So, I think, I actually don't know her pronouns. So, I shouldn't assume her. But Dana Raymaker. They did a fantastic article that is the first to clinically define and research autistic burnout. It's a qualitative study. For people who don't know what that is, I really like qualitative studies, because it stays with people's stories. 
So, they interviewed like 19 autistic people. 10 of them were women, which is rare for an autistic study, foreword genderqueer or gender, not in the binary, which is, again, fantastic for a study on autism. And then, I think there were like six or seven men. 
So, first of all, I love a study that's representing autism from a more diverse lens, gender-speaking. And they found some themes, I realize I'm doing the very autistic, like, [INDISCERNIBLE 00:02:07] like, here's the design of the study, here's the people versus just like, what is autistic burnout? Okay, I'm zooming back out.
PATRICK CASALE: It's cool, you're fun.
MEGAN NEFF: So, okay, fantastic study, people should read it and there's a lot of kind of versions of it that I think it's a more accessible read than some peer-reviewed studies. So, they interviewed folks and listened for themes. That's how you do qualitative study, you listen for themes and you pull those out.
Their definition of autistic burnout is, it's defined by three features, chronic exhaustion, this is emotional, this is physical, this is all the domains of exhaustion that are possible. It is a loss of skills. So, particularly, executive functioning skills, speaking skills. I know for me that is a big one, my ability to speak coherently or speak at all is really impacted by burnout. And then sensory sensitivities increase during burnout. 
So, those are the three core features. They define it as three months or longer. Honestly, I think just when you're defining anything clinically you have to kind of put a timeframe around it. But I'm curious about that three months mark, why that's there. And they show how it really is distinct from like, you know, culture talks a lot about occupational burnout, that this really is distinct from that. It's also distinct from depression. Now, it often leads to depression, but it is distinct from depression. 
I think this is such an important thing for mental health therapists to understand, because this is one of the leading pathways to suicidality for autistic people. And mental health therapists often don't understand burnout. They think it's depression, they treat it like depression, but it needs a different support, different treatment. 
It's also more common among high maskers. They identified that masking was one of the huge factors contributing, which makes so much sense to me. So, I think this really sets people up to be misunderstood by their therapist, if their therapist not aware of high masking autism, not aware of suicidality. Okay, I'll stop there, because I've done a bit of a little info. But yeah, that's the clinical definition of autistic burnout.
PATRICK CASALE: I love this, because this is Megan and my process where we're obviously processing information very differently, and then, relaying it very differently, too. 
And I think it's important to have your info dumps and your perspectives, because people need to know that component too, right? Like, this is the definition, this is, clinically speaking, what this looks like. And I think so often we're you using the term burnout in society in general, right? And you mentioned it was more related, workforce-related. Like, hey, yeah, we get it, work is stressful, and it's hard, and you're overworked and underpaid, and all the things that come with it, and then that leads to burnout. But this is different. And I think main component that you mentioned really set that apart. 
And, I mean, we can go layer upon layer here, where it's like, what about autistic people in the workplace experiencing both like workplace burnout, autism burnout, etc. But in reality, like, it gets missed a lot. And clinically speaking, for sure, but also in friend groups and society in general. Like, the general advice around burnout is like, take a break, and like, go on vacation, or like, take a week off from work, and you'll be okay. And that is not what we're talking about here. I mean, even in that situation, a week off doesn't do it justice, but like…
MEGAN NEFF: Right, right? Because then we're returning to the life that's burning us out. And that's what's different about, you know, allistic person, or neurotypical person who's experiencing burnout. They often can go through a recovery period, and then, like, bounce back. But for the autistic person, like, what I see a lot, what I've experienced a lot into the last two years when I deeply restructured my life it's like burnout, go back to my normal, but then I burnout again, because it was the normal life that was burning me out. 
And so, that kind of bounced back and forth between burnout, like somewhat functional burnout, functional burnout, functional… And so, there isn't that idea of like bouncing back to some idea of normal. Often, it's not the case when we're talking about autistic burnout.
PATRICK CASALE: I love that you made that distinction, because that's an important one here. And for the autistic person who's experiencing autistic burnout, when you said a minimum of three months, right? I know we're talking clinically speaking, this could be going on for years, this could be going on for-
MEGAN NEFF: Oh, yeah.
PATRICK CASALE: …lifetimes. 
MEGAN NEFF: Totally, totally. 
PATRICK CASALE: You and I DM each other on Instagram a lot, like, and I did it before we started recording and I wish we were recording. I'm glad you kind of pointed that out. I asked you like, "Hey, how are you doing today?" And that's such a like conditioned question. You know, like, I'm supposed to introduce that way. And you were like, "I don't know. Like, I'm kind of here." Right? Like…
MEGAN NEFF: Yeah, I do wish we were recording that moment of… And then, I think I told you. "No, that's a terrible question." Which is funny. That's actually how I respond to that question now. I mean, with you, I'm obviously really comfortable and will be like, "Yoh, that's a terrible question. Why you're asking me that neurotypical…."
But with people who maybe aren't as an autistic culture, I will ask them to clarify like, what part of my life are you asking about? Because it's such a complex, like, what bucket in my life are we talking about when you ask me that?
PATRICK CASALE: One, I love that. We are comfortable enough to just name it in our interaction. And two, I think that's such a good fucking point. 
And I was talking to a caller yesterday about like, fluffing up emails of like, I kind of get straight to the point, you know, ask you what I need to ask you, or give you the information that you need, or whatever, and just be done with it. But then I always find myself, like, inserting a smiley face, or a lol, or like punctuation mark to emphasize my point, or like going back and copying and pasting, like, "Hey, how are you today, I hope all is well." Then jumping into the point that I actually want to make, and even operating from that neurotypical lens and expectation of communication leads to burnout, because that [CROSSTALK 00:09:09]-
MEGAN NEFF: Oh, yeah.
PATRICK CASALE: …energy to constantly think about how you are responding to things and how you're being received.
MEGAN NEFF: Yep, yep, it takes that extra step of, I do the same thing. I read an email, and then I go back, and I like I warm it up. It's like, okay, I need to, like, have some sort of intro. And, oh, I shouldn't just say the thing. So, yeah, that whole extra step. And it is, it's prefrontal cortex work every time we're doing that. We do it in email, we do in conversation. So, all of these things that are happening on a more intuitive level for other people that we do when we mask, you know, that's all that prefrontal cortex, which is part of why it makes so much sense to me that masking is such a significant factor when it comes to burnout.
PATRICK CASALE: Yeah, just think about how much energy is being spent all the time. And then, how much is being absorbed all the time? And the differentiation there between like, once you start to get into that burnout place where you mentioned, a lot of it is sensory and overstimulation. 
I'll give you an example. I was hosting a retreat that I was running a couple of weeks ago in New Orleans, and you know, I'm recovering from surgery, my energy is low, my capacity is low, my distress tolerance is already low. It hit me in a moment where I was sitting in the room with 20 people, they're all socializing, they're all having fun, but I'm picking up on like every word that everyone is saying. It's starting to get louder. And then, every noise is starting to like become more and more irritating. And the temperature is getting really hot. And I'm starting to find myself like stemming and like, needing the need to just regulate myself. 
And I just realized in that moment, like, you're burnt out already, and you haven't even started what you're embarking upon this year. And combined surgery recovery with, you know, the autistic burnout piece of just the realization of when you're in that moment your distress tolerance skills kind of dissipate. Like, your executive functioning, like you mentioned, just starts to crumble. 
And that was the first time for me, and I'm going to be really vulnerable here and honest, for our listeners, like, where I realized, I am so much closer to feeling that I am disabled or unable to function. And that world that sees me does not see it, because of how much energy and effort goes into doing whatever I'm doing. 
And I had this major fucking grief moment and that moment where I was like, not only am I recognizing this, but I also realized like, I've created this thing in my business that am I really not capable of actually doing? That was really hard to try to process in that moment.
MEGAN NEFF: It sounds like such a claustrophobic moment when you describe, like being in that moment, seeing what you had to do in front of you. And then, like the limits you are encountering in your body?
PATRICK CASALE: Yeah, yeah, it was hard. And you were one of the first people I thought about messaging that to, because I was like, "I need to talk to someone about this who kind of understands what I'm talking about."
PATRICK CASALE: It's just such a challenge in that moment. And all you want to do is like retreat, and turn off the world, and disappear from it. And I know that that is a way to sensory soothe, too, but when you're expected to be participating, or involved, or hosting, or coaching, or whatever the responsibility is, it becomes too much.
MEGAN NEFF: I know for me in those moments there's a narrative that kicks in, I should be able to push through, what is wrong with me that I can't push through? Was that part of it, too?
PATRICK CASALE: Oh, absolutely. It was like, that was coming up, "You're letting your co-host and business partner down, because you're not pulling your weight. Why can't you just do the thing that you've done before? Clearly, something is wrong with you." And, "You're not able to do this thing." I like having fucking limitations placed upon what I can do.
MEGAN NEFF: Oh, my gosh, right? Yeah, yeah. I mean, that's something I've thought so much about the last two or three years, is the limits and how that is for me, claustrophobic, that is the word for it. I feel claustrophobic when I encounter the limits in my body. 
And they feel like they shouldn't be there. Like, even when I am, like my head knows, right? Like, the social disability model. And autism is a disability, and, like, I know these things, but in those moments, like, my felt experience is still, there's something wrong with you that you can't push through. And I'm not attributing it to being disabled. I'm not attributing it to being autistic, because it's been so baked into me my whole life that you should be able to do what others can do, you should be able to push through. Why are you making this so hard? It's in your head. Like, all those narratives are still baked into my body.
PATRICK CASALE: Yeah. When that's coming up for you, I mean, how are you managing that? How are you kind of getting through those moments, because they can be so painful too and so debilitating?
MEGAN NEFF: Yeah, yeah. I mean, so I'll answer two ways. On one level, I think I've restructured my life to reduce those moments, right? It's interesting sometimes when I disclose this to people, people seem surprised. And I realize like, "Oh yeah, if you encountered me digitally you might not realize this." Like, I rarely leave my house. I mean, I'll go on walks. But I rarely see people, I rarely interact with people in body form, I rarely commit to things where I know I might encounter that claustrophobic, like, I've got a pretty fierce-like autonomy demand avoidance streak going on. 
So, one, I've structured my life, I think, to avoid those moments. Last year, I was adjunct teaching at a university leading like a clinical team once a week. And it was three hours, eight students, but I'd come home exhausted, and be so exhausted the next day. And I stopped doing that this year. So, that'd be an example of I have restructured my life to avoid those painful moments. 
And then, what do I do when I am encountering those moments? Like, I'm very meta in how I talk to myself. So, I'll talk myself through it of like, I'll identify the scripts that are playing, and I'll remind myself of the scripts I know that are true, but that I don't yet, like they're not living in my body yet. So, I'll do a lot of that kind of mindful naming of scripts in the way I talk to myself and remind myself. And then, I'll check in of like, what do I need? And I'm typically able to get myself some version of what I need.
PATRICK CASALE: Yeah, I love that answer. And, you know, I think the ability to restructure is wonderful. And I also think that for us, we've talked about this before, it's also a privilege that we have [CROSSTALK 00:16:57].
MEGAN NEFF: Absolutely, absolutely, yeah. 
PATRICK CASALE: And I start thinking about, like, what if you don't have the ability to restructure and really be mindful of how your days are laid out and who you're interacting with, and when, and having control and autonomy over your situation like that?
MEGAN NEFF: I'm so glad you brought the privilege piece up, because I think this is such an integral part of the autistic burnout pieces, is I'm very aware, I've been able to restructure my life because of all of my privileges. 
When I started my business, at that point, we were dependent on my spouse's income. So, there's economic privilege. I have a doctorate. So, there's a lot of education that gives me a lot of mobility in the professional space. 
So, I feel that when I work with clients in burnout, you know, whether they're in middle of graduate school, or due to socio-economic barriers, or name any of the barriers, cannot restructure their life, I think that's when I as a therapist feel the most stuck of like, there are systemic issues here, there are like neurobiological vulnerabilities here, there's very little I can say. Like, yes, we can talk about their sensory profile and we can talk about how to recover. But at the end of the day, there's these very real systemic blocks that we're running into that I have no control of and that feels claustrophobic. That's like my word of the day, apparently. I feel very stuck when I'm in that place with clients.
PATRICK CASALE: Yeah, yeah. That's a great point, because there's nothing as the therapist that you can do to change that situation or their experiences, or responsibilities, even. And it's so challenging, because the system is not designed for folks who can't fit into that neurotypical model, especially, in the workforce. It's just, 99% of it just doesn't feel well-suited or set up with our needs in mind.
MEGAN NEFF: And then, also, thinking about kind of supports for disabled people of like, when someone… when they're functioning, there's issues with that word, but it… Okay, when they're functioning [CROSSTALK 00:19:34]. Yeah, when their function ebbs and flows, like, we don't really have societal support for people like that. I think, individually, we don't know what to do with ourselves when we're someone who's, you know, I can go from, like, speaking on a stage to be non-speaking and laying flat on the couch the next day. Like, there's not really a template for folks of us who have such a range, because there's so many spikes, and there's so many valleys, and yeah, there's not great supports built-in, we have to kind of figure them out ourselves. Which again, if you have privilege, you're able to do that.
PATRICK CASALE: Yeah, yeah. And I think that's the paradox here, right? Is like, but even with that being said, to share from our own experiences of recognizing our privilege, but also recognizing that we are currently stuck or feeling like we're in our own versions of our own autistic burnout of, we still have responsibilities to take care of, right? Like, I know, you have your kiddos, I have two businesses to run, those responsibilities don't go away. And that means that I have to get really laser-focused, and really intentional about what I'm saying yes to, and what I'm not responding to. 
And for the people pleasers and us, like myself, who I feel like I'm a recovering people pleaser, I feel like shutting off the world, there's this almost push pole guilt feeling of like not responding to people. And it feels good to have people in your life where you can just tell them very honestly, like, "I can't do this right now, this is all I'm capable of doing."
And for me, that typically looks like turning all the lights off and laying in bed, watching something that's mindless over, and over, and over again, and not able to do anything else. But there's a cost there too, with like, partnerships, and communication, and just connection. But that's really all I can do. And coming back from New Orleans, I laid in bed for almost a week and a half. Like, if I wasn't doing one or two things a day that I had built in, that was all I could do.
MEGAN NEFF: So, I'm having a new thought listening to you talk and like the picture of you in a room, lights off, week and a half, and knowing you, knowing that like, yes, Game of Thrones like is enlivening for you, but also knowing that you do thrive on relationship and connection. 
Okay, so here's the thought I'm having. What if the recovery from autistic burnout is depressing, like in the sense of like, isolation, darkness? Like, what a brutal Catch-22 if what we need for our bodies to recover are also things that disconnect us and like, slow our bodies down to a degree that we're then losing connection with the things that give our life meaning and joy. And yeah, I don't know. Yeah, like, can I ask how are you faring after a week and a half of like dark room recovery?
PATRICK CASALE: Yeah, one, I think that's a wonderful point that you just pointed out, like, you're spot on. The things that we need may also be the things that do lead to that depressive state. So, it is that Catch-22. 
And you and I are both ADHD. The ADHD parts of me are like, "This is fucking terrible. Like, laying here, doing nothing, not creating, not feeling energized, like not feeling like there's a spark or something to get excited about." And the autistic part wins every time, because it's like, waving the white flag, right? Of like, I can't. Like, I can't do more than I can do right now. 
But to answer your question, how am I doing now? I still feel it and I can't connect the dots between what is still recovery from surgery and what is also this autistic burnout piece. I think that they're both kind of intensifying the other. Does that make sense? Like-
MEGAN NEFF: Oh, absolutely.
PATRICK CASALE: I just feel like if I'm typically running on like at 100% right now I feel like I'm at like 20%. So, it's pretty depleted. And then, the question becomes like, how do you replenish that to even get to a place where you can at least get through the day and the tasks that you've created for yourself? I think that's a Catch-22 of being an autistic entrepreneur, because, in New Orleans, I was saying thinking, "Okay, you're going to Costa Rica to speak at a conference." Which I actually backed out of today and I feel very proud of myself for doing, "And then you're hosting a retreat in Ireland." And I just kept thinking, "I can't do this stuff. Like, this is my world right now."
And that's why I think the next month going into February, you know, I don't know when we're going to publish this episode, just for frame of reference, like, I'm going to be doing very little until I leave to go to Ireland in March because I want to conserve and like, regenerate, and replenish as much energy as I can. But here's the Catch-22 to that Megan, Ireland will then take all of it and more. So, you're playing this catch up game all the fucking time of like, how do I replenish? How do I recharge if I'm constantly depleting?
MEGAN NEFF: I wonder if, not necessarily better, but an alternative term for demand avoidance would be like energy scarcity mindset of, like demand avoidance is so logical, based on what you're just describing of you have to store up energy for six weeks to go do a 10-day thing and then you have to recover from it. Yeah, energy scarcity mode. Can we make that a thing?
PATRICK CASALE: Yeah, I think we could definitely make that a thing. I think we can do an episode on that. I mean, I think you're so right, because the demand avoidance, like you said, is very logical. When you lay it all out [INDISCERNIBLE 00:26:31]. Of course, I'm going to avoid doing this. But in reality, it's like, I'm just so aware of how much energy it is going to take and how much I'm going to be depleted, that you have to go into that scarcity mode of like, I can't give it anywhere else, because there's nowhere else to give it or to receive it.
MEGAN NEFF: Yeah, yeah. I'm thinking of, like, when I get an alert on my, you know, iPhone, or like, Apple Watch of like, you have low battery, would you like to go into low power mode? Where it's like, okay, all of the things that are draining power, we're going to turn it off. It's kind of like living in low-power mode. And then when that becomes your life, I think it's hard to not be depressed.
PATRICK CASALE: Yep, because that's really when you're in that mode, where, okay, you turn it all off, right? And you recognize that you're there or you're very aware of what's going on. But then you can't say yes to the things that do bring you satisfaction and joy, because you're depressed, and you feel rundown, and you feel antisocial. Like, I feel like I don't want to interact with people. And that's a good indicator for someone like myself to acknowledge like, this is where I'm at, because I thrive on the connection that I have. And for me to want to avoid that at all costs is usually a very good indication of like, okay, we've arrived here, and this is where we're at.
MEGAN NEFF: I love that you have a litmus test of like, this is my gauge of I know kind of where my power mode's at. For you, it's kind of how you respond to connections. For me, it's how I respond to ideas or books. And this was before I realized I was autistic. I've always been an avid reader. I love philosophy. I love kind of existential deep books and reading, and playing with ideas. When I can't pick up a book it's like, "Oh, my goodness, what is wrong with me?" And partly because I've had so much chronic fatigue, I could pretty much always sit on the couch and read a book. 
But those moments in my life where I couldn't pick up a book, I couldn't listen to a podcast that had ideas, I couldn't take in any new ideas, that was my litmus test. Pronunciation is a hard thing for me. You'll realize that by doing a podcast with me. I'm speaking make up words all the time. But yeah, so I think it's really helpful for people when they know what their litmus test, however you say that word is of, oh, this is a sign, I'm entering low power mode, I'm entering burnout.
PATRICK CASALE: I love that you just named that. Are you in that mode right now where books and new ideas are just [INDISCERNIBLE 00:29:21].
MEGAN NEFF: So, I actually can't tell. I was thinking about that as we started like, okay, am I in autistic burnout, or is this like winter chronic fatigue? And I think I've had chronic fatigue, essentially, since I had kids. So, it's hard for me to tease out what is burnout, what is chronic fatigue. 
You know, I make a workbook a month, which is a lot of work, but I've been able, right now I'm working on one about just how we relate to our thoughts and cognitions, and I've been able to really enjoy learning about some of these concepts and reworking them to the fact that I'm able to enjoy parts of it. To me, I'm like, okay, I'm not at completely, like, burnout mode. But other areas of my life are definitely, I can tell I'm in burnout mode. So, I would say, I'm like, yeah, 50%. If you're at 20%, I would say I'm at 50%, because I still have things that can spark my curiosity. When I'm in deep burnout nothing sparks my curiosity.
PATRICK CASALE: And I think that's the exact point right there, that's it. You just nailed it. Something can spark your curiosity, but if it can't that is a great indication that that is where you are, that you are in autistic burnout. 
And I want all of you listening to think about what are the things that spark your curiosity? What are the things that you feel really, like, energized by and passionate about, interested in? If nothing is coming to mind right now, if you're feeling any of the things that Megan and I are talking about, could be a very good indication that that's where you're at, as well. 
And I think one thing that we're not touching on and that's important to name too, is I think, when you are in autistic burnout substance use is going to ramp up, drastically. 
MEGAN NEFF: Absolutely, absolutely.
PATRICK CASALE: And I noticed that for me that I was out of a fucking retreat in New Orleans, which is a city of debauchery and surrounded by 20 people that I had to be on for the entire time, so alcohol is my best friend at that moment, because I was messaging you about that of like, the socializing piece, the dropping into the, "Socially [CROSSTALK 00:31:37]" Right? Of being able to interact with people, to be able. To have some semblance of small talk alcohol has to be the lubricant for me. And acknowledging that is the realization of like, you have to pay attention to that for yourselves, for any of you who are listening, like, whatever the substance of choice or process of choice is, because it can get dangerous very quickly, and it can get out of hand very, very quickly, too.
MEGAN NEFF: Yeah, yeah, yeah. So, this is interesting. This isn't something I've talked too much about. I hope to talk more about, because I think it's a really important part of being neurodivergent, of burnout. But I have struggled with disordered relationship to alcohol in the past, and particularly, around burnout. 
So, it's interesting. I'm curious about… there's something I've noticed. So, my spouse and I respond really different to alcohol. For me, it energizes me. For them, he's like ready to go to sleep after a glass or two of wine, or beer, or whatever it is. I noticed among autistic people and this is totally anecdotal, I noticed that it tends to be more energizing for them, which I'm really curious about. 
So, for me, I often used it to energize and as like liquid dopamine. So, if I had papers to grade or some tedious task, and I was in burnout, then I'd be like, "Oh, well, I'll pair it with some wine tonight." And that became… like, because I could not mobilize. And it was before I knew about ADHD and autism, so I had no like medication support around dopamine and stimulants. 
So, I think whether it's socializing, because it takes a sensory edge off, and it makes socializing easier, or whether it's to try and motivate us, or because it gives us this kind of faux sense of regulation and energy, I think there's so many reasons we're really vulnerable to, particularly, I would say alcohol during burn out.
PATRICK CASALE: I agree 100% and with everything you just said, including the energizing component. And you know, there's such a cost to it too, because you don't sleep well, and then you throw in alcohol into the mix. And I mean, it's just so challenging. 
So, really trying to, you know, figure out, for our listeners, too, you do a great job, Megan, I want to highlight this of like, really posting valuable, tangible content where you can put it into motion immediately and start putting it into place. And you talk about sensory soothing a lot, and you talk about skills and techniques to kind of manage burnout when you're in it. And I'm just curious about things that our listeners who may not be mental health professionals and have access to the things that we do, that they can do when they're experiencing some of this stuff.
MEGAN NEFF: Yeah, yeah. I've got cascading thoughts happening. So, on one, I think, identifying those self-soothers that are like faux self-soothers. Like, they're self-soothing in the moment, but they're actually making your burnout worse. So, things like alcohol use or other substance use. I would think identifying those and really targeting those things, because those create a cycle, a loop that then perpetuate the burnout. 
And I think for a lot of people working with a medical provider or mental health therapist when they're targeting those self-soothers that are actually in the long run causing more harm, it can be really helpful to work with someone around those things. 
And then, yeah, I talk about sensory detox a lot, sensory soothing. You have to have some interoceptive awareness to be able to identify when you're sensory overloaded and then soothe yourself. So, sometimes you have to actually go back a few steps and kind of work on interoceptive awareness, which there's some kind of simple mindfulness. That sounds like a big thing, work on interoceptive awareness, but there's simple mindfulness things. Like, I have a smoothie right here, I can grab my smoothie, I can focus on the sensation of the coldness on my hand and what that feels like, I can do that for 10 seconds while I drink my morning smoothie. And by mindfully attending to the sensory experience, putting my smoothie down, noticing the difference in my hand, that's interoceptive awareness builder right there. And it's not an extra I have to do in my day, it's when I'm grabbing my coffee or my smoothie. 
Wow, I'm like diverging all over the place, so interceptive awareness, sensory soothers, like using all the kinds of sensory accommodations that can be helpful, and it often, I think, takes a lot of experimenting, especially, for later in life diagnosed people and high maskers who maybe are so disassociated from the body by the time they get to diagnosis or identification. It takes a lot of experimenting to figure out what is soothing for my body? What does my body, like? What doesn't it like? 
So, giving yourself a lot of kind of play space to figure that out. Rest, there's lots and lots of rest, dropping demands, and those can be small. Like, sometimes we think, "Well, I can't leave my job." Or "I can't, you know, walk away from my business." 
For our family, there's some demands that can always be dropped, for example, family dinner. If someone is having an overloading day they can eat in their room, they can eat in a quiet space. That's an example of a more simple demand drop or maybe not showering that day. Like, there can be these more simple demand drops. But I think thinking through where can I drop demands. 
And spending less time masking. So, figuring out who are the safe people to be around who I don't have to mask as much. Are there things I can say no to? To say no is huge, just like working on boundaries. And then that gets into people pleasing. 
And, again, working with a therapist, I think around why I say no hard can be really helpful. I just spewed off a random list. There's more and I think I have a few blog posts that talk about recovery tips, we can link to that. You're going to get a more linear version of me when I write versus when I talk.
PATRICK CASALE: I like to get both versions because both are unbelievably helpful. And I just learned a new word today from you. So, interoceptive, I did not know that term. So, here we are. 
But these are great tips. And I think you're so spot on when it's like different things are going to work for different people. And it's so easy to say like, here's a list of 10 things to try things out. You know, for me, I always need to take hot showers, and like I've always been obsessed with them.
PATRICK CASALE: And I never realized why I take two showers a day. But now I have a very good understanding and just doing those types of things have been really helpful. And, again, hitting home on having a neurodivergent affirmative therapist really important. If you're, you know, struggling and you're autistic, if you're ADHD, if you have any form of neurodiversity. Like, having good therapy is so crucial. 
And yeah, being able to unmask, like Megan said, so when you go on a podcast with your friend, and you know each other you don't start with the conversation with, "Hey, how are you doing today?" Knowing that Megan is going to say, "Oh, that's a really bad question." But those are the things, right? That we were talking about, the little things that build up. So, if you can remove these little things from your day-to-day, like the energy it takes to revisit your emails, the energy it takes to communicate with your friends or your loved ones, it's really helpful, because it's just that one extra fucking thing that you don't have to do, or you don't have to worry about, or you don't have to put your energy into. And I think it's so hard when everything takes that extra little bit of energy,
MEGAN NEFF: Yeah, absolutely.
PATRICK CASALE: Well, this has been a really great conversation about a topic that I think is, obviously, near and dear to our hearts and that we know a lot of you are experiencing in the moment or have experienced. And I hope that this has been helpful. And we're going to continue to have conversations about these topics that a lot of people are just not having. And I think that getting this perspective is really great. 
So yeah, I don't have anything else to add today. I think I'm hitting my limit. So, I'm going to be honest about that on air. And, yeah, I think that's where I'm at.
MEGAN NEFF: I love that. And that's perhaps the best you asked about, like, what can people do to help with burnout? I think that's actually probably one of the best things is to recognize when we're at our limit and honor it.
PATRICK CASALE: Yeah. I've gotten used to now post-surgery two things a day. And my schedule is my limit. And that used to be really hard. And it's getting to be a welcomed part of my week where I can say like, all right, I get to talk with Megan for my second thing of the day, and then I'm done. 
But yeah, I think for any of you listening, all this information will be in the show notes, too. All the links to the blogs Megan's talking about, and the articles. And I just hope that this has been helpful for everyone, too. We still don't know how to close this podcast out, so…
MEGAN NEFF: Didn't we come up with like an awkward…?
PATRICK CASALE: Yeah, we're just going to say goodbye and then turn it off.
MEGAN NEFF: Yeah, but we had some kind of tagline. I'm trying to remember at the moment, like the place where we do awkward goodbyes, goodbye.
PATRICK CASALE: The place where we do awkward goodbyes on the Divergent Conversations podcast coming out every single week. Goodbye. 
MEGAN NEFF: Perfect.

Wednesday Dec 28, 2022

Have you ever felt like there was some big mystery that you could never solve as to why you acted and thought the way you did?
Maybe you were told that you are neurodivergent but struggle to understand what that means for you.
Do you feel tired of masking and don't know where to find a voice that will speak out, be supportive, and educate about neurodivergence?
This episode is for you.
Top 3 reasons to listen to the entire episode:
Understand what it means to be autistic and how it can be easily misdiagnosed and misunderstood.
Identify the many ways in which autism shows up in a person and its diversity.
Understand what it means to mask and how this reflects in and shifts the dynamics of relationships.
In this episode, you'll hear from Dr. Megan Anna Neff, Psychologist, and Patrick Casale, MA, LCMHC, LCAS, 2 Autistic-ADHDer Therapists, and see what this podcast has in store for you.
MEGAN NEFF: Hey, I'm Dr. Neff, I'm an autistic, ADHD psychologist.
PATRICK CASALE: And I'm Patrick Casale, I'm an autistic, ADHD psychotherapist. And this is Divergent Conversations. And we are really happy to start this podcast together. So, Megan, episode one, we've been talking about this on Instagram and are making this a reality. So, do you want to take over and just kind of tell everyone what we're doing here?
MEGAN NEFF: Yeah, so we have gotten to know each other through, we recorded two podcasts together on your podcast. And then through messages, realized that it felt like we had a lot to talk about, specifically, around autism and ADHD. And we wanted to create a space where we could have more of those conversations.
PATRICK CASALE: Yeah, and I think that's the really important part for our audience is to have those conversations. Megan is going to talk a little bit about all the content that she creates and puts out on her Instagram, and all the resources, and the things that she does. 
And it's really important to also be able to have authentic, real conversations that our audience can listen to and participate in. And we want you all to be listening and just feeling like there's a place for you and there's a safe space for you because we realize so often that we get so much feedback about the work that we put out and it's just really important for us. 
So, Megan, did you want to talk a little bit about what you're doing behind the scenes, outside of this podcast?
MEGAN NEFF: Sure. I think my mic, okay. Okay, yes, I do. But so, a little bit of context for my life. Do you like how I need to nail down the prompt there a little bit more? Like Patrick, that's too broad of a question. What am I doing here? 
PATRICK CASALE: Yeah, a little-
MEGAN NEFF: I think it'd be context for my life. Actually, I had that thought as we were, like, starting this episode, and even as you were like, Megan Anna, do you want to tell our audience what we're here about. I had that like moment of freeze, of like, "Oh, shit. Like, this is the kind of thing I haven't pre-scripted it, this is a summary statement, how am I going to summarize, like how this came to be?" 
So, it's interesting to be in this moment with you. We're creating a frame, but it's not yet established. And I'm noticing that autistic part of me is craving like, okay, what's the frames? What's the rules? What are we talking about here? So, that's my interpersonal in the moment divergent thought. 
Back to your question, what's my context? So, my context, I live in the Northwest in the United States, in Oregon. I have a small private practice where I work primarily with neurodivergent adults and I do some autism and ADHD assessments. I think I'm one of a small handful of neurodivergent-affirming assessors in the States. It's a slightly different assessment process. 
And then I create content on Instagram, mostly educational content. Neurodivergent Insights is my handle over there. 
Part of what I've been noticing I'm longing for and one of the reasons I'm really excited for this project to get started, is that a lot of what I do is education. And the things that really get me excited is where I'm talking more vulnerably about the experience of being an autistic ADHD human. And I think that's what I noted in the conversations we've had in the past is, it felt like we could go there pretty easily. And so that's what I'm hoping for this project is that we're able to grapple with both the joy, and the grief, and the complexity of what it means to be a neurodivergent human on this earth.
PATRICK CASALE: Yeah, I love that. And I appreciate you also naming your vulnerability in the moment because I think that's going to be an important part of this process of like, yeah, I need the prompt and I need it to be concrete right now. 
And it's so interesting how we are processing this experience very differently in the moment because as someone who… let me circle back and backtrack, I will give some context now. I am in the southeast in Asheville, North Carolina, originally from upstate New York. I own a group practice here, Resilient Mind Counseling, made up predominantly of neurodivergent therapists, and prescribers, and entrepreneurs. We specialize in ADHD, and autism, as well as the LGBTQ community. 
And then I also own All Things Private Practice, which is a private practice coaching business where I help therapists start and grow their businesses throughout the country and have a podcast, the All Things Private Practice Podcast, and host domestic and entrepreneurial international retreats. 
I notice as I'm talking right now, I'm like, "Ooh, do I even know my context or my bio?" I hate bios. So anyway, I think that, you know, the two episodes that you've come on my podcast and we've talked about our own experiences for me have been really freeing because it's really enjoyable to talk with someone who gets it. And we can almost, like, read and pick up off of each other's energy and experience. 
And I remember the last episode you were on with me where you looked at me and you stopped talking, and you were like, "Wow, this is really fucking dark right now." And I think what happened in the moment because I've been getting feedback about that episode recently of like, "Oh, my God, it wasn't dark at all, it was so validating, it was so helpful." 
I think what was happening is we were picking up on each other's vulnerabilities. And we were really absorbing the pain, and the grief, and the struggle that we both experience on a daily basis. And even though we were putting the information out there very succinctly, and very real, and authentically, like, I think it was the energy that was being transferred back and forth is what we were experiencing that day, perhaps, and I'm excited to see where this goes. 
And you mentioned to me on Instagram, like, this has to be real, like this cannot be cookie cutter. Like, I want deep conversation, I want real, authentic relationship. And I look into our lives and other neurodivergent folks who come on the podcast as guests really being able to be vulnerable and share their stories, too.
MEGAN NEFF: Yeah, yeah, absolutely. I think that's something you and I have talked about in our conversations is, we crave place for complexity, place for nuance. And I hear a lot of people talking about that these days, that with so much communication kind of gravitating towards social media and these online spaces, I think we are losing the ability for some of those more complex, nuanced conversations. 
And when it comes to neurodivergence, it is a really complex experience. And so, we have to have space for this complicated, like, what is the word I'm looking for? Paradoxical. Like, when you're trying to hold to things intention, we need space for this sort of paradoxical conversations. They're hard to have, you know, in a 90-second reel, or a single post, or even a blog post, it can be a bit complicated to try and host that sort of nuance.
PATRICK CASALE: Yeah, absolutely. And I think it's so hard to capture in those moments because things can be misinterpreted if you're [INDISCERNIBLE 00:07:32] a 90-second reel. You can only put so much information into that. And it's so easy to pick something like that apart, and to really have longer conversations, and really get into some things that are really deep. And like you said, paradoxical. There's a lot of, all things can be true in a lot of these conversations and I think that that can be really challenging too, to try to make sense of. 
And I want to give some background on both of our, you know, stories as autistic, ADHD people before even delving into the mental health component, and the entrepreneurial component. Like, life has been pretty hard in a lot of ways for both of us. And, you know, like Megan just said, there's challenges moment by moment, and a lot of these days, and just trying to figure out how you're feeling, and what you're experiencing, what's coming up and reacting appropriately in those moments is quite challenging. 
So, you know, I am a late-diagnosed autistic adult who was diagnosed last year after kind of having plenty of suspicion most of my life. And after telling most of my close friends and family, they were not surprised. But I certainly was. 
And Megan and I have talked about grief before in terms of diagnosis, and it was challenging. And I think it was also liberating and that feels paradoxical in a lot of ways.
MEGAN NEFF: That's so well said. I had such a similar experience around… Well, I think at first came to liberation for me. And for me, this is a very familiar story, especially, for autistic adults. And I see this a lot, particularly, among autistic moms, is that it's after a child's diagnosis that we discover ourselves. And that was very much my story. 
And at first, it was so liberating because I'd been in-depth therapy for about four years and I had probably 100 questions or mysteries, that frankly, I was working to come to acceptance of, I will never know why I'm the way that I am. So, I was working to accept that my existence was a mystery. And then what fell into my lap was this one thing that explained all the mysteries and that is such an empowering, freeing, liberating experience. And then came the grief. Like, so the law aberration, and then the like, oh, wait, these are permanent limits, this fatigue it's probably not going to go anywhere anytime soon. 
And holding the both of that has been so important for my journey. And I think you and I are both staunchly in the neurodivergent affirming world. I think it can be a little bit harder to talk about the grief, and still sound affirming or be affirming. But I think it's deeply affirming to honor both experiences.
PATRICK CASALE: I completely agree. And I think that is one of those things that feels really, really challenging to make sense of and to discuss openly and freely. And, you know, to honor other experiences, too. 
And I just know that my diagnosis came with grief immediately where I was just like, "Oh, well, this could have explained a lot when I was growing up had I known and had my parents ever decided to pursue any sort of support." Which they did not. 
And then it came with a lot of questioning and then a lot of putting things together like, "Oh, that makes sense. Ooh, my Thai Beanie Baby and Garfield collection at an early age makes a lot of sense now." 
And, you know, I think I see myself like really struggling in the social aspect of all of this in terms of where things ended up landing for me and just realizing like, that's why it's been so hard to make so many friendships and so hard to feel connected. And like you were saying, like searching for your arrival point.
I often thought that like, "What the hell is wrong with me? Why can't I connect with people? Like, I know, people care about me, and they love me, and they tell me this, and I can make sense of that rationally. But I can't feel it, I can't absorb it." And I often don't feel that that feeling in a way that is also shared. 
And, you know, I always made sense of the ADHD part. And I think that society does a good job of kind of helping cishet white men come to terms with being ADHD. Like, it's like almost expected in a way at times, of like, yeah, you're a young white man. Like, you have all this energy and like, this is just who you are. And it's so much more complex than that. And also true to some degree, like majority of our research is done on white men and boys in particular. 
And, you know, I think that this last year has been really freeing because now I can say to myself, like, I understand my energy limits, I understand what I do, and don't want to socialize and who I want to socialize with. I understand that I'm going be using sensory or soothing tools most of the time when I'm socializing. And I just have to really be aware of where my energy goes. And I also know, like, you said, like, oh, this is lifelong. Like, okay, this is something that I'm going to be managing and struggling with throughout the duration of my life. And I think that's hard to still come to terms with at times.
MEGAN NEFF: Yeah, yeah. This is kind of a random association to something you said. But you mentioned kind of the cultural script about being a white cishet, ADHD male. And also, thinking about the fact that you are a late-in-life diagnosed white cishet, autistic man. Some of the people I work with that struggle the most with diagnosis and with imposter syndrome are late in life diagnosed white cishet men because like, for me, I feel like, well, of course, I wasn't identified. I'm a woman, I present in these other like, non-stereotypical ways. So, when you can have something to point to of like, it makes sense I'm late identified, I think in some ways, I mean, there's other challenges that come with that for sure. But it makes sense of the later diagnosis. 
I also feel like sometimes I have to catch myself of, it's like there's a split that happens of like, genderqueer, BIPOC women autism, like, and then those white cis men who get the diagnosis early. And so, then it's like, I don't know. I don't know if you've felt tension around that. But it's something I've been thinking about lately of partly the split, and I don't even like how I always talk about it because I realize I talk about it as if white cishet men with autism, wow, that was a word slip, autistic men have some kind of privilege as if they aren't also experiencing a lot of complexity around this.
PATRICK CASALE: Yeah, and this is why we started this podcast because this… my thought process right now around my response is complicated. And it's so interesting because as someone who was late diagnosed, not knowing this throughout most of my life, you know, I don't think I would have ever, you know, had any thought or knowledge that I could fall into, you know, the neurodiversity, you know, marginalized community. I don't think even, you know, I pass, obviously, very well, in most instances, and I didn't have to think about it, you know? I don't think I had to feel forced into thinking about identity because I have so much privilege. And it's so complicated because I also struggled so fucking much growing up. And childhood was hard. Adolescence was hard. And adulthood was hard. 
But I know that it's harder for a lot of people. And I think that makes it challenging to carry both and to really conceptualize both are true. And again, lots of paradoxes here and just, yeah, I don't know. I feel like it's challenging. And it's heavy. It's just heavy. 
PATRICK CASALE: And, yeah, go ahead, I'm sorry. 
MEGAN NEFF: Well, I was just going to jump in, like, this is part of the complexity of identity, right? Like, both you and we're part of a neuro minority and a lot of our pain is associated with that. We are also very, very privileged within our neuro-minority group, right? We're both entrepreneurs, we're both white. Like, I identify as genderqueer, it's… that could be a whole other podcast. I'm attached to the idea of being an autistic woman and I identify more as agender. 
But I have like, het or I'm in a cishet partnership. And I'm in a cishet partnership and I am cis passing and cis presenting. So, I've got a ton of privilege around, like, I've got cishet privilege, white privilege, economic privilege. 
So, we're in this space where we're very privileged within our neuro-minority group. And then within society, we also have this marginalized experience, and to be able to speak to both of those experiences, honor both of those, I think, I know that my privilege identities provide so much buffer from my more marginalized identities. And I think it's really important to talk about that, so much of autistic advocacy space is dominated by white privileged people who aren't considering the complexity around that. So, yeah, here we are episode one. And we've kind of tripped into this huge conversation,
PATRICK CASALE: Which is exactly, again, I want to just say this is what we want because staying above the surface doesn't work for either of us, and artificiality doesn't work. And it's so challenging to just not have real-depth conversation too. And we can also say that if we were recording prior to recording, you would have seen that Megan and I were using artificial intelligence to talk about a weird children's book that I had it write today and all sorts of other shit. So, like, you know, rabbit holes galore. 
But nevertheless, you know, I think it's important to just really name what you just named, and we'll continue to advocate and we'll continue to show up in honor and listen to people whose voices really matter. And we want to have a lot of those folks on this podcast, too. 
When you messaged me, originally, we were talking about this idea. And I think you said something that really stood out to me, which was something like, "I'll bring the chaos and you'll help organize it." And I feel like that could definitely be the tagline here. But it's so interesting how, you know, sometimes my autistic self like really is dominant. And other times ADHD is like, nope, I'm here like, this is my show. So, can you talk a little bit about that?
MEGAN NEFF: First of all, it's so funny. Okay, so I like Carl Jung, who's a psycho-analytic person, and he talks about the collective energy or the collective unconscious. And right before you said the thing about the chaos in the order, I was having the thought, because you were like, pulling us back out of this kind of complex puddle that I'd let us do. And you're giving like bird eye view, and I was like, "Oh, this is the chaos order thing." And then you mentioned it, so…
PATRICK CASALE: I just bought one of my staff who is a bit young and therapist and psychoanalyst union tarot cards and union socks for our holiday party that we just had, just wanted to name that. 
PATRICK CASALE: So, Zach if you ever listen to this, you're welcome.
MEGAN NEFF: That's a good gift.
PATRICK CASALE: So, anyway, the chaos and order piece and the organization of the chaos because I think that can flip flop all the time, right? Like, because there are definitely things that I really struggled with structure and orderliness around. And there are lots of people in my life who are like, they have spreadsheets for their spreadsheets and they're very happy about this. And I cannot make sense of that. Like, my brain doesn't work that way. Spreadsheets freak me out. But I know how helpful they can be. And I'm just curious about your processes in terms of when you've said that to me and just in general.
MEGAN NEFF: Yeah, well, I mean, you were even surprised. I think, partly, I took a screenshot of my computer and I had, you know, like, 15 browsers open reaction. 
PATRICK CASALE: Visceral reaction.
MEGAN NEFF: uh-huh (affirmative), uh-huh (affirmative). It's interesting, I think I present to the world more organized and perhaps more autistic than I am… like, my work process is very ADHD, which I'm sure is part of my stress. Like, if you opened up my Canva, which is where I make all my infographics, like, it is just a mess, there's no order to it, which makes it really hard to find like templates or whatnot. 
So, my process is pretty disorganized. I tend to somehow be able to wrap it up into a way that I think, like, when I present a infographic or a blog post, I think it has some order to it. But the behind the scenes is just like a messy closet of like whirlwind, which I'm sure contributes to my stress. And I wish I had the executive functioning to know how to create those systems, but that is not my strength.
PATRICK CASALE: Yeah, I appreciate you naming that. And those are the things that I feel like are my strengths. And then I have this system where internal chaos, it's more like my ideas are all in my head, but I never map them out. And I lose things or lose track of things so often. And it's so challenging. And I'm so thankful for the folks in my life who are either admin assistants, or virtual assistants, or the people who help me with those processes. And I just really struggle with it. 
But everything in my office right now has its place and is very orderly and is very clean. And if I walk into my wife's craft room right now, I would have almost a mini panic attack. So, I struggle with just stuff being everywhere, visually. And that is really overwhelming to me. 
But other than that, like, everything is very rigid in my thinking. And it's just interesting to see. You know, I think the ADHD parts of myself for entrepreneurial success a lot because I think that's when my creativity really starts to take over is when that part of my brain is really stimulated, and that part of me is just like. But then I also struggle with the fact that I will definitely hyper-fixate, and lose track of time, and lose track of things. And then all of a sudden, I don't even know what the fuck I was doing for the last hour.
MEGAN NEFF: Yeah, which that experience, right, can either feel so good or so terrible, probably depending on what's grabbed our attention for the hour. Like, I hate the feeling of wasting time. I think it's one of the worst feelings in the world. So, if it's been something like bad it feels terrible. And it's almost like I want to figure out how do I get that time back? I think it's just part of being really existential. And I see this a lot in autistic ADHD people of, I'm very aware I'm going to die, and so, I'm very aware, like, if I just wasted an hour scrolling, that's an hour of my life I'm not getting back.
PATRICK CASALE: Megan, I almost messaged you about this the other night. Like, it was like 3:00 am. And I was thinking to myself, but like, if I go to sleep now, that's an hour lost, right? Like, what if this is really important? What if this show that I really want to watch is really important, and very aware of like, okay, I have less time going forward. I have less time going forward. And I'm thinking about that all the fucking time.
MEGAN NEFF: Yeah, yeah. I'm curious what it is about autistic ADHD mindset. I notice we tend to do that more. Like, I know, for me, I definitely have a scarcity mindset when it comes to time and I imagine partly it's because my resources, my energy resources, my executive functioning resources feel scarce. I also imagine it's more than that, but it's certainly something I've noticed being more common among this group.
PATRICK CASALE: Yeah, it's like a video, game, lifeforce in a way, you know, while it gets depleted, you realize like, I have less and less ability, I have less and less capability right now. And I think that, if you're hyper-focusing or just very aware of how depleted you get, and how often you get depleted, and just know how valuable it is when you're feeling okay, or you're feeling good, or you're feeling just able to complete the task on your to do list like, I don't want to waste that. And those moments can be fleeting and it can be really challenging to kind of regenerate that energy again.
MEGAN NEFF: Yeah, yeah, yeah.
PATRICK CASALE: I think that before we started you were talking about my throat and my surgery and saying, like, "I don't want to waste this resource that we have right now." And you know, it's just that feeling of like, there's this urgency in a way. And I agree with you about the timeliness thing, that's really a struggle for me. 
Just thinking out loud, you know, about what we want to offer people who are going to be listening going forward. I mean, what are your thoughts on kind of what you want to offer this community, and who's going to be listening to this podcast?
MEGAN NEFF: Yeah, I hope that we can offer a space where there's some recognition. I think, even thinking back to the two podcasts we recorded on your podcast and the comments that I've gotten on Instagram, and that you've gotten a lot of those comments, the ones that felt really meaningful were around like, "Oh, either I feel really recognized in this or this helps to give me language around this experience I'm having." 
I think, there are so many experiences around the autistic ADHD experience that can feel really isolating, that can induce a lot of shame. So, I think giving it space, like breathing space, to talk about some of these things so that people feel less alone can be more gentle with themselves, is my hope. I think part of that will involve public learning, which terrifies me like, I'm already catching my brain ruminating on the conversation we just had around identity and privilege because it's such a sensitive topic. And I'm like, oh, shoot, like, what did I say? How are the ways that this… or maybe I wasn't as careful in my speech as I could have been, or this could be experienced by a listener?
But I think, for us to do the kind of podcast we're wanting to do, being okay with public learning and with diving into that complexity, which sounds, frankly, kind of terrifying and enlivening at the same time. But I think that will be an element of what we're doing here.
PATRICK CASALE: Yeah, I couldn't agree with everything you just said more than that. And there's going to be a lot of moments where there's going to be public learning. And I think whenever you're talking about just people, and struggle, and the complexity behind multiply marginalized identity, there's always room to grow and learn. And I just hope that we will continue to do that, and amplify voices of people who also are parts of community that we do not exist in, and just really making sure that we are trying to the best that we can to just show up and to honor space. 
And I don't think that people will agree with everything that we have to say about our experiences, either, you know? And I think that's a part of identity. And I hope that we're able to, like you said, just referencing people reaching out to us privately about either your work that you're doing on your Instagram, or our podcast episodes, or just whatever we've got going on to help people validate and affirm because so many people just either don't have language or experience, or just don't feel supported, or safe enough to talk about experience. And I think that's why we ultimately decided we wanted to do this. 
And I hope that, you know, it allows people to feel like even if they can unmask by themselves while listening, or it gives a little bit of liberation in a way, or it leads to late adult diagnosis, if that's something you're interested in, whatever it feels like that allows you to really align with who you are, and your identity, I think is really important here.
MEGAN NEFF: I like how you said that, yeah.
PATRICK CASALE: And I think going forward, you know, just trying to talk about how we're doing too while we're going through this process, you know, it's interesting to co-host something you're going to learn a lot about each other along the way and it's just an interesting back and forth process. And I love having conversation like this. And I also overthink conversation afterwards where I'm like, "How did I come across? Like, was I a douchebag that entire time? Did I overthink this or say too much?"
MEGAN NEFF: Yeah. I mean, and like, that's that classic masking self, right? I always must say this, someday I'm going to learn how to actually say it. But that experience of like going over past conversations with a fine, okay, a fine comb tooth? What am I trying to say? 
PATRICK CASALE: A fine tooth comb.
MEGAN NEFF: A fine tooth comb. I can never say that. Like, when you go over that past conversation with a fine tooth comb of like, okay, what did I say? How could it have been interpreted? I'm that anxious ruminating. That is so pervasive among high maskers. I mean, that, until I understood what was happening, I spent so many hours of my life doing that, I still do that. And I'm sure I'll do that with this podcast. But I do notice I do a lot less of it now that I feel like I'm living a less masked version of myself.
PATRICK CASALE: Yeah, I definitely agree. And I like that you name that for sure. I just want to thank everyone for listening to episode number one. And we are going to continue this process and just learn and grow as we go. And I think that this is going to be a really exciting journey to go on together.
MEGAN NEFF: I agree. You're looking at me like I should chime in here.
PATRICK CASALE: This is what I was talking about. It was like how do we close episode one? And that's what I'm thinking about right now as I'm talking, so like my words are coming out faster than my thoughts.
MEGAN NEFF: Have you always been bad at goodbyes. This is like an autistic thing. I really [INDISCERNIBLE 00:31:55] goodbyes. 
PATRICK CASALE: Yeah. I'm [CROSSTALK 00:31:57]. 
MEGAN NEFF: We just like end and have it be like a really autistic goodbye, where we don't have a greeting, we don't have an ending, it's just bye.
PATRICK CASALE: I kind of like that because, my God every social situation I've ever been in has ended like that. And it's always like, how the fuck do I get out of here before I can [INDISCERNIBLE 00:32:18] people can make eye contact with me or before like I have to say goodbye.
MEGAN NEFF: Or they ask for a hug. 
PATRICK CASALE: Yeah, they want… 
MEGAN NEFF: Yeah, yeah. 
PATRICK CASALE: Then I have to read, do I handshake, do I hug? [CROSSTALK 00:32:28] Do we just look at each other and nod? I mean, it's…
MEGAN NEFF: Yeah. I just always awkwardly leave and avoid the goodbye.
PATRICK CASALE: Yeah, I mean, I do that now. And I think I used to like linger in the space of like, "Oh my God, I feel like I need to say goodbye. I don't want to say it. I want to leave. I feel bad leaving." So much internal dialogue, for sure. So…
MEGAN NEFF: Maybe our sign-off can be something like a place where we don't do awkward goodbyes or a place where we do, do awkward goodbyes, goodbye.
PATRICK CASALE: So yeah, I like that a lot. So, a place where we do awkward goodbyes, goodbye. And then that could just be it.
MEGAN NEFF: I like it. Let's do it.
PATRICK CASALE: All right, well, a place where neurodivergent and I just said the name of the podcast wrong. This is a good glimpse into the creation world. But Divergent Conversations podcast, a place where we do awkward goodbyes, goodbye!


Divergent Conversations

Dr. Megan Neff and Patrick Casale are two neurodivergent therapists in a neurotypical world. During this podcast, they’ll talk about their own personal experiences as Autistic-ADHDers. They will reflect on their lived experience as AuDHD mental health professionals, and entrepreneurs, as well as offer clinical guidance, and support. Episodes will be conversational in nature, and they’ll interview other ND Folx to amplify the voices of other neurodivergent advocates and individuals as they share their authentic stories. New episodes will come out weekly, on all major platforms. Megan told Patrick, ”I’ll bring the chaos, You organize it.” This perfectly sums up their working relationship and friendship. Reflections of two neurodivergent clinicians. Raw, Vulnerable, Affirmative As Hell.

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