[FLASHBACK] Episode 24: Exploring Different Neurotypes: Ask an ADHDer [featuring Dr. Donna Henderson]
Jan 18, 2024
Show Notes
Ever wonder what the differences are between the ways non-Autistic ADHDers and Autistic ADHDers process and move through the world?
In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, talk with Dr. Donna Henderson, a non-Autistic, ADHDer psychologist, about her personal experience as an ADHDer, as well as explore the overlap and differences between ADHD and autism.
Top 3 reasons to listen to the entire episode:
- Understand what life looks like as an ADHDer in regards to things like executive functioning, sensitivity and reactiveness, conversational tempo, working memory, and task switching.
- Identify the ways Autism and ADHD can influence how we process information and engage in conversations, as well as how this shows up in relationships.
- Learn about what it really means to do self-care and how to break free from the generic standards of healthy living to act in alignment with what you actually need and want.
There is a surprising number of differences between the way Autistic individuals and ADHDers might experience the world. This episode only covers the experience of one ADHDer, so we encourage you to further explore the nuances and diverse perspectives of ADHDers.
More about Dr. Donna Henderson:
Dr. Donna Henderson has been a clinical psychologist for over 30 years. She is passionate about identifying and supporting autistic individuals, particularly those who camouflage, and she is co-author (with Drs. Sarah Wayland and Jamell White) of two books: Is This Autism? A guide for clinicians and everyone else and Is This Autism? A companion guide for diagnosing. Dr. Henderson’s professional home is The Stixrud Group in Silver Spring, Maryland, where she provides neuropsychological evaluations and consultations for children, adolescents, and adults who would like to understand themselves better. She is a sought-after lecturer on the less obvious presentations of autism, autistic girls and women, PDA, and on parenting children with complex profiles. She also provides case consultations and neurodiversity-affirmative training for other healthcare professionals.
- Dr. Donna Henderson's Website: drdonnahenderson.com
- You can grab Dr. Donna Henderson's books here: isthisautism.com
- Dr. Donna Henderson’s Masterclass on PDA (with Neurodivergent Insights): https://learn.neurodivergentinsights.com/pda-masterclass/ (As a listener use “PDA10” to get $10.00 off the Masterclass!
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Transcript
PATRICK CASALE: So, Megan and I are very excited to introduce our little miniseries within a series about interviewing different neurotypes within the neurodivergent and neurodiversity communities. We want to just put a big, big, big, big disclaimer out there that we understand that by interviewing one person per neurotype there are lots of different perspectives, different experiences, one person does not speak for the entirety of a neurotype. And we just want to really make that clear. But we are really excited today for our guest and our interview with our Ask an ADHDer. And I'm going to turn it over to Megan.
MEGAN NEFF: Yeah, so likewise, I'm really excited for this series. And I think it's kind of a playful series. And I'm glad you mentioned the disclaimer of, of course, we're not going to nail down all experiences in one interview per neurotype or however many we have. But I cannot think of a better person to be, kind of, getting us started on this process than Dr. Donna Henderson. I am just going to gush over to you for a minute, Dr. Henderson. I hope that's okay with you. I don't like when people gush over me. I hope you have more tolerance for it.
DONNA HENDERSON: I have mixed feelings about it.
MEGAN NEFF: Okay, we could process that, we have to. I am such a fan of your work, as you know. Dr. Donna Henderson has done a lot in, I would say, advancing the conversation around non-stereotypical autism. She and her co-authors just released two books this summer, Is This Autism? Which is a green book. And then the second one, Clinicians Guide. What's the other book?
DONNA HENDERSON: So, they're both called Is This Autism? And the subtitle is different.
MEGAN NEFF: The subtitle is different.
DONNA HENDERSON: The subtitle of the first one is A Guide for Clinicians and Everyone Else. And the second one is A Companion Guide for Diagnosing.
MEGAN NEFF: Got it. So, if you're a clinician, check out the blue book. And if you're everyone else, check out the green book. Am I oversimplifying? I'm sure I am.
DONNA HENDERSON: A little bit because we feel really strong… we wrote them as one book and we were very upset when they had to be divided into two books. But you know, I went way over my word limit. And-
MEGAN NEFF: Understandably, it's a complex topic.
DONNA HENDERSON: It is. And we really want clinicians to start with the first book because the first book tells you kind of know what to look for. And the second book tells you how to look for it. And if you don't know what to look for, it doesn't matter if you know how to use-
MEGAN NEFF: I love that-
DONNA HENDERSON: [CROSSTALK 00:02:35], yeah.
MEGAN NEFF: Okay, I'm actually so glad, like, that was just a divergent trail based on the introduction. But I'm actually really glad we had that conversation because I've been wondering how to recommend your books. And I've read the green one, not the blue one yet. And I remember thinking like, this is so much helpful information for a clinician in training. I want alternative programs to have your book.
So, yes, one of the reasons I love your book and I love you is because I think you're putting… So, Routledge just published it. This is a really academic, solid publisher. I think it's really hard for a medical provider to look at the case you put forward and say this is rubbish. And so that is one of the reasons I'm such a fan of your book is you're taking what is, I would say, known in the autistic community, and really putting kind of a research backbone to it, to where it's going to be hard for the field to continue to depend on stereotypical ideas around autism.
DONNA HENDERSON: Yeah, and that came from, it's the way I structure my reports. I literally use the DSM diagnostic criteria. And people have all kinds of feelings about them but I think if you actually understand the scope of them, and what they really mean, then they do make sense. And they can be very clinically useful.
And so when I write a report for somebody who is autistic and has been misunderstood over and over and over again by their health care professionals and everyone else, I literally write how they meet each diagnostic criteria because I want to arm them with that document, so a future healthcare professional can't say, "Well, I don't think you're autistic." Because they have the proof, you know?
MEGAN NEFF: Yeah, yeah, well, and now you've done that for a wide audience, which is why this is so valuable. Okay, I'm bringing myself back on track. So, other than these fantastic books, like, also, I've been at your trainings, I've heard your trainings, I've posted some of your trainings around PDA, around autism in girls. I know there's a podcast that has, like, gone viral where you walk through the DSM criteria for girls. So, you're well-known in this field as an expert on autism.
So, you being on our podcast today is a little bit different because we asked you to come on to speak from your personal experience as an ADHDer. I think it's so interesting, here you are at the forefront, I would say, of the clinical research around autism and you're an ADHDer, which you talk less about. I have heard you talk about it here and there, but I haven't heard you talk about it in depth.
So, first, I'm just curious, what is it like to be coming onto a podcast where it's not like ask the expert, it's let's talk to Donna the ADHDer?
DONNA HENDERSON: It's a little bit nerve-racking, you know? To do, you know, something more personal, but I ask people to tell me their personal stuff all day, every day. So, turnabout is fair play, I guess.
And I think one of the reasons I'm drawn to, you know, studying, and working with, and writing about, and talking about autistic people because what resonates with me is I was misunderstood for so many years. You know, I'm 58 years old. And so I had no hope of being diagnosed as an ADHDer when I was a kid. I was also you know, a girl who, you know, found school to be relatively easy. I messed up a lot, I didn't get the best grades, and all that, but it wasn't super effortful for me. And so I had no hope of being identified.
I got identified and diagnosed when I was in my, I think, mid to late 30s. And so I understand, to some extent, at least, what it's like to be misunderstood, and then to internalize all the shame and blame, and to, you know, blame yourself, and be really hard on yourself. And then to have that experience of somebody seeing you and saying, "Actually, this is what's been going on." And how unbelievably life-changing that can be.
MEGAN NEFF: Yeah. It's so liberating, so liberating. And this is something I think Patrick and I have talked about some, but I'd be curious what some of your internalized labels were? I think different and both shame-based, but I think some of my most, like, just aggressively negative labels I've put on myself is actually more from my ADHD than my autism. Do you feel comfortable sharing what were some of the internalized narratives that came online for you, having been undiagnosed till your thirties?
DONNA HENDERSON: Sure. Definitely, when I was younger, like in high school and college, lazy. I knew I was smart, I knew I was capable of, you know, advancing in my academic career, and yet, you know, I avoided hard work, I couldn't sustain attention or effort sometimes. And so, definitely, I thought of myself as lazy. And now I realize I'm absolutely anything but lazy.
MEGAN NEFF: Right, when you literally just came out with two books this summer.
DONNA HENDERSON: Yeah, so that's been a big change. But that was, you know, the first half of my life, I definitely thought of myself as lazy.
One that I'm still really struggling with is sensitive. I grew up with people constantly saying, "You're so sensitive, you're so sensitive." In a negative way. And I definitely internalized that as something incredibly negative. And now, I definitely still struggle with it and there are many times I wish I was less sensitive, and I get mad at myself for having such big emotional reactions. But at least I understand it's not a character or logical problem, this is my wiring. And that gives me a fighting chance of not, you know, blaming myself at the end of the day.
MEGAN NEFF: I love how you word that, not a character or logical, it's my wiring. Okay, so this is going to kind of trail us somewhere. And I'm curious what you mean by sensitivity? Because I know like emotional regulation is harder when we're ADHDers. But also, I'm thinking about like, HSP, highly sensitive person kind of phenotype. Something I see a lot in the autistic community right now are folks saying and I used to say this too, focusing HSP is just a repackaging of autistic traits. I've backed off that because I've now seen and, like one of my kids is an ADHDer who also wouldn't be considered HSP. I'm curious, like, does the HSP, that highly sensitive person, is that part of what you meant by sensitive? Does that fit your experience?
DONNA HENDERSON: I read that book so long ago, it's hard to for me to remember.
MEGAN NEFF: Yeah, it's-
DONNA HENDERSON: I could say, I'll sort of make a differentiation, I think. My sensitivity, I would say, most of it, is about me feeling judged or criticized easily.
MEGAN NEFF: Okay. So, like rejection sensitivity, emotion regulation sensitivity.
DONNA HENDERSON: Yes, exactly-
MEGAN NEFF: Okay, cool. No, that's what I was-
DONNA HENDERSON: It's very specific to that as opposed to a more general, like I just finished a parent interview this morning about their daughter who, you know, I don't know yet, but I suspect she's autistic. And my gosh, this poor girl is hypersensitive to everything, just everything, throwing out a used crayon, she feels really badly for the crayon, but like, you know, it's so generalized her sensitivity, and you know, sensory stuff, and all of that. I don't experience that level of very generalized sensitivity. For me, it's that specific sort of RSD kind of thing.
MEGAN NEFF: I love how you can put words around this stuff. Okay, so sensory, that's a big overlap, but I like how, again, you are… and I feel like another conversations I've had with you it's the globalness of some of the things that distinguish like autism from ADHD. But, yeah, what is your kind of sensory experience of the world?
DONNA HENDERSON: Yeah, so I think my perspective is that ADHDers and autistic people, one area of overlap with sensory stuff is hyperresponsivity to, you know, all kinds of things. You know, noises, lights, whatever. And I have a little bit of that. It's just a little though it doesn't majorly affect my life. I put on clothes that feel comfortable to me, that may or may not look great. But comfort is the most important thing.
If I have to wear something uncomfortable, though, it's not the hugest deal in the world. So, I would call it a minor hypersensitivity. So, as opposed to one of… well, I won't get into that story, never mind. I think that sort of hyperresponsivity is pretty typical in a lot of ADHDers. What I don't see a lot in ADHDers, but I see more in autistic people is hyporesponsivity, being less responsive to internal or external sensations. And I don't see a lot of atypical sensory craving. Sometimes sensation seeking if you have hyperactivity impulsivity, but not atypical sensory craving, like looking objects or smelling objects. That's just not typical.
MEGAN NEFF: I love that. Okay. And this is more question for clinical Dr. Henderson. I've often thought hypo responsivity and sensory seeking kind of went together. Like, if someone was hypo, then they might be sensory seeking because they're looking for that additional input. But am I kind of conflating ideas there?
DONNA HENDERSON: I mean, I think they can go together, but I think of them as separate things, you know? And when I think of hyporesponsivity, I think of interoception more than any other sensory system really, and like not perceiving, or contextualizing, or understanding, or responding to your internal sensations as much.
MEGAN NEFF: So, like, with interoception would you have pretty accurate understanding of what's happening inside your body?
DONNA HENDERSON: Me?
MEGAN NEFF: Mm-hmm (affirmative.)
DONNA HENDERSON: I think so. I mean, when I've learned about it, it never resonated with me, I'm like, "Oh, my God, that explains it." Now my son, who is autistic, he's 22 years old. He has really, really, really low interoceptive awareness. And it's so important, I think, for clinicians and for everybody to understand this because I think people call it denial if they don't understand the physiological basis.
MEGAN NEFF: Absolutely, yeah.
DONNA HENDERSON: And I remember once he was in therapy with someone for he has a really bad needle phobia. And this became a crisis when he needed the COVID vaccine, of course, and so he was in in therapy for that. And she was doing a hierarchy, and she had him watch a video of somebody getting a shot. And he literally, like, scooted his chair back, he gasped, he put his hand to his mouth, and she stopped the video and said, "So, you're feeling anxious?" And he said, "No, I'm not." And I think that therapist could mistakenly call that denial, which is a psychological defense mechanism. But no, he genuinely did not realize he was anxious and that's really global for him.
MEGAN NEFF: Yeah, yeah, yeah. I have so many thoughts, but Patrick, I've been hogging the conversation, so…
PATRICK CASALE: You can continue to hog it. I'm lost in my own head. So, I'm just paying attention and listening.
MEGAN NEFF: Patrick flew yesterday, he traveled yesterday.
PATRICK CASALE: Yeah, I had at 5:00 AM flight out of California-
DONNA HENDERSON: Oh, my God.
PATRICK CASALE: Got back to East Coast at 7:30 PM. So, my brain is not online.
DONNA HENDERSON: I feel you and I love it [CROSSTALK 00:14:58]. No, I was just going to say that. And you know what, that's something that has evolved for me as an ADHDer. I used to try to hide it a lot more. And now I'll say things like that, you know whether or not I have a good excuse like you do. I'm more willing to say in conversations, you know what? I just completely blanked out for no good reason. I actually really want to hear what you just said. Can you tell me again? And it's sort of freeing to be able to do that and not to constantly feel like I have to pretend I'm paying attention perfectly well all the time.
PATRICK CASALE: Megan and I just released our episode on masking. And that is just kind of the definition for me, in regards to communicating how I'm experiencing conversation or social interaction, is just to be like, I'm not really able to follow this or pay attention to this right now. I'm sorry. Like, I'm here, but I'm not here.
DONNA HENDERSON: Right.
MEGAN NEFF: Yeah, yeah, yeah. I think that's a beautiful example of ADHD and masking to be able to own like, I'm sorry, my brain's space off, I do care about you. One, I've been getting more and more requests for resources for ADHD couples. You know, Kate McNulty has a great book for autistic partners. But I am yet to find like a really good book for ADHD partnerships. And I think this sort of thing happens a lot where the ADHD partner, we get distracted or we misplace something significant like keys, and the other partner experiences it as us not caring.
DONNA HENDERSON: Yes.
MEGAN NEFF: And yes, so I love how you model that ability to be able to say, whether it's to your spouse, or to someone else, like actually, I do care about you, my brain just, you know, went offline for a minute,
DONNA HENDERSON: Right, but it's hard because, you know, it takes a lot of self-awareness on everybody's part. And then it takes communication on everybody's part. So, here's an example. I listen late. So, when somebody starts talking to me, it takes me a few seconds to realize, "Oh, this person's talking to me, and I missed the first sentence." Right?
And so my husband will walk into my, you know, I'm in my home office now. He'll frequently just walk in and start talking while I'm writing. And then by the time I realize he's talking, I've missed, you know, the important first sentence or two, and then he gets upset. Like, "Hey, how come you don't listen to me?" And so I've had to explain, here's what I need, I need you to walk to me, say my name, and wait for me to look up, and then problem solved, right?
MEGAN NEFF: I love that because I feel like that's like advice you give ADHD parents. Like, get their name, get some sort of, like, visual cue. That's been so helpful in my family since discovering, you know, the majority of us are neurodivergent is task-switching language. Like, so if a child now comes up to me because that used to happen a lot with children, I'd be hyper-focused. And I'll now say like, I need three minutes to task switch out of this, and then I'll be able to help you. And to be able to just have that language of like, "Give me a minute to task switch then I can actually take in your words."
But yeah, I think that was actually one of our questions we wanted to ask you was around like, task switching, hyper-focus. Sounds like you're-
DONNA HENDERSON: Oh, God, switching, it's like my nemesis. I mean, sometimes I switch too easily, right? I'm writing a report, I'm into it, and I'll randomly think, "I should check my email." And then I do. And I realized that that's not, I'm trying not to judge myself too much for that because, as Johann Hari says, in his amazing book on attention, you know, there are 10,000 engineers on the other side of your screen that are doing that to you, right? There are forces that have nothing to do with my ADHD that are pulling my attention in this culture that we're now living in.
But yeah, sometimes I switch too easily. And then other times, I can't switch when I want to switch. So, I wish I just had more control over my switching and as a hyperactive type ADHDer, I need a lot of stimulation. So, I tend to jump from one task to another, which is not good, you know? It makes you make mistakes, and makes up less efficient, and is sort of tiring. So, what's a girl to do when she needs a lot of stimulation, and which switch, right?
MEGAN NEFF: I call it my tree branch projects where I will like, I'll switch to something because it might be like, I'll check my email, but then, like, will turn into this huge project and like, I'll be five steps over on a project. And like, how did I get on this? Like, why am I making a new landing page with a new… Like, why? Oh, because I checked my email, and that led to this which led to this, which I think I've found ways to structure my life where I have space for tree branch projects, which I've noticed that reduces my executive, like, stress a lot just by having the bandwidth to be able to chase those. But it is really stressful. And it's like, I just want to get this thing done, but I'm five steps over here.
DONNA HENDERSON: Yeah, but what I'm hearing is that you sort of changed the narrative about it. And so it's not necessarily a bad thing when you go off and do a new project. It's a branch of the tree, you know? And every branch has its own place, right? So, just thinking about it differently could be helpful.
MEGAN NEFF: Yeah, yeah. And I think-
PATRICK CASALE: And because I think you can-
MEGAN NEFF: Yeah, oh go ahead.
PATRICK CASALE: Sorry. I think you can get into the narrative, you know, especially, for a lot of ADHDers of like those "tree branch projects" that Megan's referencing as like, "I can't finish anything, I can't follow through with anything. Every time I start something, I diverge somewhere else and that makes me really frustrated with myself." So, just the ability to reframe that and think about it differently. I think, like you're saying, Donna, is super helpful.
DONNA HENDERSON: Yeah, I'm really great at starting things.
MEGAN NEFF: This is where I think my autism really helps my ADHD is I typically do finish projects. There's a lot of unfinished projects, but I typically do because the stress of having, like the completionist in me, the stress of it having it incompleted it is too stressful. And I've often wondered, like, how do you all do it? How to ADHDers who don't have the support of autism, like, do it? So, yeah, like finishing tasks, how do you navigate that?
DONNA HENDERSON: So, when I'm doing something for other people, it's super helpful, like when other people are counting on me to get something done.
MEGAN NEFF: And is the RSD, like, helping with that then?
DONNA HENDERSON: For sure, for sure. And I think that's just part of my nature. And you know, what's important to me. Honestly, I get a lot of help. My husband has amazing executive functioning. I have terrible executive functioning. And so he makes a lot of decisions, he does most of our planning, and it works out really, really well for us. And I'm lucky, we didn't know this about each other when we got married, but it's worked out well.
And at work, I used to try to manage my own schedule and I was a disaster. I made constant mistakes. I would triple-check something and still get it wrong. And I've just remembered, you know, Bill [INDISCERNIBLE 00:22:31] he wrote some great books. He's my mentor, and I once showed up at his house on a night when there was no meeting, no plan for me to be there. I literally walked in, like, "Hey." And he and his wife looked at me like, "What are you doing here?" I mean, that's how calendar-challenged I am.
And so I finally accepted that. And so at work, I now have somebody who manages my schedule. And it takes all of the decision-making and planning off my plate. And I listened to your PDA episode and I heard you, you know, talk about you needing control over your schedule, that's the exact opposite of what I need. I love it when somebody else decides what my schedule will look like. And then I wake up in the morning, and they hand it to me, and I follow it. Yeah.
MEGAN NEFF: [CROSSTALK 00:23:23] I wonder if, oh-
PATRICK CASALE: Sorry. Well, it's interesting, that's-
MEGAN NEFF: I'm curious if that's one of those subtle differences between ADHD and autism. Again, there'll be diversity, but like, yeah, my autistic daughter, it's like, what is the schedule? Let's make it together. Like, there's got to be urgency in creating the schedule. My ADHD is like, "Stop giving me decisions." Like, just give me breakfast. Like, just tell me what to wear. Just tell me what we're going to do today. So, I hadn't thought about that before. But like how we feel about our schedule and who's in control of it [CROSSTALK 00:23:59] subtle.
DONNA HENDERSON: Yeah, it would be an interesting thing to think about. We'd have to sort out the non-PDA autistics from the PDA autistics, of course, and then, so many autistic people also have ADHD. So, it could be messy. But it's an interesting thing to think about, you know.
And for me, you know, the important thing is, knowing that about yourself, and trying to set up your life to accommodate that and not judging yourself. Like, I used to get really frustrated with myself for being so bad at planning, and scheduling, and all that. And now it's another one of those things I can own and say, "Yeah, I'm terrible at that, and that's okay. I'm going to get help. You know?
MEGAN NEFF: And that's the nice thing is if there's a lot-
PATRICK CASALE: That was actually going to be my question.
MEGAN NEFF: Oh, go ahead.
PATRICK CASALE: It's great, Megan and I are going to do this a lot today. That was going to be my question that you just answered Donna, was like, was there shame, and guilt, and frustration building up when, and initially it was like, why can't I do this? Why is this so challenging for me?
DONNA HENDERSON: Yeah, yeah, and I just kept thinking, "Donna, come on, concentrate, concentrate, you know, stop being so distracted." And get so mad at myself. And obviously, it's embarrassing too, you know, walking into somebody's house and just, you know, the million and one times I just screwed up my schedule. And now I have to laugh at myself and I have to be okay.
Dina Gassner said something really, really smart, wise, wise to me, once. Dina is an autistic researcher. And she wrote one of the forwards for one of my books, and she said, "The goal for any of us isn't independence, it's interdependence. It's understanding all the ways that you do and inevitably will depend on other people." And that's okay, right?
MEGAN NEFF: I love that, I love that. Yeah, especially, in psychology, there's a lot of focus on the individual. And I'm writing a book right now, Self-care for Autistic People, just kind of funny because I have a weird relationship to the term self-care because I feel like so much pop psychology is self-care, but without that interpersonal relational lens that, like, we are interdependent. Like, we have always been, modernity gives us the illusion we're not. But we do best when we're actually supporting kind of interdependence.
DONNA HENDERSON: Right, absolutely, yeah. I'm glad you're writing that book. I knew you were working on something. I didn't know it was that and I'm tired of all the self-care advice being exercise more, eat right, get enough sleep. Like, of course, those things are important, of course, they are. But you know, there's so much more to it than that. And those things are so hard for so many people, right?
MEGAN NEFF: Yeah. For both ADHDers and autistic people, right? Like, if you think about the executive functioning that goes into any of those tasks you just listed.
DONNA HENDERSON: Right, right, yeah.
MEGAN NEFF: So, like…
DONNA HENDERSON: Yeah, I'm going to try to think about how to say this without outing somebody. So, I have a challenging relationship with someone in my life who is not an immediate family member. And that person says hurtful things to me. And for years, I have then immediately, without thinking about it reacted and said things that I regret because I don't want to be hurtful or disrespectful, and also, because it just feels crappy when you lose it a little bit and say things you regret.
And I've been working on paying attention to what's happening in my body when that person says hurtful things. And so, you know, recently that person said something hurtful, and I was able to just notice, oh, my heart rate just escalated. Wow, like, I hear sort of a whooshing sound in my ears, my muscles just tensed and I feel like I'm preparing for a fight. And I was aware of my body. And because I could do that, it allowed me the three seconds of grace I needed to not just say something, but to respond in a way that I was proud of. And to me, that's sort of the beginning of self-care, to be able to notice what the heck is happening with your own body, right?
MEGAN NEFF: I love that. I love how you connected that, like, having that internal narrator of like I'm naming and narrating and, like, I sometimes call that self-attunement because we're attuning to ourselves. I love thinking about that as the basis of self-care. And I steal that from my book. I love that idea so much.
DONNA HENDERSON: Absolute, yeah. And I'm sure I'm not the first person who made that connection. But when I think about self-care, yeah, but I love that phrase. That's the first step is you have to be attuned to what's going on with yourself, you know, before you can do anything else, you have to know you're tired before you try to get some sleep. You have to know you're hungry before you try to put some food in your body. It's pretty basic,
MEGAN NEFF: Which gets back to that entire assumption, if it's not basic then nothing about self-care is basic, yeah.
DONNA HENDERSON: Right, that's true.
MEGAN NEFF: Can I… I don't know why I'm asking permission to diverge [INDISCERNIBLE 00:29:36].
DONNA HENDERSON: I know, right?
MEGAN NEFF: Because I'm very cognizant of like, I feel like I'm talking a lot, but there's one piece I want to make sure I get on our conversation today. And this is a conversation, I don't know if you remember us having it. It was probably one of the first or second times you and I had met. So, there's this term context blindness. I don't like the term myself. I prefer, like, I'll talk about out high context communication that gets into anthropology, which is confusing, need for high context communication. But there's a conversation where I asked, like, I was saying how, you know, someone asked me like, what's my favorite book? I really struggle with this. Do you remember this conversation?
DONNA HENDERSON: No, I don't.
MEGAN NEFF: And okay, so I asked you, and I was saying how like, I would struggle with that because I'd be thinking about what bucket are we talking about? Are we talking about psychology buckets? Are we talking about fantasy books? Like, how do I possibly pick one favorite book? What's the context?
And what you said, you were like, "Well, for me, if my neighbor was asking it, like this book would pop in my head. Whereas if I was at work, this book will pop in my head." And I remember asking you, "Like, you mean, you're not analytically like sifting through all that." And that was such an aha moment for me around, there's definitely something different for an ADHDer who's not also autistic around intuitively, I guess, picking up context cues would be the way to say that.
DONNA HENDERSON: Yeah. So, my friend, Dr. Amara Brooke, who's a psychologist-
MEGAN NEFF: Yeah, she's great.
DONNA HENDERSON: Do you know… yeah, well, she once in a conversation with me called it context independence. So, I liked it.
MEGAN NEFF: Oh, I like that term.
DONNA HENDERSON: Right. It was too late, the book had already gotten to press. I couldn't stick it in the book. But I liked it. It's context independence, right?
MEGAN NEFF: Yeah, because it doesn't depend on the context. I'm not going to change my authentic self based on the context.
DONNA HENDERSON: Right, right. And so there's no right or wrong. There's two different ways of, sort of, moving through the world. And for non-autistic people, for the most part, well, everybody has top-down and bottom-up processing, right? So, I'm going to oversimplify, but for most non-autistic people, the top-down processing is prioritized. And so we take the context first. And here's the key, that happens for us subcortically, automatically, within milliseconds without our awareness. It just-
MEGAN NEFF: And it's not through the prefrontal cortex, right?
DONNA HENDERSON: Correct. It's subcortical, right? Correct. There's no awareness, there's no effort the overwhelming majority of the time. It just happens like magic, right?
MEGAN NEFF: It's so [INDISCERNIBLE 00:32:25].
DONNA HENDERSON: But for most autistic people, there's more of a bottom-up processing where you have to take in all the details, get all the details, and sort of build up to the big picture from there.
And, again, not better or worse, but there are different advantages and disadvantages to each style. And a huge, huge disadvantage to the context-independent style, the autistic style, is the time, and energy, and effort that it takes to move through all of that information when you're under pressure to respond to somebody, right?
And so often, I get, you know, referrals for kids, or adolescents, or adults where everybody is saying, "We think they have slow processing speed." But on testing, their processing speed is just fine because testing does not require context. So, it's working tempo, it's conversational tempo that you might need extra time to build up to figure out the context. Does that make sense?
MEGAN NEFF: Totally, yeah. I see something similar that often autistic people are deep processors, not slow processor. Like, we're processing so much so deeply that it takes more time. Yeah, absolutely.
DONNA HENDERSON: Yeah, for sure, for sure. Especially, compared to, you know, a hyperactive impulsive style ADHDer like me, we tend to be fast, and, you know, I don't always go as deep. I'm capable of going as deep. But as I move through my day, it's not my natural way of being.
MEGAN NEFF: So, in my first Venn diagram was putting autism and ADHD together. I put high-context communication in the middle because I talk with a lot of ADHDers where it feels like they share a lot of context to get to what I think neurotypical people might call the point. Like, how would you categorize that in the top down, bottom down? Or is that totally unrelated? And also, do you also observe that in ADHDers or on also autistic kind of a high context way of sharing stories or divergent to the point.
DONNA HENDERSON: In the people I've known who are most context-independent or in the traditional term, you know, have the most context blindness, I haven't noticed, like, it would be interesting for me to go back and look how many of them also had ADHD, right? I think I might do that because that would be very, very interesting. And I've lost track of your question now.
MEGAN NEFF: I love that.
DONNA HENDERSON: I have no working memory.
MEGAN NEFF: Like, if high context communication or like, in telling a story needing to share a lot of context, if that feels like an ADHD thing, or, again, maybe [CROSSTALK 00:35:20]-
DONNA HENDERSON: No.
MEGAN NEFF: …autism, that doesn't feel like maybe it's too-
DONNA HENDERSON: No, to me that feels like if you don't intuitively have the context of what your listener already knows and actually needs to know or wants to know, you're at risk of giving too many details or too few details, right? And that happens sometimes too.
MEGAN NEFF: All the time. Like, I do this, I hear this all the time. I either I'm sharing not enough or too much. Like magical Goldilocks of just enough information.
DONNA HENDERSON: And to me as a non-autistic ADHDer, that's very intuitive. Like, how much detail to give someone in any given moment, and I'm not saying I, you know, get it right 100% of the time, obviously, but for the most part, it's pretty intuitive and easy for me to know that. And I've never had like a complaint about that.
MEGAN NEFF: That's fascinating. I did think that was kind of an ADHD thing to, like, share long-winded, verbose stories that diverged all over the place. But that's really interesting to hear you say that.
DONNA HENDERSON: Yeah, I think ADHDers, you know, sometimes we maybe talk a lot, or can be interrupting, or maybe go a little bit off-topic, but to have a pattern of providing too much what we would call irrelevant detail because that's really what you're talking about. I don't personally see that as an ADHD thing. It's not for me, it's not something I've noticed in my clients.
PATRICK CASALE: Sometimes I wonder if that being an autistic trait, if it's also because you're trying so hard to read the other person's body language and facial expressions of how are they reacting to said information. And if I'm not getting the reaction that I think I should be getting, then I'm offering more and more and more information. And then I get lost in that explanation. And then I'm like, "Did that even make sense?" And the person is like, "No, I didn't track that at all." My wife will look at me and be like, "Why are you telling me all of this?" I'm like, "I was trying to figure out where the reaction was to what I was saying, and then, ultimately, I get lost in that."
DONNA HENDERSON: And would it like feel natural for you or not to just like, what I would do in that moment is say, I can't read your reaction or I'm not sure if you want to hear more about this. Like, I would check in with the person verbally.
PATRICK CASALE: No, I don't think that comes to mind immediately for me, when I'm in a conversation like that. I think it's just like, I get this anxious process that comes over me where I'm like, "Oh, my God, I don't know where to go from here. And now I feel trapped in this conversation."
DONNA HENDERSON: And I wonder if that's, you know, partially just non-autistic conversations not being intuitive for you, and partially just having had bad experiences with conversations in the past, then they bring out that anxiety. And, like, so I don't happen to have either of those differences. And so for me, if I'm in a conversation, and I feel like wait, we're having a disconnect, the most natural thing is to be like, "Hey, I think we might be having a disconnect. What's going on? Like, what do you want? Do you want me to talk more or less? What's happening?"
PATRICK CASALE: Save me a lot of time connecting.
DONNA HENDERSON: Yeah.
MEGAN NEFF: And I do that too, Donna. And I think I've trained myself, like I have developed a hypervigilance, and I think this is part of autistic ADHD masking, a hypervigilance to other people. So, for me, like, gaining psychological safety in conversation is knowing what's happening. So, I'll do a lot of like, "Okay, what's happening here?" The only therapists that I've actually worked well with was someone who was willing to do interpersonal work with me because I don't feel psychologically safe in a conversation unless I can check in with the other person and get an honest answer about what they're experiencing in that moment.
DONNA HENDERSON: Yeah, that makes a lot of sense to me. And I think I've heard similar, you know, experiences from quite a lot of autistic people, late diagnosed autistic people, in particular, yeah, yeah.
MEGAN NEFF: Yeah. Okay, small talk. Like, I've heard you talk about bread crumbs. You pick them up, like do you like small talk? Do you tolerate small talk? Like, I know you're good at it.
DONNA HENDERSON: Yeah. So, I have to tell you this story. Sorry, I'm going to take a drink of water first. Sorry about that. So, I have a colleague who is autistic. And his name is Eric. And we've worked together for over a decade. And we work very well together. And I walked into his office one morning, I was in a big hurry. And I said, "Hey, the client you're seeing today…" And then I caught myself and said, "I'm sorry, that was so rude of me, how was your weekend?" And he laughed, and he was like, "Seriously, I do not need you to ask me about my weekend. I do that for you guys, meaning all of us non-autistic colleagues. And I'm good if we never ever do that again."
And to be clear, like, I think Eric and I like really like each other and work very, very well together. But he's like, "There's no need to get into any of those social niceties." So, that was probably two, maybe three years ago. I cannot tell you how hard it is for me to like, engage my prefrontal lobe and stop my natural way of interacting when I see him and not say, "Hey, what's new? How's your daughter? What's going on? You're taking a vacation this summer?" It's so hard.
MEGAN NEFF: But you're putting on a break to not do that. Like, for me and I think for Patrick, it's like forcing myself. It's like, I have to hit the gas to get myself to ask those damn questions that I really don't like. But for you, it's like putting on a break, it's holding something back.
DONNA HENDERSON: That's exactly right. And I feel like it gives me this tiny little window into what it must be like to be autistic and to have to be, like, very aware in the moment of this is what my urge is to do in this situation. But this is what I must do if I want this situation to be comfortable for the other person. It's hard. And I only have one person I do that with.
MEGAN NEFF: That's such a great example of the double empathy problem of like this two-way street of like, it's just a different cultural reference of how we're communicating. I had never thought about small talk that way as like, hard to hold it back. I have a lot more empathy all of a sudden for people.
DONNA HENDERSON: Well, but most of us don't hold it back, right? I mean, it's just sort of unnatural. Like, if I see one of my neighbors, I'm like, I will cross the street in order to just make small talk for five or 10 minutes because for me, that's very… Patrick's laughing.
PATRICK CASALE: [CROSSTALK 00:42:17] right now with my neighbor trying to do that to me the other day and me pretending not to hear them, and like getting in my car, and like backing out the driveway looking at them in the eye like…
MEGAN NEFF: I literally cross the road. Like, if I see someone I'm I going to cross, I will cross the road, but I'll do it soon enough, so it doesn't look like I'm doing it to avoid them. But I will cross the road even to avoid eye contact.
DONNA HENDERSON: Yeah, yeah.
MEGAN NEFF: Like, just to avoid, like, any sensory experience of interacting with another human body.
DONNA HENDERSON: All right, so I know you're supposed to be asking me questions. But may I ask you guys a question about this?
MEGAN NEFF: Yeah, absolutely.
DONNA HENDERSON: So, with my son, and he wouldn't mind me saying this, you know, as a non-autistic person, one of the ways I feel connected with other people is by connecting verbally, by talking. And it's not always deep and important. A lot of times it's, "So, what you're doing tonight? How was your day?" And kind of stuff, which is like the absolute last thing in the world he ever wants to do.
And so the only way I've ever figured out of really connecting with him is to sort of go entirely to where he is. He loves military history, so like to go to a battlefield with him, to go to a battle reenactment with him, which is like my idea of hell. But I do it because like, that's… but I don't know, like how to bridge the gap so it's not, you know, one way or the other way, but that we can build some connection. You know what I mean?
MEGAN NEFF: Absolutely, absolutely. First of all, I love that as a parent you're doing that. You're entering into their, I call it special interests, like our ecosystems, that you're entering into his ecosystem. Because you're right, like Patrick and I have talked about this a lot of, if you want to get access to the inner world of an autistic person, like entering through special interests. And I think a lot of parents who are trying to figure out how to connect with their autistic kids, I think that's often what they're doing.
DONNA HENDERSON: Yeah.
MEGAN NEFF: But yeah, it'd be nice for you not to have to go to like a historical event to connect with your son. And so, yeah, I think talking about it, like, and I don't know if there's a way of like talking about it without doing it. But that's often how, even if it's just to warm up the conversation, right? Because the questions are like, "What are you doing tonight?" Like, to me, that would be a sensory demand. But if the conversation has been warmed up through a special interest and then if we're able to then link to other things that, yeah, I think about it as a warm-up.
And again, from a nervous system lens of like, if it's just a question that's invoking a deep response, that's a demand, my nervous system isn't warmed up for social interaction. But if it's been kind of melted and warmed through talking about something of interest, and then diverging to something that might feel more connecting for both of you, that's one approach I take. I don't know, Patrick, do you have thoughts on that?
PATRICK CASALE: Yeah, I think that for people in my life, where I don't necessarily have safety, or I can be my true self around them, then that small talk, that demand, I'm going to shoot it down pretty quickly. And that's probably where I would really appreciate, you know, moving into the conversation through even a subset of the special interests or just something in general, that felt much more interest-focused.
But for people who I have regular contact with, like, several of my best friends, my wife, etc., like, there's definitely small talk that goes on just because the relationship feels safe. And I also understand that that's what they need in a lot of ways in order to have some sort of reciprocity in the relationship. So, I'm not like freely giving it out, I'm not going out of my way to have it. But I'm certainly much more amenable to that.
If my mom wants to call me right now. And like, say, "Hey, how was your weekend? How was your birthday?" I'd be like, "It was fine. It was fine." But it's just a very different relationship for me. So, I do think it matters for me, specifically, on the relationship, on the context of the relationship too, and the safety that has already been established in terms of just communication.
And I think it's complicated. Like, there are definitely times where my wife is asking me questions. And I'm like, "I don't want to have like the small talk conversation with you right now". And I will be able to name that. Megan's been able to name that with me before when I said, "Hey, Megan, how was your day?" And she's like, "Stop asking me that." So, I think it's about being able to also ask for what you need in that moment. Like, hey, stop asking me that because that's not helpful here. This isn't where you have to interact that way, that's really helpful for me."
DONNA HENDERSON: Right, right. And for me as a non-autistic person, it's also, I'm working on not thinking of there being a right way and a wrong way to interact. And it's really hard for me, it's really hard, yeah.
PATRICK CASALE: For sure.
MEGAN NEFF: It's hard to not think there's a right and a wrong way.
DONNA HENDERSON: Yeah, I think my way is the right way.
MEGAN NEFF: No, and don't we all as humans, too.
DONNA HENDERSON: Sure, sure, yeah.
MEGAN NEFF: Yeah. I'm like looking at the clock and now I'm feeling pressure of like, we should have some profound ending, I should have some profound question. Like, what is your favorite part about being an ADHDer? Or what is the hardest part? I don't know [CROSSTALK 00:47:56]-
DONNA HENDERSON: I want to bring something, yeah-
MEGAN NEFF: Yeah, go ahead.
DONNA HENDERSON: No, there's no pressure because we're just going to do our awkward goodbye in a minute and it'll be excellent. But I want to bring up one thing that I wonder about is a difference, and obviously, everybody's an individual, but working memory, I think about. I've met so many autistic people who don't have ADHD, who have absolutely phenomenal working memory. Like, phenomenal working memory.
MEGAN NEFF: Yes.
DONNA HENDERSON: And I as an ADHDer have, like, absolutely terrible, terrible working memory. And for those of your listeners who aren't super familiar, I tell kids, it's the blackboard in your brain where you can write something down while you're working on it. And I write in disappearing ink on my blackboard.
MEGAN NEFF: Same.
DONNA HENDERSON: And, you know, one thing I've noticed, just with family members who have great working memories, they think a lot about the past and the future. And I am almost incapable of thinking about the past and the future. I just am very much in the moment and that leads to my difficulty with planning. And it's good and bad, right? They are so much better than I am at planning because they can hold the future in their brains. And, you know, think of different scenarios and choose the best scenario, which is very hard for me to do, but they also obsess a lot about the past and the future, which I don't tend to do. So, it's just something I've thought about as a difference.
MEGAN NEFF: And that like, and I don't love this. I think, in general, we're going to find ways of moving away from ableist language but time blindness is how, like, that's often referred about of just the here and the now. And I love how you both see like what it gives you, but also what it takes from you, right? There is less of that obsessive. I think I've noticed that, too.
I hadn't connected the obsessive tendency toward, you're right, that lack of lack of time blindness, but like that ability to perceive the future and the past definitely leaves us vulnerable. Somehow I managed to have both. I both struggle with time perception and my working memory is terrible. But I also do think a lot about the future and the past.
DONNA HENDERSON: Well, maybe my theory is wrong, then.
MEGAN NEFF: Well, I mean, maybe it's part of being an autistic ADHDer, maybe there's, yeah.
DONNA HENDERSON: Yeah.
MEGAN NEFF: Do you do both Patrick?
PATRICK CASALE: I obsess about the past and the future constantly. And I'm a really good planner. I mean, I'm planning entire events, and retreats, or things that feel very natural to me. I really struggle moment to moment working memory where I will forget what I'm doing during the day all the time. I'll forget like, why I went down to the kitchen for something. I will forget like the three things that are in my mind that if I don't write them down immediately or respond to immediately they'll be gone. But everything else is constantly obsessing, and thinking about, and analyzing, and processing all the different alternative outcomes, so quite exhausting.
MEGAN NEFF: Yeah, that's my experience too, what you just described.
DONNA HENDERSON: As a non-autistic ADHDer, like, everything you just, I can't relate to that, that constantly, like planning, and obsessing, and running scenarios that you're… I'm like, "Oh, God, make it stop." Like, I just don't do that, which it's a blessing and a curse, right?
PATRICK CASALE: For sure. And, you know, I've said it very often that I wish I could just turn it all off. Like, I wish I could just stop it. And yeah, definitely, it's exhausting.
DONNA HENDERSON: It sounds exhausting.
PATRICK CASALE: And on that really negative note, this has been fun.
DONNA HENDERSON: I'll give you a quick positive, I don't want to end on a negative. Do I have time to do a quick positive-
PATRICK CASALE: Yeah, sure, absolutely.
DONNA HENDERSON: …so we don't end up… So, I tried stimulant medication a little bit over the past year, which I haven't really done in the past. And it really worked well for me in that it took away the urge to constantly move. I was able to sit still. I was able to get so much work done. But then I inevitably ended up with like a headache or my neck would be stiff, or my back would hurt. And I finally realized and I changed my internal narrative, my body is helping me out by wanting to move all the time. That's what my body needs. And I just need to lean into that and not try to fight who I am and my wiring.
PATRICK CASALE: I love that.
MEGAN NEFF: I love that. I love thinking through like, yeah, the ways your body and these things we call symptoms are actually working for you, and helping you out, and telling you what you need, yeah.
PATRICK CASALE: Absolutely, yeah. Well, this has been a lot of fun and I wish that… I'm surprised like the hour went like that. And it was really, really great to have this conversation. I feel like we could have continuations of this for sure and go down so many different, like, areas and different perspectives. So, thank you so much for coming on and just sharing some of your story, too.
DONNA HENDERSON: Well, thank you so much for having me. I agree, it went quickly and it was a lot of fun.
PATRICK CASALE: Megan, you any got anything before I awkwardly sign us off?
MEGAN NEFF: This is the part I get really awkward at. I'm so glad you came on Donna. Like, this has been, like, so fun to have this kind of hybrid clinical personal conversation. And thank you for your vulnerability. I know it is different to bring our lived experience to the conversation, especially, as clinical psychologists. We're kind of taught not to do that. So, thank you for being willing to do that.
PATRICK CASALE: Totally. So, for everyone listening to the Divergent Conversations Podcast, new episodes are out every single Friday on all major platforms and YouTube. You can like, download, subscribe, and share.
And Donna just made me realize while I was saying that we didn't give you any opportunity to share where they can find more of your work too. So, please feel free to-
DONNA HENDERSON: Oh, okay.
PATRICK CASALE: …share that as well. We'll put it in the show notes.
DONNA HENDERSON: That would never have occurred to me actually. I'm the worst with that. My website is drdonnahenderson.com. And the website for the books is isthisautism.com.
PATRICK CASALE: Perfect. All of that will be in the show notes so everyone has easy access as well. And now I don't know what else to say, so goodbye.
