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Episode 51: “What is Autism?” (Part 4): Special Interests and Complex Sensory Experiences

Apr 25, 2024
Divergent Conversations Podcast

Show Notes

Navigating a world packed with all sorts of seemingly mismatched sensations, either overstimulating or understimulating, and having passionate interests that can appear as all-consuming to others, can be challenging and greatly impact the way we build relationships and even just get through the day.

In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, talk about the nuances and misconceptions surrounding special interests and sensory experiences for Autistic people.

Top 3 reasons to listen to the entire episode:

  1. Learn about the role of special interests in fostering connections for Autistic individuals, and how personal sensory nuances impact relationships with oneself and the world around them.
  2. Gain insights into how to create more inclusive autism assessments that acknowledge the diverse experiences of Autistic individuals, including behaviors, sensory experiences, or interests that might be more stereotypically associated with allistic individuals.
  3. Understand the different sensory systems and explore the broad spectrum of sensory experiences that influence everything from social interactions and relationships to meeting basic necessities of food, clothes, and shelter.

Think about how we all experience the world differently and why it's important to make space for those differences so that we can honor who we are and have more compassion for one another.


For this conversation, we are using Is This Autism By Donna Hendreson, Sarah Wayland, and Jamell White. You can find it hereBut wait...

  • The publisher is giving our listeners a special coupon during this series! Use Code: NDI24 to get 30% off and free shipping Valid through 6-Jul 2024 (must purchase using this link)

Also, we’ll be reading this book together for our book club in June in the Neurodivergent Learning Nook. You can learn more about our community here.

DISCLAIMER: We're using the DSM-5 criteria as a framework for this conversation, and this is not our endorsement of the DSM. There have been a lot of very thoughtful critiques of the DSM in the last several years, and more specifically, how autism is presented in the DSM is very deficit-based. So, we are not in alignment with that view, but we did use that as a framework to walk through our experience of autism and to unpack the many ways that those criteria could show up in a person. The reason we chose to do this is that we believe in the power of transparency and demystifying the process of diagnosis, which has historically been very obscure and hard to understand. And so this is our effort for those who perhaps are interested in pursuing a diagnosis or who have gone through the process and want to understand it better. This is our attempt to help demystify that experience. It is not our endorsement of the DSM. Thank you for understanding that.


🎙️Listen to more episodes of the Divergent Conversations Podcast here


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A Thanks to Our Sponsors: Freed The Receptionist for iPad

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PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.

MEGAN NEFF: And I'm Dr. Neff.

PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health, and there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.

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MEGAN NEFF: Hey there. So, it is April which means it is Autism Awareness/Autism Acceptance Month. And we're going to be doing a series around here on unpacking what is autism.

We want to issue a pretty big disclaimer here. We're using the DSM-5 criteria as a framework for this conversation. And this is not our endorsement of the DSM.

There have been a lot of very thoughtful critiques of the DSM in the last several years. And more, specifically, how autism is presented in the DSM is very deficit-based. So, we are not in alignment with that view. But we did use that as a framework to walk through our experience of autism and to unpack the many ways that those criteria could show up in a person.

The reason we chose to do this is that we do believe in the power of transparency and demystifying the process of diagnosis. The process of an autism diagnosis has historically been very obscure and hard to understand. And so this is our effort for those who perhaps are interested in pursuing a diagnosis or who have gone through the process and want to understand it better. This is our attempt to help demystify that experience. It is not our endorsement of the DSM. Thank you for understanding that.

PATRICK CASALE: Hey, everyone. So, Megan and I are wrapping up our Autism 101: What is Autism? series that we've been doing as we've gone through the DSM, and we've kind of broken things down criteria by criteria.

We have gotten a lot of feedback that these episodes have been really helpful. And I think we're also going to do an ADHD series next. So, thank you for the feedback.

Today, we are wrapping up with special interests. And we are also wrapping up with… What did you just say?

MEGAN NEFF: Oh, that's interesting that you forgot that one. Okay, I won't analyze you. It's too early in the morning for that, sensory, sensory-

PATRICK CASALE: That's right. Sorry, brain is scattered, getting ready to leave the country on Friday.

MEGAN NEFF: Or maybe you don't want to think about sensory [CROSSTALK 00:03:40]-

PATRICK CASALE: I never want to think about sensory.

MEGAN NEFF: Exactly, it's obnoxious.

PATRICK CASALE: Dissociation by default. So, we're going to talk about those two things today. And wrap up the rest of this criteria.

And if you have questions about any of these things in these episodes, post them to our Instagram or send us an email. And we will happily try to do some follow-up on this stuff, too. Because I think that these resources are really helpful as we're kind of in the thick and midst of Autism Acceptance Month because it's the middle of April right now.

So, Megan, do you want to take it away from the diagnostic portion of this? Which is always what I'm going to just throw to you.

MEGAN NEFF: Sure, yeah. And we have a whole other episode on special interests. So, we can also, maybe, direct people to that as well. So, this is one where, I think, there's a lot of cultural misunderstanding about this, you know? If we think about shows like atypical and that really stereotypical presentation of autism. Like, I think penguins is his special interest in atypical. So, they're often presented as these really bizarre, irrelevant special interests.

In the DSM, it says, I don't know the exact wording, but it's like either kind of atypical or intensity. And I think that's the part that gets missed a lot is there's a lot of us who have, like social justice as a special interest or reading. Like, reading can be a special interest.

But no one's going to be like, "Let's get this kid assessed for autism because they read too much." Like, that's just not… You know, it's socially desired behavior.

PATRICK CASALE: And I'm so happy you named that and shared that example because that was kind of my childhood was that I was so immersed in reading, and like kept getting bumped upgrades for reading comprehension. And that's something my parents would say today, present day. Like, "We never thought to get you assessed for autism because you were reading all the time. You were a super smart kid."

Which is just unbelievably flawed and ableist as it is. But like, it was the reality of like, "Oh, this is a healthy habit." But if you're looking at intensity, right, that's a really big portion of this.

MEGAN NEFF: Absolutely, yeah, the intensity. And also, like, why is the person doing that? So, part of special interest is they have a really strong self-soothing aspect to it. So, like, is the person doing this to block kind of negative emotions or negative thoughts? Is this what they do to soothe? If they don't have access to this, do they become pretty dysregulated? Are they often either trying to gear conversations to their interest? Or like that manager who's like, "Okay, don't bring it back to books, don't bring it back to books." Right? That either you're working hard, not to always bring it back to your interests or you tend to, like, gear conversations to your interests.

PATRICK CASALE: Think about how much mental energy that takes to like, have that narrative, too, "Don't bring it back to books, don't bring it back to books." Try to insert something else that you are interested in or feign interest in something to, like, fit in, so that you don't get, like, picked on or someone doesn't say, "All you talk about is reading." Or, "All you do is A, B, and C?"

MEGAN NEFF: Well, and for a lot of us right now it's, "All you talk about is autism."


MEGAN NEFF: Like, it's mellowed out because yeah, I'm almost like four years in. But the last few years my kids were like, they did a funny, like, meme of our typical family conversation for us. And when they imitated me, it's like, "Oh, and this connects to neurodivergence and autism."

And it's like, I just kept… anything that came up I would associate it to autism. And I talked about this in the special interest episode. But it's because it was the lens I saw everything through. So, for me to meaningfully take something and like if my spouse is talking about soccer, if I can somehow connect it to autism or my special interest, that means I can remember and I can appreciate what he's saying to me.

And so, yeah, that tendency to just, like, when you're taking in new information you kind of anchor it on whatever your framework is, which typically, at least, through my experience is special interest.

PATRICK CASALE: Sorry, dog just walked in and that's going to bother me.

Yeah, and I think that's such a wonderful recognition of how that allows for you to then join in on that world, and conversation, and have that ability to be social and connected because it does allow you to focus more on…

And I think, when we talk about special interest, it can feel like really all or nothing in a lot of ways, too. And we've kind of talked about all-or-nothing and black-and-white thinking patterns in general. And I think that was the one that we could not really figure out. Like, the mechanism or usefulness in a lot of ways in terms of how this, actually, like help us in certain situations.

But special interest-wise, it makes a lot of sense. And I think this is why people get so confused when, like, autistic people are so immersed in like shows, movies, literature, etc. And if there's a character that dies, if there's a show that comes to an end, if there's a movie that just, you know, isn't going to be created or a sequel isn't going to come out, like, that can really actually have a massive emotional impact for us because we are so invested in our special interests that becomes a part of our world. And the soothing piece is really the piece I think that gets missed a lot too or misunderstood.

MEGAN NEFF: Yeah, absolutely, absolutely, that soothing piece of like there's a reason that we're talking about this or thinking about it so much. It's anchoring. It's grounding. Yeah, yeah.

One thing I thought of when you were saying that, so this, like, in one of my children, right? When they were younger, some shows, some of these, like, popular kid shows became a special interest. And like, that doesn't look atypical, right? Like, it's common for a kid to be really into Paw Patrol or whatever it was.

But what was different was then they were like, "I want to redesign my whole room that way, I want to play this character. When I play with my friends, I want to play the show." It's the pervasiveness of it. That's what's different.

So, again, from an assessment perspective, if it's like, oh, cool, you're into, like, psychology and understanding humans, and books, and you like this K-pop band, like that all sounds pretty typical. So, you have to look at like, how many posters do you have in here? Like, how much do you know about this band? You know, how many concerts it will… I don't know about concerts for us, but like, you have to dig deeper of what is the intensity of this hobby, or this passion, or this interest?

PATRICK CASALE: Yeah, that's a good point. And I'm glad you brought up assessments because I think this gives us some space to talk about, like, how can you build in to your assessment process? For those of you who are listening, or either clinical or medical providers space for special interest?

And the fact that you're mentioning intensity, and you're talking about frequency, and you're talking about, it goes a lot deeper than just surface level. Like, what do you do for fun? Or like, what's your hobby? Or like, what's your favorite book?

If I said to you, "My favorite book is The Lord of the Rings." And you're like, "Oh, cool. That's great. I like it, too." And we moved on, would you know that I read the book like 200 times? Like, would you know that I have, like, Lord of the Rings stuff all over my room, that it's like a coping skill when I'm really feeling burnt out. Like, we would miss a lot of that if we just kind of took that at face value.

MEGAN NEFF: And this is why I love the MIGDAS. So, again, for those who do assessors or for those who are like, "What should I be looking at when someone's like, 'This is what's on the assessment battery?'"

I really love the MIGDAS because it leads with interests and passions. And I like it for so many reasons. One, because it really centers that aspect of it. But two, by kind of starting the assessment interest forward, it makes it a much warmer experience than like, "Let's talk about all the things that are hard for you." It's like, let's start with what are your interests and your passions. Especially, for those who are looking to incorporate more affirming assessments, I highly recommend looking into the MIGDAS, too. I love that as an assessment.

PATRICK CASALE: That's a great point, too, when we're thinking about assessment. Like, if we're approaching it from an interests and strengths-based perspective, it's a hell of a lot easier to feel comfortable in that environment when you're there for a testing, evaluation, or an assessment, instead of going in with, like, really an intensified level of anxiety and dread. Because it's really easy to kind of get into that mindset of like, "This is a very sterile clinical environment. Of course, I'm going to answer questions a certain specific way." And that can really lead to a lot of missed diagnosis as well.

MEGAN NEFF: This is kind of tangent… I can never say that word, but I love-


MEGAN NEFF: …the word tangent. Yes, thank you. But I'm reading Adam Grant's new book right now, Unlocking Hidden Potential. And he's not even talking about neurodivergence. It's interesting, he talks so much about divergent thinking, but he doesn't talk about neurodivergence. So, I want to be like, "Adam Grant, like, connect to these things, please. I would love to hear you talk about it."

Anyways, he talks about interview processes. And there's actually someone who started a call center for disabled people. And I don't know if this person had autism in mind when they did this. And they restructured the interview process.

So, the interview process for people who have any kind of stigma, the stress of the interview process goes way up because of the fear of like, if there's any kind of stereotype of that person, whether it's a disability, whether it's a racial stereotype, that person stress and interview tends to go up and we don't see people's potential when they're under stress, and their working memory goes like way down.

So, this one person, how we reinvented the interview was he flipped it and he started with, talk about your passions and your interests. Like, that's the first. And I think that was actually in paperwork before the interview. And then when you come in for the interview, it's like you can bring a support person or a support animal. You come in and they're like hosting you versus interrogating you.

But I loved that idea of if you're in a position of interviewing someone, have them start talking about their passions and their interests. You're going to learn so much about them, I think for anyone. But, especially, for autistic people that's going to open us up in an interview setting so much more than, like, "Tell me about your strengths and your weaknesses."

PATRICK CASALE: Yes, like, what is your five-year plan? Tell me about what you, yeah, exactly. I love that perspective. I think I'm going to adopt some of that for interviewing some new clinicians. So, thank you for sharing that.

MEGAN NEFF: You're so welcome.

PATRICK CASALE: So, in terms of when we're looking at special interest diagnostically, you're mentioning intensity, you're mentioning frequency, you're mentioning the self-soothing aspect, what else should we be looking for?

MEGAN NEFF: The other thing is, it can sometimes be like atypical for age development. So, that could be an adult who's still really into like, stuffies or like, things that we would think are younger, or could be a kid really interested in pretty advanced things.

Like, for me, I've talked about this before, I know. But when I was 15, when my special interest became, mine have often been very justice-oriented. So, the child sex trafficking industry in Thailand.

And so I was like a 15-year-old and anyone who would listen to me, I'd be like, "You have to hear what is happening to these children in Thailand." And I would like go on a monologue. That's not what a lot of 15-year-olds are talking about-


MEGAN NEFF: …turns out. So, there can be that kind of age piece as well. That's another aspect of it.

PATRICK CASALE: Yeah, that's a great point. Because I think that that's a good way to take a step back and look at things from that lens of like, okay, where are we in terms of age range? And what feels like age era appropriate, too? What should 15 year olds be into?

And it's really interesting to think about it that way. And I'm sure like, that was on the forefront of your mind pretty regularly during that time period. And I'm sure you did a lot of research around it. And you were just like, there was a lot more than just like a concept. So, I think that's also important to notate.

MEGAN NEFF: Absolutely. Like when I was in college, whenever I'd be assigned a paper, I'd wrap it into that. So, if I was in an econ, then I would study the economics of the sex industry. If I was in a sociology class, I would study some of those social act pieces that contributed to it, if I was in a religion class, I was studying Buddhism, and like how that factors into it.

And from a learning perspective, it's great. And I was engaged in all these papers because I centered my interest. And I also had a really, like, deep understanding of all the systemic pieces that played a part of it. But you're just seeing that in each individual class. So, like, someone's not seeing that, like, every single paper I write in college is centering this one thing.

And then in seminary, it became African theology, that was the thing that I would, every time I could center a paper on that it would be that thing. But yeah, yeah.

One thing I also want to add, so back when I was doing assessments, one thing that I found was kind of tricky is if someone's ADHD dominant, this is a little bit harder to find. And so ADHD passions, and autistic special interest, in general, I think those are hard to tease out because they both have a lot of intensity.

One thing I have noticed is that with ADHD-dominant folks, feel, like cycle through their interests a bit more quickly, and sometimes won't have that, like, really enduring interest. And so that's, like, a tricky point I have experienced as an assessor in the past.

PATRICK CASALE: Yeah, I'm glad you named that. That makes a lot of sense, too. And it's so hard in an assessment sometimes because you have such a brief window and snapshot. And you don't really get to see the timeline or the variation that comes with levels of intensity, especially, if they're at peak intensity level when they're coming into your office.

MEGAN NEFF: Absolutely, absolutely. Oh, I had another thought. And then I promise we can move on.

One thing I also noticed was identity theories. And this was, especially, I noticed this most with, like, both queer and BIPOC folks is that sometimes someone would get really into queer theory or black studies. And the intensity of it, that was also tricky because the intensity of makes sense if you have a marginalized identity, and now there's this wealth of wisdom you're drawing from, intensity around that makes a lot of sense. But there are times where that was the special interest.

And that's another one that's easy to miss because the intensity makes sense. And so there's, again, a lot more digging of like, okay, how is this functioning in the person's life for us to understand, like if this is a special interest, or if this is part of the, like, social experience around having that identity?

PATRICK CASALE: It's a great point. There's so much nuance to this. I think that's a big piece of this, too. And I agree, I just want to, like, circle back to your statement about the MIGDAS does being really a supportive tool because I think if we can lead from an example of like curiosity, really supporting someone in terms of sharing that part of themselves, it really gives us a really good glimpse into their inner world opposed to like, "Here, fill out this stuff, like answer these yes or no questions. Or like respond with whatever immediately comes to mind." And you kind of get frozen in that sometimes, at least I do.

MEGAN NEFF: Yeah, exactly. This is kind of nerdy. But like the MIGDAS is more of a qualitative assessment. If you think about the quantitative research and qualitative, like, qualitative really sticks with story, and it stays very close to people's experiences. And then you look for themes within that. Whereas quantitative is more of like, numbers-based, and like, fill out these metrics.

And the MIGDAS is a very, like, qualitative assessment in that sense. And that's one of the things I really like about it. It takes a really long time to complete. But it is so rich, yeah. It has taken off in popularity and I hope to continue to see that. I much prefer it to the ADOS.

And I know that there's some people who will, like, pull some parts of the ADOS and pull some parts of the MIGDAS because sometimes you do need some of that. Like, you also need the quantitative aspects in an assessment.

PATRICK CASALE: Yeah, absolutely.

MEGAN NEFF: Norms and numbers. It all matters, too.

PATRICK CASALE: My favorite part of all of this autistic experiences, what we're going to talk about next, which is sensory.


PATRICK CASALE: And for those of you listening and having, you know, struggle with picking up on sarcasm, I'm being very sarcastic. I think this is my absolute least part of my own experience, at least is my sensory system.

MEGAN NEFF: For sure, me too, hands down. Like, easy. Yeah. I've perhaps said it on here before but oh, I think I said it, well, it's not been aired yet. I have said this before, or people hear this again. But in self-care for autistic people, one of the things I say that I've gotten a lot of feedback around is that the hardest part of being autistic is not the social stuff, but my relationship to my body. And a lot of that is the sensory stuff.


MEGAN NEFF: This is where I do wish, like, obviously, I'm affirming of my autistic identity. I think you've said this, like, autistic body, one star review, would not recommend. I'd love to actually have it like a hoodie like that, where it's like I get to grieve the hard part of having this body because yeah, totally one star review. I do not recommend autistic sensory stuff.

PATRICK CASALE: And we've talked about making merch, so-


PATRICK CASALE: …we can use that line. I mean, it feels accurate, right? Like, yeah. I would give it less than one star. Honestly, if I can rank it zero stars, half a star. You mentioned a couple, like, I don't remember what episode it was in, I think it was when we were talking about our college experiences. And you mentioned like, the soul longs for connection, the body yearns for isolation, or something to that extent, that post.


PATRICK CASALE: That video clip also went super viral. Didn't ever tell you that, but here we are. But it was mainly because so many people were like, "That's it. Like, that pinpoints the autistic experience for me."

And you're right. The social challenges that I face, I can navigate. It is the pure, like, sensory hell that is so hard. And for me, this is like minute by minute. And there's often such a hyper, like, intense awareness of how uncomfortable I am. And I'm constantly thinking of like how to distract, numb, run away from, dissociate, whatever, to manage my sensory system.

MEGAN NEFF: Patrick, do you feel that? I mean, that sounds excruciating. And I'm curious, do you feel that when you have complete control of your sensory environment? Like, you're in your space right now, is that still there? Or are you talking about in the moments where you don't have control of your sensory environment?

PATRICK CASALE: It's a great question. Moments where I don't have control, I mean, then it's like 100 out of 100, right? Moments when I do have control, it's still there. But it's not as debilitating. It's a little easier for me to, like, move through, instead of letting it, like, consume.

And for me to have complete control, I need it to be dark, I need it to be quiet, I need it to be cool. I need to not have a lot of, like, screen time. I need to not have a lot of stimulation. I probably need to be a movement in some way. There's so much that goes into, like, the regulation and the actual feelings of being "comfortable."

MEGAN NEFF: Like, in this moment right now I'm pretty comfortable. I've got my pressure on my head for my hat. I've got the Is This Autism? book on my lap, which has given me way, I'm swaying in my chair, the lighting is to a degree I am comfortable with. So, in this moment I'm comfortable in my body for the most part. Are you in this moment uncomfortable?

PATRICK CASALE: No, I actually feel pretty comfortable. I'm like, swaying back and forth on my chair because it's a rocker. I have a fidget in my hand, my dogs are sleeping, the lighting feels like where I want it to be, the temperature because I have the air conditioning on because it's like 85 degrees out here. So, all of those things have to happen, though, to like create that like perfect recipe for comfort. And the littlest variation, though, can throw that into such, like, a loop.

MEGAN NEFF: Right. This is why, like, leaving the house for me gets a one star review. Just don't do it.


MEGAN NEFF: Yeah, something has to be, like, really, really either high high value or high high motivation to get me to leave the house. The things that got me to leave the house this year was I needed sunshine, so I went to California twice. And that was like, I was desperate.

And so, yeah, but I think it is because it is so uncomfortable. So, even like taking the dogs on a walk, I like it because there's nice nature but like, if we pass another dog the sensory of like, managing my dog's, the other person like, so even that. I mean, it's a mixed bag. The nature is very connecting, but yeah, yeah, sensory stuff.

Okay, diagnostically, though. So, this is one of the most recent pieces to be added. I'm so glad they added it. But it can also be complicated because, for some autistic people, it shows up as like, under responsivity. So, it takes more stimulus to even perceive a thing via touch, smell, taste sound. For other autistic people like you and I, there's a lot of over-reactivity, meaning the slightest smell, like for me, I can tell when something's been… Like, I remember going to [INDISCERNIBLE 00:28:46] therapist's office once. And I was like, "Oh, did cleaning happened recently?" And he was like, "No." And then he thought about and was like, "Oh, over the weekend, I think the cleaners were in here." And it's like, the smallest thing will register.

And then, right, in one sensory system, we might be under-responsive, and another sensory system we could be over-responsive. So, this also can be difficult to detect because it can be all over the place. What's consistent is just, like, atypical sensory processing.

PATRICK CASALE: Right. Yep, yep, yep, yep. Yeah, over-responsivity is so challenging. So, my sense of smell is just outrageous. And it is like the littlest variation from homeostasis last baseline, creates such a fallout. And it's one of those situations, right? Where like, rationally and logically you can go into this place where you are, like, trying to convince your brain not to react the way that everything is reacting. Like, "This shouldn't be such a big deal. Don't let this impact you so much. Like, it's just a smell."

But in reality, like, I can actually feel and experience physical pain when I am smelling something that is not pleasant, or it's too strong, or it's just constantly when I'm constantly aware of it and it's so hard.

MEGAN NEFF: Yeah, I mean, for me, it's mostly chemicals. So, I've had this, like, working theory, I need to come up with a good metaphor for it, for this working theory of like, I kind of want to make a children's book out of it. But this idea that we autistic people are like the litmus test for humanity, like we're the signals of like when humanity has gone awry, right? So, like, I know a lot of us, especially, around chemicals have really sensitive responses. Like, things that are not good for humanity, that are not good for the planet, a lot of us have systems that respond to that.

And I feel like we, like, serve this sacrificial role, look at me [INDISCERNIBLE 00:32:00] of signaling like, hey, humanity, this isn't good for us. And because we have these responses to things that, frankly, are not good for humanity, and we have them with much more intensity.

PATRICK CASALE: It's a great point. And I think, you know, for those of you who are listening, who don't get to work from home, and have more control over your environment, talk about how challenging that is, right? Like, you go into an office setting where you don't have control over the environment a lot of the time, and other co-workers, and colognes, perfumes, deodorants, lack of deodorants, temperatures, lighting, all of the things, especially, if you're not working in a place that is neuroinclusive, and affirming to neurodivergent needs, it's a lot.

MEGAN NEFF: Yeah, I mean, I think this is probably one of the biggest barriers to employment for a lot of us is the sensory stuff. I actually, just over the weekend read The Neurodiversity Edge, which is a fantastic book for anyone interested in, like, workplace inclusion.

But it was encouraging to see, like, the number of remote workers has gone, like, up so significantly since 2020, which I think is making work so much more accessible for autistic people because like more of us are able to find remote work where we can have control of our sensory environment and work. And I hope that trend increases. Obviously, not all jobs can be remote. But I hope that trend increase because, I mean, yeah, that's been such a huge difference for me is working for myself and from my own environment. The hospital setting was just, oh my gosh, so sickening. Like [CROSSTALK 00:33:59]-

PATRICK CASALE: I worked at the house all the time, right? And thinking back, we've done episodes on chronic illness and health conditions, and all the ways that our immune systems are more susceptible and compromised. I just think back to how often I was sick being in those spaces. Like, you know, granted working in a 24-hour crisis unit is not healthy for anybody. But it was just, like, I couldn't go a month without getting sick. I couldn't go a month without having some sort of flare-up or issue. And I'm so grateful to be able to have significantly more control over my day-to-day because of that.

MEGAN NEFF: So, I'm not sure how we should approach this chapter. Like, should we go system by system of sensory stuff or should we be more broad strokes?

PATRICK CASALE: For the purpose of this series, let's go system by system because we've done episodes on sensory stuff. We've done episodes on meltdown, shutdowns. We've done episodes on sensory systems. So, this is a topic we will revisit infinitely.

MEGAN NEFF: Okay, yes. So, hearing, right? That's one of our systems. And again, that could be low registry or high registry.

I feel like I notice more high registry around hearing and one thing I'll, this is so funny. There's a funny meme about, like, how terrible autism assessment questions are. But there's one question that is, like, "Do you hear things that other people don't hear?" And someone did a meme of this on Instagram of like, "Well, how would I know?" Which is such a great question like, how would know [CROSSTALK 00:35:37]?

And also, that question can also be used as a question for psychosis. Like, it depends on the context. But so, like, electrical sounds. So, I have pretty sensitive hearing. But one of my children, like we got Segways a few years ago. And they were hearing a really high-pitched sound from it that I wasn't hearing. And it was before we had autism on our radar.

And I hate this, but my first instinct was like, "No, there's not a sound." Like, I don't know that I said that. But that was in my head.


MEGAN NEFF: But then I realized, like, no, like, they're experiencing a sound that I'm not registering. But that happens a lot, especially, or like hearing the buzzing of even if like toasters are plugged in that other people aren't hearing, but there's a lot of invalidation around sensory experiences that happen because other people would be like, "There's no sound or you're overreacting." Whereas for the person, they're legitimately hearing a high pitch frequency that other people are not picking up.

PATRICK CASALE: Yeah, absolutely. And speaking of hearing as my Shih Tzu started barking, yeah, that. And thinking about, like, if we struggle so much with sleep, right? And sleep deprivation and you finally fall asleep, but you are more susceptible to hearing sounds in your house or sounds in any device in your home, that's going to continuously bother you, right? Like, you're going to keep waking up, you're going to be like, "Does anyone else hear that? Like, why is this not bothering you?"

I also just struggle majorly with, like, very loud environments with varying degrees of volume from like, different conversations, music playing, maybe different sounds of things happening, fire, like sirens and EMS stuff.

MEGAN NEFF: I'm flogging out just hear you list all these things. Yeah, it's terrible. Yeah, yeah. I mean, I think that's one of the reasons crowds are really hard for me is the sound.

I have found loops have helped me, like, I mean, I've talked about this before, but I respond by dissociating. And I've found if I'm wearing loops I can stay, like, 10% longer before I start dissociating because yeah, the sounds are just so overwhelming.

But at the same time, I love to put on headphones and listen to, like, loud, intense music on repeat. And so it's not to say if someone sounds sensitive, that all sound, right? Like, that's in my control, I listen to the song on repeat, so my brains know what to expect. So, there can also be elements of sensory seeking, and sensory avoidance within the same sensory system. So, like, for me, I have both sensory avoidance and sensory seeking regarding sound. I use sound a lot as a stim.

PATRICK CASALE: Yep, yep. That makes a lot of sense. And I think one thing that happens to me is that as I'm experiencing more sensory overwhelm, and my executive functioning takes a hit, everything gets louder.

And that can mean, like, you're in a room. And the opening and closing the refrigerator door gets louder. The putting a glass on the counter, the like small talk that I couldn't hear earlier, and all of a sudden it feels like you're in a room with 1000 people. And it's just so overwhelming. And I just noticed, like, my irritability goes way up. And I am now all of a sudden, like, very inside of my head and very aware of my surroundings where I maybe wasn't before and it's also not an enjoyable experience.

MEGAN NEFF: Yeah, leaving the house [CROSSTALK 00:39:33].


MEGAN NEFF: Oh, okay, touch. So, and this is where this can include how people touch you, this can also include, like, the textures. So, yes, touch.

This is another like a common assessment question, which I think is just funny. Like, do you like hard or firm touch? I mean, I guess maybe I have actually asked some people this whether they prefer light touch? For the life of me, I can't understand why anyone would say they like light touch. That, like, I have a visceral response even thinking about light touch. It's so weird to me. Like, who was like, "Yes, I love like a light caress on my arm."

PATRICK CASALE: Yeah, I love just, like, that gentle tickle on my neck, yeah.

MEGAN NEFF: Oh, my gosh.

PATRICK CASALE: I'm way beyond that.

MEGAN NEFF: This could show up in our clothes a lot. So, like, you know, cutting tags out. And this is also interesting, you know, again back when I was doing assessments, sometimes we were like, "No, I don't really have sensitivities." And then I'm like, "Well, do you cut out your tags, talk about your clothes?" And the less like, you know, 10 accommodations they're already doing. And so they don't perceive themselves as having sensitivities because they've self-accommodated.

I know, for me, like, combination of construction. So, I wear a lot of, like, construction under clothes. And then soft. So, I wear some sort of sweat material almost every day. And I mean, that came after my diagnosis. Before I wore like, pencil skirts, and like silk, and like nylons. It's so much uncomfortable shit. And that's made a huge difference, just to be able to actually feel comfortable with my clothes.

PATRICK CASALE: Makes a massive difference. And I think, for me, I wear a lot of like athletic sportier stuff in general. So, soccer jerseys stuff that I have, like soccer shorts, like lots of soft materials. And, you know, you buy these shirts that can feel like almost like cardboard, or like they're so uncomfortable to even touch.

So, just really allowing myself to have that permission to just be like, I'm going to dress however I want to dress. And throwing out the label of like, or the thought process of, "But I have to be professional in setting A, B, C, and D." And it's like, I would much rather be comfortable, comfortable over "professional" any day of the week.

There was an argument in my Facebook group a couple of weeks ago about like, "What do you let your clinicians wear to work. Like, does anyone care? Does anyone let their clinicians wear shorts?" I'm like, "One, who the fuck cares about this? And two, yes. Like, if I can't be comfortable in my clothing, how can I possibly be focused on anything that's happening around me at any given time?"

MEGAN NEFF: Yeah, absolutely, absolutely. Yeah, I talk about clothing as like our second skin, like, and I treat mine that way, yeah.

I don't really want to go too much into this. I know people have asked us to do an episode on sex. And if we do, I just want to draw from a lived experience, that feels way too intimate.


MEGAN NEFF: But maybe we'll bring in like a sex expert, and they can talk about it. Touch is like, it is a huge part of intimacy. And I think this is an area that a lot of people who are in any sort of partnership can struggle with. And it requires so much communication around what kind of touch feels good, where does it feel good. And so I think this can absolutely complicate intimacy, as well. And I don't think it gets talked about enough. Partly, because it's hard to talk about, and it can also bring on shame if it's like, yeah, I mean, again, I don't necessarily want to go down that trail today. But-


MEGAN NEFF: …just [CROSSTALK 00:43:34]-

PATRICK CASALE: And I think it's a topic we should have, and we should bring in a sex expert. And I think you're right, though, it does create complication, especially, in partnerships where there are different neurotypes involved, too, and different sensory struggles. And I think that can create a lot of conflict in communication and also in connection, so it's a good one.

MEGAN NEFF: Yeah. Also, okay, I said weren't going to go down here and here we go. So, there's an overlap between autistic culture and [PH 00:44:08] heed culture. And I actually think part of it, I think, there's a lot of reasons for that. But I think part of it has to do with touch. I think some of heed culture creates a container for how to make touch, like, more tolerable.


MEGAN NEFF: And there's also, like, sensory seeking aspects of heed culture. But I think that there's something about creating kind of a container around touch that heed culture does well.

PATRICK CASALE: Yeah, that's a good point. And-

MEGAN NEFF: Oh, yeah, go ahead.

PATRICK CASALE: Just real quick, I also think, like, just the simple act of like, and this can also circle back to like, social norms and expectations, hugging when you meet someone. Like-

MEGAN NEFF: Oh my God.

PATRICK CASALE: …hand my can shaking. Like, stuff that I'm constantly cringing at and I'm always trying to figure out how to navigate. It's not just about the social component, it is literally about the touch component. So, it's so hard to navigate that in environments where someone is like, actively reaching out and you're like, "Augh."

MEGAN NEFF: As someone who presents, like, as a woman, like, I get so much of that and its's oh my goodness. Like, I will like try to, like, pick up my dog, or pick up like a handful of books. Like, I will literally intentionally think through like, okay I haven't seen this person in a while, they're probably going to reach for a hug. So, can I just pick up a bunch of random stuff that makes a hug impossible?

Like, and I'll literally ruminate about it for like 10 minutes, like for a long time before I even seen the person of just how can I get out of this five-second interaction?

PATRICK CASALE: Yeah, totally, yep.

MEGAN NEFF: Yeah, unwanted hugs don't do it, one star review. Which are a whole collection of [INDISCERNIBLE 00:45:56].

Okay, I think I'm getting uncomfortable. So, let's talk about vision. And this is an interesting one because like some of the stereotypical things are very like visual seeking. So, like, you know, watching a fan on repeat, like there's a lot of visual stims. I know water is this visual soother for a lot of us.

I'm very sensory avoidant, which is so unfortunate for my ADHD, which makes a mess of everything. So, I live with a lot of visual clutter which is hard for my visual system because I easily visually overwhelm. Like, I've mentioned this before, too, but like, even stripes, like stripes will make my eyes go wonky and I'll get a headache. So, patterns, lighting, visual clutter, all of the above. Very, very sensitive, too.

PATRICK CASALE: Yep, clutter, for sure. That for me is up there with smell. Yeah, clutter for sure. Patterns, not so much. But yeah, I do have to be really aware of stuff like that too, in certain environments.

And like, again, I've talked about this before, but my office that I'm in versus my wife's craft room zero out of 10, do not recommend. It's actually a lot better right now than it usually is. I'll give her credit, but like. So, that can be really challenging, too.

MEGAN NEFF: It can be so interesting to see how this plays out. Like, I've got one child, he's a visual seeker and likes visual stimulus. And one who's a visual avoider. So, like one of their rooms is so sparse. And the other one is like we got LED lights in there, like it's so alive visually. And so, yeah, it's just so interesting to see how this, especially, when you've got polar opposites in the same family how this could show up.

PATRICK CASALE: For sure, yep. And I just want to, I keep thinking about this because I've been doing a lot of talks on neurodivergent affirming practices, but like, visually, in your room, in your office setting, and this is also smell related, I should have talked about this too, that's why we say don't light candles, don't use chemicals. Like, use really dim lighting. Do not use LED overhead lighting, like. So, I think these are the little things that we can do to create more of an inclusive environment too, and doesn't take a lot of effort or energy to kind of put those mechanisms in place.

MEGAN NEFF: And I think the big thing, I think, I've been hearing more about is like creating flexible environments. So, you want to create an environment that's flexible enough, so having a couple lighting options, you might have an overhead light, you might have if possible natural light, you could have lamps, like so creating environments that are just flexible enough that they can be tweaked since you will be working with a lot of clients with different sensory profiles.

PATRICK CASALE: And just ask them, too.

MEGAN NEFF: And, yeah-


MEGAN NEFF: …asking, exactly. Yeah, taste, that's another big one. Like, I mean, we this hasn't aired yet, but we have an episode coming out on where we touch [INDISCERNIBLE 00:49:29]. And eating disorders. But yeah, taste is a huge one, which is part of what can lead to that restricted diet is that there's just…

And again, this could be all over the range. Like, for me, I love, love, love spicy food. So, I'm a sensory seeker. I'm a gustatory sensory seeker, where some people it's like, the faintest spice it's like, "Oh, that's way too spicy." So, again, we can have really different reactions to flavors, and tastes, and textures, also, a part of that.

PATRICK CASALE: I love that you keep bringing up the fact that there can be opposite ends of these extremes because I think we so often think about things as like this one-sided situation like so that's a perfect example between spicy food versus was like, oh, that's way too spicy like. So, thanks for mentioning that.

MEGAN NEFF: Yeah, [CROSSTALK 00:50:28]-

PATRICK CASALE: I also love spice.

MEGAN NEFF: …is so important with, especially, this criteria because otherwise some people can be missed, for sure.


MEGAN NEFF: I feel like taste is pretty, yeah, self-explanatory.


MEGAN NEFF: Smell we already kind of talked on that. But again, some people are sensory seekers here, right? So, like another, I think is more on the children's assessments, it'll be like, "Does your child go up and like smell people?" Like, that will be their way of orienting to new objects is to smell them.

And actually, as a kid, I was sensory-seeking. Like, I loved gas stations. I loved the smell of gas. And I loved the smell of cigarettes. Like, now, oh my goodness, that stuff would make me feel nauseated.

And like, that can also happen where someone can transition from being sensory seeking to sensory avoidant. Like, these things ebb and flow throughout the lifespan.

PATRICK CASALE: Yeah, for sure.

MEGAN NEFF: Okay, I'll add this anecdote, and then… So, I have had because I think people will probably relate to this, this was before I knew I was autistic. I had friends that for whatever reason, when I was in their presence, I would start getting kind of irritated at them. But then I knew I really liked them as humans and over text, like, I would be so much more expressive and like, I really care about you.

And I think this confused my friends because they were like, "It's weird when I'm with you, I feel like you want to leave. But then you'll say you really care about me over text." And I think it gave a lot of kind of confusing social messages.

Looking back, what I realized is those were high-sensory people, like either because maybe just energetically they were a lot to take in or because maybe they wore cologne or perfume. And so I had no lens for understanding this. And so I just thought I was like, "Why am I so like, hot and cold in this friendship with this person?"

But looking back, it's like they were a great text-based friend. But whenever we were two bodies in a room together, I felt repelled because it was too much to take in. And so I thought about that with smell because, especially, friends who have worn like cologne and perfume, I just can't tolerate to be around them. But because I didn't realize that was going on I just thought like, I'm not liking this moment of being with them so I want to leave. And I miss attributed it. I think that was the piece I miss attributed what I wasn't liking to like, my feelings about the friendship, if that makes sense.

PATRICK CASALE: It's a great point.

MEGAN NEFF: Do you know what I mean when I say high-sensory people?

PATRICK CASALE: Yeah. Oh, totally.

MEGAN NEFF: Like a lot to take in.

PATRICK CASALE: Yeah, I mean, it could be energetically. And like you said, it could be smell, it could be like, someone who speaks really loud, really quickly, and takes up a lot of that space, both physiologically and just emotionally. I think that stuff is really tricky to navigate socially.

Because you're right, if you're not thinking about it from that perspective, you really do attribute it to more of a personality trait. And yeah, that can definitely feel miss attuned when that communication like you're like, "Oh, I really care about you. Text messaging is so easy. This is so enjoyable." And yeah, they can definitely receive that very differently.

MEGAN NEFF: This is why, like, I typically don't do well with in-person friendships with extroverts. And I am so sorry if you're an extroverted person, this is not like, some of my, like, I really connect, I can connect well like over text or email, but it's that in person.

There's actually some research about how extroverts and introverts take in sensory information differently. Like, extroverts on average, like they get in more car accidents, partly, because it takes them longer to see the brake lights in front of them. So, there tends to be a slower response to stimulus and they need more of it whereas introverts tend to have sensitivity to stimulus.

So, one of my working theories is I think this is why, like, when I'm around an extrovert I feel very overwhelmed very quickly. And I think it's partly because of how our systems are perceiving sensory stuff. And not all extroverts are high sensory people, but for me, a trend that I've noticed is most of the people in my life that I'm close to, and connect most easily with are introverts.

PATRICK CASALE: Makes a lot of sense.

MEGAN NEFF: You're an introvert. Yeah, I don't even need to ask you.

PATRICK CASALE: Yeah, for sure.


PATRICK CASALE: Yeah, absolutely. I think that I have more of a need socially, in some ways, but socializing for me needs to be, like, very specific. And it exhausts me unbelievably quickly.

MEGAN NEFF: Yeah. So, I think in our criteria it would [INDISCERNIBLE 00:55:35] that you have a much larger social motivation and better than me.

PATRICK CASALE: Yeah, yeah. And some of that social motivation, going back to what I was just saying about, like, needing to dissociate from my body is sensory driven where it's like, if I can be with someone else, right? And body double, or just be in the same space as someone else that can help co-regulate, and allow me to move out of that sensory place where it's like, I'm so uncomfortable, I'm so uncomfortable, I'm so uncomfortable.

MEGAN NEFF: Yeah, yeah.

PATRICK CASALE: That's only with select people. That's not with all people. That's like-

MEGAN NEFF: Right [CROSSTALK 00:56:09]-

PATRICK CASALE: …it just have to be the right people.

MEGAN NEFF: Yes, yes. Absolutely, absolutely. Okay, a couple more systems. So, proprioception. And that's, like, knowing where our body is in space. So, that's, like I mentioned earlier, I like having weight on my lap. Those of us who, like, appreciate proprioceptive input tend to like pressure, and weight, and constriction.

And again, you can be under or over-responsive. So, people who are under-responsive tend to love, like, as children roughhouse play. They have a hard time knowing how much force they're using. So, they can accidentally hurt people because they don't realize how much force they're doing it. They might, like, have food on their face and not notice it.

But for proprioceptive, sensitive folks, like, again, one of my, again, I have one of each in my family. And when they were younger, if the sibling, like, just even walked by them, but didn't touch them, they thought they had been touched. Like, that's how sensitive it was, is sometimes you're not even touched, but it feels like you're being touched. So, it's like extra sensitive input that, like, you feel with a lot of intensity.

Yeah, like, that's not the most articulate I've described it before. But that's, yeah. Anything to add to proprioceptive? I mean, you're a-

PATRICK CASALE: No, I don't think.

MEGAN NEFF: a big athlete. I'm sure your that's proprioception input is probably big, a piece of that.

PATRICK CASALE: Yeah, absolutely. And I think that's also a big sensory seeking need of mine is that intensity seeking a piece of it? But no, I think it's a good, like, little summation. So, the flip side of that, interception.

MEGAN NEFF: Yeah, interception. So, that's knowing like, inside our body. So, the signals that are coming from inside, so things like hunger, thirst, the urge to use the bathroom. This is why potty training or toilet training is hard for a lot of kids. Emotions rely on interoception. And so, you know, whenever we talk about alexithymia, which I know we've done on here a few, that's like best seen under the umbrella of interoception because it relies on that.

So, the ability… and this, also, like I hear it most often talked about in the autism community as low registration. But it can also be heightened registration. So, you feel emotions with a lot of intensity, you feel pain with a lot of intensity. And there also can be differentiation struggles. So, it's like, is this anxiety? Or is this a stomach pain? Or is this hunger?

And so differentiating the cues can also be more difficult. The studies that have looked at it, it's not that the, like, what's more common, not necessarily the person is not experiencing stuff coming from the inside, but that it's not as accurate. So, the way they measure this is like they put you up to a heart rate measurement. And they ask like, how many heartbeats like, were the last minute. And on average, autistic people tend to be off by more.

The first time someone mentioned that other people could feel their heartbeat I was like, "What?" Because I don't. Do you feel your… Like, unless I'm, like, you know, intense workout. I don't feel my heartbeat, do you?

PATRICK CASALE: No, no, I would have to actively be like, looking for it, and trying to feel for it in order to be aware of it.

MEGAN NEFF: Even when I like, if I just sit here and try to feel for it, like I'd literally have to put my, like, fingers to my wrist and feel the pulsing through.

PATRICK CASALE: Yeah, that's what I mean. It's like I would have to, like, check my pulse or check like is it vibrating? But no, it's not something that I'm often aware of.

MEGAN NEFF: Yeah. So, interception I think it's really interesting. Kelly Mahler has so many fantastic resources on this. I wish all therapists learned about this because emotion regulation practices rely on interoceptive awareness. And so this is, like, foundational to some of those higher level skills.

And so I think a lot of times, like, if someone goes to therapy and they're like, it's not working and these skills aren't working, they can start feeling defeated about that. And it's often because these more foundational skills like interoceptive awareness haven't been built.


MEGAN NEFF: Oh, I'm circling back. One of the reasons people sit weird, like, I don't know about you, but I'm always, like, sitting like in pretzel or stuffy. Like, I want pressure on my body. That's because of proprioceptive. Because like, we want the pressure. So, like, if we sit cross-legged, or just weird sitting positions that's like a common autism and ADHD experience.

PATRICK CASALE: Yeah, I'm often like, twisting my legs over themselves, and like doing this like, yeah.

MEGAN NEFF: Yeah, you're giving yourself proprioceptive input.

PATRICK CASALE: Yeah, I need that pressure all the time.

MEGAN NEFF: Yeah, same, same. And then vestibular. So, that has to do with balance and movement. And again, it can be really, like, sensitive to it, high responder, under responder. People who have a heightened sensitivity to it get dizzy really easy, so they might get carsick easily, things like elevators or escalators can be really uncomfortable. And it could show up as like anxiety.

Like, I remember, as a kid, I had a lot of anxiety around escalators. I'm guessing it had to do with vestibular input, like, as part of that, or seeking. So, someone who's like twirling all the time, or swinging all the time, or like just seeking that sensation, that can be soothing for [CROSSTALK 01:02:15]-

PATRICK CASALE: And think about how often that's misdiagnosed, right? Like, if you are struggling with vestibular, I'm losing my words, if you are struggling with this, and this vestibular sense, and you were nervous to get on an escalator, that could really be interpreted as like panic disorder, phobia, et cetera, et cetera, et cetera. Therefore, you may go down like the ERP response, or the OCD protocol, or like, something that was really off base if we're not aware of this in general.

MEGAN NEFF: Absolutely. I think, especially, with these, sometimes these are called like the hidden sensory systems proprioceptive, interoception, and vestibular. Especially, with these, like, before diagnosing anxiety or panic, understanding, like, what is the sensory experience, like, behind this? Versus just like, is this like a cognitive-based anxiety about escalators are scary? I love that point. Yeah, absolutely.

Let's see. Other sensory stuff we should talk about.

PATRICK CASALE: I think that's a good overview. I think also just, and you've mentioned this many times that, you know, sensory is foundational. Like, regulating our sensory system, we can't really do anything else in terms of regulation or navigation without regulating our sensory system. And I think that has to be paramount and at the forefront all the time.

MEGAN NEFF: Absolutely. Like, I don't feel like I have access to myself unless I'm sensory-regulated.


MEGAN NEFF: I think that's part of why I like, I know I joke a lot about not leaving the house, but like, I have feelings about that. Like, it's hard to have such a small life. But it's also hard to be out in the world and feel so utterly disconnected from my body and my experience.


MEGAN NEFF: Yeah, yeah, yeah. I really like, I wouldn't choose to not be autistic. But like, if you were like, "Hey, do you want a different sensory system?" I'd be like, "Hell yeah. Give me the pill."

PATRICK CASALE: Yeah, and listen, I think that's just vulnerable in naming that, but I also think that a lot of people listening are going to be like, "Yeah, absolutely." And I would agree with you, 100%. I do think it's one of the most challenging things about my existence. It sounds like for you, similarly. And I know that a lot of people feel very similar to that sentiment as well.

MEGAN NEFF: And like, I don't know, I feel pressured to like, leave on a more positive note, but I do just want to mention that, you know, I've heard more people talk about like, sensory pleasure and sensory delight. And I think that is the flip side of that for those of us with a heightened sensory experience. The pleasure that we get from sensory experiences can also be more intense.

Like, I think the pleasure I get from listening to music, I actually think it's more intense than what most people experience. And so, yeah, the flip side of this or people that spend a lot of time in nature and how deeply connected they feel to nature that's partly because of that more sensitive sensory system. So, there is a flip side to this. So, I think for me, I would still trade it in even with the flip sides. But I just want to mention it's not all [CROSSTALK 01:06:01]-

PATRICK CASALE: And that's a great reframe on that, for sure. Like, it doesn't lessen or negate the fact that it's unbelievably challenging. But it doesn't mean that it's also all pain, and suffering, and negativity, either.

MEGAN NEFF: Right, right, absolutely. One thing I do want to mention because it's weird, I don't know if this is still circulating. I saw this circulating on social media a lot a couple years ago. Like, whenever I'd post a Venn diagram, if it's sensory sensitivities in the middle, people be like, "No, it's not. That's autism." Like, you can't steal that from us.

And it's like, autism does not have a monopoly on sensory sensitivities. I do think they tend to be more pervasive and like extreme. But people with PTSD have sensory sensitivities, ADHD have sensory sensitivities. When you have an anxiety disorder, your sensory sensitivities go up. I mean, think about like your nervous system is more revved up. So, your sensory system is going to be more of that. So, by no way, what am I trying to say? I don't know, there's a sentence in there.

But, like, having sensory sensitivities does not equate autism. It just doesn't. And I kind of present that that idea is out there that anyone who has a sensory sensitivity therefore is autistic. That's just not true.

PATRICK CASALE: Yeah, that's probably a rabbit hole that I could go down right now. But I agree 100%. And another good point for sure, it is not an all-or-nothing concept.

MEGAN NEFF: Yeah, yeah. We can't monopolize traits as much as we might like to.

PATRICK CASALE: Yep, for sure. Well, I hope that this series has been helpful. I think that it's a really great way to parse apart and have a better understanding of autistic experience and diagnostic criteria. And I think that the ADHD series will be really great, too, especially, because we don't talk about ADHD as often on here. So, I'm looking forward to doing that. I know you love series and collections. So, it's a win-win.

MEGAN NEFF: Thank you for going with, like, collection. And I think I feel more organized coming into this podcast if it's like we're doing a mini-series or a collection. Yeah [CROSSTALK 01:08:34]-


MEGAN NEFF: …my brain. When we're doing ADHD maybe we should also touch on, like, I know, we made some points when we went through this, but how autism criteria can look different when someone's ADHD dominant. That's getting super nuanced. But I mean, there's a lot of autistic ADHDers out there, and that can absolutely muddy the diagnostic picture on both accounts.

PATRICK CASALE: For sure. Absolutely. Well, I think we're at our endpoint. And, yeah, my brain's now fried. So, I think this is a good wrap-up point. And we'll do our ADHD series next. And we've got a lot of good episodes in the pipeline. So, looking forward to sharing those with you all.

And again, share feedback, questions, comments. You know, we try to address what we can and limit capacity that we have.

And you're listening to the Divergent Conversations podcast. We have new episodes on Fridays on all major platforms and YouTube. You can like, download, subscribe, and share. And, goodbye.

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