Let’s Talk About Autism Acceptance
Historically, April has been “Austism Awareness Month” but in the past year or so, the push has become “Autism Acceptance Month.” Listen as Dr. Terry Brennan explains why this is important and helps debunk 10 common myths about autism.
Note: Recording took place on the campus of the Autism and Developmental Services campus and some external noise is captured in the audio. Due to extra social distancing and masks being worn during recording for the safety of all parties, some audio may sound more muffled than normal.
Announcer:
Thanks for joining us for this episode of Centra Scripts, where we talk health and wellness and practical tips for your everyday life. And now here’s your host, Kate Kolb.
Kate Kolb:
Well, thanks for joining us for another episode of Centra Scripts. It’s always a pleasure to have you tune in and listen to all the things that we have going on around Centra. And I am so excited to sit down today with Dr. Terry Brennan, who is a provider here at our Autism and Development Center. Did I say that right?
Dr. Brennan:
Mm-hmm (affirmative). That’s right.
Kate Kolb:
I always say it wrong, here we go. And so thank you so much, Dr. Brennan, for being here.
Dr. Brennan:
Thanks for having me, Kate. And I’m so happy to be with you and to have a chance to have a conversation about autism and just some of the questions that our listeners might have about it.
Kate Kolb:
Absolutely, and we wanted to highlight this specifically this month because it is autism month. And so we’re going to talk a little bit about that in a minute, but Dr. Brennan, do you mind giving us just a little bit of your background and your specialty and what brought you to Centra?
Dr. Brennan:
So I am from New York originally, and I went to medical school at Johns Hopkins in Baltimore and did my pediatric training there, and always just loved developmental pediatrics. So I did do a fellowship at Duke and then a developmental fellowship at UVA. And my husband and I moved here about 35 years ago. So over the years I’ve built a practice of developmental pediatrics and have moved about town, various locations. But I’ve been here for about six years and it’s just been the most wonderful place to work. And I love the collaboration and all the different services that are available, so…
Kate Kolb:
Yeah. Well, that’s awesome. Well, we are so glad to have you here at Centra. We hear wonderful, wonderful things about your practice and from your patients all the time and just the collaborative services that this practice offers to not only just Centra patients, but people in the community as a whole. So we thank you so much for-
Dr. Brennan:
Well, thank you.
Kate Kolb:
… your practice and how you do that. And I wanted to just launch right in here because we haven’t had the opportunity to have a podcast on the topic of autism before. And so this is brand new to our listenership, brand new information for people to tune into. And so let’s just start with the basics of what is autism and maybe what is it not, and define both sides of those.
Dr. Brennan:
So autism is a spectrum of symptoms, but the core symptom is a difficulty with social interaction and communication. And so it’s fundamentally a language disorder, where the individuals have trouble with social engagement and interaction, and it could be ranging from very, very mild to very severe. And so it’s also associated with certain secondary symptoms and those really range again, along the spectrum. So they involve sensory sensitivity, sensitivity to noise, to closing or to certain kinds of food, or the desire to have things be a certain way. Not because the children are… or the older individuals are being difficult, but because it’s the way their brains are wired and wants the world to be. So they want to have their toys arranged a certain way or that they want to use certain eating utensils, or there’s a variety of little specific rigid thought patterns or behaviors that are also part of the secondary characteristics. So there’s such a variety of different symptoms and a variety of severity that every individual with autism is going to present a little bit differently.
Kate Kolb:
Right. Now I do want to talk real briefly here, because there are some questions that we get sometimes when people are talking about autism in general, and the definition between the difference between an autism behavior and something that would present itself as more of like OCD or obsessive compulsive disorder, are those closely related? for-re they not related at all? How does that work its way into that conversation?
Dr. Brennan:
Well, some of those atypical secondary characteristics like children who want to have things done a certain way, they want to do things in a certain order. They want to adhere to routine and most children love routine. Most of us love [crosstalk 00:04:45].
Kate Kolb:
Whether we want to admit it or not, we do, right?
Dr. Brennan:
But it’s just when it’s to an extreme degree and variations from that routine make you just feel very distressed, that’s when it becomes more of a concern that it’s beyond the normal range. So some of those behaviors can look like obsessive compulsive disorder, but when you see those behaviors in the constellation of language impairment, and it could be very subtle language impairment or difficulty interacting socially and communicating socially with others, then those really represent part of the picture of autism.
Kate Kolb:
Okay. All right, that makes sense. So in the past autism month, it falls in April, which is why we’re doing this podcast now, but we have typically referred to it as autism awareness month, and there has been a drive really in the past year or so to change that conversation a little bit from awareness to autism acceptance. And so I wanted to talk to you a little bit about that today and why the change in the way we approach this and why is that fundamentally helping us to grow not only the awareness but how we treat autism?
Dr. Brennan:
I think the difference is that yes, we do want people to be aware that some behaviors may be related to a diagnosis of autism. And we know that the sooner that those children are diagnosed and given appropriate therapy, the better they tend to do in terms of making progress with their social skills, making progress with their language skills, making progress with their ability to interact with others, their behavior. So it’s very important that identification early and appropriate therapies early is part of the picture, but we don’t want it to stop there with just being aware of autism, because there are… rather than looking at these individuals as having just a disability, we want to look at them as being differently abled and we look at their strengths. Because many of the characteristics of autism, if they are supported, if the individuals are supported through areas of distress, problems with behavior or interaction with others, they can actually wind up being strengths down the road.
Dr. Brennan:
So we do want to focus not just on awareness, which is important and identification of children as early as possible. And then offering, we have some really wonderful therapies available. And this center is a good example of that. That really can make a huge difference in the quality of a child’s life, in the quality of the child’s family’s life. But we don’t want to stop just there, we want to celebrate the differences that these children bring because they bring some color and some fun and some… a different way of looking at the world and some of our great contributions to humanity if I keep up with autism, so.
Kate Kolb:
Which I think is amazing when we consider that. Yeah, that’s great. So in context, I think maybe historically speaking a lot of times there has been a negative context when we talked about students or adults that have struggled with their autism and how to embrace it, and how to deal with that. How do we change the conversation that’s around that? How do we change the approach to that? So that, again, it’s not just an awareness of this exists, but it’s an acceptance of how we deal with it.
Dr. Brennan:
I think it is a question of education and advocacy for these children, and some of the children are really good advocates for themselves. I had one patient who said to me, “Well, am I going to outgrow my autism? I don’t think I really want to because we think it’s a super power.”
Kate Kolb:
That’s great.
Dr. Brennan:
So I do think though that for children that may not be able to articulate it quite that well or young adults, I think we need to help just frame things differently for them so that they are celebrated for who they are, but also supported in the areas that are difficult because sometimes it’s very hard for their families.
Kate Kolb:
Sure. And what would you say to a family who maybe is encountering this for the first time? Maybe they’ve seen some of these idiosyncrasies or some of these behaviors and things, and they’re just now starting to get into that journey of like, “Oh, okay, this is autism. This is what we need to do with it.” How do you start that conversation for new a family?
Dr. Brennan:
Well, I think because every child is unique. We need to look at what that child’s individual strengths are. Where they are cognitively, there’s a broad spectrum of cognitive abilities in individuals with autism. So not all children are delayed cognitively and not all are gifted cognitively, and there’s a broad spectrum in between. So we do need to take into account what are the child’s strengths and where can we play to those strengths? And then what are the challenging behaviors at home that are making it hard to lead a happy normal family life together? And what’s making it difficult for them to function in their community, whether it be school or Boy Scouts or Girl Scouts or whatever activity they’re part of? So for each individual family, what I tried to…
Kate Kolb:
That was Baxter, in case anybody heard, so cute.
Dr. Brennan:
He’s sleeping and he’s talking in his sleep.
Kate Kolb:
Baxter is our resident therapy dog here. He’s precious a little bit.
Dr. Brennan:
So we try to look at what that child’s areas of challenge are so that we can help the families. Number one, frame those as not intentional behavior, sometimes that’s very freeing for families to realize, “Well, he’s really not doing this to be naughty or to be annoying or to be defiant. And how can we help understand what the triggers might be?” This is where ABA therapy comes in. This is where speech and language therapy comes in and where occupational therapy comes in, and where individuals psychotherapy comes in to help families and children understand what things are setting this child off and upsetting them so that we can try to intervene with more positive and adaptive behaviors that will be… still able to allow them to express any frustration, but also not impair their functioning.
Kate Kolb:
Okay. Well, that’s great. You’ve mentioned some of these things in your answer here as the conversation has been going on. But I was doing some research on my own before this and just was… there are a lot of myths for lack of a better term surrounding autism and the way that people think about it, and how they even choose to interact with it. And that’s both from the side of somebody that maybe is dealing with it themselves and somebody who’s dealing with it coming in from the outside. And so just wanted to take a few minutes here in the podcast to take roughly about 10 of those myths that I found repeated over and over again in my research and just have you respond to that and talk us through them and see what that looks like. So the first one that was almost number one on every single list that I looked at was the myth that autism is a disease. And so can you speak to that terminology around it and maybe debunk that a little for us.
Dr. Brennan:
Right. So getting back to the fact that autism is a spectrum, it’s really a spectrum of what are normal behaviors, just take into a degree that may impair the child’s functioning. So it’s… I think more helpful to look upon it as almost like an imbalance of certain things like sensitivity to noises or to light or to environmental chaos, that kind of thing. And it’s more helpful to see it as a difficulty knowing how to articulate, how to put into words, the way you’re feeling, the way you are reacting to a situation. It may be a situation where it’s a difficulty knowing how to make a friend, wanting to be friends but not knowing how to approach and engage others. So as opposed to a disease that needs to be cured, it’s a different set of abilities that need some channeling and guidance.
Kate Kolb:
Okay. That’s great. And along that same line, I kept seeing over and over again in these articles, the myth of, well can’t autism just be cured with medicine? And what would you say to people that just want to start the medication on it?
Dr. Brennan:
Right. Unfortunately, we do not have a magic pill or a silver bullet. There are some symptoms associated with autism that occasionally medication does help, but medicine is not the first line of treatment for even secondary symptoms. And so the first line of intervention is really things like ABA therapy and speech and occupational therapy. And if a child has extreme hyperactivity, extreme impulsivity, extreme inattention symptoms of ADHD, which do co-exist frequently with autism, and those symptoms are interfering with the child functioning in school or at home and learning for even in social situations. Sometimes medication can be helpful, but it’s not addressing the primary course in terms of autism. That’s really more directed towards secondary symptoms. Anxiety is another symptom that we sometimes will see in older children and adolescents, young adults. And again, psychotherapy can be very helpful. Certain programs like yoga and exercise can be helpful, but sometimes medication winds up being an option that’s helpful for some individuals.
Kate Kolb:
Okay. All great information. Along that same lines, the nutritional side of things was something that would come up in a lot of the things that I was looking at. And so myth number three is special diets can just cure autism. What would you say to that?
Dr. Brennan:
Unfortunately it’s not that easy. Certainly if anyone is allergic to a certain type of food, if they have a dairy allergy, if they have a true gluten allergy, if they are eating something that’s going to make you medically and physically feel less than well, is going to exacerbate symptoms. So we certainly want to support anyone with a true food allergy, but food allergies are not the etiology of autism.
Kate Kolb:
Yeah. All right. So myth number four, and I think this probably has to do more with the external glance in when we have people dealing with how to deal with individuals with autism. This would be the belief that individuals with autism are either super geniuses or they are intellectually disabled. And there’s this thought that it’s one or the other and it swings in the middle, and I don’t even love that. I don’t like that word disabled at all, at all with this. But what would you say to people who have a very specific thought on the brain function of somebody with autism?
Dr. Brennan:
Well, all of us have our own cognitive strengths and weaknesses. Usually we’re pretty even in terms of our ability to learn things visually and learn things auditorily through our sight and through our hearing. There’s not usually a great big gap, but there can be an imbalance there. Some people with learning disabilities may demonstrate a differential like that. So there’s a difference in this is spectrum and cognitive abilities in individuals with autism. So there will be people at both ends of the spectrum and we won’t talk about proportions of those, but there’s going to be a range of people throughout the cognitive spectrum. And there’s also going to be some of that imbalance in having much, much better visual skills than verbal skills. That’s probably a little more common than some of the other imbalances because autism is a language disorder. And so some individuals are very gifted artists and… but have trouble with language. So it’s not just so simple as you’re either very gifted or very delayed in terms of your cognitive ability. It’s a complex interaction between the differential abilities that we all have.
Kate Kolb:
Okay. And then myth number five, was this idea that individuals with autism do not actually want to make friends, they prefer to be isolated. What would you say to somebody who has that thought pattern?
Dr. Brennan:
Well, I think we’re maybe projecting some interpretation and the way children behave. Some children are not verbal enough to tell us how they feel, but the children that are, will frequently say how much they long for friendships, but don’t know how to go about making friends. So again, it really depends upon the child, but I think it’s really, probably better not to try to pass judgment on intention and just to assume that some children, especially children that are making efforts to interact with others may just need some support in knowing how to do that.
Kate Kolb:
Right. Yeah. And from a personal standpoint, I have three children. I’ve mentioned that before on the podcast and both of my boys, my oldest and my youngest, they both have very, very good friends that are on the autism spectrum. And I would have to say that they are two of the most delightful people that I think I’ve ever encountered. And they just love spending time with them, and they’ve made such a rich improvement to my kids-
Dr. Brennan:
That’s so great.
Kate Kolb:
… friend lives in the way that they do that. So, yeah, I love that.
Dr. Brennan:
That’s great.
Kate Kolb:
So myth number six would have to do with the educational side of things that children with autism just simply cannot learn like, and that there will just have to be modified behavioral blankets over them, so to speak. And what would you say to somebody who just writes off then they can learn.
Dr. Brennan:
We would miss so much richness of thought process and discovery if we allow that statement to be accepted. And if we operated on that basis, it’s like the spectrum of cognitive abilities. There are many, many very successful, fascinating, fabulous people who have autism. And in certain career paths it’s actually an advantage, when you are able to find your path that you are just single-mindedly passionate about and you can block out the rest of all the distractions in the world, it can be an advantage to have that cognitive ability. And so I know there are many very successful physicians and meteorologists and engineers, and lots of people whose career paths demand a quantitative way of thinking sort of a math brain, who may in retrospect have had more difficulty when they were younger and found their way by one way or the other, and were able to successfully find a very, very successful career paths for themselves. And some of those individuals probably had undiagnosed autism.
Kate Kolb:
That’s interesting. Well, this next one has to do with the family home. And I was surprised by how many times I saw this come up when I was researching different articles. So myth number seven is that bad parenting causes autism, and that just came up over and over and over again. And so what would you say to these parents who are encountering this diagnosis of autism for the first time and maybe feel that sort of, “Did I do something wrong?”
Dr. Brennan:
Felt guilt.
Kate Kolb:
Yes.
Dr. Brennan:
I think that’s our go-to as parents. What do I do to process and there’s nothing further from the truth. When autism was first described by Leo Connor back in the fifties, or might have been the forties even. There was this theory that refrigerator mothers caused autism, and it’s so far from the truth, it’s false. And there’s no other way to put it and that is not the cause of autism. And we do know that there’s a lot that families can learn to support and help their children with autism to just function better, be happier. And for the whole family to function better and be happier, but it’s not the cause of autism.
Kate Kolb:
Right. Well, that’s great. And I know that there will be parents that hear that, are just very thankful for that statement for sure. Because I know some of my very good friends, parent autistic children, and they are the most loving. There are many days that I tell my friend that, “Oh, you’re such a better mom than me.” She’s just doing amazing job.
Dr. Brennan:
I’m so frequently inspired by the families that I see in this office and who are just doing a wonderful job and their children are benefiting from the gift of really, really wonderful parenting. And so if you can put that aside and not let those… just that completeness misinformation, create guilt and just move on to things that you can do positively. It’s so much better for the children and for the parents.
Kate Kolb:
Excellent advice for sure. All right. Myth number eight is a little bit touchy, but I do want to get your opinion on it. And this is probably the most common myth that we would see in presentation, in media and other places is vaccines. Vaccines cause autism, and I know we’ve seen that endlessly over the years. And what would you say to people that are concerned about that?
Dr. Brennan:
Vaccine. If there’s anything that we have the most evidence to disprove, it’s that statement over the course of years, it’s been studied more thoroughly than any other environmental or epigenetic phenomenon and vaccines do not cause autism. Autism is multifactorial, there is a genetic substrate but it’s not just a single gene or a simple genetic predisposition without additional factors. It’s those additional factors that we don’t totally understand.
Kate Kolb:
Okay. Well then I like that, simple answer. All right. Number nine, this one’s a little bit more societal in how people look at it in the myth states. Well, there just seems to be this epidemic of autism going on that all of a sudden, there’s just all these people that have been diagnosed with autism. And is it even real? I guess, is what I kept seeing in different articles. So what would you say to people that just think it’s an over-diagnosis or why is everybody quote, unquote being diagnosed as autistic?
Dr. Brennan:
Well, there’s something to be said for the recognition of autism, having significantly improved over the past number of decades and also the definition of autism and the clinical criteria have changed and broadened. So that’s part of the increase prevalence, but it’s probably not completely just increased recognition. So, that’s been a matter of debate for me.
Kate Kolb:
Interesting. All right, now our final myth that I want to talk about here goes back to the behavior that comes with autism and different things, but the myth that individuals with autism cannot understand emotion nor do they feel any emotion themselves. And what would you say to people in that?
Dr. Brennan:
So I think that again, looking at autism as a difficulty with communication. It’s the communication of feelings that seems to be the biggest difficulty in terms of the emotional life and health of individuals with autism. Not that they don’t feel things deeply. And there is another meth that children are not loving, they don’t like to be cuddled or loved. Some children are more sensory sensitive to certain expressions of love and affection, but it’s not that they’re not loving and wanting, feeling those deep emotions, but sometimes expressing them is part of what creates the distress to the child and to families. So if we can help them read themselves and also communicate what they really mean better through some of these therapeutic modalities, then it really helps them get beyond that difficulty in expressing how they feel.
Kate Kolb:
Okay. Well, thank you. I appreciate you [democking 00:27:31] all those for us. And then as we’ve gone through those, if there’s anybody listening and they’re checking off different things, as they’re hearing these and thinking, “Okay, maybe I have some concerns here or maybe I have some additional questions.” Resource wise, what would you tell families that are interested in finding out more information about autism or different resources that would be available maybe for somebody that already has an autism diagnosis.
Dr. Brennan:
Right, right. So there are some really great resources online, including the… we have a lot of resources through the Centra Autism website. UVA has a wonderful echo autism platform that has lots of resources for families of children with autism, or for families who are concerned about the possibility of autism. Autismspeaks is a great website that has good evidence-based information. There’s a lot out in cyberspace, you can’t believe so you don’t have to be a little bit careful about where you’re getting your information, but if you stick to more proven websites and more evidence-based information, it’s just so much more helpful. If you have a child under three, the infant, toddler connection of Central Virginia, or if you’re in Farmville there’s a separate infant and toddler connection there. Same thing for the Danville Pennsylvania County area.
Dr. Brennan:
So children with language delay or language disorders, or maybe disordered communication and behavior can be evaluated through that network of agencies, infant and toddler connection up until three. If your child’s two by the end of September, your local public school system has an early childhood program that can evaluate children with concerns. And those resources can be accessed by families, and I would just encourage anyone with concerns about their child to speak to your primary care provider and to don’t wait, don’t say, “Well, he has a big brother who’s talking for him.” Or we moved, or… if you have concerns, don’t wait. Because the sooner that child’s evaluated and can get some services the better, we know that really makes a big difference in how well they do.
Kate Kolb:
Right. And that’s an excellent point. I think that sometimes maybe going back to that guilt that we feel as parents, maybe sometimes we put that off because we’re like, well I don’t know, maybe… or it’s fine, these conversations that we have in our heads. So that’s an excellent point, make sure that you advocate for your child and do it early and often. Well, I, again, just want to thank you very much for sitting down with me today and for the information that you’ve provided here, again, to our listeners, you can find out more information about the services here at the Centra, and also just autism in general on our website, centrahealth.com. And then you can also check out any other of our blogs that will be at centrascripts.com and other resources that we have listed there. But is there anything else that you would want to say to parents or families or caregivers of students, or even older children that have autism that you would just be remiss if we didn’t mention today?
Dr. Brennan:
Again, I just want to say, our families that come here. I’m so inspired by the love that they show their children and just the faithfulness and then the care that they show. That inspires me every day, and it’s just the best thing for children. So if you have concerns about your child, try to dispel any self guilt or accusing yourself and give that child the big hug and get some help.
Kate Kolb:
Yeah. Well, great. Well, thank you again, Dr. Brennan so much for being here. And thank you all for listening and for being a part of this, we are so grateful for this platform of Centra Scripts and for the work that’s being done here at the Centra for these families and in our community as a whole. So again, you can check out our other resources online and we look forward to talking to you next time.
