Audio transcript (edited)

JASMINE B. MACDONALD: Hi everybody. Welcome to today’s webinar, Supporting the Developmental Needs of Children with Neurodiversity. My name is Dr Jasmine B. MacDonald, I’m a senior research officer with the Child and Family Evidence team here at the Australian Institute of Family Studies. I’d like to start with an acknowledgement of the Bunurong and Wurundjeri people, the traditional custodians of the land on which I’m speaking to you in Melbourne. I would also like to pay my respects to the Elders past, present and emerging of the Kulin Nation and extend my respects to other Elders and Indigenous Australians attending the webinar today.

Today we’re joined by two fantastic presenters to discuss research and practice insights in the context of work with children who experience neurodivergence. Such children may need additional support to help them engage, and benefit from counselling, develop new skills, participate in learning environments and to develop self-regulation.

Right from the outset though, we want to acknowledge that there are ongoing broad discussions around terminology. And we acknowledge that neurodiversity is a feature of the human experience. And today what we’re primarily discussing is neurodivergence, which refers to a range of developmental conditions and experiences like autism. Hopefully the rich discussion today though shows what really matters is the children and families that we work with, see in our practice, values and behaviours that recognise, support, accelerate neurodiversity.

So, setting the scene for us today, we have Dr Sara McLean, registered psychologist and the knowledge translation advisor for Emerging Minds. Sara works with families in child protection, disability, developmental difference and challenging behaviours. Sara’s interest and depth of knowledge about child development is immense, so we’re really thrilled to have her presenting today. And Sara also wrote the CFCA paper supporting children with neurodiversity that this webinar actually builds upon. We’ve included links to this paper on the event page and in the handouts for this webinar. So, Sara, welcome.

Joining us today, we also have Dr Clare Holmes, a clinical psychologist at Towards Optimism Psychological Services and part of the Autism South Australia diagnostic services team. Clare and Sara have worked together and share a passion for this topic. And what I think is cool about that, is we get to benefit from their shared rapport and knowledge and for them to cover this topic in a really open way. Clare has a collaborative approach to research and therapy, drawing on individual strengths and expertise to address their needs. And support wellbeing using strategies from a range of therapeutic approaches and really importantly, neurodiverse affirming principles. Hey there, Clare. Welcome. Great to have you both with us.

CLARE HOLMES: Thanks, Jas.

SARA MCLEAN: Thanks, Jas. And hello everyone. And thanks for setting aside the time to join us today.

JASMINE B. MACDONALD: Amazing. So, as we expected, there is a lot of interest in this topic. So, we thank you so much for sending through questions for the presenters when you registered for this webinar. We use those questions to guide conversation and hopefully get to the issues and questions that you really want addressed.

It’s pretty important to mention that the topics that we cover today could lead you to experience some kind of discomfort or experience a range of emotions. And if that’s the case, we just want to encourage you to reach out to your GP for support or reach out to services like Lifeline and Beyond Blue. We’ve included a list of helpline services in the handout section so that you can easily access those.

Okay, so, I’m going to throw over now to Sara to set the scene of what we’re going to discuss today. So, Sara, over to you.

SARA MCLEAN: Thanks, Jas. And welcome everyone. My job to start with is just to really do a bit of scene setting around neurodivergence. I’d like to talk a bit about what the evidence – transdiagnostic evidence – suggests are the important areas of difference involved in neurodivergence. And so provide a bit of an overview and an introduction to the topic before we move onto autism more specifically.

As I think Jas mentioned, we’re going to be talking about neurodivergence in a more in-depth way. And Clare’s going to be talking a bit more about how neurodivergence is defined and understood in the autism research community, but also in the autism lived experience community. And that’s an important thing to cover. But my job first is just to do a little bit of scene setting around neurodivergence and what the research suggests.

So, looking transdiagnostically, what the research suggests to us is that there are three broad areas of development difference involved in neurodivergence of all sorts. Autism, but also other forms of neurodivergence or other conditions associated with neurodivergence. So, it’s really important for us as adults in children’s lives to be able to recognise and respond to neurodivergence in children, because we know that children who experience neurodivergence are at more risk of overtime developing behavioural, mental health and social difficulties if we’re not able to provide them with the support that they need.

It’s also really important to recognise that neurodivergence comes with a whole set of strengths, as well as a whole set of challenges. And typically, as a psychologist and allied health professional or a teacher, it’s the challenges that bring children to our attention. So, it’s important to name those challenges.

The other thing I’d like to say right at the outset is that the way that I understand neurodivergence, and I think Clare would say this as well, is that we very much frame neurodivergence as a social construct, rather than a medical construct. And what that means is that neurodivergence is not inherently problematic, but it can become problematic for children if we as adults, we as services, schools, systems, aren’t able to respond to kids in the way that they need to maximise their development and their opportunities in life.

So, therefore I would argue it’s really important for us as adults to be able to recognise neurodivergence. And fortunately, neurodivergence comes with some pretty clear behavioural, social and learning kind of indicators. And I want to touch on those first before we move onto a deeper discussion about autism spectrum disorder.

So, if we look transdiagnostically – so setting aside diagnostic labels – there are three broad areas of developmental difference typically involved in neurodivergence. And that’s true whether the neurodivergent child has a diagnosis of autism, whether they have a diagnosis of a mental health condition such as OCD, or whether they come with a set of developmental experiences such as complex trauma or early developmental trauma, early adversity. So, putting aside the diagnosis labels, we find that neurodivergence is associated with some pretty clear areas of developmental difference. And those areas come with behavioural, social and learning indicators that we can really learn to pick up on as adults and give us a clue that we might need to support the child in additional or different ways.

So, the first of these broad areas of developmental difference is that neurodivergent children frequently have differences in the way that they process information in the world. The easiest way to recognise this in children is the child who has difficulty with managing, directing, redirecting, focusing their attention. Whether it’s in a classroom or a therapy type environment.

And the other clue for us is the child who has challenges around cognitive flexibility. So, in the case of autism spectrum disorder, these challenges or these additional support needs might look like a need for additional supports when switching attention from task to task, a need for some additional supports around transitioning, a preference for deep and kind of narrow focus of attention possibly, rather than a broad focus of attention that we often demand of kids, a preference for black and white thinking, a preference for structured over unstructured, predicable over unpredictable environments.

So, it’s common for neurodivergent children to have differences in the way that they process the world and that as adults, we can help them by making their environment as predictable and structured as possible and reducing their cognitive load, their language load, to respond to their natural preferences. But also helping them by simplifying our language and leveraging visual supports to help kids to focus on what we would like them to focus on, to focus their attention and to kind of participate in learning and to participate in therapeutic supports.

So, the second broad area of developmental difference that’s common with neurodivergence is differences in the way that the child’s inner sensations and perceptions are experienced, how efficiently they are recognised and understood, but also how the child then interacts, accommodates, registers processes, integrates, synchronise with the external world that they’re involved with. So, we can easily recognise clues that neurodivergence might be present for kids when there are emotional regulation difficulties, sensory regulation difficulties and possibly also sleep difficulties.

So, in the case of autism, that might look like a child who needs additional supports to regulate, who may have strong sensory preferences and strong sensory aversions and who might need some support around managing or creating a sensory environment that works for them, that keeps them focused and attending class. And also, typically that might also involve difficulty with sleep. And I think we’ll probably touch on that a little bit later when it comes to a discussion of autism more specifically.

So, it’s common for children who are neurodivergent to have differences in the way that they experience, register and understand their inner experiences, but also differences in the way that they experience the external world, the impact of the sensory world and also the impact of social demands that we place on them. And we can help them by supporting them to develop their capacity to understand themselves, their own internal experiences, but understand what kind of environment that they need to manage best in a school environment or in a therapy environment, and that often involves creating a predictable and structured environment, it involves understanding sensory triggers, building sensory diets and behavioural strategies to manage that.

And particularly in this area of support, it’s really, I think, very important for the professionals involved to be on the same page. To be able to share and collaborate their learnings about – share with others their learning about the child and what the child’s learned about themselves, but also to focus on strategies that are I guess portable or transferrable. So, strategies that will work for both the school environment and the counselling environment and the home environment. So, it involves a lot more collaboration than possibly many allied professionals are used to.

And then finally, the final area of developmental difference is really – it’s common for neurodivergent children to have additional challenges around picking up learning new skills and behaviours, particularly adaptive behaviours, developmentally appropriate living skills and self-care skills, but also social strategies that other children might pick up more intuitively or implicitly without explicit support. So, it’s common for children who are neurodivergent to require some additional specialised and explicit support to learn new skills, that in turn then helps them to participate fully in society, in learning, in social relationships and whatnot.

So, it’s the adult’s responsibility to understand the child as a learner, what their learning needs are, what motivates them as a learner, and how they like to be prompted. Understand them as a learner and what their cognitive level – understand them as a learner, but then also use very explicit structured and systematic approaches to help them embed new skills.

So, that’s a bit of an overview of the three areas or the developmental domains that are quite commonly different in children who are neurodivergent. And some of the clues that we can pick up that neurodivergence might be present. So, I think I’m going to hand over to Clare now who’s going to go through some of the terminology that’s important to understand working in the autism community.

JASMINE B. MACDONALD: Clare, if you don’t mind, could I just start a bit of a conversation – because I just want to acknowledge what an awesome intro that was, Sara.

SARA MCLEAN: Thank you.

JASMINE B. MACDONALD: You’ve covered a range of things there around regulation, that’s really fascinating, and highlighting the point that this is a nuanced area, it’s quite complex. And I particularly appreciated and wanted to emphasis you talking about the social construction and also the strengths of the people that were working within this area. And just because we happen to see them at a time of challenge, it doesn’t mean that we shouldn’t be also acknowledging that strength.

But the part I want to jump on and bring Clare into this discussion – and this is a brief one – is who’s on your multidisciplinary dream team of working with clients in this context? You both have a psych background. Who else do you bring to the bat with you to support people in this space?

CLARE HOLMES: So many different people. Thinking about various people I support. We can have an occupational therapist, speech pathologist, social workers, sometimes we have play therapists, the education team, your wellbeing team. We’d be missing many. You want to have as big a team as relevant to that person as possible, I think.

SARA MCLEAN: And teachers and parents are important players in that as well. Or foster parents. What I’ve learned, time is a precious resource for everyone, and particularly for families. So, it’s really I guess our responsibility as professionals to make sure that we’re all speaking the same language and working – as a psychologist, if someone accesses me on the NDIS, I want to understand what the occupational therapist is working on, I want to understand what strategies the teacher is using in the classroom so that we can join them up. My job then is to fall into whatever’s already in place and help the child to kind of internalise that. If that makes sense. Rather than adding another set of new experiences into the child’s life. So, that kind of idea of really collaborating well, like you’re saying, Clare, is really key.

JASMINE B. MACDONALD: Amazing. Thank you both for that. I think we’re off to a fantastic start. So, we’re talking today about a particular type of neurodivergence. We’re going to focus on autism. And so, Clare, I’m wondering if you could talk us through – as Sara was segueing too before I jumped in – could you talk us through some terminology and some considerations when we’re talking about autism.

CLARE HOLMES: Sure. I think it’s really important to acknowledge that language around neurodivergence and autism is continually evolving. And I think one thing that I’ve found really helpful in the area is to really just check in with what language is a specific person you’re working with using and what do they prefer.

And so throughout this kind of discussion, you’re going to hear terms like neurodivergent and neurotypical. So, I guess just to make sure we are all on the same page, a neurotypical person is simply put, someone who isn’t neurodivergent. And a neurodivergent person is just someone whose brain functions in a different way which means how they experience the world, their emotions, some aspects of their physical environment, all of those sorts of things, it’s just different from the average person or the general population. And that includes a wide range of people. So, neurodivergent people can be people on the autism spectrum, ADHDers, it includes learning differences. The list just goes on and on there.

And you might notice today in the language that we’re using around autism, we’re mainly focusing on using identity first language. So, autistic person or person on the autism spectrum. There was a big survey in my state and that was what came out from the autism community about what language they preferred best, so that’s what I’ll be using today. But I really encourage you to just tune into whoever you’re working with and what they prefer as well and go from there.

JASMINE B. MACDONALD: Great. Did you have anything to add to that, Sara?

SARA MCLEAN: No. I think that’s really nice.

JASMINE B. MACDONALD: So, Sara was talking about some of the different areas of neurodivergence that we might see in children. So, Clare, I was wondering, so that we have something to pin these ideas to, could you talk us through the case study of Shay and kind of getting a sense of what some of the things we’re talking about might look like.

CLARE HOLMES: Sure. So, with the resources that came through, there was a case study about Shay, who is not a real person but is sort of based on the feedback that we got from you when you registered for the webinar, and also just our experiences working with people on the autism spectrum.

So, Shay is a 10-year-old, she’s recently been formally diagnosed as an autistic person. And she lives with her parents and her brother and they migrated to Australia a number of years ago. And everything’s been going pretty well for her, she’s been attending a local primary school. But the sorts of things that I might see as a clinician is that I’m getting some feedback from the young person that perhaps they don’t want to go to school, they’re really stressed, they just know something’s off, but they can’t really tell me what is off for them.

And with Shay in the case study, we kind of talked about her parents giving some feedback that she’s having more meltdowns, she’s really struggling after school, her concentration is just not what it normally is. Teachers might also be commenting she’s needing some extra support socially, her learning, her engagement there, something – everyone’s just noticing that something isn’t right with the way Shay normally functions. So, we’ll be using that as a bit of a start off point I guess today.

JASMINE B. MACDONALD: Great. Thank you for that overview. So, I’m feeling like the first place we should start is really how can we support people – thinking about this case study with Shay, how can we support non-neurodivergent or neurotypical people appreciate what the neurodivergence experience is like?

CLARE HOLMES: I think that’s a really important thing because whatever we’re doing supporting someone who’s neurodivergent, we need to make sure we’re all on the same page. So, say for example, if I was starting to work with Shay for the first time, I’d really want to explore neurodivergence, what that is, what that means for Shay and her family. And really just acknowledge that it’s about difference. Because unfortunately sometimes the neurodivergent kids that we might be supporting, as a parent, as a teacher, as a therapist, are getting messages that because they’re neurodivergent, they’re wrong or they’re broken or just that the way they exist is wrong. And they’re really harmful, unhelpful, wrong messages.

In the resources, I think we’ve put some accounts from autistic people about what it means to be neurodivergent. There’s some lovely examples of that. And that can be a really helpful starting off point to get some actual perspective from the neurodivergent community. Whatever particular community is relevant to the child that you’re supporting and being able to see people that are like them is really helpful in getting those conversations going.

JASMINE B. MACDONALD: I think the thing that I’m continually hearing, and the messages from both of you, is look into that induvial nuance of it’s really good to have a broader sense of what neurodivergence might look like, but what is it like for this person. And that client centred focus. What’s happening for them and what supports and needs do they personally have. I’m wondering just in covering that, Sara, is there anything else you wanted to add to that broader understanding for neurotypical people and the appreciation of work from the children of families in this area?

SARA MCLEAN: I mean, I think Clare’s covered it really nicely. And you highlighting it really is about the child’s experience of that. And just spending some time understanding the child’s perspective. So, nobody is textbook across all the diagnostic criteria of autism. Say we’re talking about autism today. So, no one has all of those experiences. And some things are more present or impactful for a child than others. So, understanding the child’s experience, but also understanding what’s important to them right now about being neurodivergent, what is the most important. Is it friendships, is it getting in trouble at school, or is it not being able to sleep. Or what’s going on for them right now that we can help with.

JASMINE B. MACDONALD: And appreciating those things you’re touching on have developmental appropriateness at that age anyway, but have unique aspects that are going to come along with the experience of neurodivergence. That’s really interesting. I’m thinking we should jump in and start thinking about self-regulation. What tools do you have in mind that worked from practice that the practitioners who are joining us today can try out?

CLARE HOLMES: There’s a few things that I think we could share today. Things like pace breathing, progressing muscle relaxation even, and some sensory dimming breaks. But I think before we dive in at that level, it’s really important to acknowledge that whether you’re a carer and an educator, a clinician, you might be in the position where you’re pretty sure you’re working with someone who’s neurodivergent that maybe hasn’t been confirmed yet, but they’re experiencing self-regulation difficulties. And I do think that even at that point, we can still come in and we can help with some of the strategies that I can run through. Just as long as we take that idea of presenting these as options, really tuning into the young person, checking in with family and teachers about how the strategies are working and just modifying it to suit the child. And definitely trying to refer onto other services as well for assessment or OT to investigate what’s happening. In the meantime, if we’re really careful and cautious and just use the resources we have already, there is no reason that we can carefully just try to help in that sort of phase.

So, I guess jumping to pace breathing. We talk a lot about breathing with regulation. And I think it’s really important just to – whether it’s with the young person or the family – to kind of talk through why. It’s got to have some relevance for us to want to do any of these tools. So, I guess why everyone harps on about breathing is because we’ve seen a lot of research that essentially shows that when we’re feeling different emotions, we have different breathing patterns. The really cool thing about that research is that it shows that even if we’re not feeling calm, if we copy the way someone does breathe when they’re calm, we actually start feeling calm. So, that’s why everyone goes on about take a deep breath. And what I would usually work on with someone like Shay is just focusing on breathing out longer than you breathe in. That is the calm breathing pattern.

And I might do something like suggest to the family if they’ve got any junk mail lying around, once they’re finished reading with it, maybe get Shay to tear out some of the pages, screw them up into little paper balls and have a very slow race to see how smoothly and slowly you can blow them across the table. It’s a great way to kind of practice the skill in a fun way, get some feedback about what that looks like.

And for people around Shay’s age, but even older people as well, there’s a great little app in our resources, it’s called PanicShield, and it gives you a bit of a visual cue to breathe in time with. It’s very fun for the kids as well. You can pick the shape or the colour on the screen. It’s completely free and it just expands and decreases in size and you essentially just breathe along with it. And you can even adapt the length of the breathing just to suit whoever you’re working with because for some people five seconds out, three seconds in, they’re going to be gasping for air. So, you can play around with that, which is good. And progressive muscle relaxation, that’s also in the resources. But the same principle, if we can make our bodies pretend to be a bit calmer, they kind of relax as well.

One that’s really popular that is pretty easy for whatever context you’re in to use, is one called Squeezing Lemons. With a neurodivergent person, I might try and bring in their interests. So, let’s say Shay’s particular focus at the moment is zombies. So, what I might do with her is, “Okay, you’ve got to pretend to be a zombie. You want to stretch out like you’re trying to eat someone’s brain, and now squeeze those fists. You’ve got the brains, squeeze, squeeze, squeeze. And now we’re all going to go floppy like a jellyfish.” So, it’s just an example of how you can adapt that a little bit to suit the child. But you can make it squeezing lemons if zombies aren’t relevant for whoever you’re working with as well. So, there are a couple of ones.

And I guess before I jump across to perhaps looking at sensory and some stimming ones, perhaps Sara might have something to add there as well.

SARA MCLEAN: I mean, I guess the only thing – I mean, I really love those physiological sort of things. And down the track, perhaps not initially – and depending on the child’s needs – it may be addressing some of the kind of thought or cognitive aspects. It’s also helpful just flagging that there are a range of kind of off the shelf programs like Superflex and We Thinkers and programs like that, that target that kind of one feature of autism spectrum disorder, that kind of inflexible kind of thinking. And try and encourage children to have a bit more flexibility. But that’s kind of a longer-term thing, wouldn’t you say, Clare. And also depends very much on what the child’s level of function is. Or the Social Detectives program. A lot of schools have these kind of programs as well, so just tag teaming with the school about what they are using already is sometimes helpful.

JASMINE B. MACDONALD: Nice.

CLARE HOLMES: I guess the other thing is thinking about strategies people can bond with right now. I’m a big believer in sensory breaks and stimming breaks. So, I’m just going to tackle sensory to begin with. So, we know that all of us, whether we’re neurotypical or neurodivergent, we all have sensory preferences. Where I think it is different for neurodivergent people, and focusing specifically on autistic people, is there’s a sensory need. In order for your sensory system and your body to regulate and feel calm, those needs have to be met. And they can look very different to a neurotypical person. So, for a lot of neurodivergent people, it’s really handy if we can refer onto an OT, but in the interim – perhaps while you’re sitting on a waiting list or that’s on the to-do list, you can look around at the resources you might already have. And, again, being really mindful of presenting options. And say for example, if Shay seemed really upset by one option, we wouldn’t go near that again, but we make a note and share that information with the other people in the team. And certainly with the OT.

So, things that I tend to do, is I look at visual things we can do. Touch, texture-based things I can do, and movement. So, for visual, a couple of my favourite go-tos are Where’s Wally. Might pull out the little Where’s Wally book and go, “I’ve got a challenge for you. What’s the funniest thing on this page? What’s the strangest thing?” And of course, where’s Wally. If you haven’t got your books handy, something like, “How many red things can you see in this room?” It gives you a bit of feedback about whether the young person you’re working with really tunes into that, and that helps them concentrate and regulate.

The tactile things. Sometimes at home there might be a favourite blanket or something that they can seek out. In the classroom environment, we might have a sensory space with a few options. But we can also work a little bit with what we’ve got, especially with movement. Are there swings nearby, can we have some sandpit time, or some water play, or can we do funny walks across the classroom. All of those sorts of things are things that don’t really require resources. Or too many. And as long as you’re tuned in with the mobility capacity of the child and any relevant safety issues, things that you can maybe just try and monitor. And start with that. And scheduling those kind of breaks across the day can be really handy. So, for Shay, if I was getting feedback from the educators that she’s really struggling in that last couple of classes of the day, I’d be making sure we have a sensory break before, during and after that period of the day, just to sort of help her regulate.

And I guess stimming is a similar principle, but I’m mindful that not everyone necessarily knows what stimming is. And there are sort of slightly different definitions. So, what I’m working with today when I’m talking about stimming is sort of repetitive behaviour. So, that could look like sorting, collecting, taking things apart, it could look like playing with words and sounds, it could look like motor movements. So, kind of those classic ones we think like standing and rocking, but also finger flicking, fidgeting, all of that. And also, sensory seeking behaviour.

And there are really, really innate useful regulation tools for people on the autism spectrum. Sometimes they can communicate to us neurotypical people – Shay might be feeling a certain way, maybe she needs some more support. And they can also be inherently soothing. So, having options and scheduling some time to do that is really helpful. Sometimes that can be a bit logistically challenging at school.

So, in in the resources there’s a great little YouTube channel called Way-to-Stim-Wednesday. And it’s fantastic. And someone on the autism spectrum explains stimming, gives you all sorts of ideas and even has one about how can I stim in a library and what are all the options if I’ve left my usual fidgets at home. So, it’s really great and it’s useful for those occasions where if there’s a safety risk, we might need to present an alternative way of stimming where perhaps at home that might be something that would be maybe supporting someone like Shay to do after school to help with that recharge and reset after a long day.

JASMINE B. MACDONALD: Really practical examples. And I like that in context, what do I have around me that I could use in a library. I think that’s a really nice example. And I love that you found a way in your practice to include Where’s Wally and zombies. That’s impressive. I love it.

You’ve already started talking about this, Clare, but I was really interested as you started to talk about what does this look like in a school context. And I want to kind of throw back to what Sara was saying around structure. And I was wondering if you might talk about that a little bit.

CLARE HOLMES: Definitely. So, if we take Shay for an example and say that as a parent, as an educator, as a therapist, we’re starting to get feedback from Shay at the start of the term or towards the end of the school year. That last term that all these sorts of things are coming up for me. I find that’s probably the least structured and predictable part of the entire school year is term one and term four. So, in a school context, I might be trying to liaise with parents and educators to see can we find out when PE Day is. We might not know the classes, the class, who’s in it yet or who the teacher is, but can we find out where they’re going to be, can we give that information to Shay?

And in term four when things sort of get a bit more unstructured towards the end of the year, it might be trying to create some vision schedules or some sense of predictability or even actually creating some routines that give Shay a sense of control. Even if it’s what she’s having for breakfast in term four on a certain day. Or even day after school, she does a certain thing. That can give that predictability that Sara was touching on, is so important.

JASMINE B. MACDONALD: What about other aspects, for the two of you, in terms of those social breaks, you were saying that recharging that – You might focus on when Shay gets home from school, but what do you think is the capacity or what does that look like in a school context?

CLARE HOLMES: I might weigh in first. Sorry, Sara.

SARA MCLEAN: Sure.

CLARE HOLMES: I think with that one, I think what I really try and make sure everyone’s on the same page with, is that neurodivergent people have different social capacity. So, I’d be really working with Shay to find out what’s the sweet spot with her. Does she want to be playing more with the kids during break time, or is she quite happy and needs her space. Are there aspects of the way we’re communicating with her in the classroom that are challenging. So, social breaks might be things like as an educator, being mindful let’s not ask for eye contact, unless it is absolutely necessary. Because a lot of people on the autism spectrum report it’s physically painful. That’s not helpful for concentration or engaging in learning.

It might be that if actually our learning goal is learning about the planets, if that’s a learning goal and the learning goal isn’t working with other people, we give Shay that option you can work if you like with someone that we know she gets along with and can trust her comfort with, or maybe you can do this yourself. And give her some options because she’s starting to feel a bit overloaded. She’s got some choices where she can sort of still do the work, still engage with the curriculum, but do it in a way that’s not going to completely overload her.

JASMINE B. MACDONALD: Anything else you wanted to add to that, Sara?

SARA MCLEAN: In relation to the school environment. We go into that in more detail in the paper, but basically what can you do to make the environment as structured and predictable as possible. And I think early educators are really good at this. Lots of things are made explicit for kids and it’s a good thing to do. We need to think about how can we support transitions for kids like Shay. So, transitioning out of the classroom into lunchtime, unstructured setting, what can we give her to do so that she can feel like she knows what to do. Sometimes we can offer two choices of what games she can play at recess or lunchtime.

So, supporting transitions between class, from class, out to the unstructured play area often is quite challenging for kids. So, giving them a transition task. For young kids, transition songs and transition objects are really good to use. And just anything we can do to reduce the cognitive kind of load for them.

But even sometimes kids have meltdowns when they come home from school and it’s just all – it’s been a big day and it’s quite overwhelming. Sometimes I’ve found it helpful just – it’s easier in younger years of schooling, to have kind of those – send pictures home to the parents so the parent still gets a sense of what’s gone on in the day, but the child doesn’t have to then engage in a big reflective conversation about how was school today. So, it’s little things like that that are supporting the transitions between different environments I think can be helpful and something we quite often can miss in a busy life.

JASMINE B. MACDONALD: That’s a really practical example of what you were saying before of who’s my dream team in terms of multidisciplinary approach. It includes teachers, it includes parents that support -

SARA MCLEAN: Definitely.

JASMINE B. MACDONALD: - transitioning across. I think that’s a really nice, tangible thing for us to think about. Clare, I jumped in because I got excited. I’ll throw back to you to see if there was anything else in that school context that you wanted to highlight.

CLARE HOLMES: I think a couple more things. Definitely what Sara said, those transition points are really crucial in providing those supports there. And it may be that coming back to the classroom after a break is a good time for a sensory or a stimming break. But I guess some other [broader] 00:43:00 things I would add is that we know from speaking to people on the autism spectrum, that certain types of socialising work really well for them. So, in a school environment, if we can provide some opportunities to facilitate that, that’s going to help with friendships, it’s going to help make break times a positive experience.

So, lots of autistic people talk about one-on-one interactions or having a familiar person there definitely eases that socialising. And also around structured activities. So, sometimes just being in the same space as other people doing an activity, be it a craft activity, even Lego or computing or something like that, where you can socialise if you want to but you’re also just hanging out with other people with the same interest. So, that can sometimes be something that’s useful to set up at school.

And it doesn’t always have to be that resource intensive, it might be that there’s a craft station somewhere or once a month there is something in the library that’s a little bit more facilitated. And just making sure that we’re mindful of the social needs of those young people on the autism spectrum. So, we know that we have to be careful about how we’re putting in social supports. So, it’s kind of looking like teaching a young child on the autism spectrum to behave like a neurotypical child. We get lots of feedback from older people on the autism spectrum that it’s really not helpful and sometimes what we’re inadvertently doing is telling them that they’re inherently wrong in the way that they want to socialise.

So, we can certainly support with strategies for things like social safety. If a young person’s coming to us – like Sara was saying before – saying I really want to make friends, but it’s hard. We can certainly support with strategies in that environment, but we have to just be really careful about how we’re doing it and that we’re not overloading. Because it’s really cognitively demanding to have to work out in a non-intuitive way how I’m supposed to go up and do this. And so if we can meet everyone halfway and really be selective in what social supports we’re putting in and why, that goes a long way.

SARA MCLEAN: Do you find sometimes, Clare, that sometimes the need to teach social skills reflects sometimes parents’ desire or other people’s desire, adults’ desire, for them to – or did it get that wrong?

CLARE HOLMES: Definitely. No, I definitely – and I understand where it’s coming from, because it’s usually coming from a place of, “I want my child to have emotionally rewarding social relationships,” which we all want for our young people.

SARA MCLEAN: Of course, yeah.

CLARE HOLMES: And sometimes that can be challenging, especially when you’re neurotypical and we might have a particular idea about what that should look like. So, I think just the how and the why of how we’re supporting things socially matters. And I’m not saying that we should never, ever teach a social strategy, but we need to think about the casing of it and the reasoning behind it. And that it’s nice and flexible. That it’s something that if we teach this one idea, it’s going to be something that you can lather, rinse, repeat across different contexts. Instead of someone trying to keep in their head seven different social rules. That’s exhausting. So, it’s just keeping that in mind too.

JASMINE B. MACDONALD: I think that everything you’ve covered so far is really fascinating. And normalising, extending, upon a bunch of experiences that are typical but with nuance. We’re all exhausted at the end of the day and if someone said to me, “Here’s seven things that you have to work on today,” “No.” So, there’s practical tips and appreciating that what we need to do is be flexible and adjust, not just expect adjustment on behalf of the young person that we’re working with.

I’m really excited now because we get the chance to go to the questions that are coming in from the audience. There’s a lot here that kind of really naturally extends upon what we’ve been talking about. One of the first ones I wanted to throw to the two of you is what – maybe with the Shay case study, what cultural aspects might you be taking into account with the work that you’re doing?

CLARE HOLMES: Definitely. I think coming back from those earlier conversations we might have about neurodivergence, I think at that stage I’d also be checking in with any family, but also especially if I know there might be a cultural difference compared to my experience. What does the word ‘autism’ mean to them, or ‘neurodivergence’. Or what do they think of other words they might be hearing like ‘disability’ or ‘difference’ or ‘assessment’ or ‘diagnosis’. Because we do need to acknowledge that different cultures have really different perspectives on that. And sometimes that places more culturally diverse families in Australia in a bit of a bind because they’re trying to work within their cultural norms and values, and they might be quite different to the systems that might be really pushing things like disclosure and certain terminology. That might have a very different meaning from their own culture. So, I think validating that.

Casting around for resources. There is a resource pack for First Nations families that we might be working with, a really lovely book about neurodivergence in general and would apply nicely to young people on the autism spectrum, that takes it from that cultural perspective. So, there’s great stuff out there. It’s definitely worth having a search on the web as well to see what we can recommend to support that.

JASMINE B. MACDONALD: Right. Okay. I am just – sorry, I’m pausing for a sec because I was flicking through and considering the questions. One of the ones that has come through from a few people is that connection between neurodivergence, specifically autistic people, the things we might be working with in this context, and trauma experiences. And I kind of was thinking this earlier when, Sara, you were talking about the ability to control an environment, the predictability. And so some of those elements can overlap a little bit. I guess I’d like to leave that open for the two of you to kind of share your experience clinically of the overlap here, and things people should be thinking about.

SARA MCLEAN: I guess I would just like to comment I get a lot of questions about is this trauma or is this disability. And I understand the question and I would also say alongside that is sometimes we really won’t ever know what a child’s background is. Certainly in the space that I work in out of home care, we may never know the complex experiences that children have had. So, I find the dichotomies – sometimes this is this – is actually not that helpful. And so that’s kind of my reasoning for kind of taking a transdiagnostic approach in a way, because it kind of – like cutting through whatever the label is or accepting that we may never know what the experiences are of a child, what are some of the things we know, we’ll support them. And if we work in these ways – so, neurodivergence informed approaches – also are the same kind of things that a child who’s experienced complex trauma will benefit from as well. So, I kind of don’t see any mismatch there. So, providing structure, supporting self-regulation, supporting learning and participation are going to help any child to participate more in the world. Does that make sense?

JASMINE B. MACDONALD: Yeah, absolutely, yeah. Clare, did you have anything you wanted to add to that?

CLARE HOLMES: I’d say definitely I agree with everything that you said, Sara. And I think we don’t need to, but sometimes we tie ourselves up in knots when we’re not sure is it neurodivergence and some form or neurodivergence and trauma. And there is discussion that trauma is neurodivergence in itself as well. So, I think those commonalities are really important to focus on. And at the heart of it, we know that whether it’s coming from a trauma perspective or an autism perspective, there might be self-regulation challenges. So, if we can just step in, in that do no harm approach, try some strategies, see what works, that’s what’s really important.

The one thing I would say that’s just something I see a little bit as a practitioner, is that sometimes it is if we can figure out whether something’s been driven more by trauma or more by autism, that’s helpful to tease out. So, say for example, we might see toileting differences in both populations or where there’s overlap, and so sometimes we might need to kind of go, “This sensory approach is helping, but not as much as I would expect.” And maybe that’s telling us there’s something to do with trauma angle that we need to factor in a bit more than we already have been. So, it’s again just being flexible.

SARA MCLEAN: And similarly, you might want to work to reduce the cognitive and language load when you’re interacting with kids, but for different reasons. But the practice is – the starting point might be very similar.

JASMINE B. MACDONALD: And it comes back to that information gathering and taking the lead from a child and a family, like you were saying at the start is something that you incorporate too. What can you work out, what do we know, and then trying to take that transdiagnostic approach. And for anyone who’s interested – Sara’s already mentioned this, but I think it’s a good thing to say – if you go to that paper, there’s some really practical examples and explanation of that approach within the paper.

All right. Some other questions that we have. One of them is around formal peer workers being used to support people with neurodiversity. Any kind of comments or thoughts on the extent to which peer support workers are being used?

CLARE HOLMES: It’s certainly something that I see. It’s certainly something I recommend. Within NDIS funding, I’ll say some peer work might be really helpful. I think it can be really useful speaking to someone that’s had a similar experience at a similar vantage point to you as well. I think it’s sort of a growing area. Not just within the neurodivergent community, but within mental health and other sectors as well. I think it can be really helpful.

And, again, I know we keep saying the same thing, but coming back to what works for that person. Because with any relationship or support, there needs to be a good fit between the people. So, not every neurotypical person gets along and it’s the same, not every neurodivergent person gets along as well. So, I think it is a really, really great support. And just like any support, work to find the right fit of peer worker or any other worker for that neurodivergent person.

JASMINE B. MACDONALD: Nice one. We also have people wondering if there’s a specialisation within psychology of the kind of psych that would work with people living with neurodivergence? Or is a referral to a general psych going to be okay as well?

CLARE HOLMES: Do you want to start off with that one, Sara?

SARA MCLEAN: I don’t know if you have a view on that. But to me, it’s more about the skills and the attributes of the person and the willingness to work in a different way I suppose. What would – sorry – do you think?

CLARE HOLMES: I think that’s it in a nutshell. It’s more about how you do things. The ‘what’ you do matters as well, but how you do things. Your standard psychology training program does not specifically teach you in great depth how to support neurodivergent people. It gives that grounding so that people can go on and do further training in the areas they want to work in. So, I think it really doesn’t matter what type of psychologist.

For example, I’m a clinical psychologist but I work with absolutely amazing general psychologists who are just as qualified. So, I think it just depends on asking them about what they work with. And we do know that some forms of – for example, mental health therapies, looking at the autistic community specifically, we know that some autistic people will respond better to things like [ACT] 00:56:29 or – than say CBT, but again, there’s variants there. So, I guess really as long as you’re with someone that gets neurodivergence or is constantly working on that and working with you as a team, you’re probably onto something good.

JASMINE B. MACDONALD: Nice one. Okay, so, just looking at the next question. This one I think is for you, Clare. We’ve got some people wondering about – what we’ve been talking about today is self-regulation with Shay and that’s for, you know, a younger child. What do you think are some of the things to take into account when we might be working with older children or with adolescents?

CLARE HOLMES: That’s a good question. I think when we’re working with older kids, there can be that – that we’re trying to move them towards managing things in an age appropriate, more independent way. And sometimes particularly if we’re working with adolescents, they want to be taking more ownership of their self-regulation as well. So, sometimes ways of making those prompts less person dependent a bit more external.

Some people that I work with will use things like reminders on their watch or their Fitbit. Or we might try and work with them and go, “Okay, at lunchtime, maybe you can try this strategy,” or, “In the last lesson the day, you can try that strategy.” Just some things to kind of cue them in either just to check in at that point, or to use a strategy. And maybe to have some sort of external cue that they can be in control of, with some alarms or some reminders that just prompts them to do that, as a way of supporting increasing independence with using some of those skills.

JASMINE B. MACDONALD: Great. That was really nice examples. Okay. I’m just checking out for another one. Okay, this one, Sara, I think is for you. I’m wondering if you might be able to talk through some of the things you take into account or focus on when you’re working with and supporting parents.

SARA MCLEAN: I think working with parents – I think the distinction when you’re working in the neurodiversity space is around – as psychologists, we’re often trained to work in short-term interventions. Very focused on a diagnostic category. When we’re working with families where neurodiversity is there, we’re looking at a long-term relationship and walking alongside the family. So, for me it’s really important to meet the family where they’re at, at the first instance. So, working with parents about what’s really important for them right there in that moment.

And for parents, it’s often about safety or it’s about sleep. Because when a child doesn’t sleep – and sleep disorders are extremely common amongst neurodivergent children – it’s exhausting for the family. So, it’s very hard for parents to parent in the way that they really want to when those kind of things are getting in the way. So, often we will address those kind of things first as a way that I can value add to parents. Otherwise, why would they bother coming back to me. So, that’s the kind of first thing, accept the family where they’re at, meet them where they’re at.

And then I would next prioritise kind of relationships in the family. So, sibling relationships particularly. And often refer families to Siblings Australia because often siblings do – with the best possible intentions – inadvertently get overlooked.

And then the other thing is helping families to work with time. So, families are very time pressured. So, supporting them to leverage their resources that they might have under NDIS in the best possible ways. What can they outsource to people that really doesn’t matter, and what do they really need to focus on to have quality relationships with their kids. And I can help with that often, as a psychologist, by coordinating all the professionals and making sure that parents aren’t engaging in stuff that could be outsourced to other people I suppose.

And really finally, just in terms of neurodivergent children, it’s a lifelong journey and so I find it’s really important to work with parents around reframing particularly behaviour. Because a lot of people come to me around behaviour concerns. That it’s not that they don’t or they won’t, but it’s just that they can’t right now. And so that kind of reframing is often very helpful.

JASMINE B. MACDONALD: Absolutely. And what I’m hearing from what you’re saying, is that kind of systems approach and almost like a Maslow’s Hierarchy of Needs. We all go to sleep.

SARA MCLEAN: That’s right.

JASMINE B. MACDONALD: And let’s build up from there.

SARA MCLEAN: Absolutely.

JASMINE B. MACDONALD: All right, we also have a question here that I think I’ll throw to Clare, and it’s around I guess those therapeutic considerations and what you take into account in terms of gender and neurodivergence.

CLARE HOLMES: Definitely. So, that’s a big topic. And I guess whatever population you’re working with, gender informs most, if not all, aspects of our lives in some shape or form. So, I think it’s something that’s really important to acknowledge and to work with. So, thinking about autistic people specifically that I might be working with, we also know that there is a high incidence of gender diversity. So, outside of that gender binary. So, things like being mindful of checking in with pronouns, things like – again, you want to sort of be with people that have a similar experience as you as well. So, sometimes my role can be a bit about linking in females with resources like the Autistic Women and Non-Binary Network, which is an organisation run by autistic people that shares resources about non-binary and female gender and how that presents for them from their experience.

And also it might be about finding parenting resources that’s about dads or mums and how autism comes into that. So, it’s just trying to help people link into the communities that are relevant to them and just keeping in the back of our mind that gender is part of the human experience and so we need to accommodate that too.

JASMINE B. MACDONALD: Great. I think there’s some really nice considerations there for people to take into account. Thanks, Clare. All right, I think this might be our last one for today and I’m going to throw it to you, Sara. Lucky last. And this one is around – I’m kind of linking a question to something I was thinking about with the paper.

In the paper, you talk about attention and cognitive flexibility challenges that neurodivergent children might face – and I’m thinking in the therapeutic context – when you’re working potentially one on one with the young person. Kind of seems to me like some of those things you were highlighting as challenges in terms of attention and cognitive flexibility that the young person might face in a school context or in a family context similarly might impact or be a first barrier in your work and therapeutically. So, I wondered if you could talk us through some strategies that you use, maybe specifically around communication style, to really get that therapeutic alliance working?

SARA MCLEAN: Sure. So, my kind of motto is structure, simplify and then move onto scaffold. So, I’ve got the kind of three Ss. So, I guess we’re trained to ask open questions and reflective questions in counselling. So, for me, it’s really important to not do that. So, it’s important to try to break down complex reflective skills into very concrete decisions. So, into a more kind of manageable communication style so kids can find it easier to engage and understand what is it they’re doing in therapy.

So, the very first thing probably is just to give an explanation of what a psychologist is and what I actually could do for them. And just a couple of possibilities. And then ask them, “Are any of those things of interest?” Sometimes we’d use their own interests. Like, for example, if they’re interested in Thomas the Tank Engine, we might say something like, “Well, we can help you to feel more like Thomas and less like Gordon.” You know, sort of using their own interest like Clare was talking about before, to kind of make the what’s in it for me kind of conversation work for kids.

And so from then, really what I’m trying to do is make complex kind of metacognitive kind of conversations that we might normally do in therapy, a really, really concrete – and I do that by breaking the questions up, using the blanks levels of question, try and make the levels of questioning as low as possible, but also use visual supports whenever I can to help them focus their attention and help them get to the core concept of what I’m trying to get them to decide on.

So, instead of asking, “How are you feeling today? How was school?” I would say, “Is it mostly bad or mostly good today?” So, kind of breaking it down into simple questions. And then you can move onto choice questions. “Would you like to do this first, or this first?” for example. As a very simple example. And then when you’re asking them to reflect on their experiences, which are higher level questions, then you can bring in visual prompts like thermometers, zones of regulation cues and the various range of visual strategies that you can use.

And then when you’re asking them to make kind of the bigger question decisions, semantic sort of stuff, “Who’s a safe person in your life,” that kind of stuff, then there’s visual resources you can use to help them to make those decisions or communicate their needs, participate in their goal setting and decision making. For example, you can use safety circles, you can have tokens that they can vote. Dad has so many tokens and Mum has so many tokens. Or who’s the angriest person in your family? Dad has five tokens, Mum has six tokens. So, it’s those kinds of – trying to anchor complex concepts into very concrete, tangible ways. And visual prompts are a very big part of that.

JASMINE B. MACDONALD: It sounds like tactical empathy is really trying to understand how the person you’re working with understands the world. And then you being more flexible to incorporate that into the work you do. And I like that you highlighted it’s almost like everything that you were taught, unlearn it. Not quite, but in terms of [inaudible] 01:07:52.

SARA MCLEAN: I little bit – I mean, I think, Clare, you mentioned before about being flexible and I think that’s possibly – I don’t know about with autism, but neurodivergence generally or disability generally, it’s up to us to take on the role of being flexible until such time as our young people can internalise that themselves.

JASMINE B. MACDONALD: So true. Absolutely. I’ve really enjoyed this conversation. I would consider myself quite fortunate to be in this position. And we’ve really covered a lot of interesting ground, a lot of practical tips and things for people to think about in their own practice. So, I just want to thank the two of you for making the time, coming along and sharing the experience and knowledge that you have. Thank you so much.

CLARE HOLMES: Thank you.

SARA MCLEAN: Thank you, Jas.

CLARE HOLMES: [It’s been an absolute pleasure] 01:08:40.

SARA MCLEAN: And thanks for your time and facilitation and thanks to everyone for joining us today.

WEBINAR CONCLUDED

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Slide outline

1. Neurodivergence

• What do we mean by neurodivergence?
  • Rationale for understanding neurodivergence
  • Social model
  • Autism is a commonly encountered form of neurodivergence
• Why is it important to explore neurodivergence?
  • Behaviour, social relationships  and learning as indicators
  • Neurodivergence underpins many differences
  • Need for adults to do things differently

2. Common Experiences 1

• Neurocognitive differences
  • Attentional control and cognitive flexibility (metacognition)
• What might this mean for children?
  • How a child processes the world
  • What helps

3. Common Experiences 2

• Self regulation
  • Emotional regulation
  • Sensory regulation
  • Regulation of sleep
• What might this mean for children?
  • Impact of the world on the child
  • What helps

4. Common Experiences 3

• Adaptive behaviour & new learning
  • Daily living skills & developmentally appropriate tasks
• What might this mean for children?
  • How a child develops in the world
  • What helps

5. Glossary

• Neurotypical (NT): A person who is not neurodivergent
• Neurodivergent (ND): A person whose brain operates differently from the majority of the general population. ND people include but are not limited to: Autistic people, ADHDers, learning differences etc.
• Autistic person / Person on the autism spectrum: Preferred language within the autistic community for describing a person on the autism spectrum.
• Self-regulation: A developmental process that continues into young adulthood in which people develop the ability to recognize and respond to their individual emotional, physical, and sensory needs in helpful ways. Self-regulation is not necessarily independent regulation.