Are you curious about autism? Do you wonder about its relationship to mental health conditions? You are not alone, as autism is one of the top search terms on PsychCentral.com.
Common questions people ask are “Is autism a mental illness?” and “Are people with autism more likely to be violent or aggressive?” Today’s guest lives with autism spectrum disorder and has children who are also on the spectrum. Learn the answers to these questions — and more — on today’s episode with Juli C. Liske.
Juli C. Liske is the president of Red Door Nonprofit Consulting, LLC, and consults with local nonprofits on improving their autism-related programs and services. She also currently serves on the Tennessee Governor’s Council for Autism Spectrum Disorders, as well as the national SPARK for Autism Advisory Council. As a highly capable individual with autism, Liske has worked in the field of autism for over 19 years. She is also the author of “In the Eye of the Hurricane: Finding Peace Within the Storm of Autism.” From 2008 to 2017, Liske worked as the founder and executive director of The Brown Center for Autism in Nashville. The mission of The Brown Center was to provide comprehensive early intervention to young children with autism, as well as intensive parent training, support, and community education. Additionally, Liske is an authorized facilitator for Stewards of Children. She resides in Brentwood, TN with her husband, Jim, and has two exceptional sons, ages 31 and 21, both of whom are on the autism spectrum, and one amazing daughter, age 30.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.
To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Calling into the show today, we have Juli C. Liske. Ms. Liske is the president of Red Door Nonprofit Consulting, LLC and currently serves on the Tennessee Governor’s Council for Autism Spectrum Disorders, as well as the National Spark for Autism Advisory Council. Ms. Liske, welcome to the show!
Juli C. Liske: Hi, it’s great to be here.
Gabe Howard: This is the first time we have ever discussed autism on this podcast because as I understand it, autism is not a mental health issue. Now when you and I first met, Ms. Liske, you correctly pointed out that people with autism do have mental health and therefore can have mental health issues. So we’re going to dive into all of that in just a few minutes. But just to ensure that I’m on the mark, is autism a mental illness?
Juli C. Liske: Actually, no, it is not, Gabe, and you’re correct that most people think that autism does fall into the mental illness category.
Gabe Howard: How is autism diagnosed?
Juli C. Liske: Autism cannot be successfully evaluated by using any kind of objective measure, such as blood test, genetic testing or anything like that at this point. So we have to look at subjective measures instead. And that’s where a lot of the confusion comes in.
Gabe Howard: Before we go any further, let’s talk about your personal connection to this subject, because while you’re highly qualified as an expert in this subject, you also do have that personal connection. Can you talk about you and your family a little bit?
Juli C. Liske: I sure can, and that personal connection does make all the difference. Most importantly, I have two sons who are on the autism spectrum. One is 21 and one is 31, and then I have a neurotypical daughter in the middle, Sarah, who is 30, and then myself, I’m diagnosed with autism level 1, which back before the DSM started classifying everyone under the autism umbrella that would have been considered Asperger’s syndrome. However, I was nonverbal until I was almost four years old, and so I remember growing up with a lot of the challenges that I see young people with autism face as well as across the lifespan. So I have a very, very deep and personal connection to autism, for sure.
Gabe Howard: You blew my mind when I first met you because you pointed out that people who are on the autism spectrum can have mental health issues, and the way that mental health issues are diagnosed are going to look different between somebody that is on the autism spectrum and somebody who is not. And I remember when you said that and I just sat there thinking, Huh, how did I miss that? That sort of brings me to my question, is it common for somebody who lives with autism to experience a mental health issue? Is it more or less common? Where does all that land?
Juli C. Liske: Well, that’s a really good question, because you do see a lot of different types of mental illnesses that co-occur with autism and people with autism are more likely, are much more predisposed to develop a mental illness as a result of autism, if that makes sense. Simply because people with autism are typically more socially isolated. Many of them have significant communication disorders, which can make them more of a target for unfortunate situations such as abuse in the home, sexual abuse, bullying someone taking advantage of them, which can result in an increased rate of mental illness.
Gabe Howard: Now, obviously, some cases of mental illness might be exacerbated or, I mean really, they may be caused by trauma, but Juli from your perspective and your vantage point, are there any types of mental health issues that are more common in people with autism.
Juli C. Liske: Yes, we do see ADHD and ADD more commonly diagnosed alongside autism. That obviously wouldn’t have anything to do with trauma, but there are some overarching things that are similar between autism and ADD and ADHD as far as sensory processing. So the accuracy of that is still out there to question whether or not it’s actually ADHD or a sensory processing issue with autism. But besides that, we see commonly obsessive compulsive disorder, anxiety and depression. But some other mental health issues that people with autism might experience are some types of eating disorders that are also tied to sensory processing. Occasionally we see Tourette’s. We see again, the obsessive compulsive is very prominent, so those are the primary ones, although there are many others that could be associated as well.
Gabe Howard: There are several myths surrounding an autism diagnosis. Let’s talk about the big one. Do vaccines cause autism?
Juli C. Liske: Thank you for asking me that question, Gabe. I get asked that question every week, at least once a week. Vaccines do not cause autism and that does rattle a lot of people’s trees whenever I say that. And it’s because we do have a lot of longitudinal studies that do show populations that have never been vaccinated to have the same incidence and prevalence of autism. The research does show that, like I just said, that autism is not decreased by being non-vaccinated.
Gabe Howard: I understand that this myth came from an actual scientific study, and that’s why people believe it. Do you know the history of where this came from and why people have bought into it and held onto it so tightly?
Juli C. Liske: I do. And I remember when it occurred, it was shortly after my younger son was diagnosed with autism, and so I was hit full force with information from everyone around me. Did you hear? Did you hear? And I started digging and looking into it and it was actually a doctor in the UK, Andrew Wakefield, who did a single subject design study. And for those who are unfamiliar with that, he had one subject in the study, as opposed to many studies that have thousands of people that are looking at over a longer period of time. So a single subject design study is obviously not as valid or rigorous as the other type of study to clarify that. And so he published this in The Lancet, the most prominent medical journal in the UK, that vaccine injury caused this person’s autism. People grabbed hold of that. People wanted an answer. Why does my child have autism? Who can I blame? And there was some speculation that this was the result of him working in collaboration with personal injury attorneys who were looking to sue Big Pharma.
Juli C. Liske: So that’s kind of how that started. All the specifics on that. I won’t claim to have the exact answers, but that’s the overarching story. So that did take hold because again, parents want solutions or they want to know why. And they also want to know, how can we fix it? Of course, those answers aren’t easy. There’s a lot of, a lot of stuff in there, but we do also have the coinciding presence of we get vaccinated every few months during that period of life. And that’s also when we also see the signs of autism typically appear. So the way those two things converge has led parents to feel that way.
Gabe Howard: Juli, thank thank you so much for that. I just, I really, really, really want to hit this hard for our listeners. I’ve done a lot of research on this and bad science in well, just bad science period, hurts a lot of people. But I’ve seen it over and over again in mental health and mental illness circles where people are just relying on data that is just frankly, either no longer true, was never true, the result of a bad study and this autism vaccine, it’s just everywhere. And I want to point out that this original study has been debunked over and over and over and over and over again. It was originally published in 1998, and almost immediately epidemiological studies were conducted and published refuting the link between MMR vaccination and autism. And by 2004, ten of the 12 co authors of the paper retracted the results, saying that “no causal link was established between MMR vaccine and autism.” And it was shown that Wakefield had in fact been funded by lawyers who had been engaged by parents in lawsuits against vaccine producing companies, and that he failed to disclose this financial interest before publication, which is ethically and morally bankrupt. And in 2010, The Lancet itself, the journal that published this original study completely retracted it, saying that in addition to failing to disclose his funding sources, Wakefield was also guilty of “ethical violations and scientific misrepresentations.” That is an exact quote, and that should have been the final nail in the coffin. It should have been over, but strangely, it was not. In 2011, the British Medical Journal published a series of articles showing that Wakefield and his team were actually guilty of deliberate fraud. They cherry-picked their data, and they only used data that supported their cause, discarding the rest, and they outright falsified some of the results.
Gabe Howard: They made it up. They lied. They just lied. I cannot be more clear. They literally just made it up. And they did it because they were paid. Wakefield was paid over £400,000 by one of the lawyers. That’s over 575,000 US dollars, over one half a million dollars, all the way back in 1998. It’s probably important to point out that a half a million dollars is a lot of money today. I again, I apologize for the passion in my voice, but I actually read the article in The British Medical Journal, The BMJ, and it was just amazing, amazing to me the depth of this fraud. The retracted study was of 12 children, and the writers of this article in The BMJ actually tracked down these kids, their medical records and some of their parents, and found a lot of contradictions. They said that out of the 12 patients, quote, “no case was free of misreporting or alteration.” One parent was even quoted saying that he hoped Wakefield would have his license revoked because “his misrepresentation of my son in his research paper is inexcusable.” And Wakefield’s license was revoked. At his fitness to practice hearing, the UK General Medical Council called him again, these are not Gabe’s words, quote, “dishonest, unethical and callous.” And despite all of that, this idea that vaccines cause autism lives on. It is just incredible to think that something so egregiously false has managed to scare parents away from vaccines for over 20 years. And this false fear has led to disease outbreaks and children have died because of this. It is sickening to me. It is just sickening.
Juli C. Liske: Absolutely. Absolutely.
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Gabe Howard: We’re back discussing mental health and autism spectrum disorders with Juli C. Liske. Is mental illness treated differently in people with autism?
Juli C. Liske: Yes, it is. We don’t have specific drugs for autism, and that’s what makes it so challenging because autism is what we call a global disorder or difference in functioning. It affects every area of functioning, social, behavioral, emotional, cognitive, even motor planning. How we move in space. All of those things are impacted by autism. So there has not been any successful production of a drug that is successful in treating autism. So it’s kind of a Band-Aid approach. And if you’re going to treat it with pharmaceuticals, it’s absolutely a Band-Aid approach. So we typically have to blend in other types of interventions, such as behavior analysis, cognitive behavioral therapy, different approaches that will complement certain drugs. However, when you’re treating a person with autism, you’re more likely to see sensitivities to drugs that are administered. I’ll just use myself as an example, since I’m the easiest person, I can violate my own HIPPA if I want to. So I take [beep] specifically for PTSD associated with autism as a result of autism and getting into situations that you weren’t aware that were dangerous. So I take that, however, I’m very sensitive to the serotonin reuptake inhibitor part of that drug, and so I can get serotonin syndrome very easily with a low dose. And so that kind of reaction is very common in autism.
Gabe Howard: Having been the host of this podcast for a long time, I’ve learned a lot of what I consider to be disturbing facts and one of the ones that’s coming into my brain right now is I learned that that pharmaceutical companies in drug trials generally test them on men. And they do that because men can’t get pregnant and therefore they lower the risk of harm to a fetus, lowers their liability. There’s all kinds of reasons for this, and on the surface, this kind of makes sense. I mean, nobody wants to put a pregnancy in harm’s way. Nobody wants to harm an unborn child. But on the other hand, it means we’re not getting the data that we need to see how this treatment impacts women. Now, I imagine in treatment trials, drug trials, et cetera, they’re probably not utilizing people with autism. How do you find out the best practices when all of these practices are created on neurotypical people yet in your community, they need to be used for your wellness?
Juli C. Liske: That’s an amazing question, Gabe, and you’re absolutely spot on. And it is challenging, so you have people who they’re testing and they’re not on the spectrum, and so we don’t have a means of knowing how to go about that. I know there are now tests that they can administer to people, anyone, but it’s particularly useful for the population who has autism, that can let you know what drugs you’re sensitive to and in what way. So that seems to be our only tool right now at this time until they can expand the initial testing to people who are impacted by autism. And I’m not sure how easy that would be, but you’re absolutely correct, especially in the diagnostics area. I don’t mean to jump topics, but it’s very similar in diagnostics is that the diagnostic instruments being used to measure the severity or the impact of autism, those tests are they’re normed by people who are neurotypical. And so in my opinion, it’s like, you know, you’re giving a visual processing test to a blind person when you’re trying to give testing that is primarily language based to people who have what is considered primarily a communication disorder. So there are so many holes in this, whether it be pharmaceuticals or testing for people with autism, we have a long, long way to go.
Gabe Howard: Staying on the theme of stereotypes and misinformation, one of them is that people on the spectrum aren’t in relationships, they’re not getting married, they’re not having families. Now you’ve already answered that question with your life. We know that people on the autism spectrum get married and have kids because you have. But where do you think that comes from? Why is that a persistent belief in our society?
Juli C. Liske: There’s a lot of things in the media that have went to that stereotype that people with autism don’t want to be connected with other people, prefer to be isolated or alone. And that’s simply not true. People with autism, a few of them do prefer to be alone, just like people without autism. It’s a variation in personality. However, the ability to connect with other people can be compromised when you have autism because the lack of ability to read social cues, non-verbal cues when you’re interacting with people, how to speak to someone without standing too close or looking away from them. How to make it appear that you’re connecting. Those features are where the challenges lie in autism. So when you interact with someone on the spectrum, on the autism spectrum, who is able to communicate, 99% of the time, they’ll tell you that they very much want to have friends and they want to have relationships and they want someone to be with. And it is difficult for them to do so. So that is very much a myth that people with autism do not want connection. It’s just the way they connect is different.
Gabe Howard: One of the things that’s surprising to me is that it’s called the autism spectrum. Spectrum is right in the name. Yet there is this persistent myth that every single person with autism is identical, that there’s only one way that autism can present.
Juli C. Liske: Yeah, I think there’s some underlying features that are common across the spectrum that you can see. One of them, most notably, it can be eye contact. Although some people with autism have good eye contact, that’s usually takes some time. So the eye contact piece can be one thing that people look at when they’re thinking of someone with autism. But as you mentioned, there’s a host of different features that a person with autism can have. And so it’s assembling all those pieces and parts and you have your unique person with autism. But those beliefs do come somewhat from the media. They also come often from when children are very young and diagnosed with autism, and they have they’re very much impacted by autism. The features do appear a lot more similar sometimes aggression, lots of activity, not communicating with others, not using gestures like pointing at an airplane like, Look, daddy, there’s an airplane. You don’t see those features in a person with autism, but as that person grows, they become very much they’re a unique person, and I think a lot of that is media driven.
Gabe Howard: Now you mentioned aggression, are people with autism innately aggressive or even violent?
Juli C. Liske: No, I know when we had talked before, we talked about any time you have seen, you know, in years past school shootings or different types of violence in the community, and you just kind of hold your breath and wait for them to say that that person had some type of mental illness or they were somewhere on the autism spectrum. And that always turns my stomach when I hear that. People with autism are no more likely to be aggressive or violent than anyone else. Being marginalized and left out and bullied and mistreated, abused different things or traumas that can happen to a person because they are on the autism spectrum can lead to that type of behavior, but it can also lead to that type of behavior in a person without autism.
Gabe Howard: As you alluded, mental health advocates, we get dogged by this as well, that there must be a reason, it has to be somebody’s fault and it’s probably some sort of mental health issue, disability, something. And of course, this makes it very difficult for people to exist in society. Do you feel that the media is perpetuating these stereotypes in a way that is detrimental to your community, much in the same way that many people in the mental health community feels that the media perpetuates these stereotypes?
Juli C. Liske: I do. I do. Whenever the media gets hold of any kind of diagnosis of any kind, as you know, they put that out there and there’s no explanation given for any of the conditions in which they grew up surrounding that diagnosis. If you’ve noticed, that’s never mentioned. However, at the same time, like here in Tennessee, you know, we’re currently having the trial for a father who killed his son with autism, which happens all the time. It’s horrifying. But no one makes that connection between the two, how this person with autism is treated and how this person who may be somewhere on the spectrum may have committed a violent crime. But look at the track record of violence against people who are on the spectrum. There’s no attention given to how that fleshes out on the other side when we do see violence perpetrated by people on the spectrum.
Gabe Howard: We’ve obviously picked on the media a lot, but let’s talk about pop culture, television, movies. How do you feel about the pop culture representation of autism? I’m thinking about, like the Netflix show Atypical.
Juli C. Liske: Yeah, I have seen Atypical, I think I saw a couple of episodes, I don’t keep up with pop culture as much as I probably should. I think that’s a function of something being on the spectrum. I prefer more factual and information that I like to consume and documentaries, but I have seen a few of those because I’m asked that question so often. There are some overlapping features with some of the characters, but by and large, we’re starting to see more of those characters being portrayed as more functional. And I do appreciate that they are getting better at showing these individuals very differently. I think the person who starred in Parenthood as the person on the spectrum is very different than the person in Atypical and very different than the person on Good Doctor. So that’s good. But that’s the extent of my knowledge in pop culture. But I look forward to seeing it become much more diversified and seeing people who are able to achieve the levels that a lot of people with autism are able to achieve and how they contribute in a positive way rather than being some type of burden. That would be my hope.
Gabe Howard: Do you see any improvement or anything that gives you hope in this regard?
Juli C. Liske: I do. I do. I’m saying many, many, many more women getting a diagnosis, albeit late, because we do present differently, but it does clear things up and help people establish what’s going on in their lives, what’s happened in the past. Help make sense of why these things happen. That it’s not their fault, however, you want to look at it. Whatever’s happened in your life and that has enriched the lives of a lot of people being able to get accurate diagnoses. And better yet, we’re seeing more and more young girls getting their diagnosis earlier. So it’s wonderful to see some progress being made in that regard.
Gabe Howard: Ms. Liske, thank you so much for agreeing to be on the show and for sharing this information with our listeners. I understand that you have a book?
Juli C. Liske: I do. I do. It is on Amazon. It is called In the Eye of the Hurricane and the subtitle is Finding Peace in the Storm of Autism. And it is essentially a memoir, and since I had my children in eastern Kentucky, everything in eastern Kentucky is rural, so I don’t have to put rural in there. My objective was to create a resource for families who lived in rural areas or lack the financial means to access the quality of care that you can access in more metropolitan areas. So that book is still out there, and you can find it on Amazon, again In the Eye of the Hurricane: Finding Peace in the Storm of Autism by Juli C. Liske.
Gabe Howard: And if any of our listeners want to reach you, how can folks do so?
Juli C. Liske: I would recommend just emailing me directly, you can reach me at Juli. And just remember that my first name does not have an E, so it’s Juli.Liske@gmail.com.
Gabe Howard: Thank you so much for being here, we really appreciate it. And a big thanks to all of our listeners. Wherever you downloaded this podcast, please subscribe or follow the show. It’s absolutely free. Also, take a moment and review the show. Tell other people why you are listening so that they can listen too. My name is Gabe Howard and I’m the author of “Mental Illness Is an Asshole and Other Observations.” I’m also a nationally recognized public speaker who would love to be at your next event. You can grab a signed copy of my book or learn more about me over at gabehoward.com. I’ll see everybody next Thursday on Inside Mental Health.
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