Over 70 million Americans are neurodivergent or live with learning and thinking differences. What does that mean? Is it a mental disorder, and what can be done? What type of prognosis do these folks have? Join us as today’s guest, Understood.org’s Dr. Andrew Kahn, who identifies as neurodivergent, explains how to help neurodivergent children find academic and lifelong success.
Dr. Andrew Kahn is a licensed psychologist specializing in working with individuals who think and learn differently. In his role as a Subject Matter Expert in Psychology and Learning, Dr. Kahn focuses on ADHD, autism spectrum disorders, anxiety, general learning and behavioral challenges, and learning and social-emotional functioning.
For nearly 20 years, Dr. Kahn worked within the public school system providing training, evaluations, direct consultation, and therapeutic support to students, their families, and staff. He has worked closely with underserved communities struggling with the impact of poverty, food insecurity, and limited access to educational support. Additionally, he supported school committees to develop policies on mental health, suicide prevention, and access to learning interventions.
Prior to joining Understood, Dr. Kahn served as a clinician, clinical director of a community mental health agency, and a presenter for Summit Professional Education on ADHD, autism, and anxiety for nearly 10 years. He was also an appointee to the Maine Advisory Committee for School Psychology and educator at the University of Maine. Dr. Kahn identifies as a person with learning and thinking differences. He earned his bachelor’s degree in psychology from Syracuse University and both master’s and doctoral degrees from Nova Southeastern University.
For more information on Understood.org, please visit https://www.understood.org.
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: Greetings, everyone. I’m your host Gabe Howard and calling into the show today. We have Dr. Andrew Kahn. Dr. Kahn is a licensed psychologist specializing in working with individuals who think and learn differently. Dr. Kahn identifies as a person with learning and thinking differences and has earned his bachelor’s degree in psychology from Syracuse University and both master’s and doctoral degrees from Nova Southeastern University. Dr. Kahn, welcome to the show.
Dr. Andrew Kahn: Thanks, Gabe. Thanks for having me.
Gabe Howard: Let’s start with the line in your bio that says that you specialize in working with individuals who think and learn differently. Can you clarify and expound upon that for our listeners?
Dr. Andrew Kahn: Sure. Sure. When we talk about learning and thinking differences, we’re really talking about general categories, things like dyslexia and ADHD, conditions that are focused on the way that people process information and interact with their environment due to some of their neurological differences.
Gabe Howard: Now having a neurological difference in Gabe’s world, it almost always means mental illness or mental health challenge. But I understand that, like, for example, autism, it’s not a mental illness. It’s just a difference in processing or thinking. Can you explain sort of two things for our listeners? One, why is that not a mental illness? And two, well, why isn’t it? I guess it’s only one thing. Can you explain why is that not considered a mental illness? Why is that just considered a difference?
Dr. Andrew Kahn: Yeah, and I think part of that, Gabe, comes from the culture of describing autism because technically speaking, when we’re looking in the diagnostic manual, autism is in the diagnostic manual, it maintains a diagnosis code. So that in terms of the practical world, if someone who has an autism spectrum diagnosis is going for care and treatment, that code and that diagnosis is going to be a sort of a key to get them into those services. Within the culture and understanding of autism as an experience, as a neurological syndrome, people are talking about the idea that autism is about the way that you think, the way that you process information and sensation. And it is a global difference in how that brain works within their environment and understanding their world. So I think in that sense, you know, it is such a global experience that it really doesn’t fit in the same category of talking like something like anxiety or depression. Autism can be more of a defining aspect of how someone’s neurology interweaves with who they are as a person.
Gabe Howard: One of the common discussions that happened sort of out in the larger society is, well, then, but autism is an illness, a disorder, a disease. There’s something wrong. There’s supports that are needed, etc. But I often talk to people like yourself and people in the autism community and they’re like, look, is there a difference? Yes, but difference doesn’t mean bad. Where is that disconnect and how do we get together on that? Because I know that, you know, autism is a spectrum, right? Some people will need more supports than others. How do we include everybody and get us all on the same page?
Dr. Andrew Kahn: Yeah. I think the challenge there, Gabe, is that because our culture is so focused on pathology, people define conditions like autism based on the impairment. So if you think about impairment, those are the things you struggle to do, the things that you can’t do. And I think that when we talk about autism more globally, if you only focus on the things that people can’t do, it can be pretty disrespectful to that person’s neurology and their experience as a human. So for example, in the neurodiversity movement, which includes people who have autism, people who have ADHD, like myself, we talk about the differences in the way the brain interacts with information sensation in the world. Yes, there are periods where I might struggle and be somewhat impaired or challenged in what I do in the day-to-day. So, for example, as a kid sitting in that classroom as an inattentive kid, I would be really focused on sounds in my environment, and it would be hard for me to pay attention to a teacher if they weren’t saying something of interest to me. That was somewhat of an impairment to my functioning. Simultaneously being neurodivergent, there are also strengths and differences that come into play. So for example, when I’m driving in a car at night, I am so wired to observe changes in my environment so that if there was an animal moving on the side of the road or something changed in terms of the light conditions from my headlights on the road, I would notice that way before some other people would.
Dr. Andrew Kahn: So I think the challenge there, Gabe, is we’re focused on impairment so entirely, and with a spectrum disorder, impairments change over time. So for example, a young child who has autism might really struggle in their initial communication and their ability to talk in a classroom, but they develop skills. And as they develop some skills through interventions and through some therapeutic intervention, that impairment tends to lessen. Could it come back and be worse? We often see that it does when they become teenagers. Think about what it is to be a teenager and you have these different developmental leaps where we’re expected to do things in our environment. So I think for a lot of us who are neurodivergent, what we see is the idea that impairment can come and go over time, but our impairments are not the definition of the person. And I think that whole person, whole life model is so important because it allows us to take ownership of who we are, address impairments when they come into play, but still have an identity that takes into account all the good in what we do and who we are.
Gabe Howard: One of the things that keeps rattling around in my brain is Stephen Hawking. For example, if we focus on what he can’t do, he couldn’t walk. He’s famously in a wheelchair. He can’t talk. He famously uses the speaking aid. These were some pretty big drawbacks. Yet he was an incredibly well-respected physicist. I mean, he was just a genius. He was somehow able to overcome the hurdle of what he couldn’t do and people ultimately focused on what he could do. Now there’s not that many Stephen Hawking’s in the world, but what does the autism community or the neurodivergent community need to do to get people to stop looking at the proverbial wheelchair or speech assist and instead look at the fact that there’s a personality and an opinion? Nobody describes Stephen Hawking as that guy in the wheelchair. They always describe him as that genius physicist. How do we get that for everybody?
Dr. Andrew Kahn: Right. So let’s give the wheelchair its due. The wheelchair and the voice assist device were adaptations that permitted Stephen Hawking to be no longer defined by the physical neurological deficits that were blocking his body from movement and from forming words in the neurotypical sense, in the typical sense. So if we think about someone with autism or someone with ADHD, we have to think about can we adapt their environment, their learning situations, their interactive opportunities so that we can then start defining them similarly from the things they’re doing, the successes they have with people, and what they’re able to show us both intellectually and in terms of their day to day interest? So much of this is figuring out what does the context fail that individual with if that individual needs some support to communicate. And in the most challenged areas, some of our young people have communication devices not actually dissimilar to what Dr. Hawking had. And in other cases, kids receive intervention services to learn how to form those conversations. And that adaptation through intervention allows them to eventually have that opportunity to really engage in the world in the way that they’re capable of.
Dr. Andrew Kahn: So how we adapt to the environment, how we adapt learning. For example, if a child who has autism learns far better in a visual modality than a verbal modality. Let’s figure out how to get more images in front of those eyes. And if that individual needs an opportunity to show their brilliance and they have dysgraphia, if they have difficulty handling a pencil or a pen, then what we have to do in our world here is to figure out ways to capture their knowledge in some other fashion. If we had left Stephen Hawking in a situation where the only way he was going to be able to communicate his brilliance to us was through his ability to physically speak, all of his brilliance would have been lost. Much in the similar vein, we have to consider how do we adapt the way that we gather information, the way we magnify and spotlight the strengths of our individuals with these conditions and give them the opportunity to then be defined by what they know and what they’re able to do with support.
Gabe Howard: Now, of course, being neurodivergent or living with autism doesn’t change the fact that mental illness can still, you know, rear its ugly head. You know, bipolar disorder, schizophrenia, depression, anxiety, mental health issues, even things like grief are all present in people who are neurodivergent. But of course, all of the treatments generally are designed, tested, studied and practiced on people who are not neurodivergent. Is this a difficulty for your community?
Dr. Andrew Kahn: Absolutely. When we see research, particularly psychological or psychiatric research, for them to make the statement that this is an effective treatment, what do they want to do? Well, you can bet your bones that the folks want to put into play some sort of research that keeps the cleanest statistical data possible. So only people who have this singular condition or only these people who have these singular concerns so that we can come up with a better explanation for why our treatment or why our medication or why our service is effective. And that doesn’t translate well to real-world applications. That’s one of the big shortcomings of the science, is that we’re not really able to serve the greatest number of people because the research is so bottlenecked into this really small focus group. And again, that’s about business. That’s a lot about I’ve got to prove that something works and it’s easiest to prove it if I really limit the complexity of my treatment group. And I get that. That’s the only way that science can show that. But it doesn’t really help us in the real world terribly well.
Gabe Howard: So taking all of that into account, what is the prognosis for someone who has, for example, autism and mental illness? Can those folks be successfully treated?
Dr. Andrew Kahn: Oh, absolutely, Gabe. Understanding that when we talk about autism, autism is not something we cure. Autism is something that has to do with your neurological patterns. It has to do with your interactions in the world. So it’s about really creating strategies as early as you can to help people navigate the world around them. Best case scenario, we’re navigating, helping the environment adapt to the individual as well, because if we don’t do that, we continuously exclude people with differences from access to employment, access to entertainment, access to all kinds of different experiences. And I think so prognostically speaking, you know, like any condition where mental health comes into play, engagement in evidence-based therapies, in cases where it’s necessary medication. And I have to emphasize, when we’re talking about specifically about autism, there are no medications designed for autism as a diagnosis. They treat symptomatology that’s associated with autism. So, if someone has severe anxiety reactions to changes in their environment, which is an autistic-like way of reacting to the environment, they may look at an anxiety medication to help that individual.
Dr. Andrew Kahn: They treat the components of the emotional functioning. And lots and lots of the folks that I’ve worked with over the years have experienced a tremendous amount of success in navigating and having really enriching lives where they thrive. It’s really about getting those interventions as early as possible and working on breaking down some of that stigma between how the parents are going to get on that path with them and helping their environments really work to adapt and adjust. Because really, if the world is going to be rigid and one of the qualities of autism at times that can be such a barrier is rigidity of thinking. What you have is two rocks slamming into each other, and all that’s going to happen is the smaller rock is going to be damaged, and that’s the kid with autism. So, the environments really need to be addressing how do you flex, how do you create context for success, and how can those interventions integrate with the world in a way that’s functional, that provides the best chance for all people to thrive wherever they fall within the mental health realm, autism or otherwise.
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Gabe Howard: And we are back with Dr. Andrew Kahn from Understood.org. For individuals with learning and thinking differences, is there a recommended approach to treating those mental health challenges? That is different, that has been researched, that has been studied, that we can rely on?
Dr. Andrew Kahn: That’s a great question, Gabe. So, when we think about it, we’re talking about the treatments that we’re providing. Let’s use dyslexia as an example. So much of what we do with dyslexia is based almost entirely on the academic experience. The focus of that intervention would be on developing the skills to become more skilled in reading and navigating the challenges of your neurology as it relates to the written word. Now, very commonly learning and thinking differences, because they provide barriers early in someone’s life to achieving daily life tasks like socialization, learning and engagement in environments that can provide them the chances of feeling good about themselves. We see a lot of co-occurring mental health concerns. So what happens is I’ll use myself as an example. The child is sitting in the classroom and they’re distracted and they’re being told, Hey, no, don’t do that. Stop where you’re moving. Don’t do. So I thought, for years is your name No, Stop and Don’t? You know, you hear so much negative messaging because you and your environment are having a conflict. So my ADHD led to me hearing lots and lots of negative messaging, which led me to be susceptible to experiences of feeling depressed and feeling anxious.
Dr. Andrew Kahn: So in terms of my intervention approaches, they needed to address how that environment was responding to my inattention, providing opportunities, for example, for me to get up and move, for me to expend energy, for me to use things like noise blocking headphones and opportunities for me to work on filtration of sensation in my environment. The more that that was permitted for me and it was never permitted for me as a student. Gabe, you and I are about the same age. I’m probably about five years your senior. You and I went through schools that had fairly similar methods for kids. If you were naughty, you got disciplined, if you were inattentive, you were told to work harder. These methods really didn’t take into account the environment’s flexibility. As an adult, I’ve been able to do the things that we recommend for kids. All of these strategies for moving my body, creating stimulation through white noise, background music when I need it, and opportunities to take breaks and use timers for what I’m doing so I can pay attention to how time is moving, which is one of my deficits at times. When you think about accommodating the learning and thinking difference relative to the environment, that’s your first intervention. Very commonly, though, you then have to move on and use interventions like good solid counseling and therapy and in some cases, if necessary engaging in medication management services.
Dr. Andrew Kahn: My personal bias is that medication management should always be married with psychotherapy because so much of what happens is developing the idea that I am the one who is steering my ship. If I’m learning strategies and skills and I’m in control, and oftentimes for kids who are most challenged, the medications might give them the opportunity to engage in things they couldn’t have otherwise. But the skills we teach during that, that calm in the storm that the medications can provide are the things that they’re going to carry forward as they get older. Because many of the kids that I worked with over the years, their desire was to get off of medication. And getting off of medications left them with what? What they learned in therapy. And those were the skills that became integrated into who they are and how they cope with life situations.
Gabe Howard: I live with bipolar disorder. Now, when I was in high school, I was unaware that I had bipolar disorder. So I didn’t understand that I saw the world differently. I felt about things differently. And I just things were different for me, but it was a very much one size fits all approach in my schooling. And I was very, very talkative and not exactly unusual for somebody who may be experiencing mania. But my whole career in school, I was told to sit down and shut up. Sit down and shut up. Sit down and shut up. Sit down and shut up. You know, be quiet. Let other people talk. This was very much pushed into my psyche, so much so that even as a podcast host, a public speaker, an interview subject, sometimes I think to myself, am I talking too much? Should I be talking? It’s right there in the job. Speaker, right? I’m supposed to talk nonstop for an hour. Like people are paying me to do this. And there’s almost always a moment, even years later, decades later, in fact, where I think to myself, Hey, maybe I should give somebody else a turn.
Dr. Andrew Kahn: Right.
Gabe Howard: That never goes away. Is that the detriment to the one size fits all approach? And have we advanced past that? I mean, I graduated high school in the nineties. We’re now in 2022. Are we getting better?
Dr. Andrew Kahn: Yeah. I mean, certainly, the one size fits all method is an epic failure and it does not provide anything that is consistently required for people with learning and thinking differences. I would say that, thank heavens, it is starting to change. We’re absolutely making adaptations and working to provide more opportunities for kids who have differences and who think and learn differently. But it’s an ongoing battle because we still see tremendous stigma within those environments. And I sort of made the analogy before that. So often what we saw in research was the desire to have these homogenous groups so that we could define success. And I think schools can fall into that trap as well. If schools want to show that they’re being successful, they’re using things like test scores and certain pieces of data about achievement or how many kids from your high school go to college. And I think those singular defining terms or defining ways of saying success are harmful as a rule because the path of all of our young people with differences needs to be driven by what their interests are, what their talents are, and what we allow them to develop. And if we only create one or two paths, we’re going to lose millions of kids who have the opportunity to be successful and thrive in life.
Gabe Howard: Dr. Khan, if a parent suspects their child has a learning and or thinking difference, what should they do to support him or her? You know, we’ve talked a lot about the things that have been going wrong. But to your point at the beginning of the podcast, let’s talk about how we can do this right.
Dr. Andrew Kahn: The first and most important thing to do is to have that conversation with your child, find out what’s going on. What are you upset about? What’s easy for you, what’s hard for you? Make sure that your child knows that you’re here to help and you’re going to help them get through this. Parents don’t need to know everything. They just need to be a part of the conversation and create that sense of hope and optimism for their child that we’re in this together. Second thing. Start those conversations with your child’s teachers and caregivers, giving yourself a better view of what’s going on in the realm around their lives will give you a much better sense of things that you might not see in your household. Often times when a kid is not showing certain behavior at home, but in an environment with different demands, whether they’re social or academic. Learning that information from a daycare provider or a teacher can be really crucial for a lot of parents. We talk about using things like behavior logs and motion tracking logs, and we offer a handful of those on our website at U.org. We have anxiety trackers, and one of the great things about keeping track of what’s going on with your child is that’s great information.
Dr. Andrew Kahn: If you decide to go see a therapist or if you decide you’re going to go see their pediatrician coming bearing gifts is going to give them data. And it’s a great starting point. And I think probably finally but not unimportant is making sure that you learn some strategies with your child. One of the hardest things for kids across the board is learning to self-calm and self-regulate. So learning activities like deep breathing, stretching, even yoga in some cases can help kids calm their bodies. One of the phrases I use in my therapy settings is that when kids are stressed or when they’re anxious, one of the things we want to do is help them create the incompatible physiological response. Now, that’s a load of psychobabble. Let me define it for you. When your body is stressed or your body is angry, your brain and wiring are designed for no thinking. They’re designed to protect you, to fight, to scrap and make that environment safe in some fashion. It’s that lower brain thinking, that animal thinking. When you do deep breathing or even you engage in laughter or humor, your body can no longer maintain that anger and that high level of intensity.
Dr. Andrew Kahn: So breaking those patterns through really concrete, self-calming strategies is a huge thing for kids and can be really helpful. I use it daily. In fact, I used it right before meeting with us here today because you know what? It’s a little anxiety-provoking. So I was trying to create that response to my brain could open back Betup. And I talk about for parents modeling those strategies with your kids can be so incredibly important. I think the final strategy that I would probably talk about back earlier this year on our website, I helped create what we call a feelings wheel, and it has an array of information to help parents and their kids talk about what they’re feeling. And it goes everywhere from talking about simple things like, is my body tense? Does my stomach hurt? Does my head hurt? They’re working on connecting that to actual feelings. Because you know what? It doesn’t always happen naturally. It isn’t always something that happens organically, particularly with kids and learning and thinking differences. So we teach it and we sort of cultivate that learning for kids.
Dr. Andrew Kahn: The thing we have to understand with things like ADHD and learning disabilities is that we don’t outgrow them. They’re part of our neurology for life. What we do find is that people steer away from doing things they’re bad at. But if we can help them have a greater array of success in things that are challenging for them, they will feel more confident. They will build more skills to do the things that give them the chance to thrive as adults and through their lives.
Gabe Howard: Dr. Khan, can you tell everybody what Understood is?
Dr. Andrew Kahn: Understood is a social impact organization, a nonprofit that’s focused on being the lifelong guide for 70 million plus Americans who struggle with learning and thinking differences like ADHD and dyslexia. And one of the keys within this organization for me is that it’s one of the few places that have this holistic model and have a life span model to work with people across the age range. So having been somebody who worked for so many years in schools, when we got between K to 12, what happened? Well, Community Services didn’t do a great job. So Understood is uniquely positioned in that way. We create things like resources online through our U.org website tools, community spaces and expertise that provides all kinds of information and learning experiences that help our population move forward and become sort of more successful in the ways that they want to go in their lives.
I wish this organization was around when I was a kid because there’s a lot of things I would have done a lot earlier. I won’t trade my my journey for anything, but what I’ll say is I’m really pleased to be part of other people’s journey and to see these changes happen in our culture and our communities.
Gabe Howard: Where can folks find Understood?
Dr. Andrew Kahn: Understood can be reached at Understood.org on the Web. And we look forward to seeing some of you folks visit the site.
Gabe Howard: Dr. Khan, thank you so much for being here, and thank you for addressing all of these things. I hope this sparks more conversations and gets more people moving. And I’m certainly glad that we could give it space on Inside Mental Health.
Dr. Andrew Kahn: Me, too. Me, too. Thanks so much, Gabe. I really appreciate it. This is really nice to have a conversation today.
Gabe Howard: You are very welcome, Dr. Khan, and a big thank you to all of our listeners. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” as well as an award-winning public speaker who could be available for your next event. My book is on Amazon, or you can grab a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the absolutely free, and hey, do me a favor, and recommend the show to everybody. You know, recommending the show is how we grow. I will see everybody next Thursday on Inside Mental Health.
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