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[Music] background working with neuro and gender diverse children and teens so my name is Finn Bratton they/them pronouns I'm a psychotherapist so elm FTL PCC and I work with kids to adults who are on the gender spectrum and also on the neuro diversity spectrum and and I also work a lot with trauma which fits into those pieces a lot there's a lot of trauma experienced by those two populations and I think I've been working with gender expensive transgender folks since ice like the last ten years since I started practicing really I've seen with autism spectrum your experience does neurodiversity in general and autism specifically somehow correlate with gender diversity there's been a lot of reports people said oh I'm seeing a lot of like seems like autistic people in my practice or a B and Consulting Group's and somebody will go through a case and this will be a confusing case and I'll say they sound like they might be on the spectrum and it's as anybody who is in this community starts to pick out there's there's a lot more there's it seems like be a hot March higher percentage it's only in the last year that I've seen a little bit better studies and we still have a long long way to go most of the studies before we're super super small you know 12 people 15 people last year a Boston Children's Hospital had a study had like 39 people in it still super small and of those 23% so I think nine more autism spectrum so that's a super small study so is it 23 is it 10 is it you don't know what was interesting about it was only two of them were identified as autistic before they started accessing services for gender care then either their first therapist before they sent them over to Boston Children's or Boston Children's in its short little study of this I'm doing the Asperger's quotient survey found that nine of them qualified as Asperger's so that means gender people are going to be catching lots of autistic kids and adults who are never diagnosed because those kids were probably most of them would still never be diagnosed they were average age was almost 16 the next study came out right after that and was New York University much bigger like 403 a lot more assigned male at birth and they were all people who had been identified as autistic and that that that hospital was working with because of that and they just used the the big survey that has I don't know hundreds of questions and one question was do you wish you were the opposite sex which is not a diagnostic survey of gender diversity you know it may be may be might catch half of them and five percent of the autistic people were identified as transgender which is much higher than the national prevalence and then if you add in all the ones who would say I am the sex I am or I am somewhere in that great die you know variants in between wish I was the opposite sex I expect that would be higher so that's that's what we've got for actual survey results I know and it matches what we're saying anecdotally adult wise a young adult as somebody was doing their master's thesis on autistic people's experiences with social social communication classes and they just put in the beginning of it a low line instead of putting male/female for their demographic they put gender and probably about 15% my memory identified something other than male or female and they were very specific specific they knew all the words so these were more young adults and older adults they were all over 18 but 15 percent of them were in that what are some of the theories as to why there seems to be a correlation between the two a lot of people have this question like how come how come the correlation you know we have these so scientific minds and we want to know why you know and I I know my mind works that way too however we really really don't know and any studies or research is really an infancy about that and I'm afraid there's a lot of bias there's a lot of bias in the autistic research that's based upon find a cure there's something wrong with this what's going wrong in this brain and that scares me it's like it's the old style what's going wrong this brain that this person would be trans what's going wrong in the spring that this person is autistic it's kind of interesting for sure and I kind of be interested in reading the research but the honestly I'm much more interested in the people and just that this is and I wish just like much research I wish my research was being spent on so what do we do because there's a lot of them so that's where I land what do we do now does neurodiversity interfere with someone's ability to accurately assess their own sense of gender my first answer would be just know what is a challenge is the neurotypical neurodivergent interface so there can be a communication challenge between a neurotypical and a neurodivergent person so that they aren't able to on both sides really understand the other person's how they're communicating about their thinking or experience process so in that case I could say it might take me a little bit longer because even though I'm a neurodivergent person identify as autistic it's a very heterogeneous crew and they think really differently from me as well as differently from other people and I have to kind of figure out how not so much are they thinking correct you know about themselves but do I understand their words right am i trying to put some words in their mouth too make it makes sense to me so that takes a little slowing down and learn and learning what they mean and also as a neurodivergent person I know this is true and for my clients is true there's so much experience of people not getting your experience and having to emulate other people's behaviors and communication to to just operate in the neurotypical world that they may present themselves as something a little bit different from how they feel because they're afraid they won't be taken seriously so if they have kind of of aches a vague feeling like I know I'm not a man but I'm not sure about woman but I'm afraid people won't take me seriously unless I say I'm a girl then I have to kind of help that be okay and and put out that I know that we do this as near a divergent people - because people don't take us seriously so that's that's a stumbling block there I think another experience that people will bring up is that gender or so many things sexuality feelings are a body based experience and autistic people have a harder time maybe accessing their bodies sensations in a way that doesn't overwhelm them or they haven't shut down so then they have a little bit of difficulty accessing the body sense it doesn't not a genitalia since it's just a like a felt sense of who you are and that because they may not be coming from there and coming from a place that's a place that they hold us them it's just not the way neurotypical will people will do it their communication about their own experience of gender may not be like how somebody who's neurotypical would say it it may be a little less body based and they might want to get a little bit more body sense and need some like navigation in there to be able to do that without it being overwhelming I think they know who they are I haven't had you know any more than any other population had that from from non-binary to clearly male/female and I just want to help them be able to find Lane you know be able to understand their language and then if they need to for the other people to interface with them kind of help them be able to navigate that whether I'm helping them do it with their parents or whether they're getting some of the ways to play this game I generally don't like to teach people this is the way you play the game like that's like teaching trans people this is how you play the assist game and that feels so wrong but there's sometimes for safety you need it just as you do with trans things so that's when I jump in on that say we got to figure out there's this interface problem it's not just you it's them they're not figuring out how to listen and think your way yeah what are some things you try to convey to your neuro and gender diverse patients as you work with them you're totally okay as you are same thing you're conveying to your trans by this why do I train people who provide services to trans folks are just perfect for working with neurodivergent folks is that is that we know you've been living with the experience of you're not okay even before even before words you know your internal experience did not match how people were meeting you and I am recognizing that that's true for you not just in trans but also in that you weren't met or mirrored even when people try to because they weren't getting that you were thinking in a different way and experiencing the world in the different way and I'm getting that and now I want to know more from you about how you experience the world some come in they already know I'm autistic you know I'm Asperger's I know that some don't know it all so those are it's two different groups really with if I'm conveying about gender one of the first things that is good for them to know often is that there's an awful lot of folks like them in the trans non-binary community and that it's a it's one of the more welcoming community just because it's such a parallel experience of being marginalized for being told for so many so much to be expected from birth really to be performing in a identity that's that's not your core identity so that's a good thing for them to know this can be a good place for you you may find other people that are just good buddies here I they often don't have a really good broad understanding without judgment and without imperative to fix themselves of what it is to be nirodha version what it is in the community because that's a lot focused in schools on the social communication they they may be missing that there's an executive functioning component and what that does how that affects them and how they can work with them so I'm just hoping them identify things and communicate with those parents about the things the things that the parents may be thinking they're being entitled or they're being resistant or lazy or something so I hope reframe a lot of those experiences I work with them a lot about quote special interests you know that this that this is a a way that you can connect and so we'll do that I make it okay for them to do the things they do and I'm really curious like the things they have to do with their hands and their bodies when they're in the office you know I kind of see my office which I may walk around and show you there's there's a lot of abilities for how you're gonna sit and move and do things with your hands and bodies and I so one of the key ideas is you've been getting you've been given a a script that's really the wrong script for you and we're gonna try to change that some you do these things whatever it is the that somebody considers problematical and i will help them identify what about they're doing is what is what does that help with does it soothe does it help them organize does it you know help them get a little buffer between things what does it do for them and then work from there so then they start seeing their own how much they've done in their lives to support themselves because the stories usually different it's how many ways they don't do things right like if some of the kid will throw themselves on the floor when they're about to have to go you know just to somewhere I will ask more like what's good about the floor you know well you know like it's not it's often not just resistance like oh I can relax you know I can like it feels solid and everything feels like it's going crazy then when I'm a flaw it's better and then we might do one like you're in this tiny hallway and a bunch of people are trying to go through can you throw yourself on the floor like a little bit before that or so I think the biggest thing I do is try to take away the shame and try to help them understand and then try to connect them with the community of older people at least they're writing about their lives and how how they've done this over time to their twenties and thirties yeah but this is a common thing so you're gonna find somebody's in this world and that being neurodivergent being autistic does not you know mean that you're not trans in the right way that to affirm their experience and that their experience in the trans community - and if they're feeling like people aren't getting them in this support group that that's because that support group needs a little education around neurodiversity and that will do that that's that's our job what are some things you try to convey to the parents of neuro and gender diverse patients as you know parents are going to be all over the map about this just the way they are old enough about their kids trans identities I start to I tell them that what they're going to find on the internet about autism is going to not be very helpful and is probably going to hurt them just as if they just just googled trans or trans youth and I direct them to specific people insights to learn about neuro diversity and I mean had you ripped into this it's called the real experts readings for parents of autistic children it's by autistic adults and to sites like this Nick Walker site where he's got a previous video and lots of connections and similar and I'll explain I I'm often the first person to educate about autism spectrum and to educate them about it's more than the social things it's it includes a lot of sensory issues often when parents start to get both the internal and the external sensory issues and they start to understand the things about eating and that are problem and I alert them to problems that might arise many times I've got kids who are super thin because they can't eat enough they don't talk like normal like typical anorexic people because it's not about body image but nevertheless they are becoming malnourished and we have to try to figure that out without making anybody wrong because during diversion people are neurodivergent they're not gonna do gender the way typical people will so there may be some like well they're not dressing female like no they have a lot more freedom in their head about how they're gonna do this that's and so you just need to accept that you know you can they're they're not going to be typical in the social presentation of things that doesn't mean they're not the gender they identify as so that's how I talk about it with particularly around gender and many times it quickly goes away from gender they're kind of okay about gender and then like oh god now help me with these all these problems we were having with sleeping and eating and sensitivities and how do we navigate these that are the real the because those are often much more daily and challenging things than the trans anything and sometimes there's just a challenge the parents don't want to accept that they think I'm seeing autistic and everything you know ah you know I just try to go through the pieces executive functioning social things sensory things and some special interests and the difference between us I'm female birth assigned male at birth how many people are not diagnosed in the history of how that happened fortunately like Stephen Silverman's Nero tribes came out and there's that fortunately it's in Spanish now so if I have some monolingual primarily that they can get them in Spanish so that's that's the work the other piece I have to mention is oftentimes the two parents will be in different places if there's two parents or there could be four parents but they'll be in different places and one may be like I thought there was something and I've been saying this and others saying no we you know they they they don't want to accept that autistic identity and becomes a little problem for the child as well because they're they're feeling that that creep of the stigma that moved through the parent like this is a bad thing to have and then that gets into the kid too and often there's a parent who's also on the spectrum who may be the more resistant to the thing the other parent is going to see I told you you - yeah what would you want any providers are viewing this program to take away and apply to their own practice okay so key things I would like providers to know is that you have if you're seeing trans people you're seeing neurodivergent people you just are if it's 10% or 15% you just are and you may be missing some of them and that may explain why some things are being more challenging for them so just study more learn more about what nerd what that can look like because we all of us the world got a very poor picture of what an autistic person looks like we see a little professor white guy and that's not what it looks like it's every race every gender and presentations that look a lot like me you know I am neurodivergent I am also older and have figured out how to do some things and so that's that's a really big thing to know it's because you've got them and they are afraid to share those things with you and in which and will include some gender related things like I'm not going to share something that's kind of weird about my gender or the way I think about sexuality or things like that because I'm afraid you will not care about me as a person I know you care about me as a trans person and I'm afraid you might even stop some things or tell my parents you know and then they'll stop this trans thing you know my my transition or whatever I'm doing so that creates tremendous that shame and protection creates tremendous anxiety and difficulty working in the office another thing I would like providers to know if they're not neurodivergent even if they are is it's a cultural diversity issue and just as you need to do need to learn if you're a cisgender what the experience of a trans person is as near a typical person you need to really put yourself in that experience weed as much as you can of first-person experiences of being autistic or otherwise neurodivergent and feel what that would be like play that out how that would be like if you went into a therapists office if you try to go the doctor huh you know trying to you know be sent to a support group things like that just feel it out like bit by bit and keep on putting yourself in each of these different like people you read through watch their videos you know like go to youtube and watch videos of neurodivergent folks going this is my experience and then try to put yourself in that and that sensory experience in that you know ostracization all those in that mind they can't make the words come out in time to do it and that would be soo were helpful what are some concrete ways to make the physical space of your office more comfortable for neuro-diverse youth once you do that you'll find you'll change some things in your office in your intakes so in your on your website if you have a website do you need to be accessible in ways other than just voice I couldn't talk to people on the phone I had to train myself on people's answering machines in the 80s you know and then I moved up to actually calling them so when you're talking with teenagers young adults who who are who have the out of texting so they're not even trying you know they're they're not working that one as much you need to be accessible in other ways and not make that something they can't do even in the office you need to make it okay to not speak you know well to go and to have no issue about that like I have some whiteboards I have paper and we can type in the computer and do text-to-speech we can have a sign if you have that thing because usually it's an anxiety thing when when it starts shutting down if it starts to shut down one we don't want to get you that anxious so I'm learning that but if that happens then we'll have a sign and we'll we'll take we'll switch to something that works and so that they know you're taking you're being an ally you're taking you're making an effort I always put on I always make it a lot of opportunity for people to move in different ways in my office so and to have things to do with their hands and their bodies and that's all fine and part of that means you don't sit perfectly still like wait for them you Kanha you got a like model that that's okay that you might get up and move around when you get up you know you know worked up about something I'll show you I walk around show you a bit of things here so there is there is the land of everything I piled up here come if you can see I have what client who just did the whole session balancing on the ball they I have a gazillion of like fidget voice they are packets of them everywhere land of fidget toys autistic people are not the only ones we're gonna love fidget toys but so nobody complains I have sandbags I used two sandbags I'm a somatic therapist but I don't think you have to be a somatic therapist to have a way to blanket or some sandbags and things when things get a little too for people I'll just say you know I got these sandbags you can put them on your feet off and they kind of help or put them wherever you want have this way to blanket it might not be the right texture for you tell me if it's a bad texture so you're already showing you understand something about like the touch sensitivity and they may not and and they may work for you and they may not some people like really so it's not like your failure if it doesn't but but being being artistic being here divergent you gotta experiment a lot with trying to make yourself comfortable so I'm just give me a lot of things to experiment with will find what works and doesn't I asked them about sitting and I have a rolling day rolling chair so I will I will get the distance that feels right for them and that feels like they're being met some about that and there's Swilly chairs all the chairs they can sit still on the sofa but that chair that's your swivels this chair swivels need to keep drawing on a big pad small ones sometimes they're problem I have big ones small ones they want some with more like friction because that feels better for drawing as like it that and some don't look at me just draw the whole you know time they're doing it just making that all fine and then around the gender stuff often which often there's something to consider around blood draws or shots or things like that so I spend a while on those things many times that's a real challenge and that's kind of longer discussion but just to just to present like you're gonna do this thing and it's this is going to happen a lot of people go in a big deal but you know there might be a deal for you and let's figure out how we can do it knowing what you figured out already about your body that you know that how you manage things like that and see if I've got some other tips from other people around that I tell them that that people in the spectrum react much more strongly their bodies their heart rates their their stress responses are much much stronger than your typical people and so it would be normal normal for them it would make sense for them to have a really big reaction and I direct them it's on my website they direct them to the autism and health survey where it will print out in response to a bunch of questions interface report that you can give a doctor and they it gives them a sense of what make what's going to make that work better everything from procedures to instructions and things that's a big long answer to a short question what are some of your other thoughts about meeting the needs of neuro and gender diverse patients these kids are getting the double whammy in stigma and minority stress and in addition they have sensory and executive functioning stressors that that are very diff physically and lead to a pretty high stress response in their body and often a lot of shame so most of these kids I see are really having a rough time so they will be different in some of your more neurotypical trans kids who are well supportive like it it feels like this is kind of happy work you know there this is this is these could suffer they tend to be more suicidal there's a 5 to 9 times higher suicide rate for Asperger's and there's 9 times higher for you know trans people you don't add them you multiply the Year if you're working with these people here you're often thinking hospitalization but hospitalization is particularly hard for artistic trans people it's hard as trance your misgendered all the time and when you're autistic they're not going to feed you the right thing and they're going to make you wrong for it and you can't eat it and and all your behaviors are considered they don't get it so that often makes kids worse so you're having to figure out what do I do with this kid another kid I might try to hospitalize but this one I can't figure out how to do that you're having to do a lot with parents and try to get other team members on who might be seeing them in a way that's not being very supportive so this is this is extra work and these kids will weigh on you a bit more for how you wish you could do more so things like the warning on a warning label thing god they need you you know and it's going to get to your heart so the other piece is kind of hard thing I'm a somatic psychotherapist and that's made sense to me as a neurodivergent person because I'm extremely sensitive a lot of people think autistic folks are not that sensitive in emotions they're extremely sensitive and extremely impactful cognitive way like because that person said that then that makes me think they might feel that that they might not get they get that you're hurting they get the they feel things super so it may sound like woo but one of the biggest things about being a semiotic therapist is if you're and I've been trained to do touch work so there's touch piece too but even not here what you've got to set first is your own body so one you've got to settle that and then you've also going to extend it's like mindfulness work you may you're going to extend and receive from them who they are receive it into your body and extend out to them from your heart and from your solid ground and acceptance so welcome a curiosity a love for them and I do believe that does a good piece of the work because I think they really are very and you know sensitive to that presence we all are we meaning everybody than the whole world of neuro diversity which is everybody we all are they don't have they're not living in the social nuance thing so they're having to use this other one I have this experience and many and I've had many people report this of making better connection with like foreigners than with people of the culture you live in because the foreigners are not living are not operating in the social nuance thing they're having to connect from a different place and usually a deeper place because that's what's available and I in the same token kind of use that one imagine if you're near typical connecting with someone who barely speaks your language and so you're going to connect from not just face because that might be wrong but from here and how that affects them and that I think is the it's so so key to any kind of cultural diversity work in this case working with whose social you know reading of the nonverbal cues or whatever may be different from yours you hi Carlos here to keep the commerce going make sure you join the gender spectrum lounge at gender spectrum org slash lounge we hope to see you there