Developmental and clinical psychologist, Kathy Platzman from Floortime Atlanta, an expert on the Developmental, Individual differences, Relationship-based (DIR) model and the Director of Clinical Training for the Interdisciplinary Council on Developmental and Learning (ICDL) who is also a Fielding Graduate University faculty member is here to help ponder the question that many parents whose kids are on the spectrum have: Am I neurodivergent? I certainly have wondered, the more I read of autistic self-advocates and the more people I meet with ADHD. It wouldn’t be far-fetched since my autistic son’s personality is just like mine. What are the considerations and what is the value of a diagnosis for a parent?
Am I Neurodivergent Like My Child?
What is considered to be Neurodiverse?
Dr. Platzman says that to some extent, neurodiversity is determined by the culture, not the nervous system. Different historical contexts define neurodiversity differently as well. Kathy gave the example of her father who went to school in a little red school house. She asked him about kids with ADHD and he didn’t understand. Kids who couldn’t pay attention just worked on the farm that day. It wasn’t a problem. Different cultures tolerate things as different times. Also, we inherit our parents’ nervous systems just like they do their eye or hair colour, Kathy says.
Kathy continues that some families have different diagnoses whether they’re bipolar, ADHD, or autism. Some aren’t diagnosed. The outward manifestations of our nervous systems may not match because we have different solutions to our nervous systems. In addition, our environments influence our symptoms. Sometimes you’re fine until you started school. They do well on vacation, but not at home. Sometimes if you want a diagnosis, you want a medication. But psychostimulants help everybody so it might not be indicative of a diagnosis. It’s not so helpful when figuring out why some things are difficult for them but not for others.
I added that the people you interact with can also be an environmental influence. If you are supported and nurtured versus if you aren’t can impact your experience. Who your siblings are and how you got along. In marriages, do your nervous systems calm each other or set each other off? There are so many moving variables that are constantly changing. Kathy concurs. She adds that as we grow our nervous systems develop so sometimes you can have a smooth childhood until hormones kick in in adolescence.
Dr. Platzman described ‘shadow diagnoses’ where you think you’re looking at the problem, but you’re really just looking at a shadow of the problem. ADHD (Attention Deficit and Hyperactivity Disorder) is the most common psychiatrist diagnosis given and the reason is that it’s a shadow, she says. You may indeed have ADHD, but ADHD also comes with OCD (Obsessive Compulsive Disorder), depression, anxiety, learning disabilities, global delays, language problems, motor problems, and emotional problems she explains, as an ‘add on’. Any trauma you may experience can make you lose the ability to focus or concentrate and you may have symptoms of ADHD, but they are shadows of what the real problem is, Dr. Platzman explains.
She continues that there used to be a diagnosis called Multisystem Developmental Disorder that said that sometimes you can have an individual difference that is so big that it can make you look autistic, for instance. If you support and fix the challenges in that one area, you lose the diagnosis which was hopeful for those who want life to get easier and easier for children as they grow, rather than harder and harder, she explains. She wishes she could still give this ‘wait and see’ type of diagnosis when children are still young and their struggles are still being determined.
Looking to DIR for a Game Plan
The ‘D’: Kathy looks to the DIR Model for the game plan when parents are trying to figure out what their diagnoses might be. It’s like a crossword puzzle or being like Sherlock Holmes, she says, as you figure out the family history and look at individual differences. If you look at the Functional Emotional Developmental Capacities, and first consider the core of development of relating to others, communicating with others, reasoning and thinking, let’s look at the first developmental capacity of being able to stay calm, focused and alert, while taking in information through all sensory modalities while staying at least vaguely connected to somebody. If you have any diagnoses, that first capacity is shaken, Kathy asserts.
A lot of trauma and psychological models are now wising up to the fact, she continues, that if you can’t stay calm, focused, and alert, good things can’t happen, so we see a lot of therapeutic models now moving towards calming the body and mind, and then seeing what you have left. When psychologists see a child or adult with regulation difficulties in one of the big three areas of attention, behaviour, or mood, Dr. Platzman explains, we get very interested in just fixing that capacity, and then seeing what you have–which is called ‘going beyond the diagnosis’.
The ‘I’: Look to the capacities, she says, and if you find one that is a struggle and needs some support, then you move to the ‘I’ for the ‘why’. “Why are you having such a struggle staying calm, focused, and alert while taking in sensory information and staying connected to people?” she asks. When you begin this hunt, she explains, you have to accept that this will take awhile. Enjoy the journey and notice what works in what situations–a child might be fine in math, but struggle to pay attention in language arts.
The way to think about Individual differences is to think about what your nervous system is really doing for you. It shuffles incoming sensory information so you know what to pay attention to and what to ignore, she explains. If you can’t shuffle correctly, you have to ask why. Maybe everything is coming in but you can’t shuffle, remember, or integrate it, she says, or maybe one day you can, but another day you can’t. All this information helps her as a clinician. This helps you figure out what developmental capacity is constricted and in what contexts, and with what people, etc. Then you can get beyond the diagnosis, she says. Everybody might think he has ADHD, but I know it might be more complicated than that.
Dr. Platzman continues that sometimes you can take in information but you struggle to process it, and that is a learning disability. You might struggle with visual processing but the auditory is fine. Kathy tends to speak loud and fast, especially when she is excited. If she sees a child with auditory processing challenges, she slows down and looks to see if the child understands her. Then she speeds up to see if the child is lost again. This gives her a clue. You have to look at the diagnosis, she states, as a triangle in a bucket of murky water where you can only see above the water line: a child who might be agitated, underachieving, anxious or argumentative, etc.
The investigation needs to go where you can’t see in that murky water. If you can find out what’s at the bottom of that triangle and fix it, everything above it gets better. What is usually on that bottom layer, she reveals, is usually mood or sensory processing. If you stabilize the mood, for instance, you will see that there is an attention problem. She’ll see a child being diagnosed with ADHD be given a prescription for ritalin and it doesn’t work, then you stablize the mood and see there is no anxiety, but there is an attention problem. Then you can take the mood stabilizer away and the ritalin works this time. She’s seen it over and over. It’s ok to be confused and take the time to figure it out. It’s about looking at those developmental capacities first and stabilizing that first one, she states.
Everything is an interaction between the world and your nervous system.
The ‘R’: Dr. Platzman says that we spend a lot of time in DIR working on the Relationship first to build up a sense of trust and safety. If you don’t spend time getting the relationship, it’s difficult to move forward. The things we learn that are challenging, we learned because someone we trusted helped us out. It’s an opportunity you don’t want to steal from kids, Kathy says. You want to give them the opportunity when you have a good relationship.
For parents who wonder if they are autistic and/or if their child is autistic from their genes, it may not be that your child is autistic because of you, but it may be that they inherited your nervous system and that is what is making your child look autistic, Dr. Platzman says. Going beyond the diagnosis is the most important thing to do. Identify what is hard for you and what is easy for you. Kathy can only see so much in the office, whereas parents have every context. So by forming a relationship with the parents over time, she can go beyond the diagnosis. Having parents as the cornerstones in Floortime couldn’t be more true than when trying to get diagnostic clarity, she states.
First Diagnosis in the Family
I asked Dr. Platzman, what about families who have no history of diagnoses of any kind and their child is the first? She sees that a lot. She says that people in families may be similar so may not notice that anxiety is anxiety, in the case of her extended family. It’s only when you are with other families you may notice it. It’s not unusual if it’s normal in your family. And sometimes the world changes. She gives the example of Bronfenbrenner’s social ecological theory where the individual is a part of the family, the community, etc. but someone changed it where all the circles were ‘the internet’. The internet can make us look like we have diagnoses, she says.
Kathy says that sometimes a diagnosis can come out of the blue, or it can come from prenatal insult, but regardless of the reason, you have to be comfortable with not knowing, and we also can’t invalidate the situation for anyone. When some family members have a diagnosis and some don’t, you can simply say, “This is who you are; this is who we are, and this is what we share.” And Kathy jokes that many parents then wonder which side of the family it came from which involves both blame and validation.
Individual Strengths and Challenges
I shared with Dr. Platzman the example Virginia Spielmann and I discussed in a past podcast about the vu meter on a sound mixing board where the diagnosis might be like the on/off switch, but the most important thing is where the levels are on each control meter, and how we can adjust them. Each person can have such a unique combination of Individual differences and they impact everything. Then they change with situations and with different people as well, and over time as we develop. Kathy says not to focus on the diagnosis so much.
For parents who suspect they have some neurodivergent, they might not realize they had certain challenges until they have a child with challenges, and it’s important to know they can get support in the areas they struggle with. Kathy says that parents can choose to help themselves in a way that their kids cannot. For example, they can choose to go to the grocery store in evening when it’s more quiet, but kids can’t choose when to go to school. And as our kids get older, they get more freedom in choosing what to study or do in life.
Since parents have more control over their environment, they sometimes forget or can’t relate to how hard it can be for their kids who don’t have that control. What might help parents is having a coach, like Mike Fields mentioned that he has for his ADHD. Kathy gave a funny example of a couple she knew. The gentleman was very time organized but was visually spatially impaired while his wife was the opposite. He said if they met for lunch, she’d be at the right corner at wrong time, and he’d be at the wrong corner at the right time.
Dr. Platzman says that self-acceptance is what’s important; validating who you are. She is a list maker, but not a list reader. It’s calming for her and organizing for her to write lists. But it doesn’t make her feel good to put checks on them as she completes items on the list. It’s not how she executes. She thought something was wrong with her. It’s been a hard journey for her to realize that it’s just about writing the lists. If she didn’t write the lists, it really didn’t work. She added that when you clean up your desk it might mean you might not be organized for the next few days. I shared how I struggle with staying on top of preparing for meals everyday.
You have to know your strengths and challenges, she continues. Embrace them, laugh at them, don’t hate the challenges.
Ride with them, validate them and model for our kids that we can validate our quirkiness and our solutions. Kathy says we need to be in a world that embraces self advocates. We also talked about how some people have different advantages over others. It’s ok to acknowledge that and learn about that. Don’t believe everything you think is how another person thinks about it. One of the gifts of people saying who they are, coming out of dark corners, and being able to live their truths is that they can self-validate and be proud, Kathy says.
It’s one of the most humbling experiences for Dr. Platzman when her clients teach her how they advocate for themselves. She again returns to DIR, which teaches that regulation, calmness, and self-acceptance come first. Each capacity has more self-knowledge than the previous capacity, too, she points out, even up to the 16th Functional Emotional Developmental Capacity (FEDC). It turns into knowing yourself and helping society. Any experience that helps you know yourself a little bit better is good, she asserts.
I hear, “Celebrate individual differences!” and pointed out that it has seemed to be a positive that has come out of the pandemic. Understanding ourselves helps us understand, accept, empathize and support our children and Kathy adds, calm down about it. So, parents struggling with identity issues who can identify their strengths and challenges in turn can help identify those of their children’s.
This week's PRACTICE TIP:
This week let’s identify our own strengths and challenges as a parent or practitioner! If you care to take it further, you can identify how you can get support for your challenges.
For example: A strength of mine is staying on top of paying bills, getting groceries, doing laundry and general household management. A challenge of mine is planning meals. I get stuck and feel overwhelmed when I am suddenly hungry and realize I have to prepare a meal which will take at least 30 minutes, and that this will push back whatever else I had to do and makes me feel discouraged for not being on top of something so trivial. A plan that involves preparing meals and freezing them for the week, or assigning cooking duties to each parent might help going forward.
I’d like to thank Dr. Kathy Platzman for discussing this important topic with us and sharing her professional opinion about where to place a ‘diagnosis’ in the grand scheme of things and how to instead focus on strengths and getting support for your challenges. If you enjoyed and found it useful and helpful, please do share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. The next podcast will be in two weeks time.
Until next week, here’s to affecting autism through playful interactions!