Dr. Jeremy Sharp (01:19)
Hey folks, welcome back to the podcast. Hey, today I’m talking about autism again. I’ve been doing a lot of episodes on autism recently just because there are so many questions that are coming up around autism assessment and research is continuing to develop and new research is emerging. And so today we continue that theme with Dr. Wen Lawson. Dr. Wen is Audi HD, dyslexic and dyspraxic. He’s passionate about all things autism.
He’s a British psychologist, a qualified social worker, well-known autistic researcher, author, speaker, and poet. Wen is a key theorist of the monotropism theory of autism, and he’s an adjunct associate professor with Curtin University in Western Australia. We talk about many different things that fall under Wen’s umbrella. And the title of episode, which is beyond the DSM,
what we’re missing in the diagnostic criteria, I think is pretty accurate. So we dive pretty deep into Wynn’s theory on monotropism and how that drives a lot of the characteristics of autism. We talk about sensory concerns. We talk about object permanence. We talk about how monotropism shows up in different ways. We of course talk about camouflaging and different
different aspects of autism in different populations and many other things. This was a fascinating episode. We of course also touch on the clinical aspects of Wynn’s ideas and how we can shift our practice to accommodate and integrate some of these ideas. So as always plenty to latch onto here and there are many things that you could put into play pretty immediately if you would like to in your practice.
Speaking of practices, Crafted Practice is quickly coming up. It’s late July. We’re getting really getting down to it. I think at the time this episode goes out, there should be another week or two left in registration. I don’t know if at this point, because I’m recording so far in advance, whether there will be spots available or not, but I’m really looking forward to it. If there are spots available, go check it out. You know, we’re talking about the theme this year is the sustainable CEO.
We’re great at the clinical work, but I think we built practices that in large part depend entirely on our presence for many of us. And this year at the retreat, we’re going to focus on how to maintain your clinical reputation, but let go of a lot of that grunt work through workflow autonomy. So we have a few, I mean, I hope we have a few spots left, but you’ll have to go double check to make sure. The registration deadline is June 14th at midnight.
So go check it out. It’s the testingpsychologist.com slash crafted practice. If you’re ready to make that shift. Love to have you. All right. Let’s jump to my conversation with Dr. Wann Lawson.
Dr. Jeremy Sharp (04:29)
When Hey, welcome to the podcast.
Wenn Lawson (04:32)
Thank you. It’s really good to be here.
Dr. Jeremy Sharp (04:34)
Yeah, likewise. Good to have you, especially, I know we’re working with a bit of a time difference here and with you being over in Europe. So I appreciate you taking some time out of your evening to chat with me for a little bit.
Wenn Lawson (04:47)
Yeah, no,
I feel privileged. Thanks, Jeremy.
Dr. Jeremy Sharp (04:50)
Yeah, yeah. Well, I’ll start with a question that I always start with, which is, you know, of all the things that you could care about and spend your time on, what is it about this topic that is compelling for you?
Wenn Lawson (05:04)
I’m an autistic adult and ADHD, dyslexic, dyspraxic and a other things. So for me, it’s really important that the world that I’m part of and that my kids and their kids are part of understand what it’s like living as an autistic person and plus other issues. So I’m incredibly passionate about this topic. It’s where I work in and teach and study.
research and ride about.
Dr. Jeremy Sharp (05:32)
Mm-hmm. Mm-hmm. I feel like that’s where things become the most powerful when there’s that overlap between personal and professional.
Wenn Lawson (05:39)
Yeah, absolutely. And the team at the university where I’m part of Curtin University in Western Australia, they’re as dedicated as I am. And we support each other. There’s a lot of mutual support. There’s a lot of autistic people in our research team. So very hands on. People talk about lived experience and I want to say living. I’m not dead yet.
Dr. Jeremy Sharp (06:05)
Ha ha.
Wenn Lawson (06:06)
very
much living experience yeah yeah yeah
Dr. Jeremy Sharp (06:08)
Uh-huh. Uh-huh. It’s happening. Yeah. In the moment for sure. And continually changing and
evolving. Yes. Well, I want to, I want to just jump right into it. I know you have a lot to share on many topics related to, to autism. So maybe we just jumped to the diagnostic framework right off the bat. I mean, there’s been a lot of discussion over
I don’t know, past especially 10 years maybe around our current diagnostic framework with the DSM-5 and does it fit, does it not fit? They made some changes for the DSM-5. I would just, you know, it’s kind of an open question. I would love to just get your thoughts on the current diagnostic framework and how it’s worked.
Wenn Lawson (06:51)
Yes, it’s the DSM-5 with its revisions in 2022, still doesn’t have the kind of subtleties that it needs for diagnosing a lot of people. So if you’re a female, you may miss out on a diagnosis. If you’re very able, whatever gender you are, it might not be picked up.
Dr. Jeremy Sharp (07:03)
Hmm.
Wenn Lawson (07:14)
And it’s actually really important that it is recognized because otherwise as autistic people, we’re very hard on ourselves. We’re not good at self-compassion and other people have a expectation and benchmarks that we’re supposed to reach. And there might be a lot of reasons, especially sensory stuff, which is included in the DSM five, which was not ever there in previous versions of the DSM. So it’s really.
really good that they mention this, that there’s sensory stuff. There’s a lot of things that are not mentioned. They don’t really talk about interoception, our internal senses. They don’t talk about the issues we have with object permanence. They don’t talk about the differences that come from being single-minded. They talk about rituals and being perhaps obsessed, is the word people use.
obsessions and I prefer passions. They don’t go into explaining what’s behind the diagnostic criteria criteria. So that’s the bit that’s missing, but it’s a good starting point. But if you’re not trained and you’re not, familiar with how autism presents in a variety of different people, different genders, different ages and so on, you could easily overlook a lot of people. so
been a lot of overshadowing, a lot of misdiagnosis and stuff like that because of not the DSM just doesn’t go into those more subtle expressions. If you have ID or an intellectual disability, which is a separate thing, it’s not autism, but it can co-occur, then it’s easier to see that there’s something different about this person.
And unfortunately, then people start talking about profound autism and separating it from autism per se, which makes me a bit sad because you can be a very able autistic person in some ways, but have a lot of spiky dips. So I’m, I have a PhD, but I can’t do my own shopping. So it gets a little difficult when people start separating those things out. The DSM five doesn’t go into those.
Dr. Jeremy Sharp (09:25)
Mm-hmm.
Wenn Lawson (09:27)
enough detail, it talks about the levels of one, two and three, which are pretty rigid. And there’s a lot of movement between those you can go through level one, two and three in the same day. When you’re assigned the level, that assessment, it may not actually pan out in your life. And people need to be aware of all those things they need to know and be familiar with autism and autistic people.
Dr. Jeremy Sharp (09:50)
Yeah, yeah. We get a lot of questions from folks around the levels and it’s always a hard question. Um, you know, it seems like, well, I mean, parents and adults want to know, you know, parents about their kids and then adults about themselves. And it’s always a tough question. It does feel like we’re like throwing darts at a dartboard in some fashion where we’re just sort of guessing based on the information we have. But like you said, that might shift, you know, functioning shifts throughout the day. Right.
Wenn Lawson (10:15)
Yeah, it’s the information you have on that day with that person at
that time and can be quite different in another situation. ⁓ And that’s not accounted for.
Dr. Jeremy Sharp (10:22)
Yeah. Yeah.
Right. Right. So let me ask you a little bit more, you know, in this diagnostic framework, I know there’s a lot of, there is a lot of talk around, I’ll say different.
types of autism for lack of a better term. That’s not right. But you know, you, you mentioned sort of like profound autism, quote unquote, like the, maybe like the nonverbal, you know, high, high support needs sort of individuals. Then there maybe is a distinction with,
Wenn Lawson (10:46)
Alright.
Dr. Jeremy Sharp (10:53)
lower support need individuals or like you said, subtle presentation. And then there’s some discussion around like, is there a female autism phenotype? So is there a, like a different type for women? And I’m obviously simplifying and you know, kind of amplifying at the same time, but how do you sort of, yeah.
Wenn Lawson (11:03)
Yeah, yeah.
Yeah. But it’s good. It’s good to have those conversations. But
everybody is so different. And, you know, women have usually not always they have a double X chromosome and sociability is coded in the tip of the X chromosome. So women come primed with a double dose of being able to recognize social
Dr. Jeremy Sharp (11:17)
Yeah.
Wenn Lawson (11:37)
nuances, etc. might not know if you’re autistic might not know how to use them or when, but then it’s more likely that females will mask and copy to try to fit in to keep themselves out of trouble to get a friend a relationship a job. And that masking is exhausting. And it actually doesn’t do you any good because it’s not your authentic self.
Dr. Jeremy Sharp (11:39)
Mm-hmm.
Mm-hmm.
Wenn Lawson (12:02)
But the world doesn’t give us permission to be our authentic selves. So it’s a very difficult scenario. And men have one X, one Y chromosome usually, not always. So they don’t have that double dose of awareness socially. And I think that’s one of the factors that impacts the different presentation in autism. And then of course you’ve got varying genders that this impacts on.
Dr. Jeremy Sharp (12:05)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Wenn Lawson (12:28)
It isn’t cut and dried. It’s not black and white.
Dr. Jeremy Sharp (12:31)
Sure, sure. So would you ask a very simplified question, but I mean, are you of the mind that we are talking about sort of the same diagnosis, so to speak, across all these different presentations?
Wenn Lawson (12:43)
Yeah,
I quite like the idea of the autisms, because it does impact people differently. But I’m also aware from the research we’ve done, and the study and our own experience and autistic people, I know that foundationally, there is a difference cognitively in how we’re put together and how we think, which we tend to think of as being very single minded for all autistic people.
Dr. Jeremy Sharp (12:48)
Mmm.
Mm-hmm.
Wenn Lawson (13:09)
the term used for that, and people can look this up if they’re interested, is monotropism. Being mono seems to be every person, every autistic person I’ve come across, comes from that starting point. And then they have their personality, their gender, their culture, race, and all those other things on top. But they still have this one thing that seems to be across the line for all autistic people.
We’re mono, we’re monotropic, single-minded, single-focused, only able to really attend to one thing at one time. And no one attends to lots of things at once. It’s a myth to say that people multitask, but if you’re not autistic, you seem to be born with that ability to be polytropic, which just means shift attention more easily. Think, feel, notice, taste.
Dr. Jeremy Sharp (13:39)
Mm-hmm.
Wenn Lawson (14:03)
Imagine a whole heap of things seem to co-occur almost simultaneously. That doesn’t happen with autistic people. We’re very single-minded, one thing at a time. All of our senses can be taken up with whatever it is we’re attending to. So we won’t actually notice whether we’re hungry or tired or what sort of pain levels we have or lots of other things like that. If all our attention is on one thing, no spare attention for anything else.
Dr. Jeremy Sharp (14:10)
Mm-hmm.
Mm-hmm.
Wenn Lawson (14:30)
And that being mono, that disposition seems to be across all autistic people. We also come across this in ADHD, monotropism very much in the ADHD population as well. But that pull push, if you’re autistic and ADHD, that pull push scenario impacts, will lead to a different presentation. And that can complicate things, but it’s important to get that right, to understand it.
Dr. Jeremy Sharp (14:42)
Can I ask?
Sure, sure. I want to ask more about monotropism because that’s where, you know, it feels, this feels like kind of a foundational characteristic, but I’m going to detour for just a second because of something you said, and this came up literally yesterday in our consultation meeting of all the psychologists here in my practice. We were talking about this question of,
you know, term odd EHD, right? And yes, you know, we have individuals who are autistic and diagnosed with ADHD. Those co-occur a lot. Is there something different and separate and distinct in an odd EHD profile from just having a dual diagnosis of autism and ADHD? Does that question make sense?
Wenn Lawson (15:40)
Yeah, yeah. No, I think there is. But in all the HD folk, there’s again a different presentation than you might see in somebody who’s autistic without being ADHD. It’s really clear the the monotropic disposition seems to occur in both. But the need for novelty for moving on for not staying with the same is also very strong. So there’s a conflict, a push pull, we call it.
Dr. Jeremy Sharp (15:42)
Yeah.
Sure.
Mm-hmm.
Mm-hmm.
Wenn Lawson (16:09)
for ADHD,
which you don’t see in a profile that’s autism alone. You see monotropism, you see rumination, you see getting stuck, inertia, a whole heap of things, which you can also see in ADHD, but there isn’t that drive to get onto something new, to move past whatever it is you’re focused on. You want to stay with same. And that’s really strong in the autistic disposition.
Dr. Jeremy Sharp (16:22)
Mm-hmm.
Wenn Lawson (16:36)
We did some work, Patrick Dwyer, myself and a couple other researchers did some work on this and looked at the differences. I’m very happy to send you the paper and what we found because we were surprised. We didn’t expect to see such a high amount of monotropism in ADHD or all the ADHD. So if you were autistic and ADHD, were actually, you had a, you were more monotropic, not less. We expected to find.
more monotropism in the autistic population, not in the ODHD one. So that was quite a surprise.
Dr. Jeremy Sharp (17:13)
Sure, sure.
Yeah, yeah. Yeah, I would love to dig into that a little bit more. It was a good discussion.
Wenn Lawson (17:18)
Yeah, and I’ll send you some infographics and
some things, Jeremy, that I don’t know if I’ve sent already, the picture, map it out so people can understand it better.
Dr. Jeremy Sharp (17:30)
Yes, that’d be great. That’d be great. Visuals are always good. Yes. So, okay. Let’s steer back to the monotropism topic. I mean, you mentioned a lot of ways that it manifests and shows up. Are there other ways that it shows up that we maybe haven’t discussed? Like other facets of monotropism? Yeah.
Wenn Lawson (17:31)
Hmm. Hmm. Hmm.
Yeah, yeah.
Absolutely. So this is not a choice. This is the way we are born. This is how we come. So our cognitive disposition is literally to only be able to have enough energy and attention for one thing at a time. And when autistic kids are real small, two, three, four, five, six year olds, even, they may not be focused on any one thing in particular. They’re still
Dr. Jeremy Sharp (17:56)
Mm-hmm.
Mm-hmm.
Hmm.
Wenn Lawson (18:14)
drifting and moving from thing to thing to find out what it is that grasps their attention. So it will grow into a particular interest, probably. If you’re all DHT, autistic and ADHD, then it will you will have more than one. But if you’re monotropic, as an autistic person, you tend to focus on one thing at one time. It could be it could be period pain. It could be a headache. It’s not always
Dr. Jeremy Sharp (18:36)
Mm. Mm-hmm.
Wenn Lawson (18:39)
a special interest as in hobby. It’s anything that actually grabs your attention at that time. So that means it can change, but it’s very likely to be a similar thing for quite a long time. So I loved, always loved animals, still do. But then as I got older, birds came into the picture for me. I loved piston engines as a younger person and cars and motorbikes.
Dr. Jeremy Sharp (18:43)
Yeah.
Mm-hmm.
Wenn Lawson (19:07)
and airplanes, this sort of thing. So that I’ve moved away from the pistol engine. I haven’t moved away from animals that has stayed. So that sort of thing can happen. It impacts things like your sensorings, your sensing system, external sensing. So things can be too loud, too bright, too smelly, overwhelming. You can suddenly just be aware of all the labels or all the buttons.
Dr. Jeremy Sharp (19:09)
Yes.
Mm-hmm.
Wenn Lawson (19:33)
seems in something that you wear that can take over all of your attention and you take your clothes off, take your socks off, take your shoes off. You can’t cope with them. And if you’re nonverbal or at least you don’t speak, it can be hard to identify the reason you might’ve taken your clothes off. it’s impacts on how we feel temperature, how we notice if we’re unwell or well comfortable, not comfortable, public, private,
Dr. Jeremy Sharp (19:35)
Mm-hmm.
Mm-hmm.
Wenn Lawson (19:59)
impacts on, when I talk about object permanence, I mean, this is a term psychologists would know, that that is used for when you have a cognitive understanding that something can still exist, even when it’s out of sight. So we do these little tests with kids and might put a toy car under a blanket and they look for it. But up to a certain age, they believe it’s actually gone. You know, you play peekaboo, babies get upset because suddenly you’re not there anymore. But actually,
Um, and this is usually established before the ages of 12, 18 months, but in autism takes an awful lot longer to know and trust something still exists when you can’t see it. So in America, Temple Grandin has, um, uh, everything all over the walls of her office. So she used to, uh, I guess she still might, if she can’t see it, it doesn’t exist. And yet she has this amazing ability to draw and compose animal
Dr. Jeremy Sharp (20:43)
Okay.
Mm-hmm.
Wenn Lawson (21:00)
feed stations, animal, humane. There’s a name for this, which I can’t think of at this moment, but she can conjure up that and draw it from diagrams in her head that she puts together, but she can’t hold on to something that might have happened if it’s suddenly not there anymore. She loses that and then she can see visually the photo of it. When I was in as an exchange student in Bradford in England in Yorkshire, I went from Australia to Yorkshire for
Dr. Jeremy Sharp (21:07)
Mm-hmm.
Mm-hmm.
Yes.
Wenn Lawson (21:29)
six months as a student years ago. I knew Australia existed, but honestly, didn’t feel like it did. I could see it in a book of maps, but I had no sense of my family. I had no sense of connection. It was awful. And I was really miserable. And I met somebody at an autism support group meeting who said to me, have you got a photo over your family? You can put that in your wallet and look at it. Remind yourself they still exist.
And that changed everything for me being able to see something that I could still still there. Even though academically I knew Australia still existed. That’s an object permanency, relationships and relating to other people. Remembering birthdays. It’s not just a male thing. If we get there’s a whole heap of how real big area and I can again send you some infographics to explain this better on how this impacts our daily lives. So
Dr. Jeremy Sharp (22:27)
Yes.
Wenn Lawson (22:27)
The need for structure and routine absolutely can help with some of that. But if there’s a failure of structure, a failure of the routines, that there’s a change, it’s dramatic. It’s like the end of the world. I can’t envisage what will happen next if I can’t see it, if I can’t touch it, find it. And that happens a lot for us as autistic people.
Dr. Jeremy Sharp (22:46)
Yeah.
Sure, So are you, sorry, I want to track and make sure I’m following. Are you saying that monotropism is sort of driving the object permanence concern?
Wenn Lawson (22:59)
absolutely.
It drives the lack of the difficulty with connecting to an understanding of permanence. So I’ll have certain clothes set for the summer, for the winter. But it might not be cold enough to wear them or it might be not warm enough to change. But it’s set on that day.
Dr. Jeremy Sharp (23:06)
Mm-hmm.
Mm-hmm.
Wenn Lawson (23:21)
That’s when the season starts. That’s when I changed my clothes and some of those things. It’s kind of hard to explain it unless you’re living it, but that’s an object permanency directly related to being mono being mono dropping. And there’s lots more that this impacts on in a really big way. So it will impact. If you can’t see your partner or your child, if you’re an autistic adult, you may not
Dr. Jeremy Sharp (23:25)
Mm-hmm.
Wenn Lawson (23:47)
You might not get a sense that they exist or I’ve made a promise, you I’m going to text you when I arrive at this position where I get to. But when I get there, being there takes over all my attention and the need to text my partner to say I’m safe goes. And that’s an object permanency. There are so many areas that this impacts. Certainly the DSM-5 never talks about any of this.
Dr. Jeremy Sharp (23:50)
Mm.
Wenn Lawson (24:15)
but it’s a really, really big issue and it’s one we live with daily.
Dr. Jeremy Sharp (24:19)
Right, right. Yeah, I mean, in the DSM, we just get the, I guess you maybe you’d say like the superficial capturing of it, you know, in restricted interests or sensory concerns, you know, but it doesn’t, it sounds like this is sort of the deeper layer. You. Yeah.
Wenn Lawson (24:31)
Yeah.
It’s much deeper. And
rather than passing it off, we need this to be accommodated, understood, and we need to plan for it and work towards making it okay to decrease stress and anxiety, which can be huge, especially in the kids. It’s a massive area of concern.
Dr. Jeremy Sharp (24:48)
Mm. Mm-hmm. ⁓
Absolutely, yeah. Now you mentioned interoception earlier in our conversation. I would love to chat about that as well, because that is a big part of this experience too, right? Yeah, talk to me about interoception.
Wenn Lawson (25:06)
Again, Yeah.
Interoception is our inner sense, our inner sensing of needs like hunger, bathroom needs. If you need if you’re tired, if you’re anxious, it lets you feel your heart rate to know if you’re you know, anxiety levels, a whole heap of things come from that
Dr. Jeremy Sharp (25:19)
Mm-hmm. Mm-hmm.
Wenn Lawson (25:33)
inner knowing that are different for external sensing. But again, if you’re monotropic, or your attention is taken up with whatever it’s taken up with, you may not notice you’re tired may not notice. I remember jumping on a trampoline as a kid. And I sort of knew it was time to stop my, my, my mom was telling me I needed to stop. I couldn’t stop. I could tell my legs were not quite comfortable. But I was jumping.
Dr. Jeremy Sharp (25:35)
Mm-hmm.
Mm-hmm.
Wenn Lawson (26:03)
and I didn’t know the process of how to go from jump to stop. I had to learn that stuff. that’s all interoception stuff. And there’s schools in South Australia in particular where they’ve brought interoception exercises into the daily school curriculum for at least four times a day for five minutes. They do these exercises to help connect.
to our interoception self, and that has decreased a lot of what we would think of as challenging behavior. It’s decreased our anxiety, which was behind the challenging behavior. It’s enabling the young kids to get in touch with that sense that they haven’t been able to. But unless you stop, interrupt your attention to do this, it can be really difficult to notice. So I’ll often be way past.
Dr. Jeremy Sharp (26:36)
Mm-hmm.
Wenn Lawson (26:57)
the time to go to the bathroom way past the time for my dinner way past time to go to bed. Because I haven’t noticed all of my attention is taken up with the thing I’m researching studying that does research rabbit holes. And I haven’t noticed that I really should have water. Hydrating is really important and I never never feel thirsty.
Dr. Jeremy Sharp (27:16)
Right, right.
So I feel like we’ve kind of long believed that poor interoception is kind of a soft sign of, you know, of autism, but it feels like, I mean, you’re kind of advocating like, hey, this is a major feature and.
Wenn Lawson (27:32)
It’s a major issue
and it’s something all humans can struggle with. Everybody knows what it’s like to be taken up with something you’re really interested in. And two hours have gone by before you even recognize. We all know that. But for autistic people, it’s not a choice. Your attention is very mono. It’s taken over by whatever captures it, which is not always a special interest, but it might be.
Dr. Jeremy Sharp (27:41)
Yeah.
Yeah.
Mm-hmm.
Wenn Lawson (27:56)
There’s no spare attention for other things. It is very much part and parcel of being on the spectrum.
Dr. Jeremy Sharp (28:02)
Yeah, yeah, certainly, certainly. And so we’re just kind of running through these different characteristics because, you know, I love your perspective on each of these. And I want to touch on camouflaging or masking. And, you know, this is, again, something that’s being talked about a lot right now in the context of autism. And I would love to hear your perspective on this and what’s happening and camouflaging and ⁓ maybe an alternative view.
Wenn Lawson (28:24)
Yeah,
Dr. Jeremy Sharp (29:46)
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Wenn Lawson (30:54)
absolutely.
I tend to think of it as adaptive morphing. Because as autistic people, we adapt to morph into the background or into the setting, so that we are not standing out as so different. And if you have the social skills or the social awareness, probably is a better term, then masking can be really
Dr. Jeremy Sharp (30:58)
Mm-hmm.
Mm-hmm.
Wenn Lawson (31:17)
huge thing that you feel you need to do if you don’t know what to do, you copy the girl or the boy or whoever next to you. You live your life through that other person. Because you have no connection or natural essence of what it is that’s happening socially. And masking for some people, I spoke to a friend, an autistic friend in her 40s with three autistic kids. And she said to me, I don’t know anything else. I only know the mask. She’s never
Dr. Jeremy Sharp (31:27)
Mm-hmm.
Hmm.
Wenn Lawson (31:46)
She didn’t know what her authentic self was. So we were having sessions for autistic people to be themselves. They could stim, they could have fidget toys. People didn’t know what to do or how to do that. Because they’ve been stopped forcibly from stimming, know, hands down in pockets, hands in pockets, stand still. The energy it had taken to make them
Dr. Jeremy Sharp (32:01)
Mm-hmm.
Wenn Lawson (32:09)
seemingly more like non-autistic kids was exhausting and was causing a lot of pain. But they didn’t know how to not do that. So masking is exhausting and it can take over all of your energy so there is nothing left at all, even for the things you would like to be doing.
Dr. Jeremy Sharp (32:19)
Mm-hmm.
Wenn Lawson (32:30)
It’s responsible for a huge amount of mental health issues and autistic people and suicidality. So ⁓ it’s a huge thing. And the world we live in just is not designed for autistic people to be themselves. So they’re often pushed by family, by even by their own selves to mask because their difference just feels too uncomfortable around from the people around them. And that’s not how it should be.
Dr. Jeremy Sharp (32:38)
Tell me about that.
Mm-hmm.
Wenn Lawson (32:58)
remember,
you probably don’t because you’re probably too young, but years and years ago, people who were in wheelchairs, or we used to call them spastics, were hidden away in institutions. You never saw people who were disabled. And then there was a big push to get people out into the community and for us to be in touch with people who are different. So we began to accept that a person who is disabled or who has spasticity in their limbs,
Dr. Jeremy Sharp (33:02)
Ha
Mm.
Wenn Lawson (33:26)
could be a father or a mother, could have children, could have a relationship. It’s a similar thing with autistic people. We need to be seeing our natural selves so that people will stop trying to make us different and begin to accept, okay, you need to regulate yourself by flapping. You need to have something to fidget in your hand. need more dairy. You need to hum every now and then. You need to get home from school.
Dr. Jeremy Sharp (33:43)
Mm-hmm.
Wenn Lawson (33:51)
Run around your bedroom three times. Whatever it is, this is normal and natural and authentic to you so that we don’t need to adapt to morph and spend all that energy trying to be our non-selves for acceptance is not okay. It really is responsible for a lot of mental health issues.
Dr. Jeremy Sharp (33:53)
Mm-hmm.
Mm-hmm.
Mmm. Yeah. Yeah. I mean like you said it takes up a lot of mental energy it causes a lot of stress ⁓ I was not aware of that connection between camouflaging and suicidality that’s Very high very meaningful. Yeah. Yeah Is camouflaging different for autistic folks than? Neuro typical folks, I mean cuz I know you know like camouflaging happens right like we all do it to some degree ⁓
Wenn Lawson (34:13)
and
Yeah, yeah, it’s very high.
Yeah, yeah, people will say
they wear different caps for different roles. Their dad cap, their granddad cap, their employee, employer at school, whatever it is, they have a different persona, seemingly. But I don’t think that’s the same thing. For one thing, they know, I’m putting on my dad cap. They seem to recognize I’m going to work, I’m going to
Dr. Jeremy Sharp (34:39)
Sure, sure.
Yeah. Mm-hmm. Mm-hmm.
Mm-hmm.
Wenn Lawson (34:59)
These are my work clothes. I’m going to school. This is my school uniform. I’m to the shopping mall, to the doctor. This is me going to these places. That’s not the same thing. Camouflaging or adapting to morph into a background of a situation means taking on a persona that you think is what the world expects of you. It’s not you. It’s not you adapting to fit into work or school because of that’s the uniform.
Dr. Jeremy Sharp (35:20)
Mm-hmm. Mm-hmm.
Wenn Lawson (35:26)
it’s becoming what that role is that you think is what people will accept. That acceptable, whatever that is, if you’re monotropic, takes all your attention and it really is exhausting. And it ends up you feeling not valuable, not valued. Self-compassion goes out the window. There’s no place for you to be who you are. the read that
that bends the back that breaks that situation doesn’t take very much. takes a small thing to tip you over and into what people call a meltdown or burnout. It really doesn’t take much. And once you’re in that place, if you’re going to burnout in particular, can take like 12 months to recover. And then recovery for autistic people again is different than for non-autistic people because non-autistic people need to be away from demand and they need to rest.
Dr. Jeremy Sharp (36:00)
Mmm.
Mm-hmm.
Mm-hmm.
Mm-hmm.
Wenn Lawson (36:25)
autistic people being away from demand and resting and then going back into the same situation that sent you there. No, that’s not going to work. And we also need our passions to we need to be engaged in those passions as part of that repair situation if you’re going to burnout, which isn’t something non-autistic people need, they might enjoy and like, but we need it.
Dr. Jeremy Sharp (36:48)
Hmm. Yeah, I like that we’re talking about this. I was definitely wanted to ask about autistic burnout and you know, we’re we’re Veering into that direction for sure. Can you say more about you know, how autistic burnout is maybe different than normal burnout or Yeah, yeah what what might help?
Wenn Lawson (37:03)
Yeah. Yeah.
If you think about the foundation of being mono monotropic, compared to polytropic, having that ability to adapt to change, having that ability to explore something different and new, which which is very much a polytropic disposition. If you’re an autistic person, you’re more drawn to same you’re more drawn to the structures, you know, even if you create it.
Dr. Jeremy Sharp (37:22)
Mm-hmm.
Wenn Lawson (37:29)
routines you know that you do. So change is a huge thing in the world of autism. Excuse me. So we move into that place of burnout quicker and the recovery takes longer. For burnout to happen in non-autistic people, and it certainly does happen, it’s often because they’ve overloaded, they’re taking on too much. But for us, too much might be working five days a week.
not not work, parenting, friendship, doing the groceries, cleaning the house or whatever extra things are. No, just the one thing that can send us there. So yeah, hard to regulate when there’s an expectation you’re an adult now. You should you should you should that’s a big word should know. It isn’t like that. It’s not I am autistic.
I only can manage these amount of hours. I can’t do the washing up unless the washing up is sorted and organized for me first. I can’t make the right side of the bed only the left side. There are all these differences that impact on us as autistic people that non-autistic people have no idea about because they’re more even in their abilities to do when it comes to coping with things that are different. For us, we’re not made that way.
Dr. Jeremy Sharp (38:46)
Mm-hmm.
Wenn Lawson (38:47)
takes a bit more work to work out what it is that will enable us to manage the bits that we can and avoid burnout. It really does take a lot of care for yourself. And it takes also that awareness, knowledge and value of who you are to be able to say to a partner, family member, a teacher, an employer, as an autistic person, this is what I can manage.
And I manage better if you do A, B and C, but there will become a time when I need to stop and I need to recharge and it will take less time and I need to recharge over a longer period. It’s different.
Dr. Jeremy Sharp (39:28)
Yes.
Yes. Yes. Well said. I want to go back to the camouflaging topic just for a second and ask what will probably be a dumb sort of clumsy question. This is something that comes up a lot and it’s kind of wrestling with the paradox. Maybe you know where I’m going here. Like wrestling with the paradox of, you know, autism having these core features.
theoretically of like trouble with social skills, understanding social norms and know behaviors and things like that and yet having enough I guess awareness to like camouflage effectively you know and sort of blend into social environments. How do you think about this or how do you think about that seeming paradox?
Wenn Lawson (40:13)
Yeah. Yeah, yeah.
It’s very real. If someone’s attention is all on mirroring, copying, noticing this, and this and this keeps that person safe. This, this and this keeps them out of trouble. That’s where all of their monotropic attention will go. And it’s not about social skill. It’s about what you notice to help keep yourself safe. It’s a bit like a, you know, the
Dr. Jeremy Sharp (40:29)
Mm-hmm.
Mm-hmm.
Hmm.
Wenn Lawson (40:43)
chameleon lizard that changes its color and blends into the background. It’s biological. It’s built in. And that’s a very different scenario to being able to notice how to be appropriate socially, what’s private, what’s public, what’s shared. That’s a very different skill. And I really don’t like social skills clubs and social skills stuff.
Dr. Jeremy Sharp (40:48)
Hmm. Mm-hmm.
Mm-hmm.
Wenn Lawson (41:08)
because that tells me I’m not valuable the way I am. I would prefer that young people and adults learn turn-taking, yours, mine, private, public, learn that through the games and the passions that they employ. So a chess game, if you’re into chess, can teach you lots of things about being quiet, being still, turn-taking, processing. You can learn a lot of social stuff through a game.
Dr. Jeremy Sharp (41:12)
Mm-hmm.
Wenn Lawson (41:34)
Video games, it’s the same online video games, know, on a computer or iPad or something. You can learn those sorts of skills. If that’s where your heart is, if you’re into those things, if, if you’re not into those, then don’t, don’t use those, but there will probably be some environment that you’re comfortable in that is where you can still learn those kinds of skills naturally and, they’re valued. But as soon as you start having
special social skills lessons and so on. You’re confirming that I’m a dud. I’m no good and that’s not okay.
Dr. Jeremy Sharp (42:11)
Hmm and then that just yeah Makes it even more more pressure to to camouflage. Yeah. Yeah Yes, yes, so this is a it’s not like a perfect
Wenn Lawson (42:15)
Ask some of them. Yeah, yeah. That’s a little more pressure.
Dr. Jeremy Sharp (42:24)
segue necessarily, but I did want to touch on the double empathy issue. I mean, I think there’s some, it kind of fits in with this discussion, right? Or at least my understanding of the double empathy issue is like autistic folks tend to get along pretty well when they’re all together, but not so well when neurotypical folks get mixed in. ⁓ So yeah, take that wherever you want to take that.
Wenn Lawson (42:32)
does.
Yeah.
Yeah, yeah. It’s like, I don’t understand you, you don’t understand me. So there’s a lack of understanding or empathy on both sides. So it’s called a double empathy issue. And that comes because you’ve got a cognitive disposition that’s mono, trying to relate to a cognitive disposition that’s poly. We’re just different species, two aliens who come from different worlds trying to connect, unless you find something in common.
Dr. Jeremy Sharp (42:50)
Yeah.
Mm. Mm-hmm.
Wenn Lawson (43:12)
it really is hard to actually connect because what do you have? What do you have? So that double, double empathy thing is a very big issue. And know, Damian Milton, whose work this is, has come out of that, has proved that over and over. And then of course that moving on, we now have the triple empathy problem, which I probably spoke to you about, which is again, interesting because that’s saying it isn’t just the empathy of the human.
Dr. Jeremy Sharp (43:22)
Mm-hmm.
Mm-hmm.
Yeah.
Wenn Lawson (43:40)
It’s the empathy of the environment and the situation they’re in. we have the medical world, for example, has its own language, its own expectation, its own way of being. And that actually is an issue for empathy when it comes to working with autistic people who perhaps are not showing signs of pain or they’re not showing signs of being unwell. They’re not showing them in the way they expected.
Dr. Jeremy Sharp (44:03)
Hmm.
Wenn Lawson (44:07)
So then we get the triple empathy problem. And it’s not just the medical world. There’s other agencies and areas out there that have their own rules and regulations. Education system is one of them. So then you get the triple empathy thing creeping in. Again, we need to be building the bridges across connection. I’ll send you an infographic on that as well if I haven’t done already, because I find it fascinating.
Dr. Jeremy Sharp (44:08)
Mm-hmm.
Great. Yeah. Yeah. I would love any of that info. Yeah. We’ll put it in the show notes for anybody listening. Of course. So let’s transition a little bit. This, all this discussion has been fantastic and I feel has really like set the stage now to talk about the application to clinical practice. You know, this is, you know, always interesting to folks. Like what do we actually do with this information? How does this change or, you know, alter our practice? So,
Wenn Lawson (44:35)
Yeah.
Dr. Jeremy Sharp (44:58)
Maybe we start at the place that is the first point of contact for a lot of us, think, which is the interview, like the diagnostic interview. We meet with the person the first time. How does this change? don’t know, questions we ask or ways we approach an individual.
Wenn Lawson (45:04)
Yep.
Yeah, absolutely. No,
it totally does. Because we need to be listening to what isn’t said. We need to be watching a person in their everyday life. So sometimes in the office, we miss this, because a person can put on a show in an office and we might not get past to see who they really are. So I’m not currently doing assessments. I’m trying to focus on research, but
Dr. Jeremy Sharp (45:17)
Hmm.
Mm-hmm.
Wenn Lawson (45:36)
When I was doing assessments, I would look at somebody in their home or in their school or at work and gather a bigger understanding of that person in different domains, because they can be one thing in one position in one situation that where they’re feeling comfortable in the home may not show what’s actually difficult for them. We might not see it. So it would be very easy to conclude they don’t have those difficulties when they do. But it depends on the environment and the situation they’re in.
Dr. Jeremy Sharp (45:36)
Mm-hmm.
Wenn Lawson (46:03)
So when someone comes in for an assessment, the lens we look at that person through, if we understand monotropism, should be a monotropic lens. If we understand the foundation to what’s underneath the DSM-5 criteria, we need to have that in mind when we’re listening to them, when we form the questions that we ask, when we write to them before we meet to share information about what they’re coming to and who they are.
Dr. Jeremy Sharp (46:08)
Mm-hmm.
Mm-hmm.
Wenn Lawson (46:29)
and give them a chance
Dr. Jeremy Sharp (46:29)
Mm-hmm.
Wenn Lawson (46:30)
to write a bit about themselves and a bit of a story. All those things should come into play because without listening and picking up those subtle characteristics, you can’t put the puzzle together appropriately.
Dr. Jeremy Sharp (46:42)
Sure. Do you have any examples of these questions or ways to write to someone ⁓ that we could take into account?
Wenn Lawson (46:49)
Yeah, yeah.
Yeah, I can send you the ones that we use. they’re like, pro forma is already worked out. If you get information from working with children, get information from parents, that’ll be from the parental perspective. It’s important to actually get information from the young person you’re working with as well, from their point of view of how they see whatever it is that you’re going to ask them.
Dr. Jeremy Sharp (47:16)
Mm-hmm.
Wenn Lawson (47:16)
if you
get them talking about something that’s really of interest to them. So I will ask someone to bring along some photographs of things they’re really interested in. Or I’ll give them a camera and say, take some pictures of what you’re really interested in. And those throw away cameras, they’ll only take things they’re interested in. So I am getting an understanding of what their passion might be if they have one. Very likely there will be something that captures their interest. And if that is all they can talk about and that
Dr. Jeremy Sharp (47:29)
Mm-hmm.
Wenn Lawson (47:44)
brings them to look to life in the meeting. And what will happen when I try and take that away or add another element in? What happens? I watch their reaction. I see if it’s really difficult for them to shift, very difficult to change without making them really uncomfortable. I have to be very careful about this, but I’m looking for very autistic disposition in their everyday life. And that initial thing from sharing an interest is very helpful.
And it’s not just kids, we do this with teenagers, do this with adults as well. So that they’re starting off feeling comfortable, they’re starting off coming from a perspective that they feel comfortable to talk about, and then we take it from there.
Dr. Jeremy Sharp (48:27)
Love that, love that. What about changes to our paperwork or forms? This is sort of a in the background, important.
Wenn Lawson (48:32)
Yeah, we, yeah, the forms,
paperwork, all that stuff that we pre-write, we try to write that in an accessible format. So it should be nothing about me without me. So we have autistic people telling us how best to write the form for this or the form for that. We have maps about how to get to where we’re going to do assessments if we’re going to meet initially in one.
one place, someone will ask a person where they would like to meet with us. We have everything from their perspective, we send it out and say, does this feel for you? there a way to make this better? We do a lot of visuals, we do a little video, so they can watch like a little trailer of what to expect when they come in. We do an introduction about who we are, the person they’re to meet with a photograph and you know, person.
Dr. Jeremy Sharp (49:04)
Mm-hmm.
Wenn Lawson (49:24)
information about that person. It needs to be really based on nothing about me without me. Yeah.
Dr. Jeremy Sharp (49:32)
Yes, yes, I love that idea of maps. It’s a simple thing, but something that not all of us are doing by any means.
Wenn Lawson (49:34)
Yeah,
Yeah, maps
and visuals and any other way. Sometimes we had a young person who was was into dogs. That’s all they were really interested in. So we we put little pictures of dogs on some of the format forms that we were using. We put dog into the interview with a video that we sent out beforehand. We tried to personalize it so this person felt connected even before we met.
Dr. Jeremy Sharp (50:02)
Mm-hmm.
Wenn Lawson (50:05)
yeah, things like that.
Dr. Jeremy Sharp (50:07)
Sure, sure. Yeah, these are great ideas. Now, how about the actual testing process? Yeah, let’s talk about the testing process. Is there anything we can do or be aware of?
Wenn Lawson (50:10)
Yeah.
Yeah.
Yeah, standardized testing doesn’t use autism friendly language. So I can think of one young person who was told to give somebody they had colored blocks and they were circular, rectangular, triangular and square. The person said to this young person, give me the circle. They didn’t cooperate. They didn’t do anything. We looked out the window.
Dr. Jeremy Sharp (50:37)
Mm-hmm.
Wenn Lawson (50:45)
As far as this young man was concerned, he didn’t have circles, he had blocks. So when we’re talking, we need to make sure that we’re finishing the concept. Give me the circular block would have been okay. We need to make sure it might be the red circular block, because there might be a green one as well. We need to make sure that we’re giving a fuller understanding of what we’re asking without getting complicated so that
Dr. Jeremy Sharp (50:55)
Mm-hmm. Mm-hmm.
Yes.
Yes.
Wenn Lawson (51:12)
If you think of being monotropic, that’s the lens you need to go through, then I’m going to be literal. You asked for a circle, I don’t have any, I have blocks. This understanding needs to inform the way we deliver questions. So we can’t change, unfortunately. The standardized testing, there isn’t at the moment anything written that’s ulti-friendly. So.
Dr. Jeremy Sharp (51:21)
Sure.
Wenn Lawson (51:35)
And some will tell you, must not adjust the language, but I believe you must, because we want to connect with this person, absolutely meet them where they are, and find out what’s, who they are, and what’s happening for them. So we need to use language that is meaningful. You avoid metaphors. You know, all those things that we know, working with autistic people need to come right in at the beginning of an assessment to start with, not after.
Dr. Jeremy Sharp (51:57)
Yeah.
Yeah. You mentioned visuals quite a bit, know, pictures, graphs, ⁓ infographics, videos. Is there or what does evidence look like as far as autistic folks in particular benefiting from visual input?
Wenn Lawson (52:03)
Yeah. Yeah.
It’s quite a bit of, of evidence. A lot of autistic people will tell you they’re visual. I’m not particularly. Um, then there’s, you’ve got to check with the person themselves because someone can be aphantasic or have aphantasia, not know. So they’re not able to conjure up an image in their head, but they can very well relate to the image in front of them. Um,
Dr. Jeremy Sharp (52:21)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mm-hmm.
Wenn Lawson (52:42)
These are things we don’t know until we’ve met somebody and had conversations and spent time together. Some people are very auditory and they look away and they’re listening. But if they look and listen, they can’t, it interferes. So if that person is responding that way and they seem to hear better when they’re not looking at you, that’s already telling you something. Some people are very kinesthetic and they need to get up and move around.
Dr. Jeremy Sharp (52:46)
Mm-hmm.
Mm-hmm.
Wenn Lawson (53:09)
They attend much better when they’re moving. So all of these things we need to have an awareness of. I mean, most of us are a mixture of all of those, but we still are likely to have a more dominant side, a sense to ourselves. So yeah, get to know us and work with what our strengths and talents are. And they’re not always visual, but there is a lot of evidence to show that is the majority probably, or the higher amount of autistic people will be.
Dr. Jeremy Sharp (53:36)
That’s fair. Is there any relationship between aphantasia and autism?
Wenn Lawson (53:42)
It doesn’t appear to be, but there’s not enough research on this yet. It was a relatively new kind of understanding. yeah, and, yeah. So there just isn’t the research in that field. A lot of the times the researchers focused the other way. Things are more imaginative, brighter, more colorful, more patent for autistic people.
Dr. Jeremy Sharp (53:44)
Yeah, yeah, yeah, that’s fair.
Yeah.
Wenn Lawson (54:07)
and you’ve got a patternizer or a systemizer or, you know, people talk like this. And I still think that’s too black and white, but there is a tendency. Yeah.
Dr. Jeremy Sharp (54:18)
Okay.
Okay. Let’s talk about, uh, sensory adaptations for the office space or the building. Um, I feel like this is important as well. And we, I mean, we try to accommodate, you know, and make changes to the space as best we can. I would love to hear some of your ideas on how we can, how we can do that and do best.
Wenn Lawson (54:40)
Yeah. And again, I think
we need to ask those that we’re bringing into our office. Some people just are very happy with a bean bag on the floor and not too many, you know, plain carpet, not patterns, plain colored walls, not too much information around. Other people like that, that detail and they’ll tell you what it is that they really need. So I don’t think it’s one size fits all.
Dr. Jeremy Sharp (54:45)
Mm-hmm.
Mm-hmm.
Wenn Lawson (55:06)
But I do think the least clutter, the more meaningful, the less pattern and the less colour you have, better. I’m an absolute lover of colour. My house is painted green and yellow and red, know, very different. But I don’t think I’m the majority. I would have plainness and not too much cluttering and everything really clearly signed.
Dr. Jeremy Sharp (55:21)
Mm-hmm.
Wenn Lawson (55:32)
wayfinding signs, that’s really clear that you need to better get into a place and then where the bathroom is and if there’s a place to have a coffee or all those things should be signed and signed clearly.
Dr. Jeremy Sharp (55:46)
Sure, Okay, that’s reasonable.
We’ve talked about many things. there other aspects of the testing process that would be… I mean, we haven’t talked about feedback or report writing actually, you know, and how we communicate results. Maybe we touch on that if that’s okay. Yeah.
Wenn Lawson (56:00)
Yeah.
It’s really important. Absolutely.
So I, in all of my report writing, I make sure that, yeah, there’s a professional report if it needs to go to an, I don’t know, another doctor or psychiatrist or an employer. There’s a way of writing that is fit for purpose. And for the client, I make sure that I don’t use a lot of jargon and I make sure it’s really clear. And I ask them to tell me if something isn’t clear so I can go over that. I make sure there’s things that
Dr. Jeremy Sharp (56:26)
Mm-hmm.
Wenn Lawson (56:33)
that show what can be done for them, what they can do that’s helpful, not just a list of deficits. That’s awful. Where do we go from here? What are the next steps? All those things should be in the initial report so they know what the follow up is, how many times they might be able to continue to see you or whoever it is they’re working with that will support them and where they can go for more information that should be in the report. There’s a lot of stuff on YouTube. There’s a lot of stuff.
online good stuff that we can filter out and put in. So I use links in my in my reports and they have a digital copy they can click on it on their computer. They have a printout. Yeah.
Dr. Jeremy Sharp (57:05)
Mm-hmm.
That’s great.
Yeah, yeah, I love this. We talked about a lot of things. Are there other aspects of the testing process? Interview? Yeah.
Wenn Lawson (57:22)
they probably are the thing
that to mind. didn’t mention things like noise and fluorescent lights, but they’re really important things in an office to make sure that there’s no music playing. They don’t have bright lights. You know, I turned the lights off and I might have a lamp I can turn off. need to. yeah, but I really make sure I’m in touch with the person before they come to try to work out what it is that they need when they come to me so that I can set that up.
Dr. Jeremy Sharp (57:45)
Mm-hmm. Mm-hmm.
Wenn Lawson (57:48)
ahead of time. With photographs of what the office looks like, pictures of me, or whatever it is that they’re prepared for what they’re going to see. I try and wear the same shirt that I wore in the photograph. I don’t wear percums and colognes and things like that. Strongly scenting stuff or I need my cap. For me, this is this helps as a sensory tool and my glasses. I couldn’t work without those.
Dr. Jeremy Sharp (57:50)
Mm-hmm.
Wenn Lawson (58:12)
but I let them know that this is gonna happen. So yeah, that’s the only other things that come to mind really.
Dr. Jeremy Sharp (58:14)
Yes.
Yeah, yeah. Well, you’ve given us a lot of ideas really across the board, both from the research side and informational side, but then also the practical side for how we can do the best job we can with folks who may be autistic. Yeah. Yeah. This has been a pleasure. If folks want to find you, connect with you, you know, see more of your work, what’s the best way to do that?
Wenn Lawson (58:34)
Yeah.
Yeah.
I have a webpage, which is just www.WenLawson.com. I have a YouTube channel. If you type Wen Lawson into YouTube, you’ll find my channel. There’s lots of animations, very short videos and longer videos that explain a whole heap of things. And my email should be on the webpage as well.
Dr. Jeremy Sharp (59:11)
OK, OK, fantastic.
This has been a great conversation. I really appreciate it. We talked about different things, like different perspectives, and gone into depth on some topics that we haven’t really gone into depth on in the podcast before. So yeah, thanks for shedding some light on some these lesser discussed topics.
Wenn Lawson (59:28)
Thank you. And I’ll send you
some things through to your email that you could add as links for people to look up or look at. ⁓
Dr. Jeremy Sharp (59:38)
Yeah, yeah, that’s perfect. Like
I said, we’ll put all those things in the show notes for anybody listening, you know, go check it out. Yeah. Well, thanks again, Wynn.
Wenn Lawson (59:43)
Yeah, thank you.
Thank you.
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