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Episode 44: Adult Autism: Neurodivergent Insights [featuring Megan Neff]
Episode 443rd August 2022 • All Things Private Practice Podcast • Patrick Casale
00:00:00 00:45:06

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I was diagnosed as Autistic at 35 years old. Adult Autism Diagnosis is becoming increasingly more common as we learn more about it and have more advocacy and awareness around it.

Adult Autism Diagnosis — How many of us have been overlooked, misunderstood, and searching for lifelong answers?

Dr. Megan Neff and I speak about our own experiences as autistic people and therapists, and how to build lives that work for us. We are hoping that people listening are able to feel validation, support, and acceptance.

Some of the things that we talk about:

  • Special Interests (my Garfield and beanie baby collection)
  • Our own experiences as autistic adults, mental health therapists, and entrepreneurs
  • Our own "ah-ha" moments
  • Misdiagnosis and underdiagnosis
  • Liberation and Grief behind diagnosis and understanding
  • "I'm around people I love but I just can't take it in."
  • "I can't enjoy things that are supposed to be enjoyable." – Megan
  • The paradox of masking — liberation vs. torturous exhaustion

More about Megan:

Dr. Megan Anna Neff has a doctorate in clinical psychology and is currently a psychology resident in private practice where she specializes in working with neurodivergent adults and provides neurodivergent affirming assessments. They are a parent to two neurodivergent children and in an inter-neuro partnership. She is a late-in-life diagnosed autistic-ADHDer who is passionate about educating the mental health field on non-stereotypical presentations of autism and ADHD. 

Neff has co-authored two books, published in several peer-reviewed psychological journals and serves as a peer-reviewer for APA journals. She has a passion for research and for translating research into visualizations. You can also find their work on Instagram (@Neurodivergent_Insights) where they turn peer-reviewed academic articles into visual pixels one post at a time.

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A Thanks to Our Sponsor!

I would also like to thank The Receptionist for iPad for sponsoring this episode.

Chances are you've paid special attention to making sure your clients feel welcomed and at ease from the moment they walk into your practice's space. Make sure you don't overlook one very important step, their check-in experience.

The Receptionist for iPad is the highest-rated digital check-in software for therapy offices and behavioral health clinics, used by thousands of practitioners across the country.

The Receptionist for iPad is a simple, inexpensive way to allow your clients to discreetly check in, notify providers of a patient’s arrival, and ensure your front lobby is stress-free.

The software sends an immediate notification to the therapist when a client checks in, and can even ask if any patient information has changed since their last visit.

Sign up for a 14-day free trial of The Receptionist for iPad by going to thereceptionist.com/privatepractice, and when you do, you’ll also receive a $25 Amazon gift card.

Transcripts

PATRICK CASALE: Chances are you've paid special attention to making sure your clients feel welcomed and at ease from the moment they walk into your practice's space. Make sure you don't overlook one very important step, their check-in experience. This episode is sponsored by The Receptionist for iPad. It's the highest-rated digital check-in software for therapy offices and behavioral health clinics used by thousands of practitioners across the country.

With a visitor management system like The Receptionist for iPad, your clients won't be left wondering if you know they've arrived, as the software sends an immediate notification to the therapist when a client checks in and can even ask if any patient information has changed, and needs to be updated since their last visit.

The Receptionist for iPad is a simple, inexpensive way to follow your clients to discreetly check-in, to notify providers of a patient's arrival, and to ensure your entire front lobby experience is stress-free.

Sign up today for a free 14-day trial of The Receptionist for iPad by going to thereceptionist.com/private practice. And when you do, you'll also receive a $25 Amazon gift card.

Hey, everyone, you are listening to another episode of the All Things Private Practice Podcast. I'm your host, Patrick Casale, joined today by Megan Neff. They are a psychology resident in Oregon, and the Moderator of Neurodivergent Insights, a Instagram page that gives a lot of education around autism, and ADHD, and parenting autistic children, and neurodiversity in general, is very, very helpful. They have a wonderful following, wonderful content. I highly recommend following that page. And I really appreciate you making the time to be here.

MEGAN NEFF: Absolutely, I'm looking forward to this.

PATRICK CASALE: So, before we hit record we were kind of talking about autism, like, autistic diagnoses, ADHD, in general, and being entrepreneurs, therapists, helpers, and how that kind of manifests, and just wondering if you wouldn't mind sharing a little bit about your own story and coming to run Neurodivergent Insights, because I really do believe it's one of the more helpful social media handles that I've come across in a long time. It's helped me quite a bit even with my own, like verbiage, and language, and things that I experience. So, yeah, take us through a little bit of that journey and where you are today.

MEGAN NEFF: Yeah, absolutely. So, yeah, on one hand, it was like an unconventional journey, and then, on the other, then more late in life diagnosed people I meet, I'm like, "Oh, actually, my story feels really classic." So, a kind of sketch, I've always had mental health issues, you know, in childhood and adolescence, kind of OCD, and childhood depression, anxiety, but just always figured it was those things. And then, it was, actually, a year ago, like, I'm still pretty new to this process. It was a year ago that my daughter and I were having a conversation after she'd had a significant meltdown over-interpreting something literally. And she had been diagnosed with ADHD in early childhood. Again, classic autistic story first diagnosed ADHD.

And we started talking with her. I was like, "You know, is it possible maybe this is autism. Let's look at this together." And I have this really fun memory of we sat side by side, and we found Paige Lael, on TikTok. We found a bunch of her videos, and I kind of, like, looked through them before I shared them with her, she's a preteen.

And both of us were just having this aha moment of her life made sense to her for the first time, me parenting her made sense for the first time. So, we started the process for her. And then, of course, autism became a special interest as things do for my brain. And I started down the deep dive. I learned typically when a child's diagnosed autistic, one of the parents is at least on the broader autism phenotype. So, at first, I was, like, scanning my husband and his family tree. And then, the more I was reading about autism and women, I was like, "Oh, my gosh, it's me." So, here I was a month away from graduating with my doctorate in clinical psychology and just now seeing autism in my daughter, autism in myself.

Fast forward, she's been diagnosed, I've been diagnosed. And once I saw the pieces come together, it was kind of one of those pattern-finding aha moments. I don't know if you've had any of these? But I've experienced these, like, a lot of the clients I work with experience these, like, we see a pattern out there, and it's often based on a social issue. And it's like, "Oh, my goodness, everyone needs to know this."

So, I was seeing, right, like, see things like borderline personality disorder and all these other things diagnosed so often in women in autism, so under-diagnosed. So, that really lit a fire under me of, if I have the highest degree possible in the mental health world, and I didn't see it in my daughter, in myself, in my clients, I knew other people were missing it.

So, my first series, Misdiagnosis Monday, is really what took off. And that's where I was comparing common misdiagnoses.

So, I had no plans of it becoming what it has. I started with my personal Instagram, which is 300 people, and I came out, which was terrifying. And then, just slowly over the year, I've been creating content as it's my special interest. And it seems to be resonating with people, which is why it has become what it is now.

PATRICK CASALE: Yeah, and I appreciate you sharing that. And I think that we're seeing this so much more often in terms of late diagnoses, right? Especially, like you said, for women where it goes misdiagnosed, or under-diagnosed, or diagnosed personality disorder, diagnosed ADHD, diagnosed anxiety, like, but the autism diagnosis doesn't come very often. And if it does, it's later in life.

But what I like that you really said is that it felt like everything kind of came into place for not only you and your parenting style, for your daughter, and her experience, and for you, and your experience, right? Like, isn't there something beautiful in the validation, although, there's also the acknowledgment of the grief and the torturous process that we go through on a day-to-day basis?

MEGAN NEFF: It's such a complex process. I love how you capture all that there, and it very much was that for me. Everything clicked into place. You know, I started doing depth therapy when I started my doctorate just because it was like, "Well, this is a good idea, if I'm going to be doing therapy I should, like, do some depth work." So, I'd been in therapy for about four years. And I felt like I had a million mysteries that I was essentially coming to terms with. I'll never know why certain things are the way they are, why I'm wired this way. I just need to learn to embrace it. I never thought I would have an answer to these millions of mysteries about just how I experience the world, how I experience myself. So, it was a… like, I talk about this in some of my writing, it felt like I became aligned with my body for the first time ever, because I understood it. And so, there was a deep come into alignment with this diagnosis.

And yes, the grief, like, there is grief. And I think it's so important to create space for that. I'm all about affirming autistic identity, but I am now coming to terms with limits that I was hoping were like seasonal limits. It's like no, there's a lot of things I'll never do that other people can do. And I'm craving those limits.

PATRICK CASALE: Yeah, I truly appreciate you sharing that. And I think that so often gets overlooked. I know that my diagnosis is much more recent. It's been about six months and maybe a little bit longer. Actually, I can't fucking track time anymore.

MEGAN NEFF: That time blind thing.

PATRICK CASALE: I know, time blindness and COVID where I'm like, I don't know. Did I leave my house today? But, you know, I think that for so long, similarly to you, I was like searching for this answer. Why does my life feel the way that it feels? And what I was really experiencing so profoundly, I had been diagnosed ADHD like six, seven years ago. And we all know that, like, young white men get diagnosed with ADHD way quicker than most other people.

MEGAN NEFF: Absolutely.

PATRICK CASALE: It makes sense, I was like, "All right, interests, right, they change, I lose interest, I gain interest, I'm excited, I'm not, sometimes I can't pay attention. Okay, that makes sense to me." And then, like, going through the next couple of years I'm like feeling this really internally conflicting and borderline torturous just existence of life where you could be surrounded by people who love and care about you, but you can't always connect, or land, or take it in and…

MEGAN NEFF: Oh, my gosh.

PATRICK CASALE: Thinking like, "What the fuck is wrong with me? Like, what is wrong with me? Why does this existence have to be so disconnecting and isolating?" And what ended up prompting this, which seems kind of strange, perhaps, is like, I was at a conference in Hawaii last August, and I went and saw the Anthony Bourdain movie, because I was always a big Anthony Bourdain fan, kind of explained the process of, like, wanting to be around people, not feeling connected to them, never feeling truly loved, or embraced, or seen, always wanting to be on the go and I was like, "That kind of sums up my life."

And my diagnosis was so validating, but I had to process like the grief of the validation first of like, one, okay, this makes a lot of fucking sense. Two, I wish I had known sooner because maybe life could have been a little bit more manageable. Three, now it explains the collection of like Garfield stuff I had, like, stuff, and Beanie Babies, and like, all this fucking shit, but like, as a child and teenager I'm like, "I just think this is normal, right?" Like, I have 200 Garfield ceramics on a shelf in my room, and like, so the grief process was lengthy and heavy, but at the same time, I have never felt more aligned with who I am in my life until the last couple of months and that that has been really liberating in some ways.

MEGAN NEFF: Yeah, yeah, yeah, I got chills when you talked about the kind of, "I'm around people I love, and I just can't, like, take it in." I feel like I described almost a similar thing to my therapist of, before I know of I feel like I'm living behind Plexiglas, and I just can't get into my experience. And I didn't have language to realize, like, for me, I shut down. So, I go parasympathetic mode.

b out, like, I [INDISCERNIBLE:

PATRICK CASALE: It's really painful, you know, to even hear you say that, because that is so identifiable for me and for so many others. And a lot of people who just can't put that into words, or at least express it in a way that makes it feel like okay, this makes sense to me. And a lot of people in our lives probably really don't get that. So, what has your experience been with that? I mean, weddings, like dinner parties, socializing, I can relate to all of it. I shut down too. And weddings for me it's like, I'm going to reach for unhealthy coping skills to be able to be here, or I'm just literally not going to be able to be here.

MEGAN NEFF: Yeah, yeah, yeah. I mean, for the last couple years with COVID, like, there's just not been those events. And then, I've just stopped going, which, at some point, I probably should push myself a little bit, or that's an interesting thing I just said. I don't know if I should push myself. I think, value consistency. I think there's certain events that because of values I choose to go to even though I know I'll just be numbed out. I don't think I'm answering your question. I think your question was how have people responded to this?

You know, my husband has found it helpful. When we'd be at an event, he'd come up to me and he'd be like, "Are you okay?" Which I would experience it's kind of annoying, because it'd be a sensory demand coming in of like, "Are you okay, are you okay?" And then, "I'm fine, stop." Like, now, you know, we had, I think it was a family gathering in April, and I was logging out. And I asked him afterwards, I was like, "How was that for you? You were seeing me as being autistic." And he was like, "You know, it's actually nice just to know what's going on. Like, I just knew okay, Megan is sensory overloaded, and she'll be fine when we get home. Should maybe need to, like, go for a walk to decompress, or whatever. But it was just nice to understand what was happening to you versus worrying about like, 'Is she okay, is she okay.'"

PATRICK CASALE: It sounds like feeling seen in a lot of ways, then. And having your partner be able to at least take that in from a different perspective. And you did answer the question both ways. You know, and I think it was similar for my wife. Like, I had this diagnosis process, it was overwhelming. I already anticipated the result being the result. But I didn't want to admit that, I don't think. And she and I, and a couple of close friends and I had these conversations about this. And she was like, "Well, I think I always knew this about you, though. Like, I don't see why this would be any different now that we have a label for it." Which was great to hear, right? That feels like okay, validation in some ways, but it also feels like, "Yeah, but I need to own this experience. Like, I need to be able to embrace it. Otherwise, it's just going to come with like shame, and guilt, and even further disconnection and loneliness."

So, it's really been an interesting journey, and to be able to see people like yourself and other people out there just talking about it openly. I think it's helping, like, shed some light and illuminate the fact that there are so many people out there who are undiagnosed autistic or ADHD and just don't have the resources, don't have the ability, or simply maybe just have been misdiagnosed, like you've mentioned several times. And that just feels painful, because so many people are also going through life and experiencing it in a way where it probably doesn't make a whole lot of sense.

MEGAN NEFF: Yeah, yeah. And it's so alienating. It's alienating from ourselves when we don't have a narrative to wrap around our experience. And then, it's hard to form authentic connections when we're alienated from ourself.

PATRICK CASALE: Yeah, it's hard to.

MEGAN NEFF: Can I, oh, go ahead.

PATRICK CASALE: No, go ahead. Sorry.

MEGAN NEFF: Well, I was wondering if I could throw a question your way?

PATRICK CASALE: Sure, yeah, absolutely.

MEGAN NEFF: I thought of it when you were talking about your own experience of diagnosis and kind of creating space for it. I recently came across an article that talked about how women and genderqueer people tend to experience the diagnosis as more liberating, and then, tend to experience it with more grief. And I thought about that when you were talking. I was curious if you have any thoughts about why that might be or if that matches your experience? Because like, I hear both when you talk about it, both the liberation, but also, the shame, and the grief that it brought up.

PATRICK CASALE: It's a good question. It definitely brought up both. I mean, the liberation, I think, feels like, again, like alignment of, okay, this is why your brain works the way that it does, this is why you socialize the way you do, this is why you, you know, take in energy the way that you do. So, in a very literal sense, it's easy for me to then say like, okay, like this now makes sense, right? Like, this is easy to just start to conceptualize in that manner.

And I think the grief part came so intensely, the shame is always there for a lot of reasons. But like the grief part really washed over me, because it was like, I just kept thinking and flashing back to like inner child wounding, and then, like, traumatic experiences throughout life. And just thinking, like, if we had the verbiage at the time, or if my parents had been aware, or like, if any of these things had have happened could life have maybe been easier? And maybe the answer is no. But there was this grief for, like, inner child, Patrick of like, okay, growing up, maybe you could have not felt so alienated or maybe, like, didn't always feel so disconnected and alone. And I think that's what really brought up a lot of sadness for me.

But it's interesting to think about the research, though, in terms of, like, how people experience these diagnoses. And I could understand why it would feel liberating as well. It just feels like, I guess if society tells you you're supposed to act and interact a certain way all of your life and your masking, right? And we can talk about masking and how painful that is. But then, when you can unmask in a way and I know so many people don't get to. I think that's the liberation, is the unmasking, like you said, coming out on social media for you, I'm sure it was a huge fucking step. And I'm sure it was really scary to, like, be like, "Hey, this is who I am and this is how I experience life."

And even when I got the diagnosis from the psychologist that I worked with, there was a part of me that rejected it, you know? There was a part of me that was like, "No." And my mind immediately went into, like, an ableist mode of like, "I'm high functioning, though. I have multiple businesses. I have a Master's…" You know, like, all of those things start running through my head. And then, I think there can also be an association of, like, what's the immediate association when you think about autism, and I worked in group homes in New York, and I was like, "This isn't me." And then, I had to do so much learning, and being like, "Oh, my God, I'm so ill-informed on this and this has been my entire life."

MEGAN NEFF: Yeah, yeah. I mean, there's so much deconstructing we have to do to see ourselves in the diagnosis. I remember as part of my training, like, you take all the personality assessments that, you know, that I'd be giving to clients. And I remember on one of the personality assessments I took they gave automated reports, and it pops up, like, possible things to be looking at. And autism came up as like possible thing to, like, for further review. And I remember being like, "What the hell? Like, no way."

And, after all of that, actually, am really glad I have that moment, because it's a moment of, I can really see all of my ableism. I can go back to the moment and like, the emotional reaction I had to see that on that paper and how much I wanted to push against that and be like, "No way. Like, yes, I like my routines, and yes, I have sensory issues, but there's no way I'm autistic. This report is shit." Like, it was so visceral and so deep.

PATRICK CASALE: Absolutely. Yeah, I think that a lot of late diagnosed and adult diagnosed autistics have that experience, because throughout most of your life you've probably had some of this stuff coming up. You didn't know what it was, maybe you rejected it, maybe you thought this could be a potential possibility. But that brings up a lot of shame and stigma. And I'm not willing to own that or embrace that.

And, you know, when I had been diagnosed with ADHD years ago, the moment I sat down with a psychologist who I'd never met before, she was like, "Are you autistic?" And I was like, "What?" And I was like, "I'm…" She was like, "Yeah, your expression is just so flat. Like, I just had to imagine that you're autistic." And I was like, "I don't even know you. Like, I just feel uncomfortable coming here to do testing" But in reality, I mean, now I'm looking back at that and like, "Huh, okay." Like, that was a very… I feel like it could have been bad bedside manner in a way. But at the same time-

MEGAN NEFF: I was going to ask, yeah, like, I don't know if to give props to that psychologist or like, because I think that's awesome that she was willing to bring it up, because most psychologists are like afraid of that word. But yeah, well, it's a really direct way.

PATRICK CASALE: And it hit me, like, right? One, we don't have any rapport. And for those who are therapists listening or therapy clients, like, rapport matters, and bedside manner matters. And I'm like, "If I had known you for a session or two maybe I would be much more open to receiving that." But that immediately led to a shutdown of like, "Fuck, man." And I noticed, thinking about that experience right now that I then started to immediately mask in that environment, where I started, like, smiling more, where I started laughing more, where I started paying attention more to like her body and her like head movements. And I was like, "I am going to have to mask now so that I'm…"

that's the way I'm [CROSSTALK:

And you were talking about unmasking and how torturous it is to mask all the time the other day on your social media. Do you want to talk about that? Because I think it's such an important part of going through life with neurodiversity.

MEGAN NEFF: Yeah, yeah. And part of why I talk about it is because, you know, I've been thinking a lot about questions like, what are the support needs of those of us who society would deem high functioning? And even coming into some pushback around, like, why would someone like me get diagnosed, right? Like, I can pass as non-autistic if I choose to. And I think it's such a allistic-centered way of thinking about autism, of like, well, if you don't have social communication, like, difficulties, you're fine, which I do have difficulties, they just show up differently. They're more subtle, I guess.

But there's nothing about my experience of autism that's subtle and masking, it's so much more than social mimicking, it is a kind of, "I'm going to vacate my personhood to figure out, like, who is in this room, who they need me to be, I'm going to become that, I'm going to become a chameleon." And it comes at a great cost, a cost of, again, that alienation of self. We have such a diffuse sense of who we are if we're always responding to the environment.

that I think, [INDISCERNIBLE:

So, when you're masking, there's just so much that you're putting on your prefrontal cortex. It is exhausting. So, like, for me, when I was doing an eight to five in the world, I'd come home and I'd be… the way my family would describe it, I'd be semi-verbal. Like, I'd be very foggy, I'd go lay on the couch, and all of my time at home was recovering so I could go back out in the world.

Now, I realize it's like, "Oh, my goodness, I was totally exhausted. My brain was fried from decoding, and interpreting, and then, you know, telling my body what to do." I've had chronic fatigue for about 10 years, and I'm sure it's related to masking. So, this is a very long-winded way of answering your question of masking is so much more than just like scripting and rehearsing. It is, we're overriding our bodies and our body's tendencies to regulate, and we're putting so much demand on our bodies. And so, of course, we're going to see things like depression, anxiety, chronic fatigue, substance abuse when someone is chronically masking.

PATRICK CASALE: I like that that was long-winded, because it's very clear how you can lay that out for someone who really doesn't understand, because I think what happens and I'm trying to choose my words carefully, I think what happens is that people just assume that, you know, like you said, it is a social construct, we're just like being chameleons. I hear the word even codependency getting thrown around at times. Like, "You're just trying to adapt to your environment to please someone." Or whatever the case may be, but then, the differentiation between social anxiety, and autism, and the overlap that can look like in social situations was sensory overload.

But like you're saying, the amount of energy that goes into masking, there is a cost, like, to be able to show up to a wedding, to show up to an event, to know, preemptively, this is going to cost me days or hours of my life to recover from. And this may then lead to severe depression, anxiety, hopelessness, potential suicidality, substance use to try to get back on my feet to do it again. And I think because people don't recognize it or don't understand the process, it can look very much, like we said, personality disorder, right?

MEGAN NEFF: Mm-hmm (affirmative.)

PATRICK CASALE: Like, we can say all sorts of different reactions to this, even hearing attention seeking sometimes is a subject that we throw around a lot. And I just think about so many times in my life where I can present as like an extrovert in social situations, I'm good at hosting, I'm good at gathering, I'm good at connecting. I host entrepreneurial retreats. I did one in Ireland, I cannot tell you how long I had to recharge from that. It was about a month where I couldn't function. Like, couldn't get out of bed, couldn't stop watching Game of Thrones or the Lord of the Rings. But the difference for me now, learning this diagnosis, learning about myself, having good support systems in place is I think unmasking for me, and it's very privileged to say this, is that I can openly speak about it to my social support system, my friend, group, my wife, and they get it. So, they check in on me and they they're like, we know what you need, we're going to leave you be, and we know you're okay.

Not a lot of people get to have that type of support and have to get up and do the fucking nine to five grind every day. And it's like no wonder why the rest of your life behind the scenes is just completely falling apart, because you can't attend to it.

MEGAN NEFF: Yeah, yeah, I really appreciate you naming the privilege. I think when it comes to masking privilege is a really important part of the conversation. We're both in a position of privilege and that we own our own businesses, we can control our schedules and our rhythms.

The other piece around privilege and masking is that sometimes masking is the less of two evil in the sense that… and it's not like unmasking, it's not like it's this wonderful cure-all. If you're choosing to unmask in public, you then are dealing with a sensory load of people looking at you funny, or like emotionally taking in how people are responding to you, that's also exhausting and takes a toll. So, it's not like there's one good option here. It's like there's two shitty options.

And, and I'm also talking as a white person, right? Like, masking is so different when we start talking about race, and threat, and danger. This is why, like, you will never hear me publicly come out as anti-ABA in all contexts, because some families, for some people, that is the less of two evils.

If, for example, you have a black autistic boy, it is a danger to their life to have a meltdown in public. And so, when it gets to masking, I think, it's so important to bring awareness at the cost of masking. I also think nuancing it with privilege and understanding racial dynamics is also so important. So, that is the one downside of Instagram, is you can't host like super nuanced conversation in one reel or one post, but the conversations are just so complex.

PATRICK CASALE: They are so complex, and I'm so glad you named that. Because for trans people and for people of color, unmasking can be a matter of life and death. And being in society walking down the street using a fidget toy, like, pacing or, you know, whatever you're doing, and stimming in general. I mean, that literally has been a matter of life and death for people in this country. And I also like that you bring up the social media component, because on Instagram, on TikTok, you can't get all of this information across in a 30-second, one-minute clip. I mean, you just can't. And I think that's why it's important that there's so much information being out there.

But there's also the downside of a lot of misinformation being out there. And, you know, it's a balancing act. And I do like that you name that unmasking is not like this ultimate liberating factor either. Like, it is important to unmask, but it's also important to acknowledge, like, where you unmask, and how you do so, and how it still impacts you regardless.

Like, I know, you've mentioned like sensory soothing, and, you know, potentially, like darkness, and music, or whatever you need, playing with your animals, anything you need to do at home, that still comes with a cost, right? Because unmasking at home is great, it's safe. It also means you can sometimes further disconnect yourself from a world that you already feel disconnected from.

MEGAN NEFF: Yeah, yeah, yeah, yeah. Which again, that's kind of this terrible paradox a lot of us are in of to move toward, like, values I have, or people that are important to me it requires a great deal of energy expenditure. And this is kind of where I'm at in my therapy right now, I'm trying to figure out, like, how to build a life that works for me of, I barely leave my house now. And, you know, I do teletherapy, and I have meaningful connections. But it's this question of, how much do I want to expend energy to get connected to communities that are like embodied communities? And how much do I want to protect my energy and my sensory system? And it's hard. Like, it's really hard to find that balance of living consistently with my value of community and connection, while also honoring my very real energy limits and sensory limits, I would say more so than all of those are connected.

PATRICK CASALE: That is really fucking hard. It's just really hard to show up, and do things consistently, and try to acknowledge the fact that certain people in our lives really almost require us to show up or at least, would prefer that we do and trying really hard to prioritize that. And also, like you said, energy expenditure and just protecting it as much as we can. It's such a fine line and balancing act. And I think that we miss the mark a lot, sometimes when we push ourselves too much for whatever reason, and then, there's a cost associated with that, too. And there's a cost associated with being present on social media.

I mean, making videos, making content, responding, but I think, and I can't speak for everybody, for me, I feel more connected to my audience on social media than I feel connected to a lot of people in my life. And I think it's just because it feels safer to be in that space in a lot of ways.

MEGAN NEFF: I relate to that a lot. Partly, there's a shared culture, there's a shared knowledge base, what I have had a few experiences of coming out in real life, and then, like, it's just a bucket of cold water of remembering like, "Oh, right, these people aren't in this world." When they hear autism, they hear, you know, what I heard five years ago when I saw it on that paper, and my stomach drops. Like, there's something about being connected to people who have a shared framework for this conversation that is very, very comforting.

PATRICK CASALE: Yeah, I agree. It's very comforting. And I think that's why so many autistic people spend a lot of time in online spaces. And I think that it's a protective factor, but it's also a way to connect with the world. And sometimes that can be misinterpreted of like, a lot of people will say, oh, I'm a workaholic, because I'm doing work a lot of the time, but work for me is one of those hyper focus points, and that I enjoy most of the time, can't say all the fucking time. But I also have people that I can connect with in a way where I'm like, I feel safe being able to communicate in a way that I don't have to do in person where even if I feel connected to the person, right, like good friends, partners, etc. I'm still very aware of my energy and how I'm feeling uncomfortable, and that can create even more complexity when you are with people who get you, and know you and see you, and you still feel that constant hyper vigilance and focus on like, how am I engaging socially? How am I feeling in this space? Fucking exhausting.

MEGAN NEFF: So exhausting, so exhausting. I love what you said about work. I often say work is play for me. And my husband for years he said like, "You don't really rest." But then, I realized like ADHD plus autism, like, what is rest? And I think normal, I think, that for some of us work is play. And so, when we talk about doing self-care, like, for me, it looks like creating content, like, that's a playground for me.

PATRICK CASALE: Absolutely. I love that you said that, because I've had some people who I've unfortunately lost relationships with because they've said like, "You're so driven and achievement-oriented, and you're so into like capitalism, or internalized capitalism, and hustle culture." And I'm like, "No work is play. Like, work is actually the way I connect with the world." And it just feels like that can be really dismissive if you don't truly understand how a lot of this is impactful. And I think that it's really important to just be able to name it and just clarify in that way too. But I also think that comes with a cost as well.

MEGAN NEFF: Totally, totally, it's not the rhythm of the neurotypical culture. Yeah, and the hustle culture, so I feel like that can be a great, I don't know, you'll think about this, but I think that can be a great replacement. Maybe I shouldn't use word replacement. It activates similar dopamine that less healthy coping strategies also activate, like, kind of in the same way a video game, like, with leveling up, or, you know, dopamine with gambling, or alcohol, but in a way, where it's actually contributing good to the world if you're doing kind of advocacy work. And so, I know, for me that it taps into a dopamine structure that feels familiar, but that feels healthy.

PATRICK CASALE: I love that you just said it that way, because that's so true. And there is some external validation that comes with putting things out to the world that are well received, or, you know, supported, or you have positive interaction with, and there's definitely a component of that, too. But you're right, it's hitting similar parts of the brain. And I can think about it two ways, right? Like, I had a gambling addiction for a very long part of my life. This June is 10 years of not gambling. However, you know, it is that same, that process of that dopamine hit. But if I can reframe it in a way where it's like, but this is positive, this is impacting people, this is helping people, I can get behind that. It's almost like a harm reduction strategy in a way.

it my dopamine [INDISCERNIBLE:

PATRICK CASALE: I think that's a really, I love that outlook on that. That's such a good reframe, and perspective, too. I mean, I think a lot of this, for what we're both saying, there's just so much learning, like you said, so much deconstructing, a lot of advocating, and using our privilege to be able to voice things that a lot of people can't do. And, you know, I have basically as much privilege as you can have minus the religious component. And I just feel like, I really want to be able to continue to speak about something that feels like it causes people a lot of shame, in terms of, I can be a therapist and an entrepreneur, I can own businesses, and all these things. And I can still struggle with all of this stuff. And that does not mean that it's not hard. And there's a lot of behind-the-scenes stuff where there is a energy deficit, or you're really paying for it in other ways.

And I just hope that your platform, my platform, other platforms out there, all the advocates that are out there doing the work that they're doing, you know, that we all know how important it is to continue and how I appreciate you showing up in your space, because you have what, like 20 plus thousand followers at this point in time? It could even be more, I may have read that wrong.

MEGAN NEFF: Yeah, I think it's around 26 right now, which is still… I think, I just pretend that's not actually the case. Otherwise, I would never post anything.

PATRICK CASALE: It just feels like five or six, like, obviously, people, yeah, yeah.

ah, I just pretend [CROSSTALK:

PATRICK CASALE: That's good. But, you know, it has a trickle-down effect, it has a ripple effect, right? Like, putting that information out to the world and having it be shared or commented or at least seen. And it can have such an impact on people who maybe don't have access to going to therapy or don't have access to certain resources to just have that information available to them. And I really do appreciate what you're doing and how you're showing up.

MEGAN NEFF: Well, thank you. Same, I have really appreciated your work. And, I mean, we didn't even get into like being a therapist with ADHD autism but really normalizing that there are ADHD autistic therapists out there and all the coaching you're doing in the private practice. I think that is just so inspiring. Maybe we should have another conversation sometime where I get to hear more about that, because I am really interested in kind of how you show up in the private practice space working with therapists.

PATRICK CASALE: Yeah, that could actually be a great follow up and I was literally thinking that before you just said that. I was like, "I don't want to ask if you want to do this again." But yes, I think that would be a great follow up and we could both share our perspectives on that, because you are also a therapist about to become a psychologist once you go through residency, and that has shown up all my life. And I do think there's this association that autistic people can't be empathic and can't connect, and it's complete bullshit. But it is a major, major misconception, and it exists, and hell, I had it myself years ago when I was thinking, like-

MEGAN NEFF: Me too.

PATRICK CASALE: …this was, like, you know, socially, I can't connect with people. And it's like, well, no, that's not true. It's just, we have to take all of these things into account. And, you know, one story that really I think about right now is like, not just therapy and how I've always connected with my clients, but I was in Ireland, and I was at the St. Patrick's Day parade, which was overwhelming enough as it could be. You know, I felt very grateful to be there.

But there was probably a younger kid, like, seven, eight years old, who came up with his mom to the front of the parade. And she asked me, like, "Can you stand with us?" I said, "Yeah, absolutely." She was like, "He's autistic and ADHD, you probably don't know what that means. But like, he's overwhelmed right now." And I was like, "Oh, me too." And then, like, I had this sensory toy, and I just took it out and gave it to him. And like, I could see him like self-soothing the whole time, and like stimming, and it was really beautiful to witness.

And I think as therapists we are more attuned to, you know, even if I didn't identify in that way, we are just more attuned to people who are struggling. And I think that's been a beautiful part of this process as well is just recognizing as autistic people we typically are taking in everything, right? And paying attention to everything that's going on around us. So, I think we probably have a lot of moments where we don't even recognize that we're doing that and just the recognition that we just connect differently. And I think that is actually beautiful in a lot of ways, too.

MEGAN NEFF: Yeah, that's so well said, that's such a precious moment with that kiddo, and oh, my goodness.

PATRICK CASALE: It felt, I don't know, I have such a hard time taking things in, you know, and having that experience, but that felt really important to me, and just trying hard right now. I don't have kids, and I never will, but trying really hard to be able to provide enough resource for parents out there who do and for people who went through life feeling just lost, and disconnected, and like, felt broken, or like, I just don't get why my existence feels the way that it does. I just want to help, be a part of a voice out there that can help support that as well.

MEGAN NEFF: Yeah, yeah, absolutely.

PATRICK CASALE: I do really want to have a follow-up on this. And we can talk all about the experience from the other side of the couch, too, and how that plays a role in how we show up for our clients and in that world and that space. So, I would really love to have you back on. And you know, I really, really appreciate you coming on, and making the time, and just being vulnerable. I think it's so important. And I hope for everyone listening that this was helpful. And I hope that Megan's story and resources can be useful for you. And they've been really useful for me. And I do want to just thank you. And I would love for you to share with the audience where they can find more of what you offer, because it's invaluable.

MEGAN NEFF: Yeah, yeah, absolutely. So, neurodivergent_ insights on Instagram. And then, I also have a website, neurodivergentinsights.com. And I do have, kind of speaking what you were saying around increasing access for folks who maybe can't get into therapy, I do have a bunch of digital downloads now available, and I'm working on creating some courses in the future. Again, so many interventions need to be adapted to work with ADHD and autistic people. So, in the next year, I'm going to be prioritizing doing more of that. And I've got a Patreon, so folks who subscribe to that they can get kind of early access to my e-books and my workbook that I'm working on as I'm going through the course creation process.

So, there's a few different ways folks can connect with me. For therapists listening, I do some consultation, like, individual, and I will be starting a consultation group for folks who are wanting to become more neurodivergent informed and affirming in their therapy work. So, I also am consulting.

PATRICK CASALE: It's fantastic. And again, I can't say enough about Megan's resources, and I will link them in the show notes for anyone listening. I think they can be useful in so many different ways. And I just want to say, again, I appreciate you coming on and making the time.

MEGAN NEFF: Thanks so much for having me. I've really enjoyed our conversation today.

PATRICK CASALE: You're welcome. For everyone listening to the All Things Private Practice Podcasts, new episodes coming out every Sunday morning. You can like, download, subscribe and share on all major platforms. If you would like to learn more about coaching with me, private practice, and entrepreneurial retreats, podcast information, you can go to allthingspractice.com and you can go to the All Things Private Practice Facebook group. I almost forgot what my Facebook group is called, and I hope to see you next week. Doubt yourself, do it anyway, and thanks for listening.

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