Episode 78: Dispelling Myths about Autism and ADHD

TikTok can make autism and ADHD feel instantly recognizable, but recognition is not diagnosis. We sit down with Dr Alton Bozeman, Director of the Menninger Assessment Center, to separate viral “signs” from the clinical reality of neurodevelopmental disorders and to explain what qualified psychological assessment actually looks for: persistent patterns, true deficits, and real life impairment.
 
 We dig into the biggest misconceptions around autism spectrum disorder, including the idea of a “level zero” autism that needs no support, the confusion between quirky personality and core social communication differences, and the myth that autism automatically comes with either low intelligence or savant-level gifts. We talk about what clinicians and families mean by disruption, how severe sensory issues or rigidity can become, and why accurate language matters when some people need intensive support across school, home, and adulthood.
 
 Then we pivot to ADHD, where the most common misunderstanding is treating it like a performance upgrade for already high achievers. We unpack how anxiety and perfectionism can mimic ADHD, why accommodations like extra time can sometimes worsen rumination, and how rising demand affects the system, from stricter disability documentation to stimulant medication shortages. If you have symptoms that are disrupting your life, we also share the most practical next step: get a comprehensive evaluation so you can target the real driver, whether that is ADHD, anxiety, trauma, insomnia, or something else.
 
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Transcript

Dr. Kerry Horrell

Well, welcome back to the Mind Dive podcast. I am very excited today to have one of our own. We're joined today with Dr. Alton Bozeman, a psychologist here at the Menninger Clinic, one of our directors, which I'll get into in a second. But we're so glad to have you here. Thanks for coming.

 Dr. Alton Bozeman

Well, thanks for having me.

 Dr. Kerry Horrel

Let me tell our listeners a little bit about you, and then we'll get into our topic for today. I should mention, today we're going solo host as Dr. Boland is taking some well-needed vacation. So today it’s just me and Dr. Bozeman. Dr. Alton Bozeman is the Director of Outpatient Assessments at the Menninger Clinic, though I think we're now calling it the Menninger Assessment Center?

 Dr. Alton Bozeman

Assessment Clinic, yes.

 Dr. Kerry Horrell

Yes, okay, okay. Well, let's say this differently then. Dr. Alton Bozeman is the Director of the Menninger Assessment Clinic at the Meninger Clinic. He's an Assistant Professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, and he provides psychological, developmental, and neuropsychological assessment for children, adolescents, and adults, along with individual therapy here at the clinic. 

 Prior to coming to Menninger, Dr. Bozeman worked at the Harris Center's Intellectual and Developmental Disabilities Division in Houston, where he provided assessment and support services for individuals with a range of developmental and behavioral needs. He earned his Doctorate in Clinical Psychology from the Chicago School of Professional Psychology and his undergraduate degree from Texas Christian University in Fort Worth, Texas. Dr. Bozeman completed a pre-doc internship in Pediatric Neuropsychology (those are very challenging internships to get) at Jackson Memorial Hospital and the University of Miami School of Medicine and went on to complete a postdoctoral fellowship in Child and Adolescent Psychology at Canyon Lynx Residential Treatment Center in Lubbock, Texas. His clinical work focuses on neurodevelopmental disorders, including autism spectrum disorder, ADHD and intellectual disability. And we're excited to talk to him today about common misconceptions around neurodevelopmental disorders in general and his approach to psychological assessment and understanding how we can improve diagnosis, support, and care for our folks with neurodevelopmental disorders. Welcome, Dr. Bozeman.

Dr. Alton Bozeman

Thanks for having me.

Dr. Kerry Horrell

As is so evident from your bio, you're an expert on neurodevelopmental disorders and the assessment of them, the treatment of them. Can you tell us a little bit about your career and how this became the area that you wanted to focus and specialize in?

Dr. Alton Bozeman

Yeah, so in graduate school, my focus was pediatric neuropsychology, there in the Chicago Medical Center, primarily worked with people that had TBIs-- traumatic brain injuries. And so that could be either through accident or it could be through medical procedure like tumor resections and things. And so my internship was similar and then, after my internship, my options were kind of to stay in the primary medical field and continue to work primarily with traumatic brain injuries or to leave that particular niche area. The issue with that area is I also like psychotherapy, and I also like doing parent consultations and work with parents. And so there wasn't a lot of room to do both.

 Dr. Kerry Horrell

Yeah, that makes sense.

Dr. Alton Bozeman

And so when I left the primary medical area, what I found was that there wasn't a lot of demand for the more traditional pediatric neuropsychology referrals, like brain injuries, that was still going to those hospitals.

Dr. Kerry Horrell

Yes, that happening in the hospital systems, yeah. That makes sense.

Dr. Alton Bozeman

So and then in the kind of regular world, so to speak, or outpatient clinic world, it tended to be autism, intellectual disabilities, also with neuropsych, just by virtue of the training, it's very behavioral based. And so then that also lent itself to doing behavioral interventions. So things like applied behavioral analysis was just kind of already, we had already received training on it. Right. And so then that also ended up being in great demand was helping families with children with intellectual disabilities, autism, or just other behavioral issues, and training them on how to help, you know, to improve their children's behavior, or even train with skills, like skill acquisition. So then that just kind of led to a route of kind of being in the that world of developmental disabilities or developmental delays, intellectual delays, and so and then eventually came to the manager center, where again my clinical duties broadened even more to kind of be also just kind of neurotypical children, and then eventually into the administrative roles.

Dr. Kerry Horrell

Which has been incredible. Again, you've led the charge in developing our Menninger Assessment Service, which is really cool.

Dr. Alton Bozeman

Well, thank you.

Dr. Kerry Horrell

Well, we're going to talk today, as  I said, about the misconceptions around neurodevelopment disorder, neurodevelopmental disorders. And we were joking before we got on the podcast, like this is kind of a hot topic. Yeah, it is. So we're going to traverse it with care because obviously, as you're sharing about your career, like this is something that you care a lot about, this population, these people, of course, I do as well. And so as I think as we're talking about misconceptions, we'll come to this as well. Like it is because understanding these disorders and understanding them well helps people who have them.

Dr. Alton Bozeman

That's correct, and their families.

Dr. Kerry Horrell

And I do think, and maybe we can also come to this as well. People who are struggling, who maybe are linking their struggles to neurodevelopmental disorders when that's not it, they're not getting the care they need if they are doing that as well.

Dr. Alton Bozeman

That's very true. Right. And we have seen that in person.

Dr. Kerry Horrell

Yes. So you know, this talking about these misconceptions, of course, like we're not being critical. We're just thinking we want people to get the right care.

Dr. Alton Bozeman

That's right.

Dr. Kerry Horrell

So the first place I want to start is:  do you think that there has been a rise or a change in people misunderstanding these disorders over the last, you know, decade or so?

Dr. Alton Bozeman

For certain. So the internet and access to information is both a positive and a negative. It's a positive in that a lot more people have a lot more access to information. And that can be very useful and that can be very helpful. But also it can be a negative in that there's not necessarily a gatekeeper as to who is sharing this information. And so there's been lots of research, and it's you know fairly consistent, almost to the point of being obvious that when they look at a lot of the internet information, especially when it's like social media driven, that it's largely inaccurate.

Dr. Kerry Horrell

Yeah. Yeah, there's a ton. I mean, you can't scroll TikTok for too long at all without getting something about ADHD or autism. And it is usually these like flashy videos of like “five signs you didn't know was related to being autistic.”

Dr. Alton Bozeman

Yeah, and because the goal is to get clicks and the goal is to have membership, the more broad you make that, the more you're going to get, right? So if your five signs are very niche, then you're not going to have many people watching your channel. So just by virtue, even if it's not purposeful, by virtue, you're going to want it to be as broad as possible.

Dr. Kerry Horrell

Yeah. And so with that in mind, and we'll start with autism, what are some of the major misconceptions that are out there right now about this is what autism is, or this is what autism is about?

Dr. Alton Bozeman

Yeah, I think the primary misconception where it stems with is the idea that forgetting that it's a disorder, right? Yeah.

Dr. Alton Bozeman

So we have different levels of autism. So we'll have level one, level two, level three. And so at the the most mild version of autism is level one, meaning you need some support specifically with the traits related to autism. And a lot of the current misconception is almost an argument of there being like a level zero, right? I have this and it doesn't impact me. It's I feel it internally, it's my internal experience or my subjective experience, but I don't need support, right? And they may not be saying that out loud, but that's in essence what they're saying because they're not needing interventions with the autism. And so it's a disorder. So if you remove that and you keep it at this like level zero, then in essence, we could all say we have autism, right? There are very few symptoms of autism, like echolalia is one of them that is not present in all of us.

Dr. Kerry Horrell

Yeah, yeah.

Dr. Alton Bozeman

We all mask. Yeah, I do not talk the same at work as I talk at home.

Dr. Kerry Horrell

Yeah.

Dr. Alton Bozeman

I don't talk to the same as my coworkers as I talk to my children, that's for certain. you know, and so every trait of autism, where none of us are perfect socially, we all make social errors, you know, and so we all monitor ourselves. So if you stretch the definition very broadly, eventually you're just talking about where we fit on the spectrum of being people, not where we are on the autism spectrum, but just where we are on the people spectrum. And so I think that's at its base level, that's the big misconception.

Dr. Kerry Horrell

Well, and I'm thinking about, you know, one of my clear interests is mentalizing. And so I'm really interested in understanding people's minds. And as a therapist, people's minds are vastly different. The way people interpret information, the way that they see the world, the way that they think is so vastly different. And I think that, yeah, one of the things that I've seen is that people maybe there can be this assumption that most people think similarly. And so when people run into this way that they're like, this is how my mind works differently, it must be that I have autism or something that would make sense of it, rather than be like, no, we actually all have very different minds and styles of thinking and styles of again having our mind work. Correct.

Dr. Alton Bozeman

And when you think about it, like how extreme that can be, right? You have people such as myself who cannot sing at all in key. Right. And then you have other people at like perfect pitch, right? Or people who can type super fast and other people who use but two fingers, right? In an MBA player, right, versus somebody who can't play sports at all or consider very uncoordinated, right? So you think it is an extreme difference between what our brains can do, right? A Cirque de Solel person, right? So that's what people need to think about is that yes, some of us really are very introverted, some of us are very extroverted. Yeah, some of us lack a lot of stimulation, some of us want very little stimulation.

Dr. Alton Bozeman

Yeah.

Dr. Alton Bozeman

And just being at kind of at natural extremes of some of these does not mean that you have, you know, an actual neurological or neurodevelopmental condition.

Dr. Kerry Horrell

And this is where, I mean, this is a commonality, just to like pan way out for a second, among all of our psychiatric disorders is that for almost all of them, I’m actually pretty sure all of them, there is a part of the diagnosis that says, and it's getting in the way of your life. It's either subjectively distressing, it is impacting you socially, academically, or what's the last one? Interpersonally, which I guess is socially, but yeah, it's getting in the way of your life somehow. And so again, to have these things be like, well, this is just how my mind works, and it's not functionally impairing me and it's not subjectively distressing, it does mean that like then then what however your mind is working or however that is for you doesn't rise to the threshold of being a disorder.

Dr. Alton Bozeman

Correct, right? Yeah, a lot of times I'll see someone say, I watch everybody in the room, I read the room, and then I imitate them to fit in. And it's like, well, that's what everybody does. And if you're saying you're able to do that on the fly, then you're actually quite strong at that, right? When autism at its very core is a deficit, right, of social communication skills and abilities, right? The idea of being able to fake to the point of someone can't notice a skill you don't have doesn't really exist, right? We don't have that in any other areas, yeah. It would be similar to saying, I'm going to pretend that I am not dyslexic by being a better reader than you.

Dr. Kerry Horrell

Which is true, like if you could do that, you know, then you can read. You probably don't have

dyslexia. What about the misconception about autism having something to do with intelligence? Because I do think that most people, I don't know, I could be wrong about this. I think it's out there as an idea that part of the criteria for autism has something to do with intellectual ability. And that's not part of the criteria. And I wonder if you can speak to that kind of thing.

Dr. Alton Bozeman

Yeah, so it's not part of the criteria. So the research, the long-standing research would say that about two-thirds of people with autism have intellectual disability. That is changing. It's changing both in an accurate, evidence-based way and kind of in a misinformation way. So in some regards, some of the people that don't have intellectual disability probably also don't have autism. But also I think we are finding more people that truly have it that also don't have intellectual disability. So in the past, when we were assessing children or adults and we're trying to convince a family member that your child or adult child does have autism, oftentimes they were saying, well, they can't because they're smart. And we were trying to explain that, well, no, not everybody has an intellectual disability. Now that's kind of turned 180, where a lot of people think that with autism comes like some kind of talent with it, right? Or some kind of extreme intelligence to the point where you become kind of like socially awkward. Yeah, like it's a savant syndrome. Right. And so the negative of that can be expectations. So people with autism that are really struggling or their family members that are really struggling, and people thinking that they have some skill set that's going to really help them somehow function in life that they don't have. And you know, the number of savants with autism is actually pretty small.

Dr. Kerry Horrell

Yeah. And so it there again, it’s something where there's comorbidity, but it's not necessarily like there is a direct link where you know if you have autism, it looks this one way.

Dr. Alton Bozeman

Right, exactly. No, and a lot of the savant abilities are actually directly related to the autism too, right? So if you can filter out all the other noise because you're not comprehending it or you're not focused on it, then you might have this really strong pattern recognition, which makes you be able to, you know, replay a song after hearing it once. Yeah.  You know, so a lot of times it's the deficits in other areas that lead to these strengths that we can say.

Dr. Kerry Horrell

Yeah. The other misconception that I see a lot, and listeners will know I work with young adults and adolescents primarily, is that kids who are a little quirky, they're, you know, they're kind of a little oh, what's the right way to phrase this? Yeah, they're silly. Maybe they make jokes that are a little off color. Again, maybe they're not reading the room great, but they're just a little socially quirky. That that gets sort of flagged as autism really quickly these days, is my sense.

Dr. Alton Bozeman

Yeah, I agree. And that's what we see often, or we'll even see people that are now adults and they'll point back to the fact that they were that way as children. You know, so that is a trait of autism, right? Is kind of not knowing the social rules or quick enough or on the fly enough to fully fit in or not come across as quirky, especially if that quirkiness or eccentricity causes problems for them. Yeah. Maybe they want to be more accepted by friends and they aren't. But then with autism, you also need the mental rigidity and the repetitive behaviors, yeah, and other aspects of sensory sensitivities that that does not include, right? So it's kind of like that's necessary but not sufficient. Yeah.

Dr. Kerry Horrell

Yeah, that makes sense. That reminds me, I actually think maybe this is a good place to land the plane for the autism part. That is probably the biggest stuff that feels like the misconception is the stuff that we would label as “necessary but not sufficient.” Where, you know, I've had people be like, well, I rub my feet together at night before I go to sleep, and I don't like the way that certain clothes feel on me, and you know, I'm really shy. I think that means I have autism. And those are things that might be common for people with autism, or we might see that often. But again, it’s like the core symptoms are not there.

Dr. Alton Bozeman

Correct. Another thing with that is, again, the degree of disruption that those symptoms caused. So I think this for both ADHD and for autism, I think that another thing to consider is that we only know our experiences. We can't feel the experiences of others. And so when someone is saying, I don't like the way certain clothing material feels on me, I think that they're kind of saying to themselves, everybody else feels comfortable in all clothes. Right. Yeah, yeah, yeah, yeah, yeah. So they're starting to overthink certain traits they have because they've read about it or heard about it in social media related to autism. When the reality is we all have certain sounds we don't like, certain materials we don't like, and for some worse than others, right? But with people with autism, like when you talk to their parents, right? It was a disruption. Think about it this way, the way that a diagnosis comes about is seeing it, right? In other words, there was no autism at some point, at some point there was no such thing, and they kept seeing these children that had these issues that were really impairing functioning or really difficult for their parents. Yeah, right. So that's the way you have to think about it. They weren't seeing somebody who is silently uncomfortable with their clothing, yeah, right. That would have never gotten spotted. Yeah, yeah, yeah. So you know, when you see these symptoms, I think a lot of people, if they haven't worked with a lot of people with autism or don't know someone, they don't know how extreme they can be, right? Yeah. That it's full-on fits on the floor crying tantrums, you know, about wearing certain clothing.

Dr. Kerry Horrell

This is, I mean, I'm thinking about I I do some autism testing. I'm thinking about like when I'm doing a developmental interview and I'm talking to a parent and they'll say something like: Yeah, they were missing school like once a week at the least, because getting them into their clothes was so challenging. Or they only had like two shirts that they would wear and they were very like it was a full blown tantrum if they couldn't wear those shirts.

Dr. Alton Bozeman

Or the same with food. It wasn't just that they're a picky eater, like lots of children are. These are children that would literally starve if you didn't give them the right food, right? Or would start to have some semantic somatic complaints like vomiting and things like that.

Dr. Kerry Horrell

Yeah, yeah. 

Dr. Kerry Horrell

Let's so switch to ADHD because there's also a lot out there in regard to ADHD as well. We did say though I think it was maybe a good thing just to highlight autism it is a social communication and what was the other word you used? Social communication and I don't know I'm sure it was brilliant. Yeah it was it's a disorder related to social connection and communication and rigidity, and you know restricted behaviors. ADHD, as the name absolutely suggests, is a disorder related to attention and hyperactivity. You can have one, the other, or both but that is the core of the disorder.

What are some of the common misconceptions that you've seen around ADHD?

Dr. Alton Bozeman

Again, forgetting that it's a deficit, so a lot of times people look at it as an optimalization.  I would like to be able to work 60 hours a week and then get home and raise my children and make a meal and get ready for the next day and I cannot.

Dr. Kerry Horrell 

Yeah.

Dr. Alton Bozeman

So therefore, I might have ADHD, right, and so oftentimes I find myself pointing out to people like you're probably in the top 10% of productivity and you want to be in the top one percent. You know, but remembering that this is a deficit meaning you're at the bottom percentiles of somebody's ability to attend or somebody's ability to sit still. Yeah. And so again I think a big misconception is kind of forgetting that it is a disorder.

Dr. Kerry Horrell

Yeah I think that if I am correct in this, though, this is a little bit anecdotal, I think this has been partly because parents want their kids on medication that really helps them to perform well. Like I think that that you know I've heard this and I don't work with really young kids. But when I did work in a high school for just a little bit when I was a trainee, this was like what I'd hear. It's like well my kid is taking four AP classes and is doing water polo and is also doing you know baseball and studying for the SATs and you know he's just like not able to study at 8 p.m. when he comes home from his extracurriculars. And I think he'd really benefit from being on a medication that I hear little Johnny's on that makes it so he can do that. And it's like…your kid's 15 and it doesn't sound like there's a deficit there.

Dr. Alton Bozeman

Correct, right. In fact they're very high achieving, right, so it's kind of saying my child is outperforming most other children with one arm tied behind their back. Right. Yeah they also have a deficit,  which they don't have,  so we'll hear the scenario you just gave a lot from parents. We'll also hear from schools often ---sometimes parents are aware that they're maybe looking for the diagnosis because they want to keep up with the peers and they feel it's unfair. And other times they're sincerely unaware, but they're thinking that their child should be performing at a certain level. So,  if they're not performing at that level, ADHD is the diagnosis they're aware of.

Dr. Kerry Horrell

Yeah.

Dr. Alton Bozeman

And in those cases we get a lot into what you mentioned at the beginning, which is a lot of times you have a child that's perfectionistic which is almost the opposite of ADHD, but they're so perfectionistic that they're inefficient. Yeah that they're procrastinating, they're slowing down… procrastinating because they're so worried about being perfect or they're  double checking their work so often and so then you know so they're still inefficient. They're not getting the work done and so that can look like ADHD but really, it's the opposite, and so giving those children time and a half can sometimes backfire because now instead of two hours to ruminate over their work, they now have three hours to ruminate over their work right? And they still take up all the time right because it's not really about having enough time. And then you can miss a diagnosis like anxiety which perfectionism tends to be driven by and so you don't want that. And then stimulant medication could obviously make anxiety worse.

Dr. Kerry Horrell

Right like that's not going to help your anxiety if anxiety is driving some of these symptoms.

Dr. Alton Bozeman

Correct.  Another thing too is if you have someone who's perfectionistic and you look for accommodations, then you're also reinforcing that message, because you were saying to them that that 90 was not good enough because you need accommodations, right? The majority of your peers don't have accommodations… that you need accommodations, right? So, you're really making a big deal right those final few points and so then that can heighten anxiety and again it can backfire.

Dr. Kerry Horrell

I want to come back to this general idea that I really truly believe-- which is that there can be this misconception that everybody else functions in a particular way. Like I think there's a sense sometimes, and I work with college kids that 90-minute lectures, for example, everybody else is paying perfect attention to every minute of a 90-minute lecture. Which honestly, professors out there who don't take a break in a 90-minute lecture, come on, what are you up to? But again, they think, well, everybody else is paying attention-- and that's probably not true right? Most people can't sustain attention for super long periods of time, even with completely baseline normal cognitive functioning.

Dr. Alton Bozeman

Exactly. It goes back, again, to we only know our experiences and so oftentimes during an interview I'll ask about inattention in class and people will give examples that are pretty global right?  That would mean everybody, or they'll say, oh,  just for the really big test, I struggled.  That's everybody, right?  There's so much information you have to now encode back into your brain and recall for a test… or taking a test in a noisy environment…and so what someone's implying is that there's other people that don't struggle with this. You’ll see the same again with dyscalculia, which is a disorder with math, or dyslexia disorder reading,  where people are thinking that math comes really easy to everybody else or that reading comes really easy to everybody else. And a lot of times we're not seeing any real deficits, but people think it.

Dr. Kerry Horrell

Yeah yeah that's the real tough thing about average-- is that most people don't realize that most of us are average. I'm telling you I have such mad respect for neuropsychologists because I took neuropsychology and I did some training in it and I was like this is very challenging because most people don't want to hear the feedback you're giving them. You're either disappointing them because they don't have a disorder,  you're disappointing them because they do have some struggle, or you're disappointing them because you're saying you're average. And they're like, what? I'm average? And you're like, well, yeah, that's where, based on your age and based on a comparison to your peers, you're exactly where we'd expect you to be. You're right where most people like you are.

Dr. Alton Bozeman

Yeah and going back to your original question about misconceptions, another one is that smart children don't show ADHD.  And so a lot of times I'll say to someone, you've had no consequences academically, whatsoever vocationally, socially, there's not evidence of this impacting your life--and they'll say well, I'm smarter, right, I'm above average? And that's another misconception. So you can speak with medical doctors, PhDs, you know I've worked with so many people that are genius level and they will tell you that they were still a complete pain to their parents during their grade school times because the day-to-day was a wreck.  You know, maybe they would ace the test, maybe everybody that talked to them were like “you're a really really bright kid,”  but it doesn't mean that their backpacks didn't have crammed up, crumpled paper, you know…and that they weren't forgetting when their due dates were due and so forth. You know it's a daily struggle because of the disorganization and the inability to focus.

Dr. Kerry Horrell

Yeah. Well I want to shift to talking a little bit about what where some of this problem kind of comes from. You mentioned this already, but I want to talk a little bit about social media and the effect of social media in disseminating these misconceptions. And I wonder do you feel like social media is-- like are you thinking the same way I am -- that like this is the major culprit? Well let me start there, and I have another question after that.

Dr. Alton Bozeman

Yeah I I definitely think it's the major culprit, sort of speak, as far as how it originated. I think now it might have a life of its own because before we were hearing it from a social media demographic, right, younger people? Now it's making it for older people and it's even making it into some clinicians that don't specialize in these areas, where you hear some of these symptoms that are not accurate or this idea that you can completely cover up these symptoms effectively, and yet you still have it. So I do think it definitely originated kind of twofold. One, you have kind of social media as instructor, where it is a person who hosted a channel or something giving out false information. Oftentimes I've seen it where the person does have the disorder and they quickly realize that they need to broaden the criteria if they want to have viewers. And then oftentimes people that clearly do not have the disorder. And then on the other end of it, you have social media where it's kind of more like group chat. Right. So then it might be like Reddit, where there's not like a host, but it's a bunch of people within a community spreading disinformation with each other or reinforcing the disinformation because they're like, “oh this person has it, and their symptoms sound like mine” and in reality, neither of y'all have it.

Dr. Kerry Horrell

Right. And I wonder if you have thoughts, this is where my other thought was going, about if this has to do with a sense of belonging? Because I do… one of the things that I think I'm seeing more and more is that people are finding a home in the community of other people who identify with autism or ADHD, and that then this feels like “oh I found my people.” Which I think this is actually one of the really painful things is when I do testing and I'm like, “you don't have autism,”… it feels like I'm really taking away something important to a person's identity and their sense of community. I wonder if you have thoughts on this?

Dr. Alton Bozeman

Yeah, we definitely hear that… we hear it from the individuals themselves. We hear it from their parents oftentimes saying, you know, they felt like they found a community. They felt like they found an explanation. And so some of that is probably just in itself rewarding, the being part of the community. Then, for others, they really do have struggles and whatever condition they have is causing disruption socially, vocationally or academically,  it just may not be ADHD or autism. And so when they discovered that and they felt like I have an understanding, right? I have an understanding for why I become very panicky in a crowded area and have a panic attack. It's just that the reality is it might be, you know, more of agoraphobia or a type of anxiety and not necessarily autism. So, for that second group, it's been really important to validate their experiences that you do have symptoms that cause distress. And also, for people that don't have a diagnosable condition, I also oftentimes are telling people, like, your reality is what it is, right? You do have some behaviors that might be consistent with autism. And we're not saying you don't have those behaviors and we're not saying you haven't had these experiences. Yeah. We're just saying it didn't qualify.

Dr. Kerry Horrell

It didn't meet a threshold, but the way you're describing your mind is how your mind works. Right. And when you leave this office today you're still you. Yeah, well and this is where again I  say this because I think one of the factors in all of this is social media. I think is a piece of this is we're living through such a time of disconnection and people not feeling like they belong and I think people are hungry to find community. And I think that this is where we see a larger issue of people identifying with mental health conditions and disorders as a way to find community. And again, I think that's a very double-edged sword. Like I'm a big believer in people finding other people who have their same lived experience and using them for support. 

But when it comes to the point of like I, for example, wouldn't want to get better from this disorder, or I don't want to get support, so that it's not impacting my life because then I don't fit in a community… it becomes a real problem. And again. I think we see this a lot with our teens. It is this over identification with a disorder for the sake of belonging. Yeah, and I wonder if you have thoughts. it's kind of a vague idea… 

Dr. Alton Bozeman

But no… I know completely what you mean. So you know our colleague Sean Hirsch, when I did a presentation with him and he had a really good slide where I was talking about, you know, the pros and cons of social media and the internet in general. And one of the big cons of the internet was, when he did the research, percentage wise, was how many of them do not push or support the idea of getting better. Right. They just kind of sit in it and if it's causing distress, that's not a good thing or if it's problematic. And so if you're a family member of that loved one, then you want them to get better. And I'm not saying that all symptoms or traits of autism are things to quote unquote “get better at,” I'm saying but there's certain aspects right…

Dr. Kerry Horrell

 …We want a higher level of function. We want people to feel like they have the support they need to do that. They're able to live their life in a way that that is more, you know, adaptive. 

Dr. Alton Bozeman

And so part of that aspect too is shown in the divide of do we say someone is autistic or do we say someone has autism? I think with a lot of the higher functioning individuals that have autism, or those that don't have it and may maybe think they have it, they tend to say autistic, right? And that kind of goes back to what you're saying, right? This sense of belonging and ownership, which can be great, right? Because if you do have it and you are high functioning and you want to claim it and have pride in it, then that that's great. The reason why I think those of us that have been in the field longer tend to say someone “with autism” is because when you work with a lot of people that are lower functioning, and this is a really struggle point for their parents, then you don't want them defined by it. And so it's like when someone looks at my son, you know, my hypothetical son that has level two or level three, they can see the autism right? They're stimming or they're having a tantrum or having an adjustment with transitions.  But I don't want them just to see that, I want them to also see that their favorite color is blue. And I also want them to see that they like jazz music. And so, they don't want them just to be autistic right?  You want it to be someone with autism as just one piece of the puzzle.  When you see my child or myself, if somebody has it.

Dr. Kerry Horrell

And this is where again. I say this and this is a segue a bit into my last kind of question for you today. But I see people finding connection and belonging over their interests, the way their mind works, the way that they have their quirks…that's such a good thing. And I think separating that from, you know, disorders, as that being so part of a person's identity, would be really important that people find each other.  Find your other little weirdos and like connect and that'd be so okay without it getting into the idea that I have to look a certain way to be able to feel connected to other people like this. And this is where my last question for you today is… understanding these misconceptions and having more clarity for these diagnoses… why is that really important for people who do have neurodevelopment disorders? Why is this something that that really is important for this community?

Dr. Alton Bozeman

So starting with autism, I have worked alongside and with parents and individuals where the autism has been so impactful in their lives. It has caused the disruption of marriages. It has made it difficult for the parent after the dissolving of their marriage to find another partner because the child is so demanding. Difficulty with career and how they're going to live independent livers, you know ,moving forward. Just really significant and profound difficulties and a lot of these families and individuals have fought blood, sweat and tears to get states to pass laws to make funding to protect, right. That's what I was thinking of-- Americans with Disability Act and things like that to really fight for this and so therefore if you end up changing the kind of perception of it, as it is just something I have internally that most of you all cannot even see, then you can end up doing damage to a lot of that right. Or you can end up minimizing the experiences of others. And so I also will take that a little bit further by saying that those who do have autism or believe that they have autism that are high functioning…be careful about speaking for everyone as you know so I'll hear a lot of times they'll say “don't try to change us,” “don't do interventions” and so forth. And it's you have friends, you date, you have a job, you're in college, like it's easy to say “don't try to change me” right? 

Dr. Kerry Horrell 

…Or offer support to make my life more adaptive…

Dr. Alton Bozeman

For someone who has come to me and, this is my actual experience,  “Dr. Bozeman I want to have friends. I want to know what it's like to have friends.”  You know and so we're going to give those skills to you to help you have friends, right,  and so be careful about speaking for everyone… and the same for jobs.

Dr. Kerry Horrell 

Or a parent who comes to you and says I'm worried that when I die my child won't be able to take care of themselves and I'm terrified.

Dr. Alton Bozeman

Exactly. And again, being able to get a state to have funding for that… to have group homes… to have places where they can know my loved one will be taken care of. That's expensive. It's a lot right?  And so you don't want to change it to the idea that everyone just goes on as being an independent liver.

Dr. Kerry Horrell

And for ADHD, the Atlantic,  I think it's the Atlantic, just came out with an article that talks about the proliferation of accommodations in colleges and how it was suggesting that because so many people are coming to disability services in colleges and looking for accommodations for ADHD, they're just becoming stricter and stricter and harder to get. And I think this impacts people who really would benefit from having accommodations

Dr. Alton Bozeman

I was going to go for the ADHD part , that it would be that it's making people more resistant to the idea of accommodations. So there are high schools and colleges that often are very academically competitive that have as many as 40% of the students that are receiving accommodations usually for ADHD, when research and just kind of common sense, lets us know that that those are actually the schools with the least percentile of them, right? Yeah, because of the deficits that it causes and the academic rigor of those schools. And so it makes it harder for those who do have it to be taken seriously and to get the accommodations. It also has led to oftentimes there being medication shortages…

Dr. Kerry Horrell

… which has definitely been happening right the last few years.

Dr. Alton Bozeman

So it used to be just a few years ago, if somebody came to me and they said I go to Texas A&M, for example…I don't really know if Texas A&M did this much, using it as an example… that they say I need testing to get accommodations. I used to be able to go on the university website and kind of see the general requirements of what they're going to need from me as the psychologist. I can't now, most of the schools have now scrubbed that from their websites because of, I think, their concern about so many people gaming the system. 

Dr. Kerry Horrell 

Yeah is that a referral you see pretty often come into the assessment center… is people wanting testing to support accommodation?  

Dr. Alton Bozeman

Yes, so that's a broad question… because schools do want recent testing, so there are children who have had ADHD diagnosed since the time they were age four and they might still need assessment again before going to college or during college because the schools just want updates on it. But yes, then you also have the people where, it's for the very first time, they're coming to get diagnosed at that age. Oftentimes it’s sincere because, again, that's subjective reality. In other times because they're looking for accommodations and the schools now are kind of more wise, so it's the schools want to see a history of it.

Dr. Kerry Horrell

Yeah. These are real disorders and there is real support out there. And you know I've had the privilege of working alongside of you in the Outpatient Assessment Service you know a good handful of times and I've seen what you all do in providing people clarity. So if they have the disorder, what does that actually look like and how does it impair their life and then what can they do about it? And for people who, they don't fit the disorder, what actually makes sense of what's going on for them and what support's out there? And so I think that again I know these conversations they're tricky. They can be loaded with lots of feelings, but there is support out there. I think whether people have these specific disorders with specific criteria or not, there is support out there.

Dr. Alton Bozeman

Yeah. And it's a good point you bring up is that if you're somebody who feels like you have some symptoms that are causing distress or disruption in your life or limitations in functioning and you're not sure if it's ADHD or autism, the message is not for you to not go in and get tested. The message is for certain to go and get an assessment by a qualified professional. Because even if it's not one of those two conditions, then we might be able to find out what it is, right? And so oftentimes it is something like anxiety and sometimes it's recreational substance use and people think they're using it recreationally and responsibly and they're surprised to know the impact that it's having on things like attention and executive functioning.

Dr. Kerry Horrell

I didn't think about that. That's a great point.

Dr. Alton Bozeman

And then also things like insomnia, so by all means, get a qualified assessment and, if it's not one of those two conditions we talked about today, maybe we can end up addressing something that it is.

Dr. Kerry Horrell

Yeah. Yeah. I know I'm just throwing this in because I think it's interesting—trauma. 

Dr. Alton Bozeman

Yes, trauma is a big one…and It looks very much like ADHD.

Dr. Kerry Horrell

Yeah. Yeah. And again, there's support out there if that is what is underneath someone's symptoms. So gosh, I think this is a really cool and important conversation. And I'm curious if you have any final word for our listeners, who are mostly mental health practitioners… if there's any final word you have for our listeners before we wrap up for today?

Dr. Alton Bozeman

I think it would just be repeating what I mentioned… don't shy away from having individuals assessed. A good assessment can lead to some diagnostic clarity that can help… and sometimes the lack of a diagnosis is also confirming for somebody because it kind of puts their mind at rest that it's not that. 

Dr. Kerry Horrell

Well, thank you very much for joining us, Dr.Bozeman. Again, you've been listening to Dr. Alton Bozeman and this has been the Mind Dive podcast.

Dr. Alton Bozeman 

Thank you for having me. 

Dr. Kerry Horrell 

Thanks for joining us… that was great.