The Other Autism

What Can Occupational Therapy Do for Autistic Adults? An Interview With Courtney Benner

July 26, 2023 Kristen Hovet Season 3 Episode 3
The Other Autism
What Can Occupational Therapy Do for Autistic Adults? An Interview With Courtney Benner
Show Notes Transcript Chapter Markers

Courtney Benner, a neurodivergent occupational therapist based in Utah, shares how occupational therapy can help autistic adults. She also talks about her neurodivergent identities and the ways these help her relate to her clients.

Courtney shares the lead-up to her diagnoses and how much of an impact they had on her life. Additionally, she shares some very interesting statistics about autistic sleep patterns, explains the zones of regulation and how these can be used or adapted for adults with alexithymia, talks about the hurdles to becoming an autism assessor, and more.

If you'd like to know more about topics discussed in this episode, check out:

Check out "10 Surprising Ways OT Can Help Adults With Autism and ADHD" by Courtney Benner

"Take the ACE [Adverse Childhood Experiences] Quiz" via NPR

Episode outro music: "Stream This" by Smartface

Theme music: "Everything Feels New" by Evgeny Bardyuzha.

All episodes written and produced by Kristen Hovet.

To submit a question to possibly be answered in a future episode, please email kristen.hovet@gmail.com

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Kristen Hovet:

Please say hello to my guest for today, Courtney Benner, an occupational therapist based in Utah.

Courtney Benner:

My name is Courtney Benner and I live in Utah County, Utah. I am 30, flirty, and thriving. I grew up in a small town in Wyoming. If you see my picture you'll understand this. But this is one of my most asked questions. It's what are you? So I am a quarter Japanese, but then the rest is Caucasian, like English, Irish, German. When I grew up, my parents got divorced when I was six. I have a younger brother and then a younger half brother, but I was also close with my cousins growing up and my grandparents, my aunts, my younger brother's grandparents and then my grandma. They both had horses, so I was very into the ranching, Wyoming part of it. I'll tell you how I came to Utah. It all started I was a cross-country skier in high school and we would travel out of state to Soldier Hollow, which is a ski race in Midway, Utah, which is the fancy part of Utah. I just loved it. Then, once I was in grad school for occupational therapy, I was randomly assigned a level one fieldwork here in Provo at the Utah State Hospital. Fast forward to the following summer and I did a level two there and I just loved it. So I wanted to move back, but it took a while. So I moved to Boise, Idaho, for about a year-ish and then I was able to come back here and get a job at an outpatient clinic for kids with autism, and I have been here ever since. Now I work at a charter school for kids with autism and an inpatient behavioral hospital. One of the things we were going to talk about was hobbies. It's a very underutilized coping skill. My goal after getting divorced was to find three based on the rule find one to keep you in shape, one to keep you creative, and one to make money. Mine are walking and blogging as of now. I also have another master's degree in applied behavior analysis from National University, but I don't use it. I do have work history in early intervention, schools, outpatient clinic, community mental health, inpatient behavioral hospital, telehealth, and higher education. Then I found this podcast because it was an advertisement on The Weekly Trash, which is a Utah-based podcast. Then I listened to a couple episodes so I subscribed, like the addiction one and the one with ABA, and they were just so good, I loved it. I'm super excited to be here.

Kristen Hovet:

You mentioned ABA, so I have to ask. Y ou mentioned it twice. I'd love to know, first of all, why you don't use your second degree, your master's degree, and if you have any, has your thinking changed in that area?

Courtney Benner:

Oh my gosh. I guess for the listeners, if you don't know what it is, you definitely want to research it. It's a very controversial therapy, but at the time when I got my degree, I felt like I wanted to go back to school. I just didn't know for what and my company at the time offered to pay for it. I was like, oh my gosh, this is perfect, I can work full-time and do it part-time online. Well, once I got into it, I started to realize what it was and I was like, oh no, then I got laid off. Then I ended up like, well, I've already started, I should just finish anyway. So I was already in too deep. And the way the BCBAs get their hours is really strange. It's not like in OT school where they send you out on fieldworks that are like 12 weeks long, like you pay someone, and it was just a very strange experience. That's as nicely as I can put it.

Kristen Hovet:

That makes sense to me. So I guess we can go back to when we were emailing initially. You mentioned in one of your emails that you've been diagnosed with anxiety and ADHD, so I'd love to hear anything you'd like to share about getting diagnosed and what led to your decision to get assessed.

Courtney Benner:

So I was not diagnosed until I was an adult, for both of them. And a big part of it was like being in rural Wyoming there's just not a lot of health care, so we would travel out of state or at least travel two hours just for health care, and my parents just weren't the most informed on mental health just in general, so like they had no idea. Like they just thought like oh, you know, she's being quote, unquote, bad or whatever. I've always been very shy and reserved. I always say I'm an introvert waiting for an extrovert to adopt me. But I began to notice it when I got into grad school. Like I don't, they say it's a developmental disorder, attention deficit, hyperactivity disorder, but I don't remember it being as big a problem when I was little and I'm wondering if it's just like that age where the stressors of moving out being in grad school it just all kind of caved in. But when it caved in it was like boom. So I would like cry every day of grad school. I was just so overwhelmed I didn't know how to cope. Like I didn't learn self-regulation skills when I was little. So I started OT school in May of 2013. So in December of 2014, I was hospitalized for bronchitis during finals week and, looking back, like you would think that's not a big deal, but that was like the end of the world to me, just because they weren't very understanding about sickness, let alone missing finals week. So I'm like, okay, I'll just stay up all night, I'll go take my final at like 8 am, it'll all be good, like my grade's high enough. And then they admitted me. So I ended up being at the hospital longer than planned. My stepdad is an attorney and like we've got to figure out, like, what is their policy on this? I was just freaking out. Before all that, I should say, I was in the ER just sobbing and one of the doctors he was listening to me and he's like has anyone ever told you you have an anxiety disorder? And like he handed me a box of tissues. He was very understanding and then that only made me cry more and I'm like, no, like there's just no way. I was in complete denial. And then, when I did my fieldwork summer of 2015 here in Utah, like I have access to more medical treatments. So I was like I am going to go get, talk to a doctor and see. And so I started on 10 milligrams of Lexapro. It's escitalopram. Oh, it was so life changing, like I was just more relaxed, I could socialize better, and I think that third year I was just better. It was by far the easiest in grad school quote, unquote easiest. And then another thing that was really interesting, I ended up increasing my dosage down the road, but when I had my daughter in the spring of 2021, I had this really intense fear of her like suffocating because there's like warnings on everything and when you're a new mom you're just like, oh my gosh, like what am I doing? So, looking back, again, this isn't diagnosed, but I'm pretty sure I had postpartum anxiety. I don't think I had depression because I'm pretty upbeat, I'm a real go-getter, but postpartum anxiety was definitely crippling. Then we get into ADHD. So one thing that was really interesting to me in my psychology classes in graduate school is they told us that biracial children in general are more likely to be diagnosed with ADHD, and I don't know why that is, but I remember thinking, oh, that's interesting. Little did I know I had it. I was looking at an article and there's actually racial disparities in minorities getting diagnosed and receiving treatment in comparison to whites. So I thought that was really interesting. Like I wish I could find that resource, but I couldn't. So I did not get diagnosed with anxiety till I was 22. I was 28, this was after having a baby, I was diagnosed with ADHD because I was like there is just something still a little off, I can't put my finger on it. In graduate school we had three hour classes, like three of them back to back, on top of all the assignments. Like it was just insane. I was a really good student in like elementary school, middle school, high school, even the first two years of college, and then I was like a straight C student in graduate school and I'm like well, this is very sad. I was always more fidgety, too, and I needed more breaks than everyone else. Like I could never understand how they could just sit for that long. I also get frustrated really easily, which I didn't realize was part of ADHD, especially with like different personalities. I love looking around the room and, as I'm sure you'll understand today, I'm very easily distracted. A lot of my patients love that, though. This one, I kind of think, is funny. I'm very immature and I have a silly sense of humor. I always told myself like, oh, I'll outgrow it. And I'm 30 now and it's just the way I am and I love it. I have a hard time listening to topics that don't interest me, but I'm good at like masking, just to be polite. Oh, another thing that was interesting to me that was like, I should probably go get tested, is I loved going to the movies as a kid, and as I got older, I could not sit through a movie to save my life. I just could not do it. And then another thing, too, I thought this was part of having a baby, but it's not I guess. My memory got worse when I was in high school. I was really good at classes like Anatomy and Spanish because I could just memorize it and do really good. Now, after having a baby, I have to write everything down. I counted it up. I have two personal calendars, one work calendar. I set reminders on Google task apps and I write it down on my Google calendar, otherwise it doesn't get done. I did a screener with my psychiatrist and she started me on 10 milligrams. Now I'm up to 20. And it was so amazing because I could think for the first time and like, actually pay attention because my brain is just always going. Do you know this about ADHD medicine? It's the only one where you take it and, if it works for you, then you have it. I took it and it worked for me and my psychiatrist is like, yeah, then you definitely have it.

Kristen Hovet:

You mentioned masking, too, so I guess that's usually associated with being autistic. So in what ways is it similar, in what ways is it different between ADHD and autism?

Courtney Benner:

I have to like tell myself okay, you have to face them, make eye contact, like don't be rude. I have to ask myself, okay, what were they saying? What were they saying, like, what would be a good follow- up question to that? What could I say to let them know that they're validated? That's how it looks for me, I guess.

Kristen Hovet:

How has life changed for you after being diagnosed with ADHD?

Courtney Benner:

I am a huge advocate of going to a psychiatrist because it is literally life changing and had the biggest positive impact on my quality of life. It's just amazing. Like at work I can put out higher volumes, better quality of work. My biggest one that I love is I started a blog in December of 2022. Before that, like there is just no way I would have had the attention span to do that. I wish I would have started a lot sooner, but it's okay. Like it's just part of the journey. I am able to keep my apartment cleaner, which is kind of crazy, because I'm not like bouncing around, like I go in a room, I'm like, oh, let me do that, let me do that, and then I forget, and then, like I ended up doing too much, I get overwhelmed, I shut down. It's a vicious cycle. I was also really tired, too, because my brain was constantly going, which I learned is part of the hyperactive part of the diagnosis is your internal state is just going, going, going. I also am a better mother because I am diagnosed and getting treated. Motherhood is very stressful for those who don't know, and I can tell a huge difference in the amount of attention and like quality time I'm there for my daughter. If you're on the fence, I say go for it.

Kristen Hovet:

When you've told others about your diagnosis, what have their responses been?

Courtney Benner:

My mom is still in denial. But what is so funny is, once I got medicated, she's like, oh my gosh, like you're so mature, you're growing up, and I'm like, no, I'm just getting treated for my mental illness. But what's interesting, though, is it's overall pretty positive. People are like, oh yeah, that makes sense. But they like to hear, like, what were my red flags? What it looks like in women, because it's so different in men and women, too. It's been pretty positive. I know there's that stigma. I'm trying to break it.

Kristen Hovet:

You called it a mental illness just now. Is that how you would define it?

Courtney Benner:

I guess I'm going off the DSM-5, like the billing code. They classify it in the DSM-5, so I think technically that would. But it also is neurodevelopmental, too.

Kristen Hovet:

You've mentioned that you're an occupational therapist, or OT for short, which we've said a few times already. So for listeners who might not know what that is, can you define occupational therapy and outline what an OT does?

Courtney Benner:

There's kind of a joke with OT. It's like, wow, we all have ADHD. Because it is like such a broad therapy, it's very unique, it's very holistic. I was really trying to think of another profession that it's like, and we're like PTs, we're like counselors, we're like nurses, speech therapy, like there's just such big overlap. But the biggest thing we do, the end goal is looking at occupations and how it impacts their ability to function in life. So those eight occupations are activities of daily living, instrumental activities of daily living, IADLs, so that's like care of others, rest and sleep, education, work, play, leisure and social participation. We also do task analysis to analyze habits, routines, and roles. I didn't understand that one as much, I guess, until I read Atomic Habits and I'm like, oh my gosh, like I totally get it now. A lot of it's adjusting the environment, whereas most people think it's change your thoughts and then it'll happen. But your environment actually has a huge impact on that. So I thought that was really interesting. And then we look at the skills that you need to be successful in those occupations, like sensory processing, executive functioning, self-regulation, even like social interaction, and then we have to use evidence-based treatment and we try to individualize everything so that they can participate in those occupations which are the long- term goal. So like the skills are kind of like the short- term goal.

Kristen Hovet:

How can OT assist or support autistic and ADHD adults?

Courtney Benner:

I wish there was more for adults and it kind of puzzles me as to why there isn't. But I came up with a list. It's called 10 surprising ways occupational therapists can help adults with autism and ADHD because there is a lot of overlap. So for number 10, this one's probably really surprising, is pelvic floor therapy. The occupations we would be looking at would be like sexual activity, activities of daily living. It's usually an OT or a PT that does pelvic floor therapy and they teach you how to strengthen and relax the proper pelvic floor muscles. You would probably want to see a specialist if you have any of the symptoms like pain during intercourse, so like your muscles are too tight, constipation, frequently having to urinate in the middle of the night and, for males, erectile dysfunction. They give you stuff like vaginal dilators if your muscles are too tight. I tried to find some statistics for each of these, too, and this one was really surprising for me. Nine in 10 autistic women have been victims of sexual violence, which is two to three times higher than the non- neurodivergent women. They are only 30%. I tried to find out like why that is and it's like they're more vulnerable. The self advocacy component, maybe like social cues not picked up, like maybe safety awareness, and they might not get as much sex education because people assume it's like quote unquote, not an issue like oh, they're not sexually active. So OTs can help with self advocacy, especially advocating for sex education in public school, good hygiene, understanding boundaries, like establishing what you're comfortable with and then labeling private parts based on their anatomical names. That also, for some reason, is a huge way to decrease sexual abuse. And then onto number nine is hippotherapy, which is working with horses to use sensory input, improve neurological function. It helps with emotional as well, like bonding and caring for the horse. It helps process emotions like anxiety, trauma, setting boundaries and improving self-esteem and impulse control. Number eight is aquatic therapy, which the occupation would be health management and maintenance. That was the same for a hippotherapy as well. Oh, for both of these, most Americans, I know you're based out of Canada, but most everybody has a weak core, so if you're getting hippotherapy it would help with core strength and balance in general, which tends to go as we age. And then with aquatic therapy, I thought this was really interesting as well. Individuals with neurodivergence tend to have joint hypermobility, which is where the joints move beyond typical normal limits and if it's too much, it's actually like Ehlers-Danlos syndrome. So you can use aquatic therapy to help strengthen your muscles and improve your endurance, and then your joints won't fall out, which increases injury as well.

Kristen Hovet:

I'm just going to jump in. I actually have the hypermobile Ehlers-Danlos and I was diagnosed actually after being diagnosed as autistic. It's like the doctors kind of started putting all the pieces together. I think the first one I got was mast cell activation disorder, which also falls under the umbrella, and my geneticist said they appear so commonly together that it might be its own disorder or label one day.

Courtney Benner:

Really.

Kristen Hovet:

It's not severe with my Ehlers-Danlos. It's not to the point where my joints kind of come apart. But I do have to be careful with avoiding certain things so that I don't get arthritis later on.

Courtney Benner:

Neurodivergent people tend to have poorer posture, like our tongue position, we have the forward neck posture, and another interesting thing is we tend to favor one leg over the other, so that also can cause balance issues. Number seven is hobbies, which I'm a huge advocate for because I think more people should do them. I think it's kind of become a lost art over time. So as OTs we'd be looking at leisure exploration and leisure participation. Unfortunately, some of the biggest barriers are time and money. As far as leisure goes, there is a difference between leisure and hobby. So leisure is strictly free time, it's a time to relax, freedom from the demands of life, and it's an underutilized coping skill. A hobby is any activity or interest done for fun, pleasure, enjoyment, so it's slightly more structured than the quote, unquote free time. There are a lot of benefits to hobbies, like stress management, improving your wellbeing, adding meaning to your life, boosting creativity, and makes you more interesting. So OTs can help you find hobbies that you like and enjoy. Number six is sleep. So I also learned this interesting statistic from my dentist of all people, one third of people with ADHD suffer from sleep apnea, which is where your brain doesn't get enough oxygen while you're sleeping so you can wake up like gasping for air, and it can lead to daytime fatigue and drowsiness and poor memory. And then I started looking at insomnia. Individuals with autism, they take 11 minutes longer to fall asleep and their sleep is often disrupted, which I thought was interesting. So they only spend 15% of their sleeping time in rapid eye movement, critical for learning and retaining memory, whereas most non-neurodivergent people spend 23% in the REM stage. If you don't address sleep problems, it can lead to obesity, heart disease, high blood pressure, and diabetes, and it also affects your cognitive performance, like alertness, reaction, memory, and learning. So the biggest things that OTs would do in this, I mean you'd want to get diagnosed for like insomnia or sleep apnea because they do have medication for that, but OTs can also adapt your sleeping environment, like looking at the lighting, how comfortable your bed is, establishing nighttime routines like turning off screens one hour before bedtime, yoga or gentle stretching, journaling, skincare, and restructuring your daytime routines in a way that's just more effective. Number five is ergonomics for job performance. As I said before, individuals with ADHD and autism tend to have poorer posture and weak cores, so this results in muscle imbalances, decreased body awareness, which is a lot of like proprioception, which is part of our sensory system, and difficulty maintaining proper alignment, which later on creates a lot of issues. OTs can adapt various work environments like offices, industrial, and healthcare. The biggest one I follow is the 90-90 rule, so making sure your hips, knees, and ankles are all at 90 degrees. And your computer screen should be right at eye level, and you should also take frequent breaks throughout work, and you can also get things like accommodations as well. Number four is obesity. So the occupation we look at there is health management and maintenance and meal prep and cooking. If you have never done this, I highly recommend doing it. It's taking the adverse childhood experiences questionnaire and it gives you a rating scale and the way they came about it was really interesting. It was a study of looking at people who were obese and they found out that they actually became that way because of what happened in their childhood, so traumatic things like seeing their mother get hit, or like addiction or a parent incarcerated. This all played into it. There is a link between ADHD and obesity which most people would think like oh, you're hyperactive, you're always on the go, like, how could that be? A lot of it is unhealthy lifestyle and genetics, like poor nutrition, lack of sleep, lack of exercise, lots of stress. There also tends to be an abnormal eating pattern, like binge eating, skipping breakfast, eating in the evening and at night, eating a lot of junk food, and then overeating to cope with your emotions, like a negative mood. With autism, most of them are oh, it was, nearly half are overweight or obese, and those with severe autism tend to be more overweight and this is mostly because they're less active, they have more screen time, and picky eating, which I thought was really interesting. So OT s also really specialize in feeding. There's feeding therapies. I once had a client who only ate chicken nuggets for McDonald's. Like it had to be that for breakfast, lunch, and dinner. So they were working on introducing foods that weren't like yellow or carbs. So it's finding ways that is actually enjoyable to move your body, planning and cooking healthy meals, and establishing real habits that you can maintain, so you don't quote unquote fall back into the old habits when it becomes a cycle. You want to make small changes if possible.

Kristen Hovet:

As you were speaking about the overlap with obesity, I was thinking also I've read a lot about the overlap with anorexia, too. I've heard that if you have someone come into like an eating disorder clinic and they're not diagnosed autistic yet, to automatically do an assessment because the overlap's so high.

Courtney Benner:

Actually, now that you say that I have had a couple clients that were like that. I can completely see how that makes complete sense you would screen them for that. Number three is sensory processing. In the school system we more do sensory strategies as opposed to full-on sensory integration. Sensory processing is using our sensory systems to make sense of the world around us. We gather the information from our environment and then we produce a response. So the eight sensory systems are vision, hearing slash auditory, taste slash gustatory, olfactory or smell, touch or tactile, vestibular, proprioceptive, and interoception. Honestly, sensory processing is like so in-depth, it could be a podcast all in itself, so I was just going to focus on two of them that I think are pretty interesting and you should know about. One is vision and then interoception. So I shadowed a vision therapist. It was actually an optometrist. It was really interesting because it helped me with car sickness. It was the most fascinating thing because being car sick is an imbalance between your vestibular system and your vision system. Like your eyes tell you you're still, but your inner ear is telling you you're moving, so that's what causes like the nausea and stuff. So vision therapy is like if you have a lazy eye, cross-eye, eye fatigue, eye- hand coordination. They do a bunch of exercises, they use prisms and other stuff like that, and it's really interesting. If you can go check it out, I highly recommend it. Oh, and they also make car sickness glasses now, too, which is really cool. So most people think there are only five senses and there are actually eight. The newest quote, unquote newest one is interoception, and the more I learn about it, the more fascinating it is to me. It's so simple, yet so complex. So this sense is helping you understand what's going on within your body and it has a lot to do with emotional regulation, with the brain and the body and like positive emotions, affections, intimacy. So it's all of the systems of your body, but, like for your heart, this would be blood pressure, your heart rate, your lungs, so how fast you're breathing. Is it shallow, is it deep? Your skin, which is like pain, temperature. Are you thirsty, are you hungry? The urinary system, like, do you have to pee, do you have to poop? And then the nervous system, which this makes sense with the emotion, the fight or flight response. However, there's four now I learned, fight, flight, freeze, or fawn. Fawning is where you try and get in on the good side with your attacker, which is an effective way to fight off danger. And then rest and digest, which is the parasympathetic. Number two is executive function, and this definitely impacts all occupations. For those of you who don't know, executive function is the higher- level cognitive processes that control lower- level processes for goal- directed behavior. These help us plan, remember, and pay attention. It's associated with the frontal lobe and it typically develops in early adulthood. What's interesting with ADHD is your frontal lobe is like two years behind developmentally, so that is part of the poor impulse control, I guess. Executive functioning skills are 99% genetic, but your brain is very plastic, so these skills can be strengthened. One thing that is also really interesting about executive functioning skills, they predict successful outcomes more than intelligence quotients, which is your IQ. So these are skills like time management, like can you arrive places on time? Self monitoring, like how am I doing in social situations? Am I being polite? Emotional control, which is part of the self- regulation, memory recall, so using things you've learned in the past and applying it to the present. Attention, which is one I struggle with, are you able to pay attention for extended periods of time? Planning and prioritizing, so knowing what to focus your energy on. What is the most time- sensitive that needs to be completed? Impulse control, so refraining from engaging in behaviors or saying things you shouldn't. Task initiation, so just starting. Task completion. Perseverance, which is continuing with a challenging task when you don't have motivation, and problem solving. So some things that OT can do is help them identify goals, help them establish consistent routines, come up with different breaks they can do, use the quality over quantity approach for modifying work, and limiting distractions and setting up the environment so they can be successful. And number one is self- regulation, and it impacts all occupations, but I'd say the biggest one is social participation. So self- regulation is the ability to understand and manage your thoughts and emotions, to form appropriate behaviors based on the situation you're in. So it's the ability to calm yourself down when you're feeling upset, to cheer yourself up when you're feeling down, show what you value through your behavior. There's this curriculum we use at the school I work at, it's called Zones of Regulation and it was designed by an OT. It has the different emotions we have in different categories. Even though I'm an adult, I like it because it makes sense to me. Blue Zone is low energy. Green is ready to learn, you're paying attention. Yellow is where you're feeling a little out of control and Red is where you are feeling completely out of control. So any emotion you feel can fall into those, like elated could be the Red Zone if you are completely out of control. One thing OTs, I wish they did more was anger management, helping with that. We also help patients understand their strengths and weaknesses, what they're good at, what they need to work on, and then regulating their nervous system by using coping skills. I read through one of the studies that individuals with ADHD and autism tend to turn to addiction because it does provide that regulating aspect to their nervous system. But I wish we would invest more in self-regulation skills, like even if we just talk about social emotional curriculums in schools across the board because it would significantly decrease violence, abuse, physical, emotional, sexual, school shootings, incarcerations, you name it, it would be incredibly positive and pretty straightforward. Those are the 10 surprising things that OTs can help adults with autism and ADHD with.

Kristen Hovet:

When you were talking about the Zones of Regulation, how is that typically used in an actual OT appointment?

Courtney Benner:

It has set curriculum. You have different lessons. So the first one is actually making the posters. So you cut out the emotions and then you categorize them in the colors. The book gives you emotions typically found in there, like tired, depressed or Blue Zone emotions like calm, content, happy are like Green Zone, Yellow is frustrated, anxious, silly, goofy. Red is angry, elated, aggressive, violent. So you categorize that and then at the bottom you put the coping skills you can use when you're feeling in that zone. Another one you do with the zones lessons is you'll watch YouTube videos of maybe their favorite show, say Shrek, and it's like, okay, how do you think they were feeling here? How can you tell like, looking at their eyes, their eyebrows, their mouth, their body language?

Kristen Hovet:

One thing that I guess I thought of was for people with alexithymia, where they can't really identify their emotion. Sometimes I have that, too, if I'm in a really challenging emotional state, like I could identify a zone but not necessarily the specific emotion. So if I had that, I could be like I'm red or yellow, like that's easy to identify, right, and then from there break it down.

Courtney Benner:

No, that is. It was originally designed for kids, but I'm an adult and I'm like actually this is really helpful. And then another thing I try and teach my patients and students, try and notice where in your body you feel your emotion. I clench my jaw and I scrunch up my shoulders, so they're all really tight, and it's just kind of noticing that part, like where do you hold all your emotions?

Kristen Hovet:

Right. As an OT, you often work with autistic clients, clients with ADHD, and clients with other diagnoses. How has your own identification as neurodivergent informed your work?

Courtney Benner:

I knew I wanted to go into pediatrics when I got into OT school. Like I loved to babysit. I was a substitute teacher. I was a junior counselor at Sinks Canyon Camp, so I knew I wanted to do pediatrics. But once I started my outpatient job here in Utah, it was strictly clients with autism and I'm like I love this, I just really click. So I've just been drawn to the population ever since. I've developed really good quote unquote radar so I can tell if people are on the spectrum or not, even if they aren't aware. But I do advocate for like early intervention, so you know it's a gift and a curse because I see it, I'm like, do I say something? Also, being diagnosed with ADHD, it's helped me understand them better. I have better empathy and I can also recommend things that have worked for me. Like my memory's gone so bad. I recently bought, like you know, those pill bottles that's like Sunday, Monday, Tuesday, Wednesday, Thursday, Friday and you go through and you organize all your pills. So I've been doing that because my memory is so bad. I just have better recommendations for people because I know what it's like to go through. With mental health as well, typically occupational therapists don't go into mental health because it's very low pay and pretty high stress. I mean, I don't view it that way, but others tend to view it as pretty high stress. So since 2000, there were 5.2% of OTs in the mental health field. As of 2015, it's dropped to 2.4%. So it's almost been cut in half, like OTs just are not going into mental health. The long-term goal eventually to own my own clinic. I want to get certified in the ADOS, the assessment to diagnose with autism. Like there's just such a need, but it's like $10,000 alone, that does not include the courses to get certified in it, but it's so needed.

Kristen Hovet:

I noticed in terms of language, you say person with autism. Is that very common where you work?

Courtney Benner:

So in grad school that is how they taught us and they called it person first. But I have heard that from the autistic population that they just want to be called autistic. It's a hard habit to break.

Kristen Hovet:

What is a myth or stereotype about autism or autistic people that bothers you the most?

Courtney Benner:

The biggest one that bothers me is that autistics don't feel emotion. That's actually anti social personality disorder or like sociopaths or psychopaths, you know. They actually do feel emotion very intensely at times. They just struggle with how to regulate them and like the social awareness when it's appropriate, when it's not. Another thing, too, is people think autism is like a newish thing or it's on the rise. What they don't realize is autism has always been here. It's just more people are having access to getting diagnosed than in the past, whereas in history they had to be hidden and they couldn't live authentically. Oh, and then another one of my pet peeves is that sensory processing disorder is not a diagnosis in the DSM- 5. Kind of blows my mind a little.

Kristen Hovet:

How is that related to, I guess, your clients? Or do you see like that diagnosis separate these days, or is it usually tied in with other diagnoses, like with autism?

Courtney Benner:

It's usually co-occurring but it's very complex because there's a different threshold. So it's almost like across, like high, low, and it's like passive, active, just how you interpret all the different sensory responses. But our sensory system is like what we are taking in and how we're interpreting it and then how we're going about the world. So if your senses aren't working and you develop these distorted thoughts or unregulated emotions, like you're not gonna exhibit the best behavior.

Kristen Hovet:

Same question about myths or stereotypes for ADHD.

Courtney Benner:

The classic young boy bouncing off the walls, can't sit still in class. Basically that girls don't have ADHD. They do, it just looks a lot different.

Kristen Hovet:

Do you have a message for adults who are contemplating or planning an autism and or ADHD assessment?

Courtney Benner:

I say do not wait to get diagnosed. Early intervention is key. It's best if you can get it birth to three, but it's never too late. It really helps to know, oh, like there are other people who are experiencing what I'm experiencing, like I'm not alone in this. Your diagnosis is gonna open the door to receiving evidence-based therapy, medical treatment for co-occurring disorders like asthma, allergies. You can get accommodations at school, in college, there's different programs and plans you can try out and it's just overall gonna have a very positive impact on your life.

Kristen Hovet:

I have heard about some people, and I this isn't my experience, but in the United States specifically like people who have the autism diagnosis and then, I guess, experiencing discrimination when it comes to parenting. I've even heard of people losing custody when it's discovered that they're autistic. If you have any insight on that. Oh my gosh, no, that's like the first time I've heard of that. There's like a list of things I haven't really, because I've only been diagnosed like five years, going on five years, I'm still learning different things, besides like the accommodation to work from home, I don't have any other accommodations.

Courtney Benner:

There's a lot of accommodations like you should definitely look into it. If everyone could go check out my little blog and just support me, it's www dot courtney benner dot com, and I would greatly appreciate it. And thanks for having me on.

Kristen Hovet:

A huge thank you to Courtney for being my guest on The Other Autism podcast. And that's all I have for you today. Thank you so much for being here. Until next time, bye.

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