Neurodevelopment PT 1 ASD

We've got a fantastic guest with us today. Her name is Hannah Salazar, and she is both a therapist AND a professional school counselor. She also tutors new therapists as they work to pass their NCMHCE licensure exam. So, if you need one-on-one tutoring, send Hannah an email at:

 Info@TheGoodNeuron.com

... and I'm sure she'll get you up to speed for your exam.

Ever met a client whose childhood “quirks” suddenly became roadblocks at work, at home, or in relationships? We dig into the real-world nuances of neurodevelopmental disorders with therapist and school counselor Hannah Salazar. We unpack autism spectrum disorder through a brain-based lens—frontal networks, amygdala, cerebellum, and connectivity—so the social reciprocity gaps, nonverbal communication challenges, restricted interests, and stimming behaviors make sense instead of feeling mysterious or oppositional.

From there, we map the edges: what actually separates ASD from ADHD, social anxiety, language disorder, and intellectual developmental disorder, and how to avoid false positives when culture shapes eye contact, tone, and social rules. You’ll hear practical cues to look for when adult responsibilities outstrip old coping strategies, plus how to document onset, identify pervasiveness, and test hypotheses with empathy. We also touch on overlap with OCD and schizotypal personality disorder, highlighting distinctive patterns of sensory processing, developmental course, and social cognition that sharpen your diagnostic lens.

If you’re studying for the NCMHCE or refining your intake flow, this conversation offers concrete takeaways: translate criteria into behaviors, run a quick differential drill, and connect findings to supports—from visual structure and social scripts to academic testing and executive function scaffolds. Press play to sharpen judgment, reduce bias, and bring more clarity to clients who’ve waited years for a name that fits. If this helped your practice or your study plan, follow the show, share it with a colleague, and leave a quick review so more therapists can find it.

If you need to study for your national licensing exam, try the free samplers at: LicensureExams


This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.

Chapters

• 0:00 Welcome & Surprise Guest
• 0:39 Meet Hannah Salazar
• 1:08 Today’s Focus: Neurodevelopmental Disorders
• 1:56 Why Adult Diagnoses Are Rising
• 2:50 ASD Fundamentals & Brain Basis
• 4:09 DSM-5-TR Criteria for ASD
• 5:19 Social Reciprocity and Communication
• 7:09 Stimming, Nonverbal Cues, and Culture
• 9:14 The Spectrum Principle: One Person, One Pattern
• 11:14 Differential Diagnosis Strategy
• 12:49 Overlap with OCD, Anxiety, Personality

Transcript

Linton: 0:08

Hello, all you wonderful therapists out there, and welcome to another episode of our licensure exam podcast. I'm your host, Dr. Linton Hutchinson, and I'm here with my co-host, Stacy Frost. Hey, Stacy. Toe. Hey, Toe, Linton. Yeah, well, tell us uh what our surprise is today.

Stacy: 0:26

Let me guess. You got some extra visabi on your BOGO Public sushi there.

Linton: 0:30

No, that's not it.

Stacy: 0:32

All right, just kidding. Okay. That's not the surprise. We've got a fantastic guest with us today. Her name is Hannah Salazar, and she is both a therapist and a professional school counselor. She also tutors new therapists who are working to pass their NCMHCE licensure exam. So if you need some one-on-one tutoring, send Hannah an email at info at thoodneuron.com, and I'm sure she'll get you up to speed for your exam. Welcome, Hannah.

Hannah: 1:00

Hi guys, thanks so much for having me today.

Linton: 1:04

Really? Oh, today's episode, we're going to talk about neurodevelopmental disorders that you may seem to know for the exam. We'll be talking about autism spectrum disorder, attention deficit hyperactivity disorder, and specific learning disorder.

Stacy: 1:24

And you may not be very familiar with the ins and outs of these disorders unless you specialize in working with kids because the neurodevelopmental disorders have an onset during the early developmental period. Although you might see an adult client who has neurodevelopmental issues that have gone undiagnosed until they wind up in your office.

Linton: 1:42

I see a lot more of that on, you know, when I go to the publics and you look at the little magazine racks, there seems to be more about adult ADHD. Have you noticed that? Yeah. So really, it's actually pretty common for ADHD or autism spectrum disorder to go really undiagnosed until adulthood, where the increased responsibilities and demands of adulthood seem to start to overtake the coping strategies that that person developed when they were a child. So it's good to have a solid working knowledge of these disorders. And it's really essential because as a therapist, you'll be working with adults that are exhibiting these characteristics.

Stacy: 2:26

So let's kick it off with autism spectrum disorder. And Hannah, I know that you've got expertise in working with kids on the spectrum. So could you walk us through the DSM 5 TR criteria and some key diagnostic features that therapists will need to know about autism spectrum disorder? We can also just shorten it and call it ASD.

Hannah: 2:45

Yeah. So yeah, I actually started working with autism spectrum disorder or ASD. Oh my gosh, almost 10 years ago now. It's insane. So I started working way, like way back in 2017. But when we're talking about diagnosing any disorder, it's really, really important to understand what the disorder is and the symptoms that come with it. It's also important to understand what is going on in the brain and why the disorder is manifested the way it is. So when we even talk about autism spectrum disorder, we really can't talk about it without explaining how it's a complex brain disorder that affects the frontal cortex, the cerebellum, the temporal lobe, the amygdala, the mirror neuron system, the connectivity between brain systems, including neurotransmitters, aka the way your brain talks to itself. We could also talk about how neurotransmitters are, those neurotransmitters are affected. What by talking about the glutamate or like GABA? But that's probably for another podcast for another day. That sounds quite fun. Just know like your basic neuroanatomy will help us to truly understand how this can affect a person and really affect how they view and they see the world. So when you are diagnosing ASD, there are key features we really want to pay attention to. So mainly we're looking at challenges with social communication, social interactions. We're looking for restricted repetitive behaviors or these hyperfixation type of interests. These are all going to really characterize ASD. Specifically, when we talk about what the DSM5TR criteria focuses on, it more focuses on these persistent deficits. So we're looking at all of these things all together. So what does it all mean? Well, typically we see that these social skills that are very, very low. For example, we may have a small child who has an interest in cars. But instead of playing with cars like they should, where they're racing them, where they're putting them against each other and going vroom, vroom, vroom, vroom, we will see that they're just lining up their cars the same way all the time, this repetitive type of play, or they only prefer all the cars to be red or blue or green, or they're gonna tell you about every single car part there is and every detail and how this brand is different than this brand, and it'll be extremely detailed. But we'd also be looking at how they're going to react to changes in their daily routines and schedules, if they're making eye contact with others, if they communicate to others their wants and needs effectively, all of these things are going to paint that picture.

Linton: 5:28

That's interesting. But Hannah, how do uh those deficits manifest in uh social communication?

Hannah: 5:34

Well, one of the big ones is social emotional reciprocity, which is the back and forth flow of social interactions and sharing of emotions and interests. We typically see this and people with ASD kind of manifests in an atypical way. It might be hard for them to, it might be hard to gauge their emotions or interests because they don't know how to openly share what they're thinking or what they're feeling. Many people will struggle with even naming or recognizing their emotions. This is partly due because someone who has ASD, they truly think better in images or visuals, and they have less connection with words and less connection with how their body will feel. And that's a key factor, even when we start talking about treatment for ASD as well. So some will have difficulty initiating or responding to social interactions, and some will have trouble even keeping up a conversation. I often have seen this with children as, you know, young as three or four, where you have them come into your office and they, you know, don't really talk at all. Or if they do talk, it's only about specific things that they truly care about. So they may even look like they have, you know, extreme social anxiety. They may engage in what we consider stimming behaviors, which are repetitive movements to help calm that anxiety. So things where they're shaking, they have a bead necklace and they're twirling the bead necklace over and over and over and over again and they're staring at it and watching it. Um, it could be, you know, hand flapping, we talk about a lot with younger people with ASD, especially younger toddlers and children. We can talk about jumping. Some people do that as stimming behavior. So it really is a very big, various amount of stimming behaviors we can see with kids. But sometimes the client will also exhibit difficulty with nonverbal communication, like what does it mean when someone smiles at me? Or why do I have to make eye contact? Or, you know, I didn't understand that you were mad at me. They don't really pick up on any kind of nonverbal communication, which is really difficult to communicate with someone doesn't, given our communication is always about 95 to 98% nonverbal. So many children with ASD will just avoid eye contact altogether. But we have to always talk about cultural sensitivity and being aware that some cultures teach their children not to make eye contact with adults. I experienced this for firsthand as a child growing up in an Asian culture where children are taught from a young age, it's very rude to make that eye contact as a child with an adult. So we do have to be very aware of how cultural influences can also influence how a child reacts in social situations. Differential diagnosing is something I always talk about, but it's definitely warranted if this is one of the only symptoms that we're seeing with a young one. There's also the relationship aspect. So people who have autism have trouble the understanding, developing, maintaining relationships. They often have trouble even changing or adjusting their behavior to match different social settings. So they may act one way here in school, and then they may not change that to go play or anything because they're really, really rule-bound. They often have difficulty adjusting or misinterpreting other people's intentions and perspectives, kind of like what I was talking about. What do you mean? Why do I have to smile? Or what did I didn't know you're mad at me? They will have trouble reading social cues and understanding all of those verbal nonverbal communication dynamics.

Stacy: 9:09

Gotcha. So, for example, a child with autism spectrum disorder might have trouble with greetings, like saying hi or farewells, saying goodbye, sharing their toys or even experiences with our kids, responding when their name is called. And of course, like you're talking about, you know, relationships and making friends at school. And this doesn't necessarily mean they don't want to connect with others, right? But they don't quite understand those unwritten rules of social engagement.

Linton: 9:35

Oh man, Stacy, that sounds just like my entire childhood. I guess it didn't help that I wrote backwards and upside down. But it made perfect sense to me, but my teachers were always on my case about something. And and the fact that I had a stutter didn't help at all. Kids really didn't want to be my friend. So I was always picked last for whatever game was was going on. And as far as adults, sure, I didn't want to respond or interact with anybody.

Hannah: 10:06

Oh, well, I'm sure you made that up in your later years.

Linton: 10:10

Yeah, I guess so.

Hannah: 10:13

It's also, I think it that brings up a great point because it's really important for us to view autism spectrum as the name implies, that autism is on a spectrum. So no two cases are the same. So, like I was saying before, and early in my career, I was working at Ford Autism Center, and one of my colleagues told me something I don't think I will ever forget. They said, if you meet one person with autism, you've met one person with autism. Oh, that's cool. Right. Yeah. And that stuck with me because if you think about it that way and you think about how broad, how big the spectrum is, and we can have, you know, all these different kinds of characteristics on it. But if you think about that, it really helps to view each case with that mindset of yes, you've seen autism cases before, but you haven't seen this one. Right. And so we have to keep it's it's really important to internalize that and really important to approach each case and each case that you come across with an open mind, as well as understanding how each person's lived in experiences are just unique to them. Some people will have, I've you know, definitely seen people with very mild challenges, so just kind of very shy, very introverted, a little bit of that social anxiety, what we would consider, oh, you're just a little awkward with people, versus sometimes we see people where they're nonverbal, right? We have people that use iPads for communication. You know, you have substantial supports built into their lives all the time. They're in, you know, they have those IEPs, they are in special education classes. So we have to consider all of the different manifestations of this disorder. Most people, I would say, however, that they are some are kind of in between. They pretty much struggle to varying degrees with social interaction, communication, but they will also exhibit these restrictive repetitive behaviors or interest. So not only do we need to know the DSM 5 TR criteria for the exam, but you'll also be tested on your knowledge of the differential diagnoses, which is where you have two or more conditions that share similar signs or symptoms. I will always harp on this with people like Tutor because differential diagnosing is so so important when we decide to make a diagnosis for somebody. We need to always make sure that we're aware of which diagnoses are differentials for each other. So some of the differentials for ASD include other neurodevelopmental disorders. We have ADHD, intellectual developmental disorder, language disorder, select amusism, and social communication disorder. There's also a couple other ones, but those are those are the main ones. One thing I emphasize when talking about autism with counselors, when we're going through tutoring or just you know conversing about it, is what can you suspect causes these particular disorders to be differentials for each other? I always like people to really think about that question. Because when we're talking about differentials, we're talking about those symptoms that are similar, but but why? Why do these disorders share such similar symptoms? The answer is because they all affect the same brain regions. So to truly understand these neural developmental disorders, we can look at the basic neuroanatomy and kind of see what areas are going to be affected. This is actually a pretty great way of studying and kind of looking at it because once you understand the areas that are affected, you can understand why these are all differentials for each other.

Linton: 13:49

Wow. I can see why people uh why you're in high demand as a tutor for people studying for this exam, Hannah.

Stacy: 13:57

Yes, it's not just enough to know it, but it's like why? Let's go a little bit deeper with it. Wow. Yeah. Yeah. So you mentioned some of the differentials of the neurodevelopmental ones. So there's also a few others, obsessive-compulsive disorder, some of the anxiety disorders. Like you mentioned a lot of social anxiety issues. So social anxiety disorder and agoraphobia, and a few personality disorders, which I thought was really interesting.

Linton: 14:22

Personality disorders. That's a really interesting one, uh, Stacy.

Stacy: 14:25

I know that's one of your favorite ones to study, one of your favorite areas. It is. So, yes, especially schizotypal personality disorder. And this disorder has some overlap with ASD in terms of unusual preoccupations, odd thinking or speaking, that lack of close friends or relationship, and maybe some odd or eccentric, what we might call eccentric behavior. And there's differences in onset, cognition, sensory issues, emotional skills, and insight that can help you distinguish between these two disorders.

Linton: 15:00

Definitely sounds like some IT people that I know. Got it. It's in there.

Stacy: 15:08

It's in there.