Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / When Two Neurotypes Collide. Episode 1.

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When Two Neurotypes Collide. Episode 1. · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello, this is Kim Lee, child and adolescent psychotherapist, and welcome back.
• 0:06
  SPEAKER_00: This is a new series that I've been wanting to do for some while, and it has to do with the two conditions, autistic spectrum disorder and ADHD, otherwise known as attention deficit hyperactivity disorder.
• 0:25
  SPEAKER_00: I think it's really important to understand that that term ADHD is a coverall term because it's not one or just one specific condition.
• 0:39
  SPEAKER_00: The term describes a range of attentional difficulties.
• 0:44
  SPEAKER_00: Sometimes what we see is children being diagnosed, or adults too, with inattentive or hyperactive attentional disorders.
• 0:57
  SPEAKER_00: But these are particular in terms of their presentation, but they also have common themes.
• 1:09
  SPEAKER_00: Now, this particular series has to do with when autism and ADHD meet, as I framed it, when two conditions collide.
• 1:23
  SPEAKER_00: When I looked more deeply into this, what I found was that there was considerable research on AUDHD, which is this combination of both conditions.
• 1:39
  SPEAKER_00: Now, they are structurally quite different, and the organization and functioning within the brain is almost opposing.
• 1:50
  SPEAKER_00: So let's commence with episode one, when we where we examine two neurodevelopmental systems in one brain.
• 2:01
  SPEAKER_00: Start with something that I first saw some while ago.
• 2:19
  SPEAKER_00: Sometimes they need everything to stay exactly the same.
• 2:23
  SPEAKER_00: And then other times they are restless, impulsive, and constantly looking for stimulation.
• 2:32
  SPEAKER_00: And what they're describing is something that clinicians are increasingly recognizing.
• 2:38
  SPEAKER_00: And that is a child whose neurological development reflects both autistic spectrum differences and attention deficit hyperactivity disorder.
• 2:49
  SPEAKER_00: We now refer to this as AUDHD.
• 2:52
  SPEAKER_00: For many families, this combination can feel deeply confusing because the child often appears to move between two very different patterns of behavior.
• 3:02
  SPEAKER_00: So at times they seek and need routine predictability and structure.
• 3:08
  SPEAKER_00: But at other times they seem driven towards novelty, stimulation, and rapid engagement.
• 3:15
  SPEAKER_00: So parents sometimes feel as if they are being pulled and the child is being pulled in two different directions.
• 3:22
  SPEAKER_00: But in many respects, that is exactly what's happening.
• 3:25
  SPEAKER_00: Because what we're observing isn't a question of personality or willpower.
• 3:30
  SPEAKER_00: We're observing two different neurological systems operating within the same brain.
• 3:37
  SPEAKER_00: Understanding ADHD is complex but becoming clearer because when people hear the term, they often think first about behavior.
• 3:49
  SPEAKER_00: They imagine hyperactivity, distractability, and impulsivity.
• 3:54
  SPEAKER_00: But over the last 30 years, researchers such as Russell Barclay have helped us to understand that ADHD is fundamentally a difficulty in the regulation of executive brain function.
• 4:10
  SPEAKER_00: Executive functions are the processes that allow us to organize behavior over time.
• 4:16
  SPEAKER_00: They involve abilities like holding information in working memory, inhibiting impulses, sustaining attention, planning and sequencing tasks.
• 4:28
  SPEAKER_00: Now these functions depend heavily on networks within the prefrontal cortex of the brain, which regulate behavior through complex dopamine pathways.
• 4:40
  SPEAKER_00: The prefrontal cortex is essentially the thinking and regulating part of the brain.
• 4:46
  SPEAKER_00: But when dopamine regulation is inconsistent, the brain finds it difficult to sustain attention unless the activity itself is highly stimulating.
• 4:58
  SPEAKER_00: Therefore, the ADHD brain is drawn towards what is new, interesting, immediate, and rewarding.
• 5:07
  SPEAKER_00: Tasks that are repetitive or slow can feel almost neurologically inaccessible.
• 5:13
  SPEAKER_00: It's not that the child doesn't understand what needs to be done, it's that the brain struggles to maintain the mental organization required to do it.
• 5:24
  SPEAKER_00: Now, we turn our attention to autism, which has a very different set of neurological characteristics, because autistic individuals, people with autistic difficulties, often experiences experience differences in areas such as sensory processing, predictive processing, social communication.
• 5:47
  SPEAKER_00: And one useful way of thinking about autistic cognition is that the brain works particularly hard to reduce uncertainty.
• 5:56
  SPEAKER_00: Therefore, there can be a reliance on predictable routines, clear structure, repetition, and focused interests.
• 6:06
  SPEAKER_00: And these patterns help the nervous system maintain stability.
• 6:10
  SPEAKER_00: When the environment becomes unpredictable or overwhelming, the brain may respond with distress, withdrawal, or attempts to regain control.
• 6:24
  SPEAKER_00: Now when these system meets, these systems meet, and there is a color current, both ADHD and autistic neurodevelopmental difficulties occur, something very interesting happens.
• 6:40
  SPEAKER_00: The ADHD system may push the child towards stimulation and novelty, but the autistic system may simultaneously push the child towards predictability and stability.
• 6:55
  SPEAKER_00: The result can feel like an internal push and pull.
• 6:59
  SPEAKER_00: And if you can picture it, two opposing drives sitting alongside each other and the child somehow trying to manage this.
• 7:10
  SPEAKER_00: So a child may crave change and excitement one moment and then become overwhelmed by the consequences of that stimulation the next.
• 7:20
  SPEAKER_00: Now, parents sometimes experience this as inconsistency, but from a neurological perspective, it makes perfect sense.
• 7:28
  SPEAKER_00: Two different systems are attempting to regulate the same nervous system.
• 7:36
  SPEAKER_00: A child I worked with some years ago, or you was referred to me when he was eight.
• 7:41
  SPEAKER_00: And for the purposes of confidentiality, I'm going to call him Daniel.
• 7:47
  SPEAKER_00: Daniel's teachers were deeply frustrated.
• 7:50
  SPEAKER_00: In class he appeared unable to remain seated for more than a few minutes.
• 7:55
  SPEAKER_00: He would begin tasks but quickly abandon them.
• 7:59
  SPEAKER_00: He interrupted frequently and struggled to follow instructions.
• 8:03
  SPEAKER_00: At home, his parents described a similar picture.
• 8:06
  SPEAKER_00: Homework became a nightly battle, yet there was something about him that puzzled the adults.
• 8:15
  SPEAKER_00: Because when he became interested in something, his focus was extraordinary, laser-like.
• 8:22
  SPEAKER_00: His parents told me that he could spend hours constructing elaborate Lego structures, entire imaginary cities that emerged on the living room floor.
• 8:34
  SPEAKER_00: And the level of detail was remarkable.
• 8:38
  SPEAKER_00: When I first met Daniel, I asked him about these constructions, and within minutes he was describing the transportation systems between different districts of the city he had built.
• 8:50
  SPEAKER_00: He designed road systems, power networks, and even imaginary weather patterns.
• 8:57
  SPEAKER_00: So what became increasingly clear over time was that Daniel's attention wasn't absent, it was selectively regulated.
• 9:06
  SPEAKER_00: And when the activity was intrinsically interesting and predictable, his attention stabilized.
• 9:12
  SPEAKER_00: When it wasn't, his executive system struggled to maintain engagement.
• 9:19
  SPEAKER_00: And as the work continued, another layer became visible.
• 9:25
  SPEAKER_00: He also showed very clear autistic traits.
• 9:28
  SPEAKER_00: He relied heavily on routine.
• 9:32
  SPEAKER_00: Unexpected changes in the day caused significant anxiety.
• 9:38
  SPEAKER_00: Certain sounds overwhelmed him.
• 9:41
  SPEAKER_00: But once we began to understand Daniel through the lens of AUDHD, the behavior that had once appeared chaotic began to make sense.
• 9:52
  SPEAKER_00: Another important piece of this picture involves the development of emotional regulation.
• 9:59
  SPEAKER_00: And the psychiatrist Daniel Siegel has written extensively about how the developing mind emerges through relationships.
• 10:08
  SPEAKER_00: Children do not simply learn to regulate themselves in isolation, they learn regulation through repeated experiences of co-regulation with adults.
• 10:20
  SPEAKER_00: So when a child becomes distressed and an adult responds with calm understanding, the child's nervous system gradually learns how to return to balance.
• 10:31
  SPEAKER_00: I see this in the consulting room every day.
• 10:36
  SPEAKER_00: Over time, these relational experiences become internalized, not consciously, but they are absorbed by the child.
• 10:47
  SPEAKER_00: But when a child's neurological profile makes regulation more difficult, those relational supports become even more important.
• 10:58
  SPEAKER_00: Now one of the greatest difficulties faced by children with these difficulties is misunderstanding.
• 11:06
  SPEAKER_00: Sometimes adults may assume that the child is not trying, being oppositional, deliberately disruptive.
• 11:16
  SPEAKER_00: What we're often seeing is a nervous system that is working extremely hard just simply to remain organized.
• 11:26
  SPEAKER_00: When behavior is interpreted only at the surface level, the child may receive repeated messages that they're getting it wrong.
• 11:36
  SPEAKER_00: And of course, over time, this will have a powerful impact on their self-esteem.
• 11:44
  SPEAKER_00: There was another moment with Daniel that I remember towards the end of our work together.
• 11:52
  SPEAKER_00: He'd been describing how difficult school sometimes felt.
• 12:05
  SPEAKER_00: And it was a very simple statement, but it captured something important.
• 12:10
  SPEAKER_00: For many children with these difficulties, it is not about a lack of ability.
• 12:17
  SPEAKER_00: It's that the systems responsible for organizing experience are working under unusual pressure.
• 12:26
  SPEAKER_00: So when we begin to understand these neurological patterns, something shifts in the way we think about behavior.
• 12:33
  SPEAKER_00: So instead of asking, why is this child behaving like this or making the mistake of asking the child, which will never work, we begin to ask a different question.
• 12:43
  SPEAKER_00: We ask, what is happening inside this child?
• 12:48
  SPEAKER_00: What is the nervous system trying to manage?
• 12:53
  SPEAKER_00: We might not be able to answer the question, but asking it to yourself is vital because that change in perspective can be transformative.
• 13:03
  SPEAKER_00: Once we begin to understand the brain beneath the behavior, our responses become more thoughtful, more patient, and ultimately more effective.
• 13:15
  SPEAKER_00: Now, in the next episode, we're going to explore something that lies at the heart of many children's difficulties.
• 13:22
  SPEAKER_00: And this is the way the nervous system regulates stress and safety.
• 13:28
  SPEAKER_00: We're going to look at what's called the polyvagal theory, drawing on the work of Stephen Boyes.
• 13:36
  SPEAKER_00: And we'll look at how some children's nervous systems move rapidly between anxiety and shutdown, and how this understanding, or how understanding this sh really does help parents support their children more effectively.
• 13:55
  SPEAKER_00: I talk a lot about psychoeducation, and psychoeducation is a term that covers many approaches, but essentially by educating parents, helping them understand what is what is happening, it makes it possible for them to start to make subtle and sometimes radical shifts in their approach to children, which supports my clinical work with the child concerned.
• 14:28
  SPEAKER_00: Thank you for listening.