Autism and Neurodivergence: New Research, Insights, and Approaches with guest Dr. Suzanne Goh

About this Episode

If you or someone you love has autism or a neurodivergent brain, you don’t want to miss this 2-part series of the Brainy Moms podcast when Dr. Amy and Teri interview one of the top experts in the field, Dr. Suzanne Goh. Working at the forefront of comprehensive health services for autism, Dr. Goh shares research, statistics, and insights from the autism community. From nutrition and biofeedback to communication skills and the shift toward identity-first language, there’s so much new information to learn about neurodiversity-affirming care and supporting those we love. More than just a doctor or scientist, Dr. Goh offers front-line experience working with a variety of people with differently wired minds, something to which she brings curiosity, compassion, and a commitment to helping each individual thrive and feel respected. She also shares insights from her book, “Magnificent Minds: The New Whole-Child Approach to Autism”.  Join us for this in-depth conversation that may completely turn the tables on how you think about neurodiversity.

About Dr. Suzanne Goh

Dr. Suzanne Goh is cofounder and chief medical officer of Cortica, the largest provider of comprehensive health services for autism in the United States. A graduate of Harvard University, Oxford University, and Harvard Medical School, she is the former codirector of Columbia University’s Developmental Neuropsychiatry Clinic for Autism, where she conducted research on the biological causes of autism and used brain imaging to identify patterns of neural circuitry and brain chemistry. Goh is a practicing pediatric neurologist and behavior analyst, a frequent speaker for advocacy organizations, and champion of neurodiversity-affirming care. She’s the author of the book, “Magnificent Minds: The New Whole-Child Approach to Autism”.

Connect with Dr. Goh

Website:  www.DrSuzanneGoh.com

Facebook: @DrSuzanneGoh

Instagram: @DrSuzanneGoh

YouTube: @Cortica

LinkedIn: /suzanne-goh-0668197a/

Cortica: www.CorticaCare.com

Buy her book on Amazon: Magnificent Minds: The New Whole-Child Approach to Autism

Listen or Subscribe to our Podcast

Watch this episode on YouTube

Read the transcript for this episode:

DR. AMY: Hi, smart moms and dads. Welcome to another episode of The Brainy Moms Podcast brought to you today by LearningRx Brain Training Centers. I’m your host, Dr. Amy Moore coming to you today from Colorado Springs, Colorado, and I am joined by my lovely cohost, Teri Miller, and Teri and I are super excited to have a conversation today with Dr. Suzanne Goh. Dr. Goh is co-founder and chief medical officer of Cortica, the largest provider of comprehensive health services for autism in the United States. A graduate of Harvard University, Oxford University, and Harvard Medical School, she is former co-director of Columbia University’s Developmental Neuropsychiatry Clinic for Autism, where she conducted research on the biological causes of autism and used brain imaging to identify patterns of neural circuitry and brain chemistry. Dr. Goh is a frequent speaker for advocacy organizations and a champion of neurodiversity-affirming care. And she’s here today to talk with us about her new book, “Magnificent Minds. The New Whole-Child Approach to Autism.” Welcome, Dr. Goh.

SUZENNE:  Thank you so much. Delighted to be here.

TERI: Well, we like to start every episode just by hearing from our guests about what you do, how you came to doing what you do, what brought you here, studying autism and why did you write this book?

SUZANNE: Well, you know, my journey to pediatric neurology and to autism and development really started when I was in high school. So I was a teen growing up in Toledo, Ohio, and had the chance to volunteer at a summer camp for neurodivergent children. It was really my first time working closely with children who had autism. Some had cerebral palsy, spina bifida, epilepsy, and it was just a really magical experience. And so one of the wonderful things that the camp did was they paired a neurotypical camp counselor with a neurodivergent camp counselor. So my co counselor was a young man with cerebral palsy, who was in a wheelchair. And getting to know him and how smart and funny and, the depth, you know, of his, compassion. It just really stayed with me. And so then, as I went on through college and ultimately medical school, I was really drawn to thinking about the developing brain, the meaning of neurodivergence, all the different ways that the brain can develop. The strengths, the very unique strengths that can come with neurodivergence and it’s just been a passion of mine since then.

DR. AMY: What a really great practice for a camp to do that because not only does that help the kids who are attending the camp feel like they have a counselor that’s connected to them, but what a way to grow neurotypical counselors in their empathy and their understanding and their respect for neurodiversity, neurodivergent thinking, right?

SUZANNE: That’s right. That’s absolutely right. And so one of the dreams I have for Cortica is that we’ll come to a point where we can do the same. Where we can have young neurotypical people come in and really expand their way of thinking by helping them form relationships with neurodivergent peers. And having roles like mentors and counselors and having … What is one of the most wonderful things about our clinic is that as some of our patients or clients as they grow, we see them express a desire to come back and serve as mentors and, you know, and coaches and so forth. So, I agree. It’s just there, I really hope that our society will build more and more of those kinds of opportunities.

TERI: I want to jump in Amy, before we even start talking about autism, which is your focus, I want to back up even further for our listeners and have you explain what is neurodivergent thinking? What are, what do you even mean? What is neurodiversity? What’s that definition?

SUZANNE: Yes, some of these terms are quite new and a lot of people maybe haven’t heard them or aren’t sure what they mean or sure how to use them.  I think what’s so exciting is that in really the past just 20 years or so, the neurodiversity movement has really taken off and that is a human rights movement. It’s a civil rights movement that is really aimed at social justice for what we think of as neurological minorities. So people who have neurological features that are underrepresented in our society. And the neurodiversity movement is really about counteracting what’s called ableism. So that’s another term that like racism, like sexism, you know, ableism refers to a set of harmful ideas and practices that lead to the discrimination and really widespread negative attitudes toward neurological differences. So the neurodiversity movement is about changing that. It’s about recognizing that, you know, the idea that neurotypical abilities are somehow inferior or superior. That’s a myth. And we really need to shift our way of thinking. And so the word neurodivergence refers to, you know, neurological features that diverge, you know, from what’s considered really average or in the past has been considered the norm, but really part of understanding neurodiversity is recognizing that there is no normal. You know, there is no single normal. Everyone is different. And we have these natural neurological differences. That are in all people and lead us to experience and engage with the world in different ways. So I really, I think these terms are so important and I hope people will use them more and more. Neurodiversity, neurodivergence, also, the term neurodiverse. You know, so neurodiverse is the word that refers to when you have a group of people where different neurological features are represented. And then the word neurodivergent is used for individuals. And it’s very broad. So it could refer to individuals who have autism, ADHD, anxiety, OCD, various learning differences, history of trauma, you know, so the word neurodivergent is very, very broad. But I love the fact that it’s really the neurodiversity movement that has given rise to these words and has imbued them with this really positive meaning. Historically in the past, it was often the medical field that was coming up with words and those words often brought with them, you know, quite a negative connotation, a sense of deficit, impairment, and deficiency. And I think it’s time we move beyond that.

DR. AMY: So speaking of language and words, you actually open your book, talking about, identity-first language versus person-first language. And so you have said that the autism community actually prefers identity-first language, to say “autistic child” rather than “child with autism.” And we know that, especially in professional and academic writing, I mean, there’s a trend that says that we say, child with autism, child with ADHD, that we don’t use an identity first type approach. So, that’s interesting. That really intrigued me. How did you determine that the autism community actually prefers identity-first language? Talk to us about that.

SUZANNE: Yeah. So like you, I was trained to use person-first language. The idea that we’re putting the person before the diagnosis or the disorder and that, that is based in, I think there’s a lot of positive intent. You know, around, but I think it’s so important for us as professionals to always be reading and tuning into the autistic community, you know, reading the books they’ve written or being part of their social media, seeing what’s online, because what they’re putting out into the world is so important and valuable and really should shape the way we are acting as health care professionals. And that’s where the, you know, the desire for identity-first language has emerged now. It’s really interesting because for some parents or caregivers, you know who I work closely with identity-first language is uncomfortable for them. And I get it because in the past, to call a person autistic was sometimes used in a negative way, you know. And so we come from a very complex history. But I think, really, if you look at both person-first language and identity-first language, both have arisen out of a desire to really honor the value and worth of the individual to show respect. And so whichever type of language is used, I think one, it’s important to use the language that’s preferred by the audience, you know, we’re speaking to, if we know what that is. Sometimes it’s a mixed audience. So you just, you never know. And the second is to make sure that the content of the message that’s being delivered is one that is very positive. And I think of this life of affirming. And so it’s really focusing, I think, a little bit more on the content and the meaning of the message, but also being aware that the words matter and that different groups have different problems.

TERI: I appreciate … I recently was talking to my daughter about this. She is studying clinical psychology right now. She’s in her master’s program and she was just talking about this, the difference between the identity first language versus person first. And the thing we discussed is the difference between considering that neurodiversity is a problem or diagnosis or a condition, as opposed to just saying something like, a happy child versus a child with happiness, a depressed teenager versus a teenager with depression. And in with different, you know, concepts or diagnoses or issues, yeah, you’re going to use person first, but then with autism is that depression? Is that a child with the flu? You know, you don’t say a flu child. You say a child with the flu. And so it’s just really, really interesting. Is autism really something that we want to consider a diagnosis, a problem, a sickness? It’s just the way that kiddo thinks, it’s a part of who they are, it’s a part of their brain, a brown-eyed child, that’s who they are.

SUZANNE: And I love the, you know, the shift. I think the idea that autism can be a valued part of one’s identity is really, really important. And to not jump in and immediately frame it as a disorder. So that’s, I think, important. I think it’s also important for a person to have the right and to kind of state their own preference and their own identity and define their own identity. And this is why I think one of the, for people to understand what autism is and that it can come with what we call co-occurring features or co-occurring conditions. That distinction is also really important because there might be co-occurring conditions like having seizures or you know, like having, you know, sleep disturbance or GI pain, right? Those may be things we truly want to treat because we feel a person should not have to suffer with those. But that’s different from saying we’re somehow treating or changing autism. You know, so I think that distinction is really important because autism itself, which comes with some unique ways of socializing or communicating, those can be valued. And in some ways, some of those can even be seen as strengths. So I think it, it helps to understand what is part of autism and what is a co-occurring feature.

DR. AMY: Yeah, that’s a good distinction. So I want to back up just a little bit and, and have you just talk a little bit about the basics, like how you define autism, how common it is. And then what have you learned about the autistic brain in your research? We do neuroimaging as well in our research. And so I just could geek out on that with you for hours. But for our listeners, just talk about some of the cool findings.

SUZANNE: Yeah. So, um, so autism is defined in a number of different ways. I like to think of it as an alternate trajectory of brain development that brings with it certain strengths and certain areas of challenge.

If you look more at the DSM criteria, you know, which we rely on as health care professionals, it defines autism. The DSM is the manual diagnostic and statistical manual of mental disorders, and it defines autism according to two main categories of features. One relates to differences in social interaction and communication, and the other is differences in behavior. So a tendency toward more, what they call more restricted, repetitive patterns of behavior and interests. I think as healthcare professionals, we struggle a little bit with the DSM because it’s very deficit oriented. The words are, you know, very much about deficiency and impairment. And so I like to think about our autism core features as differences in social communication and as differences in flexibility, when it comes to thoughts, behaviors, even sensory responses to the environment. And autism now, based on data from the CDC, is diagnosed in 1 in 36 children. And that prevalence, so that rate has really skyrocketed, you know, in the past 10, 20 years. And people often are wondering, is that why? You know, why have rates increased so much and based on the research, our understanding is that some part of that is related to increased awareness and increased diagnosis. But that doesn’t explain all of it. So there actually is a true increase in autism and what’s driving that increase, based on the, you know, the best research studies is likely is a combination of different what we call, you know, some genetic and environmental factors and how they interact. And I’m happy to go into that a little bit more, but I think the important point is that autism is increasing. And so, how we, what we do to diagnose and then support children is super, super important.

DR. AMY: So you’re referring to epigenetics, right? So where there could be some, there’s preexisting genetic tendencies that switch gets flipped by something in the environment or in utero or whatever, like MTHFR, for example.

SUZANNE: Yes. Mm hmm. Yes. And there are, you know, there have been thousands and thousands of studies looking at different genetic factors in autism. So there are at least 100 different gene variants or alterations that we know seem to increase the likelihood of autism because they affect brain development in some way. But it’s usually not just one of those genes. It’s many that kind of interact in complex ways and then together also interact with these environmental factors. Again, complex ways. So it’s almost like every person with autism has a unique fingerprint in terms of their brain because of the different pieces that kind of come together to shape brain development. And you had asked about brain imaging, you know, what do we know actually about how the brain is developing? And it’s really, really interesting. And again, thousands and thousands of brain imaging studies have been done on autism. So one very interesting fact that we know is that even before a child is born, there seem to be differences in how the brain is developing. And so, as you know, you know, fetal brain development is so intricate and part of what has to happen during that time is that neurons have to migrate. They have to move to the places in the brain where they’ll reside and they’ll form connections. And those movements of neurons early in the fetal brain are different. So that the very intricate microarchitecture of the brain already seems to be different by the time a child was born. And then from birth to two years of age, the brain and autism that is actually growing more rapidly compared to other children. There are more neurons, there are more synapses, which are the connections between neurons. And so again, right from the beginning, the autistic brain has almost, you know, it’s this unique developmental trajectory. But then after that into adolescence and adulthood, there aren’t those differences in brain volume in brain size. So that unique trajectory is telling us that there’s something just very different about how the brain is developing and how connections are being formed.

And part of those differences have to do with electrical function, you know. So the brain has electrical and chemical properties. And in autism, there’s a more of a tendency for neurons to fire in what we call in neurology, a hyper synchronous way. And you can even see those patterns when you do an EEG to measure the brain’s electrical function, you can see those patterns. And when we can do an EEG and see where those hyper, you know, that excess firing is happening, it can help us better understand a child too. So all of that that information can be really helpful. And then I would say, you know, in terms of neurochemistry, you know, like the neurotransmitters like serotonin and dopamine and gaba and glutamate, the research findings aren’t quite as clear. We don’t know. And it’s probably because it’s different for different people. But for some, there might be, there seems to be some under activity of dopamine in some parts of the brain. Dopamine, as you know, is very important for this feeling of reward that we get. And it looks like even for some people engaging in some repetitive behaviors seems to enhance dopamine. And so we can kind of understand why, you know, why a person would be engaging, you know, in those kinds of behaviors. So it’s really, really fascinating. And we’re learning just more and more about the brain and autism each passing year. That’s really helped helping to deepen our understanding.

DR. AMY: So then when you talk about being able to see where the excess firing is happening by using EEG, does that mean that neurofeedback is something that can dampen some of that excess firing or talk a little bit about that?

SUZANNE: Yeah. Well, so neurofeedback, which is one type of biofeedback, is really fascinating. And we could talk, if it’s helpful, I could, you know, we can talk a little bit about biofeedback in general, which is such a powerful tool. So, you know, I think of biofeedback as it falls in the, for me, in the category of neuromodulation. You know, ways that we’re using technology to alter brain function and activity. And biofeedback is all about giving the person information about what their body is doing, you know, whether it’s their brain activity or their heart rate or the respiratory rate or blood pressure. And then based on that, teaching persons ways to then modulate their own physiology. So it’s very, very empowering. And neurofeedback, of all the different biofeedback modalities, I think neurofeedback is the one that’s still sort of, where research is still kind of the newest, right? We, there’s so much we still don’t know. There have been some research studies that have showed some wonderful effects of neurofeedback and then others where it’s less clear. And so I think for us as practitioners, it’s always been a little bit hard for me to know how much to prioritize. I think what we know about neurofeedback is, well, the setup is around it does involve usually a simplified EEG recording so that, um, software, you know, computer system is picking up the brain’s electrical activity and based on that, then modifying some input, whether it’s through a screen that a person is looking at. Or whether it’s through a tactile input or sound, then giving the brain information that then encourages sort of positive patterns of brain activity and discourages some of the negative. There were times that we had neurofeedback systems in our clinics and it was a very helpful tool, but I think it’s one area where we’re just not quite sure yet exactly how to use it and for which people and for how long. So my hope is that the research will advance and help guide us more.

TERI: What are some of the environmental factors you talked earlier, you said there are genetic markers, there are things just happening in the brain, even from the womb that make that brain function differently. And then you also mentioned that there, as we’re seeing an increase in autism, that there are environmental contributors. What are some of those?

SUZANNE: Yeah. Well, there are a few different categories. So one major category are maternal health factors. So I imagine your listeners would be super interested in this because really what it points to is that the health of the mother, leading up to and during the time of pregnancy, is so important. And so anything that expecting mother could do for her own health will directly help the child. So one of the things we know is that, um, autoimmune conditions or things that activate the immune system or inflammation seem to predispose for autism and also certain maternal we call them metabolic conditions like a gestational diabetes, even obesity. Some of these metabolic conditions also seem to increase the likelihood of autism. There are also factors in the environment that kind of fall within the umbrella of toxins. So we consider medications to be one of them. So if a mother was taking certain medications during pregnancy, that we know can increase the risk of autism. And then unfortunately, there are some, you know, industrial chemicals that are just widespread in our environment that really are impossible for us to avoid that are even now detected in the cord blood of newborns that research has shown can have and have effects on the developing brain and make pesticides.

DR. AMY: Like pesticides?

SUZANNE: Pesticides are a big category. Yeah. Or some of the chemicals found in plastics, things of that kind. So, you know, when, given that the research shows this, a lot of parents will ask me, well, now my child is 2 or 3 or 10 or 15, what should we do? And it’s hard to know because a lot of this happens so early in life, you know. But my feeling is that to the extent that we can, that we have some control and can avoid increasing exposure to some of these things, is a good idea. It’s just that sometimes it takes quite a lot of effort, you know, time and energy and resources to do that. To make those choices, to be selective about the foods we eat and the environments that we’re in and household products, all those things. So I say a good place to start is just to, one of the resources I like is the Environmental Working Group, EWG, and just to begin to be, become educated and then see what sorts of changes might fit in with your family and your lifestyle, right?

DR. AMY: So if you are planning to get pregnant, um, or already pregnant, is it your recommendation then to eat organic foods? Is it your recommendation to drink out of glass water bottles versus plastic? That’s what I’m hearing. You say that those could be contributors. So would you want to make those changes.

SUZANNE: Yes, I think those changes are very, very good idea. In addition to others that can help to reduce an expectant mother’s overall stress level, inflammation. Yeah. So, you know, things like consistent moderate exercise, you know, have has tremendous benefit. But even things like making sure you have social connection and that you’re, you know, these psychosocial factors, you know, can have just as much of an impact on a person’s physical health. So it really is about this kind of, I think of it as more of a holistic overall approach to health and wellness for an expecting mom.

DR. AMY: So you mentioned autoimmune. Is there an association with a father’s autoimmune illness and autism?

SUZANNE: So there, there, it’s much stronger, at least as far as the research currently shows. It’s really for maternal health. And, but we also know that increased parental age. Both maternal and paternal, so mother and father over the age of 40 also seems to be associated with increased likelihood of autism. So yeah, so there are some paternal factors, some maternal, and then family history, you know. So when there’s a family history of different autoimmune conditions and certain neurological and psychiatric conditions, those do tend to tend to be more common when a child has autism.

DR. AMY: All right, so let’s say we didn’t know this while we were pregnant. Now we have a child who is autistic. You have an entire holistic approach to supporting children. Autistic children. So,  we need to take a break. Let Teri read a word from our sponsor, LearningRx, and when we come back, we want to hear all about that approach.

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DR. AMY: Okay. So we are talking to Dr. Suzanne Goh, um, about her whole-child approach to autism. Dr. Goh, tell us what that looks like, what your approach to care and support is. How does it benefit autistic children?

SUZANNE: Well, when approaching autism, I like to think of it as, our goal is to see the whole child. And I think because there are so many potential facets of autism and so many approaches therapies that could potentially be beneficial, it can be overwhelming. And so one of the first things I like to say is that I truly believe that as caregivers, you can have as a goal to try to understand all aspects of your child’s autism. And that means. thinking about your child’s development at a few different levels. So I sometimes will say, you know, we can zoom in and then we can zoom out. And when we zoom in, we’re really thinking about the brain, um, almost at a microscopic level. Like, what do we know about your child’s brain in terms of its electrical function, its neurochemistry, how our synapse is being formed for your child? And then we can zoom out a little bit and think, okay, well now if we support the brain in that way, then it can create brain network, and those brain networks are what translate into a child’s developmental skills. You know, everything from sensory processing to motor coordination, cognitive language, social emotional, all of that is made possible by the formation of brain networks. And then we can zoom out a little bit further and say, okay, the brain is not, doesn’t exist in isolation. The brain is in the body. And so all the other systems of the body, like the GI system, the immune system, metabolism, everything else, influences the health and function of the brain. And then we can zoom out even one level more, just to say, okay, now your child is having experiences at home, in school, in the community, and those are profoundly shaping the brain. That’s called experience-dependent neuroplasticity. So now that we know there are all these different levels that are important for brain development, we can think about the tools we have. So, how do we influence electrical chemical function? Well, a lot of that is actually done through things like food we eat. And  in the medical care that’s offered, you know. So medications, sometimes nutritional supplements, increasingly there are these device-based therapies, you know, that can minister electrical stimulation or magnetic stimulation to enhance the brain. And then so many of the therapies that are available by, I refer to them under the umbrella of developmental or behavioral approaches, things like occupational therapy, speech-language therapy, music therapy, feeding therapy. All of these are ways that a therapist, a skilled professional, teaches a child. And in that teaching, builds brain networks. So that is kind of the whole child or holistic toolkit that we have. And the, the component I sometimes will conceptualize and I use this image in the book, child development as a tree. You know, and I think of the strong roots, the foundation as being a child’s experiences in the home, community, and school. And so we really want to think about the home. How does the home feel for the child, for all family members? And what is the health and well-being of family members? And what are those relationships like? And it can be a little bit—sometimes caregivers don’t really want to focus on that. You know, they want to put all the attention on the child and you know what medications the child is taking and dietary changes and you know. But really, I think of it as, I use the phrase “spreading the spotlight.” We really want to expand the spotlight and be thinking, you know, not just about the child, but about all the people that are really are important in the life of the child.

TERI: I was going to say, kind of looking at the opposite, what is the medical community get wrong in terms of treatment? Why is it complicated to treat? Like, what are we missing in general perspectives? You write about tunnel vision in autism care, so tell us about that, as opposed to the whole-child approach.

SUZANNE: Yeah. Well, the opposite of the whole child approach is a fragmented and siloed approach. And unfortunately, that’s what exists currently in our health care system, and it’s very widespread. So a family, you know, when an autism diagnosis is made, they’re faced with a really overwhelming set of disconnected institutions, professionals, and treatments. And they have to navigate that on their own. You know, the parents have to be quarterback. And so often one parent has to actually leave their job in order just to manage the child’s care full time. And it just, it shouldn’t be that way. It’s that’s because our healthcare system is so fragmented. And it makes it much, much harder for families to carry through, even though they’re putting forth often heroic effort to do so. We’ve made it almost impossibly hard by having such a fragmented system.

DR. AMY: Right. So everybody’s specialty is what their focus is on, right, to the exclusion of, you know, how can how can we look at it, take a multidisciplinary approach, right? My husband is a retired fighter pilot and fighter pilots always joke, “What’s the best plane in the sky? The one that you fly.” Right? And so, yeah, other planes, you know, have benefits too. So, talk a little bit about what parents can do. Well, first of all, I love that your book is almost a blueprint, right? It says to parents, “Hey, here’s. Here are all of the different components that you need to address as a whole-child approach.” But let’s zero in on a couple of those because I know our listeners are saying, “What can I do today? What can I do today to make a change?” And so I, I’d love to talk about nutrition for a few minutes because we know that the gut is the second brain.

You know, we know the influence of food on brain activity. And so. And talk a little bit about some changes, maybe gluten or sugar, or tell us what we could do.

SUZANNE: Yes. So, you know, in amongst, in the field of autism, there for a long time has been a lot of interest in nutrition. And, you know, earlier you’d asked me sort of, you know, what has led me to this place and this way of practicing my career, and a lot of it has been learning from the families who come to me and the questions they ask. When I was, 20 years ago, there was, so I would meet with a family and half the questions they asked me, I couldn’t answer. I just didn’t know. It wasn’t part of my training as a pediatric neurologist, but I wanted to learn about and so that took me on this journey of learning a lot more about nutrition and integrative health and functional medicine. And then once I was, once I dove into that research and attended those conferences and read books. Then I just thought this has to be, but there’s so much evidence that this is really important for brain development and health. And it has to be part of my approach. So, what often happens in autism though, is there’s a lot of interest in what are called elimination diets. So, diets that take something out of, you know, remove something. There are benefits to that. So there are for certain people, removing gluten is very helpful. In fact, celiac disease, so allergy to gluten is more common. It’s a co-occurring condition of autism. So yes, there can be huge benefits of eliminating certain foods from the diet. But for a lot of children with autism, because they have selective palates, you know, they’re they tend to be more picky about what they’ll eat. They often have a more restricted diet. So they tend to be eating fewer foods. There are many who come in through my practice where they come in, they’re only eating 10. Their whole diet consists of only 10 foods or less. And when you have such a restricted diet, it can be really risky to start removing things. Because sometimes you’ll remove something and it gets replaced with ultra-processed food, which might be even worse for health. And so for most children, the first step, I think, for nutrition, is to begin to expand the diet. So to be really focused on nutrient density and to do laboratory testing to identify any nutrient deficiencies. Because if those are present, like iron deficiency or low B12 or folate deficiency or vitamin D deficiency, correcting that is the top priority. And, you know, doing it through food is best, but often it’s hard to eat enough of the types of food that would be needed to correct. So then, you know, dietary supplements are important. But once a child, once you’re sure that a child’s nutritional needs are being met, and ideally through whole foods rather than processed foods, then you can begin to think about whether elimination diets make sense.  I think it’s so helpful to work with a professional when trying to eliminate foods because you have to eliminate them for a certain amount of time and then reintroduce and be really carefully tracking data during that time to know, you know, the effects of the food.

DR. AMY: So a nutritionist?

SUZANNE:  A nutritionist, uh, or it could be a physician or a nurse practitioner physician assistant, you know, or a nutrition coach. You know, just somebody who, um, is familiar and can be a skilled partner.

DR. AMY: Because what we have found is that physicians who are trained in functional medicine understand nutrition, but physicians who haven’t been trained in functional medicine or to have not taken it upon themselves to get post grad nutrition training. They aren’t necessarily the best experts.

SUZANNE: That’s right. That’s right. So you’re really looking for somebody whose practice is focused in this area. And it is helpful for it to be somebody who has nutrition specialization and also a focus on pediatric neurodevelopment, which can bring, you know, its own unique needs.

DR. AMY: So you talked about the importance of those family dynamics and the relationships among the people in the household. What is the best way to nurture those relationships? What types of help should families be getting? Because I know our listeners are hearing this and go, “Well, okay, how do we improve our relationships or how do we make a change?” What would that look like?

SUZANNE: Yeah. Well, there are, you know, so some of the principles that I think are really important. One is self-care. So each member of the family is an individual as well. And so what are, what is that individual doing that is filling their cup in some way? And for everybody, some might be something different. For some people, it might be meeting with a psychotherapist. You know, psychologist or marriage family therapist or social worker, you know, somebody who can help through talk therapy. But for others, it might be, you know, reengaging in activity or recreation or music or something that they love. For others, it might be putting a little bit more time into friendships. And so it can look very different for different people, but I like to say that every member of the family should be doing something as an individual that nourishes them.  I also think it’s important to realize that within a family, there are unique relationships between all family members. You know, so they’re almost like, like dyads, you know. So like, and those relationships have very unique features to them. You know, a parent may have a very different relationship with one child than another, siblings with different siblings, and parent with child. And so thinking about is that particular dyad, that relationship, getting some time and some nurturing. Sometimes, especially if there’s, you know, if when autism is part of the, is part of the family, or sometimes even, a family might have children with different neurodevelopmental diagnoses, it can make it hard for everybody to be together at once. And I sometimes will have families that tell me, why is it, why can’t we just be all together and enjoy each other? You know, why is it always that it ends up in a meltdown or a fight or something? And sometimes it takes steps to get there. And for, for that, I think professional support is really important. Honestly, today in today’s modern world, I think all of us benefit from having a trusted, you know, mental health professional in our lives. So I really, really strongly encourage it and I’ve been heartened to see that really over the years, I feel like people are becoming more and more open to it. So more and more. Whereas maybe 10 years ago I had to really, really kind of strongly encourage mental health support families, now many so many more are coming and asking me for it. And so, just trying to connect people to those resources, both at our center at Cortica, but also in the community.

DR. AMY: So in the very beginning of, um, our talk together, you talked about looking at those differences rather than deficits and we know that, you know, autism is most closely associated with differences in social skills. So what is your recommendation for helping autistic children develop social skills that are more effective? Well, did I say that right? Yes, I’m trying to use your language.

SUZANNE: You absolutely did a beautiful job. I think it starts with recognizing that social skills or social abilities rest on other sets of abilities. So, for example, to interact socially, interact with another person, requires sensory skills. You have to see what the other person is doing, hear what they’re saying, see their body movements and be able to process all of that. It also requires motor skills. Then you need to respond, which requires some type of movement. So you really can’t interact with another person if you’re not both perceiving them and then able to move your body in some way. You know, we don’t, we can’t use telepathy. So social interactions are hugely reliant on sensory processing skills and the planning and execution of movement. Both of those areas we know are a challenge in many autistic children. And that’s why, so often there’s such a focus on social skills, which of course is very important. But sometimes I’ll have to explain to caregivers, well, we’re going to start with occupational therapy focused on sensory processing skills. Because that’s a building block to get there. We’re also going to focus on, you know, occupational therapy or physical therapy or music therapy with a motor emphasis. We’re going to really help your child to begin to plan and execute sequences of movements because that’s going to be so helpful for their socialization. So that’s, that’s how I think about building social skills. And I think another really important piece is to see, well, for a child, what happens when they’re with other people, whether peers or adults, and does that help with their learning? Are they motivated by having peers around them? Then they should be in groups. But for some children being with other children, the noise that the other children make or the unpredictability of other children in their space gets in the way of learning, so then they might benefit from one to one. So those are just some of the considerations when thinking about, you know, ultimately building social skills.

DR. AMY: All right. I’m super fascinated now. So rather than taking the approach that we see in many schools of teaching autistic children to memorize what is an appropriate response … Like, okay, so when you are talking to somebody, you have to make eye contact, right? Even though that is not a natural instinct, even though you don’t want to, you can memorize that that is what you’re supposed to be doing. What I’m hearing you say is that when we look at what underlies those social skill abilities, so the sensory processing and the and the motor skills, then maybe some of those social responses become more natural.

SUZANNE: That’s exactly right. And in fact, a great deal of harm can come from the type of approach that forces neurotypical social interaction on autistic individuals. Because, so for example, why is eye contact less, why do many autistic individuals make less eye contact? Often it’s because the eye contact, that sensory stimulus, that visual stimulus is too intense, might initially stimulate anxiety, which gets in the way of social interaction and attention. It’s often a way of controlling their senses and the sensory input so that they can interact in ways that are effective and meaningful. So by requiring certain neurotypical social skills, we might actually be impeding a person’s growth and learning and social engagement. So we have to think really, it requires us to rethink a lot of what we have been doing in the past and also to recognize some of the things that we’ve been doing may have caused harm. That’s hard for any healthcare professional to accept because our intent is always to do good. But, we’ve learned so much now. So, you know, enforcing neurotypical social expectations can cause harm for some. For other children, they’re ready. And so providing that opportunity, providing some instruction. So I like to think of it as making typical social practices an option. So for a child who’s ready, let’s teach it and give them that option. They can choose whether or not to use it. But to recognize when is not helpful.

TERI: This is so fascinating.

DR. AMY: You’re writing frantically, Teri, something’s going on over there.

TERI: I know, it’s so good! I’m writing frantically because I work with students with families, a lot of the students that come through my doors that I work with, that we do cognitive training with, not a lot, I don’t know, 50 percent maybe are autistic children. And there is, I think there has been this big push to—not in our center, but I hear it from the parents—to modify behavior. And then what we’re talking about here, yeah, specifically eye contact. That’s so fascinating to think that that maybe is a detriment because it is such sensory overstimulation. That is so fascinating. And you know what? I do want to just insert real quick for our listeners. If you’ve got a teenage kid, an adult kid, and you put them through a, put them through, that sounds terrible. You used a program, you advocated for a program, took advantage of a program like ABA therapy, something that really focused more on behavioral modification, I just want to say to listeners, we didn’t know what we didn’t know. And if we’re now learning that that may not be the best thing, I just want to say it’s, just you can’t beat yourself up about it. There’s something in our parenting where we’ve just got to constantly be improving, improving, and yet constantly forgiving ourselves for what we didn’t know yesterday or last week or 10 years ago.

SUZANNE: I think that forgiveness is so important because that forgiveness is what then allows you to take action now in ways that I think could be really helpful and it’s never too late. There is not a window that closes, you know, that’s one of the most important because I think there’s caregivers often have an idea that there’s somehow a developmental window that has shut. That’s not true. The ability to continue to learn and change and grow is there throughout life. And so it’s never too late.

DR. AMY: So, Teri mentioned ABA therapy, and that’s a super polarizing, right, when you talk about ABA therapy. I mean, there’s a camp that is like, yes, that’s the only way to treat autism. And there’s a camp that says, I would never put my child in ABA therapy. Could you just speak a little bit to it on your recommendation?

SUZANNE: So I’m a BCBA. I’m a behavior analyst. I’ve been a pediatric neurologist for 25 years, but a BCBA for three years. So it’s much more recent. And one of the reasons I went back and got my degree is because I really wanted to understand. I wanted to deepen my understanding, but also see how behavior analysts are trained. You know, what are and what is their understanding? What are they coming with when they’re delivering services. And I just want to say that, you know, ABA, as a field, is based on certain principles around how do you change the environment to maximally support a person’s learning. That’s really positive. And it’s just that there have been certain ways ABA has been practiced in the past that now I think we really should be moving away from. So some of the practices, for example, one was not being informed by neurodiversity. And so not understanding that some of these differences in these characteristics should not, we should not be trying to change them because they actually serve and benefit the individual in some way. So I think having a good understanding of neurodevelopment and being neurodiversity affirming, that is the type of ABA that we should be practicing now. There’s also a move that I think is really positive towards ascent-based ABA. That means you’re really looking for signs from a child that they are consenting. You know, they are assenting, and they’re willing participants, and they’re getting something out of the service. And then another important aspect that I think should be brought into ABA is what’s called trauma-informed care. So recognizing that based on the child’s nervous system, something we’re asking them to do might be traumatic for them, highly stress inducing. And to be really then focused on safety, trust, relationship building. And I think if you have those elements, then ABA can be just an extremely beneficial and powerful and positive tool for us.

DR. AMY: So then how would parents know that an ABA professional in their community has that kind of additional training or training that isn’t going to be detrimental but helpful?

SUZANNE: I think first ask them. Just come right out and ask them. And those are the key words to use, you know. And then read about it a bit. There’s great information online. And I tried to include information about that on Cortica’s website and in my book. So that I think as a parent, once you’re empowered and equipped with some of that knowledge, you’re in such a great position to evaluate the services and the professionals that might your child might interact with.

TERI: This is also so helpful.

DR. AMY: I know it is.

TERI: We could go on and on, but we just can’t.

DR. AMY: Right. We’re at an hour, believe it or not. And so we do need to wrap this up. Dr. Goh, is there anything that you still want to say that you didn’t get to say to our listeners today?

SUZANNE: I just want to end on a note of hope, you know. I just think the future is so bright. There’s so many more possibilities now for autistic children and their families. And one of the things that I truly believe is that when you look at an autistic child and their life and what challenges they might face, but then the challenges that they overcome, it really is, I think of it as, you know, a life story of triumph, not of tragedy.

And so I just hope that parents, other caregivers, professionals can view it that way. Because if we see it that way, I think the children will as well. And then when they see their own strengths and the possibilities ahead for them, I think the future just, you know, really, really expands.

DR. AMY: I love that message. Okay. So, listeners, we will put a link to Dr. Goh’s book, “Magnificent Minds, The New Whole Child Approach to Autism,” in our show notes, along with links to her website, DrSuzanneGoh. And that is Suzanne with a Z, and G-O-H, DrSuzanneGoh.com, and all of her social media handles so that you guys can find out more about her Cortica clinics, you can read about the autism blueprint that she provides in her new book. So thank you so much for listening today. If you liked our show, we would love it if you would follow us on Instagram and Facebook at The Brainy Moms. Go do it now before you forget. We would also love it if you would give us a five-star rating and review on Apple Podcasts so that we can reach more smart parents like you. If you would rather watch us, you can subscribe to our YouTube. YouTube channel at the Brainy Moms. And that is all the smart stuff that we have for you today. So catch you next time. See ya.