Transcript for
Autism, neurodiversity, and child-centred practice – part two

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Host Sophie Guy [00:00:08] Welcome back to this two-part conversation on autism and neurodiversity. My name is Sophie Guy and I’m joined by Erin Bulluss, a clinical psychologist and consultant on autism and wellbeing. In part one of this conversation, Erin shared an in-depth perspective on what autism is from her view as a practitioner who specialises in working with autistic people as well as someone with a late diagnosis of autism. We talked about the reasons that there can be such wide variation in the presentation of autism, as well as why, historically it tends to get missed in girls. In this episode, we discuss ways of working with autistic children. That is child centred and honouring of their uniqueness. We also touch on the overlap between autism, high sensitivity and developmental trauma. We start again today by picking up the conversation around recognising autism in girls.

[00:01:00] Erin, do you feel that ideally it would be helpful if more girls were recognised for having autism? How do you feel?

Erin Bulluss [00:01:12] Yeah and one of the themes that often comes from research, particularly into people who are diagnosed quite late in life, is that and I guess understanding yourself really can be quite a transformative process. And so often people will feel like they’re alien or that there’s something wrong with them because they can sense I guess that their way of being in the world is different from that of their peers. But there’s no kind of explanation for that. And we also know that there are particularly high levels of mental health conditions that co-occur in autistic girls. And we also know that camouflaging is associated with sort of poorer mental health outcome and also suicidality in adults. So if we can identify autistic girls during childhood, then helping them to understand themselves and work towards an autistic kind of wellbeing rather than spending their formative years trying to be someone that they’re not can be a really, really helpful thing.

Host Sophie Guy [00:02:19] And so how how much has this approach and this way of working with autism and talking and thinking about autism, how I mean, is it sort of filtering in to mainstream services or, you know, amongst practitioners or is it still very early days?

Erin Bulluss [00:02:39] I think it is more and more so. We seem to be seeing a shift from the traditional kind of approach of, you know, we must normalise this child like a lot of the early interventions were really about trying to make sure that people no longer met the diagnostic criteria for autism. Whereas we now know that it’s sort of a lifelong way of being in the world. And so we were really just teaching people to kind of hide who they really are and try and be like someone else. Whereas now more and more, I think there’s sort of more of an autism acceptance foundation to therapies. And people are understanding more and more that it’s not about sort of turning the autistic person into a non autistic person. It’s about helping the autistic person to be the healthiest version of themselves that they can be. So it does seem to be kind of filtering through. I think there’s still some work to be done. And often practitioners are not necessarily, I guess, aware of maybe their own sort of normative beliefs or the kind of neuro-normative expectations that are embedded in therapy, so because a lot of therapies are developed to ignore autistic people in mind, often there is things sort of hidden within therapies that are actually sort of biased towards non autistic person and doesn’t always necessarily meet the needs of the autistic person. And so it’s about this, I guess, being aware of whatever we’re doing in the therapy room, is that in line with meeting the needs of the autistic person or is that something that maybe is based more on the assumption that the person is non autistic?

Host Sophie Guy [00:04:28]  Are some key principles that practitioners could take away to help sort of counteract that or that can support work with children who have autism.

Erin Bulluss [00:04:40] Yeah, and I think a big part of it is getting to know the individual and having a good understanding of, I guess, what a healthy autistic child might be doing. So, for example, I mentioned stimming earlier and previously, one of the big sort of therapy goals in interventions was to try and stop stimming. So there was a lot of sort of quiet hands and trying to redirect children to other things. But it’s about, I guess, understanding that a healthy autistic person will stim in order to regulate. And that is sort of a way of expressing feelings in a way of regulating those feelings. So it’s really about, I guess, knowing the individual and coming up with an idea of what it would look like if they were the healthiest autistic individual they can be, rather than thinking about more non autistic of benchmarks of health,

Sophie Guy [00:05:41] Which then I suppose it kind of necessitates the practitioner getting into a role of not necessarily being the expert, I suppose, and perhaps kind of forming a more collaborative sort of parallel process relationship with their client. Would that be fair to say?

Erin Bulluss [00:05:57] Yeah, absolutely. I think that kind of collaboration and the client being the expert on themselves. And then it’s really about the practitioner almost taking a backseat in terms of that expert role and learning from the child about the child and then kind of chiming in maybe with some kind of psychology or professional stuff to help. But from a place of having a really good understanding of who that person is, rather than going in with that kind of expert hat on, which can be a bit of a minefield, because even people who’ve worked with lots and lots and lots of autistic children, there will still be children who are totally different from anyone they have ever met before. So it’s so important to be going in with that kind of open mind and just wanting to learn about the individual. And then from there, start to kind of create that mental health from an understanding of the individual and also working with good parents and other key people in understanding the child because children do internalise reactions and messages from their parents about themselves. So it’s not just about working with the child on understanding themselves, it’s about working with parents, on understanding and accepting some of those autistic behaviours that might seem odd and unusual and parents might have all sorts of reactions to that. But it’s about sort of working towards a place of acceptance so that the child can be free to be themselves at home.

Host Sophie Guy [00:07:31] And what does that look like in practise? Are you able to give an example of perhaps where you see a parent probably inadvertently but sending messages to their autistic child that perhaps not the most supportive. And and how you sort of work with that.

Erin Bulluss [00:07:49] And so so a big part of that would be exploring with the parent around what’s happening for them when they see certain behaviours or certain traits that their child has. And then, I guess working from that place towards an acceptance and it might even be that working on the parents, sitting with their discomfort and understanding that that’s something important for the child to be doing and something natural and healthy for the child to be doing. So often, there can be a lot of discomfort on the part of parents, for example, when they see their child, you know, doing a verbal stim. That is something that really immediately, I guess, seems quite odd and different. And so it’s something that people will notice. And then there can often be fears that their child will be viewed in a negative way or will be excluded. There can be all sorts of of kind of vulnerabilities that come up from that. And so it’s working on sitting with those feelings and accepting that actually there’s nothing wrong with their child doing that, even though a lot of people wouldn’t understand what’s happening there. So it’s a really tricky place to be in because the broader world hasn’t necessarily accepted and started to appreciate autistic behaviours like stimming. And so there are genuine concerns that if the child stims in certain situations, that people will judge that negatively and they often do. But I guess it’s about creating a safe place within the home where all the kind of autistic traits are accepted so that the child learns that the people closest to them will accept them for who they are and they can be themselves.

Host Sophie Guy [00:09:36] That’s so important. Yes, so we’re talking about stimming and regulation and that’s sort of a segway into, there seems as though there’s sort of a cross section between autistic traits and high sensitivity or, you know, temperament and aspects of developmental trauma. And I was just really curious to know what your perspective is on that.

Erin Bulluss [00:09:58] Yes. And it is a really, really murky area because there is a lot of overlap between, I guess, what we would see or experience if you know, someone who’s autistic compared to highly sensitive head, someone who’s experienced particularly sort of early developmental trauma. And there’s really particularly around autism and high sensitivity and the difference between the two, there’s not really a lot of research. So we’re kind of flying a little bit blind in terms of differentiating the two. We know that they’re different things. Well, we think that different phenomenon and I guess a way that autism and high sensitivity differ from trauma is that autism and high sensitivity are more like temperament. So that’s something that’s developing in utero and a kind of innate to the person, whereas trauma develops from experiences. So that’s a difference in I guess, the development. But that doesn’t really help us in terms of teaching them apart necessarily. So, for example, high sensitivity is really characterised, one of the core features is around sensory sensitivities. And that’s something that often also is a core feature and is one of the diagnostic criteria for autism as well. And so there are areas that really can, particularly if if a clinician has a bias towards one or the other. And same with trauma. It’s kind of a situation where we can really miss what’s happening for the individual and decide based on our diagnostic kind of biases, which of the three it is. So I think it’s a really important area to be really careful not to make assumptions too quickly and to really take time to explore people’s experiences, to explore their likes and dislikes, their preferences, to really try and get a good understanding of their childs and again, depending on their age, try and get a really good understanding of their internal experience, as well as the experiences they’ve had on the outside, and then try to best decide what’s happening for them. And it’s not necessarily an either or sort of situation, particularly when it comes to trauma. We know that highly sensitive people are more likely to be impacted by their environments than their less sensitive counterparts. We also know that autistic children can and do experience trauma as well. So we get kind of this very murky picture where we’re trying to sometimes, I guess, tease apart things that are a bit impossible to tease apart.

Host Sophie Guy [00:12:34] Sounds like it probably then is about some of things you were talking about earlier. You know, working out for that individual what it is that makes them unique and what are their interests and strengths and focussing on their strengths and then identifying what what are the things that are holding them back. And that may be trauma related. It may be other mental health challenge related. But I wonder if that’s sort of like the way you might approach trying to tease these things apart.

Erin Bulluss [00:13:03] Yeah, absolutely. And that’s where I guess working from that really child centred perspective and taking time to get to know the child, also being willing to own up to mistakes diagnostically. So sometimes we might be certain from the outset or fairly certain that a child’s presentation can be sort of accounted for by their trauma experiences. But then as we work with them for a bit longer, there might be some things that come up that just don’t quite fit with that conceptualisation. And so I think it’s important to be willing to say, I thought that, you know, that we were just looking at trauma here but now I’ve I’ve noticed these things now I’m wondering, you know, there might be something else going on as well and go from there. There’s particularly a lot of the traits of autism can be obscured and hidden. So using the example of kind of the bone dancing, nobody would know, no one would have any idea that that was something that I did.

Host Sophie Guy [00:14:11] Now we do!

Erin Bulluss [00:14:11] And so, you know, there could be a child who has all sorts of autistic traits, but they’re not obvious or they’re not easily observable. But the longer you work with that child, there might be things that come out that you’re like, oh, that’s interesting. You know, that’s kind of in the autism column rather than the trauma column, so to speak. And so being willing to, I guess, continually.  reflect as practitioners and just checking to see if there’s anything in the conceptualisation that might need changing and also to recognise it is really murky area and it’s okay not to be certain. In fact, that’s probably safer, not to be certain and just to keep a bit of an open mind and continually learn about the child rather than, I guess, getting fixed on a particular framework and then letting the framework kind of overtake the way we work with the child if hat makes sense.

Host Sophie Guy [00:15:03] Absolutely. Yeah. I think is such an important point to keep coming back to the person and the lived experience that they’re sharing in front of you.

Erin Bulluss [00:15:13] Yeah, absolutely. And to let them be the expert of their own experience. And, you know, just because you’ve got a university degree or we’re an adult and they’re child doesn’t mean that we know more than they do about themselves. And that’s really our job to be kind of reflecting back what we’re learning about the child rather than to be imparting our knowledge on to the child and their family.

Host Sophie Guy [00:15:39] I’m wondering if there’s anything else, any sort of final thoughts that you might want to share, perhaps around child centred practise when working with children with autism or anything else you might like to share?

Erin Bulluss [00:15:50] Yeah, and I guess in terms of child centred practise, it really is about taking that quite literally, which is something I’m really good at. My mind speaks literal as its first language and then has to translate it into non literal, but which is also a feature often of autism. But child centred practise really is about genuinely putting the child at the centre of the practise and at the centre of what’s happening in the therapy room. And a big part of that is to keep the child’s needs in mind. So, often I guess it can be a tricky balance when working with autistic children between honouring them as they are, as an autistic child, and also understanding that when they go out into the world, most people aren’t going to be autistic. And so trying to help the child to develop more of an understanding of their non autistic peers without giving them the message, that what they’re doing is wrong. So trying to impart that sense of these are your preferences and this is absolutely okay. And also, other people may have different preferences and this is how we can understand what’s going on for them. Probably not in those words I’d use words that are a bit more child friendly, but that sort of idea. And so when we look at skills building, for example, we’d be looking at the needs of the child and what we can help the child to learn or the skills we can help the child to develop in order to better meet their needs, rather than deciding on the basis of what other children are doing that we need to kind of build skills just because we need to build the skills. So it’s really about keeping the focus on the child and on what would benefit the child in terms of their learning rather than what we think it’s important to learn.

Host Sophie Guy [00:17:46] It’s such an important point. I think generally, and I suppose it just becomes even more sort of imperative when working with kids. You know, it’s not easy being different or in a minority group in this world. And, yes, those concepts around being child centred, letting the child be the expert in their lives is just is just so important. Isn’t it.

Erin Bulluss [00:18:07] Yeah. And it is hard being in that kind of minority place. And it is hard as well working with autistic children in terms of keeping that balance between recognising that the majority of people in the world probably won’t understand what they’re doing when they’re stimming. And so trying to keep a balance between helping the child embrace who they are and feel proud of who they are, but also not setting them up for situations that will potentially be quite negative for them, which is really tricky. And so often it involves working with the systems around them a lot as well. They’re trying to create genuinely kind of accepting systems around the child so that there’s more safe places where they can be themselves.

Host Sophie Guy [00:18:53] So as in obviously the family, but also at school or things like that.

Host Sophie Guy [00:19:00] Yes, school. And then trying to find other sorts of groups as well, whether it’s sort of youth groups or groups around interests, trying to find as many kinds of safe places, more autistic friendly places as possible around them and to be working with school and family and other systems to try and better understand the child.  Recently, there’s been research into what’s called the double empathy problem.

Erin Bulluss [00:19:28] Okay. What’s that?

Host Sophie Guy [00:19:29] Yeah, it’s actually really interesting and it makes a lot of sense once you hear. But it is something that seems to have taken a long time to get to. So for a long time, there’s been this idea that autistic people lack empathy when actually when we look at things objectively, if we kind of take a step back, we can see that it’s not so much that autistic people lack empathy. It’s that it’s hard to do what we would sort of consider like a cross neuro type empathy. So it’s hard for an autistic person to understand a non autistic person, but it’s also hard for a non autistic person to understand an autistic person but because autistic people are in the minority. There’s an expectation that they will empathise with the majority and not such an expectation that the majority will empathise with them. So the double empathy problem talks about trying to cultivate empathy in both directions rather than, I guess, placing that burden of bridging the gap on the autistic person. Yeah. so that would be a I guess a big part of child centred practise would be about not only working with the child to understand what’s happening around them, but also working with key people to better understand the child.

Host Sophie Guy [00:20:50] It’s been it’s been really interesting conversation. It feels like getting this window into autism you know what it is actually like being in the world. It’s like a little microcosm in a way for the larger world. Like there’s so much need for understanding difference generally, isn’t there, and helping people to feel good about themselves. You know, we’ve all got aspects of ourself that we try to hide and suppress because mainstream society doesn’t sort of seem to allow it or doesn’t seem acceptable. So it sort of feels like this little microcosm of what really sort of positive approaches that are really needed I think, in the world.

Erin Bulluss [00:21:28] And I guess one of the criticisms that often comes up around sort of an autism acceptance approach or this neurodiversity paradigm is that it denies the struggles and the kind of disability that comes with autism. And I mean, people, autistic people and disability go hand in hand. But the neurodiversity paradigm isn’t actually as at odds with the idea of disability as it seems. So there’s are really good paper that was published in the journal Autism a few years ago by Jac Den Houting, an autistic researcher writing about the neurodiversity paradigm, how we can accept autism and also acknowledge the disability aspect of it as well. We don’t have to kind of choose one or the other. We can be proud of who we are and also accept that there are ways in which we are disabled as well.

Host Sophie Guy [00:22:23] It’s really interesting and it’s been really helpful having you go into all these different areas and explain it. So thank you very much.

Erin Bulluss [00:22:31] Yeah. Which is quite, I guess, an autistic way of relating just going off into different rabbit holes.

Host Sophie Guy [00:22:38] Well, it’s been it’s been really interesting. And thank you very much for your time today, Erin.

Erin Bulluss [00:22:44] It’s been a pleasure.

Narrator [00:22:44] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise brought to you by the National Workforce Centre for Child Mental Health. Led by merging lines, the National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.