In light of the current coronavirus pandemic this is a special edition about helping children with autism during this time of great upheaval. In this edition of ‘Autism, a parents guide’ Dr. Ann Ozsivadjian is joined by special guest Dr. Marianna Murin, and interviewed by freelance journalist Jo Carlowe.
Ann and Marianna discuss issues that may arise for autistic children including the disruption of closing schools, anxiety and obsessive behaviours. They focus on practical tips like how to help manage anxiety, maintain structure and support and explain the situation to young people. Additionally, tips on how to keep well as a parent and reliable sources for coronavirus updates.
We are delighted that this podcast series for parents is supported by the Autism Diagnostic Practice at Clinical Partners. Working nationwide with only the most experienced consultants, Clinical Partners ensures you get the best ASD diagnosis and help tailored specifically to your child, as fast as possible. Discover more.
Other Episodes in The Series
Interviewer: Hello, welcome to the ‘In Conversation’ podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlow, a freelance journalist for the specialism in psychology. Today I’m interviewing Dr. Ann Ozsivadjian Principal Clinical Psychologist at Evelina London Children’s Hospital Guys and St Thomas’s NHS Foundation Trust, and chartered clinical psychologist, Marianna Marine, who is the founder of Autism Spectrum Directions Limited. This podcast isaimed at parents with children on the autism spectrum who wants some advice during the Covid-19 pandemic.
It is produced by the mental health charity, the Association for Child and Adolescent mental health, ACAMH for short, in partnership with Clinical Partners search for clinical partners, autism or visit www.clinical-partners.co.uk.
Welcome. Thanks for joining me at this difficult time. Can you start by saying a little about yourselves.
Dr. Ann Ozsivadjian: Yes. I’m a Clinical Psychologist with the specialism in neurodevelopmental disorders in particular autism and mental health.
Dr. Marianna Murin: Hi, I’m Marianna Murin, I am a chartered critical psychologist specializing in working with children and young people with Autism Spectrum.
Interviewer: The coronavirus pandemic raises all kinds of emotions, how must it feel for children and young people on the autism spectrum?
Dr. Marianna Murin: Of course. This is an unprecedented situation on the scale that the world or rather the current generation of people have never experienced before. So naturally, this situation evokes a wide range of emotions, furthermore emotions for which we may not have developed coping strategies or answers yet. So this pandemic causes a huge disruption to the lives of children and young people in so many ways. The disruption in plans and expectations in education, social life, or in fact in every area of life as we know it. So naturally, it emotions like anxiety or maybe even disappointment, frustration feelings of loss, especially for children and young people who were preparing for major milestones such as transitions to secondary school, college or university who will be missing out on leavers activities, proms, graduations etc. So in many ways, we would expect this situation to affect children and young people with autism spectrum in very similar ways, as young people wherever they might be on a neurospectrum, with the anxiety one being really, perhaps, the most frequently experienced emotions.
However, there is an additional entirely new dimension for children and young people on the autism spectrum. We know that any change can have huge impact on so many young people on the autism spectrum, and even minor change to routine can be a source of significant distress. And of course there has been an endless stream of changes and disruptions to normal routines as a result of the important initiatives to manage the situation.
First, many parents started working from home, then some extracurricular activity started closing down, then planned trips or events were being cancelled. So actually the result in schools closing down, and all this happened in the space of one week. All this changed evolved so fast that there was no time to follow the usual strategies parents and educators of children on the autism spectrum would normally use to help prepare children for the upcoming changes, such as gradual preparation, clarity, predictability etc.
And it wasn’t one or two changes, but it was pretty much constant change with new changes coming up every day. And of course we weren’t even able to apply usual management strategies because we couldn’t provide our children with clarity and predictability as no one has the answers or can predict how exactly will the events evolve. And this constant stream of change didn’t just affect our children and young people but also their parents and educators, who most likely themselves weren’t able to adhere to their own typical routines.
So the changes weren’t happening just externally, but we are all being so consumed by the news that everyone was much more distracted and consequently likely to be less able to be as mindful of our children’s needs and routines as we normally are.
So in my clinical experience over the past couple of weeks and a would agree with that also is that this was the second dimension that was actually the source of most distressed or concerns for most young people with autism spectrum and their families. The lack of toilet paper has been subject of discussions and concerns for most of the population. However, if your child eats only one type of rice cracker and one type of yogurt and you see it disappear completely from the supermarket shelves this would understandably raise the level of any parents anxiety to an entirely different level.
Dr. Ann Ozsivadjian: Yeah. Thanks Marianna. Obviously I echo everything that you’ve just said and would like to add a few thoughts as well. I think it’s also important to acknowledge that we, as adults, are more likely to also be experiencing a roller coaster of emotions and this is affected everyone in so many different ways whether it’s worried about our health, our livelihoods or our loved ones. The uncertainty in just about every aspect of our lives is very difficult to manage for any of us let alone for someone with autism. So I wanted to share that I’ve heard many positive stories about how young people on the spectrum are coping very positively, for example, by taking their responsibility to wash their hands seriously and protecting their parents or grandparents health etc. and volunteering to help the community, and many people in fact have just not been as worried as you might have predicted.
However, of course, I’ve also heard of many young people who are struggling with the change in routine, the confinements, the health anxieties for many children who are very anxious about attending school, in general, one anxiety has simply been replaced by another. That said some are delighted not to be attending school, but I think it’s really important for parents to acknowledge their own emotions to, and to not put undue pressure on themselves to keep it together all of the time. It’s important of course to stay as balanced and as calm as possible, but equally to model that they’re also experiencing novel and difficult emotions and that that’s okay. We’re all in this together. We will get through it. And this is a time to find positives where we can in what is a very, very strange situation.
Interviewer: For young people on the spectrum, I’m assuming some must be taking every report very literally, perhaps keeping tabs on things like the number of deaths and so on. What do you advise to parents whose children are going through this?
Dr. Ann Ozsivadjian: So here the usual advice applies. Limit where, when, how much of a behaviour takes place and that includes seeking information about Covid-19. We advocate worry time, for example, when people worry constantly, so having an allocated worry time for certain amount of time. Sometimes knowing that you will have an opportunity to problem-solve or worry later on can push the worries to one side for a while, and in fact, sometimes render them altogether forgotten. While the overriding concerns can certainly not be forgotten at the moment, it may be that people on the autism spectrum who sometimes process information differently may over focus on certain details or perhaps develop an obsessive desire to know everything about Covid-19, and in fact this could apply to any of us as well.
It’s very important for parents to model responsible information seeking, so stick to reliable sources of information such as the BBC and the World Health Organization. In this situation it is important to keep abreast of the facts and current advice, but limit the amount of times that any new sources checked, and do be careful with social media as well. Limit the amount of reassurance seeking questions that you answer. If you know that you’ve already answered a question to the best of your ability and nothing has changed since then it’s best to be honest about that. Personally, I’m only taking the news twice a day, once in the morning, just to check nothing cataclysmic happened at night, and once more in the evening just as update for facts. In between I think it’s really important to distract ourselves with either useful or enjoyable activity and this doubly applies to young people on the spectrum who may get stuck on certain thoughts. Mariana will talk about the challenges of trying to occupy autistic children or work from home with children around shortly.
Interviewer: Yeah, it’d be great to come to that. How might a parent open a dialogue about Covid-19 with their child who is on the spectrum. I imagine some parents would be bombarded with difficult questions from their children? So what advice do you have about opening that dialogue?
Dr. Marianna Murin: Yes. Yes. So many children and young people already heard a lot about a coronavirus certainly of school as teachers would have explained reasons for all the changes like hand-washing etc. In our experience schools were brilliant at trying to remain as positive as possible, and trying to remain a normal flow of activities and focus on learning as always, whilst finding a suitable time slot to deliver practical information on the coronavirus that would be related to prevention or what it is etc. and we would very much recommend parents and families to follow this model. Try to maintain as much normalcy as possible. Try to focus on atypical activities, which would be as closely following the usual family life as possible, circumstances permitting obviously, and trying to have as many times and activities where coronavirus may not figure or feature as part of the conversation, and have clear times where the discussion will focus on explaining the current situation, so and kind of talked about those boundaries.
Obviously the general recommendation such as remaining calm and reassuring whilst honest are equally as important in discussion with children on the autism spectrum. Listening to young people’s concerns is always paramount as these can be very different for each child, and for some children and young people with autism spectrum can be very idiosyncratic even and validating these concerns and taking them seriously is just as important. Now one highly recommended and very effective way of communicating concepts to children and young people on the autism spectrum is via using so-called social stories and comic strip conversations which many parents would already be familiar with. The aim of social stories is to explain specific information about what to expect in certain situations and why, from ASD friendly perspective. So the unique benefit of social stories is that in addition to explaining the situation, they also provide a brilliant platform for building in positive self-reflection based on past successes and building in positive self-talk and self-confidence of coping strategies.
There is a very helpful social story about the coronavirus and the current situation on the National District Society website, and one of our colleagues, Lucy Sanctuary, who is speech and language therapist as well as cognitive behavioral therapist with decades of experience in working with children and young people with autism spectrum, who is also a very talented writer wrote a brilliant story about coronavirus for this podcast. She very generously offered to share it with parents who might find it as a helpful inspiration. What is particularly helpful about Lucy’s stories is that they always start being embedded in child’s life and incorporating their specials interests so that children are intrinsically motivated to pay attention, and the story really draws in their interest whilst parents don’t necessarily expect anything when reading it to a child. At the same time, the story openly labels a wide range of reactions and emotions that a child might experience, as well as models coping strategies.
The children who might respond better to visual rather than verbal communication we would like to reference a social story created by Professor Jackie Rogers from Newcastle. This social story was devised to address anxiety in general rather than specifically related to the current situation, but again, it can be adapted as parents see fit for their child. So we hope that these resources will provide parents with helpful ideas and resources to personalize for what their child might respond to best depending on their age, their specialist interests, and what way they perceive information.
Interviewer: As you’ve alluded to, routine is very important to so many children and younger people with autism, given that almost all usual activities are now suspended, what can parents do to help their children cope with the disruption to their routine?
Dr. Ann Ozsivadjian: So bringing in some structure is always helpful. It’s containing for all of us and especially children on the autism spectrum who may thrive on clarity, predictability and routine. So perhaps drawing up a schedule together with your children clearly allocating slots for learning or other activities that parents will dedicate to their children, and then also times when parents have to work, and then children might be engaging in activities of their choice or other independent activities such as their special interests.
And just to reassure parents on the autism spectrum, this may well be a skill that most of them are already well ahead of the rest of us in that they may be complete experts in terms of drawing up timetables, using visual structure or laminated pictures on velcro, and the using a wide range of resources. And for older verbally able children it may be more appropriate to use calendars, whiteboards, daily schedules, and this could be a great opportunity for some skills building, and this may also mean relaxing typical boundaries maybe, for example, on preoccupations which parents have in place. That might be quite anxiety-provoking for many parents of children with autism as they have often worked really, really hard to make keep and maintain these boundaries, and parents always advised about the importance and consistency and maintaining boundaries, and this may include screen time as well, which we’ll talk about in a minute. But again, we need to remember that this is not a typical situation and we can always try to readdress the boundaries slowly and gradually when everything calms down.
Interviewer: I’m thinking that anxiety levels must be going through the roof for some people. How can parents help their children manage their anxiety at this difficult time, and can you share some helpful techniques or ideas?
Dr. Ann Ozsivadjian: So I think uncertainty and rapid changes to routine are, as we discussed, a particular challenge for people on the spectrum. So I’m going to repeat the message here about limiting news intake, ironically I saw that piece of advice on a news website, and be very careful what you read as well. It’s really important to stay socially connected but equally social media can spread so much misinformation, keep to a routine where possible, be honest about what you can reassure your child about and what you cannot, as mentioned limit reassurance seeking questions where possible.
In terms of managing anxiety, model calm where you can, easier said than done, I know, model good mental health behaviour, maybe practice deep breathing, progressive muscular relaxation techniques or meditation as a family. There are many apps such as calm and headspace etc., which might help with that, any exercise you can take at home would be good for stress levels. I think we’ve all been inundated with yoga and home fitness ideas probably. It’s probably a good opportunity to take some of those up if you can. The current events may also, of course, exacerbate OCD tendencies, especially for those already concerned with contamination fears. So while the advice is to wash your hands and keep surfaces clean etc., it’s also important not to do this to access as dry cracked or bleeding hands are not desirable either, nor is the attendant anxiety about, have I done it enough etc. It will be very challenging to resist urges, but refer to government advice, equip yourself with the facts about how transmission takes place, and try to distract your child from urges to engage in excessive hand washing or similar behaviors.
So many people may also be experiencing depression or may be at risk of experiencing depression. I would strongly advocate not to catastrophising or imagining events beyond what is already known, take things day by day, perhaps week by week, and focus on positives where possible. For example in our times the main concern has been a lack of time or lack of quality family time, this is an opportunity to spend more time with loved ones although obviously, it would be nice if it was without the anxiety. There’s no reason not to continue to plan nice things. We may not know the dates of when those things might happen, but we can still have plans to look forward to, it’s very important. We will all inevitably have to shift our priorities, and I’m hoping that the collective community spirit that we’re seeing will have long-term mental health benefits in times to come. And for any of the above conditions, you may be able to access counselors online, your GP practice will more than likely have details of individuals in your area.
Interviewer: Whilst schools remain open for some vulnerable children there will be many who are now at home. Can you give some more advice about what parents can do about home education?
Dr. Ann Ozsivadjian: This is a very important question as most parents are concerned about this very much. What is really essential to put into perspective here is that whilst everyone is talking about homeschooling, this is not home education, and we believe we owe to somehow rephrase this in our minds and how we refer to the current situation. Homeschooling is a conscious choice, one that no parent takes lightly, homeschooling is something that one considers very carefully with all the pros and cons discussed with trusted people and carefully prepares for in terms of resources and financially and in every other way in advance. However, what we have here is completely different, we found ourselves in an emergency situation with no notice, and like in any other emergency situation we are not expected to perform duties as usual.
For example, if a family member was ill or if there was any other family or work emergency, and what we need to do in an emergency situation is to focus our resources on getting through it as well as we can, and focus on keeping in sound physical and mental health as that really is all that matters. So parents are also worried about the amount of school work children have been sent by the schools and the amount of education resources and the links they are being sent by the schools, or that might be circulating on Facebook or various WhatsApp groups that parents might be part of, as it can be so overwhelming. Parents can feel under pressure, how are they going to get through all of this work with their child’s, and how they’re going to be able to motivate their child to complete all these tasks, or about the ability to deliver certain aspects of the curriculum. And we would also like to give a very clear message to parents here, no one expects you to do anything. This was not a well thought through decision by the school’s what amount of homework is realistic and achievable, teachers themselves have 48 hours to prepare for school closing.
So they were most likely desperately gathering together all the resources they have accumulated in order to be as helpful as possible whilst focusing on giving children positive experience before the school closures. So we all find ourselves in this situation without the chance to prepare. This is not home education and we should all embrace crisis management mode and focus on doing whatever helps us to maintain our physical and psychological well-being. A whole cohort of children will be academically behind, and we all fall behind with our work financially and this is what happens in times of emergency situations. When the main crisis is managed, we will all pull together to help our children gradually catch up just as we ourselves will have space to focus on growth again. The human race go through challenges over and over throughout the history and we will get through this as well.
Interviewer: So parents should take the pressure off themselves really?
Dr. Marianna Murin: Absolutely.
Interviewer: What about general advice for parents because not only are they looking after their child now with ASD, but many parents will also now be working from home at the same time. What are your thoughts around this? How can people manage?
Dr. Marianna Murin: Again, our message here is very simple. This is a very complex situation we found ourselves in so we cannot have our usual standards and expectations. We all can just do the best we can which is most likely to be very different from our typical best, and employers will have to be much more flexible than ever beat expectations. And it’s not that it’s our choice that we are working from home now, we all have to follow the guidelines in order to ensure the management efforts are effective. So employers will have to be more flexible with the flexible working hours and expectations on the work output, and we all ourselves have to lower our standards. I’m actually modeling this very much myself right now. Not many people know this, but I have huge anxiety about public speaking which is ironic because I do a lot of training events and presentations and lectures.
However, the way I manage these is by impeccable preparation. You will recall Jo, that the last time we were recording these podcasts I was very anxious to start with, I prepared a week in advance, I had a couple of colleagues provide me with some feedback, consulted a couple of colleagues about my grammar as English is not my first language etc. This time till there was simply no opportunity for any of this, and I had to accept that my English won’t be perfect and my thoughts will not be expressed as eloquently as I would normally like. And an interesting experience I had from this was the acceptance of all of this actually reduced my anxiety. I totally embrace that all I can do is my best, and actually this is the least anxious I have been when recording a podcast. It’s totally true. So the advice for the parents in relation to juggling work and childcare at the same time is reducing expectations and pressures we all put on ourselve as parents and workers.
Even right now as we are recording this my own children are on their tablets. This is the very first day since the school closed and my rock solid rules of only ever using tablets during the weekends are already out of the window, and that’s absolutely okay. Now, perhaps one final important point in this area is being proactively open with children and prepare them for the fact that things will be very different to what they are used to. I would recommend parents to be very honest and explicit with children that you will not be able to be in all the roles of the teacher, learning support assistant, playground supervisor as well as provide hot school lunches all as one person. Parents can get creative and playful with their children and ask them how many different staff members they have at school to cover different roles, and negotiate which roles do they prioritize each day. So perhaps one day you can focus on more academic study, and another day on being a cook and prepare a hot lunch with the children, one day you can maybe focus more on playground activities and games.
And secondly, as far as preparing children for the fact that things will be very different, this is also a time when we can provide endless empathy both to them as well as ourselves whenever something does not go according to plan. For example, when the websites kept crashing and suddenly everybody is using different electronic resources, or you may not be able to support your children with learning as effectively as their teacher might, don’t be afraid to validate their feelings and show empathy to them. Explain to your child that you’re not a qualified teacher, show them understanding or even turn it into a joke if you make a mistake, right. So this way we will help our young people to feel understood and we are also fostering empathy and teamwork. So essentially, something will have to give from all ends from our own expectations, work expectations and typical boundaries, but as long as we managed to ensure we all maintain some structure and protect time for well being as well. That’s all we need to focus on.
Interviewer: And looking at well-being, are there any activities that you can recommend that are particularly helpful or calming or children and young people on the autism spectrum?
Dr. Marianna Murin: So this is again an area where most people are parents of children on the autism spectrum can be remarkably experts in or have more skills that they often realize. So one of the first things that parents often spontaneously talk about when we first meet are areas of specialist interests and skills of their child, which are well recognized to be very important sources of enjoyment, self-esteem, and for well-being of children on the autism spectrum. This can also be comforting, containing and soothing, and actually having children at home can be an opportunity for children to advance their skills in the areas of their strong interests or learning to channel them in effective ways.
Whilst many children with autism can struggle to communicate emotions, most children tend to be very clear with their preferences and strong likes and dislikes. So many children have very idiosyncratic ways of self-serving that can involve sensory interest which can be hugely comforting and be very important and enjoyable for children or engaging in repetitive interest etc
Interviewer: So let’s look at that in terms of screen time. Does that mean there should be no boundaries? What would it mean for screen time?
Dr. Ann Ozsivadjian: I think we think this is most definitely a time to be flexible. Every families circumstance will be different. So some parents may be able to stick to their screen time rules, whereas for others screens may be a lifeline in order to get some work done. It should be made clear though that these are exceptional circumstances and that any new screen time regimes will not be permanent. So it may be that a shift rather than an increase in screen time is needed. So for example from after school to daytime with no access to screens in the evenings, maybe perhaps shifting to board games or other activities in the evenings. I am aware that for many families this will be very, very challenging to implement, so as I say, it’s going to be very different for different families.
Interviewer: You’ve touched on this already. I want to look at parents own self-care, so this is a hard time for all of us, but possibly even more so for parents who are trying to cope with higher levels of stress and anxiety in their children. What can parents do to keep well?
Dr. Ann Ozsivadjian: I think this is incredibly important. Firstly, I would say that it is crucial for parents not to pressure themselves too much, as always, there will be moments when people don’t do things perfectly and it’s really important for parents not to beat themselves up if that happens. It’s also important as Marianna has touched upon that parents don’t feel pressured to become teachers as well as trying to hold down jobs, keep children entertained etc. You can only do the best you can to keep things ticking over at home. And if at all possible, I do think it’s important to find some corona free time to focus on the things that you love but may not have had time for before. I’m learning a piece on the piano, I don’t think I’ve done that since I was about 12. If you can find something even if you can’t do it right now because you’re just taken up with childcare etc., think about things that you might be able to do and obviously, just take some time to relax in the evenings if possible.
Interviewer: Children on the autism spectrum may be ringing a lot and seeking out information. You know there is also a lot of misinformation around, what websites would you recommend for young people who want to better understand the situation.
Dr. Marianna Murin: We would strongly recommend sticking with the usual trusted websites such as the information from the Department of Health, and especially from websites aimed for the autistic population such as the National Autistic Society and Autistica. As you said, and previously mentioned, there are a lot of rumors and catastrophizing or misinformation and interest but interim internet, so we would strongly recommend families to be really careful with websites like Facebook, Twitter or even WhatsApp groups, and for families to limit and monitor the use of these to ensure their children are following trusted and reliable sources of information.
Interviewer: We know the NHS and community services are already overstretched and that keyworkers are being redeployed on the front line. I’m thinking that must be quite worrying for parents and younger people in receipt of professional support through CAMHs or other services. Will parent of young people still be able to access support? And if they struggle to get this, where can they go, or what can they do to get by?
Dr. Ann Ozsivadjian: It’s not really possible to answer that question, unfortunately, as all services are still trying to find their feet. Not every department or team has the technology to do remote working so this really will vary. I know that my colleagues in the NHS have been working very hard to make remote therapy or medical consultations possible, and in the daily government broadcast yesterday Dr Jenny Harris, deputy chief medical officer tried to reassure people that normal services for people with complex conditions would still take place either care at home through virtual means or arrangements will be made to bring them into clinical areas safely. I would very much hope this applies to mental health conditions as well.
Interviewer: And Mariana, is there anything else you want to add that I haven’t asked?
Dr. Marianna Murin: We would also like to signpost parents to some helpful organizations and links to charities and organizations where people who set up those organizations or their CEOs are experts by experience. So for example, London autism charity, who is offering to provide online support throughout this period as well as live streaming and will also set up Telehealth. Resources for autism.org.uk can also be a useful website for ideas and access to key workers. A2ndvoice.com is a voluntary support group run by parents and carers aimed at raising awareness, understanding and support from different perspectives, and is particularly aimed at Asian and minority ethnic communities.
So again, that can be useful. It is also important to think about the siblings of children and young people on the autism spectrum, so Sibs UK is a very helpful organization in disregard, providing advice on how to cope with and support a sibling with autism spectrum for all ages.
And finally this situation can also bring about some positive opportunities for some young people on the autism spectrum to shine in the areas of their strength, so for example throughout the past week I’ve encountered several examples where young people on the autism spectrum who have got fantastic technical abilities help their parents to suddenly set up all their work online platforms and have helped to set up everybody in the family with their technological expertise. So perhaps even thinking where their autistic strength might contribute and the situation might be helpful.
Interviewer: Anne, Mariana. Thank you ever so much. I think this podcast has been invaluable. For more information on any of the issues covered in today’s podcast, please visit the ACAMH website www.acamh.com, and Twitter @acamh. ACAMH is spelt A C A M H, for more information on Clinical Partners visit www.clinical-partners.co.uk.
Social Stories for children, as referenced in this podcast
Social stories are educational stories aiming to help children gain a better understanding of real-life events. Just click on the links below to download.
When anxiety feels overwhelming – written by Professor Jackie Rogers from Newcastle University
Principal Clinical Psychologist at Evelina London Children’s Hospital, Guy’s and Thomas’ NHS Foundation Trust
Ann trained in clinical psychology at Oxford and is now an honorary principal clinical psychologist at the Evelina London Children’s Hospital, honorary researcher at King’s College London and is also an independent practitioner. Ann worked in the Complex Paediatric Neurodevelopmental Disability Service at the Children’s Neurosciences Centre, Evelina London Children’s Hospital (Guy’s and St Thomas’ NHS Foundation Trust) for 16 years. Her clinical and research interests include the assessment and treatment of mental health difficulties in ASD, cognitive pathways to anxiety in ASD, and also working with girls and women on the autism spectrum.
Dr. Marianna Murin
Chartered Clinical Psychologist and Senior Clinical Tutor at the Anna Freud Centre and University College London
I am a Chartered Clinical Psychologist with full membership in regulatory professional organisations – the British Psychological Society, and professional recognition from the Health Professions Council. For over twenty years, I have dedicated my work to promoting the psychological well-being of people on the Autism Spectrum and improving understanding of ASD as an international trainer in diagnostics of ASD, lecturer, writer and therapist. (bio via ASD Directions)