Transcript of Understanding Autism Spectrum Disorder: Early Signs, Myths & Mental Health with Dr. Myah Gittelson

Dr. Maya Giddleson, a clinical psychologist specializing in child development, joins the We're Out of Time podcast.

There's one autism spectrum disorder, but there are different presentations. One that I'm very passionate about is female phenotype. Autism was researched on boys. No girls were in the study. Now, especially when we broadened the term of the spectrum, you were able to capture some girls that were having some similar themes going on, but they were not expressing it the way as we know boys express it. I think now we're still looking for a cause. We have found that 90% of cases of autism are linked to genetics.

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Please, we're out of time. Dr. Maya Gittleson, thank you for coming today. I really appreciate it. Dr. Maya Gittleson is the most successful psychologist in Los Angeles that deals with autism and ADHD in children. It's a pleasure to have you. Thank you. Thank you so much for coming.

This is such a hot button topic today with our new Health Leaders, Yes. Antivaxxers, causes of autism, Jenny McCarthy. How do you navigate these choppy waters these days?

This is nothing new. We've already gone through the wave of vaccines being pinpointed as a cause and debunked. I think now we're still looking for a cause. We have found that 90% of cases of autism are linked to genetics. Searching for this external environmental factor, like vaccines or something else, I'm not sure if we're going to find out, because 90% of the cases have already been determined, linked to genetics. If we are looking to cure autism or find something to eradicate this disorder, this disability. I'm not sure until we can change our genetics that we can do that.

Is there more autism spectrum neurodivergent? I want to make sure I say it correctly, but is it because we're just getting better at diagnosis?

There's a couple of reasons. One is that we changed the diagnosis, of course, to make it more broad, to capture more individuals. We also decided in 2013 with the DSM 5 that now we're able to make a diagnosis of both, autism and ADHD. Before that, it was specified that you could only have one or the other.

In the In the DSM 4? Right.

These people are so painful. Prior, you could only have one or the other. It was specified. Which diagnosis do you think parents would like to hear more? There was more ADHD diagnosis, less autism diagnosis.

When was that? I'm fully unaware of that.

The change shifted in 2013 with the DSM 5. Okay. Now, we're told as clinicians, you can have both. They're actually making a change. Hopefully soon, they're trying to look at blending the two together, to have a diagnosis that talks to both diagnosis and one descriptor name. So it's no longer you having two co-existing. You have one name, especially.

This is such bullshit. These are the same people that came up with substance use disorder. I mean, what difference does it make if you have two diagnosis or one combined. I mean, I just hate these people.

I get it. They're the worst. When you come from a place that you do, which is down and dirty, what's your affliction? How am I going to get you treated? You come from a place of experience. You come from a place of just confronting people and getting them into-Clarity is power.

Why is everything so goddamn ambiguous? Clarity is power. What's the problem? What's the solution? Fix the problem.

Right. But clarity comes with a diagnosis.

No, no. Absolutely. But where you muddle it down, where it gets all muddled. Did I use that word right? Yeah. Okay, well, I'm 58. I've never I use the word, so I don't even know how it came out of my mouth. What I don't like is, why do you have to combine two diagnosis to make people feel more comfortable? Isn't it More important to be honest and straight with people and say, This is your issue, specifically. Not this and this. This is your issue, specifically, and this is the way you deal with it.

No, 100 %. And I'm very straightforward with that.

You are. What I'm pointing out is the DSM, the people that do that, that deal with the criteria of everything, right? These guys, okay, have their head on wrong. You people have your head on wrong. Okay? Seriously. I mean, I'd like to get back to common sense where we can identify a medical issue without the woke influence, and just deal with the medical issue without it being a socially acceptable thing. It's like you can't say your ass and your face at the same time. It's one of those. All right, ramped over.

Okay. But the other issue, first we had those differentials, right? So you can only have one or the other. So then when you said you could have both, of course, numbers are going to go up, right? Because now it's okay to have autism and then also have ADHD. So your numbers go up.

Can I ask you a quick question, not to interrupt, but what happens if you have ADHD, autism, and restless leg syndrome? Is it all the same? Why don't we just put it all in one group? Seriously. And then we can do the heartburn thing, too. With Pepsid, we can have it all together. And then we can have sleep disorders. We can put everything together. Hey, guys, put everything together.

See, I don't do that. That's why I like to make a diagnosis of autism spectrum disorder, because a lot of people come in anxiety, they come in with ADHD, they come in with sensory integration disorder. And I'm like, Wait, why do you have a laundry list of diagnosis? All of this is under the umbrella of autism.

There are 72 autisms.

Pretty much. There's different presentations. So there's one autism spectrum disorder, but there are different presentations. One that I'm very passionate about is female phenotype. I focus a lot in my practice.

Explain that to him.

Okay, so female phenotype-Explain it to them. Autism was researched on boys. We all know that. If you Google and go online, you've read anything about autism, it talks about how the first research to come up with the DSM and to come up with the criteria is on boys. No girls were in the study. Then now, especially when we broadened the term of the spectrum, you were able to capture some girls that were having some similar themes going on, but they were not expressing it the way as we know boys express it.

Can you give an example?

Interests. Restricted interest. No girl that I've seen has a restricted interest in trains. A lot of boys that I'll diagnose have a restricted interest in trains. Or cars. Girls, makeup, clothing, social media stuff, they get very restricted and very obsessive about those things, which for our society is okay. It's acceptable. That's really interesting. It's acceptable to be obsessive about makeup because you're a girl. It's acceptable in a way to have an eating disorder because you're a girl. But when I look at an eating disorder and I look at girls, I'm finding spectrum. Their restricted interest is landing in those areas, food and- Sure.

And the cell phone addiction is- Makeup. I'm sure plenty of non-spectrum kids are addicted to their cell phone.

Right. I mean, that's a whole another discussion because a lot of neurodivergent individuals are going to have a hard time shifting. So shifting attention. So when you're on your cell phone, they can't just shift their brain off. So when they're with trains, when they're on their cell phone, whatever it is that they choose or land on is hyper-focused, hyper-fixation, perseveration, and unable to shift.

Is there a higher propensity for drug addiction and alcoholism in kids on the spectrum that... Okay.

Yeah, there is, but it's not what you think. In my practice, what I see is that they don't know how to socialize, right? It comes really hard for them, and they're not accepted. Some of them don't care. They don't have the desire or motivation. Some of them do or don't know how. When they get a taste of a substance, guess what happens? They can socialize. Sure.

Comfortableness with self.

Now, I'm this new person. I like this. People like this person. There's no reason to stop because Now they're comfortable. They're being accepted. They have a group to hang out with, related. Even though the group usually is using them for money to buy the substances. That's a whole nother thing. They're getting manipulated. They're getting taken advantage of. They don't get it that they are. But the group wants them around when they didn't want them before. That's one reason why they're at a higher percentage. Social acceptance. Social acceptance. But they're not really being socially accepted. That's the iron.

No, but compared to what they knew beforehand, it is really good.

You can have restricted interest, hyper-focused, be fixated. You can do some repetitive behaviors, if it's impacting and paring, and a lot of the times I'm seeing young kids, it's interfering with development. So at that point, we step in because they need intervention. For intervention, it's helpful to have a diagnosis to know and to how to be effective, to have a diagnosis to guide you through that.

You've described literally 40% of my colleagues. There's so much neurodivergency in medicine, and these people are super high. You give me, I'll take the resident or the medical student that is hyper-focused, wants their note to be perfect, goes over it, over it, over it, goes back to the patient, asks some questions in follow-up, comes back, goes back, comes back. I mean, they are high functioning. I'm like, If this kid had a diagnosis at a young age, and all of a sudden in their head... I want to be very clear, I am not disparaging what you do at all. It's that every parent's fear of, Do I want my kid to have a label? If this kid gets a label at a young age as being neurodiversion.

I don't see it as a label. Okay.

I just want to say something. It's a gift. In my experience, autism, everybody I've ever met on the spectrum, they're my best employees. They're my smartest employees. It is a gift. Now, socially, it's a little tough, and they get hammered in that area. But it is more than made up for, with the competency and the individual gifts that they have. There's a guy in the room right now. He's the smartest person in any room he walks I didn't to, and I don't care who's in the room. So the labeling, what you're talking about is, that was from when we were kids. Now, she's got it on lockdown. She can say, Oh, this is what it is, but here's the good news. You're gifted here. You're special here. You can't be touched here. You got a little issues here, and we'll work on them. Just like in practice, in sports, you work on the stuff that you're weak You can't work on it in a game because you're on automatic pilot and you're going to go to your strengths. It's the same thing.

Yeah. I try not to think of it or use the word label because it comes with a negative connotation. I always say in my practice, who is to say that we are socializing the right way and they're socializing the wrong way? Who determined that our way of socializing and being and seeing the world is the right way and that their way, because it doesn't match ours, is the wrong or negative way? That's where I start a lot with parents.

What's the most common when a parent comes in with their kid, would you say, is the most common concern that they have? I know it's such a broad question, but a few of them, just like, My child is doing this, and therefore I'm concerned that they potentially...

More recently, I was a little schooled by a parent about that question. My clinical interview always talks about, What is your concern? We're just trained that way as a clinician. Tell me your presenting problem. Why are you here today? The parent schooled me by saying, None of this is a concern. This is what my child's doing, but it's not a concern for me.

I love that parent.

How do you answer that?

Like I said, they really stopped me. It was hard to regroup from that in that moment to have a come back because they're 100% The comeback is, I absolutely love you and you are exactly correct.

That's the answer.

But if there's, as you said, if there's impairment in development because of Right.

Of course, that's what we talk about, and that was my next segue to them is, Okay, well, how is it impacting? And things like that. But a lot of the parents I do see, I should say 50/50, will come in already affirming this. Us already feeling good. Just tell me the game plan here. I think that speaks to the new generation.

Yeah, they just want to know what to expect and how to deal with it as it comes up. It's just like any other. You know what I love? I love that any parent that ends up in front of her, I feel good about their parenting skills. They're good people. They saw an issue, they don't know about it, and they go to get a professional's best thinking. The parents that do that for their kids are heroes because that didn't happen for my brother at all. If it did happen for him, he'd still be here for sure.

That's true. It also is a cultural piece, right? In the past, culturally, it was taboo. The newer generation of the same cultures are now speaking up to their elders saying, I'm sorry, we're taking our child to see someone. This is a big conversation I have with lots of different people from a diverse population. That's why I think also our numbers are increasing, because this population used to not come see us.

So it's more acceptable to go- They're making it.

Their elders are still saying it's not acceptable, but they're saying, We don't care. So this generation is speaking up, which, again, sometimes in this newer generation, I'm batting heads a little bit with some of the things that they're speaking up about. But for this piece, I love it that they're speaking up about mental health. They're coming, and that's why, again, I think some numbers are increasing because of that, too.

So you make the diagnosis. Yes. Is your follow-up in... I don't want to say treatment because I don't want to use that as a blanket statement, but are you following up with the parent? Are you following up with the child? Are you following up with both as a unit together? What does it look like? That's a broad question.

Yeah. In my practice, it's set up a lot for the diagnostic process. I'm starting to do more treatment. I don't have a lot of time. With these children, too, they're in school. In how my practice is set up, in the morning I see three to four kids to do an evaluation to determine the differential of the diagnosis, making a diagnosis, not making a diagnosis. Then in the afternoon, I held groups so I can work with more girls, specifically. To capture them in a holistic way, but not having enough time in my schedule to see all of them individually. Right.

In what I do in working at Carrera is I I like to do a full health assessment of people that really doesn't focus on the addiction piece. We'll have Dr. Smith who really will, depending on the patient, I'll do it as well, too. But if he's taking care of the addiction piece and treatment, which in terms of detoxing, people can be very straightforward cookie cutter. But I'm looking at and delving into personal trauma, medical trauma for women, obstetric trauma, surgical trauma. The untreated, a A lot of people allude to this. I was diagnosed with ADHD as a kid. I got put on Adderall. I got put on Vivance. They're not on it at present. They come in almost universally. Meth is their drug of choice. Pink cocaine now is getting mixed in there just because it's designer and vogue and in the news, but they self-medicate with meth for understandable reasons, no?

Right. I think for women, I also get a lot bipolar. I'm getting known for this specialty of focusing on women, female phenotype of ASD. I've gotten all different ages coming to me from all different places. One of the things I find in common is that they, in their history, have had this bipolar diagnosis.

So somebody, a pediatrician or whoever, psychiatrist?

Yeah, they were hospitalized or whichever their situation is, but they're coming in their history of bipolar diagnosis. But there are things that they're telling me are fitting ASD.

Can you give me an example?

When you have ASD, you have a hard time regulating emotions.

Asd is what?

Caustism structure.

Okay.

When you have ASD, you have a hard time regulating your emotions. Someone can be triggered by something in their environment or a situation that causes their emotions to get very heightened and dysregulated, and they're unable to regulate in that time. Sometimes they do a stemming behavior to then regulate or a sensory input behavior that regulates them, and then they're okay. In the outside work.

Without medication. Right.

Without medication. But in that heightened emotional experience, they maybe are going to do something that's impulsive, and they harm themselves, and they wind up in the hospital, and, Oh, this has to be a girl with bipolar because she went from this state to this state now. Having that change in that cycle must be bipolar. No one's asking her about, How do you process sensory information? Do you get over stimulated by noise? Do clothing materials bother you? How is your feeding or your food choices? You find more and more when you ask those questions. I don't think we did a great job of that in the years past, but I think we're doing better now. Again, that adds to that question, why are the numbers rising? Because we misdiagnosed them, and now they're having a different diagnosis, again, captured under ASD, but before they were bipolar.

We got zero of this in med school.

Are we using Are we using AI to go down a checklist and- It's a really good point. And really make sure... Because it seems to me like the human error piece, she just said it. When they bend all these other people, and they didn't get it right, and then they come to you and you've got to ask the questions, wouldn't it be easier to have an AI application that knocks all of this out?

Yeah.

Possible. But the problem was we didn't learn this in... I didn't learn all this in my training school. You're not being taught this at med school. So when a psychiatrist is seeing them, we go to, again, what I was saying before, I use a lot of experience in my practice versus research or textbook. These people that they're seeing are led more by default, because that's their training, by research and textbook. If it's not written in a research book or research study or a textbook, it doesn't exist. When I came up with saying, I'm seeing a female phenotype ASD, everyone's like, It's not in the DSM. It doesn't exist. You can't put that down. I'm like, But then we're not going to be able to service this person because this is- What do you mean you can't put it down?

You can't put it down. Hold on a second.

It doesn't It doesn't have a code. It doesn't have a DSM code.

Wait, all that means is that you can't bill insurance for it, okay? But you can do whatever the hell you want. If you see a diagnosis that isn't in the DSM because they're idiots, then it doesn't matter, okay? You still get to treat that person. You just don't get to bill for it because insurance companies are going to always find a reason to deny you anyway. Deny, deny, delay, delay, right? I mean, it's just... So it doesn't It doesn't matter if it's in the DSM or not. If you're not planning on getting reimbursed by an insurance company, you can still do the right thing.

You have a 15-year-old who's got to diagnose. She's self-harming. She's been labeled bipolar. You do your thing and do a screen for her. You even see, I'm putting my gynecologist hat on and saying a 15-year-old PMDD, how that's mixed into the equation that often gets overlooked. Really? Pmdd is premenstrual disorder, so PMS.

You guys don't do that, right?

You get this sense based on your screen that this person is misdiagnosed, a self-harmer, bipolar on medication. Are you going to then go to the parent and say, I think your daughter is misdiagnosed?

No, I don't say that.

Because that would be a really difficult thing to do.

I don't say they're misdiagnosed. I say that there's something else going on. There's Something is something that we're missing.

What happens if they are misdiagnosed?

There's got to be cases where you flat out are like, This person is not this.

I mean, an adult is an easier case than a 15-year-old. I've had a 30-year-old woman come to me, and all her life, in the onset of her struggles, told she was bipolar and put on medication for bipolar. Now, as an adult, we can talk candidly that that probably wasn't the diagnosis. She came to me to really figure out if she's on the spectrum, and she is, and we can go back and say, You probably were misdiagnosed. That's an easier question than to tell a parent their child's been misdiagnosed or to go against another physician. I try not to say that the physician is wrong or their findings are wrong. They made the conclusion with the information that they had, and they didn't maybe go in a place or ask certain questions.

Why don't you say that? You can explain. Look, I don't know. But if it was me and there was a misdiagnosis, I'd say the same thing I'd say about anything in treatment. They got it wrong. This is why, this is where you are, and this is what we're going to do to fix it. The end.

It's not that cut and dry, though, is it? I don't disagree with that.

No, of course not.

It's hard as a clinician. You're not a clinician, so it's great for you to say that. If I was- He's actually very good He's very good at saying that.

I'm not being humorous here. He's very good at saying that in a way with somebody who needs to hear the truth about their behaviors and their actions. You're probably one of the best there is at it.

That's the first compliment you ever gave me. That's not true.

I mean, I'm jealous sometimes when I hear influencers or others that are in social media and they don't have a degree or a license. I'm jealous what they can say.

It's an epidemic. I mean, that's a whole other podcast, right?

But it's amazing what they're able to say. So I'm bound to be careful because I want to be respectful to the other clinician.

To the clinician. So you have this... What you perceive is probably something else going on. Do you ever do clinician to clinician where you'll talk to a psychiatrist or talk to the other caregiver?

Oh, this is going to be good. Yeah, hold on. Do you ever call the bozo that got it wrong and say- We don't have to say bozo. And say, Hey, buddy, Okay, I wanted to give you some information, and then see how that lands with that ego. Right? And then, Give me one story about, please, God, give me one.

I've never picked up the phone But I am the person that is known in the valley, in San Fernando Valley, that does the differential. So the differential is someone has already evaluated this child, and they've given a diagnosis that It doesn't maybe fit what the parents are saying. It doesn't fit for what the interventions need to be. They come to me, Why are we still struggling here? We did this. My greatest is they pay 10 grand or 8 grand for a neuropsych, and I look at the neuropsych, and I can say, I don't need any of this.

Do you see patterns among providers where you're like, Doc, because I know for me, I'm going to let you off the hook. When I I see Dr. A's evaluation of abnormal uterine bleeding, I'm like, Okay, starting from scratch.

Yeah, there are some trends, but really my trend is when the parents like, I've already done a neuropsych, paid $8,000 to $10,000. I went in the wrong field. And we're still struggling, what's going on. Then all the clinicians or the interventionists, I should say, the psychoeducational therapist, the speech therapist, they're like, We're all whispering that the neuropsych didn't lead to an autism diagnosis. And so they come to me- But why not? Right.

But why? No, there's got to be a reason. You go through extensive testing. Right. Okay.

In grand word.

Well, okay, whatever. Okay, it's your kid. It doesn't matter what it is. But you go through this testing, right? And then you can't take the data from the test and come up with something accurate. Let me tell you something. That's over, man. That's over. The science is always 10 or 15 years ahead of the practice, but you're using that new AI for your notes and everything else, and it's changed your life. 100%. You can get done 10 times more. 100%. Okay? Now, I'm just telling you, I hate to be the bearer of bad news, okay? But that stuff is all over, okay? So what you guys got to do is you got to do the research to find out, and it takes five seconds. I'll show you how we do it afterwards. And we'll find you the AI software that will take data from any test and synthesize it down into what exactly the problem is and what the interventions will be. Now, people say it's not right 100% of the time, and that's exact... Hold on. And that's true. But let me ask you a question. If someone was right 90% of the time, would you take direction from them?

Because I sure would.

The testing, though, that we use, it's not as cut and dry. And maybe that's where it starts, right? There's a lot of Maybe AI can fix this, personal bias and emotion in it. If a parent is coming to you and you sense that they don't want to hear ASD, they don't want to hear autism, they'll take They'll take ADHD, they'll take dyslexia, they'll take anxiety.

But you can tell them anything, right? I mean, if you've got the kid there who's suffering and they don't want to hear autism, you just tell them ADHD and you treat the autism, right?

No, that's very hard because you take our reports and then you explain the child through the report, right? For example, a child that's not diagnosed with ASD and goes to the school district for an IEP, and they see on there, Oh, it's just ADHD. You're going to get a different set of services, and the end expectations for that child are going to be different from the teacher. So the teacher is going to look at you and say, You have the abilities. You don't have autism, so you should be able to do X, Y, and Z. You're not doing it. What's wrong with you? Because it's not matching the diagnosis. So the diagnosis, to be clear and to be concise and to be accurate, is important because it has to match the narrative for the people to understand. So go back to addiction. One of the reasons why possibly numbers are higher with neurodivergent people for addiction is that they're misunderstood. So they're walking around with maybe the wrong diagnosis and no one understands them.

That saddens my heart that we do that harm, because I take it personally that we wronged a child by making an inappropriate diagnosis.

We wronged a child at a young age. By making an inappropriate diagnosis because people give a about what the parents want to hear. How many times have I said to a parent, Hey, I don't give a what you think about this. Listen to me. You want your kid back? Listen to me. It's like, Maya, when somebody does that, when a parent says that, who gives a what they want to hear?

I want to touch on what you said about that guy.

It's a balance, right? We're all waiting as a team.

It's tough, though, because most parents, or good parents, want what's in the best interest of their child. The end. Period. End of story. And what this smacks of is, I don't want the neighbors to know that my kid is autistic. I don't want my friends to know. I don't want my social... Man, I just can't stand those people.

But that's really like, right? You alluded to that at the beginning of the podcast, is those labels and that taboo-ness around it is really dissipated a lot, hasn't it? It has. Yeah. All right.

Where can people find you?

They can go to my website, or they can- What's your website? It is drmiagittleson. Com.

How do you spell Maya Gittleson?

M-y-a-h-g-i-t-t-e-l-s-o-n.

There we go. That's where they find you? Yes. All right.

Or I guess Elisa and Jordan probably would say I should also plug Gittelson Psychology Services as well, because we are growing from just my small one-man show to having multiple therapists under. I also incorporated to be Gittelson Psychology Services. Congratulations.

That's exciting. That is a big... She's been doing this forever, man. She's a big shop. Her dad's the best psychiatrist that ever lived.

Awesome. Well, it's a pleasure to meet you.

Thank you so much. Nice to meet you, too, as well. See you next Tuesday.

He got you.