Megan Anna: So last April in 2025, there was a lot that was happening in the autistic space. RFK Junior had just entered the scene and misinformation about autism and an autism epidemic was once again running rampant. So in response to this, my colleague and dear friend, Dr. Donna Henderson and I decided to simply hop on a call and record a conversation of us talking about the bigger picture behind this so-called rise in autism and autism epidemic.

There's a lot of context that often doesn't get added to the public discussions, so that's why we sat down to have the conversation, and I'm releasing it here this year on YouTube just so that more people can benefit from getting this information and having access to it. If you've ever been asked about the rise of autism and you wanted a deeper, more nuanced explanation to provide, then I think you'll find this conversation helpful. For context, Dr. Donna Henderson is an ADHD psychologist specializing in autism.

She's co-author of Is This Autism and has spent years doing autism assessments and teaching clinicians about the female presentation of autism, as well as more nuanced presentations of autism. And then I'm Dr. Megan Anna Neff. I'm an autistic, ADHD, clinical psychologist and founder of Neurodivergent Insights, where we work to increase awareness of ADHD, autism, ADHD, and mental health. There is a lot packed into this conversation.

If having a visual guide or a PDF transcript is helpful for you as you metabolize information, then you can find both of these on our website alongside the video to support your learning and absorption of this material. So I hope you find this conversation helpful, whether it's for yourself or for advocating when these conversations unfortunately do come up. Well, good morning, Donna. Good afternoon to you.

Donna: Um, good, good morning to you. It is afternoon here,

Megan Anna: so I'm just gonna set, set the stage for whoever ends up listening to this, um, last week. R Okay. My brain. Rk RK Kennedy. Yeah. R-F-K-R-F-K-R. Last week, RFK did the whole thing, autism epidemic. You and I chatted and. I was kinda like, I feel like it'd be really fun to have a conversation with you. We record it and then we'll, I don't know, put it out to the world somehow. But right now as we're recording this, we don't really know what we're gonna talk about and we don't really know where we're gonna release this.

We're just, we're both in our ADHD energy of like, this feels like an important thing to talk about. And it's something you and I have both thought a lot about and yeah. So do I have that context right of like what we're doing here?

Donna: Yes. And if anybody has ever doubted that either of us is an ADHD or this will surely do the trick, we have absolutely no plan here.

Megan Anna: Yes. This is, uh, yeah. This is us in our ADHD kind of magic. And we'll see if something cool comes out of it or if it's like a rambly mess and we're like, well, that was cool to see you today, Donna. Bye.

Donna: Yeah. At least we get to see each other and hang out for a little while.

Megan Anna: Yeah. Well, honestly, there's been so many times that we've met to work on projects and I've been like, oh my gosh, I wish we were. We're recording this because I, I just often when I meet with you, I really love the generative ideas that come from these conversations.

Donna: Yeah. I always, always learn from you. We always inevitably have a moment of, oh my God, that's how you see it. This is how I see it. And it's always fun.

Megan Anna: Yeah. I I do love that. Um, yes. 'cause we can kind of zoom out and reflect on the cross neuro type pieces as they come up. So I guess, yeah, maybe I'll zoom out too. I'm sure you've had this question before, like, I actually had like graphics, like drafted in my Canva to talk about the autism epidemic thing, like for months that I've just not posted. 'cause this, it's not, this is not a new question. Like we've gotten this question for years. There's always been people who are like, it's an autism epidemic.

So I'm sure this is something you've thought about before, last week before RFK, whatever initials here are that Yes. That I always forget. Yeah. Um. So, yeah. What comes up for you? 'cause I'm sure you've gotten this question hundreds of times.

Donna: Honestly, what, every time I get this question, what comes up for me is individuals that I know. And you are a perfect example of that. It, it's people like you who 20 years ago you would never have been recognized as autistic 30 years ago. I mean, you would've been laughed at if you even brought it up. You wouldn't have brought it up.

Megan Anna: I still would be.

Donna: I still would be. You still would be, right? Yeah. I mean, 10 years ago it would've, I think, been almost impossible for you to get a diagnosis. It's really in the past five to 10 years that we're making such good progress. Right. I, I think you're such a great example of this.

Megan Anna: I talk about that. So I just, I just recorded and released the lost Generation course, which is, I feel like it's my, like, synthesis of my last four years of learning and your influence is all over that course. So thank you. Um, but I talk about that of like, I'm part of this generation and that I would not have received a diagnosis in the eighties or nineties people, first of all, because of the diagnostic criteria being used, but also people just weren't looking at shy academic girls, especially girls who also are ADHD.

So then there's the like, complexity of traits showing up and, and thinking autism. There was a study, I think you were the first one that pointed me to it, that talked about how I, I think it was done across four countries. This is how my brain works. I can remember the details of the study, but not the author. Yeah, it was done across four studies, but it showed people born after the mid 1990s were four times more likely to receive a diagnosis after the age of 18 versus those. Born previous. And so I like, that's something I like to tell clinicians of.

So if you're working with anyone born before mid 1990s, like this should be on your radar.

Donna: And as, uh, I think when John Elder Robeson read that article, he wrote, uh, some, uh, piece about it and he also pointed out that the data showed that the older you are, the less likely you are to be

Megan Anna: mm-hmm.

Donna: Recognized as autistic.

Megan Anna: Yeah. Yeah,

Donna: yeah.

Megan Anna: And then, and I've heard you talk about this too then. So the older you are, less likely 'cause like just what was the diagnostic criteria that was being used in childhood? What we knew about autism, but then also then they're working with adult providers. And one thing that we know is adult providers. They're not trained in adult autism. And there's that assumption, well, if it's autism, it would've been caught in childhood. So there's like that double impact happening.

Donna: Exactly. Adult providers get almost no training in autism. Hopefully that's changing, but historically they have no, so they have no knowledge, they have no confidence. And like you're saying, there is that underlying assumption. Even if it crosses their mind, they're, they, the next thought is usually, oh, somebody would've caught it by now. And so then they don't consider it.

Megan Anna: Yeah. Yeah. And I, I heard you talk about this in your autism training you did. The other thing will be providers, maybe like maybe autism's actually been ruled out before, but again, someone who had, maybe it was an based on an older version of the DSM being used or as a provider not aware of masking and that that will carry a lot of weight of like, oh, well, it's been looked into, it's been ruled out, so nope.

Donna: Right. And they don't, they're not willing to open it up again or even look back and think, well, why was it ruled out? Mm-hmm. And quite often it was ruled out because she made eye contact. Because she has a sense of humor. Right.

Megan Anna: Oh my gosh, I've heard that so many times. And I just like, I feel embarrassed. Do you feel embarrassed? Like for our field? Yes. When you hear stories,

Donna: I embarrassed and very apologize. I wanna go around apologizing to people. Yeah. Yeah. I actually worked very closely with the grad student and the name of her dissertation was, but she made eye contact because it was all about this. It was a great title.

Megan Anna: That is such a good title. Did that get published?

Donna: Not yet. Hopefully it will be.

Megan Anna: Yeah. But she made eye contact,

Donna: right? Because we've heard that phrase over and over and over and over and over again. Yeah.

Megan Anna: That is such a, that is such a good title. Yeah. Yeah. But people will pick one thing, and again, this is. Something I heard you say in a training, people will assume, because if you can do one thing that's like not a stereotypical autistic trait, clinicians will rule it out. Like

Donna: if they, they code a behavior as a non-autistic behavior, like making eye contact is a non-autistic behavior in some people's eyes. So if you do that once, it negates all the, all the million autistic traits and behaviors that they're also noting. Right.

Megan Anna: Which is such bad science. Like we're being a science field if like, can you imagine, can you imagine that with any, like almost any other diagnosis?

Donna: No, I can't. I mean it's not beyond science. It defies common sense,

Megan Anna: which goes back to the stereotypes and that's something I talk about a lot is the stereotypes that have really created this cultural archetype have made it so hard. Like that gets into our brains at a very. Fundamental level. So even if we, if we have clinical training on top of that, it doesn't undo that. And so for, for parents, like I know that that made it hard for me to see, um, my female child, 'cause I had the archetypes. And looking back, there were obvious signs. Like we literally had her hearing checked when she was three because she stopped responding to her name.

Donna: Yeah.

Megan Anna: No one thought autism

Donna: like. Yep. And it, well, and especially we know this, if, if somebody is physically attractive and intelligent and compliant, like all of those serve to cover up the autism in clinician's eyes. Right. And not, and not just clinicians, parents, teachers, everybody For sure.

Megan Anna: Yeah. Yeah. Yeah.

Donna: This brings to mind a, a whole nother reason. And for all of this that we're talking about, which is diagnostic overshadowing, because so many of these kids and adults get other diagnoses that clinicians are more comfortable with, like ADHD. Mm-hmm.

Donna: Or anxiety or borderline or whatever. Mm-hmm. Right?

Megan Anna: Yes, absolutely. Yes. And this is something I think you and I could both nerd out on literally all day. Um,

Donna: yeah.

Megan Anna: I actually made for the course, I made a new graphic. I'd love to show it to you where I, I started, I made autism in the middle, and then I put like O-C-D-P-T-S-D and I started actually mapping out like this criteria of PTSD could be like, this is a way it could overshadow this autistic trait.

Donna: Wow.

Megan Anna: Um, because, and, and, and especially 'cause we know, you know, Johann Irina's studies that he's doing around. Um, autistic adults in psychiatric clinics is so eye-opening. And one of his most recent ones was, um, showing how we have, so we have more co-occurring mental health conditions on average than non-autistic people. So it's not like, oh, the social anxiety is overshadowing the autism. It's like the social anxiety and the PTSD and that like, there's often like three or four mental health conditions in the mix. And Yeah.

Especially 'cause autism is just not on people's minds or rule out lists. It, it won't look like autism. It'll look like a really messy clinical picture of social anxiety. PTSD, depression, bipolar.

Donna: Right, right. And until recently clinicians weren't aware of this whole dynamic. And now I think more and more clinicians are becoming aware of the need to step back and look at the whole person. And I think that's contributing to the increase in diagnosis rates and recognition rates.

Megan Anna: Yeah. You know,

Donna: we weren't talking about that 10 years ago. Sorry.

Megan Anna: Oh no, go ahead. Well, I was just gonna say it's interesting 'cause when, when we talk about the increasing rates, like my understanding, correct me if I'm wrong, is it, it's all based on, I think it's usually eight year olds.

They look at like, so its not even tapping into the adults, um, that are getting diagnosed, which we know there are many, but it's 8-year-old, so now it's, I saw it's just been updated to one in 31 8 year olds have an autism diagnosis, which means we're getting a lot better at screening children, which is great from a, like being able to provide supports and education supports and self understanding for kids. Um, so yeah, it would be interesting to even look at. Prevalence rates in adults. 'cause we know that it's just, there's so many undiagnosed adults,

Donna: right? Yeah. And when I started doing this work, I got, um, I started getting a lot of clinicians who seek kids and adolescents reaching out to me for case consultation. And now it's more and more all about the adults, the case consultation work I'm doing. So many clinicians who see adults are saying, my practice is fundamentally changing as I think about this. And as people are coming in wondering if they're autistic or I'm wondering if they're autistic. I've seen a huge shift there.

Megan Anna: How do you feel about that? Like just in the sense of the work you do and 'cause Yeah. You've, you started out as like a child, a pediatric neuropsychologist.

Donna: Actually, I started out with adults.

Megan Anna: Oh, you did?

Donna: Yeah. Okay. In, in a previous lifetime, I was actually the director of a brain injury program, an acquired brain injury program for adults. Then I went into private practice just doing ADHD LD work, and only with adults. And then I gradually kept moving my age range, younger and younger. It went from 18 to 17 to 16. I've been at six for many, many years. I, I'm not gonna go below six, but, and I had to do a lot of retraining and get supervision and everything for that. But, um, I, yeah. And now

Megan Anna: it's going back up

Donna: and now it's going back up. Yeah. Yeah, yeah. Yeah. Well, I mean, you and I both love that phrase, the lost generation of autistic adults, which I think was originally Man LA and Simon Baron Cohen.

Megan Anna: I'm so glad that you can pronounce both their names because I, I. Typically like just go read this article. 'cause so I have, which I learned this word from you, phonetical, dyslexia. So pronunciation's really hard. So I'm really glad that you can pronounce, um, both of their names 'cause yes, they're the ones that coined it. That's my understanding as well.

Donna: Yeah, yeah. And I got you on the pronunciation. I got you.

Megan Anna: Thank you. No worries. Good for you. I'll, I'll just like, like whenever there's a hard word, I'll be like, uh, Donna and Simon again, can't pronounce his last name, but, um, it's interesting that he coined it 'cause he's a controversial figure in the autism space, but then that, that, that phrase feels so affirming. Um, so I'm kind of glad he's second author on that article.

Donna: Yeah. Yeah. And Wan La, who's the first author, is truly one of my all time favorite. Autism researchers. He's truly amazing.

Megan Anna: One thing we know is research happens, and this is true of medical and clinical, and it takes a long time, like sometimes 20 years to trickle down to clinical work, which is also why I got so excited about your book because it's one of the things that you are help bridging the gap between the research and the clinical training now to get training programs to actually start using that book and to start doing the training. But that is also part of this increase, is that things that are known in the autistic community or even in research, take time to get into clinical training.

Donna: For sure, for sure. But I mean, I I, we started this conversation with me saying that you are such a great example of why the prevalence rates are going up. And as I think about it, I am a great example of why the prevalence rates are growing up in a totally different way, which is that 20 years ago, so I've been, I was licensed in 1991 when I went to graduate school. I don't know that the word autism was uttered once. I mean, if it was, it, I certainly didn't notice it. I absolutely never had a class or an entire lesson on it. It just wasn't part of my training in the late, um, 1980s.

And so I never diagnosed autism year after year, after year after year. I didn't diagnose it. Now I diagnose it all the time. And there are tons of clinicians like me who got training in this so much later, so recently, and now we're diagnosing it a lot. That's not an increase in prevalence, that's an increase in clinician awareness, right? Mm-hmm. So,

Megan Anna: mm-hmm.

Donna: I'm a good example, just like you are.

Megan Anna: That'd be a really interesting list. Again, I'm, I think in visuals, like crossing out, increase in prevalence, strike out, and then an increase of, and like what actually is this an increase of? So one would be, what did you just say? Clinical, um,

Donna: awareness.

Megan Anna: Clinical awareness. What else

Donna: can I put, can I put with that clinical, I'm writing these down too.

Megan Anna: Yeah.

Donna: Clinical, um, confidence.

Megan Anna: Clinical confidence. I love that. Yes. Clinical confidence. Mm-hmm.

Donna: Because when I first started diagnosing autism and a lot of people around me weren't seeing it the way I was, there were times that I didn't diagnose it that I wanted to because I wasn't confident enough. If I was getting pushback from the psychiatrist, say, or from the parents, I wasn't confident enough to really go to bat for that kid and help everybody understand.

Megan Anna: Well, especially because, especially well still, but especially a while ago, it was seen as giving someone tragic news. And so you, you do want to make sure it's not anything else before I hand over this tragic news to this family or this child. I guess it's maybe an increase in autism appreciation or neurodiversity appreciation where more and more people and families and clinicians aren't seeing this as like a tragic thing now that, that's still actually quite prevalent, but much less so than, you know, 20 years ago.

Donna: One, uh, 100% I agree. Can, can we call that clinician comfort?

Megan Anna: Clinician comfort, yes. So we, I feel like we need like a clinical version of this, but then also like a societal,

Donna: so we have clinician ones, clinician awareness, um, and, and knowledge. Right. Which are two different things. Awareness is just generally having autism on your radar, which in it in and of itself is a big deal. And then separately, clinician knowledge, actually knowing how to understand the diagnostic criteria and knowing what questions to ask and how to listen to people. And then clinician confidence to not be afraid, um, and to trust our clinical knowledge. And then clinician comfort to not think we're giving horrible news to somebody like You have cancer.

Megan Anna: Yeah. Yeah.

Donna: Right.

Megan Anna: Yeah. Wow. That was, yeah, that was really brilliant. What your mind just did there. Clinical awareness, clinical knowledge, clinical confidence, clinical comfort.

Donna: I don't know. I was just thinking, I, I don't know how this fits into it. Probably in comfort and confidence, but I can't tell you how many clinicians have said to me. I have some clients I am sure are autistic, but I don't feel empowered to bring it up, much less diagnose it because either a, I'm master's level, like an LCSW, um, but in many, if not most states, they are allowed to diagnose autism. Um, but they've been given to believe that it has to be a psychologist or a psychiatrist, which is not true. And that's so important because it's an access issue. Or B, they're not trained to give the ados, which makes me absolutely crazy.

Megan Anna: Mm-hmm.

Donna: Because you don't need to give an ADOS to diagnose autism. So these, you know, misunderstandings that clinicians have about all of this.

Megan Anna: Yeah, and I think, I mean that's a huge piece of it too, is there is so much fear. Like that was, it was in, it's interesting hearing you talk about your training experience. 'cause mine is not that long ago. I graduated in 2021 and autism was talked about. I briefly remember it in our like psychopathology class when going through the DSM and then in the developmental class. But adult autism was not talked about like in depth training. It was just very clear if you do autism then you do like another five extra years and it's like your residency and it's, it's, you go specialize in it.

Otherwise it was not talked about, which is wild again, when we like Johann Nina's work, which showed one in five people seeking outpatient psychiatric care were, or 18.9% to be more specific, were autistic and only 0.5, 3% new. So it's wild that in mental health, when we're training to be mental health providers, we are not, um, talking about adult autism. That was a rabbit trail training. My training also did not talk about autism and I also, even as a psychologist, I was like, I don't think I can diagnose this. One of the most empowering conversations I had, it was my, it was my.

Internship year and I wanted to diagnose autism and I wasn't sure I could. And my supervisor was like, well, it's in the DSM, like you can diagnose it. Yeah. And that, and, and this was a non-autistic supervisor and it was really beautiful to me that she like, kind of granted me permission to rethink this idea that, you know, autism can't be diagnosed without robust neuropsych assessments or the a OS

Donna: Yeah. I'm like making, making a list. If we both like making lists. I think it's, it's the list that, that I was writing while you were talking because I was really, really. Wonderful. Megan and Anna myths that clinicians believe there are so many myths that clinicians believe that they need to be doctoral level. That's not necessarily true that they need to be a neuropsychologist or to do some kind of testing or even rating scales. That's not true that they need to be ADOS trained. That's not true that they need specialized training in autism. That's kind of sort of partially true, right?

Like, we need to be educated, we need to understand these things. But you don't necessarily need like a specialized postdoc

Megan Anna: like, go take your training on autism or read your book, or take my last generation training and like, I feel like people would be good to go.

Donna: Yeah.

Megan Anna: With that info.

Donna: Yeah. And, and do case consultation when you need it. If you have a case you're not sure about. Right. It doesn't have to be doing some years long specialized training at Harvard Medical School or whatever. Right? Yeah. Um, I think there was one more myth. Oh, if. If it was, you said this earlier, this meant that if somebody else ruled it out, then I either don't need to consider it or shouldn't consider it, or can't consider it, or am excused from considering it.

Megan Anna: Oh, I love that con, con excused from considering it. Yeah, yeah,

Donna: yeah.

Megan Anna: Yes, and and partly that excuse, I mean, it's complex to consider, especially if you've not been trained in it. So I can see, I can see, yeah. Excuse from considering it and if there's, if there's emotional discomfort, because if you do have that ableism around it of like, well, I would definitely not feel comfortable bringing this up to a client. So like, yeah, we don't need to consider that bad thing. There'd be relief in that for a lot of clinicians.

Donna: Right.

Megan Anna: Did I ever tell you about the time. In my training, I was, it was my assessment class the very first year. And so obviously when we're learning to do assessments, we first do them on ourselves. And it was the kind where it gives you like a printout report of things to look into. And on that report, the second condition listed, um, was autism. I, I like see the visual autism, autism spectrum disorder, uhhuh. And I remember looking at that and being like, what? Like, what the heck? Like first of all, I had my own ableism. I, I had a negative response to seeing that.

And then I like laughed at it and I was like, that's ridiculous. Why would, and I had all those thoughts of like, that's a childhood thing. There's no, there's no way that, like what is this test that's recommending I look into autism and I just totally disregarded it for, you know, five more years until I revisited the autism conversation.

Donna: That, that is amazing because it just goes to show you like how far we've come. That you didn't even, you, you took that test in a time, not that long ago. We're not gonna do the math

Megan Anna: 20. It was, you're

Donna: gonna do the math. Okay.

Megan Anna: 2017 is when I took that and saw

Donna: that, okay. In 2017, that is not that less than 10 years ago, that your response was, this is obviously a mistake. How absurd. Mm-hmm. Unbelievable. Right? Yeah. How far we've come. Yeah.

Megan Anna: Yeah. Yeah. Like I, I literally was staring at data that was like, you should look into this. And I was just like, Nope.

Donna: Right. And if you had brought it to any clinician at that time, they would've said, you're right. You, you, this is a mistake. You must have answered the questions wrong or something. So, let's see. We made a list of

Megan Anna: mm-hmm.

Donna: Clinician reasons.

Megan Anna: Yeah,

Donna: for the increased recognition. Go ahead.

Megan Anna: Oh no, finish your thought.

Donna: I was just gonna say, let's make, let's make more lists.

Megan Anna: Yeah. Well, perfect. That's what I was gonna say is like, I kind of love this social historical context and I actually like talking about this. 'cause there is a lot, understandably, there's a lot of anger toward clinicians, which again, like very understandable. But one thing I, I'm big on, one of my big things is I like to kind of melt defenses and shame when I'm introducing new ideas. Just 'cause I think it's,

Donna: yeah,

Megan Anna: more humanizing, more effective. So I like to walk people through like, here's the last kind of a hundred years of autism. So if you feel like, oh my goodness, oh no, I've been missing people. Like it's, it's okay in the sense of we are all working with a very specific social context that has led to this moment. And I think that kind of zoom out view is really helpful. Like if we think to. Just, you know, 60. Okay. Now my math is being stretched. 80 years ago, 70 years ago, we were, we were talking about this as child onset schizophrenia.

Donna: Yep.

Megan Anna: Like, so much has changed,

Donna: right? Yeah. I actually, um, at one point went through the DSM, the various DSM, um, the way they wrote up autism, and it, it was sort of mind blowing. And early on in, I wanna say it was the second DSMI have notes here somewhere. I, autism wasn't even mentioned as, it's, it's, it's the third DSM. It was, it was, right. So I'm just saying like in the 1970s, it was part of schizophrenia. Mm-hmm. It was like a childhood kind of psychosis, right? So if you raise children in the seventies, there was zero chance you were even gonna remotely think of autism for your kid, right?

And then you're right, it was the, the DSM three, right? Mm-hmm. But even then, in 19, that was 1980. That was infantile autism. So the name tells you they were really thinking about children under the age of three. And the diagnostic criteria were, um, very extreme in the way they were written. And I think there were like eight and you had to meet all eight. There was no flexibility and the criteria, oh, I just pulled, pulled some of them up onset before 30 months of age. So very strict there. Pervasive lack of responsiveness to other people. Gross deficits in language development.

I mean, I could go on and on, but you get the idea. I mean, it was really extreme.

Megan Anna: So it's captur in a very, what we now would say is a very specific

Donna: right

Megan Anna: presentation of autism,

Donna: right. Only that for sure. And so if you were, we're, we're going through this, you brought this up because of like the parents and clinicians who might feel guilty about not having recognized kids in the past, but so if you were raising or clinically seeing kids in the 1980s, that those were the diagnostic criteria, of course you were gonna miss them, right?

Megan Anna: Yeah. And it's why I can't say like, oh, I was missed in childhood. I wasn't like, I wouldn't have met that criteria.

Donna: Right? That's right. That's exactly right. Yeah. So, so like, as Bill Gates said, I think he said recently, if I was being raised now, he, I don't think he said I was missed in childhood. Right.

Megan Anna: Yeah, no, his language, I noticed his language too. 'cause it wasn't, it, it wasn't even like I'm autistic. It was if I was a, I it was, it was very distancing. But I mean, I, I actually enjoyed pieces of that, that interview, but it's just interesting his language. If I was a child now, I would be diagnosed with this. Yeah. Um,

Donna: right.

Megan Anna: Yeah.

Donna: Yeah. Yeah. Okay. So then 1987 was the, the revision of the DSM three. So the three R, and they did relax things a little bit, so then you needed like eight out of 16 criteria. But the wording and the examples were still completely extreme. So here's some examples. Treats other people as if they were pieces of furniture.

Megan Anna: Wait,

Donna: what Read? That was an example in it. Reed's phone book to uninterested here, marked distress. For example, if a vase is moved from its usual position, I gotta give you one more insists on carrying around a piece of string.

Megan Anna: Those are so specific and it's not getting at like what's happening beneath, like why is that string important? Why might a child be rehearsing text to someone else? Those are so, and those, so those are so Rainman rain,

Donna: so Rainman, right. And, and Rainman. And, and so that was, that was 1987 and Rainman came out in 1988. I don't know if there's a connection there, but Interesting. And, and in that one it still was very much focused on before 36 years of age. Although they did say, like, as a clinician you could say, oh, this is a late diagnosis. Meaning after 36 months of age would be like a late diagnosis.

Megan Anna: Right. That's wild. Yeah. That means a very, that has very different meaning now when we talk about late diagnosis.

Donna: Right.

Megan Anna: Am I like,

Donna: like you're five, you're sixties, right? Exactly, exactly. Um, do you, do you think this is helpful to, d is

Megan Anna: so helpful, like, no, I think this walkthrough is great and, and maybe we can even make some visuals to go with it. Okay. So we're up to 87.

Donna: Okay. So 80 happens. So 87 still really restricted childhood. So then in 1994 we had the DSM four and um, it was called autistic disorder and which was separate from Asperger's and RET syndrome and pervasive developmental disorder not otherwise specified, which people may or may not know that the old joke about P-D-D-N-O-S, so pervasive developmental disorder not otherwise specified. It was like a waste basket, like a. I think this kiddo is kind of sort of autistic, but I'm not sure, and I'm not confident. So I'm gonna go with pd, DNOS.

And we used to all say it stood for physician, didn't decide, or psychologists didn't decide what the PDD was. It was like a way where you didn't have to really decide or you didn't have

Megan Anna: to commit to the big bad thing.

Donna: Bad thing. Right, exactly. You didn't have to drop the A word. Yeah. And so that what was in there as of 94, um, but it still said onset prior to three years, even in the nineties. We had that onset prior to three years. Um, and there was no talk about camouflaging at that point still. Mm-hmm. So that was the dm

Megan Anna: and,

Donna: and then Asperger's

Megan Anna: was also introduced.

Donna: Exactly, yeah. Asperger's was, was in, in there. And I had a question as I was thinking about this, when the CDC. Talks about rates of autism diagnosis when they were looking at the DSM four, like in 94, 95, 96, all those years, did they include people who were then diagnosed with Asperger's or rats or PDD? Because,

Megan Anna: yeah, I don't know

Donna: because not that's a big deal

Megan Anna: and that would be a huge, like from a data perspective, that would be a huge spike. 'cause all of a sudden if those were spread out right across five different diagnoses and then all of a sudden they become one, that in and of itself would be a huge spike in the data. Wait, that's a good question. I, I want us to put this out and then I want someone who to understand,

Donna: someone to tell us

Megan Anna: to tell us,

Donna: because I also read that over 90% of the kids who had been diagnosed with any PDD, so. Autism, Asperger's, P-D-D-N-O-S, rets, I feel like I'm forgetting one, but you get the idea. Over 90% of them met the DSM criteria when we went to the DSM five.

Megan Anna: Mm-hmm.

Donna: So they are all autistic.

Megan Anna: Yeah.

Donna: So we need to understand that

Megan Anna: data

Donna: point.

Megan Anna: That's a huge, that is one I had not considered. Like I've considered several points for the increase, but I had not considered that data reporting. That's huge.

Donna: Yeah. Huge.

Megan Anna: And wait, when would that, that would've gone into effect in 2013.

Donna: In 2013.

Megan Anna: So that, because the graph, like the graph I have in the one that's often cited is from 2000 to 2020, where we go from 101 in one 50 to one in 36. Now one in 31. 'cause it's a, it's a huge, like, um, but that would've made such a big difference in 2013 if all of a sudden we're take like that would, yeah. Okay. We need to know that.

Donna: It goes up sharply ar after that. It really, and it's a combination of all the different kinds of things we're talking about today, but that's a big piece of it.

Megan Anna: And ADHD, like you can now diagnose both ADHD and autism when we get to, or are we done with DSM four before we jump?

Donna: Yeah, but this is good. Now let's make a list of all the changes in DSM five. So like, the first one is lumping all the things together.

Megan Anna: Oh yeah. Okay. I'll start, I'll work on that list. All the Ds.

Donna: You do that. Okay. Okay.

Donna: I'm done typing,

Megan Anna: I'm talking all, all lists.

Donna: Okay. Alright. DSM five changes. So one was all these different diagnoses got lumped together as autism spectrum disorder. So, and over 90% of the kids with all the other ones fit into this, so that's huge right there. Then as you just pointed out, before 2013 clinicians were not allowed to diagnose autism and ADHD in the same person. Never made any sense to me. I have yet to meet somebody who understands that rule. And so, think about it, if you're a clinician and you have to choose between diagnosing autism and diagnosing ADHD, right? What, what, what are you gonna do?

The big scary one or the one that everybody's comfortable with, where you could just take a pill to fix it. Right? So we know that that happened a lot. Um, and now as of 2013 and the DSM five, we could diagnose them together. The other big change in the DSM five was recognition of camouflaging. Like it actually says it in there. It says, you know, I, I forgot the wording.

Megan Anna: And was that in the tr TR update, or was the original DSM,

Donna: I think it was in the original DSM five, not the TR update. Yeah. It said something like symptoms may not manifest until social demands exceed. Mm-hmm. Limited abilities. Yeah, something like that.

Megan Anna: It's very like, it's very vague, but it's in there. Which is

Donna: Yeah,

Megan Anna: huge. Yeah. Yeah.

Donna: Yeah. And, and I'm gonna, I'm pulling out my DSM now to check myself there. I don't think there's anything about age for the first time. So they finally got rid of that. That also, oh, that's a clinician myth. Do you still have a clinician myth list going? This whole idea that there, it has to be shown by age three or any other age, like there is no age. It says, okay, I pulled out my DSM. It has to be present in the early developmental period, but may not become fully manifest until social demands exceed limited capacities or maybe masked by learned strategies in later life. I mean, that's huge right there.

Megan Anna: That is so huge. That is so

Donna: huge. Yeah. Yeah.

Megan Anna: So I thought, and I could be wrong, but I thought those were tr updates that were just put in 2020, but I.

Donna: I, I could be wrong too. So we need to find out.

Megan Anna: Okay. We should find that out because that would also, that would signify more like recent shift. Um,

Donna: but I'm looking, so my little book here is copyright 2013. It's not the tr Okay. Which this is my, my mini DSM.

Megan Anna: Got it. So, yeah. No, so you're right. Yeah. I, I know the TR did something, 'cause I remember being very like, interested in what they were gonna do and I know they did something. And for those it was really

Donna: minor.

Megan Anna: It was really minor, yeah. For listeners, so like the DSM changes, numbers every whatever, but then TR are kind of like updates between, like, we're not ready to go to DSM six, but we might update it. So there was like, you were earlier talking about, was it DSM three tr, which was kind of in between DSM three and four. Um, okay. So that is DSM five. I didn't realize that. That's actually good for me to know. Um. And the TR updates were super minor.

Donna: The tr it was nothing substantial. I know, I remember I was deep holding our breath deep into writing the book. Right? Yes.

Megan Anna: We were all hoping for like really big updates in the TR and then I remember it was like, uh,

Donna: yeah, it was really minor, minor, minor things.

Megan Anna: Yeah. Okay. Okay. So DSM changes so far. I have all diagnoses get lumped into autism spectrum disorder. We get rid of Asperger's and all the other ones. Yeah. Um, 90% fit into that. Um, ADHD you can now diagnose both masking and camouflaging is mentioned and the age requirement is loosened.

Donna: And I'm not a hundred percent sure about this. Maybe you'll remember. I think that's the first time sensory got put in there.

Megan Anna: Yes. It's it's

Donna: huge. It's, that's huge's.

Megan Anna: Yes. Sensory got added. Um, yeah, I wanna actually look at the criteria. What was be beyond adding. Sensory was beach because now it's, you have to meet two of the four for criteria B.

Donna: Right.

Megan Anna: Were there other changes there that you're aware of beyond adding sensory?

Donna: I don't think so because interests, repetitive behaviors and, um, flexibility I think have been in there for a long time.

Megan Anna: Yeah.

Donna: I think sensory was the big change there and making it two out of four, which is like, um, it some, I feel like I keep saying the word huge. Mm-hmm. But it was huge.

Megan Anna: I mean, when you go from like, you have to meet all eight of these criteria in DSM three that are very like specific to,

Donna: yeah,

Megan Anna: here's three criteria, A and two, four, and then there's examples of like all the ways this can show up. Yeah. I mean that, that, it is huge. It's a huge shift. Of course, we'd go from one in 25,000 to one in, I mean, not of course, but. To one in 31. But that makes sense. So yeah, this is a huge, huge one. And it's actually number one on my list of, I ha I put together a list of five reasons, and my number one was broadening diagnostic criteria. So it is huge. It really is.

Donna: Right. And you know, it would be interesting, I don't know if anybody's done this, but take a group of autistic people and who absolutely meet the current criteria and then see if they would've met criteria with the two, with the three, with the four. I think that would be really telling

Megan Anna: that actually, because

Donna: you wouldn't

Megan Anna: have video, like

Donna: Yeah.

Megan Anna: Yeah. That'd be such a great way of visually capturing this. Right? I mean, so many, there's so many of us. And it could even be like, well no wanted a Met criteria because they already had an ADHD diagnosis in 2010. So like

Donna: Right.

Megan Anna: Have for that reason and listing out the reasons why. Yeah. Okay. So diagnostic, broadening.

Donna: Yeah. And, and then just our understanding of what each criteria means is the other way that we broaden our understanding of all of this is that stemming doesn't necessarily just mean flapping or echo stemming can show up in countless ways. Right? Like pacing back and forth or watching the office 47 times.

Megan Anna: Yeah. Or like for me, something I've done my whole life, like I'll listen to a song on repeat for like a week and, and like, never thought of that as stemming or weird or, it was weird to me that other people like listened to songs like a playlist. Like, like why would your brain want that?

Donna: Yeah. And if I had to listen to the same, even a great song like over and over again for a week, I'd lose my mind. Yeah.

Megan Anna: Yeah, if someone, so I actually had a, it was, she's also a psychologist, she's ADHD. I was autistic. I didn't know I was autistic. We were driving to a conference together and we're, we're, I think it was kind of in a, like, getting to know each other, like, what's some of your favorite music? And I put my, my playlist up and like, we wouldn't even finish a song and she'd move to the next one. And I was like, what is happening? And then I was looking back and I was like, oh, that was ADHD and autism there.

Donna: Maybe we need to, um, design our own little questionnaire and this could be part of it.

Megan Anna: Mm-hmm.

Donna: Right. You know? Do you prefer to listen to the same song over and over again for a while? Or do you prefer to move from one song to the next? I dunno.

Megan Anna: Rapidly. Yeah.

Donna: Yeah.

Megan Anna: Yes, yes. So more. More deep understanding. And I'd kind of put that in the awareness bucket too. As more lived experience, more people started talking about the autistic experience of like, Hey, I do this thing and this is, this is what domain can look like. Yeah. 'cause all of, so much of it was the stereotypical, like hand flapping, like that's the one people love to, right. It's like hand flapping.

Donna: You don't flop your arms, you can't be autistic.

Megan Anna: Mm-hmm.

Donna: Yeah. Mm-hmm.

Megan Anna: Yep. Yep. Yeah. And special interests would be another one of like the ones that culturally blend in or are socially acceptable awareness that, yeah, like an intense interest in psychology or social justice, like that can also be a special interest. It doesn't have to be, um, obscure. Like it doesn't have to be. Um, but a bizarre is the word that was often used.

Donna: Oh, this might have been a change in the new DSM too, I think in the 20 20 13, from overtly atypical interest to either atypical mm-hmm. Or intense.

Megan Anna: Yes.

Donna: I wonder if that was, do, do you know? That is true.

Megan Anna: I don't know it off the top of my head, but it feels right and I want to know now, but it feels

Donna: right. Me too. I'm gonna look it up later and I'll

Megan Anna: let you know. Even with that update, um, a lot of clinicians will still, if it's not quote unquote bizarre. They, they'll miss the ones that are like atypical and intensity, but not content. Which also, again, that's weird of like, who gets to decide what's bizarre and what's not.

Donna: I know, I know. I had a whole debate about this with a colleague once because I had an 8year-old, um, who I was sure was autistic and I was going through the criteria and, um, he had an interest in opera and I thought that was atypical for not an 8-year-old, an eighth grade, or he for an eighth grade. Boy, I had never met an eighth grade boy who was into opera and her argument was lots of people are into opera. There's nothing atypical about that, which is true. But for me, like the context, context is everything. The context is of this boy, he wasn't musical, he didn't play an instrument.

His parents weren't into opera. He didn't go to a like theater oriented school. Like there was nothing about his life that made, that made you go like, oh yeah, opera. Mm-hmm. That makes sense, right?

Megan Anna: Yeah. That's interesting. So like for the context of that person's life is the interest

Donna: Right.

Megan Anna: Quote unquote bizarre. I like that way of thinking about it. Yeah. Yeah. Huh.

Donna: Yeah,

Megan Anna: that's interesting.

Donna: And, and I mean, I don't, I don't use the word bizarre.

Megan Anna: Yeah. I'm using it quote. Yeah. I'm trying to, I'm using a lot of air quotes here on it 'cause it's, um, would be like the pathologized way of looking at it.

Donna: Got it. Makes sense.

Megan Anna: Or atypical. So

Donna: should we talk about this whole other category of increased prevalence rates that

Megan Anna: Yes.

Donna: Do you wanna bring one up? Go ahead. Do you have one? Oh,

Megan Anna: the next on my list is more screening, but mm-hmm. I don't know, did you have one on mind in mind?

Donna: I did, but I can wait. Yeah. Definitely more screening. What, what were you thinking about there?

Megan Anna: Well, again, when I look at that chart specifically 2000 to 2020, um, some things that come to mind is like in 20, I think it. It was published in 2007, but I think it kind of went into effect in 2006 where the Pia, American Pediatric Association recommended routine screening for children. Yeah. And then we see that's one of the points where we start seeing a big spike. So just implementing routine screening is huge.

And then I, I'm not as like fluent on education policy, but my understanding also is that there were some changes in like kind of how children could access supports, where there was more incentive to get an autism diagnosis for families because of the supports that could be offered through that. And so just from an incentives perspective for families, there would, there's also more education supports to access if you have that diagnosis.

Donna: Yeah.

Megan Anna: And so I, I think about, yeah, the screening and then like education shifts that just. Made it much more likely that we'd be catching autistic children.

Donna: Yeah, yeah. No, you're, you're exactly right. I was, I was wondering about that too. I didn't remember the exact year when the American Academy of Pediatrics started that, but,

Megan Anna: well, I don't

Donna: recite six sounds right.

Megan Anna: I don't recite phone books, but dates of studies like stick,

Donna: maybe you're not autistic, making

Megan Anna: cute. Got everything my career.

Donna: Yeah. There you go. Um, you know what crossed my mind too, as you were saying that I, I wonder too about insurance companies and when you know all this nonsense about, you know, you need an autism diagnosis for us to pay for you to have a, BA and of course everybody needs a, b, a and I wonder if there was a little bit of impact there too that motivated people to get the diagnosis so that their kids could get a, b, a. And to be clear, I'm not saying it was. I'm not

Megan Anna: Yes.

Donna: For a B, A. Right. Yeah.

Megan Anna: But that would've been one of those systemic pieces, right? Right. Again, there was just so many system pieces that shifted from especially 2000 to 2020. Yeah. Yeah. Insurance screening. Yeah. Anything else in the screening bucket that you'd add?

Donna: I think you hit the big ones. Yeah.

Megan Anna: Yeah. So what was on your list?

Donna: So a few other things. One is I, I found myself wondering if, and I think that it has, if everything's just been increasing like crazy, and could we make a chart that shows the autism increases and the ADHD level increases and the anxiety level increases and the depression level, and even things like dyslexia. I wonder, is autism increasing more than everything else?

Megan Anna: Does that mean more autistic people are having sex than,

Donna: well, that was a whole other thing we needed to talk about, right?

Megan Anna: So,

Donna: right.

Megan Anna: Mm-hmm. Yeah. So

Donna: no, that's a, that's, they're separate to me.

Megan Anna: Oh, they're separate. Okay. So everything's right. Increasing. And when you say everything's increasing in your mind, are you saying true prevalence is increasing, or diagnosed cases are increasing?

Donna: I pro, I think probably both.

Megan Anna: Okay.

Donna: I mean, I know kids are more and adult, everybody's more anxious now.

Megan Anna: Oh yeah, that's true. Yeah.

Donna: I mean, there's so much more anxiety now. There's so much more depression now. There's so much more ADHD now. Right. Yeah. There was a whole article in the New York Times this weekend about like the explosion of ADHD. So part of me wondered like, so is autism different from all of these other diagnoses or, or not really?

Megan Anna: So would you That's cur, I mean, that's a whole other conversation. But same thing with ADHD. Like we could say there's been an under-diagnosis. And this, actually, this is something I like about you, Donna, is it's tempting to look at that and be like, it's not an epidemic. It's better identification. That's typically what I say, but I typically will have a footnote of like, and we can't rule out that there is a true increase in true prevalence. And that's kind of, and I like that you can hold the new nuance of that, of maybe there is true prevalence increasing of all the things.

Donna: Yeah. I, I think there may be, and, and this is where we can now bring sex into it, right? So. Autistic people in our current culture may have better luck finding each other, finding partners and procreating like because of,

Megan Anna: yes.

Donna: The rise of technology.

Megan Anna: It's literally what I said in my article of like, we, 'cause we know the cross neurotype study, like we tend to connect better with each other and now with dating apps and with digital, like we can find each other in the mating process, the mating process. Whereas before, if you were just like, well, I'm gonna find someone like in what my local community or I, I don't know how people found, I mean, I guess I found my person in college. Um, but yeah, it's, so it would be so much easier, I imagine for autistic people to connect and then to have sex and then to have babies.

Donna: Right. A absolutely. And you know, when I was young and dating before technology, you had to go out there in the world and spontaneously talk to people and connect quickly enough and well enough to then continue on and build a relationship, which is harder for autistic people than non autistic people. Yeah, that sounds terrible.

Megan Anna: That sounds terrible to me. Everything you just described, I was like, why would you do that?

Donna: Right. Yeah. And, and then separately, the rise of technology in general has given a lot of autistic people like think Bill Gates, um, jobs, careers.

Megan Anna: Oh my gosh.

Donna: Yeah. And like that lead to and that sort of, that full on success in life that is more likely to potentially lead you to becoming a parent and having a family. Right. So I think there's that piece of it too.

Megan Anna: Yeah. I think about this all the time with like social disability model and like. Like, I run a pretty successful business and I've hired, I have like four employees, three of whom are Audi, ADHD, and none of our jobs would exist without the internet as it is.

Donna: Right?

Megan Anna: Yeah,

Donna: yeah.

Megan Anna: Right. It's, that's a huge shift, but I, but shift in like, it can create some financial stability, which I don't know that that's actually correlated with having more kids necessarily, but Yeah. Yeah.

Donna: Yeah. I sure don't know. I certainly haven't seen any research on it. It just feels like there might be, I just remember at one point hearing that there was concern because there was so much autism being diagnosed in Silicon Valley that they thought like there was something in the water there, and we were all like, no, y'all are autistic and you're having babies and it's all okay.

Megan Anna: Yeah, no, totally. Well, and it's, and I know that there's some pushback on this language of broader autistic phenotype, but then again, especially if you've got two tech people who are on that broader autistic phenotype, they're gonna have children who, um, I think would probably be more classically autistic or stereotypically autistic. And so absolutely that's happening. I think Steve Silverman did such a good job outlining that in neuro tribes. I think it was in his book that the number one medical field of like having autistic kids was actually the medical field.

And then it was maybe engineering and then tech, which is really interesting too, to think through where are the broader autistic phenotype folks. Um, I, and I'm, I don't wanna quote it quite that confidently, but it was interesting. He had some data in there about the fields of like the parents of autistic kids.

Donna: Oh, that is interesting. Megan. Anna, you and I could just make a living coming up with dissertation topics. That would be such an interesting dissertation, because I'm also thinking lawyers and college professors.

Megan Anna: Mm-hmm.

Donna: Right? Yeah,

Megan Anna: yeah, yeah, yeah. So yeah, we're having babies. That's a huge one. Um, we're connecting 'cause of the digital world. Speaking of digital, I think that's its own point of just the internet has changed everything in regards to lived experience. And then we've connected as an autistic culture and community and, and now we see ourselves recognized in each other. And that's just lifted the bar of awareness. Because A, we're connecting. B, we've really created some autistic culture, which in return, like that's how we know things like, well, stimming can look like this or like that.

And so that's been so huge from an awareness perspective. And then also busting some of those myths around autism is a big, bad, terrible thing. So the internet, and again, if we look at that 2000 to 2020 what, like iPhones was 2010. And I, I feel like we, that's, we've been living in the digital age the last 20 years and then the social media age and it's just changed everything.

Donna: Yeah. Well said. Well summarized for sure. Yeah. I, oh, go ahead. No, I wanna hear it.

Megan Anna: Well, I was just gonna say, I do have one more point that I wanna make sure and get to, but I.

Donna: Because I was gonna say, like, I think we, I think we solved it

Megan Anna: well, better recognition of underrepresented groups. So for example, the research that's looked into autistic women has been huge, but then also bipoc and genderqueer and trans, I think, I don't know what the most recent CD, C, but I feel like the one that was in one in 36 was one of the most encouraging for catching black children. Like it was like, can't remember the exact rates, but the gap had, um, lessened quite a bit. I, I think we know still, especially in Latinx populations, this is still very under, under identified.

But with, especially with bipoc children, we're getting a lot, lot, lot better, um, historically, often like conduct disorders or od um, oppositional defiant disorder. Um, there's some great research. I'm gonna synthesize it this Friday. But I think on average it takes what, like three years longer than a white child to get a diagnosis and, um, that, and that, that research is back in, I think it was like 2007, kind of early two thousands. There's a huge discrepancy there. And then of course, autistic girls, like, especially girls that do not have a co-occurring intellectual disability.

Um, more numbers. 'cause my brain is fun in that way. I think, again, I think I might have first learned this from you, but this was, and this was early two thousands or late 1990s, where autistic girls with co-occurring intellectual disabilities, the, the prevalence was two to one, two autistic boys to one, but then without a co-occurring intellectual disability, I think they were using 80 or above. Yeah. Um, it jumps to nine to one.

Donna: Yep.

Megan Anna: Meaning like, it, it would make no sense for prevalence to actually shift that much. It just means we didn't know how to catch. Those, those girls. And so that's been a huge shift in that we're getting better at identifying anyone who's not a white cis boy with very stereotypical traits.

Donna: Right, right. Yeah. Again, really, really well summarized. I don't know that I have anything to add to it, except, yep. That's all true. And then if somebody has multiple, is in multiple minority groups. Mm-hmm. So if you're a, a black trans female, right? Mm-hmm. You know

Megan Anna: mm-hmm.

Donna: E even harder to identify for sure.

Megan Anna: Absolutely. Yeah. Absolutely. And then even, and I always, again, this is a footnote I like to add. There's also, there's still plenty of white cis men. Who also are undiagnosed, even with stereotypical traits because again, of how much has changed diagnostically and awareness and screening.

Donna: Right, right. I mean, I saw a boy this week, white cis boy, who had been seen on and off throughout his life and never diagnosed with autism. And I thought it was gonna be like a really challenging case to figure out. And I mean, within five minutes of meeting him, he exhibited really clear unambiguous autistic traits.

Megan Anna: Yeah.

Donna: And, and going through it with his parents, it was clear. His clinicians weren't comfortable with autism in the past. His parents weren't uncomfortable work, uncomfortable with autism in the past. They overtly said to me, we can, we see this now and we're comfortable and we want this diagnosis. We, it's useful to see him through this lens. We didn't feel that way 10 years ago. We would have absolutely pushed back against this 10 years ago. And they were saying, we think that's part of the reason clinicians didn't diagnose it. Nobody, none of the adults in the room were, were comfortable. Yeah.

So I guess I'm just reiterating what I said before, even, but even for a white boy

Megan Anna: that's so beautiful and it comes full circle of it. I, I, this is where I really, I'm so grateful for the autistic community of the awareness work and, and by awareness work, I also mean the like movement toward. Bringing forth affirming narratives of autism that is impacting clinicians, it's impacting parents. 'cause they're more likely to say, yep, I'm willing to look at this. And it's, that is a huge driving force in the increase is that there is now a culture and a community who's saying, this is an experience that many of us have and it is okay. And this is a word we're allowed to say.

Donna: Yeah. 100%. I, I, I think that's so beautifully said. I, I go back to this experience I had in graduate school in 1987, maybe, um, where I thought I had never met a gay person before. Obviously I had, but nobody ever talked about it back then. And one of my professors said that he was gay. He came out to our class in a very casual, like it wasn't a big deal. He was like, by the way, here's the deal. And it was the first moment of realizing, oh, they're all around me. I had no idea. And it's the same thing with autism.

And every time an autistic person comes out and says, oh, by the way, I'm autistic. It raises everybody's awareness. Yeah. Not just that it's everywhere, but that there's a million different ways it can look. Right.

Megan Anna: It's literally like, that's literally why I, I came out, like I had no idea what was gonna happen when I came out as autistic and like professionally impact it would have. But I was like, I just. I just need to do this. I need people to know. There's like autistic psychologists out here. Um, and Devin Price talks about this really beautifully in his, in the first, um, autistic unmasking book of, I can't remember the exact quote, but like, visibility is advocacy and, and partly for those of us for whom we can more safely be visible.

So as a, as a white, as a white human with a lot of like, uh, so much privilege, right? Yeah. It is so much safer for me to be visible. And so the ability for me to do that, it also like, um, raises the safety for, for everyone. So those of us for whom we can more safely be visible, it, it is really powerful advocacy.

Donna: I know I speak for countless people, thousands of people, that your work is so appreciated. Just you, not only your, your intellectual work, which is massive, Megan Anna, but your personal work, understanding yourself, understanding your own experience, and then sharing that with the world, uh, you, you make a huge difference and we all appreciate it.

Megan Anna: Well, thank you. And now I am gonna hot potato pivot 'cause that's, that, that, that is very meaningful to take in, but it's also, um, actually no, I'm gonna, I'm gonna practice. I'm gonna try to take that in. Thank you. I appreciate that.

Donna: Good, good.

Megan Anna: Yeah.

Donna: I, I feel like, I feel like we're, we've, we've, we're at a stopping point.

Megan Anna: Yeah. I, I think we're, and we've also talked for a long time. Um, and so again, we don't yet know where we're gonna release this or what we're gonna do with this, but I'm really glad we had this conversation. For one, I've just enjoyed it, but also I think. I love your brain so much, and especially like walking through the DSM changes. That was amazing, and just being able to contextualize this conversation with you. Um, I've really enjoyed this.

Donna: Me too, 100% always. Let's do this again.