Transcript for:
Reframing Therapy for Autistic Individuals

Hello, it is such a pleasure to join you to talk about my work and reframing therapy. It has been a passion of mine ever since I started listening to the experts, which are autistic individuals. I can say that I've been an occupational therapist for 30... four years and really had a fundamental shift in my perspective when I had a chance to sit down and interview in the late nineties, um, autistic adults, both who were speaking and non-speaking and had various ways of communication.

And I had been working in the area of sensory processing prior to then, and knew that sensory issues were important, knew that they mattered, knew that we as therapists, um, had information that we could share, but we were coming at it from an expert. kind of view of even fixing, right? Fixing the problem and seeing how we can fix and change it and making more normalized behaviors, I would say. Most of the therapy community that I was in definitely was thinking about.

And then I had a fundamental shift in my perspective when we did do these interviews. And we learned so much as to what therapists were doing wrong. And we were doing a lot of things wrong and we still do a lot of things wrong.

So what I hope to share with you are ways to reframe it for therapists. And if you're a therapist listening, just do different from after you have information. When you know different, you do difference at Maya Angelou. And so hopefully you are knowing different by listening to autistic individuals and learning from them and changing your practices that I would say at a minimum are are misinformed at times with a deficit model and at the maximum are harmful.

So let's go ahead and get started. The title of my talk is Reframing Therapy, Embracing an Authentic Strength-Based Paradigm Shift because I think we have to shift. And I'm going to lead with my strength.

I think everyone should lead with their strength. And I have said this over and over again, but I think it's probably one of the most powerful ways for therapists to look at this is that we spend all of our educational programs learning how to... remediate weaknesses.

Our K through 12 system in the United States spends an inordinate amount of time doing goals to remediate weaknesses. And I think we all have to realize that not one of us, not one of us as a therapist, not one of us as an autistic individual, no one, no one builds their life on their remediated weaknesses. Yet we're asking a group of individuals that are in treatment or in therapy to work real hard to remediate their weaknesses. That is the wrong model. It's a model that really has to change and shift in collaboration with stakeholder engagement and partnering with autistic individuals.

So how do we change that? How do we actually help build a life if you don't build your life on our mediated weaknesses, right? So how can we fundamentally shift the lens that we use as therapists in partnership with learning from experts that are the autistic individuals themselves?

I think it's going to take a lot of work. I think it's going to take a lot of work to really look at what our expectations are, but also it's easy once you realize that you're asking people to do the impossible as a therapist with the bias that you bring and the assumptions that you bring. We'll talk about professional bias later, but Lawrence Carter Long is a wonderful self-advocate with cerebral palsy, has cerebral palsy, and he really, I think, sums it up well that We, you know, in order for people with disabilities, all disabilities in the therapeutic, and I would say medical community, they have to overcome their conditions, right?

We talked about they do something in spite of, not because of, and it's just a fundamentally wrong perspective to have. Because that means that person must strive to be as normal as they can, meaning not disabled, which he calls the impossible, which it is, it's the impossible. And...

Success is not determined by the person's achievements, skills, and talents, but rather by the disabled person's desire to become like non-disabled people. That is not success. That is a skewed view of how any practice and any engagement should go. But I still think it is in the minds of parents.

It's in the minds of mostly parents, a lot of parents, and also a lot of professionals that say, can you make my child normal? Can you make them less autistic? Can you make them not flap? And we really have to think about kind of who does that serve?

That serves the professional community, right? It gives us jobs. It gives us a purpose.

It allows us to put our training into practice. But we know fundamentally that it does not serve individuals that are autistic or neurodiverse. So we've really got to question that assumption at all times and ask yourself, am I doing this? And I think, you know, right from the start, this is Donna Williams quote, who all of you, I'm sure all of you know, but this is where it all, it all goes off track when professionals are the ones that are judging the condition, the condition from the outside and not having in-depth knowledge of how it's experienced, you know, and as more autistic advocates have come to the forefront and say, this is how I experienced the world and more and more therapists are listening. We've got to move beyond that too.

Not only this is how I'm experiencing the world, but accept it, modify expectations, and work with me, not against this, not just have an awareness of how I experience the world, but fundamentally as a professional serving this community, change your practices. Change your practices, which I'll get into later. And I want to give an example to you of a typical therapist reaction.

So this is... An individual that has auditory hypersensitivity, right? They can hear people whispering to rooms over from school. They can hear their family talking when they're upstairs.

They were sitting right next to them. So can hear airplanes and helicopters overhead. So when I do this presentation and this part of this presentation to a group of therapists, what I'll say is now imagine what rain means to this person.

You know, and as therapists, we are all in the mindset of... oh, auditory hypersensitivity, this must be a problem. We know sensory is a problem. So we quickly switch into the mode of how do I fix this? Or we quickly switch into the mode of all sound must be painful.

So when I do this and I tee it up in a live workshop, I get things like, it must be chaotic. It must be really uncomfortable. It must be frightening. It must be unbearable. And all these words that are laid in with our value judgments about sound and the experience for that individual.

And I invariably encourage all those negative words and all those, those atypical words, because then I think when I show this next slide, which I'll read, it really does, it has, it should unsettle you as a therapist that you're making some of the wrong assumptions. So rain means different sounds, sounds out of the ordinary of daily and sounds that are utterly fascinating. I've heard people say that no two snowflakes are the same.

Well, I can also say that no two rainstorms are the same. They each have a distinctive sound. It's like a symphony and it's delightful.

Rain falling on a flat roof sounds different than rain falling on an angled roof. Rain hitting windows of different thickness makes different tones. I can almost hear the glass ringing with the sound. The way the wind blows absolutely changes the music of the rain. Overall, it is a wonderful sound that I wish I could share with others.

And this is from my dear friend, Paul Kotler, who's non-speaking, who types independently to communicate. And he did have a blog, which I listed below, but he hasn't been active because he's very active being a college student right now, getting straight A's. But you can see how if the therapist's perception is deficit, deficit, deficit, you're going to find them and you're going to miss the inherent strengths that you may not be thinking about just based on a diagnostic criteria.

We had another self-advocate. rewrite the DSM-5 for us. He's written, and it was in an occupational therapy practice guide that my colleague Scott Tomchek and I wrote.

And he rewrote them all, but I'm showing you sensory just to kind of highlight since we're talking about sensory. But what Nick did is he kept the DSM-5 definition, but he rewrote it by adding in the red, which you can see on the right-hand column, right-hand column to me. And what it does is it gives a more nuanced view of sensory so that it's not just sensory challenges, but it's sensory experience and a nuanced sensory experience and sensory reasoning, right? Like here are the reasons why. And why is this useful?

Why is this interest in sensory aspects of the environment, for example? And he talks about they may be useful for gathering information or may provide coping strategies to handle sensory and emotional stimulus. That is important to know. That is not in the DSM, right?

And so we have these diagnostic criteria that lay it out, but what's missing, fundamentally missing, is what Donna Williams talked about, that experience from within. And then that next step of, as a therapist, once you know this information, what then becomes your role? And what then becomes your role as a partner and a change agent and really working not to change the individual.

but to change the systems that really do make things challenging. And changing the systems goes well beyond the medical model. Most therapists, I love it.

This is on the back of like a cardboard box. Liz Jackson, criticalaccess.org. If you're interested in her work, I would highly recommend you taking a look at it. It's on the bottom of this slide. But most therapists are training this medical model, right?

Which is the top one, you know, where it's the professional as expert. It is problem focused. It is something that is about making you, and you talk about indistinguishable from your peers, right? That's a very medical model, normalization framework.

The social model is better, right? So the social model says, no, the disability doesn't lie in me, it lies in this environment. And it's a social model, you know, barriers are remain, the barriers are what are the problems. So, you know, in a physical disability standpoint, it's those curb cuts, you know, and we have to make wheelchair access on our sidewalks.

For individuals that, for autistic individuals, it's how do we, how do we fundamentally change the barriers in the social environment? Are there barriers in the social environment? Are there barriers in the sensory environment? Can we do modified practices? But that only works if people act and are committed to that.

You know, I think the cultural model, which is the more nuanced model, blends these and talks about, we center the expertise. On self-advocates, we center the expertise and it's a much more complex model that recognizes the barriers that have to be addressed, but also is really led by disability publications, disability rights, disability justice, recognizes intersectionality, which I think is where these disability models will go. You need the medical model, right?

It's not that we're saying don't get rid of the medical model. When you are sick, When you are, with all experiences, pandemic, you know, I had, my son had COVID. I wanted the medical model to respond, you know, to that medical need.

But when we're talking about differences and challenges that a person is, makes up fundamentally who that person is, it's not something that, you know, they carry with them. It's who they are as an autistic individual. We've got to be more nuanced than a medical model or a social model.

So where do we begin? Well, I think we've got to adopt a strength-based approach in all areas, teaching, research, and practice. And the only way professionals and therapists are going to do that is by partnering.

And by partnering with advocates in research to ask more relevant questions. I have autistic researchers and autistic advocates on all my research teams and research projects central to that project, not as an advisory board member, paid for their work on that project and paid. Well, just like any other research member team, we also partner with advocates in teaching. If my students in occupational therapy are learning about autism, they're not learning about it from me.

They're learning about it from my autistic colleagues that we are adjunct professors at my university and we work very closely. And then partner with advocates in practice, which is the practice of therapy, right, to serve more relevant needs. And I think that even if we do all that. therapist will have a neurotypical, non-autistic professional bias. It exists and we have to be very aware of it, which we'll talk about in a minute.

So there is this call to shift. As a researcher, I have shifted my perspective as well. My work is not about studying autistic deficits. It's really looking at how autistics learn and succeed in natural settings.

We avoid language that frames autism as a defect. I avoid and do not use high functioning, low functioning. I don't use nonverbal because I think in a... the therapy community that comes with a lot of ties to cognitive deficits, which we have to break that stereotype.

Nonverbal, when you say nonverbal, therapists will instantly get some assumption in their heads that we know can be, again, dismissive and harmful at the same time. So I really want to work on our language. And I put this up because even research. Even this was at INSAR and Kat Hughes kind of highlighted this. So I love that she pointed this out.

But, you know, even when you do research and when you start to read research this way, you will find this over and over and over again as you read research where there is a finding that is counterintuitive to the non-autistic researchers bias. For example, autistic teens are more positive and involved during conflict with parents than non-autistic teens. That's what they found in the research.

So you could look at that and say, perhaps it's a strength of autistic teens. You know, they're very involved during conflict. What does that mean? What does that being more involved during conflict mean?

From are they more interested in justice? Are they more interested? You know, and you could go in that direction, but you can see what this researcher did. They framed it as a deficit based and said, well, if they're more involved in conflict and more positive, then something must be wrong with them because they're not a typical teenager.

Again, comparing it to that that typical normative standard. versus looking at it from the perspective of, as a therapist, wow, that's really something we can build on. That's really good.

And as Kat pointed out, could it maybe be, I don't know, positive? Why is difference always a deficit? And there's not intellectual curiosity around this in the research community when finding like, because you're looking to frame it in your biased perspective of how you view autism. And that has to change. So when we think about authentic change, we want to think about, can we develop a strength-based intervention designed to enhance an individual's causative qualities and support areas of challenge rather than an emphasis on eliminating deficits for normalization?

When I first talk about strength-based practice to therapists, they say, well, insurance, in America, insurance won't pay for it. And how will we do it? And I think that, and we've got to focus on these challenges.

A strength-based practice is not about ignoring challenges. You know, I think that's the therapy community can have a powerful relationship with the autistic community by partnering with them in these areas of challenge, whether it be mental health issues, anxiety, sleep issues, sensory issues, and supporting those with our knowledge base. But it's got to be paired with a practice that really does recognize value and grow strengths that really will support long-term outcomes and quality of life.

I mean, we have a K-12 special education system that focuses on deficits. Our individual educational plans are around what the student can't do. And they go K-12 with those IEP meetings. Here's what they can't do.

Here's what we have to work on. And then we wonder why our post-secondary outcomes are so poor from a standpoint of jobs. housing, friendship, however you view quality of life as an autistic individual.

Imagine if you spent, which many of you I'm sure have experienced, spent most of your school career focusing on things that you didn't do well in order to fit into this normative model and move towards that normative model. I couldn't do that. I'm allowed to specialize in my interest as someone that's not autistic.

Yet we have this model that says you must be more normal. And it's the only area I think we do this around disability. I could be wrong, but I know I don't ask someone that is blind to see more like me. And I don't ask someone that's a wheelchair user to walk more like me. But with neurodiversity, whether it's autism, learning disabilities, ADHD, some of the mental health issues, we ask children, adolescents, and adults to be more like me from a behavior standpoint.

point. And there's something fundamentally wrong with that, fundamentally wrong with that from a therapeutic standpoint. So can we replace the staff set lens in which competence is the bias?

And I'll give you two examples. So I'm in New York City. Here's the 7 train.

We have a first grader that talks about, we have lots of kids that talk about the subway system all the time. The subway system in New York City, if any of you have been here, is wonderful. You can gather so many facts, so many roots, so much information.

And we do have a lot of kids that really love the subway system. You know, therapists can frame it and how therapists are going to frame it is going to matter, right? Once you decide to frame it one way or the other, you're going to go that direction. So we can frame it. He's obsessed with the subway system or he, it's a special interest area that we can foster.

And you can see the consequences of that. If you're, if you're framing it as a pathology, then you're going to reward him when he does not talk about the subway. You're going to try to eliminate subway talk.

You're going to spend way too much time, you know, same with self-stimulant. behaviors and flapping if you view them as something that is not useful to you as someone that's not autistic without understanding how useful they may be to the person, to that autistic individual that you're supporting. So framing matters, whether it's a first grader who talks about the subway or a non-speaking adult that likes the sound of breaking glass.

You know, this was an individual that I worked with that, where I was consulting, they viewed it as very maladaptive. It had to be extinguished. They would. punish, withdraw privileges whenever he would break things.

When we flipped it and said, all right, there's something very positive about the sound of breaking glass for this individual. He was very positive emotions when he broke the glass. It wasn't, he wasn't distressed.

So we actually, you can use that interest to foster hobby. You got to break glass for mosaics, right? You can think about other ways that you would need to break glass.

As far as different hobbies, we got him a job at the recycling center and we use this interest area. He would throw the glass into the big recycling bins, which gave him a big bang for his buck, right? That sound of breaking glass was all day. That was his job. And then when he went home and he did live in a supportive housing situation with other individuals, he wasn't breaking any glass.

It was his job to break glass, you know, and he did it very, very well. And he was very satisfied, you know, and I think that how we frame things really determines how we're going to, how we're going to interact with our, with those that we say we're supporting, say we're supporting. I want to give you an example in some research that we did, restricted interest versus interest-based. You know, professionals on the left-hand column, this is the professional research, right? You know, we call them restricted interest.

We call them repetitive interest. And we label them as being bad. They have a high degree of interference, low degree of flexibility, lower interest in involving other people versus they might serve a very different purpose. purpose than professionals think.

And I don't have to tell you as autistic individuals that they serve a very different purpose than what professionals think they serve. Professionals have gotten this so wrong. So you can see on the left, all this, all this research was done by asking parents and teachers, never asking autistic individuals. So we did a study where we ask autistic adults, and this is just a snapshot of some of the findings. And you can see that, uh, they felt strongly teachers should incorporate preferred interest.

And that was, we did a focus group with autistic, um, advocates in conjunction with this research about what they should be named. And the preferred interest was the terminology that was settled upon. Um, and you can see that their teachers did not at a very high level. So there's this huge mismatch, right? Um, I'm sure a lot of you have experienced as well between what teachers think should happen and, or what autistic individuals think should happen and what actually happened in their classrooms.

And Our research participants did not view interest as problematic at all. When you look at the list, you could find literature to totally support how problematic these interests are in the classroom. And it simply was not the case.

They were viewed as calming, positive, not anxiety producing. Yet we spend so much of the effort. in classrooms and working directly with individuals to eliminate or to reduce their focus. Because it's got a different depth and breadth of intensity than I do, we view it as wrong versus that depth and intensity. How can we utilize that and partner with that individual to make sure that they can follow those interests that are inherently valued in the classroom, in work settings, et cetera.

So, you know, There's a lot of excuses that therapists give not to embrace a strength-based practice and insurance won't cover it. I'm paid, trained to remediate weaknesses. I have to find deficit areas. How do I write goals? What would I do for intervention?

And I'm going to quickly go through some of that, but it really is about, I can try to persuade you as a therapist who has changed their mind. I now am a, I'm a professor at NYU and I'm a vice dean now and the classes that I teach and the work that I do. are all about partnering with autistic individuals to change therapists'minds.

So I am all about giving you information to think about it again and think again. But ultimately, the person that's most likely to persuade you to change your mind is you. And you get to pick the reasons that are most compelling. To me, one of the most compelling reasons is no one builds their lives on remediated weaknesses. So we fundamentally have to, have to examine our practices.

And it starts with our evaluation. Here is every evaluation report. And here's the problem. We, we, we layer it up with problems and then we say, okay, there's, we give a token nod to strengths that really are not about strengths, a strength-based practice. It's about a token nod to strengths that really is not about understanding what that person is fundamentally good at.

And a strength-based practice for therapists has its roots in social work. And the problem is. problem orientation generates more problems and the problems will dominate more. You'll mask the areas of strengths.

And ultimately it looks like an exercise that meets the needs of professionals rather than those of who we are working with. And I want you to think about that if you're a therapist, that problem orientation meets your needs more than it meets that individual's needs. Strength based practice has its roots in self-determination theory.

There are three core psychological needs. So we all have this need to freely choose things in life and not be controlled, to do things that we're competent in, that we want to initiate and make a stretch. And we get to determine what close relationships we have with others.

And an environment that fosters self-determination is critical. And there's been a lot written on self-determination. So I'm not going to go into this at length, but I do want to point out how we know that autonomy is obstructed by the controlling use of rewards. And we know that many paradigms of intervention and therapeutic intervention have the controlling use of rewards.

So my advice to you with that is stop it, stop it. Um, there is nothing, uh, there's no long-term benefit to growing up. with someone controlling everything you care about and your interests and doling them out when you do something like they want you to do and really sets up a dangerous situation about agency and lacking agency. I wrote a chapter where we have function dysfunction.

I don't like those names, but in this book, it's all about function dysfunction of the child, these pediatric frames of reference. I turned it around and said, no, actually the function dysfunction is about the therapist. So what can a therapist do to be more functional? Well, they can provide intervention that supports the development of autistic individuals'goals and interests, period.

Dysfunction is you don't do that. So function would be using assessments that identify those interests. Once interests are identified, develop goals and use interventions around those interests. Use multiple means of engagement to develop a communication system. This is one slide around interests.

I kind of, I layer this in all areas around. confidence, autonomy, et cetera, in the book. I'd be more than happy to send the chapter if after this presentation, if you want it.

Um, and then facilitating autonomy by offering choice, um, that incorporate interest. So this is taking that idea of interest and applying this function, dysfunction, continua, but flipping it back on the therapist function or dysfunction. We have a lot of dysfunctional therapists out there.

Um, Paul Kotler, who you met in the rain, um, he is the rain. Um, he also writes that expectations should change. and doesn't feel we've been creative enough as a society to come up with ways to integrate people with autism without setting impossible expectations.

Access and visibility can show their potential. So how do we get more access and visibility? And how do we change in ways that are fundamentally allow for that individual to engage in ways that are meaningful to them? And I think after we assess and we actually get a view of strengths and we start to write goals as a practitioner and what do our goals look like who is this goal meaningful for who does it serve is it for normalization or is it for society's comfort and if it's for society's comfort and normalization then you're doing it wrong period you are doing it wrong so um we need to think more about inclusion, access, belonging when we're writing goals.

And writing goals in partnership is going to be fundamental to a strength-based practice. Okay, so that's the goals and really thinking about these goals. And I think that as practitioners and therapists, as we think about our assessments, as we think about our goals, that's a start.

Because our assessment and goals are going to drive interventions and supports. And I think we also need to think about this idea of interventions versus supports. And can we shift this perspective to... supports, offering supports.

Intervention is so tied sometimes to that medical model of fixing and remediating. So think about it in terms of supports in addition to rethinking your goals. I think we've got to recognize if you're not autistic, you have a non-autistic bias. And if you're a professional, you have a professional bias.

A professional non-autistic bias is very different than a professional autistic bias. And I think the bias comes out, even with the... best intentions, right, that I'm going to be mindful of this, and I'm going to try to be strength-based. We're currently working on this study, my colleagues and I, taking that information about, hey, teachers should use these, but no, teachers don't use our strengths and interests. Taking that research and extending it to a survey that we did for teachers and therapists to really look at, well, how do you use these interests?

And on the surface, When answering kind of qualitative questions, they talked about, oh, of course I use strengths. Of course I'm strength-based. But then when we probe deeper and said, well, how interfering are these? you know, or how helpful are these in your classroom?

A worrying pattern comes across. And if you could look at this slide, sorry, my apologies for the data being so small, as I look at it, but, you know, we want, we want teachers and therapists to use interests and things I care that autistic student cares about for everything, right? But you can see that this is slanted towards using those interests to address challenging behavior.

which gets back into that controlled use of a reward, which we know impedes autonomy, that controlling use of a reward. So I'll use it to help you with your challenging behavior, but I may not use it to help you learn academic content, which is that top green arrow. For the personal development of the student, which is that second to the bottom green arrow, for the peer relationships, those areas where we say, wow.

What an amazing way to use interest. And we do that for non-autistic students. Why don't we do that for our autistic students? You can see the rates are much less. They don't find them as helpful.

They find them more interfering. The ways they find them helpful are to address this challenging behavior, which is that red arrow, or to calm and soothe themselves, which is not a bad thing. But only if that's where you're bringing those interests into the classroom, that is a bad area. It doesn't really respect the inherent value of those interests. I'm sure you all know about Damian Milton's work.

I think that what he has done with the double empathy problem or the theory of double empathy is really challenged not only researchers, but also practitioners and educators to really frame this conversation from a fundamentally different perspective. You know, that it's not about that non, that autistic person can't understand that non-autistic perspective. It goes both ways.

And we see that powerfully. We see that as a non-autistic therapist, not being able to understand that autistic individual that I'm supporting. I want that autistic individual to understand my perspective, my theory of mind, my way of being, but we never go in that other direction as therapists.

We push towards this way. We push towards this normalization. And it's a real breakdown. It's a breakdown in empathy.

It's a breakdown in reciprocity and mutual understanding. I think a couple of examples of this, this is, I think, is such a good example. It's the telephone game. This was presented at INSAR.

I'm not sure if the author, Sue Fletcher Watson and Catherine Compton have published this yet, but it's the telephone game. And, you know, our assumption is that if you had social deficits in social communication, you would see them everywhere with everybody, with anybody, right? If it's a fundamental part of the diagnostic criteria. In the telephone game where we're asking people to recall details and tell details, it's the mixed group that does the worst, that autistic to non-autistic, autistic to non-autistic in a chain.

And the autistic individuals to autistic individuals actually perform the best. We also saw this in a recent paper that my lab did with Yu-Lun Chen, who's my recently graduated doctoral student, in a maker club and looking at a club in an inclusive setting. with about seven autistic, seven non-autistic students, and in a highly preferred activity, you know, and I really believe that therapists should stop doing social skills groups and just do interest-based groups and have more opportunities for real meaningful belonging at schools. But in this research, we found the same thing the telephone game did.

The best communication, the best social communication, quality, quantity was autistic. to autistic adolescent in these inclusive settings around their interest. And so I think we've got to really think about how we're, well, we know we're researching the deficits, but how can we shift that to support then intervention supports that therapists are using? And I want to finish with just two, two brief slides, you know, and Paul Collins did not even wrong. I think this is a, this is what therapists do.

You know, we try to pass that. And I don't like necessarily the square peg, round hole analogy, but I think the most important part of this is that you're destroying the peg. It's not that the hammering is hard work, it's that you're destroying the peg. So what are therapists doing with all of our interventions that seek to normalize or make goals based on society's comfort or make goals and identify problems that serve me as a professional versus the person that I serve? You know, as a therapist, I have been very lucky.

to be able to do this. This is a Japanese word that means that you do what you love, what you're good at, what you can be paid for, and that which the world needs. And that's rare.

And it's wonderful. And I feel so honored to be in the profession that I'm in. And I feel this way as an educator as well.

But we don't apply this, which I think this should be a standard, right? And you may not hit them all, you know, and you can see profession, passion, mission, and vocation. But we don't really extend this framework to those that we serve with disabilities and those that we serve that are autistic. You know, we say, no, you can't do something you love because you're too focused on it.

Or we don't spend those 12 years in school working on things that you're good at. which is that left side, right? We tend, we work on things that you're not good at, and we've gotten it all wrong.

And I go back to, you know, when you realize that, and you know that, then you have to, have to, have to do different. So I just want to, in closing, say, thank you so much for having me as a speaker at Reframing Autism. I am so honored, and I will honestly say, knowing that I was one of the few non-autistic speakers, the graciousness with which I accept this invitation and knowing that I've worked very hard to earn being an ally, I can't thank you enough for having me here and presenting today. So thank you again. Please feel free to reach out to me.

I would love to hear from you and love to stay connected on social media. And I really wish you a wonderful, wonderful conference. Thank you.