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Ellie Greenhow

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Early concerns

As a family, we had always wondered if our eldest son was neurodivergent. We picked up on a few early signs, but we were never certain, as we often thought his behaviour was typical of boys - especially one who had endured the challenges of COVID-19 lockdowns.

ADHD was first suggested as a possibility by my son’s teacher when he was six years old. He had trouble sitting still in the classroom, was easily distracted, found it difficult to follow instructions, and fidgeted often. He would also steal Blu-tack from classroom displays so that he had something to fiddle with!  

We also noticed similar challenges at home, with my son finding it difficult to concentrate on daily tasks, showing frequent hyperactive behaviour, and having difficulty with regulating his emotions. However, we could not pursue a formal diagnosis until he turned seven years old.

Making this stage easier:

  • During this time, I found it helpful to have an initial meeting with my son’s school. Together, we discussed his challenges at school and implemented some strategies to help him as we waited for a formal assessment. For instance, he was allowed to have fidget toys to play with in the classroom to channel his excess energy more productively.
  • I also wrote down as much information as I could about my son’s strengths, challenges, and neurodiverse traits so that I had these ready for the assessment process.

The assessment process

When we first started the screening and assessment journey, I felt relieved that we may finally get access to the appropriate support for my son and have a greater understanding of his daily needs. When filling out the initial screening questionnaire, I had much greater clarity about how my son's brain worked. With each recognisable statement, things became clearer.  

My child's school also filled out the screening questionnaire, and together, these results enabled us to pursue a formal assessment. During the next stage of my son's assessment, we provided greater detail about his childhood and developmental background, as well as the daily challenges and signs of ADHD that he faced. Receiving a diagnosis of ADHD has enabled us to put the support mechanisms into place that our son requires.

Tips for navigating this stage:

  • Be open and honest with the medical professionals conducting the assessment, and don't be afraid to ask questions or voice any concerns you may have.
  • Remember that you know your child best, and your input is invaluable in forming an accurate diagnosis and support plan.  
  • Find out as much as you can about ADHD and the assessment process. By staying informed, you will be better equipped to advocate for your child and make important decisions about their treatment.  
  • Be accurate and honest when filling out assessment questionnaires, and use past documentation, if required, to jog your memory about developmental milestones.
  • Speak to other parents who have been through a similar experience for practical and emotional support.  
  • Work closely with your child’s school during the assessment process. Keep the school updated on the progress and any diagnosis or support plans that are put into place.

Talking to your child about their ADHD assessment

Explaining the ADHD assessment process to my son proved challenging, but we had always felt that it was important to keep him fully informed along the way. We had a conversation with him about what was happening and used age-appropriate and neuroaffirming language. We focused on the strengths and positives of his characteristics rather than highlighting any perceived weaknesses.

Based on my experience, here are some practical tips to consider when talking to your child about their ADHD assessment:

  • Start by creating a safe and non-judgmental space for your child to talk to you about their thoughts and feelings.
  • Use simple and plain language to explain ADHD and the assessment process to your child. The language you use must be appropriate for the age of your child.  
  • Always use neuroaffirming language when speaking to your child, focusing on their strengths and abilities instead of talking about “symptoms” and “deficits.”
  • Encourage your child to ask any questions and express any concerns they may have about the ADHD assessment process, and practice active listening as they talk to you.
  • Remind your child that you are there to support them every step of the way and that they can always come to you with any questions or concerns.

In my experience, speaking to my son openly about his ADHD has enabled him to become an advocate for both himself and his neurodivergent peers!  

Final thoughts

Going through the ADHD assessment process has given me the opportunity to learn more about neurodivergence and the strengths and challenges that come with it. It has also helped me to better understand my son, and shown me how to adapt my parenting style to suit his unique needs. Remember that the assessment process is designed to help your child receive the support they need, so try to approach it with an open mind and a willingness to learn.

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Clinical
Neurodiversity

Inclusive interviews: best practice

How to make your hiring processes more neuroaffirming.
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One of the biggest barriers for neurodivergent people entering the workforce is non-inclusive interviews.Interviews typically place an emphasis on conversational ability, social skills and body language. neurodivergent candidates often show differences in these areas and so reasonable adjustments need to be considered to give them a fair chance so reasonable adjustments need to be considered to give them a fair chance.

Organisations can get ahead of the curve by adopting an inclusive approach to neurodiversity from the beginning. Here are some tips to help your company to conduct more inclusive interviews to support the neurodiverse workforce.

Before the interview

To help candidates prepare and set themselves up for success before the interview starts, here are some things to consider:

  • Provide clear directions to the interview, including photographs of streets and transport stations.
  • Provide clear instructions on how to get into the building and where they need to go when they arrive.
  • Share any interview questions in advance and allow them to bring reminder notes.
  • Allow adequate time for replies during the interview.
  • Let them know the name and job role of anyone they’ll be meeting during the interview beforehand.
  • Provide a timetable for what will happen in the interview. For example, ‘we’ll spend the first ten minutes talking about you, then spend ten minutes talking about your technical experience’.
  • If possible, provide access to a quiet space where your candidate can avoid auditory, visual, or social stimulation before and after the interview if required.
  • Ask your candidate if they’d like to be accompanied by someone they know during the interview.
  • Ask about communication preferences. Some people might prefer to support their spoken language with the option to write for example.

The right environment

Neurodivergent people often experience sensory issues. They may be distracted by noise, lights, and the surrounding environment, so if you’re hosting an in-person interview, it may be beneficial to ensure the interview room is as distraction-free as possible.

Here are some suggestions for getting the setting right:

  • Provide a notebook in case your candidate wants to make notes. This can help them organise their thoughts when giving detailed answers.
  • Invite them to move around during the interview, or factor in short breaks, if your candidate finds it difficult to sit still for periods of time.
  • Don’t expect eye contact. Neurodivergent individuals may find this uncomfortable, or it may impact their concentration.
  • If possible, provide fidget toys or stress balls to reassure your candidate by making them feel more comfortable and to reassure them that you are neuro-inclusive company.

Fair Questions

Neurodivergent candidates may struggle with open-ended and hypothetical questions, and with switching between formal and informal tones. It may also take them longer to process questions. Quick thinkers can talk rapidly and get distracted, so they may stray off topic.  

Here are some suggestions when preparing interview questions for neurodivergent candidates:

  • Be specific with your questions. For example, ‘what information governance processes did you use in your last job?’ may elicit a better response than, ‘what would you do to look after people’s data?’
  • Consider asking focused questions rather than generalised ones. For example, ask for specific examples instead of saying ‘can you give more detail?’  
  • Be prepared to accept literal responses. For example, if you ask, ‘how did you approach your last role?’ you may get a literal answer like, ‘by bus and then I walked.’
  • Try to avoid long questions that contain multiple clauses. Your candidate may have difficulty focusing and waiting for the question to be finished, especially if they struggle with processing information.
  • Multiple choice and psychometric tests can be discriminatory. It’s much more beneficial to provide an alternative style of assessment.
  • For written tasks at interview, 25% extra time is a reasonable accommodation to allow for processing and answering questions.
  • Be prepared to prompt your candidate or repeat your question if you need more information, and let them know when you have enough information.
  • Ask the candidate if they would like any reasonable adjustments for their interview.  

Considering neurodivergent jobseekers is a shift away from old-fashioned thinking, where the interview process was mainly designed with ‘neurotypical’ candidates in mind. It’s important to understand bias and be aware that we can all function in different ways, and that performance in an interview does not necessarily reflect on how a person will perform in the role.

To make sure you retain your neurodivergent talent it will be necessary to apply these principles throughout the onboarding and retainment process too. Make sure your workplace is neuro-inclusive by offering continued support from the beginning of their contracted time with you, as well as beforehand during the interview process. This should include additional support for the individual through any required assistive technology, workplace adjustments, and by making sure that all your staff are aware of and understandneurodiversity and have inclusive attitudes from the start.

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Clinical
Autism

Understanding anxiety in autistic children and teenagers

How does anxiety manifest in autistic young people?
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What is Anxiety?

Anxiety is a natural part of life and something that everyone experiences at some stage.  

Characterised by a feeling of mild or severe distress, anxiety is the emotional response to a detected of perceived danger. This creates an innate drive to enter protective mode, otherwise known as the ‘fight-or-flight’ or ‘freeze’ mode.

How Do Autistic Children Experience Anxiety?

Autistic children feel many of the same worries and fears as other children. Although the way they display their anxiety can look a lot like common characteristics of autism – such as stimming, obsessive, ritualistic and repetitive behaviour, and resistance to changes in routine and environment.

Autistic children often worry or feel stressed about things that are less worrying for typically developing children, like disruptions in their routine or unfamiliar social situations.  

They can also have trouble recognising their own anxious thoughts and feelings and can’t always tell you that they’re feeling anxious. Instead, you might notice an increase in changes in behaviour.

What are the Main Overwhelming Factors that Result in Anxiety for Children and Young People in Educational Settings?

Sensory Sensitivities

Autistic children may have varying degrees of sensory sensitivities to their environment especially when it comes to structured environments such as school or college. Loud noises, unpleasant smells and bright lights can be over whelming for them, often leading to exhaustion which can trigger further anxious feelings about their performance in the classroom.

Changes in routine

There are multiple transitions in a child’s day that could bring on anxiety, examples can include changing out of pyjamas into school uniform, changing classrooms frequently throughout the day and transitioning from work to leisure mode at break times and home-time.

Socialising

The pressures of fitting-in and being socially accepted can be challenging for a young autistic individual. Lack of structure in the playground and pressure to join in with small talk can make breaktimes the most dreaded part of the day.    

Autistic children are more vulnerable to bullying, often learning to mask at an early age in order to appear ‘normal’. This can cause extreme anxiety for anticipation of bullying and can in turn take its toll on mental health and well-being.  

Self esteem

Feelings of failure about not reaching expected norms and potential can have a very detrimental effect on an autistic child’s self-esteem and exasperate performance anxiety. Being told to ‘concentrate’, ‘try harder’ and ‘overcome challenges’, that are part of a child’s autistic identity can be a burden and effect feelings of self-worth.  

How Does Anxiety Manifest in Autistic Children and Teenagers?

Understanding and recognising how anxiety presents in autistic children and teenagers is a great step to identifying anxiety triggers in advance and in order to give support. Anxiety can be communicated through behaviour, such as:

  • Avoidance of tasks.  
  • School and/or activity refusal – this may come in the form of verbal refusal, refusing to get ready, excuses such as feeling ill, or becoming distressed when approaching the school gate.  
  • The need to have control - of routines, the environment and people around them. Higher levels of control can help the person feel a greater sense of certainty and predictability.
  • Obsessive, repetitive or intrusive thoughts also known as obsessive compulsive disorder (OCD).  
  • Repetitive self-stimulatory behaviour - hand movements, vocal noises, ticks, pacing or jumping around are important self-regulatory activities that can help soothe anxiety. It is important to be accepting of this behaviour even if it looks different to the norm.
  • Meltdowns – these can be a result of the amount of energy used throughout the day at school in order to appear normal and to hide any anxious feelings. These meltdowns typically occur on the return home and can be likened to a bottle of an extremely fizzy drink, which, once opened explodes.  
  • Shutdowns - when children turn their anxious energy inwards. The child may become withdrawn, passive, quiet or struggle to make decisions.  
  • Aggressive behaviour - autistic children may express their anxiety and fear through acting out physically. Aggressive behaviour becomes common when a child is in survival mode, doing their utmost to escape a scary trigger.  
  • Self-harming behaviour - self-injury can take many forms, such as hitting, scratching, biting or cutting.
  • Difficulty with concentration and a lack of readiness to learn new skills - when children don’t feel safe and secure it is hard for them to maintain focus on an activity.
  • Bedtime refusal - heightened stress hormones impede sleep hormones. In addition, stressful events can affect sleep by increasing the number of nightmares and night terrors.  
  • Separation anxiety - many autistic children form deep attachments to a caregiver, the separation from whom can often cause distress. In a school or nursery setting a child may feel less engaged than others due to being distracted by worrying about when their attachment figure will return.  
  • Eating disorders - especially in girls, anxiety can trigger eating issues often driven by a need for control. There are strong links between autism and anorexia. 

Recognising and Understanding Behaviour as Communication

It is important to recognise that self-regulatory behaviours are an autistic child’s way of trying to communicate, and that it is important to not reprimand your child for what may be perceived as ‘bad behaviour’.  

Behaviour is a form of communication and recognising and understanding your child’s unique way of communicating can help you to foresee and avoid difficult situations and triggers, and to enable your child to have an easier time in the classroom.

You can work with us and your child’s teachers to put in place any required reasonable adjustments to make sure their school day go as smoothy as possible. Our dedicated team can offer advice and support on how to communicate with schools and local authorities, and to help alleviate your child’s anxiety in the classroom.

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Neurodiversity
Clinical

Neurodiversity and executive function

A deep dive into executive functioning.
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When executive functioning is compromised, there can be challenges in planning, prioritisation, organisation, impulse control and staying on task.

What are Executive Function Challenges?

Everybody is different in their executive functioning strengths and challenges, and neurodivergent individuals can have very varied ‘spiky profiles’  

People may have challenges in relation to the following areas of executive functioning:

Initiation:

  • Getting going - especially when initiating uninteresting tasks. This is referred to as inertia
  • Procrastination - getting past thinking about the task to doing the task
  • Poor time management - not being able to foresee how long a task will take  
  • Thinking you need to do something but not remembering what it is.

Working memory:

  • Like a computer scratch disk - allows you to hold information in your mind while making links.
  • Challenges with short term memory - remembering what has just been said or remembering a sequence
  • Processing different streams of information - like listening to someone while remembering you need to remember your keys, for example.

Emotional and impulse control:

  • Not having internal prompts to remind you what task you need to do next, in order of importance  
  • Getting frustrated at yourself for forgetting to do important things, especially when others see you as lazy or incompetent  
  • Difficulties regulating alertness to complete hard tasks when the interesting parts have been done.
  • Finding it hard to shut off your busy brain which can affect sleep patterns
  • Experiencing RSD (Rejection Sensitive Dysphoria) which can be extremely debilitating  
  • Being impulsive and not considering the context  
  • Difficulty adjusting and graduating your pace, or changing gear. This can lead to an all or nothingmindset.

Focusing:

  • Challenges sustaining focus
  • Difficulties shifting from one task or topic to another  
  • Slower gaining information and losing focus easily

Hindsight and foresight:

  • Harder learning from past experiences and then repeating the same actions again and again
  • Difficulties with predicting future challenges

Time awareness:

This has been called “time blindness” by Psychiatrist Russell Barkley

  • Remembering to put appointments into your diary
  • Allocating the appropriate time to a task
  • Splitting a task into parts and recognizing how long each will take

Developing strategies to make everyday life easier

The good news is that once we recognise our executive function challenges, we can develop strategies that reduce the negative impact to help make everyday life easier.  

You may already have some personal strategies in place. Here are some that might be helpful if you haven’t already considered them:

Check your barometer  

Throughout the day check in with yourself. How are you coping? Do you need to take time out? Do you need a drink or something to eat? When we are tired, hungry or overloaded it can make it harder to manage new information or juggle multiple tasks.

Minimize clutter  

Make sure your workspace isn’t too distracting. Separate similar items into groups.  Use colour coding and visual prompts to help organise information on reminder charts or visual diaries.

Visualise and prioritise tasks

Use a wall-planner that visually highlights appointments, deadlines and daily tasks. Use colour coding to prioritise tasks. Create a list of actions at the beginning and end of each day and mark priorities. Carryover lists to the following day.

Take regular breaks

When in hyperfocus mode it can be difficult to remember to take a break which can lead to burnout, and if atask is uninteresting, it can be difficult to complete. Try the Pomodoro method to improve concentration. Work for 10 minutes then take a  5-minute break and increase the time if appropriate.  

Break down overwhelming tasks

If a task feels too big to handle break it down into small parts using the Kan Ban Method where you can break down large tasks visually into small parts, on post-its. Remember to congratulate yourself as you move forward, however small it is.

Make it more interesting

Try to automate ‘boring’ tasks and choose some pleasure stuff after more tedious tasks.

Increase dopamine levels

Choose some music that helps you to focus. Take regular breaks, you could even try dancing around if you feel stuck and try again.

Reminders and alarms

Use timers and set alarms to remind yourself when your deadlines are. Put all tasks and appointments into an electronic diary as soon as you know about them. Set reminders before the deadlines rather than at the deadline itself.

See the bigger picture

Try and gain an understanding of how all the different aspects of work link together in a  project or assignment. If you work as part of a team understand how your work links with others.

Supportive software

There are various types of software and apps that can help with planning, organisation and processing.

For example, Mind-mapping software, such as Inspiration and Mind Genius may be useful to map out ideas and workflow effectively or using text-to-speech and speech-to-text software could help speed up the processing of large documents.

Setting various reminders and alarms on your phone can be useful too. For things such as appointments, it can work well to set a reminder for the day before, then an hour before, giving you time to plan if necessary.

Be kind to yourself

It is not surprising that these differences can often impact on other factors such as self-esteem, energy levels and base level stress. Gaining an understanding of ourselves and the reasons why we find some things more difficult can really help in the management of this.  

Some days will be harder, or you will feel less motivated, and that’s ok. Practice your strategies and remember to always be kind to yourself and find what works for you.