RWYH 5

Episode 5 Transcript

Inside Neurodiversity with Dr. Lynette Lau and Dr. Lauren Maltby

[MUSIC PLAYING]

Lauren Maltby:
You can't ever make it so that it didn't happen, but you can make it better than it would have been because you were there.

Lynette Lau:
So much of what we deal with is invisible. Change is messy and hard. It takes time.

Aimee Hanna:
Hey, y'all. Aimee here. I'm the producer of Remember Why You're Here. And I am super excited for today's episode because we are speaking with one of three incredible presenters Dr. Lynette Lao who will be at our pre-conference happening in January 2024 as part of the International Conference on Child and Family Maltreatment at the Chadwick center in San Diego.

Also joining us today is one of our long time trainers and dear friend Dr. Lauren Maltbie. CIR's pre-conference named Building Cultural Competence to Serve the Whole Child and Family will help you build an action oriented and intersectional foundation that will serve you through the rest of the conference with confidence to see beyond trauma. To register for the special event, visit the link in the show notes.

Dr. Lynette Lau is a licensed clinical psychologist specializing in trauma informed systems of care and has extensive experience working with marginalized communities and foster care and leads initiatives for inclusion, diversity, and equity at Harbor-UCLA Medical Center. Dr. Lauren Maltbie is also based at the Harbor-UCLA Medical Center and has a strong educational background in clinical psychology and a wealth of professional experience, including roles as a licensed child psychologist and a supervising forensic psychologist. She has presented and trained on a range of topics in the field, including trauma treatment and child behavioral disorders.

Lynette, let's start with you. What do you currently do?

Lynette Lau:
So currently, I am still involved in training, and I recently got promoted in the program. So I used to be just a line item psychologist involved in seeing clients in our outpatient clinic, training pre and post-doctoral students in psychology. I've been doing countywide trainings in best practices for the birth through five population because I have specializations in infant mental health and early childhood mental health. So those are the things I used to do.

And since my promotion, I think I've taken more of a larger programmatic stance. So I'm straddling both the child and the adult clinics, outpatient clinics now in terms of thinking about process and procedure, streamlining things for access to care for our patient population who might call in for services while still doing a bunch of training.

Lauren Maltby:
I am the supervising forensic psychologist at Harbor-UCLA Kids Hub which is in the Department of Pediatrics. We are a multidisciplinary teen center, a hospital based MDT. So we conduct forensic interviews, forensic medical exams in cases of suspected child abuse.

But our clinic also provides medical care for newly detained youth, and then I also rotate in a clinic for prenatal substance exposed infants and youth, providing some psychological assessment there and then some support consultation and liaison. And then I teach and train forensic interviewers both at my clinic, but also throughout the state of California with CIR, which has been such a joy over the years, and have recently started doing more expert testimony. So I provide expert testimony about CSAS or Child Sexual Abuse Accommodation Syndrome.

Aimee Hanna:
Lauren, tell us about a specific moment that inspired you to stay with your journey.

Lauren Maltby:
So I actually started my work in child maltreatment in 2008 when I got a position at Harbor-UCLA in the Child Trauma Clinic as part of my graduate training. I was supposed to be there two days a week. And I was a little bit panicked about starting. I was like, I don't even know if I like kids. I don't know what to do in a room with a kid.

And it was such a meaningful year of growth. I still remember the very first kid that I met with. I still have a little photo album thank you book that he and his mom made for me. And that year, I got a couple of other opportunities outside of that sort of formal training program that really moved me and I would say probably are part of an aha moment of like I do want to do this work.

Our clinic director had been contacted and looped me in as well for a family where there had been a homicide within the family. And we had to tell two of the children in the family about the homicide that had happened and the subsequent incarceration and some other difficult things. Their caregiver was not able to do that for them unfortunately. And so I remember driving to the hospital that day and just thinking like, what am I doing, who signs up for this, this is awful, this is just awful.

And then remember kind of thinking, it seems like there's sort of two responses to trauma as a helping professional. Either you move towards it or you move away from it. And I just remember thinking or noticing I want to move towards it. I find myself sort of seeking out opportunities to be more involved in some of these really painful moments.

And after that day, I remember being pretty tearful after that session with the family. And my supervisor at the time, I remember her telling me, you can't ever make it so that it didn't happen, but you can make it better than it would have been because you were there. And that has always stuck with me as kind of a guiding principle that you can make it better than it would have been by your presence.

Aimee Hanna:
That's really inspiring. And Lynette, what about your journey and your aha moment?

Lynette Lau:
So I took four years off between undergrad and grad school, trying to decide what I wanted to do for my path. Somewhere along the line, I got really interested in brain science. And so that's what I do now is I became really interested in understanding how brains work and how that expresses itself in behavior.

And I think on some level-- and I discovered this in the middle of grad school when I was like I feel like I am maybe not catching everything that's getting said. And so I went to my student counseling services, and I got diagnosed with ADHD in, I think, my first or second year of grad school, and so like, oh, this makes a lot of sense now. But in this is very ADHD way, all these areas of interest kind of just converged.

And then I would say towards the end of grad school and actually, yeah, after I graduated, I started getting really interested in neurodiversity and really thinking about equity for neurodivergent individuals just because of my own journey and really thinking about what that has been like and what our current systems are like. And that's what landed me to today, really talking and teaching about equity just generally across the board. So equity and inclusive practices for divergent populations, not just for the neurodivergent, but really thinking about across all the different intersectionalities that we can really think about.

But I do have a special passion for talking about equity and inclusion for neurodivergent individuals because so much of what we deal with is invisible. And so the more we talk about it, the more people understand, oh, wait a minute, that wasn't even on my radar before. And hopefully, more and more of those blind spots are getting revealed as we talk more about it.

Lauren Maltby:
It's such an interesting parallel, Lynette, because I-- so I'm also a certified infant parent early childhood mental health, and I was trained very psychodynamically in my grad program. And then at my externships and my internships, it was very behavioral, very CBT. And I was really struggling how to put those together. And I found infant mental health and a sort of a neuro relational framework as the point of intersection, sort of the nexus of those two ways of understanding people.

And I do think a neuro relational framework and understanding more about gene environment interaction is a great way to integrate lots of different fields of study. And ironically, I was also diagnosed with ADHD during grad school. Actually, sorry, in internship.

Lynette Lau:
Yeah, because that journey for women is just like--

Lauren Maltby:
Oh, my gosh. It's so hard.

Lynette Lau:
It's so hard. We don't recognize it until further down the line, yeah.

Aimee Hanna:
Can we just define neuro relational framework for myself and everyone else?

Lynette Lau:
The neuro relational framework is a framework that was put together by Connie Lillis. And it's this idea of really looking at neurological bases of I would say relating to others like--

Lauren Maltby:
Attachment.

Lynette Lau:
Yeah, attachment really. And so if you think about the biological basis of behavior, all of us on a day to day basis, whether you're neurotypical or neurodivergent, we sense threat. We're constantly scanning for threat and danger in our environment and different parts of our brain get activated.

And so the idea is that when we feel safe with other people, when we perceive safety, then we are then able to relate better with other people and connect better with others. And that then enables us to do higher order work such as learning and planning and all the things that usually we want to see in terms of executive functioning. Does that cover it, Lauren?

Lauren Maltby:
It's like safety is sort of the necessary preconditions for ongoing development, which is I think what I like about the relational framework is that it uses science, sort of hard sciences, to describe or explain what attachment theorists have maybe observed for a long time. And so it brings those two together. But I think that framework is really relevant for anyone doing child maltreatment work, whether it's assessment, forensic interviews, treatment because of the emphasis on safety and related co-regulation.

Lynette Lau:
I will say, if you do a deep dive looking more into this framework, you'll see like intersecting circles of meaning making and your just biological systems and so like all the things that we do on a moment to moment basis because at any given moment, we're all making meaning of what all is happening. So there's this podcast that's happening right now, and I could approach this as like, hey, this is like a scary thing, or my meaning making of it is like, hey, I'm getting together with people I like to talk about things that are fun for us to talk about. So depending on the meaning making, it then changes your neurological response to the situation, which then translates itself into behaviors that you might be seeing that may or may not be problematic.

Lauren Maltby:
So kind of like they're more reactive to their environment both in positive and negative ways. You're going to grow anywhere or you're going to grow under very specific conditions.

Lynette Lau:
On some level, translates quite a bit to neurodivergent individuals.

Aimee Hanna:
Right.

Lauren Maltby:
Absolutely, absolutely. One of the things that's just so wild about my job is that at this point, I have forensically interviewed hundreds of children and teenagers, largely about sexual abuse. And I am constantly struck by both the overwhelming similarity of their experiences and the overwhelming divergence of their experience and who is really sort of bowled over by that traumatic experience and who has some resources, some psychological resource to respond and adapt in the situation.

But it's really interesting too because we also interview the parents before the forensic interview. And that also, I find, gives us a lot of very helpful information when we're thinking about how the child is responding to the sexual abuse in the context of their family system, which may or may not also have intergenerational child maltreatment.

Lynette Lau:
First of all, Lauren and I both got diagnosed in grad school. And I think part of it is that-- I'm going to speak for myself. I had a bunch of compensatory mechanisms in terms of keeping my grades up. I would just studying the very last minute. And thankfully, cognitively, I had enough skill to pull it all together at the last minute.

But if you look at my report cards, going way back to when I was in elementary school, it was a lot of has room for growth, seemed very talkative, all of these things that you would tick off.

Lauren Maltby:
Every report card, talks too much, talks out of turn, so many ideas, so many ideas, can't stop talking about them.

Lynette Lau:
Needs to be a little bit more focused to realize her full potential. So there was a lot of that. And if you look back now, you're like, oh, obviously, you had ADHD, you have had your entire life. But the reality of it is that I didn't get diagnosed until I was really struggling and I went to see someone. And I was being trained as a student in clinical psychology being able to assess for some of these things. And that wasn't even something that was on my radar.

Lauren Maltby:
And I really think it's because the diagnostic criteria that we have for different mental disorders has been so heavily based on white males that if you don't present the typical white male with that disorder or disability, we don't see it. When I was growing up, I don't think anyone knew that sometimes girls display hyperactivity and impulsivity via verbal hyper expression as opposed to physical. So the fact that I could not stop talking, I could not inhibit that impulse was maybe a little bit of a red flag. But people just thought, try harder.

Lynette Lau:
Or emotional impulsivity. And so you see those big jumps. And a lot of women who are ADHDers tend to get diagnosed as bipolar or borderline because of that emotional impulsivity that we might be seeing. In terms of my own story, it's like, so I got diagnosed in grad school. And years later, pandemic happened. I think, OK, it's time to probably get back on meds because the pandemic's really doing a number on my mental health and my ability to focus.

So I went to my primary care physician who then referred me to the psychiatry department. It took me about four months to make that phone call after that referral to get connected to set up an appointment. Then they had a social worker interview me on the phone and then transferred me to a psychiatrist. And I told them all the things I needed to.

And then they're like, OK, so the next step is either you get me those records from grad school that show this diagnosis or you complete this questionnaire and also have a friend or family member write a letter about what they noticed about your symptoms. So I've managed my ADHD behaviorally for a good amount of time. Now I knew if I didn't get done right away, I wouldn't get it done. So I got that questionnaire to him pretty much right away.

But the other steps-- so this is where ADHDers have difficulty of multi-step instructions sometimes and follow through. I know, Lauren, I've spoken to you multiple times about this letter that I need a friend to write for me. This is--

Lauren Maltby:
This started like three years ago, yeah.

Lynette Lau:
I know. I know. This was a while ago, right? So finally, I happened to be at UCLA for a different conference earlier this year, I think back in April. I brought all paperwork with me, and I got a copy of like my mental health records.

So the next step I need to do was to scan them in and upload them to my psychiatrist so that he can see it and then prescribe me the meds. Don't even get me into the fact there's a national shortage of meds for ADHD right now. But so have I done that step? No, I haven't because the things that you want an ADHDer to do to jump through the hoops to prove that they have ADHD are exactly the things that we struggle with.

Lauren Maltby:
Right. Or once they write you the prescription, it's with no refills because it's a controlled substance. So every month, I have to remember on a certain date to call my doctor before I'm out of meds, by the way. I have to remember to call my doctor and say, I'm almost out of meds, can you please call the pharmacy. Then when the pharmacy fills the prescription in some magical world where there's enough Adderall or stimulants or whatever we're sort of, calls me to say it's ready for pickup, I have to remember to go get it at a certain time.

We're really banking on working memory there. We're really banking on like executive functioning, which is literally one of the dysfunctions of ADHD. So it's a little problematic.

Lynette Lau:
A lot of women get missed because of how the diagnostic criteria in the DSM are patterned on white male people. I would say that's true for ADHD and autism. But if you think about depression and anxiety, we're frequently looking at how women express depression and anxiety. And so if you think about gender bias-- and this is talking about gender in a very binary way. So in the DSM, you're going to see all the criteria for depression and anxiety and it's going to look a lot more like how women express certain things about their lives.

When we look at prevalence rates like, oh, there are many more women who are depressed and anxious compared to men, we're also doing a disservice to them. They're because of the way we perceive things in our diagnostic criteria.

Lauren Maltby:
And a disservice to males or non-binary folks who--

Lynette Lau:
Exactly that.

Lauren Maltby:
--aren't presenting symptoms that way just like we're doing a disservice to girls and women and non-binary folks who don't present with autism like a four-year-old boy who's interested in trains.

Lynette Lau:
Exactly. And then when you get these things combined, so someone who is ADHD, autistic, and an ADHDer, on some level, sometimes those symptoms cancel each other out because if you think about an ADHD, it's someone who's like stimulus seeking, they're interested in risk and novelty, they're seeking all these. But then the autistic side of them says, no, I want everything to be the same, I like patterns, I like routine. It kind of cancels itself out sometimes in such a way that people miss it.

And the other thing that happens, I will say, is that there's a lot of spikiness involved in these disabilities in the sense that on certain days, I can perform just like that and it doesn't take me a lot of effort. But on other days, I know I need to get the thing done, can I get myself up to do the thing? No, I can't get myself up to do the thing. Or so people go, well, were able to do it last week, why can't you do it now. And it's just a function of how this disability works.

Aimee Hanna:
So with all of this said, do either of you or both of you have any advice for how neurodivergent folks can maybe have support when navigating these very difficult processes?

Lynette Lau:
I think a lot of it boils down to understanding your condition and being able to self advocate. The nice thing is that there's a lot more on social media now that's raising awareness about how these different conditions present. And I know people are going to say, oh, not everybody who says, oh, I have all these things that comes into my office for an assessment is going to be an autistic person or an ADHD or this is you're just self-identifying on the wrong scale.

But like on some level, having this awareness is important because then you can start that conversation with your service provider say, hey, I think this is what's happening to me, can we go down this route to explore it. Now obviously, there's a range of service providers in terms of people who are hip to the different ways in which these different disabilities and disorders can present and then there are people who are not. So I think being linked with other self-advocates is really important, trying to find providers who are at least on the path to trying to be open about different ways things can present, I think, is super important, and it might just take trips to maybe one, two, three different people-- it depends. It really depends on who you find and who's available to you. But finding someone who is open and sympathetic to equity in neurodiversity, I think, is super important.

Lauren Maltby:
Yeah, and I think especially related to ADHD in particular, especially for women, finding providers who believe you about your symptoms. Initially, my diagnosis actually happened sort of accidentally at first. I was learning to give a continuous performance test. And so my supervisor said, take it so that you can learn what it's like to give it. And I took it and I said, oh, this can't be right because these results have ADHD, I don't have ADHD. And she was like, well. I was like, what, no, I just didn't try hard enough, I'll go back and do it again.

So go back and do it again. I try as hard as I can. It's like, no, wildly impulsive, wildly impulsive on this little spacebar. I was like, oh, OK. But then when I started talking to my general practitioner, doctor, my psychiatrist, et cetera, they were like, no, I don't think so because you have a PhD. So you're fine. And I was like, no, I think that's just why it wasn't found for so long.

I sometimes joke that my anxiety was my compensatory strategy for my ADHD. And like once my anxiety resolved, now the ADHD can come and blossom in full with all these gifts and costs to my life. But yeah, finding a provider that will believe you when you know that you're not performing at the best of your ability.

Lynette Lau:
And what you said there is, Lauren, about I just wasn't trying hard enough is such a common thing. And I think that's the sad thing about is frequently, if you haven't been diagnosed and you don't understand your disability, you just think you're not trying hard enough.

And the reality is people with ADHDers, disabled people, people with these invisible disabilities frequently are trying at 150%, and they don't even recognize that they're going, I'm just not trying hard enough, because they're looking at everybody else. And it's not like our internal experiences are out there for everyone to see. I know how hard I'm trying. But to someone else on the outside, it looks like I'm doing nothing maybe.

Aimee Hanna:
So if you had the chance to speak to these providers who are servicing neurodivergent people and people with disabilities, what is one thing you would tell them?

Lynette Lau:
I think about my own training and I think about the training that I do now and the training that I see come through my office. The reality of it is most of us in the helping profession are not well trained in working with disabilities, period. And so there is this dearth of knowledge about how to treat disabled people in a way that doesn't infantilize them or doesn't fragilize them. And the reality is they're just humans just like everyone else.

And so to be able to educate yourself, take responsibility for hearing the voices of people with lived experience and what that is like for what their existence is like I think goes a long way in creating not only awareness and understanding, but some empathy.

Lauren Maltby:
Yeah, I think for me, listening to autistic people describe their own experience has been life changing and that's not the same thing as formal training. But sometimes, when our formal training systems have yet to catch up to lived experience, we need to defer to the people with the lived experience. And I think for a long time, psychology in particular has sort of been like, OK, well, disability and developmental services is one thing. We're dealing with mental health. That's a separate thing, stay in your lane.

And while there is some truth to stay in your lane, don't practice outside of your scope of training, there is also a need for more intersectionality and understanding the impact of disability on mental health and the impact of mental health on disability just like there's been a need for more intersectionality in understanding the experience of marginalized people who are not just women or just queer. They are intersecting identities, they have lots of identities at once. And so I hope that as a field, we're moving more in that direction even though it is more complex, but it's also more rich.

Aimee Hanna:
Lauren, what are you most excited for-for Lynette's presentation at the Pre Conference? 

Lauren Maltby:
I have been fortunate to listen to Lynette over the years and learn from her about neurodivergence and how it intersects with issues of equity and justice. And I'm just so excited to get to hear her with the other co-presenters. I'm actually most excited about their dialogue back and forth because I was just saying about intersectionality. I'm the most excited to watch these people have a conversation. That's what I would say.

Lynette Lau:
Yeah, I think very similar to Lauren. I'm really looking forward to having a dialogue with my colleagues there, thinking about how are different areas of expertise intersect. I'm very, very excited to be talking to more people about justice and equity for neurodivergent individuals and disabilities because that is-- I think, again, the more we talk about, the more we can at least plant the seeds of these ideas in people who are in the helping community, the more likely we are to be progressing towards a world in which we have more equity and justice for different people. I think I'm looking forward to a day where every trainee who comes through my training sphere said, yes, I actually have been exposed to ideas about disability and I do think about disabilities from a social model rather than the traditional medical model of thinking about disabilities and deficits.

Aimee Hanna:
So this question is for both of you, Lauren and Lynette. When you reflect on your work, what are some things that you're most grateful for?

Lauren Maltby:
I would say, the first thing I'm grateful for is that I get the chance to watch kids be brave every day, which is amazing, and I get to watch parents break generational cycles of abuse, which is so hard. And it's not always the case. Sometimes I watch generational cycles continue and sometimes kids aren't ready, and that's OK too. But I get a lot of solace from watching kids be brave and break cycles.

I am incredibly grateful for my boss and my coworkers and my forensic interviewing team. They make the work doable for me for sure. I would not be able to do it without them. And it's interesting because both of those things that I'm grateful for come back to people. And that's actually a quote that I have on my desk at work.

It's this quote that says, "Do not depend on the hope of results. You may have to face the fact that your work will be apparently worthless and even achieve no result at all. As you get used to the idea, you gradually struggle less and less for an idea and more and more for specific people. In the end, it is the reality of personal relationship that saves everything."

And that's a quote from Thomas Merton. And just think about that in terms of clinical work, in terms of my relationships with coworkers, in terms of advocacy, whether it's for child maltreatment survivors, for neurodivergent folks. It's the reality of personal relationship.

Aimee Hanna:
Lynette?

Lynette Lau:
As Lauren was talking about the things that she's grateful for, I think you can tell we're both infant mental health people because the themes are the same for me. The first thing that popped into mind for me are all the people that I work with now. I have an incredible boss, which hasn't always been the case, by the way.

I have an incredible boss. I have incredible coworkers. Even though I don't work directly with Lauren, she's an incredible colleague that I can call and talk with. I'm so grateful for the trainees with whom I've had the privilege of working with because even though they come to learn from me, I'm learning just as much from them every year that they're coming in. And we're talking about different concepts in psychology and systems work.

And I'm really just grateful for even all my past colleagues. There's a bunch of people that I'm still in contact with today, all the way reaching back to when I was in community college. And they're all around the world. And it's just lovely having all these connections that I know I don't get to see or communicate with enough. If I had unlimited time and day, I'd love to just be able to just be more present in their lives.

But everyone's busy. So the fact that I've had the short amount of time I've had with each one of them, I'm super grateful for that. And if they're listening, please know that you all always in my mind. So I'm grateful for things like Facebook which connects me to them in a very small way, in social media, and for all of the voices of people with lived experience who are brave enough to put their stories and their experiences online because with all of these stories, I'm learning and growing with each one that I'm exposed to.

And so many things I'm grateful for. I have a cousin's trip coming up. I'm very excited about that. Excited for my friends and family and thankful for them.

Aimee Hanna:
Is there anything else that you want to leave our listeners with?

Lauren Maltby:
So I would just really-- I want listeners to understand that the way that you have always been taught to think about disability and neurodivergence is not the way it really truly is or has to be. I am very fortunate to be parenting a neurodivergent child who has some other disabilities along with it. And I had no idea, I had no idea how our educational system was structured to disadvantage her to really not-- it was not built for her. It was not built with her in mind.

And so I have had to confront my own ableist beliefs and biases as I have found myself disappointed in certain parts of the educational system and wondering why I'm disappointed in that and what was I hoping for and what do I believe is valuable. And it has been such a great but messy journey of self-discovery and sort of rooting out my own internalized ableism. And I'm so grateful for that because my life has become immensely richer as a result.

Lynette Lau:
What I'd like to leave the listeners with is the idea that change is messy and hard. It takes time and it doesn't always feel very comfortable. So to just be patient with the process and to not rush it. Even if you've got all these strong feelings about wanting to go out and change the world, know that it's a long marathon.

So to be able to pace yourself, to find allies along the way who will offer you shelter and refreshments. And then there's this fabulous quote, I don't know who said it, but there's this idea that in a symphony, everyone has their role to play. And so if you get tired, usually there's someone else in the symphony who's carrying on that note so you don't feel like you have to always consistently be doing the thing all the time.

Rest is so important when it comes to this work of being a change maker. So just to really know these things. And I hope you all have the opportunity to be a change maker whether it's in a big influential change the world way or change the world for someone in your tiny little circle or yourself. It can be on a day to day mundane basis that you're making change. But never underestimate the power of just one very small act.

Aimee Hanna:
Thank you both for being incredible change makers. Thank you so much for listening to this episode. As a reminder, the transcript for this episode will be on our website at cirinc.org. We have a coupon code for you to register for our very special pre-conference in the show notes. And remember to click that follow button so that you may be notified of our next episode where we will be speaking with our other two wonderful presenters.

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