Tony Mantor: Why Not Me ? - Dr. Sanam Hafiz: Unfolding Neuropsychology – From Holistic Profiling to Navigating Adulthood Challenges in Autism and Giftedness

Episode Date: December 18, 2024

Send us a text Unlock the secrets of the mind with our esteemed guest, Dr. Sanam Hafiz, a leading neuropsychologist renowned for her work in trauma, ADHD, learning difficulties, and autism. Join us as Dr. Hafiz unfolds her intriguing journey into neuropsychology, revealing a methodology that transcends traditional diagnostic approaches. She shares how she crafts a holistic profile for each individual by considering family history, environmental factors, and detailed collaborations with educators. Her insights offer a fresh perspective on the vital role genetics play in mental health, applicable to all ages. The conversation broadens to address the often-overlooked challenges faced by autistic individuals transitioning into adulthood. Hear compelling stories about the vulnerabilities in this journey, from the threat of online scams to everyday misunderstandings. Dr. Hafiz also guides us through essential safety measures and legal processes that can safeguard wellbeing. Finally, we dive into the nuanced intersection of giftedness and autism, examining the unique mental health challenges this overlap presents. Connect with Dr. Hafiz and engage in a dialogue that promotes a deeper understanding of these complex issues. https://tonymantor.com https://Facebook.com/tonymantor https://instagram.com/tonymantor https://twitter.com/tonymantor https://youtube.com/tonymantormusic intro/outro music bed written by T. Wild Why Not Me the World music published by Mantor Music (BMI) The content on Why Not Me: Embracing Autism amd Mental Health Worldwide, including discussions on mental health, autism, and related topics, is provided for informational and entertainment purposes only. The views and opinions expressed by guests are their own and do not reflect those of the podcast, its hosts, or affiliates.Why Not Me is not a medical or mental health professional and does not endorse or verify the accuracy, efficacy, safety of any treatments, programs, or advice discussed.Listeners should consult qualified healthcare professionals, such as licensed therapists, psychologists, or physicians, before making decisions about mental health or autism- related care.Reliance on this podcast's contents is at the listener's own risk. Why Not Me is not liable for any outcomes, financial or otherwise, resulting from actions taken based on the information provided. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Welcome to Why Not Me The World Podcast, hosted by Tony Mayator. Broadcasting from Music City, USA, Nashville, Tennessee. Join us as our guests tell us their stories. Some will make your laugh, some will make you cry. Real life people who will inspire and show that you are not alone in this world. you gain more awareness, acceptance, and a better understanding for autism around the world. Hi, I'm Tony Mantor. Welcome to Why Not Me the World. Today we welcome Sanam Hafiz, a renowned pioneer in neuropsychological assessments with expertise in trauma, learning problems,

ADHD, and autism. As a trusted media expert, she has received multiple honors, including faculty appointments, and is on the New York City Panel of Medical Experts the court systems. Since founding Comprehend the Mind in 2006, her organization has experienced continuous growth. It's an honor to have her with us today. Thanks for coming on. Thank you. Thanks for having me on. Oh, it's my pleasure. So if you would, give us a little background on how you started and what led you to do the work that you do today. So I have a doctorate in psychology and the doctorate was very sort of scientific for a doctrine in psychology, very evidence-based cognitive behavioral therapy with a huge emphasis on assessments and evaluations.

And then it turned out that I absolutely just loved it. I loved the diagnostic part of neuropsychology. And I ended up, my first job out of graduate school was as a neurodevelopmental psychologist in a hospital in Brooklyn. I enjoyed that immensely. And I enjoyed that immensely. And I started like a small private practice on the side, which evolved and became big enough that at one point I had like 100 contractors evaluating for me. And now we have a small center about five psychologists and a decent-sized team that does administrative and psychometric type tasks. So I spend my time managing or directing the private center, seeing patients. I see patients every day. And I do some forensic and media work like we're doing right now. So do you specialize in any one thing with your

psychology, or do you expand into other things as well? So my specialization is assessments, it's diagnostics. So you name, you know, whether it's ADHD, learning disabilities, autism, but also to parse out bipolar disorder from depression or to diagnose schizophrenia, you know, the brain is a beautiful organ, but it's, very small, and so it's sometimes a lot of things overlap. You could have something neurological, but also have some things psychiatric going on. Sure, because many times you'll see an autistic person that is also diagnosed with ADHD. It's very common to have overlapping diagnoses, yes. So what's your process when a parent brings a child to you, not knowing what's going on?

What are the steps they have to take to find out whether it's autism, ADHD, or whatever else it might be? So it's a really well-structured and it's complex but a simple process. We start with a very detailed initial assessment that allows me to interview. And if we're going to talk about children, then I interview the parents. I interview the child. I observe. I get the teachers involved. And so we kind of develop a profile, a background. You know, children are, they don't exist and they're not an island. They don't exist in isolation. they're a eco, they're part of a big ecosystem that involves, you know, who lives at home,

their family history, genetics, the teachers, the school, the kind of services they get. And so to do an evaluation without taking all of those factors

into account would be such a disservice, as you can understand, right? And so I, I called my initial assessment a probe. I'm probing.

I am digging. I'm asking, you know, questions as in so, so, who goes grocery shopping in your home, you know,

and you'd be amazed at what, what a lot of simplistic questions can bring up about a family. I ask, has anyone been diagnosed? And a lot of times, answer is like, no, you know, back in the day, no one ever went to a psychologist or a psychiatrist or, you know, my culture has been very sort of suspicious or mistrusting of mental health. So we don't have a lot of that. But I dig and I find out that they're often family members, relatives, people they've never met where there was a fair history or at least a narrative that there was something going on with them mental health-wise. So I try to show families that, look, you may have a grandparent

that you've never met, but their DNA has met you, right? Their genes have somehow made it down to you and into your child. And it really does open up a lot of dialogue with families that have never considered that. So that's one aspect of it. Then I basically take all that data that I've gathered, a lot of the quantitative data that I've gathered, and I go back to my team and we design what we call a testing battery. So in my center, because what we primarily do is diagnostics, we have standardized measures that test for everything, from your IQ to your academic functioning, to your neurological and psychiatric functioning. And we designed a battery of tests, a set of tests based on what the patient might have come looking for, but also what that initial assessment evoked or brought up.

And I say, well, I also want to look at this, this and this. And so when we set out to test, we're looking at all facets of a child's functioning or an individual's functioning. If you were to come to my office, we would use the same exact paradigm, if you will, on you. Okay, that was my next question. What's the difference between a five-year-old, a 15-year-old, a 25-year-old, or even a 35-year-old that may come to you? So, you know, it's interesting. It differs, but it really doesn't differ because people are people. And so a five-year-old might have an in-progress.

Like, it's a site under construction, right? when you're five, your cognitive functioning is not set in stone yet. You're still developing. You might be getting services at the school level. You have parents that control or determine a lot of what's happening with you. A 25 or a 35 year old are in, even though they're adult, they're in two developmental milestones or developmental stages that are very different. So a 25 year old, maybe someone who just gone out of school, maybe someone who's getting a job and lives with a bunch of roommates, It's maybe someone who's struggling and has moved back in with his or her parents. They may not have a lot of history about themselves, right?

So a lot of times they say, if you have a parent around, especially if you have a mom around, ask her, ask her these things. You know, ask her if she recalls having concerns about, let's say, let's talk about autism, I see a lot of adults, very concerned that they may be on the spectrum. And really, almost sometimes even fighting for that diagnosis. And I say, well, if you have a parent around, ask them when you spoke, ask them when you walked, ask them how related you were, if you made eye contact, if you toe walked, if you flapped your hands, if you had tantrums. So a lot of times the adults of 25 and 35 year olds may not have

a lot of historical narrative about themselves because they've never asked anyone. But I will say, do you recall getting pulled out for services? Do you recall struggling when you were younger? And so that does bring up a lot of stuff that doesn't always point to autism. And so we cannot do psychiatric testing or personality measures with a five-year-old, but we can do that with a 25 and a 35-year-old. When a parent comes to you with their child, you see that they are really struggling, not knowing exactly what's going on. Their child has meltdowns that happen from time to time. They have all the markers that point towards their child being autistic. How do you define those markers so they can go to their local charity or their local community so they can search out

and find the help that they need to get them through this. So when we do the assessment process, when they come back to us for testing, we use, like I said, a battery of tests. And at the end of that assessment model is an appointment that's almost always with me to discuss the results and findings. So what they get after I give them the results and the diagnoses, they get a report, a written, detailed 30, 40, 50, 50 page report that entails all of that data, that entails a summary of the findings and what that means, diagnoses and very detailed recommendations. Because a neuropsychological

evaluation can look really fancy, but if you don't tell people what to do with that, it's useless, right? It's essentially doesn't mean anything, just fancy words and tables on a report. So I am very, very detailed and very committed to having people, patients of mine, find resources and find ways to remediate or help themselves. Of course, when someone brings us a five-year-old, the world's my oyster, right? I can recommend a million things and, hey, come back every year and a half so I can keep reassessing your kid. But what do I do with a 25 and a 35-year-old that has missed a lot of time to make some of those changes? But also, life gets in the way. Spouses get in the way. Jobs get in the way. And so I insist, look, if you don't follow some of these things,

things are not going to change. But even if you implement three or four of the recommendations out of the 20 that I'm making, when you come see me back in, you know, 2025, you're going to see that you're a very different person than you are now because the change isn't going to happen overnight. But consistency is what matters. What you said about are down during this podcast is true for valuations and treatment as well. Consistency and a commitment to doing it day and day out is what's going to make a big difference. And yes, a year and a half, two years later, people come back and they are like they're born and new. But a lot of that, we just did the job of assessing them, diagnosing them, and giving them the direction. A lot of that is really on them. They do the work. Once you diagnose them, you find them to be autistic, ADHD, or whatever the case may be. Do you help them find other areas that can help them expand, learn, and evolve so that they can keep moving forward with their life? So we explain them, you know, what their diagnoses mean clinically, what the implications are, why there's so much of an overlap. They start to make those connections. When we give them the final report, we also give them resources. We give them resources such as psychiatrists who are in their

neighborhood who take insurance. We give them psychologists or therapists in their neighborhood who take their insurance. With individuals who are on the spectrum or have ADHD, we have resources in the community in New York City, you know, entire agencies and charities that are dedicated to working with those populations. We refer them to a state agency if they're under the age of 18. There's a state agency called OPDD. It is basically stands for Office of Persons with Developmental Disabilities. It is funded by New York State. It's a federal agency. It's a state agency that gets federal funding. And they can get set up for services and help basically throughout life. They get something called a Medicaid waiver and it allows them to access those services. Now, let me bring you back to that

25 year old. Now, let's say a 25 year old when they turned 18 or 20, they graduated from their school's special education program. They went to an adult with disabilities program, but they also graduated from there. You can't stay there indefinitely, right? And maybe they train them to do some sort of a job. And so they have a job, you know, something simplistic, perhaps, you know, they get mail from the office and they feel a sense of, you know, community and a sense of contribution to their life. But mom says, listen, I'm getting older and I'm worried that my son may have a job, but he can get taken. And these are real stories, by the way. My 25-year-old autistic son goes online and has gotten scammed and we've had to get the police involved.

Or my son ignored the jury duty notice three times until we got a warrant or something. These are things that happen to people because you don't wear a sign on your chest that says, I'm autistic. And a lot of autistic folks look very neurotypical. You can't tell. That's so very true. I've said right along that the reason why some charities have a difficult time raising money is because it's a mental issue that can't be seen. With that said, what can we do to help people and help change that dynamic? So one of the things that I've been a huge advocate for is how do we keep them safe? Right. Safety is a big. deal. And I recall this one patient I was seeing since he was maybe 14 years old. The last time I saw

him, he was maybe 17 or 18. No, the time before last. And I said to his dad, I said, look, your son is autistic, but he does not look autistic. I mean, I don't know even what that is, right? A lot of people don't. And I said, if something happens and he had suddenly grown to be very tall and very big, if something were to happen in public, if he reacts, if he bolts, he just looks like a big black guy. And I worry about him because what does that mean? The next time dad comes back and he goes, Dr. Hafiz, I've got to tell you, he had a seizure. He passed out in a McDonald's when he woke up. There were cops looking at him EMS and he bolted and he was a big guy. And I had asked him to have him like make, and this is like 10 years ago. I had asked dad to maybe make a bracelet and make him

wear it that said, hi, my name is so and so. I'm autistic. And when the cop saw that, he told everyone, stop, stop, stop. You're going to freak him out. He's autistic. And the dad was like, had I not done that, I am really shook by what could have happened to my son that day. Well, that is just such a great idea and such a great story for people to hear. So it's important for parents, aging parents sometimes to make, to take stop of their child's situation and say, what happens to them when I'm gone? So I then also guide them towards what we call surrogate court. It's a court that allows you to bring a case to the judge to the court and say, this child has profound about mental disabilities. They cannot make decisions for themselves. They may be intelligent on paper, but they have autism or a defining

disability that will not allow them to make that decision. So I need to be able to assign another adult to either take full guardianship, which the courts are not crazy about, or specifically financial and medical guardianship or conservatorship. So there are ways to address, but you have to address everything. You can't just be like, okay, we'll put them on medication. That'll be the end of it. You've got to teach them skills. You've got to get them into job training, but you also got to take care of the legal end of things.

That's what I try to do with that end goal in mind. So you diagnose. Once you have your diagnosis complete, do you follow through with them, or do you direct them to other people that can help that may be closer to them where they live? How do you get that network together, so they have that safety net in place to help them through any particular crisis,

just in case something doesn't go as planned. Yeah, so we do both. We do follow up with them. We do an evaluation in another year and a half, but we're not a treatment facility. So we connect them to a lot of treatment providers, psychiatrists, therapists, like I said, charities, institutions, agencies, then they then provide the services we recommend in our reports.

Yeah, that makes sense. So now, it's the big unknown. When a parent brings their child between four and eight or eight to ten, or even as much as 12 years old, it's the big unknown. They don't know what's going on. They're confused. They see all these things that it could be. They hear all the stories. They hear everything.

They're just really totally overwhelmed. Because the biggest fear and unknown is that most people, when first introduced, you know, to autism, they just have no clue as to what it is and what it's about. So that's a huge debate. You know, when I started working, autism was, it had very clean, clear demarcations. You know, if you were not fully autistic, like textbook autistic, we could look for features of Asperger's or people who were maybe PDDNOS, we used to call them, pervasive developmental disorder, not otherwise specified.

There were a couple of other types of autism called RETS syndrome, or or childhood disintegrative disorder. When the DSM-5 kind of redid autism, we got rid of all of those terminologies. We just made it one big spectrum of autism. Over the pandemic, and I can tell you because I've been in practice and in the center doing assessments for almost 18 years now,

over the pandemic, people had a lot more time on their hands, and a lot of people were taking to social media. And obviously, it's not a bad thing that there's so much awareness of stuff, but there were articles being written that could not quite capture everything about what autism is. And the idea of neurodivergence really gained popularity. We went back to work,

and we only took maybe about three months off. When we went back to work, you know, the idea of autism sort of exploded. Everyone wanted to come in and be evaluated and assessed for autism. Everyone was neurodivergent, and there were some people who wouldn't take no for an answer. So it kind of became frustrating because, you know, I have actually said these exact words, but if you knew you're autistic, why'd you bother coming to see us? You know, were people with licenses and doctorates and two or three decades of experiences. I've got other people in my team who've been practicing for longer than me. So I would tell them, look, we are not just giving you expert opinion with clinical discretion.

We're also using standardized tests to tell you whether you're autistic. And if you're not, what else might be going on that could mimic or look like autism? And a lot of times people are very grateful for it. And there are a lot of times that it's primarily to do with autism where people are so married to the idea that all their difficulties stem from autism, that they're unwilling to accept what else it might be. Yeah, that's very interesting. So tell me, what have you found that mimics autism where people think they might be autistic, but in reality, they're not? Yeah, I mean, look, some people, and let's talk about adults for a minute, they might just have certain personality trait. A lot of times

I find that that's not always the only thing. They usually have a parent who also might have been on the spectrum or looked like they were on the spectrum. People who were, you know, back in the day we would call quirky or odd or peculiar. And yeah, in younger children for the longest time, remember the diagnosis I said, PDDNOS. So if there was a child who, let's say, wasn't speaking yet, or speech was a big part of the problem and they were having temper tantrums and someone suspected autism, but we didn't have enough information about it. We might just give them PDDNOS. So to this day, you know, now we have better tools and better understanding of autism. And if there are some other things going on, you know, very often I've put in reports and I've

explained to the families that your child may have had a diagnosis of autism, but your child also is intellectually deficient. So it's hard for us to parse out the low cognitive functioning, the low intelligence from autistic features. And so this is why we need to see him again in a year and a half. So we can, you know, it's sort of like the oil and water. It separates and you get to see the different things. With older people or not children, but let's say teenagers or adults, we know.

Notice a tremendous amount of overlap in people who might have pretty severe ADHD, maybe some social emotional immaturity, and a lot of times anxiety or OCD. So a lot of rigidity around things can look like autism, especially if you combine it with neurological, neurodivergence like ADHD. Wow, that's pretty interesting. So is there anything else that can mimic autism within adults? Sometimes people who have severe social anxiety and can't make eye. contact can appear autistic to the naked eye. Sometimes people with, you know, even mood disorder,

PTSD and bipolar disorder can appear autistic if there's enough of a neurological spin to the way they present outwardly. And we do these tests, these very sensitive standardized tests like IQ testing and there's a measure for autism called the ADOS. It's the autism diagnostic observation schedule. We also give them self-reporting scales. And then we observe them through several sessions. and it's a team effort and it's not always black and white, but we're able to tell them, hey, this test comes up, yes, you rated yourself pretty high as autistic. But when we did the ADoS, which is a clinician administered test, you were able to have a lot of reciprocal conversation. Not only did you make eye contact, you were able to integrate nonverbal

communication with verbal communication. For instance, you're sitting there, you're nodding, I can see your eye blinking exactly when I say something. You're holding your chin. As I'm talking, I'm using my hands, I'm gesturing an emphasis, even though the majority of people who are all of the people who are listening to me are not going to be able to see this. But this is the integration of nonverbal communication into verbal communication. Autistic individuals have a very difficult time with that. They can learn eye contact to some degree, even though it looked tilted and awkward or forced, they cannot learn how to do this and they cannot learn how to do this at the same level that I'm doing it right now. So those are the things that you can't always put

into words or really explain to a lot of people who really believe that they check off all the criteria, maybe on paper, but not when I see though. What other information could you give us for any parent that may be thinking their child might be autistic? If you are a parent, for instance, and you're listening to this and you're wondering about your child, look for things like eye contact, look for a child having a really difficult time, and I don't mean a child who is having a temper tantrum because they didn't get what they wanted. I mean a child who likes to sleep on a specific pillow or likes to eat very specific foods

or doesn't like loud, unanticipated noises, or has issues with textures, or really either struggles to make friends or has no interest in socializing, or they don't understand or display inflection. Their language doesn't have the intonation, the music of language. They don't understand sarcasm. They don't get jokes. Those are the things to look for. If you're an adult, the funny or the ironic thing is that if you're an adult and you may be on the spectrum, you don't necessarily recognize that you may be on the spectrum. Having an awareness, a hyper awareness of yourself, so sort of the inward navel gazing, is not something autistic people can do very well.

That is a defining feature. So when people come and really go to bat for their diagnosis, I go, if you are truly autistic, you probably couldn't do that. Yes, I can understand where knowing yourself and understanding yourself might really make a big difference. Unfortunately, they think they can outgrow autism, and that's just not the case. It is not something that goes away, doesn't change.

And when people sort of deny that they may not be autistic, they're actually shutting off the things that you can't fix. You can't cure autism. What you can do is treat the things that sometimes come along with autism. So even if that is true, let's say you're an Asperger's type person. The way to correct that is to go into cognitive behavioral therapy be with someone who knows autistic people who can teach you social strategies, work with you on eye contact.

We're not trying to change who they are. We're trying to make them feel more at home or more easy to get along with or maybe go to an interview and get the job that they want and not feel left out. Medication for anxiety can be helpful. Medication for ADHD can be helpful. The key is first to get a full assessment to you understand where you really belong on that spectrum. And, you know, when people tell me they've had a diagnosis, I am very curious.

where they got that diagnosis. Who diagnosed them? What tools did they use to give them that diagnosis? Because the majority of people I know don't own an ADOS have never been trained on an ADOS and don't have the faintest idea

what the ADOS says. And it's a very critical tool. Everyone on my team has a doctorate and is licensed and primarily does assessments. I still have everyone trained on the ADOS every two years because there's so much research

and critical thinking about autism that comes out every couple of years. That's great. I think that's good for everybody to know. Now, there's one last thing I wanted to mention. I've heard that it's tough to diagnose the difference between autistic people and some of those people that might be gifted. Gifted individuals tend to have a tremendous overlap with autism. I actually have a table that I use from the Davidson Institute and the CDC. And it's basically the overlap or the similarities between people who are gifted and the people who are autistic. Sometimes a gifted person can in fact be autistic. There is no rule that makes autism mutually exclusive. You can have both.

But sometimes what looks like autism is really giftedness. Being gifted is a bit of a blessing and a curse. I have yet to meet someone who got told that they were gifted who went, oh wow, look at me, I'm gifted. They feel like it is a burden. The brain never slows down. The brain never shuts down. The brain never takes a break.

The brain is firing on all cylinders all the time. time and it's exhausting. Yeah, I can just imagine. How do people find you? Comprehend the mind. And my Instagram is just my name, Dr. Sanam Hafiz. Well, this has really been great conversation and great information. So I really appreciate you coming on. Yeah, great work. Thank you. As a mental health provider, I thank you. It's been my pleasure. Thanks again. Thanks for taking the time out of your busy schedule to listen to our show today. We hope that you enjoyed it as much as we enjoyed bringing it to you.

If you know anyone that would like to tell us their story, send them to tonymentor.com, contact, then they can give us their information so one day they may be a guest on our show. One more thing we ask, tell everyone, everywhere, about why not me, the world. the conversations we're having and the inspiration our guests give to everyone, everywhere that you are not alone in this world.