You Must Be Some Kind of Therapist

Swell AI Transcript: 76 - Ryan Wexelblatt De-Ummed.mp4
00:00 Ryan Wexelblatt I am really worried because I think we are headed towards a segment of the population of young people with neurodevelopmental differences who are going to meet the criteria for what is often called failure to launch. And I think that that is going to happen, not because anybody is doing anything wrong, not because their parents are doing something wrong, but rather because their parents are taking really bad advice on social media.

00:25 Stephanie Winn You must be some kind of therapist. Today I'm speaking with Ryan Wexelblatt, also known as the ADHD Dude. He's a licensed clinical social worker, former school social worker, and a father to a son. He founded ADHD Dude, which is an evidence-informed resource for parents of children diagnosed with ADHD. that provides practical strategies to address ADHD-related challenges. He creates content for the ADHD Dude YouTube channel and membership site. He's worked for two decades in the field and is a contributor to Attitude Magazine. He's also about to launch Raising Boys on the Spectrum, the first male-specific resource for parents of boys diagnosed with higher verbal autism. I am excited to dive into ADHD today, something we have not really covered on this podcast, but I want to frame it in terms of the sort of debate that we're having as a society right now. Because I feel like I've heard from voices and perspectives all over the matter, ranging from thinking that it's underdiagnosed, to that it's overdiagnosed, to that it doesn't really exist. I've heard the evolutionary perspective on ADHD, the neurodivergence perspective, the lifestyle perspective. So this is a hot topic. And so I think Ryan and I will start off with some philosophical exploration of the topic of ADHD and how our culture thinks about it today. Before we dive into practical tools, especially that parents of boys with ADHD can use, as well as parents of girls and people with adult ADHD. So Ryan, welcome. Glad to have you here.

02:04 Ryan Wexelblatt Thank you for having me. I'm excited to talk to you.

02:08 Stephanie Winn Yeah, I want to frame this in terms of, you know, when I think about the contention around the idea of ADHD, I feel like this is one of many topics where people get into black and white thinking that can result in this kind of baby and bathwater issue. And I want to compare it to my experience of long COVID, for example. For those who don't know, I've had long COVID for a year and a half. I basically got COVID a year and a half ago. I've never been the same. I've been diagnosed with POTS as a result. And my biggest problem is chronic fatigue. And I'm not somebody who wants to identify as disabled. I hate feeling like I can't use my body. But there's been times that on the internet when the subject of long COVID comes up, there are people who jump in saying that it doesn't exist, that it's not a real thing. And when I see what their thought process is, it's that for them it's political, right? Because they think that if you believe long COVID exists, it means that you have a particular stance that they disagree with on things like masks, lockdowns, vaccines, things like that, right? So they can't separate the two issues that there are people who are really struggling with this illness from the politics around it and the division in our society about how do we deal with the problem. Or they think that people who say that they have long COVID are just people who are getting secondary gain out of identifying as ill, right? And that's been really frustrating for me because I have my own experience and I see this with so many things, this kind of rigid thinking, this jumping to conclusions. So I feel like when it comes to ADHD, There are probably people who are of that same mentality, right? Oh, this can't exist. We should stop talking about it. And really what their issue is, is they're having an issue with over-prescription of psychiatric meds in the United States or with the way people cling to a victim label because of this concept of neurodivergence. And so it makes it hard to talk about what it is that we're really talking about. So I just kind of wanted to frame it up that way and then hand you the floor. What are your thoughts on alt?

04:19 Ryan Wexelblatt Yeah, so one thing, Stephanie, I mean, I believe in following science and I'm involved in the medical ADHD community in the sense I go to the medical ADHD conference every year. And all the content I put out is really based in and grounded in science. So what we know is that ADHD is genetic. There are biological markers of you know, showing that ADHD is not a, you know, cultural creation. The first mention of ADHD in a medical textbook was actually about 1790. So, it has gone through many different names over the years. It's always been around. I think what has happened is, you know, obviously different things. So, the, you know, for one thing, the fact that, you know, ADHD is often mistaken for developmental trauma. that's one of the reasons why it gets overdiagnosed. There are some racial aspects as well. So for instance, children from lower socioeconomic status who are black and brown tend to get diagnosed with ADD, an oppositional defiant disorder, when really it's, again, it's the developmental trauma piece or adverse childhood experiences. So there's lots of different arguments we can make, but the bottom line is there is scientific evidence proving that ADHD is

05:31 Stephanie Winn You said the first mention of it in a medical textbook was 1790, and I can't imagine it was called Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder. So what was it called back then?

05:45 Ryan Wexelblatt I used to know all the names and I don't remember all of them now, but the most recent one before ADHD was called Minimal Brain Dysfunction.

05:54 Stephanie Winn Minimal Brain Dysfunction. Yes. So I can see the memes now.

05:59 Ryan Wexelblatt Right. Right. So, you know, my my father is somebody who, you know, definitely had pretty severe ADHD, was not diagnosed in childhood. But had he been diagnosed in childhood, you know, in the 1950s or whatever was, you know, it would have been called minimal breaks.

06:14 Stephanie Winn I've never heard of this before. So what did minimal brain dysfunction refer to?

06:19 Ryan Wexelblatt The inattentiveness, the hyperactivity, impulsivity, kind of the core features that people tend to think of ADHD, because that was really before we had an understanding of executive function.

06:30 Stephanie Winn So you say it's genetic and that you've been studying the science on this issue. What's your perspective on the balance of nature and nurture in this situation? Because I think most people would agree that most things are some combination of nature and nurture. And I think there are people who lean much more heavily into the nurture side of things who would attribute ADHD as a modern phenomenon to our diet, our lifestyle, lack of sleep, screens, cultural laziness. In your view, with what you've studied, how much do you think that lifestyle plays a role in comparison to the genetic component?

07:14 Ryan Wexelblatt Yeah. You know, it's really hard to say. I understand why ADHD can be mistaken for something, you know, being, you know, a result of our modern environment. That makes sense to me. But, you know, again, the bottom line is it's not. Are these things like excessive screen time and being forced to sit at a desk all day in school and not have enough breaks and enough unstructured replay Do they make things worse for a child with ADHD? Absolutely. But do they make things worse for every child? Yes. So I think the question is really, where is the line? And I just want everyone to understand, you can't develop ADHD as a result of environmental factors, but there are certainly environmental factors that can make it look like an individual has ADHD.

07:57 Stephanie Winn How do you distinguish between those two? Let's say someone brings their child to you for an assessment. They say, I think my son has ADHD. Can you help him? How would you, during that assessment process, figure out this is really a lifestyle thing? There's no evidence that it's genetic or that it's in the brain.

08:17 Ryan Wexelblatt So the way an accurate ADHD diagnosis is made is through collecting data from various people who have seen a child in their natural environments. In the case of we're making an adult diagnosis, that developmental history is really critical to this. So that's really the best determination. Are there a consistent set of symptoms across the board, whether, you know, that's in school, whether it's at daycare, whether it's, you know, on the playground. So that's what we're looking for is this consistency of symptoms in, you know,

08:47 Stephanie Winn And so this, when we talk about inattentiveness and hyperactivity, do you think it's difficult to recognize that those are the underlying experience behind the behaviors that we're seeing? Because it's been my understanding that children with ADHD here know a whole lot more than their peers without it. And that most often, especially with boys, what we really see is the behavioral manifestation of that. It can look a lot like disrespect or willfulness. You talked about the differential diagnosis with oppositional defiant disorder. How do adults in a child's environment learn to recognize that this isn't necessarily willfulness, disrespect or a behavioral issue? It's it's a difficulty with executive functioning.

09:40 Ryan Wexelblatt You know what, Stephanie, to answer your question, this is why I call ADHD the joke of the mental health field, because I don't believe it's taken seriously in the mental health field. I believe a lot of people think, oh, this is a condition that anybody can treat. Right. Just tell them to, you know, hang up lists around the house, that kind of thing. So what I have found is there is a tremendous amount of lack of information out there, a tremendous amount of misinformation and disinformation about ADHD. And really my goal is to provide clarity for people about what is factual, what is misinformation, what's disinformation, and how to discern facts from opinions. Because I think that's where people, particularly parents, are really struggling.

10:20 Stephanie Winn So on that note, how would you help someone tell if this is an attitude problem or an underlying mental health or neurodevelopmental condition?

10:33 Ryan Wexelblatt Yeah. Well, again, going back to the first thing is having that developmental history and hearing from different people who have seen the individual and those natural environments during childhood, but then also looking at other factors. Has there been some adverse childhood experiences that might be contributing to this? Is there a history of underlying mood stuff that we need to look at? So yes, there are pieces that we have to parse out here. What I typically find though in many cases when somebody is diagnosed in childhood is if there's not a history of developmental trauma there or adverse childhood experiences, things become pretty clear pretty easily. Because one of the things with ADHD is people tend to go way overboard with diagnoses. They tend to go to a neuropsychologist or go to a psychologist for testing and nothing is wrong with those things, but that's not how the most accurate diagnosis is made. So we have to look at the behaviors within the context of the environment, like anything else really.

11:31 Stephanie Winn All right. So let's talk about what are some of those key symptoms and behaviors that you observe. You get the feedback from parents, teachers, maybe other significant people in the child's life. And what are some of the main things you hear that tip you off that ADHD is the issue?

11:48 Ryan Wexelblatt Yeah, let me focus a little bit on the ones that are less familiar to people, because I think that would be most helpful. So number one is what we would call lack of an internal dialogue or self-directed talk. So people with ADHD tend to vary in degrees are not always hearing their internal dialogue, particularly children. So what that can look like is when they're supposed to be getting dressed in the morning and going through a sequence of steps to get ready, they're not having an internal dialogue saying, OK, here's what I need to be doing next. They're also not visualizing, right, that they need to be ready for school and what they should look like when they're ready for school. That's what's called nonverbal working memory. So how does that present on the surface? Well, it presents just sitting there or, you know, petting the dog. Well, that could easily be misjudged as being lazy, right, or being oppositional, whatever. But it's not that. It's this underlying executive function deficit in this internal dialogue, as well as in nonverbal working memory. Another really common one that people misunderstand is cognitive inflexibility. So, you know, I think a lot of kids with ADHD get diagnosed with oppositional defiant disorder because I'm of the opinion that the mental health field does not understand executive functioning. So when they don't understand something, what do they tend to do? Pathologize it. So if you pathologize a lagging executive function skill, well, then it looks like oppositional defiant disorder. And there's a lot of controversy around this, but I can tell you I have yet in my 20 plus years of doing this to meet somebody with oppositional defiance disorder who did not have ADHD or another neurodevelopmental.

13:21 Stephanie Winn Okay, so let's talk about when you talk about cognitive inflexibility and how that can look like ODD, my brain goes to ASD. Rigidity is a key feature of kids on the spectrum. What's unique about the cognitive inflexibility of ADHD? How would we recognize that?

13:42 Ryan Wexelblatt Yeah. So there's a great deal of crossover because, you know, approximately 60% of people with autism also have ADHD. They meet the criteria for ADHD. So there's that, you know, executive functioning piece as well. Here's the difference though, with somebody with ADHD, They have the capacity to be flexible. However, if that is not exercised, or if it's accommodated, they're in flexibilities accommodated, their capacity to be flexible will never necessarily be brought out or see. It's a muscle, essentially, that we have to exercise. With somebody with autism, it could be the same thing. The difference is, though, people with autism tend to really struggle with abstract thinking more so than people with ADHD, and they tend to struggle with perspective taking. So understanding other thoughts and feelings and how you come across others, they tend to struggle with that more than people with ADHD. So the difference, I always say, is this, that somebody with ADHD has these skills. They may be lagging behind and they're using consistently, but they're there. Whereas somebody with autism may have these skills, and they also may be lagging behind or using consistently, or they may not have them really at all, and they have to be developed from the beginning.

14:56 Stephanie Winn Olivia, you described the lack of internal dialogue or self-directed talk, and you gave the example of, let's say, getting ready to go. Getting ready to go to school or to an outing is one of those things that sounds like one task, but it's actually 10 smaller tasks. So as you're working with children who are still developing, how do you distinguish between sort of that normal developmental process whereby any child still needs to work on having things broken down step by step to learn? Getting ready to go means first thinking about what pants I'm wearing, then what shirt I'm wearing, then putting my dirty clothes away that you know, like, how do you know which kids just need that as a developmental capacity that still needs to be scaffolded versus which ones when it's an indicator that there's an underlying problem with executive functioning skills, and maybe they need more than your typical amount of handholding.

15:54 Ryan Wexelblatt Yeah, that's an excellent question. One thing I just want to clarify real quick is that, you know, the recommended evidence-based treatment for kids with ADHD is not individual therapy. It's parent training. So really what is most effective if we train the parents to create scaffolding around kids to help build these skills. So to your question, one of the things we need to look at is, you know, is the child on a normal developmental trajectory here? So for instance, you know, I don't expect a four-year-old to necessarily get ready for school completely independently. Some could, but most I would not expect that too. They still need some scaffolding and, you know, some help with that. I expect a 13-year-old to be able to get to school or get ready for school without constant prompting. If they're not able to do that, well, that's a good indicator probably that they have difficulty with executive functioning. So that's the difference really, is that, is the developmental trajectory here off? And if so, is it because they have difficulty regulating their attention or difficulty with internal dialogue? People often think of ADHD as just difficulty paying attention. It's actually not that. People with ADHD can hyper-focus on something that's interesting to them. It's difficulty sustaining your attention, that's the issue. at sustaining your attention to things that are not interesting, like getting dressed.

17:16 Stephanie Winn Let's talk about time blindness. You sent me a video in which you had a conversation with a young man that you'd coached, and you had this really interesting conversation where he had showed you a TikTok. As a young woman, and you pointed out in your conversation with him that there are millions of TikToks like this, right? a young woman having an emotional meltdown, crying to the whole internet about someone in some situation, I don't know if it was an employment situation or what, but refusing to accommodate her so-called time blindness as if it's a disability. Now, we know time blindness is an informal term. It's not in the DSM-5 list of symptoms for ADHD, but it's a commonly used informal term to describe an aspect of executive dysfunction. Now, this young man you worked with said time blindness isn't a real thing. I think we could talk about what people mean, though, when they say time blindness. I certainly experience it. I've talked about it as in terms of myopia, nearsightedness, right, which I have. I wear contacts. So it's not that I can't see in the distance at all. It's that if I want to see really close, if I want to see really clearly without my contacts, it has to be about this far from my face. That's how That's how close it has to be for me to see it 100% clearly. The further it is, the blurrier it is. And I think that's a good analogy for how a lot of people with ADHD or executive dysfunction experience time. If it's right in their face, there's a sense of immediacy. But if it's any further out, it's hard to have a sense of reality about it. But this young man made some good points, and you joined him in saying, that it's basically it's not fair to expect the world to cater to you if you have this condition. I would I would join you in that and say that if you're aware, that you have something that you find, you find the language time blindness helpful for describing that or executive dysfunction, then that gives you the responsibility of figuring out how to move through the world without inconveniencing other people. I love sleep. Sound sleep is a crucial foundation of good mental and physical health, from mood and concentration to metabolism and cellular repair. And I sleep very well thanks to my Eight Sleep Pod Pro Cover. My side of the bed is programmed to be warm when I get in and cool down to a neutral temperature in the middle of the night so I don't wake up overheated like I used to. How would you customize your bed temperature? Visit 8sleep.com and use promo code SUMTHERAPIST to take up to $200 off your purchase. Even if they're already running another sale, this code will get you an additional $50 off. 8Sleep currently ships not only within the USA, but also to Canada, the UK, select countries in the European Union, and Australia. Thanks for considering purchases that support the show.

20:13 Ryan Wexelblatt One thing I just wanted to clarify real quick, you know, with that young man, I mean, I've known him for 11 years since he was a little boy. I think he misspoke in the video. He knows time blindness exists because it's something he experiences. I think what he was trying to convey was that this idea that, you know, your time blindness should be excused because you have ADHD is not something, you know, that he agrees with, you know. So, I think the question is, or let me rephrase this and say, the reason why he sent me that video is because he was unaware that people on TikTok are weaponizing a neurodevelopmental difference, and he perceived that as somebody saying, I'm a victim of this ableist world that won't accommodate me. And his belief is, you know, I need to get to class on time. Somebody needs to get to work on time. That's just life. You know, the world is not going to accommodate you because you have executive function challenges.

21:09 Stephanie Winn And so again, with that baby in bathwater issue, right, there are so many people who are fed up hearing about neurodevelopmental differences because they associate it, tragically, with that victim mentality that's being promulgated. But I think there's equally a case to be made that, to the extent a diagnosis or the label of a symptom is helpful, it's helpful in helping the individual put a name to the thing that they need to work on. or the thing that they need to look for some additional tools or help with. Now, when it comes to time blindness, again, I'm looking at this kind of nature versus nurture thing and thinking about what makes time more or less palpable. And in our hyper modern world, I think it contributes to time blindness and I don't know if you would agree with me on this because you think of ADHD as genetic and you have plenty of research that you've looked at to support that and I'm just kind of going to grapple with this out loud and take our listeners with me on this because I'm thinking about how most humans lived a few hundred years ago, where we didn't have artificial light, where we didn't have nearly as much control over our indoor climate, so we could feel heat and cold a lot more intensely, and where there's a rhythm to the day. So you're in the darkness, then The dawn comes, you hear the roosters, or you hear the chorus of morning birds because we haven't made them all go extinct and we're living more closely with nature. Or you hear the baby crying because we used to have more children. Or when you know that the cows need to be milked and that the eggs need to be picked up and you feel that brisk morning air and you get that exposure to morning sunlight, which we know light regulates mood and sleep, and sleep is an important component of ADHD management. So in a world where we have more connection to nature, where we feel the rhythms of the sun going up and down, where we feel it getting darker at night, and where there are kind of these things built into our lives that require us to make contact with the natural world. Those things give time a rhythm. And also, when we have more community, I'm thinking about what it might have been like to live in a village in Europe in the 1700s. I don't really know. I can romanticize it. I'm sure there were things that were very inglorious about it. But there were holidays and festival days where everyone stopped what they were doing, or whether it was a wedding or funeral. There were times when the whole pulse of the whole community moved together. And I can just imagine that living in that type of world would have a much different impact on everyone's sense of time than living in a world where it's the same temperature all the time. The brightness of the light around you is completely up to you turning on and off the lights. Where you're staring at screens and there's kind of this like endless, timeless amount of stuff to scroll through. And there aren't as many sort of things rooted or anchored in time giving that rhythm to your day. Do you share my opinion that our modern world can worsen things like time blindness or do you have a different perspective on that?

24:18 Ryan Wexelblatt with you. Let me bring it to a little more of a recent time. I'm going to use myself as an example. So I'm about 12 years older than you. When I was younger, I'm an only child, so I was obsessed with the Brady Bunch. My life in elementary school revolved around when the Brady Bunch would be on TV. So, after school, I had to plan my life around that because I grew up at a time when I was in elementary school, VCRs weren't even around yet. So, what happened was that we used to plan our life around these different time markers, like wanting to watch something on TV or whatever it was. What has happened is with this generation is that they have never had to plan life around anything because everything is on demand. So, you know, watch a video on your phone on demand, you know, whatever video games on demand, this and that. So on top of that, we have, you know, we don't see analog clocks anymore. An analog clock, seeing the big hand move on an analog clock is actually the way you learn to sense the passage of time, because the way we learn to see time is in unit volume, just the same way we use to measure liquid. So when you see that big hand moving on an analog clock, like this is the analogy I always give. Think about when, you know, when I was in school and I was in math class and I couldn't stand it, I was waiting for it to be over. I would be staring at the clock, right? Watching the big hand move very slowly, waiting for the bell to ring. That's how we learn to sense the passage of time. That doesn't exist in our modern society anymore. Nobody has to wait for anything because there are no time markers. So yes, the further away we've gotten away from nature and just a cyclical nature of life and move towards constant technology, I think it has absolutely impacted people's executive function.

25:59 Stephanie Winn That's a really good point to bring it even to the more recent past because I go hundreds or thousands of years back for that evolutionary perspective. But even thinking about what it was like 20 years ago when your favorite shows on TV at a certain time or your favorite radio show or even just participating in activities out in the world as being the main thing. If you want to see your friends, you got to make it to the ballgame or the movie or the dinner party on time and there's there's a sense of sort of the palpable preciousness of life and I think the last few years have really done us in with regard to everything being online all the time and I really feel for young people who are coming of age during this time where like you say everything's on demand And there's no real healthy sense of urgency, that fire under your butt, oh, I got to get it together to get to this thing that I really care about, to see these people I care about, or to do this thing that's fun and enjoyable and meaningful for me. But there is a false sense of urgency with all the notifications and the little adrenaline and dopamine jolts of life on the internet.

27:11 Ryan Wexelblatt You know, Stephanie, just one thing to add on to that as well. You know, when we're talking about this, the way that everybody develops executive function skills and as well as social skills in childhood is historically it's been through unstructured play, unstructured hanging out. Because think about with unstructured play, you know, there's planning involved, there's negotiating, right? All these skills that we develop organically, we've taken away from kids. Right. Because you can't play outside anymore because, you know, you'll be kidnapped in two seconds. Right. Which is just statistically, you know, it's not, you know, it's not a fact. So we've people are so scared of allowing kids to have freedom today that is really impacting their executive functioning and their social skills because they're not developing these, you know, collaborative problem solving skills. They're not engaging in, you know, imaginative play. They're not engaging in, you know, learning how to occupy themselves when they're bored by just entertaining each other. So all these things just really have a detrimental effect, I think, on childhood development, ADHD or not.

28:13 Stephanie Winn I just finished Feminism Against Progress by Mary Harrington, who I hope to be able to interview her pretty soon. That should be in the works. And she talks about the impact of separating mothers from babies early on and the normalization of babies going into daycare at a very early age. And one of the differences that she looks at between a baby being in the home with its mother versus a baby being in daycare, of course, there are many differences, but one of those differences that she picked up on, which I thought was quite interesting, is that as a mother, knowing her own baby and being right there in her own home, she could allow her baby to take more safety risks because she knows her child and she's right there, whereas in a daycare center, They don't want anybody getting hurt on their watch. They don't want to get sued. And they don't know every baby as an individual as well as that baby's mother knows it. So they have to kind of apply more universal standards of just avoiding any safety risks. She examines what is the impact on children raised in that environment in terms of their ability to trust their own risk-taking capacities, to have a healthy and accurate sense of risk, and their expectations from those they view as authority figures. So when you're talking about TikTok, for instance, and the sort of trend of young people identifying with a diagnosis as Meaning, that they're some kind of victim, that they deserve a special treatment. To what extent does that stem from even this kind of very early exposure to safety-based culture?

29:54 Ryan Wexelblatt Yeah. Well, I think two things we have to differentiate, and I'm sure this will be hard for some people to hear, but I think we need to acknowledge a lot of people who are creating this content on social media are self-diagnosed. They've never been formally diagnosed. I mean, and I'm sure, Stephanie, you know, you know, there's this whole, you know, hashtag self-diagnosis is valid. You know, I'm going to reject science. I'm rejecting professionals. You know, they are oppressors. You know, so there's this mentality there that there is no need for a formal diagnosis anymore. Right. Anybody, if you say you're something, then absolutely you have it. So I think that's one thing we have to differentiate. But the other part with this as well is I think for a lot of individuals who do truly have a neurodevelopmental difference, they have gone through life feeling misunderstood and often judged and criticized. So my feeling is it's no surprise why this kind of victim posture would appeal to them. Because if this is the first time they're feeling understood by other people on social media, and this becomes their sense of community, of course they're going to embrace that. Because they're not getting that acceptance or understanding in their own life. So it makes sense to me.

31:03 Stephanie Winn So let's say you had a young person, because you work primarily with kids or exclusively with kids, although sometimes you work with them until they're in college, right?

31:12 Ryan Wexelblatt Well, I primarily work with parents now, but kids as well.

31:15 Stephanie Winn Oh, parents of kids. But you don't work with adult ADHD. You work with ADHD in children through doing family work. Okay. So let's say that as part of family work, you had, let's say, a teenager who spent a lot of time on TikTok. came saying, I think that I have ADHD because of all these TikToks that I've watched, and they've sort of absorbed this mentality. How would you respond to some of the messages that they've received? What would you maybe validate or agree with from the messaging out there? And then how would you try to maybe redirect or reframe how they're thinking about it?

31:49 Ryan Wexelblatt Yeah, well, let me share this story with you real quick. In the past few months, I've had three separate conversations, one with a psychiatrist, one with a psychiatric nurse practitioner who primarily treats children and adolescents, and one with a neuropsychologist. And one of the things that they shared with me is they are, and these people are in different cities, by the way, they are all experiencing girls and young women coming into them seeking an autism diagnosis. And one of the things with that is the one person said to me when that happens, and by the way, they're talking about young women who have no developmental history of autism symptoms. One of the things that, you know, one of the providers shared with me is that she explores their relationship to social media. So that's the first thing she wants to know is how immersed are they? Because one of the things she shared with me that is, you know, makes sense is that she finds that, you know, what we know is young women tend to spend a lot more time on social media than young men. So I think they're much more susceptible to this influence. And of course she will explore and do developmental histories with them and everything. But I think one of the things is we have to, really in a way, it's teaching media literacy. It's teaching that because this person on social media says this or checks off a bunch of things that resonate with you, that doesn't mean that you have ADHD. And I think what social media has done, it's provided this very simplistic type of self-diagnoses process that is misleading and confusing for a lot of young people. as well.

33:18 Stephanie Winn And there's probably something to be explored there with regard to why is this appealing? Why does this not only resonate with you as something that you recognize in yourself, but what is that part of you that wants to identify as having some kind of disability. What does that give you, right, in terms of secondary gain? We can't separate that from sort of the social climate. But let's switch gears and dive into the meat of what it is that you do. So first of all, why is it important to recognize ADHD in boys and help them with it? And what are some of the major themes you encounter in doing this?

33:59 Ryan Wexelblatt Yeah. So let me just mention, you know, I never set out to kind of specialize in ADHD in boys and I don't think of myself that way, but because I'm a rare male in a female dominated field and I'm an even more rare, more rare male in a, you know, completely female dominated field of neurodevelopmental differences over time, I find, I found that parents sought me out because I offer a different perspective or take on things or, you know, understand their kids differently. I think one of the things that I just tried to convey to parents is that obviously there are differences in the way ADHD presents in boys than it presents in girls. And I think, are the underlying executive function challenges the same? Yes. But when we're talking about things like social skills, I mean, the way boys develop friendships with each other is different than the way girls develop friendships with each other, which is different than the way a boy and a girl would develop a friendship with each other. And I think really just my goal is to help people understand that we don't live in this genderless world. as some people would like to pretend there is, I think. So, one of the other things I think is just in the mental health field, a few years ago I decided, I said, I'm going to start researching how many books are out there about helping clinicians learn how to do therapy with men and boys. And what I discovered through my research is there's essentially one collection out there, one curated collection. There is, I mean, at how many books are there about working with girls and women? Tons. It's just a subject that I feel has not warranted much interest or discussion. And I don't know how much of that is a result of the fact that it is a female dominated field or if it's more political or what it is. But I started saying to myself when I realized the dearth of information out there is that this is something that warrants some attention and some study. And that's what really got me interested in this.

35:53 Stephanie Winn So it kind of chose you. You didn't set out to do this, but you realized that there was a need for you to fill this particular role.

36:01 Ryan Wexelblatt Yeah. And if I can backtrack a little bit, the way that this first peak my interest was, I've done a lot of training in what I guess we would call the social learning field or what people would typically call social skills. And when I would go to these different conferences and these different trainings, I would be one of three or four guys in a room of 200 women. And I started realizing, as I learned more about social skills, was that what I really found was, and I never spoke about this for years because I was scared of being shamed for this, was that the social skills field is primarily very well-intentioned female clinicians, mental health, speech-language pathology, who are teaching overly formal etiquette to boys. You know, most of the people receiving help for social skills for males and most of the people providing the help are females who understandably were never part of a male peer group growing up, right? They didn't grow up male just as I didn't grow up female. And that's when I realized, hmm, you know, what these kids are learning really is making them sound like an adult woman. You know, it's not, they're not learning to communicate in ways that are relatable to other boys. And this has nothing to do with, you know, being masculine or bro culture, anything like that. It's just there's different ways to communicate, and that's what actually first attuned me to this.

37:20 Stephanie Winn Well, it's easy to see how examples of that would overlap with ADHD or neurodevelopmental differences because, for example, it's well known, although not frequently enough acknowledged, that males tend to bond through side-by-side activities where you're focused on whatever it is, the game, the hunt, the fishing, the project that you're working on together, and you're not facing each other, looking in the eyes, just focusing on having a conversation. And that is how a lot of male bonding occurs, is you get closer through a common interest. And so when we talk about social skills, it's really easy for me to imagine, although I haven't been in those same trainings, that you have a room full of women talking about how to get children to understand the importance of eye contact. Now, that's not to say that there aren't times where it is important to show eye contact, especially when interacting with your female peers, for example, or if you're a boy entering adolescence and you're interested in the opposite sex, you should probably learn how to interact with girls. And it's important to know how to interact respectfully at a dinner party or in various social situations. But yeah, if you're driving home the importance of eye contact and you're not being specific about which situations that's most important, then yeah, how does that make room for the fact that a lot of your peers are going to want to bond through playing video games, right?

38:52 Ryan Wexelblatt Yeah. The joke, Stephanie, I always used to say is, you know, I, I would see these boys, you know, who would say, learn how to, you know, communicate with other boys by saying things like, what are your hobbies? You know, boys don't talk that way to each other, you know? And I, that's when I, that's when it's, I said, there's a need for somebody to address this from a male perspective. So boys can learn how to connect in an organic way that is natural to other boys and doesn't feel like this overly scripted etiquette. Yeah.

39:16 Stephanie Winn It's so easy for me to see how that could go wrong. I can imagine the skills trainer saying to the kid, ask them about their hobbies. And when she says, ask them about their hobbies, she does not mean, so what are your hobbies? But she's not realizing that you might have to scaffold that a little bit more. What do you mean when you say, ask them about their hobbies? What would be a natural way to do that?

39:41 Ryan Wexelblatt And I think on the other end, and I don't know if you want to get into this, but what we're seeing now in the neurodevelopmental disabilities field is this anti-behaviorism, anti-teaching any skills under the guise of if you teach somebody with a neurodevelopmental difference social skills, well, that's ableist. You're not letting them be themselves. You're trying to make them conform. And one of the things, Stephanie, is, and I don't talk about this on social media because it'll scare people, but I can't tell you how many young men, particularly with what we used to call Asperger's, now we call higher verbal autism, I have worked with and even more so heard about who have gotten into serious trouble because they meet social faux pas, particularly with young women, because they lack the social understanding. So we have these people saying, well, no, that's ableist. We shouldn't teach that. Just let them be themselves. I'm neurodiverse affirming. Well, how neurodiverse affirming are you going to be when a young man does something sexually inappropriate in front of your eight-year-old daughter?

40:43 Stephanie Winn Really Ives at home. Yeah. A friend of mine who was on this show, Deb Philman, shared a story of her daughter being, I guess you could say harassed by a boy. But really it was a boy who was just very poor at reading social cues. It sounded like he was following her around. He clearly liked her. And he was always trying to talk to her when she was talking to other people. And so she started by being subtle, and then she had to ramp it up to the point of saying, please go away. I don't want to be your friend. And then the boy paddled on her. And she got called into the principal's office. I might be butchering the story. I don't know. Counselor's office. But, you know, basically she gets admonished and she gets told everyone's friends with everyone at this school. She gets told you're not allowed to reject a boy. And, of course, as a mother of a daughter. to be told that you're not allowed to set boundaries with the boy. Although at this stage, it was at a much earlier stage than anything that would lead to sexual assault. But still, that's laying the foundation because it's teaching a girl she doesn't have her right to boundaries. And it's teaching, what's the lesson for the boy here? That that's OK, that you can just follow around girls that you like, no matter how they feel about it. And then if a girl rejects you, you can go to an authority figure who will tell her that she's not allowed to reject you. Like, this is really serious. And it is just it. I think that there's also this kind of real naivety in the expectation of special treatment, like the example that we talked about earlier of that TikTok video of the girl crying because someone wouldn't accommodate her so-called time blindness. In other words, wouldn't permit her to be late because the missing component is that empathy for the other person that, let's say you have an employer. Well, if you want to succeed in life, it's really good to learn how to empathize with the needs of your employer and to take those into consideration so that you're responding well at work. And so this young woman in the video clearly wasn't thinking at all about how the situation looks from the other's perspective, that they already have 50 things to manage that day. And by asking for an accommodation around your so-called time blindness, asking them to work around you being late, you're adding a 51st, 52nd, 53rd thing to their to-do list. And so there's this kind of empathy gap between those who view themselves as not only having some kind of neurodevelopmental disability, but as belonging to a special protected victim class. There's like a lack of empathy for just anyone who may or may not have a condition themselves, but we're all still human. We all still have things to manage. And I think it creates a real hindrance because then they're not expecting themselves to develop those skills or to develop the empathy to see themselves as on equal footing with other people, to recognize others' perspectives. And it's like, it's cute on TikTok, and it's cute while you're young, and you can get away with it in your 20s maybe. But where does all that lead? I mean, we know the long-term outcomes for creating that kind of victim mindset and that expectation of entitlement and youth, and it's not pretty. It's broken relationships, broken families. health problems and lots of regrets.

44:26 Ryan Wexelblatt Two things I wanted to bring up. The story that you just shared before about this girl, I worked with a boy in high school who did exactly that. He developed this fixation on one of the popular cheerleaders at his school, and it was the exact situation you shared. And then he went to kiss her one time, and then he got suspended for that. And his parents went into the school and lashed out at the principal. And I said to them, he is not exempt from sexually harassing a young woman because he has autism. He does not get a pass for that. And they didn't like to hear that, but they knew that I was right. And I think that was their wake up call to understand that he had to learn to function in society. Society was not going to accommodate him because he had an interest and was showing it in inappropriate ways to a young woman. But to your other point, Stephanie, I am really worried because I think we are headed towards a segment of the population of young people with neurodevelopmental differences who are going to meet the criteria for what is often called failure to launch. And I think that that is going to happen, not because anybody is doing anything wrong, not because their parents are doing something wrong, but rather because their parents are taking really bad advice on social media. What I have seen historically with failure to launch cases are well-meaning, loving parents who have a very low threshold for tolerating their child being uncomfortable. And that's really what it comes down to. So if they can't tolerate seeing their child struggle or sitting with discomfort and they rush in to make everything better, then what happens is that the individual doesn't develop resiliency. They don't develop coping skills. They don't develop independent problem solving skills. and they don't learn how to, you know, function independent of their parents. One thing I want to tell you is I had an experience, you know, years ago where I met a young adult and he kept saying we, and I didn't know why he kept saying we instead of I. And then I realized it was because he and his parent, he did not see him and his, he did not see himself and his parent as two separate people. They were one entity. And I shared this with one of my professional mentors and I said, look, I just had this case of this young man and he kept referring to himself and his parents as we. And she said, I've seen that all the time. And then I had it happen more times. Those those are often the cases where I see failure to launch. It's this this failure to separate and see themselves as an individual, but also to develop those skills because they've been their feelings have always been protected because their parents couldn't tolerate them, you know, seeing them uncomfortable. And I'm not saying that with any form of kind of parent blaming or shaming. What I'm saying is that nobody provided these parents with information saying that, you know, what you're doing in an attempt to be helpful is actually hurtful.

47:25 Stephanie Winn So what would you say to a parent listening who maybe has an 18 or 19 year old at home that they're starting to worry like, Oh no, my kid's not talking to me about college or the workforce or anything, and maybe they're about to graduate from high school or they've already graduated, and that fear is starting to sink in.

47:46 Ryan Wexelblatt Yeah. I would say, first of all, it's never too late to turn things around, but you're going to have to probably step into your parental authority here, which is challenging for a lot of parents of kids with neurodevelopmental differences, but if we're talking about planning for the future, and helping to set a young person up for success, there needs to be discussions happening. And a lot of young people want to avoid those discussions because they're anxiety producing. One of the things particularly for people with autism is they tend to stay in school as long as possible because school is comfortable to them. It's a structure they're familiar with. And to step outside of that structure is uncomfortable. But but, you know, we can't just, you know, address this after the fact. We have to start preparing them ahead of time, you know, for transitions that come in life, because throughout life there's transitions, whether we like them or not.

48:35 Stephanie Winn Do you think that for some of these boys who are struggling, who are maybe future, you know, headed toward failure to launch or who are in that stage already, that video game addiction plays a role?

48:48 Ryan Wexelblatt Absolutely. Yeah. And I also want to differentiate, you know, there's a different, I think a lot of times what we call compulsive gaming, I'm sorry, what a lot of times what we call video game addiction is not technically addiction, it's compulsive gaming, but compulsive gaming is problematic in itself. So yes, that is absolutely a big variable in this. And again, it comes down to, you know, the that a lot of parents are scared to set limits around this because they're scared of their child's emotional dysregulation. A lot of times your child emotionally manipulates them by, you know, threatening suicide or holding knives up to themselves that they threaten to take away video games. So I understand why white people are scared. But, you know, this is why we need to support parents and why parents need to hear that, you know, kids need more than just love and connection. you know, to be successful, particularly kids with neurodevelopmental differences.

49:36 Stephanie Winn If you're looking for a simple way to take better care of yourself, check out Organifi. I start every day with a glass of their original green juice powder mixed with water. It contains moringa, ashwagandha, chlorella, spirulina, matcha, wheatgrass, beets, turmeric, mint, lemon, and coconut water. 100% organic with no added sugar. It's the best tasting superfood supplement I've ever tried, it's super easy to make, and it makes me feel good. Organifi also makes several other delicious and nutritious superfood blends such as red juice, immune support, protein powders, a golden milk mix, and even superfood hot cocoa. Check out the collection at Organifi.com slash Some Therapist. That's O-R-G-A-N-I-S-I dot com slash Some Therapist. And use code Some Therapist to take 20% off your order. I see this a lot too, where things have just already gotten to such a severe point, whether it is in a situation of, like you say, compulsive gaming or For teen girls who are addicted to their phones and social media or whatever the bad habit is that parents are having a hard time setting limits with, oftentimes by the time they see me, things have already gotten to that point where they're so afraid of their kid having a major blowout, threatening self-harm or getting into a knock knock-down-drag-out fight, and that to me is indicative of a problem that's been brewing for years, because kids are sort of designed to test limits until they know exactly where they are, and if you're going to be wishy-washy with those limits, then you're kind of keeping yourself in that dynamic where they are going to keep pushing and testing. And so when I hear this from a parent, it often is an indicator that they weren't solid with their boundaries in smaller ways earlier on. And so they they've learned to anticipate this type of behavior. And there's like a sense of helplessness and anxiety, whether that's, you know, sometimes it's bringing up a parent's own trauma. Let's say that they didn't have a good upbringing or they have some kind of trauma history. And in themselves, you can see That, like, fear, that almost like trauma response where they're afraid of their child. So when you think about what is this doing to the parent-child relationship, the parent doesn't have authority in their child's eyes. They're not able to guide them. They're not able to set limits that are healthy for everyone in the family. And it's not healthy for the kid either because, of course, they're pushing for more and more power. That's what they're going to do. But it's really alarming when you yourself are a child, you feel out of control of your own behavior, you know that you don't know how to navigate the world, and you feel powerful enough to overpower your parents and be ruling the household. It's sending a message that you are some kind of monster or tyrant or that you can't be trusted with power.

52:34 Ryan Wexelblatt And it's incredibly anxiety producing, particularly for kids with ADHD or autism who tend to see the world very concretely. When they realize I'm in control here and I control my parents, that is incredibly unsettling to them. And they don't feel emotionally contained in my experience. And that's where a lot of these behaviors come from, is that they don't feel contained and that they're anxious about it because they feel like they're in freefall because their parents have either been told or for whatever reason, they are so scared of stepping into their parental authority and creating that structure and those boundaries. And again, I want to say, I don't blame parents for this. I mean, there are so many different reasons why this happens. But there is somebody who I do blame, Stephanie, and that is increasingly I have been hearing from parents of clinicians who have said to them, don't put limits on screen time. She's very fragile. Just let her. And when I hear that, it just infuriates me. because these clinicians are not giving these parents evidence-based information. They're sharing opinions on a topic that they're not well informed about, and it's causing damage to the parent-child relationship. And I hear this so frequently.

53:43 Stephanie Winn When things have already gotten to that point where the parent feels that they've lost control and they're actually scared of their child, I hear you explaining the why behind why it's important to regain parental authority, but are there any tools or strategies or words of wisdom that you use to walk people through the how of turning it around?

54:03 Ryan Wexelblatt Yeah, so one of the things I really focus on my work is reducing what we call parental accommodation. So a parental accommodation is when parents modify their behavior to, you know, excuse me, alleviate their child's temporary distress. Again, very natural family dynamic in many families, but particularly for kids with neurodevelopmental differences, as well as for kids with anxiety. So what I really try to focus on is the fact that nobody's to blame here. We're not worried about what happened in the past. What we're focusing on here is how do we shift the way we parent the child by reducing accommodation, because that's what they need to be successful. with the understanding that this is not always going to feel good to you because your child is going to lash out. They're not going to like this because this feels like a loss of control. When you reclaim your parental authority, that feels like a loss of control to them. And although inevitably it will help them feel better, there's going to be some bumps here. I mean, I tell parents all the time, things are going to get worse before they get better. And then when that starts happening, parents often say to me, how long is this going to take? And I say, I can't tell you, you know, every child is different. You know, it really depends on on how soon they're going to realize that, you know, you're being firm here, you know, and you're being firm out of love and care for them.

55:18 Stephanie Winn So authority and reestablishing boundaries are important parts of the parent work that you do. What are some other key themes in how you help families where they have a kid with neurodevelopmental differences?

55:32 Ryan Wexelblatt Yeah. So again, I, you know, I want to explain to people that sitting in the therapist's office, talking about feelings, you know, that is not how you, you know, address ADHD related challenges. So what I focus on in my work is helping parents learn how to build skills. So learning how to improve executive function skills, learning how to improve social skills, learning how to help the child improve behavior at home. So the focus is never on, we need to get the child to change. It's about what are you doing to change, to help your child? You know, the child in what I do is never the identified patient. No. When, when I work with kids, you know, directly, so I do school year programs for kids and I have, you know, a summer camp. And again, it's about educating and, you know, teaching skills and it's just helping them to understand, look, you know, if you're, you know, if you want to make and sustain friendships, you're going to have to learn to be flexible. You know, if, if that's not important to you, well then you don't have to, but if you know, this is something that you value, then you're going to have to learn how to give in relationships. And part of giving is being flexible. So it's those kinds of things that, that really we focus on. It's all skill.

56:37 Stephanie Winn I noticed that how you framed that was speaking to the child's motivation, right? So you're not just saying it's important to have social skills. You're saying if you want to have friends, if you value spending time playing games with other people, for example, then it's going to be important for you to be more flexible with them because that's what people enjoy. That's what makes you an easy friend. Is that part of your approach, sort of tying the desired behavior that you're going for with the kids' motivation?

57:11 Ryan Wexelblatt Yeah, because I don't believe in saying to kids, you know, you need to do this. It's, you know, if this is what you want in life, then this is what needs to happen. You know, and because I think, right, we want them to decide for themselves what what they want. You know, one of the things, you know, for not really for people with ADHD, because most people with ADHD are socially motivated, but, you know, there's some individuals with autism who are just not socially motivated. And that doesn't mean they're unhappy. It just means they don't get much out of social relationships, which is totally fine. But that being said, they still need to learn how to function in a job situation. You know, if you don't want to have to interact with people outside of a job, I'm OK with that. You know, but then don't expect to have a romantic partner if you're not putting any effort into this. You know what I mean? Or don't expect to sustain a job if you're disrespectful to your boss regularly when they ask you to do something.

57:59 Stephanie Winn Besides social issues, what are some common ADHD behaviors that you work with parents on skills for. I'm imagining things like, you know, earlier we talked about difficulty getting ready for school on time. I know also with ADHD kids, difficulty with turning in homework. Sometimes it's forgetting to do it in the first place or losing it. But I've actually been shocked in my career how many kids do their homework and forget to turn it in. That's a weird one.

58:31 Ryan Wexelblatt Yeah, that's really common. Yeah.

58:33 Stephanie Winn And so pick a few of the ones that you see the most and then some skills that you use.

58:37 Ryan Wexelblatt Yeah. Well, you know what, Stephanie, what I really emphasize with parents is the things that I see adults with ADHD struggle with, you know, because I, you know, having done this long enough, I see there are certain things that for in many cases naturally get better, but there are certain things that do not naturally get better. So a lot of adults with ADHD still have a propensity to be inflexible. You know, that's problematic. That's part of the reason why people with ADHD, I believe, tend to switch jobs much more. You know, adults with ADHD still struggle with perspective taking. So understanding how they're coming across to others, that's something else I focus on. So I want parents to understand, you know, what I'm teaching is not for the right now. It's about helping your child develop these long-term skills that they're going to need to be successful in life. So the flexibility, perspective taking, obviously the executive functioning piece, independent problem solving, those types of things.

59:30 Stephanie Winn With executive functioning earlier, we were talking about scaffolding, and you mentioned that when we have clocks with hands on them, it helps us have a sense that time is more real. So with executive functioning, are there any kind of specific skills you implement? I think earlier you referenced people who talk about putting things on the wall, and it sounded like that wasn't necessarily in your toolkit.

59:55 Ryan Wexelblatt I'm sorry, Stephen, one other thing I wanted to mention too is, as I was saying, that I want parents to understand what skills their child's going to need to be a functional adult one day. Part of that, again, is understanding that as much as right now there's this, I don't know what I want to call it, noise on social media of people saying, your child doesn't need to change, the world needs to change for them. That's not realistic. And if you want to have this idealistic fantasy that that's how the world is going to work for your child, I'm sorry, but you're being naive. So to your question, in terms of the executive functioning piece, what I really try to focus on is those underlying skills. So helping kids develop their internal dialogue. helping with what's called situational awareness or what people often refer to as reading a room. That tends to be challenging for people with ADHD. The time piece, yes, that's important, but more what I'm concerned about is are you able to have that internal dialogue with yourself? Are you able to visualize things coming up in the future? Because what we know is for people with ADHD, kids in particular, they tend to live in the moment because what we call their time horizon or their ability to visualize the future is quite limited. It gets better with age, but it's pretty limited. You know, it's approximately, you know, two to three years behind their same age peers.

01:01:18 Stephanie Winn So how do you get a kid to develop an internal dialogue? I'm actually really curious about how you identify it's missing in the first place, because that's not, it's not something I frequently think of, but it was one of the first things you mentioned earlier when I asked you to describe ADHD symptoms in kids. You described a lack of internal dialogue. So first of all, how do you identify that it's not there and then how do you build that skill?

01:01:43 Ryan Wexelblatt Yeah. So just to give some context, I want to explain that all the training I've done in executive functioning for the most part has come from the speech language pathology field. The reason why is that field tends to understand executive functioning much better and they understand that so much of executive functioning is based in language. This is what's missing from the mental health field. So for instance, you know, the whole piece of internal dialogue, you know, and you ask, how do you know what's missing? Well, if a child is just, you know, sitting there staring off into space when they're supposed to be getting ready, that's a lack of internal dialogue. People just think they're daydreaming, you know, or they're distracted. Well, that might be the case, but they're also not telling themselves what they should be doing. So one, something I want people to understand is that, you know, if you have ADHD, you do not have a good executive functioning. People sometimes will use terms like executive dysfunction, which is fine, but they're not two separate things. ADHD is impaired executive functioning. Somebody with ADHD can absolutely learn to compensate for their executive function challenges, and being motivated to do so certainly helps with that. So in terms of how do we help kids develop an internal dialogue, it's really the parents learning how to shift the way they use language. So for an example, if instead of saying, you know, you left your water bottle for school on the counter, you know, we would say, look around the kit, look around the kitchen, figure out what needs to happen. Because when you use that kind of declarative language, that requires them to use their internal dialogue to think, what is my parent talking about right now? What do they mean? Look around the kitchen. That's part of the way we do it. So we shift from prompting language to declarative language.

01:03:17 Stephanie Winn Thank you. I was like I knew there was something specific I was trying to pull out of you and that really helped crystallize it for me because I can relate it back to my own parenting experience. I have I have step kids and so I'm still in that process of adjusting to kids that I didn't I didn't create. And actually this episode with you is coming out right after my first episode on the topic of step parenting. So any other step parents please check out my conversation with Jeremiah Wallace. But that one I get that because I'm not suggesting there's any neurodevelopmental issues with my kids. They're just young. So with the nine-year-old especially, unless you direct his attention at the thing, he's not going to notice it. And so I have tried language exactly like that. Instead of saying, you left your dishes on the table, I might say, look around and see if there's anything that needs your attention. Same thing because he likes to play with little balls. He's always bouncing a ball. So there's tiny balls and marbles all over the house, right? So just look around and see if there's anything that you need to take care of. And it does, yeah, it gets their gears turning. And oftentimes, they'll miss things. And then I'll have to point it out. But at least they're practicing being more aware of their environment and having to think about, yeah, developing that skill. And I've also been working on things like we're getting ready to go. Think about what you need and get ready. And then we'll review to see if there's anything you're missing.

01:04:55 Ryan Wexelblatt Right. I'll give you another example. I use this term I called read the field. So the reason I use that is because at my camp, one of the things I realized was how it's a camp for kids with ADHD. And when we would go to park somewhere in a parking lot, they were all completely oblivious to being aware of what's happening around them in the parking lot. So I learned this strategy from the women who I did the executive function training with. They, they called stop and read the room. So I adapted it. So, because a lot of times we have to use situational awareness when we're outside, like in a parking lot. So, you know, we can say, read the field, figure out what's supposed to be happening right now. So instead of a kid just walking cluelessly, you know, through the parking lot or a parent holding their hand, when they cross the street, we want them to develop their own situational awareness, right? Because we can't always act as their executive

01:05:42 Stephanie Winn Yeah, and so it's almost that Socratic method of getting their gears churning. One of my favorite teachers was like that professor in grad school who taught child and family therapy classes. He would present these scenarios to us. He would describe the presenting problem in a family saying, OK, parents are bringing their child and they're saying that the child is having this behavior. And he would give us a few pieces of information. and then get our gears turning saying, what do you think is happening here? And then we'd hypothesize. We'd dialogue amongst ourselves. And he would sit back and watch and only give us little bits of information and then maybe another clue. And then he would say, OK, well, here's what we actually discovered was going on. And here's the way we approach it. And then it was such a great way to learn for me, to be asked to figure it out myself. So I think of that as the Socratic method.

01:06:43 Ryan Wexelblatt I'm not sure if that's actually the right way of thinking about it, but- It's funny because I never thought about that before, but that is very similar to how I teach, yeah. Kids at least. With parents, I'm more direct because with parents, parents want solutions. So my thing is, I'm not going to waste your time. I'm going to tell you exactly what I believe needs to be done. And I think they appreciate that because so much out there is, particularly in the aviation field, is not tangible advice. It's speaking in concepts, but not saying specifically what to do. But yeah, with kids, definitely. I want them to use their critical thinking skills about these things.

01:07:16 Stephanie Winn Learning over time that there is something to be paid attention to, because it's so easy to just kind of be in your own little world. But being repeatedly asked to think about it or to look around is just over time, it's filling in the gaps. So, you've mostly focused on ADHD and it's ended up being mostly about boys because you recognize there's a need for a male perspective on these issues and for interventions that work for boys. However, you are also about to launch Raising Boys on the Spectrum. So, tell us about this shift toward focusing on higher verbal autism and what are some of the tools that you're launching with this project?

01:08:04 Ryan Wexelblatt Yeah, so let me mention, Stephanie, the reason why I don't use the term high-functioning autism is this. When I used to present an autism conference, I would share this information, that the three, and I put this in air quotes, lowest-functioning individuals I have ever worked with all had college degrees. So they were individuals who were diagnosed with Asperger's in childhood, they graduated from college, and they were unable to function in the world. That's why I don't use the term high functioning because I don't believe functioning level should be, you know, you know, dependent on somebody's cognitive abilities. I believe it's, you know, should be based on what is their ability to function in the world as an independent, you know, adult to the best of their capacity. So really my entire career has been spent both in working in special education schools and in my private practice with kids with ADHD and higher verbal autism. I decided to move away from autism for a few reasons initially. One is I realized that my strong suit is not working with parents who tend to be highly enmeshed with their children. And I'm not saying that in any kind of judgmental way. I'm saying that is not my skill set. And that is a very common family dynamic in families of children with autism. The other reason why I moved away from it is because I believe that ADHD is such a neglected area that people really were looking for ADHD-specific resources. So the reason why I'm getting back into this is number one, I miss the kids tremendously. That's really the main reason. The other reasons why are, as I mentioned before, I see parents getting really bad advice and opinions on social media that are not based in evidence, they're based in ideology. And looking and knowing that there's this generation of kids who are headed towards failure to launch, I thought to myself, I can just be complicit in this and say, okay, I'm just going to ignore it because I don't do autism anymore. But I feel like I have a responsibility to help try to cut this off, so to speak, or try to prevent it in any way I can by giving people information that is evidence-based, but also is going to be helpful to their children over the long term. I'll tell you the part about why I chose to focus on boys is this. So I've worked with a lot of girls with ADHD. You know, I even feel comfortable, although I didn't grow up female. I know some of the specific challenges of girls with ADHD when it comes to socializing. My experience with autism has pretty much been primarily boys. And something I learned pretty early on in my career, and this is going to sound a little extreme maybe, and I've never talked about this on a podcast, but one of the things I learned was I saw a lot of young men with higher verbal autism who I felt were basically emasculated. And they weren't allowed to become young men. They were essentially little boys in an adult body. And here's what I mean by that, that their whole life they have been surrounded by well-meaning female teachers, therapists, whomever, who all kind of took on these surrogate mother roles with them with the best of intentions. And it was done in a loving way. But what happened was the males in their life were often pushed to the side. Their fathers often did not have much influence in their lives. And what I found happened was from this mothering that they were surrounded with all throughout their school year, their school career, is that they never kind of learned how to identify with other males. they didn't know how to connect with other males. And most of them did not feel like, you know, they did not, I could tell that they did not feel like that they were, you know, a young, but a grown young man. And I said, this is really a problem. You know, because we're denying them, they're being denied the ability to learn how to connect with other males. And I see how much they want that. I mean, so many of the boys with autism who I've worked with, they crave friendships with other boys. So many of them crave a closer relationship with their fathers. And it's not like, you know, mothers are intentionally pushing the fathers out of the way. It's just that, you know, fathers don't know that you have to take a more proactive role here, you know, because obviously women, you know, mothers tend to do most of the child rearing. And for kids with autism, it's even more so because they feel this need to protect them. And that's how they tend to develop this, you know, a meshed relationship. And again, I'm not saying that with any kind of blame, but but something they they're missing something in the process. They're alert. They're not learning how to become men. And I see that as a problem. And right now, as I have to say this, I'm like, how quickly is it going to be before I get canceled by, you know, the angry mob on social media who's going to say that I'm sexist or whatever? But, you know, again, I mean, I, you know, and I didn't just, you know, come out and blurt this. I mean, I've had this discussion with many of my female colleagues, you know, in the autism field, and they all get it. You know, I don't think they're comfortable speaking out about it, but they all get it without question.

01:13:19 Stephanie Winn Yeah. No, I see what you mean. In families with autism, I mean, we know that the divorce rate is high amongst parents raising children on the spectrum because it can take such a toll on the marriage. And especially early on, it is mothers that are usually doing most of the caregiving. And so when you have a kid with a disability or a learning difference of some kind, it's easy to see how the mother would take even more responsibility and end up doing that. in her own maternal way. And it can be hard for parents of any kids to adjust as their kids get older to know when do I step back, stop doing something for them that they're used to me doing for them. It can also be hard to avoid taking shortcuts. This is something I see a lot with all kinds of parenting struggles that Usually the thing that is most convenient for you as a parent in the moment is not the same thing as what's going to help your kid in the long run. For example, cooking a meal, you can cook it a lot faster if you cook it yourself. You can cook dinner in half an hour. It's going to take two hours if you let your 11-year-old help you. But at the same time, how good is it to let your 11-year-old figure out how to help you make a meal or how to do it themselves? That's a valuable skill. And there are so many things like that where we're not always parenting with the best, or excuse me, we are parenting with the best of intentions, but we're not always parenting with the highest intentionality. We have to do things on autopilot just to get through the day and manage all the responsibilities on our plate. So it's really easy to see in a family that's been worn down by behavioral issues, a family where the parents aren't getting that affection back from their kid who's not socializing in the same way, or where maybe one parent's working a lot or both parents are working a lot to support the family, how things would end up in this really lopsided dynamic that's not necessarily the most intentional or the best in the long run. But yes, where the mom is just filling in for all the deficits that the boy has and just sort of letting him be very bright and very geeky and very passionate about what he's passionate about, but not really demanding that he contribute, because it's just not worth the stress of fighting over it, teaching him how to do it, and all of that. And so I completely see how things could end up in that situation where a boy reaches, let's say, the age of 20, and he's just so used to his mom doing everything for him, or maybe if he has sisters, sisters filling in the gaps too, sisters being the champions of their autistic brother at school. There's so many ways to see that going, given that his therapists were most likely to be female, his teachers were most likely to be female, and he's just been catered to and accommodated, that there is that real lack of a masculine presence. And so, given that these boys do have Also executive functioning deficits and social skills deficits, and that the people in their lives especially let's say overworked burnt out moms who have just learned, I'm not going to put up a fight I'm not going to ask my son to take care of this I'm just going to take care of it myself because it's easier that way. How do you turn that ship around? And what expectations? Well, I guess it's there's no way to say this. It's not customized to a particular family because it's always going to be different. I'm just wondering about like how families learn to hold any different expectations of their young men.

01:17:04 Ryan Wexelblatt Well, one thing I want to share is that I think the most powerful thing I can do for families is share my own lived experience. So I didn't mention this before, but I adopted my son as a single parent through the foster care system when he was eight. And he came with a slew of challenges, to put it lightly. And I was no different than any of those parents. You know, I was burnt out. And, you know, it was much easier for me to, you know, to go up and get his laundry basket and ask him to bring it down, knowing that, you know, it would cause some kind of fight and it could result in, you know, bookcase being tipped over, you know, for whatever reason. So I really try to share with parents that I have, you know, been there and been there doing this as a single parent. So I understand this. I'm not just trying to say this is what needs to happen. And, you know, and I want to, you know, be able to share that, you know, I'm human and I did a lot of things wrong and I have a lot of parenting regrets. And what I try to do is share not just my own lived experience, but what I've learned from the families I've worked with and the fact that, you know, I'm very lucky that I still keep in touch with, you know, my some of my former students, you know, who I've known since they were, you know, in middle school or high school and they're, you know, in their 30s now. And I hope that that combination of, you know, of experience that I can share, as long as my, you know, formal training kind of lends itself to a more practical, you know, application where people can realize that, yeah, I just need practical help and we're not going to get into, you know, let's discuss your childhood and why is parenting difficult for you? You know, I don't I don't want to get into playing therapist. I just want to give you practical help, you know, and if you need therapy, that's great. Go for therapy.

01:18:44 Stephanie Winn You can now watch No Way Back, the reality of gender-affirming care. This medical ethics documentary, formerly known as Affirmation Generation, is the definitive film on detransition. Stream the film now or purchase a DVD. Visit nowaybackfilm.com and use promo code SUMTHERAPIST to take 20% off your order. Follow us on Twitter at 2022affirmation or on Instagram at affirmationgeneration. You've watched the talk raising a kid from the age of eight from the foster care system and encountering those behavioral struggles and all the pressure to just get things over with the easy way rather than the hard way that I think attests to the solid foundation that your work is based on. Out of everything we talked about today, is there anything that you wanted to follow up on or anything that you were hoping to talk about that we didn't get to?

01:19:44 Ryan Wexelblatt I think the one thing that I want to share, because my audience will hear this, is really actually more about you and that I think that your voice here is so important. I just want to tell you how much I appreciate your courage. I want to tell you, when I found you, I was feeling very alone, and I'll tell you specifically why. I had just done two presentations on ADHD, you know, like a, through a, you know, university, and it was primarily clinicians, social workers who attended. And when I, I'm, I have to say, I'm pretty good at giving presentations. You know, I usually get good reviews. And in this one presentation, I got, you know, some questions saying, you know, well, what about trans kids? And I felt that the question, you know, it wasn't really applicable to my content. I felt more like kind of a gotcha question. Like I'm going to see what this guy says. And I said, this is not my area of expertise, but let me share a thoroughly researched book with you about this topic, because I think that this could provide some clarity. And I recommended Dr. Deborah So's book. Well, when I got the reviews back for that presentation, all of them were great except two. And guess why the two weren't great? Because nothing that I said about ADHD mattered. All that mattered was that I recommended a book that they said is offensive to trans people. And I said to myself, I provided them a book with evidence and they give me a negative review for that. And what's happening here? And I started to feel really alone and feel like, you know, this is not the field that I came up in anymore. And then, you know, when I found you, it was kind of like, oh, there's somebody else who feels the same way I do. And I don't feel crazy anymore. And I just want to say to my audience how important the work is you're doing, because I think, Stephanie, in our field, I don't know how you feel about this, but I think we're coming to a reckoning that's going to happen. And I think it'll happen in the next 10 years. And I'm really wondering how our field will look back and say, you know what? We screwed up big time, and we caused damage to families. And that's why I think the work you're doing is so important because it's providing clarity around something. And I think, you know, I hope 20 years from now, people will look back and say, oh, you know what? That Stephanie was correct. You know, she wasn't crazy after all. I'm not saying that people think you're crazy, but obviously, look, I see I see the reaction you get. And I think it takes somebody with a certain, you know, internal fortitude to be able to handle this. So I just want to say how much I appreciate that. And I appreciate you.

01:22:20 Stephanie Winn Oh, well, thank you for that, Ryan. Yeah, I mean, it does require fortitude, but I, I'm a mess in my private life. Sometimes it is a lot of stress. And I really like it's weird being that a lot of people put me on a pedestal and I just want to like, break that down that yes, I have certain strengths. I think most people would agree I'm pretty gifted in the verbal department and my understanding of psychology, but I'm not fundamentally different from anyone else. I don't lack the fear response. I don't have an ego of steel. I And I appreciate you coming on the show because I think so many people in our field are afraid to take that risk. But what they forget is that, first of all, the more of us who take the risk, the sooner the whole thing is over. The more of us who stand on the ground of our credentials and say, I, as a professional trained in this field, experienced in this field, do not agree with this, the faster this will all be over with. And also that you gain new admirers and appreciators of your work, and I hope that, you know, anyone looking for help with their kid who finds resonance in your work will find you through this podcast. By the way, the book you mentioned, Dr. Deberceau, that book is The End of Gender, and that's in my bookshop, along with every other book that's ever mentioned on this show. And that's a really easy way to support the show, is just to go to sometherapist.com slash bookshop. So thank you for saying that. I do agree that we're heading toward a time of reckoning, and I wouldn't be doing this if it weren't for that. Like, I know that I have a target on my back, and if there weren't a strong evidence base that we're heading toward a great time of reckoning with the tragedy of the harm that we've inflicted, then I wouldn't be doing these things, you know? And I've ended up pigeonholed. I'm grateful to every now and then have an opportunity to talk about something other than gender on this podcast. I like talking to all kinds of people about different issues, like ADHD, for example. I just end up pigeonholed because that's what my audience is listening for and because there are people who won't talk to me. Although we have other common ground. There are people who won't talk to me because they don't want to be associated with somebody who has been called the things that I've been called.

01:24:46 Ryan Wexelblatt You know, and I think for me it was I mean, yes, it was it was the gender issue that brought me to you. But that's not why, you know, I kept listening. And that's not what attracted me to your content. It was that, you know, you're somebody who is willing to kind of look at this from an outside perspective and not just kind of go along with what the way things are going, you know, in our field. And I just want to tell you this one last thing. So for those people who don't know, as social workers, we have to do, you know, continuing education credits. Some are mandatory on certain topics. So a few months ago, I did one on, you know, the one on diversity. So I went to this training and the individual, you know, facilitating the training basically said in coded language, you know, I know that I couldn't work with somebody who voted for Trump. And I said to myself, I'm sitting here in a training about diversity. You know, but you're saying that you won't work with somebody whose views disagree with you, right? Your political views disagree with you. How are you qualified to lecture on diversity if you are intolerant of people who have different views than you? You know, and, and, and that's when, you know, I said to myself, I have to pull back from, you know, even just being in Facebook groups with people in our field, because I just, you know, I, I can't relate to them right now, which is unfortunate because I really value professional camaraderie and, and I just don't have many people who I can connect with right now, professionally.

01:26:13 Stephanie Winn What you describe is a phenomenon that we've discussed on the show. I talked in previous episodes with Leslie Elliott, who encountered that in her training at Antioch, where the professors of counseling psychology at a master's level were openly saying that this is not for people who want to work with Trump supporters. And that we talked about that with Christine Seifan, who also was a former professor at Antioch. She's involved in Critical Therapy Antidote, which is a really great resource for other therapists listening to join. It's a good community that's been building. And I've done some some great work with Critical Therapy Antidote. They have meetings and all kinds of stuff you can join. They have a podcast now as well. You know, I hate Trump as much as the average Democrat. I'm no longer a Democrat, but I find the man despicable and disgusting. I think that was, it's a wake up call for me too, because I guess I have felt a responsibility. I mean, in the spirit of so-called cultural competence and diversity, in the spirit of being able to be fair and capable of working with a wide range of clients, I do feel a responsibility to see from others' perspectives. probably one of the strongest skills that you need as a therapist is perspective taking. And so when I realized that I had some blind spots or some limitations in that department, I found it helpful, for example, to read the work of Jonathan Haidt, like The Righteous Mind is an excellent book that's also in my bookshop to, you know, moral foundations theory has really helped me understand people who think differently from me politically. And I guess it's disturbing to know that therapists are that rigid because even if you carve yourself out a niche just working with people who agree with you, and I mean, I get it. Like I've carved myself out a niche where anyone who's familiar with my work who comes to me for therapy, they're looking for a gender critical therapist. They, you know, for them it's important. And I've, I've, I had a conversation recently with a colleague about this, where we were talking about the clinical needs of detransitioners. And I was saying, for some detransitioners, it's important that your therapist be gender critical in the same way that a rape survivor is going to need to know that their therapist opposes rape. You know, like, sorry to be graphic about it, but for people who feel like they were essentially medically raped, like that, they need to know that their therapist is absolutely opposed to that. And, you know, this therapist had a fair point that he sees a different population than I do. And so some of his people are more on the fence. But anyway, as much as I do have my own experience of kind of carving out a niche where the people who seek me out are really looking for someone who they know shares their values and beliefs in some ways, I also think that we have a responsibility and oh, I remember what I was going to say. you have marketed yourself and created your practice in a certain community where your clients are all let's say politically liberal or let's say therapists who work with trans people who are you know gender affirming therapists At any point, your very own client could change their mind about things, like they could go through some kind of inner transformation or life shift. And this is part of what I find so disturbing hearing the stories of detransitioners, just knowing how poor the responses that they got from therapists were when they started thinking about detransitioning. So, even if you take the detrans issue out of it, just looking at people's politics, you could be a liberal therapist that caters to liberal clients. But what if your client has some sort of crisis of faith one day and they start seeing things from a different perspective? seeing what's happening in our government from a different angle, or they learn moral foundations theory and they're like, you know what, I've been judging my public and Uncle Joe all wrong. Are you going to be able to support that client or are your own biases going to stop you from meeting them where they're at?

01:30:46 Ryan Wexelblatt Stephanie, I want to share this with you. Because I do something so specific, I have a very diverse audience. I have a lot of families, racially, politically, religion-wise. I have a lot of evangelical Christian families who follow me because My work is very family oriented. I mean, I have a lot of Latino families who follow me. And the idea that I wouldn't support somebody and want to help their children because they have a different belief system than me, it's unfathomable to me as a clinician to think that I would not help somebody just because they have different beliefs than me. It's hard for me to conceptualize as a therapist.

01:31:25 Stephanie Winn I know you're not super active on Twitter, so you probably missed this one little blip that happened several months ago, but I was fired from a naturopathic practice as a patient without reason. Okay, so I know it wasn't non-payment. And it wasn't that they stopped taking my insurance and it wasn't that I'd been belligerent or rude or missed multiple appointments or there was nothing like that. It was just I was working with one doctor for a while and then she said, you know, I think my colleague has more experience. She referred me to the other one. I had that person twice. We were right in the middle. Like she just convinced me to try a new prescription. I mean, we were in the middle of working on an issue that she had a specialization in. although I felt there was something weird. I felt like I was getting a vibe, where I'm just like, did she read my social media? Does she disagree with what I have to say? And here I am thinking, you're a naturopathic physician. Don't you have respect for the complexity of the human body? Don't you worry about what's happening to trans-identified people medically? But I mean, all I could assume after I received this letter in the mail saying that basically we can't work with you anymore. And I could tell it was a CYA situation. They were just putting the minimum information needed to document everything that they, you know, gave me a 30 day prescription and gave, you know, referred me to back to my insurance or, you know, like I could tell they were meeting the minimum criteria that they had to by law. without providing me that information. And I was so disturbed by it. And I tweeted about it. I didn't make accusations. I said, I think this is what's happening. But the whole thing spiraled out of control, where a journalist contacted them without asking me first. And then I was like, the journalist asked them for comment? Well, now I'm never going to get an answer. I'd been thinking about reaching out to the doctor's office saying, hey, what was this about? The fact that I haven't done anything wrong Makes me think that this is some kind of personal discrimination here and But knowing that a journalist reached out for comment, I'm sure, put their guard way up. And so it's unresolved for me. And I still don't know if that was the reason. And there's nothing for me to do about it. But it became really, really disturbing because I have a serious chronic medical condition. And it's hard to find the right help. And just to know that that's a risk, that as a medical patient, where we're not even talking about matters of the heart, we're not talking about thoughts and feelings and beliefs, we're literally talking about my physical health, to know that that could present a barrier I think has really kind of made me feel almost paranoid in navigating the healthcare system. But I do know there's lots of good people out there because I talk to them every day and I hear from them every day. And I do think ultimately we're going to win this.

01:34:17 Ryan Wexelblatt And that's why, you know, whenever I hear your guests, I mean, I just feel better that things will head in the right direction. I mean, it makes me optimistic when I listen to the podcast. So thank you.

01:34:28 Stephanie Winn I'm glad to hear that it makes you optimistic. I feel like we got really heavy and dark on here, so that's good that you got something positive out of it. All right, Ryan. Well, so you're based in Tucson, Arizona. Do you work with people in person or only remotely?

01:34:42 Ryan Wexelblatt I do in person. So parents, I'll work remotely, but kids, I won't work remotely. That's only in person.

01:34:48 Stephanie Winn Okay. And since you, I know you're an LCSW, but you also do coaching. So do you work with people out of state as a coach?

01:34:54 Ryan Wexelblatt I do, yes. Yeah, that's mostly what my work is now, is parent coaching. Yeah.

01:34:59 Stephanie Winn Great. So parents from anywhere in the country who want to work online with you, who have a kid with a neurodevelopmental difference, ADHD or autism, could reach out to you?

01:35:10 Ryan Wexelblatt Absolutely.

01:35:12 Stephanie Winn And they can find you at ADHDdude.com. I'll also include your YouTube channel in the show notes. Anything else you wanted to tell people about resource wise before we wrap up?

01:35:25 Ryan Wexelblatt My YouTube channel is, is, you know, I have lots of free content. Obviously it's all free content, but it's organizing the playlist to make it easier for people to find topics that, that they feel are, you know, would be helpful. So.

01:35:36 Stephanie Winn Great. Well, thanks so much for joining me today, Ryan. It's been a pleasure. Yeah. Thank you so much for your time.

01:35:41 Ryan Wexelblatt I really appreciate it.

01:35:42 Stephanie Winn I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit SomeTherapist.com or follow me on Twitter or Instagram at SomeTherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Care, at nowaybackfilm.com. Special thanks to my producers, Eric and Amber Beals at Different Mix, and to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.