Interview between Speaker 1 (Meg) and Speaker 2 (Oswin Latimer)
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[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in occupational therapy practice. I'm Meg Proctor from learnplaythrive.com.
Meg: Before we get started, a quick note on language. On this podcast, you'll hear me and many of my guests use identity-affirming language. That means we say, 'autistic person,' rather than, 'person with autism'. What we're hearing from the majority of autistic adults is that autism is a part of their identity that they don't need to be separated from. Autism is not a disease, it's a different way of thinking and learning. Join me in embracing the word 'autistic' to help reduce the stigma.
Welcome to Episode 32 with Oswin Latimer. Oswin is the founder and president for Foundations for Divergent Minds, and a former Director of Community Engagement for the Autistic Self-Advocacy Network. Oswin consults with parents on how to support their kids at home and at school, and also with larger organisations like the US Department of Labour and the Department of Education on Disability Policy. In this episode, Oswin and I talk about what it means to have executive function differences, and the specific ways that we can best support our autistic clients' participation in meaningful daily activities. Here's the interview.
Hi, Oswin! Welcome to the podcast.
Oswin: Thank you.
Meg: So, let's get started by talking a little bit about the Foundations for Divergent Minds. Tell me a little bit about what it is and the work that you do there.
Oswin: So, we started out as an educational non-profit; specifically, helping parents, and providers, and educators that work with autistic kids and other neurodivergent kids figure out how to support kids in their natural state rather than trying to change any given behavioral trait that they're having. With the idea behind it that all behavior is communication, and all the major tenants of the neurodiversity movement build into the way that we scaffold the supports for an autistic person. And it's all based off of a framework that I created in supporting specifically sensory integration, executive functioning, communication, social interaction, and emotional regulation, with the idea that all these things are what contributes to having the whole well-rounded person for anyone. Not unique to autistic or neurodivergent people, but all people need these, need an understanding of these areas to be supported in their environments.
The thing with most neurotypical people is that they are supported in all those ways in their environment. And so, like, there's no adaptation that's needed, but for most neurodivergent people, you need to have some adaptations in all of these areas in order to be supported. And while we mostly focus on autism, because that tends to be the narrative, that neurodivergents is most stripped of those rights, we believe that this works for a variety of neurodivergents, whether it's ADHD, or dyspraxia, or dyslexia, so on and so forth, that all these areas should be supported for all people with neurodivergence.
Meg: That's wonderful. I've spent a little bit of time on your website and on your social media, and I'll definitely link to it in the show notes so that people can take a look at that framework. It's a really useful way to approach supporting neurodivergent people given the demands of the world we live in. And today, we're gonna dive into just one piece from your framework. And I know you could talk about all of them. You have so much expertise and so much to share. So, we're gonna focus in on executive function. We already started that conversation in the last episode about how executive function might appear differently neurologically for autistic people, and we really dove into some research that showed that it's not impaired. It's not that cognitive control isn't happening for autistic people, it's that they're using those cognitive control networks differently. And today is our chance to really jump into, okay, what does this mean? And how can we support autistic people in their daily lives, given those differences in executive function? But for people who missed the last episode, or caught it but still need a refresher, can you give us a breakdown of what executive function skills are?
Oswin: Sure. So, I think that when most people look at executive functioning, they tend to think of organization and planning as like the two things that are executive functioning. But as you know, there are eight different areas of executive functioning depending on — well, I use the eight skills model. I know there are others that go — that have more or less than that, like, the eight skills one. So, we're looking at initiation, impulse control, planning, organization, working memory, self-monitoring, shift, and emotional regulation. And for any given person, some of these are — can be, for — I'm going to go specifically with autism, where we mainly look for areas that are divergent from the norm. So, shift, initiation, planning, and working memory.
And this really helps us, and if we start looking at this from like, it's specific to autistic people, then usually, most of our restricted and repetitive behaviors within the diagnostic criteria are all based off of these four areas. And some of our communication diagnostic criteria is also basically — as it really, or are executive functioning traits as it relates to communication rather than looking at it from the broader aspect of it being the same problems within — when I say problems, but like, characteristics of autistic people, even in restricted or repetitive behaviors. So, when we talk about the difficulty initiating conversations in our communication, then that's an executive functioning trait, not necessarily a communication impairment or issue. But this is the same thing when we get into our special interests. It is our ability to focus and not shift from what we're doing. So, like, that's an executive functioning trait that may be seen as a deficit there. But anyways, I'm getting ahead of myself, because we're going to get to that in a second
Meg: No, that's really interesting, and I'm following what you're saying because initiation is an executive function task. If you're talking about initiating a conversation, that active initiation is coming from executive function. The interview with Dr. Gordon, one of the things that his study showed was that autistic people in this research study had a really hard time with reactive executive function when the instructions suddenly changed. And it tied in, like you're saying, to changes in routine, changes in expectation; that a very deficits-based and stigmatizing way to say that is that autistic people are rigid. And one way to look at it, even with this neurological basis, is that shifting the executive function demands of what you're expecting to what's now happening is very taxing on the prefrontal cortex of an autistic person?
Oswin: Yes. There's actually some new research that's coming out around the word 'monotropic learning style' which is this, it's talking about the cognitive style that we're talking about here, where we aren't able to shift from one thing to another, but takes it out of that deficit language and into the 'This is a learning style, it's a cognitive style'. So, we can talk about it in terms of both in a positive light or a negative light depending on the context, because everything is so context-driven, if you can step back from the deficit language.
Meg: I love that. So, thinking about attentional set shifting or shifting your attention from what you're doing to what you have to do next, most of us neurotypical people are familiar with the feeling of being very deeply engrossed in something, and having somebody call your attention away from it. And it's really, really, really hard sometimes — not often, in my experience — but sometimes when I am just really in the groove with what I'm doing, it's like somebody's calling to me from another time and space, and I just can't quite shift. And we talk about difficulty shifting attention as if it's a deficit, but I hear you saying it's the demands of the context, that we act in this neurotypical way of, "Oh, now it's time to do the next thing," rather than, is the person finished with what they're doing, or are they focused and engaged and involved in it, and not quite ready to move on? The expectations and the demands of the environment in the world aren't really matching the learning style of that person, is that right?
Oswin: Yes. And if we think about it in a broader context, with like, just all human beings, we would never ever say that somebody — that a surgeon that is going through and doing hours of surgery on this one person, on this one thing, is doing something bad or wrong. Like, this is what that person's job is. And so, we would never take that intense focus in that moment and say it's a negative thing. That would be a completely positive thing in that scenario. And so, this is why we want to think about everything is a context-driven thing rather than as a all-or-nothing approach of looking at these characteristics,
Meg: Right. Absolutely. So, knowing that autistic people have differences in their executive function skills compared to neurotypical people. And now more than ever, the executive function demands of daily life are very, very high. I know even a lot of neurotypical people with very strong — like, our executive function muscles are really being flexed or pushed to our limit with how much we have to plan, and manage, and organize. So, we're really not setting up neurodivergent people or people with any sort of executive function differences for much success with the demands of the world. Talk to me a little bit about what that looks like. So, you're autistic, you have autistic children and other autistic people in your life. Can you give me some examples of what executive function differences can look like in the daily lives of autistic people?
Oswin: So, I like to take a 30,000-foot view when I'm looking at this rather than just the personal because it's really important to not centralize just one person's experience on this. A few years ago, I was doing a presentation on executive functioning for an Autism Society of America conference, and I did an informal poll beforehand online to really get some numbers on what people thought about their executive functioning traits with their activities of daily living. So, our basic ones are eating, getting out of bed, bathing, getting around outside, toileting, and getting dressed; whereas our instrumentals are housework and grocery shopping, money management, medication management, telephone use, going places, and preparing meals, doing laundry, you know, all those things. And what I found was that most people consider their executive functioning traits to hinder all these areas, including things like going to the bathroom. Like, just getting up, initiating that task of getting up and going to the bathroom to use the bathroom, even when you are aware of the fact that your body needs to do it. Not getting into the intersection of people that may not be able to feel that to begin with, but like after that, and recognizing it, how much of these simple things can impair the way that we do our basic things.
The knowing that you're hungry does not necessarily mean that you can do the planning, doesn't necessarily mean that you can shift from what you're doing right now. As an autistic person, if I don't actively try to do these things, then I may end up at my computer at 2am, hours and hours since eating last. Still hungry, but I'm like, "I can get this one next thing done," and not being able to shut off what we're doing in that moment to just go get food. So, this is an area that where we see that this is a trait that can be an impairment. But if you have somebody that's there, supporting you, and just brings you food. Like, a simple baseline thing, bringing me food while I'm at my computer, then I can still eat and do the thing. So, it's very context-driven. This may also be a, "I am not going to go prepare food, I'm going to order food," and when it arrives, then that's a natural stopping point, because you've got a knock on the door. So, like, that's a shift. You also know it's coming, so it's not an unexpected shift, so you're able to get up and go do the thing, get the food, eat, or just bring it back so you can pick at it while you're still working. Like, these are all ways that I use in my home life to be able to get everyone's needs met, while also having these characteristics about myself that I don't necessarily want to change because it's not necessarily a bad thing at all times.
Meg: Yeah, you're really speaking my language talking about daily living skills here. I know that about seven or eight years ago, UNC Chapel Hill's TEACHH® Autism Program found a bunch of files in a closet of the first kids they had diagnosed as autistic at TEACHH® back in the 70's. And they wanted to see what factors in childhood led to positive adult outcomes, which were self-reported happiness, relationship satisfaction, independent living, employment, lots of different measures. They were psychologists doing these studies, and they went and found the people again, and did all these assessments. And they thought that the childhood factors that would lead to positive adult outcomes would be things like IQ, or how much language, or behavior, or anything like that, and it was daily living skills.
Oswin: Yeah.
Meg: It was how well the child was doing at participating in their basic daily routines that was the best predictor of these adult outcomes. And I'm really glad that you and I are having this conversation around executive function, because I think that understanding executive function differences is one of the most important things that we can do to move people away from behavioral interventions. Because if you're looking at a child who's not getting up to go do something they need to do to take care of themselves and you're saying, "Oh, they're trying to get out of it", "Oh, they're trying to get attention", these behavioral hypotheses, you're completely missing the executive function demands of the activity, the executive function skills of that child, and the opportunity to support initiation, starting the activity, moving through the steps, seeing that it'll be finished. It's such a more useful lens.
Oswin: Yes, and I completely agree. And it's one of the things I — so, I do a fair bit of consulting with BCBA's in particular, because we know that's a particular modality that most people do in the US, and Canada, and somewhat in Australia for autistic kids. And just having that baseline understanding that these are things that our brains don't naturally do. Like, our wiring is just not set up to do. It's so powerful in the way that they then go back and change the way that they are approaching an autistic child shock. Because when they realize that this is not a choice, then we can employ so many more accommodations, instead, to support those particular characteristics. And it is such a powerful thing. It's something that I have watched as my kids have grown older. Like, I have always had within their evaluations always made sure that they did an executive functioning evaluation throughout the years because it's such an important thing. And people are like, "Oh, yeah, this is what we expected to see." Yes, but why are we trying to change these behaviors when clearly, we had just shown over the course of their entire lifetime that they can't do that. That's the executive functioning trait. This is the core. The cognitive characteristic of autism, that yes, we don't expect to see this change at all, but yet, we're expecting these behaviors to change based off of a sticker or an m&m.
Meg: Right? It's like, "Hey, Oswin, when I've got your cup of coffee here. I see you normally wear glasses, but I'd like for you to read this paper without your glasses. So, can you just try a little harder, take glasses off and do it, and then I'll give you your coffee," so you're motivated. It doesn't work.
Oswin: No. Like, this doesn't change what our brains just can't do. It just makes us feel worse about the fact that we can't get what we want, sometimes need. Let's be honest, sometimes that that break that they're trying to dangle in front of you is something that you physically need.
Meg: Yeah, this has been a real theme on the podcast about what it feels like and what it does to someone's sense of self to have a deficits-based intervention approach in your face, sometimes for 40 hours a week. And it's a useful exercise to imagine yourself. I am really bad at remembering names, recognizing faces, memorization in general, telling directions. No matter how much somebody tried to do skill building for me around those things, I'd probably still be pretty terrible at it. And I don't spend my time doing that, right, I accommodate. I take my phone with me when I run, because I'm probably gonna get lost. I have learned how to politely ask people for their names, and let them know that I'm just bad at remembering. Nobody wants that in their own life. And sometimes we forget that; that the child in front of us, that this is their building their sense of themselves right now. And these are the moments of their life — Winnie Dunn eloquently said that in a podcast episode interview that I was doing with her — she said, the moments we spend in therapy are also the moments of that child's life. What do you want those moments to look like?
Oswin: Those attachment styles.
Meg: Yeah.
Oswin: I could go on and on about attachment styles. We're not going to go there today. [Laughs] But like that is — that is what we're doing when we're trying to motivate a child, is telling them that they have to do these things in order to be attached to us as adults. Like, that's the worse way that you can go about —
Meg: It is.
Oswin: — interacting with a child.
Meg: Yeah, I appreciate you bringing us back around to why this matters kind of at its core. So, let's talk about those supports. What are your favorite kinds of executive function supports for people who are struggling with the cognitive demands of daily life?
Oswin: So, I love visuals for everything. I have visuals in my home for chores, I have visuals in my home for meal planning. For the longest time for my kids, I would also put a visual for the steps 'We're taking a shower' or a bath, like just baseline. It was always there. It was — I laminated and did gooey stuff to put it on to the shower wall, so it would just stay there all the time. Like, there's no reason to move it, like nobody's gonna see it. It's behind the shower curtain. Even if they could, then I would have made it more decorative. I like making my supports decorative. But that's my first thing.
Wait times. Giving the pre-emptive notice so somebody knows it's coming, so their mind can go ahead and start shifting, and still coupling that with wait type after the fact of letting that transition happen, because we know that there's such a high rate of motor planning differences that come along with autistic people. I think the most recent paper I've looked at said like 80% qualify for — or half — of suspected developmental coordination disorder, which is just dyspraxia, but in the prettier terms that they're now using.
Oswin: So, like, having that extra wait time so that those initiating steps can happen, and those planning steps can happen as well. Because it's hard for me to look at these in a bubble of just executive functioning, because there's so much of that — so much of the sensory integration that goes along with why we're having to have those wait times, even after we have the shift happening. Now we have to get that initiation happening after the fact, based off of the information that we're getting in from our body and the information we're getting in from the external. It's hard to look at that as a singular thing. So, having those kinds of things in place.
Then, also, some things like social stories, as much as people want to think about them as social engagement pieces, that it's also really great for that expectations of what's about to come, and being able to — it's scripting your body movements, more or less. Instead of scripting language, scripting your body movements for what to expect. So, those are great.
Timers. For everything. Because you can't initiate unless somebody — so that we're not having that external person doing those, that initiating. It is something physical in that way. So, even if we're prompt dependent — because autistic people tend to be prompt dependent because of the initiation — we can have those prompts not be a physical person. That can be an external thing, such as a timer. And now that we all have phones, like you always have a timer on you. So many advances with that have been so amazing.
So, those are the main things I like to think about with executive functioning. But like, we also — I don't want to detract from the fact that many people also have ADHD select, that impulse control is also like an executive function trait, that we tend to have rubber bands on our arms for reminder things. I saw a really great Tik Tok this week with somebody that puts a key ring, you know, the spirally ones?
Oswin: On like their stove, so that when they put something in the oven, they take the thing off there and put it on their wrist to remind them that they've got something in that oven.
Meg: Oh, that's so smart.
Oswin: Right. And like they do it for like, drawing a bath. So, they have a different color one for the bath, and they have another one for laundry. So, if they have that on their wrist, they need to go do that thing. They need to keep an eye on it. And like, that's the most amazing thing I have seen on Tik Tok in a while. And yes, I know…
Meg: Yes.
Oswin: [Laughs]
Meg: Well, it's so simple. There's no prep involved. You can roll it off, and then that's your system.
Oswin: And so, like, all the systems, all the time. But it takes knowing what your executive functioning traits are and like, all the things that I don't think a lot of even autistic adults get to learn about themselves until they get really deep into exploring their autistic selves. And so, there's a whole bunch of people that will never ever know these strategies, because we haven't focused on supporting those executive functioning traits. We instead look at all the behavioral characteristics and ignore those underlying potholes.
Meg: Yeah, and you've gotten the message instead — this is true with ADHD especially — but for autistic people and people who are autistic and have ADHD, the messages they're getting instead is, "You're lazy," you're whatever —
Oswin: "You're not trying hard enough."
Meg: Yes, it's all of these negative messages. So many people say, "Oh, gosh, once I learned I was autistic, once I learned I had ADHD, I could conceive of myself differently. I'm not lazy, I struggle with initiation, and I need support."
Oswin: Now, that's for people that recognize that later on in life. How about all of the people that have been diagnosed all along and know they're autistic, and then they never get out of that mindset, because they don't have to do that. They don't do the exploring that we as diagnosed adults have to do in order to understand ourselves. They just get the message 'They haven't learned how to do things well enough'. Or, this is how we can get into people that say that ABA did work for them, because suddenly they perform if they can do those things and so, ABA saved them. But they never learned anything about those executive function traits. It's why we end up getting into all that, or burnout and autistic inertia issues when you're getting into adulthood, is because you've never learned those basic characteristics. And so, you think that you have learned how to control your behavior, so like, you've stopped. You have recovered. And instead, it's actually not sure, you haven't done any of the work that you need to understand all the supports that you need in order to achieve your greatest inter-dependence.
Meg: Oh, wow. I love that phrase. I love that. We've been really working on shifting throughout these podcast interviews. I've had so many guests make this shift from independence to autonomy. And I feel like that fits really nicely with what you're saying, that — what did you say, 'achieve your maximum inter-dependence'?
Oswin: Yes.
Meg: Like, your best self isn't an independent self. It's an autonomous self that needs other people.
Oswin: Yes. Like, the amount of need that people see of self-regulation instead of co-regulation — like, as human beings, our co-regulation skills are far more important for our sense of self and sense of feeling of safety in a social context, versus that self-reliance on self-regulation. It's usually — co-regulation is where you end up feeling the most in control of your life because you not only can support yourself, but know that there are others around you to support you, and so like that. Getting back into that attachment styles.
Meg: I mean, there's a reason we keep circling back there. You know, we're talking about executive function and at the center of everything we're talking about is letting people be okay, not traumatizing people, and supporting them instead. I love that list of supports that you gave. I was thinking about folks who work with young children who maybe don't yet make a lot of meaning out of timers or sometimes pictures, and there's so much use of hand-over-hand for initiation in therapy practice. And people who have been listening to the podcast have heard this before, because this is one of my soap boxes that we don't have the right to move an autistic child's body to get them to do what we want them to do. But there are strategies that help with initiation like handing something to the child. You want them to do the shape sorter, hand them the square that goes in the shape sorter, and that helps so much with initiation versus moving the child's hand.
Oswin: And this also gets into a little bit of the problems around withholding when you're doing therapy, when you're trying to hold things close and not give it to them until they have showed that initiation. And like, that's not a natural way of being. Like, that's not a natural way of playing with. If they were playing with peers, that would never be the way that they — well, it might, depending on the child. But in general, we're not expecting kids to give questions necessarily. Like, I really hate to rag on my daughter's SLP, but like, last session, she wanted her to ask a question after she said, "I need that piece." She then tried to form it into — get her to form it into a question. It's like, no, no, that is unnatural. What she did there was still a very natural way of asking for what she needed next. And it was very, very socially accurate for — now, my daughter is not autistic, so I'm even more particular about this because I don't want the — I don't want that unnatural language to be the cornerstone of speech therapy. That's not accurate. And like, luckily, my kids care teams are really good about taking direction when I say, "Yeah, no, that's not really an accurate way of going about doing that, because it's not a natural way of interacting during play." Saying, "I need that piece," is asking for it. But we go with this wanting to direct people so that they can learn how to do these goals in a particular way, but then we are stifling that. My word here is completely —
Meg: Authentic?
Oswin: Yes, yes. Like, we want that authentic communication, we want that authentic engagement and like, during play, you are more likely as an adult to just hand a child something.
Oswin: To get them to engage, than you are to wait for them to tell you that they want it, or point to the thing that they want.
Meg: Yeah. Handing someone something is a great strategy. It's so much better than all the words and all the coercion. You know, if I need to, even in middle school or high school or to go look at their schedule, or their to-do list and see what they're supposed to be doing, I might just casually hand them their pencil and say, "Hey, go check your list," and that starts the process, kick starts that initiation. Here's the first step, it's right there, that object is showing you what you're supposed to be doing. And then they're successful. And we don't have to go down this power struggle sort of road.
Oswin: One of my kids, the first step after making sure that all accommodations are in place in their behavior plan is asking them, or reducing the initial expectation down to writing your name on the paper, just to get them started. Because if the problem is initiation, we don't want the problem to be — we don't want it to seem like the person is not doing the work because they're choosing not to do it or they're trying to get out of it. Sometimes it is just as simple as they can't get started. And so, writing your name at the top of paper is getting started. That's all you have to worry about. Now, if that — if it continues on after that, then there's probably a different accommodation that you're supposed to be doing there. But that initial step is just trying to get started. And sometimes it's as simple as, "Okay, write your name at the top of the page."
Meg: I love that. So, they're getting started, and then we can problem solve, "Oh, they're still not doing it. Well, can they see the steps? Do they know what to do next? Can they tell that it's eventually going to be finished?" Nobody wants to do a project if they can't see that it's going to be finished. And that is an executive function task, identifying 'Finished' and making a plan to get there.
Oswin: Yes, I'm loving that. Sorry. That was great. Because it is — because there's so many reasons that a task may not be happening. And I really like to help everyone think about executive functioning in a form of task to task to task throughout the day. Like, everyone is performing a task throughout the day, from the time they wake up until the time they go to bed. Or go to sleep, actually, it's more accurate. Like, every single one of those things is a separate task that we need to think about in terms of executive functioning for an autistic person, or any person, really. And we need to be able to recognize what the problem may be in every step of getting that task, from the start to the complete.
And for larger tasks, that may be a bunch of different steps. And for something like getting out of bed — well, no, getting out of bed is really hard. I'm going to use a different example. [Laughs] Let's go back to using bathroom because that is a pretty simple task once you can get started, because your body does it naturally. You just have to get up, and go to the bathroom, and sit back there. Getting up for the day is a lot harder, because you're not just doing that one task. You're going through, and getting changed, and using the bathroom, brushing your teeth, and eating, getting your stuff ready to go. And some of these things may be more or less of a task in and of itself. So, getting out of bed is a terrible example. [Laughs] Or a simple task, because is never simple. No matter how much anybody wants to pretend to like it. Everyone hates getting out of the bed in the morning.
Meg: Yeah. And then there's that sensory piece of moving from sleep to wakefulness, it's a tough one.
Oswin: And also removing the covers if it's cold, or if it's hot. All of those things. Like, all of that goes into it.
Meg: Yes. All of our listeners are just filled with dread thinking about what it's like getting out of bed in the middle of the winter.
Oswin: Exactly. And like, we all know it, and somehow, we expect autistic kids to be able to do it when they're five, to go to school, where it's daunting. And this also gets into autistic inertia, which I think is probably one of the least known things within treatment. So, for your people, because like I said, if they've ever heard about inertia is probably pretty, pretty low. So, autistic inertia is this concept that a body — so, takes the physics definition of inertia that a thing in motion stays in motion until acted on, or stays stationary until acted on by an external. So, Newton's laws, first and second, I think. But this goes with autistic people as well. So, a person's body in motion is likely to stay in motion, so this has implications with stimming, this has implications when we're looking at special interests. I really hate the 'special interest' word, our interests aren't special. They're just interests. Our ability to deep time does not make them special. But it also has implications for when we're talking about getting up and initiating tasks. So, if our body is already not in motion, then getting it into motion is going to be a little bit more difficult because of the stationary and that monotropic learning is one of those things that autistic research, in particular, is starting to look at. I'm really getting into the monotopic learning style research because it's only a few years old and it seems to go along with autistic inertia, but also like double empathy problem research. It's really wonderful.
Meg: That's great too. So, does autistic inertia really tie into what we're talking about with initiating a task and seeing that it is finished?
Oswin: It does. So, autistic inertia ties together our initiation and the shift. It also ties in in our work working memory but there's also some emotional elements that go along with it. Not just emotional regulation, but also that self-monitoring piece that we tend to have difficulty with in the moment. And then also motor function. Like, it ties in basically all the things that are autism into this idea of our bodies at rest struggling to get out of rest, but also when we're in motion, struggling to stop moving. So, one of the great things about it with executive functioning is that we can use that — use the fact that our body is in motion to get things done. So, like, I really like getting back into the accommodations set is sequencing things around events that are naturally going to happen.
So, instead of waiting until 9am to take your medication, having your medication beside you in your bed, so you can take it when you wake up is a pretty simple accommodation, but it attaches it to a naturally occurring event in your day. I like to, as a parent, since I have a pickup time for my kids at school, then I tie eating lunch to that pickup time. So, I leave the office 30 minutes early to go get food before I go pick up my kid from elementary school. That is something that I physically have to do, like there's no getting around it. She is going to get out of school. I have to be there to pick her up. So, I tie things to that event, and if you can do this throughout your day, then you can kind of work around the inertia problems and the initiation problems because it is no longer that individual sequence, it's part of a larger sequence.
Meg: I love that. I've heard this called 'chaining', and it sort of relates to habit stacking too, as well, that if there's some routine you've established, and you want to start doing something else, connect them. Attach them, rather than making it harder on yourself.
Oswin: And this won't work for all inertia problems, this will not work for all initiation problems. And you can get into the problem of if you do this was the thing that is aversive, especially, that you may get stuck not being able to start any of that routine. So, like, I don't encourage it for like the most difficult things in your day. They should probably be standalone and not attached to something else. But for things that are not so difficult, and maybe not aversive, then the chaining helps in the — in putting it in. But I don't always recommend it for like the biggest things.
Meg: Right. Like, every time I go to get ice cream, I get my allergy shot. Now I don't want to go get ice cream at all.
Oswin: Right. So, like, it's a terrible idea if it's something that is aversive.
Meg: Yeah, that makes a lot of sense.
Oswin: But if it's just something that you're having trouble starting because your brain doesn't think about it, then chaining it is a much better plan than just not doing it.
Meg: Okay. So, you started giving us an example. I want to flesh that example out and see what you had to say about it. So, let's say this child we're talking about is nine-years-old, really bright, uses some language, reads some but still struggling with reading, love superheroes. So, he is really struggling with most areas of his life. Like you said, getting out of bed, getting ready for school, doing his homework, doing his chores, doing his homework. He can do all of those things, but he needs a lot of reminders, lots of prompts to get through them. Everyone is frustrated, including him, and he's always running late. What types of supports might a child like this benefit from?
Oswin: So, there are so many things, and I want to really think about each of these things as a separate when we're thinking about accommodations. So, like, getting out of bed. What are some things that you can do well? I'm going to make an assumption that he can stay dry through the night. And that's a really big ask, but like, I'm gonna make that assumption. If he can do that, then there is no reason that he can't take when he's done using the bathroom the night before, just dress for the next day after the bath. So, when he wakes up in the morning, there is no motor planning to change. There's no struggling to figure out what he's going to wear. All those things are already pre-set when he wakes up. So, very simple accommodation.
Having breakfast meals that maybe are more easily accessible. Instead of having him make a bowl of cereal, maybe instead we have oatmeal that's already prepared in the fridge, like that cold oatmeal thing that people like doing.
Meg: Yeah. In the mason jar.
Oswin: Yes. Pull it out. And that's your meal instead. Maybe instead you're having like a pop tart and a banana. There is no preparation involved, it is just eating. I mean, you can also use the toaster. But, you know, depending on the child, you may not have to do that. You may just be, "Here's a pop tart, here's a banana, and here's a glass of milk," or, "Here's a juice pouch," and that's it. With things like getting ready for school, that's another thing that you can do the night before instead of the mornings of, because it's something that if you're not rushing to get it done, then it's not nearly as daunting.
For after school routines and doing homework; well, having your homework station set up, where he doesn't have to gather all the supplies because that organization piece can be a real challenge, and can really prevent getting work done. But also instituting la list that, like, I have in my office when I come in in the morning, I have what I'm going to do for the day. And yes, I use PECS for my stuff.
Meg: So, it's like number one and a picture of a coffee cup. And number two, a computer. Number three shows a list, and number four shows a book and their symbolic pictures, like you said.
Oswin: Yes. So, first thing I do when I get into the office is get my cup of coffee. And then I check my emails, then I go down to my to-do list. And then I look at my calendar. And those are my four things I do first thing in the morning when I get into the office, because if I don't have those setting events, then my brain is scattered trying to come up with all the things I need to get done.
Meg: Mm-hmm.
Oswin: I also have the same list, or I have a different list for leaving. So, I go through and make my list for the next day. So, this list, traffic; this list, don't ask me why. So, like, I'm going through, making sure I've checked everything off, and then if I need to add anything. Make sure the trash goes away, clean up my desk, get my bag together, and then turn off my computer.
Oswin: And those are what I do. That way I am setting up my next day before I leave the office today. I like to encourage parents to have this in their kids' accommodation, that the kid has a check out at the end of the day so that they know what homework needs to be done and that somebody can work with them on prioritizing whatever needs to be done. And it's the most urgent as an accommodation. There's also we can do the same thing with our chores where we're having — we have something like this so we can tell what the steps are with the chores, so that we're not just making the assumption that 'Clean your room' is something that can be done without explicit instruction; like, each step of cleaning your room. So, there's all those supports that we need to put into place, but it requires a lot of planning and organization before even implementing it. So, we have to know what those accommodations and needs are for our kids before we can even create the extra things.
Meg: Yeah. I hear so much setting the child up for success in the answer you just gave. Morning time, we are reducing the demands as much as possible so that they can be successful at getting out the door with as little stress as possible. And then, the afternoon types of homework chore thing, we're using how they learn and what types of supports are meaningful to them to show them exactly what they need to do. We're making sure that someone has helped them prioritize. We're showing how to start, showing the steps, showing 'Finished'. We're really playing to their executive function skills, and maybe visual learning style as much as possible so that they can have experiences of success.
Oswin: Yes, exactly. And as somebody gets older, and I really want to emphasize this because I know that we're talking about a nine-year-old right now, but when we get into our middle school and high school years, teaching how to set those things up would be the next goal. Because I know a lot of people hear this and think, "Well, then I can have this their whole life." Well, no, they're not, but they're nine right now. They're still a child, and you're still the adult, and you know what they need. As they get older, then you can start teaching them what they need and then they can come up with what looks best for them.
Meg: Absolutely.
Oswin: Then they can implement, they can set up on their own. So maybe, before we're going to college, they have already learned these steps and then can create their own systems before they even step foot in their first class for the first semester. They already have all these things set up, because they have experienced it this whole time, and now have the skills and knowledge about what they need. So, I don't want people to hear this and think, "Oh, we're telling somebody that they're always going to have the support in place." No, they are not. But knowing that those things help them and showing them how it helps them for so long, and then them working to like, create what that looks like for them, then gives empowerment and then allows for some of that self-accommodation that we tend to need to expect of ourselves as adults, or even going into that co-regulation where maybe we have peers that we go to for support. Like, I know that I rely on a group chat with a couple of other autistic people that I'm in for, "Okay, in five minutes, we're gonna get up and go clean." We can be in completely different parts of the country and just do that as our initiation step. Okay, five minutes. And then we have to get, you know, cleaning. We kept down until we're able to get up and use each other for that initiation.
Meg: Yeah. I appreciate the example that you gave was not as this person gets older, we're going to fade out the supports, right. We're going to keep them in and help them learn how to set them up themselves. We're not going to tell you that your goal is to not use your glasses in a year. I learned by taking notes, my goal is not ever going to be to learn without having to write something down.
Oswin: Right.
Meg: We want to keep the supports but maybe make sure they have systems in place to set them up themselves. Or there's a self-advocacy piece here too, right, to ask for them. I've taught so many adolescents to say things like, "I learn better from what I see than what I hear and I missed your instructions. Can you help me write them down?" which goes over well with a professor. Like, that is a clear act of self-advocacy, to ask for what you need to be successful.
Oswin: And this can go for people that aren't going to go to college, being able to ask that of your PCA is also important.
Oswin: Being able to say, "I need help setting up my pill organizer." That is something a PCA can do. You know it needs to be done, you can ask for that help.
Oswin: Sorry, 'personal care assistant', that I was using acronyms.
Meg: Thank you, yes.
Oswin: Because these are things that with common community services, or those kinds of waivers with Medicaid, if somebody has access to that, they don't even have to come up, or don't even have to be able to do that accommodation themselves. All they have to do is know that they need that accommodation, ask somebody else. And this translates into work. And this translates into like, all these other environments after we get over 18 or 21, when we're getting into adulthood, that many of these are considered reasonable accommodations. For purposes of the ABA or five — or Section 504, the Rehab Act. We are allowed to ask for these. Like, coming into a meeting and me being able to say, "I need somebody else to take notes for me, because I can't listen and write at the same time," that is a perfectly reasonable accommodation. And most people are more than willing to do it. Sometimes they even have somebody on staff that that's their whole job, is to write down the notes for the meeting.
Meg: Yeah. Absolutely.
Oswin: So, I think it's really helpful for providers, and teachers, and other educators to recognize that we don't ever have to fade accommodations. We may have to fade some of the most intensive accommodations, depending on like, long-term goals for the person. Like, no, we're not going to be able to ask a college professor to provide a support person inside your college classes. That may be something that you have to come up with other strategies, or fade that accommodation eventually. But others, often, they're really, really easy accommodations to get in a variety of settings. And sometimes it's not even a formal accommodation. Sometimes it's just asking the person next to you, your friend, another classmate or a co-worker to do something, if they can help you with something. Sometimes it's very informal. But we can't even get to that point if we're not even talking about what those needs are, which I think a lot of people miss doing that in the educational process for most autistic kids.
Meg: Yeah. I appreciate you tying it back to where we started, in that autistic people and all neurodivergent people need to know their executive function profile, sort of.
Meg: What their skills are, what's hard, what supports help, so that they can be successful in these daily routines. So, of everything we've talked about today, if therapists have any key takeaways, what do you hope that would be?
Oswin: One, that you don't have to learn everything. Like, getting back into this last thing, you don't have to learn how to do all those initiation tasks, you don't have to work on how to shift. All you have to have is those supports in place, and know what those supports are. So, like, that's the first one. The next one is — um, we didn't really get into it in depth, but that any of these executive function traits are not impairments, or strengths, or weaknesses. They are neutral. They are on neutral ground. And it's all context-driven, on whether or not something is a strength or weakness. That is so, so important when talking about these things, because a child that's interested in dinosaurs and focusing on those things is not —may be seen as unable to take their focus off that, and that's seen as a negative thing. But I love Paula Kluth's 'Just Give Him the Whale!', because you can make just about anything in any interest into pretty much any subject area. You can write about dinosaurs, and you can count dinosaurs, and you can compare dinosaur sizes, and like all these other things that you can do with it that falls into our history, because paleontology is amazing. But you would never say that to a paleontologist, that they shouldn't be focused so heavily on their interest. That's their job. [Laughs]
Oswin: And so, like, we want to make sure that we're really looking at why it is that we're trying to stop people from focusing. And I really want to take that as instead of saying that we can't shift our thoughts, it is that we are able to highly focus on them. Because, yes, as I said earlier, if we're not eating, because we're focusing on that, then the problem isn't necessarily that we're not — that we're focusing too much. It's just that we can't seem to shift to eat, and like, what are the accommodations that we can set up for that.
And the third thing is recognizing that all of this are things that we should be doing pre-emptively, not waiting until a struggle happens. It should just be there. Like, I my Calendly. Like, it is there. When people message me on my Facebook page, they get a link for it. When I respond to an email, it's there for people to schedule with me. I don't have to do that initiation of, "Hey, let's find a meeting time that works," like, I will never be able to do that. Ever. It's just not going to be a fit. So, having those accommodations in place that I can do my job is really important.
Meg: Yes. Yeah, that's great. So, tell us what you're working on now and where we can find you online.
Oswin: So, I am doing consulting work a lot with BCBA's, but also with SLP's, and OT's and such. And you can find that at oglatimer.com. I do group trainings or company-wide trainings. I can also help people like — I've been working a bit to help people completely change the way they're doing ABA services to be an antecedent environmental change; "Did you see the changes in behavior?" rather than consequences, and reinforcement, and such. So, there's that. And then for Foundations for Divergent Minds, we're applying for grants so that we can start working on more than just that education piece or more than education for providers and parents, but also helping autistic people to implement some of the same scaffolded approach in order to prevent domestic violence and in order to really support ourselves. We're hoping to get some funding on police interaction so we have some pre-emptive strategies that people can employ instead of expecting police to understand autism, because that's not going to be their first focus, ever. That's just not police. And then we're also working on some healthcare disparities. But we are always looking for more donations so we can do more and more of that, and do more of that work, because it's really important to try and get the focus away from changing autistic people. And I think that that's — we've got some really great organizations that work on policy, but very little on the practical side of things. And so, we really focus on that because it's important to us. So, yeah, that's what we're doing.
Meg: That's great. I'll link to your website and all of your projects on the show notes. Thank you so much, Oswin.
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