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Winter 2024 | Volume 74 | Number 1

NJ PSYCHOLOGIST The Professional Journal of the New Jersey Psychological Association

In this issue: Special Section: Neurodiversity Best Practices for Conducting a Comprehensive Evaluation for Suspected Autism Spectrum Disorder (1 CE) Working With Adults Who Are (Or Could Be) Diagnosed With Autism: Conceptualization, Assessment and Interventions for General Practitioners (1 CE) Parenting Children with ADD, ADHD, Oppositional/Defiant Patterns and Excessive Rigidity Applying Aspects of Neuroqueer Theory to Systems of Psychotherapy Curanderismo, Latinx Perspectives on Neurodiversity and Future Directions Joint Hypermobility, Connective Tissue Disease, and Neurodivergence Preventable Police Fatalities in New Jersey: The Role of Psychology in Reducing Harm and Trauma

Executive Board President: Marc Gironda, PsyD President-Elect: TBD Past-President: Briana Cox, PsyD Secretary: Alexandra Miller Clark, PsyD Treasurer: Anastasia Bullock, PsyD Parliamentarian: Bonnie Markham, PhD, PsyD Members-At-Large: (A) Deirdre Waters, PsyD (A) Lauren Gerardi, PhD (A) TBD (N) Alex Gil, PsyD (N) Kelly Moore, PsyD (N) Marilyn Lyga, PhD

Special Representatives: APA Council Representative: Rhonda Allen, PhD ECP Chair: TBD NJPAGS Chair: Mary Isaac Cargill Affiliate Caucus Chair: Phyllis Bolling, PhD CODI Co-Chairs: Phyllis Bolling, PhD & Alex Gil, PsyD (EB Liaison) Executive Director: Sara Tedrick Parikh, PhD Director of Professional Affairs: Susan C. McGroarty, PhD Affiliate Organization Representatives: Essex/Union County Association of Psychologists: William MacLaney, PhD Northeast Counties Association of Psychologists: Norine Mohle, PhD Mercer County Psychological Association: TBD Middlesex County Association of Psychologists: TBD Monmouth/Ocean County Psychological Association: TBD Morris County Psychological Association: Hayley Hirschmann, PhD Somerset/Hunterdon/Warren County Psychological Association: TBD South Jersey Psychological Association: Ange Puig, PhD Editorial Board: Editor: Nouriman Ghahary, PhD Homestudy CE Article Editor: Dennis Finger, EdD Editorial Board Members: Aaron Gubi, PhD Anthony Tasso, PhD Nathan McClelland, PhD Donald Franklin, PhD Shihwe Wang, PhD Staff Liaison: Christine Gurriere

We're here to help! Central Office: 8:30 am – 4:00 pm Phone: 973-243-9800 STAFF CONTACT INFORMATION Executive Director: Sara Tedrick Parikh, PhD njpaed@psychologynj.org Director of Operations: Amy Chapman, PhD njpadoo@psychologynj.org Communications: Christine Gurriere njpacg@psychologynj.org Continuing Education: Kaleigh White njpakw@psychologynj.org Director of Professional Affairs: Susan McGroarty, PhD Consultation Request (login required)

Contents 2

Editor’s Note

Executive Director Update

President’s Message

Introducing Dr. Amy Chapman, Director of Operations

Best Practices for Conducting a Comprehensive Evaluation for Suspected Autism Spectrum Disorder (1 CE)

Working With Adults Who Are (Or Could Be) Diagnosed With Autism: Conceptualization, Assessment, and Interventions for General Practitioners (1 CE)

Parenting Children With ADD, ADHD, and Oppositional/Defiant Patterns and Excessive Rigidity

Joint Hypermobility, Connective Tissue Disease, and Neurodivergence

Curanderismo, Latinx Perspectives on Neurodiversity and Future Directions

Welcome New Members!

Preventable Police Fatalities in New Jersey: The Role of Psychology in Reducing Harm and Trauma

NJPAGS: Where Leadership Meets Community

Legislative Victories!

Thank You Foundation Donors!

Thank You PAC Contributors!

Upcoming NJPA CE Programs

NJPA Referral Service

Visit the NJPA Career Center!

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Editor’s Note

Nouriman Ghahary, PhD NJ Psychologist Editor

did our previous colleagues. I am also eager for the journal to continue its commitment to providing articles that reflect new and evolving ideas in our field and showcase the talent of our colleagues and the important work they provide for our communities.

Greetings! As Dr. Aaron Gubi brought his role as the editor of our publication to an end with the Fall 2023 edition of the NJ Psychologist, we thank him immensely for his leadership during the past three years, and we feel grateful that he has decided to stay with us as an editorial board member. At this time, it is with a great sense of gratitude and privilege that I begin my role as the editor of our organization’s journal, starting with the publication of the Winter 2024 issue. The NJ Psychologist has consistently provided enthralling articles written by our talented

The current editorial board of the NJ Psychologist includes Christine Gurriere, Dr. Dennis Finger, Dr. Anthony F. Tasso, Dr. Nathan McClelland, Dr. Donald J. Franklin, Dr. Shihwe Wang, and Dr. Aaron Gubi, our former editor. I feel fortunate to have the opportunity to work alongside this talented and dedicated group of people. Together we will continue to present to you thoughtprovoking and invigorating issues of the publication.

and visionary psychologists and psychologists-in-training. I intend to uphold the integrity and quality of the publication as

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Executive Director Update opportunities to connect with younger psychologists and psychologists-in-training, and we hope to facilitate that mentorship through formal mentorship programs, informal discussions, and student and ECP engagement in committees and special interest groups. Other membership goals include collaborating with the Board of Psychological Examiners and adding options for automatic renewals. In 2024, we will also continue to build a collaborative relationship with our Board of Psychological Examiners. We appreciate the support of our liaison, Dr. N. Maria Serra, and our Director of Professional Affairs, Dr. Susan McGroarty, in facilitating strong two-way communication. One particular area of coordination is supporting NJPA members through the introduction of the Jurisprudence Orientation. We are still working to maximize the features of our new membership platform, and we hope to roll out automatic membership renewals for 2025, as we get countless calls in Central Office from people who simply forget to renew their dues! We will also explore how to use the platform’s features to better support the work of committees and special interest groups.

By Sara Tedrick Parikh, PhD NJPA Executive Director As we enter the second year of our 2023-2027 Strategic Plan, NJPA is poised to make measurable progress in several areas. In this article, I focus on progress and goals in the area of Membership and also give brief updates on other areas. The Membership Committee held an all-day retreat in January to review membership benefits and dues categories. We considered how we can move from career-stage dues categories to benefits-based dues categories. Our goal is to broaden our accessibility to colleagues in various career tracks and stages who would like to be connected with NJPA, support our advocacy work, and serve on committees, but who may not need access to the full benefits of membership. We also want to promote and expand our benefits for full members, especially Sustaining Members. The Membership Committee and Executive Board will continue developing the new structure, with hopes to roll it out for the 2025 renewal cycle.

We will also seek continued growth in Advocacy, Governance, and Continuing Education. Telehealth remains a top Advocacy priority, as our efforts in 2023 extended, but did not make permanent, the protections for payment parity. We are also still planning how to launch a committee to track updates to reimbursement policies for various carriers in NJ. In Governance, our top priority is filling current leadership vacancies and creating leadership pipelines for the future. We are also exploring ways to increase mutual support between NJPA and our Affiliates. In Continuing Education, we are excited to launch our first NJPA Fall Convention at the Asbury Hotel in Asbury Park, NJ, on October 25th-27th. Start making your dinner and drinks plans with colleagues, and bring your sneakers to join NJPA President, Dr. Marc Gironda, for a morning boardwalk run!

We are also focusing on membership growth with Dr. Amy Chapman in our new Director of Operations position. She is particularly focused on interacting with students and Early Career Psychologists (ECPs) to build connections and better understand their needs, interests, and practice realities. We want to develop compelling programming, advocacy, mentorship, and leadership development, so that new psychologists-in-training and ECPs can build deep connections with NJPA as their professional home. We also know that many middle- and late-career members are interested in

Sara Tedrick Parikh, PhD

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President's Message Susan already provided the membership a free, 1 hour continuing education program on critical issues for licensure, on January 31, which included important information on telehealth regulations, the release of records, and the jurisprudence orientation required for licensure. We should all be proud and grateful for Susan’s consistent hard work and dedication as our DPA.

By Marc Gironda, PsyD NJPA President Another new year! Every year, it seems to me that the period between Halloween and New Year’s Eve flies by so quickly. I hope you were able to take some time with your families and to experience some rest during the typically busy end of the year, and start of the new one. With the turning of the calendar comes anticipation for the new year ahead, and I’m looking forward to sharing 2024 with you as NJPA’s president. We begin 2024 with an outstanding Central Office staff, and I’d like to take this opportunity to share about all of them. As many of you know, we welcomed our Director of Operations, Dr. Amy Chapman, in the Fall. Amy has already established herself as a valuable part of NJPA. She is especially focused on building our membership and continuing education efforts, and has done an outstanding job so far. In addition to supporting NJPA’s ongoing efforts in areas such as membership recruitment, she is injecting new energy into our various member categories, such as meeting with psychology interns and early career clinicians to help support their needs and interests. Amy is warm, welcoming, and always open to new ideas. Please make sure to say hello to her at the next NJPA event you attend. I also want to make mention of our two established staffers you likely already know, but deserve recognition for their ongoing dedication to NJPA. Through my previous work at NJPA, as chair of CoCEA and treasurer on the executive board, I have had the pleasure of working closely with both Christine Gurriere and Kaleigh White. Christine is a long-standing member of our Central Office staff who carries critical institutional knowledge and dedication into her work. She works behind the scenes in many areas of the organization, consistently supporting many of our members’ needs with professionalism and care. I am grateful for her ongoing commitment to our association. Kaleigh, who many of you likely know from her meticulous planning and execution of our membership and continuing education events, is currently on maternity leave. We are so excited for her, but we also miss her tremendously! Kaleigh is always thorough in her work, quick to make things happen when necessary, and does it all with a friendly attitude. Again, I am so grateful that she is a part of our Central Office team. Our Director of Professional Affairs, Dr. Susan McGroarty, is one of the most dedicated professionals I know. She works hard to make sure NJPA members are aware of professional issues, concerns, changes, and policies at both state and federal levels. She is regularly available for one-on-one consultations with members, and I consider this to be a significant member benefit. As usual, you will be hearing from Susan throughout the year about important professional issues.

Finally, the Central Office staff is a managed by our Executive Director, Dr. Sara Tedrick Parikh. Sara is coming up on her one year anniversary as our ED, and it’s been quite a start for her! She has managed moving us to a new website platform, jumping into important advocacy efforts, leading our effort to hire Dr. Chapman, and moving to a new office. If that was not enough, Sara has also overseen a major change to our staff-hiring interns. Our first intern, Connor, worked this past Fall and was a great addition at Central Office. We already hired 3 interns for this semester, and Sara has worked hard to make this happen. It not only gives the interns a valuable professional experience, but also helps support our full-time staff. I am looking forward to working closely with Sara this year to continue growing NJPA into one of the premier state psychological associations. I have deep gratitude for the professionalism and dedication Sara has provided in her time with NJPA, both as a board member in the past, and now as our ED. NJPA will continue to advocate for psychologists through 2024. Our Past-President, Dr. Briana Cox, led us to a major advocacy victory in 2023 by securing parity for telehealth services in New Jersey. We have work to do to make this parity permanent, but thanks to Dr. Cox’s leadership and the work of our Government Affairs Agent, Jon Bombadieri, telehealth will be reimbursed at a rate consistent with in-person care. This not only helps psychologists, but also ensures access to care for many vulnerable populations in New Jersey. On the federal level, I had the opportunity, in December, to participate through APA with some our members and our ED to advocate for important issues with our senators and congresspeople. These issues included youth mental health support, veteran concerns, and building a more diverse psychology workforce. As someone who has worked as a school psychologist and currently sees children, adolescents, and young adults in private practice, I am especially aware of the needs of mental health services for our youth in NJ. I am planning on making this issue a priority for our association through 2024. In fact, our Spring Conference will focus on adolescent mental health. Please mark April 12, 2024 on your calendars and join us at the Hanover Manor in East Hanover. In addition to our Spring Conference, we will be hosting many more continuing education opportunities throughout 2024. These will include lunch-and-learn webinars, in-person experiences such as our June wellness event, and home study opportunities. I am particularly excited for this Fall, when NJPA plans to launch our first multi-day convention. This will take place in Asbury Park and will include not only opportunities to obtain many CE credits, but also will include multiple opportunities to network and socialize with colleagues through various other activities. More details to come, but please mark off October 25-27 on your calendars! It is a privilege to serve as your president for the 2024 year. I hope to meet many of you at our upcoming events, and to work with many of you to push NJPA forward into the future.

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Introducing Dr. Amy Chapman, Director of Operations

By Amy Chapman, PhD NJPA Director of Operations I am delighted to be serving as NJPA’s first Director of Operations. I came on board in late September 2023, and have been meeting wonderful members ever since! I am glad for the opportunity to share a little bit about myself and my role here at NJPA, more broadly.

management and research. I was particularly proud of an initiative we created to fund partnerships throughout the country, which incorporated spirituality in mental health interventions as part of holistic wellness. As a researcher, my work focused on understanding how people define, develop, and change communities, specifically in the areas of how social media can be used (and misused) within educational contexts and how spirituality impacts school culture and wellness.

A New Jersey native, I was born in Florham Park, but spent most of my childhood and adolescence in Chester. I then moved to Boston for college, where I received a bachelor’s in history and secondary education from Boston College. I remained in Boston for fifteen years, first teaching in a small Jesuit middle school in the city, that served historically marginalized and low-income students, and in a large public high school just outside of Boston. I then transitioned into nonprofit administration, in both Massachusetts and Michigan, primarily working in settings dedicated to supporting and renewing education and spirituality. This work included a great deal of event work and creating opportunities for continuing education for faculty, as well as building connections locally and internationally, and my time living and working in communities around the world, which have deeply influenced my thinking and practice, including Dublin, Ireland; Camden, New Jersey; West Kingston, Jamaica; San Salvador, El Salvador; and most especially Tacna, Peru. Along the way, I earned three graduate degrees: in developmental and educational psychology (Boston College), theology (Boston College), and a PhD in Educational Psychology and Educational Technology from Michigan State University.

All of that work prepared me for my role at NJPA, which I see broadly as relationship building. My primary areas of focus will be membership recruitment and retention; strategic visioning of Continuing Education; and supporting the NJPA Foundation. As Director of Operations, I am also focused on making our work in Central Office more efficient, which will allow our small, but mighty, staff to provide the best service to our members. I am looking forward to visiting each New Jersey doctoral program in the upcoming spring semester, and we are developing a four-part series for ECPs in 2024. Over the coming year, we will be working to clarify and improve our membership tiers, as well as to expand our Continuing Education offerings. I will also be visiting group practices in the spring; if you are part of a group practice, I would be delighted to visit you in 2024 – please reach out! When I’m not doing all of these things, I love to garden,

After graduating with my PhD, I moved back to New Jersey to begin a role leading The Collaborative for Spirituality in Education, a nonprofit center housed at Teachers College, Columbia University. While there, I built a team, which created a membership organization and a year-long Institute to support educators in creating spiritual spaces in their schools and classrooms. That work included grant

read, play cards, make jam, travel with my close group of friends, and play with my fantastic nephews (Chase, 8, and Colin, 6). I look forward to working with you all in 2024 and beyond to support the work of NJPA!

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A Continuing Education Article

Best Practices for Conducting a Comprehensive Evaluation for Suspected Autism Spectrum Disorder (1 CE)

By Aaron Gubi, PhD

By Gittie Freeman, MA

By Arielle Wenig, BA

Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. In the past, the severity levels of symptomatology were dispersed between different neurodevelopmental diagnoses. In accordance with the most recent edition of the Diagnostic and Statistical Manual Of Mental Disorders, fifth edition, text revision (DSM-V-TR), all severity levels are incorporated in the diagnosis of ASD, meaning the disorder spans a spectrum of both observable symptoms and functioning levels. Due to this, to effectively diagnose an individual with ASD, a comprehensive multidisciplinary evaluation is needed. There is no standardized practice utilized by clinicians when evaluating and diagnosing ASD. ASD diagnoses are heterogeneous, and every individual presents differently, therefore, assessments may need to be adjusted accordingly. We aim to relay the best practices for a clinician to complete a total and comprehensive evaluation for individuals of varying ages presenting with behaviors associated with ASD. Initial Referral The initiation of the evaluation process typically commences when a caregiver expresses concern about their child’s failure to meet typical developmental milestones or when an individual closely associated with the child (e.g., a teacher) observes potential developmental delays and recommends that the parent seek out an evaluation. Once such concerns are identified, whether through a referral or through the family’s independent decision-making, the subsequent steps in the evaluation process remain consistent. Seeking professional guidance, families will often schedule appointments with the child’s pediatrician, related physicians (e.g., developmental pediatrician), or an appropriate clinician. Once the child and family reach the psychologist, the comprehensive evaluation begins with a clinical interview. At this point, the psychologist collects a history regarding the child's background. The scope of the interview extends beyond the immediate concerns, delving into the child's entire developmental trajectory. This encompasses an exploration of factors ranging from the preconception phase through prenatal and natal care to childbirth. This is to identify if there was any trauma or developmental irregularity early in the child's life. Gathering of information then ensues into child development, covering essential aspects, such as developmental milestones, temperament, feeding and sleeping patterns, medical history, and familial background. Questions should also focus on symptomatology related to ASD. This involves a detailed examination of difficult behaviors, restricted or repetitive behaviors or interests, challenges in social interactions and communication across diverse social environments, as well as any services utilized and related strengths and competencies of the child.

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Rating Scales

children 2-21:11 and the self-report scale can be administered to children aged 6 through college age. Specific domains on the BASC-3 include externalizing problems, internalizing problems, behavioral symptoms, and adaptive skills. The measure yields T-scores and percentiles for comparison to the general and clinical populations.

Depending on the individual's age, self-report, and/or parent-report, measures should be utilized to collect information regarding the individual's social and communication skills, restricted repetitive behaviors and interests, and other behaviors related to ASD. The Social Responsiveness Scale, Second Edition (SRS-2) (Constantino & Gruber, 2012) measures social ability and impairment in youth and adults. Scales include a measure of the individual's social awareness, cognition, communication, motivation, and restricted interests and repetitive behaviors. The measure also includes DSM-5 compatible subscales of social communication and interaction and restricted interests and repetitive behavior. Depending on the age and functioning of the client both self-report or caregiver forms could be utilized. The SRS-2 is a 65-item questionnaire covering the various dimensions of interpersonal behavior, communication, and repetitive/stereotypic behaviors that are characteristics of ASD. Items are answered on a 4-point Likert scale and are commonly utilized to document core features of ASD (Channell, 2020), including social communication, understanding and motivation, and restrictive repetitive behaviors (RRB). The Autism Spectrum Rating Scale (ASRS) (Goldstein & Naglieri, 2009) is another self-report measure for individuals aged 2-18. The ASRS is a measure commonly completed by teachers or caregivers that reports information relating to a child's or adolescent's behaviors as they may relate to ASD. The measure is a 15-item scale that questions the reporter on behaviors of the individual as they specifically relate to ASD. The ASRS is intended to differentiate characteristics of ASD from other clinical disorders. The measure yields a Tscore that distinguishes the range the individual falls in as they experience behaviors and characteristics as they relate to ASD. In addition, it is best practice to administer a broad band measure to the parent and/or child, depending on skill level, to assess the many dimensions of social, emotional, and behavioral functioning. The Behavior Assessment System for Children, third edition (BASC-3) (Reynolds & Kamphaus, 2015) is considered a broadband measure and can be administered to a child, parent, and/or teacher. The BASC-3 allows for a broader understanding of the child’s overall behavioral and emotional functioning. The parent and teacher rating scales can be administered for

Adaptive Functioning Adaptive functioning measures should also be utilized when diagnosing ASD. These measures are needed to gain an accurate depiction of how the individual's atypical behaviors related to ASD may be hindering their overall adaptive functioning. These measures are also necessary to distinguish the individual's independence level and assist in the specification of level 1, 2, or 3 in accordance with the DSM-V-TR (American Psychological Association, 2022). These levels are related to the amount of support the individual requires e.g., level 1 is used when required support, level 2 is when the individual requires substantial support, and level 3 is used when requiring very substantial support. The Adaptive Behavior Assessment System, Third Edition (ABAS-3) (Harrison & Oakland, 2015) measures an individual's adaptive behaviors in several domains. The measure provides a General Adaptive Composite score, regarding the individual's overall adaptive functioning. Included in the calculation of the general score are the domains of: Conceptual skills as they relate to the individual's adaptive communication, functional academics, and ability to self-direct; Social skills as they relate to leisure and social abilities; Practical skills as they relate to community use, home living, health and safety, self-care, and work. This measure can be administered to parents, caregivers, or the individual themselves and helps conceptualize the extent to which the individual's adaptive abilities may influence their adaptive functioning (Gray & Carter, 2021). The Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) (Sparrow et al., 2005) is another adaptive measure commonly used by clinicians seeking to understand their individual's adaptive abilities. The Vineland can also be used for individuals aged 0-89 and is administered in self-report, parent report, and/or teacher report forms. The four general domains measure the individual’s socialization and communication behaviors, independence in daily living activities, and their overall motor skills as they relate to adaptive abilities.

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Cognitive Assessments

from birth to 68 months. The Mullen calculates a developmental age in the areas of gross motor, fine motor, visual reception, expressive language, and receptive language. The Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley & Aylward, 2019) is an additional assessment that identifies cognitive delays in children aged 1-42 months. The Bayley examines developmental levels pertaining to cognitive, language, motor, social-emotional, and adaptive skills, with the aim to provide a comprehensive understanding of a child's overall developmental profile.

While conducting a comprehensive autism evaluation, inclusion of a cognitive assessment is a standard practice. Cognitive assessments are necessary to create a profile of the individual's cognitive strengths and weaknesses and how these areas may be impacting difficult behaviors. Cognitive assessments help rule out or make an additional intellectual disability diagnosis and assist in determining the specifier for severity level. The Weschler series of cognitive assessments measure both verbal and nonverbal intelligence and can be utilized in an ASD evaluation if the individual has the appropriate level of expressive communication and cognitive ability required for the tasks. The Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) (Wechsler, 2014) is utilized for children aged 2.6-7.7, the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-5) (Wechsler, 2016) is utilized for youth aged 6-16.11, and the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) (Wechsler, 2008) is utilized for those aged 16-90. Often when an individual is nonverbal, such verbal and nonverbal intelligence measures do not accurately depict the individual's overall cognitive capabilities. There are additional assessments that strictly measure nonverbal intelligence and can generate a more authentic description of the individual's cognitive abilities. The Test of Nonverbal Intelligence, Fourth Edition (TONI-4) (Brown et al., 2010) can be utilized for individuals with both verbal and nonverbal capabilities. The TONI-4 generates an IQ score, percentile rank, classification, and confidence interval for those aged 6-89:11. The Primary Test of Nonverbal Intelligence (PTONI) (Ehrler & McGhee, 2008) is a similar measure of nonverbal intelligence for children 3-9. The Universal Nonverbal Intelligence Test, Second Edition (UNIT-2) (Bracken & McCallum, 2015) also assesses intelligence regardless of the individual’s language abilities and can be administered to those aged 5-21:11.The Unit-2 assesses the individual on areas of memory, reasoning, quantitative abilities. This measure can be administered as an abbreviated, standard, or extended battery.

Autism Spectrum Disorder Measures Integral to a comprehensive autism evaluation is the use of measures designed to collect data regarding symptoms of ASD directly. A part of the gold standard for autism diagnostic assessment tools is the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) (Lord et al., 2012) and the Autism Diagnostic Interview, Revised (ADI-R) (Rutter et al., 2003). The ADOS-2 is designed as a semi-structured observation, which provides a standardized framework for systematically observing and coding social, communicative, and repetitive behaviors. This allows psychologists to construct an environment and series of naturalistic activities that are specifically designed to elicit and examine (in a standardized and normreferenced manner) core behaviors associated with ASD. During the assessment, the practitioner is to look for the presence of atypical behavior and the absence of typical behaviors expected for the individual's age. It is required for a clinician to receive formal training prior to administering the ADOS–2. The ADOS-2 can be administered to children from 12 months through adulthood, however, the individual's age and expressive language determine which module and tasks a clinician will administer. The ADI-R is a standardized interview that pairs well with the ADOS-2. The ADI-R provides information regarding the individual's language/ communication, reciprocal social interactions, and repetitive behaviors/interests. The interview can be administered to individuals as young as two years old. The ADI-R can be administered to a teacher, caregiver, or via self-report, depending on the individual's age and functioning level. The Childhood Autism Rating Scale, Second Edition (CARS-2) (Schopler et al., 2010) is another common measure clinicians utilize to report on behaviors associated with ASD. The CARS-2 incorporates a rating scale for the clinician based on

Developmental Testing When conducting an ASD evaluation with younger children, up to five years old, it is best to incorporate a developmental test. The Mullen Scales of Early Learning (Mullen, 1995) is an assessment administered to children

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observations of the child and a parent interview form that the clinician administers. The measure is designed to differentiate between those with ASD from other developmental delays lacking core features of ASD (Moulton et al., 2016).

Cultural Considerations When evaluating ASD and administering the previously discussed assessment tools, it is important to consider the individual's cultural and ethnic background. Research supports that individuals from cultures with a lower representation in the United States experiencing symptomatology of ASD are often overlooked at a young age and may receive a diagnosis later in life (La Roche et al., 2018). Research also shows that individuals from minority cultures obtain higher scores on gold-standard measures, indicating more severe behaviors (Harrison et al., 2017). Parents from minority cultures are also found to under-report observed ASD symptomatology when compared to practitioners' observations and the scores elicited on gold-standard ASD measures. These findings indicate the necessity of taking into consideration the family's cultural background throughout the entirety of the evaluation process. During the clinical interview, clinicians should be sure to question the parents' understanding of their child's development and impairment due to the potential difference in understanding of what is typical in their child's development. Clinicians may want to emphasize their direct observation of the individual and the observance of behaviors associated with ASD in combination with parent reports of the child's functioning (Stoll et al., 2021). When utilizing any assessment measures, it is important to consider the standardized population on which the measure was normed. While a practitioner may still utilize such measures, as they may provide insight into the individual's behaviors and functioning, a practitioner should consider de-emphasizing the scores these measures provide (Stoll et al., 2021). Additionally, it is important to ask caregivers their first language due to the many parent reports often utilized in an ASD evaluation that can be administered in different languages, such as Spanish versions of the ABAS-3, SRS2, Vineland-3, and BASC-3. This will allow for greater comfortability with families and more accurate results.

Multidisciplinary Consultation When conducting autism evaluations, particularly for children, it can be advantageous to collaborate with other allied health professionals. In particular, the evaluation can incorporate testing or consultation conducted by a speech therapist, physical therapist (PT), occupational therapist (OT), developmental pediatrician, neurologist and/or medical doctor. Evaluations from a speech therapist, PT, and OT are helpful towards assessing the individual’s development and needs in their language, physical, fine, and gross motor skills. A medical doctor can also be consulted to assess for physical impairments and genetic disorders that may co-occur or be a differential diagnosis for those with ASD. While seeking input from other professionals can be beneficial, it is important to recognize that it may not always be necessary, and the decision to consult with other allied health professionals should be based on the unique circumstances of each evaluation. Diagnostic Specifiers It is best practice to provide relevant specifiers and a severity level, listed in the DSM-V-TR (American Psychological Association, 2022), when diagnosing an individual with ASD. The assigning of a severity level conveys the level of support the individual requires in his/her daily functioning as it relates to his/her social communication and restricted repetitive behaviors. The levels include Level 1, requiring support; Level 2, requiring substantial support; Level 3, requiring very substantial support. The diagnosis can also include specifiers of with or without an intellectual or language impairment; associated with a genetic, medical condition, or environmental factor; associated with a neurodevelopmental, mental, or behavioral problem; and with catatonia. It is important to note that some of these specifiers require an additional code, such as if a specific genetic or medical condition is known. These specifiers help communicate the profile of the individual's presentation of the disorder and can assist in seeking the most beneficial interventions for the individual and his/her family.

Conclusion To summarize, when evaluating individuals for ASD it is imperative to utilize a comprehensive multidisciplinary evaluation. This evaluation should be tailored to the needs of the individual with their expressive and receptive communication, as well as abilities in mind. The process typically begins with a concern that is

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brought forth or a suggestion made to a parent to seek an evaluation. To begin, an interview with the individual and caregiver should be conducted. The ideal assessments include a self-report or caregiver report measure that includes ASD symptomatology. An assessment of adaptive functioning, cognitive assessment, a direct assessment of ASD, and a developmental assessment for children. The assessment can be strengthened by also including other service providers including PT, OT, speech therapists, and medical doctors. The information should be integrated to determine the diagnosis and recommendations for the individual.

Brown, L., Shecbenou, R. J., & Johnsen, S. K. (2010). Test of nonverbal intelligence-4 (TONI-4).

Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE

Harrison, A. J., Long, K. A., Tommet, D. C., & Jones, R. N. (2017). Examining the role of race, ethnicity, and gender on social and behavioral ratings within the Autism Diagnostic Observation Schedule. Journal of Autism and Developmental Disorders, 47(9), 2770–2782. https://doi.org/10.1007/s10803017-3176-3

activity here. About the Authors Arielle Wenig is a third-year doctoral student at Kean University's PsyD program in combined school and clinical psychology. Arielle currently has her masters in educational psychology and is concurrently working toward her board certification in behavioral analysis. She has worked with youth and adults with autism spectrum and related neurodevelopmental disorder in volunteer, educational, and clinical settings and plans to continue her work with this population. Gittie Freeman is a fourth-year doctoral student at Kean University's combined school and clinical psychology PsyD program. She has worked with individuals with developmental disabilities since her teenage years and continues to specialize with that population. Aaron A. Gubi, PhD, is currently an Associate Professor at Kean University. At Kean, he also serves as Clinic Director of Kean Psychological Services and directs the Center for Autism Assessment and Research Services (CAARS). His clinical and research interests focus on child maltreatment/trauma, autism/neurodevelopmental, and diversity concerns in professional training and practice. He also works part-time as a practicing psychologist within the community. References American Psychiatric Association Publishing. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr. Bayley, Nancy, & Aylward, Glen (2019). Bayley Scales of Infant and Toddler Development, Fourth Edition Bracken, B. A., & McCallum, R. S. (2015). Universal Nonverbal Intelligence Test- Second Edition. Itasca, IL: Riverside Publishers.

Channell, M. M. (2020). The Social Responsiveness Scale (SRS-2) in schoolage children with down syndrome at low risk for autism spectrum disorder. Autism & Developmental Language Impairments, 5, 239694152096240. https://doi.org/10.1177/2396941520962406 Constantino JN, Gruber CP (2012). Social Responsiveness Scale, Second Edition (SRS-2). Torrance, CA: Western Psychological Services. Ehrler, J., David, & L. McGhee, L., Ronnie (2008). Primary Test of Nonverbal Intelligence (PTONI) Goldstein, S., & Naglieri, J. (2009). Autism Spectrum rating scale. Toronto: Multi-Health Systems. Gray, S. A., & Carter, A. S. (2021). Adaptive Behavior Assessment System, Second edition. Encyclopedia of Autism Spectrum Disorders, 73–76.

La Roche, M. J., Bush, H. H., & D’Angelo, E. (2018). The assessment and treatment of autism spectrum disorder: A cultural examination. Practice Innovations, 3(2), 107. https://doi.org/10.1037/pri00 00067 Lord C., Luyster R. J., Gotham K., Guthrie W. (2012). Autism diagnostic observation schedule, second edition (ADOS-2) manual Moulton, E., Bradbury, K., Barton, M., & Fein, D. (2016). Factor analysis of the childhood autism rating scale in a sample of two year olds with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(7), 2733–2746. https://doi.org/10.1007/s10803-016-2936-9 Reynolds, C. R., & Kamphaus, R. W. (2015). Behavior assessment system for children (3rd ed.). Bloomington: Pearson. Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R: Autism Diagnostic Interview-Revised (ADI-R). Los Angeles, CA: Western Psychological Services. Schopler E, Van Bourgondien ME, Wellman, GJ, Love SR (2010). Childhood Autism Rating Scale – 2nd Edition. Los Angeles: Western Psychological Services Sparrow, S., Cicchetti, D., & Balla, D. (2005) Vineland Adaptive Behavior Scales, Second Edition. Stoll, M. M., Bergamo, N., & Rossetti, K. G. (2021). Analyzing modes of assessment for children with autism spectrum disorder (ASD) using a culturally sensitive lens. Advances in Neurodevelopmental Disorders, 5(3), 233–244. https://doi.org/10.1007/s41252-021-00210-0 Wechsler, D. (2014). Wechsler Preschool & Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) Wechsler, D. (2008). Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Wechsler, D. (2016). Wechsler Intelligence Scale for Children, Fourth Edition (WISC-V)

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A Continuing Education Article

Working With Adults Who Are (Or Could Be) Diagnosed With Autism: Conceptualization, Assessment, and Interventions for General Practitioners (1 CE)

By David Krauss, PhD

Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

When working with adult patients diagnosed, or whom could be diagnosed with autism, I find it helpful to keep in mind two relatively new ways of thinking about autism included in the DSM-5 - masked by learned strategies later in life and requiring support vs substantial support vs very substantial support; a term from speech and language therapy world - pragmatic communication; a concept from developmental psychology - theory of mind; two concepts from the intelligence and achievement testing literature declarative vs procedural knowledge and specific learning disability; a diagnosis from the occupational therapy world – sensory integration disorder; and two diagnoses from clinical psychology – obsessive compulsive personality and obsessive compulsive disorders.

A professionally successful patient in their mid-40’s asks for help improving their relationships with their children and partner – an educator who “thinks they have autism.” A bright graduate student in their mid30’s, concerned that they are alienating coworkers (as they have in the past), states that when they read a book about adult autism “I can’t put it down - they are talking about me.” A college educated patient diagnosed with autism as an adolescent, working and living independently, but socially isolated, is trying to build peer relationships and thinks “I creep people out.” More and more psychologists are meeting patients like these, adults who may or may not meet diagnostic criteria for autism or were diagnosed as children and are seeking help as adults, in their practice. Many of these psychologists, especially if they have not had specialized training and experience in neurodevelopmental disorders, find themselves looking for more information and guidance. I hope this article can help.

“May be masked by learned strategies later in life” along with “may not become fully manifest until social demands exceed limited capacities” qualifies the “symptoms must be present in the early developmental period” DSM-5 autism criteria. This way of thinking helps explain many of the ‘they may have autism’ adults that show up in a general psychology practice: they have mostly managed, but are encountering social situations that ‘exceed their capacities’ and/or may have been struggling, but using learned strategies (and much effort) to ‘mask’ their struggles through much of their lives.

Ways of thinking about Autism – Some Useful Terminology and Concepts Most of us are aware of the traditional, standard, Autism diagnostic criteria of “persistent deficits of social communication and interaction” and “restricted, repetitive patterns of behavior, interests, or activities.” Specific descriptors can be found in the DSM-5.

It is important to note that data suggests that people of color, for example Black Americans, exhibiting signs and symptoms of Autism tend to be underdiagnosed as children – healthcare professionals may be overly

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likely to interpret signs and symptoms suggestive of autism as ‘behavioral’ or due to poor parenting – and thus be even more likely to present as undiagnosed as adults (Durkin et al., 2017).

perspective taking.’ Jean Piaget, in The Psychology of the Child, writes about how children’s representation, or internal map, of the physical world (e.g., their walk to school) develops over time. He then asks the reader to imagine how much harder it is to develop a social map. Imagine navigating the social world with a poorly developed theory of mind and poorly developed map of the social world. Adults diagnosed with autism will tell you: it’s exhausting.

Requires support vs substantial support vs very substantial support are the current DSM autism severity descriptors. These remind us to think in terms of dimensions rather than categories and build on the historic shift in how psychologists think about autism: from (pre-1970s), low or non-verbal individuals struggling with daily life activities, and caused by poor parenting (e.g., ‘refrigerator mothers’), to including verbal people who may be very engaged in social, educational, and/or work environments (e.g., Asperger’s Syndrome) and caused by geneticbiological (e.g., neuro-developmental) factors. These severity descriptors also incorporate newer ways of thinking about ‘disabilities:’ focusing more on a person’s profiles of strengths and weaknesses interacting with the supports and accommodations available in their social, educational, and work environments (a person-environment fit model) and less on ‘deficits.’

Declarative Knowledge vs Procedural Knowledge is, basically, the difference between knowing about something and knowing how to (relatively quickly and automatically) do something. Think learning how to drive (drivers education class, a test, verbal instruction, another test) versus being a skilled and experienced driver (driving while talking to a passenger or on the phone or listening to the radio and seemingly not paying attention to the, hopefully familiar and uncrowded, road). Most adults diagnosed with autism you may see in your practice know a lot about rules of conversation and social norms and can often, if they stop and think about it, deduce what others might be thinking and feeling. They struggle, however, to do these types of things quickly and automatically. Imagine what that might be like. Again, adults diagnosed with autism will tell you: it’s exhausting.

Pragmatic communication includes greeting behaviors, changing communication to match context and listener, taking turns in conversations, rephrasing when misunderstood, regulating interaction using verbal and non-verbal signals, and grasping what is not explicitly stated. People who struggle with pragmatics can still have relatively strong ‘semantic’ (word meaning) and ‘syntax’ (sentence grammar) skills, which can be confusing to clinicians. I have long thought of the “deficits in social communication and interaction” aspect of autism as being like a specific learning disability in receptive and expressive pragmatic communication similar to how we can think of bright and educated people who struggle to read and write as having specific learning disabilities (e.g., dyslexia, dysgraphia). The DSM does, in fact, now include Social (Pragmatic) Communication Disorder (SCD) in the specific learning disabilities section. Imagine having a pragmatic communication learning disability and trying to interact effectively with others, how much effort (and intelligence) that would take.

Sensory Integration Disorder overlaps with autism diagnoses descriptor of hyper- and hypo-reactivity to sensory input. Sensory hyper-reactivity is one of the most common causes of ‘meltdowns’ (a child/adolescent autism term) or avoidance/withdrawal. Hypo-reactivity can lead to sensory seeking, including hyperactivity, and struggles with personal boundaries. ‘Stereotypies,’ repetitive vocalizations or motor movements, such as rocking or spinning, can often be seen as learned strategies to modulate hyper- and hypo-reactivity. Obsessive-Compulsive Personality and ObsessiveCompulsive Disorders. The ‘restricted, repetitive patterns of behavior, interests, or activities’ DSM autism criteria can be seen as having a lot of overlap with OCP and even OCD. Many of you likely already know much about how OCP and OCD behaviors can interfere with functioning and how to treat OCP and OCD (e.g., learning to value relationships in addition to work, exposure therapies).

Theory of Mind involves both recognizing that someone else has their own ‘mind,’ thoughts, feelings, intentions, and ascertaining, at least to some extent, what that person’s ‘mind’ might be up to. Theory of mind is a cognitive ‘representation’ of the other, or the ability to ‘symbolize’ the other. A related term is ‘social

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Differential Diagnoses When adults present with persistent deficits of social communication and interaction suggestive of autism, differential diagnoses include Social (Pragmatic) Communication Disorder (discussed above), auditory and visual processing disorders (may impact abilities to read social cues), alexithymia (may impact abilities to express and read emotions), ADHD (may struggle to attend in complex social situations), and Social Anxiety (may impact social information processing and social interaction).

I sometimes ask patients and their partners to complete the AQ and, on their own or in a session together with me, compare their answers. This seems to be a good way to facilitate relationship work. I sometimes ask adult patients to ask one or both of their parents to complete the Australian Scale for Asperger Syndrome as if they were completing it when the patient was a child. This provides useful ‘present in the early developmental period’ documentation (as does reviewing childhood report cards and assessments) and can also facilitate family relationship work.

When adults present with restricted, repetitive patterns of behavior, interests, or activities, differential diagnoses include sensory integration, obsessive-compulsive personality, and obsessivecompulsive disorder (all discussed above); social anxiety (learned avoidance strategies might better explain some atypical behaviors); and tic disorders (may better explain repetitive movements).

Note that while both the AQ and the Australian Scale have good face validity, their criterion validity is not well-established. They should only be viewed as screening measures, prompts for therapeutic discussion and relationship work, and as ways to gather information from non-patient informants, not as diagnostic. The AQ and Australian Scale are readily available, free, online.

Assessment Instruments

Intervention Strategies

Should you refer for a neuro-psychological evaluation? That’s often best, especially if a confirmed and well documented diagnosis means access to academic or work accommodations or disability benefits. Comprehensive neuro-psychological evaluations are, though, costly and may not be covered by insurance and thus may not be affordable for some patients.

It is important to keep in mind that, when working with people who are or may be diagnosed with autism, the goal of ‘treatment’ is to promote adjustment and well-being rather than ‘curing’ or getting rid of autism. It is important to work towards their specific goals, which are much like the goals of many of your other patients: Making friends? Getting along better with family or coworkers? Feeling safer in the social world and better about themselves?

Gold standard adult autism assessment instruments include adult versions of the Autism Diagnostic Observation Schedule (ADOS) and Clinical Assessment of Pragmatics (CAPS). Proficient use of these measures requires much training and practice, though, which may not be workable for a general practitioner. The Autism Diagnostic Interview (ADI-R) is a relatively affordable and easy to use structured interview with established validity and reliability, useful for diagnosing autism and distinguishing autism from other developmental disorders.

Shifting Attributions. Many undiagnosed neurodivergent adults come to therapy blaming themselves and with strong negative core beliefs, such as ‘I am defective/incapable/broken,’ ‘I am unlikeable/unlovable,’ ‘I am bad.’ Making a neurodevelopmental diagnosis such as autism, or even accepting in some ways a patient’s self-diagnosis as ‘neurodivergent,’ can help them shift from ‘moral’ attributions (explanations for behaviors) to ‘biological’ attributions and thus adaptively shift their beliefs about themselves. This is similar to and overlaps with trauma therapies (it is not you but your history things that happened to you) and working with people with disabilities or people of color (it is not you, but your environment-society, i.e., marginalization, structural racism). These kinds of attribution shifts (or new narratives or ‘origin stories’) help patients think about old and identify new ways of understanding themselves and their life experiences. Shifting

The Autism-Spectrum Quotient (AQ) is an informantreport questionnaire that can help clinicians and their patients collaboratively think through whether or not an adult autism diagnosis makes sense and, perhaps more importantly, prompt therapeutically meaningful conversations about the patient’s experience and what is prompting them to seek therapy. The AQ can also be used to gather information from parents, partners, or other family members.

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attributions is something most therapists do in their practice already.

This ‘masking’ vs ‘unmasking’ idea can help us understand why many adults diagnosed with autism dislike the term ‘high functioning autism.’ One of my patients talked about how the term ‘high functioning,’ while well-intentioned, invalidated how different they feel, did not recognize how much effort they put into coping with and adapting to the neurotypical world, and implied an expectation that they should act like other people as often as possible.

‘Moral’ to ‘biological’ attribution shifts can be facilitated by psychoeducation (including readings about neurodivergence) and referral to support and advocacy groups, and, perhaps especially, by repeated (re)interpretations of current between session interpersonal problems and highlighting ‘here-andnow’ of interpersonal errors in session (e.g., notice what you did/what just happened? That is an example of greeting behavior, shifting communication based on listener and context, etc.).

Knowing how and when to ‘unmask’ as ‘autistic’ can be a matter of life and death during interactions with police officers, especially for Black Americans (Drame et al., 2020). Police officers may interpret struggles with pragmatic communication, understanding and following social norms, and sensory sensitivity as noncompliance and even aggression rather than signs and symptoms of autism. Someone diagnosed with autism may not know how to, or be able to quickly and automatically, display cooperative (or even submissive) communications and behaviors and/or may not be able to ‘be still’ or ‘stop struggling’ because of sensory sensitivity. This kind of increased risk is consistent with data about the disproportionate number of cases of police violence involving people experiencing mental health crises (Nelson, 2016).

It is very important, when you can, to help shift (from moral to neuro-biological) the attributions of partners, family, friends, and coworkers. This is similar to how those of us who treat children often work to shift the attributions of parents and teachers. Shifting from ‘moral’ to ‘biological’ attributions can promote patience, acceptance, and support. Unmasking, discussed next, can be an important part of this process. Unmasking. I sometimes introduce the concept of the ‘uncanny valley’ to neurodivergent adults. Research suggests that people respond better to robots and animated characters the more life-like they are until they are almost, but not quite, life-like. When interacting with robots or watching animations in this ‘uncanny valley,’ people tend to react with distress, even anger. I suggest to neurodivergent adult patients that they, sometimes, may be in this ‘uncanny valley.’ People may see them as a typical person acting strangely rather than a neurodivergent person doing a very good job of acting typically. One young adult patient told me (and this broke my heart) “the uncanny valley is a lonely place.”

It is, of course, well documented that racism means people of color, especially Black Americans, are already at risk of being seen by police officers as disrespectful and noncompliant, aggressive, and even threatening, and are thus at increased risk of police violence. Imagine the compound risks faced by neurodivergent or ‘autistic’ Black Americans, especially teen or young adult Black males. Or read Theresa Vargas’s article describing what happened to Neli Latson, an 18-yearold Black man diagnosed with autism. Mr. Latson was sitting outside his neighborhood library waiting for the doors to open when someone called in a report of a ‘suspicious male,’ the police responded, he reacted and “.... suddenly it didn’t matter that Latson was a specialeducation student with autism who often took long walks by himself and saw the library as a social outlet.”

I explain to patients that ‘unmasking’ or ‘coming out’ as ‘neurodivergent,’ ‘on the spectrum,’ ‘aspergery,’ or even as ‘autistic’ helps other people ‘get’ them in important ways by providing an explanation for atypical behaviors. Unmasking helps other people be less judgmental and more patient and, perhaps, even see their talents and strengths, their courage and fortitude.

Those of us who are white with neurotypical white children can try to imagine what it might be like to be a parent of a Black American teen or young adult diagnosed with autism. Or, better yet, talk with and read the stories told by these parents. I know that some do not allow their neurodivergent teen or young adult children to go alone into public, especially ‘white,’ spaces. Some put ‘my child has autism’ stickers on their cars. Imagine the “resistance, persistence, and

Therapy can include working through anxiety about unmasking, developing and rehearsing scripts, and thinking through when, where, and with whom one can ‘unmask.’ I think the parallels to working with and supporting LGBTQ+ patients as they ‘come out’ is clear.

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resilience” demanded of Black families raising children with autism (Drame et al., 2020).

purpose, and relationships. Engaging online and in-person with people passionate about similar things is an opportunity to connect with like-minded people (this is obviously true for neurotypical people, as well). Neurodiverse people with mutual special interests can find and create spaces with social norms that are more relaxed and forgiving. Fandoms, conventions, board game and trivia "meet-ups," and more can be opportunities to work through social anxiety and develop social skills and, ultimately, provide a sense of belonging and positive identity, sometimes even leading to friendships and relationships. Pathologizing and discouraging intense special interests makes it harder for neurodivergent people to ‘find their tribe.’

Focusing on strengths and multiple intelligences. People diagnosed with autism have well-documented strengths. Work-place strengths include, for example, creative perspectives and ‘out of the box’ thinking, strong memory and attention to detail, including details that others might overlook, as well as being honest and direct. Identifying and helping your neurodivergent patient see their strengths and intelligences can be a key part of therapy. Perhaps obtain copies of childhood or adolescence psycho-educational or neuropsychological evaluations and review with the patient their profile of strengths and weaknesses and how these manifest in their life. Use solution-focused therapy approaches that highlight exceptions to presenting problems, times when the problem does not occur, and figure out what the patient did that helped that happen. Express curiosity and awe not only at strengths, but also persistence and fortitude. Be relentless, highlight your patient’s strengths and resources over and over again until their self-concept includes strengths, not just weaknesses or limitations. Remember, a sense of self-efficacy is one of the best predictors of attempting and persisting at new skills and tasks.

Remember that identifying and accepting, and then expressing, hidden or "masked" parts of self are key goals of most, if not all, psychotherapy orientations. Authenticity is a key to living a good life according to many respected philosophers. I sometimes share with my patients quotes from Emerson’s Self Reliance and Thoreau’s Walden, including “To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment” and “If a man does not keep pace with his companions perhaps it is because he hears a different drummer. Let him step to the music he hears, however measured or far away.” Yes, as it has been said in multiple Spiderman movies, and as I say to many of my patients, “with great power comes great responsibility.” When, where, with whom, and how frequently intense special interests are expressed does matter. We can help our patients figure this out.

Consider referring your patient to autism or other neurodivergent advocacy groups. These groups emphasize strengths and support attribution shifts and positive identity. Think about how the autism world phrase “different, not less” is like “We’re here, we’re queer, get over it” and “Black is beautiful” from the gay rights and civil rights movement.

Social and Communication Skills Training makes sense, of course, as a therapeutic intervention for people with social and communication skills deficits. Be careful, though, as this can be experienced as, and perhaps actually become, too much about hiding the self. Work to find a balance between being a part of a group and being a unique individual – a common dialectic in many therapies for a wide range of people. We all know that inhibiting or disowning key aspects of one’s self has costs.

Embracing Special Interests and Finding One’s Tribe. "Intense special interests," when "abnormal in intensity and focus," is one of the DSM-5 diagnostic criteria that makes Autism a "mental disorder." How is it decided which intense special interests are pathological and to be suppressed versus passions to be praised and even celebrated? What about the psychiatrist who added, to their clinical and research work, chairing the DSM-5 committee developing diagnostic criteria for neurodevelopmental disorders? The psychologist who sees patients all week and then reads (or writes) continuing education articles on their weekends?

Interpersonal Trauma Work can be a key part of therapy with neurodivergent people in general and people diagnosed with autism, in particular. Most neurodivergent patients have experienced repeated interpersonal traumas, from their early childhood caregivers’ frustration and anxiety (especially prediagnosis/attribution shift), to blaming and shaming

When we view intense special interests as strengths and opportunities, rather than pathology, they can offer pathways to well-being, finding meaning and

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About the Author

by teachers and school staff, to rejection and ostracization by peers, to marginalization in the larger community. They, in response and not surprisingly, may have learned a wide range of avoidance behaviors or to react to ‘looks like, sounds like, feels like, is like’ moments with anxiety and/or anger.

David Krauss, PhD has been working for over 30 years with neuro-developmentally atypical children, adolescents, and adults, along with their parents and families. Dr. Krauss has an independent practice in Hopewell, NJ and writes the “Atypical Children-Extraordinary Parenting” blog at Psychology Today.

References

Trauma treatment approaches with which you are likely already familiar, such as trauma-focused cognitive therapy, exposure therapy, EMDR, IFS (Internal Family Systems), and AEDP (Accelerated Experiential Dynamic Psychotherapy) can be adapted to help your neurodivergent adult patients (and their families) (Kinnear et al., 2016).

Attwood, T. (2015). The complete guide to Asperger’s Syndrome (Rev.). Philadelphia: Jessica Kingsley Publishers. Boucher, Jill. (2017). Autism Spectrum Disorder” Characteristics, causes and practical issues (2nd Ed.). Washington, D.C.: Sage De Jong, P. & Kim Berg, Insoo (2013). Interviewing for solutions (4th Ed.). Belmont, CA: Brooks/Cole.

Summary and Some Key Takeaways

Drame, E. R., Adams, T., Nolden, V. R., Nardi, J. M. (2020). The resistance, persistence and resilience of Black families raising children with autism. New York: Peter Lang.

I hope this article gives you some new and helpful ways to think about and work with neurodevelopmentally atypical adults in general, and adults who are (or could be) diagnosed with Autism, in particular. I invite you to think in terms of dimensions and specific inabilities rather than global yes-no categories, as well as person-environment fit and profiles of strengths and weaknesses rather than deficits. I invite you to keep in mind important concepts such as pragmatic communication, theory of mind and procedural knowledge (automaticity). I invite you to validate the exhausted-marginalizedinvalidated life experience of many of these patients and recognize their likely long history of interpersonal trauma, as well as the ways neurodevelopmental atypical people of color, in particular, may be underdiagnosed and at-risk. I invite you to intervene with a focus on shifting attributions, unmasking, embracing intense special interests, highlighting strengths and intelligences, referring to mutual support and advocacy groups, and interpersonal trauma work. Much of this is consistent with APA’s recently published Guidelines for Assessment and Intervention with Persons with Disabilities (Hanson, et al., 2023). Additional highly accessible readings can be found in the references section of this article. You can also check out my “Atypical Children – Extraordinary Parenting” blog posts at Psychology Today.

Durkin, M. S., Maenner, M. J., Baio, J., Christensen, D., Daniels, J. Fitgerald, R. & Yeargin-Allsop, M. (2017). Autism spectrum disorder among US children (2002-2010): Socioeconomic, racial, and ethnic disparities. American Journal of Public health, 107(11), 1818-1826. Emerson, R. W. (1993). Self-Reliance and other essays. Mineola, NY: Dover Publications. Gaus, V. L. (2011). Living well on the spectrum: How to use your strengths to meet the challenges of Asperger Syndrome/HighFunctioning Autism. New York: Guilford Press. Hanson, S. L., Bruyere, S., Forber-Pratt, A., Reesman, J., Sung, C. (2023). Guidelines for assessment and intervention with persons with disabilities: An executive summary. American Psychologist, 78(8), 9951009. Kinnear, S.H., Link, B. G., Ballan, M. S., & Fishbach, R. L. (2016). Understanding the experience of stigma for parents of children with autism spectrum disorder and the role stigma plays in families’ lives. Journal of Autism and Developmental Disorders, 46, 942-953. Nelson, C. A. (2016). Frontlines: Policing at the nexus of race and mental health. Urban Law Journal, 43(3), 615-684. Piaget, J. & Inhelder, B. (2000). The psychology of the child. NY: Basic Books. Price, D. (2022). Unmasking Autism: Discovering the new faces of neurodiversity. New York: Penguin Random House. Silberman, S. (2015). NeuroTribes: The legacy of Autism and the future of neurodiversity. New York: Penguin Random House. Solomon, A. (2012). Far from the tree: Parents, children and the search for identity. New York: Simon & Shuster. Thoreau, H. D. (1995). Walden; or life in the woods. Mineola, NY: Dover Publications.

Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

Vargas, T. (2021). Neli Latson is – finally – free. It only took 11 years, two governors and a national conversation about race and disability. https://www.washingtonpost.com/local/neli-latson-black-autisticfree/2021/06/23/1024d4e4-d446-11eb-a53a3b5450fdca7a_story.html

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Parenting Children With ADD, ADHD, and Oppositional/Defiant Patterns and Excessive Rigidity

By Richard Formica, PhD Parents of children who suffer from ADD, ADHD, Oppositional/Defiant Patterns or Excessive Rigidity experience far more struggle and strife in their parenting than parents of children without these issues. Why? Because they all share a most vexing problem, which each of these childhood issues creates.

rein themselves in when asked by Mom or Dad. The shouting begins at that moment. Parents yell “Stop, you’re hurting your brother,” and the child with ADHD is on the defensive immediately, once again feeling like the “bad kid,” even though he is just a kid whose self-control has not filled in yet because of neurodevelopmental immaturities. Does yelling by the parents help? Not really. In the short run, it may bring an end to the hyperactive or hyperaggressive outburst, but in the long run, their child feels hurt, becomes a bit less cooperative, and a bit more angry. This fuels more aggressive action and less cooperation.

The common problem is that children with these issues find it really difficult to do what they’re told consistently, compliantly, and cheerfully. Challenges presented by the child with ADD:

Challenges presented by the child with Oppositional/Defiant patterns:

The child with ADD is told to go to their room, wash up, get dressed, collect their backpack and homework papers, and then come down for breakfast. The problem is that their child often gets so distracted, as they are trying to follow orders, that they come down for breakfast 30 minutes later, dressed, with teeth and hair unbrushed, and without their backpack. As for their homework, they have no idea where it is. Parents become exasperated after dozens and hundreds of such days. They come to see me using descriptions of their child as “lazy,” “passive,” “lost in his or her own world,” and are utterly frustrated. This child suffers from massive distractibility, lack of focus, and poor “working memory,” that executive function, which helps us remember where we put our car keys or homework or cell phone and what we have to do next to get out of the house on time.

Oppositional/Defiant patterns are another tremendous challenge for parents. Many things can contribute to the development of a habit of opposing and not cooperating, but I have found that most cases that have made their way to my office are caused by a more primary issue, like ADHD, or a mood issue, or a rigidity issue, or a learning disability. When a child is not able to comply like they are expected to because of an underlying neurobiological issue or learning disability, they often throw in the towel in their efforts to please their parent or their teacher. They come to think of themselves in demoralized ways and think of their parents and teachers as trying to “boss them around.” They have jumped off the success train where kids are willing to be guided, coached, instructed, and given orders and rules as the price for learning new skills and developing new capacities. Parents often fluctuate between confusion, heartbreak, and anger. “I just asked him to put on his shoes and jacket so we could go to the park, which he loves, and he is having an angry meltdown, refusing the wear a jacket, and refusing to wear the weather-proof shoes I just bought!”

Challenges presented by the child with ADHD: The child with ADHD is a whirlwind of action, often acting impulsively. He or she often goes beyond the bounds of the aggression levels Mom and Dad are comfortable with. These kids get worked up, often excitedly and happily, and then go “too far,” unable to

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Challenges presented by the child with excessive rigidity: I often see children with significant, usually undiagnosed, rigidities, often associated with sensory problems. They cannot shift gears when asked to or when they need to. They melt down. They refuse to do as instructed. They refuse to end a project when their parent asks them to. Frustrated parents will, in desperation, take the project and put it somewhere away from the child. Does this work? Not really. The child will often create an emotional Armageddon, wailing about their lost project or item or plan, refusing to be comforted, and refusing to flexibly adapt to the change being asked of them.

creatively look for ways to give them a chance to succeed in pleasing you. Here are a few examples of what I mean: For the child with ADD, rather than exasperatedly saying “I can’t believe you can’t find where you put your homework,” say instead something like: “I know you get distracted with lots and lots of interesting ideas. Let’s go up to your room together and look for your homework. Later tonight I will help you figure out a better way to remember to put your homework in your backpack right away.” For the child with ADHD, rather than screaming “Stop. I said stop. Don’t you ever listen?” instead say something like: “I see you had a really hard time controlling your body and your feelings and got worked up twirling around and got mad at your brother for getting in the way. Let’s see if you can ask your brother if his body and his feelings are ok. Let’s see if he needs you to do or say something now.”

Three Basic Ideas for Helping the Child With ADD, ADHD, Oppositional/Defiant Patterns and Excessive Rigidity: What can beleaguered parents do if they have a child described above? There are dozens of useful books written just for parents on each of these topics. This very brief article will present only three basic, core ideas. I do so because I think it is by far the single most important idea and this idea is not focused on enough by parent/child educators and guides.

For the child with oppositional patterns, rather than threatening to ground them for the weekend when they refuse to get their coat for school for the umpteenth time, try saying something like “I know you hate being told what to do and I know you are sure it’s not that cold. How about bringing a sweatshirt in your backpack in case you change your mind once you’re at school in the playground? I would feel more comfortable if you had your sweatshirt in case you change your mind later.”

The first and most important idea is this: AT ALL TIMES, SETTLE YOURSELF EMOTIONALLY BEFORE YOU SAY OR DO A SINGLE THING. That’s it. This is extraordinarily simple, but extraordinarily difficult. That is your challenge. Your child cannot change to spare you this challenge. Life has handed you this child and life has handed you this challenge.

For the child with excessive rigidity, rather than grabbing his game or project in a huff because you are now late for your appointment, perhaps you can approach the child ten minutes earlier and say “I would like to help you put that game aside. Would it help you to cooperate with me if I help you mark the spot you are on and let you finish your game after dinner?”

If you can do this, it will become unnecessary for your child to become lastingly hurt, angry, oppositional, or depressed. If you can do this, you can become a benign “teacher” who simply understands your child’s limitations and who gives your child choices to make with reasonable consequences for each choice that is delivered as a teaching tool rather than as a tool for punishment or revenge.

In each and every case, your child may still refuse to go along with your offer of a positive option. They may even tantrum more intensely. Does that mean these parenting approaches do not work? Does that mean you are out of positive options? Absolutely not. The entire idea of the Rational Discipline Approach, which I developed, is to help your child feel accepted as they are, with the difficulties they bring to the table, to communicate acceptance kindly and lovingly, to set expectations, and to help the child meet those expectations. When they are unable to do so, you do NOT turn on them. Nor do you define either them or

The second idea is do everything in your power to give the child a “do-over” in which you avoid focusing on the negative, but instead focus on the positive you want. You WANT to help your child succeed. You transcend your anger at their bad behavior, and you actively and

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yourself as a failure. Instead, you simply move to the third idea for these children. The third idea is this: you do not punish your child out of anger nor get caught up in making sure they “do” what you have ordered them to do, even if it is good for them to do so. You simply get down to parenting basics: every moment brings a choice for your child. He or she chooses. You offer help to assist them in choosing better on the “do-over.” And then, if they do not choose well, they experience the natural and logical consequence of that choice, without any drama or hysterics from you. Your child with ADD turns down your offer of help in organizing a homework plan. You simply say, “If you change your mind, let me know. It’s got to be frustrating to do the work and have your teacher get mad because he thinks you didn’t do it.” Your child with ADHD refuses to make amends with his brother after knocking him down. You simply say, “When you whack someone without showing that you are sorry, they usually don’t want to play with you later in the day.” When your child with oppositional patterns refuses to take their coat or sweatshirt to school, you let them experience the discomfort of being pretty cold that day, perhaps discreetly putting the sweatshirt by the door the next morning. When your child with excessive rigidities cannot put his game away, you reorganize your approach for the next day, only allowing that game or project after you have returned home from whatever outing is required. In short, you settle yourself emotionally and you offer the child a do-over with your help, hoping they will succeed in being compliant and pleasing you. If they fail to do so, you allow natural and logical consequences to arise, without trying to protect them, and without lecturing them about how they were wrong and you were right. About the Author Dr. Richard Formica is a New Jersey licensed psychologist who has worked in private practice in Bergen County, New Jersey, for the past 40+ years. He specializes in providing integrative psychotherapy to adults and parent counseling to parents of children who suffer from ADHD and its many co-occurring disorders.

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Joint Hypermobility, Connective Tissue Disease, and Neurodivergence

By Jennifer Coleman, BCBA, LPC, LBS

By William MacLaney, PsyD

Neurodivergence encompasses a wide range of conditions, including, “autism, attention deficit hyperactivity disorder, tic disorder, and Tourette syndrome (TS) (Csecs et al., 2022, pg. 1).” These conditions have a strong impact on psychological, social, and emotional functioning (Csecs et al., 2022). Certain physical health conditions are correlated with neurodivergence, including joint hypermobility (Csecs et al., 2022). This condition is common among neurodivergent individuals, and is further associated with autonomic system dysfunction, and musculoskeletal impairments (Csecs et al., 2022). Therefore, further research is necessary to understand the connection between connective tissue deficiency and neuroatypical individuals (Csecs et al., 2022). Neurodivergence is a generalized variation of perceived normal behavior, emotions, and cognitions (neurotypical) (Martin et al., 2023). Neuroatypical individuals experience alterations in responses to others, and frequently have heightened emotional reactions (Martin et al., 2023). These differences can result in stereotypes, oppression, and discrimination (Martin et al., 2023). Autism spectrum disorder (ASD) and associated conditions [attention deficit hyperactivity disorder (ADHD), and tic disorders (specifically, TS) are highly associated with, “fibromyalgia, irritable bowel syndrome, fatigue, and autonomic dysfunction (Csecs et al., 2022, pg. 2; Martin et al., 2023)]. Further understanding the correlation between neurodevelopmental conditions and joint hypermobility may increase understanding of the etiology and articulate more specific treatment options for neurodivergent individuals with hypermobility (Csecs et al., 2022). The three types of neurodivergent conditions described in this article are ASD, ADHD, and Tourette syndrome. Autism spectrum disorder has been described by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. (DSM 5)

describes ASD as a neurodevelopmental disorder. The criterion includes “persistent deficits in social communication and social interaction, restrictive patterns of interest and behavior, symptoms must be present in the early development period, symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning, and these disturbances are not better explained by an intellectual disability, or global impairment developmental delay (American Psychiatric Association, 2013, pg. 50).” Attention Deficit Hyperactivity Disorder affects adaptive functioning in children (Magnus et al., 2023). They exhibit symptoms of inattention, impulsiveness, and/or hyperactivity (Magnus et al., 2023). The diagnostic practitioner must assess cultural and developmental factors when formulating a clinical diagnosis to prevent misdiagnosis (Magnus et al., 2023). Tic disorders include wide ranging symptoms including quick movement and/or noise without purposeful action. Common tics are articulated blinking, rapidly raising the eyebrows, moving the head to either side, moving the shoulders upward, and strong annunciation of sounds (Black et al., 2020). Typically, the condition is idiopathic (lacking a specific cause), and the average age of onset is between 3 to 10 years old (Black et al., 2020). Chronic tic conditions endure for 12 months or more (Black et al., 2020). If individuals experience both movement and unintentional verbal expression, the condition is labeled, TS (Black et al., 2020). Individuals afflicted by joint hypermobility experience movement extending beyond the general population’s ability, which occurs because of connective tissue disease, or genetic variation (Csecs et al., 2022). Hypermobility and neurodivergence are strongly correlated with autonomic

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In conclusion, a connection exists between hypermobility and neurodevelopmental disorders (Csecs et al., 2022; Martin, 2023). Some researchers have taken an evolutionary perspective, focusing on neurodiversity as an alteration in human behavior to increase a generation of specialist thinkers (Doyle, 2020). Despite this perspective, further research will assist with identifying the etiology of these conditions and help with constructing more appropriate treatment options for individuals with hypermobility and neurodevelopmental conditions.

dysfunction, fatigue, pain conditions, gastrointestinal complaints, psychiatric difficulties, and gynecological issues (Csecs et al., 2022; Martin et al., 2023). Csecs et al. (2022) assessed generalized joint mobility across a group of neurodivergent individuals. Twenty five percent of individuals were diagnosed with ASD, 51% with ADHD, and 14% were identified as having TS (Csecs et al., 2022). Additionally, over 50% of the neurodivergent group met criteria for generalized joint hypermobility (GJH) when compared to the general population equivalent control group (Csecs et al., 2022). Individuals with ASD experienced GJH at a 4.51 times higher rate than controls, 4.34 times for ADHD, and 7.02 times for TS. Theses statistical analysis calculations demonstrate the highest association between TS and GJH. However, ASD and ADHD rates were statistically significant (Csecs et al., 2022).

About the Authors: Jennifer Coleman is a BCBA, LPC, is a Counseling Psychology Doctoral Candidate at Felician University specializing in the treatment of trauma and neurodivergence conditions, and her research interests are in neuropsychology and physiological psychology.

Additionally, females were found at a higher rate than males in the neurodivergent group. Females had a prevalence rate of 69% in comparison to controls (Csecs et al., 2022). Moreover, there was a strong correlation between females and the diagnosis of (GJH). Additionally, orthostatic intolerance (a type of dysautonomia) was significantly higher in neurodivergent groups (Csecs et al., 2022). Musculoskeletal symptoms were also found at a high rate in the neurodivergent group (Csecs et al., 2022). These findings suggest a significant connection between neurodivergence, GJH, female sex, dysautonomia, and pain symptoms among individuals with ADHD, ASD, and TS.

William MacLaney, PsyD is a clinical psychologist and director of a not-for-profit, Compass Psych Services, which specializes in ADHD and other neurological conditions assessment and treatment. He attained his doctorate from Capella University and completed his internship at Woodbridge Developmental Center. Dr. MacLaney has a long history of working with individuals with comorbid chronic health conditions and behavioral interventions. References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Specifically, Ehlers-Danlos syndrome (EDS) is a group of connective tissue disorders resulting from deficiencies in, “ligaments, tendons, skin, bone, and even blood and fatty tissue” (Casanova, 2020, pg. 2). Thirteen types of EDS exist, and are caused by variations in genes (Casanova, 2020). A recent study found high correlations between ASD and EDS (Casanova, 2020). Connective tissue has demonstrated a salient role in brain development (Casanova, 2020). Moreover, children and adults with EDS report greater immune system dysfunction than those without, suggesting a connection between immune system function and neurodevelopmental conditions, such as ASD (Casanova, 2020).

Black, K., J. et al. (2020). The New Tics study: A Novel Approach to Pathophysiology and Cause of Tic Disorders.Journal of psychiatry and brain science, 5, 1-31. https://doi.org/10.20900/jpbs.20200012 Casanova, E., L. (2020). Editorial-Researchers have identified a relationship between Ehlers-Danlos Syndrome and autism. Autism Research Review International, (34), 1-2. https://autism.org/researchers-have-identified-arelationship-between-ehlers-danlos-syndrome-and-autism/ Csecs, J., L., L. et al. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain/. Frontiers in Psychiatry, (12), 1-13. Doyle N. (2020). Neurodiversity at work: a biopsychosocial model and the impact on working adults. British medical bulletin, 135(1), 108–125. https://doi.org/10.1093/bmb/ldaa02

Moreover, persistent and articulated musculoskeletal pain, chronic fatigue, autonomic sensitivity, digestive complaints, and long-standing headaches are associated with neurodivergence, fibromyalgia, and connective tissue disease (Martin et al., 2023). Additionally, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) have a higher occurrence rate in immediate family members of neuroatypical women, suggesting a correlation between autoimmunity and the development of neurodivergence (Martin et al., 2023).

Martin, R. et al. (2023).Recognising the Rheumatological Needs of Neurodivergent Females: Commentary. Rheumato, 3, 221-227. https://doi.org/10.3390/rheumato3040017 Magnus W. et al. (2023). Attention Deficit Hyperactivity Disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838

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Applying Aspects of Neuroqueer Theory to Systems of Psychotherapy

By Cristian Xavier Morillo

By Ashley Appleton, PsyD

Neuroqueer is a term that was coined by Dr. Nick Walker, to describe individuals who are both neurodivergent and LGBTQ+. Neuroqueer theory, investigates the neurodiversity paradigm and LGBTQ+ experience through a lens of intersectionality that employs elements of queer theory. In order to understand how neuroqueer theory can be applied to different forms of psychotherapy, it is important to identify the assumptions encapsulated within this school of thought. Firstly, neuroqueer theory challenges the pathology paradigm that traditionally seeks to ascribe disorders to individuals displaying a set of “symptoms” or “abnormal” behaviors. When using the neurodiversity paradigm embedded within neuroqueer theory, however, the pathology paradigm becomes increasingly contradictive. Neurodiversity posits that an individual has a unique set of cognitive strengths and weaknesses, which result in distinctive cognitive styles that differ from person to person. Furthermore, this means that “conditions” such as ASD (autism spectrum disorder), and ADHD (attention deficit hyperactivity disorder) should not, in fact, exist as pathological clinical diagnoses, but rather, as natural variations in the human cognitive make (Yergeau, 2017). In the first version of the DSM (Diagnostic and Statistical Manual of Mental Disorders), homosexuality was classified pathological and treated as a mental disorder. This contributed to a lens that pathologized the LGBTQ+ community and was subsequently exacerbated by the AIDS epidemic in the 1980s. The history of diversity being treated as pathology has had a significant negative impact on those who identify within marginalized groups. Another area that neuroqueer theory unabashedly explores are power dynamics within mainstream modern-day language. Specifically, how this language is used when addressing neuro and sexual minorities and its implications of neurotypical and heterosexual hegemonies. These hegemonies may contribute to the eliciting of the camouflaging behaviors that minority identifying individuals often engage in, such as masking for neurodivergent individuals and reluctance to come out for LGBTQ+ people (Radulski, 2022). Another important aspect of neuroqueer theory is that it assumes that not all neurodivergent people have disabilities, but are instead disabled by their society.

This essentially then acts as a barrier to the accommodations that are necessary for the optimal functioning of said neurodivergent individuals (Walker, 2021). Today, many clinical modalities are available to psychotherapists for their use with their clients. These modalities may range from evidence-based treatments such as CBT (cognitive behavioral therapy) to relational-based treatments such as psychodynamic. However, due to the novel emergence of neuroqueer theory and its common misconceptions in the realm of clinical and observational research, proper adaptations of neuroqueer elements have yet to be implemented into evidence-based practice in psychology (EBPP). This article aims to educate psychotherapists on clinically applicable alterations that they can make in line with the values of neuroqueer theory regarding most modern systems of psychotherapy. The goal for this incorporation of values aims to foster greater equity and acknowledgment of the social injustices that sexual and neuro minorities face in the context of wider society. Firstly, as clinicians, it is imperative to recognize that the therapeutic relationship independent of additional factors, holds a power dynamic where the clinician holds power over the client as a healthcare professional. It is with this fact in mind that therapists should make conscious efforts to not intimidate their client or further mimic the societal power dynamic that many minority identifying individuals experience on a daily basis. In relation to neuroqueer theory, this intentional effort can take many forms, such as the therapist introducing themselves with their pronouns and asking the client of theirs. Should a client reveal that they are gender diverse (i.e. transgender, gender nonconforming, genderqueer, etc.), the therapist should adhere to the pronouns that the client expresses they are comfortable with. This practice is especially important to keep in mind for clients whose gender identity is different than their gender expression (i.e. gender identity is male, but gender expression is feminine) as confusion or neglect of these details may result in unintentional offense and discomfort for the client. Conversely, a brief disclosure of the clinician’s understanding of the social disparities that neurodivergent

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LGBTQ+ people face may also promote trust-building early on in the therapeutic relationship. These actions normalize conversations about gender and sexuality (and their variances) and communicate to the client that the therapy room and you as a clinician are safe spaces for them to not only disclose their issues regarding those subjects, but also to exist as they are.

diversity that they embody. It should also be noted that the usage of proper pronouns, non-pathologizing language, and acknowledging the social disparities that exist between majority groups, neurotypical heterosexuals, minority groups, and neurodivergent queer individuals are essential steps toward social progression for the neuroqueer community. Proper facilitation of these steps should foster a culture of neuroqueer people who are unashamed of being themselves; freely living/expressing their gender and sexuality, and engaging in their natural neurocognitive processes free from scrutiny, hatred, and minimal stigma. History has not been kind to neuroqueer people, however, they may now have a platform that can help to facilitate community building, acceptance of the self, healing, and newly dubbed in this article: neuroqueer-informed psychotherapy.

It is also important to avoid using pathologizing language if possible when referring to a neurodivergent client. Using stigmatizing language such as implying that a client has a deficiency, has been shown in research to potentially encourage the concealing of a client’s symptoms from a clinician, which may further promote masking and closeting behaviors (Qiu et al., 2019). Walker suggests that the pathologizing of the term ADHD for example, assumes that a person with ADHD has a “deficit” or “disorder” rather than a differing cognitive style. For this reason, Walker introduces the possibility of renaming ADHD to KCS (kinetic cognitive style) to more broadly encompass the experience of those who are currently diagnosed with the condition. Another suggestion that Dr. Walker makes in her book is the idea that instead of using person-first language (i.e. person with autism) clinicians should instead be fearless in encouraging and using identity-first language (i.e. autistic person) in hopes of one day removing the negative stigma from the currently known “conditions” of neurodivergent persons (Walker, 2021).

About the Authors Dr. Ashley Appleton is an Assistant Professor in the Graduate Counseling Department at Felician University. She also has founded a local group mental health practice in New Jersey which is rooted in social justice and quality accessible mental health care for all. She is a licensed psychologist and licensed professional counselor. She received a Bachelors degree in Psychology from William Paterson University, a Masters degree in Clinical Mental Health Counseling from Fairleigh Dickinson University, and a Doctorate in Counseling Psychology from the St. Elizabeth University. Dr. Appleton’s research and teaching interests include minority stress, geriatric mental health/ population aging and LGBTQ+ mental health.

Unorthodox behaviors that may be exhibited by neurodivergent individuals should not be judged, corrected, or reprimanded. Instead, neuroqueer theory suggests that individual differences should be celebrated and normalized. Normalization may begin to happen through the efforts by clinicians to provide psychoeducation to their clients (and potentially their families, depending on the situation) on topics regarding neurodivergence and queerness from the scope of current research and relevant phenomena. This education can look like explaining what stimming (selfstimulatory behavior) is, its functions, and demystifying the misconception that only neurodivergent people engage in this behavior. The clinician can also emphasize how gender, sexual, and neurocognitive variance is natural and another form of diversity just like ethnicity and religion, for example (Salerno et al., 2020). Furthermore, clinicians may also opt to educate the client (and their guardian/family) about their neuro and queer identities and may elaborate on other neurodivergent and queer identities that embody the neuroqueer experience. This can foster a sense of community in the client with others who share their identities. This is important as loneliness and social isolation are common problems in both LGBTQ+ and neurodivergent spheres (Salerno et al., 2020).

Cristian Xavier Morillo is a doctoral student in counseling psychology at Felician University. His interests are in treating and conducting research into marginalized communities, including BIPOC, neurodivergent, and LGBTQ+ populations. References Qiu, L., Tong, Y., Lu, Z., Gong, Y., & Yin, X. (2019). Depressive symptoms mediate the associations of stigma with medication adherence and quality of life in tuberculosis patients in china. American Journal of Tropical Medicine and Hygiene, 100(1), 3136. https://doi.org/10.4269/ajtmh.18-0324 Radulski, E. (2022). Conceptualising autistic masking, camouflaging, and neurotypical privilege: towards a minority group model of neurodiversity. Human Development, 66(2), 113-127. https://doi.org/10.1159/000524122 Salerno, J., Williams, N., & Gattamorta, K. (2020). Lgbtq populations: psychologically vulnerable communities in the covid-19 pandemic.. Psychological Trauma Theory Research Practice and Policy, 12(S1), S239-S242. https://doi.org/10.1037/tra0000837 Walker, N., (2021). Neuroqueer Heresies: Notes on the Neurodiversity Paradigm, Autistic Empowerment, and Postnormal Possibilities. IBSN-13: 978-1945955266

In summary, clinicians should educate themselves on the specifics of both neurodivergent and LGBTQ+ communities as a toolbelt for tackling the systemic pathologizing that has historically and currently plague these communities. Clinicians should also celebrate the individuality of their clients and educate both them and their families about the

Walker, N. (2023). Neuroqueer: An Introduction. https://neuroqueer.com/neuroqueer-an-introduction/ Yergeau, M. (2017). Authoring autism.. https://doi.org/10.1215/9780822372189

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Curanderismo, Latinx Perspectives on Neurodiversity and Future Directions

By Cristian Xavier Morillo

By Marcela Farfan, PsyD

Neurodiversity is defined as a “concept that regards individuals with differences in brain function and behavioral traits as part of normal variation in the human population” (“Exploring a Strengths-Based Approach to Neurodiversity,” 2022, para. 3). Neurodivergence includes autism, dyslexia (difficulties with reading, writing, and spelling), ADHD, and other conditions where the brain functions differently from the neurotypical majority (“Exploring a Strengths-Based Approach to Neurodiversity,” 2022). Historically, the Latinx community and the neurodivergent community have generally had a complicated relationship marked by mistrust, social inequities, and skepticism toward the mental healthcare system, rooted in negative stigmas. In recent years, numerous obstacles have hindered many Latinx individuals from accessing mental health resources, both clinically and educationally (Acosta et al., 2023; Helu-Brown et al., 2023). Consequently, there is a prevailing lack of clarity within the Latinx community regarding the definition of neurodivergence and the supportive measures implemented for this population. This is evidenced by the observation that Latinx mothers are less inclined to report symptoms of autism in their children when compared to other children (Schmidt et al., 2022). Moreover, due to implicit bias toward non-English-speaking individuals, Latinx females are also less likely to be screened for autism due to a lack of consideration by school psychologists (Golson et al., 2021). Adding to this challenge, the values of culture, religion, and family are frequently used as a primary resource for addressing neurodivergence and mental health challenges instead of consulting a trained mental health professional (Martyr et al., 2019; Rodriguez & Smith, 2019). Due to a lack of education and negative cultural ideas surrounding neurodiversity on behalf of the Latinx community, many neurodivergent Latinx individuals do not get screened, assessed, or accommodated for their neurodevelopmental differences until much later in life, if at all (Quebles et al., 2022). The identified challenges underscore the need for proactive efforts in destigmatizing neurodivergence to ensure more equitable care for those who are seeking mental and neuropsychological treatments, particularly for minors. Although there is still work to be done in normalizing the neurodivergent population and their healthcare within the Latinx community, one cultural practice native to the Latinx population, curanderismo, has made strides toward destigmatizing mental health discussions for the Latinx layperson. Simply put, curanderismo is the Latin American cultural practice of folk healing that aims to view one’s health holistically as a collective embodiment of the afflicted individual and their mind, body, spirit, community, and natural forces. These factors interact collectively in a state of balance. According to curanderismo, disruptions in balance can result in sickness, conflict, or various forms of physical, mental, social, spiritual, or natural disasters (Roseman-Halsband et al., 2019). The practices of curanderismo and psychotherapy share several similarities regarding their logistics and overall goal to heal their clients via intervention. The structure in which curanderismo is loosely formatted includes one-on-one healing with the curandero (healer), who engages in a platica (heart-to-heart), which is essentially a deep dive into the personal history of events that lead up to the patient’s current state of discomfort. This healing is believed to be most effective in the presence of only the curandero and the patient. However, close family and spirits are also invited to observe if necessary. Following this, inquiries are made concerning the patient, their family, community, and other connections to better understand the dynamics and balances or imbalances that may exist between the patient and their surrounding entities. Subsequently, a series of rituals, community ceremonies, and repeated practices may occur (Roseman-Halsband et al., 2019). This shortened and abridged description of curanderismo captures the basic elements that reflect its similarities to psychotherapy in the sense that they both employ

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aspects of narrative medicine to identify afflictions via reflection and introspection and employ the same physical set-up as a traditional talk therapy setting (minus the addition of spirits).

during the platica aspect of curanderismo. Given that neurodivergent people have their own culture, curanderismo also advocates for cultural sensitivity by acknowledging its marginalized status as a treatment method.

While curanderismo has begun to address concerns related to mental health, it is important to recognize that it can also be used as a device of justice for the acceptance of neurodivergent people within the Latinx community. Nicolaidis et al.’s (2019) study elaborated on this, revealing that neurodivergence can be a difficult topic to address in general. This is partly due to many populations’ being unfamiliar with terms, meanings, implications, and presentations hinging on many factors such as education, exposure, and access to information regarding neurodivergence. The Latinx community is no exception to these challenges. Another study by the National Autistic Society indicated that, in general, people possess awareness of autism, a condition defined under the umbrella of neurodivergence; nevertheless, there are still prevalent stigmas associated with such diagnoses (National Autistic Society, 2017).

Many individuals in the Latinx community use curanderismo as a form of healing separate from Western medicine. This choice stems from concerns that systems relying on Western medicine often exclude those without socioeconomic privilege, posing challenges for many Latinx people in the United States, particularly in the context of immigration. Curanderismo also employs a spiritual lens that often serves as a sense of comfort for neurodivergent individuals by placing their faith in community, nature, and a higher power. Since curanderismo celebrates and acknowledges cultural sensitivity and community involvement, latently, it normalizes the treatment of neurodivergent individuals utilizing its own agenda. Given its comparison to the treatment practices of contemporary psychotherapy, adaptations from the cultural perspectives found in curanderismo may apply to culturally sensitive treatment modalities such as acceptance and commitment therapy (ACT). Should this application occur, theoretical advancement of the progression in culturally sound practices of psychotherapy may be constructed.

The basis for stigmas surrounding the neurodivergent community stems from ableism and the misunderstanding of the cognitive differences that neurodivergent people display in contrast to their neurotypical counterparts. Consequently, society perpetuates the dehumanization of neurodivergent communities such as those with autism. This is exemplified by the implementation of ableist “treatments” such as applied behavior analysis (ABA), presented as the gold standard for clinical intervention imposed on autistic communities.

Due to the familiarity of curanderismo in the Latinx population in tandem with recent efforts to compare it to psychological interventions by professionals such as Torres and Roseman (Roseman-Halsband et al., 2019), the Latinx community will continue to gain a deeper, more accurate understanding of neurodiversity and mental health conditions and practices as a whole. In the future, clinicians working with the Latinx population, especially those who are related to neurodivergent persons, may find it beneficial to consider curanderismo as a familiar framework when engaging with psychotherapy. Integrating its practices could enhance the effectiveness of treatment and advocacy for the neurodivergent population. Another direction for mental health professionals is to explore the literature related to these two forms of treatment further. By normalizing the presence of neurodivergent individuals within the Latinx community, this exploration may foster greater acceptance and compassion in the larger society. Understanding that neurodivergence is not a pathology but a form of diversity is necessary.

While ABA has its utility, in summary, it seeks to “correct” what is deemed non-normative behaviors (any behavior that does not align with the standards of neurotypicality) and replace it with socially acceptable ones. This alludes to the notion that neurodivergent individuals are seen as needing “fixing,” and they are not accepted for who they are. In addition, mannerisms such as “stimming” are considered inherently negative. Neuroqueer Heresies, a collection of writings developed by Walker (2021), elaborates on this idea and posits that neurodivergent individuals are not always disabled by nature but instead disabled by the intolerant society that refuses to make accommodations for them.

About the Authors

Curanderismo plays a role in addressing social injustices faced by neurodivergent individuals to a Latinx audience because it emphasizes the connection between an individual’s health, community ties, and the overall balance of nature. This framework provides a perspective on the existence of neurodivergent individuals as a natural aspect of the environment rather than as an abnormality or exception. Curanderismo fosters support and inclusion by emphasizing community support and acceptance through communitybased ceremonies. It allows family and spirits to be present

Cristian Xavier Morillo is a doctoral student in counseling psychology at Felician University. His interests are in treating and conducting research into marginalized communities, including BIPOC, neurodivergent, and LGBTQ+ populations. Marcela Farfan, PsyD is a licensed professional counselor. She serves as an educator at Felician University and coordinates the Master's in Counseling Psychology program. Dr. Farfan teaches master-level courses, including practicum and internship; her area of interest is in Mindfulness and the Latinx community.

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Winter 2024

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Winter 2024

Preventable Police Fatalities in New Jersey: The Role of Psychology in Reducing Harm and Trauma

By Matthew Barry Johnson, PhD

By Barbara A. Prempeh, PsyD

Sadness, alarm, anger, anxiety are common responses to headline reports of deaths linked to police practice. In 2020, protests and civil unrest following the murder of George Floyd by Minneapolis, Minnesota police officers led to the largest mass protests in US history (Buchanan et al., 2020). Complaints about police abuse and brutality have a lengthy history in the US (Kerner Commission Report, 1967). Much of this history involves racial bias against African Americans (Bor et al., 2018; Human Rights Watch, 1998), and a disproportionate number of cases involve people experiencing mental health crises (APA, 2021; Rogers, et al., 2019). Below we present recent cases of preventable police fatalities in New Jersey (see Table 1.) and discuss the role of psychology in reducing harm. We draw from the American Psychological Association’s (2021) Resolution on police use of excessive force, literature on racial trauma (Hardy, 2023), as well as public health perspectives and data (American Public Health Association, 2018; Bor et al., 2018).

assistance. However, the crisis team was not successful in transporting Mr. Washington to care and they called the police (Tebor, 2023; Niemietz, 2023). The police were engaged for an hour negotiating with Washington who was behind a door. When the officers forced their way into the room, reportedly Washington moved toward them with a knife. Though the family members have questioned whether Washington actually held a knife, the outcome was fatal police gunfire. The family reported that the police responded during a similar crisis with Washington, in 2011, and he was shot in the arm (Carlin, 2023). Najee Seabrooks - a violence prevention specialist On March 3, 2023, Najee Seabrooks, a 31-year-old Black man, was shot and killed by Paterson, New Jersey police officers. This homicide was reported in the regional and national press (Cramer & Tully, 2023). Reportedly the police spent 4-5 hours urging Seabrooks to surrender before the fatal shots were fired. What was the nature of Seabrooks’ threat? He was threatening to kill himself. Seabrooks had arrived at his brother’s apartment at 2:00am and locked himself in the bathroom with knives. According to the New York Times (Cramer & Tully, 2023), family members reported Seabrooks did not have a history of mental health difficulty and suggested he may have had a bad reaction to something he smoked. This preventable police homicide, involved another tragic irony. Seabrooks was a member of the Paterson

Andrew Jerome Washington, III – help becomes harm On August 27, 2023, Andrew Jerome Washington, III, a 52-year-old Black man, was shot and killed by Jersey City police department officers. According to CNN (Tebor, 2023), police deployed a taser prior to the fatal gunfire. Mr. Washington had a history of schizophrenia and bipolar disorder. Washington’s family reported he was acting strangely for days and it was suspected he had discontinued his medication. The family initially called the Jersey City Medical Center crisis team for

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Winter 2024

Healing Collective (PHC), a group of specialists, from a local hospital, trained to de-escalate violence. Members of the collective reported that the police blocked their direct access to Seabrooks when he was in crisis. Finally, at 12:51pm, when Seabrooks came out of the bathroom, the fatal shots were fired. In New Jersey, since 2019, due to conflict-of-interest concerns, police fatal assaults are investigated by the State Attorney General’s Office rather than the local county prosecutor (New Jersey Office of the Attorney General, 2019). A press release issued by the State Attorney General stated Seabrooks “lunged” at officers with a knife in his hands. A New Jersey ACLU official noted the Attorney General’s language and characterization prematurely justified the police fatality (Jung, 2023). A lawsuit on behalf of the Seabrooks family cites other Paterson police homicides suffered by people experiencing mental health crises (Moran, 2023). Bernard Placide, - ‘point blank range’ Six months earlier, another young Black man in a mental health crisis was killed by New Jersey police. The deceased was 22-year-old Bernard Placide and the fatal assault occurred in Englewood on Labor Day weekend (9/03/22). The family denied Placide had a history of mental health impairment. According to audio released by the New Jersey Attorney General, Placide’s mother (Myrlene Laurince) told a dispatcher, "[deleted] is trying to kill me," adding, "I don’t know what happened to him. He’s been acting crazy lately” (Katzman & Noda, 2023). When police officers arrived, they found Placide’s stepfather in the bathroom with a stab wound. Then, they encountered Placide, alone in his room. Placide held a green object and was ordered multiple times to ‘drop the knife.’ Placide was first tased by one officer and then shot at point blank range by the other officer. There is a dispute regarding whether Placide was armed at the time (Sloan, 2022). The family attorney (Eric Kleiner) asserts, Placide held only a knife handle, the blade had been broken off earlier in the day. Video cam footage may shed light on that aspect of the dispute but some argue, even if Placide was armed, appropriate methods to de-escalate the incident were indicated rather than a lethal response. The New Jersey Attorney General’s office is also investigating this case.

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Winter 2024

Major Gulia Dale, III – combat veteran PTSD Major Guila Dale, III was a 61-year-old decorated, Black army combat veteran. He had served three tours in Iraq. He was employed for the Joint Chiefs of Staff, in Washington, DC, as an Equal Opportunity Specialist, at the time of his death. He commuted to his home in Newton, New Jersey on weekends. He was scheduled to retire in October of 2021. Mr. Dale had been diagnosed with Post Traumatic Stress Disorder related to his military service. On July 4th, 2021, Dale suffered a post-traumatic stress reaction to the sound of fireworks. His wife, concerned he was suicidal, called the police for help. Four minutes after the call was placed, Guila Dale was shot and killed by two white Newton Police officers in the front of his home. According to an attorney for the one of the officers, Mr. Dale held a handgun (Comstock, 2021a; Swift & Prempeh, 2021). A local headline summarized the family’s distress, “I called for help for my husband because he was suicidal … not for murder (Comstock, 2021a).” Valerie Dale-Corbertt, sister of the veteran, has been leading the call for a thorough investigation. She cited a January 2021 incident, where a suicidal white male fired two shots toward Newton police officers. He was allowed to drive away, without gunfire from the officers. This man was later arrested and provided medical care (Comstock, 2021a; Comstock, 2021b). According to Valerie Corbertt, this illustrates the type of de-escalation and protecting of life that her brother was denied. Eighteen months after Major Gulia Dale was killed, the New Jersey Attorney General’s grand jury cleared the officers of all criminal charges (Cowan, 2023). Carl Dorsey – No bill The fatal police gunfire that killed 39-year-old, Carl Dorsey in Newark, on January 1, 2021, was not related to mental health distress. Dorsey, an African-American resident of South Orange, was out with friends, shortly after midnight, celebrating the New Year in Newark. The unarmed Dorsey inadvertently bumped or collided with a plainclothes officer exiting an unmarked police vehicle. “As Det. […] was falling to the ground, his service weapon discharged once, striking Mr. Dorsey…” (Office of the Attorney General, 2023). This official account suggests the fatal gunfire was inadvertent and accidental. However, important considerations warrant attention. The officer was one of 12 plain clothes detectives, in an unspecified number of unmarked police vehicles, working together without body cameras, in the Newark Criminal ‘Intelligence’ Unit. African-Americans, in inner city neighborhoods, are subjected to this peculiar pattern of (over-) policing that has inherent risks and associated trauma as occurred with the Dorsey fatality (Bor et al., 2018). As might be expected, the Attorney General’s grand jury declined to indict the officer who shot Carl Dorsey (Sturnsky, 2023). Newark Mayor Ras Baraka released a statement indicating the officer was no longer on active duty and the City would move swiftly to determine if there were violations of procedure or regulations involved in the case.

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Discussion

We are proposing, in addition to review of criminal or civil liability, a rigorous post-event process to examine cases that resulted in death or serious injury, as well as mental health crises interventions that were effectively resolved without injury. Data from such inquiry can help determine which types of training or technological measures that can reduce fatal and injurious outcomes. Just as the TSA investigates airline and rail disasters when there is loss of life and injuries, rigorous examination of fatalities associated with mental health crises warrants the same diligence. We call upon the New Jersey Attorney General to lead such an effort.

For several decades, research and professional psychologists have been engaged in efforts to reduce fatal and abusive police practices, especially where the mentally ill are vulnerable (Watson & Fulambarker, 2012). Similarly, African-American community resistance to police brutality has been noted throughout the 20th Century (Kerner Commission, 1967) and continues with renewed activism and popular slogans like, ‘Black Lives Matter.’ The APA’s (2021) resolution on police use of excessive force is a call for psychology to engage and support reform on a host of levels. For instance, how policing is envisioned, how police officers (and emergency dispatch personnel) are selected and trained, combatting overt and implicit bias, and creating effective civilian oversight of police, are all vital for effective reform. Other agenda items include cultivating peer awareness among police to counteract the ‘blue wall of silence.’ In this connection, the FBI (2006) report warning of white supremacist infiltration of US law enforcement warrants attention (also see German, 2020). We do not suggest all the solutions are readily identifiable at this point. It is our goal here to outline some basic principles, and alternative perspectives, that can guide practice reform and further research.

Our general understanding of trauma leads to recognition of the widening circle of harm associated with these outcomes. There is, of course, the profound and varied trauma suffered by the deceased and their family. This extends to friends and loved ones, and the community, as well. It is linked in our psyches with pain associated with George Floyd, Breonna Taylor, Michael Brown, and Trayvon Martin, as well as intergenerationally with Emmett Till, Isaac Woodard, and others. We know and appreciate this from research and our lived experience. Noted scholars (Hardy, 2023) have described this as an aspect of enduring ‘racial trauma’ that demands clinical and societal attention. We call for an alliance of mental health professional organizations, local and regional mental health advocacy organizations, and other concerned groups and individuals to engage in combatting and reducing police excessive and lethal violence.

We believe it is essential that reform, on all levels, adopt a public health orientation (American Public Health Association, 2018). That is, focus on reducing and eliminating harm, death, injury, and residual psychological trauma. De-escalation needs to be a guiding principle in police-citizen interactions. This will benefit the public and law enforcement personnel (APA, 2021). Our observation in the above cited cases is the New Jersey Attorney General’s approach has been to determine whether the police use of lethal force can be justified, while the public health question is whether the police use of lethal force was preventable (Johnson & Cobbertt, 2023). Even where lethal force might be justified, there needs to be rigorous examination of whether less than lethal measures could have been effective. This alternative question must always be engaged toward the goal of reducing and preventing fatal outcomes.

References Furnished Upon Request About the Authors

Barbara A. Prempeh, PsyD is the founder and owner of B. Resilient, LLC, a private practice that works to build resilience individually and collectively. Dr. Prempeh specializes in helping individuals, communities, and organizations overcome various types of traumas and adversities. Dr. Prempeh is currently President of the New Jersey Chapter of the Association of Black Psychologists. Matthew Barry Johnson, PhD is a Professor of Psychology at John Jay College of Criminal Justice, CUNY.

NJ Psychologist

Winter 2024

NJPAGS: Where Leadership Meets Community

By Mary Isaac Cargill Chair, NJPAGS

My name is Mary Isaac Cargill, and I am honored to serve as the Chair of NJPAGS for 2024. I am currently a third-year doctoral candidate in Montclair State University’s Clinical Psychology PhD program. My research and clinical interests center on autism, and I have been fortunate to gain clinical experience working with autistic people across the lifespan in a variety of settings.

such as networking with early career professionals, preparing for internship, and learning about specific therapeutic interventions and approaches from experts in the field. As NJPAGS continues to evolve, we are eager to continue collaborating closely with NJPA to create funding, networking, and other professional development opportunities for our students.

I was first introduced to NJPAGS as Montclair State University’s campus representative in 2022 before transitioning to the role of Secretary/Treasurer later that year. Since that time, I have been thrilled to serve as ChairElect in 2023 and now as Chair in 2024. In the course of the last two years, I have had the opportunity to connect and forge relationships with a diverse body of students and professionals across the state. During my tenure with NJPAGS, I have been consistently encouraged by professionals’ willingness to engage with students and genuinely consider our perspectives. My personal experience with NJPAGS has been incredibly rewarding and educative, and my ultimate goal is for other graduate students to similarly benefit from involvement with this organization.

While the myriad of professional benefits that accompany involvement with NJPAGS cannot be understated, I find that the sense of community is perhaps even more powerful. One of my most treasured aspects of involvement with NJPAGS is watching how quickly our members progress beyond colleagues. I am regularly in awe of the care and support with which we approach one another, and I hope to work with the rest of NJPAGS leadership to create more social spaces for students to connect with one another informally over the course of this year. As graduate students, we constantly contend with different demands on our time, and the power of an understanding and accepting community is crucial as we traverse different challenges and achieve milestones. When I reflect on NJPAGS, I am repeatedly struck by the brilliance of our members, and I am keenly aware that we have a limited amount of time as students before we join the ranks as professionals. I believe we all have a responsibility to utilize our time as students judiciously, to use our platforms and make our voices heard as future leaders in the field. NJPAGS gives us the forum to take these steps, and I am passionate about welcoming as many graduate students as possible into this space. I consider it a privilege and a joy to exist in community with the student members of NJPAGS, and I look forward to serving them and championing their needs as Chair.

Much like NJPA, NJPAGS has undergone a period of rebuilding and growth over the past few years, and I am eager to continue listening and responding to our members’ needs as incoming Chair. To that effect, I hope to use my time as Chair to increase membership and secure representation from graduate programs across the state to ensure that diverse perspectives are present in NJPAGS. Students’ needs vary considerably, and it is my intent to foster a collaborative environment where students can support one another and ultimately succeed together. I am eager to work with the NJPAGS board to continue developing programming to meet students’ stated needs,

NJ Psychologist

Winter 2024

Legislative Victories! On December 21, 2023, Governor Murphy signed the telehealth payment parity extension into law. A5757/S4127, sponsored by Assemblyman Conaway and Senator Gopal, revises reimbursement payments for providers using telemedicine and telehealth. This law extends the same protections as the current law, with a new expiration date of 12/31/2024. No additional requirements or restrictions have been added to this bill. There is much to celebrate here. Telehealth was NJPA's top legislative priority in 2023 and, although most of the reportable progress was within the last few weeks of 2023, we had been working consistently throughout the year. Telehealth advocacy is an important agenda item for every meeting of our Committee on Legislative Affairs (COLA), as well as our Executive Board. NJPA spoke with Speaker of the House, Craig Coughlin, about the importance of telehealth, educated bill sponsors on how losing telehealth parity would negatively affect our patients, promoted participation in the Department of Health survey about clinicians' telehealth use, signed on to a letter from the New Jersey Psychiatric Association, and sent our own letter to all state legislators. Our government affairs agent, Jon Bombardieri, of CLB Partners, worked closely with the bill sponsors and the Governor's office to get a version of the bill in place that the Governor would support. There is also much to do in 2024. This law is not the permanent protection we had hoped for. Governor Murphy is reserving judgement until he sees the results of the Department of Health study, now predicted to be completed in March, and there is talk of a more restricted scope of payment parity. Governor Murphy Signs A4913 Into Law! Assembly Bill 4913, which requires carriers to offer healthcare providers more than one method of payment for reimbursement, passed the Senate and the Assembly unanimously and was later delivered to Governor Murphy for final consideration. On Monday, January 8, 2024, the Governor took action on legislation and signed this bill into law. Under this bill, any network agreement between a carrier, or the carrier’s contracted vendor, and a healthcare provider for the provision of health or dental care services is prohibited from mandating only one form of payment to the healthcare provider. A carrier, or the carrier’s vendor, is also prohibited from restricting the method of payment to an out-of-network healthcare provider providing out-of-network covered services to only one form of payment. The bill also requires a carrier, or the carrier’s contracted vendor, to provide certain information to a healthcare provider, prior to initiating its first payment to the healthcare provider, where one of the available payment methods includes a fee and before changing the available payment methods. The bill prohibits a carrier from using a healthcare provider’s preferred method of payment as a factor when deciding whether to provide credentials to a healthcare provider. This law will take effect on July 6th, 2024, 180 days following the enactment of this legislation. In 2024, NJPA and NJP-PAC will continue to use our staff and financial resources to advocate for the telehealth needs of patients and psychologists in New Jersey. We will also continue to keep you, as members, informed about advocacy efforts and pending changes, so you can be prepared for what is put in place after the new deadline of 12/31/2024. If you have not already done so, now is the perfect opportunity to renew your membership for 2024 so that you can stay informed of this and other important issues affecting our field. Please consider donating to the NJP-PAC. The role of NJP-PAC is to support legislators who have demonstrated their interest in, and support of, psychology without regard to party affiliation. NJP-PAC solicits funds to be distributed in such a manner as to advance the stature of the profession of psychology in New Jersey. The generous financial contributions of our contributors are critical in accomplishing our advocacy program. The reality is that without a financial commitment to our NJP-PAC, our ability to sustain support of legislators, who promote quality mental healthcare in NJ, will become increasingly difficult. We would like to thank our members who have already contributed to NJP-PAC, as well as those members contributing now for the first time. Thank you in advance for your support. For now, let us celebrate these legislative wins, as we prepare for another year of mental health advocacy. Warmly, President, Marc Gironda, PsyD Past-President, Briana Cox, PsyD Executive Director, Sara Tedrick Parikh, PhD

Director of Professional Affairs, Susan McGroarty, PhD Government Affairs Agent, Jon Bombardieri

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The NJPA Foundation is most grateful to all of the following colleagues who have contributed so substantially to our efforts in 2023. Board of Trustees: President, Matt Hagovsky, PhD; Secretary, Toby Kaufman, PhD; Treasurer, Ann Stainton, PhD; Trustees: Eileen Kohutis, PhD; Jonathan Wall, PsyD; Elease A. Wiggins; NJPAGS Representatives: Joanna Tillson; Sadreika Williams

OUR HEARTFELT THANKS TO ALL OF OUR CONTRIBUTORS! Ray Hanbury Legacy Fund Rosalind Dorlen, PsyD: $250 Joel Kleinman, PhD : $100 James Wulach, JD, PhD: $100 Fiona Byrne, PhD: $75 Thomas Frio, PhD: $50 Joan Fiorello, PhD: $25 Kelly Jeanne Symons: $20 Angel $1000 and over Isabel Lerman, PhD Mathias Hagovsky, PhD Toby Kaufman, PhD Patron $500 - $800 Ann Stainton, PhD Rosalind Dorlen, PsyD Contributor $250 - $499 Jonathan Wall, PsyD

Supporter $100 - $249 John LoConte, PhD John Hennessy, PhD Aaron Welt, PhD Daniel Moss, PhD Marc Gironda, PsyD Vicki Barnett, PsyD Charles Katz, PhD Mark Lowenthal, PsyD Carol Blum, PsyD Deirdre Kramer, PhD Christine Hudson, PhD Maureen Hudak, PsyD Lucinda Monica, PsyD Nancy McWilliams, PhD Judith Bernstein, PsyD Michael Zito, PhD Lisa Jacobs, PhD Nick Economou, EdD Debra Roelke, PhD Francesca Peckman, PsyD Richard Dauber, PhD

Supporter $100 - $249 Katherine Rhoades, PhD Friend up to $99 Randy Bressler, PsyD Steven Reed, PhD Susan Neigher, PhD Joan Fiorello, PhD Steven Reilly, EdS Janet Berson, PhD Paul Schottland, PhD Diane Handlin, PhD Marsha Morris, PhD Robert Evans, PhD Robert Grabelsky, PhD Vincenza Piscitelli, PsyD Hadassah Gurfein, PhD Sharon Freedman, PhD Mark Reuter, PhD Shashi Jain, PhD Peter Krakoff, PhD Diane Snyder, PhD

Help Support Our Important Work! The NJPA Foundation is the heart of NJPA. We are a 501(c)(3) organization whose sole objective is to support the education and research of psychology graduate students who are dedicating their future careers to treating the mental health and well-being of underserved populations throughout New Jersey. These populations include inner-city students, children with Asperger’s, the elderly in need, and immigrants. One hundred percent of proceeds from this fundraising event go to support this mission by issuing graduate students grants and awards to help fund their training and research. Help us continue to support the important training of these students! Donate Today!

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Winter 2024

The New Jersey Psychology - Political Action Committee (“NJP-PAC”) is a voluntary, non-profit political action committee comprised of a board of trustees, consisting of New Jersey Psychological Association (“NJPA”) members/psychologists. NJPPAC is a separate entity, and is not affiliated with any political party or other political committee. President, Barry Katz, PhD; Treasurer, Mark Singer, EdD; Secretary, Kenneth Freundlich, PhD; Executive Director, Sara Tedrick Parikh, PhD

OUR HEARTFELT THANKS TO ALL OF OUR CONTRIBUTORS!

Leadership $1000 and over

Bronze $100 - $249 (cont.) Michael Zito, PhD Thomas Frio, PhD Karen Cocco, PhD Tamara Shulman, PhD Francesca Peckman, PsyD

Platinum $750 - $999 Gold $500 - $749 Silver $250 - $499 Edward Dougherty, EdD Toby Kaufman, PhD

Copper up to $99 Marsha Morris, PhD Debra Roelke, PhD AnnaMarie Resnikoff, PhD Angela Hall, PsyD Gregory Lomuti, PhD Joan Fiorello, PhD Robert Grabelsky, PhD Diane Handlin, PhD Sharon Freedman, PhD Peter Krakoff, PhD

Bronze $100 - $249 William Shinefield, PsyD Charles Katz, PhD Laurine Hollyer, PhD Mark Lowenthal, PsyD David Szmak, PsyD Deirdre Kramer, PhD James Wulach, JD, PhD Judith Bernstein, PsyD

Recent Donation History 20

Support the NJP-PAC! How can you help support our efforts? Please consider donating to the NJP-PAC. The role of NJP-PAC is to support legislators who have demonstrated their interest in, and support of, psychology without regard to party affiliation. NJP-PAC solicits funds to be distributed in such a manner as to advance the stature of the profession of psychology in New Jersey. Generous financial contributions are critical in accomplishing our advocacy program.

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The reality is that without a financial commitment to our NJP-PAC, our ability to sustain support of legislators who promote quality mental healthcare in NJ will become increasingly difficult. We would like to thank our members who have already contributed to NJP-PAC, as well as those members contributing now for the first time. Thank you in advance for your support.

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Upcoming NJPA CE Programs Adolescents and Adults ‘On the Spectrum’ and Their Families: Integrative Approaches for General Practitioners (2 CE) This workshop is designed to help practitioners who have not specialized in neurodevelopmental disorders learn effective ways to think about and work with adolescents and adults diagnosed with High Functioning Autism (HFA) and Social (Pragmatic) Communication Disorder (SCD) and their families. Click here for more information

Using Your Superpower: Psychological Testing and Consultation (2 CE) Over recent years the distinction of mental health providers has become blurred. Consumers often do not know the difference between a therapist, social worker, psychiatrist, or psychologist. What makes a psychologist unique is the foundation in providing consultations with the use of psychological tests. Much of our ability to use this superpower has been thwarted by insurance companies requiring preapproval and controlling what we can and cannot do. Click here for more information

The NJPA Referral Network Become part of our in-demand network of providers: Be a part of the solution! During the pandemic, individuals seeking mental health services skyrocketed. The expansion of telehealth services enabled many individuals to access the critical services psychologists provide creating a high demand for referrals. Your unique blend of specialized services, orientations, practice area expertise, and foreign language proficiency will help us successfully assist our diverse populations, throughout NJ, who are often conducting frustrating searches for practitioners who meet their needs. We are in need especially in the southern and western part of NJ and those with foreign language proficiency in any part of the state. Are you a licensed NJPA member? Consider joining our network today! (Free for all NJPA Sustaining Members/reduced rate for newly licensed members)