Neuroaffirming care values the strengths and differences of autistic people, those with ADHD or other profiles. Here’s how
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We’ve come a long way in terms of understanding that everyone thinks, interacts and experiences the world differently. In the past, autistic people, people with attention deficit hyperactive disorder (ADHD) and other profiles were categorised by what they struggled with or couldn’t do.
The concept of neurodiversity, developed by autistic activists in the 1990s, is an emerging area. It promotes the idea that different brains (“neurotypes”) are part of the natural variation of being human – just like “biodiversity” – and they are vital for our survival.
This idea is now being applied to research and to care. At the heart of the National Autism Strategy, currently in development, is neurodiversity-affirming (neuroaffirming) care and practice. But what does this look like?
Reframing differences
Neurodiversity challenges the traditional medical model of disability, which views neurological differences solely through a lens of deficits and disorders to be treated or cured.
Instead, it reframes it as a different, and equally valuable, way of experiencing and navigating the world. It emphasises the need for brains that are different from what society considers “neurotypical”, based on averages and expectations. The term “neurodivergent” is applied to Autistic people, those with ADHD, dyslexia and other profiles.
Neuroaffirming care can take many forms depending on each person’s needs and context. It involves accepting and valuing different ways of thinking, learning and experiencing the world. Rather than trying to “fix” or change neurodivergent people to fit into a narrow idea of what’s considered “normal” or “better”, neuroaffirming care takes a person-centered, strengths-based approach. It aims to empower and support unique needs and strengths.
Adaptation and strengths
Drawing on the social model of disability, neuroaffirming care acknowledges there is often disability associated with being different, especially in a world not designed for neurodivergent people. This shift focuses away from the person having to adapt towards improving the person-environment fit.
This can include providing accommodations and adapting environments to make them more accessible. More importantly, it promotes “thriving” through greater participation in society and meaningful activities.
At school, at work, in clinic
In educational settings, this might involve using universal design for learning that benefits all learners.
For example, using systematic synthetic phonics to teach reading and spelling for students with dyslexia can benefit all students. It also could mean incorporating augmentative and alternative communication, such as speech-generating devices, into the classroom.
Teachers might allow extra time for tasks, or allow stimming (repetitive movements or noises) for self-regulation and breaks when needed.
In therapy settings, neuroaffirming care may mean a therapist grows their understanding of autistic culture and learns about how positive social identity can impact self-esteem and wellbeing.
They may make efforts to bridge the gap in communication between different neurotypes, known as the double empathy problem. For example, the therapist may avoid relying on body language or facial expressions (often different in autistic people) to interpret how a client is feeling, instead of listening carefully to what the client says.
Affirming therapy approaches with children involve “tuning into” their preferred way of communicating, playing and engaging. This can bring meaningful connection rather than compliance to “neurotypical” ways of playing and relating.
In workplaces, it can involve flexible working arrangements (hours, patterns and locations), allowing different modes of communication (such as written rather than phone calls) and low-sensory workspaces (for example, low-lighting, low-noise office spaces).
In public spaces, it can look like providing a “sensory space”, such as at large concerts, where neurodivergent people can take a break and self-regulate if needed. And staff can be trained to recognise, better understand and assist with hidden disabilities.
Combining lived experience and good practice
Care is neuroaffirmative when it centres “lived experience” in its design and delivery, and positions people with disability as experts.
As a result of being “different”, people in the neurodivergent community experience high rates of bullying and abuse. So neuroaffirming care should be combined with a trauma-informed approach, which acknowledges the need to understand a person’s life experiences to provide effective care.
Culturally responsive care acknowledges limited access to support for culturally and racially marginalised Autistic people and higher rates of LGBTQIA+ identification in the neurodivergent community.
Authentic selves
The draft National Autism Strategy promotes awareness that our population is neurodiverse. It hopes to foster a more inclusive and understanding society.
It emphasises the societal and public health responsibilities for supporting neurodivergent people via public education, training, policy and legislation. By providing spaces and places where neurodivergent people can be their authentic, unmasked selves, we are laying the foundations for feeling seen, valued, safe and, ultimately, happy and thriving.
The author would like to acknowledge the assistance of psychologist Victoria Gottliebsen in drafting this article. Victoria is a member of the Oversight Council for the National Autism Strategy.
Josephine Barbaro, Associate Professor, Principal Research Fellow, Psychologist, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Say That Again: Using Hearing Aids Can Be Frustrating for Older Adults, but Necessary
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It was an every-other-day routine, full of frustration.
Every time my husband called his father, who was 94 when he died in 2022, he’d wait for his dad to find his hearing aids and put them in before they started talking.
Even then, my father-in-law could barely hear what my husband was saying. “What?” he’d ask over and over.
Then, there were the problems my father-in-law had replacing the devices’ batteries. And the times he’d end up in the hospital, unable to understand what people were saying because his hearing aids didn’t seem to be functioning. And the times he’d drop one of the devices and be unable to find it.
How many older adults have problems of this kind?
There’s no good data about this topic, according to Nicholas Reed, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health who studies hearing loss. He did a literature search when I posed the question and came up empty.
Reed co-authored the most definitive study to date of hearing issues in older Americans, published in JAMA Open Network last year. Previous studies excluded people 80 and older. But data became available when a 2021 survey by the National Health and Aging Trends Study included hearing assessments conducted at people’s homes.
The results, based on a nationally representative sample of 2,803 people 71 and older, are eye-opening. Hearing problems become pervasive with advancing age, exceeding 90% in people 85 and older, compared with 53% of 71- to 74-year-olds. Also, hearing worsens over time, with more people experiencing moderate or severe deficits once they reach or exceed age 80, compared with people in their 70s.
However, only 29% of those with hearing loss used hearing aids. Multiple studies have documented barriers that inhibit use. Such devices, which Medicare doesn’t cover, are pricey, from nearly $1,000 for a good over-the-counter set (OTC hearing aids became available in 2022) to more than $6,000 for some prescription models. In some communities, hearing evaluation services are difficult to find. Also, people often associate hearing aids with being old and feel self-conscious about wearing them. And they tend to underestimate hearing problems that develop gradually.
Barbara Weinstein, a professor of audiology at the City University of New York Graduate Center and author of the textbook “Geriatric Audiology,” added another concern to this list when I reached out to her: usability.
“Hearing aids aren’t really designed for the population that most needs to use them,” she told me. “The move to make devices smaller and more sophisticated technologically isn’t right for many people who are older.”
That’s problematic because hearing loss raises the risk of cognitive decline, dementia, falls, depression, and social isolation.
What advice do specialists in hearing health have for older adults who have a hard time using their hearing aids? Here are some thoughts they shared.
Consider larger, customized devices. Many older people, especially those with arthritis, poor fine motor skills, compromised vision, and some degree of cognitive impairment, have a hard time manipulating small hearing aids and using them properly.
Lindsay Creed, associate director of audiology practices at the American Speech-Language-Hearing Association, said about half of her older clients have “some sort of dexterity issue, whether numbness or reduced movement or tremor or a lack of coordination.” Shekinah Mast, owner of Mast Audiology Services in Seaford, Delaware, estimates nearly half of her clients have vision issues.
For clients with dexterity challenges, Creed often recommends “behind-the-ear hearing aids,” with a loop over the ear, and customized molds that fit snugly in the ear. Customized earpieces are larger than standardized models.
“The more dexterity challenges you have, the better you’ll do with a larger device and with lots of practice picking it up, orienting it, and putting it in your ear,” said Marquitta Merkison, associate director of audiology practices at ASHA.
For older people with vision issues, Mast sometimes orders hearing aids in different colors for different ears. Also, she’ll help clients set up stands at home for storing devices, chargers, and accessories so they can readily find them each time they need them.
Opt for ease of use. Instead of buying devices that require replacing tiny batteries, select a device that can be charged overnight and operate for at least a day before being recharged, recommended Thomas Powers, a consultant to the Hearing Industries Association. These are now widely available.
People who are comfortable using a smartphone should consider using a phone app to change volume and other device settings. Dave Fabry, chief hearing health officer at Starkey, a major hearing aid manufacturer, said he has patients in their 80s and 90s “who’ve found that being able to hold a phone and use larger visible controls is easier than manipulating the hearing aid.”
If that’s too difficult, try a remote control. GN ReSound, another major manufacturer, has designed one with two large buttons that activate the volume control and programming for its hearing aids, said Megan Quilter, the company’s lead audiologist for research and development.
Check out accessories. Say you’re having trouble hearing other people in restaurants. You can ask the person across the table to clip a microphone to his shirt or put the mike in the center of the table. (The hearing aids will need to be programmed to allow the sound to be streamed to your ears.)
Another low-tech option: a hearing aid clip that connects to a piece of clothing to prevent a device from falling to the floor if it becomes dislodged from the ear.
Wear your hearing aids all day. “The No. 1 thing I hear from older adults is they think they don’t need to put on their hearing aids when they’re at home in a quiet environment,” said Erika Shakespeare, who owns Audiology and Hearing Aid Associates in La Grande, Oregon.
That’s based on a misunderstanding. Our brains need regular, not occasional, stimulation from our environments to optimize hearing, Shakespeare explained. This includes noises in seemingly quiet environments, such as the whoosh of a fan, the creak of a floor, or the wind’s wail outside a window.
“If the only time you wear hearing aids is when you think you need them, your brain doesn’t know how to process all those sounds,” she told me. Her rule of thumb: “Wear hearing aids all your waking hours.”
Consult a hearing professional. Everyone’s needs are different, so it’s a good idea to seek out an audiologist or hearing specialist who, for a fee, can provide guidance.
“Most older people are not going to know what they need” and what options exist without professional assistance, said Virginia Ramachandran, the head of audiology at Oticon, a major hearing aid manufacturer, and a past president of the American Academy of Audiology.
Her advice to older adults: Be “really open” about your challenges.
If you can’t afford hearing aids, ask a hearing professional for an appointment to go over features you should look for in over-the-counter devices. Make it clear you want the appointment to be about your needs, not a sales pitch, Reed said. Audiology practices don’t routinely offer this kind of service, but there’s good reason to ask since Medicare started covering once-a-year audiologist consultations last year.
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit http://kffhealthnews.org/columnists to submit your requests or tips.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Alzheimer’s Causative Factors To Avoid
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The Best Brains Bar Nun?
This is Dr. David Snowdon. He’s an epidemiologist, and one of the world’s foremost experts on Alzheimer’s disease. He was also, most famously, the lead researcher of what has become known as “The Nun Study”.
We recently reviewed his book about this study:
…which we definitely encourage you to check out, but we’ll do our best to summarize its key points today!
Reassurance up-front: no, you don’t have to become a nun
The Nun Study
In 1991, a large number (678) of nuns were recruited for what was to be (and until now, remains) the largest study of its kind into the impact of a wide variety of factors on aging, and in particular, Alzheimer’s disease.
Why it was so important: because the nuns were all from the same Order, had the same occupation (it’s a teaching Order), with very similar lifestyles, schedules, socioeconomic status, general background, access to healthcare, similar diets, same relationship status (celibate), same sex (female), and many other factors also similar, this meant that most of the confounding variables that confound other studies were already controlled-for here.
Enrollment in the study also required consenting to donating one’s brain for study post-mortem—and of those who have since died, indeed 98% of them have been donated (the other 2%, we presume, may have run into technical administrative issues with the donation process, due to the circumstances of death and/or delays in processing the donation).
How the study was undertaken
We don’t have enough space to describe the entire methodology here, but the gist of it is:
- Genetic testing for relevant genetic factors
- Data gathered about lives so far, including not just medical records but also autobiographies that the nuns wrote when they took their vows (at ages 19–21)
- Extensive ongoing personal interviews about habits, life choices, and attitudes
- Yearly evaluations including memory tests and physical function tests
- Brain donation upon death
What they found
Technically, The Nun Study is still ongoing. Of the original 678 nuns (aged 75–106), three are still alive (based on the latest report, at least).
However, lots of results have already been gained, including…
Genes
A year into the study, in 1992, the “apolipoprotein E” (APOE) gene was established as a likely causative factor in Alzheimer’s disease. This is probably not new to our readers in 2024, but there are interesting things being learned even now, for example:
The Alzheimer’s Gene That Varies By Race & Sex
…but watch out! Because also:
Alzheimer’s Sex Differences May Not Be What They Appear
Words
Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:
- Longer sentences
- Positive outlook
- “Idea density”
That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).
Want to spruce up yours? You might like to check out:
Reading, Better: Reading As A Cognitive Exercise
…for specific, evidence-based ways to tweak your reading to fight cognitive decline.
Food
While the dietary habits of the nuns were fairly homogenous, those who favored eating more and cooked greens, beans, and tomatoes, lived longer and with healthier brains.
See also: Brain Food? The Eyes Have It!
Other aspects of brain health & mental health
The study also found that nuns who avoided stroke and depression, were also less likely to get dementia.
For tending to these, check out:
- Two Things You Can Do To Improve Stroke Survival Chances
- Depression, And The Mental Health First-Aid That You’ll Hopefully Never Need
- Behavioral Activation Against Depression & Anxiety
Community & Faith
Obviously, in this matter the nuns were quite a homogenous group, scoring heavily in community and faith. What’s relevant here is the difference between the nuns, and other epidemiological studies in other groups (invariably not scoring so highly).
Community & faith are considered, separately and together, to be protective factors against dementia.
Faith may be something that “you have it or you don’t” (we’re a health science newsletter, not a theological publication, but for the interested, philosopher John Stuart Mill’s 1859 essay “On Liberty“ makes a good argument for it not being something one can choose, prompting him to argue for religious tolerance, on the grounds that religious coercion is a futile effort precisely because a person cannot choose to dis/believe something)
…but community can definitely be chosen, nurtured, and grown. We’ve written about this a bit before:
You might also like to check out this great book on the topic:
Purpose: Design A Community And Change Your Life – by Gina Bianchini
Want more?
We gave a ground-up primer on avoiding Alzheimer’s and other dementias; check it out:
How To Reduce Your Alzheimer’s Risk
Take care!
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Polyphenol Paprika Pepper Penne
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This one’s easier to promptly prepare than it is to pronounce unprepared! Ok, enough alliteration: this dish is as full of flavor as it is full of antioxidants, and it’s great for digestive health and heart health too.
You will need
- 4 large red bell peppers, diced
- 2 red onions, roughly chopped
- 1 bulb garlic, finely chopped
- 2 cups cherry tomatoes, halved
- 10oz wholemeal penne pasta
- 1 tbsp nutritional yeast
- 1 tbsp smoked paprika
- 1 tbsp black pepper
- Extra virgin olive oil for drizzling
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 200℃ / 400℉ / Gas mark 6
2) Put the vegetables in a roasting tin; drizzle with oil, sprinkle with the seasonings (nooch, paprika, black pepper), stir well to mix and distribute the seasonings evenly, and roast for 20–25 minutes, stirring/turning occasionally. When the edges begin to caramelize, turn off the heat, but leave to keep warm.
3) Cook the penne al dente (this should take 7–8 minutes in boiling salted water). Rinse in cold water, then pass a kettle of hot water over them to reheat. This process removed starch and lowered the glycemic index, before reheating the pasta so that it’s hot to serve.
4) Place the roasted vegetables in a food processor and blitz for just a few seconds. You want to produce a very chunky sauce—but not just chunks or just sauce.
5) Combine the sauce and pasta to serve immediately.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Which Bell Peppers To Pick? A Spectrum Of Specialties ← note how red bell peppers are perfect for this, as their lycopene quadruples in bioavailability when cooked
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- The Many Health Benefits Of Garlic
- What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
Take care!
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Calm For Surgery – by Dr Chris Bonney
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As a general rule of thumb, nobody likes having surgery. We may like the results of the surgery, we may like having the surgery done and behind us, but surgery itself is not most people’s idea of fun, and honestly, the recovery period afterwards can be a pain in every sense of the word.
Dr. Chris Bonney, an anesthesiologist, gives us the industry-secrets low-down, and is the voice of experience when it comes to the things to know about and/or prepare in advance—the little things that make a world of difference to your in-hospital experience and afterwards.
Think of it like “frequent flyer traveller tips” but for surgeries, whereupon knowing a given tip can mean the difference between deeply traumatic suffering and merely not being at your usual best. We think that’s worth it.
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The Link Between Introversion & Sensory Processing
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We’ve talked before about how to beat loneliness and isolation, and how that’s important for all of us, including those of us on the less social end of the scale.
However, while we all need at least the option of social contact in order to be at our best, there’s a large portion of the population who also need to be able to retreat to somewhere quiet to recover from too much social goings-on.
Clinically speaking, this sometimes gets called introversion, or at least a negative score for extroversion on the “Big Five Inventory”, the only personality-typing system that actually gets used in science. Today we’re going to be focusing on a term that typically gets applied to those generally considered introverts:
The “highly sensitive person”
This makes it sound like a very rare snowflake condition, when in fact the diagnostic criteria yield a population bell curve of 30:40:30, whereupon 30% are in the band of “high sensitivity”, 40% “normal sensitivity” and the remaining 30% “low sensitivity”.
You may note that “high” and “low” together outnumber “normal”, but statistics is like that. It is interesting to note, though, that this statistical spread renders it not a disorder, so much as simply a description.
You can read more about it here:
Sensory-processing sensitivity and its relation to introversion and emotionality
What it means in practical terms
Such a person will generally seek solitude more frequently during the day than others will, and it’s not because of misanthropy (at least, statistically speaking it’s not; can’t speak for individuals!), but rather, it’s about needing downtime after what has felt like too much sensory processing resulting:
If this need for solitude is not met (sometimes it’s simply not practicable), then it can lead to overwhelm.
Sidenote about overwhelm: pick your battles! No, pick fewer than that. Put some back. That’s still too many 😜
Back to seriousness: if you’re the sort of person to walk into a room and immediately do the Sherlock Holmes thing of noticing everything about everyone, who is doing what, what has changed about the room since last time you were there, etc… Then that’s great; it’s a sign of a sharp mind, but it’s also a lot of information to process and you’re probably going to need a little decompression afterwards:
This is the biological equivalent of needing to let an overworked computer or phone cool down after excessive high-intensity use of its CPU.
The same goes if you’re the sort of person who goes into “performance mode” when in company, is “the life and soul of the party” etc, and/or perhaps “the elegant hostess”, but needs to then collapse afterwards because it’s more of a role you play than your natural inclination.
Take care of your battery
To continue the technological metaphor from earlier, if you repeatedly overuse a device without allowing it cooldown periods, it will break down (and if it’s a certain generation of iPhone, it might explode).
Similarly, if you repeatedly overuse your own highly sensitive senses (such as being often in social environment where there’s a lot going on) without allowing yourself adequate cooldown periods, you will break down (or indeed, explode: not literally, but some people are prone to emotional outbursts after bottling things up).
None of this is good for the health, not in the short term and not in the long term, either:
With that in mind, take care to take care of yourself, meeting your actual needs instead of just those that get socially assumed.
Want to take the test?
Here’s a two-minute test (results available immediately right there on-screen; no need to give your email or anything) 😎
Want to know more?
We reviewed this book about playing to one’s strengths in the context of sensitivity, a while back, and highly recommend it:
Sensitive – by Jenn Granneman and Andre Sólo
Enjoy!
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This Book May Save Your Life – by Dr. Karan Rajan
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The title is a bold sell, but the book does include a lot of information about what can go wrong in your body, and how those things can be avoided.
What it’s not: a reiteration of Dr. Michael Greger’s “How Not To Die“. It’s not dense medical information, and it doesn’t cite papers at a rate of ten per page.
What it is: an easy-reading tour guide of the human body and its many quirks and foibles, and how we can leverage those to our benefit. On which note…
Hopefully, your insides will never see the light of day, but this author is a general surgeon and as such, is an experienced and well-qualified tour guide. Here, we learn about everything from the long and interesting journey through our gut, to the unique anatomical features and liabilities of the brain. From the bizarre oddities of the genitals, to things most people don’t know about the process of death.
The style of the book is very casual, with lots of short sections (almost mini chapters-within-chapters, really) making for very light reading—and certainly enjoyable reading too, unless you are inclined to squeamishness.
Bottom line: in honesty, the book is more informative than it is instructional, though it does contain the promised health tips too. With that in mind, it’s a very enjoyable and educational read, and we do recommend it.
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