Scott Webb (Host): Welcome to UK HealthCast, a podcast from UK HealthCare. I'm Scott Webb. And today, we're talking about autism with Dr. Sarah Critchfield. She's a clinical psychologist with a specialty in Pediatrics with UK HealthCare. Doctor, welcome to the podcast.

Sarah E. Critchfield , PsyD: Thank you so much, Scott. I'm happy to be here to talk about autism.

Host: I'm happy to have you here. And I know there's never a bad time per se to talk about autism, but we tend to highlight it right in April, autism awareness. So, let's start there. Like, what is autism and who does it impact mostly?

Sarah E. Critchfield , PsyD: Yeah. So, autism can impact anybody. We most commonly see it diagnosed in younger kiddos. Most simply put, it's a brain difference. It's a neurodevelopmental disorder. So, it occurs really, really early on in development. And it causes some social communication differences. And sometimes, it can cause restricted interests, so maybe really strong interests in certain toys or certain sensory things. And it can also cause repetitive patterns of behavior, and that can be anything from rocking or certain hand movements to really rigid patterns of behavior and cognition. And like I said, it can affect anybody. We see it diagnosed most often in boys, but we're learning more and more about girls on the spectrum.

Host: Yeah. And I mentioned to you before we got rolling that I'm in my 50s. I'm considerably older than you are, and I don't remember ever hearing the word autism when I was a kid, right? I don't remember it existed. I don't remember people talking about it. So, I want to get a sense from you, like how has our understanding of autism changed in the last 10 to 20 years?

Sarah E. Critchfield , PsyD: Well, our understanding of autism has changed greatly. And that's because we have so many more clinicians who are researching autism. We have so many more clinicians who are treating it. And so because of that dedication to research, our understanding of the disorder itself has increased and so has our ability to diagnose with more specificity and more certainty. So, there are rising incidences of autism right now, and that is because of this development in research and understanding what autism can look like in younger children and in older children and in boys and girls. So, I think that's one big reason why we're seeing so much about autism. It's because we know more about autism, which is a truly wonderful feat for all researchers and clinicians.

Host: Just simply understanding it better, right? So, it's maybe not that necessarily more kids have autism today than when I was a kid, is that we understand autism better. Is that right?

Sarah E. Critchfield , PsyD: I think so. And we know now where maybe we didn't quite a few years ago that autism truly is a spectrum. So early on, autism was this very impactful diagnosis. Not that it's not impactful, but it was very debilitating. And we know now that that's simply not always the case. Autism can be very slightly noticeable or it can be something that's pretty profound. So, it truly is a spectrum, and we know that because we've done the research.

Host: Right. Absolutely. Wondering, as parents and caregivers, what are some of the signs and symptoms? You gave us a little sense there, but what are some of the signs and symptoms we should be on the lookout for?

Sarah E. Critchfield , PsyD: I think the good thing is that most pediatricians these days when we're taking our kids to their 18-month checkups and their 24-month checkups, they're screening for autism. So hopefully, if there are symptoms showing, a pediatrician will screen and then refer for evaluation. Some early things that parents might notice are sometimes some speech delays, so perhaps the child isn't producing as much functional speech as other children their age. So, maybe they're saying mama, but they're not using it to actually mean mama, or there's just a lack of speech development. Other things they might notice are repetitive behaviors, so some rocking or some hand flapping, or visually inspecting toys, like holding them really close to their eyes. But also, they might notice this child is really more interested in playing by themselves than playing with other children, or "Whenever I try to play with my child, they don't want me to, or they don't know how to respond to my play." So, that play early on looks a little bit different.

For older kids, so say it was missed early on and they're getting into their teenage years, we very often notice social and communication deficits. So, really not understanding, as well as others, some social cues, maybe not understanding sarcasm or jokes as well. Taking things really literally. But also, really intense interests. So, a lot of kids like history, but maybe kids with autism are really focused on what was going on in 1776 and they can recite everything or super intense interest in Greek mythology. I don't know. So, an interest that's just a little bit more intense, I guess, than others. I think especially for teenagers who are getting diagnosed these days, they're referring. So, they're noticing their own social difference and telling their parents like, "Hey, I think I meet criteria for this." I think that's really cool, that the teenagers themselves are noticing this difference and that research of what autism is is available to them.

Host: Yeah. That's pretty amazing. The teenagers, we've come so far in terms of maybe the stigma associated with autism that the teenagers are self-referring, right?

Sarah E. Critchfield , PsyD: Yeah. It's really great. I primarily work with teenagers on the spectrum. And I would say, especially since I've been at UK, a large portion of my cases have been teenagers who have mentioned to their parents or mentioned to their medical providers, "Hey, I am a little bit different and I think I meet criteria for autism." And then, they seek out assessment and it's so interesting and lovely. And they're usually right, which is so cool.

Host: Yeah. You think about all the research that's being done, all the experts, and then just some teenage kid says, "I think maybe I am somewhere in the spectrum. Maybe we should speak with someone," right?

Sarah E. Critchfield , PsyD: And it's great. You know, modern technology is a blessing and a curse. But I think that when a child or a teenager is appropriately consuming resources and using it as a way to kind of explain themselves and seek answers, I think that's when technology is its most powerful.

Host: Yeah, that's really cool. I have a teenager, I was mentioning, my kids are older. We were talking about your kids and Paw Patrol and Legos, and my kids are a little bit older, but it is interesting. I'm thinking now about my 17-year-old and conversations I've had with her, but that'd be a different podcast. Just wondering, what do we do if we're concerned if we spot some of the signs and symptoms and/or our child is maybe sort of self-referring? What should our next steps be?

Sarah E. Critchfield , PsyD: So, next steps can look a lot of different ways. If we're thinking specifically in this UK system, for younger kids, speak with the pediatrician. And then, the pediatrician can refer to developmental pediatrics. A lot of the times the pediatrician is sort of the first line of defense in autism testing. Like I mentioned earlier, pediatricians often regularly screen for autism early on. And so, they'll refer 18, 24-month-old kids. Sometimes kids slip through cracks, so it might be a little bit later. But speaking to your pediatrician about assessment is always a wonderful step. Many pediatrician offices at the University of Kentucky have psychology built in. So, we have primary care providers who are psychological practitioners so they can even meet with families and say, "Yeah, definitely let's refer to evaluation." And I think that's a really big strength of our healthcare system here.

If the kids are a little bit older, so like I said, those kids who have kind of like identified something in themselves, they can always have their parent call if they can self-refer, specifically to me, but they can do other people. And so, they could call Developmental Pediatrics and say, "I want an assessment," and they can get on someone's schedule. I think it's really cool how it's becoming more and more accessible to be assessed for autism.

Host: Yeah. It's never a surprise to me that UK HealthCare is unique or advanced in certain areas. Just want to have you maybe drill down a little bit more the support, treatment, patients with autism. When we think about that pediatric population, what sort of separates UK HealthCare from the rest?

Sarah E. Critchfield , PsyD: So, I think my favorite thing about UK is that we are attempting to provide access to this specialized care to a lot of Kentucky's underserved populations. So, we're hopefully providing a resource to these rural or underdeveloped community communities. We're providing access to services that might not originally be there. So, we're trying with outreach. And I think that that is really important.

The great thing about our services is that we're offering what other people don't. And especially when we're thinking about autism and neurodevelopmental disabilities, we want to be able to provide expertise and we want to be able to provide reliable care. So, we're fueled by evidence-based research to make sure that we're providing evaluations that are up-to-date and accurate. We're making sure that we're ahead of the research so we know, When we are providing a diagnosis or we're not providing a diagnosis, we can explain to the families in whatever terms necessary that here's what's going on.

I think the University of Kentucky is one of the only developmental pediatric centers in Kentucky. And I think we have a duty to provide these services and we're doing a great job in my opinion.

Host: It's okay to pat yourself on the back. You know, especially when it comes to autism, we need, you need your expertise. And as we get close to finishing up here, I mentioned earlier about the stigma with autism and that it seems like there's less of that today. As you mentioned, teenagers self-referring and not being afraid to do that. What do you want to remind the community in general, especially in Kentucky, when it comes to an autism diagnosis?

Sarah E. Critchfield , PsyD: Well, whenever we're diagnosing autism, I always love to approach it with a strengths-based focus, because sometimes it can be big and sometimes it can be scary to receive that diagnosis. I always tell my teenagers, whenever I'm diagnosing, that your brain works much more efficiently than mine ever will in several ways. It truly enhances different parts of our brain that otherwise maybe wouldn't work so well. Of course, it comes with some challenges. But I want people to remember that people who are diagnosed with autism are not defined by their diagnosis and they have really wonderful things to offer. I think autism is a tool for us to use should we have the diagnosis to self-advocate, to raise awareness. And I want more of the teens who are noticing those differences and self-referring and normalizing that. I think that that's what we need right now in the world of autism where it's getting very political, really fast. We need self-advocacy. We need awareness. We need normalization. Because it's not going to go away and the rates are going to keep increasing because we're going to keep learning more. So, that was a long answer to say autism can be wonderful. Autism can have many strengths that come along with its challenges. And the more we raise awareness, the more we'll be able to help families and help kids.

Host: Yeah, I love the word you used there, normalize. Like normalizing it, understanding that kiddos, teenagers, adults can live well with autism. And I just love the fact that we just keep learning more and more about this, about the spectrum, about how folks can live with autism and live well. It just brings a big smile to my face.

Sarah E. Critchfield , PsyD: Yeah. Yeah. I mean, I say this all the time, but truly, autism is the reason why I do what I do. I love my patients who are on the spectrum. I love my patients who are not on the spectrum. But there's a special place in my heart. I do it for a reason, and that's because it's truly the best work. I like providing those answers and I like my family's receiving those answers and my teenagers receiving those answers.

Host: That's perfect. I appreciate your time, your expertise today, your compassion. Thank you so much.

Sarah E. Critchfield , PsyD: Thank you for having me. I am happy to be here.

Scott Webb (Host): And for more information, go to ukhealthcare.uky.edu. And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate, and review this podcast and all the other UK HealthCare podcasts. Thanks for joining us.