Dr. Daniel Knoepflmacher (Host): Hello and welcome to On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. I'm your host, Dr. Daniel Knoepflmacher. In each episode, I'll be engaging in thought-provoking conversations with experts on mental health, neuroscience, and other important topics on the mind.

On today's podcast, we'll be talking about autism. A study recently released from the Centers for Disease Control and Prevention showed a significant increase in autism spectrum disorder diagnoses over the past few years. While this upward trend does not necessarily reflect an increase in autism spectrum disorder, or as it's commonly called ASD among boys and girls, it does likely reflect an increased public awareness and more robust screening for this disorder in our health system.

With over 5 million Americans with an ASD diagnosis and more than 78 million worldwide, there's a lot of discussion of autism in popular culture, the news and social media. Whether it's popular shows like the Netflix series, Love on the Spectrum, or the tens of thousands of videos on TikTok with the hashtag autism that have over 200 million views, autism is on the mind of many Americans. But what does this generational shift mean for those who live with ASD?

Today, we'll take a closer look at autism spectrum disorder, learn what defines this condition, how it's diagnosed, how it's treated, and explore how the increased awareness and attention in popular culture in media impacts the lives of people living with autism.

We're fortunate today to have Dr. Amy Lemelman joining us. Dr. Lemelman is a clinical psychologist and an Assistant Professor of Psychology and Clinical Psychiatry, working in the New York Presbyterian Center for Autism and the Developing Brain.

Dr. Lemelman, thank you so much for joining us today. Before we begin to delve into the complexities of autism spectrum disorder, I wanted to ask you how you first became interested in this topic. What was your path to becoming a psychologist and ultimately an expert specializing in ASD?

Dr. Amy Lemelman: Well, thank you for having me today. I'm excited to join you and discuss autism. My journey actually began at a young age, because I had a sibling with a speech language delay. And my mother actually frequently brought me along to their therapy appointments. And later on, I ended up actually volunteering in the summer camp that they attended, which was a summer camp for children with developmental delays. And these experiences really allowed me to see how therapy could help develop such important skills like functional communication, but in fun ways, like through play. And so, that was really the initial spark for me wanting to work with children with developmental delays. And then later on in college, I had the opportunity to be involved in both research assistantships and clinical internships working with individuals with autism.

So for research, I worked as a research assistant on a large multi-site study doing clinical phenotyping work on children with autism. And I was able to observe really the complex process of autism diagnostic assessments. And clinically, I worked as an aid at a community integration program, helping adolescents with autism participate in community activities such as going shopping or to the park or getting ice cream. And so at that time, this was the mind-2000s or so, and what stood out to me about these experiences is I really learned that there was still so much work to be done in learning about autism from a research standpoint, but also within the community with regards to understanding and accepting autistic individuals. And I really vividly remember talking about my experiences and what I was doing during these jobs and internships with friends and family, and realizing that the average person really didn't know that much about autism and how many stereotypes and misunderstandings were really commonly held. And so, that really pushed me into thinking that if I could go into working with individuals with autism clinically, I could really help bridge that knowledge gap.

And so later, I went on to pursue a graduate degree in clinical psychology and receive specialized training in autism diagnosis as well as interventions for young children with autism. And I was actually fortunate enough to do my clinical fellowship here at the Center for Autism and the Developing Brain, and I then transitioned into faculty. So, I've been here ever since.

Dr. Daniel Knoepflmacher: Well, thank you. It's really great to hear your personal connection to this and then how you developed as an expert clinician. I'm curious for you, as someone who's dedicated your professional life to working with people who've been diagnosed with ASD, can you begin by explaining what exactly it is? How do you define ASD and what are the identifying characteristics of this condition?

Dr. Amy Lemelman: Yeah. So, autism is considered one of the neurodevelopmental disorders in the Diagnostic and Statistical Manual or the DSM, essentially meaning that it affects the development of the brain and it does have long-term developmental consequences. And when we think about autism, the two primary symptom domains are the social communication domain and the restricted repetitive behavior domain. So, symptoms that would fall under the social communication domain include difficulties with social emotional reciprocity. So, that would be things like having difficulties with conversations or difficulties with initiating or responding to social interactions as well as difficulties with non-verbal communication, so things like inconsistent use of eye contact or limited use of gestures or facial expressions and difficulties with developing, maintaining, or understanding relationships. So, that could be really ranging from limited interest in your peers to difficulty in making or keeping friendships. And in that second domain, symptoms that would fall under the restricted and repetitive behavior domain would include things like repetitive speech, motor movements, or use of objects, difficulties with changes in routines or transitions, highly restricted interests and sensory-seeking or avoidance behaviors.

Dr. Daniel Knoepflmacher: So in that name of this disorder is the word spectrum, and that indicates that there's a range of severity. How do we determine when an individual meets the threshold for an ASD diagnosis?

Dr. Amy Lemelman: So first, according to the DSM, to be able to actually make a diagnosis of autism, a person must have either current or historical evidence of both social communication symptoms and at least two out of the four categories of restricted and repetitive behaviors. It's also really important to note that symptoms must have had their onset in early childhood. So, these could not be symptoms that developed or began in adolescence or adulthood, it really is a developmental disorder. And these symptoms should not be better explained by just a general global developmental delay or an intellectual disability. They really are something separate.

And regarding your comment about autism being a spectrum, I think that's sort of a common misconception that somehow there's this linear autism spectrum or that there's ends to the spectrum such as high or low functioning autism, which is something that we hear in the community a lot, people say that a lot, but it's actually nowhere written in the DSM. Actually when people are referring to high or low functioning, really most of the time what they're referring to is the individual's cognitive and verbal language abilities, not their actual autism symptoms.

And autism really affects many areas of an individual's functioning including communication, behavior, adaptive skills, sensory functioning. And so for some people with autism, one area of your functioning might be much more affected than the other. And for others, it might be the opposite. And that's really why there's such significant heterogeneity among individuals with autism. And so in the context of the DSM, when we think about severity of autism, really we're thinking more about the level of support needed, specifically with the social communication and restricted and repetitive behaviors. So, the DSM has us rate whether at this point in time, does an individual need some support for those symptoms, need substantial support for those symptoms, or do they need very substantial support for those symptoms? And that's at least according to the DSM, their sort of estimate of severity. They're talking more about how much support somebody needs, not necessarily the severity of the symptoms.

Dr. Daniel Knoepflmacher: That's a really helpful distinction and it brings up what in the community is a focus on the word spectrum. And I know you and I were talking before we did this recording and I had used the phrase on the spectrum and you pointed out to me that that's not something that's actually seen favorably in the community. That's not a good way of describing somebody who has autism. Can you speak a little bit more about that term, on the spectrum?

Dr. Amy Lemelman: Certainly, I don't want to speak for everyone, but I have heard from people that sometimes that term on the spectrum sometimes could be just not a great way of describing autism. Autism is a distinct condition. And even though we all might have some symptoms that might fall under different domains of autism, it's not a linear spectrum. And it's not like some people are a little bit on the spectrum and some people are a lot on the spectrum. So, I think that spectrum terminology can be confusing to people, and I get asked that all the time, "On the spectrum, where is my child?" And it's just not a good way of describing autism because it's not a single linear spectrum. In actuality, there's multiple spectrums, the spectrum of communication, the spectrum of adaptive skills, the spectrum of sensory concerns. Does that make sense?

Dr. Daniel Knoepflmacher: That's really helpful. And what's important here is that you're describing the complexity of this condition and that there's lots of steps that need to be taken in diagnosis. And I'd love it if you could tell us about how this is diagnosed in our medical system, how do we screen, give somebody a diagnosis and then ultimately treat autism.

Dr. Amy Lemelman: Well, universal screening for autism symptoms is recommended by the American Academy of Pediatrics at 18 and 24-month-old checkups using parent completed checklists. One of those checklists, it's called the M-CHAT or the Modified Checklist for Autism in Toddlers. But for kids who are older, there are other screening questionnaires that primary care providers can use. This should also just be combined with more general developmental screening at other pediatrician visits. And if their primary care provider or pediatrician is concerned about autism based on screening or based on a child not meeting other developmental milestones, then they should be referring children for additional diagnostic testing at a center like the Center for Autism and the Developing Brain. And a good diagnostic assessment typically consists of a parent or caregiver interview or, if this is a adolescent or adult, it could be a patient interview about the individual's background history, questions about autism-specific symptoms as well.

Additionally, there's usually some type of measurement of adaptive functioning using questionnaires as well as assessment of developmental or cognitive functioning to determine just more generally where is that individual functioning? And then, the most important part probably would be the autism-specific testing. And most places who do autism diagnosis, they will use something called the ADOS or the Autism Diagnostic Observation Schedule. And that is a structured clinical observation looking at the presence or absence of autism symptoms. And for young children, this is very play-based. It's usually pretty fun. There's things like bubbles and different toys. And for individuals who are older and have more language, it is more conversational-based and asking questions about social functioning and emotional understanding. And if the evaluation is a multidisciplinary assessment, it could also include things like more comprehensive language testing or a medical evaluation to evaluate for comorbid medical conditions that are associated with autism, such as sleep difficulties or selective eating. And ideally, there would be an in-depth feedback session reviewing the results of the evaluation with the family or the patient, and then referring them to services in the community or in their school system, depending on their age.

Dr. Daniel Knoepflmacher: I want to ask you about some terminology that you used just for some clarification. You mentioned adaptive functioning. Can you quickly explain what you mean by adaptive functioning?

Dr. Amy Lemelman: So, adaptive functioning is basically your daily living skills and how you're functioning on a day-to-day basis with taking care of yourself, communicating with others, engaging in leisure activities, being safe in the community. All of those things fall under adaptive skills. And so typically, we have parents or caregivers fill out questionnaires about all of those different areas of adaptive functioning, and we really want to see what can the child do on their own, not what the parent can help them with or what they're doing for them, but if left to their own devices, how is the child able to function on a day-to-day basis with regards to all those different things? And that's really important. That's how that person is living on a day-to-day basis. And so, we need to get a good estimate of that functioning and then we can provide additional recommendations if their adaptive functioning is not where it should be based on their expected level for their age.

Dr. Daniel Knoepflmacher: What tips do you have for parents who are out there and maybe wondering if their child might have autism?

Dr. Amy Lemelman: My best recommendation would be if you have any concerns at all that your child has autism, I would immediately recommend that you get on a waiting list for a comprehensive evaluation from a reputable specialty center like the Center for Autism and the Developing Brain. The reality is most autism centers have very long waiting lists to get into. And so, the best thing a parent can do is get on a waiting list, possibly multiple waiting list, as soon as they can. And for parents of children under three, most states also have early intervention programs that provide therapies such as speech therapy or occupational therapy or physical therapy. And many young children with autism do need these types of therapies, so I would recommend starting the process of getting therapy or intervention even if the child doesn't have a formal autism diagnosis.

Additionally, there's a lot of really great free resources available for parents who are concerned about their child's social communication development. There's websites with video-based lessons on increasing social communication in toddlers, which we'll have links to, and books that have activities that parents can be doing with their kids to help build social communication skills.

Dr. Daniel Knoepflmacher: Thanks. Those are really helpful tips for parents who might be wondering about this diagnosis. And then once a child is diagnosed with ASD, what are the next steps? Could you tell us about interventions that are available and how these interventions can improve the lives of the individuals and their families?

Dr. Amy Lemelman: So, interventions for autism are often really personalized and they should be dependent on what that individual's needs are. And a lot of time it's dependent on their age and also if there's any co-occurring conditions. When we typically think about interventions for younger children, that is going to be focused more on early intervention. So again, like I mentioned, early intervention can provide things like speech therapy, occupational therapy, physical therapy, as well as more parent-mediated forms of interventions, particularly behavioral therapy. The common behavioral therapy that people will mention with regards to autism is applied behavioral analysis or ABA therapy, which has evidence base that shows that it improves skills in children and adults with autism.

As kids get older, they actually typically receive a lot of their services through school. So again, school can provide speech or occupational or physical therapy. And then sometimes, they may participate in more community-based therapies like social skills groups. And for autistic adults and adolescents who have co-occurring mental health conditions such as anxiety or depression, they would likely benefit from modified forms of cognitive behavioral therapy.

And then when we're thinking more about adults who are in college or in the job market, they may really benefit from life skills or job skills training to help at that stage in their life. But ultimately, really an intervention plan should be highly individualized to the person's current needs and, if possible, really include input from the person with autism regarding their goals and what's important for them at that stage in their life.

Dr. Daniel Knoepflmacher: Thanks for describing the comprehensive steps that can be taken to support someone with autism. As I listen to that, I'm thinking about the parents and I just was wondering as somebody who is working with parents and children and parents are first confronting this diagnosis in their children, what kind of supports do parents need and what are some of the emotional experiences that you've encountered that parents go through as they learn to accept and adapt to a diagnosis of autism in their child?

Dr. Amy Lemelman: You know, I see a range of responses when I deliver that diagnosis during feedback sessions to parents. I see relief sometimes that finally someone is telling them what is going on with their child. I see parents who are more upset or don't really want to hear that and that can be a struggle. So, there's a wide range of emotional experiences that parents may feel when they are first given that diagnosis of autism for their young child. And I would certainly recommend participating in parent support groups. Usually, there are some available in most communities. There's also support groups available online and through chat rooms, although I would certainly recommend in-person if that's possible. And for some people who are really having a very difficult time processing that diagnosis, I would recommend individual therapy for parents to process what that means, what that means for their expectations or goals for that child and come to terms with this is where their child is at right now, and how can they help them really just live up to their highest potential.

Dr. Daniel Knoepflmacher: With all of the complex needs of a child with ASD and the variety of evidence-based interventions that can be provided, this requires involvement for many key players like family educators, and it sounds like a range of care providers. So, I'm wondering how is our system, which has all of these entrenched problems with inequities and healthcare disparities, how does this system address the needs of millions of people with autism? And specifically, if you could, can you speak to disparities in ASD treatment for minoritized groups like black Americans versus the rest of the population?

Dr. Amy Lemelman: So, this is really important and complex topic that we could really be spending all day talking about. But just to break it down a little bit, there are disparities in diagnosis and treatment of autism for minoritized groups. Historically, what we know is that black children are diagnosed with autism at a later age than their white counterparts. Recently, it looks like there is some research to show that that's changing, which is a really good thing. But historically, certainly, they were being diagnosed at a later age. And black children were less likely to receive a diagnosis of autism at all. So, a lot of times, young black children were receiving diagnoses of ADHD, for example, instead of autism, even though autism was the more accurate diagnosis. There's also been evidence to suggest that black children are less likely to receive, evidence-based treatments for autism, compared to white children.

And so, there's many different factors that contribute to these disparities. One would be the lack of access to quality healthcare due to socioeconomic factors, such as poverty or lack of health insurance. Most therapy is either private pay or it's insurance-based. A lot of providers do not take things such as Medicaid, which is unfortunate, and so that can cause barriers. There's also a shortage of culturally competent clinicians who can actually effectively assess and treat individuals from diverse backgrounds. And then, there's obviously historical and ongoing issues of racism and discrimination within the healthcare system. That can also create distrust and reluctance to seek care among minority groups. So, those would just be some of the many factors that contribute to that disparity.

Dr. Daniel Knoepflmacher: Clearly, there's a lot of work that still needs to be done in our system to address this, but I'm happy to hear that there's some progress being made. I hope we can find more in the coming years. I want to switch gears and talk about something else that I've noticed in my practice as a psychiatrist who works with adults and that's that, with this increased awareness of autism in our society, there are more adults being diagnosed with ASD and I've had adult patients come to me wondering if they might have autism, which to be frank, is not an area of expertise for me, which is why I'm so grateful to be able to talk to you today. So, is this part of a greater trend? And if so, can you share advice for adults who may be wondering whether they might meet the criteria for ASD?

Dr. Amy Lemelman: So, I'll make the disclaimer that I do not specialize in adult diagnosis. My training is mostly with children and adolescents. But this is definitely a topic that has come up. We do have adult psychologists here at the Center for Autism and the Developing Brain, and we've talked about this a lot, that we do see more adults coming in for first time diagnoses specifically. So, these are not adults that have longstanding diagnoses that are coming in for updated assessments, this is first time diagnosis. And this could be due to many factors, including the increased in awareness of autism, also some shifting in the diagnostic criteria. So actually, with the change in the DSM, the most recent update in 2013, it allowed psychologists to actually diagnose autism and ADHD together, whereas previously, you could really only have one or the other. So, there was that shift in diagnostic criteria and how we diagnose things, a better understanding of what autism looks like in adults and so on.

And so, I would say if you're an adult and you are wondering if you have autism or maybe you think that you have some symptoms that fall under autism based on things that you've read or things that you've seen, it could be beneficial for you to come in and get an evaluation. The biggest reason being that having an official diagnosis can really be helpful in accessing supports such as educational or workplace accommodations. So if you think that you might have autism and you would benefit from, accommodations or therapy to help you manage any symptoms, then I would suggest that you seek out an evaluation with a professional who specifically specializes in adult diagnosis of autism.

I myself, like I said, I do not work with adults because you do have to have additional specialized training because it's harder for professionals without that extra training to recognize those more subtle or less common symptoms of autism that can be seen in adults. So, you really have to find somebody who specializes in adult diagnosis and not just more of a general psychologist who works with children with autism.

Dr. Daniel Knoepflmacher: It's a helpful distinction as someone who works with adults but is not highly skilled in identifying autism, I would also need to refer to somebody who has that expertise. We're talking about how there's a growth in diagnosis, how there's awareness now among adults that they may have this diagnosis that wasn't diagnosed when they were children. And all of this is going along with a parallel growth and interest in our media and popular culture. Of course, this means there's been this significant growth in TV series, movies, social media content about autism. I'm wondering, as somebody who's an expert in this, do you have any favorites that you recommend?

Dr. Amy Lemelman: I get asked that all the time, what's my opinion on this show or that show? I hear a lot recently, like what's your opinion on the Good Doctor or Love on the Spectrum, things like that? And I actually try to stay away from watching some of those shows, just to put some boundaries for me and between my work and my personal life. However, what I have seen, and I do watch a lot of TV, it's been really great to see shows that are not necessarily about autism or shows that don't have a main character who has autism or clearly stated to have autism. It seems like shows just generally have been writing more characters that have autism or maybe neurodiverse, but it's not necessarily the primary focus of the show.

And really, recently an example of this that I noticed, I was doing a rewatch of Succession in preparation for the new season. And there was a scene in the first season where a child was shown not wanting to go into a large family gathering immediately upon getting there and is described as having trouble with transitions and really needs more time to get comfortable before they can come into that gathering. And that scene felt very true to life, as many children with autism do have trouble with transitions and changes with their routine. And so, it was really great to see that represented on screen, even though Succession is not a show about autism. So, it really feels like slowly Hollywood is catching up and starting to have some representation of autism and neurodiversity across movies and tv.

Dr. Daniel Knoepflmacher: As a fellow Succession fan, who also watched a little bit, before the new season started, I did not catch that reference. So, I appreciate you highlighting that. I also want to ask you specifically about the effects of TikTok or other similar social media, and the effects that platforms have on teen culture related to ASD. So anecdotally, both of my children have told me before about TikTok stars who post videos about being on the spectrum, and they talk about neurodiversity and neurodivergence, and these have clearly become buzzwords for adolescents. Often they're included among other characteristics when teens are describing themselves to each other. And all of this cultural attention comes with, I think, a complex set of impacts. While it seems to be a positive trend, because I think there's destigmatizing of a condition that affects millions of Americans, I worry also that it could lead to over-identification with neurodivergence for teens who are already at a vulnerable stage of identity formation or maybe it could be stigmatizing in certain examples. So, is this exposure helping more young people to get the help they need for ASD or is it spreading misinformation about the condition? Or is it all of the above? I'm just wondering if you can help us entangle all of these complicated social and cultural factors related to autism.

Dr. Amy Lemelman: And this also is a really complex question and I actually think the answer in my opinion, like you said, would be a little bit of all of the above. So, I do think social media applications such as TikTok can have a really positive impact in giving people of all different backgrounds platforms to share their story. And this means that neurodiverse creators have the opportunity to present their lived experiences to huge audiences around the globe, and that has been really great at creating awareness about autism and understanding about neurodiversity as well. Additionally, TikTok has created a community for autistic individuals and those who feel that they have some similar strengths. And challenges and social connection and feeling seen is so important to everyone. So, I do think that TikTok provides a lot of positive in that area.

Where it becomes more concerning to me is when there is misinformation or misunderstanding as a result of TikTok or other social media. Social media by design really provides information in short bursts and condenses really large, complex topics. So, the things that we've been talking about into very easily digestible sound bites. And so, people listen to those things and they may misinterpret what those mean because they don't have the bigger picture and the understanding, and they may take some of that at face value. So for example, if they scroll through TikTok and they hear someone say, "Well, if you were a picky eater as a child, that is a symptom of autism," which potentially is true, but many people may misinterpret that. Particularly very young people who are not thinking through that nuance may misinterpret that and think, "Well, I was a picky eater, am a picky eater, and so that automatically means that I have autism." And what we talked about earlier is we really don't diagnose autism or any mental health condition based on one symptom alone, but it's really a cluster of symptoms that are causing impairment in somebody's life. And these misunderstandings and over-identification with autism could potentially lead some individuals to self-diagnose or embrace labels that are really not accurate, leading to potentially trying to access the wrong types of therapies or treatments, or not addressing other underlying mental health or social emotional issues.

Additionally, even if a person really does have autism, a self-diagnosis based on TikTok is not sufficient for insurance companies or to get therapy or for educational or workplace accommodations. So ultimately, while TikTok and social media has been great in raising awareness about autism and giving people who really don't know that much about autism a greater understanding about what it is, it really can't replace a thorough diagnostic assessment with somebody who specializes in autism diagnosis and therapy.

Dr. Daniel Knoepflmacher: Someone like you, Dr. Amy Lemelman, I'm just so grateful to you for joining us today and really kind of taking us through the complexities of ASD and, with your amazing expertise, really adding clarity to, as we said repeatedly, a complex but really important topic. And we're fortunate to have you here at New York Presbyterian, bringing your expertise to help kids with ASD and their families at the Center for Autism and the Developing Brain. Thankfully, you actually provided us with some resources today that we can post with this podcast. One of them is a link to the Center for Autism and the Developing Brain here at New York Presbyterian, but there are some others too. Do you want to highlight some of the materials that you shared with us?

Dr. Amy Lemelman: I have a couple of different websites and links to books. And so, these resources, some of them are for families of individuals who do not have a diagnosis of autism yet. One of those in particular is a book called The Activity Kit for Babies and Toddlers at Risk, which is written by Deborah Fein and other authors, and that's a great book that families can use if they do have some concerns that their child might be showing some symptoms of autism, but they don't have a diagnosis yet. They can be doing some of those activities at home. As I mentioned, there is a video-based learning system called Help is in Your Hands that provides different modules to teach parents ways to encourage social communication in their young children who may potentially have autism.

There's also other resources for families who have a child who now has a diagnosis with autism. Another book that I want to highlight is An Early Start for Your Child with Autism written by Sally Rogers, Geraldine Dawson, and Laurie Vismara. That's a really great book written for parents that really breaks down different skills and how to work with your child to increase, again, social communication, play, and other skills that you may want to be working on. As well as just some other resources through Autism Speaks, as well as the Autistic Self-Advocacy Network, both those websites have really great information on them if you're learning about autism and you're starting out with that new diagnosis.

Dr. Daniel Knoepflmacher (Host): We'll have all of those posted with this podcast. I want to end the same way I end every episode of On The Mind, and that's to ask you a question that every guest answers at the end, which is what are some of the most important things that you, Amy Lemelman, do to help maintain your own mental health?

Dr. Amy Lemelman: For me, I've done a couple of different things. One of them that I think has been just important is to acknowledge what my specific energy givers and energy takers are. So as a self-described introvert, I've really realized that it's important for me to have stretches of unscheduled time for myself on a regular basis to recharge, especially after sort of bigger social events or things that require me to sort of be on for a longer period of time. And so, I've realized as I've gotten older that just allowing myself that break to recharge and not scheduling anything. That is self-care. It doesn't have to be self-care in the way social media defines self-care sometimes, like writing in a journal or going for a run. Those things don't really work for me. But just not doing anything and scheduling that time for myself to be alone is really important for my mental health and to recharge myself, so that I can go back to work and social engagements and feel ready to take that on.

Dr. Daniel Knoepflmacher: I can definitely relate to that. Well, thank you so much for joining us today. It was a pleasure having you on the podcast.

Dr. Amy Lemelman: Thank you. It's been a pleasure talking to you as well.

Dr. Daniel Knoepflmacher: And thank you to all who listened to this episode of On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. Our podcast is available on all major audio streaming platforms, including Spotify, Apple Podcasts, and iHeartRadio.

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