 Good day and welcome back to the Forty Auty podcast with your host Mr. Thomas Henley as usual. Today I have a very, very special episode as always. I'm talking to Dr. Megan Neff all about autism and PTSD. For those of you who don't know Megan and her work, Megan is a clinical psychologist who produces a lot of work over on Instagram. One thing that I'd really love to highlight about Megan's work is the amazing Venn diagram, graphs that she does, she gets like different diagnoses, different neurodivergencies and sort of compares and contrasts the overlap. So today, as I said, we're going to talk about PTSD, but before we do that, Megan, would you like to tell us a little bit more about what you do? Yeah. Yeah. So I, you summarized it really well. I'm a clinical psychologist in private practice in the States in Oregon. And I specialize working with neurodivergent adults to mostly late in life identified and diagnosed adults. I also do neurodivergent and firming assessments. And then, so I do that about half time and then half time I do really content creation where I think visually. So I love making infographics and turning these really complex ideas into visual pixels. So, and that is kind of my special interest. It's what recharges me. So I feel really lucky that I get to do that pretty much half time. Get the both, the, the dough for best ones. Yeah, yes, yes. Exactly. I was just going to say I'm autistic ADHD myself. Forgot to mention that. And as an ADHDR, I've noticed I have to have a lot of different projects I do in a given week to keep my brain engaged. So that's part of why my work is structured with kind of assessments, clients, content creating, structured with variety. Yes, the autistic ADHD wave. I'm actually thinking I've actually been forwarded for an assessment for ADHD or ADD, something like that, because executive functioning for me is such a massive part. And I've always quite struggled quite a lot with my focus. But it's only like, for certain certain things, like I found I could focus really, really easily on certain things that I enjoyed, but as soon as I stopped enjoying them, the focus went away. And I kind of talked to my mom about it, because she she's a special needs teacher, and she's she's gone quite high up in and stuff. And she works with a lot of ADHD and autistic children. And I think my reservations about going for a diagnosis was mostly because of my presentation, because I'm quite slow with how I think and feel. So I'm kind of on the fence about whether I am or not. You know, it presents really differently. So it's interesting, because I typically think it's easier for people to embrace their ADHD than their autism. But I'm finding, like, for me, it was opposite with autism. It was like, Oh, yes, this this fist, this makes sense. The ADHD I saw after the autism. And it was harder to see because I live in hyperfixation, like my highest, you know, those wheels of traits for autism, my highest trait is hyperfixation. I love my special interests. And I can I go into what my spouse and I call the vortex, and I can go there for hours. So but exactly what you're saying outside of interest outside of special interest, my focus is really pretty poor. But I just don't spend much time there. That it was harder for me to see the ADHD initially. And I noticed it presents really differently in autistic people, especially I kind of think of like autistic dominant people with ADHD or ADHD dominant people. Yeah. And some people it's really it's very mixed, there's not a dominant, but I often find it seems like there's a dominant neuro type with the other mixed in. So it's really complex. Yeah, I think one of the things that really drew me to your work that you because you focus on neurodivergencies, you talk a lot about like, you know, your bed diagrams do a lot of for showing like the overlap between the two. And going through them, I think the thing that that got me to get in contact with you is because I saw one about like autism and ADHD. And I was like, hmm, this is actually really, really, really helpful. Because there are there are some crossovers between the two when, you know, as we as we chatted before, we were talking about misdiagnosis and sort of the effects that that can have on someone's like identity as well as the functioning and treatment and medication. And I know it's a little bit off topic, but it's, you know, I think it's something that's really playing on my mind at the moment. And I wanted to talk a little bit about it. But I suppose going into sort of the main topic that we're here to talk about PTSD, post-traumatic stress and stress disorder, right? Yeah, yeah, I'm speaking sure. I know we're gonna, we're gonna touch a little bit on complex PTSD, as well as the overlap between autism and PTSD, what someone might want to do in terms of finding treatment, as well as what mental health providers should know about sort of the overlap between the two. So the first question that I want to ask is, what is PTSD? Such a big question. I think, okay, so I'm gonna do the linear thing, but I'm also gonna, before I do the linear, like this is the criteria, I kind of want to give us a conceptual map of what it is. So first of all, I think sometimes people don't realize, and I think this is a really important part of the conversation, is that not everyone who experiences a trauma goes on to develop PTSD. In fact, most people don't. It is the minority that experiences a trauma and moves on to it, then develop PTSD. So this is a simplification, but a simplified conceptualization of what is happening with PTSD. So the way the trauma gets encoded in the mind and the body, it is often not in a cohesive whole. It is like pieces, fragments. So particularly when a person doesn't have a cohesive narrative of the trauma. The body is encoding that in fragments. And so what can happen is the body is particularly the amygdala, which is like the fear center of the brain, I think of it as the safety alarm. I hate that one. You hate that metaphor? I hate the amygdala. Understandably, the amygdala can be, oh, I was going to swear, but it can be a little beast. We'll say beast. The amygdala is not always fun to live with. So the amygdala, the fear center, doesn't know it's no longer in danger. It doesn't know it's no longer in the trauma. So with PTSD, the body is kind of re-remembering. It's still working to metabolize the trauma to create a cohesive whole. And so memories, associations, intrusive memories can flare up that memory of the trauma. And so this is why the person's body is so hyper-vigilant, because it's constantly on alert. So that's a simplification, but I feel like that's a helpful broad frame of what's happening to the body in PTSD. I really like the analogy of the fragmenting of the event, because we talked a little bit about it before we started recording, but there's particular trauma that I've had recently, which it's really been set off by the most random things at the most random times. Absolutely. And it is always sort of in somehow connected to the event, but it's like I'm responding to the whole event rather than that particular part of it. Exactly, exactly. But your body doesn't know it's not responding to the whole thing. So it feels like you're responding to the whole thing. So something as simple as hearing a certain voice that sounds like a person that was associated with the trauma can like the body's back in it. And that's why life becomes so intolerable, because all of these little things, it's like bombarding the body with taking it back to the trauma. And that's why life is incredibly difficult with PTSD. Well, thank you very much. Yeah, would it be helpful? Oh, we're doing the autistic thing, where like, do I talk to Utah? Oh, I might not realize that you're so accused of trying to speak or not. Would it be helpful for me to go through the DSM? Well, ICD, DSM criteria, like the linear, this is what, okay. That would be great. And I actually think this is a helpful reference point. I don't have it up yet, but I'm working. So I'm doing a series called the DSM 5 in pictures. And I actually have one for PTSD. I haven't put it up yet, but maybe we could add that to the show notes, because I just think this is helpful in visuals. Yeah, yeah, definitely. So, and the DSM 5, that's America, but like the ICD 10, which is used more globally, there's a lot of overlap. Like they're pretty much typically the same criteria. So, and for any of these conditions, there's like criteria A, B, C, D, and typically all of them have to be met for diagnosis. So for PTSD, there's, I'm going to walk through kind of the five core like buckets of criteria. So criteria A, there has to be some sort of traumatic event. For a long time, it was thought this had to be like a near death experience or a fear of death. They've added, you know, in the last like 20, 30 years, not sure actually when it was added, but they've added sexual assault and victimization. Here's what's really interesting about criteria A, which we can talk more about when we talk about what I wish medical providers knew. Autistic people sometimes don't meet criteria A, but still PTSD, meaning a less traumatic experience happens, but they still develop PTSD. So typically kind of the classic traumas are violence, hearing about a violent death of a loved one, or some sort of assault are kind of the classic. But for autistic people, we can have less traumas and still, and I don't like the language of less traumas, but yeah, yeah, this is diagnostically, yeah, exactly categorizing. Exactly. Yeah, yeah. So that that's criteria A, criteria B, intrusion symptoms. So these are things like flashbacks, nightmares. This is the memory of the trauma coming back to the person, again, those fragments coming back and creating a pretty intense response for the person. It could be intrusive memories, or just intense reactions to things that remind the person of the trauma. And then avoidance. So an intrusion and avoidance, those are really key pieces of PTSD. Avoidance is actively avoiding thoughts about the trauma or emotions related to it. This is harder to gauge because it's a really internal experience or external things. So for example, if someone has something traumatic happen in a grocery store, maybe then they avoid all grocery stores. But their world is getting smaller and smaller as they're avoiding those triggers that take their body back to the trauma. So that's a key part of it. Any questions so far as I've gone through? No, it's just a few thoughts as well because I completely get what you mean about the autistic people being a lot more sensitive to the development of it because a lot of my mental health difficulties have come from negative experiences in teenage and childhood adolescence. And on paper, they're not particularly that bad. There was a lot of different factors and different things involved, and there was a lot of anxiety and paranoia from me just because of the school environment, the sensory stuff. Although, I feel sometimes quite silly if I'm sort of conversing to a loved one what I'm struggling with, the memories and stuff because it's not on paper the worst thing that anyone's ever heard. It's like emotional bullying for example, for a long period of time, just intermittent. And then I hear about individuals who have had a really rough time. One of my friends, particularly that I won't name, they've gone through a lot of stuff, a lot of different really intense traumatic events and they've had some PTSD related to one particular part of that, but the other stuff like they never had any issue with. I suppose it's quite confusing because I always have this picture of PTSD of being this military related thing that happens when people are after war, and something that perhaps is a bit more definite. It's like, this is what caused my PTSD or like. Right. Yeah. And this we're kind of jumping ahead to complex trauma, but part of what you're describing is diffuse trauma. And by diffuse, you know, if I think about steam, like when you're boiling something, like you can't point to something concrete with classic PTSD, there's typically like one concrete event you can point to. So diffuse trauma can in some ways be more disorienting because there's not that concrete thing to point to. It's like, well, why am I having such an intense reaction? But it's like a lifetime of sensory trauma or a lifetime of emotional bullying is incredibly traumatic. But it's so diffuse that it can be hard. Like, how do I process that? How do I point to that? I think we internalize a lot more weakness. So like, I must be weak that I'm not coping with this, especially if we're then comparing ourselves to like, oh my goodness, that person went through something really traumatic and they're okay. Yeah. Yeah. Yeah. But there's I think a lot of reasons, which we'll get into later, I think about why we're more vulnerable to develop PTSD, both because of our experiences, but also just our neurology makes us more vulnerable. Sure. Sure. Well, you mentioned a little bit about complex PTSD. Is that something that you could maybe break down a little bit for us? Yes. Before I jump to that, can I finish the PTSD criteria that was my autistic brain will be like skipping like, wait, you never finished the linear thing. I know exactly what you mean. So so D and E are the last two criteria I'll cover. And I actually think D is really important. It's alterations to cognition. That could just mean that you don't have the full memory of the trauma, which is common, you know, kind of that amnesia around the event. But it can also mean like exaggerated negative beliefs about yourself or the world. This I often feel like is one of the more traumatic parts of PTSD is a person's worldview gets shattered. It's like their view of themself or the view of the world becomes incredibly shattered. You know, I also work a lot in the intersection of spirituality and therapy. And so I see this a lot where a person's spiritual frame breaks down as part of post trauma. And so they're dealing with the trauma, but then they're dealing with the trauma of their whole way of orienting to the world is broken. And again, I think about autistic person. Oh, go ahead. So like a fourth wall break, like when the glass shutters and the veil is lifted. Yeah. Yeah. And the thing about how disorienting that is for an autistic person, right? Because all of a sudden, all the things I thought were certain either by myself or the world are now broken. Like that's it. That's so traumatizing of and now I don't even know what I believe about XYZ. You kind of have to build build yourself up from grand zero, I suppose. Yeah. So D was that cognition thing. And a lot of times it's really negative views about self. So like I deserved this or I brought this on myself. I think this happens a lot for autistic people. And then E is alterations in arousal or reactivity. So that's that hyperactivity. Autistic and ADHD people already have more reactive nervous systems. So this is going to be even more exaggerated with PTSD. So like a bigger startle response, this ties back to the amygdala. The amygdala is just firing of like you have to be on guard for signals of threat. And so the body is just like so much energy, so much cortisol, which is our stress hormone, just pulsing through our bodies. So that heightened reactivity, which also makes sleep hard. And then sleep is already like baseline hard for autistic people. So if you're throwing PTSD on top of it, like, it's very important for like, breaking sleep cycles and stuff, isn't it? Yeah, yeah, massive and being able to get out of our stress response is really important for sleep. Yeah, yeah. That sounds crazy because like the autism, the sensitivity and sort of like, you know, needing that that concreteness as well as, you know, perhaps being ADHD and having the already hyperacted nervous system, adding something like that on top, which it's terrible. Yeah. Yeah, I so I shared with you before we started recording in my early twenties, I had PTSD. And I for a year, didn't, oh, I can't say I didn't sleep. Of course, I slept, but like I would be up until 5am, not sleeping. And then I would get, I was in grad school at the time and I'd get like, maybe two or three hours, like my sleep was so dysregulated. And I think it was like autistic sleep, I've always had sleep issues. But then when the PTSD was on top of that, like my body was just like my systems were not operating well, especially sleep. Like it just didn't happen very often. Well, one question I want to ask, because I know that there's, you know, with PTSD, there's an action of, you know, trauma being sort of included. But if someone's struggling for that, perhaps with like memory blocks and stuff, and they, they don't really sort of process or remember this, this event, I know this has happened with my friends. How are you supposed, like, is there any sort of distinguishing factors that you can draw upon to know if it's just you feeling stressed and anxious or whether it's just or whether it's related to some kind of PTSD? Yeah. I mean, that's a good question, because stress and anxiety can also impact memory. And then ADHD can also impact memory. So I mean, I think you'd, you'd want to look outside of memory, you'd want to look at some of these other criteria points I've mentioned, like, are those also present? And that's how you would tease out, is this ADHD memory fog, is this stress memory fog, or is this traumatic, you know, is there the hyper, like hyperactivation? Is there the flashbacks that those intrusive symptoms? Is there avoidance happening? So you would look to see if other pieces of the puzzle were present. Could you, I know, I know it's, could you clarify a bit more on that aspect of my brain is still so slow from, yes, from the, from recently, yeah, totally. I'm just wondering about God, I don't know what's happening to me. Flashbacks. Because, you know, when we think of flashbacks, we think of like the movie example, you know, you flashback to event, you play through like 10 to 30 seconds of the clip of the event. But what, what, what does a flashback actually sort of present as what does it feel like? Because sometimes it can quite hard for people to visualize exactly what that means. Yeah, that's a good question, especially if someone has aphantasia, like the inability to see images, which that's higher among neurodivergent people. So it's, and it is kind of a vague description. It's the like re-experiencing of the trauma. So I don't know if you've ever had a night tear. I, as a child, I had night tears where you wake up and you think it's different than a nightmare because it feels like it's happening. I feel like that's kind of a helpful reference point of you feel like you're back in the experience and your, your body's reacting and your, your disoriented because it's, and there, it might, it might just be a moment, but that's where strategies like grounding is really helpful for PTSD, grounding strategies or strategies that help you re-anchor in this moment because it kind of helps you pull back to like, no, this is what's happening. This is what's real. So a flashback would be something that it's pulling you back and it, it's physically and cognitively disorienting because it, it's feeling like you're back in the experience. It might not have. You can sort of flip back and forth between what's happening now and what's happening in the past. And it's often triggered by something. So it could be triggered by a sound. So like you talked about military PTSD, you know, like a loud sound might activate a flashback or there are just certain signals could activate it. Certain ways of being touched on the body could activate a flashback, but it might, again, it might be very fragmented. It might not be this cohesive picture of like, oh, I'm, I'm seeing it. It might just, it might be the body responding in that visceral way of being back in the trauma. Yeah. It's really interesting. Was there, was there any of a sort of criteria of that, of PTSD or should we move into complex? Yeah, we can, yeah, we can move on. There's a few other like, there's always a few disclaimers like not attributed to this or that, but these are the core. Yeah, these are the core criteria. So complex PTSD. There's a lot of fantastic trauma advocates who have been saying, we've got to get this into the DSM or into the diagnostic criteria. I don't know if, maybe it's different in England. In the US, it's not recognized as an official diagnosis, which is really, really unfortunate because it is different in nature than PTSD. So with complex trauma, it is more of that diffuse trauma that there's not that one concrete trauma to point to. It's often associated with like complex trauma and childhood. So often when there's abuse in the home or other situations can cause it as well, but it's living in an environment that is perpetually unsafe. In this situation, the amygdala becomes very protective by becoming very, very heightened. I think a common metaphor, so if we think about the amygdala as kind of, you know, the fire alarm, a healthy amygdala, a healthy fire alarm will go off when there's fire in the home. Yeah. When you've grown up in an environment that is perpetually unsafe, it actually becomes really protective to have a really sensitive alarm. But what happens, it's like while cooking pancakes or putting something in the microwave will make the fire alarm go off. Like if the fire alarm thinks it's in danger when it's not, because thinking about a child, if they're in a chronically stressful, unsafe environment, it is really protective to know, well, when is my parent maybe going to flip and become dangerous? I need to be able to have like a really fine detection of that. So it starts as a protective mechanism, but then it creates so much suffering. It can become paranoia, but it's more in that bodily kind of hyper aware of your environment, hyper vigilant. It's again, in that stress state, chronically, which is just really hard on a person's body and mental health. That's really interesting. I think throughout my life, I've been experiencing quite severe mental health since I was 14, so about 11 years now. Quite often, my memory is very good and I can remember things very well. But I do sometimes, particularly around school or around talking about school, I have gaps in my memory. It's like I try to talk about something and then my brain shuts off and then I can't retrieve what I was going to say again. And it's something that I've talked about or tried to talk about in the past with like therapist and stuff, but it's very difficult to actually form a cohesive sentence that describes it because every it's like my brain retaliates to me trying to actively put myself in a situation. Because I really identify with the idea of diffuse PTSD because there definitely has been a lot of mental health difficulties in my life and a lot of things that I guess aren't very explainable, like random spurts of anxiety for seemingly very, very small things. And I really like that sort of concept of the diffuse because it's just, you know, for me, if I was to try and identify exactly what was my issue, I couldn't really do that. It's a mix of the environment and people and the things that are happening and how I was feeling at the time. And it's all very much a blur. And I have to make a little bit of a confession when you were talking about the diagnostic criteria and the flashbacks and stuff. I was getting a little bit of those flashbacks. And it kind of, it's kind of, it's very, very strange because it's almost like I related it to more of like, when I was trying to explain it to other people and to more of like an absence seizure where I just kind of my brain sort of blacks out. But I do have like different images cut prop up in my mind and it kind of strays me away from reality. And then I come back. And I definitely, definitely identify with the sort of the fourth wall break, the reality crashing down because, no, throughout most of my life, I've been having quite a few like existential crises. I don't know what the plural term for it is, but. So I'm really, I'm really not sure. I mean, autism is something that I'm very comfortable with and I'm very aware of and I know a lot about. But it's the other things that, and sort of the crossover between them that's really hard, especially when in therapy for neurotypical individuals. Yeah. Yeah. And there's so much crossover. I think it's 70% of us have, you know, a co-occurring mental health condition. I'm actually surprised it's that low. Many of us have more than one. Yeah. And so it is such a, it's such a more complex story than autism. It's autism and what like what is it intersecting with? Autism and what? Yeah. Yeah. I'm having an association. So one thing I often say is, you know, autistic people, you know, it's a lot of us are very existential. I hadn't yet, I hadn't connected that to trauma before, but I wonder how many of us are existential because it's trauma driven, like because we need to be existential to survive. And we need to like create a worldview that works for us, a self concept that works for us. Like, what if that is one way that we survive this world is by becoming deeply existential? I think it's, I mean, it's something that's propped up like many, many, many times of my life. These existential crises is like the typical, what do you know, the philosopher who decided that life, everything wasn't real. And he decided to just live in a bin or something on the side of the street. I can't remember what his name was. I identified with that a lot. And I've been in situations where I just kind of, you know, what are my thoughts real? I mean, how do I know that that what I'm thinking is concrete? So then how can I actually have anything in certainty? And I think there is a real desire for certainty and stability and very complex things that don't inherently have that like existence and like understanding and perceiving the world. There's so many avenues which are just completely subjective, which are just like, you know, massive parts of how we sort of process things, like mm-hmm. Yeah, yeah. Very, very, very interesting. I think I saw a paper on it before about existentialism, but I might want to brush up a bit more about that. It's always been. It's a fascinating combo. I recently had the thought that I wonder, so I didn't realize I was autistic till my daughter was diagnosed. So I was 37 when I was diagnosed that I've sometimes wondered if like, I knew I just couldn't figure out myself, like I was just going to be a mystery to me. So I spent all my energy trying to figure out kind of existence. So I, before I became a psychologist, I actually did my Masters of Divinity at Princeton and I studied theology and I was like deep into theology, philosophy. I was spending so much energy trying to figure out the meaning of life, trying to figure out what is the one best way to live. And I think it was a reaction to it. Well, I can't figure myself out, but maybe I can figure out this whole existence religion thing. Work from the outside in. Yeah, maybe, maybe. And my existential anxiety has gone down since discovering my autism, because it's like, oh, I can understand myself now. So it's okay if I can't understand the universe. It's a weird thing. Yeah, there's a lot of things when I was I was diagnosed when I was 10, 10 years old. So it was quite, I mean, it's not early, but it's it's not a late diagnosis per se. And I used to have very, very strange ways of, used to have very, very strange ways of sort of conceptualizing things about myself. So like, for example, I thought that I had different personalities because I had different emotions. So like, when I was in a certain emotional state, I didn't identify like the person that I was before in that emotional state, because because of the elixir of I'm here, not being able to feel it. I just saw that my personality was changing on a day to day basis. So I was like, like that. And there was little things like that that have occurred during my life that, you know, learning a bit more and especially about elixir of I'm here is absolutely life changing for me kind of understanding, hey, actually, this perception of my reality has, there's a reason why I'm seeing it like this, where other people are just kind of taking it for granted, it's just a part of things. And I think that a sort of different experience and not being able to fully grasp exactly what's going on because autism is not really in the picture, not really thinking about autism as you're not aware of every single aspect of it. So I find that really interesting, especially when I was young, I used to think I was an alien, genuinely. I've heard that one so much. Yeah, it's so interesting that kind of myths and stories we come up with until we realize it's autism. I would love to see like a collection of all of the different stories autistic people told themselves until they until they got the right language to understand themselves. Well, I'm really, really enjoying talking about this because obviously, I am so into philosophy, ethics, I love, I listen in my spare time, I tend to watch a lot of YouTube stuff around different philosophies and different sort of concepts and ways of looking at the world. But I know that we're talking specifically about PTSD today. So I guess now that we have sort of a broad and sort of a rough understanding of PTSD, a little bit about see PTSD, could you tell us a little bit about like the overlap between autism and PTSD and whether it's different for an autistic person or not? Yeah. So it's interesting, older studies used to think that autistic people experience PTSD at like a similar rate to non autistic people, thankfully, there's some emergent research, some newer research that is looking at it. Now, it's hard. If you see my infographics, you'll notice that the prevalence rates are like huge gaps. So like I have an infographic on trauma and autism, and it's 32 to 60% of autistic people report PTSD. That's a huge gap. And it's because it's from two different studies. And every study is going to have a different sample. So of course, it's hard to get a really accurate capturing of it. But what we are seeing is that autistic people are more prone to develop PTSD. So we experience it at much higher rates. For reference, about 4%, maybe 4.5% of the general population experiences PTSD. So even if it's that more conservative number of 30, that is still like a huge increased risk of PTSD. It's like low population, but a large amount of the PTSD diagnoses are still going to that one. Well, it's not 1%, but the minority of autistic people. Or just art, if you took any one individual autistic person, their risk of developing PTSD would be, I mean, this is an estimate, but like 10 fold the risk or potentially higher. Yeah. There's different theories. And I have some of my own theories. You mentioned earlier, having a really good memory. I do too. A lot of autistic people have really good autobiographical memory. So if you think about a traumatic event, we might encode it with more intensity, especially if we have hypersensitivities, the sensory experience of the trauma is going to be encoded with more intensity. So that's one of the theories as to why we might be more prone to PTSD. Another one is we have, so I've done, I have a series on this, the neurodivergent nervous system, but we just, we have more reactive nervous systems. What that means is, so we have, everyone has like a window of tolerance. And that's how much can I take in, how much stressors can I take in both from internal and from my environment and stay within a regulated window of tolerance. Still function. Still function, exactly. Autistic people tend to have a more narrow window. So do ADHD, window of tolerance, meaning we more easily flip into a stress state. So that's either hypermobility, so fight or flight stress response or hypomobility, like that free state. So we're more likely to flip into one of those two stress states more easily. So it takes less for us to get into our stress response. And I think that is probably a pretty significant contributor to why we're more prone to develop PTSD after traumas. Our nervous systems are going to have a harder time regulating and recovering afterward. And we have higher rates of victimization. So those are kind of the, the factors and there's more, but those are the big ones. That's, that's interesting about like the more likely to freeze more likely to hypermobility, hypermobility. As you said, mobility, right? Yeah. Or I might be confusing words there because it mobilizes us for action, hyperreactivity or hyperreactivity. Sure. So I was thinking joints like. Yeah, I think I was because it mobilizes us for action, or we've kind of freeze. I was combining concepts there, which my ADHD brain does all the time. No, no, I do that as well. It's how you think of new things. Yeah, exactly. And create new words. Yeah. But in terms of the hyperreactivity or underreactivity, would you say that because autistic people, you know, we tend to get into one of two states when we get stressed, we've shut down or we melt down. And what one is very introverted, sort of internal shutting down and functioning, freezing. The other very, very erratic, all of the place lots of emotions, lots of physical movements. And would you say that there's a kind of like the a good ways of thinking about that sort of hyperactivity? Yeah, yeah. It's the same concept exactly of either shutting down or going to stress states. And there's some research that suggests autistic people may be more, not necessarily more likely to do one or the other, but more likely than non-autistic people to go into the shutdown mode. So there's a study of autistic children who had their blood drawn, and they measured cortisol throughout the day before the blood draw, during the blood draw, after they did different measures of cortisol. And they found, no surprise, autistic children had more cortisol, higher peaks, they excreted cortisol for longer, and it took them longer to get back to their baseline. But what they also found is that some of those children who were having big cortisol spikes, they weren't showing hyperreactive behavior. They looked calm, meaning they were entering more of that shutdown stress state. So this is what, I get this language from Finn Gradan, who's a fantastic autistic advocate, full regulation, that this is full regulation. You look regulated to the outside world, but actually your body's in a very stressed state, but it's that shutdown. So you look calm, you look very regulated, but you're not, your body's in a stress state. And that seems to be more common for autistic people to do that. I love that word. Isn't it a great word? Yeah, it is. I kind of feel in like a constant state of, like I've got restless legs all the time. It's not like the restless leg syndrome, but it's like a mild, like that. I always feel sort of, I always felt like there's ants crawling on my bones, or there's like, or something related to energy or something like that. I feel I feel like that most of the time. And I like that word, because I think, you know, hiding, especially when you've, when you've had like anxiety for a long time, it's like hiding that anxiety so well, even though, you know, I could be like on the scale of one to 100, I could be like 60, 70 most of the day. But as soon as I flip into that 80, and above, then that's when it becomes like the fight off light, the shut down on that down. And for the rest of the day, I kind of just, even sometimes I pay to myself that I'm regulated and just normal, because that's what I'm used to. Cortisol. I don't know why I'm reset. Cortisol and the amygdala, if we could just put it aside, I hate that stuff. Yeah, I always, I always, that's how I explain it to people, I say, I'm okay, my cortisol is just very high. Oh, I love that. I'm okay. I'm like, I love that. That's a great way. Because it's a way of saying I'm not okay, but I'm okay. Like I'm okay, not being okay. Like I'm like, my body's having this experience and I can tolerate it. Yeah, I find it very useful to use like names for things that cause things because if you say that I feel anxious, some people, they don't really take that on board. They're saying that, oh, you feel anxious, just like, okay. But if you say, my cortisol is raised a lot and, you know, cortisol is like the thing that sort of makes you active. It activates the body. Yeah, absolutely. It goes up and you get too much of it and you get over stimulated and you hyper aware of everything. People find it a lot easier to grasp that there's this molecule in my body causing me to act or feel like this rather than me just saying I feel like this. Well, and people, it's less character based. People so often hear things like I'm anxious is like a character statement or like, oh, just calm down. Or like, I mean, then you get all kinds of unhelpful comments, right? But something like physiological, like grounding it and like, oh, my cortisol is high. It's like, okay. Yeah. I'm going to steal that one. That's really good. The other stuff you can talk about, oh, that opening is not here for me. I can't do that thing. I don't feel like that awful. The serotonin, you know, I'm up and down so much. I need a bit more of that. What if that's how autistic people just, you know, all those like small talk like, how are you today? What if we just responded with like neurochemicals? Like, you know, my serotonin feels a little bit low today. This is what I do. I love it. Well, it's good to kind of grab these concepts in physicality because, you know, people do, you know, take it as a character trait or a personality trait. Are you feeling depressed? Oh yeah, I felt depressed. It's like, okay, well, my brain is completely depleted of serotonin. Which does this, this and that. My God, that must be awful. It's like, it was the same as saying that I'm feeling depressed. But you don't get advice, I bet. Like, if you say I'm depressed and anxious, typically you get advice. Whereas if you ground it in neurochemistry. Yeah. Well, mine is, it's most, you know, you have that, there's an infographic that I came on, came across, sort of like a YouTube video, but it's talking like the causes of depression. There's like situational, neuro neurochemical, psychological existential. And I think my my mental health, because it's been like this for such a long time. And it seems to be, although it's worsened by events happening, it seems to just drop and rise as it will. Yeah. Sometimes. So, yeah, I find it very, very useful to like, think about it in neurochemicals and like, things like that. Yeah. And that's going back to like the PTSD overlap. I'm sure that's a factor too, if we have more vulnerable, like, neurology, more vulnerable neurochemicals. So if we're predisposed to depression, and then we experienced something traumatic, like, yeah, we're going to be way more vulnerable to developing PTSD afterwards. Well, I guess we've talked a lot about, like, the issues around it and sort of maybe the ways, the strange ways that Thomas describes his emotions, and speaks about himself in the first person. And I guess what I want to know is, you know, we know, we know about PTSD is very complex. Obviously, you need a professional to help you understand if it is the case. But if you feel like you sort of identify with what we're talking about, the person listening, I did find what we're talking about. What can they do? What should they do if they feel like they might be struggling with PTSD? Yeah. I mean, there's absolutely treatment for PTSD. And before we start recording, we talked about innate neurodivergence versus acquired neurodivergence. So autism isn't innate, like you're born without neurology. PTSD is acquired. And so it's an acquired neurodivergence that can be treated, can be supported, we can heal from it. I think for a lot of people, the combination of pharmaceuticals and medication support and therapy tends to be the ideal equation. This gets much more complicated for autistic people for reasons. We don't have it so far anyway, just for helping autistic people with mild anxiety. Yeah. Partly, like therapists are scared of us. If you go to a therapist and you're like, I'm autistic and I'm PTSD, a lot of therapists, if they don't have like extensive training in autism, they're like, Oh, I don't do autism. Like it feels, I mean, talk about alien, like a lot of therapists treat it like this alien other of like, Oh, you have to go to a specialist for that. So finding support. So finding someone who's not scared of you, and we'll take you on. But then also finding someone who understands your neurology. So for example, alexithymia, someone who's autistic could be in therapy and suffering a great deal. But their mood is flat. They're maybe talking about incredibly traumatic things, but not showing a lot of emotion. So a therapist might misinterpret that as they're not suffering because they're not displaying their emotion in the typical way. I suppose you have the lack of using the indirect communication as well. That as well. And yes, and also then with trauma work, really considering the sensory profile, a lot of trauma work, not all trauma work, but a lot of trauma work involves exposure to some extent, because one of the core symptoms of PTSD is avoidance. And avoidance actually perpetuates the anxiety around the trauma, and it makes it grow. So trauma treatments, different levels of exposure, some it's like really intense exposure, like a lot of kind of military PTSD treatments are very intense exposure. It's not all that intense, but there's some element of exposure to talking about it. So considering the sensory profile of the person, when you're doing exposure based work, I think that is one of the tricky things. You asked me what people could do, and I'm telling you like all the heart things about getting. So let me flip to something more helpful. So those are, I mean, those are just some of the barriers people experience. There is no one like therapy that works for all autistic people because we're an incredibly diverse group. Some of the therapies that I often hear autistic people have positive experiences with include internal family systems or parts work. And that can also be really powerful for trauma. So IFS is the acronym, internal family systems. EMDR is effective. Yeah, it's I do some IFS. And I really like it. It's you're talking about different parts of yourself, which makes it it takes this kind of abstract idea of the fact that we have multiple parts of us in terms of concrete, which I like. So I like it for autistic people for a lot of reasons. And I like it for trauma. And so I think it can go really well in the combination of autistic trauma. Some people respond really well to EMDR. Other people don't. Cognitive processing therapy is kind of the gold standard for PTSD in a lot of circles. I think that's where you really want to be considering the person's sensory profile. I think some autistic people can certainly respond well to it. Some have a really strong reaction to it. But I think I think so yeah, there's all these different theories. I think finding a therapist that you feel really safe with connected to is probably the most important part is is this someone who is curious about your experience, who you feel connected to, because that co regulation that happens in therapy, as you're working through your trauma, like, I don't want to be dismissive of what kind of therapy you do. But I actually think that's probably the most important is finding a person that you can connect with and feel safe with. So you don't you don't feel like you have to to mask how you are. You don't feel like, hey, I'm getting sensory overloaded or like, I'm shutting down. I know I look regulated, but I'm shutting down. We need to like, hit the brakes here, somewhere where you can safely communicate that. Yeah. Yeah, I'm not going to kind of look at you with an inquisitive. Like, what do you mean? Like, what do you mean? You're fine. Yeah, I've had lots of lots of ones like that before. But yeah, I'm just my head's going off on like all the barriers in therapy and stuff. And yeah, it's the I think finding someone that you can genuine genuinely connect with it's is the best because like if you if you're always closed off and you're trying to like, present in a certain way, then it's going to be really hard to to open up about things. And I've actually like, throughout all the years of therapy that I did when I was younger, and, you know, some of the therapy that I've done in adulthood, really, it's it's it's really tough. It's it's hard to find anyone. We already have an issue with employment and pretty much all of the autism specialists that I can find in the UK. Like there's no like, general health care version of it. Like it's just you go there for them to help you treat with your depression anxiety. But not in the context of autism. If I was to say, Alex, if I knew to them, they would have no idea exactly at all what I mean. They're even just the basic concepts. So the majority of the actual therapy that's done is me explaining to them bits about autism. So it's like almost I'm educating them rather than telling, you know, yeah, absolutely experiences and having it sort of dissected and broken off process them. Yeah, yeah. Yeah, there's so much education that happens. There's a really interesting article. It's a qualitative study. It talked about autistic people's experiences with therapy. And I think that was one of the themes that came up. I just feel like they were educating their therapists about what autism is, which I mean, on one hand, if it's a long term therapist, and like they're curious, I think, you know, I think that makes sense that we do some of that. And that can be part of explaining our internal world. But if it's like a shorter term therapy, and if a person's feeling like they're spending the bulk of the hour educating versus like actually diving into the work, yeah, I mean, that's just not a great equation. So it's also awareness of the overlap of things as well, like sort of the different reactions that we can have to different conditions, different narrative agencies, acquired narrative agencies, right, right, like PTSD. I mean, panic, panic disorder for me, I probably say that acquired. I don't know if it's, it's a hard world to have a game. Yeah. Can I skip I'm starting to feel guilty that I was so negative. Can I skip back to some practical suggestions for people who are maybe listening to this and like feeling so deflated now? Yeah, yeah. I think, so I know for me just learning the science of what was happening to my body with PTSD was so regulating, similar to like, like, oh, my dopamine's low. And I think for autistic people, if we can understand what's happening to our bodies, it's really helpful. A good therapist can do this, but you can also actually do this with like YouTube of the anatomy of PTSD, or just understanding the fight or fight response, and then being able to kind of like, okay, my amygdala is going haywire right now. So I think for autistic people learning what's happening is really helpful. And you, and people can do that on their own. The second thing is grounding strategies. People hear a lot about relaxation strategies, which helps get us, get us out of our stress response. I think the two like basic ingredients of a good trauma treatment starts with grounding, and then relaxation strategies. But I actually prioritize grounding first. And that is, again, those practices that help us relocate ourselves in the here and the now. So it can be as simple as going and washing your hands with cold water and focusing your attention like, this is what the water feels like on my hands or creating pressure, or like, there's the classic five, four, three, two, one, like list five things you see going through the senses. I actually have some grounding strategies up on my website available for free, like a PDF, or you can YouTube or Google grounding strategies, but education of what the heck is happening to your body, grounding strategies, and then getting some like medication support, I think for a lot of people, especially if they can't sleep, those would be kind of until you find a unicorn therapist that knows how to work with you. Well, in terms of the medication front, I mean, I don't know much about PTSD medications. I imagine it would be similar to anxiety, would it? Or is it kind of more what's like the type of thing? It depends on the person depends on the provider depends on what they're like presenting with, if they're more dominantly like shut down to breast versus if they're more in that activated state, but getting like good pharmaceutical support just to help your body kind of be able to absorb some of it, especially because like I mentioned, I think our sleep gets really dysregulated for autistic people. Sure. But yeah, there's a variety of different medication options. Well, it's just out of the interest because I know that I mean, obviously, autism is, we have all these co-occurring things. And one of the particular things that has propped up a lot for myself and a lot of people that I've talked to is substance use. Like, is that is there any particular, I know in general, the advice is to avoid substances like alcohol, you know, marijuana, I think, illegal drugs. Is there any particular sort of drugs that you know about in that sense that are really, really bad for people who have PTSD? Is it like a specific? So I mean, I don't know about like, really specifically bad because of the autism, but like alcohol is a common, it commonly co occurs with PTSD, it commonly co occurs with high masking autistic people. And it's a way of kind of alcohol gives the nervous system like it feels like a moment of relief from some of that hyperactivity. So it makes sense why people go to alcohol with PTSD, especially if they don't have like pharmaceutical support, they're kind of they're self-medicating. The risks with when you have a substance use disorder and something like PTSD, and if the person's ADHD also impulsivity goes way up. So if someone's experiencing suicidality, you know, thoughts about wanting to die or wanting to kill themself, which can be common with PTSD, and you've got substance on top of that and autism, I would say that's a very dangerous triad. And that again, that's another reason why I'm a big fan of getting pharmaceutical support, so that it makes people less vulnerable to self-medicate through substances that would increase other vulnerabilities. So I think it makes a lot of sense that a lot of us go to substances. I think it's, it's, it's another, like, to me, that's another one of the really sad pieces about my feel not understanding autism better is that they're not understanding a lot of the people that they're treating with substance use and PTSD are actually like undiagnosed autistic and ADHD people who They're kind of self-medicating because the medications they produce for a neurotypical brain and then optically, like for me, like, you know, doctors always say, oh, as is our eyes, great for depression and anxiety. Great for depression. Anxiety makes it a lot worse for me. Yeah, yeah, yeah. Yes, it's tricky. It's tricky because some of those medications activates the central nervous system. So if someone's prone to anxiety, some, some medications will actually make their anxiety worse. So yeah, which is why working with someone and we also more sensitive to medication. So a lot of times it's recommended autistic people started a lower dose. I'm not a prescriber just for like consent, but it's recommended people started a lower dose often. And sometimes it takes more medication trials to find the medication that works for us because our bodies are more 11 years and counting. I still go out with a train going through the pharmaceutical list. There's not as much. I don't think there's as much leniency with the types of medications used in the UK. I know there's a lot of medications which I hear about taught talked about more, like from American individuals. Whereas in the UK, it seems to be like SSRIs or the tricyclics or like the to pull the benzos, the health, health related drugs. But there's not there's not a lot of like explorative or all sorts of specialized medications being like tried and tested. And it's, I mean, what you're saying about the sensitivity to medication, I really, really identify with that. And it's also very strange because I'm always an under responder to like certain certain types of drugs, particularly painkillers. So like, you know, if I was to go to the dentist to get my teeth done, they would need to put like twice the normal dose in order for me to numb myself. But then with medication, that like has an impact on my brain, it's like, oh gosh, very sensitive to it. And I talked to Dr. Temple Grandin, I don't know if you know of her. Yeah, I saw that podcast. Yeah, yeah. She was she was talking about antidepressants. She was advocating for a very, very sort of low dose and stuff. And I definitely have tried that tried those low doses. They haven't been, they haven't had enough of an effect for me. And at the moment, just as a, no, I like to be open about medication, because there's no reason to feel bad about what you absolutely just as what you would say about your physical, you know, ailments and their medications. At the moment, I'm on about 40 milligrams of citalopram, which is relatively high dose. And for, and it was, I have to take it with metazapine, which is like a really weird class of drugs. It's like an NES. That's that I don't know. And that it's very, very sedative. And it's a very long acting so it takes a while to get out of your system and stuff. And that's really, really helped with the anxiety aspect of psoriasis. So it's always like a, it's a weird combination. It's like, I go too high on the metazapine. My depression gets worse because I'm so sluggish all the time and sedated. And then the opposite side, if this citalopram gets too high and too wired and I'm too anxious and all of these benefits I'm getting from the depression are just completely absolved from all the anxiety that I'm experiencing. It's like a teeter totter of like the more you address this and you've got it. Yeah, absolutely. Absolutely. These nervous systems of ours are such delicate things like too much activation, too much shutdown. Yeah, it's like the whole thing with delicate bodies of ours and ours being autistic bodies. It's like the whole thing with that, you know, you treat one ailment and that drug comes with side effects and then you treat the individual side effects and they have the branching out. Which that, you know, that's actually, so I've been saying I think medications can be really helpful, especially because it can help offset risk of substances. But it's also not great for everyone for these reasons. So another treatment, I would say biofeedback, I actually think autistic people tend to respond really well to you because it makes something abstract, concrete. So it's in, there's different kinds of biofeedback, but like one might be you're hooked up to a monitor and you can actually see like your nervous system activation, your breath rate, like these different measures. Yeah, and then you see yourself calming your body and that's really empowering. And that again, with PTSD, it's that like over reactivity. So biofeedback can be, and other body based interventions that aren't medication, I, it's not widely popular, but I'm a safe and sound provider. And it's a vagal nerve stimulator. I love it. I've done it myself. I've done it with several clients. Yeah, it's the vagal nerves, it's the parasympathetic. Yep. The base. Yeah, I'd be really interested in that more. So there's body based and they're like every year we're coming out with more, there's body based interventions that aren't medication, but also aren't talk therapy. So if you're struggling with these two, there's this like kind of somatic body based biofeedback world that I think can also be really supportive for autistic people with PTSD. Well, I think I will definitely have a little bit more look into that. I have had one experience with biofeedback and it was at my university, they had like these little sensory pods that you could go into. And they had these, well, it's kind of like a band, they're sort of supposed to do the same thing as you need to do, like checking your brainwaves and stuff. And the exercise was to meditate. And the more that you thought about things, the more like stormy the weather would become in your ears. And the more that you calm down and stop thinking about things, it's starting to become like, yeah, like sound of birds and that was really, really helpful for particularly for meditation and sort of centering myself a bit more definitely. Mm hmm. Yeah. Yeah. So I know we've been talking for quite a while. There was one last thing and I know we have also talked about sort of those difficulties with mental health practitioners, providers not really understanding autism on its own. But what about the really key things for any mental health providers out there to take away around sort of the overlap between PTSD and autism? Yeah. So if there were a few things that I really wish mental health providers understood, one, that even if the person doesn't meet criteria A, they might still have PTSD. And that goes back to what we're talking about, that maybe there's not this really concrete trauma to point to, but still treat the PTSD if they're having like all the other PTSD symptoms. So, so yes, that's one. Two, I think understanding the nervous system piece of like having more reactive nervous systems. So doing a lot of education, grounding, like training of the nervous system to get back into a regulated space. I think that's pretty integral to PTSD treatment. Understanding that we're victimized at higher rates, I think is a really important part of understanding the intersection and knowing how to work with that. And then the fourth thing is not attributing everything to trauma. I have met so many people, more women and gender queer people than men, but this certainly happens with men too, where their autistic traits are dismissed because of the trauma. So it's like, no, that's trauma. And then they're getting treatment for PTSD, but their underlying neurology is being missed. So they're not recovering in the same way. And I think, so just the avoidance of kind of that confirmation bias that this is trauma, and actually considering that it might be both autism and trauma is something I wish more therapists did. I often hear autism and ADHD dismissed because there's trauma, when it can often be a both end. And that sort of crossover is very difficult, isn't it, to kind of tease out, I suppose there needs to be quite a long process, like with anything like that. I mean, another way that the UK that my sort of medical system works is that I have to identify whether there is something wrong with me. And then I go to a specialist who specializes in that exact thing. There's no sort of like middleman that I can go to and say, I'm struggling, what have I got? Can we talk through like what may be happening here? Because the knowledge that GPs have, it's so, you know, they have a lot of knowledge and practical experience and all that, but they're very busy. And they also specialise in certain areas. And a lot of the time, they don't really understand autism that much, apart from sort of the stereotypical presentations. And, you know, sort of awareness of things like, as I said, the lexifier and different things, like it's sometimes really, really, really complex, because it's like, I don't want to keep going for different diagnoses to try and find out. I just want to go to one person and just like, absolutely. Yeah. Yeah. Well, because it's it all intersects. And so if you're going to like this for like this for PTSD, this for autism, like it, because it's all compounding. And so yeah, that reminds me that'd be the other thing I wish mental health providers would understand is alexithymia and that don't, don't, if you have a client with PTSD and autism, don't go off of their facial expressions for trying to like figure out how much stress they're under and know that they're a very elevated risk for suicide or baseline suicide risk is way higher. PTSD and suicide risk is higher. It is ridiculous. So you're throwing in PTSD and autism, have your eye out for, for suicidality and don't base it off of are they crying, like ask the person. Besides for me, I never cry. Well, I hardly ever cry. They definitely don't cry when I'm feeling very, very depressed. Right, right, right. It is. So we're emotionally dysregulated. We might not look to a therapist like we're emotionally dysregulated. Because it's not like this. And then we get missed. Factual concrete sort of interaction was the you input what's happening, they output what's happening in the circuit, there's a conversation. There's a interpersonal understanding is trying to understand their emotions. But they forget about the autism and the alexithymia. You know, sometimes they overlook that. And like, you know, it's a classic example, you go into a doctor's, I'm in extreme pain. And you don't look like you're in extreme pain. And like, okay, well, we're going to sort it out. But if you went in screaming, kicking, it's like, oh, my God, it's so much pain. Jesus, I excretion. Right, we'll get you to the ER. Absolutely. Yeah, yeah. That's a great metaphor. And the same thing happens in mental health all the time, because we don't, like, show our psychic pain in the same way all the time. You say, I'm really depressed. I'm thinking about suicide all the time. I'm so anxious. I can't function. I look like I can. And my friends don't really take me seriously. And now you don't take me seriously. Yeah. And I think that's, Thomas, that's a great example of how to advocate. So for the people listening who are clients, it's a great example of how to advocate for yourself with your therapist of say, say where you're struggling, make it explicit and say, I know I might not look like this. This is part of the autism. And make it explicit. That's such a powerful way to self advocate. Because I suppose you need, you need some kind of basis in order to help them understand a certain thing, especially if it's not fitting into sort of the basic sort of the neurotypical stereotypes. Yeah, yeah. Yeah, definitely. Well, it's been absolutely amazing to chat to you and would like to talk more. Definitely. Same. This time has flown. Yeah, it has definitely. This is a sign of a good podcast, I would say. Oh, good. So what I'm gonna do, I'm gonna do a song of the day. Do you remember what your song of the day was? I do. Yeah, it was Green Day, Boulevard of Broken Dreams. When I was recovering from PTSD, I would walk around Princeton that night. Like walking around at night has always been really soothing for me. Me too. Yeah, especially in the rain. And I would, really? Yeah, same. Same. And I would listen to that song on repeat. It was my stim song. And I think it just, it captured something that I couldn't quite articulate. But I probably listened to that song on repeat for like a year or two when I had PTSD and when I was recovering from PTSD. That's really, really good. So that's why I chose it. I mean, amazing song anyway. Great addition to the 40 or two podcast playlist, song of the day playlist as you can, you can always find it down in the description just for anybody listening. I don't know why you say anybody's listening because the people who are listening would only be able to hear me say that. And then the people who are listening. It's like if a tree falls. Brilliant. Well, I guess, you know, we've gone through, we've looked at PTSD, we've looked at sort of the Herbal Outwards and some of the difficulties in sort of therapy, some of the things that people can do to help, you know, some of the ways that might be supportive for autistic people struggling with PTSD. And also some of the things that, you know, mental health practitioners should be really aware of. It's been great to talk to you. And I guess what I want to ask now is, have you enjoyed the episode? Have you enjoyed the 40 or two experience? I have. I very much so I've been looking forward to this conversation. And it's, it's kind of what I imagined it would be. And I like that we were able to go on some neurodivergent or divergent like rabbit trails, but then you, you brought us back to the linear path that was our agenda. So it felt very neurodivergent in that way, which I always love those conversations the most. So thank you. What can people find you? They can find me on Instagram neurodivergent insights on my website, www.neurodivergentinsights.com. I have a Patreon. I make workbooks every month around like wellness and mental health. So like I just did one on Alexa Thymia recently. And so Patreon as well. Those are probably the top three places. I know I definitely encourage you if anything at least go and follow Megan over on on Instagram neurodivergent insights. Absolutely amazing resource for me, especially when trying to sort of understand both myself, sort of the crossover between things and also, you know, understanding sort of the broad complexity of it all. And, you know, the fact that, you know, research and understanding is still, still graring. And it's still things are changing things, things are being learned very, very slowly as we humans do. But there are some, you know, great people like Megan who are sort of heading sort of our awareness of different things specifically around the stuff around misdiagnosis, I think was really impactful on me. So if you have enjoyed this episode and you want to hear more of it, I have a playlist of, you know, upwards of 30 plus songs. Season one and two. Season one, it's a little bit on the, the new coming podcasting style. It's not very well produced or presented, but definitely go check out some of the more recent episodes of season two and season one. You can find the 4080 podcast, of course, on Spotify, Apple Podcast, Google Podcast, and of course on my YouTube channel, Thomas Henley under the 4080 podcast. All the video versions are available on there. And yeah, if you want to check out all of the other work that I do, head over to my social medias, particularly my Instagram at Thomas Henley UK. And if you want to get in contact about workplace training, public speaking events, interviews, modeling, getting contact with me via my website, www.thomashenley.co.uk and go through the contact form on that. I think that's everything. Been, been like a bit over a month since I've done the podcast sounds. Trying to remember exactly what. The muscle memory. The muscle memory is gone. Yeah. It's like a little, it's like a little social script, but just like with the facial expressions and the body language. Yep. Yep. Well, thank you so much, Megan for coming on. Absolutely. I did really enjoy this conversation. Great deal. For me, I hope you all have a very, very lovely day.