Episode 94: Bright Kids, Invisible Effort: Rethinking “High-Functioning” Autism (Part 1) – Dr. Lindsey Sterling

LD Expert Podcast with Jill Stowell
Bright Kids, Invisible Effort:
Rethinking “High-Functioning” Autism
(PART 1)
Dr. Lindsey Sterling

 

Jill Stowell: Bright, capable kids shouldn't have to work excessively hard just to get through the day. At Stowell Learning Centers, most families find us because their child is struggling with reading, attention, or homework, and very often dyslexia is a part of that picture. But over the years, we've also worked with many students who are on the autism spectrum, often alongside learning disabilities and ADHD.

 

What we see again and again is that these are bright, capable kids who are working incredibly hard, and yet school regulation and daily life still feel exhausting for them and for their families. Parents say things like, “My child is smart. They're doing okay academically, but everything feels hard. We have meltdowns almost every day after school, friendships are confusing, and everyday tasks take so much energy.”

 

Sometimes parents hear the term “high-functioning autism,” and it creates more confusion than clarity, because if a child is high-functioning, shouldn't things be easier? Today's conversation is about unpacking that disconnect with compassion and clarity. 

 

Welcome to the LD Expert podcast, your place for answers and solutions for learning differences, dyslexia, and attention challenges. I'm your host, Jill Stowell, founder of Stowell Learning Centers.

 

I am delighted to have Dr. Lindsey Sterling back with us today. Lindsey is the founder and clinical director of Sterling Institute for Autism. She is a clinical psychologist who directs a group practice specializing in neurodiversity.

 

Lindsey has spent years helping families understand not just whether autism is a part of their child's profile, but what that actually means for learning, regulation, and everyday life. Welcome, Lindsey. 

 

Dr. Lindsey Sterling: Thank you for having me.

 

Jill Stowell: I'm so excited to have you here. We have such a packed episode today. I have so many things I want to talk about. But before we jump into all of that, tell us a little bit about the Sterling Institute for Autism and about your new center. 

 

Dr. Lindsey Sterling: Sure. Thank you. So, we are a private practice, but we're a group practice. So, we do diagnostic assessments, individual therapy, groups, medication management. Basically, we wanted to have sort of a one-stop shop for families with children who are neurodivergent, but also for teens and adults, and really help them in a way coordinate their care too, so that it's a built-in collaborative model within our group, so that if one person does an assessment with the family and then refers them to a therapist within the group, we're all talking and having an ongoing conversation and hopefully taking some of that burden off of the parents to continue having to retell their story and communicate what it is that they want support with.

 

So, we started off in Long Beach. I started off solo, actually, and just sort of organically started bringing people on when we realized that there were greater needs in the community that I could really address on my own. And then just in January, as you mentioned, we started or we opened a new location in Newport Beach, so hopefully increasing the access for people all over Orange County.

 

It's really easy to get to right off the freeway. We were getting a lot of feedback that colleagues are referring families to us, and they just couldn't sit in the car to come all the way to Long Beach. So, we're hoping that this helps families, and now we can take families from Los Angeles and Long Beach, as well as even South Orange County to get to our Newport office.

 

Jill Stowell: Well, congratulations on that. You know, forever ago, I also started out as a private individual practitioner, and very quickly, you realize when you're doing something so specialized that the need is so great that you really have to expand and have more people, a part of it to offer the services. So, I'm really excited for you and, and congratulations on your new office.

 

Dr. Lindsey Sterling: Thank you. I think that's so well said too. Sometimes we don't know the direction even of our career or our clinic and what's based off of what the needs are, right? So, we start to pivot, and we get a sense of what it is that the community needs.

 

And when I was solo, I didn't know where to send people where I felt like I could be confident that they were getting the best high-quality care. And so, this was a way for me to be able to pick and choose the clinicians and make sure that – I always say that they're people I would send my own kids to, and have that trust in them so that we can really support these families. 

 

Jill Stowell: Absolutely. Well, I want to start off today, Lindsey, talking about high-functioning autism. It seems like this term can be a little controversial. I think I understand why, but can you just talk a little bit about that? 

 

Dr. Lindsey Sterling: Yeah, it is a little bit controversial. And I think that this is so tricky, because the word “autism” itself is so broad, right? It encapsulates such a range and so much variability. And, you know, early in my training, we had some different ways of being able to reflect that using terms like Asperger's syndrome, or PDD-NOS. And so, when people saw those words, they had a sense of what the child or the adult looked like, right? Whether they had speech with their verbal – not just verbal. The intellectual capacity was like.

 

And I think now that we just have autism that encompasses everything, it's natural that we as a field have looked for ways to differentiate what that means when we just see the word “autism” on paper. What does that mean, right? And so, I think naturally, these different terms have evolved, like high functioning, low functioning, right? So high functioning, I think people assume it means that maybe someone has an average to above average IQ, that they have fluid verbal abilities. But what has happened because of that is that it's that term, especially the term “high-functioning” has overshadowed the fact that people who are high functioning still need a lot of support, right? And that term doesn't reflect the variability within that group, right? So, someone might have really strong verbal skills, for example, but have a really hard time with executive functioning or sensory overload, or different things that make daily life actually really hard and really difficult.

 

And so not only does that terminology then sort of beg the question of, “Well, are these two dichotomous groups? If there's high functioning, there must be low functioning, right? These are two groups. And what does that mean?” which is not the case at all, right? So, it places that dichotomy on this whole population of people, which is not accurate or a fair representation at all. But then within this group that has been called high-functioning over the years, it also sort of negates their need for support, right? So then oftentimes, there are unfair expectations, like, oh, this person is high functioning.

 

So, the expectation is that they do everything that a neurotypical person does, and at their rate at their developmental rate, right? And so, the problem is that the way our brain develops, it doesn't develop in a straight line. So, someone might be very bright and have very high intellectual capacity. It doesn't mean that they aren't struggling with other things, like you mentioned in the intro, like regulation, or executive functioning, or sensory overload, or anxiety, or things that actually require a lot of support.

 

So, when we use that term “high-functioning,” unfortunately, teachers, providers, parents might see that and then think, well, then this person doesn't need the support that actually is warranted. So that's just maybe the tip of the iceberg, I think. But I think another sort of consequence of that is then the person themselves, who's labeled as high functioning, feels like they have to rise to that, whatever that expectation is.

 

And so, it forces masking, right? So, this idea that they're trying to appear like everything's okay, even though beneath the surface, they're really suffering. And there's lots of research we can get into about how masking is then related to more psychopathology, right? The development of anxiety, depression. So, it's really dangerous, actually, to just assume that somebody can handle everything that's thrown at them in daily life, just because they've gotten this label that says “high-functioning”.

 

Jill Stowell: So how do you help parents figure out, you know, how do you figure out where are the areas that these kids are masking? What does that look like? And where are the needs? You mentioned variability, and I think that's a huge thing with our gifted population. And with our kids on the autism spectrum, there's such variability. So, they are so brilliant at some things, but struggle at other things.

 

And, you know, when you have kids who are really strong in certain areas, sometimes they can cover up these really deep struggles. And so how do you work through that and help parents realize what their kids really need in terms of support? 

 

Dr. Lindsey Sterling: Yeah, and I think all of us as parents struggle with this so much, how much do we support and turn on that part of our brain that's about understanding and empathy and patience and how much do we push and say, “Well, we know you can do this. So, we're going to push and make sure that you're reaching that expectation.”

 

And it's a real struggle sometimes to know which aspects of daily life a child is struggling with, versus, you know, what it is that their capacities are. And so that term “variability” is, I mean, I think that captures it so well. And you mentioned gifted kids, right? And I have this sort of separate – like one of my special interests, you can say in twice exceptional or gifted children, because I think we see in neurodiversity, and especially in giftedness, we see what we call “asynchronous development,” right?

 

So that means it's asynchronous within themselves. These are kids who maybe can solve these really complex math problems in the 3rd grade or read at the 11th grade level, but it doesn't mean that they can process what that means emotionally, or they still can't tie their shoe, right? These different types of skills develop at different rates, and differently in comparison to their peers.

 

So, it's not following a straight line. So, it can be really confusing for parents and for providers, for teachers to know what to expect and I wish that there was an easy formula for that. But I think what I've learned, if anything, is that it's a moving target, right? So, whenever we have like an assessment, I tell parents, it's a snapshot in time, I would like to be able to tell you exactly how all of these splintered skills and strengths are going to develop and at what rates over time. But we're always trying to understand that.

 

And just when we think we've figured it out, it changes. But I think your question about how can we tell, especially when there's masking going on when a child is trying to meet those expectations, look for the emotional signs, right? The burnout, the meltdowns, we all know what these kids look like sometimes when they come home from school and they fall apart. And it just seems like their threshold for being able to deal with what might feel like a small stressor is on overload because they really are tapped out.

 

And I think that that's a sign for parents, for teachers, for providers that that child is working really, really hard to keep it together during the day. So even if they're performing well academically, at what cost, right? And I think those are signs that we have to be cued into, when we see the emotional meltdown start to seep out. That's when the mask is coming off.

 

And we have to kind of look at what their day was like, and what it was that was exhausting them so much. 

 

Jill Stowell: Right. You know, that's really important, because a lot of times, what we see as a parent or a teacher, a relative, you know, we see just the trigger point, and it might feel like nothing. And so, you think, why is he having a meltdown over this? Well, it's really, I think that was really important, what you said that, you know, all of the trying to, to do everything, meet the expectations, fit in, all of that throughout the day, has pushed and pushed and pushed at that threshold. And then there is something that it just sort of all overflows at that point.

 

Dr. Lindsey Sterling: The breaking point. Yeah. Yeah. And sometimes, you know, it depends on the child's age, it depends on their insights, their verbal capacity. But some kids get pretty good, and teens, especially get pretty good at articulating this. And there is a lot of research. My postdoc was looking at anxiety for kids on the spectrum.

 

And there are some great models of proposed hypothesizing, why it is that people on the spectrum, the autistic people are more prone to anxiety. And one of the models is looking at these factors throughout the day. So if you think about for any of us, getting ready in the morning, remembering everything we have to bring, and then you're on the way there, and a road is closed, and you have to go the other way, and then there's no parking, and then you run in, and then you forgot that you have this meeting, or you have a test or whatever it is. Life is stressful anyway to get through the day. Our cortisol levels are spiked in the morning. 

 

But if you think about a neurodivergent person who might also have sensory overload, so they make it to class, and then they're overloaded by all of these different stimuli in the classroom, whether it's the lights, or the rustling of papers, or the smells, or whatever it is. And then maybe the teacher announces that there's a change. And instead of going to lunch at this time, we're going to go at a different time, because there is an assembly. And that causes distress because we like to know what's going to happen and have predictability. And maybe there's a history of social conflict or confusion.

 

And at lunch, you see some other kids, and you don't quite know how to act, and you're trying to hold it together. And maybe there are things that you do at home that are self-regulatory, whether it's kind of rocking back and forth, or listening to something that's really soothing, or whatever it is. You can't do that at school. You're prohibited from doing those things. There are so many things that are piled on, that by the end of the day, it's not just school, it's not just that there was a test or an assignment or stress about the next day. It's having to stay regulated, because that's the expectation when you're bombarded by much more than the average person.

 

And so, then you think about that child coming home or that teenager, even adult from work. And we've talked to adults who sit in their car outside of their house for 20 minutes and listen to music or a podcast before coming inside, because they need that time to regulate. And so, adults are able to articulate that. Kids sometimes, right? If you think about kids with ADHD, I've heard them say, “I had to stay still all day, I wasn't allowed to talk to my partner next to me or touch him or blurt anything out. And all day, I was trying to, you know, stay together.” 

 

It's exhausting. And so that that idea of when you come home, and the parent says, “Time to start homework,” and the kid melts down and starts crying. And the parent is like, “But I know this isn't hard for them. They can do this work.” It's not just about the work, right? It's about the build-up from the whole day. And that's where you see the masking. That's where you see those expectations that teachers have of these higher functioning kids to keep it together. That's actually really hard.

 

Jill Stowell: Yeah. You know, I think that, just that whole idea of, it's not the homework. It's the build-up. That's huge. That's a huge takeaway. So, we keep talking about masking. Can you talk about that a little bit? What does that look like for these students? Yeah.

 

Dr. Lindsey Sterling: Well, the idea of masking is that your outer self doesn't match your inner experience and we all have done this to a certain extent. I think about people in healthcare as a psychologist. There might be something happening in my own life, but then I meet with a client or patient, and I have to have my smile and my mask on, that everything's okay.

 

And there's something adaptable about that, that we learn to do that because we have to sometimes in life. But when we talk about masking and neurodiversity, it is more intense than that, because it feels like somebody has to mask their true selves and not maybe engage in some of the behaviors that appear more neurodivergent and have to appear more neurotypical.

 

And that takes a lot of energy. And so, you'll see, you know, things like maybe looking at someone's forehead instead of their eyes and nodding and smiling and dressing a certain way. And even trying to have the same sorts of interests that maybe their typical peers have, typically developing peers. And so really trying to appear a certain way that feels like a mismatch from who they really are inside and not being able to be their authentic selves. And while like I said, that can be adaptable for all of us in certain situations, if you're doing that all the time, that becomes really exhausting.

 

And you're sort of sending a message to yourself too that your real self is not okay, or acceptable. And so unfortunately, what the research shows is that higher levels of masking, and we see this in females, especially, but you know, for both genders, all genders, that it really does lead to increased rates of psychopathology over time. 

 

Jill Stowell: So, you mentioned girls. Let's talk about that a little bit because it does seem that girls are later in getting diagnosed often, or misdiagnosed. And you mentioned to me that in the past few years, you've had an increase in girls and young women coming through your doors. So, what's going on there? 

 

Dr. Lindsey Sterling: Yeah, there's so much to say about that. So, feel free to stop me or move me in a different direction, because I literally have talked for hours about this topic. But I do think that we're learning more and more about girls and what they look like. Our conceptualization of autism, most of our research over the years has been based on boys and has been based on the original ratios that were described decades ago in the first studies of autism, where it looked like there were three or four boys, or more for every girl.

 

And even when I was in graduate school, we always tried to document that in our research that the ratio we used in our studies reflected this ratio that we see in the population. And the byproduct of that is that everything we've learned about autism over the years, it's mostly about boys. And even the assessment measures that have been developed and normed have been built around that, around how boys present.

 

And so, both the assumption that girls are not on the spectrum, and maybe they're just depressed, or they're shy, or they have something else going on. And the fact that even when they were sent for an assessment, it wasn't caught, because the signs are different. And the measures we used are really created for boys. They have been missed a lot over the years. And so, I think that those of us who are working in the field and seeing more and more girls, I can speak for myself and my group, at least we're using those measures, because they are considered the “gold standard,” right? And we have to document symptoms or differences. But we're also thinking of this in some ways as more of an art, as far as the questions that we ask and what we're looking for, because now, we're still learning. But now I think we have a much better understanding of how girls look, and how they look different from what we expected and from boys. 

 

Jill Stowell: And so, talk about that a little bit. How do they look different? 

 

Dr. Lindsey Sterling: Yeah. So I'll make some generalizations. But of course, every girl we see, just like every person we see is completely different. But some examples, I'll give some concrete examples. So, one of the things that we asked about in an assessment for autism is something like repetitive play, right? So, did the child play imaginatively, and creatively and flexibly, or was their play a little bit more repetitive? And that's one of the things we check off, when we're doing interviews about boys, and when we're playing with them. We look at how they play. But actually, with girls, we see lots of creativity and imagination and, you know, imaginative friends. And so even that, that's just one example of when we go through the interviews, we start to ask some different questions about how they played. It might be in combination with some repetitive play. But that repetition tends to come out in different ways, like reading the same book over and over, for example, or listening to the same music over and over drawing similar pictures. 

 

So, it's like the essence is still there, but it is manifested in a different way. Another big way that it's different is the socialization. So, for many of the girls who we see, they're described as being outgoing or chatty, and actually engaging with peers and wanting to engage with peers. But there are a couple of things that we see. For young kids, a colleague at UCLA did a study where they observed kids on the playground. And boys who went on to have an autism diagnosis were a little bit easier to flag for the staff, because they were doing the things that again, we might expect, not all boys on the spectrum, but we might expect so playing on their own, you know, or self-isolating, or just maybe doing something a little more repetitively on the playground. 

 

The girls on the other hand would actually be around other girls. And it would look like she was playing with them. But then when the conversation got maybe a little bit more difficult, or the complexity of the play was a little bit more nuanced, the girl with them sort of – they use the word “flit,” like flit to the next group and try that out and see how that went. So she was always around girls, but kind of flitting from one to the next and never fully integrated and parents will confirm that too.

 

Oh, they're on a sports team. And yeah, they played with the girls, but then they never really hung out with them after practice, or they were always the one kind of left out when the girls partnered up. So, it looked like they were all together, but there was something a little different where they weren't quite integrated.

 

And we'll do something that's called friendship mapping, where we'll actually ask because again, teachers will say, “Oh, she had friends,” or, you know, she was part of a brownie troop, or, you know, she played with them. And then when you actually dig deep and ask the parents, or if the girl is older, ask the girl, usually both. When they actually talk about it, they'll talk about well, yeah, they were part of that group. But then when the group had a party or did something, they actually didn't invite her or she always felt like they were having side conversations in a group chat, and she wasn't a part of it. So, it's like, on the surface looking like there are friendships. But when we actually try to understand the quality of those interactions and relationships, it's a little bit different.

 

And that tends to be more nuanced than what we see for boys. So, there are actually quite a few examples. But I would say, those are two of the examples that come up a lot in our assessments. 

 

Jill Stowell: And so, if girls are diagnosed later, then they're being misunderstood longer and not getting maybe the support that they need. What is the impact of that? What do you hear from girls who were diagnosed later? 

 

Dr. Lindsey Sterling: Yeah. Oh, it's so hard. Even that question, it's like, I can feel the emotion of some of these girls who have come through for assessments and women, I should say, we're getting women in their 30s, 40s, 50s, asking these questions. And there, I think, is some grief around thinking about maybe what life could have been like if they had supports or accommodations or understanding.

 

We feel that from the parents too, like a sense of guilt or grief. And we really try to work with parents around that because if we as the experts didn't know what that looked like 10 years ago, 20 years ago, 30 years ago, we can't expect parents to have known and to have advocated for this diagnosis specifically, right? So, there's no blame there. This is just we were behind. But unfortunately, we saw, or we still see a lot of girls who were misdiagnosed.

 

There's a lot of shame around that, again, around the masking and expectations that they should have been able to keep it together, to have these friends and excel in school and extracurriculars and have a certain role in their family. But by the time someone reaches adulthood, unfortunately, we're seeing higher rates of psychopathology and misdiagnoses. So being treated for something that maybe wasn't an accurate diagnosis.

 

Jill Stowell: And so, when you say psychopathology, what are you referring to? 

 

Dr. Lindsey Sterling: Yeah, so especially anxiety, depression, oftentimes, even, you know, suicidal thoughts. So really feeling exhausted, feeling misunderstood, feeling confused, right? Like, why are things so much harder? Why hasn't there been an explanation for this, feeling like it's their fault, feeling isolated. And then unfortunately, for females, especially, but this can, of course, happen for males, too. There tends to be social vulnerability, right? 

 

So, what I mean by that is they're coming across as maybe outgoing and, you know, pulled together, and they're part of a group. But they feel like they're not quite understanding how to connect. They feel like they're on the outskirts. And maybe they're not quite as savvy as far as picking up on some of the nuances and other people's intentions. And so, they end up being taken advantage of either by friends, in relationships. And for women, as they get older, there are reports of trauma, of being taken advantage of in different ways.

 

And so, it can be quite dangerous actually to not have this understanding and support along the way. So, when parents ask me, and maybe we'll get to this, but why assessment, right? Like, why is this important? And for me, that's one of the big reasons. 

 

Jill Stowell: And, yeah, I would like to get into that. I just want to ask you one more thing about girls. Once they've been diagnosed, and especially those that are diagnosed quite late, do you see that their identity development is able to shift after that diagnosis in a healthier way? 

 

Dr. Lindsey Sterling: That's the hope, right? So, the hope is that development of authenticity, being able to be their authentic selves. But yeah, sometimes during the course of an assessment, especially for young women, we see these “aha” moments of like, oh my gosh, it makes sense why I felt this way, or why I've experienced this and putting those pieces together. And there can be such a sense of relief.

 

I think that's the word that comes up a lot in these assessments for parents too, even when it is mixed with the grief and with the questions about why it was missed earlier on. There is that sense of like, oh my gosh. It's not to excuse things. I think that's very different. It's more to explain and feel understood and validated. So, I think that that's the first step, right? As far as the supports that are out there in the community for females and women, it's growing. It's not what it should be.

 

But we're doing that in our group. Instead of social skills groups, we have girl power groups for middle school girls, for teen girls. One of the parents asked me what the impetus was, why we formed these groups. And the truth of it is that over the last few years, every time we see one of these girls for an assessment, we hear from them that they feel like they're the only ones, that it's a very lonely experience, right? Like a girl on the spectrum, like no one understands them. And they are masking, so no one realizes what that internal invisible struggle is that they're going through.

 

And it's frustrating that they can't quite make those connections, and they're feeling very isolated. And we kept hearing that over and over again from different girls. And so, we were like, well, if we could just put some of them together, and sure, if they learn about self-advocacy, and vulnerability, and empowerment, and some skills along the way, great.

 

But the main reason was to be able to just meet each other and feel like they're in a space where they could be authentic and not mask, and realize that there are other girls who are not the same, but who are having some similar experiences. I think that's the start, right? There's so much that needs to be done. But it's a start to start to validate that this is even a thing that these girls even need the support along the way.

 

Jill Stowell: Right. So, you mentioned assessment. So, before we wrap up, let's, let's talk about that. Why is that so important? 

 

Dr. Lindsey Sterling: Yeah, so many different reasons, right? And that question is going to be different, whether it's for a child, a teen, or an adult. I get concerns from parents, really valid concerns about, well, I don't want to label my child, or if my child gets this diagnosis, is everyone going to see them in that light? Those are really fair questions. And in our assessment style, it's a very collaborative process.

 

And during the intake, we actually talk that through. How are you going to feel if your child or if you end up with this diagnosis? How are you going to feel if you go through all of this, and we don't have that diagnosis? And what do you get at the end of this? Because that's a fair question. It's a big investment for families, not just financially, but time, emotionally. And there's so many different ways to answer this, right? I think that for kids, there is that validation, especially for parents and putting the pieces together and trying to understand their child and creating a framework. A language, even for the family, for siblings to help better understand what's happening in the house. It builds empathy and understanding and just having that framework to just better understand the strengths, the struggles. 

 

And then, of course, there is the tangible thing at the end, the report and the recommendations for accommodations and potential 504 or IEP in school. So, there's the very concrete reasons for an assessment that a lot of people are driven to the assessment because of that. For adults, it is a bit different, right? So, if they're in college or they're in a job and they need accommodations, some of those reasons might be the same. But for adults, it tends to be a little bit more about self-exploration and understanding and validation and clarity to make sure that they're getting the right treatment, right intervention, right support.

 

Oftentimes, there's something that's come up with their partner that's bringing them to the evaluation and this question keeps coming up that they want to maybe put to rest about neurodiversity. So, it really depends on where someone is at in their life and what it is that they want at the end of it. And we ask that. How would you feel at the end? What would make you feel like this was worth your time and your money to go through this process? 

 

But I think I'm obviously – because this is what I do, so I'm biased, but I'm a big proponent of understanding, having parents understand, teachers understand, and for the child, teen, adult themselves to have that explanation as well. 

 

Jill Stowell: Yeah, I think that is huge. And we have seen that so many times over the years. You know, we work a lot with dyslexia and individuals with dyslexia tend to be bright and creative and have strengths that just don't match the struggles that they're having with reading. And so many times, you know, you get to the end of the assessment and begin to dialogue with the student and the family about, you know, the reason for the struggles. And the student is so relieved because they know that there's something, something, but they can't figure it out.

 

And, you know, especially when you were talking about girls, and I thought, you know, they're going through life, and they're masking, and they're trying to do all these things and look right and fit in and so they don't understand themselves either. So having a greater understanding of who they actually are, and, you know, all they know is that they're trying really hard, and it doesn't always work, you know. 

 

Dr. Lindsey Sterling: Yeah. And the age when we see a lot of these girls, we think about middle school, high school, it's hard enough anyway, right? It's so hard going through puberty and going through these transitions and trying to figure out where you fit in. And that's another thing that comes up with assessment with girls is how their interests are oftentimes more intense, and maybe different than some of their peers, and how do you find that commonality with peers, and all of that is hard anyway, right? This is a really tricky time.

 

And with girls, you know, going back to that question about what makes assessment different, even though we see girls later on average, what we do find is that that relational aggression that we see in girls, and the friendship politics, and those nuances, and that sophistication, we see that earlier than we see in boys, right? We see that in like, eight-year-old girls, nine-year-old girls. With boys, we tend to see that a little bit later, right? Like middle school maybe. Boys can get away with some of that physical play on the playground for a long time, having that one common interest for a long time. With girls, there's all those little looks and eye rolls, and this person can talk to this person, but can't talk to that person. It starts early.

 

And so that's one of the things, I think, where we see girls who are really bright, who have masked for a long time, sort of fall off the rails, right? Where all of a sudden, the parents are like, wait, they were hacking it, like they were in it, it seemed like they had this friend, or they tend to have more friends that are boys, because that's easier. And then it gets so complicated with all of the girl politics. That's when you start to see that divergence, right? And you see the development. It’s like they recognize the discrepancy more, I think.

 

And so even though we're seeing girls later for assessment, in hindsight, some of those signs start to emerge sometimes even earlier than those really bright boys, just because of gender development, and how it's different. 

 

Jill Stowell: Yeah, yeah. Well, Lindsey, when families come to the Sterling Institute for Autism, what do you want to have happen for them? 

 

Dr. Lindsey Sterling: In general? 

 

Jill Stowell: Yeah.

 

Dr. Lindsey Sterling: Yeah, I want them to feel understood, right? I'm a parent too. I know how stressful this process is. Sometimes even making the call and asking for an assessment, some of that hard work has already been done by another provider to bring it up to them, right? This is a big deal for parents to call in sometimes to even acknowledge that they need help. And so even our front desk person or coordinator, she's an MFT, she's a therapist by training. And we did that on purpose, because when families call, it is about getting the information and being efficient. But it's also about feeling like it's a personalized experience. And it's individualized. 

 

This is not just a factory, right? We want to listen to what it is that they need, and meet them there. And that's true, even for assessment. Even though we have these protocols that we follow, every assessment is about answering the questions that are important to the family. And so, I think that's the overall goal is feeling like they were understood, they were heard, they were taken care of along the way. And then the other things, the evidence-based intervention and assessment, those are all super important to us and they're at the core of our mission. But really, it's about making sure that the families feel cared for along the way. 

 

Jill Stowell: Great. And if a parent listening today is thinking, “Wow, this sounds like my child,” what would you want to say to them before we close? 

 

Dr. Lindsey Sterling: Yeah, that you're not alone. I think that that's the biggest thing for parents of any child who has extra needs, right? Parents feel like they're the only ones going to these IEP meetings. They are the only ones trying to talk to their teacher every day after school to figure out what happened in the classroom or deal with the meltdowns after school or decide if they should go to the social gathering because they're worried their child is going to melt down, feeling isolated. I think there's so much isolation for parents. And it's something we've brainstormed in our own group about how to increase the parent support.

 

So, I would want them to know that they're not alone and that there are resources, right? And sometimes they don't even know where to begin. And we try to help with that too. So, whether it's our office coordinator, or sometimes she says, you know, better to just talk to Dr. Sterling for a few minutes and see what might be the most helpful. Sometimes that's us and sometimes it's referring out and trying to figure out the right fit for the family too. So, I think that's the biggest message is that it feels very lonely, but that we promise they're not alone, that there are other people and those of us who understand also.

 

Jill Stowell: Well, as always, your perspective is so helpful and so real. So, Lindsey, how can people learn more about what you offer and about the Sterling Institute for Autism? 

 

Dr. Lindsey Sterling: Thanks for asking. They can go to our website, sterlingautism.com. And yeah, we do have a social media. It's not as sophisticated as some, but we do try to post when we have new clinicians and what's new at our office. And we try to keep the office website up to date as far as – especially things like groups that are changing, because those are always different. But as far as just our general philosophy and the services that we offer, that should always be on the website as well.

 

Jill Stowell: Thank you so much for joining us and sharing today. 

 

Dr. Lindsey Sterling: Thank you and thanks for these good questions that bring up these topics. I really appreciate it. 

 

Jill Stowell: Understanding changes everything. In part two of this conversation, I want to build on what we talked about today and talk about what this understanding looks like in action, how we support these bright kids in real world settings day to day. So be sure to tune in for part two. 

 

At Stowell Learning Centers, we help children and adults move beyond learning and attention challenges by strengthening the underlying skills that make learning easier. When those skills get stronger, everything changes, reading, writing, focus, confidence, even stress around school. If you're listening and thinking, “This sounds like my child,” you can learn more, explore free resources or connect with one of our learning specialists at stowellcenter.com. You can also follow us on social media. We're Stowell Center on all platforms. 

 

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