Episode 95: From Insight to Action: Supporting Bright, Autistic Students in the Real World (Part 2) – Dr. Lindsey Sterling

LD Expert Podcast with Jill Stowell
From Insight to Action:
Supporting Bright, Autistic Students in the Real World
(PART 2)
Dr. Lindsey Sterling

 

Jill Stowell: Welcome back to part two of my conversation with Dr. Lindsey Sterling, founder and clinical director of the Sterling Center for Autism. 

 

In our last episode, we talked about bright kids who are working far harder than they appear. Kids on the autism spectrum, often described as high functioning, yet they're struggling with regulation, executive function, and social demands.

 

Understanding is powerful. But for parents and educators, the next question always is, “Okay, now what?” So today, we're shifting from insight to action. 

 

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. Lindsey, for any of our listeners who didn't catch part one, what would you love for people to know about you and the Sterling Institute for Autism? 

 

Dr. Lindsey Sterling: Sure. So, I'm a clinical psychologist. I've specialized in autism since graduate school. It's why I went to graduate school to be a clinical psychologist. I was in academia for a number of years until I ventured into private practice.

 

And then about five years ago, expanded to create the group, the Sterling Institute for Autism, really to meet the needs of the community to make sure that we could try to serve the people who are coming to us, asking for therapy, asking for assessment. We now have medication management and we also have groups that change over time, depending on what our focus is.

 

Right now, we have girls’ groups for tweens. And for teens, we've had dating groups and process groups. But really, we want families to feel like when they come to us, they're coming to experts on neurodiversity, whether that's autism, ADHD, choice exceptionality, and that hopefully we can support them. And if not, that we can find other providers and help them connect with them too. 

 

Jill Stowell: Fantastic. And just because our listeners are not just in Southern California, there is so much that you're going to get out of this conversation. And certainly, if you're local in Southern California, then you want to look up the Sterling Center for Autism. 

 

I would really like to just open a question up to you to take in whatever direction you feel is going to be most helpful for parents. And so here it is. How do we support our kids on the autism spectrum in practical ways, without lowering expectations, without pushing them into masking, and without losing the strengths that make them who they are? 

 

Dr. Lindsey Sterling: Yeah, I think this is the gazillion dollar question. If we could all crack this code for each of our kids. And I think that what's tricky is that truly each child on the spectrum, each person is so different, which I won't get into all of the reasons for that. But in the future, I think we'll be calling it the autisms. When we understand all of these different ideologies and the variability.

 

And so that's what makes this so hard. Is that not like having diabetes, for example, is easy by any means, but there's a protocol. You kind of know what to expect. And there's a prescription to follow and specialists for that. When it comes to autism, it's so murky, because every person has a different profile of strengths and struggles, and a different context at school and different needs.

 

And so, I want to just set that context up because it is really, really tricky. I have a dream scenario of how to best support kids and then some of the realities. My dream scenario really focuses on psychoeducation. I think that we're so far from this. But I see parents doing this on their own. I see parents sort of taking on this burden of learning everything they can about autism and neurodiversity so that they better understand their child.

 

And even though the first episode was about understanding, and this is about action, I think you can't have the action without that, without really understanding the child. And so, I see parents taking on that burden. I wish that there was a more supportive way, organized way. And there are in some places, but like I said, I see parents doing reading and going into social media and researching. I wish that for educators too. I think that there's a lot of variability. Educators are responsible for so much that we can't expect them to also be complete experts in neurodiversity.

 

But that is my dream scenario. Because kids are spending so much time at school during the day. If I could have my second career launch, it would be to be supporting schools in this way, to increase understanding, because what we see at school, especially as a surface behavior, what's masked. And I think these kids are so complex that sometimes it's difficult to understand what's going on under the surface, beneath the surface. And that makes it hard to know exactly what types of supports are needed. 

 

So that's kind of the dream scenario. But as far as support, I agree with what you said, where we don't want to diminish or squelch the strengths. And so, leaning into that in any way that we can. So, I think of Roblox and Minecraft and these different interests that, you know, depending on the year, it's like the flavor of the year for, for a lot of these kiddos. So is there a way to use that to make social connections, whether it's through a club or a class, you know, at school, finding ways to capitalize on interests and strengths, but then expanding on that, whether it's to build skills, whether it's to socialize, so that the child feels confident, feels a sense of competence or doing something they like, they're comfortable with, but then can grow from there.

 

I think that's really, really important. We think about all of the negative feedback a lot of times that these kids are getting for behaviors or for not following directions or whatever it is. That sense of confidence and self-esteem is huge, super important, I think for a lot of these kids. 

 

Jill Stowell: I love that.

 

Dr. Lindsey Sterling: Kids can go in so many different directions. Feel free to chime in. Yeah.

 

Jill Stowell: I love that idea that we can look at our kids and we want them to know how to be social and to have friends and be able to keep friends and sometimes it's easy to make that jump to what we know and I like what you're saying is start where they are. Start with something that they're really good at, that they understand well and expand that to help them, you know, build some of those other skills.

 

I feel like when you say it, it's kind of like well, of course, but in practice, I don't think that's how we always think of it and I really love that. 

 

Dr. Lindsey Sterling: Yeah, I think it's important. Socialization for sure. Finding that commonality and being able – because it's like one less thing that you have to make the leap with. It's like, okay, that part is taken care of. You have that common language and so it should be easier to form relationships around that, but I think it expands to other areas too. You know, I was talking to an executive functioning tutor a while back who thought this was a great idea.

 

So, I am stealing it from her, that her first couple of sessions are actually about the child teaching her skills, whether it's about Minecraft for example or coding or whatever it is because it's important if we're expecting a child to learn skills and to listen to us and to practice things, that they also start off feeling confident and competent and able to even take that on and to be able to even listen to it. 

 

So, allowing them first to be an expert and to teach and then we learn about how their brain works. How do they teach? How do they break this down? What excites them. Where can we join with them so that then they're open to learning different skills and that can be in one-on-one tutoring but I've also seen really wonderful teachers allowing this in the classroom.

 

So, I think of Minecraft because this comes up so much but, you know, doing poetry. Not all kids want to do poetry and that can be hard to motivate but if it's about Minecraft. Then, they're open to learning those skills and practicing. And why not. Why not allow them to use their interests and what they're confident in to then apply it to other skills and I think that that's where we can be really flexible as providers, as teachers, in sort of meeting the child where they're at and then building on that instead of expecting everyone to learn the same exact way and to be interested in the same exact things. So, I think that that can expand even from socialization but to other types of learning as well. 

 

Jill Stowell: Absolutely. You know, one of the things that we have been so aware of working with all kinds of students with neurodiversity is that we have to help the child to become regulated before we can really start to change a behavior or even to build academic skills. If a child is overwhelmed or anxious or rigid or shutting down, you know, we cannot come at them with logic or consequences because their nervous system isn't available for that. It doesn't feel safe and so we have learned over the years that regulation has to come first and we have to – you know, we work with kids with underlying what we call core learning skills, just helping them to get in their body and be able to move with ease and learn what it feels like to settle themselves, what feels settling to them because a lot of times they don't know. 

 

Do you have any thoughts or advice around that whole issue of regulation and recognizing the place it has in any kind of instruction or guidance we want to give them? 

 

Dr. Lindsey Sterling: Yeah, and that is such a great point and it makes me think about what we were talking about in episode one about that threshold being lower. So, if there's also sensory overload and things that are more specific to neurodiversity going on, then it makes that regulation piece even more challenging and complicated because any of us can relate to that. But think about these additional complexities and factors that are piled on to this child, for example, and you're so right.

 

We see this in therapy when we teach. There are all these wonderful approaches, let's say to, you know, dysregulation and a child becoming really frustrated. We work on frustration tolerance and we'll talk about deep breaths or we'll talk about this rocket ship blasting off and we don't want to get to the blast off. We want to be able to recognize that when our bodies are still on the ground and it's just kind of rumbling and I've had kids later as they get older, tell me, “There was no way I could do that. I was too upset in that moment that I couldn't even …”

 

Like that's great, those strategies. But to your point, how do we get their bodies regulated so that they can even be receptive to some of those strategies? And we can all relate to that when we're so frustrated and somebody tries to give us some sort of logical advice and we're like we're not ready for that. We just need to first be able to regulate and I think that that's overlooked a lot of times because again of those expectations. Kids are expected from a very early age to be able to walk into a classroom and sit crisscross applesauce and keep their bodies together, even if there are all of these distractions and sensory overload and maybe they didn't eat breakfast for some reason because of sensory issues or because they wouldn't put their socks on that morning and then the seam of the sock is bothering them and then they're still sitting there and they're supposed to be regulated.

 

So many factors and I think depending on the context, there are different ways to get at this. In the classroom, we've talked about really simple things actually like, you know, knowing the warning signs, helping the teacher see the warning signs and suggesting to go outside and drink some cold water. Like real physical things that help to regulate someone's body when they're not able to use those cognitive resources and the cognitive resources that I mean by that are those strategies that we're taught. Try this, take a deep breath, the things that we can't access when we're really dysregulated. Sometimes it means doing something to really physiologically bring our body down.

 

So, something like getting cold water, taking a second outside, having a place in the classroom that's lower sensory stimulation with pillows in the corner. I've had some really wonderful teachers who anticipate this and before having a long sit-down instruction, they do these different wiggle activities and dances in the classroom and they run around the field, something to get those wiggles out ahead of time. I've had families who in the morning, they have their kids swing outside for five minutes before carpool or walk the dog around the block.

 

I think a lot of the physical activity is sometimes more important in those moments than – and I'm sure other people would argue with this, but more than some of those cognitive strategies that kids aren't ready to access in those moments and that even translates to what we were talking about earlier about a kid coming home and it's time to start on homework. Do they need to do something to just kind of help with their regulation first and their nervous system first to get some of those wiggles out to take a break and then come back to homework, which a lot of people say don't do that. Just go straight to homework. But that doesn't work for every child.

 

Until they're able to recognize those cues in themselves, I do think the onus of responsibility ends up falling on parents and hopefully teachers and providers to be able to help them recognize that. As they get older, we've even suggested accommodations like for a middle school or a teen, for example, to put like a colored card on their desk and the teacher knows they just need to go get some fresh air without making a big fuss and raising their hand. But I've had kids who they know this deep down even if they don't know how to articulate it. Like I've seen kids in elementary school where the teacher says they go to the bathroom 10 times a day, so they've started losing points or they have to pay to go to the bathroom. And then when you talk to the kid, they're like, “Well, I just needed a break. I just needed to go for a walk.”

 

How do we work that into their accommodation so we can help them anticipate that because they know somehow. Like they know that they need to leave the classroom to regulate. So, I think that there are so many different ways that we can get at that. These are just a few examples, but I love that you brought that up because I think it's at the core of being able to even access the strategies that we teach along the way.

 

Jill Stowell: Right. And, you know, we have to think of behavior as communication. And, you know, there's behavior that's really frustrating. And in a classroom or, you know, when you're trying to get things done at home, you know, and you have all these things that you're juggling, the behaviors can be really hard. But behavior means something. And so, when we can shift from why are they doing this to what is this behavior telling me, that makes a huge difference. And when you talk about the kid that gets up over and over and over to go to the bathroom, well, yeah, they need a break. They're bogged – they're probably just about jumping out of their skin and finally they have to do that. And physiologically, you know, it's kind of an amazing thing, but walking down-regulates our nervous system.

 

I mean, it's just built into us. And so, you know, they don't even know that, but their system knows that they need that. And so, if a teacher sees that, or, you know, a parent during homework, it's so frustrating. You're trying to get the homework done, and they're popping up and down and up and down and up and down. What does that tell you? They maybe do need to go run around the block a couple of times, or do something physical to release and settle the nervous system. 

 

Dr. Lindsey Sterling: Yeah, that's such a good way of putting it. And I love that you brought up that behavior is communication. That is the assumption that I hope we're all working from. And I think this is where we come back to this idea of psychoeducation, and helping the community understand what these behaviors are. 

 

I still hear a lot of words from teachers, from providers who, to your point, it is frustrating. Oh, my gosh, having 25 kids in a class, or I know I only have two kids. But if we're in a hurry to get somewhere, and one of my kids is behaving in a way that prohibits us from being on time, I am not my psychologist, patient self. And I'm sure that I overstimulate his nervous system because I'm so frustrated. And, you know, they can feel that.

 

I say that because I don't want to blame anyone for acting in that way, because we're human. But I think you're right. When it comes to kids, I hear these words like oppositional, or defiant, or disrespectful. And it's true, any child has the capacity, I guess, to have those intentions. But if we go with the assumption that they're trying to communicate, and no child is trying to be bad. But what we see on the surface, what we see with that behavior, it's just a representation. It's a reflection of what they're feeling inside. It's why I – and maybe there would be pushback against this from people listening, but I rarely have ever diagnosed oppositional defiant disorder. I just don't find it helpful.

 

It's describing the behaviors that we see, and putting this negative label on a child as if they have intentions to be oppositional, without trying to understand what's driving that. What is the mismatch? There's a mismatch between our expectations and what the child is capable of doing at the time. And sometimes a child knows that. It's like what you were saying about going for a walk. That child knows he needs it or I can't remember where I read this anecdote of a child refusing to do a writing task. And it just looked like total oppositional behavior, just saying no,refusal, refusing. And so, the teacher feels like this is so disrespectful, this is what's expected in the class. And later, when talking to the child, he said he didn't want the volcano.

 

And so, you know, when they were asking, “Well, what's the volcano?” Well, when I try to write, I get so frustrated that I erupt like a volcano. And I didn't want that to happen in class. And so, I just avoided doing it. So that's actually not being disrespectful. That's not being oppositional. It's trying to protect himself in the class. But we’re not always privy to that information. And so, all we see is what's on the surface. And it can be really infuriating. But at the same time, we have to try to understand why there is a mismatch. 

 

Why are our expectations not matching what they can do in that moment? What are they trying to communicate? And how can we help? How can we support them? 

 

Jill Stowell: Yeah. Wow, that is a great story to just, you know, help us really understand that what we see on the surface isn't really a complete picture. 

 

Dr. Lindsey Sterling: Yeah. And as kids get older and adults, they can articulate that. But when they're young, it's just the behaviors.

 

Jill Stowell: Right. 

 

Dr. Lindsey Sterling: It's hard. It's hard for them.

 

Jill Stowell: And so that when they're young, I mean, that definitely takes a lot of observation on the parent’s part and the teacher's part. Just over time, what are the things that yes, the child can do, but I see that they're exhausted afterwards? What are the things that are zapping their energy? And what does that look like 30 minutes later, or, you know, just having that picture, so that we can help them along the way. 

 

Dr. Lindsey Sterling: Right. And to circle back to our topic from part one, sometimes the brighter the kid, the higher the intellectual capacity, the more there is that judgment that I see.And I hear those words. I hear, “Well, we know you can do this. We've seen your test scores. We know that you're capable. So, you're choosing not to.” And that could be true. But why? 

 

Jill Stowell: Right.

 

Dr. Lindsey Sterling: Right? Why are they choosing not to? What is it that's so hard in that moment or uncomfortable? Are they so dysregulated that they can't even focus on the first problem in their homework? And what's so hard is it is different for every child. I've seen parents with two kids on the spectrum, and they're each totally different. And so, it's really hard. And again, that's why there's no blame on parents, providers, teachers. We're all just trying to figure that out. And it's a moving target. We think we have it figured out. And then our child changes. So, it's really hard. We just have to do the best we can to try to get at that information and get at what's happening underneath. And it's usually not until they're regulated that they can even begin to articulate that. 

 

Jill Stowell: Right, right. And as you were talking, it made me think that, as a parent, or a teacher, it might come to mind, okay, I can see that they're frustrated, and they're digging in, and I can accept that that means something. So, does that just mean that I don't ever expect anything of them that I just say, “Okay, well, then we won't do that”?

 

Dr. Lindsey Sterling: Right. That is the key. I think that that gets to this really complicated question about accommodations, about expectations for kids. And in an ideal world, there is a balance here where there's some flexibility. And I've talked to parents about this and kids about this, too, that we can understand, we can learn and try to understand why you did X, Y, Z, or why you dug your heels in and couldn't do X, Y, Z. 

 

And yet, in a classroom, there is the expectation that you need to do this. So how do we meet, how do we meet that child so that we can help them be successful, because accommodations and understanding doesn't mean an excuse to not do things. And that might be a contentious topic, probably depending on the school or your viewpoint. That might be different.

 

But at least for a child in public school, if we wanted to think about those kids, there are those expectations. We can only be so flexible when there's so many kids in a class, and there are milestones that need to be met and assignments that have to be turned in. This is a really hard job for teachers and parents to figure out how to accommodate and support and understand and be patient. And say, right, but then we need to get it done. And I think that's like the – if we talk about the gazillion dollar question, that's another one. It's because it's different for each child. And I think accommodations in school, things like giving extra time or preferential seating, those are all important. And I certainly advocate for those. 

 

I wish that there was also then the skill building. I wish that was part of the accommodations. I wish there was like a whole other class they could go to. Okay, you need extra time on a test.How can we help with that? So that it's not just always getting extra time, but so that we learn how to regulate at the beginning, and we learn how to strategize, and we learn how to tune out the things around us. I wish it was combined. And sometimes it is, but I wish it was always combined with learning the skills at the same time.

 

Jill Stowell: You are absolutely speaking to my heart here because accommodations can absolutely be helpful and so we need to be flexible around that and creative around that. But going deeper, we also want to directly strengthen foundational skills. And there are so many of them and you mentioned a number of them. I think of things like auditory processing and regulation and language comprehension and executive function.

 

And I think this is really important because while we definitely want to provide support for our children, we also want them to be able to be as independent and comfortable in the world as they can be. And so, building or strengthening foundational skills is different than providing accommodations or workarounds or support. It's really putting skills in place for the child that changes how the future is going to look for them.

 

And an example might be strengthening auditory processing, so that the language that they're hearing is perceived more accurately and completely, and therefore makes more sense to them. And that allows them to respond more easily. And that impacts their communication and their relationships for life, not just for today.

 

So, it's that balance of, we're going to support, we're going to accommodate, we're going to be flexible, and get underneath the surface. 

 

Dr. Lindsey Sterling: Yeah, that's so well said. And ultimately, that makes the child feel better, because they're empowered and they have that autonomy. And we see this as kids get into middle school and high school. Unfortunately, a lot of them don't want to use their accommodations. We've worked against that a lot. They don't want to advocate for themselves. They don't want to stand out. They don't want to feel like they're cheating in some way, or that they're given special treatment.

 

And so, accommodations, again, I always advocate for them, because if anything, it's at least, you know, people recognizing that the child needs extra support, and that we need to be flexible with their learning. But they only go so far.

 

Jill Stowell: Right.

 

Dr. Lindsey Sterling: Right? And are they going to get them at work? Do all jobs have accommodations? I mean, I don't know. Like, I think we're still trying to figure that out in our world, in our society and community. And so better to have the child be mastering these skills in the way that works for them along the way. Yeah.

 

Jill Stowell: So, let's think about meaningful progress. What does meaningful progress look like at school or in therapy or in general for kids on the spectrum? 

 

Dr. Lindsey Sterling: Yeah, this is another one that depends so much on the child and what the goals were and the family values. I think it's such an interesting question because meaningful progress to some people might be excelling in school and getting good grades with minimal support. And for other people, meaningful progress might be making friends and having a social group.

 

So, I think it really depends on what those values are for the person and for the family and what they see as progress. I think that there are really concrete ways of measuring progress, like grades, like need for accommodations or how much support does somebody need? But then there are those intangible ways of measuring progress. Like we were just talking about, like developing autonomy and a sense of self-competence and confidence and self-esteem and feeling connection to people and developing insight, being able to articulate what is happening beneath the surface. Those are all meaningful markers of progress also.

 

It just depends, I think, you know, if a child is working on pragmatic language skills, then having those reciprocal conversations is a measure of progress. So, it really depends on what it is that we as providers and the family and the person themselves feels like is the most important thing. And sometimes that's even how we help families prioritize. We'll give eight recommendations of a group and therapy and maybe medication management and intervention and a learning center. And how do we help them prioritize what's more important? 

 

Sometimes it's based on what's interfering most at that moment. And sometimes, again, it goes back to the family values and what they feel like they want to focus on in that moment, because we can't do everything at once. And I sometimes have to tell parents, like, not everything's an emergency too. So, it's focusing on the goals that feel the most important, and that's how we're going to end up then measuring the progress. It really depends.

 

Jill Stowell: You know, I was thinking back to the example you gave of the child going to the restroom all the time, during class, and even awareness, an increase in awareness, a child who used to do that, who starts to say, “I need a break,” we try to teach our kids to recognize when they need a brain break, or a body break. And to be able to say that, even to be able to recognize and say, “I need a break.” That's progress.

 

Dr. Lindsey Sterling: It is.

 

Jill Stowell: That increase in self-awareness. And also, I was thinking about when things become less effortful. That's progress. Yeah, maybe you can do something, but it takes a tremendous amount of effort.

 

Dr. Lindsey Sterling: For the parents too. 

 

Jill Stowell: For the parents too. 

 

Dr. Lindsey Sterling: Yeah.

 

Jill Stowell: Exactly. Exactly. And so, when you start to see, wow, dinner is less effortful for us than it used to be. 

 

Dr. Lindsey Sterling: Right, getting out of the house in the morning. Yeah.

 

Jill Stowell: Yeah, yeah. So, if you could fast forward 10 years and speak to parents who are worried right now, about their kids, what would you want them to see about their child's future? 

 

Dr. Lindsey Sterling: Yeah, this comes up a lot. Because, again, I can relate to this as a parent.We all want a crystal ball. We all want to know that our kids are okay.

 

I think that as time goes on, a lot of the kids who I see, they start to find their people around their interests, around their values, around whatever it is, the neurodiversity that they're experiencing. I think that that's hard in elementary school. It's hard in middle school. That starts to get a little bit easier as time goes on, feeling more comfortable and finding the people who they can relate to. And also, a lot of times these interests that feel really intense, they start to feed into more formal education and potentially a job.

 

I think that that's helpful for parents to know. We've actually seen that happen for a lot of our kids. But my hope, I think, on a broader level is just again, that understanding, that understanding in the community and society, taking away the shame for parents. You know, we worry so much about how our kids are behaving out in the wild, or with us. And I think my hope, I would say, is that as there's more understanding psychoeducation – but even in the media, I think that TV shows and movies are starting to portray some of these nuances a bit better.

 

My hope is that there's more understanding so that their child doesn't feel isolated. And I see that happening. I see that happening, that there's more of that community that's starting to be built around a lot of our kids. And hopefully that helps them feel more accepted and that they can be themselves, they can be their authentic selves moving forward.

 

Jill Stowell: Well, that is very encouraging, all of that. And 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, 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: Great. Well, thank you again for all you bring to this field and to families and for sharing your wealth of knowledge and your heart with our audience today. Thank you.

 

Dr. Lindsey Sterling: Thank you for having me and for prioritizing this topic that I think is so important to parents in the community. 

 

Jill Stowell: Absolutely. 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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