Dr. Amy Marschall: Accessible, neurodiversity-affirming mental health care

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“We tend to frame neurodivergence not as ‘How are you doing?” but ‘What problems are you causing for the adults around you?’ If you’re not causing problems, then you must be fine.”

Dr. Marschall has been a licensed psychologist since 2016. She’s a clinical advisor for ADHD Online, and currently owns a private practice, RMH-Therapy. Her clinical specializations include trauma-informed care, neurodiversity-affirming care, rural mental health, and telemental health.

Dr. Marschall is the author of several books, including her most recent children’s book about Slipper, a neurodivergent penguin, and the soon-to-be-released A Clinicians Guide to Supporting Autistic Clients.

We discuss what the term “neurodiversity affirming” means when it comes to the treatment of Autism and ADHD, and we discuss the ways in which Dr. Marschall is working to make telemental health more accessible for neurodivergent clients.

We talk about some of the challenges she faced when seeking her own diagnosis of Autism a few years ago, and we talk about the current and future landscape of telemental health, and how to find accessible, ethical online therapy.

Website: resiliencymentalhealth.com

Twitter: @DrAmyPsyD

https://www.facebook.com/DrAmyMarschall/

Links & Resources:

Slipper the Penguin: A Story About Embracing Neurodivergence by Dr. Amy Marschall

Dr. Marschall's Slipper stuffies on Etsy

Pre-order A Clinicians Guide to Supporting Autistic Clients by Dr. Amy Marschall

Read Dr. Marschall’s blog about North Dakota’s Autism database

Follow Supernova Momma

A Change for Better

Enjoy!

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Dr. Amy Marschall 0:00
A lot of treatment goals for neurodivergent people, kids especially, but everyone really focus on again, you're identified because you were inconveniencing the adults. So your treatment is to make you stop inconveniencing the adults instead of here are the things that you struggle with how do we support you to have the best version of your own life?

Katy Weber 0:25
Hello, and welcome to the women and ADHD podcast. I'm your host, Katy Weber. I was diagnosed with ADHD at the age of 45. And it completely turned my world upside down. I've been looking back at so much of my life, school, jobs, my relationships, all of it with this new lens, and it has been nothing short of overwhelming. I quickly discovered I was not the only woman to have this experience. And now I interview other women who liked me discovered in adulthood they have ADHD and are finally feeling like they understand who they are and how to best lean into their strengths, both professionally and personally. All right, before we begin, I would love to share with you this review from a listener on the Apple podcast platform, their name looks like a bunch of randomly typed in letters, it's g g WYINDDT g 123. And if that is your actual name, I apologize for assuming otherwise. Anyway, the review was entitled My favorite ADHD podcast as a late diagnosed woman and small business owner. This podcast has helped me so much over the last 15 months. Honestly, it's the only ADHD podcast I have stuck with due to the highly valuable experiences shared by both Katie and her guests, as well as the confidence and pace of conversation. I'm now exploring an autism diagnosis and would love to hear more ADHD autistic women interviews, if possible. 10 out of 10 would recommend lol. Well thank you for this review. I really, really appreciate the time and effort it takes to stop what you were doing and put your thoughts into words like this. And you are going to love today's interview because we talk a lot about ADHD and autism and the diagnosis process as well as best practices with assessment and treatment. So stick with us today. Okay, here we are at episode 176 in which I interviewed Dr. Amy Marshall. Dr. Marshall has been a licensed psychologist since 2016. She's a clinical advisor for ADHD online and currently owns a private practice R m h therapy. Her clinical specializations include trauma informed care neurodiversity affirming care, rural mental health and Telemental. Health. Dr. Marshall is also the author of several books, including her most recent children's book about slipper a neurodivergent Penguin, you can find a link to that in the show notes. And there's also a link to her Etsy store where she sells slipper stuffies. They are unbelievably cute, you have to go check it out for yourself. And she also wrote the soon to be released a clinicians guide to supporting autistic clients. And there's a link to preorder that book in the show notes. Dr. Marshall and I discussed what the term neurodiversity affirming means when it comes to the treatment of autism and ADHD. And we discussed the ways in which he's working to make telemental health more accessible for neurodivergent clients. We talk about some of the challenges she faced when seeking her own diagnosis of autism a few years ago, as well as some of the challenges for clients when seeking autism diagnoses. And we talk about the current and future landscape of telemental health as well as how to find accessible ethical online therapy. It's the wild west out there. Alright, without further ado, here is my interview with Dr. Amy Marshall. Welcome Dr. Amy Marshall, it's great to have you on the show. Thank you for being here today.

Dr. Amy Marschall 3:49
Thank you for having me.

Katy Weber 3:50
I will admit, as I was doing a little bit of background research, I couldn't keep track of all the organizations that you are affiliated with. So yes,

Dr. Amy Marschall 3:59
I'm very busy.

Katy Weber 4:03
which is no surprise on this podcast. So I initially found out about you through ADHD online. You're the lead psychologist there Correct.

Dr. Amy Marschall 4:13
I'm one of their psychologists and I'm also a clinical advisor. So basically, I do a number of the ADHD assessments for ADHD online and then I also do like if another psychologist needs to consult on an assessment you know, the assessment is kind of a living document we're kind of always updating it always trying to make it better. I come in and I say you know wording the question this way is better or or tweaking this or you know, those kinds of things. Awesome.

Katy Weber 4:45
Amazing. Such I love ADHD online. I love everything that they're doing.

Unknown Speaker 4:51
Yeah, me too, obviously.

Katy Weber 4:56
But Okay, so first of all, I want to hear about your diagnosis. A story because you are certainly not the first or the last clinician I've interviewed who worked with ADHD and autistic children for a long time before connecting the dots in your own life. So you were diagnosed not that long ago, what, two years ago? Right. 2020. So about three years now. Okay.

Dr. Amy Marschall 5:18
Yeah. And during the pandemic, I kind of hit my, you know, something's something's up here.

Katy Weber 5:26
Right. Well, I think you had talked about it. I think I'm Lindsay's podcast about the, the need. Surpassing the resources. Right. Yeah.

Dr. Amy Marschall 5:35
When demands exceed resources, that's when we see things popping up.

Katy Weber 5:39
Right. And, you know, it's so interesting to think about, like, what is the catalyst that led to the diagnosis? Because for me, it was the pandemic. Absolutely. And, you know, I think most you know, perimenopause, all of those types, you know, times when women tend to get diagnosed. So what we're having worked so much with children, and now adults, like, what were some of those things that you were most connecting to where you thought, Okay, this is definitely something to look into. Well, I was just, I was having more

Dr. Amy Marschall 6:06
trouble kind of zeroing in on and like finishing what I start, you know, the trail of incomplete projects behind me was starting to include things that really couldn't be left behind me. And I got, I got a lot more hyperactive as well, just not being able to sit still, I think some of that it's less about demands exceeding resources. And more about before I went fully telehealth, I was working with a lot of little kids. So a lot of the therapy I was providing was play based. And so I was always moving around. I gave it up at some point, but I used to wear one of those steps, watches, and I could get three to 5000 steps in one session, depending on what the child wanted to do that day, or depending on what direction our session took. So I think a lot of it was just my environment. And my my lifestyle, and my career just made it really easy to get by. And it didn't look like a problem.

Katy Weber 7:03
Yeah, right. One of the things you said in an interview recently, that was so I just found was so profound and so beautifully articulated what's wrong in assessment these days, right? Where you were talking about assessment of autism should be less about determining what it looks like to an observer and more about asking what it feels like to be an autistic person. And I feel like you could definitely say the same thing for ADHD salutely.

Dr. Amy Marschall 7:32
I mean, I will say, when it comes to the assessment side of things, I don't think either is really done fantastically, I think we have a lot of work to do as a field. But for example, one of the assessments that we give when we're, well, not everybody gives this but I use the Connors for ADHD assessment with kids. And that's, that's a pretty popular, it's well validated. A lot of people like it, and kids starting at age eight can complete a self report form. So as long as the child is at least eight years old, they're telling me, here's what my experiences, here's what's going on inside of my brain and my body, versus that I have not been able to find an autism rating scale. For children that even has a self report form that the equivalent to the Connors has parent and teacher, but there's no option for self report. So essentially, you know, kids are getting diagnosed and most of the information, we just assume that they're not going to provide it, we're going to go off of what adults are saying about them. And observational information is not irrelevant, but it's definitely not the whole picture. And it's a pretty huge oversight that we just just standard to prioritize. And even for adult assessments, ADHD and autism. Again, I find this more with autism than ADHD, but happens with both but really prioritizes what we call collateral data. So a lot of providers will say, Well, I can't assess you unless you will let me talk to someone who knows you really well, and I can get their perspective on your symptoms. And, again, that information can be helpful. There's an adult's equivalent of the Connors the it's actually made by the same people, the Connors, adult ADHD rating scales that has an observer form that I absolutely use, but there's a lot of, well, the observer didn't see the symptoms that you're reporting. Therefore, I'm not going to diagnose you instead of the observer didn't see the symptoms. You're reporting. Let's talk about masking or for autism evaluations. I mean, I was I was actually assessed for autism twice because the first time they said that I clearly did not have it. And some of that was based on that they talked to my husband, and he gets along with me just fine, which apparently, autistic people can't get along with their spouse, I don't know. I don't know. But they specifically mentioned me being married. And they said that most autistic people aren't married. And I'm like, Well, I know a lot of autistic people who are married. That's kind of a crappy thing to say to someone. Yeah.

Katy Weber 10:14
Well, and I think it's all of that. I don't even know what it's called success. Stigma always seems to come out with that idea of like, you can't possibly have ADHD, you can't possibly have autism, because you have a graduate degree, or you can make eye contact, or you can have relationships or all of those things where it's like, so basically, all the good thing, all the positive aspects of my life or evidence that I couldn't possibly have this till

Dr. Amy Marschall 10:39
recently, unless you were failing school as a child. They wouldn't diagnose you with ADHD at all that it was considered if you have ADHD, you cannot be academically successful. And yeah, ADHD impacts learning. And yes, many people with ADHD do struggle in school, but it's not a requirement.

Katy Weber 11:01
Yeah, I've talked about this on the podcast before because, you know, I have a son and a daughter. And so I was diagnosed before either of them. And when I was diagnosed, I immediately looked at my son and said, Of course, this is ADHD, I saw so many similarities and how he and I learned in school and, and I didn't do tremendously in school, I basically was kind of a, an A, or an F kind of student. But my daughter, I'd never thought she had ADHD. And immediately, you know, she does very, very well in school, very, very high achieving, perfectionist. And then when I started the podcast, and I started having these conversations with women who were diagnosed in adulthood, and seeing that pattern over and over and over again, a really, really high grades, perfectionism, people pleasing, high anxiety and that white knuckling element that I looked at her and thought, Oh, my goodness, yes, that's her to a tee. And I was trying to explain this when I was getting accommodations for her in school trying to explain this to her the school psychologist and the her teachers during the 504 meeting, because she was getting 90s. Right? And so they were kind of like, why are we here? Why do you need accommodations if your child is succeeding academically, and it just felt like there was no language around? At what cost? You know, it was like all they seem to care about was that Oh, accommodations are for kids who are not getting the grades. And it was just it felt really surreal to be in the room that voted him to speak like, no, there's actually, you know, the fact that she comes home and cries if she gets a 75 is not necessarily like a good thing. It's not good for her mental health, but mental health doesn't seem to come into that feels

Dr. Amy Marschall 12:41
like they want her to tank her grades. Well, I

Katy Weber 12:45
think it's again, is that evident, you know, when we look for evidence, quote, unquote, in childhood, we're just looking in all the wrong places a lot of the time for girls, especially that

Dr. Amy Marschall 12:55
for well, this happens for adults, too. But for kids, we really frame any neuro divergence as what problems are not not how are you doing, but what problems are you causing for the adults? And if you're not causing problems for the adults, then you're fine. Right. And that segment, a lot of that, I mean, this could be a whole other rants, but you know, you get the, you know, kids these days, which first of all, we've been literally saying for 1000s of years. But second of all, you get the there's been an emergence that I think is a good thing with like the positive discipline, gentle parenting, attachment focused parenting that really moves away from a lot of punitive ideas that have been really prevalent for a long time. And you get the people who say, Well, I would never have acted out like that when I was a kid. And I always Oh, why not? Oh, I wouldn't dare because my father would have would have what? What were you scared that your father was going to do that that child doesn't have to be afraid of? Because I think this is better.

Katy Weber 14:03
Right? Yeah, I know. We talked with my husband and I talked about that with food pickiness because he and I grew up at the generation where like you did not you, you clean your plate. It didn't matter if you liked what you were eating or not. You ate it at all. And so as parents, we were kind of like our kids are spoiled. They don't touch. You know, like we were looking at it in such this antiquated way and really had to change our thinking around the relationship that they were having to food. And I was like, oh, yeah, no, I had all sorts of sensory issues. I just had to ignore them and push through. Yeah. So I really I am so excited about the clinicians guide to supporting autistic clients that's coming out in April. Can we talk about it because I mean, I'm sure my podcast listeners are tired of hearing me talk about this, but I'm I'm in grad school right now to become a mental health counselor. And so it's really, really fascinating to me how How neuro divergence just isn't part of the curriculum. And, and yet, I'm seeing it everywhere.

Dr. Amy Marschall 15:08
It's all about stop it.

Katy Weber 15:10
Right? Well, and not only that, but like, I'm seeing so many like every case study, it's like I'm diagnosing every single case study with ADHD, their, like former teacher, you know, retired in depression and anxiety and retirement. I'm like, oh, that's clearly ADHD, you know, like, I'm seeing it everywhere. And I'm like, Am I missing something? Or is it just everywhere, and nobody's talking about it. So I love the fact that you're actually doing some of these really sort of specific treatment, not only treatment recommendations, but I think also, you're just this idea of like, not necessarily moving away from treating autism and ADHD and more of like neurodiversity of your nerve divergence affirming. And so can you talk about like, what is the difference there?

Dr. Amy Marschall 15:54
So I know the book has specific recommendations. And that's kind of I'm kind of a mixed on because, first of all, people want tools. People want actionable. counselors, therapists, psychologists are always like, okay, but then what should I, I'm in a session, what do I do right now, and I get that, and it's a marketing thing. But I'm also like, it's less about do XYZ, neurodiversity or neuro divergence affirming. Mental health care isn't about what specific tools you use in this session. It's about your overarching philosophy and your overarching approach to treatment, which is shifting away from this pathological medical model of something is wrong with you that we need to fix, and more about embracing the fact that so neuro divergence is the people whose brains fall outside of that neurotypical umbrella. You know, there's no such thing as normal, but this is like what society expects from you. And the neurodivergent people are the people whose brains don't automatically conform to that. And neurodiversity is everybody. So we're, you know, neurodiversity is the fool has includes everybody neurotypical neurodivergent. Like we're all we're all part of neurodiversity, but only about, according to the CDC, only about 20% of us are neurodivergent. So our brains don't fit the expectation, which is probably why that's the expectation, it is the majority of people, but that doesn't mean we say, okay, 80% of people fit in this box. So this box is going to be the only box that you know, this is the only place that anybody can sit. And so 20% of people are just going to be really uncomfortable. So being neurodiversity affirming is embracing the idea that it's not a bad thing. It's not a problem to be fixed. If you don't fit in that box, like that's okay. And it's okay to have support needs. It's okay, if your neuro divergence disables you, and you can't contribute to capitalism, because why is that the system anyway? It's okay. If your neuro divergence has aspects that make your life better, you know, my my whole, I firmly believe that my business is where it is because of the way that I hyper focus. And because of drive that I don't think I would have if I wasn't neurodivergent. It's not that toxic positivity, this is secretly a superpower. And don't let anyone ever say anything negative, it's like, well, there are also support needs. And that's like holding both of those things. And it's, it's okay, if you don't see your nerd divergence as a strength. But essentially, we're not saying you're bad, wrong or broken. We're, we're just honoring what your needs are. And it's shifting because a lot of treatment goals for neurodivergent people, kids, especially, but everyone really focus on again, you're identified because you were inconveniencing the adults. So your treatment is to make you stop inconveniencing the adults instead of here are the things that you struggle with how do we support you to have the best version of your own life? And so you know, I do come in with here are some specific things you can do and here is how those things can be neurodiversity affirming but the the main message is that shift of the mindset away from we need to fix you to know you're fine you're how do we support you

Katy Weber 19:25
you know, I as a coach have worked with so many women who have said I had a terrible experience in therapy and and I get it because I certainly as somebody who was diagnosed since university with with depression and anxiety never felt like it fit always felt like there was something else happening, but also constantly was wondering what's wrong with me, you know, and I feel like there was a lot happening in therapy that was like much more acceptance based and less dealing with Haven know what I'm trying to say like there you know, sort of that nice find balance between working on that frustration in that executive function and finding those tools. But at the same time, like you said, there's nothing wrong with you, right?

Dr. Amy Marschall 20:07
Nothing wrong. Again, not that toxic positivity of No, nothing's wrong. But just like you're not a problem to be solved. You're a person. Right?

Katy Weber 20:16
Yeah. But I also feel like thinking about like, what are some of the approaches that work really, really well with neurodivergent clients and thinking about that a lot, because the whole reason I've gone from coaching into counseling is because I think there is a lot of toxic positivity in coaching. And there isn't a lot of contextual work in terms of why you are feeling the way you are feeling and what's leading up to that. Right. So I feel like you know, there's a, there needs to be a more holistic approach. But I'm also curious about like, what are some of those unintentional harms that are being done in terms of like best practices? Well,

Dr. Amy Marschall 20:55
when it comes to autism, first of all, the so called gold standard of autism treatment was designed to cure autism and to make autistic kids stop being autistic. First of all, autistic people are more likely to have trauma than the rest of the population and are more likely to have a mental health disorder as a result of their trauma. So I forget the exact number. But is it something like 5% of people have PTSD, but 25% of autistic people have PTSD, and 50% of autistic people who were put through Applied Behavioral Analysis therapy have PTSD. So basically, this treatment that is marketed as best practice and gold standard, if you're listening with audio, not video, I'm err, quoting the hell out of this doubles your risk of developing post traumatic stress disorder, and that's considered the best option, like, sit with that for a second, the best thing we can offer you is going to make you twice as likely to be traumatized. Yeah, but that's the best, and that's what you should do. And, and neurodiversity affirming approaches are also like, by nature, you can't be neurodiversity affirming, and not also be intersectional. In your awareness, you know, it's, it's neuro divergence related disabilities, it's disability justice as the umbrella term of of all the different types of disabilities. It's it's racial justice. It's, you know, gender justice. It's LGBTQ plus justice. If you're not, you know, if you're like, I'm neurodiversity affirming. But you're also still ascribing to really racist ideas, you're not really neurodiversity affirming, you have to be aware of all those different things and the way that all those things intersect, and being aware of the systems issues that contribute to why the system is so harmful. I'm not the voice on this, I just think it's something we should all be aware of. So go listen to other people, not me. But there is discussion in the black autistic community specifically, that we are aware that ABA increases risk of trauma, and also my black son has loud public meltdowns. And ABA will make him stop having meltdowns in public very quickly, and I'm worried a cop is going to come and murder him. And I've seen in in autistic spaces I've seen black parents get screamed at by white autistic people you're traumatizing your child instead of it's pretty messed up, that their choices are increased my child's risk of being killed by the police, or put my child in a therapy known to be traumatizing, but they're more likely to survive into adulthood. Like why are those the options? So it's the whole awareness of how everything intersects and connects in the larger systems that we need to break down for that

Katy Weber 24:03
damn, who sit with that for a minute, right? It's so true, right? Anytime you are surfing along with convention, you should question it and you should think about application and all of that right. And I think there is a lot of that dogma exists in countercultures just as much as it does in traditional color you know, and so I use I see it a lot in like body image and body positivity movement. There's like a lot of dogma there that can end up being you know, feeling really bullying and and exclusive. So wow, yeah, speaking of

Dr. Amy Marschall 24:39
intersectional ism, I follow a couple of physically disabled individuals and I've seen them get ripped apart by the body positive movement, for expressing I get frustrated with things that my body is not able to do. And so like how dare you, we love our bodies. All bodies are good. And it's like I'm not saying All bodies are bad. I'm not saying, you know, I'm not feeding into any that negative like any of that like harmful stuff. But people are allowed to also have opinions about themselves and people are allowed to be frustrated. And people are allowed to narrate their own experience the way that fits for them. And, you know, we're not just we're not just saying this is, you know, this, this aspect is harmful, let's just throw it out. It's, this is harmful. What is the underlying system that's allowing it that's making it thrive? That's making it feel necessary, and how do we get rid of that, and not just this thing is bad. So we throw it out. Like if if it's propping some I mean, I had, before I got treatment for ADHD, I had a lot of anxiety. And that's because the anxiety was propping me up. I call it load bearing anxiety, it was serving a purpose. And as the ADHD stuff has become more managed, I've been less anxious because it was no longer serving a purpose. So what systems like are what what need is this propping up? And how do we meet that need in a safe, healthy, Justice oriented intersectional way so that we can get rid of the harmful system without inadvertently causing a different kind of harm? Because it was It wasn't doing it in a healthy way or a good way, but it was doing something? Hmm,

Katy Weber 26:27
yeah, right. I was just having a conversation with a another guest who is psychologists talking about, you know, neuro divergent anxiety and how oftentimes it's looks very different from textbook anxiety in terms of there's not always worry involved, a lot of it has to do with holding things in your brain and thinking about them all the time, because you're worried about forgetting them, or you're worried about losing them, right? Or you're also thinking about, you know, scripting, and anticipating what's going to happen, like so much of masking is about that hyper vigilance, you know, and so it does again, it's like quest, really, really getting to the root of behaviors and questioning, like, what purpose do they serve? Oh, wow, oh, I'm getting goosebumps.

Dr. Amy Marschall 27:13
They're bad reasons that certain things are in place. Like, the entire approach, like the whole autism industry is we need to, we need to get rid of these people. But it's eugenics like that's, that's where it comes from. And that's bad. And also, they're the systems are propped up, because they end up being the only option, or they end up being my child is my child is stimming in a way that's injuring them, they need to stop doing that. And this resource promises to help with that, or my my child is having public meltdowns, and I'm worried about police brutality, like this promises to fix the immediate issue of keeping them physically safe. And, you know, I'm not I'm not saying that's the good way to keep people safe. I'm saying when you're one person, particularly when you're a parent, just trying to keep your child alive. You're doing your best.

Katy Weber 28:07
Yeah, I know, it reminds me of working with binge eating, you know, when I would work exclusively around binge eating, and I would have parents who would be terrified, you know, that their child was already binge eating. And this is terrible. This is bad. How do we stop it right? And like, the first thing we had to do is acknowledge that binge eating is self care, right? And so can we get to a place before we even begin to recognize that your child is taking care of themselves in the only way they know how right now, so let's appreciate the fact that they are taking care of themselves before we then move to perhaps some healthier options. But yeah, it was like, again, realizing the purpose that these things these behaviors serve. I

Dr. Amy Marschall 28:49
mentioned earlier, like the positive discipline movement, supernova Mama is a voice that I follow within that movement. She and both of her children and I believe her husband also they're all all autistic, and I think there's some ADHD in there. her saying that she always will. She has a lot of things that she says a lot that are very helpful and you know, go follow her. But she one of the things she says a lot is all behavior is communication and all behavior meets a need. So you can't just say this behavior is bad Stop it, you have to say this behavior is harmful because of XYZ. But what are you trying to tell me with this behavior? And what need is this behavior meeting for you? Because when you realize what the behavior is communicating for a need, then you can say, oh, okay, yourself. The binge eating is your self care to meet this need. Okay, here are some healthier skills you can start to build and then you won't have the need to do the more harmful behavior,

Katy Weber 29:53
right, or even just in the context of school and avoidant behavior, right avoidant behavior or No kid wants to do poorly. So you always have to assume there is a barrier in the way, if they're not meeting their own potential, even though I should never say that word because I hate that word, but a lot of baggage around that one. Oh, yeah.

Dr. Amy Marschall 30:16
If they're struggling, if they're having a hard time if there Yeah, the school system either way, is a nightmare for a neurotypical child, and then he or neurodivergent kids in there, and then you're like, why does that like, you know, in hindsight, it's kind of messed up that I, I'll, I'll remember being a kid and people asking me about school and being like, Oh, ha, school sucks, right? And it's like, it's kind of messed up that we just expect kids to hate school, when that's where they end up spending a pretty big chunk of their time. They're just expected to hate it.

Katy Weber 30:50
Well, I feel like as women our entire lives, we're told to lower our expectations around things that suck, right? Motherhood, menopause, you know, all you know, just being around men like coed spaces, like it's always about, like, Yeah, it sucks. There's just such this collective shoulder shrugging around so many elements that

Dr. Amy Marschall 31:14
the guy who like, does next to nothing of consequence, but you're supposed he's Oh, he's such a great man, he doesn't hit you. And it's like, that's the bar. Is the bar.

Katy Weber 31:29
Oh, yeah. But I think about, like intern culture, and all of these ways, where you're sort of like, yeah, you just gotta, you know, you got to grit your teeth, or even, you know, in just talking about, like, practicum. And we, you know, having all these conversations around how you're unable to advocate for your mental health and how ironic it is that practicum is so terrible for, you know, or even just doctors in internships, and you know, and the hours that nurses do, like, it's just books, all of these health care providers who are in these terrible situations for their mental health. And yet, you're kind of like, well, it's bootcamp. That's how you get through it.

Dr. Amy Marschall 32:07
Why did you go into this fields like, Okay,

Katy Weber 32:09
right?

Dr. Amy Marschall 32:10
And then and then. So then they say, if you don't like it, why are you in this line of work? And then they say, why do we have a shortage?

Katy Weber 32:21
On a completely unrelated note, why? shortage?

Dr. Amy Marschall 32:24
You know, oh, yeah, you're, you're a nurse, and you get just underpaid and mistreated all the time. And, you know, people dump on you and you're supposed to just work 12 hour shifts that are rotating. So like, one day, you're working eight to eight in the morning at like 8am to 8pm. And then two days later, you're supposed to work 8pm to 8am. And oh, just do if you don't like it, you should leave. How come we don't have enough nurses?

Katy Weber 32:54
And then, you know, and then you think about it, all the fields that tend to attract people with ADHD are teaching nursing, social work, like all of these careers, where they're paid terribly, and the expectations are for them to be, you know, selfless and angelic at all times. So now, one of the things you talked about, as well in, in the book, in the clinicians guide is advocating for accommodations, right? And kind of what role do clinicians and therapists play as advocates for autistic clients? So

Dr. Amy Marschall 33:28
I'll say, first of all, I'm going to tell you what I feel that role ought to be and it's probably going to make some other clinicians unhappy. This is not necessarily how it is. And not everyone agrees with me that this is how it ought to be. I'm not saying I'm right about everything. I have all the answers. But the way that I see it is we're really taught that we don't know now it's different for social workers. But psychologists at least we're really taught that we don't advocate for our clients, we're there in our role in the office. And we can help teach the client assertiveness, but then they go and they do the rest. And, you know, yes, we should. It's good to teach people to stand up for themselves to get the tools to self advocate. But I also think that it's very important for me to advocate for them as well, because, frankly, there are times that my voice is going to weigh more, because I'm calling as the professional. I'm calling as the person with a doctorate. I'm calling as the person who did the evaluation, and I'm saying no, this is this is what you need to do. And I feel like it's important to advocate for my clients in that way. And some feel like that, that maybe doesn't empower the client to do it themselves. But I feel that you can do both. And frankly, there have been times where I will encourage the client, here's an opportunity for you to advocate and they're just not getting anywhere and I say listen, if you sign a release, I'll make a phone call and then the issue is resolved. All In One phone call. And I don't know why I would put them through making call after call after call not getting anywhere, if I can just call and say, Hey, knock it off, and then it works. Yeah.

Katy Weber 35:11
And I think that also perpetuates this idea that you have to be at your wit's end. Before you can ask for help and or, you know, and then I think that's something that's drilled into us, especially as women, even using the example of my daughter in her high grades and still wanting a 504, the same thing happened to my sister in law and her daughter, you know, they went to her high school to get a 504, her grades are fine. And so she didn't get the 504. And I was like, this is terrible, you need to go back there. And the mom was like, I don't have the fight me. And she was like, you know, we'll just see how she's doing. And if her grades start to slip, then we'll go back. And we'll talk about, and I was all up in arms, because I'm like, we shouldn't wait until their grades slip, because that affects their sense of self. Right? She's struggling now. Exactly. And so I'm like, but I think that it kind of perpetuates this idea that, like, I have to show how much I am suffering before I can ask for accommodations. And I feel like that that's just the the narrative around accommodations is all wrong, because that's where it's like, you don't have to show that you are impaired in order to want to live your ideal. The ideal situation, right? Yeah,

Dr. Amy Marschall 36:21
it's the Yeah, somebody's got it worse. Therefore, I don't, I don't have problems like, Well, no, someone's always got it worse. And that's, that doesn't invalidate what you're going through.

Katy Weber 36:34
I want to get back to the diagnostic criteria, because I had a chuckle when I was listening to one of your interviews, when you were talking about the fact that you were having a hard time getting diagnosed with autism, because you're the one who died in your state. And so you had a hard time finding somebody else. And so, you know, I'm certainly I'm at the place now where I'm like, do I or don't tie with a with a official diagnosis of autism? Same for my daughter? And I'm like, I don't know, if I have the I don't know, if I have the energy to seek it out. It's so difficult. I'm like, What do you notice in terms of adult diagnostic criteria for autism? And like, where do you feel like changes need to be implemented?

Dr. Amy Marschall 37:17
Officially, there is only one set of criteria for everybody, regardless of your like the diagnostic criteria, or the diagnostic criteria. And again, it's very much based on observation, it's very much written how young children tend to look, it's very much written how young white boys tend to look. And it doesn't it doesn't account for First of all, technically, according to the diagnostic criteria, if you can mask, then it's not really autism. And it's like, well, no, that's not how these things work. And I mean, I will say, first of all, I think that self identifying if you resonate, and you're like, Okay, a lot of this really seems to apply to me, that's valid, because it is difficult to find someone to do an assessment, it's difficult to find someone who is going to do the assessment in such a way that they're going to acknowledge, you know, even if you're masking, that doesn't mean you're not autistic. You're going to you're it's hard to find someone who has that neurodiversity affirming approach and has that acknowledgement of here are the limitations of the research and of the history. There's also risks that come with having that in your medical record. I mean, because, yes, discriminating against someone based off of disability status is illegal, but lots of stuffs illegal laws don't matter unless they're in fourth, and it's not a very well enforced law. There are also laws that blatantly discriminate against autistic people, specifically, if they have the diagnosis in their medical chart. Yeah,

Katy Weber 38:56
I remember you talking about this. Yeah.

Dr. Amy Marschall 38:59
Anytime I diagnose someone with autism, I have to put them on a government list. So I won't do autism assessments for people who are in North Dakota, because I don't see how I can ethically put someone on a government list based on their diagnosis. But the law says that they can require it and the law says that I have to comply with it. And If I refuse, they can take my license away, and they can find me $1,000 For every client that I failed to list. So I I don't do autism evaluations in North Dakota and when a referral comes up, I say, Hey, call your reps because I tried I tried calling. I tried emailing I tried contacting the North Dakota legislature. And as soon as they found out that I don't vote in North Dakota, I vote in South Dakota. None of them responded to me, because I'm not a constituent. So I let the constituents know you've got to call. You have to put the pressure on them because they're not going to listen to me being out of state But it's fair to not want your kid put on a government list to not want yourself to be put on a government list because, frankly, they're not very transparent with what they're doing with that information. Supposedly there's a report, but they haven't updated the report since I think 2017. So what have they done with that information for the last six years? I don't know. Well,

Katy Weber 40:23
I like how you're talking about how they're like, we use this information for research. And you're like, interesting, what research there was like crickets?

Dr. Amy Marschall 40:32
Yeah, what are you what are you researching? And they're like autism. And I'm like, first of all, you can't do research on people without getting their informed consent. That's, that's a human rights violation. Like, that's some UN level stuff. By the way, you can email the UN, they won't get back to you, but they have a public.

Katy Weber 40:56
I was gonna say, I'll put some link to North Dakota legislators for anyone who's listening to this who lives in North Dakota and votes in North Dakota. Yeah, yeah.

Dr. Amy Marschall 41:03
Cody pink, is in charge of the autism database. She doesn't answer my emails anymore, either. But she's in charge, and her contact information is public. And according to a letter that she sent the North Dakota Counselors Association a few years ago, she is open to questions. So

Katy Weber 41:23
well, good to know.

Dr. Amy Marschall 41:26
If you have questions about the North Dakota autism database, call or email Cody pinkes. She's happy to answer your question. Right?

Katy Weber 41:34
Fantastic. I'll put that in the show. I'll put that in the show notes. That's

Dr. Amy Marschall 41:37
not whatever instigating harassment because she put that she said, I'm the one you should contact if you have questions. So it's on the internet.

Katy Weber 41:51
Now you're, you're also licensed in New Zealand, which I was like, That's random. How did that happen? No.

Dr. Amy Marschall 41:57
Okay, so in March, well, so I got married in 2019. And in November of 2019, our honeymoon, excuse me, it was on the northern island of New Zealand. And I got connected to this woman. And she was trying to hire a psychologist for a clinic in Wellington. And so I had a job interview on my honeymoon, you know, like you do? Oh, sorry, that no, sorry, I didn't end up getting that one. But after talking to her, I connected with another clinic in Auckland. And they offered me the job and I accepted. And then my husband had found that the organization that he works for has a connection in Auckland as well. So he had applied for that. So in March of 2020, we had both accepted job offers in Auckland. And then the strangest thing happened. I contacted the immigration department and they said, You have to get an immigration physical. And so I contacted my health clinic, and I said, I need to get this immigration physical. And they said, today, we had our first confirmed community transmission of COVID 19. So we're not doing non essential procedures, please call us back in two weeks. So it was a very long, two weeks, and then their immigration office was closed and their psychology board was closed. And, and they said, You know, I was reaching. I was trying to figure out, like, how does this work and the immigration office said, we're only issuing work visas for applicants who are physically in the country. So we need you to basically move here show up. And then maybe we'll issue you a visa to work, but we can't tell you how long that will take. So I had to either we had to either give up those jobs, or basically move to New Zealand with no money and no income for an indefinite period of time until they approved us. But back when it was only supposed to be two weeks, I submitted my application for licensure. Wow, gosh,

Katy Weber 44:00
it's like the what could have been scenario but I mean, you had to admit New Zealand was the only country that didn't fuck up. They're dealing with COVID I feel like they're there. They dealt with it on

Dr. Amy Marschall 44:14
like New Zealand, it actually would have only been two weeks, but Well, it did like I did. It would have only been two weeks. So but I you know, I processed I ended up going nonpracticing. But then I connected with a woman who's actually originally from New York, Ashley, and she's living in Christ Church, and she has a mental health startup. She's a counselor, and basically her vision, which is also now my vision is how do we make mental health care affordable and accessible without shortchanging the providers on their income? Because the solution and we see this in the US as well the solution to I can't afford treatment has just historically been, you got to find a therapist who's willing to just not make a living wage to see you. And then we're called selfish and greedy and evil when we're like, Hey, I can't, I can't make my mortgage payment. If I do that, you know, we're that we're the bad guys, then, you know, it's not that UnitedHealthcare had record breaking profits are that the CEO of Blue Cross makes seven figures a year, like that's not why there's problems. But basically what she she has a platform that she's built to be an A mental health resource, we have all kinds of free blogs and articles. It's called the change for better I just realized that ever said the name. I'm a terrible marketer,

Katy Weber 45:40
that'll be in the show notes. Don't worry, I've got it. Yeah,

Dr. Amy Marschall 45:43
so the change for better has all these resources, there's a bunch of free resources. And then there's also like, there's a, like digital downloads for you know, self led education about mental health books, self led courses on self care, things like that. And then a directory, which right now is new, Zealand's specific, the hope is to be everywhere, but to be able to connect people. And to properly vet, the counselors, and the therapists make sure that everyone has the credentials that they're claiming to have making sure that people are being transparent, getting informed consent about who they're getting services with the type of service, they're getting all of that. And then the change for better fund, we earlier this year, got charity status in New Zealand, and that's when I activated my license from nonpracticing to practicing, because the change for better Fund is a fund. And the goal is if I need services, and I can't afford them, I go to a therapist who the fund has vetted and verified, this person has the credentials that they say that they have this person, you know, practices in a way that's ethical, this person practices in a way that shares our values as an organization. And the therapist can say, my rate for a session is say, $150. And the client might say, well, I can afford $50. And then the fund then pays the therapist $100 A session, so that the person can get the care at the rate they can afford. But the therapist gets paid the amount that they need to be paid to live, we've been using the fund to supplement the cost of assessments, because in New Zealand, there's like a two to three year wait to be evaluated for ADHD or to be evaluated for autism, unless you go the private route, which costs about 3000, New Zealand dollars for an assessment. So first of all, I'm offering it for less because I feel as a provider, as a clinician, that I can be confident about a diagnosis without making you sit through eight hours of testing. Like I feel like I can get it with less information. So I you know, what, why would I make you sit through something that's not essential to figuring out your diagnosis?

Katy Weber 48:04
And just to clarify GPS cannot diagnose a New Zealand? Correct, it has to be a psychologist or psychiatrist.

Dr. Amy Marschall 48:10
Right. Right. Yeah. And, and even in the US, if they don't have the proper training in that specific type of assessment, you know, it's very, there's some limits, you have to have the training to do the testing and to you know, do all it's a whole thing. So what we've been doing and actually, the the funding for my assessments has mostly been me volunteering my time. It's not that the funder is paying me to do these assess, it's that I'm saying, okay, you know, here, I'm basically just doing it sliding scale. But the hope is for the funds to get to the point where other psychologists can join and can get paid, again, a living wage, but people can get an assessment that they can afford. And so that's, that's the dream. And we're getting there. It's been a little complicated because I am licensed in New Zealand, but I never got over there. So it's a little bit weird for people that I'm like, Yes, I'm in South Dakota, but I will be testing you. Like, I have a page on my website about this where we're basically like, I swear, I'm not breaking the law, like, here's my licensing information. Here's the Board's website where you can input my name and see that I am licensed New Zealand requires cultural supervision, which I think is awesome. And I think that we should do that in I think we should do that everywhere. So I have I have a supervisor to make sure that I'm learning the cultural differences and the the things to be aware of. I also have voluntarily got a second supervisor, because a lot of the cultural things that I need to learn are specific to Maori people, which is the indigenous people of New Zealand, and I couldn't find a Maori psychologist And the psychology board wouldn't recognize someone who wasn't a psychologist. So I just voluntarily have a second supervisor so that I can. I'm basically paying a Maori woman to teach me about her culture. So, yeah, so I'm, you know, I'm pretty thorough with all of that. But it's still like, you're halfway across the world, like, what are you doing? And it's like, well, because I feel very strongly about this.

Katy Weber 50:26
So I'm curious about tele mental health, the climate around the landscape has changed so much so quickly, in the last three years since the pandemic, and places like BetterHelp grew out of the pandemic. And now it's like, you know, just I saw your face when I said better help you write it. There's so problematic for the problem.

Dr. Amy Marschall 50:47
I love telehealth, obviously, I've written a lot about it. I've thought about it. And same,

Katy Weber 50:51
I think there's so many positives, it's great.

Dr. Amy Marschall 50:55
But the problem is that again, what's the need, and you know, how is an abusive system being upheld by a need, people need support, people need care. And people need to not have to wait forever to get in. And these platforms promise that and they do they get you in very quickly. But the problem is that they're doing so in a way that's harmful. BetterHelp, earlier this year was fined $7.8 million for selling therapy client data to advertisers. When you signed up to get therapy from them, they took your information, and they claimed they never took information from sessions. But I don't think that that matters, they shouldn't have taken any of the information. But they sold, they sold therapy clients data to Facebook and to other advertisers. And so they profited. They they took people who were like, I desperately need to see someone and I can't find someone available and accessible and affordable. And they took that vulnerability and they sold people's private confidential medical information to advertisers. Yeah,

Katy Weber 52:05
I've heard so many strange, you know, so many anecdotes from clinicians to in terms of the the poor treatment of clinicians from from BetterHelp. to that. I'm like, where do you see telehealth going? Ideally in the next few years, especially when it comes to diagnoses, but also treatment?

Dr. Amy Marschall 52:26
Well and better HELP loan diagnose? And I mean, better health? No, I

Katy Weber 52:32
know, I know, they're totally different. I don't want to lump ADHD online and BetterHelp in the same category, because they're definitely not,

Dr. Amy Marschall 52:39
oh, God, they're not. They're not comparable at all. First of all, BetterHelp. I know they've, they've tweaked this a bit. But BetterHelp was illegally providing services across state lines for quite a while. So I'm surprised that wasn't part of the fine ADHD online has never done that. And I'm happy to pick on BetterHelp. They're not the only platform who has done some terrible things. So they're not the only platform that I that I'm mad at. But telehealth is fantastic for a lot of reasons. I've been doing telehealth in South Dakota since 2016. Because we would have people driving three hours each way for a 45 minute therapy session because we're the closest clinic to them, and telehealth, you don't have to get to my office to be able to be seen by me. You know, if you're in a rural area, you don't have to get to an office. If you're a therapist who wants to live in a rural area, you could do a telehealth practice and not see people in your own town and you can go to the grocery store without running into six clients, you can have some more professional boundaries. And when you do it that way, as long as the licensure stuff is appropriate. You can see someone who specializes, even if you can't reasonably get to their office. You can't You know, I have a colleague who specializes in pastoral mental health who had clients who struggled with you know, I don't What if What if one of my parishioners sees me in your waiting room? And you know, the the privacy, stemming stigma reduction is a whole other topic to address. But in that moment, the client says I'm concerned about who sees me in your waiting room. And you don't say, Well, you just shouldn't you just shouldn't have stigma around your mental health. You say, Okay, well, I can see you from home and then and then nobody's in the waiting room. I work with kids. So kids in families that have a lot of kids don't have to figure out what to do with the siblings. You know, a parent can cook dinner while their child has the session. They don't have to like be sitting in the waiting room. They don't have to get put it's it's fantastic. It just that it has to be done ethically. Like any mental health care. The problem is that the tech, certain corners of the tech industry have seen it as an opportunity for profit instead of seeing it as an opportunity to improve access. to care. And so they're trying to churn out these services that, again, are claiming to be there to meet this very real need, but instead are doing so in a way that's harming people. Yeah. So ADHD online, though I'm, I'm, I mean, I work for them. And I hope my last couple of rants have made it clear that I'm very particular about who I'll work with. If a company doesn't meet my ethical standards, I will not work with them. By the way, speaking of change, for better we actually have, we're finalizing right now, our own ethics code. So basically, we said, here are the ethics codes that we have to follow. And here are the things that we feel our ethics code should have higher standards on. And we said, Follow those ethics codes and also meet our additional standards. So I take that kind of thing very seriously.

Katy Weber 55:52
Oh, and I think that is very evident in the way ADHD online talks about diagnoses and assessment, like just everything in the language to the people I've met in this company. It's head and shoulders above any of the other telehealth,

Dr. Amy Marschall 56:08
we didn't get investigated. Like some of those other companies, like you look into those investigations. There's a reason we're never on that list. We have I haven't I have an email because right after the BetterHelp find news broke. I every company that I work with, I sent an email and I was like, Hey, do you do anything like this? And they were like, Absolutely not. And I was like, I figured that was but I wanted it in writing.

Katy Weber 56:35
Yeah, you know, for a long time, I promoted better health because I felt like the good outweigh the bad, right? Where I was like, there's so much benefit to accessibility, especially in a mental health crisis that we're in. But when the red flags just start piling, like at some point, well, one

Dr. Amy Marschall 56:54
thing is that BetterHelp was kind of operating in a vacuum for a while there was nothing else. So like, I've never worked for BetterHelp. But when I did my, my internship and my postdoc, I was in middle of nowhere, Ville, Arkansas, and I was like, I should probably talk to someone. Well, the only clinic in my town is this one. The only other therapist in driving distance is my boss. So I guess that's not one of the choices. And so I was briefly a client of BetterHelp because it was that was it. Yeah, there were no other options. So I don't know I looked into it the dates that I went are not I'm not eligible for compensation under that fine. But if you've been a better help client look into it, because they're gonna divvy that fine up among all the the affected people. So check, right? Get your class action lawsuit money, like do that. But I yeah, I was a client of theirs. And I was like, for the first thing I noticed, by the way, was that my therapist was not licensed in Arkansas. Hmm.

Katy Weber 57:59
Interesting. Now, do you know of other US based group practices or agencies that are operating more along a change for better in that same same model?

Dr. Amy Marschall 58:14
There are some that are good, basically, which I mean, no hesitant to endorse someone I haven't worked with, because then I get to, like, see all their operations. But you want to look for HIPAA compliance. You want to read the privacy policy. I know, I know that they're just mind numbingly boring, and they're awful. But you want to read the privacy policy, and you want to specifically look at the section on third party disclosures. They have to have basically a statement of we do third party disclosures when it's legally required of us, that's just that's meant all 50 states have mandated reporting laws, if you tell your therapist, that if you're a child, and you tell your therapist someone is abusing you, if you're an adult, and you tell your therapist that you abused the child, it's illegal for that therapist not to report that. So they have to have provisions for that they have to have a note that if a judge issues a court order that they'll comply with the court order. But if they have anything about we sell your information, or we we give information to advertisers or we share information, anything outside of what's legally required, we run away. Now, I didn't write the privacy policy. So I'd have to double check. But there might be like, change for better has a will will sometimes take anonymized data, so they might take like statistics about how many views how many people visited our website from the United States today. And they'll monitor that information for the business's knowledge but that doesn't include that doesn't say, Kenny was on the website that just says X number of people in the United States were on the website and they're like they're very particular about like a na anonymize data, you can do a little bit more with before it gets ethically icky. But when you're selling identifiable data then no.

Katy Weber 1:00:10
Yeah, yeah. Well, it's a fascinating field. I didn't realize I was gonna get so riled up from this. Sorry.

Dr. Amy Marschall 1:00:22
I do that I do that. Yeah. No, I

Katy Weber 1:00:24
love it. And this has been so great. So you, I mean, you have we haven't even talked about the dozen other books you've already written but very excited for this book to come out in April. It's called a clinicians guide to supporting autistic clients.

Dr. Amy Marschall 1:00:39
So that one came out in October. I've got a children's book about neuro divergence that that just came out recently to if we're, if we're plugging my stuff in this moment, I can tell ya,

Katy Weber 1:00:51
is that slipper? The penguin? Yes, yes, I

Dr. Amy Marschall 1:00:54
have. She's on my bookshelf over there. But yes, it's a penguin who who thinks that she's a bad bird because she doesn't fly like her friends. And she learns that she's good at other things. And she can't fly. It's okay that she can't fly. And it's a sweet little story. So we've got plushies coming next year, so

Katy Weber 1:01:12
Oh, I love it. Okay, that's amazing. I feel like penguins are the perfect mascot for Neuro divergence, because they they skirt convention at every turn. So that's awesome. Oh, wonderful. And

Dr. Amy Marschall 1:01:26
yet we love them. And we love them for it.

Katy Weber 1:01:31
Well, thank you so much for joining me today. It's been an absolute pleasure chatting with you. And

Dr. Amy Marschall 1:01:36
it's good to meet you do this, do this again. So yes,

Katy Weber 1:01:39
please Good luck with the book and all the best in the new year. Thank you.

There you have it. Thank you for listening. And I really hope you enjoyed this episode of the women and ADHD podcast. If you'd like to find out more about me and my coaching programs, head over to women and adhd.com If you're a woman who was diagnosed with ADHD and you'd like to apply to be a guest on this podcast, visit women and adhd.com/podcast guest and you can find that link in the episode show notes. Also, you know, we ADHD ears crave feedback. And I would really appreciate hearing from you the listener, please take a moment to leave me a review on Apple podcasts or audible. And if that feels like too much, and I totally get it. Please just take a few seconds right now to give me a five star rating. Or share this episode on your own social media to help reach more women who maybe have yet to discover and lean into this gift of nerd of urgency. And they may be struggling and they don't even know why. I'll see you next week when I interview another amazing woman who discovered she's not lazy or crazy or broken. But she has ADHD and she's now on the path to understanding her neurodivergent mind and finally using this gift to her advantage. Take care till then