Interview with Andrew Sheridan - Neurodivergence
In an age where patients and families have a wealth of information at their disposal about diagnosis, ranging in quality from excellent to poor/misleading, remaining well informed as clinicians is more important than ever. First and foremost, families usually want to know “what is going on with my child developmentally?” but beyond that they want to know “how can we make things better for them?”. When we work in clinically referred populations, I like to point out to my students that developmental conditions (Autism, ADHD, intellectual disability, language delay, and a number of others) are ‘always on the table’. For example, although the general population rate of Autism is 1-2%, in mental health clinics the figure is likely to be more like 10-25%; and although the general population rate of ADHD is around 5%, in mental health clinics it can be more like 25-50%. One of the hardest things about diagnosis is the fact that the symptoms of the various diagnoses often show considerable overlap. If you’re ever curious about the context in which diagnoses evolved, and the pressures felt by diagnosticians to find a ‘label’ that uniquely fits each possible syndrome, the book “Madness Explained” is an excellent if provocative read. When lecturing students on diagnosis I sometimes play a fun game that I found on uQuiz, called “Goose or Duck?”. There are 11 pictures and you have to identify geese from ducks: you’d think that any preschooler could tell a goose from a duck, but it’s actually extremely difficult in some cases! After all, both have certain features in common: beaks, feathers, and webbed feet. But presumably (though I’m no zoologist) there are important differences also. Much the same with developmental diagnoses. What are the ‘common features’ then amongst various diagnoses affecting children and adolescents? Children, adolescents, and young adults often present with: social difficulties communication problems emotional dysregulation learning challenges All of these can occur in Autism - but also commonly appear in ADHD , Intellectual Disability , and Language Delay for very different reasons. This article breaks the problem down into: Core Autism features A breakdown of how each differential can appear similar to ASD, but also crucially which Autism features are not present The features that positively distinguish each condition from Autism Core Features of Autism Across ages, Autism is defined by two core domains , with onset in early development: 1. Social communication differences Reduced social reciprocity (back-and-forth interaction, sharing of interests, responding to others’ emotions) Difficulty using and reading non-verbal social cues (facial expressions, gesturing, body language, and eye contact) Difficulty adjusting communication to context, and in general, knowing and applying the ‘unwritten rules’ that make social interaction smooth and comfortable Peer relationships that are qualitatively different, such as a tendency towards social rejection/isolation or gravitating towards one or two ‘safe’ people 2. Restricted / repetitive patterns Repetitive/stereotyped movements, mannerisms, or speech Strong preference for sameness, rituals, and routine (and often marked distress when everyday conditions/routines change) Restricted or intense interests (i.e. typical interests of extreme intensity, or interests/collections that others without ASD wouldn’t usually share) Sensory sensitivities and sensory seeking (sounds, textures, tastes/smells, movement, lights) and sometimes reduced sensitivity (e.g. to temperature) Here, the main point is that Autism is not just social difficulty or awkwardness, and it’s also not just getting upset when things change - it’s a constellation of differences and difficulties that work together to form an overall clinical picture. Differential 1: ADHD vs Autism Where ADHD can look like Autism Poor conversational turn-taking (e.g. info-dumping) Interrupting or talking excessively Missed social cues (see below though - largely due to inattention) Emotional dysregulation Peer difficulties (again, often for differing reasons) Sensory seeking or sensitivity/avoidance (especially in younger children) This overlap is why ADHD is the most common mis- or co-diagnosis with Autism. To make matters more tricky, they do of course often co-occur (which we’ll cover towards the end). Autism features you would NOT expect in ADHD alone Persistent difficulty understanding social meaning and applying theory of mind skills (i.e. once an ADHD-er has noticed a social cue they generally get it) Reduced social motivation is more common in Autism Deep need for sameness or rigid routines for their own sake (e.g. rather than the more ADHD style ‘I always carry a notebook in case I forget my tasks’) Restricted interests that dominate identity and defy attempts at redirection Social difficulties that persist even when attention is well supported Features that distinguish ADHD from Autism Social mistakes are inconsistent not pervasive, and generally easily addressed Social understanding is intact when attention is engaged (e.g. they might miss social cues if they’re not paying attention in the right way, but they can easily understand their social errors/missteps once they tune back in) Strong imaginative play and humour is more characteristic of ADHD Flexible identity and interests: ADHD-ers often find it easier to pick up on their own info-dumping and adapt Impulsivity rather than rigidity in terms of habit preference Anecdotal example: I often tell clients and colleagues a useful example: you could equally well imagine a person with ADHD or a person with Autism talking all night about their new promotion at work, despite the fact that their friend sitting quietly in the group has just been fired from their job. However, the difference is that as soon as you remind the person with ADHD about this blunder they’ll be mortified and will instantly ‘get’ which social rule they broke. That’s not to say that the person with Autism wouldn’t get it at all, but it may have to be explicitly explained in some cases. Differential 2: Intellectual Disability vs Autism Where Intellectual Disability can look like Autism Delayed speech and language Immature social behaviour Difficulty with abstract social concepts Reliance on routine Limited peer relationships Autism features you would NOT expect in Intellectual Disability alone Uneven cognitive profile (e.g. high reasoning + poor social insight), i.e. with intellectual disability the difficulties are generally across the board Social differences that exceed overall developmental level in Autism Circumscribed interests that are unusually intense Atypical social communication style (not just delay - e.g. the ‘erudite professor’ style is a qualitatively different form of social communication in Autism) Sensory reactivity disproportionate to cognitive level Features that distinguish Intellectual Disability from Autism Global delays across all domains, not just social: and in general the social skills tend to match or exceed the mental age Interest range is limited but not idiosyncratic Communication difficulties reflect comprehension limits rather than social connection difficulties per se No distinct autistic social style: more likely to feel like a delay rather than a quirky social style In summary: ID presents as difficulty with independence and reasoning, whereas Autism if high functioning may present with high intelligence but profound social fatigue or misunderstanding; and lower intellectual functioning with Autism tends to co-occur with much more of the restrictive/repetitive behaviours. Differential 3: Language Delay / Developmental Language Disorder vs Autism Where Language Delay can look like Autism Late talking Difficulty expressing needs Reduced conversation Pragmatic (social language) weaknesses Frustration-driven behaviour Peer misunderstandings Autism features you would NOT expect in Language Delay alone Reduced social interest or reciprocity Poor eye contact independent of language demand Restricted interests Repetitive behaviours unrelated to communication Sensory sensitivities as a core feature Difficulty understanding social intent once language improves Regressions in language functioning after skills have been established for a period are much more common in Autism - unless there’s also a Neurological presentation such as epilepsy Features that distinguish Language Delay from Autism Strong non-verbal communication (gesture, eye contact, shared enjoyment) Social curiosity and engagement, stronger drive to connect and ‘make it work’ despite the speech delay Rapid social improvement as language develops Play skills are socially reciprocal: kids with language delays will usually find a way to connect and transcend linguistic communication Little or no insistence on sameness, nor fixed/restricted interests In summary: Language Disorder may show as academic or expressive difficulty, while social understanding is otherwise age-appropriate. Side-by-Side Summary Table
Dr Andrew Sheridan - Podcast
We all know that one of the biggest challenges as a parent is responding effectively when a child misbehaves. We kinda know we’re not supposed to shout, but what if we’re all out of ideas and they’re still not listening? Children tend to learn best when consequences are calm, consistent, and predictable . Fortunately, this is easier than you’d think: I find that confidence and calm come from staying one step ahead of the situation. Below are four simple, practical strategies that you can use to reduce conflict and teach accountability - without constant battles or raised voices. 1. Bitter Before the Sweet Children often resist chores or routines because the payoff feels too far away - or sometimes it’s because they’re doing something fun instead. Structuring the day so that the “bitter” (necessary tasks) comes before the “sweet” (fun activities) takes much of the struggle out of consequences. In the morning, this might mean: get dressed → breakfast before screen time. In the evening: homework → tidy up before free play or dessert. When a child hasn’t done what’s required, you don’t need to lecture or punish - you simply point back to the structure: “When you’ve helped tidy up, then the tablet is ready.” The consequence is built in. This approach creates clarity, reduces arguments, and helps children understand that privileges are earned, not automatic . This works especially well when you can afford to wait them out, since it’s their free time they’re losing. 2. Do-Overs and Making Things Right Not every mistake needs to lead straight to a penalty. Sometimes, what a child needs most is the chance to try again or to repair the harm they caused. A do-over : If your child rudely demands a snack, you might say, “Try that again with better manners, please, and then for sure you can have some toast.” Making things right : If they spill water, the consequence is mopping it up. If they hurt a sibling’s feelings, writing a short apology note helps rebuild the relationship. The beauty of this method is that it teaches responsibility while preserving connection. If you’re serious enough about it then you can also combine it with one of the other methods, like delaying whatever’s next in the day until they’ve fixed the situation up. 3. The Timer Method For delays, refusals, or transition struggles - like coming off a device or getting ready to leave - the timer method is highly effective. It can be used for any situation where there’s still chance for the child to fix things up and turn their behaviour around. The way it works is you set a timer once you’ve given the instruction and you’ve counted to 3. However many minutes tick by before your child complies are minutes deducted from an upcoming privilege: “It took you three minutes to come off your game once I started the timer, so you’ll lose three minutes from tomorrow’s screen time.” “You took five minutes to start getting dressed, so five minutes comes off your bedtime story.” This approach externalises the consequence. Instead of arguing, you can calmly point to the timer: “The minutes are adding up - it’s your choice - we can do your shoes together if you need help.” It helps children see that their actions directly shape their privileges. 4. Docking a Privilege When a behaviour is clearly unacceptable - like swearing, aggression, or repeated disrespect - sometimes a fixed consequence is needed. Compared to the timer method for ongoing situations, this is often best for things that have already happened. Docking a privilege is straightforward and effective: Swearing: lose 10 minutes of screen time or $1 of pocket money. Aggression: no tech for 24 hours. Riding the bike without a helmet: lose the bike for a while. The key is to scale the consequence to the behaviour and to be clear and consistent in how it’s applied. Children learn that privileges come with responsibilities, and that crossing certain lines carries predictable costs. Final Thoughts Consequences don’t need to be angry or excessive. When they’re calm, consistent, and clearly proportionate to the behaviour, they teach children far more effectively. Bitter Before the Sweet builds structure. Do-Overs and Making Things Right teach repair and respect. The Timer Method encourages responsibility for time and transitions. Docking a Privilege sets firm boundaries around unacceptable behaviours. Of course, even with these tools, it’s normal not to get it right every time. Parenting is a constant learning process - but with practice, the conflicts do tend to resolve more peacefully over time. Without losing the sense of closeness and teamwork, or losing your temper, your child can gradually learn that you mean what you say.
On Sunday evening my daughter came home from a birthday party in floods of tears. She was inconsolable, struggling for nearly ten minutes to even get her words out. My mind ran through all the possible dramas - had she fallen out with the friend? Been left out of a game? Someone bullying her at school? Finally, through sobs, the cause of her intense emotional upheaval emerged: she wished it had been a sleepover as she’d had so much fun. Now it did take me a moment to calibrate to the correct scale of human tragedy, from natural disasters on one end to the non-extension of birthday parties at this end. But hey, we are each only living life from our own perspective after all. And in her defence, it was a pretty fun party, and a lovely new friendship that seems to be going really well. Plus she’s 7 of course, and it’s her second late night in a row. I wouldn’t be a Psychologist if I didn’t also consider that there may have been deeper layers, like the fact that she’s just changed schools, or that her closest playmate in our household is six years younger. I guess what struck me most was the fact that a seemingly small trigger had caused such a storm of feelings. I did manage to stay patient and hear my daughter out, but it reminded me of how often I hear my patients talk about how their child also gets intensely distressed about seemingly minor upsets. I can relate to their frustration as well to a degree, since the impatient part of me was yearning for her to be in bed so that I could enjoy a bit of well earned Sunday evening chill time. Since we’re all human, there’s always that part of us that wants to respond in a more impatient or frustrated way, since it’s often the last thing we feel like dealing with in that moment right before bed-time. However, this blog post is about trying to find a more connected, patient, and effective response. The reality of parenting is: our children’s emotions are complex, often overwhelming, and rarely convenient. The way we respond to these moments sets the tone for how our children will learn to navigate their feelings, and whether they will choose us as a trusted guide to help them. Why Staying Calm Is So Hard for Parents When our child is emotionally dysregulated, it’s easy to lose patience. Here are some common reasons: It feels disproportionate. Parents often think, “This isn’t a big deal, it seems so silly- why are you so upset?” or “should we really condone this type of reaction?” Comparison. You might notice other children don’t react as strongly to similar situations. Your own upbringing. Many of us weren’t given much sympathy when upset, so it can feel foreign to offer it now. Fears for the future. Parents sometimes worry, “If my child melts down over this, how will they cope later in life?” Repetition. After dozens of similar upsets, frustration easily builds. Sheer exhaustion. At the end of a long day, patience runs thin, and sometimes you just want quiet. All of these reactions are normal - but if we let them drive our response, we risk escalating the situation, or on a more basic level the missing an opportunity to connect with our child in a difficult moment. Why Calm Matters Getting annoyed or impatient rarely helps. In fact: Anger fuels more upset. Children often cry harder or lash out when they sense their parent’s frustration. It can create shame. Kids may internalize the idea that their emotions are “too much” or “wrong.” It blocks learning. Emotional regulation isn’t taught through lectures or punishment - it’s absorbed through modeling. Staying calm doesn’t mean ignoring your child’s distress, and nor is it about letting the situation get completely beyond your grasp. It means anchoring them while the storm passes. And once it starts to pass, they are much more likely to be receptive if you feel there’s a ‘teachable moment’ to be had. The Ferris Wheel of Emotions I like to imagine emotional processing as a giant Ferris wheel. The climb up: Emotions are building, and distress rises quickly. The peak: This is the most intense part—loud crying, big feelings, sometimes anger. The descent: Once feelings have been acknowledged and validated, the intensity gradually eases until the child feels grounded again. Sometimes you can gently help them come down if they’re struggling to pull themselves back: but other times you won’t need to. Overall the parent’s role is not to fast forward, reverse, or somehow cancel the ride: instead we climb on board, we gently guide things along as needed, and we wait for the cycle to run its course. Practical Up And Down Strategies Trust the cycle. Most intense upsets last 20–30 minutes, not hours. Remind yourself: this will pass. ‘Lean in’ to the emotion. Instead of rushing to calm them, validate their feelings: “You really wanted that climbing frame, didn’t you?” “It feels unfair when someone else has something you wish you had.” Guess if needed. If they won’t tell you what’s wrong, make gentle guesses until you land close to the truth and you might see a few little nods of the head. Respect sensitivity. Some kids are wired more intensely. The upside is they’re often more empathic and perceptive. Research shows that when these children are validated, they often become well-adjusted adults. Guide down gently. Once they’ve been heard (but not before!), you can help them move forward if needed: Suggest a calming strategy (slow breaths, a hug, a drink of water). Offer perspective (e.g. “Remember, we have only just moved in - maybe we’ll get monkey bars one day too”). Transition to the next routine (e.g. bath, bedtime). There does need to be that gentle bit of accountability once it feels realistic and fair to bring it in. Remember “fast is slow.” Trying to rush a child through their feelings often backfires. Paradoxically, patience shortens the process. Final Thoughts Parenting a sensitive, emotional child can feel like a never-ending cycle of ups and downs. But if you can stay calm, validate their feelings, and gently guide them through, you teach your child one of life’s most important lessons: emotions are not to be feared, ignored, or shamed. They are to be understood, accepted, and eventually managed with mastery and self awareness. If you can ‘sit with’ your child’s big emotions you’ll find a more enriching bond and shared understanding. Hopefully they’ll choose to come to you in the difficult moments, trusting that you’ll create an emotionally safe space. So next time you sense another emotional Ferris wheel coming along, try to ride it all the way round - the gains in closeness and emotional maturity will be worth it.
Have you ever noticed how, after spending hours playing your favorite video game or scrolling through social media, it seems like everyday activities like reading, exercise, or even spending time with friends seem dull and unappealing? This phenomenon is often attributed to dopamine downregulation, a complex process that affects our brain's reward system. What is Dopamine Downregulation? Dopamine is a neurotransmitter that plays a crucial role in motivation, pleasure, and reward processing. When we engage in activities that stimulate dopamine release, such as playing video games or scrolling on social media, our brain associates these activities with pleasure. However, when we overindulge in these activities, our brain adapts by reducing the number of dopamine receptors and altering the expression of certain genes. This process is called downregulation. Why Does the Brain Downregulate Dopamine? The brain's primary goal is to maintain homeostasis, or a stable internal environment. When we repeatedly engage in activities that flood our brain with dopamine, it can disrupt this balance. To compensate, the brain downregulates the dopamine system to prevent overstimulation. Kind of like how a thermostat turns your heater down when the room gets too hot. The Role of Delta FosB One key player in dopamine downregulation is a protein called Delta FosB. When we repeatedly engage in intense ‘quick fix’ rewarding activities, Delta FosB accumulates in the brain's reward centers, such as the nucleus accumbens. This accumulation triggers a series of molecular changes that ultimately lead to a decrease in the sensitivity of the reward system. In other words, our brain becomes less responsive to dopamine, making it more difficult to feel pleasure from everyday activities, as well as a tendency to crave higher doses of the intensively rewarding activities to feel good again (or even just normal). The Spicy Food Analogy Imagine devouring an extremely spicy meal. At first, the intense flavor and heat stimulate your taste buds, giving the experience of an intense flavour. But after repeated exposure to such spicy food, your taste buds become desensitized, and ordinary food seems bland by comparison. Similarly, when we excessively engage in highly dopamine-flooding activities, our brain's reward system becomes overwhelmed, leading to downregulation. The Consequences of Downregulation Downregulation can have significant consequences on our motivation and behavior. When our brain's reward system is downregulated, the more ‘slow burn’ activities that previously brought us steady joy and satisfaction (such as exercising, seeing people, and going outside) may no longer be appealing. This can lead to: Lack of motivation: Everyday activities seem dull and uninteresting, so tend to be harder to get started with. Increased cravings : We may crave more intense or longer bouts of dopamine-stimulating activities to feel pleasure. Mood disturbances : Downregulation can contribute to depression, anxiety, and irritability. Breaking the Cycle Fortunately, there are ways to mitigate the effects of dopamine downregulation: Moderation: Set limits on activities that are highly dopamine-flooding, such as gaming or social media. You can do this gradually rather than making it too jarring Balance and variety: Engage in a variety of activities you enjoy, such as exercising, socializing, being in nature, and creative pursuits. Gradually phase these back in as you phase the dopamine flooding activities out: they’ll start to feel good again soon enough. Mindfulness and self-awareness: Recognize when you're overindulging in dopaminestimulating activities (or just about to) and take steps to rebalance your life. Notice the patterns: were you trying to deal with stress, boredom, or overwhelm? Conclusion Dopamine downregulation is a complex process that can have significant consequences on our motivation and behavior. By understanding the mechanisms behind downregulation, and disentangling the ‘quick fixes’ from the more balanced activities, we can reduce the sense of burnout and cultivate a more fulfilling life.
Most of us have felt the sting of rejection at some point - whether it's a friend drifting away, a date not texting back, or feeling left out in a group. It’s a very human experience. But for some people, this feeling goes deeper and lingers longer. This is known as rejection sensitivity, and it can make social and romantic interactions feel like walking a tightrope. The good news? Often what we perceive as rejection is actually something else entirely: a lack of compatibility. And when we reframe it this way, we can start to feel a lot less anxious and a lot more empowered. Understanding Rejection Sensitivity Rejection sensitivity is more than just a dislike of being left out - it's an intense emotional response that can shape how we think, feel, and behave in relationships. It’s completely normal to want to be accepted. In fact, our ancestors’ survival depended on it. Living in tribes meant that being excluded could literally be life-threatening. So it makes sense that our brains evolved to fear rejection and avoid it where possible. But for some, especially sensitive individuals, this fear can become exaggerated. It often stems from earlier life experiences - perhaps being treated critically or coldly by parents or siblings, facing bullying or social exclusion at school, or going through painful romantic breakups. Over time, the brain starts seeing social situations as dangerous territory. In therapy (particularly Cognitive Behavioural Therapy (CBT)) we often talk about the interaction between thoughts, feelings, and behaviours. People with rejection sensitivity often hold negative core beliefs like: “I’m boring.” “I’m too much.” “People don’t like me.” “Others are critical or quick to judge.” These beliefs lead to protective behaviours like withdrawing from social situations or ‘playing it safe’ by presenting a bland, edited version of ourselves. Unfortunately, this can become a self-fulfilling prophecy: people don’t get to know the real you, so deep connection doesn’t happen, reinforcing the fear that you’re somehow not enough. But what if rejection wasn’t really about you at all? Reframing Rejection: It’s About Compatibility, Not Your Worth Imagine Mozart performing at a heavy metal concert. If the crowd didn’t love his music, should he feel rejected? Of course not. It’s not that his music is bad - it’s just not compatible with that audience. That’s what’s often happening when we feel rejected: it’s not about our value as a person, it’s about the fit. So here are three practical tips to help you focus less on rejection and more on compatibility: Tip 1: Compatibility Isn’t Universal You don’t need to be loved by everyone - and frankly, trying to be would be exhausting. I often ask clients to imagine going to a house party and talking to 50 different people for five minutes each. How many would they expect to feel an instant connection with? Maybe 5, possibly fewer. Some people you’d click with right away. Others you’d find “just okay.” And some you probably wouldn’t enjoy at all. That’s not a personal failure - it’s just how human chemistry works. Tip 2: Compatibility is Subjective Think of it like listening to 50 random songs on Spotify. A few you’ll love, a few you’ll dislike, and the rest? Just okay. If you skip a song, you're not insulting the artist - you’re just saying it’s not your vibe. It’s the same with people. Just because someone doesn’t “click” with you doesn’t mean you’re boring or flawed. It just means your personalities, interests, or communication styles aren’t the right match. Importantly, people don’t usually reject you as a whole - they’re responding to what you’ve shared so far. And that means there’s always room to explore other points of connection. Tip 3: Compatibility is About Common Ground Think of a conversation like a picnic where both people take turns bringing out snacks. A great conversation happens when both people love what’s on the blanket. But what if you only bring out super safe, generic snacks because you’re afraid the other person won’t like the real you? Or worse, what if you don’t bring anything at all? People with rejection sensitivity often hold back or stick to ‘vanilla’ conversation to avoid risking disapproval. But this limits your chances of finding real compatibility. The more open you are, and the more you pay attention to what the other person is passionate about, the more likely you are to find real points of connection that spark genuine interest for both people. And when it clicks, it feels amazing. Final Thoughts: It’s Not Rejection - It’s Just Not the Right Fit Feeling rejected can hurt. But most of the time, it’s not about your worth as a person - it’s about compatibility. Not everyone can be your favourite person, and the same goes the other way round: and that’s ok, it doesn’t mean you’re doing anything wrong. Reframing rejection experiences in this way can help you feel freer and braver to be yourself. And that’s where the magic happens - when you start sharing more of the real you, you give others the opportunity to genuinely connect with you. Sometimes it won’t click, and that’s okay. But some times it will - and those are the relationships that truly matter. Let compatibility, rather than fear, be your compass. Because when you find your people, you won’t have to work so hard to be accepted, you’ll simply be yourself: this seems like it’d be worth a few slightly awkward picnics here and there.
Are You Stuck in a Dopamine Loop? Here is how to rebalance your brain chemistry
