The New Way of Understanding Autism & Social Behaviour | Dr. Suzanne Goh & Jim Kwik

An estimated 1 in 36 children in the United States is diagnosed with autism.

I truly believe today a diagnosis of autism opens more doors than it closes.

Autism presents challenges, but with the right understanding and the right approach, we can unlock our remarkable potential.

Parents might be scared to raise their concerns. One of the biggest challenges is that when those early signs appear, often those signs are ignored.

New research has shed light on the many factors that determine a child's trajectory, but many parents are still navigating this complex terrain without a roadmap.

But we sometimes forget behavior comes from a person's experience and perception of the world, which is because of their sensory system.

How has technology influenced the diagnosis or treatment and understanding of autism?

Most exciting is technology related to the tracking of eye movements.

What about brain scans?

A lot of the brain imaging research has been done in autism using brain MRI. has been responsible for helping us understand autism in the depth that we do now.

Where do you usually start with clients, patients, recommendations?

The way I organize it for myself is I think in terms of the domains of brain development. And those 6 domains are—

Welcome back, Kwik Brains. I'm your host and your brain coach, Jim Kwik. Pediatric neurologist Dr. Suzanne Gough has spent decades working with autism and has come up with a research-based guide that shares new, innovative, whole-child approach that combines optimal medical treatment with the most effective strategies for advancing cognition, communication, and behavior. She's the author of Magnificent Minds, highly recommend this book, The Whole Child Approach to Autism. Welcome to the show, Dr. Goh.

Thank you so much for having me.

I was saying before we started recording, I really appreciate your, your whole child approach. And, you know, I highlighted so much of this book. It's a question we get a lot in our community. is a parent has, their child has been, has had the diagnosis of autism and, you know, they're confused. You know, there's an overwhelming amount of information online and maybe even some misinformation certainly. And, you know, in terms of its causes and what to do. And so maybe you could start with, and I know this is a longer conversation, but just your perspective in terms, maybe shed some, a little bit of clarity in terms of where autism comes from, and then we'll go into some of your recommendations.

Well, I'm so happy to be here, and I've been studying autism for many decades now as a pediatric neurologist, as a neuroscience researcher, as a behavior specialist. And I think one of the biggest misconceptions about autism is that a diagnosis of autism is somehow an answer. Really, I view it as just the start of coming to understand a child or a teen or an adult. Autism is a medical diagnosis, but it's based on just a set of descriptive characteristics. So it doesn't tell us anything about a person's underlying biology, neurology, physiology. And so a diagnosis of autism is just the start of the process of coming to truly understand your child or yourself. And there's so much more investigation that needs to happen from there. Unfortunately, a lot of children who are diagnosed today with autism don't get the appropriate testing, medical testing or ongoing evaluation until many, many years after the diagnosis is made, and some never receive it at all. And so that was much of what motivated me to write Magnificent Minds, is to give caregivers, parents and professionals, the tools to make sure that the children in their care get the best, the absolute best quality of care.

Yeah, and that was one of the questions that our community, when they were excited because we recommended the book before the interview and we had questions inspired, and one of them was what inspired you to write Magnificent Minds and what was the main message that you hope readers will take away from it because, you You offer so much hope and real help for, for people that are, you know, are maybe struggling or confused in, in this area.

When I think back to, to my, my own path to where I am now, um, and the path that Kortika has taken, you know, Kortika is our, is my clinic, which has now 24 locations across the country. We serve about 20,000 families a year. Um, I think back to an experience I had when I was in high school. And I grew up in Toledo, Ohio, and I volunteered at a summer camp for neurodivergent children. And that was my very first experience interacting with people in a very close way who had autism, ADHD, epilepsy, spina bifida, cerebral palsy, intellectual disability. And it really just opened my eyes to now what I think of as the beauty of neurodiversity. And so, so much of my path since then has been driven out of curiosity. wanting to understand more and more about the brain and how we optimize brain health for everyone. You know, so many of the principles that apply to autistic children apply to all people. And as a field, as a medical profession, we've often neglected that, you know. So factors like, you know, health of the body, nutrition, movement, exercise, emotional wellbeing, relationships, they matter so much. for neurodivergent children. And I think that's a, that's a really big part of the message. And I've also, you know, as a pediatric neurologist myself, working with families over the years, I've always wanted to hand them a book, you know, that I felt—

Right.

Had all of the, you know, essential information. I think of it as sort of like liquid gold, you know, and was really manageable, you know, for parents to be able to, to get through in the course of their busy lives. And I just never, there was never that book for me. And so I really hoped that I could provide through Magnificent Minds, could provide that to parents.

Yeah, there's this idea that if you wish there was a book out there and it's not out there, then maybe you're the one to be able to write it. And I love how you're inspired. There's so many nuggets in this book. And so where would you like to start in terms of practical strategies that are in the book? Because there's so many of them for parents or educators to support children with this unique cognitive, or maybe they have certain, uh, emotional needs? Where do you usually start with clients', patients', recommendations?

For me, because I'm so immersed in thinking about the brain, and, you know, for me, helping a person to develop new skills, to learn new abilities, that's very much my job and my passion. And the way I organize it for myself is I think in terms of the domains of brain development. Because we're trying to build brain networks in each of those domains. You know, there's 6. 6 is kind of something you can wrap your, you know, wrap your mind around. It's not an infinite number, so it's manageable. And those 6 domains are sensory, motor, cognitive, language, social, and emotional. And really where it starts is coming to a deep understanding of a person in each of those domains. And so really, All of us have what I think of as a neurodevelopmental profile. No matter what age we're at, we have ways that we process sensory information from the environment through our senses. You know, how do you respond when you see certain things, when you hear certain things, when you taste, when you touch? What's your sense of your body position and how your body's moving? Our senses are taking in information all the time and giving us of an experience of the world around us. And that's really where it starts. And so we, you know, if we're thinking about an autistic child, what is their experience of the world? Because their behavior is a reflection of their perception of the world. And we often, so much in the autism field, we lose sight of that. You know, there is a part of autism that is a therapy called Applied Behavior Analysis, or ABA, and it's very much focused on behavior. But we sometimes forget behavior comes from a person's experience and perception of the world, which is because of their sensory system. And so that is a, a great place to, to start. Um, and then, you know, then we can move on to some of these other domains of development. Motor, or how we move in the world, is another big one. We know that, uh, difficulty executing sequences of movements, which is referred to as apraxia or dyspraxia, is extremely common again with autism. And so a child can't always move in the way they want to. They may not— and speech, we know, is a very intricate, highly skilled type of movement. To speak requires extremely coordinated, subtle movements of the mouth, tongue, the lips, the palate. And so children might not speak, Because they have difficulty moving, but they may have tremendous understanding of the world around them.

Yeah.

And so when we recognize that, you know, that should then influence how we speak to the children, the cognitive stimulation we offer. And so really for me, if we're thinking about how do we wrap our hands around this, is going really methodically through each of these domains of brain development and coming to a deep and rich understanding of each unique Yeah, I want to reiterate to everyone listening that this podcast, you know, and Dr.

Go's is not meant to diagnose or treat anything. Obviously, talk to your health practitioner. Also check out her clinic. Also, we'll put a link to the website in our show notes as we always do at jimkwik.com/notes. I really want to highlight this unique perspective. It's been my experience In the past few decades as well, that some of the most— there's this gift I often see that trends through, that it's not how smart someone is, it's really how are they smart. And because when we're talking about autism, experiencing the world and having a different perspective, often it's often the superpower. Sometimes in my experience, you know, I have this shirt on that says believer in abilities, but, you know, I love the strength-based approach that you take. Just like anything, there's with a child, if a parent or a caregiver is, it could be very mental, emotional, you know, financially, you know, stressful. And so my heart goes out to those individuals that are listening. What are the common challenges that you see recurring in this space of neurodivergent? And how does your book address? Maybe we could talk about one or two of the most common ones.

One very common challenge is that Sometimes the early signs of autism are subtle, and we know from research studies now that children even as young as 6 months, 9 months, 12 months are very often showing some of these signs. And yet parents might be scared to raise their concerns, bring them to their doctor. They might be questioning themselves. So one of the biggest challenges is that when those early signs appear, which in my view should then lead us to provide the right testing and evaluations and supports, because we know early support makes a big difference, often those signs are ignored or there can be some degree of denial and fear. So what I like to tell parents and professionals is that I truly believe today a diagnosis of autism opens more doors than it closes.

Hmm.

And so these are, these early signs should be things that prompt parents and prompt pediatricians to get children evaluated. Sometimes we don't know for sure, you know, a diagnosis may not be clear until maybe 2, 2 and a half, 3 years, sometimes even older. But that doesn't mean there's not a lot we can do. So if a child is showing speech-language delays, differences in how their motor system is developing, we can support each of those areas even if we're not sure yet if autism is present.

In the book, you emphasize the mind-body connection in your approach. Maybe you could explain a little bit how physical health impacts cognitive development and what are the steps that could be taken to advance this connection? You know, I know you take a very whole child approach. So it includes nutrition, your microbiome, sleep is so critically important, physical movement and exercise. Maybe we could put a spotlight on that.

It's so important. And just in a very basic sense, you know, we sometimes forget that the head is connected to the body. And we don't just recognize how important the health of all the other body systems are to brain health. And if you were to ask a doctor, even just, you know, 10, 15 years ago, can things like physical exercise and nutrition make a dramatic difference in the development of an autistic child? A lot of doctors would've said no. And now we realize we, the answer is absolutely yes. And in fact, probably it makes an even bigger difference. For somebody, you know, for an autistic individual. And there's so many, the research now is just unequivocal, you know, so things like what we eat, how we move our body, if we're outdoors, what sorts of pollutants or toxins we're exposed to, they influence the body in profound ways. And many of, much of it is through biochemistry. you know, by influencing the body's metabolism. And so an area that has been a part of my research is mitochondrial function. And there's a lot of research now showing that mitochondria are functioning differently in autism, sometimes over, you know, over-function of mitochondria, sometimes under-function. And that if there's a lot we can do to understand the function of mitochondria through different medical tests, and then we can support it through different dietary changes, Um, through nutritional supplements, um, sometimes through medications. So there's, there's just so much that we can do to enhance physical body health that then translates into better brain health, better cognitive function, and better development.

Are you tired of constantly feeling overwhelmed by your never-ending to-do list? Do you struggle to find enough hours in the day to accomplish everything you need? But what if I told you there's a solution that can help you take back control of your time, your focus, your productivity? I'd like to introduce you to Kwik Productivity. This 10-day course is designed to provide you with the proven strategies you need to get more done in less time without burning out. So if you're ready to learn to get the most out of your time, your tasks and your life, then don't wait any longer. Click the link below to learn more and secure your spot and your access right now. And when you're talking about mitochondria, I mean, it's influenced by genetics, by environmental factors. When we're talking about your clinic and various technologies, how has technology influenced the diagnosis or treatment and understanding of autism? And are there any specific technologies that you find particularly promising?

One of the most exciting is technology related to the tracking of eye movements. So one of the things we know is that eye movements are very intricate. You know, they're— it's under the control of our motor system. And we can get a lot of signs about a person through their eye movements. And so there's wonderful research that has come out of the lab of Ami Klin, at Emory. And there are ways now of tracking an infant or toddler's eye movements that can help us both diagnose autism, but also then track a child's progress over time. And the thought is that tracking of eye movements and other fine motor movements might be an even better way to track a child's development than looking at behavior.

Hmm.

You know, so we might one day be able to replace some of these very intensive sort of behavioral assessments with something more objective, more quantifiable, and more accurate, like, uh, measurement— measurements of eye movements and other fine movements.

What about brain scans? Is— does that reveal anything? Yeah.

So a lot of the brain imaging research that's been done in autism using brain MRI has been responsible for helping us understand autism in the depth that we do now. Clinically, there is a role for brain MRI for, for many autistic individuals. It's more of a priority for those who had a regression or a loss of developmental skills at some point in their life. So it's not always very revealing for all people, but for some it can be a very, very helpful tool. I think part of the reason why brain scans aren't as central to autism care at the moment is because of limitations in our technology. So we're just a little bit limited as far as how much we can see. Through a brain scan, but the technology is also advancing. And so it's very promising, especially the use of more functional rather than just structural types of imaging.

And then even in treatment, you know, transcranial magnetic stim, or I don't know if there's promising treatments or supportive technologies.

There is for sure. So the use of the neuromodulation in the form of either magnetic stimulation to the brain or electrical stimulation to the brain or other parts of the nervous system is a very, very promising area of therapeutics also for autism. The one that we use most often in my clinic is a type of electrical stimulation that actually helps to balance the autonomic nervous system so that, you know, we all have a part of our nervous system that helps to regulate our stress response or the body's fight or flight response. And that's balanced by another branch of the nervous system that helps to put us in a state of relaxation or rest and digest.

The parasympathetic.

The parasympathetic, exactly. So the sympathetic and the parasympathetic. And in autism, there's a lot of research now showing that there is overfunction of the sympathetic branch and underfunction of the parasympathetic. That means that many of these children are functioning in a state of heightened stress, and that, that makes it harder to pay attention, to learn. And so there are types of electrical stimulation, especially stimulation that reaches the vagus nerve, that can help to rebalance the autonomic nervous system. So that's a, that's an approach that we use, and it's becoming much more widely available now.

That sympathetic kind of fight or flight, you know, I would imagine a lot of listeners could even relate when they're in that state. It's hard to focus or study or do the things that you need to do.

Exactly.

Do you have a favorite story from your practice, or maybe one that you featured in the book that illustrates and illuminates maybe a key principle or maybe a success story from Magnificent Minds that's one of your favorites?

Yeah. If I could, I'll share 2 because they kind of demonstrate what is possible at 2 different ages for 2 different, very different, what we call phenotypes or profiles. So one is a 2-year-old boy who I met, who came to me because he had a diagnosis of autism. And we ultimately, as part of the investigation process, found that he had a genetic syndrome. And he also had seizures. And his particular seizures were happening at night. And we never would have known that he was having seizures if we hadn't had done an EEG. While he was sleeping. And by detecting his seizures, we were then able to treat and also eventually stop the seizures. And the moment we stopped his seizures, his development began to progress again. And so for me, that was such an important example of why it's important to be looking further and why this type of medical testing is so essential and why it's important to do it quickly. Another part of his journey was that he, because we knew he would be prone to having seizures lifelong, he was able to start a diet called the low glycemic index diet, which we know has a lot of health benefits, including helping to prevent seizures. And because he's been, he was on that for many years, he has remained seizure-free. And so he's a young boy who too had autism, but then by the time he was 6, was able to enter a mainstream first grade and has done extremely well with his development. I'll tell you about another young man. This young man I met when he was 26, so very much at the kind of the opposite end of the age spectrum. He spoke very little, and at the time his parents brought him to me, they were most concerned that they would not be able to keep him at home because of his aggressive and self-injurious behaviors. And their greatest fear was that they would have to put him in a residential facility where he would be overmedicated. And so in working with them, we were able to implement a program that included both dietary changes, so reducing sugar in his diet, increasing protein and fat content, implement an exercise program where he began running and eventually was able to participate in 5K and 10K races. So he became an avid runner. And as he began to run more and more, His aggression and self-injury really dropped until he, until he was no longer having those behaviors. And one of my favorite aspects of working with him was that he, he loved baseball. And so one of his favorite things was to go see his, his favorite baseball, professional baseball team play. But he hadn't been able to do that for years because of the sensory overload that he experienced when he would go into a ballpark. So he loved it. He wanted to be there, and yet he couldn't handle the lights, the, the sounds, the unpredictability. But through this gradual process of understanding and supporting him and making changes, also using medications, but in a very careful, selective, and safe way, he was then able to go back and enjoy watching his favorite baseball team play.

That's outstanding. So I just got goosebumps and I call them truth bumps. Yeah. So if people want to find more resources, certainly I recommend the book Magnificent Minds, that if this conversation resonates with you, you could get it where books are sold. You also are the co-founder and chief medical officer. I believe you said it was Cortica.

Yes.

And so they are a provider of comprehensive health services for autism. The largest in the US?

That's right.

Where can people connect with you there?

Yeah, so our website has a lot of information about our services. That's corticacare.com. And we have 24 locations across the country from the West Coast to the East Coast and a lot of services available online too.

And we'll put, we'll put that website as we always do again and links to the book at jimkwik.com/jimkwik. And again, I highly recommend Magnificent Minds. This is the new whole child approach to autism. And Dr. Goh, I could talk to you for hours on this subject. I want to thank you for your work. You know, it's very inspiring. And I know it's going to help so many of our listeners.

Thank you so much, Jim.

All right, everybody. I want to thank you for tuning in to this episode. Definitely continue if this if you found this valuable, definitely stay in touch with Dr. Goh and get her book, look into the clinic. And I want to thank her for joining us and for sharing a comprehensive research-based roadmap for parents and caregivers to navigate the complexities of autism. Autism presents challenges, but with the right understanding and the right approach, we can unlock And even more, just like with everybody, our remarkable potential, you know, for every age and stage in life. And as always, you can find more ways to fuel your brain's potential on our YouTube channel where we post the extended version of this conversation. So I encourage you to go there. You could join our over 1.5 million strong community on YouTube and subscribe there and leave a comment under this episode to let me know your thoughts. And as always, this is your brain coach, Jim Kwik. Until next time, be limitless. Thank you, everybody.