We're talking specifically about the people who have been traversing the world

to the best of their ability, trying to appear normal for their

entire lives and then find out that they were

normal. And, like, we've made cookies. Because, again,

that was something that was meaningful for someone to then pass out

to other people who lived in the facility or, like, with their grandkids.

I always knew that it was gonna rewire people's brains about how they think about

themselves. When you take away all meaningful engagement for people,

how that doesn't help them physically or mentally get better.

All right, here we go. I'm gonna pretend I'm pushing record, because that feels right.

Okay, I'm pressing record. Boop. Hi,

everybody. I'm Lauren Howard. I go by L2. Yes,

you can call me L2. Everybody does. It's a long story. It's actually not that

long a story, but we'll save it for another time. Welcome to Different

Not Broken, which is our podcast on exactly that.

That there are a lot of people in this world walking around feeling broken, and

the reality is you're just different. And that's

today. I have a very special guest with us. I can't wait to spend a

little bit of time talking about her area of expertise, because we

are so lucky to not only have her with us today, but also

as a huge partner within lb. And she's helping us build out

some things for autistic adults that literally don't exist

elsewhere. And I could just sit and stare adoringly and

listening to her talk for hours. So I figured, like, why not? Today we have

the person who leads our occupational therapy efforts, Jayna Kneeblock, who

is here with us. She's an incredible occupational therapist. Well, thank you for that.

I feel like that might have been overdone, but I still appreciate it. It's

never overdone. I am a multiply neurodivergent

ot and with my own host of

sensory things that I didn't understand until

I got to become an OT and kind of dive into this

sensory world. And fortunately for me, the people I was

learning from were very affirming

before. That was really kind of conceptualized the way that it is

today. I didn't realize kind of at the time that the reason

I loved it so much was because of the way that it was affirming. Because

I've now come to understand there's a lot of ways that it's done that is

not affirming. And so when we're

looking for making sure that, you know, someone is Paired

with an OT that's affirming, or when you and I are talking, it's how do

we help people create meaning out of their experiences,

Bringing that to just kind of the foundation of what

affirming OT should look like. It's not about changing the

way that we process things, but it's about understanding why

and then using our interests and our strengths to be

able to maximize our capabilities and allow

that creativity that also comes out of being

neurodivergent to like, fully form in our brains as our

idea and then come to fruition. You know, me randomly

reaching out to you and being like, I have an idea. People shit on

LinkedIn all the time. And I get it. Like, it's got a reputation of being

a really, really cringy place for cringy people to talk about how

their dog taught them about B2B sales. I get that. However,

that has not actually been my experience. In fact,

that's actually how we met and how we moved in the direction of

building these things that. I'm not being dramatic when I say these

things don't exist. There is no

consistent available programming for

autistic adults, and in a lot of cases, ADHD adults. If you're talking

about some of the neural complexities that I know that you deal with

through what you do, it doesn't exist. And part of the challenge,

part of what I was always really concerned about is, yes, we can

get people to diagnosis and we can get them there more easily

and more accessibly than what is available in the market now. And we've done

that, and I'm so proud of it. We're not done doing it. We're gonna keep

changing how we do it, we're gonna keep modifying it, but we've by and large

done that really, really successfully. But then what do you get on

the other side? Like, there's nothing waiting for you on the other side.

And it felt really bad to me to give people this,

what might be a life affirming but is certainly a life changing

diagnosis and have nothing for them on the other side. Because the

only interventions we really have institutionally or in

these programs anywhere are for children under the age of 13.

And so what do you say? Like, people look at them and say, cool, you're

an autistic adult, but you've got this far, so you can probably figure it out.

And it's like, okay, they got this far miserable, or they got this

far with a ton of really, really difficult situations

that they had to figure out how to get through without any help, because nobody

was talking to their brain the way it works. Because if you were able to

get through it, it's probably fine. And so you reached out to me at

the same time that I was probably publicly lamenting, like, I know we can

do the diagnostic part. We have to figure out the aftercare part. And then it

was like an instant, like, immediate, direct message of, like, I

can help with the aftercare part. And I was like, okay, stranger

on the Internet, I have no idea who you are or what you do, but

tell me more. And now we have built the first of its kind

program that will continue to grow in many educational and clinical

ways. Because you were like, I can do this. And I was

like, I'm gonna trust you. It's funny how many people I've been

like, I think I can do this. And then they're like, okay, do it. And

it's like, okay, let's see. Because I think

to your point, like, what happens after this diagnosis? And

there's this gigantic misconception that all forms

of neurodivergent autism, adhd, anything else are just like

mental health, and that there's differences in social interaction.

It's like, well, no, there's all of these physical parts,

whether it be the sensory experience that changes how

I physically engage with the world, or my ability to motor plan

and know how I actually put together the way I want my body to. To

move to accomplish my idea. And then we layer on

this level of intelligence that people often ignore, or they've

been told that they're not smart because they can't engage in neurotypical

education when they're actually, like, beyond intelligent.

So, yes, now we have a diagnosis, but, like, I still am not making

meaning of all of these experiences and being able to

kind of be okay with my body and who I am and

understand those strengths. And I think that's been kind of the, like,

beautiful part about this educational offering, too. The

sensory education program is every week just seeing people feeling more

okay with sharing about how the things we're talking about connect

with their experiences. It's in a way that unmasking,

because, you know, they're protecting themselves. They're in this new group at first

talking about things that we got some. Yes, it's resonating.

But, like, now that we're, you know, we have just two sessions left,

they're really sharing about their experiences and connecting with, like,

oh, yes, that's similar for me, or a loved one or a child that I

have, you know, those pieces. And Just that community around.

It's not just me. It's also okay that this is happening. Or

I now have an idea of how to navigate this tricky situation

at work. Because I now understand why my body's

having this response versus before, when it was a

lot of that negative self talk that we're really great at as

neurodivergence. Because there's just no understanding other than

like, okay, maybe now with this diagnosis, but that points me

in one direction. But there's all these, all these details.

And then if you go looking for resources yourself, even if it's just, you know,

searching TikTok or Googling, because there's not a lot of

places to go for adults, how do you know that the information that you're

getting is actual based on

science and research and not an autistic person

on the Internet saying things about their own experience? Like,

anecdotal information is important and it's humanizing and

it, it can be validating. And if we have the same anecdotal

experience, that makes me feel understood, it makes me feel

seen, it overcomes isolation, but that's still

anecdotal. It's not something that you can apply

to a body of research and say that there's any

kind of commonality there. And so when people are forced to

get there because there's not good information

or not a ton of good information on the adult autistic experience,

or let's say for people who are. We're talking specifically about the people

who have been traversing the world to the best of

their ability, trying to appear normal for their entire lives

and then find out that they were normal only

because normal doesn't exist. The way their brain works is for a

reason, and we can teach them about that. But the, you know, for

most people, the only information they're getting on that is from like TikTok or

Instagram. And not to say that there isn't good information there, because there is

a lot of good information, but there's no way to vet good information against

bad information. We all end up with 15 different interpretations

of the same thing. And a lot of people believe stuff that just isn't

true. That's where they're getting their affirmation is from somebody who has

anecdotal experience that is similar to theirs. And it doesn't mean it's not right. It

just means it's not validated. Well, and then when someone

comes in with different information or a different experience, then those

individuals feel invalidated again

because their source of Information was like a TikTok. And

being able to use the evidence that we do have

about sensory with neurodivergent populations and

give them, like, really concrete information. Because part of what we talk about is,

like, the neurology and physiology of some of these

experiences. Because touch and tactile is a

big piece for people. And, like, why clothing might feel uncomfortable

and why that, you know, can cycle and feel different at different

days is important to understand. But just understanding that you have different

ways of receiving that information and processing it,

because they're all being told, well, like, if you're okay with this, then why aren't

you okay with that? Well, it's literally a different piece of the system. Like,

it's not the same. So there's a part of this that I really want to

demonstrate for anybody who's listening, because I think it's one thing to say

we talk a whole lot about how brains work and how people

process information. And that's true. And our education programs, like,

I'm floored by them every time I look at something else that comes out of

them. Because the things that we are teaching people that they have never understood

before about how their brain works or how their senses work or how they process

information. I always knew it was good information. I always knew that it was

going to change the way, you know, it's going to rewire people's brains about how

they think about themselves. But I got a message not that long ago from somebody

who's been in our sensory education program the whole time. And actually I. It's

somebody that I knew of, and I hadn't even realized that she had enrolled. So

I. I just thought she was reaching out about something else. And she said, I've

been in the sensory education program. I think it actually has changed my

life. And I was like, hmm. But what she said

is she has been to countless ophthalmologists

during her life. She's, I want to say, like, in her 50s,

so over 40 some years, she's been to ophthalmologists

and basically said over and over, you're correcting my vision, but I still can't see.

There's something wrong with my vision still. And they would test

her and they would adjust her prescription and they would explain to her about

eyes and what's happening and why. And she would say, okay, well, all of this

is great, but I still can't see. Like, there's still

something that feels like I can't see or I don't see well enough.

Despite the Fact that you tell me that you have corrected my vision

to the amount that it needs to be corrected to. And she actually

worked in ophthalmology for a long time, so she's really acutely familiar with this

field. And what she said in the message she sent me was, this is

the first time that anybody has ever explained to me why my eyes

don't work together and what is different about the

way that I process visual information, which is the

first time I've ever understood how to get my eyes to work together. This

is all virtual. Nobody has laid a hand on her. We have not given her

an eye exam. Not that we could. Not that we're qualified for that. She literally

said, this has changed my life. No one has ever been able to explain this

to me before. And now I actually understand how my brain and my body work.

And it was just from, what, an hour of walking

someone through the visual senses, that was the. The one that she responded to.

When we say that we are creating something that is going out into the

world and giving people access to information that they have

never had before. In the small cohort that we've started

with, we already have actual proof that it's changing people's

lives. And that, like. Like, I literally have chills. Like, that just is beyond

me. I can't believe that, first off, the information clearly

exists. Like, it didn't get into your brain on accident. Why have

we not worked harder to share this? Not we as in you and I, but,

like, why is the medical infrastructure not taking this seriously enough to share it?

But also, I mean, you and I. How many nights have you and I sat

up until all hours going, how do we get this out into the world? What

is the right way to do this anyway? So it's important to me that the

world know that the work you are doing is really, really, really changing people's

lives, and that we plan to do it on a larger scale as

quickly as possible for a number of reasons. So the way we're doing it right

now is an education program. We are not doing treatment. We are doing education. We

are teaching smart people. All of our patients are smart. Everybody who

walks into our practice is smart in their own way.

And we do not assume that anybody is unable to

access the information. And if they're unable to access it, we're doing something wrong. We

need to change the way we're presenting it for this person. But assuming we

made a wild assumption that if we taught people about

all neurodivergent brains and all of the things we know about

sensory processing, that they would be able to draw their own conclusions about

how it applies to them. The reason that's important is that makes it an education

program, not a clinical program. So we're not treating them for their

symptoms. We're educating them about all presentations.

And that's really important, because as much as we are absolutely also

going to do a clinical program, and we're headed there probably faster than

Jana realizes. Don't kill me. But the education program,

because it's not gatekept by licensure, we

can take it all over the world. It's not just limited to people who are

in our country or our state or our time zone. We can take it

everywhere because sensory processing is the same in the US

as it is in the uk, as it is in Canada as it is. So

the opportunities to build something that can

impact autistic people or neurodivergent people or

any number of presentations globally is,

like, really real and really right in front of us.

So to pivot a little bit, because I want people to understand the trajectory of

how, not how we got here. I think how you got here, you

weren't specifically looking for an affirming OT education. It

just worked out to be. That was the education you got. So I want to

understand the difference. Like, when we say

affirming, what does that mean to you? What should that mean to the people who

are listening? And then what does it look like on the other side?

What. What is not included in those programs so they can kind of get an

idea of the difference. I think the biggest thing with the

affirming piece is that I am helping you understand

you in a way that helps you use your

strengths in a way that helps you make sense of

all these experiences that

maybe haven't made sense. And then we're

able to collaborate by you telling me, like, what feels

good to you, what are you interested in? What do you give a shit about?

And then I'm gonna figure out how to help you

reach that goal. The work is on me to understand

you and what's important to you and where you wanna get. And

then I have to do the work as the OT to figure out how to

get you there. Because a lot of times what will happen is

an OT comes in a room with a plan. And if you don't follow the

plan, you are the problem. That's not

affirming, and that's not what OT is rooted in.

But that's what happens, unfortunately, because of all the. All the

reasons that there's things wrong with healthcare across the world. But when we

take on the work as the OT

to make it so that this person can achieve what they're looking for

in a way that understands who they are, what they're good at and

builds those blocks up for them. That's affirming ot. So if

I'm going to give you a really rudimentary example,

one of the OT things that my dad did

when he was recovering was to learn how

to brush his teeth standing up. Again, he liked having clean teeth. It was like

a thing for him. They had a way that they teach brushing your teeth standing

up. But if you're somebody who doesn't care about brushing your teeth and

you have no motivation for this life skill, what do you do

in an affirming program to either get them toward

that? Do you figure out alternatives like what's the solution there? I think

I would go towards whatever it is that he's actually interested in.

He can figure out brushing his teeth standing up if the

goal is, you know, that he's able to stand and do things with his hands

and not have to weight bear. I've gotten permission to make margaritas with a

woman in a skilled nursing because that was what she wanted to do. Standing.

Great, let's do that. And like we've made cookies

because again, that was something that was meaningful for someone to then

pass out to other people who lived in the facility or like with

their grandkids. That's the start, right? That's the occupation piece.

Because it's not about a job, but it's what's meaningful. Like that's

literally what the heart of the profession was supposed to be. What do people

find meaningful and how do we help them then recover

because of that? And for me, I was in

undergrad on my way to med school, even though I knew I didn't want to

be a doctor because I wanted to spend time with people and get to know

them and kind of help them on a recovery journey. A good friend of mine

and a teammate was in a horrible car accident. It crushed her left side. She

was left handed. She was in a coma and ended up at a brain injury

rehab center. We got to go visit her because it wasn't far from

college and I am not a hair and makeup person,

but Tayda was very much always hair and

makeup. The OT adapted all of her hair and makeup stuff so that

she could do it for herself. And like at the time, you

know, as a 20 year old, I didn't understand what they were

Trying to do from a balance perspective, from getting that arm moving,

the sequencing of it. I'm like,

sorry, tearing up just thinking about it. Because here

was my friend who for months, her whole life had just

been like, in a bed in a hospital room. And someone knew that

this was really important to her as a 21 year old, and they gave it

back to her. That, to me, is just the beauty

of what we should be doing in affirming ot.

I did not know, I guess your hero origin story. I was gonna

say your villain origin story, but I mean, poor Canola's dose. It could be both.

You said finding things that matter to people to push them.

And I just realized that this is a thing that we did. So when

my dad was very, very sick and my daughter was six

weeks early, my dad died when she was seven. Seven weeks old. So they

only got time with each other because my uterus is

trash. He had a great PT too. And his PT came

over and would make him get up and walk with the walker and he hated

it. And he would fight him every time. And my dad would do this really

weird thing where he'd be like, no, I don't want to. And he'd be like,

get up. And he'd be like, no, I don't want to. And he'd be like,

get up. And he'd be like, okay, fine. And then the third time he would

get up and it worked like every time it was just like a switch flipped

and he was fine getting up. But toward the end, as he got more and

more resistant to it, I would stand at the end of the hallway with the

baby and just hold up the baby and go, come. And she was like two

weeks old. He would get frustrated like, damn it, that works every time. And

come traipsing down the hallway to go get his baby. But it worked every

time. And that was what he was motivated by.

He had waited a long time for that kid. And so I. I had not

thought about that. I mean, she's about to be nine, so that long.

There's something that you told me offline a couple weeks ago that has been like,

running in my head nonstop. You explained that OT

was not designed to be a physical health discipline. It was a

behavioral health discipline when it started. Can you tell me a little bit more about

that in ot? And sorry, I have an aversive reaction

to the behavioral health. Just because the word behavioral health can. Have every aversive

reaction you want. You are allowed. Just

so if you saw my itwitch, you Know why it was that. That word. But

we did. We started as a, like a mental health profession in World War II,

where we were considered more rehab aged at the time. But working

with soldiers returning from the war, finding things that they found

meaningful because they were trying to physically recover.

But they had all of these secondary mental health things that were going on, but,

you know, they were kind of put in like an institution to recover.

And weird, when you take away all meaningful engagement for people, how

that doesn't help them physically or mentally get better.

And in our education, we still

have a lot of training in mental health. And how do

you work with and support people if that's their

specific thing? But even when we're talking about physical

aspects, we're still talking about how are you addressing more

than just the physical pieces? Because it is not kind

of the separation of body and mind. It is one person. And those

things directly influence each other. And

I think it's Mary Riley, and I apologize if it's not, but

she has this beautiful quote, and I'm probably going to butcher it, that it's

man, through the use of his hands, empowers his own health.

Something to that effect that is like the basis of

ot, that by being engaged in doing, you're

able to positively change your own mental and physical

health. We probably should have started with this, but

can you give me, like, a brief explanation of what

OT is? Because I think a lot of people just assume

it's pt. It's a very different discipline with very different

goals. And I also think in the kind of physical health,

or maybe more in the geriatric rehab world, they

treat PT as the waist down and

OT as the waist up. And that is. Now that I've worked with

you for as long as I have, I know that that is not the case

at all. And that is a giant kind of misunderstanding. Yes. And

perpetuated again by insurance. Because then they try not to pay

for, like, things like hip replacement for OT services.

Physical therapy is really based in looking at motion. And how does motion

promote health? Occupational therapy, though, that word, occupation,

again, it's so confusing because it's not job. Right. It's an

activity of meaning, something that gives people purpose

and being that, you know, I'm primarily in pediatrics.

I always have to explain that to parents. Like being able to

get dressed. Right. Because that's meaningful for you, or to brush your

teeth, because that is important to you. I've,

you know, worked with individuals on hospice who all they want to do is be

able to, like, Groom their beard, because that is important

to them. And so giving meaning to that end of

life. How else can we value humanity more

than to make sure that even at the end, you're able

to go out on your terms, you're able to die, you know, with

dignity. We look at the whole lifespan that way. And

with, like, all of this affirming work in the sensory space, that's why

it's so important that it is comfortable when people are engaging in

things, that they have said yes to, trying something new,

and that they're put in a space in a situation that

allows their brain to understand it, to make sense of it. I

may consent to doing something like

going to yoga in the morning, because then I know where my body is.

But I may decide that I'm going to sleep in because I'm not giving

consent to getting up out of bed at 5am so that I can do

that before my tiny humans wake up. And we have to allow consent no

matter how someone's communicating, no matter the age of that

person. And I think that's the biggest thing,

when people are looking for affirming OT

that they have to make sure that they've been able to give consent.

Because I know some of the people in our program, too, have children they're

raising that are neurodivergent. And so they also have questions that come up

with that. That's a big piece for me, for them, because we do see

a lot of trauma coming out of people doing sensory therapy because it's

being forced on them. And that's actually

literally not what was ever supposed to be done. If you look

at Ayer's, like, original work in this space, and her whole point is like,

no, no, no, don't do that. That's not going to help. But it's

just, again, people with productivity and all those things, I understand

how they get to that space. And they weren't given the privilege that I was

of truly being put on this, like, path to affirming sensory,

because I happened to be the person who got the residency

first. And it's just fascinating to me that, like, you're so

passionate about it and you're so well versed in it that

the fact that it was basically cosmic, not deliberate,

just blows my mind.

I know how you respond to questions like this. So I'm a little excited.

If I could snap my fingers, have a fully funded,

credentialed available to operate tomorrow

program for affirming OT for every

autistic adult in the country, what would. That look like, well,

first I think it's education so that they can just basic,

like, understand all the pieces, if we can start there,

because then they can come to an ot.

And having consented to say, like, okay, now that I understand my

brain on this scale, I want to dive into some of these things that you

talked about, and I want to be able to

do this specific thing because, I mean, I will make one of these

positive changes. So allowing people

to come and say, okay, this is the thing that I'm looking at in my

life right now that feels really hard. How can you help me? But now they've

had kind of this knowledge base to be able to really come

informed to those conversations so that the OT can help

them really problem solve and navigate that particular thing.

Than if they're like, okay, and now I'm gonna go try this, and then

I'll come back to you when I have capacity. And, like, that's a part of

our routine. Or I think that to me would just be beautiful because

it is what people have capacity for. It's them

understanding themselves. So even if it's not like, the specific thing

that has come up, they're not having that negative

voice in their head about all of the things or if

it's coming up, at least they have another voice in their head that's like, but

remember, you learn this, tell that voice to be quiet.

So it sounds to me almost like the goal

is to integrate OT enough into the

programs we're building to. They turn to their occupational therapist in the same way that

they do their psychotherapist. Different purposes, different goals.

But when, you know, when you get into a relationship issue and you're not sure

how to handle it, and you have therapy coming up, you're going to talk to

your therapist about that. But when you get into a sensory issue, who

do you talk to? If you have new neighbors who moved in upstairs

and they're constantly banging and that's really bad for your sensory sensitivities,

sure, your therapist can help with that, but they're not going to explain to

you how your brain is processing that information and why

it's getting you aggravated and how you can

mitigate that. So if we could integrate OT

in a way that treats sensory

needs the same way that we treat, let's say, like, baseline mental health

needs in. In a way that's collaborative. To your point,

when you bring up, like, relationship issues, is that

rooted in sensory pieces? The neurodivergent love

locutions is like, how do neurodivergent folks

experience, like, their engagement in

relationships. And I just did this great training too,

that talked about sex. Like, specifically, how does sex feel good or

not good when you're a neurodivergent? And how does that all play into the sensory

pieces? Like, there are people actually doing that specific

work too, to help people navigate that piece.

And so then as we're going through those things, how is it

influencing our relationships? Whether it's an intimate partner,

friendship. And so having that collaborative work with

the psychotherapist and the ot, I think is like the

best way to do it. I know we just talked about masking, too,

in an internal awareness or interoception. And that was kind of my

disclaimer. If you're going to work on this, you have to talk to your psychotherapist

first because they need to understand that you're trying to work

on better connecting with your body. Because that's going to bring up

a lot of stuff. Because we try to not pay attention

when we have internal signals about, like, safety and dysregulation.

Because it's usually the things up here. I think when I think of

historically, before I met you, honestly, I thought of a mental health care

team as a psychiatrist,

a psychologist, or a therapist, and

like maybe the involved family. I always think

a psychiatrist or a psychiatric clinicians should

be involved, whether they're prescribing or not. I don't think that they should

only be used for prescriptions. I think having them involved in a care team is

important. The therapist who is handling the regular

psychotherapy and an OT who can. And

in the same way that our psychologists or our therapists and

psychiatrists refer back and forth and share information back and forth

and form a care team, the OT has to be involved in that. If we're

talking about somebody who is really working through sensory struggles,

or as you said, unmasking. I mean, there's so much complexity

there the more we talk about it. And this has been where I've ended

up every time we've talked about this. It's not an OT program,

even though we call it that. It's not an OT program that is available

with our mental health program. It's a program. It's one

program. And our mental health program has OT

involved. Jaina, thank you so much. This was wonderful. I just

love listening to you talk about what you do, because nine times out of ten

you say something that I have either never thought about before

or never heard before. Because this is like the area of mental

health that I am least familiar with, but you also come at

it from a perspective that I. Not that I hadn't thought about it before, because

that's the way we operate all of our programs, but just it has this

incredible intersection of all of the people that we see. And it just

blows my mind every time we get into it. So thank you so much for

being here. Thank you for giving us the time. To everybody listening, thank you for

stopping by. And we'll talk to you next week. Love you. Mean it.